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- Fritzell, P., et al.
(författare)
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Antibiotics should not be used to treat patients with back/leg pain
- 2020
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Ingår i: Läkartidningen. - 1652-7518. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- This report is based on results from three research groups in Sweden (Fritzell et al), Denmark (Udby et al), and Norway (Bråten et al). The groups have conducted studies published in international journals in 2019 [8-10]. The results complement each other and strongly suggest that antibiotics, in the absence of clear signs of a clinically relevant infection (discitis/spondylitis), should not be used for back pain with or without leg pain. The Swedish study showed that bacteria found in the disc/vertebra during surgery are very likely due to contamination [8], the Danish study showed that patients with Modic Changes (MC) on MR in the long term were not associated with more back pain or functional impairment than in patients without MC [9], and the Norwegian study showed that antibiotics for residual back pain after previous disc herniation had no better clinical effect than placebo [10]. Antibiotic resistance is one of the biggest threats to public health today and in the future.
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- Fritzell, Peter, et al.
(författare)
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Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish lumbar spine study : A multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group
- 2004
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 29:4, s. 421-434
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A cost-effectiveness study was performed from the societal and health care perspectives. Objective. To evaluate the costs-effectiveness of lumbar fusion for chronic low back pain (CLBP) during a 2-year follow-up. Summary of Background Data. A full economic evaluation comparing costs related to treatment effects in patients with CLBP is lacking. Patients and Methods. A total of 284 of 294 patients with CLBP for at least 2 years were randomized to either lumbar fusion or a nonsurgical control group. Costs for the health care sector ( direct costs), and costs associated with production losses ( indirect costs) were calculated. Societal total costs were identified as the sum of direct and indirect costs. Treatment effects were measured using patient global assessment of improvement, back pain ( VAS), functional disability (Owestry), and return to work. Results. The societal total cost per patient ( standard deviations) in the surgical group was significantly higher than in the nonsurgical group: Swedish kroner (SEK) 704,000 ( 254,000) vs. SEK 636,000 ( 208,000). The cost per patient for the health care sector was significantly higher for the surgical group, SEK 123,000 ( 60,100) vs. 65,200 ( 38,400) for the control group. All treatment effects were significantly better after surgery. The incremental cost-effectiveness ratio ( ICER), illustrating the extra cost per extra effect unit gained by using fusion instead of nonsurgical treatment, were for improvement: SEK 2,600 ( 600 - 5,900), for back pain: SEK 5,200 ( 1,100 - 11,500), for Oswestry: SEK 11,300 ( 1,200 - 48,000), and for return to work: SEK 4,100 ( 100 21,400). Conclusion. For both the society and the health care sectors, the 2-year costs for lumbar fusion was significantly higher compared with nonsurgical treatment but all treatment effects were significantly in favor of surgery. The probability of lumbar fusion being cost-effective increased with the value put on extra effect units gained by using surgery.
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- Celeste, R. K., et al.
(författare)
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The individual and contextual pathways between oral health and income inequality in Brazilian adolescents and adults
- 2009
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 69:10, s. 1468-1475
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Tidskriftsartikel (refereegranskat)abstract
- We evaluate the association between incomeinequality (Gini index) and oralhealth and in particular the role of alternative models in explaining this association. We also studied whether or not income at the individual level modifies the Gini effect. We used data from an oralhealth survey in Brazil in 2002–2003. Our analysis included 23,568 15–19 and 22,839 35–44 year-olds nested in 330 municipalities. Different models were fitted using multilevel analysis. The outcomes analysed were the number of untreated dental caries (count), having at least one missing tooth (dichotomous) and being edentulous (dichotomous). To assess interaction as a departure from additivity we used the Synergy Index. For this, we dichotomized the Gini coefficient (high vs low inequality) by the median value across municipalities and the individualincome in the point beyond which it showed roughly no association with oralhealth. Adjusted rate ratio of mean untreated dental caries, respectively for the 15–19 and 35–44 age groups, was 1.12 and 1.16 for each 10 points increase in Gini scale. Adjusted odds ratio of a 15–19 year-old having at least one missing tooth or a 35–44 year-old being edentulous was, respectively, 1.19 and 1.01. High incomeinequality had no statistically significant synergistic effect with being poor or living in a poor municipality. Higher levels of incomeinequality at the municipal level were associated with worse oralhealth and there was an unexplained residual effect after controlling for potential confoundings and mediators. Municipal level incomeinequality had a similar, detrimental effect, among individuals with lower or higher income.
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- Celeste, R. K., et al.
(författare)
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Trends in socioeconomic disparities in oral health in Brazil and Sweden
- 2011
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Ingår i: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661 .- 1600-0528. ; 39:3, s. 204-212
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe the dynamics of trends in socioeconomic disparities in oral health in Brazil and Sweden among adults, to assess whether trends follow expected patterns according to the inverse equity hypothesis.Methods: In Sweden, we obtained nationally representative data for the years 1968, 1974, 1981, 1991 and 2000, and in Brazil, for 16 state capitals in 1986 and in 2002. Trends in the prevalence of ‘edentulism’ and of ‘teeth in good conditions’ were described in two groups aged 35–44 with lower and higher economic standards, respectively.Results: There was an annual decline in disparities in ‘edentulism’ of 0.4 percentage points (pp) (95% CI = 0.2–0.7) in Brazil and 0.7pp (95% CI = 0.5–0.9) in Sweden, as a result of improvements in both income groups. Concerning ‘teeth in good conditions’, in Brazil, there was improvement only in the higher income group and absolute disparities have increased (0.5pp annually), while in Sweden, there was a nonsignificant decrease (0.3pp annually) with improvements in both groups. Since 1991 in Sweden and in 2002 in Brazil, our measures of socioeconomic disparities in ‘edentulism’ were not statistically significant. Trends did not differ by sex or dental visit.Conclusions: Despite improvements in both income groups and a decrease in disparities in ‘edentulism’, the poorer group in Brazil has seen no improvement in ‘teeth in good conditions’ and disparities have increased. It appears that Brazil and Sweden reflect different stages of trend for ‘teeth in good conditions’ and the same stages for ‘edentulism’, represented by the inverse equity hypothesis.
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- Eneqvist, T., et al.
(författare)
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Does the order of total hip replacement and lumbar spinal stenosis surgery influence patient-reported outcomes: An observational register study
- 2021
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Ingår i: Journal of Orthopaedic Research. - : Wiley. - 0736-0266 .- 1554-527X. ; 39:5, s. 998-1006
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Tidskriftsartikel (refereegranskat)abstract
- Patients with degenerative hip and lumbar spine disorders requiring surgery in both locations is fairly common in clinical practice. We investigated if the order of total hip replacement (THR) and lumbar spinal stenosis surgery (LSSS) influences patient-reported outcomes (PROs). We used data from the Swedish Hip Arthroplasty Register (SHAR) and the Swedish Spine Register (Swespine), on patients operated with THR and LSSS in years 2002 to 2012. To increase the probability of having symptomatic disorders in both locations at the time of the first surgery, we only included patients with both LSSS and THR performed within 2 years. Linear and logistic regression analyses adjusted for age, sex, preoperative PROs, and time between surgeries were used to investigate the association between order of surgeries and the generic PRO measurements EQ-5D and EQ VAS. Eighty-four patients had THR prior to LSSS and 171 patients LSSS prior to THR. Linear regression showed that LSSS prior to THR was associated with higher EQ-5D index (B = 0.09, 95% confidence interval [CI] 0.03-0.16) and EQ VAS (B = 5.6, 95% CI 0.4-10.9) 1 year after the last surgery. Logistic regression showed that the odds ratio [OR] for not having any problems in the "pain" (OR = 3.0, 95% CI 1.5-6.3) and "anxiety/depression" (OR = 2.3, 95% CI 1.3-4.1) dimensions were higher for LSSS before THR. In our cohort, LSSS before THR was associated with better health-related quality of life outcomes compared to the reverse order. The results from our cohort can be helpful in a clinical situation where the physician gives advice to an individual patient when choosing the order of procedures. However, further studies are necessary in order to confirm these results in other cohorts. At present, standard of care remains that order of surgery should be individualized for each patient, with guidance from the operating surgeons.
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| 10. |
- Eneqvist, Ted, 1982, et al.
(författare)
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Lumbar surgery prior to total hip arthroplasty is associated with worse patientreported outcomes
- 2017
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Ingår i: Bone and Joint Journal. - 2049-4394. ; 99B:6, s. 759-765
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aims of this study were to describe the prevalence of previous lumbar surgery in patients who undergo total hip arthroplasty (THA) and to investigate their patient-reported outcomes (PROMs) one year post-operatively. Patients and Methods Data from the Swedish Hip Arthroplasty Register and the Swedish Spine Register gathered between 2002 and 2012 were merged to identify a group of patients who had undergone lumbar surgery before THA (n = 997) and a carefully matched one-to-one control group. We investigated differences in the one-year post-operative PROMs between the groups. Linear regression analyses were used to explore the associations between previous lumbar surgery and these PROMs following THA. The prevalence of prior lumbar surgery was calculated as the ratio of patients identified with previous lumbar surgery between 2002 and 2012, and divided by the total number of patients who underwent a THA in 2012. Results The prevalence of lumbar surgery prior to THA in 2012 was 3.5% (351 of 10 082). Linear regression analyses showed an association with more pain (B = 4.35, 95% confidence interval (CI) 2.57 to 6.12), worse EuroQol (EQ)-5D index, (B =-0.089, 95% CI-0.112 to-0.066), worse EQ VAS (B =-6.75, 95% CI-8.58 to-4.92), and less satisfaction (B = 6.04, 95% CI 4.05 to 8.02). Conclusion Lumbar spinal surgery prior to THA is associated with less reduction of pain, worse healthrelated quality of life, and less satisfaction one year after THA. This is useful information to share in the decision-making process and may help establish realistic expectations of the outcomes of THA in patients who also have previously undergone lumbar spinal surgery. © 2017 The British Editorial Society of Bone & Joint Surgery.
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