Fatigue in multiple sclerosis: associations with health‐related quality of life and physical performance

Background and purpose: Fatigue is a common, but still one of the least understood symptoms in multiple sclerosis (MS). We aimed to investigate whether fatigue was associated with demographic‐, clinical‐, health‐related quality of life (HRQoL)‐ and physical performance variables, and whether change in fatigue after treatment was associated with changes in HRQoL and physical performance. Methods: Sixty patients were included for inpatient physiotherapy. Fifty‐six patients completed the study and were available for analysis. Fatigue (Fatigue Severity Scale; FSS), HRQoL (Multiple Sclerosis Impact Scale; MSIS‐29) and physical performance (walking ability and balance) were assessed at screening, baseline, after treatment and at follow‐up after 3 and 6 months. We analysed possible associations between fatigue and other variables at baseline by regression models, and between change in fatigue versus changes in both HRQoL and physical performance variables after physiotherapy by correlation analysis. Results: Fatigue at baseline was associated with HRQoL (explained 21.9% of variance), but not with the physical performance tests. Change in fatigue was correlated with change in HRQoL, but not with changes in physical performance. All measures were improved after treatment (P ≤ 0.001). While improvements in fatigue and HRQoL were lost at follow‐up, improvements in physical performance tests were maintained for at least 6 months (P ≤ 0.05). Conclusions: Fatigue was associated with HRQoL at baseline. Improvement in fatigue seemed to be related to other factors than improvement in physical performance. A broader strategy including both physical and psychological dimensions seems to be needed to improve fatigue over the long‐term.     

Overweight and obesity trends in Copenhagen schoolchildren from 2002 to 2007

Aim: The purpose of this study is to monitor the prevalence trend in overweight and obesity among Copenhagen schoolchildren from the school years 2002 to 2007. Methods: Copenhagen community health service doctors conducted routine examinations at school entry (ages 5–8 years) and exit (ages 14–16 years). Body mass index (kg/m²) of 33 245 schoolchildren was calculated. The prevalence of overweight (including obesity) and obesity was classified using the International Obesity Task Force definitions. Results: From 2002 to 2007, although the prevalence of overweight (including obesity) in young girls decreased from 17.8 to 15.9%, the trend was non‐significant. In young boys, the trend slightly decreased, and the prevalence fell from 14.0 to 11.6%. In adolescent girls, the prevalence varied considerably and increased from 22.7 to 25.4% without a discernable trend. In adolescent boys, the trend slightly increased, and the prevalence rose from 15.8 to 18.9%. There were no significant changes in the prevalence of obesity. Conclusion: In contrast to the preceding decades, we identified a potential stagnation in the obesity epidemic among children but a continuing increase among adolescents. It remains critical to continue monitoring and to increase preventive measures to reduce the prevalence of overweight and obesity.     

Safety of specific sublingual immunotherapy with SQ standardized grass allergen tablets in children

The aim of the study was to confirm the safety of an orodispersible grass allergen tablet 75,000 SQ‐T (Grazax^®, ALK‐Abelló A/S, Hørsholm, Denmark) in children aged 5–12 yr. The study was randomized, double‐blinded and placebo‐controlled. Sixty children aged 5–12 yr suffering from grass pollen‐induced rhinoconjunctivitis (with or without asthma) from five centres in two countries (three in Germany and two in Spain) participated in the study. They were randomized at the ratio of 3:1 as receiving either Grazax or placebo tablet given sublingually once daily for 28 days outside the grass pollen season. A total of 810 treatment‐related adverse events were reported in the Grazax group. The majority of these were local reactions in the mouth or throat and were mostly mild (71%) to moderate (27%) in severity and resolved within days. Thirty‐five (78%) subjects treated with Grazax and five (33%) treated with placebo reported at least one treatment‐related adverse event. Oral pruritus, throat irritation, mouth oedema and ear pruritus appeared as the most frequently reported treatment‐related adverse events. 62% (28 of 45) of the actively treated subjects reported oral pruritus, 36% (16 of 45) throat irritation, 31% (14 of 45) mouth oedema and 22% (10 of 45) ear pruritus. Two actively treated subjects withdrew from the study: one subject due to four adverse events (moderate eye pruritus, moderate pharyngolaryngeal pain, moderate non‐cardiac chest pain and moderate dysphagia) and one subject due to a serious adverse event (asthmatic attack). The subjects recovered completely from the events. In conclusion, in the present study, Grazax was in general tolerated in a paediatric population and considered suitable for further clinical investigations in children.     

Steroid-free immunosuppression after renal transplantation-long-term experience from a single centre.

BACKGROUND: A steroid-free immunosuppressive protocol may improve the general well-being of patients, but long-term renal graft survival has been a concern. METHODS: In a retrospective clinical study, 329 consecutive transplantations with renal grafts at our centre during the period 1995-2004, were followed for up to 9.3 years. Patients mainly received steroid-free immunosuppression with an initial induction with antithymocyte globulin or basiliximab and maintenance therapy with ciclosporin and mycophenolate mofetil (MMF). Steroids were given after rejection, or if the physician judged it necessary, for instance because of primary kidney disease or when calcineurin inhibitor toxicity was suspected. RESULTS: About 71% of the patients did not take steroids at all. Nevertheless, graft survival rates at 1, 5 and 7 years were 95, 77 and 72% for all grafts, including 27% living donor transplants and 27% second or subsequent grafts. Ten patients (3.2%) died with functioning grafts. Within the first year of transplantation there were 69 acute rejections in 63 patients (19%). Four cases (1.3%) of post-transplant lymphoproliferative disorder (PTLD) occurred with one graft loss and no deaths. Owing to a high PTLD rate in a previous patient cohort, total immunosuppression was lessened after 1998. CONCLUSIONS: Steroid avoidance is possible with good results with respect to acute rejection and long-term graft survival. After introducing MMF, largely avoiding muromonab-CD3 mouse raised monoclonal antibody against CD (OKT3), and reducing doses of calcineurin inhibitor, the rates of PTLD did not differ from what is usually found. For the present, induction and use of MMF, together with a calcineurin inhibitor, is probably to be preferred.