| 1. |
- Stenman, Jane, 1955, et al.
(författare)
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Patients' attitudes towards oral health and experiences of periodontal treatment: a qualitative interview study
- 2009
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Ingår i: Oral Health and Preventive Dentistry. ; 7:4, s. 393-401
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present qualitative study was to analyse patients' attitudes towards oral health and experiences of periodontal treatment. Materials and Methods: Patients who were referred to a specialist clinic in periodontics were subjected to open-ended interviews before (Abrahamsson et al, 2008), as well as after, the phase of cause-related periodontal therapy. An interview guide was used with themes of interest. The time interval between the interviews was about 6 months. Because the study focused on psychosocial interactions, the qualitative method used for the analysis was Grounded Theory (Glaser and Strauss, 1967). Data collection and analysis were simultaneous processes that focus on psychosocial processes, existing problems and how these problems were dealt with. The interviews were tape-recorded and transcribed verbatim, and consequently analysed in a hierarchical coding process until saturation was met (n = 16). Results: In the analysis, a core category was identified: 'Understanding the seriousness of the disease condition'. This core concept was related to four additional categories and dimensions: 'The need to be treated respectfully', 'To gain insight', 'Frustration about the financial cost for treatment' and 'Feelings of control over the situation'. Taken together, the core category and its related subcategories described a psychosocial process that was related to periodontal treatment. Conclusions: The results elucidated the patients' vulnerability and the importance of patient communication in the treatment for chronic periodontitis in order for the patient to feel in control of the situation.
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| 2. |
- Stenman, Maria, et al.
(författare)
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Albumin, corticosteroid use and Karnofsky performance status predict outcome of single-fraction gamma knife radiosurgery in clear cell renal cell carcinoma patients with brain metastases
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background and Purpose: To evaluate the effects of single fraction gamma knife radiosurgery (sf-GKRS) on patients with renal cell carcinoma (RCC) brain metastases (BM) in the era of targeted agents (TA).Material and Methods: Clear cell metastatic RCC patients treated with sf-GKRS due to BM in 2005-2014 at three European centres were retrospectively analysed (n=43). Median follow-up was 56 months. Ninety-five percent had prior nephrectomy, 53% synchronous metastasis and 86% extracranial disease at first sf-GKRS. Karnofsky performance status (KPS) ranged from 60-100%. Outcome measures were overall survival (OS), local control (LC) and adverse radiation effects (ARE).Results: One hundred and ninety-four targets were irradiated. Median number of targets at first sf-GKRS were two. The median prescription dose was 22 Gy. Thirty-seven percent had repeated sf-GKRS. Eighty-eight percent received TA. LC at 12 and 18 months were 97% and 90%. Median OS from first sf-GKRS was 15.7 months. Serum albumin (HR 5.3), corticosteroids pre sf-GKRS (HR 5.8) and KPS (HR 9.1) were independent prognostic factors. MSKCC risk group, synchronous metastasis, age, number of BM or extracranial metastases provided no additional prognostic information. Other prognostic scores for BM radiosurgery, including DS-GPA, Renal-GPA, LLV-SIR and CITV-SIR, did not add prognostic value. ARE were seldom symptomatic and were associated with tumour volume, 10-Gy volume and pre-treatment perifocal oedema. ARE were less common among patients treated with TA within one month of sf-GKRS.Conclusions: We identified three independent prognostic factors with potential impact on clinical decision making in patients with clear cell RCC BM.
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| 3. |
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| 4. |
- Stenman, Maria, 1987-, et al.
(författare)
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Metastatic papillary renal cell carcinoma in the era of targeted therapy : a retrospective study from three European academic centres
- 2019
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 58:3, s. 306-312
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Metastatic papillary renal cell carcinoma (mPRCC) is understudied. The disease is often aggressive and specific treatment options are lacking.PATIENTS AND METHODS: mPRCC patients (n = 86) referred to three academic centres in Sweden and Germany in the years 2005-2015 were retrospectively identified from medical records. Statistical analyses included Kaplan-Meier curves and calculation of Cox proportional hazards, generating hazard ratios with 95% confidence intervals. The aim of the study was to evaluate overall survival (OS) of mPRCC patients treated outside of clinical trials in the era of targeted agents (TA) and to identify clinically useful prognostic factors.RESULTS: Median OS of all mPRCC patients was 11.2 months. TA were used in 77% of the patients and associated with younger age and better Eastern Cooperative Oncology Group performance status (PS). Brain metastases were common (28%). Patients with synchronous or metachronous metastases had similar OS. Variables independently associated with risk of death included age ≥60 years, worse PS and ≥3 metastatic sites. The MSKCC criteria did not provide additional prognostic information. A subgroup analysis of TA-treated patients revealed an association of lymph node metastasis with risk of death in addition to the other prognostic factors.CONCLUSION: OS in mPRCC remained short in the era of targeted agents. Age, PS, and number of metastatic sites provided independent prognostic information.
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| 5. |
- Stenman, Maria, M.D. 1987-
(författare)
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Treatment selection in metastatic renal cell carcinoma : Towards an individualised approach
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Renal cell carcinoma (RCC), a common malignancy worldwide, affects 1200 new patients yearly in Sweden. Metastatic RCC (mRCC) develops in one in three and is commonly incurable. Clear cell histology dominates followed by papillary histology. The mainstay of mRCC treatment is targeted agents (TA) against aberrantly signalling pro-angiogenic tyrosine kinase receptors, and recently also immune checkpoint inhibitors. Local metastatic therapy with stereotactic radiotherapy (SRT) or surgical metastasectomy may be considered for oligometastatic disease.The aims of this thesis were (1) to identify clinically relevant factors useful for prognostication in real-world patients with mRCC treated in the TA era, (2) to deepen the understanding of papillary mRCC, and (3) to evaluate local metastatic therapy in mRCC. The papers of this thesis were based on retrospective data from regional databases or patient records from 2005 and onwards to reflect the contemporary therapeutic landscape.Paper I was a single-centre study analysing inflammatory blood and clinical parameters in relation to overall survival (OS) in mRCC (n=84). Median OS (mOS) was 20 months. Hypoalbuminemia was a negative prognostic factor (HR 2.7), independently of patient performance status (PS) or Memorial Sloan Kettering Cancer Center risk criteria.Paper II included solely patients with papillary mRCC (n=86) treated at three centres. mOS was 11 months. Age ≥60 years (HR 2.2), ≥3 metastatic sites (HR 2.7), and Eastern Cooperative Oncology Group (ECOG) PS ≥2 vs 1 (HR 3.0) were independently associated with worse OS.Paper III included mRCC patients treated with local metastatic therapy (n=117). Survival was similar irrespective of SRT or surgical metastasectomy with a mOS of 51 months. Treatment with TA in close proximity to local therapy was well tolerated. ECOG PS 1 vs 0 (HR 2.9), intracranial treatment (HR 1.8), and watchful waiting ≥18 months prior to treatment (HR 0.3) were independently prognostic. Paper IV was a follow-up of patients with ccRCC brain metastases treated with single fraction gamma knife radiosurgery (sf-GKRS) at three European centres (n=43). 1- and 3-year local control rates were 97% and 90%, and mOS was 16 months. Hypoalbuminemia (HR=5.3), corticosteroids prior to sf-GKRS (HR=5.8), and Karnofsky PS <80% (HR=9.1) were independently associated with worse OS, whereas previously described prognostic scores were not. Adverse radiation effects (ARE) were uncommon and associated with large target volumes and pre-treatment oedema.In conclusion, this thesis identifies several factors potentially useful for prognostication in mRCC, and indicates the usefulness of local metastatic therapy, in particular SRT, in selected patients. The results should be validated prospectively.
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| 6. |
- Stenman, Ulrika, et al.
(författare)
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Association between periodontal disease and ischemic heart disease among Swedish women. A cross-sectional study.
- 2009
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; , s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of this cross-sectional study was to analyze the relationship between chronic periodontitis and ischemic heart disease (IHD). Material and Methods. A cross-section of women aged 38 to 84 years were examined in 1992-93 (analysis based on n=1056). Medical and dental examinations were included in the analysis specifically with regard to IHD and periodontitis. Other well-known risk factors for IHD were used as covariates in multivariable statistical analysis. Results. Among the dentate women in this study (n=847), 74 had IHD and 773 did not. There was no statistically significant difference between numbers of pathological gingival pockets between these groups (58.1% had one or more pathological pockets in the IHD group compared to 57.6% in the non-IHD group). Bivariate analysis of dentate individuals showed significant associations between IHD and number of missing teeth, age, body mass index, waist/hip ratio, life satisfaction, hypertension, and levels of cholesterol and triglycerides. However, in the final multivariable logistic regression model, with the exception of age, only number of teeth (<17 teeth) OR=2.13 (CI 1.20; 3.77) was found to be significantly associated with IHD. Moreover, edentulous women had an OR of 1.94 (CI 1.05; 3.60) in relation to IHD (age-adjusted model). Conclusions. In the present study, periodontitis did not seem to have a statistically significant relationship with IHD. The number of missing teeth showed a strong association with IHD, and this may act as a proxy variable tapping an array of different risk factors and behaviors.
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| 7. |
- Stenman, Ulrika, et al.
(författare)
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Oral health-related quality of life - associations with oral health and conditions in Swedish 70-year-old individuals.
- 2012
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Ingår i: Gerodontology. - : Wiley. - 1741-2358 .- 0734-0664. ; 29:2
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate oral health–related quality of life (OHRQoL) in relation to different chronic oral conditions and perception of oral health among elderly individuals. Background: Health-related quality of life is important to assess and understand the impact of different diseases and conditions on individuals’ well-being. Material and methods: Randomly selected 70-year-old individuals (N = 561) were included in this analysis. They were clinically examined and answered a questionnaire. Variables used were perceived oral health, satisfaction with appearance of teeth, problems with chewing and dry mouth, burning mouth syndrome, dental anxiety and dental visiting habits. To measure the participants′ perception of the impact of oral conditions on their well-being, the Oral Health Impact Profile (OHIP-14) was used. Results: The OHIP-14 distribution of sum of scores showed a floor effect but revealed acceptable psychometric properties with regard to reliability and validity. Multivariable logistic regression revealed three highly predictive variables for individuals with high OHIP-14 scores: using dentures, having chewing problems and being dissatisfied with appearance of teeth. Conclusion: Use of dentures, having chewing problems and being dissatisfied with appearance of teeth are associated with high OHIP-14 sums, indicating strong influence on OHRQoL.
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| 8. |
- Stewart, R., et al.
(författare)
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Associations Between Oral Health and Risk of Dementia in a 37-Year Follow-Up Study: The Prospective Population Study of Women in Gothenburg
- 2015
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Ingår i: Journal of the American Geriatrics Society. - : Wiley. - 0002-8614. ; 63:1, s. 100-105
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo investigate the association between incident dementia and previous number of teeth measured over a long interval. ParticipantsWomen with (n=158) and without (n=539) dementia in 2000 to 2005. MeasurementsTooth counts in 1968-69, 1980-81, and 1992-93. Covariates included age, education, stroke, myocardial infarction, diabetes mellitus, smoking status, blood pressure, body mass index, and cholesterol level. ResultsAfter adjustment for age, odds ratios (ORs) for dementia in 2000-05, comparing first with fourth tooth count quartiles, were 1.81 (95% confidence interval (CI)=1.03-3.19) for tooth counts measured in 1968, 2.25 (95% CI=1.18-4.32) for those in 1980, and 1.99 (0.92-4.30) for those in 1992. After further adjustment for education, ORs were 1.40 (95% CI=1.03-3.19) for 1968, 1.96 (95% CI=0.98-3.95) for 1980, and 1.59 (95% CI=0.71-3.53) for 1992, and after additional adjustment for vascular risk factors, ORs were 1.38 (95% CI=0.74-2.58) for 1968, 2.09 (95% CI=1.01-4.32) for 1980, and 1.61 (95% CI=0.70-3.68) for 1992. ConclusionIn most of the analyses, lower tooth count was not associated with dementia, although a significant association was found for one of the three examinations. Further research may benefit from more-direct measures of dental and periodontal disease.
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| 9. |
- Wennström, Anette, 1975, et al.
(författare)
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Oral health, sense of coherence and dental anxiety among middle-aged women.
- 2013
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 71:1, s. 256-62
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Aims. The specific aims of this investigation were to analyze the relationship between sense of coherence (SOC), dental anxiety (DA) and oral health status among middle-aged women, measured both subjectively and objectively and adjusted for socioeconomic status (SES). Materials and methods. Randomly selected women, 38 (n = 206) and 50 (n = 287) years of age, were included in a cross-sectional health examination. The participants underwent a series of examination stages, including a clinical and dental radiographic examination. The women responded to questionnaires concerning SES, oral health, DA and SOC. Results. The number of teeth was significantly related to SOC, where more missing teeth revealed a lower SOC level among 50-year-olds. The variables of caries, apical periodontitis and filled surfaces were not statistically significantly associated with SOC. However, the self-reported measure of oral health was associated with SOC in both age groups. High DA was significantly related to self-perceived poor oral health regardless of age. Individuals with high DA also had fewer teeth, more filled surfaces and more approximal caries. The multivariate models showed that higher SOC levels were associated with better oral health, as estimated by objective or subjective measures, while the inverse results were seen for DA. Thus, individuals reporting high DA were more likely to have fewer teeth and poor perceived oral health, taking SES into account. Conclusions. Sense of coherence and dental anxiety are psychological aspects with respect to health- and risk-factors of oral health.
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| 10. |
- Wennström, Anette, 1975, et al.
(författare)
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Trends in tooth loss in relation to socio-economic status among Swedish women, aged 38 and 50 years: repeated cross-sectional surveys 1968-2004
- 2013
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Ingår i: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 13:63
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Tidskriftsartikel (refereegranskat)abstract
- Background: Oral diseases are a health problem worldwide. Differences in oral health status may vary with geographical locations, but also within the same country and between groups with different social backgrounds. The specific aims were to describe secular trends in oral health status regarding number of remaining teeth and also to describe differences in socio-economic status, among 38- and 50-year-old women, over a 36-year period. Methods: Cross-sectional health surveys were performed at four occasions; 1968/69 (n = 746), 1980/81 (n = 532), 1992/93 (n = 165) and 2004/05 (n = 500), including randomly selected women aged 38 and 50 years. The number of teeth was determined using panoramic radiographs and self-reported measures of marital status, social class, educational level, and income were recorded. Results: The mean number of teeth among women has increased significantly. The educational level has increased while fewer women are married/cohabiting over time. There has been a shift in the social group the women belong to, where proportionally more women were categorized in a higher social group in 2004/05 than in 1968/69. Moreover, there is a significant relationship between fewer teeth and a lower social group, and among the 50-year-old women, this was irrespective of examination year. However, multivariate analyses showed that the risk to be edentulous or not, or to have fewer remaining teeth was significantly higher for women of lower social group, or living alone, in all studies over the 36 year-period. This was independent of age group, even though the risk diminished over the study period. Conclusions: Cohort comparisons of women aged 38 and 50 years during 36 years showed that dental status improved, with (i) a decreasing prevalence of edentulism and, (ii) an increasing number of remaining teeth in dentate individuals over time. Differences due to social group and education were still present, with more remaining teeth in the women in the higher social group. A time trend analysis indicated that in the later examination years the individuals had fewer teeth lost, irrespective of age, marital status and, social group.
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