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Bache-Mathiesen LK, Bahr R, Sattler T, Fagerland MW, Whiteley R, Skazalski C. Causal inference did not detect any effect of jump load on knee complaints in elite men's volleyball. Scand J Med Sci Sports 2024; 34:e14635. [PMID: 38671558 DOI: 10.1111/sms.14635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
The aim was to determine how jump load affects knee complaints in elite men's volleyball. We collected data from four men's premier league volleyball teams through three seasons in a prospective cohort study (65 players, 102 player-seasons). Vert inertial measurement devices captured the jump load (jump frequency and jump height) from 21 088 daily player sessions, and knee complaints were reported in 3568 weekly OSTRC-O questionnaires. Mixed complementary log-log regression models described the probability of (i) experiencing symptoms if players were currently asymptomatic, (ii) worsening symptoms if players had symptoms, and (iii) recovery from knee complaints. Based on our causal assumptions, weekly jump load was modeled as the independent variable, adjusted for age (years), weight (kg), position on volleyball team, and past jump load. No certain evidence of an association was found between weekly jump load and probability of (i) knee complaints (p from 0.10 to 0.32 for three restricted cubic splines of load), (ii) worsening symptoms if the player already had symptoms (p from 0.11 to 0.97), (iii) recovery (p from 0.36 to 0.63). The probability of knee complaints was highest for above-average weekly jump load (~1.2% for an outside hitter with mean age and height) compared with low loads (~1%) and very high loads (→ ~ 0%). The association between jump load and knee complaints risk remains unclear. Small differences in risk across observed jump load levels were observed. It would likely require substantially increased sample sizes to detect this association with certainty.
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Affiliation(s)
- Lena Kristin Bache-Mathiesen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tine Sattler
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Christopher Skazalski
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Bache-Mathiesen LK, Andersen TE, Dalen-Lorentsen T, Tabben M, Chamari K, Clarsen B, Fagerland MW. A new statistical approach to training load and injury risk: separating the acute from the chronic load. Biol Sport 2024; 41:119-134. [PMID: 38188114 PMCID: PMC10765439 DOI: 10.5114/biolsport.2024.127388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/19/2023] [Accepted: 04/15/2023] [Indexed: 01/09/2024] Open
Abstract
The relationship between recent (acute) training load relative to long-term (chronic) training load may be associated with sports injury risk. We explored the potential for modelling acute and chronic loads separately to address current statistical methodology limitations. We also determined whether there was any evidence of an interaction in the association between acute and chronic training loads and injury risk in football. A men's Qatar Stars League football cohort (1 465 players, 1 977 injuries), where training load was defined as the number of minutes of activity, and a Norwegian elite U-19 football cohort (81 players, 60 injuries), where training load was defined as the session rating of perceived exertion (sRPE). Mixed logistic regression was run with training load on the current day (acute load) and cumulative past training load estimated by distributed lag non-linear models (chronic load) as independent variables. Injury was the outcome. An interaction between acute and chronic training load was modelled. In both football populations, we observed that the risk of injury on the current day for different values of acute training load was highest for players with low chronic load, followed by high and then medium chronic load. The slopes varied substantially between different levels of chronic training load, indicating an interaction. Modelling acute and chronic loads separately in regression models is a suitable statistical approach for analysing the association between relative training load and injury risk in injury prevention research. Sports scientists should also consider the potential for interactions between acute and chronic load.
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Affiliation(s)
- Lena Kristin Bache-Mathiesen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Torstein Dalen-Lorentsen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Montassar Tabben
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Karim Chamari
- Aspetar, Orthopaedic and Sports Medicine Hospital, FIFA Medical Centre of Excellence, Doha, Qatar
| | - Benjamin Clarsen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
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Kristensen AMD, Munkhaugen J, Halvorsen S, Olsen MH, Bakken A, Sehested TSG, Ruddox V, Lange T, Fagerland MW, Torp-Pedersen C, Prescott E, Atar D. The Danish-Norwegian randomized trial on beta-blocker therapy after myocardial infarction: Design, rationale, and baseline characteristics. Eur Heart J Cardiovasc Pharmacother 2023:pvad093. [PMID: 38017624 DOI: 10.1093/ehjcvp/pvad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
AIM The evidence for beta-blocker therapy after myocardial infarction (MI) is randomized trials conducted more than 30 years ago, and the continued efficacy has been questioned. DESIGN AND METHODS The ongoing Danish (DANBLOCK) and Norwegian (BETAMI) randomized beta-blocker trials are joined to evaluate the effectiveness and risks of long-term beta-blocker therapy after MI. Patients with normal or mildly reduced left ventricular ejection fraction (LVEF≥40%) will be randomized to open-label treatment with beta-blockers or no such therapy. This event-driven trial will randomize ∼5700 patients and continue until 950 primary endpoints have occurred. As of July 2023, 5228 patients have been randomized. Of the first 4000 patients randomized, median age was 62 years, 79% were men, 48% had a STEMI, and 84% had a normal LVEF. The primary endpoint is a composite of adjudicated recurrent MI, incident heart failure, coronary revascularization, ischemic stroke, all-cause mortality, malignant ventricular arrhythmia, or resuscitated cardiac arrest. The primary safety endpoint includes a composite of recurrent MI, heart failure, all-cause mortality, malignant ventricular arrhythmia, or resuscitated cardiac arrest 30 days after randomization. Secondary endpoints include each of the components of the primary endpoint, patient-reported outcomes, and other clinical outcomes linked to beta-blocker therapy. The primary analysis will be conducted according to the intention-to-treat principle using a Cox proportional hazards regression model. End of follow-up is expected in December 2024. CONCLUSION The combined BETAMI-DANBLOCK trial will have the potential to affect current clinical practice for beta-blocker therapy in patients with normal or mildly reduced LVEF after MI.
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Affiliation(s)
- Anna Meta Dyrvig Kristensen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway, Institute of Behavioural Medicine, University of Oslo
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, Norway
| | - Michael Hecht Olsen
- Department of Regional Health Research, University of Southern Denmark, and Department of Internal Medicine 1, Holbæk Hospital, Holbæk, Denmark
| | - Arnhild Bakken
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, Norway
| | | | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital Trust, Tonsberg, Norway
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital - North Zealand Hospital, Hillerød, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, and University of Oslo, Norway
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Bekkenes ME, Fagerland MW, Solberg OG, Aaberge L, Klingenberg O, Norseth J, Rosseland LA. Reply to: exploring cardiac effects after oxytocin 2.5 IU or carbetocin 100 μg - a randomised controlled trial in women undergoing planned caesarean delivery. Eur J Anaesthesiol 2023; 40:453-454. [PMID: 37132304 DOI: 10.1097/eja.0000000000001841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Maria Egeland Bekkenes
- From the Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital (MEB, LAR), the Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (MEB, OK, LAR), the Oslo Centre for Biostatistics and Epidemiology, Research Support Services (MWF), the Department of Cardiology (OGS, LA), the Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway (OK), and the Vestre Viken Hospital, Department of Clinical Biochemistry, Drammen, Norway (JN)
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Nguyen THP, Fagerland MW, Hollan I, Whist JE, Feinberg MW, Agewall S. High-sensitivity cardiac troponin T is associated with disease activity in patients with inflammatory arthritis. PLoS One 2023; 18:e0281155. [PMID: 36763689 PMCID: PMC9916599 DOI: 10.1371/journal.pone.0281155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/14/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE To investigate whether high-sensitivity cardiac troponin T (hsTnT) correlates to markers of disease activity in inflammatory arthritis (IA), and whether antirheumatic treatment influences hsTnT levels. METHODS We assessed 115 patients with active IA (64 rheumatoid arthritis (RA), 31 psoriatic arthritis and 20 ankylosing spondylitis) before and after using methotrexate (MTX) alone or tumor necrosis factor inhibitor (TNFi) with or without MTX co-medication (TNFi±MTX). All patients starting with TNFi had been previously unsuccessfully treated with MTX monotherapy. HsTnT (measured in serum by electro-chemiluminescence immunoassay (Roche Elecsys® Troponin T- high-sensitivity)), and other clinical and laboratory parameters were evaluated at baseline, and after 6 weeks and 6 months of treatment. RESULTS Of markers of disease activity, baseline levels of hsTnT positively correlated with Physicians' Global Assessment Score of disease activity in the total patient cohort (p = 0.039). In RA group, hsTnT positively correlated with swollen joints, Disease Activity Score for 28 joints with ESR and serum tumor necrosis factor levels (p = 0.025, p = 0.008, p = 0.01, respectively). Median hsTnT at baseline was 5.0 ng/L, and did not change significantly at 6-week visit (6.0 ng/L, p = 0.37) and 6-month visit (6.0 ng/L, p = 0.18) with either antirheumatic therapy. CONCLUSIONS HsTnT levels were associated with inflammatory markers for IA disease activity. However, while inflammatory markers significantly improved after antirheumatic treatment, hsTnT did not change during the 6-month follow-up period.
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Affiliation(s)
- Thao H. P. Nguyen
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- * E-mail:
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Ivana Hollan
- Beitostølen Health and Sport Centre, Beitostølen, Norway
- Norwegian University of Science and Technology, Gjøvik, Norway
| | - Jon Elling Whist
- Department of Laboratory medicine, Innlandet Hospital Trust, Lillehammer, Norway
| | - Mark W. Feinberg
- Harvard Medical School, Boston, MA, United States of America
- Division of Cardiology, Brigham and Women´s Hospital, Boston, MA, United States of America
| | - Stefan Agewall
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
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Moseid NFH, Lemyre N, Roberts GC, Fagerland MW, Holm Moseid C, Bahr R. Associations between health problems and athlete burnout: a cohort study in 210 adolescent elite athletes. BMJ Open Sport Exerc Med 2023; 9:e001514. [PMID: 36896364 PMCID: PMC9990658 DOI: 10.1136/bmjsem-2022-001514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives We studied associations between the burden of health problems and athlete burnout in a population of athletes from Norwegian Sport Academy High Schools. Methods This is a mixed prospective/retrospective cohort study. We included 210 athletes, 135 boys and 75 girls, from endurance, technical and team sports. We used the Oslo Sports Trauma Centres Questionnaire for Health Problems to collect 124 weeks of health data. During the first 26 weeks, athletes reported the health data prospectively using a smartphone app. For the following 98 weeks, we collected health data by interviewing athletes at the end of their third year in Sport Academy High School. At the time of the interview, the athletes also completed a web-based questionnaire, including the Athlete Burnout Questionnaire and covering social relations in sports and school, coach relations and living conditions. Results A greater burden of health problems was associated with a higher score for athlete burnout (B: 0.16, 95% CI 0.09 to 0.22, p<0.001). In a multivariable model, this was true for both illnesses (B: 0.21, 95% CI 0.10 to 0.32, p<0.001), acute injuries (B: 0.16, 95% CI 0.04 to 0.27, p=0.007) and overuse injuries (B: 0.10, 95% CI 0.002 to 0.18, p=0.011). This was also true in gender and sports category subgroups. The coach having a high influence on training week was associated with a lower score for athlete burnout. Conclusion A greater burden of health problems was associated with greater symptoms of athlete burnout in athletes attending Sport Academy High Schools.
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Affiliation(s)
- Nils Fredrik Holm Moseid
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Nicolas Lemyre
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | - Glyn C Roberts
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | | | - Christine Holm Moseid
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Solberg R, Steene-Johannessen J, Fagerland MW, Anderssen SA, Berntsen S, Resaland GK, van Sluijs EMF, Ekelund U, Kolle E. Aerobic Fitness Mediates The Intervention Effects Of A School-based Physical Activity Intervention On Academic Performance. The School In Motion Study - A Cluster Randomized Controlled Trial. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000876068.12516.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Bache-Mathiesen LK, Andersen TE, Dalen-Lorentsen T, Clarsen B, Fagerland MW. Assessing the cumulative effect of long-term training load on the risk of injury in team sports. BMJ Open Sport Exerc Med 2022; 8:e001342. [PMID: 35722043 PMCID: PMC9152939 DOI: 10.1136/bmjsem-2022-001342] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Determine how to assess the cumulative effect of training load on the risk of injury or health problems in team sports. Methods First, we performed a simulation based on a Norwegian Premier League male football dataset (n players=36). Training load was sampled from daily session rating of perceived exertion (sRPE). Different scenarios of the effect of sRPE on injury risk and the effect of relative sRPE on injury risk were simulated. These scenarios assumed that the probability of injury was the result of training load exposures over the previous 4 weeks. We compared seven different methods of modelling training load in their ability to model the simulated relationship. We then used the most accurate method, the distributed lag non-linear model (DLNM), to analyse data from Norwegian youth elite handball players (no. of players=205, no. of health problems=471) to illustrate how assessing the cumulative effect of training load can be done in practice. Results DLNM was the only method that accurately modelled the simulated relationships between training load and injury risk. In the handball example, DLNM could show the cumulative effect of training load and how much training load affected health problem risk depending on the distance in time since the training load exposure. Conclusion DLNM can be used to assess the cumulative effect of training load on injury risk.
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Affiliation(s)
| | - Thor Einar Andersen
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
| | - Torstein Dalen-Lorentsen
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Smart Sensors and Microsystems, SINTEF Digital, Oslo, Norway
| | - Benjamin Clarsen
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway.,Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Morten Wang Fagerland
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway.,Research Support Services, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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Kvaslerud AB, Bardan S, Andresen K, Kløve SF, Fagerland MW, Edvardsen T, Gullestad L, Broch K. Intravenous iron supplement for iron deficiency in patients with severe aortic stenosis scheduled for TAVI Results of the IIISAS randomised trial. Eur J Heart Fail 2022; 24:1269-1279. [PMID: 35579454 PMCID: PMC9544901 DOI: 10.1002/ejhf.2557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The aim of this trial was to evaluate whether intravenous iron could provide benefit beyond transcatheter aortic valve implantation (TAVI) in iron‐deficient patients with severe aortic stenosis. Methods and results In this randomised, placebo‐controlled, double‐blind, single‐centre trial, we enrolled patients with severe aortic stenosis and iron deficiency (defined as ferritin <100 µg/L, or 100–299 µg/L with a transferrin saturation <20%) who were evaluated for TAVI. Patients were randomly assigned (1:1) to receive intravenous ferric derisomaltose or placebo ∼3 months before TAVI. The primary endpoint was the between‐group, baseline‐adjusted 6‐min walk distance measured 3 months after TAVI. Secondary outcomes included quality of life, iron stores, hand grip strength, New York Heart Association (NYHA) class, and safety. Between January 2020 and September 2021, we randomised 74 patients to ferric derisomaltose and 75 patients to placebo. The modified intention‐to‐treat population comprised the 104 patients who completed the 6‐min walk test at baseline and 3 months after successful TAVI. Iron stores were restored in 76% of the patients allocated to iron and 13% of the patients allocated to placebo (p < 0.001). There was no difference in the baseline‐adjusted 6‐min walk distance between the two treatment arms (p = 0.82). The number of serious adverse events, quality of life, hand grip strength, and NYHA class did not differ between the treatment arms. Conclusion Treatment with intravenous iron did not provide clinical benefit beyond TAVI in iron‐deficient patients with severe aortic stenosis. Clinical Trial Registration: ClinicalTrials.gov NCT04206228.
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Affiliation(s)
- Anette B Kvaslerud
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,KG Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Sara Bardan
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Andresen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Sophie Foss Kløve
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,KG Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.,KG Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway
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10
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Bekkenes M, Jørgensen MM, Flem Jacobsen A, Wang Fagerland M, Rakstad-Larsen H, Solberg OG, Aaberge L, Klingenberg O, Steinsvik T, Rosseland LA. A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway. F1000Res 2022; 10:973. [PMID: 34745566 PMCID: PMC8561611 DOI: 10.12688/f1000research.73112.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Both oxytocin and carbetocin are used to prevent uterine atony and post-partum haemorrhage after caesarean delivery in many countries, including Norway. Oxytocin causes dose-dependent ST-depression, troponin release, prolongation of QT-time and arrythmia, but little is known about myocardial effects of carbetocin. We have previously demonstrated comparable vasodilatory effects of oxytocin and carbetocin and are now undertaking a Phase 4 trial to investigate whether carbetocin causes similar changes to myocardial markers compared with oxytocin. Methods: Our randomized controlled trial will be conducted at three obstetrics units at Oslo University Hospital and Akershus University Hospital, Norway. Planned enrolment will be of 240 healthy, singleton pregnant women aged 18 to 50 years undergoing planned caesarean delivery. Based on pilot study data,
each participant will receive a one-minute intravenous injection of either oxytocin 2.5 IU or carbetocin 100 µg during caesarean delivery. The prespecified primary outcome is the change from baseline in high-sensitive troponin I plasma concentrations at 6–10 hours after study drug administration. Secondary outcomes include uterine tone grade at 2.5 and five minutes after study drug administration, adverse events for up to 48 hours after study drug administration, estimated blood loss within eight hours of delivery, need for rescue treatment and direct/indirect costs.
Enrolment and primary analysis are expected to be completed by the end of 2021. Discussion: Women undergoing caesarean delivery should be assessed for cardiovascular risk particularly as women with an obstetric history of pregnancy induced hypertension, gestational diabetes mellitus, preterm birth, placental abruption, and stillbirth are at increased risk of future cardiovascular disease. Any additional ischaemic myocardial risk from uterotonic agents will need to be balanced with the benefit of reducing the risk of postpartum haemorrhage. Any potential cardiotoxicity difference between oxytocin and carbetocin will help inform treatment decisions for pregnant women. Registration: Clinicaltrials.gov
NCT03899961 (02/04/2019).
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Affiliation(s)
- Maria Bekkenes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Ole Geir Solberg
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Olav Klingenberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Trude Steinsvik
- Department of Laboratory Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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11
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Solberg RB, Steene-Johannessen J, Wang Fagerland M, Anderssen SA, Berntsen S, Resaland GK, van Sluijs EMF, Ekelund U, Kolle E. Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study - A cluster randomized controlled trial. Prev Med Rep 2022; 24:101648. [PMID: 34976697 PMCID: PMC8684017 DOI: 10.1016/j.pmedr.2021.101648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
Physical activity is associated with increased aerobic fitness and academic performance. Little is known on mechanism of physical activity effects on academic performance. We performed a cluster randomized controlled trial. Aerobic fitness mediated the intervention effect on academic performance. Activity increasing aerobic fitness is a strategy to improve academic performance.
Little information exists on the mechanism of how physical activity interventions effects academic performance. We examined whether the effects of a school-based physical activity intervention on academic performance were mediated by aerobic fitness. The School in Motion study was a nine-month cluster randomized controlled trial between September 2017 and June 2018. Students from 30 Norwegian lower secondary schools (N = 2,084, mean age [SD] = 14 [0.3] years) were randomly assigned into three groups: the Physically Active Learning (PAL) intervention (n = 10), the Don’t Worry—Be Happy (DWBH) intervention (n = 10), or control (n = 10). Aerobic fitness was assessed by the Andersen test and academic performance by national tests in reading and numeracy. Mediation was assessed according to the causal steps approach using linear mixed models. In the PAL intervention, aerobic fitness partially mediated the intervention effect on numeracy by 28% from a total effect of 1.73 points (95% CI: 1.13 to 2.33) to a natural direct effect of 1.24 points (95% CI: 0.58 to 1.91), and fully mediated the intervention effect on reading, with the total effect of 0.89 points (95% CI: 0.15 to 1.62) reduced to the natural direct effect of 0.40 points (95% CI: −0.48 to 1.28). Aerobic fitness did not mediate the effects on academic performance in the DWBH intervention. As aerobic fitness mediated the intervention effect on academic performance in one intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents.
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Affiliation(s)
- Runar Barstad Solberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway
| | - Jostein Steene-Johannessen
- Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway
| | - Morten Wang Fagerland
- Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway
| | - Sigmund A Anderssen
- Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway
| | - Sveinung Berntsen
- Faculty of Health and Sport Science, Department of Sport Science and Physical Education, University of Agder, PB 422, 4604 Kristiansand, Norway
| | - Geir K Resaland
- Center for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Campus Sogndal, 6856 Sogndal, Norway
| | - Esther M F van Sluijs
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway
| | - Elin Kolle
- Department of Sports Medicine, Norwegian School of Sport Sciences, PB 4014, Ullevål Stadion, 0806 Oslo, Norway
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Bache-Mathiesen LK, Andersen TE, Clarsen B, Fagerland MW. Handling and reporting missing data in training load and injury risk research. SCI MED FOOTBALL 2021; 6:452-464. [DOI: 10.1080/24733938.2021.1998587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- L. K. Bache-Mathiesen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Benjamin Clarsen
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Centre, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
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Barth Vedøy I, Skulberg KR, Anderssen SA, Fagerland MW, Tjomsland HE, Thurston M. The longitudinal association between objectively measured physical activity and mental health among Norwegian adolescents. Int J Behav Nutr Phys Act 2021; 18:149. [PMID: 34784906 PMCID: PMC8594230 DOI: 10.1186/s12966-021-01211-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background Mental health among young people in many countries, including Norway, seems to be deteriorating. Physical activity (PA) has been positively associated with mental health. However, methodological issues related to study design and measurement of PA and mental health outcomes currently limits our understanding of the relationship. The purpose of the present study is to explore the prospective relationship between objectively measured PA and mental health outcomes. More specifically, volume (total PA), intensity (moderate-to-vigorous PA [MVPA]) and sedentary behaviour (SED) were explored in relation to mental health problems (MHP) and mental wellbeing (MWB). Methods Data from 599 adolescents (54.4% female, mean age at baseline ±SD 13.3 ± 0.3 years) were collected annually during their 3 years (T1, T2 and T3) at lower secondary school. PA was measured using accelerometry. MWB was measured using the ‘Warwick-Edinburgh Mental Wellbeing Scale’ and MHP by the ‘Strengths and Difficulties Questionnaire’. Multiple linear regression was performed to explore relationships between changes in PA/SED (between T1-T3) and MWB/MHP (at T3). The term ‘movement categories’ was used to refer to components on the movement continuum and includes volume (total PA), intensity (MVPA) and SED. Results Among boys, any increase in SED was positively associated with MWB (β = 0.05, 95% CI: 0.01 to 0.10), whereas a small positive association between an increase in total PA (volume) and MWB was found among girls (β = 1.13, 95% CI: 0.05 to 2.21). There were no associations between changes in any movement categories [total PA (volume), MVPA, SED] and score on MHP at T3, neither for girls nor boys. Conclusion This study provided no clear evidence of any association between change in volume or intensity of PA and MHP among an overall healthy adolescent study sample. There was, however, evidence of a relationship between increased SED and MWB among boys and increased volume of PA and MWB among girls. The relationship between movement categories and mental health may depend on the measurement used to assess both PA/SED and variables of mental health. Future research would be strengthened by researchers clarifying what construct of mental health is being used and measured. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01211-x.
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Affiliation(s)
- Ingeborg Barth Vedøy
- Inland Norway University of Applied Sciences, Postboks 400, 2418, Elverum, Norway. .,The Norwegian school of Sport Sciences, Postboks 4014 Ullevål stadion, 0806, Oslo, Norway.
| | | | | | - Morten Wang Fagerland
- The Norwegian school of Sport Sciences, Postboks 4014 Ullevål stadion, 0806, Oslo, Norway
| | | | - Miranda Thurston
- Inland Norway University of Applied Sciences, Postboks 400, 2418, Elverum, Norway
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Salte OBK, Svanevik M, Risstad H, Hofsø D, Blom-Høgestøl IK, Johnson LK, Fagerland MW, Kristinsson J, Hjelmesæth J, Mala T, Sandbu R. Standard versus distal Roux-en-Y gastric bypass in patients with BMI 50-60 kg/m2: 5-year outcomes of a double-blind, randomized clinical trial. BJS Open 2021; 5:6429825. [PMID: 34791048 PMCID: PMC8599874 DOI: 10.1093/bjsopen/zrab105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background The optimal surgical weight loss procedure for patients with a BMI of 50 kg/m2 or more is uncertain. This study compared distal Roux-en-Y gastric bypass (RYGB) with standard RYGB. Methods In this double-blind RCT, patients aged 18–60 years with a BMI of 50–60 kg/m2 were allocated randomly to receive standard (150 cm alimentary, 50 cm biliopancreatic limb) or distal (150 cm common channel, 50 cm biliopancreatic limb) RYGB. The primary outcome (change in BMI at 2 years) has been reported previously. Secondary outcomes 5 years after surgery, such as weight loss, health-related quality of life, and nutritional outcomes are reported. Results Between May 2011 and April 2013, 123 patients were randomized, 113 received an intervention, and 92 attended 5-year follow-up. Mean age was 40 (95 per cent c.i. 38 to 41) years and 73 patients (65 per cent) were women; 57 underwent standard RYGB and 56 distal RYGB. BMI was reduced by 15.1 (95 per cent c.i. 13.9 to 16.2) kg/m2 after standard and 15.7 (14.5 to 16.9) kg/m2 after distal RYGB; the between-group difference was −0.64 (−2.3 to 1.0) kg/m2 (P = 0.447). Total cholesterol, low-density lipoprotein cholesterol, and haemoglobin A1c levels declined more after distal than after standard RYGB. High-density lipoprotein cholesterol levels increased more after standard RYGB. Vitamin A and vitamin D levels were lower after distal RYGB. Changes in bone mineral density, resting metabolic rate, and total energy intake were comparable. Conclusion Distal RYGB did not enable greater weight loss than standard RYGB. Differences in other outcomes favouring distal RYGB may not justify routine use of this procedure in patients with a BMI of 50–60 kg/m2. Registration number: NCT00821197 (http://www.clinicaltrials.gov). Presented in part as abstract to the IFSO (International Federation for the Surgery of Obesity and Metabolic disorders) conference, Madrid, Spain, August 2019.
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Affiliation(s)
- Odd Bjørn Kjeldaas Salte
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Marius Svanevik
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Norway
| | - Hilde Risstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Dag Hofsø
- Morbid Obesity Centre, Vestfold Hospital Trust, Norway
| | | | | | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Jon Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tom Mala
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Rune Sandbu
- Department of Gastrointestinal Surgery, Vestfold Hospital Trust, Norway
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Bekkenes M, Jørgensen MM, Flem Jacobsen A, Wang Fagerland M, Rakstad-Larsen H, Solberg OG, Aaberge L, Klingenberg O, Steinsvik T, Rosseland LA. A study protocol for the cardiac effects of a single dose of either oxytocin 2.5 IU or carbetocin 100 µg after caesarean delivery: a prospective randomized controlled multi-centre trial in Norway. F1000Res 2021; 10:973. [PMID: 34745566 DOI: 10.12688/f1000research.73112.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Both oxytocin and carbetocin are used to prevent uterine atony and post-partum haemorrhage after caesarean delivery in many countries, including Norway. Oxytocin causes dose-dependent ST-depression, troponin release, prolongation of QT-time and arrythmia, but little is known about myocardial effects of carbetocin. We have previously demonstrated comparable vasodilatory effects of oxytocin and carbetocin and are now undertaking a Phase 4 trial to investigate whether carbetocin causes similar changes to myocardial markers compared with oxytocin. Methods: Our randomized controlled trial will be conducted at three obstetrics units at Oslo University Hospital and Akershus University Hospital, Norway. Planned enrolment will be of 240 healthy, singleton pregnant women aged 18 to 50 years undergoing planned caesarean delivery. Based on pilot study data, each participant will receive a one-minute intravenous injection of either oxytocin 2.5 IU or carbetocin 100 µg during caesarean delivery. The prespecified primary outcome is the change from baseline in high-sensitive troponin I plasma concentrations at 6-10 hours after study drug administration. Secondary outcomes include uterine tone grade at 2.5 and five minutes after study drug administration, adverse events for up to 48 hours after study drug administration, estimated blood loss within eight hours of delivery, need for rescue treatment and direct/indirect costs. Enrolment and primary analysis are expected to be completed by the end of 2021. Discussion: Women undergoing caesarean delivery should be assessed for cardiovascular risk particularly as women with an obstetric history of pregnancy induced hypertension, gestational diabetes mellitus, preterm birth, placental abruption, and stillbirth are at increased risk of future cardiovascular disease. Any additional ischaemic myocardial risk from uterotonic agents will need to be balanced with the benefit of reducing the risk of postpartum haemorrhage. Any potential cardiotoxicity difference between oxytocin and carbetocin will help inform treatment decisions for pregnant women. Registration: Clinicaltrials.gov NCT03899961 (02/04/2019).
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Affiliation(s)
- Maria Bekkenes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anne Flem Jacobsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Ole Geir Solberg
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Olav Klingenberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Trude Steinsvik
- Department of Laboratory Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Kristiansen O, Vethe NT, Peersen K, Wang Fagerland M, Sverre E, Prunés Jensen E, Lindberg M, Gjertsen E, Gullestad L, Perk J, Dammen T, Bergan S, Husebye E, Otterstad JE, Munkhaugen J. Effect of atorvastatin on muscle symptoms in coronary heart disease patients with self-perceived statin muscle side effects: a randomized, double-blinded crossover trial. Eur Heart J Cardiovasc Pharmacother 2021; 7:507-516. [PMID: 32609361 PMCID: PMC8566260 DOI: 10.1093/ehjcvp/pvaa076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/14/2022]
Abstract
AIMS To estimate the effect of atorvastatin on muscle symptom intensity in coronary heart disease (CHD) patients with self-perceived statin-associated muscle symptoms (SAMS) and to determine the relationship to blood levels of atorvastatin and/or metabolites. METHODS AND RESULTS A randomized multi-centre trial consecutively identified 982 patients with previous or ongoing atorvastatin treatment after a CHD event. Of these, 97 (9.9%) reported SAMS and 77 were randomized to 7-week double-blinded treatment with atorvastatin 40 mg/day and placebo in a crossover design. The primary outcome was the individual mean difference in muscle symptom intensity between the treatment periods, measured by visual-analogue scale (VAS) scores. Atorvastatin did not affect the intensity of muscle symptoms among 71 patients who completed the trial. Mean VAS difference (statin-placebo) was 0.31 (95% CI: -0.24 to 0.86). The proportion with more muscle symptoms during placebo than atorvastatin was 17% (n = 12), 55% (n = 39) had the same muscle symptom intensity during both treatment periods whereas 28% (n = 20) had more symptoms during atorvastatin than placebo (confirmed SAMS). There were no differences in clinical or pharmacogenetic characteristics between these groups. The levels of atorvastatin and/or metabolites did not correlate to muscle symptom intensity among patients with confirmed SAMS (Spearman's rho ≤0.40, for all variables). CONCLUSION Re-challenge with high-intensity atorvastatin did not affect the intensity of muscle symptoms in CHD patients with self-perceived SAMS during previous atorvastatin therapy. There was no relationship between muscle symptoms and the systemic exposure to atorvastatin and/or its metabolites. The findings encourage an informed discussion to elucidate other causes of muscle complaints and continued statin use.
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Affiliation(s)
- Oscar Kristiansen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway
| | - Kari Peersen
- Department of Cardiology, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, Tønsberg 3103, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Domus Medica, Gaustad, Sognsvannsveien 9, Oslo 0372, Norway
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Elena Prunés Jensen
- Department of Laboratory Medicine, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
| | - Morten Lindberg
- Central Laboratory, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, Tønsberg 3103, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 20, Oslo 0372, Norway
- KG Jebsen Cardiac Research Centre, Oslo University Hospital, Postbox 4956 Nydalen, Oslo 0424, Norway
| | - Joep Perk
- Department of Cardiology, Public Health Department, Linnaeus University, Kalmar 391 82, Sweden
| | - Toril Dammen
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Stein Bergan
- Department of Pharmacology, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
| | - Jan Erik Otterstad
- Department of Cardiology, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, Tønsberg 3103, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Dronninggata 28, Drammen 3004, Norway
- Department of Behavioural Sciences in Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
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Kristiansen O, Sverre E, Peersen K, Fagerland MW, Gjertsen E, Gullestad L, Perk J, Dammen T, Husebye E, Vethe NT, Munkhaugen J. The relationship between directly measured statin adherence, self-reported adherence measures and cholesterol levels in patients with coronary heart disease. Atherosclerosis 2021; 336:23-29. [PMID: 34610521 DOI: 10.1016/j.atherosclerosis.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 08/22/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS We aimed to determine the relationship between statin adherence measured directly, and by self-report measures and serum cholesterol levels. METHODS Patients prescribed atorvastatin (N = 373) participated in a cross-sectional study 2-36 months after a coronary event. Self-reported adherence included statin adherence the past week, the 8-item Morisky medication adherence scale (MMAS-8), and the Gehi et al. adherence question. Atorvastatin was measured directly in spot blood plasma by a novel liquid chromatography tandem mass-spectrometry method discriminating adherence (0-1 doses omitted) and reduced adherence (≥2 doses omitted). Participants were unaware of the atorvastatin analyses at study participation. RESULTS Mean age was 63 (SD 9) years and 8% had reduced atorvastatin adherence according to the direct method. In patients classified with reduced adherence by the direct method, 40% reported reduced statin adherence, 32% reported reduced adherence with the MMAS-8 and 22% with the Gehi question. In those adherent by the direct method, 96% also reported high statin adherence, 95% reported high adherence on the MMAS-8 whereas 94% reported high adherence on the Gehi question. Cohen's kappa agreement score with the direct method was 0.4 for self-reported statin adherence, 0.3 for the Gehi question and 0.2 for the MMAS-8. Adherence determined by the direct method, self-reported statin adherence last week, and the Gehi question was inversely related to LDL-cholesterol levels with a p-value of <0.001, 0.001 and 0.004, respectively. CONCLUSIONS Plasma-statin measurements reveal reduced adherence with higher sensitivity than self-report measures, relate to cholesterol levels, and may prove to be a useful tool to improve lipid management.
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Affiliation(s)
- Oscar Kristiansen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway; Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, 0372, Oslo, Norway.
| | - Elise Sverre
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway; Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, 0372, Oslo, Norway
| | - Kari Peersen
- Department of Cardiology, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, 3103, Tønsberg, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Domus Medica, Sognsvannsveien 9, 0372, Oslo, Norway
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Sognsvannsveien 20, 0372, Oslo, Norway; KG Jebsen Cardiac Research Centre, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Joep Perk
- Department of Cardiology, Public Health Department, Linnaeus University, 391 82, Kalmar, Sweden
| | - Toril Dammen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, 0372, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Dronninggata 28, 3004, Drammen, Norway; Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, 0372, Oslo, Norway
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Mecinaj A, Gulati G, Heck SL, Holte E, Fagerland MW, Larsen AI, Blix ES, Geisler J, Wethal T, Omland T. Rationale and design of the PRevention of cArdiac Dysfunction during Adjuvant breast cancer therapy (PRADA II) trial: a randomized, placebo-controlled, multicenter trial. Cardiooncology 2021; 7:33. [PMID: 34579775 PMCID: PMC8474901 DOI: 10.1186/s40959-021-00115-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/16/2021] [Indexed: 12/11/2022]
Abstract
Background Recent advances in the treatment algorithms of early breast cancer have markedly improved overall survival. However, anthracycline- and trastuzumab-associated cardiotoxicity may lead to dose-reduction or halt in potentially life-saving adjuvant cancer therapy. Early initiated neurohormonal blockade may prevent or attenuate the cardiotoxicity-induced reduction in cardiac function, but prior studies have been inconclusive. The angiotensin receptor-neprilysin inhibitor sacubitril/valsartan has been shown to be superior to traditional treatment in heart failure with reduced ejection fraction, but its cardioprotective effects in the cardio-oncology setting remains to be tested. Objective To assess if sacubitril/valsartan given concomitantly with early breast cancer treatment regimens including anthracyclines, with or without trastuzumab, may prevent cardiac dysfunction. Methods PRADA II is a randomized, placebo-controlled, double blind, multi-center, investigator-initiated clinical trial. Breast cancer patients from four university hospitals in Norway, scheduled to receive (neo-)adjuvant chemotherapy with epirubicin independently of additional trastuzumab/pertuzumab treatment, will be randomized 1:1 to sacubitril/valsartan or placebo. The target dose is 97/103 mg b.i.d. The patients will be examined with cardiovascular magnetic resonance (CMR), echocardiography, circulating cardiovascular biomarkers and functional testing at baseline, at end of anthracycline treatment and following 18 months after enrolment. The primary outcome measure of the PRADA II trial is the change in left ventricular ejection fraction (LVEF) by CMR from baseline to 18 months. Secondary outcomes include change in LV function by global longitudinal strain by CMR and echocardiography and change in circulating cardiac troponin concentrations. Results The study is ongoing. Results will be published when the study is completed. Conclusion PRADA II is the first randomized, placebo-controlled study of sacubitril/valsartan in a cardioprotective setting during (neo-)adjuvant breast cancer therapy. It may provide new insight in prevention of cardiotoxicity in patients receiving adjuvant or neo-adjuvant therapy containing anthracyclines. Furthermore, it may enable identification of patients at higher risk of developing cardiotoxicity and identification of those most likely to respond to cardioprotective therapy. Trial registration The trial is registered in the ClinicalTrials.gov registry (identifier NCT03760588). Registered 30 November 2018.
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Affiliation(s)
- A Mecinaj
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - G Gulati
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - S L Heck
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
| | - E Holte
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology NTNU, Trondheim, Norway
| | - M W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - A I Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - E S Blix
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway.,Immunology Research Group, Institute of Medical Biology, UiT The Arctic University of Norway, Tromsø, Norway
| | - J Geisler
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Oncology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - T Wethal
- Department of Stroke, Clinic of Medicine, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - T Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Bache-Mathiesen LK, Andersen TE, Dalen-Lorentsen T, Clarsen B, Fagerland MW. Not straightforward: modelling non-linearity in training load and injury research. BMJ Open Sport Exerc Med 2021; 7:e001119. [PMID: 34422292 PMCID: PMC8351477 DOI: 10.1136/bmjsem-2021-001119] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine whether the relationship between training load and injury risk is non-linear and investigate ways of handling non-linearity. METHODS We analysed daily training load and injury data from three cohorts: Norwegian elite U-19 football (n=81, 55% male, mean age 17 years (SD 1)), Norwegian Premier League football (n=36, 100% male, mean age 26 years (SD 4)) and elite youth handball (n=205, 36% male, mean age 17 years (SD 1)). The relationship between session rating of perceived exertion (sRPE) and probability of injury was estimated with restricted cubic splines in mixed-effects logistic regression models. Simulations were carried out to compare the ability of seven methods to model non-linear relationships, using visualisations, root-mean-squared error and coverage of prediction intervals as performance metrics. RESULTS No relationships were identified in the football cohorts; however, a J-shaped relationship was found between sRPE and the probability of injury on the same day for elite youth handball players (p<0.001). In the simulations, the only methods capable of non-linear modelling relationships were the quadratic model, fractional polynomials and restricted cubic splines. CONCLUSION The relationship between training load and injury risk should be assumed to be non-linear. Future research should apply appropriate methods to account for non-linearity, such as fractional polynomials or restricted cubic splines. We propose a guide for which method(s) to use in a range of different situations.
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Affiliation(s)
- Lena Kristin Bache-Mathiesen
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
| | - Torstein Dalen-Lorentsen
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
| | - Benjamin Clarsen
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
- Centre for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Morten Wang Fagerland
- Department of Sports Medicine, Oslo Sports Trauma Research Centre, Norwegian School of Sports Sciences, Oslo, Norway
- Research Support Services, Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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20
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Heck SL, Mecinaj A, Ree AH, Hoffmann P, Schulz-Menger J, Fagerland MW, Gravdehaug B, Røsjø H, Steine K, Geisler J, Gulati G, Omland T. Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): Extended Follow-Up of a 2×2 Factorial, Randomized, Placebo-Controlled, Double-Blind Clinical Trial of Candesartan and Metoprolol. Circulation 2021; 143:2431-2440. [PMID: 33993702 PMCID: PMC8212877 DOI: 10.1161/circulationaha.121.054698] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adjuvant breast cancer therapy containing anthracyclines with or without anti-human epidermal growth factor receptor-2 antibodies and radiotherapy is associated with cancer treatment-related cardiac dysfunction. In the PRADA trial (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy), concomitant treatment with the angiotensin receptor blocker candesartan attenuated the reduction in left ventricular ejection fraction (LVEF) in women receiving treatment for breast cancer, whereas the β-blocker metoprolol attenuated the increase in cardiac troponins. This study aimed to assess the long-term effects of candesartan and metoprolol or their combination to prevent a reduction in cardiac function and myocardial injury. METHODS In this 2×2 factorial, randomized, placebo-controlled, double-blind, single-center trial, patients with early breast cancer were assigned to concomitant treatment with candesartan cilexetil, metoprolol succinate, or matching placebos. Target doses were 32 and 100 mg, respectively. Study drugs were discontinued after adjuvant therapy. All 120 validly randomized patients were included in the intention-to-treat analysis. The primary outcome measure was change in LVEF assessed by cardiovascular magnetic resonance imaging from baseline to extended follow-up. Secondary outcome measures included changes in left ventricular volumes, echocardiographic peak global longitudinal strain, and circulating cardiac troponin concentrations. RESULTS A small decline in LVEF but no significant between-group differences were observed from baseline to extended follow-up, at a median of 23 months (interquartile range, 21 to 28 months) after randomization (candesartan, 1.7% [95% CI, 0.5 to 2.8]; no candesartan, 1.8% [95% CI, 0.6 to 3.0]; metoprolol, 1.6% [95% CI, 0.4 to 2.7]; no metoprolol, 1.9% [95% CI, 0.7 to 3.0]). Candesartan treatment during adjuvant therapy was associated with a significant reduction in left ventricular end-diastolic volume compared with the noncandesartan group (P=0.021) and attenuated decline in global longitudinal strain (P=0.046) at 2 years. No between-group differences in change in cardiac troponin I and T concentrations were observed. CONCLUSIONS Anthracycline-containing adjuvant therapy for early breast cancer was associated with a decline in LVEF during extended follow-up. Candesartan during adjuvant therapy did not prevent reduction in LVEF at 2 years, but was associated with modest reduction in left ventricular end-diastolic volume and preserved global longitudinal strain. These results suggest that a broadly administered cardioprotective approach may not be required in most patients with early breast cancer without preexisting cardiovascular disease. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01434134.
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Affiliation(s)
- Siri Lagethon Heck
- Department of Diagnostic Imaging (S.L.H.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Albulena Mecinaj
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Anne Hansen Ree
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Pavel Hoffmann
- Section for Interventional Cardiology, Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases (P.H.), Oslo University Hospital, Ullevål, Norway
| | - Jeanette Schulz-Menger
- Department of Cardiology, Charité Campus Buch, Universitätsmedizin Berlin, Germany (J.S.-M.)
- HELIOS Clinics, Berlin, Germany (J.S.-M.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway (M.W.F.)
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, (B.G.), Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- Division of Research and Innovation (H.R.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Kjetil Steine
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Jürgen Geisler
- Department of Oncology (A.H.R., J.G.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
| | - Geeta Gulati
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
- Department of Cardiology, Division of Medicine (G.G.), Oslo University Hospital, Ullevål, Norway
| | - Torbjørn Omland
- Department of Cardiology (A.M., K.S., G.G., T.O.), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (S.L.H., A.M., A.H.R., H.R., K.S., J.G., G.G., T.O.)
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Sverre E, Peersen K, Kristiansen O, Fagerland MW, Perk J, Husebye E, Vethe NT, Dammen T, Munkhaugen J. Tailored clinical management after blinded statin challenge improved long-term lipid control in coronary patients with self-perceived muscle side-effects. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helse Sør-Øst, Vestre Viken Trust
Background
Statin discontinuation due to self-perceived muscle side-effects is a major challenge in clinical practice. Strategies are needed to improve lipid control in these patients.
Purpose
We studied if information about the results of a blinded statin challenge experiment, followed by tailored lipid lowering treatment, had long-term effects on lipid control in coronary patients with self-perceived muscle side-effects.
Methods
A post-trial intervention study of patients classified with statin dependent (N = 20) and independent (N = 50) muscle complaints in the MUscle Side-Effects of atorvastatin (MUSE), a randomized, double-blinded, crossover trial. All participants were informed of the MUSE trial results in an individual consultation and provided tailored lipid-lowering treatment according to protocol with 1-2 follow-up calls. Lipids were controlled at the end of follow-up.
Results
Mean age was 64 (SD 9.5) years and 33% (N = 23) were females. During an average follow-up of 13 months (SD 3.3), mean LDL-cholesterol was reduced by 0.3 (SD 0.6) mmol/L (p = 0.005) in patients with statins and by 1.7 (SD 1.0) mmol/L (p = 0.005) in patients without statins at inclusion in the MUSE trial (Table). We found no changes in the overall use of high-intensity statins, but ezetimibe was used by 11 additional patients and 4 patients were prescribed a PCSK9-inhibitor. Participants in the subgroup without statins at inclusion used; atorvastatin (N = 2), rosuvastatin (N = 3) or a PCSK9-inhibitor (N = 2) at follow-up. 90% found their own trial results useful in making decisions about future statin use.
Conclusions
Information about the results of a statin challenge experiment combined with tailored and systematical prescription of lipid-lowering agents had favourable long-term effects on lipid control in coronary patients with self-perceived muscle side-effects.
Characteristics of the study population Using statins at inclusion (n = 62) Not using statins at inclusion (n = 8) Classified with statin-dependent side-effects, n (%) 15 (24) 5 (63) LDL-cholesterol at inclusion, mean (SD) 2.2 (0.8) 4.2 (1.1) LDL-cholesterol at follow-up, mean (SD) 1.9 (0.7) 2.5 (0.8) High intensity statin (ie. ≥40 mg atorvastatin or ≥20 mg rosuvastatin) at inclusion, n (%) 40 (55.6) 0 (0) High intensity statin at follow-up, n (%) 38 (61) 2 (25) Ezetimibe at inclusion, n (%) 13 (21) 3 (38) Ezetimibe at follow-up, n (%) 26 (42) 1 (13) PCSK-9 inhibitor at follow-up, n (%) 2 (3) 2 (25) Usefulness of own trial result in making decisions about future statin use on a 0 to 10 Likert scale, mean (SD) 8.1 (2.0) 9.6 (0.6)
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Affiliation(s)
- E Sverre
- Drammen Hospital, Drammen, Norway
| | | | | | - MW Fagerland
- Oslo University Hospital, Oslo Centre for Biostatistics and Epidemiology, Oslo, Norway
| | - J Perk
- Linnaeus University, Faculty of Health Sciences, Kalmar, Sweden
| | | | - NT Vethe
- Oslo University Hospital Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - T Dammen
- University of Oslo, Department of Behavioural Sciences in Medicine, Faculty of Medicine, Oslo, Norway
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Kristiansen O, Sverre E, Peersen K, Fagerland MW, Gjertsen E, Gullestad L, Perk J, Dammen T, Husebye E, Vethe NT, Munkhaugen J. High but not low self-reported statin adherence was confirmed by a novel method based on plasma-statin measurements in coronary outpatients. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Helse Sør-Øst
Background
To what extent self-reported adherence measures correspond with directly measured statin adherence is unknown.
Purpose
To determine the relationship between, self-reported adherence measures, low density lipoprotein-cholesterol (LDL-C) and directly measured statin adherence in coronary outpatients.
Methods
Patients on atorvastatin (N = 373) participated in a cross-sectional study median 16 months after a coronary event. Adherence to statins the past 7 days, general medication adherence assessed by the 8-item Morisky medication adherence scale (MMAS-8), and the Gehi adherence question was obtained by a self-report questionnaire. Atorvastatin was determined in spot blood plasma samples by a novel liquid-chromatography tandem mass-spectrometry method discriminating between adherence (0-1 doses omitted) and reduced (≥2 doses omitted) adherence. Participants were unaware of the atorvastatin analyses at study participation.
Results
Mean age was 63 (SD 9) years and 19% were females. Mean atorvastatin dose was 64 (SD 21) mg. The number with reduced adherence by the different measurement methods, Cohens kappa agreement score between the self-reported and direct adherence measures, and LDL-C are shown in the Table. Statin adherence was confirmed by the direct method among 96% reporting high statin adherence the past 7 days, among 95% reporting high adherence on the MMAS-8 and among 94% reporting high adherence on the Gehi adherence question. In contrast, among patients classified with reduced statin adherence by the direct method, only 40% reported reduced statin adherence the past week, 32% reported reduced adherence with the MMAS-8 and 22% with the Gehi adherence question.
Conclusions
The direct method confirmed high, but not low, self-reported statin adherence in this selected sample of coronary outpatients. In patients with elevated LDL-cholesterol, plasma-statin measurements emerges as a potential improvement for clinical statin management.
Adherence measures and LDL cholesterol Directly measured atorvastatin adherence Self-reported statin adherence past 7 days Self-reported medication adherence past month (Gehi) 8-item Morisky medication adherence scale Number with reduced adherence, % 7.8 5.5 3.0 8.4 Cohen"s kappa (95% CI) Reference 0.4 (0.2 to 0.6) 0.3 (0.1 to 0.5) 0.2 (0.1 to 0.4) LDL-C, Adherent, mean (95% CI) 1.9 (1.8 to 1.9) 1.9 (1.8 to 2.0) 1.9 (1.8 to 2.0) 1.9 (1.8 to 1.9) LDL-C, Reduced adherence, mean (95% CI) 2.8 (2.4 to 3.2) 2.8 (2.3 to 3.2) 3.2 (2.5 to 3.8) 2.1 (1.9 to 2.4) LDL-C, Adherent versus reduced adherence P <0.001 P = 0.001 P = 0.004 P = 0.07 Agreement between directly measured atorvastatin adherence, self-reported measures of adherence, and mean low density lipoprotein-cholesterol (LDL-C)
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Affiliation(s)
| | - E Sverre
- Drammen Hospital, Drammen, Norway
| | - K Peersen
- Vestfold Hospital Trust, Department of Cardiology, Tønsberg, Norway
| | - MW Fagerland
- Oslo University Hospital, Section for Biostatistics and Epidemiology, Oslo centre for Biostatistics, Oslo, Norway
| | | | - L Gullestad
- Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway
| | - J Perk
- Linnaeus University, Faculty of Health Sciences, Kalmar, Sweden
| | - T Dammen
- University of Oslo, Department of Behavioural Medicine, Oslo, Norway
| | | | - NT Vethe
- Oslo University Hospital, Deparment of Pharmacology, Oslo, Norway
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Vethe N, Husebye E, Andersen AM, Bergan S, Kristiansen O, Fagerland MW, Munkhaugen J. A novel direct method to determine adherence to simvastatin therapy in patients with coronary heart disease. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): National Association of Health
OnBehalf
NORCOR
Background
Poor adherence to statin therapy remains a public health concern associated with adverse clinical outcome. Reliable classification and detection of statin adherence is needed in clinical practice and for clinical studies with overall aim to improve the lipid management. Simvastatin is a frequently used statin in cardiovascular disease prevention.
Purpose
To develop a feasible test based on spot blood samples to monitor the adherence to simvastatin therapy in coronary heart disease (CHD) patients.
Methods
Eighteen CHD patients on an evening dose of simvastatin 20 mg (n = 7), 40 mg (n = 5) and 80 mg (n = 6) were studied at steady-state pharmacokinetics. Ten patients were instructed to avoid simvastatin dosing and return for blood sampling the subsequent three days. Dose-normalized plasma concentrations of simvastatin lactone, simvastatin acid and the sum of the two were evaluated as discriminators between adherent dosing and dose avoidance. Bioanalytical quantifications were performed with liquid chromatography tandem mass spectrometry.
Results
The dose-normalized plasma concentrations at steady-state demonstrated 23-fold and 39-fold interindividual variabilities for simvastatin lactone and simvastatin acid. A simvastatin acid cut-off at 1.0·10^-2 nmol/L/mg identified 100% of those omitting 2 doses and 60% of those omitting a single dose (Figure 1). Simvastatin acid showed superior ability to discriminate dose avoidance from adherence, and also the best agreement between samples handled at ambient and cool temperature (median deviation 3.5%, interquartile range -2.5 to 13%). A cut-off for morning dose schedule, with similar ability to discriminate, was estimated at 2.0·10^-3 nmol/L/mg.
Conclusion
A novel method discriminating between good and poor adherence to simvastatin therapy in CHD patients has been developed. The sample handling is feasible for routine practice, and the assessment of adherence can be performed by direct measurements in spot blood samples, according to specific cut-off values.
Abstract Figure 1 Drug levels vs dose avoidance
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Affiliation(s)
- N Vethe
- Oslo University Hospital Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - E Husebye
- Drammen Hospital, Department of Medicine, Drammen, Norway
| | - AM Andersen
- Oslo University Hospital Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - S Bergan
- Oslo University Hospital Rikshospitalet, Department of Pharmacology, Oslo, Norway
| | - O Kristiansen
- Drammen Hospital, Department of Medicine, Drammen, Norway
| | - MW Fagerland
- Oslo University Hospital Rikshospitalet, Oslo Centre for Biostatistics and Epidemiology, Oslo, Norway
| | - J Munkhaugen
- Drammen Hospital, Department of Medicine, Drammen, Norway
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Traaen GM, Aakerøy L, Hunt TE, Øverland B, Bendz C, Sande LØ, Akhus S, Fagerland MW, Steinshamn S, Anfinsen OG, Massey RJ, Broch K, Ueland T, Akre H, Loennechen JP, Gullestad L. Effect of Continuous Positive Airway Pressure on Arrhythmia in Atrial Fibrillation and Sleep Apnea: A Randomized Controlled Trial. Am J Respir Crit Care Med 2021; 204:573-582. [PMID: 33938787 DOI: 10.1164/rccm.202011-4133oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sleep apnea (SA) is highly prevalent in patients with atrial fibrillation (AF), and both conditions are associated with adverse cardiovascular outcomes. OBJECTIVES To determine the effect of continuous positive airway pressure (CPAP) on AF burden. METHODS This open-label, parallel-group, randomized, controlled trial included patients with paroxysmal AF and moderate-to-severe SA (apnea-hypopnea index ≥15). Eligible patients were randomized (1:1) to 5 months' treatment with CPAP plus usual care (CPAP, n=55) or usual care alone (control, n=54) by a computerised system. Outcome assessment was blinded. The planned primary outcome was the difference between CPAP treatment and control in change of AF burden (% of time in AF), as measured by implantable loop recorder. MEASUREMENTS AND MAIN RESULTS A total of 579 patients with paroxysmal AF had respiratory polygraphy, of whom 244 (42.1%) had moderate-to-severe SA. Of these, 158 (64.8%) participated in the CPAP run-in period, of whom 40 (25.3%) patients did not tolerate the treatment. One-hundred-eight patients were available for the primary analysis. The mean time in AF decreased from 5.6% at baseline to 4.1% during the last three months of CPAP intervention and from 5.0% to 4.3% in the control group. The adjusted between-group difference at follow-up was -0.63 (95% confidence interval: -2.55 to 1.30) percentage points; P=0.52. Seven serious adverse events (13%) occurred in the CPAP group, and two (4%) occurred in the control group. CONCLUSIONS In patients with paroxysmal AF and SA, treatment with CPAP did not result in a statistically significant reduction in the burden of AF. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02727192.
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Affiliation(s)
| | - Lars Aakerøy
- St Olavs Hospital University Hospital in Trondheim, 60510, Trondheim, Norway
| | | | | | | | | | - Svend Akhus
- St Olavs Hospital University Hospital in Trondheim, 60510, Trondheim, Norway
| | | | - Sigurd Steinshamn
- St Olavs Hospital University Hospital in Trondheim, 60510, Trondheim, Norway
| | | | | | | | - Thor Ueland
- Oslo University Hospital, 155272, Research Institute of Internal Medicine, Oslo, Norway
| | | | - Jan Pål Loennechen
- St Olavs Hospital University Hospital in Trondheim, 60510, Trondheim, Norway
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25
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Aghayan DL, Kazaryan AM, Dagenborg VJ, Røsok BI, Fagerland MW, Waaler Bjørnelv GM, Kristiansen R, Flatmark K, Fretland ÅA, Edwin B. Long-Term Oncologic Outcomes After Laparoscopic Versus Open Resection for Colorectal Liver Metastases : A Randomized Trial. Ann Intern Med 2021; 174:175-182. [PMID: 33197213 DOI: 10.7326/m20-4011] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Despite the recent worldwide dissemination of laparoscopic liver surgery, no high-level evidence supports the oncologic safety of this approach. OBJECTIVE To evaluate long-term oncologic outcomes after laparoscopic versus open liver resection in patients with colorectal metastases. DESIGN A single-center, assessor-blinded, randomized controlled trial (OSLO-COMET [Oslo Randomized Laparoscopic Versus Open Liver Resection for Colorectal Metastases Trial]). (ClinicalTrials.gov: NCT01516710). SETTING Oslo University Hospital, the only provider of liver surgery for the 3 million inhabitants of southeastern Norway. PARTICIPANTS Patients with resectable colorectal liver metastases were randomly assigned to have open or laparoscopic liver resection. INTERVENTION From February 2012 to January 2016, a total of 280 patients were included in the trial (laparoscopic surgery: n = 133; open surgery: n = 147). MEASUREMENTS The primary outcome was postoperative morbidity within 30 days. Five-year rates of overall and recurrence-free survival were predefined secondary end points. RESULTS At a median follow-up of 70 months, rates of 5-year overall survival were 54% in the laparoscopic group and 55% in the open group (between-group difference, 0.5 percentage point [95% CI, -11.3 to 12.3 percentage points]; hazard ratio, 0.93 [CI, 0.67 to 1.30]; P = 0.67). Rates of 5-year recurrence-free survival were 30% in the laparoscopic group and 36% in the open group (between-group difference, 6.0 percentage points [CI, -6.7 to 18.7 percentage points]; hazard ratio, 1.09 [CI, 0.80 to 1.49]; P = 0.57). LIMITATION The trial was not powered to detect differences in secondary end points and was not designed to address a noninferiority hypothesis for survival outcomes. CONCLUSION In this randomized trial of laparoscopic and open liver surgery, no difference in survival outcomes was found between the treatment groups. However, differences in 5-year overall survival up to about 10 percentage points in either direction cannot be excluded. This trial should be followed by pragmatic multicenter trials and international registries. PRIMARY FUNDING SOURCE The South-Eastern Norway Regional Health Authority.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre at Oslo University Hospital and Institute of Clinical Medicine at University of Oslo, Oslo, Norway, and Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia (D.L.A.)
| | - Airazat M Kazaryan
- The Intervention Centre at Oslo University Hospital, Oslo, and Østfold Hospital Trust, Grålum, Norway, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia, and I.M. Sechenov First Moscow State Medical University, Moscow, Russia (A.M.K.)
| | - Vegar Johansen Dagenborg
- Institute of Clinical Medicine at University of Oslo and Oslo University Hospital, Oslo, Norway (V.J.D., K.F.)
| | - Bård I Røsok
- Oslo University Hospital Rikshospitalet, Oslo, Norway (B.I.R.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway (M.W.F.)
| | | | - Ronny Kristiansen
- The Intervention Centre at Oslo University Hospital, Oslo, Norway (R.K., Å.A.F.)
| | - Kjersti Flatmark
- Institute of Clinical Medicine at University of Oslo and Oslo University Hospital, Oslo, Norway (V.J.D., K.F.)
| | | | - Bjørn Edwin
- The Intervention Centre at Oslo University Hospital and Institute of Clinical Medicine at University of Oslo, Oslo, Norway (B.E.)
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Kalstad AA, Myhre PL, Laake K, Tveit SH, Schmidt EB, Smith P, Nilsen DWT, Tveit A, Fagerland MW, Solheim S, Seljeflot I, Arnesen H. Effects of n-3 Fatty Acid Supplements in Elderly Patients After Myocardial Infarction: A Randomized, Controlled Trial. Circulation 2020; 143:528-539. [PMID: 33191772 DOI: 10.1161/circulationaha.120.052209] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND High intake of marine n-3 polyunsaturated fatty acids (PUFA) has been associated with reduced risk of cardiovascular events; however, this has not been confirmed in patients with a recent acute myocardial infarction (AMI). Elderly patients are at particularly increased cardiovascular risk after myocardial infarction, but few trials address this group specifically. Omega-3 fatty acids hold the potential to reduce cardiovascular events with limited adverse effects in this vulnerable group. The hypothesis was that daily addition of 1.8g n-3 PUFA to standard of care secondary prophylaxis in elderly patients who have survived an AMI would reduce the risk of subsequent cardiovascular events during 2 years follow-up. METHODS The OMEMI trial (Omega-3 Fatty acids in Elderly with Myocardial Infarction) is an investigator-initiated, multicenter, randomized clinical trial adding 1.8 g n-3 PUFA (930 mg eicosapentaenoic acid and 660 mg docosohexaenoic acid) versus placebo (corn oil) daily to standard of care in patients aged 70 to 82 years with recent (2-8 weeks) AMI. The primary endpoint was a composite of nonfatal AMI, unscheduled revascularization, stroke, all-cause death, heart failure hospitalization after 2 years. The secondary outcome was new atrial fibrillation. The safety outcome was major bleeding. Serum fatty acids were measured as biomarkers of adherence. RESULTS In total, 1027 patients were randomized. Follow-up data were available for 1014 patients who were included in the intention-to-treat analysis. Mean±SD age was 75±3.6 years, 294 (29%) were female, and mean triglycerides were 111.4±61.9 mg/dL. The primary endpoint occurred in 108 (21.4%) patients on n-3 PUFA versus 102 (20.0%) on placebo (hazard ratio, 1.08 [95% CI, 0.82-1.41]; P=0.60). The secondary endpoint occurred in 28 (7.2%) patients on n-3 PUFA versus 15 (4.0%) on placebo (1.84 [0.98-3.45]; P=0.06). Median changes in eicosapentaenoic acid and docosahexaenoic acid were +87% and +16% for n-3 PUFA versus -13% and -8% for placebo. Major bleeding occurred in 54 (10.7%) and 56 (11.0%) in the n-3 PUFA and placebo groups, respectively (P=0.87). Similar results were found in per-protocol analysis (n=893). CONCLUSIONS We could not detect reduction in clinical events in our elderly patients with recent AMI who were treated with 1.8 g n-3 PUFAs daily for 2 years. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01841944.
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Affiliation(s)
- Are Annesønn Kalstad
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway (A.A.K., K.L., S.S., I.S., H.A.).,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.A.K., P.L.M., S.H.T., P.S., A.T., I.S., H.A.)
| | - Peder Langeland Myhre
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.A.K., P.L.M., S.H.T., P.S., A.T., I.S., H.A.).,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway (P.L.M., S.H.T., P.S.)
| | - Kristian Laake
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway (A.A.K., K.L., S.S., I.S., H.A.)
| | - Sjur Hansen Tveit
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.A.K., P.L.M., S.H.T., P.S., A.T., I.S., H.A.).,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway (P.L.M., S.H.T., P.S.)
| | - Erik Berg Schmidt
- Department of Cardiology, Aalborg University Hospital, Denmark (E.B.S.)
| | - Paal Smith
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.A.K., P.L.M., S.H.T., P.S., A.T., I.S., H.A.).,Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway (P.L.M., S.H.T., P.S.)
| | - Dennis Winston Trygve Nilsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway (D.W.T.N.).,Department of Clinical Science, Faculty of Medicine, University of Bergen, Norway (D.W.T.N.)
| | - Arnljot Tveit
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.A.K., P.L.M., S.H.T., P.S., A.T., I.S., H.A.).,Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, Gjettum, Norway (A.T.)
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway (M.W.F.)
| | - Svein Solheim
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway (A.A.K., K.L., S.S., I.S., H.A.)
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway (A.A.K., K.L., S.S., I.S., H.A.).,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.A.K., P.L.M., S.H.T., P.S., A.T., I.S., H.A.)
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Norway (A.A.K., K.L., S.S., I.S., H.A.).,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway (A.A.K., P.L.M., S.H.T., P.S., A.T., I.S., H.A.)
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Dalen-Lorentsen T, Bjørneboe J, Clarsen B, Vagle M, Fagerland MW, Andersen TE. Does load management using the acute:chronic workload ratio prevent health problems? A cluster randomised trial of 482 elite youth footballers of both sexes. Br J Sports Med 2020; 55:108-114. [PMID: 33036995 DOI: 10.1136/bjsports-2020-103003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The acute:chronic workload ratio (ACWR) is commonly used to manage training load in sports, particularly to reduce injury risk. However, despite its extensive application as a prevention intervention, the effectiveness of load management using ACWR has never been evaluated in an experimental study. AIM To evaluate the effectiveness of a load management intervention designed to reduce the prevalence of health problems among elite youth football players of both sexes. METHODS We cluster-randomised 34 elite youth football teams (16 females, 18 males) to an intervention group (18 teams) and a control group (16 teams). Intervention group coaches planned all training based on published ACWR load management principles using a commercially available athlete management system for a complete 10-month season. Control group coaches continued to plan training as normal. The prevalence of health problems was measured monthly in both groups using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. RESULTS The between-group difference in health problem prevalence (primary outcome) was 1.8%-points (-4.1 to 7.7 %-points; p=0.55) with no reduction in the likelihood of reporting a health problem in the intervention group (relative risk 1.01 (95% CI 0.91 to 1.12); p=0.84) compared with the control group. CONCLUSIONS We observed no between-group difference, suggesting that this specific load management intervention was not successful in preventing health problems in elite youth footballers. TRIAL REGISTRATION NUMBER ISRCTN18177140.
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Affiliation(s)
- Torstein Dalen-Lorentsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - John Bjørneboe
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Benjamin Clarsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Department for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Markus Vagle
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway, Horten, Norway
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Norway.,Department of Sports Medicine, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Hansen BH, Dalene KE, Ekelund U, Wang Fagerland M, Kolle E, Steene-Johannessen J, Tarp J, Alfred Anderssen S. Step by step: Association of device-measured daily steps with all-cause mortality-A prospective cohort Study. Scand J Med Sci Sports 2020; 30:1705-1711. [PMID: 32427398 PMCID: PMC7496562 DOI: 10.1111/sms.13726] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
Introduction Walking is free, does not require special training, and can be done almost everywhere. Therefore, walking is a feasible behavior on which to tailor public health messages. This study assesses the prospective association and dose‐response relationship between daily steps and all‐cause mortality. Materials and Methods Daily steps were measured by waist‐mounted accelerometers in 2183 individuals (53% women) for seven consecutive days at baseline (2008‐09). Participants were followed for a median period of 9.1 years and associations between steps and all‐cause mortality determined by registry linkage were assessed using Cox proportional hazard regression with adjustment for relevant covariates. Results Mean age was 57.0 (SD 10.9) years at baseline. Median (IQR) daily steps across ascending quartiles were 4651 (3495‐5325), 6862 (6388‐7350), 8670 (8215‐9186), and 11 467 (10 556‐13 110), respectively. During follow‐up, 119 individuals died (68% men). Higher number of daily steps was associated with a lower risk of all‐cause mortality with hazard ratios of 1.00 (referent), 0.52 (0.29‐0.93), 0.50 (0.27‐0.94), and 0.43 (0.21‐0.88) across ascending quartiles of daily steps in the multivariable‐adjusted model with follow‐up commencing 2 years after baseline. Risk differences per 1000 individuals for ascending quartiles were 6.8 (2.9‐9.3), 7.1 (0.8‐11.1), and 8.0 (1.7‐12.1), respectively. Conclusions Daily steps were associated with lower mortality risk in a non‐linear dose‐response pattern. The risk is almost halved when comparing the least active referent against the second quartile equivalent to a difference of about 2200 daily steps. Encouraging those least active to increase their daily steps may have substantial public health implications.
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Affiliation(s)
- Bjørge Herman Hansen
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Knut Eirik Dalene
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Ulf Ekelund
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Elin Kolle
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Jakob Tarp
- Department of Sports Medicine, The Norwegian School of Sport Sciences, Oslo, Norway
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Kåsine T, Romundstad L, Rosseland LA, Fagerland MW, Kessler P, Omenås IN, Holmberg A, Sauter AR. Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study. Reg Anesth Pain Med 2020; 45:634-639. [PMID: 32540878 DOI: 10.1136/rapm-2020-101349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Onvision is a new technology for needle tip detection and tracking in ultrasound-guided regional anesthesia. The system consists of a piezoelectric sensor close to the needle tip and an electronic console integrated in the ultrasound system. The needle tip is visualized by a green circle on the ultrasound screen. The aim of the study was to investigate the effect of the new needle tip tracking technology on in-plane infraclavicular plexus blocks. METHODS The study was a randomized, controlled, observer blinded cross-over trial in 26 healthy volunteers. Two specialists in anesthesiology performed an ultrasound-guided infraclavicular lateral sagittal brachial plexus block with and without needle tip tracking. Primary outcome was procedure time, measured from insertion of the needle until local anesthesia injection was completed. Secondary outcome measures included the number of hand movements and path lengths (assessed by hand motion analysis), block success rate, onset time and duration, discomfort experienced by the volunteers, and the anesthesiologists' confidence as to whether their block would be successful or not. RESULTS Mean (SD) procedure time was 183.0 (56.1) s with and 206.8 (56.2) s without needle tip tracking (p=0.16). There were no significant differences in any of the secondary outcomes. Two volunteers' experienced Horner syndrome after blocks without needle tip tracking. No other adverse events occurred during the study. CONCLUSION Our study on needle tip tracking for infraclavicular blocks did not reveal any significant differences between active needle tip tracking and the control procedures, neither for primary outcome nor secondary outcome measurements. TRIAL REGISTRATION NUMBER NCT03631914.
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Affiliation(s)
- Trine Kåsine
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Luis Romundstad
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - L A Rosseland
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatics and Epidemiology (OCBE) Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Paul Kessler
- Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital Friedrichsheim, Frankfurt am Main, Hessen, Germany
| | - Ivar Nagelgaard Omenås
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Anne Holmberg
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Axel R Sauter
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway.,Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway.,Department of Anesthesia and Pain Medicine, Inselspital Bern University Hospital, Bern, Switzerland
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Nielsen RO, Shrier I, Casals M, Nettel-Aguirre A, Møller M, Bolling C, Bittencourt NFN, Clarsen B, Wedderkopp N, Soligard T, Timpka T, Emery C, Bahr R, Jacobsson J, Whiteley R, Dahlstrom O, van Dyk N, Pluim BM, Stamatakis E, Palacios-Derflingher L, Fagerland MW, Khan KM, Ardern CL, Verhagen E. Statement on methods in sport injury research from the 1st METHODS MATTER Meeting, Copenhagen, 2019. Br J Sports Med 2020; 54:941. [PMID: 32371524 PMCID: PMC7392492 DOI: 10.1136/bjsports-2019-101323] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 01/08/2023]
Abstract
High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods—methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting.
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Affiliation(s)
- Rasmus Oestergaard Nielsen
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark .,Research Unit for General Practice, Aarhus, Denmark
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Marti Casals
- Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain.,Medical Department, Futbol Club Barcelona, Barça Innovation Hub, Barcelona, Spain
| | | | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Caroline Bolling
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Natália Franco Netto Bittencourt
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Sports Physical Therapy Department, Minas Tenis Clube, Belo Horizonte, Brazil.,Physical Therapy, Centro Universitário UniBH, Belo Horizonte, Brazil
| | - Benjamin Clarsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,The Orthopedic department, Hospital of Southwestern Jutland, Esbjerg, Denmark
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Toomas Timpka
- Health and Society, Linköping University, Linköping, Sweden
| | - Carolyn Emery
- Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
| | - Jenny Jacobsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Orjan Dahlstrom
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Babette M Pluim
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Section Sports Medicine, Faculty of Health Science, University of Pretoria, Pretoria, South Africa.,Medical Department, Royal Netherlands Lawn Tennis Association, Amstelveen, The Netherlands
| | - Emmanuel Stamatakis
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,University College London, London, UK
| | - Luz Palacios-Derflingher
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
| | - Karim M Khan
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada.,British Journal of Sports Medicine, London, United Kingdom
| | - Clare L Ardern
- Division of Physiotherapy, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Karolinska Institute, Stockholm, Sweden
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Shah K, Nergård BJ, Fagerland MW, Gislason H. Limb Length in Gastric Bypass in Super-Obese Patients-Importance of Length of Total Alimentary Small Bowel Tract. Obes Surg 2020; 29:2012-2021. [PMID: 30929197 DOI: 10.1007/s11695-019-03836-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In super-obese patients, rates of weight loss failure and weight regain are high after RYGB. In order to improve weight loss, lengthening of the biliopancreatic limb is vital. In this study, efficacy and safety of two types of RYGB with 2-m BP-limb were assessed in improving weight loss and in the resolution of comorbidities compared with standard RYGB in a long-term follow-up. METHODS This is a retrospective cohort analysis on 671 super-obese patients operated in a 10-year period. Patients were classified into three groups: (1) 155 patients; roux limb 150 cm, BP-limb 60 cm; (2) 230 patients; roux limb 60 cm, BP-limb 200 cm; and (3) 286 patients; roux limb 150 cm, BP-limb 200 cm. EWL, TWL, BMI, failure, weight regain, comorbidity resolution, nutritional status, and complications were assessed. RESULTS Total alimentary limb length was shortened with 60 cm in group 1 and with 200 cm in groups 2 and 3. EWL, BMI change, and TWL were higher in the 2-m BP-limb groups vs group 1. No differences in complication rates were found, except higher frequency of marginal ulcers in patients with a shorter roux limb. EWL failure was higher in group 1 (10.3%) vs the other groups (4.3%; 5.2%). Group 3 had significantly less weight regain (26.6%). Remission of comorbidities was higher in the 2-m BP-limb groups at expense of nutritional and vitamin deficiencies (3.9%; 5.9%). No difference in hypoalbuminemia was noted. CONCLUSION Lengthening of the BP-limb gives significantly higher weight loss, lower rate of EWL failure, and lesser weight regain along with better resolution of obesity-associated comorbidities.
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Affiliation(s)
- Kamran Shah
- Aleris Obesity Clinic and Department of Surgery, Aleris Hospital, Fredrik-Stangsgate 11-13, 0264, Oslo, Norway.
| | - Bent Johnny Nergård
- Aleris Obesity Clinic and Department of Surgery, Aleris Hospital, Fredrik-Stangsgate 11-13, 0264, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Hjörtur Gislason
- Aleris Obesity Clinic and Department of Surgery, Aleris Hospital, Fredrik-Stangsgate 11-13, 0264, Oslo, Norway
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Tarp J, Hansen BH, Fagerland MW, Steene-Johannessen J, Anderssen SA, Ekelund U. Accelerometer-measured physical activity and sedentary time in a cohort of US adults followed for up to 13 years: the influence of removing early follow-up on associations with mortality. Int J Behav Nutr Phys Act 2020; 17:39. [PMID: 32169059 PMCID: PMC7071621 DOI: 10.1186/s12966-020-00945-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/09/2020] [Indexed: 12/26/2022] Open
Abstract
Background Observational studies linking physical activity with mortality are susceptible to reverse causation bias from undiagnosed and prevalent diseases. Researchers often attempt to deal with reverse causation bias by excluding deaths occurring within the first 1 or 2 years from the analysis, but it is unclear if excluding deaths within this time-frame is sufficient to remove bias. Methods We examined associations between total and intensity-specific physical activity and sedentary time with all-cause mortality in a prospective cohort of 3542 individuals from the 2003–2006 NHANES cycles. In order to yield measures of association hypothesized as minimally influenced by reverse causation bias the primary analysis excluded individuals with < 5 years of follow-up. Accelerometer-measured physical activity was linked with recently updated vital status from the National Death Index with a median follow-up of 10.8 years. Results Hazard ratios (95% confidence intervals) were 0.74 (0.53, 1.04), 0.52 (0.37, 0.73), and 0.61 (0.38, 1.01) for ascending quartiles of total physical activity against the least active reference. Hazard ratios for ascending moderate-to-vigorous physical activity quartiles against the reference were 0.67 (0.47, 1.96), 0.67 (0.47, 0.95), and 0.68 (0.39, 1.18). Associations for light intensity physical activity and sedentary time were smaller in magnitude and all confidence intervals included unity. Total activity and moderate-to-vigorous physical activity hazard ratios from analyses only excluding deaths within the first 2 years were inflated by 13 and 26% relative to analysis restricted to ≥5 years of follow-up. Conclusions The pattern of associations suggested total physical activity and moderate-to-vigorous physical activity were associated with lower mortality after more than 10 years of follow-up and excluding the first 5 years of observation time to minimize the impact of reverse causation bias. Excluding deaths within the first 2 years appeared insufficient to minimize the impact of reserve causation bias.
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Affiliation(s)
- Jakob Tarp
- Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806, Oslo, Norway.
| | - Bjørge Herman Hansen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806, Oslo, Norway.,Department of Public Health, Sports and Nutrition, University of Agder, Kristiansand, Norway
| | - Morten Wang Fagerland
- Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806, Oslo, Norway
| | | | - Sigmund Alfred Anderssen
- Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806, Oslo, Norway
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sports Sciences, Sognsveien 220, 0806, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Lydersen S, Fagerland MW. Hvilken t-test er best? Tidsskriftet 2020; 140:20-0750. [DOI: 10.4045/tidsskr.20.0750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Shah K, Nergård BJ, Fagerland MW, Gislason H. Distal gastric bypass: 2-m biliopancreatic limb construction with varying lengths of common channel. Surg Obes Relat Dis 2019; 15:1520-1526. [DOI: 10.1016/j.soard.2019.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/26/2019] [Accepted: 05/02/2019] [Indexed: 12/16/2022]
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Aftab H, Fagerland MW, Gondal G, Ghanima W, Olsen MK, Nordby T. Pain and nausea after bariatric surgery with total intravenous anesthesia versus desflurane anesthesia: a double blind, randomized, controlled trial. Surg Obes Relat Dis 2019; 15:1505-1512. [DOI: 10.1016/j.soard.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/26/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Kåsine T, Romundstad L, Rosseland LA, Ullensvang K, Fagerland MW, Hol PK, Kessler P, Sauter AR. Needle tip tracking for ultrasound-guided peripheral nerve block procedures-An observer blinded, randomised, controlled, crossover study on a phantom model. Acta Anaesthesiol Scand 2019; 63:1055-1062. [PMID: 31037724 PMCID: PMC6767137 DOI: 10.1111/aas.13379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Onvision needle tip tracking (NTT) is a new technology consisting of a needle with an ultrasound sensor close to the needle tip and a console for computerised signal processing. The aim of the study was to evaluate NTT technology during ultrasound-guided simulated peripheral nerve block procedures in a porcine phantom model. METHODS Forty anaesthesiologists performed in-plane and out-of-plane simulated nerve blocks with and without NTT guidance. The primary outcome measure was procedure time. Secondary outcomes were hand movements and the path length travelled by the hands measured by motion analysis, precision of the needle tip related to the target structure, success rates and violations of the target structure, and the participants confidence whether their procedure would be successful or not. RESULTS Procedure time was reduced from 66.7 (SD = 47.5) seconds to 43.8 (SD = 29.2) seconds when NTT was used for out-of-plane procedures (P = 0.002). The number of hand movements of the probe hand was 13.9 (SD = 30.2) with NTT and 22.8 (SD = 30.0) without NTT (P = 0.019). No significant differences were registered during the performance of in-plane procedures. The participants confidence in a presumed block success was increased with both in-plane procedures (8.50 (SD = 1.18) with NTT vs 7.65 (SD = 1.96), P = 0.004) and out-of-plane procedures (8.50 (SD = 1.09) vs 7.10 (SD = 1.89), P = 0.0001). CONCLUSIONS The new NTT technology significantly reduced the procedure time and the number of hand movements for ultrasound-guided out-of-plane PNB procedures. No significant differences were found for the in-plane procedures.
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Affiliation(s)
- Trine Kåsine
- Division of Emergencies and Critical Care, Department of Anaesthesiology Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
| | - Luis Romundstad
- Division of Emergencies and Critical Care, Department of Anaesthesiology Oslo University Hospital Oslo Norway
| | - Leiv Arne Rosseland
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- Division of Emergencies and Critical Care, Department of Research and Development Oslo University Hospital Oslo Norway
| | - Kyrre Ullensvang
- Division of Emergencies and Critical Care, Department of Anaesthesiology Oslo University Hospital Oslo Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology (OCBE) Research Support Services, Oslo University Hospital Oslo Norway
| | - Per Kristian Hol
- Institute of Clinical Medicine, Faculty of Medicine University of Oslo Oslo Norway
- The Intervention Centre Oslo University Hospital Oslo Norway
| | - Paul Kessler
- Department of Anaesthesiology, Intensive Care and Pain Medicine Orthopedic University Hospital Friedrichsheim Frankfurt Germany
| | - Axel Rudolf Sauter
- Division of Emergencies and Critical Care, Department of Anaesthesiology Oslo University Hospital Oslo Norway
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Hokstad I, Deyab G, Wang Fagerland M, Lyberg T, Hjeltnes G, Førre Ø, Agewall S, Mollnes TE, Hollan I. Tumor necrosis factor inhibitors are associated with reduced complement activation in spondylarthropathies: An observational study. PLoS One 2019; 14:e0220079. [PMID: 31335881 PMCID: PMC6650069 DOI: 10.1371/journal.pone.0220079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/07/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The complement system is involved in pathogenesis of cardiovascular disease, and might play a role in accelerated atherogenesis in spondylarthropathies (SpA). Hence, we examined complement activation in SpA, and its relationship to antirheumatic treatment, inflammatory and cardiovascular markers. METHODS From PSARA, a prospective observational study, we examined 51 SpA patients (31 psoriatic arthritis (PsA), and 20 ankylosing spondylitis (AS)), starting tumor necrosis factor (TNF) inhibitor alone (n = 25), combined with methotrexate (MTX) (n = 10), or MTX monotherapy (n = 16). Complement activation was determined by the soluble terminal complement complex (sC5b-9), inflammation by erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and endothelial function by finger plethysmography (Endopat) at baseline, after 6 weeks and 6 months of treatment. RESULTS SpA patients had sC5b-9 levels at (PsA) or above (AS) the upper limit of the estimated reference range. Median sC5b-9 levels decreased significantly from baseline to 6 weeks, with no significant difference between the AS and PsA group. Notably, a significant reduction in sC5b-9 was observed after administration of TNF inhibitor ± MTX, whereas no significant changes were observed in patients treated with MTX alone. Between 6 weeks and 6 months, sC5b-9 remained stable across all subgroups. Reduction in sC5b-9 was independently related to decreased ESR and CRP, and to increased high density cholesterol and total cholesterol. Reduction in sC5b-9 from baseline to 6 weeks was associated with improved EF in age and gender adjusted analyses. CONCLUSION TNF-inhibition, but not MTX monotherapy, led to rapid and sustained reduction of complement activation in SpA. Thus, the observed decrease in cardiovascular morbidity in patients treated with TNF-inhibitors might be partly due to its beneficial effect on complement. TRIAL REGISTRATION Clinical Trials (NCT00902005), retrospectively registered on the 14th of May 2009.
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Affiliation(s)
- Ingrid Hokstad
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Gia Deyab
- Department of Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Torstein Lyberg
- Department of Medical Biochemistry, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Øystein Førre
- Department of Rheumatology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Stefan Agewall
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
- Oslo University Hospital Ullevål, Oslo, Norway
| | - Tom Eirik Mollnes
- Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ivana Hollan
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
- Department of Medical Biochemistry, Innlandet Hospital Trust, Lillehammer, Norway
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Fretland ÅA, Dagenborg VJ, Waaler Bjørnelv GM, Aghayan DL, Kazaryan AM, Barkhatov L, Kristiansen R, Fagerland MW, Edwin B, Andersen MH. Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases. Br J Surg 2019; 106:1372-1380. [DOI: 10.1002/bjs.11227] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Most treatments for cancer cause a decline in patients' health-related quality of life (HRQoL). Limiting this decline is a universal goal for healthcare providers. Using minimally invasive instead of open surgical techniques might be one way to achieve this. The aim of this study was to compare postoperative HRQoL after open and laparoscopic liver resection.
Methods
This was a predefined substudy of an RCT comparing open with laparoscopic liver resection. Patients with colorectal liver metastases were assigned randomly to open or laparoscopic parenchyma-sparing liver resection. HRQoL was assessed with the Short Form 36 questionnaire at baseline, and 1 and 4 months after surgery.
Results
A total of 280 patients were randomized, of whom 273 underwent surgery (129 laparoscopic, 144 open); 682 questionnaires (83.3 per cent) were available for analysis. One month after surgery, patients in the laparoscopic surgery group reported reduced scores in two HRQoL domains (physical functioning and role physical), whereas those in the open surgery group reported reduced scores in five domains (physical functioning, role physical, bodily pain, vitality and social functioning). Four months after surgery, HRQoL scores in the laparoscopic group had returned to preoperative levels, whereas patients in the open group reported reduced scores for two domains (role physical and general health). The between-group difference was statistically significant in favour of laparoscopy for four domains after 1 month (role physical, bodily pain, vitality and social functioning) and for one domain after 4 months (role physical).
Conclusion
Patients assigned to laparoscopic liver surgery reported better postoperative HRQoL than those assigned to open liver surgery. For role limitations caused by physical health problems, patients in the laparoscopic group reported better scores up to 4 months after surgery. Registration number: NCT01516710 (http://www.clinicaltrials.gov).
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Affiliation(s)
- Å A Fretland
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - V J Dagenborg
- Department of Tumour Biology, Oslo University Hospital, Oslo, Norway
- Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - G M Waaler Bjørnelv
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - D L Aghayan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Surgery 1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - A M Kazaryan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Surgery, Fonna Hospital Trust, Stord, Norway
- Department of Faculty Surgery 2, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Surgery 1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - L Barkhatov
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - R Kristiansen
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Information Technology, Oslo University Hospital, Oslo, Norway
| | - M W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - B Edwin
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M H Andersen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Moseid CH, Myklebust G, Slaastuen MK, Bar‐Yaacov JB, Kristiansen AH, Fagerland MW, Bahr R. The association between physical fitness level and number and severity of injury and illness in youth elite athletes. Scand J Med Sci Sports 2019; 29:1736-1748. [DOI: 10.1111/sms.13498] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Christine Holm Moseid
- Department of Sports Medicine, Norwegian School of Sport Sciences Oslo Sports Trauma Research Center Oslo Norway
| | - Grethe Myklebust
- Department of Sports Medicine, Norwegian School of Sport Sciences Oslo Sports Trauma Research Center Oslo Norway
| | - Marit Kyte Slaastuen
- Department of Sports Medicine, Norwegian School of Sport Sciences Oslo Sports Trauma Research Center Oslo Norway
| | - Jonathan Brun Bar‐Yaacov
- Department of Sports Medicine, Norwegian School of Sport Sciences Oslo Sports Trauma Research Center Oslo Norway
| | - Aase Helen Kristiansen
- Department of Sports Medicine, Norwegian School of Sport Sciences Oslo Sports Trauma Research Center Oslo Norway
| | - Morten Wang Fagerland
- Department of Sports Medicine, Norwegian School of Sport Sciences Oslo Sports Trauma Research Center Oslo Norway
| | - Roald Bahr
- Department of Sports Medicine, Norwegian School of Sport Sciences Oslo Sports Trauma Research Center Oslo Norway
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Munkhaugen J, Vethe NT, Fagerland MW, Dammen T, Perk J, Gjertsen E, Otterstad JE, Gullestad L, Bergan S, Husebye E. Statin-associated muscle symptoms in coronary patients: design of a randomized study. SCAND CARDIOVASC J 2019; 53:162-168. [DOI: 10.1080/14017431.2019.1612085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils Tore Vethe
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Toril Dammen
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Joep Perk
- Institute of Health and Caring Sciences, Linneus University, Kalmar, Sweden
| | - Erik Gjertsen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | | | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Stein Bergan
- Department of Pharmacology, Oslo University Hospital, Oslo, Norway
- School of Pharmacy, University of Oslo, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
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Lydersen S, Fagerland MW, Laake P. Fishers eksakte test – hvordan smaker teen? Tidsskriftet 2019; 139:19-0237. [DOI: 10.4045/tidsskr.19.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lydersen S, Fagerland MW, Laake P. Pearsons khikvadrattest. Tidsskriftet 2019; 139:18-0125. [DOI: 10.4045/tidsskr.18.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Papp J, Zima E, Bover R, Karaliute R, Rossi A, Szymanski C, Troccoli R, Schneider J, Fagerland MW, Camm AJ, Atar D. Changes in oral anticoagulation for elective cardioversion: results from a European cardioversion registry. Eur Heart J Cardiovasc Pharmacother 2018; 3:147-150. [PMID: 28329309 PMCID: PMC5843131 DOI: 10.1093/ehjcvp/pvx003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/09/2017] [Indexed: 12/21/2022]
Abstract
Aims In patients with atrial fibrillation (AF) pharmacological or electrical cardioversion may be performed to restore sinus rhythm. The procedure is associated with an increased risk of thromboembolic events, which can be significantly reduced by adequate anticoagulation (OAC). Our aim was to create a partly prospective, partly retrospective cardioversion registry, particularly focusing on OAC strategies in different European countries, and on emerging choice of OAC over time. Methods From September 2014 to October 2015, cardioversions due to AF performed in six European city hospitals in five European countries (Hungary: Budapest-1 and -2; Italy: Bari and Pisa; France: Amiens; Spain: Madrid; and Lithuania: Kaunas) were recorded in the registry. Results A total of 1101 patients (retrospective/prospective: 679/422, male/female: 742/359, mean age: 67.3 years ± 11.2) were registered. Most of the cardioversions were electrical (97%). Oral anticoagulants were administered in 87% of the patient, the usage of non-VKA oral anticoagulants (NOACs) vs Vitamin K antagonists (VKA) was 31.5% vs 68.5%, respectively. Seventy seven percent of the patients were given oral anticoagulants more than 3 weeks prior to the procedure, and 86% more than 4 weeks after the procedure. When using VKA, international normalized ratio (INR) at cardioversion was above 2.0 in 76% of the cases. A decline in VKA usage (P = 0.033) in elective cardioversion over approximately 1 year was observed. During the observation period, there was an increase in apixaban (P < 0.001), a slight increase in rivaroxaban (P = 0.028) and no changes in dabigatran (P = 0.34) usage for elective cardioversion. There were differences in use of OAC between the countries: Spain used most VKA (89%), while France used least VKA (39%, P < 0.001). Conclusion According to current AF guidelines, NOACs are adequate alternatives to VKA for thromboembolic prevention in AF patients undergoing elective cardioversion. Our results indicate that NOAC use is increasing and there is a significant decrease in VKA use.
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Affiliation(s)
- Judit Papp
- Department of Cardiology, Medical Center Hungarian Defence Forces, 44 Robert Karoly Krt., 1134 Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, 68 Varosmajor u., 1122 Budapest, Hungary
| | - Ramon Bover
- Cardiology Department, University Hospital Clinico San Carlos, Profesor Martin Lagos s/n, 28040 Madrid, Spain
| | - Rasa Karaliute
- Lithuanian University of Health Sciences, Cardiology Clinic, 2 Eiveniu str., 50161 Kaunas, Lithuania
| | - Andrea Rossi
- Cardiothoracic Department, Tuscany Foundation Gabriele Monasterio, 1 Via G. Moruzzi, 56124 Pisa, Italy
| | - Catherine Szymanski
- Cardiology Department, Amiens University Hospital, Avenue Rene Laennec, 80000 Salouel Amiens, France
| | - Rossella Troccoli
- Cardiologia Ospedaliera Polyclinic of Bari, 11 Piazza Giulio Cesare, 70124 Bari, Italy
| | | | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - A John Camm
- Molecular and Clinical Research Institute and Cardiology Clinical Academic Group, St. George's University of London and Imperial College, London SW17 0RE, UK
| | - Dan Atar
- Cardiology Department B and Faculty of Medicine, Oslo University Hospital, University of Oslo, 166 Kirkeveien, Building 3-A, 0407 Oslo, Norway
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Aga C, Risberg MA, Fagerland MW, Johansen S, Trøan I, Heir S, Engebretsen L. No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years' Follow-up. Am J Sports Med 2018; 46:2341-2354. [PMID: 30021073 DOI: 10.1177/0363546518782454] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The double-bundle reconstruction technique was developed to resemble the properties of the native anterior cruciate ligament (ACL) more closely than the conventional single-bundle technique. The clinical benefit of the operative procedure is controversial, and there is a need for studies with a focus on patient-reported outcomes (PROs). STUDY DESIGN Randomized controlled trial; Level of evidence, 1. HYPOTHESIS Anatomic double-bundle ACL reconstruction would be superior to anatomic single-bundle reconstruction regarding the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscore from baseline to 2-year follow-up. METHODS According to sample size calculations, 120 patients aged 18 to 40 years with a primary ACL injury of their knee were randomized to the anatomic double-bundle or anatomic single-bundle reconstruction groups. Patients with posterior cruciate ligament, posterolateral corner, or lateral collateral ligament injuries or with established osteoarthritis were excluded. Patients with residual laxity from a coexistent medial collateral ligament injury were excluded. Data were registered at baseline, 1 year, and 2 years. In 24 patients, postoperative 3-dimensional computed tomography was performed to verify the positioning of the bundles. The outcome measures were the change in KOOS subscores and the International Knee Documentation Committee 2000 subjective score, pivot-shift test result, Lachman test finding, KT-1000 arthrometer measurement, activity level, return-to-sports rate, and osteoarthritic changes on radiographs. A linear mixed model was used for the analysis of all the PROs, including the primary outcome. RESULTS The change in the KOOS QoL subscore from baseline to 2-year follow-up was not different between the double- and single-bundle groups (mean change, 29.2 points vs 28.7 points, respectively; -0.5-point difference; 95% CI, -8.4 to 7.4 points; P = .91). Neither were there any differences between the 2 groups in the remaining PROs, knee laxity measurements, or activity levels of the patients. Radiological signs of osteoarthritis were found in 2 patients. Eleven patients had a graft rupture: 8 in the single-bundle group and 3 in the double-bundle group ( P = .16). Three-dimensional computed tomography of the knees verified the positioning of the anteromedial bundle, posterolateral bundle, and single-bundle grafts to be within acceptable limits. CONCLUSION There was no difference in the KOOS QoL subscore, the remaining PROs, knee laxity measurements, or activity levels comparing the double- and single-bundle ACL reconstruction techniques. The number of bundles does not seem to influence clinical and subjective outcomes, as long as the tunnels are adequately positioned. Registration: NCT01033188 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Cathrine Aga
- Department of Orthopedic Surgery, Martina Hansens Hospital, Bærum, Norway.,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - May Arna Risberg
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Center, Oslo, Norway.,Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Steinar Johansen
- Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Ingrid Trøan
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Stig Heir
- Department of Orthopedic Surgery, Martina Hansens Hospital, Bærum, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.,Oslo Sports Trauma Research Center, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ekelund U, Brown WJ, Steene-Johannessen J, Fagerland MW, Owen N, Powell KE, Bauman AE, Lee IM. Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. Br J Sports Med 2018; 53:886-894. [DOI: 10.1136/bjsports-2017-098963] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/06/2018] [Accepted: 05/16/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveTo examine whether the associations between sedentary behaviours (ie, daily sitting/TV-viewing time) and mortality from cardiovascular disease (CVD) and cancer differ by different levels of physical activity (PA).DesignHarmonised meta-analysis of prospective cohort studies. Data on exposure variables were harmonised according to a predefined protocol and categorised into four groups for sedentary behaviours and into quartiles of PA (MET-hour/week).Data sourcesPubMed, PsycINFO, Embase, Web of Science, Sport Discus and Scopus.Eligibility criteria for selecting studiesIndividual level data on both sedentary behaviours and PA and reported effect estimates for CVD or cancer mortality.ResultsNine studies (n=850 060; deaths=25 730) and eight studies (n=777 696; deaths=30 851) provided data on sitting time and CVD and cancer mortality, respectively. Five studies had data on TV-viewing time and CVD (n=458 127; deaths=13 230) and cancer (n=458 091; deaths=16 430) mortality. A dose–response association between sitting time (9%–32% higher risk; p for trend <0.001) and TV time (3%–59% higher risk; p for trend <0.001) with CVD mortality was observed in the ‘inactive’, lowest quartile of PA. Associations were less consistent in the second and third quartiles of PA, and there was no increased risk for CVD mortality with increasing sedentary behaviours in the most active quartile. Associations between sedentary behaviours and cancer mortality were generally weaker; 6%–21% higher risk with longer sitting time observed only in the lowest quartile of PA.ConclusionPA modifies the associations between sedentary behaviours and CVD and cancer mortality. These findings emphasise the importance of higher volumes of moderate and vigorous activity to reduce, or even eliminate these risks, especially for those who sit a lot in their daily lives.
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Kaale A, Smith L, Nordahl-Hansen A, Fagerland MW, Kasari C. Early interaction in autism spectrum disorder: Mothers' and children's behaviours during joint engagement. Child Care Health Dev 2018; 44:312-318. [PMID: 29034499 DOI: 10.1111/cch.12532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/01/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND More knowledge about the interaction between young children with autism spectrum disorder and their parents is one way to improve intervention. This study aims to investigate the behaviours of mothers and children with autism spectrum disorder during joint engagement, with a focus on pacing or rate (i.e., incidences per minute) of their behaviours when being in this state. METHOD Video recordings of 10 min of free-play between 58 children (2-4 years) diagnosed with childhood autism and their mothers were used to examine rate of mothers' and children's behaviours (i.e., toy introduction, toy expansion, positive affect, and language) during joint engagement, the association between rate of mothers and children's behaviours, the relation between rate of mothers' behaviours and time in joint engagement, and how child factors might be associated with the latter. RESULTS Mothers(m) and children(c) showed similar rate of positive affect (Mm = 0.6/Mc = 0.5) and toy expansion (Mm = 0.7/Mc = 0.7) per minute, whereas mothers talked almost three times more than their children (Mm = 10.2/Mc = 3.8). In contrast, mothers introduced fewer toys compared to the children (Mm = 0.7/Mc = 1.2). Rate of mothers' toy introduction, toy expansion, and positive affect was inversely related to time in joint engagement (Regression coefficient = -70.7 to -48.5, p = .006 to .024). Rates of mothers' and children's behaviours were associated (Spearman rank order coefficient = .53 to .29, p < .001 to .03), but neither rate of children's behaviours nor mental age was associated with the observed relation between rate of these maternal behaviours and time in joint engagement. CONCLUSION Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Thus, intervention teaching parents of young children with autism strategies designed to increase time in joint engagement may be vital. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation.
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Affiliation(s)
- A Kaale
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - L Smith
- Department of Psychology, University of Oslo, Oslo, Norway
| | - A Nordahl-Hansen
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - M W Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - C Kasari
- Center for Autism Research & Treatment, University of California, Los Angeles, Semel Institute, Los Angeles, CA, USA
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Ofstad AP, Ulimoen GR, Orvik E, Birkeland KI, Gullestad LL, Fagerland MW, Johansen OE. Long-term follow-up of a hospital-based, multi-intervention programme in type 2 diabetes mellitus: impact on cardiovascular events and death. J Int Med Res 2017. [PMID: 28627980 PMCID: PMC5718720 DOI: 10.1177/0300060517707674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective To report the long-term impact on cardiovascular (CV) outcomes and mortality of a 2-year hospital-based multi-interventional care programme as compared with general practitioner (GP)-provided standard care. Methods Patients with type 2 diabetes with ≥ 1 additional CV risk factor were randomized to 2 years of specialist-based, multi-intervention comprising lifestyle modification and specific pharmacological treatment, or GP-based standard care. After the 2-year intervention period, all participants returned to pre-study care, but were followed up for CV outcomes and mortality. The primary outcome was time to any first severe CV event or death. Results A total of 120 patients (31 women) were enrolled in the study. During the mean ± SD observational period of 8.7 ± 2.0 years, 27 patients (16 and 11 in the multi-intervention and standard care groups, respectively) experienced at least one primary outcome event, with a hazard ratio (HR) if allocated to the multi-intervention group of 1.73 (95% confidence interval (CI) 0.80, 3.75). The HR for total mortality was 1.82 (95% CI 0.66, 5.01). Conclusions Hospital-based multi-intervention in patients with type 2 diabetes mellitus improved long-term glycaemic control, but failed to reduce CV outcomes and deaths. Clinical trials.gov id: NCT00133718.
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Affiliation(s)
- Anne Pernille Ofstad
- 1 Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | | | - Elsa Orvik
- 1 Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Kåre Inge Birkeland
- 3 Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,6 Institue for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars L Gullestad
- 4 Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Morten Wang Fagerland
- 5 Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Odd Erik Johansen
- 1 Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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Kvakkestad KM, Wang Fagerland M, Eritsland J, Halvorsen S. Gender differences in all-cause, cardiovascular and cancer mortality during long-term follow-up after acute myocardial infarction; a prospective cohort study. BMC Cardiovasc Disord 2017; 17:75. [PMID: 28288586 PMCID: PMC5348805 DOI: 10.1186/s12872-017-0508-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Gender differences in short-term mortality in acute myocardial infarction (AMI) have been studied extensively, whereas gender differences in long-term mortality and cause of death largely remain unknown. The aim of this study was to assess the long-term risk of all-cause, cardiovascular and cancer death after AMI in women compared to men. METHODS Consecutive AMI patients were enrolled in a prospective registry between 2005 and 2011. Date and cause of death were obtained by linkage with the Norwegian Cause of Death Registry, with censoring date 31 December 2012. AMI patients with ST-segment elevation (STEMI, n = 5159) and without (NSTEMI, n = 4899) were analysed separately. RESULTS The 5-years all-cause mortality rates in STEMI were 29% in women vs. 17% in men, and 42% vs. 29% in NSTEMI, respectively. After adjustment for age and other confounders, women with STEMI had similar (HR 1.13 [95% CI: 0.98-1.32]) and women with NSTEMI lower (HR 0.82 [95% CI: 0.73-0.92]) risk of long-term all-cause mortality compared to men. Competing-risks analysis showed no significant gender differences in age-adjusted risk of cardiovascular death nor of cancer death. In both genders, the annual risk of cardiovascular death was low after 1 year, but exceeded annual risk of cancer death throughout follow-up. CONCLUSION During long-term follow-up, women with STEMI had similar and women with NSTEMI lower adjusted risk of all-cause mortality compared to men. Age-adjusted risk of death due to cardiovascular disease was similar in both genders and higher than risk of death due to cancer throughout the follow-up period.
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Affiliation(s)
- Kristin Marie Kvakkestad
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424, Oslo, Norway.,University of Oslo, Postboks 1072 Blindern, 0316, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Postboks 1110 Blindern, 0317, Oslo, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424, Oslo, Norway. .,University of Oslo, Postboks 1072 Blindern, 0316, Oslo, Norway.
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Skatteboe S, Røe C, Fagerland MW, Granan LP. Expectations of pain and functioning in patients with musculoskeletal disorders: a cross-sectional study. BMC Musculoskelet Disord 2017; 18:48. [PMID: 28125978 PMCID: PMC5270237 DOI: 10.1186/s12891-016-1386-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has suggested that patient expectations are associated with treatment outcome and evolve along with patient communication within the musculoskeletal field. However, few studies have investigated if or how physical medicine and rehabilitation (PMR) consultations affect the attending patients' expectations regarding pain and functional improvement. Hence, the aims of the present study were to compare patient expectations regarding pain and functional improvement before and after a PMR consultation and to assess patient characteristics, including diagnosis, that could perhaps predict changes in expectations. METHODS The study design was cross-sectional. Eligible participants were first-time patients with neck/back or shoulder complaints who were referred to a PMR outpatient clinic between January and June 2013. Questionnaires (the Patient Shoulder Outcome Expectancies, or PSOE, questionnaire and a numeric rating scale, or NRS) focused on expectations regarding pain and functioning were completed immediately prior to and after a consultation with a PMR specialist. RESULTS In total, 257 patients were included. In total, 24% of the subjects expected a more positive outcome after the PMR consultation compared with before the consultation, while 10% of the subjects exhibited a negative change in expectations. Few patient characteristics other than sick leave were associated with changes in expectations; however, patients with shoulder complaints seemed to be more optimistic than patients with neck/back complaints. CONCLUSION Expectations can be influenced by a single specialist consultation. Among clinical prognostic factors, only sick leave influenced the change expectations. However, patients with shoulder complaints seemed to be more optimistic than patients with neck/back complaints. TRIAL REGISTRATION The study was approved by the Data Protection Office at Oslo University Hospital, 2012/2574. ISRCTN registration: 40963362 (registered retrospectively 12.12.2016).
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Affiliation(s)
- Sigrid Skatteboe
- Deparment of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway. .,, Ullveien 19b, 0791, Oslo, Norway.
| | - Cecilie Røe
- Deparment of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Lars-Petter Granan
- Deparment of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.,Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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