| 1. |
- Björk, Jan, et al.
(författare)
-
Periampullary adenomas and adenocarcinomas in familial adenomatous polyposis : Cumulative risks and APC gene Mutations
- 2001
-
Ingår i: Gastroenterology. - : Elsevier. - 0016-5085 .- 1528-0012. ; 121:5, s. 1127-1135
-
Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Patients with familial adenomatous polyposis (FAP) have a high prevalence of duodenal adenomas, and the region of the ampulla of rater is the predilection site for duodenal adenocarcinomas. This study assessed the risk of stage IV periampullary adenomas according to the Spigelman classification and periampullary adenocarcinomas in Swedish FAP patients screened by esophagogastroduodenoscopy (EGD). The genotype of patients with stage IV periampullary adenomas and periampullary adenocarcinomas was also investigated. Methods: A retrospective study of 180 patients screened by EGD in 1982-1999 was undertaken. Kaplan-Meier analysis was performed to evaluate cumulative risk. Mutation analysis was carried out in patients with periampullary adenocarcinomas diagnosed outside the screening program, in addition to patients in the screening group with stage IV periampullary adenomas and adenocarcinomas. Results: Periampullary adenoma stage IV was diagnosed in 14 patients (7.8%), with a cumulative risk of 20% at age 60 years. Periampullary adenocarcinoma was diagnosed in 5 patients (2.8%), with a cumulative risk of 10% at age 60. Three of the adenocarcinomas occurred in patients with stage IV periampullary adenomas compared with 2 in patients with less severe periampullary adenomatosis at screening (odds ratio, 31; 95% confidence interval, 4.6-215). Fifteen (88%) of the APC gene mutations were detected; 12 of these were located downstream from codon 1051 in exon 15. Conclusions: The life time risk of severe periampullary lesions in FAP patients is high, and an association between stage IV periampullary adenomas and a malignant course of the periampullary adenomatosis is strongly suggestive. Mutations downstream from codon 1051 seem to be associated with severe periampullary lesions.
|
|
| 2. |
- Prignitz Sluys, Kerstin, 1956-, et al.
(författare)
-
Six years beyond pediatric trauma : child and parental ratings of children’s health-related quality of life in relation to parental mental health
- 2015
-
Ingår i: Quality of Life Research. - : Springer Netherlands. - 0962-9343 .- 1573-2649. ; 24:11, s. 2689-2699
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeTo examine the relationship between child self-report and parent proxy report of health-related quality of life (HRQL) and how parents’ mental health status relates to the HRQL ratings 6 years after minor to severe injury of the child.Materials and methodsThis cross-sectional cohort study was performed at a regional pediatric trauma center in Stockholm, Sweden. The PedsQL 4.0 versions for ages 5–7, 8–12, and 13–18 years were completed by 177 child–parent dyads 6 years after injury to the child. The parents also rated their own mental health through the mental health domain (MH) in the SF-36 Health Survey.ResultsThe children’s median age was 13 years (IQR 10–16 years), 54 % were males, and the median ISS was 5 (IQR 2–9). Most of the parents were female (77 %), born in Sweden (79 %), and half had university degrees. There was no statistically significant difference between child self-report and parent proxy report in any of the PedsQL 4.0 scales or summary scales. The levels of agreement between child self-report and parent proxy reports were excellent (ICC ≥ 0.80) for all scales with the exception of emotional functioning (ICC 0.53) which also was the scale with the lowest internal consistency in child self-report (α 0.60). Multiple regression analyses showed that worse parental mental health status correlated with worse child self-report and parent proxy report of children’s HRQL.ConclusionsChildren and their parents’ reports on child’s HRQL were in agreement. Decreased mental health in parents was associated with lower scores on parent proxy reports and child self-reports of HRQL after injury. The current investigation highlights the possible relationship between parent’s mental health status and children’s HRQL long after an injury, which should be considered in future investigations and in clinical care.
|
|
| 3. |
- Sluys, Kerstin, 1956-
(författare)
-
Adult and pediatric trauma : outcomes and health-related quality of life
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Trauma is the number one killer of children and young adults and the most common cause for hospital admissions for these age-groups in Sweden. Trauma is also one of the most common causes for hospital care and early death for older people. In the last decades trauma care has advanced and improved short-term survival of injured but knowledge of the long-term outcome is limited.The overall aim of this thesis is to investigate long-term outcome and health-related quality of life after injuries in different age groups and to identify factors associated with outcome.Methods: The thesis is based on four studies. In the first study patients with major trauma were contacted 5 years after injury and HRQL was measures using the SF-36 questionnaire and compared to an age and sex-matched reference group. In the second study data was collected on children with injuries to describe demographic and injury characteristics and outcome. The sample in the second study was the source for the third and fourth study. The third study measured HRQL using the PedsQL 4.0 in a cohort of children 6 years after injury and determined the relationship within subgroups in the cohort. The fourth study measured child HRQL in a sample of children after injury and their parent´s and determined the relationship within scoring results and the impact of parents reported mental health status.Results: The adult major trauma patients (n=205) reported significantly lower HRQL scores in all eight domains compared to the reference group. A large number of patients suffered from physical (68%) and psychological disabilities (41%) and nearly half reported the need for better follow-up after discharge from hospital. The severity of the injury did not anticipate a lower health-related quality of life. In the pediatric group (n=432) the median injury severity score was 4 (IQR 1-9), 50% sustained head injuries and the most severe head injuries were seen in the youngest age group. Mortality rate was low (1%), 19% stayed in a PICU and the median length of hospital stay was two days. In the follow-up study (n=204) the youngest children had the lowest PedsQL scores. Children who suffered from extremity injuries had lower scores in the school functioning compared to children with head injuries. The levels of agreement between child self-report and parent proxy report of PedsQL 4.0 scales were excellent (ICC≥0.80) for all scales with the exception of children´s self-reported emotional functioning. Multiple regression analyses showed that poor parental mental health status contributed to worse child self-report and parent proxy report of children´s HRQL.Conclusion: Adult major trauma patients have significant disabilities 5 years after injury. Improved follow-up by trauma specialist teams are needed. Children´s HRQL 6 years after trauma seems to in parity or better than healthy peers. Parent´s mental health status can possibly impact on children´s HRQL long after an injury. Further studies are recommended to evaluate the PedsQL 4.0versions for self-report in pediatric trauma population.
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
- Sluys, Kerstin, 1956-, et al.
(författare)
-
Outcome and quality of life 5 years after major trauma
- 2005
-
Ingår i: Journal of Trauma. - Baltimore : Lippincott Williams & Wilkins. - 0022-5282 .- 1529-8809. ; 59:1, s. 223-232
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study aimed to determine quality of life after injury and identify factors potentially associated with outcome.METHODS: Five years after injury from blunt or penetrating trauma, patients received a questionnaire based on the SF-36 Health Survey.RESULTS: Two hundred five patients (83%) replied. Most were men, median age 39 years, 93% injured by blunt energy, median Injury Severity Score 14 (range 9-57). Mean SF-36 scores were significantly lower than in a matched reference group. Poor outcome was associated with: in-hospital days, intensive care days, surgical procedures, in-hospital major complications, age, recurrent injury, and inadequate information. Subjects reported considerable physical (68%) and psychologic (41%) disabilities. Near half reported need of improved follow-up care. Injury severity did not predict poor health-related quality of life 5 years later.CONCLUSION: Adequate information, sufficient pain management and follow-up by trauma specialist teams are needed. Certain factors can help identify patients in need of additional help and support.
|
|
| 9. |
|
|
| 10. |
|
|
