Kathrine Frey Frøslie

Reliability of the Pediatric Evaluation of Disability Inventory (PEDI)

Pediatric Evaluation of Disability Inventory (PEDI) is an instrument for evaluating function in children with disabilities aged 6 months to 7.5 years. The PEDI measures both functional performance and capability in three domains: (1) self-care, (2) mobility, and (3) social function. The PEDI has recently been translated into Norwegian. The purpose of this study was to investigate the inter-rater, inter-respondent and intra-rater reliability of the Norwegian version of the PEDI. Reliability was investigated in a sample of 30 Norwegian children without disabilities between 1.0 and 5.0 years. Interviews with parents were conducted twice by the same occupational therapist, and once by a physiotherapist. Kindergarten teachers were also interviewed by the occupational therapist. Using children without disabilities allows us to set up a standard for functional ability. Deviation from the point may indicate improvement or worsening of the state. The inter-rater and intra-rater part of the study showed excellent agreement of the observations, indicated both by small differences and high Intraclass Correlation Coefficients (ICC) (0.95-0.99). The discrepancy between the different interviews was highest between the reports from the parents and the kindergarten teachers (inter-respondent reliability), indicated by ICC from 0.64-0.74. Results of this study indicate that improved reliability is secured when the same interviewer interviews the same respondent, as well as when two trained interviewers interview the same respondent. The consistency of scores should be reviewed when different respondents are interviewed. Professionals administering the PEDI needs to be trained following a required procedure in order to secure consistency in their rating.

Modifiable determinants of fetal macrosomia: role of lifestyle-related factors

Background. Newborn macrosomia is associated with both short‐ and long‐term health risks for the infant, and increases the prevalence of birth complications. Parity, maternal age and gender of the child are known variables that influence fetal growth. The purpose of the present investigation was to evaluate prospectively the contributions of modifiable maternal predictors of fetal macrosomia (≥4,200 g), which included lifestyle‐related factors, such as nutritional intake, physical activity, and plasma glucose values, in addition to overweight and pregnancy weight gain. Methods. Some 553 women were followed through pregnancy. Predictive variables were subjected to univariate and multiple logistic regression analysis. Among these were: body mass index (BMI), weight gain, maternal subcutaneous fat (mm), fasting and 2‐h plasma glucose, self‐reported physical activity before and during pregnancy, and nutritional intake of macronutrients. Gestational age, parity and gender were also included in the model. All continuous variables were dichotomized using the upper quartile as the cut‐off point in most cases. Results. If physical activity was left out of the analyses, BMI, weight gain, plasma glucose and gestational age were independent determinants of macrosomia. After including low level pre‐gestational physical activity in the model, we found that this was now a significant determinant of delivering a macrosomic infant with an OR = 2.9 (95% CI: 1.9, 7.3). Conclusion. The present study indicates that a low level of pre‐gestational physical activity adds to the modifiable determinants of newborn macrosomia.

Anxiety, depression, and psychological well-being 2 to 5 years poststroke.

OBJECTIVES We sought to explore psychological well-being and the psychosocial situation in persons with stroke, 2 to 5 years after discharge from a specialized rehabilitation hospital. METHODS The Hospital Anxiety and Depression Scale; the 30-item General Health Questionnaire; and a questionnaire were mailed to 255 former patients. RESULTS A total of 64% answered (36% women), and the average age was 58 years. The Hospital Anxiety and Depression Scale identified problems in 47% (anxiety in 36% and depression in 28%) and 30-item General Health Questionnaire in 54%. About half had experienced periods of anxiety, depression, or both since discharge. Most were satisfied with support by family/friends (88%), home ward (68%), and community therapy services (57%). Marital status was as in the general population. CONCLUSIONS Long after stroke, almost half of the investigated patients with stroke had psychiatric problems according to the questionnaires. This is higher than in the general population but is comparable with some other chronic, somatic populations in Norway.

Birth complications, overweight, and physical inactivity

Objective. Maternal lifestyle factors are potential predictors of pregnancy complications. We examined relations between modifiable factors and delivery complications. Design. Prospective cohort. Setting. University hospital antenatal clinic, Oslo, Norway. Sample. A cohort of 553 women followed through pregnancy and delivery. Main outcome measures. Pre‐specified birth complications: cesarean section (CS), operative vaginal deliveries (VDs), third and fourth degree of perineal lacerations and hemorrhage (≥1,000 ml). Methods. Univariate and multiple logistic regression analyses were performed. Besides high birthweight (≥4,200 g), modifiable predictors (high body mass index (BMI), fasting glucose and physical inactivity) and non‐modifiable predictors (parity, maternal age, gestational age, and gender) were considered. Results. Significant predictors for induction of labor were parity (odds ratio (OR): 2.1; 95% CI 1.3–3.5), maternal age (OR: 2.0; 1.2–3.4), gestational age (OR: 1.9; 1.1–3.1), and BMI ≥30 (OR: 4.2; 2.2–7.8, p<0.01). High birthweight and high BMI were overrepresented among CSs. Emergency CS was associated with birthweight (OR: 3.7; 1.7–8.1), parity (OR: 3.5; 1.7–7.2), maternal age (OR: 2.6; 1.3–5.3), and induction of labor (OR: 4.8; 2.6–9.1). After excluding CS, operative VD was associated with parity (OR: 8.7; 3.8–20) and gender (OR: 2.2; 1.2–14.1). Perineal laceration was associated with pre‐gestational physical inactivity (OR: 6.1; 1.6–22.9) and operative VD (OR: 5.1; 1.5–17.6). Hemorrhage was associated with high birthweight (OR: 4.2; 1.2–4.7) and BMI ≥30 (OR: 4.6; 1.2–17.7). Conclusions. Pre‐gestational physical inactivity increased the risk of perineal lacerations and male infants were associated with higher risk of vaginal operative delivery.

Assessing body composition in healthy newborn infants: reliability of dual-energy x-ray absorptiometry.

Dual-energy X-ray absorptiometry (DXA) is used to measure body composition in newborns; however, data on DXA accuracy are limited. We investigated the reliability of body composition measurements by DXA. The present study included 207 normal-term newborn babies, recruited from a larger study on the determinants of birth weight in healthy pregnancies (STORK) between 2005 and 2008. Reliability analysis of total fat mass (FM(DxA)), fat-free mass, lean mass (LM(DxA)), bone mineral content (BMC), and bone mineral density (BMD) were based on 2 DXA scans of 50 neonates. We also performed a comparison analysis for DXA (FM(DxA)) measurements and caliper (CLP) or circumference (CF) measurements of trunk and extremities (performed on all neonates, n=207). Reliability: All intraclass correlation coefficients (ICC) were satisfactory to excellent for total body and the extremity-compartment FM(DxA), LM(DxA), BMD, and BMC; ICC ranged from 0.86 to 0.96 but with a lower ICC for trunk FM(DxA). For comparison analysis, the Pearson correlation coefficients for CLP vs DXA and CF vs DXA ranged from 0.48 to 0.79 and 0.41 to 0.77, respectively. Quadriceps CLP and CF measurements correlated best with the most reliable DXA results, whereas more modest correlations were found for the trunk region. DXA measurements of body composition demonstrated good reliability and can be used as a reference method in neonates. CLP and CF measurements are appropriate for larger cohorts or when DXA is unavailable, and they provide fair rough estimations of fat mass.

Increased risk of macrosomia among overweight women with high gestational rise in fasting glucose

Objectives. Maternal overweight is a risk factor for gestational diabetes (GDM) and for newborn macrosomia. Among women without GDM, it is not well understood why some women with high body mass index (BMI) give birth to macrosomic newborns while others do not. We wanted to explore the effect of BMI and fasting plasma glucose (FPG), fasting plasma insulin (FPI) and insulin resistance (HOMA-IR) on the risk of newborn macrosomia. Methods. A cohort of 553 Caucasian women was followed throughout pregnancy. The dependent variable was high birth weight (≥4200 g). Independent variables included gestational age, intake of macronutrients and energy, maternal BMI, weight gain, FPG, FPI and HOMA-IR. Results. FPG in late pregnancy (30–32 weeks) remained a significant determinant of newborn macrosomia in multiple regression analysis (OR: 1.9, 95% CI: [1.1, 3.4]), whereas FPI and HOMA-IR did not. The women in the highest BMI quartile (≥27 kg/m2) who gave birth to macrosomic newborns had higher increase in FPG and HOMA-IR from early to late pregnancy. Among women in this BMI category, the risk for delivering a macrosomic infant was higher among those with an increase in FPG above 0.60 mmol/l (upper quartile) (OR = 4.5, 95% CI: [1.7, 12.5]). Conclusion. Fasting plasma glucose at week 30–32, but not fasting plasma insulin or insulin resistance, is a determinant of newborn macrosomia. Overweight women with high increase in fasting plasma glucose from early to late pregnancy had a 4.5-fold increase in risk of newborn macrosomia compared to the remaining group with high BMI.

Walking ability and predictors of performance on the 6-minute walk test in adults with spastic cerebral palsy

Aim  To describe walking ability and identify factors predicting walking capacity in adults with spastic cerebral palsy (CP) assessed with the 6‐minute walk test (6MWT).

Seasonal variation in maternal and umbilical cord 25(OH) vitamin D and their associations with neonatal adiposity

DESIGN Neonatal body fat is an important indicator of foetal energy supply and growth with potential importance for long-term health. In this study, we wanted to explore seasonal variation of 25-hydroxy-vitamin D (25(OH)D) in maternal and umbilical cord plasma (UCP) to examine whether maternal and foetal 25(OH)D levels were associated with maternal BMI and neonatal fat mass (FM), and to explore the relationship among maternal and neonatal 25(OH)D levels, maternal glucose/insulin levels and UCP C-peptide. METHODS An observational, prospective study of determinants of foetal growth and birth weight in healthy pregnant women. Total body composition in 202 newborns was measured by dual-energy X-ray absorptiometry. Circulating levels of biomarkers were assessed in mothers at gestational weeks 14-16 and 30-32 and UCP. RESULTS The mean 25(OH)D concentration in UCP was significantly lower than in maternal circulation (31 vs 45 nmol/l, P<0.001). Maternal and UCP 25(OH)D levels varied significantly with season. No significant association between maternal BMI (weeks 14-16) and UCP 25(OH)D concentration was found. We found a strong positive association between maternal 25(OH)D and UCP 25(OH)D (P<0.001). There was no significant linear association between maternal BMI (weeks 14-16) and maternal 25(OH)D. We found no association between maternal 25(OH)D levels and glucose/insulin levels, nor with maternal or UCP 25(OH)D on UCP C-peptide levels. Finally, neonatal total body FM was positively associated with UCP 25(OH)D, P=0.02. CONCLUSIONS We demonstrated seasonal variation in maternal and neonatal 25(OH)D levels at northern latitudes. UCP, but not maternal, 25(OH)D was a significant predictor of neonatal total FM. Maternal BMI and metabolic parameters such as glucose, insulin and UCP C-peptide levels were not associated with 25(OH)D in mothers or offspring.

Shape information from glucose curves: Functional data analysis compared with traditional summary measures

BackgroundPlasma glucose levels are important measures in medical care and research, and are often obtained from oral glucose tolerance tests (OGTT) with repeated measurements over 2–3 hours. It is common practice to use simple summary measures of OGTT curves. However, different OGTT curves can yield similar summary measures, and information of physiological or clinical interest may be lost. Our mean aim was to extract information inherent in the shape of OGTT glucose curves, compare it with the information from simple summary measures, and explore the clinical usefulness of such information.MethodsOGTTs with five glucose measurements over two hours were recorded for 974 healthy pregnant women in their first trimester. For each woman, the five measurements were transformed into smooth OGTT glucose curves by functional data analysis (FDA), a collection of statistical methods developed specifically to analyse curve data. The essential modes of temporal variation between OGTT glucose curves were extracted by functional principal component analysis. The resultant functional principal component (FPC) scores were compared with commonly used simple summary measures: fasting and two-hour (2-h) values, area under the curve (AUC) and simple shape index (2-h minus 90-min values, or 90-min minus 60-min values). Clinical usefulness of FDA was explored by regression analyses of glucose tolerance later in pregnancy.ResultsOver 99% of the variation between individually fitted curves was expressed in the first three FPCs, interpreted physiologically as “general level” (FPC1), “time to peak” (FPC2) and “oscillations” (FPC3). FPC1 scores correlated strongly with AUC (r=0.999), but less with the other simple summary measures (−0.42≤r≤0.79). FPC2 scores gave shape information not captured by simple summary measures (−0.12≤r≤0.40). FPC2 scores, but not FPC1 nor the simple summary measures, discriminated between women who did and did not develop gestational diabetes later in pregnancy.ConclusionsFDA of OGTT glucose curves in early pregnancy extracted shape information that was not identified by commonly used simple summary measures. This information discriminated between women with and without gestational diabetes later in pregnancy.

Umbilical cord levels of sclerostin, placental weight and birth weight are predictors of total Bone Mineral Content in neonates

CONTEXT During pregnancy, changes occur in the maternal calcium homeostasis to fulfill fetal demand. We hypothesized that the fibroblast growth factor 23 (FGF23) system and Wnt signaling pathway are important for normal skeletal development in the offspring. AIMS Circulating α-klotho, FGF23, sclerostin, and 25-hydroxyvitamin D (25(OH)D) at the fetal and maternal sides of the placenta were measured to investigate associations with newborn bone mass independent of maternal BMI, calcium and phosphate levels, placental weight, and birth weight. METHODS In a prospective cohort of healthy pregnant women, the total body bone mineral content (BMC) in 202 newborns was measured by dual-energy X-ray absorptiometry. Maternal circulating levels of the biomarkers were measured at gestational weeks 30-32 and in umbilical cord plasma (UCP) at birth. RESULTS Mean α-klotho and sclerostin concentrations in the UCP were significantly higher than maternal levels (3004 vs 1077  pg/ml; P<0.001 and 629 vs 346  pg/ml; P<0.001 respectively), and mean 25(OH)D was lower (31 vs 45  nmol/l; P<0.001). The UCP and maternal FGF23 levels were similar. No significant effects of maternal biomarkers on BMC were found in regression analyses. Among UCP biomarkers, only UCP sclerostin was significantly associated with BMC in univariate analyses, and the effect remained significant after adjustment for birth weight and other confounders. CONCLUSIONS We found that UCP sclerostin levels, birth weight, and placental weight were significant predictors of neonatal BMC but found no evidence for a main role of maternal levels of α-klotho, FGF23, sclerostin, or 25(OH)D nor of UCP levels of α-klotho, FGF23, or 25(OH)D.