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  • Tuvemo, T, et al. (författare)
  • Final height after combined growth hormone and GnRH analogue treatment in adopted girls with early puberty
  • 2004
  • Ingår i: Acta Paediatrica. - 0803-5253. ; 93:11, s. 1456-1462
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Girls adopted from developing countries often have early or precocious puberty, requiring treatment with gonadotrophin-releasing hormone (GnRH) analogues. During such treatment, decreased growth velocity is frequent. Aim: To study whether the addition of growth hormone (GH) to GnRH analogue treatment improves final height in girls with early or precocious puberty. Methods: Forty-six girls with early or precocious puberty (age ≤9.5 y) adopted from developing countries were randomized for treatment for 2-4 y with GnRH analogue, or with a combination of GH and GnRH analogue. Results: During treatment, the mean growth velocity in the GH/GnRH analogue group was significantly higher compared to the control group. Combined GH/GnRH analogue treatment resulted in a higher final height: 158.9 cm compared to 155.8 cm in the GnRH analogue-treated group. Three out of 24 girls (13%) in the combined group and nine of the 22 girls (41%) treated with GnRH analogue alone attained a final height below -2 standard deviation scores (SDS). Conclusion: The difference between the two groups is statistically significant, and possibly of clinical importance. A future challenge is to identify a subgroup with clinically significant advantage of GH addition to GnRH analogue treatment. Being very short on arrival in Sweden and being short and young at start of treatment are possible indicators.
  • Pundziute-Lycka, A, et al. (författare)
  • The incidence of Type I diabetes has not increased but shifted to a younger age at diagnosis in the 0-34 years group in Sweden 1983 to 1998
  • 2002
  • Ingår i: Diabetologia. - 0012-186X. ; 45:6, s. 783-791
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims/hypothesis. To analyse the incidence of Type I (insulin-dependent) diabetes mellitus in the 0-34 years age group in Sweden 1983-1998. Methods. Incidence and cumulative incidence per 100 000 and Poisson regression analysis of age-period effects was carried out using 11 751 cases from two nation-wide prospective registers. Results. Incidence (95%-CI) was 21.4 (20.8-21.9) in men and 17.1 (16.6-17.5) in women between 0 and 34 years of age. In boys aged 0-14 and girls aged 0-12 years the incidence increased over time, but it tended to decrease at older age groups, especially in men. Average cumulative incidence at 35 years was 748 in men and 598 in women. Cumulative incidence in men was rather stable during four 4-year periods (736, 732, 762, 756), while in women it varied more (592, 542, 617, 631). In males aged 0-34 years, the incidence did not vary between the 4-year periods (p=0.63), but time changes among the 3-year age groups differed (p<0.001). In females the incidence between the periods varied (p<0.001), being lower in 1987-1990 compared to 1983-1986, but time changes in the age groups did not differ (p=0.08). For both sexes median age at diagnosis was higher in 1983-1986 than in 1995-1998 (p<0.001) (15.0 and 12.5 years in males, 11.9 and 10.4 in females, respectively). Conclusion/interpretation. During a 16-year period the incidence of Type I diabetes did not increase in the 0-34 years age group in Sweden, while median age at diagnosis decreased. A shift to younger age at diagnosis seems to explain the increasing incidence of childhood Type I diabetes.
  • Nystedt, Astrid, et al. (författare)
  • Epidural analgesia for pain relief in labour and childbirth - a review with a systematic approach.
  • 2004
  • Ingår i: Journal of Clinical Nursing. - 0962-1067. ; 13:4, s. 455-66
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Clinical ambiguity concerning effects of epidural analgesia for pain relief in labour seems to reflect a need for evidence-based knowledge for midwives. AIMS: This study aimed to review, with a systematic approach, the literature about effects and risks associated with the use of epidural analgesia for pain relief in labour and childbirth. DESIGN: A structured question was formulated and used for deriving search terms, establishing the inclusion of certain criteria and retrieving articles, i.e. what are the effects of epidural analgesia for pain relief in labour and childbirth? References were obtained through searches using MeSH-terms in Medline and Subheadings (SH) in CINAHL (e.g. Obstetrical Analgesia combined either with psychology or adverse effects and together with, Dystocia, Caesarean Section, Infant Newborn and Breastfeeding). The articles were divided into prospective randomized trials (C), non-randomized prospective studies (P) and retrospective studies (R). Scientific quality of the studies was assessed on a three-grade scale: high scientific quality (I), moderate scientific quality (II) or low scientific quality (III). RESULTS: Twenty-four articles were retrieved and systematically assessed. Seven studies were judged as high quality, 15 as moderate quality and two as low quality. The majority of studies appraised in this review failed to obtain or establish a cause and effect relationship. According to the data, it seems clear that the use of epidural analgesia is considered to be an effective method of pain relief during labour and childbirth from the perspective of women giving birth. RELEVANCE TO CLINICAL PRACTICE: Midwives and doctors can recommend this form of pain relief. However, information about possible associations with adverse effects in mothers and infants must be provided to expectant couples.
  • Andersson, P L, et al. (författare)
  • Bioaccumulation of selected PCBs in zebrafish, three-spined stickleback, and arctic char after three different routes of exposure.
  • 2001
  • Ingår i: Arch Environ Contam Toxicol. - 0090-4341. ; 40:4, s. 519-30
  • Tidskriftsartikel (refereegranskat)abstract
    • The uptake and elimination of 20 structurally diverse tetra- to heptachlorinated biphenyls were studied in zebrafish (Danio rerio), three-spined stickleback (Gasterosteus aculeatus), and Arctic char (Salvelinus alpinus). The polychlorinated biphenyls (PCBs) were administered to the fish through food, intraperitoneal injection of peanut oil, or intraperitoneal implantation of silicone capsules. The retention of the PCBs in fish exposed through their diet was related with the substitution patterns of the compounds. Ortho-substituted congeners with no unsubstituted meta-para positions had high biomagnification potential. PCBs with low biomagnification all had adjacent vicinal hydrogens, indicating that congeners with this feature may have been metabolically eliminated. The retention characteristics of the PCBs in the diet-exposed and the injected zebrafish were similar. The pattern of congeners in Arctic char indicates that they have a lower capacity to metabolize PCBs compared to three-spined sticklebacks and zebrafish. The levels in the fish exposed to the PCBs through a silastic implant were negatively correlated with the hydrophobicity of the congeners. Most probably congener-specific release rates of the PCBs from the implants mask their retention characteristics. It is suggested that food, mimicking the natural intake route, should be used in PCB exposure studies to validate extrapolations to natural situations.
  • Lin, W. W., et al. (författare)
  • Perturbation analysis for the eigenproblem of periodic matrix pairs
  • 2001
  • Ingår i: Linear Algebra and Its Applications. - 0024-3795 ; 337, s. 157-187
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper is devoted to perturbation analysis for the eigenproblem of periodic matrix pairs {(A(j), E-j)}(j=1)(K). We first study perturbation expansions of periodic deflating subspaces and eigenvalue pairs. Then, we derive explicit expressions of condition numbers, perturbation bounds and backward errors for eigenvalue pairs and periodic deflating subspaces. (C) 2001 Elsevier Science Inc. All rights reserved.
  • Lugina, Helen I, et al. (författare)
  • Assessing mothers' concerns in the postpartum period : methodological issues.
  • 2004
  • Ingår i: J Adv Nurs. - 0309-2402. ; 48:3, s. 279-90
  • Tidskriftsartikel (refereegranskat)abstract
    • AIM: This paper reports a study evaluating the sensitivity of a semi-structured interview schedule and card sort methods in assessing postpartum concerns of women. BACKGROUND: Several methods have been used to assess postpartum maternal concerns and the process of becoming a mother, but few studies have evaluated the methods with respect to their sensitivity for obtaining information. METHOD: A cohort of mothers was followed-up at one (n = 110) and 6 weeks (n = 83) after childbirth in Dar es Salaam, Tanzania. Women with a minimum of 7 years of primary education were interviewed and they also sorted cards. Those with less fewer than 7 years of primary education were interviewed only. The methods were used in alternate order to assess method interaction. RESULTS: In the interviews at 1 week, mothers more often expressed worry and interest related to the baby or themselves when they had sorted cards first. The extent to which women expressed worry and interest about specific baby- and mother-related topics was generally higher for women who had sorted cards before the interview at both 1 and 6 weeks. Independent of whether they were interviewed only, interviewed after sorting cards or before, mothers more often expressed a higher degree of interest than of worry about the baby and self at both 1 and 6 weeks. The order of the data collection methods did not influence the way women sorted cards as being worries and interests. CONCLUSION: Compared to interview using a semi-structured interview schedule, our findings suggest that the card sort is more sensitive in obtaining information about women's concerns. Although the interview method has the advantage of reaching less educated people, the card sort is a technique that is associated with fewer barriers and is a more participatory method for those who can use it.
  • Lindholm, Christer, et al. (författare)
  • Invasive cutaneous malignant melanoma in Sweden, 1990-1999. A prospective, population-based study of survival and prognostic factors.
  • 2004
  • Ingår i: Cancer. - 0008-543X. ; 101:9, s. 2067-78
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND. The objective of the current study was to compile prospective, population-based data on cutaneous invasive melanomas in Sweden during the period from 1990 to 1999, to describe and analyze survival data and prognostic factors, and to make comparisons with previously published Swedish and international data. METHODS. Twelve thousand five hundred thirty-three patients, which included 97% of all registered melanomas in Sweden, were included and described. Among these, 9515 patients with clinical Stage I and II melanoma were included in an analysis of survival and in a univariate analysis, and 6191 patients were included in a multivariate analysis of prognostic factors. RESULTS. There was no significant change in melanoma incidence during 1990-1999. Favorable prognostic factors were found, especially in younger and female patients, resulting in a relative 5-year survival rate of 91.5%. In the multivariate analysis, significant factors that had a negative effect on survival were Clark level of invasion, Breslow thickness, ulceration, older patient age, trunk location, greatest tumor dimension, nodular histogenetic type, and male gender. CONCLUSIONS. During the period from 1990 to 1999, the 5-year survival of patients with malignant melanoma in Sweden was better compared with the previously reported rates in published, population-based studies from Sweden, probably as a result of better secondary prevention due to better knowledge and awareness by both patients and the medical profession. The more favorable prognostic factors and the change in melanoma location found in younger patients, compared with earlier reports, may reflect changes in clothing as well as tanning habits; however, a decrease also was found in Clark Level II and thin melanomas for the same patient group. The authors concluded that further improvements can be achieved with better access to health care and with the use of early melanoma detection campaigns. (C) 2004 American Cancer Society.
  • Olsson-Strömberg, Ulla, et al. (författare)
  • Comparison of busulphan, hydroxyurea and allogeneic bone marrow transplantation (BMT) in chronic myeloid leukaemia : BMT prolongs survival.
  • 2004
  • Ingår i: Hematol J. - 1466-4860. ; 5:6, s. 462-6
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Whether busulphan-treated patients develop blastic transformation earlier than hydroxyurea treated has been a controversial issue. In a randomised prospective study, we examined the busulphan versus hydroxyurea influence on time to blast crisis and on survival. When we opened our study in 1984, the clinical benefit of allogeneic bone marrow transplantation (BMT) was not well known, to follow up the long-time outcome of this treatment was therefore of great interest. Materials and methods: Previously untreated CML patients were randomly started on either hydroxyurea (30 mg/kg/day) or busulphan (0.1 mg/kg/day). The end points of the study were overall survival and time to blast crisis. A total of 26 patients subsequently underwent BMT. Results: A total of 179 patients were randomised, 90 to hydroxyurea, and 89 to busulphan treatment. There was no significant difference in survival between hydroxyurea- and busulphan-treated patients (P = 0.46), median survival was 3.5 and 3.2 years, respectively. In all, 85 of the patients were subsequently diagnosed with blast crisis, 41 in the busulphan and 44 in the hydroxyurea group. There was no significant difference between the two groups (P=0.91). The 26 patients who were allotransplanted survived significantly longer than those who were not transplanted (P=0.0001). The 5-year-survival rates were 50 and 22% and the 10-year-survival rates were 46 and 2%, respectively. The median survival was 4.7 years for the transplanted and 3.3 years for the nontransplanted patients. Conclusion: We did not find any difference between hydroxyurea and busulphan treatment, either in overall survival or in blast crisis-free survival, transplanted patients survived significantly longer than nontransplanted patients. © 2004 The European Hematology Association All rights reserved.
  • Petersson, Gunnel H, et al. (författare)
  • Comparing caries risk factors and risk profiles between children and elderly.
  • 2004
  • Ingår i: Swedish dental journal. - 0347-9994. ; 28:3, s. 119-28
  • Tidskriftsartikel (refereegranskat)abstract
    • The aims of this study were to compare the caries risk profiles of children and elderly, the actual annual caries increment and the impact of some selected caries related factors. Another aim was to find out if there were gender differences among the participants. The risk profiles were created by a computerised risk assessment program, the Cariogram, which evaluates data and presents the weighted and summarized result as one figure, illustrating the ‘percent chance of avoiding caries’ in the future. Methods: The Cariogram was earlier evaluated in two longitudinal studies for its capacity to assess caries risk. One study comprised about 400 children, 10-11 years of age and the other study included about 150 elderly (age 55, 65 and 75). At baseline, information on past caries experience, diet, oral hygiene and use of fluoride was obtained. Saliva analyses included mutans streptococci and lactobacilli, buffering capacity and secretion rate. The caries risk was assessed and the participants were divided into five groups according to the calculated Cariogram risk profiles. After two and five years, respectively, caries was re-evaluated and the incidence was compared with the predictions. Results: The Cariogram risk predictions were statistically in agreement with the actual caries increment. Fifty percent of the children, but only two percent of the elderly appeared in the lowest caries risk group. Of the elderly, 26.4% belonged to the highest caries risk group versus 3.1% of the children. The median value ‘chance of avoiding caries’ was 44% for the elderly and 80% for the children. The main Cariogram sectors contributing to the observed higher caries risk among elderly was the bacterial components in combination with higher susceptibility. Individual factors contributing significantly to the higher risk profiles for the adults compared to the children were higher plaque scores, higher counts of mutans streptococci and lower buffering capacity. Conclusion: comparing the risk profiles of the children and the elderly showed that the elderly were at a higher risk developing caries lesions. Overall one may say that the risk for caries, as assessed by the Cariogram, was twice as high for the elderly.
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