Serologiske markører ved inflammatorisk tarmsykdom

SEROLOGICAL MARKERS IN INFLAMMATORY BOWEL DISEASES Background Correct diagnosis of inflammatory bowel disease (IBD), especially the differentiation between Crohn`s disease (CD) and ulcerative colitis (UC), is highly important toward treatment and prognosis. Serological markers are noninvasive diagnostic tools that could be of value in differentiating CD from UC, and in the identification of IBD cases. Perinuclear antineutrophil cytoplasmic autoantibodies (pANCA) have been suggested as a serological marker for UC, and anti-Saccharomyces cerevisiae antibodies (ASCA) have been suggested as a serological marker for CD. Variable prevalences have been reported from different countries. The prevalence of these markers has not yet been studied in a Norwegian cohort of patiens with established IBD. Aims To examine the prevalence and diagnostic value of serologic markers in a Norwegian cohort of patients with established IBD, using a group of patients with non-IBD illnesses as controls. In addition, we wanted to examine whether these antibodies could be related to a specific clinical phenotype or course of disease in IBD. Methods Sera from 173 patients with established IBD and 170 patients with non-IBD illnesses were evaluated for the presence of ASCA and pANCA. Immune marker status was determined by investigators blinded to clinical characteristics, and all clinical variables were extracted retrospectively from hospital records by one investigator. Results ASCA was positive in 48% of CD vs. 17% in UC, p<0.001. On the other hand pANCA was positive in 43% of UC as compared to 16% of CD, p<0.001. These figures are lower compared to most previous studies. The highest specificity for differentiating CD from UC was achieved using the combination of both markers. The combination of ASCA+/pANCA-, had a specificity for CD of 89%, whereas pANCA+/ASCA- had a specificity for UC of 88%. Using multiple regression analyses, ASCA in CD patients were shown to be independently associated with early age of disease onset and small bowel disease as well as fibrostenosing and penetrating disease behaviours. Conclusions pANCA and ASCA testing are spesific but not sensitive for UC and CD. We found prevalences of the serological markers that were lower than in most studies from other countries. ASCA seems to be a prognostic risk factor for complications in CD. Thus ASCA may prove useful in determining subgroups that would benefit from a more aggressive medical treatment early in the course of CD

Fotballtreneres beslutningsstiler : en undersøkelse av treneres beslutningsstiler i relasjon til alder, erfaring og idrettsutdanning

Masteroppgave i idrettsvitenskap- Universitetet i Agder 2011Formålet med denne studien er å undersøke fotballtreneres beslutningsstiler i relasjon til alder, erfaring og idrettsutdanning. For å studere denne sammenhengen gjennomførte 99 mannlige fotballtrenere fra alderbestemte lag til eliteserie, og landslag, en spørreundersøkelse for å undersøke i hvilken grad treneres alder, erfaring (spiller- og trenererfaring) og idrettsutdanning (høgskole- og universitetsutdanning, og trenerkurs) påvirker valg av beslutningsstil. For å måle treneres beslutningsstiler ble Scott og Bruces‟ (1995) General Decision- Making Style (GDMS) benyttet. Resultatene viser at den unngående beslutningsstilen er negativt korrelert med den rasjonelle beslutningsstilen, og den rasjonelle beslutningsstilen er positivt korrelert med den intuitive og avhengige beslutningsstilen. Den intuitive beslutningsstilen viser også positiv korrelasjon med den spontane og avhengige beslutningsstilen. Videre viser resultatene at de eldste fotballtrenerne anvender den rasjonelle og avhengige beslutningsstilen oftere enn de yngre fotballtrenerne. T- testen viser at trenerne med trenerkurs på høyt nivå anvender den rasjonelle og intuitive beslutningsstilen oftere enn trenerne med trenerkurs på et lavere nivå innen fotball. Samtidig viser resultatene ingen gruppeforskjeller mellom trenere med ulik grad av idrettsutdanning og valg av beslutningsstil. Resultatene viser videre at trenerne med spillererfaring på høyt nivå anvender den intuitive beslutningsstilen oftere enn trenere med spillererfaring fra et lavere nivå, og trenerne med trenererfaring fra høyt nivå anvender den rasjonelle beslutningsstilen oftere enn de med trenererfaring på et lavere nivå. På bakgrunn av resultatene vil jeg avslutningsvis diskutere tiltak som kanskje kan bidra til å øke treneres kvalitet og bevissthet i beslutningsprosessen. For treneren vil beslutningene som blir foretatt i høy grad være avgjørende for trenerens egen utvikling, men også for lagets suksess

Cardiometabolic risk, health related quality of life, and effect of treatment in children and adolescents with severe obesity

Obesity during childhood and adolescence increases the likelihood of obesity in adulthood, negatively affects psychological and physical health, and is associated with increased levels of cardiovascular risk factors. Treatment aims to reduce the physical and psychological burdens associated with obesity, and to improve health-related quality of life (HRQoL). Treatment effects are often low to moderate. The first aim of this thesis was to investigate regional differences in modifiable cardiovascular risk factors among 2327 adolescents (12-18 years) with obesity from three tertiary care outpatient clinics in Italy, Germany and Norway. We found a high prevalence of risk factors, with the highest proportion affected by elevated non-HDL-Cholesterol (60%) in Norway, and the highest prevalence of high blood pressure (66%) among the German cohort. The prevalence of metabolic syndrome in Norway, Italy and Germany was 24%, 26% and 40%, respectively. Secondly, we aimed to compare the effects on obesity, cardiovascular risk factors and HRQoL among children and parents participating in a 2-year camp-based treatment compared with an outpatient treatment, in a randomised, controlled study. The study was located at two rehabilitation clinics, two tertiary care hospitals and primary care in Norway. Families with at least one child (7-12 years) and one parent with obesity were randomised to either summer camp for two weeks and four repetition weekends or lifestyle school including four days of family education. Both groups had monthly follow-up in primary care. Treatments were based on behavioural techniques motivating families to a healthier lifestyle. The camp-based programme had significantly larger effects on obesity-specific HRQoL, BMI and some cardiovascular risk factors in children, although no significant differences were found in the primary outcome, BMI SDS, or for the parents’ BMI or HRQoL. The camp-based programme was costly compared with the out-patient treatment

Camp-based family treatment of childhood obesity: randomised controlled trial

Objective To compare the effectiveness of a 2-year camp-based family treatment programme and an outpatient programme on obesity in two generations. Design Pragmatic randomised controlled trial. Setting Rehabilitation clinic, tertiary care hospital and primary care. Patients Families with at least one child (7–12 years) and one parent with obesity. Interventions Summer camp for 2 weeks and 4 repetition weekends or lifestyle school including 4 days family education . Behavioural techniques motivating participants to healthier lifestyle. Main outcome measures Children: 2-year changes in body mass index (BMI) SD score (SDS). Parents: 2-year change in BMI. Main analyses: linear mixed models. Results Ninety children (50% girls) were included. Baseline mean (SD) age was 9.7 (1.2) years, BMI 28.7 (3.9) kg/m 2 and BMI SDS 3.46 (0.75). The summer-camp children had a lower adjusted estimated mean (95% CI) increase in BMI (−0.8 (−3.5 to −0.2) kg/m 2 ), but the BMI SDS reductions did not differ significantly (−0.11 (−0.49 to 0.05)). The 2-year baseline adjusted BMI and BMI SDS did not differ significantly between summer-camp and lifestyle-school completers, BMI 29.8 (29.1 to 30.6) vs 30.7 (29.8 to 31.6) kg/m 2 and BMI SDS 2.96 (2.85 to 3.08) vs 3.11 (2.97 to 3.24), respectively. The summer-camp parents had a small reduction in BMI (−0.9 (−1.8 to −0.03) vs −0.8 (−2.1 to 0.4) in the lifestyle-school group), but the within-group changes did not differ significantly (0.3 (−1.7 to 2.2)). Conclusions A 2-year family camp-based obesity treatment programme had no significant effect on BMI SDS in children with severe obesity compared with an outpatient family-based treatment programme. Trial registration number NCT01110096

Camp-based family treatment of childhood obesity: randomised controlled trial

Objective To compare the effectiveness of a 2-year camp-based family treatment programme and an outpatient programme on obesity in two generations. Design Pragmatic randomised controlled trial. Setting Rehabilitation clinic, tertiary care hospital and primary care. Patients Families with at least one child (7–12 years) and one parent with obesity. Interventions Summer camp for 2 weeks and 4 repetition weekends or lifestyle school including 4 days family education. Behavioural techniques motivating participants to healthier lifestyle. Main outcome measures Children: 2-year changes in body mass index (BMI) SD score (SDS). Parents: 2-year change in BMI. Main analyses: linear mixed models. Results Ninety children (50% girls) were included. Baseline mean (SD) age was 9.7 (1.2) years, BMI 28.7 (3.9) kg/m2 and BMI SDS 3.46 (0.75). The summer-camp children had a lower adjusted estimated mean (95% CI) increase in BMI (−0.8 (−3.5 to −0.2) kg/m2), but the BMI SDS reductions did not differ significantly (−0.11 (−0.49 to 0.05)). The 2-year baseline adjusted BMI and BMI SDS did not differ significantly between summer-camp and lifestyle-school completers, BMI 29.8 (29.1 to 30.6) vs 30.7 (29.8 to 31.6) kg/m2 and BMI SDS 2.96 (2.85 to 3.08) vs 3.11 (2.97 to 3.24), respectively. The summer-camp parents had a small reduction in BMI (−0.9 (−1.8 to −0.03) vs −0.8 (−2.1 to 0.4) in the lifestyle-school group), but the within-group changes did not differ significantly (0.3 (−1.7 to 2.2)). Conclusions A 2-year family camp-based obesity treatment programme had no significant effect on BMI SDS in children with severe obesity compared with an outpatient family-based treatment programme

Camp-based family treatment of childhood obesity: randomised controlled trial

Objective To compare the effectiveness of a 2-year camp-based family treatment programme and an outpatient programme on obesity in two generations. Design Pragmatic randomised controlled trial. Setting Rehabilitation clinic, tertiary care hospital and primary care. Patients Families with at least one child (7–12 years) and one parent with obesity. Interventions Summer camp for 2 weeks and 4 repetition weekends or lifestyle school including 4 days family education. Behavioural techniques motivating participants to healthier lifestyle. Main outcome measures Children: 2-year changes in body mass index (BMI) SD score (SDS). Parents: 2-year change in BMI. Main analyses: linear mixed models. Results Ninety children (50% girls) were included. Baseline mean (SD) age was 9.7 (1.2) years, BMI 28.7 (3.9) kg/m2 and BMI SDS 3.46 (0.75). The summer-camp children had a lower adjusted estimated mean (95% CI) increase in BMI (−0.8 (−3.5 to −0.2) kg/m2), but the BMI SDS reductions did not differ significantly (−0.11 (−0.49 to 0.05)). The 2-year baseline adjusted BMI and BMI SDS did not differ significantly between summer- camp and lifestyle-school completers, BMI 29.8 (29.1 to 30.6) vs 30.7 (29.8 to 31.6) kg/m2 and BMI SDS 2.96 (2.85 to 3.08) vs 3.11 (2.97 to 3.24), respectively. The summer-camp parents had a small reduction in BMI (−0.9 (−1.8 to −0.03) vs −0.8 (−2.1 to 0.4) in the lifestyle-school group), but the within-group changes did not differ significantly (0.3 (−1.7 to 2.2)). Conclusions A 2-year family camp-based obesity treatment programme had no significant effect on BMI SDS in children with severe obesity compared with an outpatient family-based treatment programme

Cardiometabolic risk factors differ among adolescents with obesity in three European countries - a cross sectional study

Aim: We aimed to compare modifiable cardiometabolic risk factors among treatment‐seeking adolescents with obesity in Italy, Germany and Norway. Methods: This retrospective, registry‐based, cross‐sectional cohort study included 2,327 (59% girls) 12–18 year‐old adolescents with obesity from three tertiary care outpatient clinics in Europe, between 1999 and 2015. The prevalence of cardiometabolic risk factors was compared between clinics, and multivariate logistic regression models including gender, age, waist circumference and body mass index were used to assess the associations between population and cardiometabolic risk. Results: In total, 1,396 adolescents (60% girls) from Italy, 654 (58% girls) from Germany and 277 (51% girls) from Norway were included. The mean ± SD age was 15.2 ± 1.6 years, body mass index 38.8 ± 6.5 kg/m2 and body mass index standard deviation score 3.21 ± 0.43. The prevalence of elevated nonhigh‐density lipoprotein‐cholesterol in Norway, Germany and Italy was 60%, 54% and 45%, while the prevalence of high systolic or diastolic blood pressure (≥130 or ≥85 mmHg) were 15%, 46% and 66%, respectively. Conclusion: Cardiometabolic risk factors among treatment‐seeking adolescents with obesity from Italy, Germany and Norway differed across the populations in this study, which might imply that preventive clinical work should reflect such differences

Health-related quality of life after camp-based family obesity treatment: an RCT

Objective To compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations. Design Randomised controlled trial. Setting Rehabilitation clinic, tertiary care hospital and primary care. Patients Families with at least one child (7–12 years) and one parent, both with obesity. Interventions Summer camp for 2 weeks, with four repetition weekends, or lifestyle school, including four outpatient days over 4 weeks. Behavioural techniques to promote a healthier lifestyle. Main outcome measures Children’s and parents’ HRQoL were assessed using generic and obesity-specific measures. Outcomes were analysed using linear mixed models according to intention to treat, and multiple imputations were used for missing data. Results Ninety children (50% girls) with a mean (SD) age of 9.7 (1.2) years and body mass index 28.7 (3.9) kg/m2 were included in the analyses. Summer camp children had an estimated mean (95% CI) of 5.3 (0.4 to 10.1) points greater improvement in adiposity-specific HRQoL score at 2 years compared with the lifestyle school children, and this improvement was even larger in the parent proxy-report, where mean difference was 7.3 (95% CI 2.3 to 12.2). Corresponding effect sizes were 0.33 and 0.44. Generic HRQoL questionnaires revealed no significant differences between treatment groups in either children or parents from baseline to 2 years. Conclusions A 2-year family camp-based immersion obesity treatment programme had significantly larger effects on obesity-specific HRQoL in children’s self-report and parent proxy-reports in children with obesity compared with an outpatient family-based treatment programme

Cardiometabolic risk factors differ among adolescents with obesity in three European countries - a cross sectional study

Aim: We aimed to compare modifiable cardiometabolic risk factors among treatment‐seeking adolescents with obesity in Italy, Germany and Norway. Methods: This retrospective, registry‐based, cross‐sectional cohort study included 2,327 (59% girls) 12–18 year‐old adolescents with obesity from three tertiary care outpatient clinics in Europe, between 1999 and 2015. The prevalence of cardiometabolic risk factors was compared between clinics, and multivariate logistic regression models including gender, age, waist circumference and body mass index were used to assess the associations between population and cardiometabolic risk. Results: In total, 1,396 adolescents (60% girls) from Italy, 654 (58% girls) from Germany and 277 (51% girls) from Norway were included. The mean ± SD age was 15.2 ± 1.6 years, body mass index 38.8 ± 6.5 kg/m2 and body mass index standard deviation score 3.21 ± 0.43. The prevalence of elevated nonhigh‐density lipoprotein‐cholesterol in Norway, Germany and Italy was 60%, 54% and 45%, while the prevalence of high systolic or diastolic blood pressure (≥130 or ≥85 mmHg) were 15%, 46% and 66%, respectively. Conclusion: Cardiometabolic risk factors among treatment‐seeking adolescents with obesity from Italy, Germany and Norway differed across the populations in this study, which might imply that preventive clinical work should reflect such differences

Monitoring children and adolescents with severe obesity: body mass index (BMI), BMI z‐score or percentage above the International Obesity Task Force overweight cut‐off?

Aim: Body mass index (BMI) metrics are widely used as a proxy for adiposity in children with severe obesity. The BMI expressed as the percentage of a cut‐off percentile for overweight or obesity has been proposed as a better alternative than BMI z‐scores when monitoring children and adolescents with severe obesity. Methods: Annual changes in BMI, BMI z‐score and the percentage above the International Obesity Task Force overweight cut‐off (%IOTF‐25) were compared with dual‐energy X‐ray absorptiometry (DXA) derived body fat (%BF‐DXA) in 59 children and adolescents with severe obesity. Results: The change in %BF‐DXA was correlated with the change in %IOTF‐25 (r = 0.68) and BMI (r = 0.70), and somewhat less with the BMI z‐score (r = 0.57). Cohen's Kappa statistic to detect an increase or decrease in %BF‐DXA was fair for %IOTF‐25 (κ = 0.25; p = 0.04) and BMI (κ = 0.33; p = 0.01), but not for the BMI z‐score (κ = 0.08; p = 0.5). The change in BMI was positively biased due to a natural increase with age. Conclusion: Changes in the BMI metrics included in the study are associated differently with changes in %BF‐DXA. The BMI z‐score is widely used to monitor changes in adiposity in children and adolescents with severe obesity, but the %IOTF‐25 might be a better alternative