| 1. |
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| 2. |
- Aljassim, Obaid, et al.
(författare)
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Inflammatory response and platelet activation after off-pump coronary artery bypass surgery.
- 2006
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Ingår i: Scandinavian cardiovascular journal : SCJ. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:1, s. 43-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiac surgery induces a systemic inflammatory activation and alterations in the hemostatic cascade. The responses contribute to postoperative complications but may also have protective effects. We investigated the relationship between inflammation, hemostasis and bleeding after off-pump coronary artery bypass surgery (OPCAB). METHODS: Ten OPCAB patients were included in a prospective descriptive study. Selected markers of inflammation (IL-6, IL-8, PMN-elastase, C3a, and SC5b-9), and hemostasis (platelet count, ss-thromboglobulin, anti-thrombin, D-dimer and fibrinogen) were measured before and immediately after surgery. Postoperative bleeding was registered. RESULTS: Inflammatory variables did not alter significantly during surgery while ss-thromboglobulin concentrations increased and anti-thrombin and fibrinogen decreased. There were significant postoperative correlations between PMN-elastase and ss-thromboglobulin (r=0.82, p=0.004), between PMN-elastase and fibrinogen (r=0.69, p=0.03) and between C3a and ss-thromboglobulin (r=0.71, p=0.02). In addition, there were significant inverse correlations between postoperative bleeding and pre- and postoperative fibrinogen levels (r=-0.76, p=0.011 and r=-0.84, p=0.002 respectively), between bleeding and postoperative ss-thromboglobulin levels (r=-0.66, p=0.04) and between bleeding and postoperative PMN-elastase (r=-0.75, p=0.01). CONCLUSIONS: The results give further evidence for an association between the inflammatory response and hemostasis after cardiac surgery.
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| 3. |
- Berg, K., et al.
(författare)
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Oxidative stress during coronary artery bypass operations : Importance of surgical trauma and drug treatment
- 2006
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:5, s. 291-297
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate oxidative stress and myocardial injury at different stages of coronary artery bypass grafting (CABG). Design. Twenty patients underwent CABG with use of cardiopulmonary bypass (CPB) and with intermittent sampling of plasma and urine. Main markers were: 8-iso-PGF(2 alpha) (oxidative stress); troponin T (myocardial injury); and 15-keto-dihydro-PGF2 alpha and hsCRP (inflammation). Results. Plasma 8-iso-PGF2 alpha increased after start of surgery, but there was no further rise during CPB or after aortic cross-clamp release and no significant myocardial arterio-venous differences. An increase in troponin T was seen early after the operation, but no relationship was established between 8-iso-PGF2 alpha and troponin T. 8-iso-PGF2 alpha levels were elevated by preoperative withdrawal of acetylsalicylic acid (ASA) but reduced by intraoperative use of heparin. 15-keto-dihydro-PGF2 alpha was elevated during operation and hsCRP following operation. Conclusions. In the present study oxidative stress was multifactorial in origin with main impacts from surgical trauma, less from CPB and little if any from myocardial ischemia-reperfusion events. In addition, cardiovascular drugs in common use like ASA and heparin seemed to influence the pro- and antioxidant balance, a finding that has to be confirmed in future studies.
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| 4. |
- Ekman, Mattias, et al.
(författare)
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Cost-effectiveness of the Taxus paclitaxel-eluting stent in the Swedish healthcare system
- 2006
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:1, s. 17-24
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse the cost-effectiveness of Taxus compared to a bare-metal stent in patients with coronary artery disease in the Swedish healthcare setting. DESIGN: A decision-analytic model combining clinical data on revascularization rates with Swedish unit costs for medical resources and utility data from the literature. RESULTS: For patients of moderate risk, the average cost per patient at 12 months is 72,200 SEK for Taxus and 66,900 SEK for a bare-metal stent, while the average cost for high risk patients is nearly equivalent (73,000 vs. 71,700 SEK). The cost per revascularization avoided is generally favourable, while the incremental cost per QALY gained varies depending on the assumptions made; from 2,351,000 SEK for patients of moderate risk at 12-months to cost saving at 24 months for high risk patients. Budget impact scenarios at 12 months are cost-neutral. CONCLUSION: The Taxus stent is cost-effective in high risk patients, particularly at 24 months. Although it may be less cost-effective for the general population, there is still a substantial offset of initial procedure costs through lower rate of repeat revascularizations.
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| 5. |
- Friberg, Örjan, et al.
(författare)
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Cost effectiveness of local collagen-gentamicin as prophylaxis for sternal wound infections in different risk groups
- 2006
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:2, s. 117-125
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In a randomized trial addition of local collagen-gentamicin in the sternal wound reduced the rate of sternal wound infection (SWI) to about 50% compared to intravenous prophylaxis alone. The aim of the present study was to evaluate the economic rationale for its use in every-day clinical practice. This includes the question whether high-risk groups that may have particular benefit should be identified. DESIGN: For each patient with SWI in the trial the costs attributable to the SWI were calculated. Risk factors for SWI were identified and any heterogeneity of the effect of the prophylaxis examined. RESULTS: The mean cost of a SWI was about 14500 Euros. A cost effectiveness analysis showed that the prophylaxis was cost saving. The positive net balance was even higher in risk groups. Assignment to the control group, overweight, diabetes, younger age, mammarian artery use, left ventricular ejection fraction <35% and longer operation time were independent risk factors for infection. CONCLUSION: The addition of local collagen-gentamicin to intravenous antibiotic prophylaxis was dominant, i.e. resulted in both lower costs and fewer wound infections.
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| 6. |
- Hannuksela, Matias, et al.
(författare)
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Thoracic aorta : dilated or not?
- 2006
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:3, s. 175-178
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Knowledge of normal aortic diameters is important in the assessment of aortic disease. The aim of this study was to determine normal thoracic aortic diameters.Design: 77 patients undergoing computed tomography of the thorax were studied. The diameter of the thoracic aorta was measured at three levels in the ascending aorta and at three levels in the descending aorta. The diameter was studied in relation to age, sex, weight and height.Results: We found that aortic diameter is increasing with increasing age. Even sex and BMI influence the aortic diameter but to a lesser extent than age. The upper normal limit for ascending aorta can be calculated with the formula D(mm) = 31 + 0.16*age and for descending aorta with the formula D(mm) = 21 + 0.16*age. Thus a 20-year-old person has an upper normal limit for ascending aorta of 34 mm and an 80-year-old person has a limit of 44 m.Conclusions: The thoracic aortic diameter varies with age, sex and body weight and height. The strongest correlation can be seen with age. Age should therefore be taken into consideration when determining whether the thoracic aorta is dilated or not.
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| 7. |
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| 8. |
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| 9. |
- Olsson, Christian, et al.
(författare)
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The Swedish Heart Surgery Register : Data quality for proximal thoracic aortic operations
- 2006
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:6, s. 348-353
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To review the data quality and validity in the nationwide Swedish Heart Surgery register for patients operated on the proximal thoracic aorta. Design. Medical records from a random sample of 300 patients in The Swedish Heart Surgery register were reviewed with register data items systematically re-reported. Variable reporting frequency, proportion of adequately reported data, and number and correctness of diagnostic and procedural codes were analysed. Results. After exclusions, 251 patients (84%) remained in the analysis. Reporting frequency for individual items varied from 12% to 100% (median 61%). For core variables, reporting frequency was 96%-100%. In 40 of 43 (93%) reviewed variables, registry data were at least 85% correct. A total of 485 diagnoses and 673 procedures were reported, compared to 617 diagnoses and 758 procedures identified in the review process. Conclusions. The register data quality and validity for patients operated on the proximal thoracic aorta was satisfactory overall, but need further improvement for complications. The register coverage and completeness was very high. Register-based reports should be accompanied by review of data quality.
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| 10. |
- Petursson, Petur, 1973, et al.
(författare)
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Association between glycometabolic status in the acute phase and 21/2 years after an acute coronary syndrome
- 2006
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Ingår i: Scand Cardiovasc J. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:3, s. 145-51
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Tidskriftsartikel (refereegranskat)abstract
- ObJECTIVES: To evaluate the association between glycometabolic status in the acute phase and 21/2 years later in patients with acute coronary syndrome (ACS). METHODS: Non-diabetic patients (n = 762) presenting with ACS were prospectively followed up for 21/2 years. Patients were stratified by admission plasma glucose (<6.1 mmol/l, 6.1 - 6.9 mmol/l and >or=7.0 mmol/l) and HbA1c (or=5.5%). The predictive value of glucose levels >or= 7.0 mmol/l and HbA1c >or= 5.5% for glycometabolic disturbance (i.e. diabetes or impaired fasting glycaemia (IFG)) was analysed. RESULTS: Of 762 patients, 13% had a diagnosis of diabetes and 16% had IFG at follow-up. The prevalence of glycometabolic disturbance at follow-up increased with increasing plasma glucose at admission, from 19% in patients with < 6.1 mmol/l to 42% in patients with >or= 7.0 mmol/l. Sixty-one percent of patients with HbA1c >or= 5.5% had glycometabolic disturbance after 21/2 years compared to only 25% of those with HbA1c < 5.5%. CONCLUSION: Non-diabetic patients with ACS and hyperglycaemia are at high risk for developing glycometabolic disturbance. HbA1c may be an even stronger predictor of glycometabolic disturbance than plasma glucose.
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| 11. |
- Rosenqvist, M
(författare)
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Monitoring compliance to guidelines
- 2006
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Ingår i: Scandinavian cardiovascular journal : SCJ. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 40:5, s. 260-261
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 12. |
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| 13. |
- Erlandsson, Soly, 1942-, et al.
(författare)
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A longitudinal study investigating the contribution of mental illness in chronic tinnitus patients
- 2006
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Ingår i: Audiological Medicine. - : Informa UK Limited. - 1651-386X .- 1651-3835. ; 4:3, s. 124-133
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Tidskriftsartikel (refereegranskat)abstract
- The nature of affective components seen in relation to tinnitus suffering was investigated in 70 patients consulting at an audiological clinic. They were interviewed and answered the Spielberger's State and Trait Anxiety Inventory (STAI) and the Beck's Depression Inventory (BDI). It was hypothesized that an anxious and depressed mood might be a sign of a serious psychiatric illness and, therefore, diagnostic interviews including the Structural Clinical Interview for DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders), Axis II (personality) disorders (SCID-II), the BDI, the Montgomery A?sberg Depression Rating Scale (MADRS) and the Hopelessness Scale (HS), as well as biomedical tests, were conducted in a subgroup of 18 individuals. Fifty per cent (two women and seven men) were diagnosed as suffering from a personality disorder. No significant relationships were revealed when various biochemical markers were analysed. One and a half years later, 16 subjects were interviewed a third time and answered the STAI and the BDI. There was a clear trend in the data showing that patients having a personality disorder did not change their distress profile from the first to the third period of assessment. In these patients, a vicious circle caused by pronounced intolerance to life stress seems to operate in a more serious way than in patients who do not suffer from a personality disorder. © 2006 Taylor & Francis.
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| 14. |
- Johansson, Magnus, et al.
(författare)
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Prevalence of dizziness in relation to psychological factors and general health in older adults
- 2006
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Ingår i: Audiological Medicine. - : Informa UK Limited. - 1651-386X .- 1651-3835. ; 4:3, s. 144-150
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Tidskriftsartikel (refereegranskat)abstract
- The present study examined the point prevalence of dizziness among older adults in the Swedish population. It also explored the relationship between dizziness and general health and psychological factors, and the impact of dizziness on daily life. Data were obtained by means of a postal survey, administrated to 2000 randomly selected adults. Among the responders, 247 were aged 65-79 years. Dizziness was defined as being at least slightly annoyed by dizziness or unsteadiness at present. Results showed that the point prevalence of dizziness was estimated at 25.2%. Dizziness increased significantly with age among the women, but not among the men. Statistically significant associations were found between dizziness and anxiety, anxiety sensitivity, depression, hearing problems, tinnitus, pain in neck or shoulder and muscle tension. Almost 10% of the sample had visited a physician during the last 12 months concerning their dizziness and more than 10% reported having been prevented from working or performing normal activities for at least a day due to dizziness. In conclusion, the present study suggests that, at present, more than 25% of the older adults in Sweden are suffering from dizziness. It also suggests that a large proportion of the older adults in the country visit a physician concerning their problems with dizziness each year, and that there are associations between dizziness and factors in multiple domains in this population. © 2006 Taylor & Francis.
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| 15. |
- Bjerlemo, Berit, et al.
(författare)
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Recovery after early vestibular rehabilitation in patients with acute unilateral vestibular loss
- 2006
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Ingår i: Audiological Medicine. - : Informa UK Limited. - 1651-386X .- 1651-3835. ; 4:3, s. 117-123
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to follow the recovery process, and explore the disease impact on sick leave in patients with acute unilateral vestibular loss (AUVL). Another aim was to investigate whether initial signs of nystagmus, caloric response, and subjective symptoms of vertigo could predict the return to work. Recovery was followed through the reduction in spontaneous and head-shaking nystagmus, evaluated by Video-Frenzel examination, and by caloric response/asymmetry and spontaneous nystagmus, evaluated by bithermal binaural caloric testing. Information regarding employment, sick leave and subjective symptoms of vertigo was collected using a questionnaire. Twenty-seven patients with AUVL participated in a physiotherapy training programme, starting within 48 h of disease onset. Four assessments were performed: at disease onset, in the acute stage, and after one and six months. In most patients a very rapid cessation of spontaneous nystagmus could be observed (14/27 at a median time of two days after disease onset, a further 10 patients after one month and the remaining three patients after six months). A more prolonged persistence of head shaking nystagmus was observed (24/27, 14/27 and 5/21 of the patients showed head-shaking nystagmus at the three assessments). Caloric asymmetry was normalized after six months in 11/27 patients. A positive and significant correlation was observed between long-lasting sick leave and caloric asymmetry, sense of unsteadiness when standing and walking and older age. Unsteadiness when standing and walking, as well as existence of spontaneous nystagmus, were also positively and significantly correlated with the degree of caloric asymmetry. Spontaneous or head-shaking nystagmus, caloric asymmetry and subjective vertigo at disease onset did not, however, predict sick leave after one or six months. Recovery was excellent in most of the patients.
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| 16. |
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| 17. |
- Andersson-Felé, Lena, 1946
(författare)
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Time to Revive Luther Gulick, on Span of Control and Organisation Quality, SPA Working Paper 2006:15
- 2006
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Ingår i: SPA Working Paper 2006:15. - 1651-5242.
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Forskningsöversikt (refereegranskat)abstract
- For the last few decades health care services as well as other parts of the public sector have gone through comprehensive rationalisation and financial cut-backs. Rationalisation means, almost by definition, increased demands on managers and their subordinates, since the intention is to retain an unaltered production or produce more with fewer employees. In association with rationalisation the public sector has also used many of the working and managing methods that have developed from and seen to be successful within the private sector. Flat organisations with few management levels and lean production, without essential support resources, have been sought for. This paper is about organisational prerequisites for managers at an operational level within the health care industry. These managers, with direct responsibility for personnel, are usually called supervisors, foremen, middle-managers or first line managers: They work closest to the personnel, the subordinates, and have direct responsibility for personnel, finance and the organisation on a daily basis. The main focus in this paper is on the relationship between the number of employees a manager is responsible for – the span of control - and primarily the quality of the working environment and performance – the internal quality. The purpose of this paper is to show both how the theories around the span of control have developed and also which empirical studies that have been carried out with respect to the span of control’s effect on the quality of the organisation. The paper begins with legislative demands on efficiency and quality in Swedish health care. This is followed by a section on the consequences of a more streamlined organisation, different levels of management, theories on the span of control and a review of empirical studies. The paper ends with a discussion around the importance of the span of control on work environment and performance.
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| 18. |
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| 19. |
- Erlanson-Albertsson, Charlotte, et al.
(författare)
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Reply to letter by Aarts and Greiner.
- 2006
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 95:5, s. 624-625
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 20. |
- Hook, B, et al.
(författare)
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Prenatal and postnatal maternal smoking as risk factors for preschool children's mental health
- 2006
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 95:6, s. 671-677
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify maternal prenatal and postnatal smoking as risk factors for psychosocial behaviour problems in Swedish preschool children. Methods: This prospective, longitudinal population study compared mothers' self-reported smoking during pregnancy and when the child was 3 mo old with behaviour problems according to Achenbach's Child Behavior Checklist at 3 y ( 1428 children) and 5.5 y of age ( 677 of the children). Results: 16% of the mothers smoked during pregnancy and the same number after the birth of the child. Controlling for possible confounding variables, maternal smoking was significantly related to externalizing problems, aggressive behaviour, and destructive/delinquent behaviour both at 3 y and 5.5 y. The effect was as strong for girls as for boys. Length and weight were lower for children of smoking mothers than for children of non-smoking mothers. Conclusion: Our study supports the importance of preventing maternal smoking during pregnancy and the infant years. Even a few cigarettes per day have negative consequences for the child. The goal must be total abstinence from smoking both pre- and postnatally.
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| 21. |
- Ljungberg, Elinor, et al.
(författare)
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Hospitalized Swedish children with hand and forearm injuries: A retrospective review.
- 2006
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 95:1, s. 62-67
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To analyse incidences and find risk groups in children hospitalized with hand injuries in a national retrospective study. Methods: All children with a primary hand or forearm injury admitted to Swedish hospitals during 1987 - 2001 were retrieved from the Swedish Hospital Discharge Register and analysed as to incidence and characteristics. Results: Among 9855 children included, the median age was 7.0 y and two-thirds were boys. The incidence increased in both younger ( 0 - 6 y) and older ( 7 - 14 y) children. Wounds and fractures almost doubled, while muscle/tendon injuries decreased. In younger children, wounds and burns were the most frequent diagnoses. In older children, fractures and muscle/tendon injuries were common. Sharp objects caused most of the injuries. University hospitals treated almost half of the children. Conclusion: The number of children with hand injuries admitted to hospitals in Sweden increased annually. Analyses of causes behind the increase are important to counter this trend.
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| 22. |
- Jacobson, Inger, et al.
(författare)
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Injuries among female football players : with special emphasis on regional differences
- 2006
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 8:2, s. 66-74
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Tidskriftsartikel (refereegranskat)abstract
- In this 1-year prospective study, the aim was to investigate if there are any differences concerning injuries and injury incidence during an entire football season between Swedish female football players from different geographical regions. A total of 130 out of 253 players (51%) sustained 229 injuries. The overall injury incidence was 9.6/1000 h of football. The incidence of injury during practice was 8.4/1000 h and during game was 13.3/1000 h. Players in the north had a higher incidence of injury during game than those in the south (19.5 vs. 7.2/1000 h, respectively, p<0.001). Fifty-nine per cent of all injuries were traumatic injuries. Both traumatic and overuse injuries occurred mainly during the early preseason and at the beginning of the competitive spring season. Of all injuries, 13% were classified as slight, 39% as minor, 37% as moderate and 11% as major injuries. Players in the north had a higher injury incidence concerning moderate injuries than players in the south (p<0.01). In the present study, evidence is presented that regional factors play a role in the injury incidence. Female football players in the north and south have different injury patterns. This could be a result of different conditions for football as a sport between the regions.
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| 23. |
- Lundmark, Robert
(författare)
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Cost structure of and the competition for forest-based biomass
- 2006
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Ingår i: Scandinavian Journal of Forest Research. - : Informa UK Limited. - 0282-7581 .- 1651-1891. ; 21:3, s. 272-280
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Tidskriftsartikel (refereegranskat)abstract
- Biomass has become a popular alternative to satisfy expanding energy demand and as a substitute for fossil fuels and phased-out nuclear energy in Europe. The European Union White Paper stipulates that the utilization of biomass shall increase to 1566 TWh by 2010. However it is often overlooked that the forest resources are already, to a large extent, used by the forest industries. When promoting biomass for energy generation the consequences for the forest industries also need to be considered. Sweden is an excellent case study, as there are vast quantities of forest resources, nuclear power is starting to be phased out, there are restrictions on expanding hydropower and the political desire exists to "set an example" with respect to carbon dioxide emissions. This paper attempts to estimate and analyse the supply of two types of forest resource, namely, roundwood and harvesting residues derived from final harvesting and commercial thinnings. Two separate supply curves are estimated: one forroundwood and one for harvesting residues. The cost structure is based on an economic-engineering approach where the separate cost components are constructed from the lowest cost element into aggregates for labour, capital, materials and overhead costs for each forest resource. The results indicate an unutilized economic supply of 12 TWh of harvesting residues in Sweden. However, after these 12 TWh have been recovered it becomes more profitable to use roundwood for energy purposes than to continue extracting further amounts of harvesting residues.
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| 24. |
- Lycken, Anders, et al.
(författare)
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A multivariate approach to automatic grading of Pinus sylvestris sawn timber
- 2006
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Ingår i: Scandinavian Journal of Forest Research. - : Informa UK Limited. - 0282-7581 .- 1651-1891. ; 21:2, s. 167-174
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to create an easier way to handle the often complicated and intricate situations with which the operator of an automatic grading system is faced each time a change to the grading rules is proposed. The scope of the study was the possibility of a holistic method of automatic appearance grading of sawn wood similar to manual grading and based on multivariate statistics. The study was based on 90 Scots pine ( Pinus sylvestris L.) sawlogs. The logs were sawn and the boards were scanned and manually graded. The result of the manual grading was defined as the true grade. Models for prediction of board grade based on aggregated defect variables were calibrated using partial least squares regression. The classification based on the multivariate models resulted in 80-85% of the boards being correctly graded according to the manual grading. In conclusion, this paper shows that a multivariate statistical approach for grading timber is a possible way to simplify the process of grading and to customize the grading rules when using an automatic grading system
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| 25. |
- Melander-Wikman, Anita, et al.
(författare)
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Patient empowerment in rehabilitation : "somebody told me to get rehabilitated"
- 2006
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 8:1, s. 23-32
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Tidskriftsartikel (refereegranskat)abstract
- Within healthcare, there is a growing interest in patient influence and participation. The aim of this study is to describe patients' experience of participation in and influence on rehabilitation with the focus on physiotherapy. Interviews with patients from three different primary healthcare centres were conducted. The result indicated low patient participation in and influence on the rehabilitation process within the hospital. The informants trusted the competence of the caregivers and tried to be as compliant as possible. Their experiences were that training must be supported and followed up. Information about rights was requested. The informants felt that they were listened to and confirmed by the physiotherapists. The positive attitude was combined with low demands and a great feeling of gratitude as a matter of course. Using information and support from the physiotherapist, together with friends and next of kin, the informants had learned to cope with the new situation. In this paper, these results are understood and described in terms of the parallel process of rehabilitation, based on traditional and individual models, and implying that the patient copes with the situation by shifting between being compliant and adopting more self-regulatory behaviour, for example. Attitudes are changing in society and this study reflects the patient of today, and is confirmed by recent studies
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