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Örjan Skogar,1,5 Per-Arne Fall,2 Gunnar Hallgren,3 Birgitta Bringer,2 Miriam Carlsson,1 Ulla Lennartsson,3 Håkan Sandbjörk,3 Carl-Johan Törnhage,4 Johan Lökk51Department of Geriatrics, Ryhov Hospital, Jonkoping, Sweden; 2Department of Geriatrics, University Hospital, Linkoping, Sweden; 3Department of Neurology, 4Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden; 5Institution of Neurobiology, Karolinska Institutet, Stockholm, SwedenObjective: Nonmotor symptoms are common in Parkinson’s disease (PD). Health-related quality of life (HRQoL) is negatively affected by different factors, of which pain and sleep disturbances are important contributors. This study was performed to evaluate and describe subjective experiences of pain, sleeping patterns, and HRQoL in a cohort of PD patients with chronic pain.Methods: A total of 45 participants with established PD for more than 2 years, and PD-related pain for the preceding three months, were recruited from three sites in Sweden. Data regarding time point for onset, duration and degree of pain parameters, body localization of pain, external influences, and treatments were obtained. HRQoL was evaluated with the Short Form-36® Health Survey, and sleeping patterns were registered with the Parkinson’s disease Sleep Scale, both completed along with a questionnaire.Results: In one-third of participants, pain preceded the PD diagnosis. Median pain score measured with a visual analog scale was 6.6 and 5.9 (for females and males, respectively) the week before the study. In almost half of the participants, pain was present during all their waking hours. Significantly more females described their pain as troublesome, while more males described their pain as irritating. Feelings of numbness and creeping sensations at night were strongly associated with the maximal visual analog scale scores. Polypharmacy was common; 89% used medication for anxiety/insomnia, and 18% used antidepressants. Only one-third of patients who reported pain relief with analgesics had these prescribed on their drug lists. Sleep was characterized by frequent awakenings. Urinary urgency and restless legs were frequently reported as troublesome. Patients rated HRQoL as significantly worse in all items compared with a healthy reference population matched for age and sex.Conclusions: Experiences of chronic PD-related pain are complex; there is substantial sleep fragmentation and negative impact on HRQoL.Keywords: data reporting, pain, Parkinson disease, sleep fragmentation

Ö Skogar1,4, P-A Fall2, G Hallgren3, J Lökk4, B Bringer2, M Carlsson1, U Lennartsson3, H Sandbjork3, C-J Törnhage51Department of Geriatrics, Ryhov Hospital, Jonkoping, 2Department of Geriatrics, University Hospital, Linkoping, 3Department of Neurology, Skaraborg Hospital, Skovde, 4Institute of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, 5Department of Pediatrics, Skaraborg Hospital, Skövde, SwedenBackground: Parkinson’s disease (PD) is a chronic neurodegenerative disorder. There is limited knowledge about the function of the hypothalamic-pituitary-adrenal axis in PD. The primary aim of this prospective study was to analyze diurnal salivary cortisol concentrations in patients with PD and correlate these with age, gender, body mass index (BMI), duration of PD, and pain. The secondary aim was to compare the results with a healthy reference group.Methods: Fifty-nine PD patients, 35 women and 24 men, aged 50–79 years, were recruited. The reference group comprised healthy individuals matched for age, gender, BMI, and time point for sampling. Salivary cortisol was collected at 8 am, 1 pm, and 8 pm, and 8 am the next day using cotton-based Salivette® tubes and analyzed using Spectria® Cortisol I125. A visual analog scale was used for estimation of pain.Results: The median cortisol concentration was 16.0 (5.8–30.2) nmol/L at 8 am, 5.8 (3.0–16.4) at 1 pm, 2.8 (1.6–8.0) at 8 pm, and 14.0 (7.5–28.7) at 8 am the next day. Total secretion and rate of cortisol secretion during the day (8 am–8 pm) and the concentration of cortisol on the next morning were lower (12.5 nmol/L) in the reference group. No significant correlations with age, gender, BMI, duration of PD, Hoehn and Yahr score, Unified Parkinson’s Disease Rating Scale III score, gait, pain, or cortisol concentrations were found.Conclusion: The neurodegenerative changes in PD does not seem to interfere with the hypothalamic-pituitary-adrenal axis. Salivary cortisol concentrations in PD patients were increased in the morning compared with the reference group, and were not influenced by motor dysfunction, duration of disease, or coexistence of chronic or acute pain.Keywords: cortisol, hypothalamic-pituitary-adrenal axis, Parkinson's disease

The aim was to investigate whether kangaroo care (KC) with and without nasogastric tube feeding (NG) is tolerated by sick preterm infants during the first week of life. Seventeen infants with current or resolving illness received 1 h of KC. The study patients were originally recruited for a study on the response of intestinal peptides to feeding during KC. Median gestational age was 28 wk and median birthweight 1238 g. During KC, eight infants received NG. During KC, oxygen requirements were unchanged or decreased in 15 infants and increased in 2 infants. Changes in arterial blood gases, transcutaneous pO[sub 2]/pCO[sub 2], heart rate and temperature were minimal. One episode of apnoea occurred. In conclusion, KC was well tolerated, as was NG, during KC. [ABSTRACT FROM AUTHOR]

Our knowledge about regulatory gut peptides in preterm infants is scanty. We therefore began a study of plasma somatostatin (SS) and cholecystokinin (CCK) in preterm infants at birth and during the neonatal period. Plasma SS and CCK levels were assessed in 77 mothers and in 91 preterm infants immediately after birth (umbilical cord) and during the first day of life (1F) (n = 69, median age 5 h). The gestational age ranged from 23 to 36 weeks and the birth weight from 460 to 3,350 g. After Sep-Pak C18 semichromatography of plasma, SS and CCK were analyzed by RIA. Both plasma SS and CCK levels increased significantly during the first hours of life. Plasma SS levels were negatively correlated to gestational age, birth weight and birth length. When the SS-1F levels were adjusted for gestational age in a multivariate analysis there was no independent association with birthweight but a weak association with birth length. Plasma CCK-1F levels were not correlated with any of these variables. Plasma SS-1F levels were lower after cesarean section. Plasma SS and CCK levels during the first day were not correlated to multiple birth, mode of anesthesia, umbilical pH, Apgar score and blood glucose level before first meal.