1126 Relationship Between Headache and Sleep: A Longitudinal Study from the Population of Sao Paulo City (Brazil)

Introduction

The complaint of nocturnal awakening with headache (NAH), was prevalent (8.4%) in the São Paulo population and was associated with sleep disturbances, as demonstrated in a study conducted in 2007 (EPISONO). Indeed, this relationship between sleep and headache is well documented in the literature. Objective: To assess the incidence and evolution of NAH and to associate sleep-related variables in an eight-year prospective study.

Methods

From 1042 volunteers enrolled in the baseline, 712 agreed to participate in the follow-up. Questionnaires and scales were applied and polysomnography and actigraphy performed. The complaint of NAH was analyzed according to a frequency questionnaire and separated into frequent or occasional.

Results

At follow-up, 110 volunteers reported NAH, of which 82 were the same as those from the baseline, but only 38 had frequent complaints. Comparing with volunteers whose headache has become occasional, we have as a difference the insomnia severity index which is significantly higher in the group with frequent NAH (8.40 ± 5.10 vs 11.20±6.40 p:0.03) and worse sleep quality as measured by the Pittsburgh questionnaire (7.25±3.60 vs 10.25±4.60 p:0.002). In addition, these volunteers had higher anxiety (10.40±9.30 vs 12.00± 10:00 p: 0.008) and depression (10.60±9.90 vs 12:00±9.90 p:0.005) from Beck’s questionnaires and greater fatigue (4.85±3.10 vs 9.75±5.55 p:0.001). The associations of NAH with insomnia, nightmares, and bruxism observed in the baseline continued, but no difference was observed between those who had frequent or occasional complaints at follow-up.

Conclusion

Our study showed that NAH was highly prevalent in the Sao Paulo population in both the baseline and follow-up studies, but this frequency had a reduction in follow-up. Volunteers who persisted with the frequent complaint showed greater severity of insomnia, higher anxiety and depression and greater fatigue.

Support

Associação Fundo de Incentivo à Pesquisa (AFIP) and São Paulo Research Foundation (FAPESP)

First abundance estimate for white whales Delphinapterus leucas in Svalbard, Norway

The Svalbard Archipelago (Norway) is experiencing rapid declines in the seasonal duration and extent of sea-ice cover, and local tidewater glaciers are melting. These environmental changes represent a threat to ice-associated species in the region, including white whales Delphinapterus leucas. However, no estimates of stock size or trends are available for this stock. An aerial survey was conducted during the summer of 2018, covering the coastlines of all major islands in Svalbard, as well fjords and open ocean areas. A total count was attempted for the coastlines, while coverage of the fjords and open ocean areas was designed as distance-sampling line transects. In total, 265 white whales were detected in 22 groups along the 4965 km of coastline coverage. No whales were observed on fjord (1481 km) or open ocean transects (535 km). After correcting for surface availability using behavioural data from the same area (in summer) and making adjustments for small areas not flown during the survey, the stock size was estimated to be 549 individuals (95% CI: 436%%CONV_ERR%%723). This estimate is surprisingly low given that this species is one of the most frequently observed cetaceans in the area, but it confirms suspicions based on difficulties in finding animals when operating white whale tagging programmes over the past decade. This first population estimate is important in the context of the rapid environmental change taking place in the Arctic and for providing a baseline for comparison with future estimates.

Pelagic vs Coastal-Key Drivers of Pollutant Levels in Barents Sea Polar Bears with Contrasted Space-Use Strategies

In the Barents Sea, pelagic and coastal polar bears are facing various ecological challenges that may explain the difference in their pollutant levels. We measured polychlorinated biphenyls, organochlorine pesticides, polybrominated diphenyl ethers in fat, and perfluoroalkyl substances in plasma in pelagic and coastal adult female polar bears with similar body condition. We studied polar bear feeding habits with bulk stable isotope ratios of carbon and nitrogen. Nitrogen isotopes of amino acids were used to investigate their trophic position. We studied energy expenditure by estimating field metabolic rate using telemetry data. Annual home range size was determined, and spatial gradients in pollutants were explored using latitude and longitude centroid positions of polar bears. Pollutant levels were measured in harp seals from the Greenland Sea and White Sea-Barents Sea as a proxy for a West-East gradient of pollutants in polar bear prey. We showed that pelagic bears had higher pollutant loads than coastal bears because (1) they feed on a higher proportion of marine and higher trophic level prey, (2) they have higher energy requirements and higher prey consumption, (3) they forage in the marginal ice zones, and (4) they feed on prey located closer to pollutant emission sources/transport pathways.

Derivation of whole blood biomonitoring equivalents for lithium for the interpretation of biomonitoring data

INTRODUCTION

Lithium salts have numerous industrial uses and are also used in the treatment of bipolar disorders. The main source of lithium exposure to the general population is drinking water and foods. Lithium is nephrotoxic at higher doses. Thus, oral exposure guidelines for lithium have been derived, including ICH's permitted daily exposure (PDE = 0.008 mg lithium/kg-bw/day) adopted by Health Canada and the United States Environmental Protection Agency's (U.S. EPA) provisional peer reviewed toxicity value (PPRTV = 0.002 mg lithium/kg-bw/day), both based on human data.

OBJECTIVE

To derive whole blood biomonitoring equivalents (BEs) associated with PDE and PPRTV to interpret population-level biomonitoring data in health risk context.

METHOD

A simple kinetic relationship based on plasma clearance value (0.5 L/kg-bw/day) and the oral absorption fraction (100%) was used to derive blood BEs for PDE and PPRTV.

RESULTS

This analysis resulted in BE values in plasma and whole blood of 16 and 10 μg/L, respectively, based on the PDE values developed by the Health Canada and of 4.2 and 2.7 μg/L, respectively, based on the PPRTV developed by U.S. EPA.

CONCLUSION

The derived BE values can be used to interpret population-level biomonitoring data.

Health assessment of newly arrived refugees to the Municipality of Copenhagen, Denmark

Background

Research data on the health status of newly arrived refugees is sparse. Newly arrived refugees and family reunified in The Municipality of Copenhagen has since 2016 been offered a general health assessment. These assessments are conducted by clinicians with expertise in refugee and migrant health from the Section of Immigrant Health. This study describes the sociodemographic characteristics and the burden of disease in this population.

Methods

In this cross-sectional study the population consists of adult patients examined January 2017 to February 2019. Clinicians performed the health assessment including a questionnaire regarding sociodemographics, medical history, symptoms, traumatic events during/before migration, a clinical examination and blood samples.

Results

The population had an equal presentation of males (N = 81) and females (N = 79) primarily from Syria (33%) and Iran (29%). The median age was 31,5 years (SD = 10,9). 67% had ≥8 years of schooling, while 11% had a maximum of 2 years. More than half had experienced war and 50% persecution. 76% suffered from Vitamin D deficiency, 31% of B12 deficiency and 12% of anemia. Few suffered from infectious and somatic diseases, yet many experiences symptoms such as pain (53%) and headaches (54%). 33% presented with symptoms of PTSD.

Conclusions

A high frequency of micronutrition deficiency was prevalent in the refugee group. Furthermore, many suffered from physical symptoms while very few had serious somatic issues. Numerous traumatic experiences were reported and 33% presented with symptoms of PTSD. The data is presumably a reflection of the healthy migrant bias.

Key messages

Despite refugees presumably being tested pre-entry and at holding level, they still suffer several health issues when granted asylum. Many newly arrived refugees suffer from micronutrition deficiency. These conditions are easily treated and could enhance the overall health of the individual.

NTCP model validation method for DAHANCA patient selection of protons versus photons in head and neck cancer radiotherapy

Introduction: Prediction models using logistic regression may perform poorly in external patient cohorts. However, there is a need to standardize and validate models for clinical use. The purpose of this project was to describe a method for validation of external NTCP models used for patient selection in the randomized trial of protons versus photons in head and neck cancer radiotherapy, DAHANCA 35. Material and methods: Organs at risk of 588 patients treated primarily with IMRT in the randomized controlled DAHANCA19 trial were retrospectively contoured according to recent international recommendations. Dose metrics were extracted using MatLab and all clinical parameters were retrieved from the DAHANCA database. The model proposed by Christianen et al. to predict physician-rated dysphagia was validated through the closed testing, where change of the model intercept, slope and individual beta's were tested for significant prediction improvements. Results: Six months prevalence of dysphagia in the validation cohort was 33%. The closed testing procedure for physician-rated dysphagia showed that the Christianen et al. model needed an intercept refitting for the best match for the Danish patients. The intercept update increased the risk of dysphagia for the validation cohort by 7.9 ± 2.5% point. For the raw model performance, the Brier score (mean squared residual) was 0.467, which improved significantly with a new intercept to 0.415. Conclusions: The previously published Dutch dysphagia model needed an intercept update to match the Danish patient cohort. The implementation of a closed testing procedure on the current validation cohort allows quick and efficient validation of external NTCP models for patient selection in the future.

Life-Cycle Assessment as a decision-support tool for early phases of urban planning: evaluating applicability through a comparative approach

While ambitious environmental objectives are being set for new constructions in Switzerland, the assessment of urban-scale projects and comparison of their performance to national targets are made possible by a growing number of life-cycle assessment (LCA) tools. However, previous research emphasizes the lack of existing tools to support the decision-making process at the early design stage, characterized by a low level of project details. This paper presents a comparison between three LCA tools. The first, stemming from a research and development project (SETUP), is an exploration tool relying on a database of urban-level scenarios and their environmental performance, able to convert district targets (e.g. 2000-Watt society objectives) into specific sub-targets at the building or component levels. The other two are online LCA tools currently available to practitioners (Sméo and Calculation tool for 2000-Watt-society-sites RH II ), that allow assessing the project and verifying its compliance with a given target. Each tool was applied to a low-carbon case study, the blueFactory district in Fribourg (Switzerland), in two hypothetical contexts corresponding to the schematic and detailed project development phases, characterized by different levels of details. When used for the assessment of a project at a more advanced development stage with a high resolution of detail, findings indicate that Smeo and RH II provide similar environmental performance results. However, in early planning stages, SETUP shows better abilities to support decision-making by providing ranges of results and highlighting uncertainties and the influence of design parameters that have not yet been fixed.

Temporal Trends of Persistent Organic Pollutants in Barents Sea Polar Bears ( Ursus maritimus) in Relation to Changes in Feeding Habits and Body Condition

Temporal trends of persistent organic pollutants (POPs: PCBs, OH-PCBs, p, p'-DDE, HCB, β-HCH, oxychlordane, BDE-47, and 153) in relation to changes in feeding habits and body condition in adult female polar bears ( Ursus maritimus) from the Barents Sea subpopulation were examined over 20 years (1997-2017). All 306 samples were collected in the spring (April). Both stable isotope values of nitrogen (δ¹⁵N) and carbon (δ¹³C) from red blood cells declined over time, with a steeper trend for δ¹³C between 2012 and 2017, indicating a decreasing intake of marine and high trophic level prey items. Body condition, based on morphometric measurements, had a nonsignificant decreasing tendency between 1997 and 2005, and increased significantly between 2005 and 2017. Plasma concentrations of BDE-153 and β-HCH did not significantly change over time, whereas concentrations of Σ₄PCB, Σ₅OH-PCB, BDE-47, and oxychlordane declined linearly. Concentrations of p, p'-DDE and HCB, however, declined until 2012 and 2009, respectively, and increased thereafter. Changes in feeding habits and body condition did not significantly affect POP trends. The study indicates that changes in diet and body condition were not the primary driver of POPs in polar bears, but were controlled in large part by primary and/or secondary emissions of POPs.

General practitioners' and nurses' views on medication reviews and potentially inappropriate medicines in elderly patients - a qualitative study of reports by educating pharmacists

OBJECTIVE

The aim with this study was to understand more about how general practitioners (GPs) and nurses in primary care experience their work with medication reviews in elderly patients.

DESIGN

This qualitative study was nested within a cluster randomised trial and analysed narrative and unstructured diaries written by two pharmacists who performed academic detailing, i.e. educational outreach visits in primary care. The educational sessions dealt with potentially inappropriate medicines, and stimulated interprofessional dialogue in relation to medication reviews. The purpose of the diaries was to document and structure the pedagogical process of academic detailing and contained quotes from 194 GP and 113 nurse participants in the sessions, and the pharmacists' reflections. The data was explored using thematic analysis.

SETTING

Thirty-three primary care practices in Stockholm, Sweden.

SUBJECTS

GPs and nurses working in primary care.

MAIN OUTCOME MEASURES

Thematic descriptions of academic detailing by pharmacists.

RESULTS

Five themes were identified: 1) Complexity in 3 'P': patients, pharmacotherapy, and primary care; 2) What, when, who? Clash between GPs' and nurses' experiences and guidelines; 3) Real-world problems and less-than-ideal solutions; 4) Eureka? Experiences with different steps during a medication review; and 5) Threats to GP autonomy.

CONCLUSION

GPs and nurses should participate in the construction and release of guidelines in order to increase their usability in clinical practice. Future research should analyse if alternative strategies such as condensed medical reviews and feedback on prescribing are easier to implement in primary care. Key points Complex medication reviews have been introduced on a large scale in Swedish primary care, but knowledge on GPs' and nurses' views on such reviews is lacking. In the context of primary care alternative strategies such as condensed medication reviews and feedback on prescribing may be more applicable than medication reviews according to guidelines. GPs and nurses should make contributions to the development of guidelines on medication reviews in order to increase their usability in clinical practice.

Aquatic behaviour of polar bears (Ursus maritimus) in an increasingly ice-free Arctic

Polar bears are ice-associated marine mammals that are known to swim and dive, yet their aquatic behaviour is poorly documented. Reductions in Arctic sea ice are clearly a major threat to this species, but understanding polar bears’ potential behavioural plasticity with respect to the ongoing changes requires knowledge of their swimming and diving skills. This study quantified time spent in water by adult female polar bears (n = 57) via deployment of various instruments bearing saltwater switches, and in some case pressure sensors (79 deployments, 64.8 bear-years of data). There were marked seasonal patterns in aquatic behaviour, with more time spent in the water during summer, when 75% of the polar bears swam daily (May-July). Females with cubs-of-the-year spent less time in the water than other females from den emergence (April) until mid-summer, consistent with small cubs being vulnerable to hypothermia and drowning. Some bears undertook notable long-distance-swims. Dive depths up to 13.9 m were recorded, with dives ≥5 m being common. The considerable swimming and diving capacities of polar bears might provide them with tools to exploit aquatic environments previously not utilized. This is likely to be increasingly important to the species’ survival in an Arctic with little or no persistent sea ice.

Mitochondria, glycogen, and lipid droplets in skeletal muscle during testosterone treatment and strength training: a randomized, double-blinded, placebo-controlled trial

Low testosterone levels in aging men are associated with insulin resistance. Mitochondrial dysfunction, changes in glycogen metabolism, and lipid accumulation are linked to insulin resistance in skeletal muscle. In this randomized, double-blinded, placebo-controlled study, we investigated the effects of six-month testosterone replacement therapy (TRT) and strength training (ST) on mitochondrial, glycogen, and lipid droplet (LD) content in skeletal muscle of aging men with subnormal bioavailable testosterone (BioT) levels. Mitochondrial, glycogen, and LD volume fractions in muscle biopsies were estimated by transmission electron microscopy. Insulin sensitivity (insulin-stimulated Rd) and body composition were assessed by euglycemic-hyperinsulinemic clamp and dual X-ray absorptiometry, respectively. TRT significantly increased total testosterone levels, BioT, and lean body mass (LBM) (p < 0.05), whereas percent body fat decreased (p < 0.05), and insulin sensitivity was unchanged. Baseline mitochondrial volume fraction correlated inversely with percent body fat (ρ = -0.43; p = 0.003). Δ-mitochondrial fraction correlated positively with Δ-total testosterone (ρ = 0.70; p = 0.02), and Δ-glycogen fraction correlated inversely with Δ-LBM (ρ = -0.83; p = 0.002) during six-month TRT, but no significant changes were observed in mitochondrial, glycogen, and LD volume fractions during TRT and ST. In conclusion, in this exploratory small-scale study, the beneficial effects of six-month TRT on total testosterone, LBM, and percent body fat were not followed by significant changes in fractions of mitochondria, glycogen, or lipid in skeletal muscle of aging men with lowered testosterone levels. Six-month ST or combined three-month ST+TRT did not change intramyocellular mitochondria, glycogen, and LD fractions compared to placebo. However, further studies with a larger sample size are needed.

Choose Your Poison-Space-Use Strategy Influences Pollutant Exposure in Barents Sea Polar Bears

Variation in space-use is common within mammal populations. In polar bears, Ursus maritimus, some individuals follow the sea ice (offshore bears) whereas others remain nearshore yearlong (coastal bears). We studied pollutant exposure in relation to space-use patterns (offshore vs coastal) in adult female polar bears from the Barents Sea equipped with satellite collars (2000-2014, n = 152). First, we examined the differences in home range (HR) size and position, body condition, and diet proxies (nitrogen and carbon stable isotopes, n = 116) between offshore and coastal space-use. Second, we investigated how HR, space-use, body condition, and diet were related to plasma concentrations of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs) ( n = 113), perfluoroalkyl substances (PFASs; n = 92), and hydroxylated-PCBs ( n = 109). Offshore females were in better condition and had a more specialized diet than did coastal females. PCBs, OCPs, and hydroxylated-PCB concentrations were not related to space-use strategy, yet PCB concentrations increased with increasing latitude, and hydroxylated-PCB concentrations were positively related to HR size. PFAS concentrations were 30-35% higher in offshore bears compared to coastal bears and also increased eastward. On the basis of the results we conclude that space-use of Barents Sea female polar bears influences their pollutant exposure, in particular plasma concentrations of PFAS.

Ambient pressure phase transitions over Ir(1 1 1): at the onset of CO oxidation

In this study we report on the adsorbate structures on an Ir(1 1 1) surface during the phase transition from the inactive to the active state during CO oxidation. The CO oxidation over Pt(1 1 1) is used as a reference case. Where Pt(1 1 1) either is inactive and CO covered or active and O covered, Ir(1 1 1) exhibits a transition state with co-existing chemisorbed O and CO. The observed structural differences are explained in terms of DFT-calculated adsorption energies. For Pt(1 1 1) the repulsive CO-O interaction makes co-existing chemisorbed CO and O unfavourable, while for Ir(1 1 1) the stronger O and CO adsorption allows for overcoming the repulsive interaction. At the onset of CO oxidation over Ir(1 1 1), a CO structure containing defects forms, which enables O₂ to dissociatively adsorb on the Ir(1 1 1) surface, thus enabling the CO oxidation reaction. At the mass transfer limit, the Ir(1 1 1) surface is covered by a chemisorbed O structure with defects; hence, the active surface is predominately chemisorbed O covered at a total pressure of 0.5 mbar and no oxide formation is observed.