Amiloride evokes significant natriuresis and weight loss in kidney transplant recipients with and without albuminuria.

Albuminuria in kidney transplant recipients (KTRs) is associated with hypertension and aberrant glomerular filtration of serine proteases that may proteolytically activate the epithelial Na+ channel (ENaC). The present nonrandomized, pharmacodynamic intervention study aimed to investigate if inhibition of ENaC increases Na+ excretion and reduces extracellular volume in KTRs dependent on the presence of albuminuria. KTRs with and without albuminuria (albumin-to-creatinine ratio > 300 mg/g, n = 7, and <30 mg/g, n = 7, respectively) were included and ingested a diet with fixed Na+ content (150 mmol/day) for 5 days. On the last day, amiloride at 10 mg was administered twice. Body weight, 24-h urine electrolyte excretion, body water content, and ambulatory blood pressure as well as plasma renin, angiotensin II, and aldosterone concentrations were determined before and after amiloride. Amiloride led to a significant decrease in body weight, increase in 24-h urinary Na+ excretion, and decrease in 24-h urinary K+ excretion in both groups. Urine output increased in the nonalbuminuric group only. There was no change in plasma renin, aldosterone, and angiotensin II concentrations after amiloride, whereas a significant decrease in nocturnal systolic blood pressure and increase in 24-h urine aldosterone excretion was observed in albuminuric KTRs only. There was a significant correlation between 24-h urinary albumin excretion and amiloride-induced 24-h urinary Na+ excretion. In conclusion, ENaC activity contributes to Na+ and water retention in KTRs with and without albuminuria. ENaC is a relevant pharmacological target in KTRs; however, larger and long-term studies are needed to evaluate whether the magnitude of this effect depends on the presence of albuminuria.NEW & NOTEWORTHY Amiloride has a significant natriuretic effect in kidney transplant recipients (KTRs) that relates to urinary albumin excretion. The epithelial Na+ channel may be a relevant direct pharmacological target to counter Na+ retention and hypertension in KTRs. Epithelial Na+ channel blockers should be further investigated as a mean to mitigate Na+ and water retention and to potentially obtain optimal blood pressure control in KTRs.

Intensive screening for osteoporosis in patients with hip fracture.

Opportunities to evaluate, treat, and prevent future osteoporotic fractures are often being overlooked, especially in patients with a prior osteoporotic fracture. We find that an intensive outreach osteoporosis investigation strategy can help increase the number of patients investigated and treated for osteoporosis following a hip fracture. PURPOSE: Patients experiencing a hip fracture are subject to an increased risk of subsequent fractures. This suggests an urgent need to develop strategies that will allow a higher number of patients with fragility hip fractures to be investigated and treated for osteoporosis. In accordance, we developed a secondary osteoporosis prevention program and evaluated the results of the program. METHODS: In the study period, 1071 patients with a hip fracture were admitted to Hvidovre University Hospital. Eligible patients were offered an osteoporosis investigation program, which included a DXA-scan with vertebral fracture assessment and a medical consultation. The data retrieved from this program were registered and analyzed. The primary goal of the study was to describe the number of subjects, who completed the program, and to characterize the initiated osteoporosis treatment. Secondary outcomes evaluated were prevalence of DXA-verified osteoporosis, changes in T-score due to treatment, and 1-year mortality rate. RESULTS: In total, 557 patients were offered participation of which 333 patients completed the full program. Among these, 159 patients had DXA-verified osteoporosis and 192 patients were started treatment. This resulted in a significant higher T-score at the lumbar spine and femoral neck compared with subjects not treated. Additionally, we report a 1-year mortality rate of 27.7% among all patients with hip fracture. CONCLUSION: We report that an intensive outreach osteoporosis investigation program can help increase the number of hip fracture patients being tested and treated for osteoporosis. Further, the initiation of treatment can significantly increase the T-score.

Post hatch recovery of a probiotic Enterococcus faecium strain in the yolk sac and intestinal tract of broiler chickens after in ovo injection.

Concerns about antibiotic-resistant bacteria and their presence in animal products grow and thus alternatives to use of antibiotics in animal production are being investigated. Probiotics have gained increased focus due to improvements in performance, immune health and pathogen reduction when provided to poultry through feed. These traits may be further improved if probiotics can be provided to the embryo before hatch, before meeting environmental pathogens. The objective was to determine the faith of a probiotic Enterococcus faecium (M74) strain in the yolk sac and intestinal tract of broiler chickens after injection into hatching eggs. E. faecium M74 (1.4 × 107 CFU/egg) was applied in ovo at day 18 of incubation. From 1- and 7-day-old chickens, 20 samples from yolk sac, caecal tonsils and rest of the intestinal tract were subjected to CFU counting. Isolates from a sample subset were typed by pulsed-field gel electrophoresis (PFGE). Enterococci were found in varying numbers: 1.0 × 104-2.2 × 1010 CFU/g. The prevalence of M74 PFGE profiles was high in 1-day-old (88%) and 7-day-old chickens (67%). This demonstrates that the embryos ingested M74 before hatching, that M74 is viable for intestinal colonization through in ovo administration, and that the strain multiplies in the chickens gastrointestinal tract post hatching.

Delirium assessment in neuro-critically ill patients: A validation study.

BACKGROUND: Delirium is underinvestigated in the neuro-critically ill, although the harmful effect of delirium is well established in patients in medical and surgical intensive care units (ICU).To detect delirium, a valid tool is needed. We hypothesized that delirium screening would be feasible in patients with acute brain injury and we aimed to validate and compare the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist against clinical International Classification of Diseases-10 criteria as reference. METHODS: Nurses assessed delirium using the Confusion Assessment Method for the ICU and Intensive Care Delirium Screening Checklist in adult patients with acute brain injury admitted to the Neurointensive care unit (Neuro-ICU), Copenhagen University Hospital, if their Richmond agitation-sedation scale score was -2 or above. As the reference, a team of psychiatrist assessed patients using the International Classification of Diseases-10 criteria. RESULTS: We enrolled 74 patients, of whom 25 (34%) were deemed unable to assess by the psychiatrists, leaving 49 (66%) for final analysis. Sensitivity and specificity for the Confusion Assessment Method for the ICU was 59% (95% CI: 41-75) and 56% (95% CI: 32-78), respectively, and 85% (95% CI: 70-94) and 75% (95% CI: 51-92), respectively, for the Intensive Care Delirium Screening Checklist. CONCLUSIONS: Our findings suggest that the Intensive Care Delirium Screening Checklist may be a valid tool and the Confusion Assessment Method for the ICU is less suitable for delirium detection for patients in the Neuro-ICU. In the neuro-critically ill, delirium screening is challenged by limited feasibility.

Treatment dropout and missed appointments among adults with attention-deficit/hyperactivity disorder: associations with patient- and disorder-related factors.

OBJECTIVE: Knowledge of factors associated with treatment dropout and missed appointments in adults with attention-deficit/hyperactivity disorder (ADHD) is very limited. On the basis of proposed hypotheses that past behavior patterns are more predictive of current behaviors of treatment dropout and missed appointments than are sociodemographic and clinical characteristics, we examined the associations of sociodemographic variables, clinical variables, risk-taking behavior, educational and occupational instability, and behaviors during mandatory schooling with the primary outcome measures of treatment dropout and missed appointments. METHOD: In a naturalistic cohort study of 151 adult outpatients with ADHD initiating assessment in a Danish ADHD unit from September 1, 2010, to September 1, 2011, the Adult ADHD Self-Report Scale v1.1 symptom checklist (ASRS) and a thorough clinical interview were used to assess ADHD according to DSM-IV-TR criteria. Stepwise logistic regression analysis was used to estimate reported associations. RESULTS: A total of 27% of patients dropped out of treatment and a total of 42% had ≥ 3 missed appointments during treatment. Mood and anxiety disorders significantly lowered the odds of treatment dropout (odds ratio [OR] = 0.18; 95% confidence interval [CI], 0.05-0.65), whereas having started but not completed 2 or more educational programs apart from mandatory schooling significantly increased the odds of dropout (OR = 3.01; 95% CI, 1.32-6.89). Variables significantly associated with most missed appointments were low educational level (OR = 2.19; 95% CI, 1.12-4.31), 3 or more employments of less than 3 months' duration (OR = 2.86; 95% CI, 1.30-6.28), and having skipped class often/very often during mandatory schooling (OR = 2.65; 95% CI, 1.29-5.43). Additionally, the predominantly inattentive ADHD (ADHD-I) subtype lowered the odds of missed appointments (OR = 0.17; 95% CI, 0.05-0.62). CONCLUSION: Our results suggest that past behavior in terms of highest dropout rates in the educational and occupational systems and highest rates of skipping class during mandatory schooling is equally associated with current behavior of treatment dropout and missed appointments as are sociodemographic and clinical factors. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02226445.

Associations of Age, Gender, and Subtypes With ADHD Symptoms and Related Comorbidity in a Danish Sample of Clinically Referred Adults.

OBJECTIVE: The aim was to examine associations of age and gender with ADHD subtypes and subsequently to examine associations of age, gender, and subtypes with comorbid psychiatric disorders. METHOD: Odds ratios were calculated and logistic regression performed using information from a clinical sample of 155 ADHD adults referred to a Danish specialized ADHD unit from 2010 to 2011. RESULTS: A majority of men (65%) was found in the sample. Most patients were subtyped ADHD combined (78%), followed by ADHD inattentive (18%), and ADHD hyperactive-impulsive (4%). No significant differences were found in gender and age across subtypes. Current comorbid disorders were found in 57% of the ADHD patients. Significantly more comorbidity was found in the ADHD combined type and in patients ≥25 years. Significantly more men had substance use disorders and significantly more women had personality disorders. CONCLUSION: When assessing adult ADHD patients' age, gender, subtype, and related comorbid symptom profiles should be taken into account.

Education, occupation and risk-taking behaviour among adults with attention-deficit/hyperactivity disorder.

INTRODUCTION: No Danish studies examining functional impairments in a naturalistic sample of clinically referred adults with attention-deficit/hyperactivity disorder (ADHD) are available. Our study aimed to examine educational and occupational outcomes and risk-taking behaviour in a Danish clinical sample of adults with ADHD. METHODS: Naturalistic, cross-sectional study of 155 ADHD adults consecutively referred to a Danish ADHD clinic from 2010 to 2011. RESULTS: A total of 51% had primary/lower secondary school only as their highest education, and 65% were not self-supporting at the time of their assessment. Criminal behaviour was found in more than 50%, suspension of driving licence in 16% and risk-taking sexual behaviour in 37-51%. Co-morbidity did not significantly increase the odds for a low educational level or of risk-taking behaviours. Having a personality disorder (PD) increased occupational vulnerability. Male gender and ADHD-C (combined type) were significantly associated with criminality and suspension of driving licence. Patients with substance use disorders and PD had non-significantly increased odds for risk-taking behaviours. CONCLUSION: Functional impairments were evident in this Danish sample of adults with ADHD. Most of our findings could not be accounted for by co-morbidity, underlining the importance of targeting treatment at ADHD itself. FUNDING: This research was funded by The Psychiatric Research Foundation of the Central Denmark Region. TRIAL REGISTRATION: not relevant.

Evaluation of a controlled, national collaboration study on a clinical pharmacy service of screening for risk medications.

BACKGROUND: Risk medications are frequently associated with adverse events and hospitalisations. OBJECTIVE: To evaluate a risk medication screening service for in-patients at Danish hospitals. SETTING: Danish hospitals. METHODS: The study was designed as a controlled, prospective intervention study. Inpatients were screened for the use of five risk medications; anticoagulants, digoxin, methotrexate, NSAIDs and opioids, and during the intervention period recommendations were made by clinical pharmacists according to a standardized intervention scheme. The recommendations were discussed with the physician face-to-face. MAIN OUTCOME MEASURE: Readmissions within 6 months after discharge. RESULTS: In total, 1,007 control and 775 intervention patients were included in the study. The study found that half of the patients (50 % during the control and 48 % during the intervention period) admitted to Danish hospitals were treated with at least one of the five selected risk medications, significantly more drug related problems (DRPs) were identified during the control period (1.7/patient during the control and 1.4/patient during the intervention period (p < 0.001)), and the acceptance rate of recommendations (62 %) was similar to medication management service studies in the literature (39-100 %). However, no impact on outcome measures was found. The majority (69 %) of the clinical pharmacists reported that they had increased their professional competences by participating in the study, and that a national clinical pharmacy study may be used in promoting and implementing a unique clinical pharmacy service throughout the country (67 %). CONCLUSION: The study showed that a national screening service for risk medications could help identify and address DRPs. Despite no impact on the selected outcome measures, it is likely that the screening service could be included in a medication management review with further focus on the individual patient to ensure positive outcomes, or that the screening service should be delivered to selected patients groups, who might have maximum benefit of the service.

A model for communication of sensory quality in the seafood processing chain.

Sensory quality has a key influence of consumer perception of a product. It is therefore of great importance for the processing industry that the sensory quality fulfils the expectations of the consumer. Sensory evaluations are the ultimate tool to measure and communicate sensory quality, but it is generally not fully implemented in the chain from catch to consumer. The importance of communicating sensory demands and results from evaluations in the seafood processing chain is described and a Seafood Sensory Quality Model (SSQM) is suggested as a communication tool.

Cod and rainbow trout as freeze-chilled meal elements.

BACKGROUND: 'Meal elements' are elements of a meal, e.g. portions of pre-fried meat, sauces, frozen fish or pre-processed vegetables typically prepared industrially. The meal elements are distributed to professional satellite kitchens, where the staff can combine them into complete meals. Freeze-chilling is a process consisting of freezing and frozen storage followed by thawing and chilled storage. Combining the two would enable the manufacturer to produce large quantities of frozen meal elements to be released into the chill chain according to demand. We have studied the influence of freeze-chilling on the quality attributes of cod and rainbow trout portions. Sensory profiling and chemical analyses were used to determine the changes in quality after slow thawing and subsequent chill storage and to find the high-quality shelf life. RESULTS: Cod had a consistent and high sensory quality during the first 6 days of chilled storage, and the corresponding time for rainbow trout was 10 days. After this period the sensory quality decreased and chemical indicators of spoilage were seen to increase. CONCLUSION: The consistent quality during storage and the high-quality shelf life are practically applicable and cod and rainbow trout seem potential candidates for freeze-chilled meal elements.

[Two cases of invasive Haemophilus influenzae type f infection]. / To tilfaelde af invasive infektioner med Haemophilus influenzae type f.

Two cases of invasive Haemophilus influenzae type f infection are presented: a three-week-old boy with meningitis and a 62-year-old woman with arthritis and bacteremia. Since 1993 vaccination against H. influenzae type b (Hib) has been offered to Danish children. The result has been a remarkable decrease in invasive Hib disease. However, physicians need to be aware of the existence of non-type b invasive H. influenzae disease.

Changes in liquid-holding capacity, water distribution and microstructure during chill storage of smoked salmon.

BACKGROUND: During recent years, increases in liquid loss and soft texture in cold smoked salmon have been reported, possibly due to increased lipid content and a change in muscle structure. These problems can lead to downgrading of the product. This study aimed to investigate the influence of raw material composition and chill storage on quality parameters of cold smoked salmon. RESULTS: Initial smoked fish had a higher liquid-holding capacity (LHC) than samples stored for 20 days. Large fish lost more liquid than small fish. The difference in LHC was consistent with a change in water distribution, which could indicate denaturation of muscle protein. Studies of the microstructure showed the influence of both processing and chill storage. An indication of lipid released from the cells was seen after 20 days of chill storage, which could be related to the reduced LHC at that time. CONCLUSION: Both raw material composition and chill storage affected the quality parameters of smoked salmon. This study has improved knowledge about the relationships between muscle structure, liquid-holding properties and water distribution in smoked salmon. Copyright © 2007 Society of Chemical Industry.

The Danish national multicenter schizophrenia project: assessment of psychotic patients for dynamic psychotherapy (APPP).

Clinicians need guidance in selecting schizophrenic patients for individual psychodynamic psychotherapy. The purpose of the present study was to investigate whether a 17-item questionnaire (APPP) for quantification of suitability for psychotherapy could predict continuance, adherence and outcome from individual dynamic psychotherapy with patients with schizophrenic psychoses. Therapists rated 72 first-episode patients with schizophrenic psychoses in the initial interview. The scores were then correlated to the course of therapy and change in symptoms. APPP was tested to have good psychometric characteristics and had a satisfactory interrater reliability ((ICC,2)=0.70), when four raters scored eight videotaped interviews with eight different patients. The scale scores were highly correlated to "therapeutic alliance" measured by the Working Alliance Inventory (WAI) and the Active Engagement Scale (AES). APPP suitability gave a good early prediction of adherence to therapy (continued in therapy at least 12 months and a satisfactory number of sessions), but had no predictive value of symptomatic improvement or improved social function after 1 year.

[Educational outreach visits. Choice of strategy for interviewing general practitioners]. / Det personlige efteruddannelsesbesøg. Valg af strategi for mødet med den praktiserende laege.

INTRODUCTION: The clinical behaviour of General Practitioners (GPs) can best be influenced by identifying their incitements and barriers in the first place. The purpose of this paper was to describe a model for the outreach visits, in which the purpose was to facilitate and evaluate the desired changes in the clinical behaviour of the GPs. We demonstrate the usefulness and workability of the model as a tool to be used in future implementations. MATERIALS AND METHODS: A total of 41 GPs in the Counties of Aarhus and Vejle participated in the spring of 2000 in an advanced educational programme about how to diagnose and treat patients with functional disorders. All participating GPs received an invitation for a six-month follow-up visit. The purpose of the follow-up visit was to facilitate and evaluate their educational benefits and experience in using psychiatric rating scales. The strategy of the visit was to structure the dialogue with reference to identifying incitements and barriers and to emphasize their strengths, weaknesses, opportunities and threats in connection with the change of their clinical behaviour. RESULTS: Thirty-eight (93%) of the GPs participated in the follow-up outreach visits. The chosen strategy proved to be useful in primary care settings. We identified several areas in which the motivation of the GPs and their possibilities to implement the desired behavioural changes could be strengthened. CONCLUSION: The results suggest that the incitements and barriers of the GPs to change their clinical behaviour can be identified using the strategy described. We suggest that the strategy should form part of the development and evaluation of outreach visits in Denmark.

[Illness perception in general practice--in relation to patients with somatization disorder]. / Sygdomsopfattelser i almen praksis--i relation til patienter med somatiserende lidelse.

In this paper different perceptions of disease and illness in general practice and possible implications of these perceptions for the GP's clinical work are described and discussed. The focus is on patients with medically unexplained symptoms and on the question whether the illness perception of the GP to some extent can explain the often inappropriate treatment of these patients.

[The postgraduate training of general practitioners in communication and counseling. A questionnaire survey in the county of Aarhus]. / Alment praktiserende laegers efteruddannelse inden for kommunikation og samtaleterapi. En spørgeskemaundersøgelse i Arhus Amt.

INTRODUCTION: The study aimed to describe the postgraduate training of the general practitioners (GPs) in communication and psychiatric counselling. MATERIAL AND METHODS: GPs in Aarhus County, Denmark, received a mailed questionnaire about psychiatric hospital training, participation in courses and Balint groups (psychiatric supervision), and their need for further training. RESULTS AND DISCUSSION: The questionnaire was returned by 320 (74.4%) GPs. Almost all GPs had received some kind of postgraduate training although to a very varying extent. Almost half had taken courses of more than three days' duration, and half were members of a psychiatric supervision group. Two-thirds of the GPs thought they needed further training. The need was independent of the GP's evaluation of his/her own psychiatric education.

[Survival of children born with cerebral palsy. Children born 1971-1986]. / Overlevelse for børn født med cerebral parese. Fødselsårgangene 1971-1986.

INTRODUCTION: Since 1967, children with cerebral palsy in Eastern Denmark have been registered in the Danish Cerebral Palsy Registry. We wanted to investigate the survival of Danish patients with cerebral palsy and examine different factors that influence on survival. We also compared the survival rate with that of the background population. MATERIAL AND METHODS: All patients in the Cerebral Palsy Register, born between 1971 and 1986, were included in our study cohort. We examined the influence of the following factors on the survival of persons with cerebral palsy: sex, epilepsy, type of cerebral palsy, mental retardation, functional disability, birth year, and birth weight. Each factor was tested with Cox regression. RESULTS: Seventy-seven of the 1093 persons included (7%), died before September 1997. Our study showed that survival was associated with the type of cerebral palsy, epilepsy, mental retardation, and the degree of functional disability. Surprisingly, birth year and birth weight had no influence on survival. Persons with cerebral palsy had a lower survival rate than the background population. However, there was no significant difference between cerebral palsy persons with walking abilities, and the background population. DISCUSSION: Compared to earlier studies, the survival rate seems to have improved. The Danish cerebral palsy patients had a survival as good as, and maybe even better, than that of cerebral palsy patients from other countries. Persons with low functional disabilities had a survival rate comparable to that of the background population, a finding that may be relevant in regard to life insurance.

Thawed Cod Fillets Spoil Less Rapidly Than Unfrozen Fillets When Stored under Modified Atmosphere at 2°C.

The effect of two months of frozen storage at -20°C on the spoilage characteristics and shelf life of thawed and modified atmosphere packed (MAP) cod fillets stored at 2°C was studied. Thawed MAP cod fillets were compared with fresh cod fillets stored in CO2-containing modified atmospheres with and without added oxygen. The shelf life of 11 to 12 days in the fresh MAP cod was extended to more than 20 days in the thawed MAP cod at 2°C. This shelf life extension was most likely due to the inactivation of the spoilage bacterium Photobacterium phosphoreum during frozen storage as reflected both in Chemical analyses and sensory evaluation. In contrast to fresh MAP cod fillets no significant production of trimethylamine occurred and almost no amine odor and taste were detected during 20 days of chill storage of thawed MAP cod fillets. The use of frozen fillets as raw material not only provides a more stable product in MAP but also allows much greater flexibility for production and distribution. However, a slightly increased concentration of dimethylamine, a larger drip loss, and detection of weak frozen storage flavor were observed in the thawed MAP cod fillets.