| 31. |
- Aaberge, Rolf, et al.
(författare)
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U.S. versus Sweden: The Effect of Alternative In-Work Tax Credit Policies on Labour Supply of Single Mothers
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- An essential difference between the design of the Swedish and the US in-work tax credit systems relates to their functional forms. Where the US earned income tax credit (EITC) is phased out and favours low and medium earnings, the Swedish system is not phased out and offers 17 and 7 per cent tax credit for low and medium low incomes and a lump-sum tax deduction equal to approximately 2300 USD for medium and higher incomes. The purpose of this paper is to evaluate the efficiency and distributional effects of these two alternative tax credit designs. We pay particular attention to labour market exclusion; i.e. individuals within as well as outside the labour force are included in the analysis. To highlight the importance of the joint effects from the tax and the benefit systems it appears particular relevant to analyse the labour supply behaviour of single mothers. To this end, we estimate a structural random utility model of labour supply and welfare participation. The model accounts for heterogeneity in consumption-leisure preferences as well as for heterogeneity and constraints in job opportunities. The results of the evaluation show that the Swedish system without phase-out generates substantial larger labour supply responses than the US version of the tax credit. Due to increased labour supply and decline in welfare participation we find that the Swedish reform is self-financing for single mothers, whereas a 10 per cent deficit follows from the adapted EITC version used in this study. However, where income inequality rises modestly under the Swedish tax credit system, the US version with phase-out leads to a significant reduction in the income inequality.
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| 32. |
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| 33. |
- Aaen, J., et al.
(författare)
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Clinical and MRI findings in lumbar spinal stenosis: baseline data from the NORDSTEN study
- 2022
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 31:6, s. 1391 - 1398
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm(2)) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (>= 15 degrees) 11.9%, degeneration of multifidus muscle (2-4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings.
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| 34. |
- Aaen, J., et al.
(författare)
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Is the presence of foraminal stenosis associated with outcome in lumbar spinal stenosis patients treated with posterior microsurgical decompression
- 2023
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Ingår i: ACTA NEUROCHIRURGICA. - 0001-6268. ; 165
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Tidskriftsartikel (refereegranskat)abstract
- Background We aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS). Methods The study was an additional analysis in the NORDSTEN Spinal Stenosis Trial. In total, 230 men and 207 women (mean age 66.8 ( SD 8.3)) were included. All patients underwent an MRI including T1- and T2-weighted sequences. Grade of foraminal stenosis was dichotomized into none to moderate (0-1) and severe (2-3) category using Lee's classification system. The Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and numeric rating scale (NRS) for back and leg pain were collected at baseline and at 2-year follow-up. Primary outcome was a reduction of 30% or more on the ODI score. Secondary outcomes included the mean improvement on the ODI, ZCQ, and NRS scores. We performed multivariable regression analyses with the radiological variates foraminal stenosis, Pfirrmann grade, Schizas score, dural sac cross-sectional area, and the possible plausible confounders: patients' gender, age, smoking status, and BMI. Results The cohort of 437 patients presented a high degree of degenerative changes at baseline. Of 414 patients with adequate imaging of potential foraminal stenosis, 402 were labeled in the none to moderate category and 12 in the severe category. Of the patients with none to moderate foraminal stenosis, 71% achieved at least 30% improvement in ODI. Among the patients with severe foraminal stenosis, 36% achieved at least 30% improvement in ODI. A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. When investigating outcome as continuous variables, a similar association between severe foraminal stenosis and less improved ODI with a mean difference of 9.28 points (95%CI 0.47, 18.09; p=0.04) was found. Significant association between severe foraminal stenosis and less improved NRS pain in the lumbar region was also detected with a mean difference of 1.89 ( 95% CI 0.30, 3.49; p=0.02). No significant association was suggested between severe foraminal stenosis and ZCQ or NRS leg pain. Conclusion In patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI. Trial registration The study is registered at ClinicalTrials. gov (22.11.2013) under the identifier NCT02007083.
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| 35. |
- Aaen, J., et al.
(författare)
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The association between preoperative MRI findings and clinical improvement in patients included in the NORDSTEN spinal stenosis trial
- 2022
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 31:10, s. 2777-2785
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To investigate potential associations between preoperative MRI findings and patient reported outcome measures (PROMs) after surgery for lumbar spinal stenosis (LSS). Methods The NORDSTEN trial included 437 patients. We investigated the association between preoperative MRI findings such as morphological grade of stenosis (Schizas grade), quantitative grade of stenosis (dural sac cross-sectional area), disc degeneration (Pfirrmann score), facet joint tropism and fatty infiltration of the multifidus muscle, and improvement in patient reported outcome measures (PROMs) 2 years after surgery. We dichotomized each radiological parameter into a moderate or severe category. PROMs i.e., Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ) and Numeric rating scale (NRS) for back and leg pain were collected before surgery and at 2 year follow-up. In the primary analysis, we investigated the association between MRI findings and ODI score (dichotomized to >= 30% improvement or not). In the secondary analysis, we investigated the association between MRI findings and the mean improvement on the ODI-, ZCQ- and NRS scores. We used multivariable regression models adjusted for patients' gender, age, smoking status and BMI. Results The primary analysis showed that severe disc degeneration (Pfirrmann score 4-5) was significantly associated with less chance of achieving a 30% improvement on the ODI score (OR 0.54, 95% CI 0.34, 0.88). In the secondary analysis, we detected no clinical relevant associations. Conclusion Severe disc degeneration preoperatively suggest lesser chance of achieving 30% improvement in ODI score after surgery for LSS. Other preoperative MRI findings were not associated with patient reported outcome.
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| 36. |
- Aagaard Nohr, Ellen, et al.
(författare)
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Evidence-based midwifery
- 2022
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Ingår i: Theories and perspectives for midwifery: a Nordic view. - Lund : Studentlitteratur. - 9789144143194 ; , s. 79-94
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Bokkapitel (refereegranskat)abstract
- In this chapter, the history of evidence-based care and practice and their main principles will be presented, including a special focus on the field of obstetrics and midwifery. We will describe and discuss the main components of evidence-based midwifery and how they have been applied on important topics within maternal and newborn care. Finally, we will discuss the opportunities and challenges that midwives in the Nordic countries face when applying evidence-based care in a clinical setting that is dominated by large obstetric wards.
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| 37. |
- Aagaard, P., et al.
(författare)
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Early repolarization in ECG. Definition, prevalence and prognostic significance
- 2015
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Ingår i: Läkartidningen. - 0023-7205. ; 112
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Tidskriftsartikel (refereegranskat)abstract
- Early repolarization defined as antero-lateral ST-segment elevation exists in 1-2 % of the general population and has been considered a benign ECG finding for decades. However, early repolarization, defined as infero-lateral J-waves, has in recent studies been associated with an increased - albeit low - risk of sudden and cardiovascular death. This ECG pattern is present in 3-13% of the general population. However, exercise training can induce all types of early repolarization, and the prevalence in the athletic population rises to 20-90%. There is large variability between sports (higher in endurance athletes) and also throughout the season (higher during times of peak fitness). In athletes, early repolarization, regardless of type, is considered benign. In asymptomatic non-athletes, the absolute risk is too low to use this ECG finding in clinical practice. In individuals with J-wave syndrome, on the other hand, ICD implantation should be strongly considered to prevent sudden cardiac death.
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| 38. |
- Aagaard, Philip, et al.
(författare)
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Early Repolarization in Middle-Age Runners-Cardiovascular Characteristics.
- 2014
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Ingår i: Medicine & Science in Sports & Exercise. - 0195-9131 .- 1530-0315. ; 46:7, s. 1285-1292
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to assess the prevalence and patterns of early repolarization (ER) in middle-age long-distance runners, its relation to cardiac structure and function, and its response to strenuous physical activity. Methods: Male first-time cross-country race participants >45 yr were assessed pre-and postrace by medical history and physical examination, 12-lead ECG, vectorcardiography, blood tests, and echocardiography. ER was defined either as ST elevation or J wave and categorized according to localization and morphology. Results: One hundred and fifty-one subjects (50 +/- 5 yr) were evaluated before the race, and 47 subjects were evaluated after the race. Altogether, 67 subjects (44%) had ER. Subjects with versus without ER had a lower resting HR (56 +/- 8 vs 69 +/- 9 bpm, P = 0.02), lower body mass index (24 +/- 2 vs 25 +/- 3 kg.m(-2), P < 0.001), higher training volume (3.0 +/- 2.6 vs 2.1 +/- 2.7 h.wk(-1), P = 0.03), and faster 30-km running times (194 +/- 28 vs 208 +/- 31 min, P = 0.01). Vectorcardiography parameters in subjects with ER showed more repolarization heterogeneity: vector gradient (QRS-T-area) (120 +/- 25 vs 92 +/- 29 mu Vs, P < 0.001), T-area (105 +/- 18 vs 73 +/- 23 mu Vs, P < 0.001), and T-amplitude (0.63 +/- 0.13 vs 0.53 +/- 0.16 mm, P < 0.001); these parameters were inversely related to HR (r = -0.37 to -0.48, P < 0.001). ER disappeared in 15 (75%) of 20 subjects after the race. Conclusions: ER is a common finding in middle-age male runners. This ECG pattern, regardless of morphology and localization, is associated with normal cardiac examinations including noninvasive electrophysiology, features of better physical conditioning, and disappears after strenuous exercise in most cases. These findings support that ER should be regarded as a common and training-related finding also in middle-age physically active men.
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| 39. |
- Aagaard, P., et al.
(författare)
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Heart Rate and Its Variability in Response to Running-Associations with Troponin
- 2014
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Ingår i: Medicine and Science in Sports and Exercise. - : Ovid Technologies (Wolters Kluwer Health). - 0195-9131. ; 46:8, s. 1624-1630
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The objective of this study is to investigate the time course of autonomic tone changes after a first-time endurance running race participation and associations with postexertional high-sensitivity troponin (hsTnT) levels in middle-aged males. Methods: Male (n = 42) first-time long-distance running race (Lidingoloppet 30 km) participants >= 45 yr (50.5 +/- 5) were examined. HR and HR variability (HRV) in the time domain (SDANN) was measured continuously from 2 d before to 4 d after the race using a wireless cardiovascular monitor that also recorded arrhythmia episodes. In addition, subjects were assessed pre- and postrace by medical history and physical examination, 12-lead ECG, blood tests including hsTnT, and echocardiography. Results: Compared with corresponding prerace values, nighttime (2: 00-4: 00 a.m.) HR was significantly elevated (63.6 +/- 9.4 vs 53.9 +/- 8.3 bpm, P < 0.001) on the first night postrace, whereas HRV remained reduced for a median of 64 h (interquartile range, 51-102 h). A prolonged HR recovery period (r = 0.48, P = 0.005) and a larger reduction in postrace HRV (r = -0.49, P = 0.003) correlated with higher postrace hsTnT levels. The association between reduced HRV and higher hsTnT remained significant after multivariate analysis (A = -0.48, P = 0.01). No sustained ventricular arrhythmias were recorded, but atrial fibrillation occurred in two subjects. Conclusion: Endurance running race participation caused a prolonged alteration of autonomic tone. More marked and prolonged changes were associated with higher levels of hsTnT, suggesting that the magnitude of troponin increase after strenuous exercise may reflect the magnitude of exercise-induced cardiovascular stress.
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| 40. |
- Aagaard, P, et al.
(författare)
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Preparticipation Evaluation of Novice, Middle-Age Long-Distance Runners.
- 2013
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Ingår i: Medicine and science in sports and exercise. - 0195-9131 .- 1530-0315. ; 45:1
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Tidskriftsartikel (refereegranskat)abstract
- Abstract PURPOSE: To assess the cardiovascular health and risk profile in middle-aged males making an entry to participate for their first time in a long-distance race. METHODS: Male first-time participants ≥45 years in the world's largest cross-country running race, the Lidingöloppet, were evaluated with a medical history and physical exam, European risk-SCORE, 12-lead ECG, echocardiography and blood tests. Further diagnostic work-up was performed when clinically indicated. RESULTS: Of 265 eligible runners, 153 (58%, age 51±5 y) completed the study. While the 10-year fatal cardiovascular event risk was low (SCORE: 1% (IQR: 0 - 1%)), mild abnormalities were common, e.g. elevated blood-pressure (19%), left ventricular hypertrophy (6%), elevated LDL cholesterol (5%). ECG changes compatible with "athlete's heart" were present in 82%, e.g. sinus bradycardia (61%) and/or early repolarization (32%). ECG changes considered training-unrelated were found in 24%, e.g. prolonged QTc: 13%; left axis deviation: 5.3%; left atrial enlargement: 4%). In 14 runners (9%) additional diagnostic work-up was clinically motivated, and 4 (2%) were ultimately discouraged from vigorous exercise due to QTc intervals >500 ms (n=2), symptomatic atrioventricular block (n=1), and a cardiac tumor (n=1). The physician exam and the ECG identified 12 of the 14 subjects requiring further evaluation. CONCLUSIONS: Cardiovascular evaluation of middle-aged men, including a physician exam and a 12-lead ECG, appears useful to identify individuals requiring further testing prior to vigorous exercise. The additional yield of routine echocardiography was small.
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