Search

Aims: We aimed to explore (a) how different patterns of physical activity (PA) over time (36 years) were associated with all-cause and cause-specific mortality, (b) if the association was similar for males and females and for different body mass levels and (c) how change in PA was associated with mortality for subjects who started out as physically inactive. Methods: The study is based on the prospective population-based cohort Trøndelag Health Study (HUNT) from 1984 to 2020, across four study waves. Data were linked to the Norwegian Cause of Death Registry. There were 123,005 participants, divided into three groups: persistently active, persistently inactive and mixed, with two cut-offs for PA: 60 and 150 minutes per week. The results are reported as cumulative incidence and hazard ratios (HRs). Results: At 60 minutes of PA per week, 8% of participants were persistently inactive, 15% were persistently active and 77% had a mixed pattern. At 150 minutes, the corresponding numbers were 32%, 2% and 65%. Compared to the persistently inactive group, for the 60-minute cut-off, the mixed group had an all-cause mortality HR of 0.83 (95% confidence interval (CI) 0.70–0.98), and the persistently active group had an HR of 0.51 (95% CI 0.40–0.65). For the 150-minute cut-off, the corresponding HRs were 0.84 (95% CI 0.75–0.94) and 0.48 (95% CI 0.26–0.88). The patterns were similar for males and females and across body mass index levels. Initially inactive participants had lower mortality if they ended up physically active, regardless of their activity level at an intermediate time point. Conclusions: At least 60 minutes of PA per week was associated with a marked reduction in mortality when this was a lasting habit over three decades. Given that six times as many people reach this less ambitious goal, it is vital to encourage all levels of PA in public health promotion. Any increase in PA during the lifespan is beneficial. [ABSTRACT FROM AUTHOR]

Background The non-ionic agent iohexol is increasingly used as the marker of choice for glomerular filtration rate (GFR) measurement. Estimates of GFR in children have low accuracy and limiting the number of blood-draws in this patient population is especially relevant. We have performed a study to evaluate different formulas for calculating measured GFR based on plasma iohexol clearance with blood sampling at only one time point (GFR1p) and to determine the optimal sampling time point. Methods Ninety-six children with chronic kidney disease (CKD) stage 1-5 (median age 9.2 years; range 3 months to 17.5 years) were examined in a cross-sectional study using iohexol clearance and blood sampling at seven time points within 5 h (GFR7p) as the reference method. Median GFR7p was 66 (range 6-153) mL/min/1.73 m.sup.2. The performances of six different single time-point formulas (Fleming, Ham and Piepsz, Groth and Aasted, Stake, Jacobsson- and Jacobsson-modified) were validated against the reference. The two-point GFR (GFR2p) was calculated according to the Jødal and Brøchner-Mortensen formula. Results The GFR1p calculated according to Fleming with sampling at 3 h (GFR1p.sub.3h-Fleming) had the best overall performance, with 82% of measures within 10% of the reference value (P10). In children with a GFR [greater than or equal to] 30 mL/min/1.73 m.sup.2 (n = 78), the GFR1p.sub.3h-Fleming had a P10 of 92.3%, which is not significantly different (p = 0.29) from that of GFR2p (P10 = 96.2%). Considerable differences within and between the different formulas were found for different CKD stages and different time points for blood sampling. Conclusions For determination of mGFR in children with CKD and an assumed GFR of [greater than or equal to] 30 mL/min/1.73 m.sup.2 we recommend GFR1p.sub.3h-Fleming as the preferred single-point method as an alternative to GFR2p. For children with a GFR < 30 mL/min/1.73 m.sup.2, we recommend the slope-GFR with at least two blood samples. Clinical Trial Registration: http://clinicaltrials.gov http://clinicaltrials.gov , Identifier NCT01092260, https://clinicaltrials.gov/ct2/show/NCT01092260?term=tondel&rank=2, Author(s): Camilla Tøndel [sup.1] [sup.2] , Cathrin Lytomt Salvador [sup.3] [sup.4] , Karl Ove Hufthammer [sup.5] , Bjørn Bolann [sup.6] [sup.7] , Damien Brackman [sup.1] , Anna Bjerre [sup.8] , [...]

Key Points: Question: What is the effect among patients with small- or medium-sized vestibular schwannoma of upfront radiosurgery on tumor volume at 4 years vs a wait-and-scan approach with treatment given only when tumor growth was documented radiographically? Findings: In this randomized clinical trial that included 100 patients, the mean ratio between tumor volume at the trial end and baseline (V4:V0) was 0.87 in the upfront radiosurgery group and 1.51 in the wait-and-scan group, a significant difference. Meaning: Among patients with small or medium vestibular schwannoma, a treatment strategy consisting of upfront radiosurgery was more effective at reducing tumor volume at 4 years than was the initial wait-and-scan approach. Importance: Current guidelines for treating small- to medium-sized vestibular schwannoma recommend either upfront radiosurgery or waiting to treat until tumor growth has been detected radiographically. Objective: To determine whether upfront radiosurgery provides superior tumor volume reduction to a wait-and-scan approach for small- to medium-sized vestibular schwannoma. Design, Setting, and Participants: Randomized clinical trial of 100 patients with a newly diagnosed (<6 months) unilateral vestibular schwannoma and a maximal tumor diameter of less than 2 cm in the cerebellopontine angle as measured on magnetic resonance imaging. Participants were enrolled at the Norwegian National Unit for Vestibular Schwannoma from October 28, 2014, through October 3, 2017; 4-year follow-up ended on October 20, 2021. Interventions: Participants were randomized to receive either upfront radiosurgery (n = 50) or to undergo a wait-and-scan protocol, for which treatment was given only upon radiographically documented tumor growth (n = 50). Participants underwent 5 annual study visits consisting of clinical assessment, radiological examination, audiovestibular tests, and questionnaires. Main Outcomes and Measures: The primary outcome was the ratio between tumor volume at the trial end at 4 years and baseline (V4:V0). There were 26 prespecified secondary outcomes, including patient-reported symptoms, clinical examinations, audiovestibular tests, and quality-of-life outcomes. Safety outcomes were the risk of salvage microsurgery and radiation-associated complications. Results: Of the 100 randomized patients, 98 completed the trial and were included in the primary analysis (mean age, 54 years; 42% female). In the upfront radiosurgery group, 1 participant (2%) received repeated radiosurgery upon tumor growth, 2 (4%) needed salvage microsurgery, and 45 (94%) had no additional treatment. In the wait-and-scan group, 21 patients (42%) received radiosurgery upon tumor growth, 1 (2%) underwent salvage microsurgery, and 28 (56%) remained untreated. For the primary outcome of the ratio of tumor volume at the trial end to baseline, the geometric mean V4:V0 was 0.87 (95% CI, 0.66-1.15) in the upfront radiosurgery group and 1.51 (95% CI, 1.23-1.84) in the wait-and-scan group, showing a significantly greater tumor volume reduction in patients treated with upfront radiosurgery (wait-and-scan to upfront radiosurgery ratio, 1.73; 95% CI, 1.23-2.44; P =.002). Of 26 secondary outcomes, 25 showed no significant difference. No radiation-associated complications were observed. Conclusion and relevance: Among patients with newly diagnosed small- and medium-sized vestibular schwannoma, upfront radiosurgery demonstrated a significantly greater tumor volume reduction at 4 years than a wait-and-scan approach with treatment upon tumor growth. These findings may help inform treatment decisions for patients with vestibular schwannoma, and further investigation of long-term clinical outcomes is needed. Trial Registration: ClinicalTrials.gov Identifier: NCT02249572 This randomized clinical trial evaluates whether upfront radiosurgery is more effective in reducing vestibular schwannoma tumor size than treatment delivered only when tumor growth has been detected radiographically. [ABSTRACT FROM AUTHOR]

A total of 477 bones of the great auk (Pinguinus impennis) from 53 localities and 55 periods in Norway are studied. All but two, are archaeological sites from the Holocene, mainly from 6000–2000 cal years bp. The two non‐anthropogenic sites date to the Ice Age: probably 36,000–34,500 and 14,690–12,890 years bp. The bones are mainly unburned and well preserved but fractured. Except for the open‐air sites in northern Norway, the bones are mainly from rock‐shelters and caves. In combining archive data, chronological information, and morphometrical studies, we suggest the great auk disappeared from the most southern part of Norway (and Sweden and Denmark) prior to 4000 years bp: a decline in distribution 2000 years ago: It became absent from the Norwegian coast 1000 years ago. Data suggest that it was distributed on the coast and in the fjord systems in winter and early spring. The presence of bones of juveniles/subadults indicates that it was also distributed in northern Norway in the autumn. To evaluate possible size differences, in time and space, nine bone elements have been measured according to standard recommendations. Multiple imputation was used to handle missing data before any statistical analysis. Analyses indicate that bones from Nordland are larger than from the rest of the country, while bones from the northernmost sites are smaller. At some localities, size differences, especially in total length of the bones, are found. It has not been verified if this is due to individual variation or sexual differences. The great auk became extinct in the 19th century. The study supports the theory that human predation at breeding sites was the main cause of its extinction. [ABSTRACT FROM AUTHOR]