| 1. |
- Allmyr, Mats, et al.
(författare)
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Human Exposure to Triclosan via Toothpaste does not change CYP3A4 Activity or Plasma Concentrations of Thyroid Hormones
- 2009
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Ingår i: Basic & Clinical Pharmacology & Toxicology. - : Wiley. - 1742-7835 .- 1742-7843. ; 105:5, s. 339-344
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Tidskriftsartikel (refereegranskat)abstract
- Triclosan is an antibacterial compound commonly used in cosmetics and personal care products for everyday use. As previously shown, triclosan is found in the plasma, urine and milk from large parts of different human populations. Recent studies have revealed that triclosan is able to activate the human pregnane X receptor in vitro and thus possibly affecting metabolism of drugs in humans via the induction of CYP3A4. Besides, triclosan has been shown to affect thyroid hormonal levels in rats in vivo. In the present study, we investigated if an everyday exposure to triclosan via triclosan-containing toothpaste for 14 days in 12 adult humans caused an increase in plasma 4 beta-hydroxycholesterol, indicative of CYP3A4 induction, and/or alterations in thyroid hormonal status. The plasma triclosan concentrations increased from 0.009-0.81 ng/g to 26-296 ng/g (ranges) upon exposure. Despite this, there were no significant changes in plasma levels of either plasma 4 beta-hydroxycholesterol or thyroid hormones during the exposure. This indicates that the normal use of triclosan-containing toothpaste is not likely to alter metabolism of drugs via CYP3A4 induction or cause adverse events because of thyroid disturbances in humans.
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| 2. |
- Astvaldsdottir, Alfheidur, et al.
(författare)
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Longevity of posterior resin composite restorations in adults : A systematic review
- 2015
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Ingår i: Journal of Dentistry. - : Elsevier BV. - 0300-5712 .- 1879-176X. ; 43:8, s. 934-954
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Forskningsöversikt (refereegranskat)abstract
- Objective: To conduct a systematic review of the literature on the longevity of posterior resin composite restorations in adults. Material and methods: A systematic literature search was conducted according to predetermined criteria for inclusion and exclusion. The studies selected were prospective clinical trials with a minimum follow-up time of 4 years, 40 restorations per experimental group and an annual attrition rate of less than 5%. Initially, abstracts and full-text articles were assessed independently and the assessment was subsequently agreed on by five reviewers. The methodological quality of the studies was assessed according to the Swedish Council on Health Technology Assessment (SBU) standard checklist for determining the extent to which studies meet basic quality criteria. Results: In all, the literature search identified 4275 abstracts and 93 articles were read in fulltext. There were eighteen studies which met the criteria for inclusion, eight of which were included in the analysis. There were 80 failures of restorations with a total follow-up time at risk for failure of 62,030 months. The overall incidence rate for all causes of failure was 1.55 lost restorations per 100 restoration years. The most common biological reason for failure (a total of 31 restorations) was secondary caries, with or without fracture of the restoration. The quality of the evidence was low. Conclusions: In an efficacy setting, the overall survival proportion of posterior resin composite restorations is high. The major reasons for failure are secondary caries and restoration fracture which supports the importance of adequate follow-up time. Clinical significance: The overall survival proportion of posterior composite restorations was high, but the results cannot be extrapolated to an effectiveness setting. The importance of adequate follow-up time is supported by the finding that secondary caries often occurred after 3 years or later.
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| 3. |
- Bay, Bjorn, et al.
(författare)
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Response of human oral mucosa and skin to histamine provocation : laser Doppler perfusion imaging discloses differences in the nociceptive nervous system
- 2009
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Ingår i: Acta Odontologica Scandinavica. - London : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 67:2, s. 99-105
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the existence of histamine-excitable nerve fibers in the oral mucosa and to compare the response to histamine provocation in healthy volunteers with that in a small group of patients with chronic oral pain. Material and methods. Thirteen healthy volunteers and six patients suffering from chronic oral pain took part in the study. Blood perfusion was monitored in the hard palate, the tongue, and the skin of the cheek using laser Doppler perfusion imaging (Perimed; Sweden). Baseline scannings were performed, followed by 15 scannings after iontophoresis of histamine (1%). A free description of the sensations was then obtained from the participants after finishing the measurements. Results. Compared to pre-histamine scanning, histamine application resulted in a considerable increase in blood perfusion in all regions (p0.001) that was significantly higher in skin than in oral mucosa (p0.001). There were no significant differences between the healthy volunteers and the patients regarding baseline blood flow, increased blood perfusion, or flare size after histamine provocation. The sensory impression was reported to be more persistent and intense in the skin than in the oral mucosa. No effect on mucosa could be detected by visual inspection. Conclusions. Intra-oral flare could be induced by activating histamine-excitable nerve fibers. Both duration and intensity of the flare were considerably less pronounced than in the control skin site. Histamine application was not clearly associated with itch.
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| 4. |
- Dalheim Englund, Ann-Charlotte, et al.
(författare)
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Life without professional work : perceptions about one’s self, interpersonal relations and social life after retirement
- 2019
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Ingår i: Healthy Aging Research. - : Wolters Kluwer. - 2261-7434. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to understand how healthy, older adults in Sweden perceive their life situation after retirement. The study is based on a lifeworld approach, and a phenomenographic method was used. Eighteen participants were interviewed, and data were analysed according to the phenomenographic principle of qualitatively different categories. Two categories were developed. The first category, “perceptions that draw attention inward, towards one’s self”, was further described in three subcategories: Sense of decreased status in society, the desire to keep aging at a distance, and contemplation of one’s own existence. The second category, “perceptions that draw attention outward, away from one’s self” was further described in the following four subcategories: caretaking of family members, involvement in social relationships, finding of deep meaning in animals and nature and engagement with society. In the discussion, the findings are further illuminated through comparisons with concepts such as maturity, wisdom and gerotranscendence, and reflections on the findings ‘relevance to a caring context follow. The conclusion suggests this study can provide knowledge that will allow healthcare providers to bridge the gap between generations in order to provide high-quality care. However, for a more profound caring dialogue, for example, about the end of life, a deeper analysis is required.
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| 5. |
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| 6. |
- Engblom, Monika, et al.
(författare)
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When physicians get stuck in sick-listing consultations : A qualitative study of categories of sick-listing dilemmas
- 2010
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Ingår i: Work. - 1051-9815 .- 1875-9270. ; 35:2, s. 137-142
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Many physicians find sick-listing tasks problematic. The aim of this study was to identify categories of dilemmas experienced by physicians in their sick-listing practice. Design and subjects: Data was collected at courses that were aimed at improving physicians' sick-listing skills, arranged in different parts of Sweden. Before the course the participants, general practitioners (GP) sent in a written report of a sick-listing case they found problematic. The material consisted of group discussions of some 100 case reports from GPs. The process of categorisation of the dilemmas was a one-step, straightforward qualitative analysis. Results: Eight different categories of sick-listing dilemmas experienced by the physicians were identified. Examples of them are "Not the doctors' pigeon" (when the patients' problem was perceived as not being medical in nature), "Diagnosis as disguise" (when there is a discrepancy between how the patient describes the problems and what the physician apprehends), and "Harmed by sick listing - reversible" (when the physician perceives that the main problem is the iatrogenic adverse effects of sick listing per se). Implications: The contribution of the study is to provide understanding of and labels to the specific difficulties experienced by physicians in their sick-listing practice face to face with patients.
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| 7. |
- Englund, Annika, et al.
(författare)
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Hodgkin lymphoma - a survey of children and adolescents treated in Sweden 1985-2009.
- 2015
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Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 54:1, s. 41-8
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background. Hodgkin lymphoma (HL) in children constitutes approximately 30% of all pediatric lymphomas in Sweden. The chance of cure is high, but the frequency of late effects has been considerable. Over recent years, efforts have been made to reduce treatment with maintained survival. Material and methods. All patients 0-17 years, identified in the Swedish Childhood Cancer Register as diagnosed between 1985 and 2009, were included. The material was analyzed using descriptive statistics and for survival estimates the Kaplan-Meier method was used. Results. Three hundred and thirty-four patients were identified during this time period. The median age was 14 years. Male sex was over-represented, especially in lower age groups and in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). In nodular sclerosis and in age group 15-17 years, female sex dominated. Most of the cases presented in stages I or II. B-symptoms were present in 38% of cHL, but only in 7% of NLPHL. The number of patients receiving radiotherapy has been significantly reduced during the period studied. The relapse rate in cHL was 10 ± 2% and in NLPHL 16 ± 7%. The relapse rate was significantly higher in cHL stage IIB compared to other stages in the same therapy group. In cHL 6% died, and in NLPHL 0%. The 5-, 10- and 20-year overall survival estimates in cHL were 96 ± 1%, 95 ± 1% and 90 ± 3%, respectively, with no significant difference when comparing different treatment regimens and time periods. The 5- and 10-year overall survival after relapse in cHL was 81 ± 8% and 75 ± 10%, respectively. Conclusion. During the period studied there is no indication of a decline in survival despite changes in treatment. Survival rates in Sweden are high, and even after relapse chances of cure are high. We were not able to identify any characteristics specific for the group of patients that did not survive.
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| 8. |
- Englund, Annika
(författare)
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Hodgkin Lymphoma in children, adolescents and young adults
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hodgkin lymphoma (HL) is a heterogeneous condition varying from engaging one single lymph node site to a widespread condition. The prognosis with contemporary treatment is excellent for the vast majority. However, the treatment might cause severe late adverse effects in a proportion of the affected individuals.We evaluated all children and adolescents diagnosed in Sweden and registered in the Swedish Childhood Cancer Register over a period of 25 years. The incidence has been stable and the overall survival (OS) is very good, comparable to the best results in the world. Approximately ten percent encountered a relapse, but even after relapse the chances of survival were good. During the study period there were no detectable changes in survival estimates. The use of radiotherapy has decreased.Epstein Barr virus (EBV) and numbers of eosinophils, mast cells and macrophages in the tumors were investigated in 98 cases. Young children were more likely to express EBV. In patients with advanced disease the mast cell and macrophage counts were higher and they also had more affected laboratory parameters. Patients with Nodular Lymphocyte Predominant Hodgkin Lymphoma did not express EBV in the tumor, had significantly lower numbers of eosinophils, mast cells and macrophages and less affected laboratory parameters compared to classical HL.Outcome and clinical presentation were investigated in a cohort of children, adolescents and young adults in Sweden and Denmark and treatment in pediatric and adult departments was compared. OS and event-free survival (EFS) did not differ between the three age groups nor between pediatric and adult treatment. However, the Danish pediatric patients had lower EFS, which corresponded to less use of radiotherapy. Adolescents and young adults shared similar characteristics, while children presented differently with less advanced disease and male preponderance.Hospitalization rates and outpatient visits after end of treatment were evaluated to see whether the excess need of resources described in the literature is evenly distributed among the survivors or whether it is limited to a smaller group. Most of the patients had a low burden of health care use and the relapsing patients were the main drivers of the excess need.
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| 9. |
- Englund, Annika, et al.
(författare)
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The role of tumour-infiltrating eosinophils, mast cells and macrophages in Classical and Nodular Lymphocyte Predominant Hodgkin Lymphoma in children
- 2016
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Ingår i: European Journal of Haematology. - : Wiley. - 0902-4441 .- 1600-0609. ; 97:5, s. 430-438
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study Hodgkin lymphoma (HL) microenvironment in a Swedish paediatric population and its relation to clinical parameters.METHODS: Tumour tissue from classical HL (cHL) (n=87) and nodular lymphocyte predominant HL (NLPHL) (n=11) was investigated for Epstein-Barr Virus (EBV) and analysed for eosinophils, mast cells and macrophages.RESULTS: In cHL, EBV positivity was more common in low age (p<0.001) and in mixed cellularity (MC) (p<0.001). Higher mast cell infiltration was seen in stage III-IV (p<0.001), and with presence of B-symptoms (p=0.01). Cases with high mast cell counts displayed higher erythrocyte sedimentation rate (ESR), lower haemoglobin and albumin levels. Higher macrophage infiltration was seen in stage III-IV (p=0.02) and there was elevated ESR and neutrophil count. All NLPHL cases were EBV negative, had lower rates of inflammatory cells and lower degree of inflammatory reaction in laboratory parameters. There was no difference in survival estimates with regard to infiltration of inflammatory cells.CONCLUSIONS: Higher levels of mast cells and macrophages in cHL tumours reflected the clinical presentation in laboratory parameters, B-symptoms and more advanced stages. NLPHL differs from cHL in numbers of inflammatory cells in the tumour, and in laboratory parameters. This article is protected by copyright. All rights reserved.
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| 10. |
- Englund, Gunilla, et al.
(författare)
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Association between the number of coadministered P-glycoprotein inhibitors and serum digoxin levels in patients on therapeutic drug monitoring
- 2004
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Ingår i: BMC Medicine. - : BioMed Central (BMC). - 1741-7015. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe ABC transporter P-glycoprotein (P-gp) is recognized as a site for drug-drug interactions and provides a mechanistic explanation for clinically relevant pharmacokinetic interactions with digoxin. The question of whether several P-gp inhibitors may have additive effects has not yet been addressed.MethodsWe evaluated the effects on serum concentrations of digoxin (S-digoxin) in 618 patients undergoing therapeutic drug monitoring. P-gp inhibitors were classified as Class I, with a known effect on digoxin kinetics, or Class II, showing inhibition in vitro but no documented effect on digoxin kinetics in humans. Mean S-digoxin values were compared between groups of patients with different numbers of coadministered P-gp inhibitors by a univariate and a multivariate model, including the potential covariates age, sex, digoxin dose and total number of prescribed drugs.ResultsA large proportion (47%) of the digoxin patients undergoing therapeutic drug monitoring had one or more P-gp inhibitor prescribed. In both univariate and multivariate analysis, S-digoxin increased in a stepwise fashion according to the number of coadministered P-gp inhibitors (all P values < 0.01 compared with no P-gp inhibitor). In multivariate analysis, S-digoxin levels were 1.26 ± 0.04, 1.51 ± 0.05, 1.59 ± 0.08 and 2.00 ± 0.25 nmol/L for zero, one, two and three P-gp inhibitors, respectively. The results were even more pronounced when we analyzed only Class I P-gp inhibitors (1.65 ± 0.07 for one and 1.83 ± 0.07 nmol/L for two).ConclusionsPolypharmacy may lead to multiple drug-drug interactions at the same site, in this case P-gp. The S-digoxin levels increased in a stepwise fashion with an increasing number of coadministered P-gp inhibitors in patients taking P-gp inhibitors and digoxin concomitantly. As coadministration of digoxin and P-gp inhibitors is common, it is important to increase awareness about P-gp interactions among prescribing clinicians.
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| 11. |
- Englund, Gunilla, et al.
(författare)
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Cytochrome P450 Inhibitory Properties of Common Efflux Transporter Inhibitors
- 2014
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Ingår i: Drug Metabolism And Disposition. - : American Society for Pharmacology & Experimental Therapeutics (ASPET). - 0090-9556 .- 1521-009X. ; 42:3, s. 441-447
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Tidskriftsartikel (refereegranskat)abstract
- Drug transporter inhibitors are important tools to elucidate the contribution of transporters to drug disposition both in vitro and in vivo. These inhibitors are often unselective and affect several transporters as well as drug metabolizing enzymes, which can make experimental results difficult to interpret with confidence. We therefore tested 14 commonly used P-glycoprotein (P-gp), breast cancer resistance protein (BCRP), and multidrug-resistance associated protein (MRP) inhibitors as inhibitors of cytochrome P450 (P450) enzyme activities using recombinant enzymes. A subset of P-gp and/or CYP3A inhibitors were selected (cyclosporin A, elacridar, ketoconazole, quinidine, reserpine, and tacrolimus) for a comparison of P450 inhibition in human microsomes and hepatocytes. Most P-gp inhibitors showed CYP3A4 inhibition, with potencies often in a similar range as their P-gp inhibition, as well as less potent CYP2C19 inhibition. Other P450 enzymes were not strongly inhibited except a few cases of CYP2D6 inhibition. MRP and BCRP inhibitors showed limited P450 inhibition. Some inhibitors showed less P450 inhibition in human hepatocytes than human liver microsomes, for example, elacridar, probably due to differences in binding, permeability limitations, or active, P-gp mediated efflux of the inhibitor from the hepatocytes. Quinidine was a potent P450 inhibitor in hepatocytes but only showed weak inhibition in microsomes. Quinidine shows an extensive cellular uptake, which may potentiate intracellular P450 inhibition. Elacridar, described as a potent and selective P-gp inhibitor, displayed modest P450 inhibition in this study and is thus a useful model inhibitor to define the role of P-gp in drug disposition without interference with other processes.
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| 12. |
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| 13. |
- Englund, Gunilla, et al.
(författare)
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Efflux transporters in ulcerative colitis : decreased expression of BCRP (ABCG2) and Pgp (ABCB1)
- 2007
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Ingår i: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1078-0998 .- 1536-4844. ; 13:3, s. 291-297
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Tidskriftsartikel (refereegranskat)abstract
- Background: Efflux transport proteins are important components of the intestinal barrier against bacterial toxins, carcinogens, and drugs. This investigation was conducted to determine the expression of Breast Cancer Resistance Protein (BCRP/ABCG2), P-glycoprotein (Pgp/MDR1/ABCB1), and Multidrug Resistance Protein 2 (MRP2/ABCC2) in the gut mucosa of patients with ulcerative colitis (UC). Methods: Patients were thoroughly diagnosed according to well-established clinical, endoscopic, and histologic criteria to be included in the group of patients with active UC (n = 16) or UC in remission (n = 17). Colonic and rectal mucosa from patients with UC were compared with tissues from control subjects (n = 15). The mRNA expression (TaqMan) of the efflux transporters and the proinflammatory cytokines interleukin (IL)-1β and IL-6 was determined. Western blot was used in the analysis of protein expression and the tissue localization of BCRP was determined with confocal microscopy. Results: BCRP and Pgp expression was strongly reduced in individuals with active inflammation compared with controls and was negatively correlated with the levels of IL-6 mRNA. The BCRP staining of colonic epithelium seen in healthy mucosa was diminished in inflamed tissues, with concurrent disruption of epithelial F-actin structure. Conclusions: Two of the efflux transporters of importance for the barrier function of the gut mucosa, Pgp and BCRP, are expressed at strongly reduced levels during active inflammation in patients with UC. Investigations are warranted to determine whether the low levels of efflux transporters during active UC contribute to altered transport and tissue exposure of carcinogens, bacterial toxins, and drugs.
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| 14. |
- Englund, Gunilla, 1975-
(författare)
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Interindividual Variability of Drug Transport Proteins : Focus on Intestinal Pgp (ABCB1) and BCRP (ABCG2)
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The appearance of adverse drug reactions is a common reason for hospitalization in Western countries. Research on underlying biological mechanisms for interindividual variability in drug response aims to better identify patients with exceptional genetic traits, disease conditions or risk of drug-drug interactions and thereby help to prevent adverse drug reactions. Active transport mechanisms are involved in the absorption and disposition of several therapeutic agents. The main objective of this thesis was to investigate factors potentially affecting transport proteins and thus contributing to variability in drug absorption and disposition. Studies of physiological, genetic, environmental, and pathological factors were included. The main focus was the two ATP-binding cassette (ABC) transporters: P-glycoprotein 170 (Pgp) and Breast Cancer Resistance Protein (BCRP). Quantification of transport protein mRNAs along the human intestine indicated that eight of the nine investigated drug transporters were expressed in a region-dependent manner. Effects of drug-drug interactions may therefore vary depending on the site of absorption. The genetic aspect was illustrated by identification of sequence variation in the gene encoding BCRP, the most highly expressed ABC transporter along the human intestine. Drug-drug interactions are important environmental causes of interindividual variability. An evaluation of the effects of Pgp-mediated drug-drug interactions showed that patients receiving Pgp inhibitors had elevated serum concentrations of the Pgp substrate digoxin and that digoxin concentrations were positively correlated with the number of co-administered Pgp inhibitors. The final topic in this thesis was that of drug-disease interactions. BCRP and Pgp were down-regulated during active inflammation in patients with ulcerative colitis. This may contribute to altered concentrations of drug in the intestinal mucosa during periods of inflammation and possibly to changes in drug absorption. To summarize, results of this thesis emphasize the complex background to the interindividual variability of drug transport proteins, where physiological, genetic, environmental and pathological factors all can contribute.
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| 15. |
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| 16. |
- Englund, Gunilla, et al.
(författare)
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Regional levels of drug transporters along the human intestinal tract : Co-expression of ABC and SLC transporters and comparison with Caco-2 cells
- 2006
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Ingår i: European Journal of Pharmaceutical Sciences. - : Elsevier BV. - 0928-0987 .- 1879-0720. ; 29:3-4, s. 269-277
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Tidskriftsartikel (refereegranskat)abstract
- A vast number of drugs are subjected to active or facilitated transport and multiple transport mechanism may contribute to the net flux during drug absorption. The main objective of this study was to quantify the regional mRNA expression and determine the co-expression of drug transporters from the ABC (Pgp, BCRP, MRP2, MRP3) and SLC (PEPT1, MCT1, OATPB, OCTN2, OCT1) families along the human intestine (duodenum, jejunum, ileum, and colon). A second objective was to compare the transporter expression between the different intestinal regions and Caco-2 cells. Eight out of nine of the investigated transporters exhibited significant regional differences in expression. OATPB was the only transporter that did not show a region-dependency in the expression along the human intestinal canal. The expression of Pgp, BCRP, OCTN2 and MCT1 differed along the small intestine, but the expression differences were greater than five-fold only for Pgp. The rank order of transcript prevalence was identical in the ileum and the jejunum. Between the ileum and colon, seven transcripts were differentially expressed, and MCT1, OCTN2 and MRP3 were expressed at higher levels in the colon than in the small intestine. The expression of transporters in Caco-2 was closest to the expression pattern in the small intestine, although the expression of OATPB, BCRP and MRP2 differed more than five-fold between the Caco-2 cells and ileum. In conclusion, this study provides quantitative data on the expression of transporters from the ABC and SLC families along the human intestine, which can be useful in the interpretation of clinical studies where more than one intestinal transporter contribute to the net transport and in the computer modelling of drug absorption.
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| 17. |
- Englund, Mikael C. O., 1971, et al.
(författare)
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The establishment of 20 different human embryonic stem cell lines and subclones; a report on derivation, culture, characterisation and banking.
- 2010
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Ingår i: In vitro cellular & developmental biology. Animal. - : Springer Science and Business Media LLC. - 1543-706X .- 1071-2690. ; 46:3-4, s. 217-30
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Tidskriftsartikel (refereegranskat)abstract
- This report summarises our efforts in deriving, characterising and banking of 20 different human embryonic stem cell lines. We have derived a large number of human embryonic stem cell lines between 2001 and 2005. One of these cell lines was established under totally xeno-free culture conditions. In addition, several subclones have been established, including a karyoptypical normal clone from a trisomic mother line. A master cell banking system has been utilised in concert with an extensive characterisation programme, ensuring a supply of high quality pluripotent stem cells for further research and development. In this report we also present the first data on a proprietary novel antibody, hES-Cellect, that exhibits high specificity for undifferentiated hES cells. In addition to the traditional manual dissection approach of propagating hES cells, we here also report on the successful approaches of feeder-free cultures as well as single cell cultures based on enzymatic digestion. All culture systems used as reported here have maintained the hES cells in a karyotypical normal and pluripotent state. These systems also have the advantage of being the principal springboards for further scale up of cultures for industrial or clinical applications that would require vastly more cells that can be produced by mechanical means.
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| 18. |
- Gillsjö, Catharina, Senior Lecturer, 1963-, et al.
(författare)
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Balance in life as a prerequisite for community-dwelling older adults' sense of health and well-being after retirement : an interview-based study
- 2021
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE This study aimed to describe community-dwelling older adults’ perceptions of health and well-being in life after retirement.METHODS This study is part of a larger project using a mixed-methods design to address lifestyles’ influence on community-dwelling older adults’ health. Individual semi-structured interviews were conducted with 18 older adults in age 70 to 95 years. Data were analysed according to a phenomenographic approach.RESULTS The results encompass four categories describing variations in community-dwelling older adults’ perceptions of health and well-being after retirement: feeling well despite illness and disease, interacting with and being useful for oneself and others, independently embracing opportunities and engaging in life, and maintaining a healthy lifestyle.CONCLUSIONS The absence of illness and disease is not a clear prerequisite for a sense of health and well-being. To promote and preserve health and well-being after retirement, older adults strived for—and coached themselves to uphold—a balance in life, focusing on not burdening others. This life orientation after retirement must be acknowledged by society at large, especially from an ageist perspective, and in health and social care to preserve and promote health and well-being.
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| 19. |
- Hedberg, Linn, et al.
(författare)
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White matter abnormalities mediate the association between masticatory dysfunction and cognition among older adults
- 2023
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Ingår i: Journal of Oral Rehabilitation. - : John Wiley & Sons. - 1365-2842. ; 50:12, s. 1422-1431
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Tidskriftsartikel (refereegranskat)abstract
- Background: Masticatory parameters, such as reduced number of teeth and posterior contacts, have been shown to be associated with reduced cognitive status. The underlying mechanisms that affect these associations, are however, not well understood. Objectives: The study aims to investigate the association between masticatory dysfunction and cognition and explore the mediating effect of brain structure. Methods: In this cross-sectional study, 45 older adults with subjective masticatory dysfunction (mean age 72.3 +/- 4.0 years) were included. Mini-Mental State Examination score <25, brain trauma, neurological disease, neurodegenerative disorders, depression or poor Swedish language skills were criteria for exclusion. Cognitive functions (executive function and episodic memory) and masticatory dysfunction defined by functional occluding status (FOS; the number of occluding units and number of remaining teeth) were analysed with partial correlation models. Structural magnetic resonance imaging was performed on 28 feasible participants. Multiple regression analyses were performed to evaluate the predictive value of brain structure and white matter hypointensities (WM-hypo) on cognitive functions. A mediation analysis was applied to assess significant predictor/s of the association between FOS and cognition. Results: Both episodic memory and executive functions were positively correlated with FOS. WM-hypo predicted cognitive status (executive function, p = .01). WM-hypo mediated 66.6% (p = 0.06) of the association between FOS and executive functions. Conclusion: Associations between FOS and cognitive functions are reported, where FOS, a potential modifiable risk factor, was related to both episodic memory and executive functions. The mediating effect of WM-hypo on the association between FOS and executive functions highlights the impact of the vascularisation of the brain on the link between mastication and cognition. The present study provides increased knowledge that bridges the gap between masticatory dysfunction and cognition.
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| 20. |
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| 21. |
- Jacobsen, Thomas, 1954, et al.
(författare)
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Application of laser technology for removal of caries: A systematic review of controlled clinical trials
- 2011
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 69:2, s. 65-74
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Forskningsöversikt (refereegranskat)abstract
- Objective. To evaluate the scientific evidence regarding laser technology for removal of carious tissue. Material and methods. A search for literature on the effect of treatment and on economic aspects of laser technology identified 23 papers. No relevant studies on economic aspects were found. Regarding the effect of treatment, 16 papers were selected for assessment according to established criteria. Results. Cavity preparation and caries excavation by erbium laser were evaluated in three studies of medium quality. The time required to remove carious tissue was evaluated in five studies assessed as being of medium quality for this outcome. In four studies the effect of laser treatment on the dental pulp was included as an outcome but, due to the short follow-up time, the quality was assessed as low. Two studies that included the longevity of the restoration as an outcome were also assessed as being of low quality because the follow-up time was inadequate. Patient response was evaluated in three studies, which were assessed as being of medium quality with respect to this outcome. Conclusions. There is limited scientific evidence that laser treatment is as effective as a rotary bur for removing carious tissue. Treatment time is prolonged. There is limited scientific evidence that adults prefer laser treatment. No conclusions can be drawn regarding biological or technical complications, children's perception of laser treatment or the cost-effectiveness of the method. © 2011 Informa Healthcare.
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| 22. |
- Kehoe, Laura, et al.
(författare)
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Make EU trade with Brazil sustainable
- 2019
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 364:6438, s. 341-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 23. |
- Kumar, Abhishek, et al.
(författare)
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Chewing and its influence on swallowing, gastrointestinal and nutrition-related factors : a systematic review
- 2022
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Ingår i: Critical Reviews in Food Science and Nutrition. - : Taylor and Francis Ltd.. - 1040-8398 .- 1549-7852. ; , s. 1-31
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Forskningsöversikt (refereegranskat)abstract
- The study aimed to evaluate the hypothesis that chewing is a mechanical and physiological contributor to swallowing, physiologic/pathologic processes of the gastrointestinal tract (GIT), and nutrition-related factors. A search strategy was applied to three different databases to investigate if chewing function in adults affects the swallowing, physiologic/pathologic processes of the GIT, and nutrition-related factors compared to controls with no exposure. The included studies were evaluated for methodological quality and risk of bias and certainty of evidence. The results showed 71 eligible studies. Overall, the results showed that 46 studies supported the hypothesis while 25 refuted it. However, the GRADE analysis showed low to very low certainty of the evidence to support the hypothesis that chewing is an important contributor in the swallowing process, and physiologic/pathologic processes in the GIT. The GRADE analysis also showed a moderate to very low certainty of the evidence to suggest that chewing function contributes to nutrition-related parameters. The overall results of the current study showed that a majority (64.7%) of the studies (46 out of 71) supported the hypothesis. However, robust studies with proper design, adequate sample size, and well-defined outcome parameters are needed to establish conclusive evidence.
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| 24. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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Consumption and direct costs of dental care for patients with head and neck cancer : A 16-year cohort study
- 2017
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- Patients with head and neck (H&N) cancer are commonly treated with surgery and/or radiotherapy, which can increase the risk of oral infection, dental caries, and periodontal disease. The present study investigated dental care consumption and costs in patient with H&N cancer before and after the cancer diagnosis. Data from Swedish regional and national registers were used to follow up dental care utilization and dental procedure costs. The analysis included 2,754 patients who had been diagnosed with H&N cancer (exposed cohort) in Stockholm County, Sweden, during 2000–2012 and 13,036 matched persons without cancer (unexposed cohort). The exposed cohort was sub-grouped into irradiated and non-irradiated patients for analysis. The exposed cohort underwent a moderately higher number of dental procedures per year than the unexposed cohort in both the year of the cancer diagnosis and the year after cancer diagnosis; in addition, these numbers were higher in the irradiated than in the non-irradiated subgroup of the exposed cohort. Dental care consumption and costs in the exposed cohort declined over time but remained at a slightly higher level than in the unexposed cohort over the long term (more than two years). Examinations and preventive procedures accounted for most of the higher consumption in the short term (2 years) and at the longer term follow-up. Swedish national insurance subsidized costs for dental treatment, which were highest in the irradiated subgroup and lowest in the unexposed cohort. Direct costs to the patient, however, were similar among the groups. Swedish national health insurance protects patients with H&N cancer from high dental expenditures. Further studies on the cost-effectiveness of preventive dental care for patients are needed.
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| 25. |
- Lexomboon, Duangjai, 1965-, et al.
(författare)
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The Effect of Xerostomic Medication on Oral Health in Persons With Dementia
- 2018
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier. - 1525-8610 .- 1538-9375. ; 19:12, s. 1080-1085
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Medication-induced hyposalivation can increase the risk for oral complications, including dental caries and tooth loss. This problem is particularly important in people with dementia because of their declining ability to maintain oral care. The objective of this study was to describe the association between the number of xerostomic medications used and tooth loss and restorative and dental preventive treatment in a population of persons with dementia. Design: A longitudinal population-based register study with a 3-year follow-up was conducted. Data were extracted from the Swedish Dementia Registry (SveDem), the Swedish Prescribed Drug Register (SPDR), the Swedish National Patient Register (SNPR), and the Dental Health Register (DHR). Setting and participants: Participants were persons with dementia who were registered in the SveDem at the time of their dementia diagnosis. Measures: The exposure was continuous use of xerostomic medications over the 3 years prior to dementia diagnosis (baseline). The outcomes were the incidence of tooth extractions, tooth restorations, and dental preventive procedures. Poisson regression models were used to estimate incidence rate ratios (IRRs) for the association between the exposure and outcomes, adjusting for relevant confounders. Results: A total of 34,037 persons were included in the analysis. A dose-response relationship between the exposure and tooth extractions was observed. Compared with nonusers of xerostomic medication, the rate of tooth extractions increased with increasing number of xerostomic medications used (IRR = 1.03, 1.11, and 1.40 for persons using an average >0-1, >1-3, and >3 xerostomic medications, respectively). However, the risk for having new dental restorations and receiving preventive procedures did not differ between groups. Conclusion: Continuous use of xerostomic medications can increase the risk for tooth extraction in people with dementia. This study highlights the importance of careful consideration when prescribing xerostomic medications to people with dementia, and the need for regular and ongoing dental care.
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| 26. |
- Lundquist, Patrik, et al.
(författare)
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Functional ATP-Binding Cassette Drug Efflux Transporters in Isolated Human and Rat Hepatocytes Significantly Affect Assessment of Drug Disposition
- 2014
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Ingår i: Drug Metabolism And Disposition. - : American Society for Pharmacology & Experimental Therapeutics (ASPET). - 0090-9556 .- 1521-009X. ; 42:3, s. 448-458
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Tidskriftsartikel (refereegranskat)abstract
- Freshly isolated hepatocytes are considered the gold standard for in vitro studies of hepatic drug disposition. To ensure a reliable supply of cells, cryopreserved human hepatocytes are often used. ABC-superfamily drug efflux transporters are key elements in hepatic drug disposition. These transporters are often considered lost after isolation of hepatocytes. In the present study, the expression and activity of ABC transporters BCRP, BSEP, P-gp, MRP2, MRP3, and MRP4 in human and rat cryopreserved hepatocytes were investigated. In commercially available human cryopreserved hepatocytes, all drug efflux transporters except human BCRP (hBCRP) exhibited similar expression levels as in fresh liver biopsies. Expression levels of hBCRP were 60% lower in cryopreserved human hepatocytes than in liver tissue, which could lead to, at most, a 2.5-fold reduction in hBCRP-mediated efflux. Fresh rat hepatocytes showed significantly lower levels of rat BCRP compared with liver expression levels; expression levels of other ABC transporters were unchanged. ABC transporters in human cryopreserved cells were localized to the plasma membrane. Functional studies could demonstrate P-gp and BCRP activity in both human cryopreserved and fresh rat hepatocytes. Inhibiting P-gp-mediated efflux by elacridar in in vitro experiments significantly decreased fexofenadine efflux from hepatocytes, resulting in an increase in apparent fexofenadine uptake. The results from the present study clearly indicate that ABC transporter-mediated efflux in freshly isolated as well as cryopreserved rat and human hepatocytes should be taken into account in in vitro experiments used for modeling of drug metabolism and disposition.
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| 27. |
- Matsson, Pär, et al.
(författare)
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A Global Drug Inhibition Pattern for the Human ATP-Binding Cassette Transporter Breast Cancer Resistance Protein (ABCG2)
- 2007
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Ingår i: Journal of Pharmacology and Experimental Therapeutics. - : American Society for Pharmacology & Experimental Therapeutics (ASPET). - 0022-3565 .- 1521-0103. ; 323:1, s. 19-30
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Tidskriftsartikel (refereegranskat)abstract
- In this article, we explore the entire structural space of registered drugs to obtain a global model for the inhibition of the drug efflux transporter breast cancer resistance protein (BCRP; ABCG2). For this purpose, the inhibitory effect of 123 structurally diverse drugs and drug-like compounds on mitoxantrone efflux was studied in Saos-2 cells transfected with human wild-type (Arg482) BCRP. The search for BCRP inhibitors throughout the drug-like chemical space resulted in the identification of 29 previously unknown inhibitors. The frequency of BCRP inhibition was 3 times higher for compounds reported to interact with other ATP-binding cassette (ABC) transporters than for compounds without reported ABC transporter affinity. An easily interpreted computational model capable of discriminating inhibitors from noninhibitors using only two molecular descriptors, octanol-water partition coefficient at pH 7.4 and molecular polarizability, was constructed. The discriminating power of this two-descriptor model was 93% for the training set and 79% for the test set, respectively. The results were supported by a global pharmacophore model and are in agreement with a two-step mechanism for the inhibition of BCRP, where both the drug's capacity to insert into the cell membrane and to interact with the inhibitory binding site of the transporter are important.
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| 28. |
- Naimi-Akbar, Aron, et al.
(författare)
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Cognitive function among sons of women who worked in dentistry
- 2012
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Ingår i: Scandinavian Journal of Work, Environment and Health. - Helsinki, Finland : Finnish Institute of Occupational Health. - 0355-3140 .- 1795-990X. ; 38:6, s. 546-552
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Exposure to elemental mercury vapor can impair neurological function as it is neurotoxic in doses higher than usually found in dentistry. Little is known about the potential effects of fetal exposure to elemental mercury among offspring of female dental workers. We investigated cognitive function among offspring of women working in dentistry at the time of their pregnancy.Methods: We compared results for cognitive function examinations taken by the majority of young men in Sweden at the time of compulsory military enlistment (age 17-18 years). Sons of female dentists (N=365) and dental nurses (N=3181) born during the 1960-1970s were compared with sons of female physicians (N=378) and assistant nurses (N=12 667).Results: Analysis by linear regression showed that sons of dental workers had similar or higher cognitive function test results compared to their matched cohorts.Conclusion: We found no evidence of poorer cognitive function among male offspring of female dentists or dental nurses.
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| 29. |
- Naimi-Akbar, Aron, et al.
(författare)
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Mortality among sons of female dental personnel : a national cohort study
- 2014
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Ingår i: Journal of Perinatal Medicine. - : Walter de Gruyter. - 0300-5577 .- 1619-3997. ; 42:5, s. 655-661
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Dental personnel are exposed to mercury when using dental amalgam. This exposure constitutes a potential hazard to offspring of women working in dentistry. The present study examined increased mortality risk in offspring of mothers working in dentistry.Methods: Mortality was compared between sons of dental personnel and sons of nondental health-care personnel. Hazard ratios were calculated for three decades (1960s-1980s), when the magnitude of mercury exposure in dentistry was likely to have varied.Results: During the 1960s, there was a statistically significant increase in the risk of neonatal mortality for sons of dental nurses when compared with sons of assistant nurses: hazard ratio (HR) 1.82 (95% confidence interval, CI: 1.04-3.22). There was no increased risk in the subsequent decades, but a trend test demonstrated a consistent decrease in the risk over the three decades: HR for trend 0.63 (95% CI: 0.44-0.90). The raised mortality risk was limited to neonatal mortality. The comparison between dentists and physicians had insufficient statistical power.Conclusions: There is no increased mortality risk among sons of female dentists after the 1960s. Although the results should be interpreted with caution, they suggest a modestly raised risk of neonatal mortality, during the 1960s, when exposure to mercury was thought to be highest.
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| 30. |
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| 31. |
- Palmér, Lina, 1979-, et al.
(författare)
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The intertwining of reconciliation and displacement : a lifeworld hermeneutic study of older adults’ perceptions of the finality of life
- 2020
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to explain and understand the existential meaning of the finality of life from the perspective of healthy older adults. Method: Participants were recruited from a major project on older adults’ life situations. They were interviewed about their thoughts on the end of life, and their responses were interpreted using a lifeworld hermeneutic approach. Results: The findings showed that thinking about the inevitable finality of life involves feelings of liberation, frightening thoughts, a comforting promise of something beyond death, acceptance of the concept of death as a companion in life and a desire to live. Philosopher Simone de Beauvoir’s existential ideas about ageing and death were then used to further explain and understand the meaning of the finality of life and to support a comprehensive understanding. de Beauvoir suggests that when the temporal horizon of existence shrinks, one lives closer to the finality of life. For a comprehensive understanding, attributing meaning to the finality of life required the intertwining of reconciliation and displacement. The interpretations were further discussed using ideas from the fields of existential philosophy and caring science in order to develop a basis for caring practice. Conclusions: The conclusions suggested that professional health care for older adults would benefit from a lifeworld-led caring science approach that includes readiness for a caring dialogue that focuses on existential issues.
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| 32. |
- Palmér, Lina, 1979-, et al.
(författare)
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The meaning of growing old : A lifeworld hermeneutic study on existential matters during the third age of life
- 2019
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Ingår i: Healthy Aging Research. - : Wolters Kluwer. - 2261-7434. ; 8:2, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates existential matters in the third age of life, which encompasses the years after retirement and ends when extensive support needs emerge in the fourth age. As the theoretical starting point in a lifeworld hermeneutic approach, 18 healthy older adults were interviewed about what it means for them to grow old. The interviews were interpreted according to Gadamer's principles of openness and Ricoeur's proposal to provide suggestions on how meaning can be explained. The findings are presented in three interpreted themes: Feeling free, Becoming vulnerable, and Existing in closeness to death. The themes are further interpreted, and a comprehensive understanding is reached with theoretical support from Jean-Paul Sartre's idea of factuality and project. The meaning of growing old is discussed in terms of positive factors, such as healthy aging, transition and gerotranscendence, but also in respect to concerns over future suffering in relation to illness and dependence. It is concluded that the freedom of the third age is greatly appreciated for a healthy life, but also threatened by increased risks of ill health. It is not morbidity in itself that worries most, but the risk of being dependent on care and support from others. This is important to consider when planning and performing care in order to promote a healthy aging.
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| 33. |
- Prahl, Charlotte
(författare)
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Den frånvarande dialogen : Om en utbildningssatsning inom demensvård
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Educational investments may serve several purposes. They can be carried out in order to increase the students’ knowledge within a specific discipline, but also to increase the level of knowledge within an organization. ’Silviahemmet’ in Stockholm, which was inaugurated in the year of 1996, had as one of its objectives to become a school for education of assistant nurses working in the area of dementia care. The educational program had the aim to educate assistant nurses to become supervisors in dementia care, the assistant nurses should acquire an edge competence in the close care of patients with dementia. This educational investment has been investigated in order to study the significance an educational investment may have for a health care organization in which some of the health care personnel has participated in an education and moreover, to study how this knowledge is communicated within the organization.Thus, the overall purpose of my study is to describe and analyse the significance an educational investment is given, by the participating assistant nurses as well as by other health care personnel. The study was carried out during the year 2005 and concerned assistant nurses educated in the years between 1996 and 2001. Four different data gathering techniques were used; questionnaires, interviews, observations at two workplaces and conversations with health care personnel. The questionnaire concerned all 34 assistant nurses who had participated in specialist training in dementia care during this period. Seven persons were interviewed.Summing up my results, the knowledge that the assistant nurses have achieved from the education is theoretical and social knowledge of dementia. This constituted a platform to stand on for the assistant nurses in their work when meeting the patientAn important result of the study, concerning the importance of the assistant nurses specialist training for other categories of health care personnel, is the lack of verbal communication between personnel categories that seems to be at hand. Furthermore, dialogues or shared reflections among the personnel could not be noticed. Often it was solely one-way communication that existed on the wards. A knowledge creating dialogue was missing. Questions were asked, but only regarding about "what" and "when" a work task should be performed, not "why" something should be carried out.An obstacle regarding the communication of new knowledge appears to be the gap existing between an educational investment and the everyday reality of the health care organization. The result of the study shows the importance of adopting the theoretical knowledge to the reality that the health care personnel is facing. Other obstacles seem to be status and hierarchies.The study showed that the assistant nurses working hours did not allow for educating health care personnel in dementia. There ought to be possibilities within the organization to make space for the use and communication of new knowledge through the supervising of health care personnel caring for elderly with dementia. This in turn may lead to better health care for elderly. This supervision could take the form of a dialogue and shared reflections concerning the patients and their need of health care.
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| 34. |
- Sandborgh Englund, Gunilla
(författare)
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Pharmacokinetics of mercury from dental amalgam
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the present work has been to obtain quantitative and qualitative data on mercury from dental amalgam in humans. The influence of amalgam removal on mercury levels in blood, plasma and urine has been studied in twelve volunteers. All amalgam fillings were removed during one dental session. A transient increase of mercury in blood and plasma was observed within 48 h after amalgam removal, and sixty days after the mercury levels in all media had decreased to about 60% of the pre removal levels. A bi-exponential model was applied on mercury in plasma with the median half-time of the second phase being 88 days. The kinetics of mercury in urine was fitted to a mono-exponential model, the median half-time being 46 days. The pharmacokinetics of mercury vapor was studied after a single dose exposure in human volunteers. Nine subjects were exposed to 400 µg/m3 mercury vapor for15 min. The retention was on average 67% of the inhaled mercury dose. A rapid absorption phase was seen in blood and plasma, followed by a bi-exponential decline. In plasma the median half-time of the second phase was 10 days with a large inter-individual variation. The estimated total amount of mercury excreted via urine during 30 daysranged from 8% to 41%. Mercury levels in saliva and feces before and after amalgam removal were studied. The fecal mercury concentrations were more than ten times higher in the pre-removal samples than those found in a reference group with no amalgam fillings. Two days after removal, the fecal mercury concentrations increased about 100 times, followed by a significant decrease. Sixty days after amalgam removal, the mercury levels in feces were still slightly higher than in the reference group. In saliva the median mercury levels declined from the pre-removal level of 200 nmol/kg to 1 nmol/kg sixtydays after amalgam removal. The kidney is a target organ for inorganic mercury and in animal studies decreased renal function has been shown after placement of amalgam fillings. The mercury levels in blood, plasma and urine and the kidney function were studied before and after amalgam removal. A number of sensitive renal parameters were determined: the glomerular filtration rate (GFR) and the excretion of N-acetyl-ß glucose aminidase (NAG), ß2-microglobuline and albumin. No signs of kidney dysfunction were detectable. Effects on mercury levels in blood, plasma and urine after 14-days treatment with a chelating agent (DMSA) or placebo were studied in twenty subjects, relating their symptoms to mercury exposure from amalgam fillings. In addition, these effects were related to possible changes of symptoms. Three cases of generalized hypersensitive reactions were encountered at the end of the treatment period. A significant increase in urinary mercury excretion was apparent during DMSA treatment, and the blood mercury levels decreased. There was no evidence that chelating therapy alleviated symptoms allegedly attributable to mercury from amalgam fillings. In summary, amalgam fillings constitute a significant source of exposure to mercury. Mercury levels in blood, plasma, urine, saliva and feces decrease considerably after the removal of dental amalgam. No adverse effects on the kidney function were observed from the mercury exposure in conjunction with amalgam removal. DMSA treatment appears to mainly affect the mercury excretion from the kidney, and the risk of hypersensitivity reactions is considerable during prolonged treatment. Combined evaluation of the decline of mercury in plasma after amalgam removal and after the single dose exposure clearly verifies the pharmacokinetics of mercury as at least tri-exponential. The pharmacokinetic analysis of mercury verifies the daily mercury dose in subjects with an average number of amalgam fillings to be 5-9 µg per day.
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| 35. |
- Tan, Edwin C. K., et al.
(författare)
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Medications That Cause Dry Mouth As an Adverse Effect in Older People : A Systematic Review and Metaanalysis
- 2018
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 66:1, s. 76-84
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: To assess and quantify the risk of drug-induced dry mouth as a side effect in older people.DESIGN: Systematic review and metaanalysis.SETTING: A search of the literature was undertaken using Medline, Embase, Cochrane, Web of Science, and PubMed from 1990 to 2016.PARTICIPANTS: Older people (aged 60) who participated in intervention or observational studies investigating drug use as an exposure and xerostomia or salivary gland hypofunction as adverse drug outcomes.MEASUREMENTS: Two pairs of authors screened titles and abstracts of studies for relevance. Two authors independently extracted data, including study characteristics, definitions of exposure and outcome, and methodological quality. For the metaanalyses, random-effects models were used for pooling the data and I-2 statistics for exploring heterogeneity.RESULTS: Of 1,544 potentially relevant studies, 52 were deemed eligible for inclusion in the final review and 26 in metaanalyses. The majority of studies were of moderate methodological quality. In the intervention studies, urological medications (odds ratio (OR)=5.91, 95% confidence interval (CI)=4.04-8.63; I-2=62%), antidepressants (OR=4.74, 95% CI=2.69-8.32, I-2=21%), and psycholeptics (OR=2.59, 95% CI=1.79-3.95, I-2=0%) were significantly associated with dry mouth. In the observational studies, numbers of medications and several medication classes were significantly associated with xerostomia and salivary gland hypofunction.CONCLUSION: Medication use was significantly associated with xerostomia and salivary gland hypofunction in older adults. The risk of dry mouth was greatest for drugs used for urinary incontinence. Future research should develop a risk score for medication-induced dry mouth to assist with prescribing and medication management.
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| 36. |
- Tan, Edwin C. K., et al.
(författare)
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Validating a model for medication-related dental outcomes in older people
- 2022
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Ingår i: Oral Diseases. - : Wiley. - 1354-523X .- 1601-0825. ; 28:6, s. 1697-1704
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To externally validate a model for medication-related dental outcomes in (a) a general older population with dementia and (b) a matched population without dementia.Subjects and Methods: This validation study used population-based data from seven Swedish national registers (2008–2017). Individuals aged 60+ with dementia were matched to those without dementia on age, gender, and county of residence at the date of diagnosis (index date). The exposure was continuous use of xerogenic medications during the 3-year period before index date. The primary outcome was the number of tooth extraction and restorative procedures within 3 years after index date.Results: A total of 334,220 individuals were included in the final sample. In the dementia cohort, the use of urological drugs (incidence rate ratio [IRR] 1.08, 95% CI 1.03–1.13), respiratory medicines (IRR 1.10, 95% CI 1.04–1.17), and proton-pump inhibitors (IRR 1.09, 95% CI 1.05–1.13) was associated with the primary outcome. In the non-dementia cohort, respiratory medicines (IRR 1.03, CI 1.00–1.05), proton-pump inhibitors (IRR 1.06, CI 1.04–1.08), opioids (IRR 1.05, CI 1.03–1.07), and antidepressants (IRR 1.06, CI 1.04–1.08) were associated with the primary outcome.Conclusions: Although there were differences in prescription patterns, the model performed similarly in both those with and without dementia.
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| 37. |
- Tan, Edwin C. K., et al.
(författare)
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Xerogenic Medications as a Predictor for Dental Health Intervention in People with Dementia
- 2020
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 75:4, s. 1263-1271
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Tidskriftsartikel (refereegranskat)abstract
- Background: Older adults with dementia often have poor oral health. Chronic use of xerogenic medications may contribute to adverse dental outcomes.Objective: To investigate the impact of xerogenic medication classes on the predicted risk for dental interventions in people with dementia.Methods: Thiswas a population-based cohort study involving 30,955 individuals registered in the Swedish Dementia Registry (SveDem) from 2008 to 2015. Data were linked with other national registers. The exposure was xerogenic medication classes used in the three years prior to dementia diagnosis (baseline). The primary outcome was the composite of number of tooth extractions and dental restorations over the three-year follow-up period. Secondary outcomes included the number of tooth extractions and number of dental restorations. Poisson regression models were used to estimate the association between the exposure and outcomes. Analyses were adjusted for age, gender, Mini-Mental State Examination, living arrangement, dementia disorder, average number of medications, Charlson’s comorbidity index, number of dental visits, and number of teeth.Results: After adjusting for potential covariates, the use of urological drugs (incidence rate ratio [IRR] 1.16, 95% CI 1.04–1.28), proton pump inhibitors (IRR 1.13, 95% CI 1.04–1.23), and opioids (IRR 1.19, 95% CI 1.06–1.34) were significantly associated with the primary composite outcome.Conclusion: The use of specific classes of xerogenic medications was associated with an increased risk for tooth extractions and restorations in people with dementia. The risks and benefits of xerogenic medications, in the context of oral health, should be carefully assessed in this vulnerable population.
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| 38. |
- Vähäsarja, Niko, et al.
(författare)
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Neurological disease or intellectual disability among sons of female Swedish dental personnel
- 2016
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Ingår i: Journal of Perinatal Medicine. - Berlin, Germany : Walter de Gruyter. - 0300-5577 .- 1619-3997. ; 44:4, s. 453-460
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Prenatal exposure to elemental mercury may be a potential hazard for the offspring of female dental personnel working with dental amalgam. The aim of this study was to investigate whether potential in utero exposure to mercury might have affected the development of nervous system of the sons of Swedish female dental personnel leading to an increased risk of neurological disease or intellectual disability.Material and methods: We used national Swedish registers to investigate risks for diseases potentially related to adverse effects on neurodevelopment. Sons of female dentists (n=1690) and dental nurses (n=10,420) were compared with cohorts consisting of sons of other female healthcare personnel. Due to changes in mercury exposure in dentistry during the study period, analyses were stratified by decade of birth. Hazard ratios (HRs) were calculated using Cox proportional hazard models.Results: We found no elevated risk for neurological disease, epilepsy or intellectual disability among the sons of dental personnel during any of the decades studied. HRs for neurological disease among the dental nurse cohort were even below 1.00 during the 1970s and 1980s. A low number of events resulted in uncertainty regarding results in the dentist cohort.Conclusions: We did not find any support for the hypothesis that mercury exposure in Swedish dentistry during the 1960s, 1970s or 1980s had any effect on the incidence of neurological disease or intellectual disability among the sons of female dental personnel. Our results imply that current use of dental amalgam should not represent an elevated risk for neurological disease or intellectual disability among the offspring of dental personnel.
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