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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
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- 2019
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Alkharaan, Hassan, et al.
(författare)
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Persisting Salivary IgG Against SARS-CoV-2 at 9 Months After Mild COVID-19 : A Complementary Approach to Population Surveys
- 2021
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Ingår i: Journal of Infectious Diseases. - : Oxford University Press (OUP). - 0022-1899 .- 1537-6613. ; 224:3, s. 407-414
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Tidskriftsartikel (refereegranskat)abstract
- Background. Declining humoral immunity in coronavirus disease 2019 (COVID-19) patients and possible reinfection have raised concern. Mucosal immunity, particularly salivary antibodies, may be short lived although long-term studies are lacking. Methods. Using a multiplex bead-based array platform, we investigated antibodies specific to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proteins in 256 saliva samples from convalescent patients 1-9 months after symptomatic COVID-19 (n = 74, cohort 1), undiagnosed individuals with self-reported questionnaires (n = 147, cohort 2), and individuals sampled prepandemic (n = 35, cohort 3). Results. Salivary IgG antibody responses in cohort 1 (mainly mild COVID-19) were detectable up to 9 months postrecovery, with high correlations between spike and nucleocapsid specificity. At 9 months, IgG remained in blood and saliva in most patients. Salivary IgA was rarely detected at this time point. In cohort 2, salivary IgG and IgA responses were significantly associated with recent history of COVID-19-like symptoms. Salivary IgG tolerated temperature and detergent pretreatments. Conclusions. Unlike SARS-CoV-2 salivary IgA that appeared short lived, specific saliva IgG appeared stable even after mild COVID-19, as for blood serology. This noninvasive saliva-based SARS-CoV-2 antibody test with home self-collection may be a complementary alternative to conventional blood serology.
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| 4. |
- De Palma, Patricia Alvarado
(författare)
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Oral health among a group of homeless individuals from dental professional's and patient's perspective
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The homeless are a vulnerable group in society. They are frail, in poor general health and tend to have difficulty expressing expectations and needs. While poor oral health is clearly an added burden for people who struggle daily to survive under miserable living conditions, there are also many barriers to dental care. There are currently approximately 17 800 homeless people in Sweden, of whom 3 900 are in Stockholm. The overall aim was to describe the oral status of a sample of homeless adults, to analyse their perceptions of oral health and the consequences to focus on adequate dental care for the homeless. Both quantitative and qualitative research methods were applied. In Paper I, the study population comprised 147 homeless individuals. All subjects underwent oral examination, including registration of periodontal status and caries data. The results showed that homeless adults in Stockholm had fewer remaining teeth than the general population. Heavy plaque accumulation will also have an effect on caries progression, expressed in this study as high DMFT (Decayed-Missing- Filled Teeth) values. Loss of teeth is likely to create dental and chewing problems, eventually resulting in increased dental and medical treatment needs. In Paper II, the perceptions of homeless people concerning their oral health and perceived consequences of dental treatment were analysed. Open, tape-recorded interviews were conducted in conversational style. A phenomenological-hermeneutical method was used to analyse the subjects' stories. All narratives revealed expressions of loss as well as recovery in the informants' life- world. Both aspects highlight the fact that being homeless means loss not only of a permanent residence but also of many values and similarly, oral health was described and interpreted in terms of loss and recovery. In Paper III sentences related to the homeless individual as a person, the underlying meanings of what the text talked about, were interpreted as codes and subthemes labelled as two themes, "Struggle to retain integrity" and "Need for freedom without responsibility". In sentences related to the homeless individual as a patient in dental care, the underlying meanings of what the text said were likewise interpreted in codes and subthemes labelled as two themes "Meeting the patient where he/she is" and "Future dental care". A common complaint from the homeless patients was disrespect from care providers. There were many ways of facing the dilemma, e.g. to keep a distance, to try to act normal. Ordinary regular dental contact could be seen as one way back to normal life. In Paper IV 147 subjects were interviewed with a specially designed structured interview covering attitudes to oral health. 93.8% considered that the teeth are important, 86.3% experienced pain or soreness of the teeth.92.5% report ed chewing difficulties due, to pain, 68.4% subjects expressed embarrassment about the appearance of their teeth, 93.8% refrained from dental treatment due to economical reasons, and fear of dental treatment was confirmed by 70.5%, 74% subjects reported dry mouth, 67.4% had no toothbrush. 91.8% did not have a address or at least a poste restante, 92 % were drug abusers, 85% were tobacco smokers. The median number of teeth was 18.O.The median duration of homelessness was 5.0 years, the interval since previous dental treatment varied between 0.5 and50 years. 115% of the individuals had known HIV-infection, 20.4% reported known heart disease.
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| 5. |
- Rafat, Sonja, et al.
(författare)
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Oral Health Among Swedish Patients with Substance Use Disorders : A Comparative, Cross-Sectional Study
- 2020
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Ingår i: Oral Health & Preventive Dentistry. - : Quintessence. - 1602-1622 .- 1757-9996. ; 18:2, s. 229-237
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study explored the oral health of individuals with substance use disorders and examined the relationship between oral health and type and number of years of substance use disorder. Materials and Methods: This comparative cross-sectional study comprised patients with one of four groups of substance use disorders - alcohol, cannabis, central nervous system stimulants (CNSS), and opiates. All participants underwent a dental examination and were included in the study based on their clinical findings. Results: Of 95 participants, 79 (83%) were male and 37 (39%) were homeless. Statistically significant difference between the groups was observed in 6-12-mm periodontal pocket depths (p <0.05), as were differences in oral mucosal changes (p <0.001). Statistically significantly lower proportions were observed in the cannabis group for Mob G:0 and Mob G:1 and Furcation G:1 compared to the CNSS and opiate groups; the proportion of Furcation G:0 was significantly lower in the alcohol group compared to the cannabis group. Analysis of variance (ANOVA) revealed statistically significant between-group differences in age, number of years of substance use disorder, number of teeth. and decayed, missing and filled teeth (DMFT). When controlling for age and gender, substance type was found to be a statistically significant predictor of number of teeth (B = -4.4: 95% CI: -8.1 to -0.38; p = 0.03) and DMFT (B = 2.1; 95% CI: 0.86 to 3.3; p = 0.001). Conclusions: These results indicate poor oral health among individuals with substance use disorders. It seems that oral health problems are lower among abusers of cannabis than of CNSS, alcohol and opiates.
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