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- Lyttkens, Linda
(författare)
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Health Related Quality of Life in patients with screening detected Sub-Aneurysmal aorta and Abdominal Aortic Aneurysm
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective Paper I: Most screening and opportunistically detected abdominal aortic aneurysms (AAA) are small and kept under surveillance for several years before preventive surgery. Living with the diagnosis of an AAA may have an influence on the patient’s life. The aim was to review systematically review the current knowledge of the effect on health related quality of life (HRQoL) and patients’ experiences of living with an AAA while under surveillance.Paper II: To investigate HRQoL and comorbidity in men with screening detected AAA, Sub-Aneurysmal aorta (SAA) and Controls at baseline screening and after long-term follow-up.Methods Paper I: A systematic literature review of quantitative and qualitative studies, which were quality assessed according to the GRADE system, was carried out. PubMed, Cochrane, Embase, CINAHL, PsycINFO, and MEDLINE were searched. Narrative synthesis and meta-analysis were performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Paper II: Between 2006 and 2015, 16 689 sixty-five-year old men participated in the aortic screening program in the county of Uppsala in Sweden. All 539 men diagnosed with an SAA or AAA were invited to participate in the study UpAAA and 324 accepted. Baseline questionnaires was distributed after screening, and at 5-year follow-up. For each year a control group of approx. 50 men, participating in the screening program with normal aorta, were included. ResultsPaper I: Synthesis and meta-analyses of studies based on the Short Form-36 demonstrated that patients with an AAA consistently rated their general health lower than controls and conveyed no significant negative impact for patients with an AAA when assessed at follow up and compared with pre-screening. Analysis of HRQoL estimates of mental health, anxiety, and depression demonstrated no significant differences for patients with AAA compared with controls, or within the AAA group. Qualitative studies revealed that patients with an AAA felt safe being under surveillance and receiving a diagnosis of AAA set thoughts and feelings in motion regarding health, ageing, and mortality. Patients’ lack of knowledge about the disease, its progression, and future planning can cause insecurity and worries.Paper II: AAA and SAA group both has impairment in the physical dimensions of HRQOL and a higher prevalence of co-morbidity at baseline, compared to controls. At 5-year follow-up, the similarities between AAA and SAA group remained with no difference in HRQOL but a higher prevalence of CVD, hypertension and diabetes in men with AAA. Compared with controls both AAA and SAA had significantly higher impairment in HRQoL, and prevalence of co-morbidity and the AAA group was most affected.
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| 2. |
- Lyttkens, Linda, et al.
(författare)
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Long-term Health Related Quality of Life in men with screening detected abdominal aortic aneurysm: A five-year follow-up study.
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To investigate how HRQoL and comorbidity differs in men with screening detected abdominal aortic aneurysm (AAA), sub-aneurysmal aorta (SAA) and controls screened with a normal aorta, measured after baseline screening and at five-year follow-up.Methods: Between 2006 and 2015, 19 738 65-year old men were invited and 16 689 participated in the AAA screening program in the county of Uppsala in Sweden. All 539 men diagnosed with an SAA or AAA were invited to participate in the study, of whom 324 accepted. HRQoL (RAND-36) and health questionnaires was distributed approximately two weeks after screening, and at 5-year follow-up. For each year a control group of approx. 50 men with normal aortic diameter at screening were included. Results: Compared with controls, AAA and SAA patients reported significantly lower scores in the dimensions Physical Function (Mean 90.6 vs 84.8 p=0.005 and 81.3 p=0.002), General Health (76.7 vs 71.0 p=0.005 and 67.5 p<0.001), and Vitality (78.2 vs 73.2 p=0.049 and 69.6 p=0.003) with a corresponding higher prevalence of co-morbidity at baseline. After 5 years of follow-up, SAA and AAA patients showed a further reduction in HRQoL scores in several dimensions. Despite a significantly higher comorbidity burden among AAA patients (vs SAA), the numerical difference in HRQoL between the two groups was not significant. Conclusion: AAA and SAA patients are burdened with a higher degree of comorbidity and an associated impaired HRQoL at baseline screening, with a further deterioration during long-term follow-up up to 5 years, with an associated deterioration in health.
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| 3. |
- Lyttkens, Linda, et al.
(författare)
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Systematic Review and Meta-Analysis of Health Related Quality of Life and Reported Experiences in Patients With Abdominal Aortic Aneurysm Under Ultrasound Surveillance
- 2020
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 59:3, s. 420-427
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Forskningsöversikt (refereegranskat)abstract
- Objective: Most screening and opportunistically detected abdominal aortic aneurysms (AAA) are small and kept under surveillance for several years before preventive surgery. Living with the diagnosis of an AAA may have an influence on the patient's life. Thus, it is important to study patients' experiences so that the screening process and follow up care are adapted to the patient's needs. The aim was to review systematically review the current knowledge of the effect on health related quality of life (HRQoL) and patients' experiences of living with an AAA while under surveillance.Methods: A systematic literature review of quantitative and qualitative studies, which were quality assessed according to the GRADE system, was carried out. Pubmed, Cochrane, Embase, CINAHL, PsycINFO, and MEDLINE were searched. Narrative synthesis and meta-analysis were performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results: Synthesis and meta-analyses of studies based on the Short Form-36 demonstrated that patients with an AAA consistently rated their general health (GH) lower than controls and conveyed no significant negative impact for patients with an AAA when assessed at follow up and compared with pre-screening. Synthesis and meta-analyses of HRQoL estimates encompassing mental health, anxiety, and depression demonstrated no significant differences for patients with AAA compared with controls, or within the AAA group. Qualitative studies revealed that patients with an AAA felt safe being under surveillance, and receiving a diagnosis of AAA set thoughts and feelings in motion regarding health, ageing, and mortality. Patients' lack of knowledge about the disease, its progression, and future planning can cause insecurity and worries.Conclusion: The current evidence does not support a negative impact on HRQoL from being under surveillance for an AAA. Qualitative data indicate that adequate patient information and professional care have the potential to reduce unnecessary worries and concerns in patients with an AAA.
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| 4. |
- Pyykkö, I., et al.
(författare)
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The effects of TTS-scopolamine, dimenhydrinate, lidocaine, and tocainide on motion sickness, vertigo, and nystagmus
- 1985
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Ingår i: Aviation Space and Environmental Medicine. - 0095-6562. ; 56:8, s. 82-777
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Tidskriftsartikel (refereegranskat)abstract
- The effects of TTS-scopolamine, dimenhydrinate, lidocaine, and tocainide on motion sickness and vertigo and on caloric and postrotatory nystagmus were evaluated in healthy volunteers. TTS-scopolamine was administered transdermally (delivering approximately 10 micrograms X h-1 scopolamine base) and 100 mg dimenhydrinate orally. Lidocaine and tocainide were administered intravenously (average plasma concentration of lidocaine 6 mol X L-1 and of tocainide 20 mol X L-1). TTS-scopolamine and dimenhydrinate significantly reduced vertigo induced by calorization of the ears, nausea provoked with Coriolis maneuvre, and nystagmus in caloric and rotatory tests. During treatment with lidocaine and tocainide no alleviation of vertigo and nausea was observed. Caloric nystagmus was reduced but rotation induced nystagmus was virtually unchanged. Presumably the motion sickness drugs act at the brain stem where TTS-scopolamine and dimenhydrinate have their target cells in the vestibular nuclei. Furthermore, the alleviation of motion sickness was linked to a decline of nystagmus. Lidocaine and tocainide, the action of which in vertigo and nausea in patients is proposed to be on the vestibular end organs and the supratentorial brain structures, consistently failed to alleviate motion sickness.
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| 5. |
- Thorbjørnsen, Knut, et al.
(författare)
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Quality-adjusted life years in 65-year-old men screened for abdominal aortic aneurysm : a five-year follow-up study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: The objective of the present study was to assess population and disease-specific health utility (HU) values in men screened for abdominal aortic aneurysm (AAA) in a population-based screening program.Methods: A total of 110 men with AAA at least 30mm, 148 with subaneurysmal aorta (SAA; 25-29mm), and 123 controls (<25mm) with normal aortic diameter reported their health- related quality of life (HRQoL) utilising the EQ-5D-3L instrument, at baseline screening and after five years. HU was calculated according to a Swedish experience-based value set. Mean HU between the groups and within each group were compared. Also men undergoing AAA repair and those still under surveillance were compared after 5 years. To adjust for confounding factors (smoking and comorbidity) a regression model was used.Results: At baseline screening the mean HUs did not differ between controls: 0.94 (standard deviation (SD);0.06), and AAA: 0.92 (SD; 0.07, P=0.114), and SAA: 0.93 (SD;0.06, P=0.509). After 5 year follow-up no difference was observed between controls: 0.93 (SD;0.06) and SAA: 0.91 (SD;0.08, P=0.183), while men with AAA reported a significantly lower mean HU value: 0.90 (SD;0.09) than the control group (P=0.049). After adjustment for differences in smoking and comorbidities this significance was, howerver lost (P=0.759). No significant differences in mean HU values were seen between men with a screening detected AAA undergoing surgery within 5-years; 0.90 (SD;0.08) and men with small AAAs still under surveillance; 0.90 (SD; 0.09), P=0.757).Conclusion: Compared to SAA and controls, lower health utility scores were observed in men with AAA after five years, most likely explained by the observed higher frequency of smoking and other comorbidities among men with AAA. These contemorary HU values can serve as important components in up-coming health-economic evaluations.
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