Takeda (Norway)

Despite the global phase-out of leaded gasoline, lead poisoning is estimated to cause 5.5 million premature deaths and the loss of 765 million IQ points annually. However, the contributions of different lead exposure sources to blood lead levels (BLLs) are poorly understood. We conducted a systematic literature review using the Scopus database, examining 39 studies that attribute BLLs to specific sources of lead exposure, published since the year 2000 and with sample sizes >100. The 39 studies were from 26 countries; 22 were from low- and middle-income countries, with an average sample size of 1003 participants. Twenty-three of the studies reported absolute BLL impacts (μg/L) from lead exposure sources, other studies reported odds ratios for elevated BLLs (>50 or>100μg/L). Averaged across the studies, the BLL impacts were 42.3μg/L from living near industrial lead pollution hotspots, 31.4μg/L from occupational and take-home exposure, 28.0μg/L from deteriorated paint, 19.8μg/L from traditional medicines and cosmetics, 19.3μg/L from foodware (glazed ceramics and melamine plates), 17.3μg/L from smoking, 15.4μg/L from foods, and 12.9μg/L from geophagy. Only one of the reviewed studies assessed the BLL impact of metal cookware, and did not find a significant relationship with BLLs. However, the statistical power of the attributional studies to detect relationships with BLLs was often limited. Future studies should investigate the ingestion routes from industrial pollution, the contamination of foods and spices, BLL impacts of lead-contaminated metal cookware, and traditional medicines administered to young children and infants.

Biologic treatment and surgery are complementary therapies for patients with moderate-to-severe IBD. Biological treatment has been available for the last 18 years, but there is limited knowledge about treatment patterns in different age groups. The aim of this study was to describe the use of anti-TNFα therapy and IBD-related surgery in three different age groups in Norway. Data were collected from the Norwegian Patient Registry (NPR) and included information on every individual hospital treatment episode for IBD patients (ICD-10 codes K50 and K51) from 2008 to 2015. The results were calculated for patients who were first observed with an IBD diagnosis in the registry between 2010 and 2012. The patients were followed for three years after the first observed IBD diagnosis and only patients with at least two IBD-related hospital events during the three years were included. The use of anti-TNFαs (both intravenous and subcutaneous) is recorded with ATC codes for each patient in the NPR. The occurrence of first IBD-related major surgery was assessed over the same time period, based on surgery codes for resections, colectomies, strictureplasty and intestinal obstruction repair. The analysis was stratified by disease type; ulcerative colitis (UC) or Crohn’s disease (CD) and age group (0–19 years, 20–59 years, 60+ years). The study population included 8257 patients (CD: 2829 [34%]; UC: 5428 [66%]). For CD, 355 (13%), 1937 (68%) and 537 (19%) patients were aged 0–19, 20–59 and 60+ years old, respectively. For UC, corresponding patient numbers were 297 (5%), 3665 (68%) and 1466 (27%). Three years after identification, the proportion of CD patients treated with anti-TNFαs was 50.1%, 29.6% and 11.7% in those aged 0–19, 20–59 and 60+ years, respectively. For UC, the corresponding proportions were 30.0%, 12.8% and 5.5% (Figure 1). Three years after identification IBD-related surgery was performed in 7.9%, 14.1% and 16.6% of CD patients aged 0–19, 20–59 and 60+ years, respectively. For UC, the corresponding proportions were 6.7%, 4.5% and 6.6% (Figure 2). Cumulative probability of receiving anti-TNFα therapy within three years by diagnosis and age groups (%). Cumulative risk of undergoing a resection among patients with and without pCD. Both for CD and UC, there were observed differences in the proportion of anti-TNFα treated individuals and in IBD-related surgery rates between age groups.

Complaints of dry mouth and poor dental health are common in persons with narcolepsy. The aim of this study was to investigate whether salivary secretion is reduced in narcolepsy. Persons using tricyclic anti-depressants (TCAs) were excluded, since TCAs are known to reduce salivary secretion. Thus, two patient subgroups were studied, one on central stimulant (CS) treatment (medicated group, n = 12), and one unmedicated group (n = 8), representing all persons with narcolepsy living in the Oslo area meeting these criteria. The survey group and 20 age- and sex-matched healthy control persons without symptoms of dry mouth were examined with respect to the following parameters: unstimulated (UWS) and chewing-stimulated (SWS) whole salivary flow rates, citric-acid-stimulated parotid and submandibular flow rates, buffering effect, and number of some aciduric micro-organisms in the oral cavity. As a group, persons with narcolepsy had lower whole salivary flow rates, a lower buffering effect, and higher Candida albicans scores than the control group. When the patients were divided into the medicated and unmedicated groups, these differences were valid only for the medicated group. Whether the observed differences were effects of CS medication or reflected that these persons were more seriously affected by the disease has to be further explored.