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Introduction: In this study we explore the added value of bicycle crash descriptions from open text fields in hospital records from the Aarhus municipality in Denmark. We also explore how bicycle crash data from the hospital complements crash data registered by the police in the same area and time period. Method: The study includes 5,313 Danish bicycle crashes, of which 4,205 were registered at the hospital and 1,078 by the police. All crashes occurred from 2010 to 2015. We performed an in-depth analysis of the open text fields on hospital records to identify factors associated with each crash using four categories: bicyclist, road, bicycle, and the other party. We employed the chi-squared test to compare the distribution of variables between crashes registered at the hospital and by the police. A binary logit model was used to estimate the probability that a crash factor is identified, and that each crash factor is associated with a single-bicycle crash. Results: The open-ended text fields in hospital records provide detailed information about crash factors not available in police records, including riding speed, inattention, clothing, specific road conditions, and bicycle defects. The factors alcohol and curb had the highest odds of being identified in relation to a single-bicycle crash. Crash data registered at the hospital included a larger number of bicycle crashes, particularly single-bicycle crashes and crashes with slight injuries only. Conclusion: Crash information registered at the hospital in Aarhus Municipality contributes to a better understanding of bicycle crashes due to detailed information about crash-associated factors as well as information about a larger number of bicycle crashes, particularly single-bicycle crashes. Practical implication: Efforts to improve access to detailed information about bicycle crashes are needed to provide a better basis for bicycle crash prevention.

Background Measles vaccine (MV) has beneficial non-specific effects protecting against non-measles infections in some situations. Within a trial of the effect of MV on mortality, we assessed effects of early MV on the secondary outcomes consultations and growth, overall, and by sex and exposure to campaigns with oral polio vaccine (OPV). Materials and methods Children were randomly assigned to MV at 4.5 + 9 months or MV at 9 months as recommended. At enrolment and 9 months children had their mid-upper-arm-circumference (MUAC) and weight measured. Consultations (out/inpatient) were registered at monthly home visits. Weight-for-age and MUAC-for-age Z-scores were obtained using the WHO growth reference and compared by group in linear regression models. Consultation rates between enrolment and 9 months were compared in Cox proportional hazards models, providing consultation Hazard Ratios (HRs) for early MV versus no early MV. We tested whether the effect of early MV was modified by OPV campaigns by splitting observation time at exposure to OPV campaigns. Results Among 3548 children enrolled between 2012 and 2015, early MV had no effect on MUAC-for-age (mean difference comparing early MV vs. no MV −0.01, 95% CI −0.06–0.04), weight-for-age (mean difference −0.03, 95% CI −0.07–0.02) or rates of consultations (HR = 1.03, 95% CI 0.92–1.16). The rate of consultations for children enrolled was lower after exposure to OPV campaigns (HR = 0.81, 95% CI 0.71–0.92). The effect of MV differed before exposure to OPV campaigns (HR = 1.12, 95% CI 0.98–1.29) and after OPV campaigns (HR = 0.83, 95% CI 0.67–1.03) (test for interaction: p = 0.03). Associations did not differ by sex. Conclusion Early MV had no overall effect on consultation rates and growth between enrolment and 9 months of age. However, early MV tended to have beneficial effects for children subsequently exposed to OPV campaigns. As beneficial effects were observed in subgroups, the results should be interpreted with caution. Clinical trials registration: NCT01644721 .

Background Low-grade optic pathway glioma (OPG) develops in 15–20% of children with neurofibromatosis type 1 (NF1). OPGs are symptomatic in 30–50% and one-third of these require treatment. A few studies have suggested female sex as a risk factor for visual impairment associated with NF1-OPG. This descriptive study investigated the correlation between NF1-OPG growth, sex and visual impairment. Method We based our cross-sectional study on a systematic, retrospective data collection in a NF1 cohort of children and adolescents below 21 years of age followed at Center for Rare Diseases, Aarhus University Hospital, Denmark. For each patient with OPG a medical chart review was performed including demographics, ophthalmological examinations and magnetic resonance imaging (MRI) of OPG. Results Of 176 patients with NF1 (85 females, 91 males), we identified 21 patients with OPG (11.9%) with a preponderance of females, p = 0.184. Eight females (62%) and one male (13%) had visual impairment at the last ophthalmological evaluation. Five out of 21 children with OPG (24%) underwent diagnostic MRI because of clinical findings at the ophthalmological screening. Nine children (43%) had symptoms suggestive of OPG and seven (33%) experienced no OPG-related symptoms before the diagnostic MRI. Of eight children diagnosed with OPG ≤ two years of age, one had visual impairment. Of 13 children diagnosed > two years of age, eight had visual impairment; in each group, four of the children were treated with chemotherapy. The study suggested no correlation between NF1-OPG growth and sex. Conclusion Our data suggest sex as a risk factor for visual impairment, while an OPG diagnose ≤ two years of age was a protective factor for visual impairment. Females with NF1-OPG had a higher prevalence of visual impairment outcome compared to males. Interestingly, our data also suggest a better response to treatment in children with OPG diagnosed ≤ two years of age compared to older children. The findings in our study suggest sex as a potential prognostic factor for visual impairment.

Practice-based studies have demonstrated how institutional logics function as repertoires of cultural resources that actors may use strategically for professional (re-)positioning. This article focuses on the concept of hijacking based on a qualitative study of the implementation of a randomized controlled trial (RCT) in specialized cancer palliation. Using the logics-as-resources perspective as theoretical framing, we describe the negotiations and hijacking of logics that followed the introduction of the RCT and the temporary reversal of home logics between professional subgroups in cancer treatment and care. The analysis shows how hijacking unfolds in a highly institutionalized and complex professional healthcare setting characterized by intra-institutional heterogeneity. We contribute to the literature by highlighting how hijacking is related to power differentials and identity work and may contribute to obscuring underlying conflicts, in this case between science and care logics. The article develops our understanding of hijacking as a theoretical concept and an empirical phenomenon.

Shared decision making (SDM) is on the international healthcare agenda among patient advocacy groups and decision makers in healthcare worldwide [1–5]. In Denmark, implementation of SDM with all ca...

Introduction: Children treated for cancer with a central venous catheter are often bothered by scarring. We studied whether glucocorticosteroid during patch occlusion has a beneficial effect on scar outcome in children and adolescents treated for neoplastic disease. Methods: A double-blinded placebo-controlled randomized clinical trial was performed. The main outcome was the Vancouver Scar Scale (VSS). Secondary outcomes were scar width and scar quality measured using the Patient and observer scar assessment (POSAS). The patients were divided into an intervention groups and a control group. The intervention group was randomized into two groups; Active and placebo group. The active treatment consisted of cream with glucocorticosteroid and fusidic acid. The placebo treatment consisted of cream with fusidic acid. Both groups were also treated with a silicone gel patch for three months after central venous catheter removal. The control group did not receive any specific skin care. Results: Assessment at 6 months were completed for 44 in the intervention group (21 in the active and 23 in the placebo group) and 47 in the comtrol group. The intervention group had a significantly lower VSS and a smaller scar compared to the control group (p = 0.00, p = 0.02). The POSAS by the patients and the study nurse showed no significant difference between the intervention and control groups (p = 0.84, p= 0.36). Conclusions: Silicone gel sheet alone or in combination with application of glucocorticosteroid during sheet occlusion improved scar outcome after removal of central venous catheter in children treated for neoplastic diseases.

IntroductionMoped riders have a comparably high risk of getting seriously injured or killed in road traffic crashes. The moped is the first motor vehicle legally available to adolescents, but knowledge about young moped riders is limited. The few existing studies indicate that violations are a key factor in crash involvement.MethodUsing the Theory of Planned Behaviour, the purpose of this study is to explore and identify key beliefs underlying engagement in violations among adolescent moped riders. We conducted four focus groups including 35 participating adolescents aged between 15 and 17. We analysed the data using a four step directed content analysis approach.ResultsEngagement in violations was associated with affective and functional advantages such as excitement, saving time, convenience and avoidance of expenses and parent involvement. Level of approval varied across violations and was expressed directly as well as indirectly by both parents and peers. Strong beliefs in good riding skills and the ability to keep control over the moped facilitated engagement in violations. Actual and expected apprehension by the police was the main barrier, thus preventing engagement in violations.ConclusionAdvantages associated with engagement in violations, approval from peers, parents and general society, and a strong belief in the ability to avoid negative consequences facilitate engagement in violations among young moped riders. Inclusion of the identified beliefs in preventive measures is discussed.

The majority of research on bicyclist injury severity relates to bicycle-motor vehicle crashes, even though single-bicycle crashes make up more than half of bicycle crashes. This study explores the factors related to the injury severity outcome of single-bicycle crashes. We use single-bicycle crash data obtained from medical records collected in the period 2010-2015 combined with road maintenance data. The data includes three injury severity categories: 'severe injury', 'slight injury', 'no injury'. The relation between the factors surrounding single-bicycle crashes and the resulting injury severity is estimated using a latent class ordered probit model. The model estimation identifies three latent classes where the likelihood of cyclist membership depends on the bicyclist's age and gender. Furthermore, several factors appear to affect the likelihood of injuries in single-bicycle crashes. These are the road geometry (i.e. if the crash occurred on a bicycle lane or a road section), maintenance level, and the interaction between road geometry and maintenance level. The findings suggest that single-bicycle crashes on road sections result in more severe injuries than single-bicycle crashes on bicycle lanes. The largest effect is seen when a single-bicycle crash occurs on a road section with a poorly maintained bicycle lane being available. Crashes on low volume roads with few bicyclists are also related to an increased probability of severe injury as well as crashes occurring after dark.

ObjectiveRecent studies have shown that people with mental illnesses have higher mortality and morbidity rates due to long-term conditions and lifestyle diseases. This knowledge has led to health promotion initiatives in mental health care to improve the physical health of people with mental illness. This article explores how mental health nurses experience working with health promotion activities in mental healthcare practices.DesignWe adopted a qualitative research design using an interactive approach. Qualitative content analysis was used to develop the analytical framework.ParticipantsFocus groups (n=7; n=5) were conducted with two groups of mental health nurses who attended health specialist training sessions in Denmark in the spring and fall of 2018.ResultsThe findings showed that working with health promotion activities in mental health care created two dilemmas for the mental health nurses: (1) dilemmas related to health promotion that involved discrepancies between the health promotion activities that were offered and patients’ autonomy and wishes, and (2) system-related dilemmas stemming from working with screening for risk factors and documentation programmes. The mental health nurses developed different strategies to navigate these dilemmas, such as devising interview techniques for the screening questions and bending guidelines.ConclusionsMental health nurses found it challenging to implement health promotion activities in mental health care, although they generally found these activities meaningful. The findings show that new health promotion activities need to be adapted to nurses’ existing mental healthcare practices; however, this may require some adaptation of existing nursing practices.

Road anger is an increasing problem that does not only lead to discomfort but is also associated with aggressive driving and an increased risk of crash involvement. Based on a cognitive-behavioural approach, we developed and tested a short group intervention (90 min) that aimed at decreasing road anger among drivers. We used a before-after control group design, surveying people who did (EG) and who did not (CG) participate in the group intervention. The sample (n = 126) consisted of 80 men and 46 women with a mean age of 54 years (SD = 13). In addition, a sub-sample (n = 37) participated in a driving simulator study before and after the intervention. To enrich the survey- and simulator-based findings, we conducted a focus group discussion about post-intervention experiences in traffic. Comparisons of pre and post survey results showed that constructive expression as measured by a slightly revised sub-scale of the Driving Anger Expression Inventory (DAX-short), increased significantly for EG participants but not within the CG. In addition, the involvement in milder forms of road anger (e.g., yelling) decreased significantly in the EG but not in the CG. In the simulator study, we observed that EG participants decreased the extent of aggressive driving, commenting and gesturing - however, none of these differences were statistically significant. EG participants self-assessed the intervention overall positive and 44 % reported that they had changed their way of thinking or reacting in traffic. Overall, results indicate a positive effect of the cognitive-behavioural group intervention. Study limitations, possibilities to improve the intervention and different areas of application are discussed.

BackgroundThe mosaic form of neurofibromatosis type 1 (NF1) is called mosaic NF1 (MNF1). No specific MNF1 follow-up guidelines exist. It is debatable if patients with MNF1 should be clinically examined and undergo follow-up in accordance with the standard NF1 guidelines, as MNF1 patients more often may develop more benign phenotypes and thereby less disease-associated complications including cognitive impairment. We discussed the need for a specific MNF1 follow-up guideline with focus on frequency of plexiform neurofibromas and NF1-associated complications.MethodA systematic retrospective data collection in a MNF1 cohort from one of two Danish national centers of NF1 Expertise was completed. Data collected included demographics, clinical features including NF1 diagnostic criteria and NF1-associated complications. Recent literature in the field was reviewed.ResultsWe identified 17 patients with MNF1 with a median age of 37 years [4; 66]. Eleven (65%) were females. Five patients (30%) had a plexiform neurofibroma. The median age at detection of plexiform neurofibroma was 30 years [14; 60]. Nine (53%) had at least one NF1-related complication; scoliosis, hypertension, ADHD, learning disability, language delay, autism and delay in gross and fine motor function development. We reviewed nine articles. In total, 126 cases were described within three case-series. Nineteen (15%) had a plexiform neurofibroma and in total, 23 NF1-associated complications were reported including language delay, learning disability and skeletal abnormalities. Furthermore, from the literature it was evident that the diagnosing of MNF1 varies among physicians and across countries.ConclusionPatients with MNF1 present with plexiform neurofibromas and other NF1-related complications with a frequency requiring that follow-up of MNF1 patients should be in accordance with the standard NF1 guideline in both childhood and adulthood. Physicians should be aware of cognitive impairment as a complication to MNF1. To develop a specific MNF1 follow-up guideline, there is a need for an international consensus on the diagnostic criteria for MNF1 and a follow-up study conducted in a larger MNF1 cohort.

Recently studies have focused on how health promotion interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health promotion interventions often do not draw on situated understandings of the contextual aspects of health and illness practices. Theoretically, this study departs in practice theory and contemporary public heath discussions on targeted health promotion. Based on semi-structured interviews with 18 people living in a social housing association we explored the significance of participating in a preventive health check and how participation configured into everyday life. All participants in our study had been identified with a ‘risk’ health profile. Overall, we found that they were well aware of their health risks and challenges, and that they reflected a great deal on how their health status was intrinsically linked with their lifestyle and health practices, such as lack of exercise or smoking. The health checks were, however, not able to support or improve their general health, and did not seem to address the challenges the participants seemed to struggle with in life. By way of conclusion, we suggest that we implement a more practice-oriented form of public health that focus on the ‘lives’ that people live, and the problems that they face. Moreover, attention should be paid to how and to whom health promotion initiatives are offered, in order to ensure the relevance of targeted interventions.

Multiple system atrophy (MSA) is a rare disease with a fatal outcome. To date, little is known about the molecular processes underlying disease development. Its clinical overlap with related neurodegenerative movement disorders underlines the importance for expanding the knowledge of pathological brain processes in MSA patients to improve distinction from similar diseases. In the current study, we investigated DNA methylation changes in brain samples from 41 MSA patients and 37 healthy controls. We focused on the prefrontal cortex, a moderately affected area in MSA. Using Illumina MethylationEPIC arrays, we investigated 5-methylcytosine (5mC) as well as 5-hydroxymethylcytosine (5hmC) changes throughout the genome. We identified five significantly different 5mC probes (adj. P AREL1 gene involved in antigen presentation was decreased in MSA patients. This decrease correlated with increased 5hmC levels. Further, we identified functional DNA methylation modules involved in inflammatory processes. As expected, the decreased 5mC levels on AREL1 was concordant with increased gene expression levels of both AREL1 as well as MHC Class I HLA genes in MSA brains. We also investigated whether these changes in antigen-related processes in the brain associated with changes in peripheral mononuclear cells. Using flow cytometry on an independent cohort of MSA patients, we identified a decrease in circulating non-classical CD14+CD16++ blood monocytes, whereas T and NK cell populations were unchanged. Taken together, our results support the view of an active neuroimmune response in brains of MSA patients.

Driving anger increases risk-taking in traffic and road traffic accident involvement. Herein, we examine the links between self-reported and observed driving anger, self-reported and observed aggressive driving, and personality traits. Specifically, sixty drivers drove in an anger-inducing simulated driving scenario. A video camera recorded their verbal and gestural expression during the simulator drive. Two weeks before the simulator drive, we assessed participants’ basic personality traits, driving anger expression, and aberrant driving behaviour via an online survey. State anger was measured immediately before and after the simulator drive. From recorded simulator and video data, we obtained four measures: the number of accidents (simulator), an aggressive driving score (simulator), verbal expression of driving anger (video), and related gestures and headshakes (video). Verbal and gestural expression while driving were related to an increase in state anger in the simulator drive and different self-reported measures: While observed verbal expression was positively related to lapses and negatively related to constructive expression, gestural expression was positively related to both self-reported violations and self-reported aggressive expression. The traits Emotionality and Honesty-Humility were related to an increase in state anger and to verbal expression in the simulator drive, yet, age and gender modified the relation to personality traits. Results can support the development of personalised anger management interventions and anger mitigating in-vehicle devices.

We aimed to estimate the effect of organized mammography screening on incidence-based breast cancer mortality by comparing changes in mortality among women eligible for screening to concurrent changes in younger and older ineligible women. In a county-wise balanced, open-cohort study, we used birth cohorts (1896-1982) to construct three age groups in both the historical and screening period: women eligible for screening, and younger or older women ineligible for screening. We included women diagnosed with breast cancer who died within the same age-period group during 1987-2010 (n = 4,903). We estimated relative incidence-based mortality rate ratios (relative MRR) comparing temporal changes in eligible women to concurrent changes in ineligible women. Additionally, we conducted analyses comparing the change in eligible women to younger, ineligible women with either continued accrual and follow-up period (eligible women only) or continued follow-up period. All three age groups experienced a reduction in mortality, but the decrease among eligible women was about the same among ineligible women (relative MRR = 1.05, 95% CI: (0.94-1.18)). Varying the definition of follow-up yielded similar results. Mammography screening was not associated with a larger breast cancer mortality reduction in women eligible relative to ineligible women.

Background People suffering from serious mental illness face a high risk of lifestyle-related health problems, and higher mortality and morbidity rates than the rest of the population. The solution to the problem has been to integrate health promotion initiatives in mental health care. In Denmark psychiatric departments have implemented a new strategy and mental health nurses are now asked to screen for risk factors. The aim of this study is to explore how mental health nurses experience working with the screening of risk factors amongst patients with mental illnesses as part of their health promotion activities. Methods We employed a qualitative research design using an interactive approach. Two focus group interviews (n = 7; n = 5) were conducted with mental health nurses attending a mental health specialist training in Denmark in 2018. The interviews lasted 1 ½ hours, were recorded and transcribed verbatim. Data were organized using NVivo 12 software and a qualitative content analysis was used to describe experiences in a conceptual form. Results The implementation of health promotion activities in mental health care created two different types of dilemmas for the mental health nurses: 1) dilemmas related to health promotion that involved discrepancies between patients’ autonomy and wishes, and the health promotion activities that were offered; 2) system-related dilemmas originated from structural factors and working with screening for risk factors. The mental health nurses developed various strategies and found new solutions to navigate these dilemmas. Conclusions Mental health nurses found it challenging to implement health promotion activities in mental health care, although they generally found these activities meaningful. They developed new strategies to overcome the dilemmas. Key messages Health promotion initiatives need to be adapted to mental health nurses’ existing mental healthcare practices in order for them to be meaningful. Screening of risk factors is insufficient as a health promotion activity in mental health care.

Unlicensed driving among youth is associated with increased crash risk, and partly motivated by a wish to learn to drive. In this paper we examine whether crash involvement among 17-year-old unlicensed drivers changed after post-licence accompanied driving from the age of 17 was allowed in Denmark in 2017. The study includes police-registered crashes occurring three years before and three years after the change (2014-2019). Results show an increase in crash involvement among 17-year-olds and a small increase in crash involvement among unlicensed 17-year-olds, if population size is taken into account, but no differences in the crash and person characteristics before and after the change. Being male, speeding, and impairment at the time of the crash predicted unlicensed crash involvement. A latent class clustering analysis (LCCA) identified seven clusters of crashes involving an unlicensed 17-year-old. The cluster characteristics reveal different patterns in the associated factors such as females and parked vehicles being more likely to be included in C1, alcohol impaired in C2 and drug impaired in C7. Brief crash descriptions provided by the police indicate that driving with extra motives such as showing-off or pleasure are prevalent in all clusters. Results confirm, that unlicensed crash involvement among 17-year olds is associated with risk-taking behaviours such as speeding, impaired driving, showing-off, and the car being pursued by the police. However, unfortunate manoeuvres and loss of control of the vehicle possibly related to poor driving skills are also associated with the crashes. Crash characteristics such as impairment by alcohol and drugs indicate that unlicensed crash involvement is a distinct safety challenge associated with health risk behaviours rather than a transport related need for a driver's license. Additional studies exploring the motivations and circumstances associated with unlicensed driving among 17-year olds are needed along with measures to prevent car access among unlicensed youth..

Objective A severe or lethal prenatal diagnosis places great demands on prospective parents, who face choices of far-reaching consequences, such as continuing or terminating the pregnancy. How best to support these parents is a clinical challenge. This systematic review aimed to identify and synthesize the qualitative evidence regarding prospective parents’ responses to such prenatal diagnoses. Methods Following PRISMA guidelines, four databases were systematically searched and 28 studies met the inclusion criteria. Thematic analysis guided data extraction and synthesis of findings. The CERQual assessment tool was utilized to assess confidence in the findings. Results Prospective parents experienced multiple losses, e.g. of the healthy child, normal pregnancy and envisioned future.. After diagnosis, they requested timely and reliable information and empathetic continued interaction with clinicians. Prospective parents who continued the pregnancy wished to be acknowledged as parents, and engaged in planning to obtain a sense of meaning and control. Selective disclosure and concerns about negative responses were issues both for the parents who terminated and those who continued a pregnancy. Conclusion Clinicians can support parental coping following a severe prenatal diagnosis through continued dialogue and collaboration. Further research is needed on the experiences of parents who choose to terminate a pregnancy following prenatal diagnosis.

Around Denmark, Laminaria digitata and Saccharina latissima are particularly common macroalgae species and are considered as prospective candidates for biorefineries. In this study, the carbohydrate composition and protein levels of L. digitata and S. latissima from three different sites in Denmark were compared for 1 year, and compositional variations of wild L. digitata harvested in August from the North Sea was monitored for 3 years. Glucan levels of L. digitata were consistently higher than those of S. latissima irrespective of harvest site and time of the year. Glucan levels in wild L. digitata from Kattegat peaked in October with 37.0% by dry weight compared to 22.6% by dry weight in wild S. latissima (Kattegat) and were accompanied by lower ash contents (18.5% w/w in L. digitata versus 26.5% w/w inS. latissima). Alginate contents were almost constant throughout the year, but mannuronic/glucuronic acid ratios differed between species and location from 1.33 to 3.64. Wild L. digitata harvested from the North Sea in August contained >50% glucans by weight and had low ash contents for three consecutive years (2012–2014). Compositional variation of the seaweeds was mainly related to season but also varied with species, location, and within populations. Among environmental variables (temperature, salinity, phosphate, nitrate, ammonia), only temperature was found to correlate with the chemical composition of the seaweeds. Amino acid profiles were dominated by glutamic acid, aspartic acid, and alanine and varied with season, especially for L. digitata from the North Sea, and location. Total nitrogen contents fluctuated more between samples than the actual protein contents; hence, application of a common N-to-protein factor cannot be recommended.

Objective This article explores how a diabetes app called Diapplo affected adolescents’ participation in their healthcare by investigating adolescents’ meaning-making in relation to their use of the app. Methods Using a qualitative single case-study design, we adopted a multimethod responsive approach to data generation that included written data from the app development process, individual and group interviews and observations of the adolescents in the clinical situation. This article presents the results from a qualitative content analysis of group and individual semi-structured interviews conducted with five adolescents diagnosed with type 1 diabetes during and after the four-week test phase of a prototype of the app. Results The adolescents appreciated the diabetes app’s design and interface and having an overview of their blood glucose values. However, they stated that the app’s content only partly met their needs and they considered several of its features unnecessary. They would have liked the app to have a social platform and emphasized that the app should be compatible with their blood glucose monitors and pumps for them to continue using it. Conclusions The participants in our study highlighted the value of social platforms integrated in health apps for patient participation, as well as their preference for health app features that reduced the effort of managing their chronic condition and facilitate greater knowledge. Theories of sociomateriality and material participation helped to account for the challenges of integrating users’ perspectives, suggesting the value of early, comprehensive identification and prioritization of users’ values when developing mobile health technologies.

We present five Danish individuals with Hajdu-Cheney syndrome (HJCYS) (OMIM #102500), a rare multisystem skeletal disorder with distinctive facies, generalised osteoporosis and progressive focal bone destruction. In four cases positive genetic screening of exon 34 of NOTCH2 supported the clinical diagnosis; in one of these cases, mosaicism was demonstrated, which, to our knowledge, has not previously been reported. In one case no genetic testing was performed since the phenotype was definite, and the diagnosis in the mother was genetically confirmed. The age of the patients differs widely from ten to 57 years, allowing a natural history description of the phenotype associated with this ultra-rare condition. The evolution of the condition is most apparent in the incremental bone loss leading to osteoporosis and the acro-osteolysis, both of which contribute significantly to disease burden.

Background: Mammography screening increases incidence because cancers are detected earlier in time and because of overdiagnosis. We developed an Excel-based model to visualize the expected increase from lead-time amplified by increasing background incidence. Subsequently, we added overdiagnosis to the model.Methods: We constructed two hypothetical populations of women aged 50-79 in 5-year age and calendar groups: one with screening for women aged 50-69 and one without. The user enters information on population at risk, number of breast cancers, trends in background incidence, average length of lead-time and, optionally, overdiagnosis. The model computes incidence rate ratios (IRRs) comparing incidence changes with screening to changes without in open and closed cohorts.Results: We entered information from Norway from 1990 to 1994, the period preceding the gradual introduction of a national mammography screening programme. As expected, the Screening Illustrator showed prevalence peaks and compensatory drops. Only the closed cohort approach remained unaffected by increasing background incidence. The model showed a 20% sustained increase in incidence (IRR: 1.20) from lead-time and increasing background incidence in the open cohort approach for women aged 50-69. However, real life Norwegian data show a corresponding 38% increase. For the model to achieve the observed incidence, 10-14% overdiagnosis had to be added.Conclusion: The observed breast cancer incidence increase in Norway after screening implementation could not be obtained from an average lead-time of 2.5 years and empirical background incidence trends, but had to incorporate overdiagnosis.

Objective. The aim of the study was to determine sonographers’ experiences with the introduction of an offer of noninvasive prenatal testing (NIPT) to a new moderate-risk (MR) group at the combined first-trimester prenatal screening (cFTS). Study Design. A qualitative approach consisting of seven semistructured interviews with five sonographers (midwives and nurses). Data was analyzed using thematic analysis. Main Outcome Measures. Sonographers’ perception of offering NIPT to women in MR. Results. The sonographers understood NIPT as a positive development in prenatal screening due to a safe procedure and high detection rates for trisomies 13, 18, and 21. Prior to the introduction of MR, the sonographers were concerned about inducing worry in pregnant women in this new risk group. However, the pregnant women responded very positively, which the sonographers attributed to several factors such as the women’s overall reason for participating in prenatal screening, the simplicity of the NIPT procedure, and the communicative strategies used by the sonographers. The strategies included all sonographers using the same words and explanations, emphasizing that statistics were in the women’s favor, initiating the presentation of MR with a positive message, and downplaying the MR category. Conclusion. Sonographers’ communicative strategies succeeded in limiting worry in pregnant women in MR. As such, the findings are valuable for health professionals, who are responsible for communicating about prenatal screening results and diagnostic options.

Background Reviews of the randomized controlled trials (RCTs) of mammography screening conducted during the 1970s and 1980s reported a 15–21% reduction in breast cancer mortality. Improved cancer treatment and enhanced awareness may however have reduced the potential net benefit from mammography screening. New RCTs are no longer feasible and observational studies yield widely varying estimates of the reduced breast cancer mortality (0% to 43%), depending on study design. In Norway, mammography screening was introduced gradually during the period 1996–2004. Using this as a natural experiment, we aimed to estimate the effect of organized mammography screening on incidence-based breast cancer mortality by comparing changes in mortality among women eligible for screening to concurrent changes in younger and older ineligible women. The use of un-screened age-groups as control groups allowed us to conduct a balanced incidence-based mortality study in which we aimed to distinguish the screening effect on breast cancer mortality from the effect of the concomitantly established diagnostic centers, which may also have improved treatment. Methods In a national county-wise balanced, open-cohort study in Norway, we used birth cohorts (1896–1982) to construct three age groups in both the historical and screening period: women eligible for screening and younger or older women ineligible for screening. We included women diagnosed with breast cancer who died within the same age-period group during 1987–2010 (n = 4903). We estimated relative incidence-based mortality rate ratios (relative MRR) comparing temporal changes in eligible women to concurrent changes in ineligible women. Additionally, we conducted analyses comparing the change in eligible women to younger, ineligible women with either continued accrual and follow-up period (eligible women only) or continued follow-up period. Finally, we checked for unadjusted confounding in two negative control analyses expected to produce a null result (relative MRR = 1). First, we compared the mortality change in younger women to the concurrent change in older women. Second, we extended the study period to include the period 1987–2010 for all counties and repeated our analysis as if screening had been introduced at the midpoint of the actual pre-screening period and the actual screening period in each county, respectively. Results All three age groups experienced a reduction in mortality when screening was introduced, but the decrease among eligible women was about the same among ineligible women (relative MRR = 1.05, 95% CI: [0.94–1.18]). Varying the definition of follow-up yields similar results. The negative control analyses all had relative MRRs close to 1 (estimates ranged from 0.91 to 1.04 and with all 95% CIs overlapping 1). Conclusion Mammography screening was not associated with a larger breast cancer mortality reduction than that of women ineligible for mammography screening. Based on the negative control analyses we found limited uncontrolled confounding in the applied observational design.

How to determine if a population group has better overall (multidimensional) health status than another is a central question in the health and social sciences. We apply a multidimensional first order dominance concept that does not rely on assumptions about the relative importance of each dimension. In particular, we show how one can explore the “depth” of dominance relations by gradually refining the health dimensions to see which dominance relations persist. We analyze a Danish health survey with many health indicators. These are initially collapsed into a single composite health dimension and then refined to four, seven, and ten health dimensions, each representing an (increasingly refined) area of health. Overall we find that younger age groups dominate older age groups in up to four dimensions, but no dominance relations are present with a more refined view of health. Comparing education groups, we often see dominance relations in four and seven dimensions, but the depth of the dominance vary considerably. We also compare groups based on gender, marital status, region, and ethnicity, where we generally find less dominance relations. Our empirical illustration shows that it is possible to operationalize and meaningfully apply the multidimensional first order dominance concept with gradual refinements of health status in up to ten health dimensions.

Background When an infection is suspected in a child with cancer and a central venous line (CVL), cultures are often only obtained from the CVL and not from a peripheral vein (PV). This study was undertaken to evaluate the importance of concomitant blood cultures from the CVL and a PV. Procedure Clinical data and the results of all cultures taken concomitantly from the CVL and a PV were registered prospectively in children admitted with fever from April 2008 to December 2012 at the Department of Pediatrics at Aarhus University Hospital Skejby. Results During the study period 654 paired cultures obtained from the CVL and from a PV within two hour of each other were included. A true bloodstream infection (BSI) was registered in 112 episodes. In 20 (17%) out of 112, true BSI growth of a microorganism was detected only in the culture from a PV including seven cases of Escherichia coli and three cases of Staphylococcus aureus. In 52 episodes the same microorganism was cultured from both the CVL and a PV. Twenty-four of these episodes were classified as catheter-related bloodstream infections (CRBSI) using differential time to positivity. In total, 64 (57%) of all true BSI were defined as CRBSI. Conclusions Blood cultures should be obtained from a PV in addition to cultures from CVL at the onset of fever in pediatric patients with cancer in order to maximize the findings of true BSIs. The frequency of CRBSI may be over-estimated if blood cultures are drawn from CVL only. Pediatr Blood Cancer 2015;62:99–102. © 2014 Wiley Periodicals, Inc.

Central venous catheters (CVC) are an inevitable part of thetreatment of children with cancer. Although many attempts havebeen made to reduce the risk of catheter-related infections, CVCsremain a major risk factor of bloodstream infections [1–4]. Stud-ies have shown that biofilm develops quickly once a CVC isinserted into a patient [5]. Bacteria living in a biofilm can bevery difficult to eradicate and are likely to be involved in casesof recurrent CRBSI [5,6].Heparin is often used to lock the catheter to prevent clottingwhen the catheter is not in use although heparin may enhance thegrowth of bacteria and the biofilm formation [7]. A Cochranereview has found prophylactic antibiotic catheter-lock to be ben-eficial in preventing CRBSI, but it is not routinely recommendeddue to the risk of selecting resistant microorganisms [8,9].Taurolidine is derived from the naturally occurring amino-sulphonic acid taurinamide and formaldehyde [10]. Taurolidineand its active metabolites contain an activeN-methylol groupthat cross-links with the protein part of the bacterial cell walland thereby neutralizes endotoxins and probably also to someextent exotoxins [11,12]. Taurolidine has also been reported tohave anti-adherence properties [13] and may reduce biofilmformation [14–16]. The substance has shown a broad spectrumof antimicrobial activity against both gram-positive and gram-negative bacteria as well as fungi. Taurolidine used as a cathe-ter-lock has shown efficacy in preventing CRBSI in adultpatients [17,18]. One non-randomized study of the use oftaurolidine as a catheter-lock in children with cancer reducedthe rate of gram-positive bloodstream infections [19]. Nointrinsic microbial resistance towards taurolidine has beenreported [20].We report the result of a prospective, randomized, controlledopen-label study in which CVCs locked with a taurolidine solu-tion were compared to CVCs locked with a standard heparinsolution.

Background High-dose cytarabine has been associated with a high frequency of viridans group streptococcal (VGS) bacteraemia. VGS bacteraemia causes considerable morbidity and mortality. The Nordic Society of Paediatric Haematology and Oncology (NOPHO)-AML protocols use higher cumulated doses of cytarabine and more chemotherapy series (n = 6) than other protocols with the potential increased risk of severe VGS infections. Procedure Medical records of all Danish children enrolled on the NOPHO-AML-2004 protocol between January 2004 and September 2011 (n = 45) were retrospectively reviewed and all febrile episodes were registered. Results Following 236 courses of chemotherapy, 112 positive blood cultures were registered. VGS were found in 38% of all positive blood cultures. Infectious episodes with VGS resulted in more days of fever and intravenous antibiotic therapy compared with infections caused by other microorganisms. VGS were involved in 45% of all episodes categorized as sepsis (n = 51) and in 67% of life-threatening bloodstream infections (n = 9). Penicillin resistance was found in 40% of the VGS strains. No significant difference was observed in the proportion of VGS isolated following courses with low-dose cytarabine versus courses with high-dose cytarabine. Conclusions VGS were the most commonly isolated pathogens causing the most severe infections and the majority of life-threatening infections. A substantial proportion of the strains were resistant to penicillin. The high rate of VGS seemed independent of high-dose cytarabine but was more likely caused by the intensive chemotherapy treatment leading to severe mucositis and neutropenia. Pediatr Blood Cancer 2013; 60: 1154–1160. © 2012 Wiley Periodicals, Inc.

The purpose of the study was to assess the risk of first-time bloodstream infection (BSI) according to type of central venous catheter (CVC) during induction therapy in children with acute lymphoblastic leukemia (ALL). Patients eligible for our analysis were all newly diagnosed children with ALL treated at 3 pediatric centers in Denmark between 2008 and 2014. A total of 136 patients were followed from initial CVC placement until first BSI, CVC removal, death, or day 28, whichever occurred first. Thirty-nine BSIs were detected, of which 67% were gram-positive infections, and 59% met the criteria for being CVC associated. The 28-day cumulative incidence of BSI was similar in 77 patients with a nontunneled CVC (28%; 95% confidence interval, 19%-40%) and in 59 patients with a tunneled CVC with external lines (TE) (33%; 95% confidence interval, 23%-47%). Subgroup analyses showed that gram-negative blood isolates occurred more frequently in patients with a TE, and that lower incidences of BSI were detected in patients older than 9 years with a TE, and in patients with T-ALL. It is concluded that the type of CVC inserted at diagnosis has no impact upon the risk of BSI in patients with ALL undergoing induction therapy.

Despite overall improvements in traffic safety levels, young male drivers continue to be over represented in accidents. In this study the association between driving style and leisure time was examined in two groups of drivers. The sample consisted of 4000 male drivers of which 2000 were 18 years old and 2000 were 28 years old. A posted questionnaire was used. The overall response rate was 51% (N = 2018). A similar factor structure of three factors with regard to driving style was identified in both groups of drivers. The factors were named Thrill, Anxiety and Anger. Despite significant differences regarding specific leisure time activities, a similar relationship between leisure time and driving style was found in the two groups of drivers particularly in relation to problem behaviours. In both groups driving related interaction with friends as well as a high paced leisure time was found to be related to a high score on the factors Thrill and Anger. In the older group of drivers cruising with friends was associated with problem behaviours such as smoking pot and doing drugs. Results indicate a need for early intervention enhancing safe behavioural choices thereby preventing unsafe behaviours to become permanent behavioural strategies in life.

The radioligand [carbonyl-(11)C]WAY-100635 ((11)C-WAY) is a PET tracer of the serotonin 5HT(1A) receptors in the human brain. It is metabolized so rapidly in the circulation that it behaves more as a chemical microsphere than as a tracer subject to continuous exchange between the circulation and brain tissue. Although reference tissue methods are useful as analyses of uptake of some radioligands with indeterminate arterial input functions, their use to analyze (11)C-WAY uptake and binding is challenged by the rapid plasma metabolism, which violates the assumption that regions of interest and reference regions continue to exchange radioligand with the circulation during the entire uptake period. Here, we proposed a method of calculation (Hypotime) that specifically uses the washout rather than the accumulation of (11)C-WAY to determine binding potentials (BP(ND)), without the use of regression analysis.A total of 19 healthy volunteers (age range, 23-73 y) underwent PET to test the Hypotime application of the chemical microsphere properties of (11)C-WAY to identify regions of binding and nonbinding on the exclusive basis of the rate of washout of (11)C-WAY.The results of the Hypotime method were compared with the simplified but multilinearized reference tissue method (MLSRTM). The distribution of receptor BP(ND) obtained with Hypotime was consistent with previous autoradiography of postmortem brain tissue, with the highest values of BP(ND) recorded in the medial temporal lobe and decline of receptor availability with age. The values in the basal ganglia and cerebellum were negligible. The MLSRTM, in contrast, yielded lower BP(ND) in all regions and only weakly revealed the decline with age.The simple and computationally efficient Hypotime method gave reliable values of BP(ND) without the use of regression. The MLSRTM, on the other hand, appeared to be affected by the early disappearance of the radioligand from the circulation and the associated uncertain late presence of (11)C-WAY in the circulation.

This study examined the relation between risk-taking behaviour while driving, the psychosocial function of driving, leisure time activities, car oriented peer group interaction and educational attainment. Two thousand four hundred seventeen drivers aged 18-25, randomly selected from the Danish Driving Licence Register, participated in the study. Data was collected through a mail survey. The response rate was 60.4%. A positive significant effect on risk-taking behaviour based on the score on the psychosocial function of driving was found (p

Objectives – Post-stroke depression and pathological crying (PC) implicate an imbalance of serotonergic neurotransmission. We claim that PC follows serotonin depletion that raises the binding potential (pB) of the 5-HT1A receptor antagonist [carbonyl–11C]WAY-100635, which is reversible by selective serotonin re-uptake inhibitor (SSRI) treatment. Materials and Methods – We PET scanned patients with acute stroke and PC and age-matched control subjects. Maps of receptor availability were generated from the images of eight cortical regions and raphe nuclei. Results – The maps showed highest binding in limbic areas and raphe nuclei, while binding in basal ganglia and cerebellum was negligible. Baseline binding potentials of patients were lower than that of control subjects (3.7 ± 0.6 vs 4.2 ± 0.2). Treatment with SSRI markedly reduced free receptor sites, whereas placebo administration led to a global increase. Discussion – The study is the first suggestion of changes of serotonergic neurotransmission in the early phase of stroke and the modulation of these changes with SSRI treatment.

OBJECTIVES: To estimate changes in the stage distribution of prostate cancer during the time period where opportunistic PSA-testing was introduced.SUBJECTS AND METHODS: Cancer stage, age and year of diagnosis were obtained for all men over the age of 50 diagnosed with prostate cancer in Norway during the period 1980-2010. Three calendar-time periods (1980-1989, 1990-2000, and 2001-2010) and three age groups (50-65, 66-74, and 75+) were defined. Birth cohorts were categorized into four intervals: 1941. We used Poisson regressions to conduct both a time period and cohort-based analysis of trends in the incidence of localised, regional and distant cancer for each combination of age groups and calendar-time periods or birth cohorts, respectively. Additionally, we explored the effect of cohorts on the stage-specific incidence graphically with a Poisson regression using 5-year age groups, and by estimating cumulative incidence rates for each birth cohort.RESULTS: The annual incidence of localised cancers among men aged 50-65 and 66-74 rose from 41.4 and 255.2 per 100,000, respectively, before the introduction of PSA-testing to 137.9 and 418.7 in 2001-2010 afterwards, corresponding to 3.3 (CI: 3.1; 3.5) and 1.6 (CI: 1.6; 1.7) fold increases. The incidence of regional cancers increased by a factor seven among men aged CONCLUSION: Opportunistic PSA-testing substantially increased the incidence of localised and regional prostate cancers among men aged 50-74 years, which was not fully compensated by the 30% decrease in incidence of distant prostate cancers in older men. This article is protected by copyright. All rights reserved.

Objectives: Although magnesium is now the drug of choice for the prevention of eclamptic seizures only few studies have evaluated whether magnesium may reduce blood pressure in pregnancies complicated with hypertension. Methods: A total of 33 patients with pregnancy-induced hypertension were randomized to either magnesium or methyldopa treatment. Of these 16 received magnesium and 17 methyldopa. The treatment comprised a 48-hour magnesium infusion followed by oral magnesium tablets until 3 days after delivery or 250 mg methyldopa 4 times a day in a similar period. Results: Patients treated with magnesium had 1 day after inclusion a statistically significantly lower systolic blood pressure compared to the level in the methyldopa group (138.1 ± 11 vs. 147.6 ± 11 mm Hg; p < 0.05), but no difference was observed in diastolic blood pressure (92.0 ± 6.6 vs. 96.0 ± 10.1 mm Hg; NS). From the 5th day of inclusion and until delivery both systolic and diastolic blood pressure were significantly lower in the magnesium group (p < 0.05). Including all blood pressure measurements in a single analysis showed that both systolic (138 ± 13 vs. 148 ± 15 mm Hg; p < 0.0001) and diastolic (92 ± 10 vs. 94 ± 10 mm Hg; p < 0.05) blood pressure were lower in the magnesium group compared to the methyldopa group. There was no difference between the two groups regarding gestational age at delivery, birth weight, Apgar scores and pH in umbilical cord blood. Conclusion: This preliminary study demonstrates that magnesium treatment lowers blood pressure in pregnancies complicated with hypertension. The effect is without any adverse effect on maternal and neonatal well-being.

In this study, we present a new objective method for measuring the eye colour on a continuous scale that allows researchers to associate genetic markers with different shades of eye colour. With the use of the custom designed software Digital Iris Analysis Tool (DIAT), the iris was automatically identified and extracted from high resolution digital images. DIAT was made user friendly with a graphical user interface. The software counted the number of blue and brown pixels in the iris image and calculated a Pixel Index of the Eye (PIE-score) that described the eye colour quantitatively. The PIE-score ranged from -1 to 1 (brown to blue). The software eliminated the need for user based interpretation and qualitative eye colour categories. In 94% (570) of 605 analyzed eye images, the iris region was successfully extracted and a PIE-score was calculated. A very high correlation between the PIE-score and the human perception of eye colour was observed. The correlations between the PIE-scores and the six IrisPlex SNPs (HERC2 rs12913832, OCA2 rs1800407, SLC24A4 rs12896399, TYR rs1393350, SLC45A2 rs16891982 and IRF4 rs12203592) were analyzed in 570 individuals. Significant differences (p

Taurolidine has demonstrated inhibition of biofilm formation in vitro. The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters. Forty-eight children with cancer were randomized to catheter locking by heparin (n = 22) or taurolidine (n = 26), respectively. After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Biofilm was present if morphologically typical structures and bacterial cells were identified. Quantitative and semi-quantitative cultures were also performed. Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group. A positive culture was made of six of the catheters locked with taurolidine and heparin, respectively (p = 0.78). The rate of catheter-related bloodstream infections (CRBSI) was 0.1 per 1000 catheter-days using taurolidine and 0.9 per 1000 catheter-days using heparin (p = 0.03). This randomized trial confirmed that the use of taurolidine as catheter-lock compared with heparin reduced the rate of CRBSIs; this reduction was not related to a reduction in the intraluminal biofilm formation and the rate of bacterial colonization detected by scanning electron microscopy in the two groups.

The indication for adjuvant postmastectomy radiotherapy (PMRT) in breast cancer patients with small tumors and 1–3 macrometastases in the axilla remains a controversial issue, despite the recommendation that PMRT should be applied in these patients in the most recent overview by the Early Breast Cancer Trialists’ Collaborative Group. In this report, we discuss the available data on the benefit from PMRT in patients diagnosed with N1 breast cancer. Based on this, we recommend adjuvant PMRT to the chest wall and regional lymph nodes in patients diagnosed with early node-positive breast cancer.

Udgivelsesdato: 2008-null INTRODUCTION: This study was conducted to establish the maximum tolerated dose (MTD) of intravenous vinorelbine and on the determined dose to assess efficacy and safety in patients with metastatic breast cancer previously treated with epirubicin. PATIENTS AND METHODS: Patients had histologically proven breast cancer and had received a prior epirubicin based regimen either adjuvant or as first line therapy for advanced disease. Vinorelbine was administered intravenously day 1 and 8 in a 3 weeks' schedule. Subsequently 48 additional patients were treated at one dose-level below MTD. RESULTS: Fifty-five patients were included in the dose-escalation study, which defined 40 mg/m(2) as the MTD. Neutropenia of short duration and autonomic neuropathy causing constipation were the most common dose-limiting toxicities. At the 35 mg/m(2) dose-level 60 patients were included in total. Seven (12%; 95% CI 6 to 22) had a partial response and 16 additional patients had stable disease. 27% had stable disease (clinical benefit rate 38%, 95% CI 27 to 51). The median overall survival was 45 weeks and 39% of the patients were alive after one year. DISCUSSION: The clinical benefit rate was 38% with an overall intention to treat response rate of only 12%. The results were, however, achieved with low subjective burdens of toxicity.

Udgivelsesdato: 2007-Jul The psychostimulant 3,4-methylendioxymethamphetamine (MDMA, "ecstasy") evokes degeneration of telencephalic serotonin innervations in rodents, nonhuman primates, and human recreational drug users. However, there has been no alternative to nonhuman primates for studies of the cognitive and neurochemical consequences of serotonin depletion in a large-bodied animal. Therefore, we used positron emission tomography (PET) with [(11)C]DASB to map the distribution of plasma membrane serotonin transporters in brain of Göttingen minipigs, first in a baseline condition, and again at 2 weeks after treatment with MDMA (i.m.), administered at a range of doses. In parallel PET studies, [(11)C]WAY-100635 was used to map the distribution of serotonin 5HT(1A) receptors. The acute MDMA treatment in awake pigs evoked 1 degrees C of hyperthermia. MDMA at total doses greater than 20 mg/kg administered over 2-4 days reduced the binding potential (pB) of [(11)C]DASB for serotonin transporters in porcine brain. A mean total dose of 42 mg/kg MDMA in four animals evoked a mean 32% decrease in [(11)C]DASB pB in mesencephalon and diencephalon, and a mean 53% decrease in telencephalic structures. However, this depletion of serotonin innervations was not associated with consistent alterations in the binding of [(11)C]WAY-100635 to serotonin 5HT(1A) receptors. Stereological cell counting of serotonin-positive neurons, which numbered 95,000 in the dorsal raphé nucleus of normal animals, was unaffected in MDMA-treated group. group.

Background and aims: The integrity of motor pathways and functional connectivity patterns are important in assessing plastic changes related to successful recovery, to obtain prognostic information and to monitor future therapeutic strategies of stroke patients. We tested the following hypotheses: (1) that changes in axonal integrity along the corticospinal tract after stroke can be detected as a reduction in fractional anisotropy; and (2) that sustained low fractional anisotropy is indicative of axonal loss and therefore is correlated with poor motor outcome, as measured by specific neurological motor scores. Methods: We developed a segmentation tool based on magnetic resonance diffusion tensor imaging in conjunction with three dimensional fibretracking for longitudinal studies of the corticospinal tract, and used specific neurological motor scores to test the hypotheses in five stroke patients within the first week and 30 and 90 days after the stroke. Results: Reduction in fractional anisotropy within the first weeks after stroke reflected a decline in axonal integrity, leading to Wallerian degeneration, and demonstrated a correlation between the temporal evolution of fractional anisotropy and motor function in patients with poor motor outcome. Conclusion: The study demonstrated the feasibility of fibretracking as a segmentation tool for mapping distal parts of the corticospinal motor pathways and showed that fractional anisotropy in the segmented corticospinal tract is a sensitive measure of structural changes after stroke.