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  • Lindahl, Bernt, et al. (författare)
  • A randomized lifestyle intervention with 5-year follow-up in subjects with impaired glucose tolerance : pronounced short-term impact but long-term adherence problems
  • 2009
  • Ingår i: Scandinavian Journal of Public Health. - 1403-4948 .- 1651-1905. ; 37:4, s. 434-442
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>AIMS: To compare data on cardiovascular risk factor changes in lipids, insulin, proinsulin, fibrinolysis, leptin and C-reactive protein, and on diabetes incidence, in relation to changes in lifestyle. METHODS: The study was a randomized lifestyle intervention trial conducted in northern Sweden between 1995 and 2000, in 168 individuals with impaired glucose tolerance (IGT) and body mass index above 27 at start. The intensive intervention group (n = 83) was subjected to a 1-month residential lifestyle programme. The usual care group (n = 85) participated in a health examination ending with a single counselling session. Follow-up was conducted at 1, 3 and 5 years. RESULTS: At 1-year follow-up, an extensive cardio-metabolic risk factor reduction was demonstrated in the intensive intervention group, along with a 70% decrease of progress to type 2 diabetes. At 5-year follow-up, most of these beneficial effects had disappeared. Reported physical activity and fibre intake as well as high-density lipoprotein cholesterol were still increased, and fasting insulin and proinsulin were lower. CONCLUSIONS: The intervention affected several important cardio-metabolic risk variables beneficially, and reduced the risk for type 2 diabetes, but the effects persisted only as long as the new lifestyle was maintained. Increased physical activity seemed to be the behaviour that was most easy to preserve.</p>
  • Lodefalk, Maria, 1968-, et al. (författare)
  • Food habits, energy and nutrient intake in adolescents with Type 1 diabetes mellitus
  • 2006
  • Ingår i: Diabetic Medicine. - Oxon, United Kingdom : Wiley-Blackwell. - 0742-3071 .- 1464-5491. ; 23:11, s. 1225-1232
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>AIMS: The aims were to describe the food habits of adolescents with Type 1 diabetes (Type 1 DM) and to compare them with healthy control subjects; to describe the distribution of energy-providing nutrients in patients and compare it with current recommendations and previous reports; and finally, to investigate associations between dietary intake and glycaemic control. METHODS: One hundred and seventy-four adolescents with Type 1 DM and 160 age- and sex-matched healthy control subjects completed a validated food frequency questionnaire, and 38 randomly chosen patients completed a prospective 4-day food record. RESULTS: Patients ate more regularly, and more often ate fruit and fruit juice, potatoes and root vegetables, meat, fish, egg, offal and sugar-free sweets than control subjects. Control subjects more often ate ordinary sweets and snacks. Patients chose coarse rye bread and dairy products with less fat to a greater extent than control subjects. Patients were heavier than control subjects. The intake of saturated fat was higher in patients compared with recommendations and, for boys with diabetes, the intake of protein was higher than recommended. Patients with poorer glycaemic control ate vegetables, fruit and fish less often than patients with better control. CONCLUSIONS: The food habits of adolescents with Type 1 DM were healthier than those of control subjects. The intake of energy-providing nutrients was in line with current recommendations and showed improvements compared with previous reports, with the exception of fibre intake. The association between dietary intake and glycaemic control needs further investigation in prospective studies.</p>
  • Mortensen, Henrik B., et al. (författare)
  • New definition for the partial remission period in children and adolescents with type 1 diabetes
  • 2009
  • Ingår i: Diabetes Care. - 0149-5992 .- 1935-5548. ; 32:8, s. 1384-1390
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>OBJECTIVE To find a simple definition of partial remission in type 1 diabetes that reflects both residual beta-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS A total of 275 patients aged &lt;16 years were followed from onset of type 1 diabetes. After 1, 6, and 12 months, stimulated C-peptide during a challenge was used as a measure of residual beta-cell function. RESULTS By multiple regression analysis, a negative association between stimulated C-peptide and A1C (regression coefficient -0.21, P &lt; 0.001) and insulin dose (-0.94, P &lt; 0.001) was shown. These results suggested the definition of an insulin dose-adjusted A1C (IDAA1C) as A1C (percent) + [4 x insulin dose (units per kilogram per 24 h)]. A calculated IDAA1C &lt; or =9 corresponding to a predicted stimulated C-peptide &gt;300 pmol/l was used to define partial remission. The IDAA1C &lt; or =9 had a significantly higher agreement (P &lt; 0.001) with residual beta-cell function than use of a definition of A1C &lt; or =7.5%. Between 6 and 12 months after diagnosis, for IDAA1C &lt; or =9 only 1 patient entered partial remission and 61 patients ended partial remission, for A1C &lt; or =7.5% 15 patients entered partial remission and 53 ended, for a definition of insulin dose &lt; or =0.5 units . kg(-1) . 24 h(-1) 5 patients entered partial remission and 66 ended, and for stimulated C-peptide (&gt;300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months. CONCLUSIONS A new definition of partial remission is proposed, including both glycemic control and insulin dose. It reflects residual beta-cell function and has better stability compared with the conventional definitions.</p>
  • Särnblad, Stefan, 1963-, et al. (författare)
  • Dietary fat intake predicts 1-year change in body fat in adolescent girls with type 1 diabetes
  • 2006
  • Ingår i: Diabetes Care. - 0149-5992 .- 1935-5548. ; 29:6, s. 1227-1230
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>OBJECTIVE</strong>: The purpose of this study was to determine whether objectively measured physical activity and dietary macronutrient intake differentially predict body fat in adolescent girls with type 1 diabetes and control girls.</p><p><strong>RESEARCH DESIGN AND METHODS</strong>: This study comprised 23 girls (12-19 years) with type 1 diabetes and 19 age-matched healthy control girls. At baseline, physical activity and energy intake were assessed for 7 consecutive days by accelerometry and a structured food diary, respectively. Body composition was measured by dual-energy X-ray absorptiometry at baseline and after 1 year.</p><p><strong>RESULTS</strong>: Fat intake was positively related to a 1-year change in percentage body fat (P = 0.006), after adjustment for total energy intake. No significant interaction was observed (case-control group x main exposure), indicating that the association between fat intake and gain in body fat was similar in both groups. Physical activity did not predict gain in body fat; however, total physical activity was positively associated with a gain in lean body mass (P &lt; 0.01). Girls treated with six daily dosages of insulin increased their percentage of body fat significantly more than those treated with four daily injections (P &lt; 0.05).</p><p><strong>CONCLUSIONS</strong>: In this prospective case-control study, we found that fat intake predicted gain in percentage of body fat in both adolescent girls with type 1 diabetes and healthy control girls. The number of daily insulin injections seems to influence the accumulation of body fat in girls with type 1 diabetes.</p>
  • Lima Ramos, Pedro, et al. (författare)
  • Predicting participation of people with impaired vision in epidemiological studies
  • 2018
  • Ingår i: This study was supported by FCT (COMPETE/QREN) grant reference PTDC/DPT-EPI/0412/2012 in the context of the Prevalence and Costs of Visual Impairment in Portugal: a hospital based study (PCVIP-study). PLR is funded by FCT (COMPETE/QREN) grant reference SFRH/BD/119420/2016.. - BioMed Central.
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background</p><p>The characteristics of the target group and the design of an epidemiologic study, in particular the recruiting methods, can influence participation. People with vision impairment have unique characteristics because those invited are often elderly and totally or partially dependent on help to complete daily activities such as travelling to study sites. Therefore, participation of people with impaired vision in studies is less predictable than predicting participation for the general population.</p><p>Methods</p><p>Participants were recruited in the context of a study of prevalence and costs of visual impairment in Portugal (PCVIP-study). Participants were recruited from 4 Portuguese public hospitals. Inclusion criteria were: acuity in the better eye from 0.5 decimal (0.30logMAR) or worse and/or visual field of less than 20 degrees. Recruitment involved sending invitation letters and follow-up phone calls. A multiple logistic regression model was used to assess determinants of participation. The J48 classifier, chi-square and Fisher’s exact tests were applied to investigate the possible differences between subjects in our sample.</p><p>Results</p><p>Individual cases were divided into 3 groups: immediate, late and non-participants. A participation rate of 20% was obtained (15% immediate, 5% late). Factors positively associated with participation included years of education, annual hospital attendance, and intermediate visual acuity. Females and greater distance to the hospital were inversely associated with participation.</p><p>Conclusion</p><p>In our study, a letter followed by a phone call was efficient to recruit a significant number of participants from a larger group of people with impaired vision. However, the improvement in participation observed after the phone call might not be cost-effective. People with low levels of education and women were more difficult to recruit. These findings need to be considered to avoid studies whose results are biased by gender or socio-economic inequalities of their participants. Young subjects and those at intermediate stages of vision impairment, or equivalent conditions, may need more persuasion than other profiles.</p>
  • Silén, Marit, et al. (författare)
  • Nurses' conceptions of decision making concerning life-sustaining treatment
  • 2008
  • Ingår i: Nursing Ethics. - London : Edward Arnold. - 0969-7330 .- 1477-0989. ; 15:2, s. 160-173
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician-nurse collaboration, lack of confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed.</p>
  • Löf, Lennart, et al. (författare)
  • Severely ill ICU patients recall of factual events and unreal experiences of hospital admission and ICU stay--3 and 12 months after discharge
  • 2006
  • Ingår i: Intensive & Critical Care Nursing. - 0964-3397 .- 1532-4036. ; 22:3, s. 154-166
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>There is a lack of knowledge regarding how critically ill patients recall of the ICU and their life-threatening condition changes over time. The purpose of this study is to describe critically ill and ventilator-treated patients' recollections of both factual events and unreal experiences at 3 and 12 months following discharge from the ICU. The study is qualitative and encompasses nine critically ill ICU patients, ventilator-treated for more than 72 h. The participants were interviewed twice, at 3 and 12 months after their discharge from the ICU. The interviews were analysed using qualitative content analysis. The patients in this study reported unreal experiences, memory confusion and/or disturbances before admittance to the ICU and before their respirator treatment. Their "unreal experiences" were far clearer than their memories of factual occurrences. Patients' fragmentary memories of factual events and their recall of unreal experiences were practically unchanged after 12 month. Their unreal experiences could still be recalled and related after 12 months, but not with the same expression and feeling as earlier (3 months). The unreal experiences were not - after 12 months - their initial recollections, as they had been after 3 months. Conclusions: Patients' recollections of both factual events and unreal experiences show very little variation between 3 and 12 months. The stability of long-term memory after 12 months shows that the recollection of their experiences had been both traumatic and emotionally charged. This study shows that critically ill patients were affected by cognitive disturbances and/or disturbed memory before their arrival at the ICU. This result indicates the need of ICU follow-up clinics.</p>
  • Möllerberg, Marie-Louise, et al. (författare)
  • The effects of a cancer diagnosis on the health of a patient's partner : a population-based registry study of cancer in Sweden
  • 2016
  • Ingår i: European Journal of Cancer Care. - 0961-5423 .- 1365-2354. ; 25:5, s. 744-752
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>The aim of this population-based registry study was to explore how cancer influences the health of partners, by examining the onset of new diagnoses for partners, health care use and health care costs among partners living with patients with cancer. The sample consisted of partners of patients with cancer (N = 10 353) and partners of age- and sex-matched controls who did not have cancer (N = 74 592). Diagnoses, health care use and health care costs were studied for a continuous period starting 1 year before the date of cancer diagnosis and continued for 3 years. One year after cancer diagnosis, partners of patients with cancer had significantly more mood disorders, reactions to severe stress and ischaemic heart disease than they exhibited in the year before the diagnosis. Among partners of patients with cancer, the type of cancer was associated with the extent and form of increased health care use and costs; both health care use and costs increased among partners of patients with liver cancer, lung cancer, colon cancer and miscellaneous other cancers. The risk of poorer health varied according to the type of cancer diagnosed, and appeared related to the severity and prognosis of that diagnosis.</p>
  • Ohlin, Andreas, et al. (författare)
  • Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia
  • 2008
  • Ingår i: Acta Paediatrica. - Oslo : Taylor & Francis. - 0803-5253 .- 1651-2227. ; 97:10, s. 1376-1380
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>OBJECTIVE: To evaluate a real-time PCR assay for the diagnosis of neonatal bacteraemia. PATIENTS AND METHODS: Two hundred ninety-five plasma samples from 288 newborns with suspected neonatal sepsis were collected prospectively for the purpose of polymerase chain reaction (PCR)-based bacterial detection. A real-time PCR targeting the bacterial gene for 16S-rRNA gene combined with four specific probes designed to detect Gram-negative bacteria, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) was developed. All samples positive in the universal PCR were further sequenced for bacterial identification. RESULTS: When applied to a material from 50 patients with positive blood culture and 245 patients with negative blood culture, the universal PCR showed a sensitivity of 42% (28-57), a specificity of 95% (92-97), a positive predictive value of 64% (45-80), and a negative predictive value of 89% (84-92) (95% confidence intervals in brackets). CONCLUSION: A new real-time PCR technique was for the first time applied to a well-defined prospectively and consecutively enrolled material of newborns with suspected sepsis, combining the benefits of real-time PCR with specific probes and sequencing. The method managed to detect bacteraemia with high specificity even though the sensitivity was low. Factors causing the low sensitivity are identified and further strategies to develop the method are described.</p>
  • Osika, Walter, et al. (författare)
  • Sex differences in peripheral artery intima, media and intima media thickness in children and adolescents
  • 2008
  • Ingår i: Atherosclerosis. - Amsterdam : Elsevier. - 0021-9150 .- 1879-1484. ; 203:1, s. 172-177
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Objective Males have higher coronary heart disease (CHD) lifetime risk and increased magnitude of atherosclerosis, compared with women. Using very high-resolution ultrasound, we have shown that the intima thickness (IT) of radial and dorsal pedal arteries, measured separately from the media thickness (MT), increases with age. We wanted to test whether there is already a difference between the sexes in childhood for IT, MT and intima media thickness (IMT) in the radial and dorsal pedal arteries. Methods and results A total of 252 children (age 14.5 years S.D. ± 1.0 girls/boys 139/113) from two schools in Gothenburg, Sweden, participated in the study. The high-resolution (55 MHz) ultrasound measurements showed that boys had larger values than girls for the radial IT (0.057 ± 0.010 mm vs. 0.054 ± 0.008 mm, P = 0.007), MT (0.176 ± 0.033 vs. 0.153 ± 0.025, P = 0.031), IMT (0.232 ± 0.035 vs. 0.207 ± 0.026, P = 0.000), and for dorsal pedal artery MT (0.160 ± 0.039 vs. 0.149 ± 0.034, P = 0.022) and IMT (0.222 ± 0.041 vs. 0.209 ± 0.037, P = 0.016). Conclusion With this new very high-resolution ultrasound technique, we demonstrated in a large study population of children, that both intimal and medial arterial wall layers were thicker in boys than in girls. These findings may constitute an “early background” explaining why CHD starts sooner in men compared with women.</p>
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