| 1. |
- Hambraeus, Mette, et al.
(författare)
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Functional outcome and health-related quality of life in patients with sacrococcygeal teratoma – a Swedish multicenter study
- 2019
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 0022-3468 .- 1531-5037. ; 54:8, s. 1638-1643
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Tidskriftsartikel (refereegranskat)abstract
- Background/Purpose: The aims of this study were to evaluate bowel and urinary tract function, to identify predictors for dysfunctional outcome and to evaluate health-related quality-of life (QoL) in patients treated for sacrococcygeal teratomas (SCT). Methods: Medical records of patients with SCT born between 1985 and 2015 treated at three Swedish pediatric surgical centers were reviewed. Questionnaires regarding urinary tract function, bowel function and QoL were sent to patients and parents. Different QoL instruments were used for the different age groups. Results: Totally 85 patients were identified. Four patients died in the neonatal period. Forty-nine patients answered the questionnaires (60%). Median age at follow-up was 8.9 years (range 3.6–28.8). Bowel dysfunction was reported by 36% and urinary tract dysfunction by 46% of the patients. Univariate analysis revealed that urinary tract dysfunction correlated with gestational age (p = 0.018) and immature histology (p = 0.008), and bowel dysfunction correlated with gestational age (p = 0.016) and tumor size (p = 0.042). Low gestational age was an independent predictor for both urinary tract and bowel dysfunction. Good or very good QoL was reported by 56% of children aged 4–7 years, 90% of children aged 8–17 years and 67% of the adults. Conclusion: Although a considerable proportion of bowel and urinary tract dysfunction was found, the reported QoL was good in a majority of the patients with SCT. Low gestational age was found to be a predictor for bowel- and urinary tract dysfunction. Level of Evidence: Level III.
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| 2. |
- Magnusson, Carl, 1976, et al.
(författare)
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Prediction of a time-sensitive condition among patients with dizziness assessed by the emergency medical services
- 2021
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Ingår i: BMC Emergency Medicine. - : Springer Science and Business Media LLC. - 1471-227X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Dizziness is a relatively common symptom among patients who call for the emergency medical services (EMS).AIM: To identify factors of importance for the early identification of a time-sensitive condition behind the symptom of dizziness among patients assessed by the EMS.METHODS: All patients assessed by the EMS and triaged using Rapid Emergency Triage and Treatment (RETTS) for adults code 11 (=dizziness) in the 660,000 inhabitants in the Municipality of Gothenburg, Sweden, in 2016, were considered for inclusion. The patients were divided into two groups according to the final diagnosis (a time-sensitive condition, yes or no).RESULTS: There were 1536 patients who fulfilled the inclusion criteria, of which 96 (6.2%) had a time-sensitive condition. The majority of these had a stroke/transitory ischaemic attack (TIA). Eight predictors of a time-sensitive condition were identified. Three were associated with a reduced risk: 1) the dizziness was of a rotatory type, 2) the dizziness had a sudden onset and 3) increasing body temperature. Five were associated with an increased risk: 1) sudden onset of headache, 2) a history of head trauma, 3) symptoms of nausea or vomiting, 4) on treatment with anticoagulants and 5) increasing systolic blood pressure.CONCLUSION: Among 1536 patients who were triaged by the EMS for dizziness, 6.2% had a time-sensitive condition. On the arrival of the EMS, eight factors were associated with the risk of having a time-sensitive condition. All these factors were linked to the type of symptoms or to clinical findings on the arrival of the EMS or to the recent clinical history.
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| 3. |
- Hasserius, Johan, et al.
(författare)
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Treatment and Patient Reported Outcome in Children with Hirschsprung Disease and Concomitant Congenital Heart Disease
- 2017
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Ingår i: BioMed Research International. - : Hindawi Limited. - 2314-6133 .- 2314-6141. ; 2017
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. Congenital heart disease (CHD) is reported to be associated with Hirschsprung disease (HD). The aim was to evaluate any differences between children with HD with and without CHD, respectively, with regard to patient characteristics, medical care, and patient reported bowel function. Method. This is a retrospective chart study and a cross-sectional long-term follow-up of patients older than 4 years old, including all children with HD operated on with transanal endorectal pull-through (TERPT) at a tertiary center of pediatric surgery. Information about patient characteristics, diagnostics, surgery, and medical care was compiled. At long-term follow-up, bowel function was assessed by Bowel Function Score. Results. Included were 53 HD-patients, 13 with CHD and 40 without CHD. Children with CHD more commonly presented with failure to thrive; 4 (23%) compared to those without CHD (0%) (p<0.01). In the long-term follow-up, including 32 patients (6 with CHD), constipation was more commonly reported by children with CHD 5 (83%) than by children without CHD 4 (27%) (p=0.01). No differences were shown in the other parameters such as fecal control and incontinence. Conclusion. HD-patients with CHD more commonly presented with failure to thrive and more frequently reported constipation than HD-patients without CHD. The findings indicate that HD-patients with CHD might need special consideration in their initial care and long-term follow-up.
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| 4. |
- Hedbys, Josefine, et al.
(författare)
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Children with Hirschsprung's Disease and Syndromes with Cognitive Dysfunction : Manifestations, Treatment, and Outcomes
- 2019
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Ingår i: The Surgery Journal. - : Georg Thieme Verlag KG. - 2378-5128 .- 2378-5136. ; 5:3, s. 103-109
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Tidskriftsartikel (refereegranskat)abstract
- Introduction To assess differences in initial symptoms, treatments, and bowel function between children with Hirschsprung's disease (HD) with or without a cognitive dysfunction (CD). Materials and Methods The study included children with HD who underwent transanal endorectal pull-through. A retrospective chart review was performed to collect data on patient characteristics, diagnosis, and treatment. Data on bowel symptoms in children older than 4 years without a colostomy were compiled during a cross-sectional, patient-reported follow-up. Results Fifty-three children with HD were included; of these, 12 (23%) had CD. The median birth weight was lower, frequency of vomiting as the presenting symptom was lower, and time until the first contact with a pediatric surgeon was higher in children with CD than in those without (3,295 vs. 3,623 g, p = 0.013; 28 vs. 66%, p = 0.02; and 4 days vs. 1 day, p = 0.048, respectively). At follow-up, 5 (15%) of 33 children aged over 4 years had CD. More children without CD had some ability to hold back defecation and sense the urge to defecate than those with CD ( p = 0.002 and p = 0.001, respectively). Conclusion HD children who have CD present with different initial symptoms, have a delay in the first consultation with a pediatric surgeon, and experience poorer bowel function outcomes than HD children without CD. Therefore, HD children with CD should receive special attention in both clinical practice and research.
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| 5. |
- Lundström, A., et al.
(författare)
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Periodontal conditions in 70-year-old women with osteoporosis
- 2001
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Ingår i: Swedish Dental Journal. - : Sveriges Tandläkarförbund. - 0347-9994. ; 25:3, s. 89-96
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to examine the periodontal conditions in an age cohort of 70-year-old women and compare an osteoporosis group with a control group with normal bone mineral density. 210 women 70 years old and randomly sampled from the population register of the community of Linköping were examined. Bone mineral density (BMD) of the hip was measured by dual energy X-ray absorptiometry. 19 women were diagnosed with osteoporosis (BMD below 0.640 g/cm2 in total hip). 15 of them accepted to participate in the study. As a control group 21 women with normal bone mineral density (BMD exceeding 0.881 g/cm2) were randomly selected from the initial population. The clinical examination included registration of the number of remaining teeth, dental plaque and periodontal conditions. The radiographic examination included a dental panorama and vertical bite-wing radiographs. The subjects also answered a questionnaire about their general health, age at menopause, concurrent medication, smoking and oral hygiene habits. The results from this study showed no statistically significant differences in gingival bleeding, probing pocket depths, gingival recession and marginal bone level between the women with osteoporosis and the women with normal bone mineral density. In conclusion, the present randomly selected and controlled study of osteoporotic and non-osteoporotic women, showed no statistically significant differences in periodontal conditions or marginal bone level. As periodontitis as well as osteoporosis are associated with age, our study of a well-defined age cohort is of interest, but the results should be interpreted with caution since the compared groups are small.
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| 6. |
- Åström, Johan, 1977, et al.
(författare)
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Variability analysis of pathogen and indicator loads from urban sewer systems along a river
- 2009
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Ingår i: Water Science and Technology. - : IWA Publishing. - 1996-9732 .- 0273-1223. ; 59:2, s. 203-212
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Tidskriftsartikel (refereegranskat)abstract
- The pathogen loads within surface waters originating from urban wastewater sources needs to be assessed to support drinking water risk estimations and optimal selection of risk reduction measures. Locally reported discharges from sewer systems (>100,000 persons connected) were used to simulate the potential microbial loads into the Gota alv river, Sweden. Using Monte Carlo simulations, the median and 95% percentile (i.e. worst case) of total microbial load from wastewater treatment plants, sewer network overflows and emergency discharges were assessed and presented for dry and wet weather conditions. Wastewater treatment plants with secondary treatment represented a major source of E. coli, norovirus, Giardia and Cryptosporidium. During wet weather, comparably high microbial loads were found for sewer overflows due to heavy rains. Substantial loads were also associated with an incident of the emergency discharge of untreated wastewater. Simulated river water concentrations of faecal indicators (E. coli, sulfite reducing clostridia, somatic coliphages) and pathogens (norovirus, Giardia, Cryptosporidium) were confirmed by river sampling data, suggesting that urban wastewater is the major microbial source for this river.
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| 7. |
- Åström, Johan, 1977, et al.
(författare)
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Variability analysis of pathogen and indicator loads from urban wastewater systems along a river for drinking water risk estimations
- 2007
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Ingår i: Abstract, WaterMicro 2007. 14th International Symposium on Health-Related Water Microbiology. ; Extended abstract:P1036, s. 2-
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND AND OBJECTIVESPathogens in source waters represent a health risk for drinking water consumers that may result in waterborne diseases, if not sufficiently removed within water treatment plants. According to the water safety plans in the WHO Drinking Water Guidelines (3rd ed.), identification and comparison of drinking water hazards within the catchment is of significant importance to accomplish effective risk management. In comparison to baseline concentrations significantly higher levels have been documented after heavy rainfalls (Kistemann et al. 2002; Signor et al. 2005) and a large number of waterborne outbreaks documented have been preceded by periods of heavy rainfalls (Rose et al. 2000; Curriero et al. 2001). Heavy rainfalls with wastewater discharges, in combination with treatment failures, resulted in the largest waterborne outbreak in Sweden in 1988. In this paper we have assessed the spatial and temporal distribution of wastewater discharges from urban areas along the river Göta älv used for drinking water supply to about 700 000 people including the city of Göteborg. The objectives were to assess the pathogen loads and variability by simulations of wastewater discharges from the urban sewage systems. The simulations have been compared with measured concentrations of pathogens and faecal indicator bacteria in the river.METHODSMicrobial point sources in municipal sewage systems along the river Göta älv, upstream the raw water intake to the city of Göteborg, were identified and quantified in relation to time and magnitude. Data on discharges of treated wastewater from wastewater treatment plants (WWTPs), as well as untreated wastewater from combined sewer overflows (CSOs) and sanitary sewer overflows (SSOs), were collected, including onsite monitoring and urban wastewater modelling results. Literature data on the concentrations as well as the reduction of indicator bacteria (E. coli and spores of clostridia), Campylobacter, noroviruses, Giardia and Cryptosporidium within sewage systems were used. Through Monte Carlo simulations the daily microbial loads to the river were calculated using pathogen concentrations and discharge information from the wastewater systems for each single discharge point. Microbial loads were calculated for baseline conditions and for rain event conditions, based on a half year data period. Baseline conditions were defined as dry weather periods with discharges predominantly of treated wastewater. Rain event conditions were separately described for two wet weather periods, including discharges from CSOs and SSOs. Assuming a total mixing of wastewater pathogens discharged into the river, the downstream microbial concentration was approximated and compared to sampling data on indicator and pathogens from the river Göta älv for the same data period.RESULTSThe discharge volumes of treated wastewater varied highly between WWTPs along the river as a function of persons connected and the portion of stormwater within the system. CSOs as well as SSOs activated during wet weather periods increased the discharge volumes from the urban sewer systems. Daily loads simulated for the indicator bacteria as well as the pathogens were presented in figures, showing the contributions for the separate municipalities along the river. In general, the pathogen loads during baseline conditions were defined by the flow and the number of persons connected to each system, while the pathogen loads during rain conditions were additionally set by the degree of combined and sanitary sewer overflows. Downstream positive detections of norovirus were made during a wet weather period with multiple discharges of combined and sanitary sewer overflows registered along the river, confirming the simulated results. Overall, the river concentrations approximated by these simulations, were in the same range for the faecal indicator bacteria as compared to sampling data for the same period, but higher for the Campylobacter and slightly lower for norovirus, Giardia and Cryptosporidium. CONCLUSIONS AND SIGNIFICANCE OF THE WORK In this study, local flow and volume registrations were used to theoretically assess the pathogen load along a river used as a source for drinking water production. The range of pathogen loads from the urban areas, as well as the differences between dry and wet weather conditions, illustrates the potential variability of source water pathogen concentrations. This information may be used for assumptions on pathogen concentration, such as within quantitative microbial risk assessments. Present simulation results also suggest a first prioritization for reduction of microbial loads within urban wastewater systems along this river, such as the need for local additional wastewater treatment steps in order to bring down the spread of pathogens. This investigation is also a starting point to further investigate presently unquantified microbial sources, such as unregistered CSOs, SSOs and animal contaminations, as well as the microbial effects from sedimentation, die-off and the downstream microbial transport mechanisms in the river.
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