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The development and validation of the Leiden Bother and Needs Questionnaire for patients with pituitary disease: the LBNQ-Pituitary
Background
Patients report persisting impairment in quality of life (QoL) after treatment for pituitary disease. At present, there is no questionnaire to assess (a) whether patients with pituitary disease are bothered by these consequences, and (b) their needs for support.
Objective
To develop and validate a disease-specific questionnaire for patients with pituitary disease which incorporates patient perceived bother related to the consequences of the disease, and their needs for support.
Methods
Items for the Leiden Bother and Needs Questionnaire for patients with pituitary disease (LBNQ-Pituitary) were formulated based on results of a recent focus group study (n = 49 items). 337 patients completed the LBNQ-Pituitary and six validated QoL questionnaires (EuroQoL-5D, SF-36, MFI-20, HADS, AcroQol, CushingQoL). Construct validity was examined by exploratory factor analysis. Reliabilities of the subscales were calculated with Cronbach’s alphas, and concurrent validity was assessed by calculating Spearman’s correlations between the LBNQ-Pituitary and the other measures.
Results
Factor analyses produced five subscales (i.e., mood problems, negative illness perceptions, issues in sexual functioning, physical and cognitive complaints, issues in social functioning) containing a total of 26 items. All factors were found to be reliable (Cronbach’s alphas all ≥.765), and the correlations between the dimensions of the LBNQ-Pituitary and other questionnaires (all P ≤ .0001) demonstrated convergent validity.
Conclusions
The LBNQ-Pituitary can be used to assess the degree to which patients are bothered by the consequences of the pituitary disease, as well as their needs for support. It could also facilitate an efficient assessment of patients’ needs for support in clinical practice. We postulate that paying attention to needs for support will lead to optimal patient care (e.g., improvement in psychosocial care), and positively affect QoL
Anthromes dispaying evidence of weekly cycles in active fire data cover 70% of the global land surface
Across the globe, human activities have been gaining importance relatively to climate and ecology as
the main controls on fire regimes and consequently human activity became an important driver of the
frequency, extent and intensity of vegetation burning worldwide. Our objective in the present study
is to look for weekly cycles in vegetation fire activity at global scale as evidence of human agency,
relying on the original MODIS active fire detections at 1 km spatial resolution (MCD14ML) and using
novel statistical methodologies to detect significant periodicities in time series data. We tested the
hypotheses that global fire activity displays weekly cycles and that the weekday with the fewest fires
is Sunday. We also assessed the effect of land use and land cover on weekly fire cycle significance
by testing those hypotheses separately for the Villages, Settlements, Croplands, Rangelands,
Seminatural, and Wildlands anthromes. Based on a preliminary data analysis of the daily global active
fire counts periodogram, we developed an harmonic regression model for the mean function of daily
fire activity and assumed a linear model for the de-seasonalized time series. For inference purposes,
we used a Bayesian methodology and constructed a simultaneous 95% credible band for the mean
function. The hypothesis of a Sunday weekly minimum was directly investigated by computing the
probabilities that the mean functions of every weekday (Monday to Saturday) are inside the credible
band corresponding to mean Sunday fire activity. Since these probabilities are small, there is statistical
evidence of significantly fewer fires on Sunday than on the other days of the week. Cropland, rangeland,
and seminatural anthromes, which cover 70% of the global land area and account for 94% of the active
fires analysed, display weekly cycles in fire activity. Due to lower land management intensity and less
strict control over fire size and duration, weekly cycles in Rangelands and Seminatural anthromes,
which jointly account for 53.46% of all fires, although statistically significant are weaker than those
detected in Croplandsinfo:eu-repo/semantics/publishedVersio
Activation of nuclear factor-κB in human prostate carcinogenesis and association to biochemical relapse
Nuclear factor (NF)-κB/p65 regulates the transcription of a wide variety of genes involved in cell survival, invasion and metastasis. We characterised by immunohistochemistry the expression of NF-κB/p65 protein in six histologically normal prostate, 13 high-grade prostatic intraepithelial neoplasia (PIN) and 86 prostate adenocarcinoma specimens. Nuclear localisation of p65 was used as a measure of NF-κB active state. Nuclear localisation of NF-κB was only seen in scattered basal cells in normal prostate glands. Prostatic intraepithelial neoplasias exhibited diffuse and strong cytoplasmic staining but no nuclear staining. In prostate adenocarcinomas, cytoplasmic NF-κB was detected in 57 (66.3%) specimens, and nuclear NF-κB (activated) in 47 (54.7%). Nuclear and cytoplasmic NF-κB staining was not correlated (P=0.19). By univariate analysis, nuclear localisation of NF-κB was associated with biochemical relapse (P=0.0009; log-rank test) while cytoplasmic expression did not. On multivariate analysis, serum preoperative prostate specific antigen (P=0.02), Gleason score (P=0.03) and nuclear NF-κB (P=0.002) were independent predictors of biochemical relapse. These results provide novel evidence for NF-κB/p65 nuclear translocation in the transition from PIN to prostate cancer. Our findings also indicate that nuclear localisation of NF-κB is an independent prognostic factor of biochemical relapse in prostate cancer
Increased Hair Cortisol Concentrations and BMI in Patients With Pituitary-Adrenal Disease on Hydrocortisone Replacement
Context: Intrinsic imperfections and lack of reliable biomarkers preclude optimal individual dosing of hydrocortisone replacement in adrenal insufficiency (AI). However, the clinical relevance of optimal dosing is exemplified by frequently occurring side effects of overreplacement and the dangers of underreplacement. Cortisol in scalp hair has been identified as a retrospective biomarker for long-term cortisol exposure. We compared hair cortisol concentrations (CORThair) of patients with primary or secondary AI on replacement therapy with those of patient controls with a pituitary disease without AI (PCs) and of healthy controls (HCs). Methods: In this cross-sectional study, hair samples and anthropometric data were collected in 132 AI patients (52 males), 42 PCs (11 males), and 195 HCs (90 males). The proximal 3 cm of hair were used. CORThair were measured using an ELISA. Results: CORThair were higher in AI patients than in HCs and PCs (P <.001), and hydrocortisone dose correlated with CORThair (P =.04). Male AI patients demonstrated higher CORThair than female patients (P <.001). AI patients had higher body mass index (BMI) than HCs (P <.001), and BMI correlated with CORThair in the whole sample (P <.001). Conclusion: Physiological hydrocortisone replacement is associated with increased CORThair. The association between CORThair and BMI could suggest a mild overtreatment that may lead to adverse anthropomorphic side effects, especially in males. CORThair measurements may be a promising additional tool to monitor cumulative hydrocortisone replacement in AI