No Differences Between 12 Weeks of Block- vs. Traditional-Periodized Training in Performance Adaptations in Trained Cyclists.

The purpose of this study was to compare the effects of 12 weeks load-matched block periodization (BP, n = 14), using weekly concentration of high- (HIT), moderate- (MIT), and low- (LIT) intensity training, with traditional periodization (TP, n = 16) using a weekly, cyclic progressive increase in training load of HIT-, MIT-, and LIT-sessions in trained cyclists (peak oxygen uptake: 58 ± 8 ml·kg-1·min-1). Red blood cell volume increased 10 ± 16% (p = 0.029) more in BP compared to TP, while capillaries around type I fibers increased 20 ± 12% (p = 0.002) more in TP compared to BP from Pre to Post12. No other group differences were found in time-trial (TT) performances or muscular-, or hematological adaptations. However, both groups improved 5 and 40-min TT power by 9 ± 9% (p < 0.001) and 8 ± 9% (p < 0.001), maximal aerobic power (Wmax) and power output (PO) at 4 mmol·L-1 blood lactate (W4mmol), by 6 ± 7 (p = 0.001) and 10 ± 12% (p = 0.001), and gross efficiency (GE) in a semi-fatigued state by 0.5 ± 1.1%-points (p = 0.026). In contrast, GE in fresh state and VO2peak were unaltered in both groups. The muscle protein content of ß-hydroxyacyl (HAD) increased by 55 ± 58% in TP only, while both TP and BP increased the content of cytochrome c oxidase subunit IV (COXIV) by 72 ± 34%. Muscle enzyme activities of citrate synthase (CS) and phosphofructokinase (PFK) were unaltered. TP increased capillary-to-fiber ratio and capillary around fiber (CAF) type I by 36 ± 15% (p < 0.001) and 17 ± 8% (p = 0.025), respectively, while BP increased capillary density (CD) by 28 ± 24% (p = 0.048) from Pre to Post12. The present study shows no difference in performance between BP and "best practice"-TP of endurance training intensities using a cyclic, progressively increasing training load in trained cyclists. However, hematological and muscle capillary adaptations may differ.

Successfully treated patients with vortioxetine versus venlafaxine: a simplified cost-effectiveness analysis based on a head-to-head study in Asian patients with major depressive disorder.

Objective: To compare the rates of successfully treated patients (STPs) with vortioxetine versus venlafaxine in major depressive disorder (MDD), using dual endpoints that combine improvement of mood symptoms with optimal tolerability or functional remission, and conduct a simplified cost-effectiveness analysis.Methods: The 8-week SOLUTION study (NCT01571453) assessed the efficacy and safety of vortioxetine (10 mg/day) versus venlafaxine XR (150 mg/day) in adult Asian patients with MDD. Rates were calculated post-hoc of STP Mood and Tolerability (≥50% reduction from baseline in Montgomery-Åsberg Depression Rating Scale [MADRS] total score and no treatment-emergent adverse events) and STP Mood and Functioning (≥50% reduction from baseline in MADRS total score and Sheehan Disability Scale total score ≤6). The incremental costs per STP were assessed using the 2018 pharmacy purchase prices for branded vortioxetine/branded venlafaxine in China as the base case.Results: STP Mood and Tolerability rates were 28.9% for vortioxetine and 19.9% for venlafaxine (p = .028); the corresponding STP Mood and Functioning rates were 28.0% and 23.5% (p = .281). Drug costs for the 8-week treatment period were CN¥1954 for vortioxetine and CN¥700 for venlafaxine. The incremental cost per STP for vortioxetine versus venlafaxine was CN¥13,938 for Mood and Tolerability and CN¥27,876 for Mood and Functioning.Conclusions: Higher rates of dual treatment success were seen with vortioxetine versus venlafaxine. Although vortioxetine was not dominant in the base case, the incremental cost per STP for vortioxetine versus venlafaxine were overall within acceptable ranges. These results support the benefits previously reported with vortioxetine versus other antidepressants in broad efficacy, tolerability profile and cost-effectiveness.

Early life predictors of intelligence in young adulthood and middle age.

BACKGROUND: Studies on early predictors of intelligence often focus on single or few predictors and often on childhood intelligence. This study compared the contributions of a broad selection of potential early predictors of intelligence at different adult ages. METHODS: Information on predictors was recorded prospectively in the Copenhagen Perinatal Cohort during pregnancy, at delivery, and at 1- and 3-year examinations for children born between 1959-61. Adult intelligence was assessed at three independent follow-ups using three different tests of intelligence: Børge Priens Prøve, Wechsler Adult Intelligence Scale, and Intelligenz-Struktur-Test 2000R. From a total of 4697 cohort members, three non-overlapping samples were derived. RESULTS: The included predictors explained between 22.2-24.3% of the variance in adult IQ, with parental socioeconomic status and sex explaining 16.2-17.0%. Other consistent predictors were head circumference at birth, increase in head circumference head during the first three years, and 3-year milestones. Head circumference was the most important anthropometric measure compared to measures of weight and length. CONCLUSION: Besides social status and sex, the strongest and most consistent early predictors of adult intelligence were physical or behavioural characteristics that to some extent reflect brain-and cognitive development.

Cognitive symptoms in major depressive disorder: associations with clinical and functional outcomes in a 6-month, non-interventional, prospective study in China.

Objective: Cognitive symptoms in major depressive disorder (MDD) are common and may negatively impact clinical and functional outcomes. The Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study aimed to assess the prevalence and course of cognitive symptoms, and their associations with clinical and functional outcomes during 6 months of antidepressant treatment, in a real-world setting among Chinese patients with MDD. Patients and methods: Outpatients (n=598) aged 18-65 years with MDD and a total score ≥17 on the Hamilton Depression Rating Scale - 17 Items (HAM-D17) were observed over 6 months after initiating new antidepressant monotherapy, with follow-up visits at months 1, 2, and 6. Cognitive symptoms were assessed using the Perceived Deficits Questionnaire - Depression (PDQ-D) and cognitive performance using the Digit Symbol Substitution Test (DSST). Results: At baseline, 76.9% of patients had indications of cognitive symptoms (PDQ-D total score ≥21); at month 6, this was reduced, but still present in 32.4%. Across the 6-month study period, patients improved across cognitive, clinical and functional assessments. High levels of cognitive symptoms (PDQ-D) consistently predicted worse clinical outcomes, ie, lower odds for remission and increased odds for relapse, as well as worse patient-reported functional outcomes and lower quality of life. In contrast, cognitive performance (DSST) predicted performance-based functioning but only a few patient-reported functional outcomes (absenteeism and quality of life), and no clinical outcomes. PDQ-D and DSST scores were uncorrelated at baseline. Conclusion: The study highlights the importance of assessing and targeting cognitive symptoms for increasing patients' chances of recovery and restoring functioning in the treatment of MDD. The results further highlight the relevance of complementary assessment methods to fully capture aspects of cognitive symptoms in patients with depression.

Vortioxetine for attention deficit hyperactivity disorder in adults: A randomized, double-blind, placebo-controlled, proof-of-concept study.

BACKGROUND: Stimulants remain the mainstay of treatment for attention-deficit hyperactivity disorder (ADHD) but are often associated with insufficient response or poor tolerability, leading to many patients not wishing to be treated with controlled substances. AIMS: This randomized, placebo-controlled, proof-of-concept study (NCT02327013) evaluated the efficacy of a multimodal antidepressant, vortioxetine, in the treatment of ADHD, using a two-stage sequential parallel comparison design. METHODS: Patients aged 18-55 years with a diagnosis of ADHD (DSM-5) and a total score ⩾24 on the Adult ADHD Investigator Symptom Rating Scale (AISRS) were randomized in study stage I with a 1:1:3 ratio to six weeks of treatment with vortioxetine 10 or 20 mg/day, or placebo ( n = 227). In study stage II, placebo non-responders (AISRS total score reduction <30% from stage I baseline) were re-randomized with a 1:1:1 ratio to six weeks of vortioxetine 10 or 20 mg/day, or placebo ( n = 59). RESULTS: Across the two study stages combined, ADHD symptoms improved by approximately eight AISRS points in all treatment groups, showing no difference from placebo for either dose of vortioxetine, the study thus failing to meet its primary endpoint. However, both doses of vortioxetine separated from placebo in improving overall patient functioning, as measured by the Sheehan Disability Scale. CONCLUSION: Studies are warranted to further investigate this suggested benefit of a multimodal antidepressant for patient functioning in ADHD while addressing issues of non-adherence and placebo response. The study confirmed vortioxetine 10 mg and 20 mg as generally well-tolerated.

Infeksjon i operasjonsområdet.

BACKGROUND: All Norwegian hospitals must submit data to the Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections (NOIS) regarding surgical site infections following coronary artery bypass graft, caesarean section, hip arthroplasty, cholecystectomy and colonic surgery. The purpose of our study was to identify the proportion of patients undergoing surgery in 2016 who developed a surgical site infection, and the consequences in the form of prolonged postoperative hospitalisation, readmission or revision surgery. MATERIAL AND METHOD: All patients who underwent one of the five surgical procedures registered in NOIS in 2016 were included and followed up for 30 days after the surgery. The criteria set out by the European Centre for Disease Prevention and Control were used to define infections. RESULTS: From among the 31 401 patients included, a total of 1 225 surgical site infections were recorded. The incidence was highest following colonic surgery (10.9 %) and lowest following total hip arthroplasty (1.8 %). Median postoperative length of hospitalisation was three days for those with no infection, and six days for the 544 patients with a deep infection or an infection in an organ or cavity. The infections resulted in the need for revision surgery in 308 patients and readmission for 323 patients. INTERPRETATION: A total of 3.9 % of patients registered with a surgical procedure included in NOIS developed a surgical site infection. Consequences such as increased hospitalisation time, and more readmissions as well as revision procedures serve to highlight the importance of preventing such infections.

Antibiotic use and infections in nursing homes. / Antibiotikabruk og infeksjoner i sykehjem.

BACKGROUND: Residents in nursing homes have a higher risk of developing infections that require antibiotic treatment than elderly people living at home. Use of antibiotics may cause adverse effects and result in the development of antimicrobial resistance. MATERIAL AND METHOD: Data on healthcare-associated infections and antibiotic use in 540 Norwegian nursing homes were retrieved from the Norwegian Institute of Public Health's point prevalence survey in the spring of 2016. Based on information on drug, dosage and indication, we assessed whether the use of antibiotics for the treatment of UTIs was in accordance with the National Guidelines for the Use of Antibiotics in Primary Care. RESULTS: UTI was the most commonly occurring type of infection, with a prevalence of 2.7 %. Prescription of first-line antibiotics accounted for approximately 60 % of the prescriptions for treatment of this illness. Choice of drug, dosage and microbiological testing when treating lower UTIs was not always in accordance with the national guidelines. The study showed widespread use of methenamine in Norwegian nursing homes. INTERPRETATION: The survey indicates that compliance with the national guidelines when treating lower UTIs could be improved with regard to the choice of drug, dosage and microbiological testing. Norwegian nursing home doctors should also consider whether their use of methenamine is in accordance with national and international recommendations.

Broad-spectrum antibiotics in Norwegian hospitals. / Bredspektrede antibiotika i norske sykehus.

BACKGROUND One of the objectives in the action plan to reduce antimicrobial resistance in the health services in Norway is to reduce the use of broad-spectrum antibiotics in Norwegian hospitals. This study describes the use of certain broad-spectrum antibiotics mentioned in the action plan in Norwegian hospitals, and assesses prescribing practices in relation to the Norwegian guidelines for antibiotic use in hospitals.MATERIAL AND METHOD Data were analysed from a nationwide non-identifiable point prevalence survey in May 2016 where all systemic use of antibiotics was recorded.RESULTS Broad-spectrum antibiotics accounted for 33 % of all antibiotics prescribed. Altogether 84 % of all broad-spectrum antibiotics were prescribed as treatment, 8 % were for prophylactic use, and 8 % were classified as other/unknown. Lower respiratory tract infections were the most frequent indication for treatment with broad-spectrum antibiotics, involving 30 % of all broad-spectrum treatment.INTERPRETATION This point prevalence survey in Norwegian hospitals in spring 2016 indicates a possibility for reducing the use of broad-spectrum antibiotics in the treatment of lower respiratory tract infections and for prophylactic use. Reduction of healthcare-associated infections may also contribute.

Is It Valid to Compare Surgical Site Infections Rates Between Countries? Insights From a Study of English and Norwegian Surveillance Systems.

OBJECTIVE To assess whether differences in surveillance methods or underlying populations significantly influence internationally reported national SSI rates by comparing surveillance data from 2 countries. DESIGN Retrospective cohort. SETTING England and Norway. METHODS We assessed the population under surveillance and surveillance methodology to compare SSI rates in 2 countries (September 2012-January 2015) for 4 surgical categories: coronary artery bypass graft (CABG), colon surgery, cholecystectomy, and hip prosthesis (HPRO). We compared the inpatient SSI incidence using logistic regression, adjusting for the following known risk factors: sex, age, ASA score, wound class, postoperative hospital days, and operation duration. Subsequently, we restricted further analyses to the procedures reported by both countries. RESULTS There were important differences in case definitions for superficial infection, so we restricted our analyses to deep incisional and organ-space SSIs. For CABG, the crude odds ratio (OR) for England compared to Norway was 2.4 (95% CI, 1.4-4.4), whereas adjusted OR (aOR) lost significance (aOR, 1.1; 95% CI, 0.57-2.0). For colon surgery the decreased odds (OR, 0.68; 95% CI, 0.56-0.81) remained significant after adjustment (aOR, 0.42; 95% CI, 0.34-0.51). We found no associations for cholecystectomy. For HPRO, the crude OR suggested no significant difference (OR, 1.2; 95% CI, 0.72-2.1), whereas the aOR was significantly lower in England (aOR, 0.45; 95% CI, 0.25-0.81). Including only the subset of procedures reported by both countries yielded comparable results. CONCLUSION Differences in case definitions and population under surveillance in the English and Norwegian SSI surveillance systems affected SSI estimates, making the comparison of crude rates unreliable. Standardized definitions and adjustment for established risk factors are essential for European comparisons to guide related public health actions. Infect Control Hosp Epidemiol 2017;38:162-171.

The quality of denominator data in surgical site infection surveillance versus administrative data in Norway 2005-2010.

BACKGROUND: High quality of surveillance systems for surgical site infections (SSIs) is the key to their usefulness. The Norwegian Surveillance System for Antibiotic Consumption and Healthcare-Associated Infections (NOIS) was introduced by regulation in 2005, and is based largely on automated extraction of data from underlying systems in the hospitals. METHODS: This study investigates the quality of NOIS-SSI's denominator data by evaluating completeness, representativeness and accuracy compared with de-identified administrative data for 2005-2010. Comparisons were made by region, hospital type and size, age and sex for 4 surgical procedures. RESULTS: The completeness of NOIS improved from 29.2 % in 2005 to 79.8 % in 2010. NOIS-SSI became representative over time for most procedures by hospital size and type, but not by region. It was representative by age and sex for all years and procedures. Accuracy was good for all years and procedures by all explanatory variables. CONCLUSIONS: A flexible and incremental implementation strategy has encouraged the development of computer-based surveillance systems in the hospitals which gives good accuracy, but the same strategy has adversely affected the completeness and representativeness of the denominator data. For the purpose of evaluating risk factors and implementing prevention and precautionary measures in the individual hospitals, representativeness seems sufficient, but for benchmarking and/or public reporting it is not good enough.

Low to Moderate Average Alcohol Consumption and Binge Drinking in Early Pregnancy: Effects on Choice Reaction Time and Information Processing Time in Five-Year-Old Children.

BACKGROUND: Deficits in information processing may be a core deficit after fetal alcohol exposure. This study was designed to investigate the possible effects of weekly low to moderate maternal alcohol consumption and binge drinking episodes in early pregnancy on choice reaction time (CRT) and information processing time (IPT) in young children. METHOD: Participants were sampled based on maternal alcohol consumption during pregnancy. At the age of 60-64 months, 1,333 children were administered a modified version of the Sternberg paradigm to assess CRT and IPT. In addition, a test of general intelligence (WPPSI-R) was administered. RESULTS: Adjusted for a wide range of potential confounders, this study showed no significant effects of average weekly maternal alcohol consumption during pregnancy on CRT or IPT. There was, however, an indication of slower CRT associated with binge drinking episodes in gestational weeks 1-4. CONCLUSION: This study observed no significant effects of average weekly maternal alcohol consumption during pregnancy on CRT or IPT as assessed by the Sternberg paradigm. However, there were some indications of CRT being associated with binge drinking during very early pregnancy. Further large-scale studies are needed to investigate effects of different patterns of maternal alcohol consumption on basic cognitive processes in offspring.

No association between prenatal exposure to psychotropics and intelligence at age five.

OBJECTIVE: To examine associations between prenatal exposure to selective serotonin reuptake inhibitors (SSRIs)/anxiolytics and intelligence assessed with a standard clinical intelligence test at age 5 years. DESIGN: Longitudinal follow-up study. SETTING: Denmark, 2003-2008. POPULATION/SAMPLE: A total of 1780 women and their children sampled from the Danish National Birth Cohort. METHODS: Self-reported information on use of SSRI and anxiolytics was obtained from the Danish National Birth Cohort at the time of consent and from two prenatal interviews. Intelligence was assessed at age 5 years, and parental education, maternal intelligence quotient (IQ), maternal smoking and alcohol consumption in pregnancy, the child's age at testing, sex, and tester were included in the full model. The IQ of 13 medication-exposed children was compared with the IQ of 19 children whose mothers had untreated depression and 1748 control children. MAIN OUTCOME MEASURE: Wechsler Preschool and Primary Scale of Intelligence - Revised. RESULTS: In unadjusted analyses, children of mothers who used antidepressants or anxiolytics during pregnancy had higher verbal IQ; this association, however, was insignificant after adjustment for potentially confounding maternal and child factors. CONCLUSION: No consistent associations between IQ and fetal exposure to antidepressants and anxiolytics were observed, but the study had low statistical power, and there is an obvious need to conduct long-term follow-up studies with comprehensive cognitive assessment and sufficiently large samples of adolescent or adult offspring.

Surgical site infections after hip arthroplasty in Norway, 2005-2011: influence of duration and intensity of postdischarge surveillance.

BACKGROUND: Most surgical site infections (SSIs) after hip arthroplasty are detected after a patient is discharged from hospital, making postdischarge surveillance (PDS) an important component in surveillance systems. We investigated how long it was necessary to monitor hip arthroplasty patients for SSIs after hospital discharge and if passive PDS through readmissions could replace active PDS by patient questionnaire in detecting SSIs. METHODS: We used data from the Norwegian surveillance system from 2005-2011, which has active 1-year PDS, to investigate proportions of SSIs found at different time intervals after surgery and whether these SSIs could have been detected through passive PDS by investigating the proportion of patients with SSIs that were readmitted. RESULTS: We found that 79% of all SSIs and 82% of deep SSIs were detected after hospital discharge. 95% of deep SSIs were detected within 90 days after surgery. 14% of the deep SSIs were detected beyond 30 days after surgery, and all of these patients were readmitted because of their SSI and thus could have been detected by passive PDS. CONCLUSIONS: Our data suggest that most deep SSIs are detected within 90 days and that passive PDS beyond 30 days after surgery may replace active PDS without reducing sensitivity.

Healthcare-associated infections in Northern Russia: Results of ten point-prevalence surveys in 2006-2010.

BACKGROUND AND OBJECTIVE: Statistics on healthcare-associated infections (HAIs) in Russia is scarce and has been considered to suffer from underreporting. We assessed the prevalence and changes in the prevalence of HAIs over 5 years and identified factors associated with acquiring HAIs in the pediatric hospital in Arkhangelsk, Northern Russia. MATERIALS AND METHODS: Ten cross-sectional studies were conducted in the Arkhangelsk regional pediatric hospital biannually during 2006-2010. We used a standardized protocol, including the criteria of HAI proposed by the Centers for Disease Control and Prevention. Binary logistic regression was applied to study factors associated with HAI. RESULTS: Altogether, 3264 inpatients were enrolled in the study and 347 of them had HAI (11.2%). The prevalence of HAI per survey ranged from 7.1% (95% CI: 4.8%-10.4%) to 16.7% (95% CI: 13.1%-21.2%). The most prevalent HAIs were upper respiratory tract infections 5.1% (95% CI: 4.4%-5.9%), followed by urinary tract infections, 1.5% (95% CI: 1.2%-2.0%), and acute gastroenteritis, 1.4% (95% CI: 1.1%-1.9%). Compared to infants, children aged 5-9 years (OR=0.7, 95% CI: 0.4-1.0), 10-14 years (OR=0.4, 95% CI: 0.3-0.7), and ≥15 years (OR=0.3, 95% CI: 0.2-0.5) were less likely to have HAI. Neutropenia (OR=1.5, 95% CI: 1.0-2.3) and use of intravascular catheter(s) (OR=1.8, 95% CI: 1.1-3.0) were positively associated with HAI. CONCLUSIONS: The observed prevalence of HAIs is within the range reported in several other European countries. We do not recommend generalizing our findings to other Russian settings given considerable variations between regions in both socio-economic situation and conditions of medical facilities.

THE EFFECT OF LOW TO MODERATE PRENATAL ALCOHOL EXPOSURE AND BINGE DRINKING EPISODES ON DRAW-A-PERSON AT AGE 5 YEARS.

This study examined the effects of maternal alcohol consumption and binge drinking during pregnancy on children's Draw-A-Person (DAP) scores. Participants were 1,533 5-year-olds from the Danish National Birth Cohort. Regression analyses revealed an adverse effect of nine or more drinks per week. A drop in mean DAP score of 6.26 (95 % CI: -12.24; -0.39) was observed in the fully adjusted model. A significant interaction between average weekly consumption and binge episodes also was observed. Findings suggest that prenatal exposure to moderate weekly doses of alcohol and binge drinking episodes are associated with lowered scores on the DAP.

Mortality related to hospital-associated infections in a tertiary hospital; repeated cross-sectional studies between 2004-2011.

BACKGROUND: Hospital-associated infections (HAIs) are reported to increase patient mortality and incur longer hospital stays. Most studies to date have focused on specific groups of hospitalised patients with a rather short follow-up period. In this repeated cross-sectional study, with prospective follow-up of 19,468 hospitalized patients, we aimed to analyze the impact of HAIs on mortality 30 days and 1 year after the prevalence survey date. METHODS: The study was conducted at Haukeland University Hospital, Norway, a large combined emergency and referral teaching hospital, from 2004 to 2011 with follow-up until November 2012. Prevalence of all types of HAIs including urinary tract infections (UTI), lower respiratory tract infections (LRTI), surgical site infections (SSI) and blood stream infections (BSI) were recorded four times every year. Information on the date of birth, admission and discharge from the hospital, number of diagnoses (ICD-10 codes) and patient's mortality was retrieved from the patient administrative data system. The data were analysed by Kaplan-Meier survival analysis and by multiple Cox regression analysis, adjusted for year of registration, time period, sex, type of admission, Charlson comorbidity index, surgical operation, use of urinary tract catheter and time from admission to the prevalence survey date. RESULTS: The overall prevalence of HAIs was 8.5 % (95 % CI: 8.1, 8.9). Patients with HAIs had an adjusted hazard ratio (HR) of 1.5 (95 % CI: 1.3, 1.8,) and 1.4 (95 % CI: 1.2, 1.5) for death within 30-days and 1 year, relative to those without HAIs. Subgroup analyses revealed that patients with BSI, LRTI or more than one simultaneous infection had an increased risk of death. CONCLUSIONS: In this long time follow-up study, we found that HAIs have severe consequences for the patients. BSI, LRTI and more than one simultaneous infection were independently and strongly associated with increased mortality 30 days and 1 year after inclusion in the study.