• Rabeprazole versus omeprazole in preventing relapse of erosive or ulcerative gastroesophageal reflux disease: a double-blind, multicenter, European trial

      Thjodleifsson, B; Beker, J A; Dekkers, C; Bjaaland, T; Finnegan, V; Humphries, T J; National Hospital of Iceland, Reykjavik. (Springer Science + Business Media, 2000-05-01)
      Gastroesophageal reflux disease (GERD) is a chronic condition, with 50-80% of patients experiencing recurrence within one year of completing initial treatment. In patients with erosive GERD, proton-pump inhibitors (PPI) provide faster healing and symptom relief than do H2-receptor antagonists and have become the treatment of choice. Rabeprazole is a new PPI with demonstrated efficacy in both the acute and maintenance treatment of erosive GERD. The primary objective was to compare efficacy and tolerability of rabeprazole and omeprazole in preventing relapse of healed erosive GERD. Secondary objectives included comparison of efficacy in preventing GERD relapse symptoms and in maintaining quality of life. In this multicenter, double-blind, parallel-group study, 243 patients with healed erosive GERD were randomised to receive rabeprazole 10 mg once daily in the morning (QAM) (N = 82); rabeprazole 20 mg QAM (N = 78); or omeprazole 20 mg QAM (N = 83). Endoscopies were performed at weeks 13, 26, 39 (if clinically indicated), and 52, or when symptoms suggested recurrence. Corpus biopsies were performed at each endoscopy, and antral biopsies were performed at study entry and exit. Rabeprazole 10 mg and 20 mg QAM were equivalent to omeprazole 20 mg QAM for all efficacy parameters. At week 52, relapse rates in the intent-to-treat populations were 5%, 4%, and 5% for rabeprazole 10 mg and 20 mg and omeprazole 20 mg, respectively. All treatments were well tolerated. In conclusion, both rabeprazole 10 mg and 20 mg QAM are equivalent to omeprazole 20 mg QAM in preventing recurrence of erosive GERD.
    • Race/ethnicity and cancer occurrence in systemic lupus erythematosus

      Bernatsky, S; Boivin, J F; Joseph, L; Manzi, S; Ginzler, E; Urowitz, M; Gladman, D; Fortin, P; Gordon, C; Barr, S; et al. (Wiley-Liss, Inc, 2005-10-15)
    • Racial differences of lens transparency properties with aging and prevalence of age-related cataract applying a WHO classification system

      Sasaki, Kazuyuki; Sasaki, Hiroshi; Jonasson, Fridbert; Kojima, Masami; Cheng, Hong Ming (Karger, 2004-11-01)
      PURPOSE: To investigate racial differences of lens transparency properties and the prevalence of lens opacification by age. METHODS: Lenses of randomly selected Asian (1,038 Japanese and 517 Singaporeans) and Caucasian (1,045 Icelanders) subjects were evaluated for their lens transparency property (LTP). The prevalence of lens opacification was determined with a newly proposed WHO cataract classification system. RESULTS: LTP increased with aging for all nationalities. Light scattering intensity was significantly higher in the Singaporeans followed by the Icelandic subjects. The prevalence of cortical opacification in Singaporeans was significantly higher than those of the other nationalities up to the age of 60, and the prevalence in Asians was significantly higher than that in Caucasians aged 60-69. Cortical opacification was more prevalent than the other types for both Japanese and Icelanders in their 50s, 60s and 70s. Regarding the central optical zone, the prevalence in the Singaporeans was significantly higher than in the other two groups in their 50s and 60s. The prevalence of nuclear opacification in Singaporeans was markedly higher than those of the two other groups for all ages. Subcapsular cataract was the least prevalent type for all age groups and nationalities; however, the highest prevalence was observed in Singaporeans. CONCLUSIONS: Lens transparency decreased with age in the Singaporeans more markedly than in the other two groups. The high prevalence of nuclear opacification in Singaporeans is considered to be due to environmental rather than race-specific factors.
    • RAD50 and NBS1 are breast cancer susceptibility genes associated with genomic instability.

      Heikkinen, Katri; Rapakko, Katrin; Karppinen, Sanna-Maria; Erkko, Hannele; Knuutila, Sakari; Lundán, Tuija; Mannermaa, Arto; Børresen-Dale, Anne-Lise; Borg, Ake; Barkardottir, Rosa B; et al. (Irl Press At Oxford University Press, 2006-08-01)
      The Mre11 complex, composed of RAD50, NBS1 and MRE11, has an essential role in the maintenance of genomic integrity and preventing cells from malignancy. Here we report the association of three Mre11 complex mutations with hereditary breast cancer susceptibility, studied by using a case-control design with 317 consecutive, newly diagnosed Northern Finnish breast cancer patients and 1000 geographically matched healthy controls (P = 0.0004). RAD50 687delT displayed significantly elevated frequency in the studied patients (8 out of 317, OR 4.3, 95% CI 1.5-12.5, P= 0.008), which indicates that it is a relatively common low-penetrance risk allele in this cohort. Haplotype analysis and the screening of altogether 512 additional breast cancer cases from Sweden, Norway and Iceland suggest that RAD50 687delT is a Finnish founder mutation, not present in the other Nordic cohorts. The RAD50 IVS3-1G>A splicing mutation leading to translational frameshift was observed in one patient, and the NBS1 Leu150Phe missense mutation affecting a conserved residue in the functionally important BRCA1 carboxy-terminal (BRCT) domain in two patients, both being absent from 1000 controls. Microsatellite marker analysis showed that loss of the wild-type allele was not involved in the tumorigenesis in any of the studied mutation carriers, but they all showed increased genomic instability assessed by cytogenetic analysis of peripheral blood T-lymphocytes (P = 0.006). In particular, the total number of chromosomal rearrangements was significantly increased (P = 0.002). These findings suggest an effect for RAD50 and NBS1 haploinsufficiency on genomic integrity and susceptibility to cancer.
    • RAD51 135G-->C modifies breast cancer risk among BRCA2 mutation carriers: results from a combined analysis of 19 studies.

      Antoniou, Antonis C; Sinilnikova, Olga M; Simard, Jacques; Léoné, Mélanie; Dumont, Martine; Neuhausen, Susan L; Struewing, Jeffery P; Stoppa-Lyonnet, Dominique; Barjhoux, Laure; Hughes, David J; et al. (American journal of human genetics, 2007-12-01)
      RAD51 is an important component of double-stranded DNA-repair mechanisms that interacts with both BRCA1 and BRCA2. A single-nucleotide polymorphism (SNP) in the 5' untranslated region (UTR) of RAD51, 135G-->C, has been suggested as a possible modifier of breast cancer risk in BRCA1 and BRCA2 mutation carriers. We pooled genotype data for 8,512 female mutation carriers from 19 studies for the RAD51 135G-->C SNP. We found evidence of an increased breast cancer risk in CC homozygotes (hazard ratio [HR] 1.92 [95% confidence interval {CI} 1.25-2.94) but not in heterozygotes (HR 0.95 [95% CI 0.83-1.07]; P=.002, by heterogeneity test with 2 degrees of freedom [df]). When BRCA1 and BRCA2 mutation carriers were analyzed separately, the increased risk was statistically significant only among BRCA2 mutation carriers, in whom we observed HRs of 1.17 (95% CI 0.91-1.51) among heterozygotes and 3.18 (95% CI 1.39-7.27) among rare homozygotes (P=.0007, by heterogeneity test with 2 df). In addition, we determined that the 135G-->C variant affects RAD51 splicing within the 5' UTR. Thus, 135G-->C may modify the risk of breast cancer in BRCA2 mutation carriers by altering the expression of RAD51. RAD51 is the first gene to be reliably identified as a modifier of risk among BRCA1/2 mutation carriers.
    • Radiation dose and relapse are predictors for development of second malignant solid tumors after cancer in childhood and adolescence: a population-based case-control study in the five Nordic countries

      Svahn-Tapper, Gudrun; Garwicz, Stanislaw; Anderson, Harald; Shamsaldin, Akthar; De Vathaire, Florent; Olsen, Jørgen H; Døllner, Henrik; Hertz, Henrik; Jonmundsson, Gudmundur; Langmark, Frøydis; et al. (Taylor & Francis, 2006-06-01)
      The aim of the study was to assess the risk with radiation therapy and chemotherapy of the first cancer in childhood and adolescence for the development of a second malignant solid tumor (SMST). Also, the role of relapse of the primary tumor was studied. It is a nested case-control study within a Nordic cohort of patients less than 20 years of age at first diagnosis 1960-1987. SMSTs were diagnosed in 1960-1991. There were 196 cases and 567 controls. The risk was increased only for radiotherapy given more than five years before the development of the SMST. A significantly increased relative risk of 1.8 was found already at doses below 1 Gy. The risk increased rapidly up to a maximum of 18.3 for doses above 30 Gy. Chemotherapy alone did not increase the risk to develop an SMST. However, in combination with radiotherapy, chemotherapy showed a significant potentiating effect. Relapse was found to be an independent risk factor for development of an SMST, with a higher relative risk for females than for males.
    • Radiation therapy and concurrent topotecan followed by maintenance triple anti-angiogenic therapy with thalidomide, etoposide, and celecoxib for pediatric diffuse intrinsic pontine glioma.

      Porkholm, Mikaela; Valanne, Leena; Lönnqvist, Tuula; Holm, Stefan; Lannering, Birgitta; Riikonen, Pekka; Wojcik, Dorota; Sehested, Astrid; Clausen, Niels; Harila-Saari, Arja; et al. (Wiley-Blackwell, 2014-09)
      Despite major treatment attempts, the prognosis for pediatric diffuse intrinsic pontine gliomas (DIPGs) remains dismal. Gliomas are highly vascularized tumors, suggesting that the prevention of vessel formation by anti-angiogenic treatment might be effective.
    • Radical cystectomy in the treatment of bladder cancer in Iceland: A population-based study.

      Björnsson, Oddur; Gudmundsson, Eirikur Orri; Marteinsson, Valur Thor; Jonsson, Eirikur; [ 1 ] Landspitali Univ Hosp, Dept Urol, IS-101 Reykjavik, Iceland   Organization-Enhanced Name(s)      Landspitali National University Hospital [ 2 ] Akureyri Hosp, Dept Surg, Reykjavik, Iceland (Taylor & Francis, 2016-02)
      Radical cystectomy (RC) is the standard treatment for muscle-invasive bladder cancer. Postoperative complications are reported to be as high as 65%. The objective of this study was to investigate complications and survival in Icelandic patients with bladder cancer who underwent RC.
    • Radiographic scoring systems for psoriatic arthritis are insufficient for psoriatic arthritis mutilans: results from the Nordic PAM Study.

      Laasonen, Leena; Lindqvist, Ulla; Iversen, Lars; Ejstrup, Leif; Jonmundsson, Thorarinn; Ståhle, Mona; Gudbjornsson, Bjorn; 1Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland. 2Department of Medical Sciences, Rheumatology, Uppsala University, Uppsala, Sweden. 3Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark. 4Department of Rheumatology, Odense University Hospital, Odense, Denmark. 5Centre for Rheumatology Research, University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 6Dermatology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. (SAGE Publications, 2020-04-27)
      Background: Psoriatic arthritis mutilans (PAM) is the most severe phenotype of psoriatic arthritis (PsA). Purpose: To describe the radiological features in PAM and explore whether existing scoring systems for radiological damage in psoriatic arthritis are applicable for PAM. Material and methods: Radiographs were scored according to the modified Sharp-van der Heijde (mSvdH) and the Psoriatic Arthritis Ratingen Score (PARS) systems for PsA. Results: At inclusion, 55 PAM patients (49% women, mean age 58 ± 12 years) had conventional radiographs of both hands and feet. A total of 869 PAM joints were detected and 193 joints with ankylosis. The mean total mSvdH score was 213.7 ± 137.8 (41% of maximum) with a higher score for hands than for feet: 136.6 ± 90.1 vs. 79.1 ± 60.9. However, the total score was relatively higher in the feet than in the hands when compared to the highest possible scoring (47% vs. 38% of max). The mean total PARS score was 126.3 ± 79.6 (35% of max). Scoring for joint destruction was higher than for proliferation (22% vs. 11% of max). Strong correlation was found between mSvdH and PARS (r2 = 0.913). A significant correlation was found between scoring and duration of arthritis and the Health Assessment Questionnaire. History of smoking, BMI, and gender did not influence the scoring values. Conclusions: The two scoring systems studied may not be ideal to indicate progression of PAM in advanced disease since they reach ceiling effects rather early. Therefore, reporting early signs suggestive of PAM, e.g. signs of pencil-in-cup deformities or osteolysis, is crucial. This would reveal the presence of PAM and might lead to improved treatment in order to minimize joint damage. Keywords: Psoriatic arthritis; mutilans; psoriasis; radiology; scoring systems.
    • Radiological imaging of the neck for initial decision-making in oral squamous cell carcinomas--a questionnaire survey in the Nordic countries.

      Norling, Rikke; Grau, Cai; Nielsen, Michael B; Homøe, Preben; Sørensen, Jens A; Lambertsen, Karin; Bundgaard, Troels; Mäkitie, Antti; Grénman, Reidar; Larenne, Jussi; et al. (Informa Healthcare, 2012-03)
      Fast and accurate work-up is crucial to ensure the best possible treatment and prognosis for patients with head and neck cancer. The presence or absence of neck lymph node metastases is important for the prognosis and the choice of treatment. Clinical lymph node (N)-staging is done by palpation and diagnostic imaging of the neck. We investigated the current practice of the initial radiological work-up of patients with oral squamous cell carcinomas (OSCC) in the Nordic countries. A questionnaire regarding the availability and use of guidelines and imaging modalities for radiological N-staging in OSCC was distributed to 21 Head and Neck centres in Denmark (n = 4), Finland (n = 5), Iceland (n = 1), Norway (n = 4) and Sweden (n = 7). We also asked for a description of the radiological criteria for determining the lymph nodes as clinical positive (cN+) or negative (cN0). All 21 Head and Neck centres responded to the questionnaire. Denmark and Finland have national guidelines, while Norway and Sweden have local or regional guidelines. Seventeen of the 19 centres with available guidelines recommended computed tomography (CT) of the cN0 neck. The waiting time may influence the imaging modalities used. Lymph node size was the most commonly used criteria for radiological cN+, but the cut-off measures vary from 0.8 to 2.0 cm. Overall, CT is the most commonly recommended and used imaging modality for OSCC. Despite availability of national guidelines the type and number of radiological examinations vary between centres within a country, but the implementation of a fast-track programme may facilitate fast access to imaging. The absence of uniform criteria for determining the lymph nodes of the neck as cN+ complicates the comparison of the accuracy of the imaging modalities. Well-defined radiological strategies and criteria are needed to optimise the radiological work-up in OSCC.
    • A radiostereometric analysis of the Bryan Cervical Disc prosthesis

      Lind, Bengt; Zoëga, Björn; Anderson, Paul A (Lippincott Williams & Wilkins, 2007-04-15)
      STUDY DESIGN: Prospective, radiostereometric study of the Bryan Cervical Disc prosthesis (Medtronic Sofamor Danek, Memphis, TN) for the treatment of a single-level disc disease of the cervical spine. OBJECTIVE: To study the stability of the titanium endplates of the disc prosthesis at the interface between the bone and prosthesis. SUMMARY OF BACKGROUND DATA: Cervical disc prosthesis is a motion-sparing technology in which the longevity is dependent on initial fixation as well as secondary fixation with bone ingrowth into the surface of the device. Little is known regarding the stability of this fixation with the currently studied prosthesis. METHODS: Eleven patients with symptomatic cervical radiculopathy underwent implantation of a radiostereometry modified Bryan prosthesis after a standard anterior cervical discectomy. The adjacent vertebrae were perioperatively marked with tantalum markers. The patients were then frequently studied with radiostereometric radiographs and evaluated for pain, and neurologic and physical function for 2 years. RESULTS: Both titanium endplates of the device were immediately stable in 5 patients. Small but measurable changes (micromotions) were recorded in 4 patients until the 3-month examination and in 2 patients at the 3-6-month time period. All prostheses continued to be stable after 6 months until the final assessment at 2 years after surgery. The recorded micromotions did not influence the clinical results. CONCLUSIONS: The Bryan prosthesis is immediately stable in many patients and is securely fixed to the bone within 3-6 months in all patients. The result of this study suggests that there is sufficient bone ingrowth on the coated surface of the Bryan prosthesis endplates to stabilize securely the prosthesis.
    • Rafeyðing á hvekk um þvagrás sökum hvekkauka : árangur fyrstu fimm árin

      Valur Þór Marteinsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 2005-02-01)
      Objective: The most common surgical intervention for lower urinary tract symptoms due to benign prostatic enlargement has been transurethral resection of the prostate (TURP). Transurethral electrovaporization of the prostate (TUVP) is a recent modification of TURP and has been used in Central Hospital Akureyri from 1997. The purpose of this study was to evaluate the safety, complications, efficacy and clinical indications in patients undergoing TUVP with benign prostatic enlargement in five years period. Material and methods: 36 patients underwent TUVP in the period January 1997 to March 2002. Prospective registration was performed during the first 4-8 weeks after operation. The author evaluated all patients before the intervention. Conventional surgical instruments for transurethral surgery were used with a roller electrode instead of a loop and in half of the patients some tissue was removed with a loop. Results: The average age was 77.2 years (56-94) and average hospital stay was 5.3 days (2-14). 24 (58.4%) patients had urinary retention before the operation and average operation time was 27.6 minutes (15-42). No operative or in-hospital mortality was in this study or during the first 30 days and all patients were discharged. No one required transfusion or re-intervention within 30 days from operation. Three (8.3%) patients got complications within 30 days and one underwent bladder neck incision during the follow-up period. 32 (89%) were discharged without urinary catheter and 33 (91.7%) were satisfied with the result of the operation. Conclusions: TUVP is a safe, efficacious and technically feasible operation for patients with benign prostatic enlargement. Despite limited material, the clinical outcome and complications rate were comparable to larger series.
    • Raised IgA rheumatoid factor (RF) but not IgM RF or IgG RF is associated with extra-articular manifestations in rheumatoid arthritis

      Jonsson, T; Arinbjarnarson, S; Thorsteinsson, J; Steinsson, K; Geirsson, A J; Jonsson, H; Valdimarsson, H; Department of Immunology, National University Hospital, Landspítalinn, Reykjavík, Iceland. (Informa Healthcare, 1995)
      In rheumatoid arthritis (RA) seropositivity has been associated with poor prognosis including bone erosions and extra-articular manifestations. However, findings have been conflicting on the association between individual rheumatoid factor (RF) isotypes and extra-articular manifestations. In this study the occurrence of extra-articular manifestations was examined in the context of the RF isotype patterns rather than individual RF isotypes. IgM, IgG and IgA RF was measured by ELISA in 74 patients with RA and the findings correlated with the presence or absence of extra-articular manifestations. Of the IgA RF positive patients 80% had one or more extra-articular manifestations. In contrast, only 21% of patients with raised IgM and/or IgG RF but normal IgA RF had some extra-articular manifestations and 27% of the seronegative patients. It is concluded that the previously reported association between raised RF and extra-articular manifestations in RA can largely be attributed to the IgA RF isotype.
    • Raloxifene for older women: a review of the literature

      Hansdottir, Helga; Department of Geriatrics, Landspitali University Hospital, Landakoti, Reykjavik, Iceland. helgah@lsh.is (Dove Medical Press, 2008)
      Raloxifene is a non-steroidal selective estrogen-receptor modulator (SERM) which is used for prevention and treatment of postmenopausal osteoporosis. Raloxifene decreases the incidence of vertebral fractures by 30%-50% in postmenopausal women with osteoporosis but has not been shown to decrease the incidence of hip fractures or other non-vertebral fractures. At the present time, estrogen-replacement therapy and bisphosphonate treatment are the only medical treatments that are proven to prevent hip fractures with the exception of vitamin D and calcium replacement, which has been shown to prevent hip fractures in elderly individuals and nursing home residents. Raloxifene has been shown to have additive effects on bone turnover and bone mineral density (BMD) when used along with alendronate and teriparatide. Raloxifene could have a role in renal failure as it has been shown to increase BMD of the vertebra over 1 year of therapy. Raloxifene is as effective as tamoxifen in reducing the risk of invasive breast cancer. The increased incidence of venous thromboembolism is the main concern of raloxifene therapy and previous history of venous thromboembolism is a contraindication for use of raloxifene. Raloxifene has a role in treatment of vertebral osteoporosis in older women. The decision to use raloxifene should be based on evaluation of fracture risk and on potential other benefits than fracture reduction along with consideration of side effects.
    • A randomised study of tailored toxicity-based dosage of fluorouracil-epirubicin-cyclophosphamide chemotherapy for early breast cancer (SBG 2000-1).

      Lindman, H; Andersson, M; Ahlgren, J; Balslev, E; Sverrisdottir, A; Holmberg, S B; Bengtsson, N O; Jacobsen, E H; Jensen, A B; Hansen, J; et al. (Elsevier Science Ltd., 2018-05)
      Retrospective studies have demonstrated a worse outcome in breast cancer patients not developing leukopenia during adjuvant chemotherapy. The SBG 2000-1 is the first randomised trial designed to compare individually dosed chemotherapy without G-CSF support based on grade of toxicity to standard-dosed chemotherapy based on body surface area (BSA).
    • Randomized clinical trial of musical distraction with and without headphones for adolescents' immunization pain.

      Kristjánsdóttir, Ólöf; Kristjánsdóttir, Guðrún; Dalhousie University and IWK Health Centre, Halifax, NS, Canada. ol939557@dal.ca (Taylor & Francis, 2011-03)
      Distraction has shown to be a helpful pain intervention for children; however, few investigations have studied the effectiveness of this method with adolescents. The aim of this study was to evaluate the usefulness of an easy and practical musical distraction in reducing adolescents' immunization pain. Furthermore, to examine whether musical distraction techniques (with or without headphones) used influenced the pain outcome. Hundred and eighteen 14-year-old adolescents, scheduled for polio immunization, participated. Adolescents were randomly assigned to one of three research groups; musical distraction with headphones (n=38), musical distraction without headphones (n=41) and standard care control (n=39). Results showed adolescents receiving musical distraction were less likely to report pain compared to the control group, controlling for covariates. Comparing musical distraction techniques, eliminating headphone emerged as a significant predictor of no pain. Results suggest that an easy and practical musical distraction intervention, implemented without headphones, can give some pain relief to adolescents during routine vaccination.
    • Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe.

      Wells, Jonathan C K; Jonsdottir, Olof H; Hibberd, Patricia L; Fewtrell, Mary S; Thorsdottir, Inga; Eaton, Simon; Lucas, Alan; Gunnlaugsson, Geir; Kleinman, Ronald E; Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom. (American Society of Nutrition -ASN, 2012-07)
      The WHO recommends exclusive breastfeeding (EBF) for 6 mo after birth. However, the time at which breast milk ceases to provide adequate energy and nutrition, requiring the introduction of complementary foods, remains unclear. Most studies that investigated this issue were observational and potentially confounded by variability in social circumstances or infant growth. We hypothesized that EBF infants would consume more breast milk at age 6 mo than infants receiving breast milk and complementary foods. We measured anthropometric outcomes, body composition, and breast-milk intake at age 6 mo in infants who were randomly assigned at age 4 mo either to 6-mo EBF or to the introduction of complementary foods with continued breastfeeding. We recruited 119 infants from health centers in Reykjavik and neighboring municipalities in Iceland. In 100 infants who completed the protocol (50/group), breast-milk intake was measured by using stable isotopes, and complementary food intakes were weighed over 3 d in the complementary feeding (CF) group. Breast-milk intake was 83 g/d (95% CI: 19, 148 g/d) greater in EBF (mean ± SD: 901 ± 158 g/d) than in CF (818 ± 166 g/d) infants and was equivalent to 56 kcal/d; CF infants obtained 63 ± 52 kcal/d from complementary foods. Estimated total energy intakes were similar (EBF: 560 ± 98 kcal/d; CF: 571 ± 97 kcal/d). Secondary outcomes (anthropometric outcomes, body composition) did not differ significantly between groups. On a group basis, EBF to age 6 mo did not compromise infant growth or body composition, and energy intake at age 6 mo was comparable to that in CF infants whose energy intake was not constrained by maternal breast-milk output.
    • A randomized controlled trial reporting functional outcomes of cognitive-behavioural therapy in medication-treated adults with ADHD and comorbid psychopathology.

      Young, Susan; Emilsson, Brynjar; Sigurdsson, Jon Fridrik; Khondoker, Mizanur; Philipp-Wiegmann, Florence; Baldursson, Gisli; Olafsdottir, Halldora; Gudjonsson, Gisli; 1 Centre for Psychiatry, Imperial College London, Du Cane Road, London, W12 0NN, UK. susan.young1@imperial.ac.uk. 2 Broadmoor Hospital, WLMHT, Crowthorne, UK. susan.young1@imperial.ac.uk. 3 Reykjavik University, Reykjavik, Iceland. susan.young1@imperial.ac.uk. 4 Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK. 5 Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland. 6 Reykjavik University, Reykjavik, Iceland. 7 University of Iceland, Reykjavik, Iceland. 8 Department of Applied Health Research, University College London, London, UK. 9 Broadmoor Hospital, WLMHT, Crowthorne, UK. (Springer Heidelberg, 2017-04)
      Studies assessing psychological treatment of attention deficit hyperactivity disorder (ADHD) in adults are increasingly reported. However, functional outcomes are often neglected in favour of symptom outcomes. We investigated functional outcomes in 95 adults with ADHD who were already treated with medication and randomized to receive treatment as usual (TAU/MED) or psychological treatment (CBT/MED) using a cognitive-behavioural programme, R&R2ADHD, which employs both group and individual modalities. RATE-S functional outcomes associated with ADHD symptoms, social functioning, emotional control and antisocial behaviour were given at baseline, end of treatment and three-month follow-up. The Total composite score of these scales is associated with life satisfaction. In addition, independent evaluator ratings of clinicians who were blind to treatment arm were obtained on the Clinical Global Impression scale at each time point. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater functional improvement on all scales. Post-group treatment effects were maintained at follow-up with the exception of emotional control and the Total composite scales, which continued to improve. The largest treatment effect was for the RATE-S Total composite scale, associated with life satisfaction. CGI significantly correlated with all outcomes except for social functioning scale at follow-up. The study provides further evidence for the effectiveness of R&R2ADHD and demonstrates the importance of measuring functional outcomes. The key mechanism associated with improved functional outcomes is likely to be behavioural control.
    • Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content.

      Thorsdottir, I; Tomasson, H; Gunnarsdottir, I; Gisladottir, E; Kiely, M; Parra, M D; Bandarra, N M; Schaafsma, G; Martinéz, J A (Nature Pub. Group, 2007-10-01)
      OBJECTIVE: To investigate the effect of including seafood and fish oils, as part of an energy-restricted diet, on weight loss in young overweight adults. DESIGN: Randomized controlled trial of energy-restricted diet varying in fish and fish oil content was followed for 8 weeks. Subjects were randomized to one of four groups: (1) control (sunflower oil capsules, no seafood); (2) lean fish (3 x 150 g portions of cod/week); (3) fatty fish (3 x 150 g portions of salmon/week); (4) fish oil (DHA/EPA capsules, no seafood). The macronutrient composition of the diets was similar between the groups and the capsule groups, were single-blinded. SUBJECTS: A total of 324 men and women aged 20-40 years, BMI 27.5-32.5 kg/m(2) from Iceland, Spain and Ireland. MEASUREMENTS: Anthropometric data were collected at baseline, midpoint and endpoint. Confounding factors were accounted for, with linear models, for repeated measures with two-way interactions. The most important interactions for weight loss were (diet x energy intake), (gender x diet) and (gender x initial-weight). RESULTS: An average man in the study (95 kg at baseline receiving 1600 kcal/day) was estimated to lose 3.55 kg (95% CI, 3.14-3.97) (1); 4.35 kg (95% CI, 3.94-4.75) (2); 4.50 kg (95% CI, 4.13-4.87) (3) and 4.96 kg (95% CI, 4.53-5.40) on diet (4) in 4 weeks, from baseline to midpoint. The weight-loss from midpoint to endpoint was 0.45 (0.41-0.49) times the observed weight loss from baseline to midpoint. The diets did not differ in their effect on weight loss in women. Changes in measures of body composition were in line with changes in body weight. CONCLUSION: In young, overweight men, the inclusion of either lean or fatty fish, or fish oil as part of an energy-restricted diet resulted in approximately 1 kg more weight loss after 4 weeks, than did a similar diet without seafood or supplement of marine origin. The addition of seafood to a nutritionally balanced energy-restricted diet may boost weight loss.
    • A randomized, double-blind trial of the efficacy and safety of 10 or 20 mg rabeprazole compared with 20 mg omeprazole in the maintenance of gastro-oesophageal reflux disease over 5 years.

      Thjodleifsson, B; Rindi, G; Fiocca, R; Humphries, T J; Morocutti, A; Miller, N; Bardhan, K D (Blackwell Scientific Publications, 2003-02-01)
      BACKGROUND: Gastro-oesophageal reflux disease has a chronic course, and often requires long-term treatment. Proton pump inhibitors are the treatment of choice for both acute and maintenance treatment, but little is known from randomized controlled trials of their effects beyond 1 year. AIM: To compare the efficacy and safety of two doses of rabeprazole with 20 mg omeprazole in the maintenance treatment of erosive gastro-oesophageal reflux disease over 5 years. METHODS: Two hundred and forty-three patients who had previously responded to acute treatment for erosive gastro-oesophageal reflux disease were prospectively randomized to receive 5 years of treatment with rabeprazole (10 or 20 mg daily) or omeprazole (20 mg daily). The primary outcome measure was endoscopically confirmed relapse of erosive gastro-oesophageal reflux disease. RESULTS: One hundred and twenty-three patients (51%) completed all 5 years of the study, with similar completion rates in the three groups. Relapses occurred in nine of 78 (11.5%), eight of 82 (9.8%) and 11 of 83 (13.3%) patients in the rabeprazole 20 mg, rabeprazole 10 mg and omeprazole 20 mg groups, respectively. Gastric biopsy showed no evidence of any harmful effects. All treatments were well tolerated. CONCLUSIONS: Rabeprazole 10 mg, rabeprazole 20 mg and omeprazole 20 mg all had similar efficacy in the maintenance treatment of gastro-oesophageal reflux disease. All three were safe and well tolerated during 5 years of treatment.