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  • Sundvall, Pär-Daniel, et al. (författare)
  • Urine culture doubtful in determining etiology of diffuse symptoms among elderly individuals: a cross-sectional study of 32 nursing homes
  • 2011
  • Ingår i: BMC Family Practice. - 1471-2296. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Background The high prevalence of bacteriuria in elderly individuals makes it difficult to know if a new symptom is related to bacteria in the urine. There are different views concerning this relationship and bacteriuria often leads to antibiotic treatments. The aim of this study was to investigate the relationship between bacteria in the urine and new or increased restlessness, fatigue, confusion, aggressiveness, not being herself/himself, dysuria, urgency and fever in individuals at nursing homes for elderly when statistically considering the high prevalence of asymptomatic bacteriuria in this population. Methods In this cross-sectional study symptoms were registered and voided urine specimens were collected for urinary cultures from 651 elderly individuals. Logistic regressions were performed to evaluate the statistical correlation between bacteriuria and presence of a symptom at group level. To estimate the clinical relevance of statistical correlations at group level positive and negative etiological predictive values (EPV) were calculated. Results Logistic regression indicated some correlations at group level. Aside from Escherichia coli in the urine and not being herself/himself existing at least one month, but less than three months, EPV indicated no clinically useful correlation between any symptoms in this study and findings of bacteriuria. Conclusions Urinary cultures provide little or no useful information when evaluating diffuse symptoms among elderly residents of nursing homes. Either common urinary tract pathogens are irrelevant, or urine culture is an inappropriate test.
  • van Buul, Laura W, et al. (författare)
  • The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure.
  • 2018
  • Ingår i: Journal of the American Medical Directors Association. - 1538-9375. ; 19:9, s. 757-764
  • Tidskriftsartikel (refereegranskat)abstract
    • Nonspecific signs and symptoms combined with positive urinalysis results frequently trigger antibiotic therapy in frail older adults. However, there is limited evidence about which signs and symptoms indicate urinary tract infection (UTI) in this population. We aimed to find consensus among an international expert panel on which signs and symptoms, commonly attributed to UTI, should and should not lead to antibiotic prescribing in frail older adults, and to integrate these findings into a decision tool for the empiric treatment of suspected UTI in this population.A Delphi consensus procedure.An international panel of practitioners recognized as experts in the field of UTI in frail older patients.In 4 questionnaire rounds, the panel (1) evaluated the likelihood that individual signs and symptoms are caused by UTI, (2) indicated whether they would prescribe antibiotics empirically for combinations of signs and symptoms, and (3) provided feedback on a draft decision tool.Experts agreed that the majority of nonspecific signs and symptoms should be evaluated for other causes instead of being attributed to UTI and that urinalysis should not influence treatment decisions unless both nitrite and leukocyte esterase are negative. These and other findings were incorporated into a decision tool for the empiric treatment for suspected UTI in frail older adults with and without an indwelling urinary catheter.A decision tool for suspected UTI in frail older adults was developed based on consensus among an international expert panel. Studies are needed to evaluate whether this decision tool is effective in reaching its aim: the improvement of diagnostic evaluation and treatment for suspected UTI in frail older adults.
  • Försti, Asta, et al. (författare)
  • Polymorphisms in the transforming growth factor beta 1 pathway in relation to colorectal cancer progression
  • 2010
  • Ingår i: Genes, Chromosomes and Cancer. - New York : Liss. - 1045-2257. ; 49:3, s. 270-281
  • Tidskriftsartikel (refereegranskat)abstract
    • Transforming growth factor beta1 (TGFB1) acts as a growth inhibitor of normal colonic epithelial cells, however, as a tumor promoter of colorectal cancer (CRC) cells. To explore the association between genetic polymorphisms in the TGFB1 pathway and CRC susceptibility and clinical outcome, we carried out a case-control study on a Swedish population of 308 CRC cases and 585 age- and gender-matched controls. The cases were sampled prospectively and had up to 16 years follow-up, making the study material particularly suitable for survival analysis. On the basis of their reported or predicted functional effect, nine single-nucleotide polymorphisms (TGFB1: Leu10Pro; TGFBR1: 9A/6A and IVS7G+24A; FURIN: C-229T; THBS1: T+42C; LTBP1L: C-256G; LTBP4: T-893G and Thr750Ala; BAMBI: T-779A) were selected for genotyping. We evaluated the associations between genotypes and CRC and Dukes' stage. Survival probabilities were compared between different subgroups. The observed statistically significant associations included a decreased CRC risk for TGFBR1 IVS7G+24A minor allele carriers (odds ratio (OR): 0.72, 95% confidence interval (CI): 0.53-0.97), less aggressive tumors with Dukes' stage A+B for carriers of LTBP4 Thr750Ala and BAMBI T-779A minor alleles (OR: 0.58, 95%CI: 0.36-0.93 and OR: 0.51, 95%CI: 0.29-0.89, respectively) and worse survival for FURIN C-229T heterozygotes (hazard ratio: 1.63, 95%CI: 1.08-2.46). As this is the first study about the influence of the polymorphisms in the TGFB1 pathway on CRC progression, further studies in large independent cohorts are warranted.
  • Haglund, Emma, 1970-, et al. (författare)
  • Work productivity in a population-based cohort of patients with spondyloarthritis.
  • 2013
  • Ingår i: Rheumatology. - Oxford University Press. - 1462-0332. ; 52:9, s. 1708-1714
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To assess work productivity and associated factors in patients with SpA.Methods. This cross-sectional postal survey included 1773 patients with SpA identified in a regional health care register. Items on presenteeism (reduced productivity at work, 0-100%, 0 = no reduction) were answered by 1447 individuals. Absenteeism was defined as register-based sick leave using data from a national register. Disease duration, disease activity (BASDAI), physical function (BASFI), health-related quality of life (EQ-5D), anxiety (HAD-a), depression (HAD-d), self-efficacy [Arthritis Self-efficacy Scale (ASES) pain and symptom], physical activity and education were also measured.Results. Forty-five per cent reported reduced productivity at work with a mean reduction of 20% (95% CI 18, 21) and women reported a higher mean reduction than men (mean 23% vs 17%, P < 0.001). Worse quality of life, disease activity, physical function and anxiety all correlated with reduced productivity (r = 0.52-0.66, P < 0.001), while sick leave did not. Worse outcomes on the EQ-5D (β-est -9.6, P < 0.001), BASDAI (β-est 7.8, P < 0.001), BASFI (β-est 7.3, P < 0.001), ASES pain (β-est -0.5, P < 0.001) and HAD-d (β-est 3.4, P < 0.001) were associated with reduced productivity at work in patients with SpA regardless of age, gender and disease subgroup. ASES symptoms, HAD-a and education level <12 years were associated with reduced productivity but were not significant in all strata for age, gender and disease subgroup.Conclusion. Work productivity was reduced in patients with SpA and more so in women. Worse quality of life, disease activity, physical function, self-efficacy and depression were all associated with reduced productivity at work in patients with SpA.
  • M, Berg, et al. (författare)
  • Breastfeeding and its impact on daily life in women with type 1 diabetes during the first six months after childbirth: a prospective cohort study
  • 2012
  • Ingår i: International Breastfeeding Journal. - 1746-4358. ; 7:1
  • Tidskriftsartikel (refereegranskat)abstract
    • For mothers with diabetes, breastfeeding is a great challenge due to their struggle with potentially unstable blood glucose levels. This paper explores breastfeeding attitudes and impact of breastfeeding on the daily life of mothers with type 1 diabetes compared with non-diabetic mothers.Methods: We performed a prospective cohort study of 108 mothers with type 1 diabetes and a reference group of 104 mothers in the west of Sweden. Data were collected through medical records and structured telephone interviews at 2 and 6 months after childbirth.
  • Pourhamidi, Kaveh, 1985-, et al. (författare)
  • Intraepidermal nerve fibre density is associated with weight
  • 2011
  • Konferensbidrag (övrigt vetenskapligt)abstract
    • Background and aims: Intraepidermal nerve fibre density (IENFD) quantification is regarded to be a sensitive and specific measure of small nerve fibre dysfunction and IENFD loss is an early feature in glucose dysregulation. Our aims were to study IENFD in individuals with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and type 2 diabetes (T2D) and to study if IENFD was associated to metabolic traits, e.g. obesity and dyslipidemia, and to neurophysiologic assessments of nerve function.Materials and methods: Participants were consecutively recruited from the population-based Västerbotten Intervention Program; NGT (n=22), IGT (n=14), T2D (n=24), at the age of 60±1 years. The individuals’ height and weight were measured. Blood glucose and lipids were measured. Nerve conduction studies (NCS) were performed (sural and peroneal nerves) and the results were standardized to z-scores and compiled into a composite Z-score representing the nerve function in the leg. Neuropathy disability score (NDS) was used to evaluate neuropathic signs. In addition, thermal threshold tests (TTT) were performed to assess small nerve fibre function. Skin biopsies were performed using a 3-mm punch taken 10 cm proximal to the lateral malleolus. The intraepidermal nerve fibres were evaluated by routine immunohistochemistry and stained with anti-PGP9.5 (ubiquitin carboxyl-terminal hydrolase) antibodies. Light microscopy was used to identify nerve fibres in thin sections (5 µm) according to a standardized protocol. The IENFD was given as the mean of counts in 3 sections per millimeter of epidermal length. The assessors were blinded to the identity of the samples.Results: Patients with diabetes had lower IENFD (median 2.9 nerves mm-1, IQR 1.2-4.8) than controls (median 4.4 nerves mm-1, IQR 3.5-6.3; Mann-Whitney U test p=0.007). IGT individuals did not differ in IENFD (median 3.2 nerves mm-1, IQR 1.4-5.5) compared to controls (p=0.12) or diabetic patients (p=0.53). IENFD was positively correlated to NCS (r=0.39, p=0.002), but not to TTT and NDS. Individuals in the 3rd tertile of composite Z-score (i.e. better nerve conduction) had higher IENFD (median 4.1 nerves mm-1, IQR 2.7-5.8) than individuals in the 1st tertile (median 2.4 nerves mm-1, IQR 0.7-3.9; p=0.009). Triglycerides and cholesterols were not associated with IENFD. However, a stepwise multiple linear regression analysis revealed that weight was independently associated to IENFD, after adjustment for age, sex, height, and diabetic status (β=-0.419, p&lt;0.001).Conclusion: We conclude that skin biopsies for IENFD quantification in thin sections is a simple useful method for assessing small nerve fibre neuropathy in individuals with diabetes. The association between weight and IENFD indicates that metabolic traits other than glucose dysmetabolism might play a role in the development small nerve fibre neuropathy.
  • Sjöström, Lars, et al. (författare)
  • Association of Bariatric Surgery With Long-term Remission of Type 2 Diabetes and With Microvascular and Macrovascular Complications
  • 2014
  • Ingår i: Journal of the American Medical Association. - 0098-7484 .- 1538-3598. ; 311:22, s. 2297-2304
  • Tidskriftsartikel (refereegranskat)abstract
    • IMPORTANCE Short-term studies show that bariatric surgery causes remission of diabetes. The long-term outcomes for remission and diabetes-related complications are not known.OBJECTIVES: To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery.DESIGN, SETTING, AND PARTICIPANTS: The Swedish Obese Subjects (SOS) is a prospective matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden. Of patients recruited between September 1,1987, and January 31, 2001, 260 of 2037 control patients and 343 of 2010 surgery patients had type 2 diabetes at baseline. For the current analysis, diabetes status was determined at SOS health examinations until May 22, 2013. Information on diabetes complications was obtained from national health registers until December 31, 2012. Participation rates at the 2-, 10-, and 15-year examinations were 81%, 58%, and 41% in the control group and 90%, 76%, and 47% in the surgery group. For diabetes assessment, the median follow-up time was 10 years (interquartile range [IQR], 2-15) and 10 years (IQR, 10-15) in the control and surgery groups, respectively. For diabetes complications, the median follow-up time was 17.6 years (IQR, 14.2-19.8) and 18.1 years (IQR, 15.2-21.1) in the control and surgery groups, respectively.INTERVENTIONS: Adjustable or nonadjustable banding (n = 61), vertical banded gastroplasty (n = 227), or gastric bypass (n = 55) procedures were performed in the surgery group, and usual obesity and diabetes care was provided to the control group.MAIN OUTCOMES AND MEASURES: Diabetes remission, relapse, and diabetes complications. Remission was defined as blood glucose &lt;110 mg/dL and no diabetes medication.RESULTS: The diabetes remission rate 2 years after surgery was 16.4% (95% CL, 11.7%-22.2%; 34/207) for control patients and 72.3% (95% Cl, 66.9%-77.2%; 219/303) for bariatric surgery patients (odds ratio [OR], 13.3; 95% Cl, 8.5-20.7; P &lt; .001). At 15 years, the diabetes remission rates decreased to 6.5% (4/62) for control patients and to 30.4% (35/115) for bariatric surgery patients (OR, 6.3; 95% Cl, 2.1-18.9; P &lt; .001). With long-term follow-up, the cumulative incidence of microvascular complications was 41.8 per 1000 person-years (95% Cl, 35.3-49.5) for control patients and 20.6 per 1000 person-years (95% Cl, 17.0-24.9) in the surgery group (hazard ratio [HR], 0.44; 95% Cl, 0.34-0.56; P &lt; .001). Macrovascular complications were observed in 44.2 per 1000 person-years (95% Cl, 37.5-52.1) in control patients and 31.7 per 1000 person-years (95% Cl, 27.0-37.2) for the surgical group (HR, 0.68; 95% Cl, 0.54-0.85; P = .001).CONCLUSIONS AND RELEVANCE: In this very long-term follow-up observational study of obese patients with type 2 diabetes, bariatric surgery was associated with more frequent diabetes remission and fewer complications than usual care. These findings require confirmation in randomized trials.
  • Zhou, Bin, et al. (författare)
  • Worldwide trends in diabetes since 1980 : : A pooled analysis of 751 population-based studies with 4.4 million participants
  • 2016
  • Ingår i: The Lancet. - Elsevier Limited. - 0140-6736. ; 387:10027, s. 1513-1530
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are aff ecting the number of adults with diabetes. Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings: We used data from 751 studies including 4372000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-17.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation: Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.
  • Baliakas, Panagiotis, et al. (författare)
  • Refractory chronic "ITP" When platelet size matters
  • 2018
  • Ingår i: Clinical Case Reports. - 2050-0904. ; 6:9, s. 1779-1780
  • Tidskriftsartikel (refereegranskat)abstract
    • Key Clinical Message Inherited conditions associated with thrombocytopenia should be included in the differential diagnosis of young patients with refractory immune thrombocytopenia (ITP), even in the absence of a positive family history. Early identification of such conditions is of vital importance in order to reach the right diagnosis and avoid unnecessary or even harmful medication.
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