| 1. |
- Berglund, Malin, et al.
(författare)
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Myringoplasty Outcomes From the Swedish National Quality Registry
- 2017
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Ingår i: The Laryngoscope. - : John Wiley & Sons. - 0023-852X .- 1531-4995. ; 127:10, s. 2389-2395
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES/HYPOTHESIS: Data from patients registered for myringoplasty during 2002 to 2012 in the Swedish National Quality Registry for Myringoplasty.STUDY DESIGN: Both conventional myringoplasty and fat-graft techniques were used aimed at healing the tympanic membrane in noninfected ears.METHODS: Analysis was performed on data in a national database collected from 32 ear, nose, and throat clinics. Surgical procedures and outcomes, and patient satisfaction from a questionnaire were studied.RESULTS: The database was comprised of 3,775 surgical procedures, with follow-up available for analysis. One-third were children under the age of 15 years. The most common indication for surgery was infection prophylaxis. The overall healing rate of the tympanic membrane after surgery was 88.5%, with a high mean patient satisfaction. Complications registered were postoperative infection, tinnitus, or taste disturbance that occurred in 5.8% of patients.CONCLUSIONS: Swedish results for a large number of patients who completed myringoplasty are presented. The success rate in this study is comparable to other studies, and good patient-reported outcome measures of myringoplasty are presented. Databases for surgical procedures and clinical audits are systematic processes for continuous learning in healthcare. This study shows that clinical databases can be utilized to analyze national results of surgical procedures.LEVEL OF EVIDENCE: 2b Laryngoscope, 127:2389-2395, 2017.
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| 2. |
- Carlerby, Heidi, 1967-, et al.
(författare)
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Risk behaviour, parental background, and wealth: a cluster analysis among Swedish boys and girls in the HBSC study
- 2012
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 40:4, s. 368-376
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls.Methods: Data were collected from Health Behaviour in School-aged Children (HBSC),a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence.Results: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys.. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls.Conclusions: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.
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| 3. |
- Fomina, Svitlana, et al.
(författare)
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Clinical course of steroid sensitive nephrotic syndrome in children: outcome and outlook
- 2011
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Ingår i: The Open Pediatric Medicine Journal. - : Bentham Science Publishers Ltd.. - 1874-3099. ; 5, s. 18-28
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of our study was to investigate the relative efficiency and adverse effects of various treatments of steroid sensitive nephrotic syndrome (SSNS) in children, and to determine factors associated with relapse risk in these patients. Materials and Method: We retrospectively studied the data from 690 SSNS children treated in referral center over 25 years. The analyzed treatment protocols were: Prednisolone (PRED, eight weeks in a dose 1.5-2.0 mg/kg, then it tapering and given for 9-12 months), Chlorambucil (CHL, cumulative dose 28.5-30 mg/kg), Cyclophosphamide intravenously (CYC I.V., cumulative dose of 30-36 mg/kg, then supporting dose of CHL, cumulative dose of 20-25 mg/kg) and intramuscular (CYC I.M., cumulative dose of 120-150 mg/kg). The alkylating agents were used after remission induction by PRED and under its protection. Results: Cumulative relapse-free survival was 81.9%, 69.0% and 64.5% after 12, 36 and 60 months, respectively. In multivariate analyses, relapse risk was associated with age of treatment (<6 years), and both PRED and CYC I.V. The only predictive factor for early relapse was PRED, unlike two and more relapses group where PRED and CYC I.V. as well as age from 3 to 6 years was highly prognostic. The high probability of sustained remission in combination with relatively mild adverse effects was observed for PRED used at first episode and CHL used at relapse. Conclusion: To summarize, our protocols characterized by the prolonged PRED and CHL demonstrated promising results and should be considered as an efficient alternative strategy in SSNS management.
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| 4. |
- Fomina, Svitlana, et al.
(författare)
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Clinical patterns and renal survival of nephrotic syndrome in childhood : a single-center study (1980-2006)
- 2010
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Ingår i: The open urology & nephrology journal. - 1874-303X. ; 3, s. 8-15
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Tidskriftsartikel (refereegranskat)abstract
- To investigate changes in the diagnostic patterns, disease profiles courses and therapeutic strategies for severe forms of childhood nephrotic syndrome (NS), the clinical features of 1 349 children treated during two consecutive time periods, 1980-2000 (n=1 162) and 2001-2006 (n=187), were retrospectively reviewed. The significant increase in initial renal impairment, NS with hypertension, and NS with hypertension and hematuria was observed (27.7% vs 51.3%, 1.0% vs 5.3% and 16.4% vs 21.9%, respectively). The rate of both secondary steroid resistance (SR) and Focal Segmental Glomerulosclerosis increased significantly, (1.8% vs 5.6%, p=0.032, and 14.9% vs 29.0%, p=0.034, respectively). The initial renal insufficiency and hypertension were highly predictive of the development of stage 3 of chronic kidney disease (CKD3) among SR patients in a multivariate Cox regression (p=0.001) for years 1980-2000. A higher hazard of CKD3 in male SR patients from three to six years old was observed in 2001-2006. Kaplan-Meier survival curves revealed a shift in the cumulative probability of CKD3, indicating a slower decline of the renal function for SR NS in the years 2001-2006 (p=0.008): the estimated five-year CKD3 risk was 39.7% vs 27.7%. Achievements in inducing remission and retarding the development of CKD3 in combination with increased severity of NS indicate the effectiveness of domestic strategies of NS management.
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| 5. |
- Grzymala-Lubanski, Bartosz, et al.
(författare)
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Mechanical heart valve prosthesis and warfarin : treatment quality and prognosis
- 2014
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Ingår i: Thrombosis Research. - : Elsevier. - 0049-3848 .- 1879-2472. ; 133:5, s. 795-798
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Every year about 2500 patients in Sweden undergo surgery due to heart valve disease. A mechanical heart valve prosthesis causes risk of thromboembolic stroke or thrombus formation in the valve while anticoagulant treatment increases the risk of bleeding. Treatment quality with warfarin is crucial for patients with mechanical valve prostheses. It has previously been shown that poorly controlled warfarin treatment increases mortality in this patient group. TTR (Time in Therapeutic Range) on warfarin has been shown to affect the risk of complications in atrial fibrillation, but has not been studied in patients with mechanical heart valves. Our aim is to evaluate the impact of TTR on the risk of complications in this patient group. Materials and Methods: A non-randomized, prospective study of 534 adults with mechanical heart valve prostheses from Malmo and Sundsvall registered in the Swedish National Quality Registry Auricula between 01.01.2008 and 31.12.2011. Quartiles regarding individual TTR levels were compared regarding risk of complications. Results: The risk of complications was significantly higher at lower TTR levels for all complications (p = 0.005), bleeding (p = 0.01) and death (p = 0.018) but not for thromboembolism. In multivariate analysis the risk was significantly increased at lower TTR levels for bleeding and all complications but not for death or thromboembolism. Conclusion: Patients with a lower warfarin treatment quality measured by TTR have a higher risk of complications such as severe bleeding or death. A TTR of 83% or higher at the individual level should be obtained for best outcome.
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| 6. |
- Hautala, Laura, et al.
(författare)
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Performance of Variables in Screening for Gestational Diabetes
- 2019
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Ingår i: European Endocrinology. - : Touch Medical Media. - 1758-3780. ; 15:2, s. 101-105
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. The strategies used to screen for GDM vary both internationally and nationally. Therefore, we investigated the performance of the capillary random plasma glucose (RPG) test, maternal body mass index (BMI) and maternal age in predicting GDM.Methods: In a retrospective cohort study, we included pregnant women without pre-existing diabetes or metabolic disease who gave birth in Västernorrland County, Sweden, in 2015–2016. Values for RPG in gestational weeks 23–28 were obtained from obstetric medical records for each pregnancy. The development of GDM was confirmed by evaluating data in the obstetric records. The ability of RPG, maternal BMI, and age to predict GDM was assessed with receiver-operating characteristic curves.Results: In total, 4,698 pregnancies were included in the final statistical analysis. RPG was fairly effective in screening (area under the curve [AUC] 0.73; 95% confidence interval [CI] 0.66–0.80), and BMI performed slightly better (AUC 0.75; 95% CI 0.68–0.82), whereas maternal age performed poorly (AUC 0.61; 95% CI 0.53–0.68). Combining RPG ≥7 and BMI ≥27.9 yielded the best overall sensitivity (75.4%), specificity (70.1%), and AUC (0.75; 95% CI 0.68–0.82).Conclusions: Our results show that the sensitivity of capillary RPG alone in predicting GDM is fair. The combination of RPG with maternal BMI or age showed greater sensitivity. However, none of the screening factors (RPG, BMI, and maternal age), alone or combined, showed sufficiently good performance in predicting GDM.
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| 7. |
- Jong, Mats, 1968-, et al.
(författare)
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Feasibility and Effects of Touch Massage and Nurse Led Sleep Counselling in the Treatment of Primary Insomnia
- 2016
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Ingår i: Journal of Sleep Disorders. - : Blackwell Publishing. - 2325-9639. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cognitive Behavioral Therapy (CBT) is basically the only evidence based treatment both in short- as well as long term treatment of insomnia. Previous studies suggest that massage may have a role in initiating sleep and relaxation. This pilot study investigated the feasibility and effects of tactile massage (TM) and nurse led sleep counselling (SC) in the treatment of primary insomnia. Method: Thirty women with primary insomnia were randomized into three different groups: TM, SC or ‘care as usual’ (CAU) followed by a six weeks intervention period. Sleep quality was assessed with sleep diary and polysomnography.Results: The results show that it is feasible to treat primary insomnia with TM. ‘Within’ group analysis showed that the TM group experienced significant improvements in measures of subjective sleep, SC and CAU had no improvements. No significant differences were found in the ‘between’ group analysis.Conclusion: On the basis of the findings, we can conclude that it is feasible to use the methods of TM and SC in the treatment of primary insomnia. Especially TM shows preliminary improvements in subjective measures of sleep, results which needs confirmation in full scale research. Based on the observed effects the research protocol/design is recommended to be simplified and also to combine TM and SC as intervention in future studies.
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| 8. |
- Jong, Mats, 1968-, et al.
(författare)
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The Effects of Tactile Massage (TM) On Blood Pressure, Heart Rate and Blood Glucose in a Sample of Women Suffering from Primary Insomnia
- 2012
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Ingår i: Scientific Abstracts Presented at the International Research Congress on Integrative Medicine and Health 2012. ; , s. P241-
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Konferensbidrag (refereegranskat)abstract
- The overall objective of this pilot study was to study the direct effects of tactile massage (TM) on blood pressure, heart rate and blood glucose in a sample of women suffering from primary insomniaThe study had an experimental prospective design, with a total of 10 women (mean age; 53 years, ±5.4). The participants underwent TM twice a week for six weeks resulting in a total of 120 treatments. For short term effects, systolic and diastolic blood pressure, heartrate and blood glucoses were assessed by the therapist before and after each treatment. Long term assessments were made at baseline, at week 7, and at week 13.As a short term result after the treatment with TM, the participants reached a statistically significant reduction of; systolic blood pressure (-5.5 mmHg, ± 5.0), diastolic blood pressure (-2.0 mmHg, ± 4.4), Heartrate (-5.1 beats per minute, ± 3.4) and blood glucose (-0.2 mmol, ± 0.5). No long term effects with respect to the studied variables can be observed.In summary, we have shown in a normotensive but highly stressed sample of women, that TM has beneficiary effects on parameters of stress and cardiovascular function. In total, 120 TM treatments was analyzed with respect to the objective of the study, but in order to more understand the practical effects, and to more deeply evaluate TM’s place in the modalities of stress reduction, we recommend further studies with larger samples.
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| 9. |
- Kadum, Bakir, et al.
(författare)
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Clinical and radiological outcome of the Total Evolutive Shoulder System (TESSA (R)) reverse shoulder arthroplasty : a prospective comparative non-randomised study
- 2014
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Ingår i: International Orthopaedics. - : Springer Science and Business Media LLC. - 0341-2695 .- 1432-5195. ; 38:5, s. 1001-1006
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. Methods This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. Results We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome. Conclusions Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.
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| 10. |
- Kanti Saha, Samir, et al.
(författare)
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Relationship between 24- hour Holter variables, chest discomfort and syncope : Does age matter?
- 2013
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Ingår i: International Cardiovascular Forum Journal. - : Baracaray Publishing. - 2410-2636 .- 2409-3424. ; 1:2, s. 90-95
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Tidskriftsartikel (refereegranskat)abstract
- One hundred and forty four ambulatory, non-emergent human subjects from 20-88 years of age were investigated followingroutine 24 hour Holter monitoring referred by primary and tertiary care centers primarily for evaluation of palpitationsand syncope. The patients were grouped into 3 different age categories: a) 20-59 years of age (16%), B) 60-69 yearsof age (26.4%) and C) > 70 years of age (57.6%). Heart rate profile, RR intervals, symptoms, frequency of prematuresupra ventricular and ventricular complexes were registered. The data show that though the occurrence and frequencyof premature atrial and ventricular contractions over a period of 24 hours did not differ between the groups, the youngersubjects documented more subjective discomforts during the Holter monitoring. Extra-systoles in excess of 1000 beats / 24hour occured incessantly throughout the registration. patients with syncope and those without did not differ as regards theHolter variables. However, subjects with atrial fibrillation had acceptable rate control and had significantly lower incidenceof syncope than those with sinus rhythm. The findings suggest that in a county setting, Holter monitoring for evaluation ofsyncope may not be the first hand mode of investigation in a non emergent setting. on the contrary, the modality appearsto be valuable for monitoring patients with atrial fibrillation. Even mild symptoms in the elderly population may warrant closerclinical follow up to prevent cardiac events and/or syncope leading to serious physical injury.
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