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| 2. |
- Altman, Daniel, et al.
(författare)
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A generic health-related quality of life instrument for assessing pelvic organ prolapse surgery : correlation with condition-specific outcome measures
- 2018
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 29:8, s. 1093-1099
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: The aim of this study was to investigate the use of a generic and globally accessible instrument for assessing health-related quality of life (HR-QoL) in pelvic organ prolapse (POP) surgery.Methods: In a prospective multicenter setting, 207 women underwent surgery for apical prolapse [stage ae2, Pelvic Organ Prolapse Quantificcation (POP-Q) system] with or without anterior wall defect. Demographic and surgical characteristics were collected before surgery. Results of the 15-dimensional (15D) instrument and condition-specific pelvic floor symptoms as assessed using the Pelvic Floor Distress Inventory questionnaire (PFDI-20), including its subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Colorectal-Anal Distress Inventory-8 (CRADI-8), and Urinary Distress Inventory-6 (UDI-6), were assessed preoperatively and 2 months and 1 year after surgery.Results: HR-QoL as estimated by 15D was improved 1 year after surgery (p < 0.001). Prolapse-related 15D profile-index measures (excretion, discomfort, sexual activity, distress, and mobility) were significantly improved after surgery (p < 0.05-0.001). Significant inverse associations were detected between increased 15D scores and a decrease in PFDI-20 and subscale scores (p < 0.001), indicating improvements on both instruments.Conclusions: Generic HR-QoL as estimated by 15D improved significantly after apical POP surgery and correlated with improvements of condition-specific outcome measures. These results suggest that a comprehensive evaluation of global HR-QoL is valid in assessing pelvic reconstructive surgery and may provide novel and important insights into previously understudied areas, such as cost-utility and cost-effectiveness analysis after urogynecological surgery.
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| 3. |
- Altman, Daniel, et al.
(författare)
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Anal sphincter lacerations and upright delivery postures - a risk analysis from a randomized controlled trial
- 2007
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 18:2, s. 141-146
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate obstetric sphincter lacerations after a kneeling or sitting position at second stage of labor in a multivariate risk analysis model. MATERIALS AND METHODS: Two hundred and seventy-one primiparous women with normal pregnancies and spontaneous labor were randomized, 138 to a kneeling position and 133 to a sitting position. Medical data were retrieved from delivery charts and partograms. Risk factors were tested in a multivariate logistic regression model in a stepwise manner. RESULTS: The trial was completed by 106 subjects in the kneeling group and 112 subjects in the sitting group. There were no significant differences with regard to duration of second stage of labor or pre-trial maternal characteristics between the two groups. Obstetrical sphincter tears did not differ significantly between the two groups but an intact perineum was more common in the kneeling group (p<0.03) and episiotomy (mediolateral) was more common in the sitting group (p<0.05). Three grade IV sphincter lacerations occurred in the sitting group compared to none in the kneeling group (NS). Multivariate risk analysis indicated that prolonged duration of second stage of labor and episiotomy were associated with an increased risk of third- or fourth-degree sphincter tears (p<0.01 and p<0.05, respectively). Delivery posture, maternal age, fetal weight, use of oxytocin, and use of epidural analgesia did not increase the risk of obstetrical anal sphincter lacerations in the two upright postures. CONCLUSION: Obstetrical anal sphincter lacerations did not differ significantly between a kneeling or sitting upright delivery posture. Episiotomy was more common after a sitting delivery posture, which may be associated with an increased risk of anal sphincter lacerations. Upright delivery postures may be encouraged in healthy women with normal, full-term pregnancy.
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| 4. |
- Altman, Daniel, et al.
(författare)
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Anticholinergic drug use for overactive bladder in Sweden: a nationwide pharmacoepidemiological study
- 2009
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 20:11, s. 1285-1291
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Tidskriftsartikel (refereegranskat)abstract
- Nationwide use and costs of anticholinergic drug for overactive bladder are unknown. We performed a nationwide study based on the Swedish Register on Prescribed Pharmaceuticals. From 2000 to 2007, there was a 68.8% increase in dispensed anticholinergic drugs in a population of 9 million. More than 93 million DDDs (calculated average maintenance dose per day) of anticholinergic drugs were dispensed corresponding to an overall DDD/TID (DDD per 1,000 inhabitants per day) of 3.5 per 1,000 persons per year. Approximately two thirds of anticholinergic drugs were prescribed to women, regardless of drug type. In 2007, the cost for anticholinergic drugs was 22 million a,not sign of which tolterodine comprised 70.8%. Solifenacin and darifenacin steadily increased their DDD/TIDs after market introduction. In this nationwide study, there was a 70% increased rate of expedited prescriptions of anticholinergic drugs for the treatment of overactive bladder in a relatively stable population.
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| 5. |
- Altman, Daniel
(författare)
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Evaluation and treatment of pelvic organ prolapse : clinical, radiological and histopathological aspects
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To assess the use of cystodefecoperitoneography (CDP) in clinical and radiological diagnosis of cystocele; to study the correlation between clinical and radiological findings at CDP and to evaluate if anatomical topography and structural abnormality corresponds to symptomatic presentation when assessing posterior vaginal wall prolapse; to evaluate if xenograft used at rectocele repair was associated with adverse clinical and histological inflammatory reactions; to prospectively examine if rectocele repair using xenograft is a safe method providing satisfactory clinical and symptomatical outcome; and to investigate the prevalence and risk factors of genital prolapse and urinary incontinence in female patients operated for rectal prolapse. Methods: The following methods were used: The Pelvic organ prolapse quantification system (POPQ), CDP, bowel function questionnaires, pelvic floor surveys, histological, histopathological and clinical inflammatory quantification. Statistical analysis was performed using non-parametric statistics, correlation coefficients and logistic regression. Results: Statistical analysis demonstrated a moderate correlation between the current definition of cystocele at CDP and POP-Q (r=0.67). An attempt to provide an alternative definition of cystocele at CDP had a similar outcome (r=0.63). Correlation statistics demonstrated that POP-Q did not reliably predict visceral involvement and prolapse size compared to CDP. There was a strong association between large rectoceles (>3 cm) at CDP and symptoms of rectal emptying difficulties (p<0.001) although severity and prevalence of bowel dysfunction showed poor coherence with clinical prolapse staging and findings at radiological imaging in general. There were no significant changes in inflammatory cell counts, histopathological inflammatory grading or clinical inflammatory quantification following xenograft augmented rectocele repair. Postoperative complications following rectocele xenograft repair were similar to suture repair. At clinical examination 12-months following xenograft rectocele repair of 29 patients with > stage II rectocele, 21 patients had stage I prolapse and 14 patients had no rectocele (P < 0.001) at defecography. Symptoms of rectal emptying difficulties remained in a majority of patients although decreased. Rectal prolapse was associated with an increased risk of surgery for uterine prolapse (OR 3.1, 95% Cl 1.4-6.9) and vaginal wall prolapse (OR 3.2, 95% Cl 1.3-7.8) compared to a matched control group. There were no significant differences between the cohorts regarding prevalence or age at debut of urinary incontinence. Conclusions: Using the current methods and definition of cystocele at CDP, the agreement with clinical findings is limited and the value of bladder contrast uncertain. Vaginal topography and POP-Q staging neither predict radiological size nor visceral involvement in posterior vaginal wall prolapse. Radiological assessment may be a useful complement in the evaluation of posterior vaginal wall prolapse. Porcine collagen mesh was not associated with an adverse inflammatory response at clinical or histological evaluation and appears to be a safe material when used for rectocele repair. Rectocele repair using xenograft improved anatomical support, but there is a substantial risk for recurrence with unsatisfactory anatomical and functional outcome one year after surgery. Our results indicate a strong association between rectal- and genital prolapse surgery suggesting that diagnosis of rectal prolapse necessitating surgical intervention should prompt a multidisciplinary pelvic floor assessment.
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| 7. |
- Altman, Daniel, et al.
(författare)
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The genetic and environmental contribution to the occurrence of bladder pain syndrome: an empirical approach in a nationwide population sample.
- 2011
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Ingår i: European urology. - : Elsevier BV. - 1873-7560 .- 0302-2838. ; 59:2, s. 280-5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aetiology of bladder pain syndrome (BPS) remains poorly understood, and a number of pathogenic mechanisms have been proposed. The importance of genetic factors for BPS is receiving growing attention, but data so far are of a preliminary nature. OBJECTIVE: To empirically assess the genetic and environmental contribution to BPS in a population-based sample of twins. DESIGN, SETTING, AND PARTICIPANTS: The study included >25 000 twins born between 1959 and 1985. Individuals with BPS were identified using latent class cluster analysis (LCCA) based on self-reported symptoms from a nationwide screening for complex diseases in the Swedish Twin Registry. By comparing monozygotic and dizygotic twins, we estimated twin similarity and the relative proportions of phenotypic variance resulting from genetic and environmental factors. MEASUREMENTS: Twin similarity was measured. RESULTS AND LIMITATIONS: The LCCA yielded an overall BPS prevalence of 1.1% and 2.4% for males and females, respectively. In males, the contribution of genetic effects to BPS could not be assessed because of the small number of concordant twin pairs. In women, twin similarity estimates indicated a genetic component for the aetiology of BPS, but genetic factors contributed less than one-third of the total variation in susceptibility to BPS. Nonshared environmental factors accounted for more than two-thirds of the variance, whereas early nongenetic factors shared within the family were of little or no consequence to the risk of developing BPS later in life. Use of self-reported symptoms to define the disease phenotype is a limitation of the study. CONCLUSIONS: The influence of environmental factors in the development of BPS in women is substantial, whereas genetic influences are of only modest importance for the possibility of developing the disease.
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| 8. |
- Altman, Eitan, et al.
(författare)
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Blockchain Competition Between Miners: A Game Theoretic Perspective
- 2020
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Ingår i: Frontiers in Blockchain. - : Frontiers Media SA. - 2624-7852. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- We model the competition over mining resources and over several cryptocurrencies as a non-cooperative game. Leveraging results about congestion games, we establish conditions for the existence of pure Nash equilibria and provide efficient algorithms for finding such equilibria. We account for multiple system models, varying according to the way that mining resources are allocated and shared and according to the granularity at which mining puzzle complexity is adjusted. When constraints on resources are included, the resulting game is a constrained resource allocation game for which we characterize a normalized Nash equilibrium. Under the proposed models, we provide structural properties of the corresponding types of equilibrium, e.g., establishing conditions under which at most two mining infrastructures will be active or under which no miners will have incentives to mine a given cryptocurrency.
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| 9. |
- Altman, Eitan, et al.
(författare)
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Mining Competition in a Multi-Cryptocurrency Ecosystem at the Network Edge: A Congestion Game Approach
- 2019
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Ingår i: Performance Evaluation Review. - : Association for Computing Machinery (ACM). - 0163-5999. ; 46:3, s. 114-117
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Tidskriftsartikel (refereegranskat)abstract
- We model the competition over several blockchains characterizing multiple cryptocurrencies as a non-cooperative game. Then, we specialize our results to two instances of the general game, showing properties of the Nash equilibrium. In particular, leveraging results about congestion games, we establish the existence of pure Nash equilibria and provide efficient algorithms for finding such equilibria.
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| 10. |
- Ankarcrona, Victoria, et al.
(författare)
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Delivery outcome after trial of labor in nulliparous women 40 years or older-A nationwide population-based study
- 2019
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 98:9, s. 1195-1203
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The number of women postponing childbirth until an advanced age is increasing. Our aim was to study the outcome of labor in nulliparous women >= 40 years, compared with women 25-29 years, after both spontaneous onset and induction of labor. Material and methods The nationwide population-based Swedish Medical Birth Register was used to study the perinatal outcome in nulliparous women with a singleton, term (gestational weeks 37-44), live fetus in cephalic presentation and a planned vaginal delivery from 1992 to 2011. We included 7796 nulliparous women >= 40 years and 264 262 nulliparous women 25-29 years. Prevalence and risk of intrapartum cesarean section, operative vaginal delivery, obstetric anal sphincter injury and a 5-minute Apgar score <7 were calculated for women >= 40 years stratified for spontaneous onset and induction of labor, using women 25-29 years as the reference in both strata. Crude and adjusted odds ratios (aOR) were calculated by unconditional logistic regression and presented with 95% confidence intervals (CI). Results Overall, 79% of women >= 40 years with a trial of labor reached a vaginal delivery. After spontaneous onset, intrapartum cesarean section was performed in 15.4% of women >= 40 years compared with 5.4% of women 25-29 years (aOR 3.07, 95% CI 2.81-3.35). Operative vaginal delivery was performed in 22.3% of women >= 40 years compared with 14.2% of women 25-29 years (aOR 1.71, 95% CI 1.59-1.85). After induction of labor, an intrapartum cesarean section was performed in 37.2% women >= 40 years compared with 20.2% women 25-29 years (aOR 2.51, 95% CI 2.24-2.81). Operative vaginal delivery was performed in 22.6% of women >= 40 years compared with 18.4% women 25-29 years (aOR 1.45, 95% CI 1.28-1.65). The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased in women >= 40 years, regardless of onset of labor. Conclusions Trial of labor ended in vaginal delivery in 79% of nulliparous women >= 40 years. The risks of intrapartum cesarean section and operative vaginal delivery were higher in women >= 40 years compared with women 25-29 years, after both spontaneous onset and induction of labor. The risk of obstetric anal sphincter injury or a 5-minute Apgar score <7 was not increased.
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