Acute low back pain – a cross sectional study: Fear-avoidance beliefs and associated characteristics

Abstract Background/Aim: Fear-avoidance beliefs (FAB) is exsessive fear of movements that may lead to movement avoidance and contribute to maintenance of LBP. The aim of the study was (i) to identify the percentage of fear-avoidance beliefs (FAB) in patients with acute low back pain (ALBP) and (ii) find any association that may exist between demographic variables, pain and FAB in the sample. Design: The study is a cross sectional survey with a strategic sample. Material: 115 patients between 20 and 70 years of age with acute (less than 12 weeks) low back pain recruited from physiotherapists in outpatient clinics in Norway in the period November 2006 to February 2007. Method: A questionnaire including questions on fear-avoidance beliefs (FABQ) was used. The questionnaire has two parts with five questions about Physical Activities (FABQ-PA) and 11 questions about work related issues. The scores go from 0-6 where 6 is worst. No cutoff values are indicates in the questionnaire, the cut values in the article are quoted from other authors. The patients were also asked for demographic variables and pain. Result: 115 patients participated in the survey: 85 percent answered the FABQ-W part and 20.4 per cent of these had high scores at a cutoff >29. In total 95 per cent answered the FABQ-PA part and 32.1 per cent of these had high scores at a cutoff >14. Mean scores of FABQ-W were 18.3 (10.9) and FABQ-PA 12.3 (5.8). Patients with lowest level of education were significantly associated with high scores on FABQ-W. Conclusion: Increased pain at present (current pain) was significantly associated with high score on the FABQ-PA. Further, being on sick leave and having attained the lowest level of education were independently associated with having high FABQ-W to a significant degree. Keywords: Acute low back pain, fear-avoidance beliefs, cutoff score, formal education

Det nøtte itj å vårrå flink ålein : innføring av telemedisinsk samhandling i norske kommuner

Innledning Innføring av telemedisinske tjenester har vist seg å være komplekse, fordi det i en telemedisinsk innovasjon utvikles nye tjenester, prosesser og organisasjonsformer. Det er forsket mye på slike innføringer på sykehus, men vi vet lite om hvordan dette foregår i norske kommuner. Derfor har vår problemstilling vært: Hvordan foregår innføring av telemedisinske tjenester i norske kommuner? Materiale og metode For å besvare problemstillingen har vi brukte en kvalitativ metode med fire fokusgruppeintervju med 24 informanter fra 21 kommuner i tre helseregioner. Vi har brukt implementeringsmodellene Normalization Process Theory og FITT- Framework for å belyse våre funn. Resultater Helsemyndighetenes føringer og finansiering har hatt innflytelse på utviklingen. Alle hadde en grundig sosiologisk forankringsprosess. Prosessene har bestått av ildsjeler, pådrivere, bred involvering, kartlegging, markedsføring og systematisk tjenesteutvikling. Videre fant vi at det er utfordringer i samarbeid med HF. Deres rolle som samhandlingsaktør er betydningsfull og deres manglende deltakelse gir stagnert tjenesteutvikling. De tekniske utfordringer har vært mange. Kommuner har for lite båndbredde, og behovet for tilpasning av nettverk, teknologi, opplæring i bruk av videokonferanse og tjenesteutførelser er stort. Konklusjon Klare anbefalinger har kommet fram i løpet av studien. Disse omfatter bl.a. at man må støtte opp om lokale ildsjeler og pådrivere, sørge for bred involvering på alle nivå, gjøre en nøye behovskartlegging både av samhandlingsbehov og tekniske behov og sørge for en interkommunal teknisk tilrettelegging i samarbeid med Helsenettet. Nøkkelord: Telemedisin, innføringsprosesser, kommuner, samhandlin

A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing

Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB

Effects of purified anthocyanins in people at risk for dementia: Study protocol for a phase II randomized controlled trial

Background: The number of people with dementia is increasing, with huge challenges for society and health-care systems. There are no disease-modifying therapies available. There is, therefore, an urgent need to identify strategies to reduce the risk of developing dementia. Anthocyanins are a class of compounds found in dark berries and fruits with some effects that might reduce the risk for cognitive decline and the development of dementia in older people. Aim: This phase II three-center, randomized, 24-week, placebo-controlled study, ongoing in Norway, aims to evaluate the safety, and efficacy of anthocyanins in modifying key dementia-related mechanisms and maintain cognitive functioning in older people at risk for dementia. Methods: Participants (220 individuals aged 60–80 years) who meet the inclusion criteria (either mild cognitive impairment or two or more cardiometabolic disorders) are being enrolled in this study at three different centers in Norway. Participants are block randomized to identically appearing capsules containing 80 mg of naturally purified anthocyanins or placebo 1:1. Dosage is 2 + 2 capsules per day for 24 weeks. The primary outcome will be the quality of episodic memory score, a composite measure from the extensively validated online cognitive test battery CogTrack®, which is administered at baseline and monthly for the next 6 months. Secondary outcomes include other major scores from CogTrack, as well as a range of neuroimaging and other biomarkers. Anthocyanin metabolites will be measured in blood and cerebrospinal fluid. The change from baseline scores will be subject to a mixed model for repeated measures analysis of covariance. The primary comparison will be the contrast (difference in the least-square means) between active and placebo at the end of the study (week 24). The primary study population will be a modified intention-to-treat population (ClinicalTrials.gov, NCT03419039). Discussion: This study aims to demonstrate whether there are beneficial effects of purified anthocyanins on cognition and relevant biological functions in people at increased risk for dementia. Forthcoming results may contribute to further improvement of intervention strategies to prevent or delay the onset of dementia, including a potential decision to take anthocyanins toward phase III trials.publishedVersio

Effects of anthocyanin supplementation on serum lipids, glucose, markers of inflammation and cognition in adults with increased risk of dementia - A pilot study

Background: Anthocyanins may protect against cardiovascular related cognitive decline and dementia. Objective: Open-label study to measure changes in serum lipids, glucose, glycosylated hemoglobin (HbA1c), and markers of inflammation after anthocyanin supplementation in people with increased risk of dementia. As a secondary endpoint we examined potential changes in a battery of cognitive test in the anthocyanin group (AG). A total of 27 individuals with mild cognitive impairment (MCI) (n = 8) or stable non-obstructive coronary artery disease (CAD) (n = 19) consumed two Medox® capsules, each containing 80 mg of natural purified anthocyanins, twice daily for 16 weeks. They provided blood samples and performed a short battery of cognitive tests. Twenty healthy normal controls (NC) (n = 20) provided blood samples, but did not receive any intervention and did not perform cognitive tests. Results: There was a significant difference between groups for CCL-5/RANTES [regulated on activation, normal T-cell expressed and secreted (RANTES)]. In addition, total cholesterol and triglycerides were significantly increased in the AG. Improvements in memory and executive test scores were observed. No adverse effects were reported. Conclusion: The results of this pilot study were largely inconclusive with regard to the potential protective effects of anthocyanin supplementation. However, anthocyanins were well tolerated, and compliance was high. Larger, placebo-controlled studies to explore the potential effects of anthocyanins on dementia risk are encouraged.publishedVersio

A Randomised Placebo-Controlled Study of Purified Anthocyanins on Cognition in Individuals at Increased Risk for Dementia

Importance Identifying nutritional compounds which can reduce cognitive decline in older people is a hugely important topic. Objective To study the safety and effect of anthocyanins in maintaining cognitive functioning in people at increased risk for dementia. Design, setting, and participants Participants (206 individuals, aged 60–80 years) diagnosed with either mild cognitive impairment (MCI) or two or more cardiometabolic disorders (i.e., diabetes, hypertension, obesity) were enrolled at three different centres in Norway. Intervention Participants were randomly assigned to four capsules with a total of 320 mg/d of naturally purified anthocyanins or placebo 1:1 for 24 weeks. Main outcomes and measures The primary outcome was the Quality of Episodic Memory composite measure (0–100) from an online cognitive test battery CogTrack, which was administered at baseline and monthly for the next 24 weeks. Secondary outcomes included other cognitive scores from the CogTrack battery. We applied mixed effects models with a baseline test score, group, time and their interaction as fixed effects, as well as other predefined baseline covariates. The primary comparison was the group difference at week 24 based on a modified intention-to-treat principle. Results : The primary analysis did not show a significant group difference at 24 weeks (78.2 versus 76.8; adjusted mean difference 1.4 (95% confidence interval -0.9–3.7); effect size 0.15; p = 0.23). However, there was a significant difference in slopes during weeks 8–24 (p = 0.007); the anthocyanin group improved while the placebo group worsened. No differences were found for the secondary cognitive outcomes. Anthocyanin capsules were well-tolerated and safe to use. Conclusion Anthocyanin supplementation for 24 weeks was safe and well tolerated in people with MCI or cardiometabolic disorders. We found no significant group difference in episodic memory at the end of the study but statistically significant differences in slopes. Further studies are warranted to explore whether anthocyanins supplementation can reduce cognitive decline in people at increased risk of dementia.publishedVersio

Development of UHPLC-MS/MS methods to quantify 25 antihypertensive drugs in serum in a cohort of patients treated for hypertension

We developed three ultra-high pressure liquid chromatography coupled to mass spectrometry detection (UHPLC-MS/MS) methods to quantify 25 antihypertensive drugs in serum samples. Patient-reported drug lists were collected, and drug concentrations were analysed in samples from 547 patients, half with uncontrolled hypertension, and all treated with ≥ 2 antihypertensive drugs. For sample preparation, serum was mixed with deuterated internal standards and acetonitrile and precipitated. Aliquots of the supernatant were injected on UHPLC-MSMS with a C18 reversed phase column. The mobile phase was 0.1 % HCOOH (formic acid) in water and 0.1 % HCOOH in acetonitrile (except in methanol for spironolactone/canrenone) at a flow rate of 0.4 mL/min. The calibrators and internal controls were prepared in Autonorm™. The calibration ranges were wide, and the models were linear or quadratic with squared correlation coefficients ≥ 0.97. The limits of detection and quantification, specificity, carry-over, and matrix effects were acceptable. The accuracy of the internal controls was in the range 85–121 %, and the intermediate precision for all drugs was 4–28 %. The patient-reported antihypertensive drug use and the detected serum drug concentrations were in accordance with that most frequently prescribed nationally. The percent non-detectable level was 5–10 % for bendroflumethiazide, doxazosin, nifedipine, and ramipril. Often the drug dose chosen was lower than the recommended maximum daily dose. We report the maximum (Cmax) and minimum (Cmin) drug concentrations after drug intake. The inter-individual pharmacokinetic variability at Cmin was 18-fold for hydrochlorothiazide, 22-fold for losartan carboxyl acid, 26-fold for amlodipine, 44-fold for candesartan, and 50-fold for valsartan. Our methods are suitable for measuring antihypertensive drugs in patient serum for therapy control.publishedVersio

Cognitive impairment - role of vascular risk factors and lipid alterations for development and progression

Background: Dementia is a growing challenge, and there is no curative treatment available. The most common cause of dementia is Alzheimer’s disease (AD), where treatment studies focusing on anti-amyloid treatment have thus far failed. Importantly, age-specific incidence of dementia has fallen in many countries, possibly due to life style changes and improved treatment of modifiable risk factors, among them vascular risk factors. However, knowledge about the effect of vascular risk factors on the progression of dementia is scarce. Of note, anthocyanins, found naturally in a number of foods, may protect against cardiovascular related cognitive impairment and dementia. Concerning AD, recent studies have investigated lipid alterations in AD pathogenesis, with the potential to complement the proteomic approaches as potential biomarkers of diagnosis and progression of AD. Aim: To increase knowledge about the role of vascular risk factors, lipid alterations and anthocyanin supplementation with respect to development and progression of cognitive impairment in a population of people with mild dementia or at increased risk of dementia. In paper I, the objective was to examine the potential effect of vascular risk factors on the progression of AD and Lewy body dementia (LBD). Paper II explored the plasma lipid profile in mild cognitive impairment due to AD and its association with cognition. Lastly, paper III explored the potential effects of anthocyanins on mechanisms relevant for cognitive decline in people with increased risk of dementia. Methods: Data from three different studies were analysed, including two longitudinal multicenter cohort studies; “Dementia study in Western Norway” (DemVest), and “Dementia Disease Initiation” (DDI). DemVest included newly diagnosed dementia patients from specialist clinics in old age psychiatry and geriatric medicine in Western Norway in the period of 2005-2013. DDI is a nationwide ongoing study including participants with cognitive impairment and normal controls from 2013 onwards from self-referrals from advertisements in media, newspapers and news bulletins, and referrals from general practitioners to the local memory clinics. In both studies, the baseline and follow-up assessments included a comprehensive battery of neuropsychological tests, clinical examination, and imaging. Cerebrospinal fluid was also analysed. In addition, an open-label pilot study, the Anthocyanin study, recruited participants with increased risk of dementia from the outpatient Memory and Cardiology clinics at Stavanger University Hospital in Norway during 2015 and 2016, who received anthocyanin supplementation for 16 weeks. For comparison, normal controls not receiving anthocyanin supplementation were recruited. Results: In paper I, smoking was the only vascular risk factor significantly associated with a more rapid cognitive decline, in patients with AD as measured by Clinical Dementia Rating Scale Sum of Boxes (CDR-SB). In contrast, being overweight was associated with a slower cognitive decline in both AD and LBD. Hypertension predicted slower decline in Mini-Mental Status Exam (MMSE) scores in all patients, and in the LBD group. Further, in the LBD group diabetes mellitus and smoking were found to be associated with a slower decline in CDR-SB scores, and in MMSE scores respectively. In paper II, a number of plasma sphingomyelin concentrations, and particularly SM(d43:2), were found to be lower in mild cognitive impairment (MCI) in cerebrospinal fluid amyloid beta positive (Aβ+) individuals compared to controls. SM(d43:2) was also nominally reduced in MCI Aβ+ individuals compared to in cerebrospinal fluid amyloid beta negative (Aβ-) participants with MCI. In addition, two phosphatidylinositols were negatively associated with visuospatial functioning at baseline. In paper III, a significant group difference was found for monocyte chemoattractant protein (MCP-1) and fasting glucose. In the anthocyanin group total cholesterol and triglycerides increased significantly, and improvements in memory and executive test scores were observed at study end. Conclusions and implications: Smoking cessation might potentially slow down the cognitive decline in AD. Since some other vascular risk factors were associated with slower decline, further studies are needed to explore how this potentially can be translated into benefit for people with dementia. Larger studies of longer duration are warranted in order to investigate the role of lipid alterations during AD pathogenesis and progression. Randomized controlled trials are needed to explore the potential effects of anthocyanins on cognitive decline and dementia risk

Spatial navigation measured by the Floor Maze Test in patients with subjective cognitive impairment, mild cognitive impairment, and mild Alzheimer's disease

Background: Impaired spatial navigation is an early sign of Alzheimer's disease (AD), but this can be difficult to assess in clinical practice. We examined how the performance on the Floor Maze Test (FMT), which combines navigation with walking, differed between patients with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and mild AD. We also explored if there was a significant relationship between the FMT and the cognitive tests or sociodemographic factors. Methods: The study included 128 patients from a memory clinic classified as having SCI (n = 19), MCI (n = 20), and mild AD (n = 89). Spatial navigation was assessed by having the patients walk through the FMT, a two-dimensional maze. Both timed measures and number of errors were recorded. Cognitive function was assessed by the Word List Memory test, the Clock Drawing test, the Trail Making tests (TMT) A and B, and the Mini Mental Status Examination (MMSE). Results: The patients with MCI were slower than those with SCI, while the patients with mild AD more frequently completed the FMT with errors or gave up than the patients with MCI. Performance on the FMT was significantly associated with executive function (measured by TMT-B). Conclusions: The performances on the FMT worsened with increasing severity of cognitive impairment, and the FMT was primarily associated with executive function. The explained variance was relatively low, which may indicate that the standard cognitive test battery does not capture impairments of spatial navigation

Ageing and exercise: building body capital in old age

Background: Research that provides better understanding of the motivational processes in older age to maintain a healthy and active lifestyle is sought after. We apply theoretical approaches to cultural capital, active and healthy aging health to shed light on the women’s experiences in maintaining physical capabilities through an active lifestyle, and thereby facilitating their own inclusion in society. Thus, the aim of this paper is to explore why older home dwelling women over the age of 70 years or more spend time in physical exercise and their experiences about the importance of participating in group exercise for their daily life. This paper reports on a qualitative study based on interviews with 16 older women aged 70 years or more and regularly attending group exercise classes in the community at an established workout center. The data were analyzed the data using an inductive content analysis approach. Results: Three overreaching and interrelated themes emerged from the interviews: “Building body capital for independence”, “Building body capital to maintain vitality and being in control” and “Building resources for social interaction”. The findings suggest that group exercise is important for building body capital. The group exercise helped the women in building bodily ability to manage everyday life, maintain vitality, being in control, pursue social interaction and live independently. These body resources were important for these older women’s experience of the manageability and meaningfulness of daily life. Conclusion: This study has provided insights into older women’s understanding and experiences of the challenges of everyday life within a theoretical framework of cultural capital and health. The women acquired cultural health capital, and more specifically body capital, by participating in the group exercise classes. The women’s investment in body capital through regular physical activity created resources which facilitated social participation. Therefore professionals need to be aware of this when performing group exercise