High headache prevalence among women with hemochromatosis: the Nord-Trøndelag health study

In this large cross-sectional population-based study, 51,272 persons responded to a headache questionnaire and were screened for hemochromatosis. Phenotypic hemochromatosis and the C282Y/C282Y genotype were both associated with an 80% increase in headache prevalence evident only among women. The reason for this association is unclear, but one may speculate that iron overload alters the threshold for triggering a headache by disturbing neuronal function.     

Impairment,disability and handicap in multiple sclerosis A cross-sectional study in an incident cohort in Møre and Romsdal County,Norway

We conducted a cross-sectional, geographically based study of functional status in an incident cohort of 124 multiple sclerosis (MS) patients with onset of disease from 1 January 1976 to 31 December 1986 in Møre and Romsdal County, Norway. The cohort comprised 58 men (46.8%) and 66 women (53.2%). One hundred and thirteen patients (91.1 %) had a primary remitting course of disease and 11 (8.9%) had primary progressive MS. The mean age of onset was 33.3 years (range 14–64), and the mean duration of disease 7.8 years (range 1–23). The Minimal Record of Disability (MRD) of multiple sclerosis was applied to measure the degree of impairment, disability and handicap. The mean Kurtzke Expanded Disability Status Scale (EDSS) score was 3.76 (0–10), and the frequency distribution of the EDSS scores in the cohort was bimodal. Twenty-eight (22.6%) patients in the cohort had marked paraparesis, paraplegia or quadriplegia. Nineteen patients (15.3%) had frequent urinary incontinence, need for almost constant catheterization, or need for constant use of measures to evacuate stools. Five patients (4%) had a severe decrease in mentation or dementia. Forty-eight patients (38.7%) reported frequent problems with fatigue or fatigability preventing sustained physical function. Less than half of the cohort (42.7%) was working fulltime, and 49.2% of the patients reported that they received external support to maintain their usual financial standard. Lack of ability to work full-time and accordingly the dependence upon external financial support were significantly associated with the primary progressive course of disease. Fatigue was statistically significantly related to lack of working ability. The estimated cost of MS in the county in 1991 was 48.2 million NOK ( 7.531.250 US $) based on the cost-of-illness methodology.     

Risk and protective factors for psychological distress among adolescents: a family study in the Nord-Trøndelag Health Study

Purpose  

The study aimed to investigate potential adolescent and parental psychosocial risk and protective factors for psychological distress among adolescents and, in addition, to examine potential gender and age differences in the effects of risk factors on adolescent psychological distress.     

Prevalence and associated factors of DSM-V insomnia in Norway: the Nord-Trøndelag Health Study (HUNT 3)

BackgroundMany studies have assessed the prevalence of insomnia, but the influence of non-participants has largely been ignored. The objective of the present study was to estimate the prevalence and associated factors of insomnia in a large adult population using DSM-V (diagnostic and statistical manual of mental disorders, 5th ed.) criteria, also taking non-participants into account.MethodsThis cross-sectional study used data from a questionnaire in The Nord-Trøndelag Health Study (HUNT 3) performed in 2006–2008, and a subsequent non-participant study. The total adult population (n = 93,860 aged ⩾20 years) of Nord-Trøndelag County, Norway, was invited. Of these, 40,535 responded to the insomnia questionnaire. Among 42,024 eligible non-participants, 6918 (17%) responded to two insomnia questions.ResultsInsomnia was diagnosed by applying modified DSM-V criteria. The age-adjusted insomnia prevalence was estimated using the age distribution of all adult inhabitants of Nord-Trøndelag. Supplementary prevalence data were estimated by extrapolating data from the non-participant study. Additionally, the association between insomnia and self-reported health was estimated, adjusting for known confounders. The total age-adjusted prevalence of insomnia was 7.1% (95% confidence interval [CI], 6.9–7.4) (8.6% for women, 5.5% for men). Adjusting for non-participants, the prevalence estimate changed to 7.9% (95% CI, 7.3–8.6) (9.4% for women, 6.4% for men). Insomnia was more than eight times more likely (OR, 8.3; 95% CI, 6.2–11.1) among individuals with very poor versus very good self-reported health, adjusting for age, gender, employment status, chronic musculoskeletal complaints, anxiety and depression.ConclusionsThe adjusted insomnia prevalence estimate in Nord-Trøndelag was 7.9%. Insomnia was strongly associated with poor self-reported health.     

Trends in prevalence and incidence of multiple sclerosis in Bajo Aragón, Spain

OBJECTIVE: Recent reports provide consistent evidence that Spain is an area of high risk for multiple sclerosis (MS) according to prevalence surveys. However, the studies of incidence are scarce. The objective of the current work is to analyse whether the increased prevalence of MS is accompanied by increasing incidence in the area of Bajo Aragón, northeastern Spain. METHODS: The data of both prevalence and incidence were retrieved from a prospective register created in 1994 and which included patients with probable or definite MS. Crude and age-standardised rates were calculated from 1994 to 2002 and compared with those found retrospectively in the previous period of 1984-1993. RESULTS: In January 2003, we found a prevalence rate of 75/100,000 (95% CI: 52-97) whereas it was 35/100,000 (95% CI: 20-50) in 1994. In a period of 9 years, 25 new cases were diagnosed in the area with a mean annual incidence rate of 4.6/100,000 (95% CI: 2.8-6.5; range: 1.6-13.6) in comparison to 17 new cases from 1984 to 1993 with a mean incidence rate of 3/100,000 (95% CI: 1.6-4.5). The standardised ratio of incidences was 1.44 (95% CI: 0.95-2.17) and, therefore, the difference of rates was not significant. CONCLUSION: We conclude that the increase in prevalence of MS is more likely to be due to improvement on case ascertainment than to increasing incidence. Nonetheless, further prospective incidence studies in larger populations are warranted in Spain to elucidate whether the frequency of this disease is truly increasing.     

Depression in older cat and dog owners: the Nord-Trøndelag Health Study (HUNT)-3

Objective: Depression constitutes a major health problem for older people, in this study defined as people 65 years of age and older. Previous studies have shown that mental health among older people who live with animals could be improved, but contrary results exist as well. Therefore, the objective of the present population study was to compare the self-rated depression symptoms of both female and male non-pet owners, cat owners, and dog owners.

Method: The participants in this cross-sectional population study included 12,093 people between the ages of 65 and 101. One thousand and eighty three participants owned cats and 814 participants owned dogs. Self-rated depression symptoms were measured using HADS-D, the scale of self-administered depression symptoms in HADS (Hospital Anxiety and Depression Scale).

Results: The main results showed higher mean values on the HADS-D for cat owners than for both dog and non-pet owners. The latter group rated their depression symptoms the lowest. When dividing the ratings into low- and high-depression symptoms, the logistic regression analysis showed that it was more likely that males who owned cats perceived lower depression symptoms than females who owned cats. No interactions were recognized between pet ownership and subjective general health status, loneliness, or marital status.

Conclusions: Our results provide a window into the differences in health factors between older females and males who own cats and dogs in rural areas. Results from population studies like ours might increase the available knowledge base when using cats and dogs in clinical environments such as nursing homes.     

Depression in relation to age and gender in the general population: the Nord-Trøndelag Health Study (HUNT)

Objective: Previous sample studies of depression have shown a higher prevalence of depression in women, and an inconsistent relation to age has been found for both genders. The aim of the present study was to investigate depression in relation to gender and age in the general adult population. Method: Of the total population of 92 100 individuals aged 20–89 years and living in Nord‐Trøndelag county of Norway, 62 344 (67.7%) filled in valid ratings of depression on the Hospital Anxiety and Depression Scale (HADS). Results: Minimal gender difference was found in dimensional depression scores and in prevalence rates of depression. Both these measures were found to increase continuously with age in both genders. Conclusion: Our results of this population‐based study differ from most sample studies reported, and these discrepancies are discussed with focus on study design, self‐rating, and the concept of depression covered by HADS.     

Multiple sclerosis and amyotrophic lateral sclerosis: is there a link?

To date, there are no reports studying the rate of amyotrophic lateral sclerosis (ALS) in relatives of multiple sclerosis (MS) patients and vice versa. This study was designed to look into this issue using two population-based databases of MS and ALS in Isfahan province of Iran. We have searched for any first, second or third degree familial kinship between the Isfahan MS Society database and Isfahan ALS population. We compared the rate of ALS among the population of first degree relatives of MS patients, with the crude prevalence of ALS in the general population of Isfahan. On the other hand, a reverse analysis was carried out to compare the prevalence of MS in Isfahan with its rate amongst the first degree relatives of ALS patients. We found 10 families among which five had first degree kinship. The rate of the diseases was significantly higher in both comparisons among the family members (p < 0.00001) and an odds ratios of more than 67 in both calculations showed a several-fold increase of ALS occurrence in the first degree relatives of MS patients and vice versa. In our study relatives of MS patients were significantly more prone to ALS and vice versa. This could give clues about the common features that the two disease share. Both diseases have an environmental and genetic component and these results mostly point toward genetic similarities.     

Outcomes in adulthood for children with foetal growth retardation. A linkage study from the Nord-Trøndelag Health Study (HUNT) and the Medical Birth Registry of Norway

Objective: The aims were to examine the long‐term functional outcome and risk of mood disorders in adulthood in individuals with foetal growth retardation. Method: In a prospective cohort study of 7806 individuals aged 20–30 years, using linked data from the Health Survey of Nord‐Trøndelag (HUNT‐2) and the Medical Birth Registry of Norway, we studied the long‐term effects of being born with a birth weight below the 10th percentile for gestational age (SGA). Results: SGA individuals had lower educational level (OR: 1.33), lower socioeconomic functioning level (OR: 1.77) and more frequent reported mood disorder in adulthood (OR: 1.26). Analyses of a substratum of infants born at term showed almost identical results. Conclusion: Foetal growth retardation measured as SGA shows a moderate risk for lower education and socioeconomic level and for anxiety and/or depression in young adulthood. Issues concerning interventions for children at risk should be considered.     

The prevalence and incidence of Parkinson’s disease in China: a systematic review and meta-analysis

Parkinson’s disease (PD) is a chronic neurodegenerative disorder affecting older individuals. There is inconsistent evidence about the prevalence and incidence of PD in China at present. The aim of the meta-analysis was to estimate the prevalence and incidence of PD and its relation to age, gender, and stage in China. The literature search was conducted using PubMed, EMBASE, Chinese Biological Medical Literature database (CBM), Chinese National Knowledge Infrastructure database (CNKI), Chinese Wanfang and Chongqing VIP database for studies investigating the prevalence and incidence of PD in China from the commencement of the database until August 2012; both English and Chinese publications were included. We estimated the prevalence and incidence of PD using meta-analysis. Thirteen eligible articles were collected. The results showed that the pooled prevalence and incidence of PD were 2 per 100,000 population and 797 per 100,000 person-years. A higher prevalence of PD was found in males than in females (OR 1.29, 95 % CI 1.05–1.57). The prevalence of PD increased with age: the highest was 1,663 per 100,000 in those aged 80 and older. The overall prevalence of PD is lower in China than in developed countries, but the incidence is higher than in some developed countries. Overall, the prevalence of PD appears to increase with age and there are sex differences evident in Chinese individuals.     

Multiple sclerosis and oxidative stress—a clinical perspective

Multiple Sclerosis (MS) has been traditionally considered to be a chronic inflammatory disease of central nervous system (CNS), resulting in demyelization and clinical presentation of physical disability. Such understanding of MS was solely related to neuroinflammation and its harmful effects; however, count-less data suggest the importance of neurodegenerative mechanisms that are evident in chronic demyelization plaques, and believed to be initiated by oxidative stress. CNS is particularly sensitive to oxidative attack due to the high level of oxygen utilization, relatively small amounts of conventional antioxidants and antioxidative enzymes, and large amounts of polyunsaturated lipids, biomolecules highly susceptible to oxidation. The role and significance of reactive oxygen species (ROS) in MS development has not been fully understood yet, it is believed that ROS formation is primarily orchestrated by immunoinflammatory mechanisms, but there are also data suggesting that certain inflammation independent mechanisms can result in neuronal degeneration and demyelization. They are mainly related to abnormal mitochondria functioning, glutamate excitotoxicity and the disruption of redox active metal homeostasis. Today, there is still a debate whether MS is an immunoinflammatory or neurodegenerative disorder; is it a cause or a consequence of oxidative stress, although clinical trials show encouraging results of antioxidant therapy usage in the disease management.     

Multiple sclerosis and cancer: When two wrongs make a right?

Introduction: Current treatments for multiple sclerosis (MS) remain partially successful, with certain patients remaining treatment resistant. A recent treatment, known as ‘immunoablation’ has been used in severe cases of adult MS with promising results. However, due to its high risk and reservation for severe or refractory cases, its full potential remains unknown.

Methods: We report the case of MM, a 14-year-old boy diagnosed with MS and a concurrent diagnosis of Hodgkin's lymphoma.

Results: After receiving aggressive chemotherapy (immunoablation) for Hodgkin's lymphoma, MM's MS symptoms appear to have remitted, and he has remained progression- and disease activity-free for over six years.

Discussion: This case study will focus on MM's cognitive and behavioural development over this time, but will also discuss treatment implications raised by this rare case.     

Headache in primary Sjögren's syndrome: a prevalence study

Objectives –  To determine the prevalence of headache in patients with primary Sjögren's syndrome (pSS) and to examine the relationship between headache types and clinical, serologic features of the disease.
Methods –  The study enclosed 133 patients with the diagnoses of pSS and 97 healthy controls. A questionnaire designed to assess the presence of headache and if present to classify it according to the criteria of the International Headache Society was used.
Results –  In 133 of the pSS patients evaluated, 104 had headache. No association was present between types of headache and the clinical and laboratory manifestations of the disease. Both migraine and tension-type headache were more common in patients with pSS when compared with healthy controls ( P  < 0.001).
Conclusions –  The high prevalence of migraine in pSS patients might be explained by a vascular headache triggered by immuno-mediated disease activity without an obvious clinic or laboratory marker.