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1. Health-related quality of life in ANCA-associated vasculitis and item generation for a disease-specific patient-reported outcome measure

Author

Robson JC, Dawson J, Cronholm PF, Milman N, Kellom KS, Ashdown S, Easley E, Farrar JT, Gebhart D, Lanier G, McAlear CA, Peck J, Luqmani RA, Shea JA, Tomasson G, and Merkel PA

Subjects
ANCA-associated vasculitis Quality of Life Patient reported outcomes Granulomatosis with polyangiitis Microscopic polyangiitis Eosinophilic granulomatosis with polyangiiitis, Medicine (General), R5-920
Abstract

Joanna C Robson,1,2 Jill Dawson,3 Peter F Cronholm,4 Nataliya Milman,5 Katherine S Kellom,6 Susan Ashdown,7 Ebony Easley,8 John T Farrar,9 Don Gebhart,10,11 Georgia Lanier,10,11 Carol A McAlear,12 Jacqueline Peck,7 Raashid A Luqmani,7 Judy A Shea,13 Gunnar Tomasson,14 Peter A Merkel10,11 1Department of Rheumatology, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; 2School of Clinical Sciences, University of Bristol, Bristol, UK; 3Department of Population Health (HSRU), University of Oxford, Oxford, UK; 4Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA; 5Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada; 6PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA; 7Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; 8Department of Family Medicine and Community Health, Mixed Methods Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA; 9Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; 10Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 11Department of Biostatistics and Clinical Epidemiology, University of Pennsylvania, Philadelphia, PA, USA; 12Vasculitis Research, University of Pennsylvania, Philadelphia, PA, USA; 13School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 14Department of Public Health Sciences, University of Iceland, Reykjavik, Iceland Objective: The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are multisystem diseases of the small blood vessels. Patients experience irreversible damage and psychological effects from AAV and its treatment. An international collaboration was created to investigate the impact of AAV on health-related quality of life (HRQoL), and develop a disease-specific patient-reported outcome measure to assess outcomes of importance to patients.Methods: Patients with AAV from the UK, USA, and Canada were interviewed to identify salient aspects of HRQoL affected by AAV. The study was overseen by a steering committee including four patient research partners. Purposive sampling of interviewees ensured representation of a range of disease manifestations and demographics. Inductive analysis was used to identify themes of importance to patients; these were further confirmed by a free-listing exercise in the US. Individual themes were recast into candidate items, which were scrutinized by patients, piloted through cognitive interviews and received a linguistic and translatability evaluation.Results: Fifty interviews, conducted to saturation, with patients from the UK, USA, and Canada, identified 55 individual themes of interest within seven broad domains: general health perceptions, impact on function, psychological perceptions, social perceptions, social contact, social role, and symptoms. Individual themes were constructed into >100 candidate questionnaire items, which were then reduced and refined to 35 candidate items.Conclusion: This is the largest international qualitative analysis of HRQoL in AAV to date, and the results have underpinned the development of 35 candidate items for a disease-specific, patient-reported outcome questionnaire. Keywords: ANCA-associated vasculitis, quality of life, patient-reported outcomes, granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis

Published
2018

2. Variations in the clinical practice of physicians managing Takayasu arteritis: a nationwide survey

Author

Barra L, Liang P, Benseler SM, Cabral DA, Fifi-Mah A, Li Y, Milman N, Twilt M, Yacyshyn E, and Pagnoux C

Subjects
Takayasu Arteritis, physician practice patterns, practice guidelines, Diseases of the musculoskeletal system, RC925-935
Abstract

Lillian Barra,1 Patrick Liang,2 Susanne M Benseler,3 David A Cabral,4 Aurore Fifi-Mah,5 Yueyang Li,1 Nataliya Milman,6 Marinka Twilt,3 Elaine Yacyshyn,7 Christian Pagnoux8 1Division of Rheumatology, The University of Western Ontario, St Joseph’s Health Care, London, Ontario, 2Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, 3Division of Rheumatology, Department of Paediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, 4Division of Rheumatology, BC Children’s Hospital, Vancouver, British Columbia, 5Division of Rheumatology, South Health Campus, University of Calgary, Calgary, Alberta, 6Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, 7Division of Rheumatology, University of Alberta, Edmonton, Alberta, 8Department of Rheumatology, Mount Sinai Hospital, Toronto, University of Toronto, Ontario, Canada Objective: Takayasu arteritis (TAK) is a large vessel vasculitis that predominately affects young women and can cause severe ischemic complications. Given the rarity of TAK, the management of this condition is challenging. We aim to describe current rheumatologist practices for the management of TAK and identify discrepancies and gaps in knowledge. Methods: An online survey (developed by the Canadian Vasculitis Network and approved by the Canadian Rheumatology Association) containing 48 questions with regard to the diagnosis, monitoring and treatment of TAK was distributed to 495 Canadian adult and pediatric rheumatologists by email. Results: Sixty-six rheumatologists completed the survey (13% response rate): the majority (73%) were from academic centers and ≤25% reported managing more than ten patients in their career. For establishing the diagnosis of TAK, they relied on a combination of signs and symptoms of ischemia, elevations of inflammatory markers and vascular imaging (typically computed tomography and magnetic resonance angiography). The frequency of monitoring for disease activity and the methods employed (clinical, laboratory or imaging) were variable. All physicians used corticosteroids for the treatment of TAK, but 42% would treat for at least 6–12 months, 26% for 12–24 months and 23% would never stop corticosteroids. Fifty-three percent would always use an immunosuppressant (most commonly methotrexate or azathioprine) in addition to corticosteroids and the remainder would only start an immunosuppressant in patients with refractory or relapsing disease. Conclusion: Physician practices for the management of TAK are variable, suggesting that there are knowledge gaps, which may impact outcomes in patients with TAK. Keywords: Takayasu arteritis, physician practice patterns, practice guidelines, large vessel vasculitis, aortitis

Published
2017

3. Association between age at disease onset of anti-neutrophil cytoplasmic antibody-associated vasculitis and clinical presentation and short-term outcomes

Author

Monti, S., Craven, A., Klersy, C., Montecucco, C., Caporali, R., Watts, R., Merkel, P. A., Luqmani, R., Achilleos, K., Adler, M., Alba, M. A., Albert, D. A., Alibaz-Oner, F., Allcoat, P., Amano, K., Amarasuriya, M., Amudala, N. A., Andrews, J., Archer, A. M., Arimura, Y., Atukorala, I., Azevedo, E., Bajad, S., Baldwin, C., Barra, L. J., Baslund, B., Basu, N., Baykal, M., Berger, C., Berglin, E., Besada, E., Bhardwaj, M., Bischof, A., Blockmans, D., Blood, J., Draibe, J. B., Brand, S., Brandao, M., Bruce, I. N., Butler, A., Calabrese, L. H., Ferrer, D. C., Carette, S., Carmona, D., Ceunen, H., Chakravarty, K., Chapman, P. T., Chocova, Z., Chung, S. A., Ci, W., Cid, M. C., Clark, T. M., Clarkson, M. R., De Jesus Contreras-Rodriguez, F., Conway, R., Cooke, K., Viros, X. C., Cordeiro, A., Costa, A., Culfear, K., Daikeler, T., Danda, D., Das, S. K., Dasgupta, B., De Castro, A. M., Dehghan, N., Devassy, R., Dhindsa, N., Diamantopoulos, A. P., Direskeneli, H., Dobashi, H., Juan, D., Durrani, M., Edelsten, C., Eifert, J., Elhayek, S., Elsideeg, S., Endo, T., Erden, A., Erer, B., Eriksson, P., Erturk, Z., Espigol-Frigole, G., Felicetti, M., Ferraro, A., Ferro, J. M., Fifi-Mah, A., Flores-Suarez, L. F., Flossmann, O., Flynn, D., Fonseca, J. E., Foot, J., Foote, M., Forbess, L., Fujimoto, S., Fukuoka, K., Furtado, C., Furuta, S., Gaffo, A. L., Gallagher, P., Gao, N., Gatenby, P., Gendi, N., Geraldes, R., Gerits, A., Gioffredi, A., Gomples, L., Goncalves, M. J., Gondo, P., Graham, A., Grainger, R., Gray, D. T., Grayson, P. C., Griffiths, L., Guo, Y., Gupta, R., Gylling, M., Hajj-Ali, R. A., Hammam, N., Harigai, M., Hartley, L., Haslett, J., Hassan, A., Hatemi, G., Hellmich, B., Henckaerts, L., Henes, J. C., Hepburn, J., Herd, V., Hess, C., Hill, C., Hinojosa-Azaola, A., Hirahashi, J., Hirano, F., Hocevar, A., Holle, J., Hollinger, N., Homma, S., Howard, T., Hoyles, R. K., Hruskova, Z., Hutcheon, G., Ignacak, M., Igney-Oertel, A., Ikeda, K., Ikegaya, N., Jagadeesh, S., Jaquith, J., Jayne, D. R. W., Jewell, T., Jones, C., Joshi, A., Kalyoncu, U., Kamall, S., Kamath, S., Lai, K. S., Kaname, S., Kanchinadham, S., Karadag, O., Karube, M., Kaszuba, M., Kaur, R., Kawakami, T., Kawashima, S., Khalidi, N., Khan, A., Kikuchi, M., Kilic, L., Kimura, M., King, M. J., Klapa, S., Klocke, R., Kobayashi, T., Kobayashi, S., Komagata, Y., Kronbichler, A., Kuczia, P., Kumar, M. S., Kurosawa, M., Lamprecht, P., Langford, C. A., Lanyon, P., Laversuch, C., Lee, S. J., Leoni, S., Li, J., Liang, K., Liang, P., Liao, H., Lee, L. A., Luqmani, R. A., Lyle, A., Macdonald, M., Mackie, S. L., Madden, L., Magliano, M., Makino, H., Makol, A., Malaiya, R., Malaviya, A., Manthri, R., Maritati, F., Da Silva, A. M., Mason, J. C., Matara, C., Matsui, K., Matteson, E. L., Mcbride, D., Mccullough, K., Mcgeoch, L., Mclaren, J., Mcmillian, C., Mendiratta, N., Menon, A., Merinopoulos, D., Merkel, P., Messier, S., Micheletti, R. G., Mills, K., Milman, N., Minoda, M., Minz, R. W., Mock, C., Mohammad, A. J., Moiseev, S., Moitinho, M., Molloy, E., Monach, P. A., Montgomery, M., Moosig, F., Moradizadeh, M., Morgan, M., Morgan, A. W., Morgan, A. -M., Muir, A., Mukhtyar, C., Muller, A., Muratore, F., Muso, E., Nada, R., Nakajima, H., Nakajima, T., Nakano, H., Nandagudi, A., Neumann, T., Y. F., Ng, K. H., Ng, Nogueira, E. L., Nolkha, N., Nordstrom, D., Novikov, P., Nugaliyadde, A., O'Donnell, J. L., O'Donoghue, J., O'Neill, L., O'Riordan, E., Oatley, M., Okubo, K., Oliva, E., Oshikawa, H., Ota, Y., Padoan, R., Pagnoux, C., Pan, L., Panaritis, K., Park, J. K., Patel, S., Patil, P., Pazzola, G., Peall, A., Pearce, F., Pehlevan, S., Pereira, L., Pettersson, T., Pineau, C. A., Pirila, L., Poglodek, B., Ponte, C., Prieto-Gonzalez, S., Priya, S. R., Purewal, B., Purschke, S., Putaala, J., Quickert, S., Quincey, V., Raghuvanshi, S., Rajasekhar, L., Ranganathan, D., Rathi, M., Rees, D., Rees, F., Renken, U., Restuccia, G., Rhee, R. L., Rice, B., Robins, D., Robson, J., Rodrigues, M., Romao, V. C., Rotar, C., Ruediger, C., Rutgers, A., A. C., Sa, Saavedra, M. J., Sada, K. -E., Sahbudin, I., Salvarani, C., Sandhu, N., Santos, E., Sato, Y., Schafer, V. S., Schiavon, F., Schmidt, W. A., Segelmark, M., Shahin, A., Sharma, A., Shotton, J., Silva, C., Singer, O. G., Sivasuthan, G., Smolen, S., Solanich-Moreno, X., Boixader, L. S., Song, Y. W., Springer, J., Sreih, A. G., Srivastava, R., Stamp, L. K., Stevens, R., Strbian, D., Sugino, K., Sunderkotter, C., Suppiah, R., Suzuki, K., Szekanecz, Z., Sznajd, J., Taimen, K., Tak, P. P., Takeuchi, T., Takizawa, N., Tames, L., Tan, B. E., Tanaka, M., Tang, M. W., Tatlisumak, T., Tesar, V., Thomas, A., Tian, X., Tokunaga, K., Tombetti, E., Tomsic, M., Toz, B., Tsukamoto, T., Uchida, S., Unal, A. U., Urban, M. L., Usui, J., Vaglio, A., Venkatachalam, S., Vermaak, E., Viswanath, V., Wada, T., Wagh, S., Wallace, D. J., Walters, G., Walz, B., Wan, J., Wang, T., Wang, G., Warrington, K. J., Watts, R. A., Wawrzycka-Adamczyk, K., Weeratunga, P., Weisman, M. H., Wickramasinghe, S., Williams, M., Wojcik, K., Woodruff, L., Xenitidis, T., Yamada, H., Yamagata, K., Yee, C. -S., Yoon, M., Yoshida, K., Yoshifuji, H., Ytterberg, S. R., Yumura, W., Zayed, H., Zeng, X., Zhao, M. -H., Zugaj, A., Zuk, J., İç Hastalıkları, Clinical Haematology, and Translational Immunology Groningen (TRIGR)

Subjects
Male, Outcome, Antineutrophil Cytoplasmic, 030232 urology & nephrology, 0302 clinical medicine, Risk Factors, 80 and over, Pharmacology (medical), Age of Onset, Young adult, Aged, 80 and over, education.field_of_study, age, anti-neutrophil cytoplasmic antibody-associated vasculitis, outcome, Adolescent, Adult, Aged, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Antibodies, Antineutrophil Cytoplasmic, Female, Humans, Middle Aged, Morbidity, Prognosis, Retrospective Studies, Risk Assessment, Survival Rate, United Kingdom, Young Adult, Vasculitis, Systemic vasculitis, medicine.medical_specialty, Population, anti-neutrophil cytoplasmic antibody–associated vasculitis, Antibodies, 03 medical and health sciences, Rheumatology, Internal medicine, medicine, education, Anti-neutrophil cytoplasmic antibody–associated vasculitis, Survival rate, Anti-neutrophil cytoplasmic antibody, 030203 arthritis & rheumatology, business.industry, Retrospective cohort study, medicine.disease, Age of onset, business
Abstract

Objectives ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- and older-onset patients are still incompletely understood. Methods We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We divided the population according to age at diagnosis: Results A total of 1338 patients with AAV were included: 66% had disease onset at Conclusion Within 6 months of diagnosis of AAV, patients >65 years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients.

Published
2021
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4. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis With Polyangiitis

Author

Grayson, P. C., Ponte, C., Suppiah, R., Robson, J. C., Craven, A., Judge, A., Khalid, S., Hutchings, A., Luqmani, R. A., Watts, R. A., Merkel, P. A., Gatenby, P., Hill, C., Ranganathan, D., Kronbichler, A., Blockmans, D., Barra, L., Carette, S., Pagnoux, C., Dhindsa, N., Fifi-Mah, A., Khalidi, N., Liang, P., Milman, N., Pineau, C., Tian, X., Wang, G., Wang, T., Zhao, M. -H., Tesar, V., Baslund, B., Hammam, N., Shahin, A., Pirila, L., Putaala, J., Hellmich, B., Henes, J., Lamprecht, P., Neumann, T., Schmidt, W., Sunderkoetter, C., Szekanecz, Z., Danda, D., Das, S., Gupta, R., Rajasekhar, L., Sharma, A., Wagh, S., Clarkson, M., Molloy, E., Salvarani, C., Schiavon, F., Tombetti, E., Vaglio, A., Amano, K., Arimura, Y., Dobashi, H., Fujimoto, S., Harigai, M., Hirano, F., Hirahashi, J., Honma, S., Kawakami, T., Kobayashi, S., Kono, H., Makino, H., Matsui, K., Muso, E., Suzuki, K., Ikeda, K., Takeuchi, T., Tsukamoto, T., Uchida, S., Wada, T., Yamada, H., Yamagata, K., Yumura, W., Lai, K. S., Flores-Suarez, L. F., Hinojosa, A., Rutgers, B., Tak, P. -P., Grainger, R., Quincey, V., Stamp, L., Besada, E., Diamantopoulos, A., Sznajd, J., Azevedo, E., Geraldes, R., Rodrigues, M., Santos, E., Song, Y. -W., Moiseev, S., Hocevar, A., Cid, M. C., Moreno, X. S., Atukorala, I., Berglin, E., Mohammed, A., Segelmark, M., Daikeler, T., Direskeneli, H., Hatemi, G., Kamali, S., Karadag, O., Pehlevan, S., Adler, M., Basu, N., Bruce, I., Chakravarty, K., Dasgupta, B., Flossmann, O., Gendi, N., Hassan, A., Hoyles, R., Jayne, D., Jones, C., Klocke, R., Lanyon, P., Laversuch, C., Luqmani, R., Robson, J., Magliano, M., Mason, J., Maw, W. W., Mcinnes, I., Mclaren, J., Morgan, M., Morgan, A., Mukhtyar, C., O'Riordan, E., Patel, S., Peall, A., Venkatachalam, S., Vermaak, E., Menon, A., Watts, R., Yee, C. -S., Albert, D., Calabrese, L., Chung, S., Forbess, L., Gaffo, A., Gewurz-Singer, O., Grayson, P., Liang, K., Matteson, E., Springer, J., Sreih, A., and Translational Immunology Groningen (TRIGR)

Subjects
Adult, Male, Vasculitis, Myeloblastin, Immunology, Churg-Strauss Syndrome, Sensitivity and Specificity, General Biochemistry, Genetics and Molecular Biology, Antibodies, Antineutrophil Cytoplasmic, Diagnosis, Differential, Rheumatology, Risk Factors, Humans, Immunology and Allergy, anti-neutrophil cytoplasm antibody, Prospective Studies, Aged, Granulomatosis with Polyangiitis, Reproducibility of Results, Middle Aged, United States, Female, eosinophilic granulomatosis with polyangiitis, Eosinophilic Granuloma, Europe, classification, Societies
Abstract

ObjectiveTo develop and validate revised classification criteria for eosinophilic granulomatosis with polyangiitis (EGPA).MethodsPatients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in five phases: (1) identification of candidate criteria items using consensus methodology, (2) prospective collection of candidate items present at the time of diagnosis, (3) data-driven reduction of the number of candidate items, (4) expert panel review of cases to define the reference diagnosis and (5) derivation of a points-based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators.ResultsThe development set for EGPA consisted of 107 cases of EGPA and 450 comparators. The validation set consisted of an additional 119 cases of EGPA and 437 comparators. From 91 candidate items, regression analysis identified 11 items for EPGA, 7 of which were retained. The final criteria and their weights were as follows: maximum eosinophil count ≥1×109/L (+5), obstructive airway disease (+3), nasal polyps (+3), cytoplasmic antineutrophil cytoplasmic antibody (ANCA) or anti-proteinase 3–ANCA positivity (−3), extravascular eosinophilic predominant inflammation (+2), mononeuritis multiplex/motor neuropathy not due to radiculopathy (+1) and haematuria (−1). After excluding mimics of vasculitis, a patient with a diagnosis of small- or medium-vessel vasculitis could be classified as having EGPA if the cumulative score was ≥6 points. When these criteria were tested in the validation data set, the sensitivity was 85% (95% CI 77% to 91%) and the specificity was 99% (95% CI 98% to 100%).ConclusionThe 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Eosinophilic Granulomatosis with Polyangiitis demonstrate strong performance characteristics and are validated for use in research.

Published
2022
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6. Carbon and [sup.15]nitrogen isotopes in autopsy liver tissue samples from Greenlandic Inuit and Danes: consumption of marine versus terrestrial food

Author

Milman, N., Laursen, J., Mulvad, G., Pedersen, H.S., Pedersen, A.N., and Saaby, H.

Subjects
Carbon -- Isotopes, Nitrogen -- Isotopes, Inuit -- Food and nutrition -- Health aspects, Food habits -- Research -- Physiological aspects -- Analysis -- Health aspects
Abstract

Background/Objectives: The content of [sup.13]C and [sup.15]N isotopes is higher in marine than in terrestrial food. [sup.13]C and [sup.15]N in human tissue therefore reflects the relative proportions of marine and terrestrial food consumed by the individual. The objective of this study was to measure [sup.13]C and [sup.15]N in liver tissue from Greenlandic Inuit and Danes. Subjects/Methods: Normal liver tissue was obtained at autopsy in 1992-1994 from 60 Inuit with a median age of 61 years (range 25-83) and in 1986 from 15 ethnic Danes with a median age of 84 years (range 66-93). By sieving, liver tissue was separated in a 'cellular fraction' and a 'connective tissue fraction'. [sup.13]C and [sup.15]N in dry liver tissue was measured on a mass spectrometer. [δ.sup.13]C indicates the [sup.13]C content relative to the IAEA-CH-6 reference standard. [δ.sup.15]N indicates [sup.15]N content relative to the atmospheric nitrogen reference standard. Results: Inuit: median [δ.sup.13]C was -21.2% in cellular and -20.0% in connective tissue fractions (P = 0.001). Median [δ.sup.15]N was 10.6% in both cellular and connective tissue fractions. Body mass index was negatively correlated with [δ.sup.13]C in the connective tissue fraction ([r.sub.s] = -0.42, P = 0.057). Danes: median [δ.sup.13]C was -27.0% in cellular and -24.3% in connective tissue fractions (P = 0.11). Median [δ.sup.15]N was 9.5% in cellular and 8.9% in connective tissue fractions (P = 0.5). Inuit had higher [δ.sup.13]C than Danes in both cellular and connective tissue fractions (P< 0.001) as well as higher [δ.sup.15]N in the cellular fraction (P = 0.01). Conclusions: Inuit showed considerable variation in the ratio between marine and terrestrial food consumption, reflecting a vanishing hunter culture where elderly Inuit still adhere to the traditional hunters food with a high content of marine food, whereas the younger urbanized Inuit population consume food with a lower content of marine food and a higher content of terrestrial food. Danes consumed food of almost exclusively terrestrial origin. The present [sup.13]C and [sup.15]N analyses are in accordance with the dietary patterns obtained by dietary surveys. European Journal of Clinical Nutrition (2010) 64, 739-744; doi: 10.1038/ejcn.2010.67; published online 2 June 2010 Keywords: [sup.13]carbon; Denmark; Eskimos; Greenland; Inuit; liver; mass spectrometry; [sup.15]nitrogen, Introduction You are what you eat! This slogan indicates that the composition of body tissues reflects the dietary intake of the individual. All atoms in human tissues, except hydrogen and [...]

Published
2010
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15. Feasibility and construct validation of the patient reported outcomes measurement information system in systemic vasculitis

Author

Tomasson, G, Farrar, JT, Cuthbertson, D, McAlear, CA, Ashdown, S, Cronholm, PF, Dawson, J, Gebhart, D, Lanier, G, Luqmani, RA, Milman, N, Peck, J, Robson, JC, Shea, JA, Carette, S, Khalidi, N, Koening, CL, Langford, CA, Monach, PA, Moreland, L, Pagnoux, C, Specks, U, Sreih, AG, Ytterberg, SR, Merkel, PA, and Consortium, Vasculitis Clinical Research

Subjects
Adult, Male, Patient-Reported Outcomes Measurement Information System, medicine.medical_specialty, Immunology, Anti-Inflammatory Agents, Pain, Physical function, Article, Disease activity, Disability Evaluation, 03 medical and health sciences, Cognition, 0302 clinical medicine, Rheumatology, Humans, Immunology and Allergy, Medicine, Longitudinal Studies, Patient Reported Outcome Measures, 030212 general & internal medicine, Longitudinal cohort, Fatigue, Aged, 030203 arthritis & rheumatology, business.industry, Systemic Vasculitis, Construct validity, Middle Aged, Social Participation, medicine.disease, Cross-Sectional Studies, Quality of Life, Physical therapy, Feasibility Studies, Female, Patient-reported outcome, Computerized adaptive testing, business, Systemic vasculitis
Abstract

Objective.The Patient Reported Outcome Measurement Information System (PROMIS) is a collection of item banks of self-reported health. This study assessed the feasibility and construct validity of using PROMIS instruments in vasculitis.Methods.Data from a multicenter longitudinal cohort of subjects with systemic vasculitis were used. Instruments from 10 PROMIS item banks were selected with direct involvement of patients. Subjects completed PROMIS instruments using computer adaptive testing (CAT). The Medical Outcomes Study Short Form-36 (SF-36) was also administered. Cross-sectional construct validity was assessed by calculating correlations of PROMIS scores with SF-36 measures and physician and patient global scores for disease activity. Longitudinal construct validity was assessed by correlations of between-visit differences in PROMIS scores with differences in other measures.Results.During the study period, 973 subjects came for 2306 study visits and the PROMIS collection was completed at 2276 (99%) of visits. The median time needed to complete each PROMIS instrument ranged from 40 to 55 s. PROMIS instruments correlated cross-sectionally with individual scales of the SF-36, most strongly with subscales of the SF-36 addressing the same domain as the PROMIS instrument. For example, PROMIS fatigue correlated with both the physical component score (PCS; r = −0.65) and with the mental component score (MCS; r = −0.54). PROMIS physical function correlated strongly with PCS (r = 0.81) but weakly with MCS (r = 0.29). Weaker correlations were observed longitudinally between change in PROMIS scores with change in PCS and MCS.Conclusion.Collection of data using CAT PROMIS instruments is feasible among patients with vasculitis and has some cross-sectional and longitudinal construct validity.

Published
2019
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27. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement

Author

Muñoz, M, Peña-Rosas, J P, Robinson, S, Milman, N, Holzgreve, W, Breymann, C, Goffinet, F, Nizard, J, Christory, F, Samama, C-M, Hardy, J-F, Universidad de Málaga [Málaga] = University of Málaga [Málaga], World Health Organisation (WHO), Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), University of Copenhagen = Københavns Universitet (KU), Service de Gynécologie et Obstétrique [Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Gynécologie-Obstétrique, Maternité, Chirurgie Gynécologique [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Network for the advancement of patient blood management, haemostasis and thrombosis (NATA Paris), Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM), University of Zurich, and Muñoz, M

Subjects
2720 Hematology, 610 Medicine & health, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, 10026 Clinic for Obstetrics
Abstract

International audience; Patient blood management (PBM) is the timely application of evidence-informed medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis and minimise blood loss in an effort to improve patient outcomes. The aim of this consensus statement is to provide recommendations on the management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period as part of PBM in obstetrics. A multidisciplinary panel of physicians with expertise in obstetrics, anaesthesia, haematology, policymaking and epidemiology was convened by the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis (NATA) in collaboration with the International Federation of Gynaecology and Obstetrics (FIGO) and the European Board and College of Obstetrics and Gynaecology (EBCOG). Members of the task force assessed the quantity, quality and consistency of the published evidence and formulated recommendations using the system developed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group. The recommendations in this consensus statement are intended for use by clinical practitioners managing the perinatal care of women in all settings and by policymakers in charge of decision making for the update of clinical practice in health-care establishments. They need to be tailored for application in individual patients or any population after consideration of the values and preferences of both health-care providers and patients, as well as equity issues; explicit assessment of harms and benefits of each recommendation; feasibility including resources, capacity and equipment; and implementability.

Published
2018
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28. Contributors and Hemochromatosis International Taskforce. Therapeutic recommendations in HFE hemochromatosis for p.Cys282Tyr (C282Y/C282Y) homozygous genotype

Author

Adams, P., Altes, A., Brissot, P., Butzeck, B., Cabantchik, I., Cançado, R., Distante, S., Evans, P., Evans, R., Ganz, T., Girelli, D., Hultcrantz, R., McLaren, G., Marris, B., Milman, N., Nemeth, E., Nielsen, P., Pineau, B., Piperno, A., Porto, G., Prince, D., Ryan, J., Sanchez, M., Santos, P., Swinkels, D.W., Teixeira, E., Toska, K., Vanclooster, A., White, D.P., Adams, P., Altes, A., Brissot, P., Butzeck, B., Cabantchik, I., Cançado, R., Distante, S., Evans, P., Evans, R., Ganz, T., Girelli, D., Hultcrantz, R., McLaren, G., Marris, B., Milman, N., Nemeth, E., Nielsen, P., Pineau, B., Piperno, A., Porto, G., Prince, D., Ryan, J., Sanchez, M., Santos, P., Swinkels, D.W., Teixeira, E., Toska, K., Vanclooster, A., and White, D.P.

Abstract

Item does not contain fulltext

Published
2018

29. Therapeutic recommendations in HFE hemochromatosis for p.Cys282Tyr (C282Y/C282Y) homozygous genotype

Author

Adams, P, Altes, A, Brissot, P, Butzeck, B, Cabantchik, I, Cançado, R, Distante, S, Evans, P, Evans, R, Ganz, T, Girelli, D, Hultcrantz, R, Mclaren, G, Marris, B, Milman, N, Nemeth, E, Nielsen, P, Pineau, B, Piperno, A, Porto, G, Prince, D, Ryan, J, Sanchez, M, Santos, P, Swinkels, D, Teixeira, E, Toska, K, Vanclooster, A, White, D, Adams, Paul, Altes, Albert, Brissot, Pierre, Butzeck, Barbara, Cabantchik, Ioav, Cançado, Rodolfo, Distante, Sonia, Evans, Patricia, Evans, Robert, Ganz, Tomas, Girelli, Domenico, Hultcrantz, Rolf, McLaren, Gordon, Marris, Ben, Milman, Nils, Nemeth, Elizabeta, Nielsen, Peter, Pineau, Brigitte, Piperno, Alberto, Porto, Graça, Prince, Dianne, Ryan, John, Sanchez, Mayka, Santos, Paulo, Swinkels, Dorine, Teixeira, Emerência, Toska, Ketil, Vanclooster, Annick, White, Desley, Adams, P, Altes, A, Brissot, P, Butzeck, B, Cabantchik, I, Cançado, R, Distante, S, Evans, P, Evans, R, Ganz, T, Girelli, D, Hultcrantz, R, Mclaren, G, Marris, B, Milman, N, Nemeth, E, Nielsen, P, Pineau, B, Piperno, A, Porto, G, Prince, D, Ryan, J, Sanchez, M, Santos, P, Swinkels, D, Teixeira, E, Toska, K, Vanclooster, A, White, D, Adams, Paul, Altes, Albert, Brissot, Pierre, Butzeck, Barbara, Cabantchik, Ioav, Cançado, Rodolfo, Distante, Sonia, Evans, Patricia, Evans, Robert, Ganz, Tomas, Girelli, Domenico, Hultcrantz, Rolf, McLaren, Gordon, Marris, Ben, Milman, Nils, Nemeth, Elizabeta, Nielsen, Peter, Pineau, Brigitte, Piperno, Alberto, Porto, Graça, Prince, Dianne, Ryan, John, Sanchez, Mayka, Santos, Paulo, Swinkels, Dorine, Teixeira, Emerência, Toska, Ketil, Vanclooster, Annick, and White, Desley

Abstract

Although guidelines are available for hereditary hemochromatosis, a high percentage of the recommendations within them are not shared between the different guidelines. Our main aim is to provide an objective, simple, brief, and practical set of recommendations about therapeutic aspects of HFE hemochromatosis for p.Cys282Tyr (C282Y/C282Y) homozygous genotype, based on the published scientific studies and guidelines, in a form that is reasonably comprehensible to patients and people without medical training. This final version was approved at the Hemochromatosis International meeting on 12th May 2017 in Los Angeles

Published
2018

30. Patient blood management in obstetrics: management of anaemia and haematinic deficiencies in pregnancy and in the post-partum period: NATA consensus statement

Author

Muñoz, M; https://orcid.org/0000-0002-2052-8959, Peña-Rosas, J P, Robinson, S; https://orcid.org/0000-0001-5279-5536, Milman, N, Holzgreve, W, Breymann, C, Goffinet, F, Nizard, J, Christory, F, Samama, C-M, Hardy, J-F, Muñoz, M; https://orcid.org/0000-0002-2052-8959, Peña-Rosas, J P, Robinson, S; https://orcid.org/0000-0001-5279-5536, Milman, N, Holzgreve, W, Breymann, C, Goffinet, F, Nizard, J, Christory, F, Samama, C-M, and Hardy, J-F

Published
2018

31. Assessment of disease activity in large-vessel vasculitis: Results of an international delphi exercise

Author

Aydin, S. Z., Direskeneli, H., Merkel, P. A., Toloza, S., Blockmans, D., Sato, E. I., De Souza, A. W. S., Cabral, D., Carette, S., Famorca, L., Khalidi, N., Milman, N., Yacyshyn, E., Tesar, V., Baslund, B., Faurschou, M., Guillevin, L., Puechal, X., Aries, P., Hellmich, B., Herlyn, K., Holle, J., Lamprecht, P., Moosig, F., Neumann, T., Zwerina, J., Tomasson, G., Bambery, P., Jois, R., Rajasekhar, L., Sharma, A., Sivakumar, R., Molloy, E., Hashkes, P., Catapano, F., Cimino, L., De Fanti, A., Pipitone, N., Salvarani, C., Vaglio, A., Kobayashi, S., Suzuki, K., Flores-Suarez, L. F., Hinojosa-Azaola, A., Brouwer, E., Rutgers, A., Stegeman, C., Suppiah, R., Hollan, I., Arguis, P., Cid, M. C., Daikeler, T., Alibaz-Oner, F., Hamuryudan, V., Hatemi, G., Hazirolan, T., Inanc, M., Kalayci, M. B., Kamali, S., Kansu, T., Karaaslan, Y., Karadag, O., Keser, G., Onat, A. M., Ozbalkan, Z., Ozen, S., Ozer, H. T. E., Pamuk, O. N., Yilmaz, S. G., Basu, N., Casian, A., Chakravarty, K., D'Cruz, D., Edelsten, C., Harper, L., Jayne, D., Levy, J., Mason, J., Robson, J., Scott, D., Stanford, M., Watts, R., Albert, D., Amudala, N., Beckman, J., Chacko, B., Chung, S., Fessler, B., Giardino, A., Grayson, P., Hunder, G., Langford, C., Lerman, M., Liang, K., Litt, H., Mason, T., Matteson, E., Mikdashi, J., Mohler, E., Monach, P., Rice, B., Sreih, A., Stone, J., Tsapatsaris, N., Villa-Forte, A., Warrington, K., Yazici, Y., Ytterberg, S., Çukurova Üniversitesi, Aydin, S.Z., Direskeneli, H., Merkel, P.A., Toloza, S., Blockmans, D., Sato, E.I., De Souza, A.W.S., and Yeditepe Üniversitesi

Subjects
Vasculitis, medicine.medical_specialty, Delphi Technique, Immunology, Delphi method, Outcomes, Severity of Illness Index, Article, Disease activity, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Large vessel vasculitis, Severity of illness, medicine, Large vessel, Humans, Immunology and Allergy, 030212 general & internal medicine, computer.programming_language, Giant cell arteritis, 030203 arthritis & rheumatology, Takayasu arteritis, business.industry, medicine.disease, Clinical trial, Physical therapy, business, computer, Delphi
Abstract

PubMedID: 28864648 Objective. To arrive at consensus for candidate outcomes for disease activity assessment in largevessel vasculitis (LVV) in clinical trials. Methods.A Delphi survey including 99 items was circulated among international experts for 3 rounds. Results. Fifty-seven items were accepted for both giant cell arteritis and Takayasu arteritis. Sixty-seven percent of experts voted to have a common approach for both diseases with additional disease-specific items such as weight loss, scalp tenderness/necrosis, morning stiffness, dizziness, visual symptoms, and imaging. Conclusion. This study highlights similarities and differences in experts' perspectives for assessing clinical activity in LVV and may guide a consensus-driven core set of validated outcomes. Copyright © 2017. All rights reserved. National Institute of Arthritis and Musculoskeletal and Skin Diseases: U01 AR51874 04, U54 AR057319 National Center for Research Resources: U54 RR019497 Sponsored by the Vasculitis Clinical Research Consortium, which has received support from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (U54 AR057319 and U01 AR51874 04), the National Center for Research Resources (U54 RR019497), and the Office of Rare Diseases Research. Additional support for the work of the OMERACT Vasculitis Working Group was received through a Patient-Centered Outcomes Research Institute Pilot Project Grant. S.Z. Aydin, MD, Associate Professor, Division of Rheumatology, The Ottawa Hospital Research Institute, University of Ottawa; H. Direskeneli, MD, Professor of Rheumatology, Division of Rheumatology, Marmara University Faculty of Medicine; P.A. Merkel, MD, MPH, Professor of Medicine and Epidemiology, Division of Rheumatology, and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania. Address correspondence to Dr. P.A. Merkel, Section of Rheumatology, University of Pennsylvania, White Building, 5th Floor Penn, 3400 Spruce St., Philadelphia, Pennsylvania 19104, USA. E-mail: pmerkel@upenn.edu Accepted for publication June 3, 2017.

Published
2017

32. Mapping of the Outcome Measures in Rheumatology Core Set for Antineutrophil Cytoplasmic Antibody–Associated Vasculitis to the International Classification of Function, Disability and Health

Author

Milman, N., Boonen, A., Merkel, P.A., Tugwell, P., Interne Geneeskunde, RS: CAPHRI School for Public Health and Primary Care, and RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation

Subjects
musculoskeletal diseases, DAMAGE, SHORT-FORM, ICF, OMERACT, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, humanities, Article, WEGENERS-GRANULOMATOSIS, Rheumatology, OSTEOARTHRITIS, Outcome Assessment, Health Care, Humans, CONCEPTUAL-FRAMEWORK, human activities, ACTIVITY SCORE, CLINICAL-TRIALS, INDEX
Abstract

ObjectiveThe International Classification of Functioning, Disability and Health (ICF) is a framework and classification of health that describes health along 4 components: body functions, body structures, activities and participation, and contextual factors. This study examined the content of instruments that constitute the Outcome Measures in Rheumatology (OMERACT) core set of outcome measures for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) by mapping them to the ICF. MethodsThe content of the instruments included in the AAV core set were linked to the ICF by 2 independent investigators according to previously established ICF linkage rules. ResultsThe AAV core set includes 3 measures of disease activity (3 versions of the Birmingham Vasculitis Activity Score), 1 damage measure (Vasculitis Damage Index), 1 patient-reported outcome (Short Form 36 health survey), and death. Linking these instruments to the ICF revealed comprehensive coverage of the ICF components body functions and body structures, limited coverage of the ICF component activities and participation, and complete absence of coverage of contextual factors. ConclusionICF was found to be useful for thematic characterization of a heterogeneous group of outcome measures for AAV, i.e., a group of complex medical conditions. Linking of the instruments selected for the OMERACT AAV core set of outcome measures to the ICF classification revealed limitations in the representation of constructs related to life impact of AAV, represented by the ICF components activities and participation and contextual factors. Further research and methods development are needed to better incorporate important aspects of functioning and health relevant to patients into clinical trials of AAV.

Published
2015

33. Correction: Identification of Novel Pre-Erythrocytic Malaria Antigen Candidates for Combination Vaccines with Circumsporozoite Protein

Author

Speake, C, primary, Pichugin, A, additional, Sahu, T, additional, Malkov, V, additional, Morrison, R, additional, Pei, Y, additional, Juompan, L, additional, Milman, N, additional, Zarling, S, additional, Anderson, C, additional, MacDonald, NJ, additional, Wong-Madden, S, additional, Wendler, J, additional, Ishizuka, A, additional, MacMillen, ZW, additional, Garcia, V, additional, Kappe, SH, additional, Krzych, U, additional, and Duffy, PE, additional

Published
2016
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35. Kost til gravide

Author

Olsen, Sjúrður F., Dragsted, L. O., Hansen, H. S., Michaelsen, K. F., Milman, N., Ovesen, L., and Tabor, A.

Published
2005

37. Sarcoidose

Author

Milman, N., Iversen, Martin Peter, Muckadell, O.B. Schaffalitzky de, Haunsø, S., Vilstrup, H., Milman, N., Iversen, Martin Peter, Muckadell, O.B. Schaffalitzky de, Haunsø, S., and Vilstrup, H.

Published
2009

38. A novel mutation in the NOD2 gene associated with Blau syndrome: a Norwegian family with four affected members

Author

Milman, N, Ursin, K, Rødevand, E, Nielsen, Finn Cilius, Hansen, T V O, Milman, N, Ursin, K, Rødevand, E, Nielsen, Finn Cilius, and Hansen, T V O

Abstract

Udgivelsesdato: null-null, BACKGROUND: Blau syndrome is a chronic granulomatous disease with an autosomal dominant trait characterized by the triad granulomatous dermatitis, arthritis, and uveitis. It is caused by mutations in the NOD2 gene, also termed the CARD15 gene. OBJECTIVE: To report a novel mutation in the NOD2 gene associated with Blau syndrome. METHODS AND RESULTS: The proband was a 68-year-old ethnic Norwegian male who had uveitis and arthritis since 10 years of age followed by lifelong recurrent arthritis and chronic eye involvement. Genetic analysis showed a heterozygous c.1814 C>A, T605N mutation in NOD2 that has not previously been described. All of his three children had Blau syndrome and had inherited the NOD2 mutation. The proband's first son had exanthema, arthritis, and uveitis from 10 years of age and later presented with granulomatous lymphadenopathy, granulomatous parotitis, and granulomatous intestinal inflammation. The proband's daughter had arthritis, uveitis, and exanthema from 3 years of age. The proband's second son had uveitis, exanthema, and arthritis from 1.5 years of age. None of the cases had any involvement of the heart or lungs. CONCLUSION: We report a novel Blau syndrome-associated mutation with an autosomal dominant heritage. Most likely the mutation has arisen de novo in the proband. Genetic counselling and antenatal diagnostics should be available to the involved families.

Published
2009

39. Pulmonary hypertension in end-stage pulmonary sarcoidosis: therapeutic effect of sildenafil?

Author

Milman, N., Burton, C.M., Iversen, M., Videbaek, R., Jensen, C.V., Carlsen, J., Milman, N., Burton, C.M., Iversen, M., Videbaek, R., Jensen, C.V., and Carlsen, J.

Abstract

BACKGROUND: The objectives of this study were to assess the frequency and severity of pulmonary hypertension (PH) and the effect of sildenafil treatment in patients with recalcitrant pulmonary sarcoidosis. METHODS: This investigation was a single-center, retrospective study of all patients (n = 25) with end-stage pulmonary sarcoidosis referred for lung transplantation. Hemodynamic measurements were evaluated by right-side cardiac catheterization in 24 of 25 patients. Sildenafil treatment for patients with sarcoidosis-associated PH was introduced in April 2004. RESULTS: The study group of 24 patients (16 men, 8 women) had a median age of 45 (range 35 to 58) years, and duration of sarcoidosis of 11 (range 2 to 38) years. Mean pulmonary arterial pressure (MPAP) was median 36 (range 18 to 73) mm Hg. PH (MPAP >25 mm Hg) was present in 19 of 24 patients (79%). Sildenafil was administered to 12 of 13 patients at a dose of 150 (range 75 to 225) mg/day for 4 (range 1 to 12) months. Sildenafil treatment was associated with reductions in MPAP of -8 mm Hg (CI -1 to -15 mm Hg), and PVR -4.9 Wood units (CI -7.2 to -2.6 Wood units). Cardiac output and cardiac index also increased during treatment (p = 0.01, respectively). There were no consistent changes in 6-minute walk distance. CONCLUSIONS: Patients with severe pulmonary sarcoidosis have a high prevalence of PH. Sildenafil treatment was associated with significant improvements in hemodynamic parameters Udgivelsesdato: 2008/3

Published
2008

40. Cardiac sarcoidosis and heart transplantation: a report of four consecutive patients

Author

Milman, N., Andersen, Claus Bøgelund, Mortensen, Sven Aage, Sander, K., Milman, N., Andersen, Claus Bøgelund, Mortensen, Sven Aage, and Sander, K.

Abstract

Heart transplantation (HTx) is a well-established treatment for severe cardiac failure. However, HTx for cardiac sarcoidosis is rare; less than 80 patients have been reported worldwide. In many patients, the diagnosis was not made prior to HTx. The aim of this study was to describe the use of HTx in the treatment of severe cardiac sarcoidosis. The series was comprised of four Caucasian patients (1 male, 3 females), aged 25-57 years. HTx were performed in the period 1990-2006. None of the patients had clinically overt extra-cardiac sarcoidosis. In one patient the diagnosis of sarcoidosis was proven prior to HTx. In three patients, all with dilated cardiomyopathy due to myocardial sarcoidosis, the final diagnosis was obtained by examination of the explanted heart. Arrythmias (supraventricular and ventricular), heart block, mitral valve insufficiency and dilated cardiomyopathy were prominent clinical features. None of the patients had recurrence of sarcoid disease in the allograft. Two patients are long-term survivors and two are deceased, one of primary graft failure, the other from Cytomegalovirus myocarditis. In conclusion, HTx is a viable treatment for cardiac sarcoidosis with end stage cardiac failure. Cardiac sarcoidosis is difficult to diagnose. Myocardial biopsy has a low diagnostic sensitivity. However, when the newest non-invasive diagnostic methods, including magnetic resonance imaging and positron emission tomography, are applied, an endomyocardial biopsy should not be mandatory to make a diagnosis of cardiac sarcoidosis Udgivelsesdato: 2008/9

Published
2008

41. Hemoglobin concentrations in 358 apparently healthy 80-year-old Danish men and women. Should the reference interval be adjusted for age?

Author

Milman, N., Pedersen, A.N., Ovesen, L., Schroll, M., Milman, N., Pedersen, A.N., Ovesen, L., and Schroll, M.

Abstract

Background and aims: In elderly Danes, reference intervals for hemoglobin (Hb) concentrations are derived from younger population groups. The aim was to examine reference intervals for Hb and cut-off limits for anemia by application of criteria for normality to a representative population of 80-year-olds. Methods: Participants in this epidemiological health survey cohort were 358 subjects (171 men) 80 years of age. A dietary survey was performed in 232 subjects. Blood samples included Hb, red cell indices, serum ferritin, serum C-reactive protein, renal and hepatic function tests. Normality criteria for Hb were: 1) values in all participants; 2) values in apparently healthy subjects; 3) values in 10-year survivors. Hb was compared with muscle strength, physical performance and diet. Results: In the entire series, median Hb was 140 g/L, 5-95 percentile 116-160 g/L in men, and 131 g/L, 5-95 percentile 114-147 g/L in women (p<0.001). The prevalence of anemia, as defined by World Health Organization (WHO) criteria, was 18% in men and 17% in women. Apparently healthy iron-replete men (n=129) and women (n=141) had median Hb of 141 g/L and 131 g/L. Median Hb levels were higher in 10-year surviving men (143 g/L) than in deceased men (139 g/L whereas surviving and deceased women had similar median Hb (131 g/L). Hb and muscle strength were significantly correlated. Subjects with physical performance score >= 20 had a lower frequency of anemia. There was no correlation between Hb and dietary or supplemental iron intake. In men, Hb was correlated to meat consumption. Conclusions: WHO decision limits for anemia should not be lowered in 80-year-old subjects. "Optimal" Hb concentrations with respect to survival appear to be at least 140 g/L in men and 131 g/L in women. Further research should evaluate whether not only treating anemia, but also increasing Hb by using erythropoietin and hematinics, may improve functional status and survival in the elderly Udgivelsesdato

Published
2008

42. Circulating serum trefoil factors increase dramatically during pregnancy

Author

Samson, Mie Hessellund, Vestergaard, E M, Milman, N, Poulsen, Steen Seier, Nexo, E, Samson, Mie Hessellund, Vestergaard, E M, Milman, N, Poulsen, Steen Seier, and Nexo, E

Abstract

Trefoil factors (TFF1-3) are 7-12 kDa peptides secreted by mucosal surfaces, with changing levels of expression reflected in serum concentrations. The genes for the peptides are located on chromosome 21, the chromosome duplicated in trisomy 21. We studied the levels of circulating TFFs in pregnant women carrying trisomy 21 foetuses and in women with normal pregnancies, throughout pregnancy and postpartum.

Published
2008

43. The impact of a meat- versus a vegetable-based diet on iron status in women of childbearing age with small iron stores

Author

Tetens, Inge, Bendtsen, K.M., Henriksen, M., Ersboll, A.K., Milman, N., Tetens, Inge, Bendtsen, K.M., Henriksen, M., Ersboll, A.K., and Milman, N.

Abstract

Background: Single-meal and short-term studies have shown an enhancing effect of meat on iron absorption, but there are few interventions of longer duration comprising measurements of biomarkers of iron status. Aim of the study: To assess the impact of a meat-based and a vegetable-based diet on iron status of women of childbearing age. Methods: For 20 weeks, 57 women aged 19-39 years with low iron stores (serum ferritin = 120 g/l) consumed either a meat-based or a vegetable-based diet. Haemoglobin and serum ferritin concentrations were measured at baseline, after 10 and 20 weeks. Information about dietary intake before and during intervention, meat/fish intake, menstruation and contraceptive methods were recorded. Results: The women who consumed the meat-based diet had a significantly (P <0.001) higher intake of meat/fish, 152 (147-168) g/day (median (Q(1)-Q(3))) compared to the women consuming the vegetable-based diet 31 (24-36) g/day, while the total iron intake was similar in the two groups (mean +/- SE) 11.0 +/- 0.5 and 12.3 +/- 0.3/day mg/day, respectively. Serum ferritin remained unchanged in women on the meat-based diet (n = 29)(before intervention (median (Q(1)-Q(3))): 16.3 (12.7-25.3) mu g/l and after intervention: 16.5 (10.3-25.3) mu g/l, but declined from 17.3 (10.9-23.7) to 11.2 (8.8-14.6) mu g/l (P <0.001) in women on the vegetable-based diet (n = 28). Conclusiions: Our results emphasize the importance of the delicate balance between dietary iron content and iron bioavailability for the maintenance of blood indicators of iron stores in women with initially low iron status.

Published
2007

48. Det videnskabelige grundlag for officielle anbefalinger om kost i forbindelse med graviditet:[The scientific basis of current official dietary recommendations in relation to pregnancy

Author

Olsen, S.F., Dragsted, L.O., Hansen, Harald S., Michaelsen, K.F., Milman, N., Nielsen, M.J., Ovesen, L., Petersen, T., Tabor, A., Olsen, S.F., Dragsted, L.O., Hansen, Harald S., Michaelsen, K.F., Milman, N., Nielsen, M.J., Ovesen, L., Petersen, T., and Tabor, A.

Abstract

The Danish Nutrition Council has examined the latest scientific literature on nutrition during pregnancy to evaluate the basis for the existing official recommendations. The recommendation to overweight women to gain only eight kilo should be accompanied with a recommendation to lose weight pre-conceptionally. Individualised recommendations should be provided in the prevention of iron deficiency, and the recommendation for calcium should include information on quantity. The recommendation of periconceptional folic acid supplementation does not benefit unplanned pregnancies. Arguments exist for adding a recommendation for vitamin D.

Published
2005

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