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- Montgomery, Scott, 1961-, et al.
(författare)
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Mortality following a brain tumour diagnosis in patients with multiple sclerosis
- 2013
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Ingår i: BMJ Open. - London, United Kingdom : BMJ Publishing Group. - 2044-6055. ; 3:11
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: As brain tumours and their treatment may theoretically have a poorer prognosis in inflammatory central nervous system diseases such as multiple sclerosis (MS), all-cause mortality following a brain tumour diagnosis was compared between patients with and without MS. The potential role of age at tumour diagnosis was also examined.Setting: Hospital inpatients in Sweden with assessment of mortality in hospital or following discharge.Participants: Swedish national registers identified 20 543 patients with an MS diagnosis (1969–2005) and they were matched individually to produce a comparison cohort of 204 163 members of the general population without MS. Everyone with a primary brain tumour diagnosis was selected for this study: 111 with MS and 907 without MS.Primary and secondary outcome measures: 5-year mortality risk following brain tumour diagnosis and age at brain tumour diagnosis.Results: A non-statistically significant lower mortality risk among patients with MS (lower for those with tumours of high-grade and uncertain-grade malignancy and no notable difference for low-grade tumours) produced an unadjusted HR (and 95% CI) of 0.75 (0.56 to 1.02). After adjustment for age at diagnosis, grade of malignancy, sex, region of residence and socioeconomic index, the HR is 0.91 (0.67–1.24). The change in estimate was largely due to adjustment for age at brain tumour diagnosis, as patients with MS were on average 4.7 years younger at brain tumour diagnosis than those in the comparison cohort (p<0.001).Conclusions: Younger age at tumour diagnosis may contribute to mortality reduction in those with highgrade and uncertain-grade brain tumours. Survival following a brain tumour is not worse in patients with MS; even after age at brain tumour diagnosis and grade of malignancy are taken into account.
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| 2. |
- Montgomery, Scott, 1961-, et al.
(författare)
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Respiratory infections in preterm infants and subsequent asthma : a cohort study
- 2013
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Ingår i: BMJ Open. - London, United Kingdom : BMJ Publishing Group. - 2044-6055. ; 3:10
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To investigate whether gestational age modifies the association of airway infections that result in hospital admission during the first year after birth, with subsequent asthma risk after age 5years.Setting: Hospital inpatients and a general population comparison group in Sweden followed for subsequent diagnoses in primary and secondary care.Participants: National registers identified 42334 children admitted to hospital for respiratory infection in their first year after birth during 1981-1995, individually matched with 211594 children not admitted to hospital for infection during their first year.Primary outcome Asthma diagnoses and prescribed asthma treatments after the age of 5years identified through registers.Results: Cox regression was used to identify a HR (and 95% CI) of 1.51 (1.47 to 1.51) for the association of respiratory infection before 1year of age with asthma after age 5years, after adjustment for sex, gestational age, chronic lung disease, maternal asthma and maternal smoking. When stratified by gestational age (and with additional adjustment for birth weight), there is statistically significant effect modification by gestational age, with the highest magnitude asthma risk among those born with a gestational age of less than 28 weeks, producing an adjusted HR of 2.22 (1.59 to 3.09). This higher magnitude asthma risk persisted until after age 10years, but differences in risk by gestational age were less pronounced for asthma after age 16years.Conclusions: Extremely preterm infants are most likely to have chronic respiratory sequelae following respiratory infections in early life.
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| 3. |
- Nordenskjöld, Axel, 1977-, et al.
(författare)
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Continuation Electroconvulsive Therapy With Pharmacotherapy Versus Pharmacotherapy Alone for Prevention of Relapse of Depression A Randomized Controlled Trial
- 2013
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Ingår i: Journal of ECT. - : Lippincott Williams & Wilkins. - 1095-0680 .- 1533-4112. ; 29:2, s. 86-92
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The primary aim of the study was to test the hypothesis that relapse prevention with continuation electroconvulsive therapy (ECT) plus pharmacotherapy is more effective than pharmacotherapy alone after a course of ECT for depression. Methods: A multicenter, nonblinded, randomized controlled trial with 2 parallel groups was performed from 2008 to 2012 in 4 hospitals in Sweden. Patients eligible had unipolar or bipolar depression and had responded to a course of ECT. The patients (n = 56) were randomly assigned (1: 1) to receiving either 29 treatments of continuation ECT with pharmacotherapy or pharmacotherapy alone for 1 year. The pharmacotherapy consisted of antidepressants (98%), lithium (56%), and antipsychotics (30%). The main outcome was relapse of depression within 1 year. Relapse was defined as 20 or more points on the Montgomery Asberg Depression Rating Scale or inpatient psychiatric care or suicide or suspected suicide. All 56 patients randomized were analyzed according to an intention to treat analysis. Results: Sixty-one percent of the patients treated with pharmacotherapy versus 32% of the patients treated with ECT plus pharmacotherapy relapsed within 1 year (P = 0.036). The Cox proportional hazard ratio was 2.32 (1.03-5.22). Cognitive function and memory measures were stable for patients without relapse in both groups. One suspected suicide and 3 suicide attempts by intoxication occurred, all in the pharmacotherapy-alone group. Conclusions: The post-ECT relapse rates were substantial in both treatment groups with a statistically significant advantage for combined treatment with pharmacotherapy and continuation ECT. Further studies are needed to define indications for continuation ECT, pharmacotherapy, and their combination.
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| 4. |
- Nordenskjöld, Axel, 1977-, et al.
(författare)
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Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder : a population based cohort study
- 2013
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Ingår i: Nordic Journal of Psychiatry. - Oxfordshire, United Kingdom : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 67:5, s. 326-333
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.
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