| 1. |
- Bratt, Ola, et al.
(författare)
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The Study of Active Monitoring in Sweden (SAMS) : A randomized study comparing two different follow-up schedules for active surveillance of low-risk prostate cancer
- 2013
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 47:5, s. 347-355
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Forskningsöversikt (refereegranskat)abstract
- Objective. Only a minority of patients with low-risk prostate cancer needs treatment, but the methods for optimal selection of patients for treatment are not established. This article describes the Study of Active Monitoring in Sweden (SAMS), which aims to improve those methods. Material and methods. SAMS is a prospective, multicentre study of active surveillance for low-risk prostate cancer. It consists of a randomized part comparing standard rebiopsy and follow-up with an extensive initial rebiopsy coupled with less intensive follow-up and no further scheduled biopsies (SAMS-FU), as well as an observational part (SAMS-ObsQoL). Quality of life is assessed with questionnaires and compared with patients receiving primary curative treatment. SAMS-FU is planned to randomize 500 patients and SAMS-ObsQoL to include at least 500 patients during 5 years. The primary endpoint is conversion to active treatment. The secondary endpoints include symptoms, distant metastases and mortality. All patients will be followed for 10-15 years. Results. Inclusion started in October 2011. In March 2013, 148 patients were included at 13 Swedish urological centres. Conclusions. It is hoped that the results of SAMS will contribute to fewer patients with indolent, low-risk prostate cancer receiving unnecessary treatment and more patients on active surveillance who need treatment receiving it when the disease is still curable. The less intensive investigational follow-up in the SAMS-FU trial would reduce the healthcare resources allocated to this large group of patients if it replaced the present standard schedule.
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| 2. |
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| 3. |
- Karalexi, Maria, et al.
(författare)
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Cardiovascular outcomes in transgender individuals in Sweden after initiation of gender-affirming hormone therapy
- 2022
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Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press. - 2047-4873 .- 2047-4881. ; 29:15, s. 2017-2026
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Tidskriftsartikel (refereegranskat)abstract
- Aims We compared the incidence of cardiovascular disease (CVD) in transgender participants with a diagnosis of gender dysphoria (GD) with and without gender-affirming hormone therapy (GAHT) to the incidence observed in the general population. Methods and results The population-based cohort included all individuals >10 years in Sweden linked to Swedish nationwide healthcare Registers (2006-16). Two comparator groups without GD/GAHT were matched (1:10) on age, county of residence, and on male and female birth-assigned sex, respectively. Cox proportional models provided hazard ratios (HRs) and 95% confidence intervals (CI) for CVD outcomes. Among 1779 transgender individuals [48% birth-assigned males (AMAB), 52% birth-assigned females (AFAB)], 18 developed CVD, most of which were conduction disorders. The incidence of CVD for AFAB individuals with GD was 3.7 per 1000 person-years (95% CI: 1.4-10.0). Assigned male at birth individuals with GD had an incidence of CVD event of 7.1 per 1000 person-years (95% CI: 4.2-12.0). The risk of CVD event was 2.4 times higher in AMAB individuals (HR: 2.4, 95% CI: 1.3-4.2) compared with cisgender women, and 1.7 higher compared with cisgender men (HR: 1.7, 95% CI: 1.0-2.9). Analysis limited to transgender individuals without GAHT yielded similar results to those with GAHT treatment. Conclusion The incidence of CVD among GD/GAHT individuals was low, although increased compared with matched individuals without GD and similar to the incidence among GD/no GAHT individuals, thus not lending support for a causal relationship between treatment and CVD outcomes. Larger studies with longer follow-up are needed to verify these findings, as well as possible effect modification by comorbidity.
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| 4. |
- Akbari, Saeed, et al.
(författare)
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Packaging Induced Stresses in Embedded and Molded GaN Power Electronics Components
- 2023
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Ingår i: Int. Conf. Therm., Mech. Multi-Phys. Simul. Exp. Microelectron. Microsyst., EuroSimE. - : Institute of Electrical and Electronics Engineers Inc..
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Konferensbidrag (refereegranskat)abstract
- Residual stresses created during the packaging process can adversely affect the reliability of electronics components. We used incremental hole-drilling method, following the ASTM E 837-20 standard, to measure packaging induced residual stresses in discrete packages of power electronics components. For this purpose, we bonded a strain gauge on the surface of a Gallium Nitride (GaN) power component, drilled a hole through the thickness of the component in several incremental steps, recorded the relaxed strain data on the sample surface using the strain gauge, and finally calculated the residual stresses from the measured strain data. The recorded strains and the residual stresses are related by the compliance coefficients. For the hole drilling method in the isotropic materials, the compliance coefficients are calculated from the analytical solutions, and available in the ASTM standard. But for the orthotropic multilayered components typically found in microelectronics assemblies, numerical solutions are necessary. We developed a subroutine in ANSYS APDL to calculate the compliance coefficients of the hole drilling test in the molded and embedded power electronics components. This can extend the capability of the hole drilling method to determine residual stresses in more complex layered structures found in electronics.
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| 5. |
- Burkard, Theresa, et al.
(författare)
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The associations between bariatric surgery and hip or knee arthroplasty, and hip or knee osteoarthritis : Propensity score-matched cohort studies
- 2022
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Ingår i: Osteoarthritis and cartilage open. - : Elsevier. - 2665-9131 .- 2665-9131. ; 4:2
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the associations between bariatric surgery and hip or knee arthroplasty, and secondary care hip or knee osteoarthritis (OA).METHODS: We performed cohort studies using data from Swedish nationwide healthcare registries. Patients aged 18-79 years who underwent bariatric surgery between 2006 and 2019 were matched on their propensity score (PS) to up to 2 obese patients ("unexposed episodes") in risk-set sampling. After a 1-year run-in period, episodes were followed in an "as-treated" approach. Using Cox proportional hazard regression, we calculated hazard ratios (HR) with 95% confidence intervals (CIs) of hip or knee arthroplasty overall and in subgroups of age, sex, joint location, arthroplasty type, bariatric surgery type, and by duration of follow-up if proportional hazard assumptions were violated. In a secondary cohort, we assessed the outcome incident secondary care hip or knee osteoarthritis (OA).RESULTS: Among 39'392 bariatric surgery episodes when compared to 61'085 PS-matched unexposed episodes (47'594 unique patients), the risk of hip or knee arthroplasty was strongest increased within the first three years of follow-up (HR 1.79, 95% CI 1.56-2.07), decreased thereafter, but remained elevated throughout follow-up. In a secondary cohort of 37'929 exposed when compared to 58'600 PS-matched unexposed episodes, the risk of hip or knee osteoarthritis was decreased (HR 0.84, 95% CI 0.79-0.90).CONCLUSION: Bariatric surgery is associated with increased risks of hip or knee arthroplasty, but also with decreased risks of secondary care OA. This contradiction supports the hypothesis that bariatric surgery may act as an enabler for hip or knee arthroplasty.
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| 6. |
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| 7. |
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| 8. |
- Carstensen, Anders, et al.
(författare)
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Integrating Requirement and Solution Modelling: Approach and Experiences
- 2007
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Ingår i: The 12th Workshop on Exploring Modelling Methods for Information Systems Analysis and Design (EMMSAD).
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Konferensbidrag (refereegranskat)abstract
- We discuss how an Enterprise Modelling approach, namely C3S3P, has been applied in an automotive supplier company. The paper concentrates on the phases of the C3S3P development process such as Concept Study, Scaffolding, Scoping, and Requirements Modelling. We have also presented the concept of task pattern which has been used in the MAPPER project for capturing, documenting and sharing best practices concerning business processes in organisation. Within this application context we have analysed our experiences concerning stakeholder participation and task pattern development.
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| 9. |
- Gerdtsson, Axel, et al.
(författare)
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Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours
- 2024
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Ingår i: BJU INTERNATIONAL. - : John Wiley & Sons. - 1464-4096 .- 1464-410X.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk-) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk- NSGCT. Patients and methods Observational prospective population-based study of patients diagnosed 2008-2019 with CS IIA Mk- NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk- disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. Results Overall, 126 patients with CS IIA Mk- NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6-18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk- NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. Conclusions Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk- NSGCT had a high rate of cancer and a low rate of teratoma.
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| 10. |
- Gerdtsson, Axel, et al.
(författare)
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Surgical Complications in Postchemotherapy Retroperitoneal Lymph Node Dissection for Nonseminoma Germ Cell Tumour : A Population-based Study from the Swedish Norwegian Testicular Cancer Group
- 2020
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Ingår i: European Urology Oncology. - : Elsevier BV. - 2588-9311. ; 3:3, s. 382-389
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Reports on perioperative complications after postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for nonseminoma germ cell tumour (NSGCT) are from experienced single centres, with a lack of population-based studies. OBJECTIVE: To assess the complications of bilateral and unilateral PC-RPLND. DESIGN, SETTING, AND PARTICIPANTS: A prospective, population-based, observational multicentre study included all patients with NSGCT who underwent PC-RPLND in Norway and Sweden during 2007-2014. Of a total of 318 patients, 87 underwent bilateral PC-RPLND and 231 underwent unilateral PC-RPLND. The median follow-up was 6 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Bilateral and unilateral PC-RPLND were compared for the outcomes of intra- and postoperative complications (graded by Clavien-Dindo) and retrograde ejaculation (with or without nerve-sparing surgery). Complications were reported as absolute counts and percentages. The χ2 test was used for comparisons. RESULTS AND LIMITATIONS: The incidence of intraoperative complications was higher for bilateral PC-RPLND than for unilateral PC-RPLND (14% vs 4.3%, p = 0.003), with ureteral injury as the most frequent reported complication (2% of the patients). Postoperative complications were more common after bilateral than after unilateral PC-RPLND (45% vs 25%, p = 0.001) with Clavien ≥3b reported in 8.3% and 2.2%, respectively (p = 0.009). Lymphatic leakage was the most common complication occurring in 11% of the patients. Retrograde ejaculation occurred more frequently after bilateral than after unilateral surgery (59% vs 32%, p < 0.001). Limitations of the study include reporting of retrograde ejaculation, which was based on a chart review. CONCLUSIONS: Intra- and postoperative complications including retrograde ejaculation are more frequent after bilateral PC-RPLND than after unilateral PC-RPLND. PATIENT SUMMARY: Lymph node dissection in patients with testicular cancer puts them at risk of complications. In this study, we present the complications after lymph node dissection.
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| 11. |
- Gerdtsson, Axel, et al.
(författare)
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Unilateral or Bilateral Retroperitoneal Lymph Node Dissection in Nonseminoma Patients with Postchemotherapy Residual Tumour? Results from RETROP, a Population-based Mapping Study by the Swedish Norwegian Testicular Cancer Group
- 2022
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Ingår i: European Urology Oncology. - : Elsevier BV. - 2588-9311. ; 5:2, s. 235-243
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The distribution of retroperitoneal lymph node metastases for patients with nonseminoma and a residual tumour of 10-49 mm in a population-based setting is unknown. This information is needed to justify selection of patients for a unilateral template resection. OBJECTIVE: To describe the location of retroperitoneal metastases and recurrences in patients with nonseminoma germ cell tumour (NSGCT) with a residual tumour of 10-49 mm. DESIGN, SETTING, AND PARTICIPANTS: RETROP is a population-based prospective observational mapping study of 213 patients in Sweden and Norway with a retroperitoneal residual tumour of 10-49 mm who underwent postchemotherapy retroperitoneal lymph node dissection for metastatic NSGCT during 2007-2014 with median follow-up of 100 mo. Patients were classified according to the testis primary tumour and the distribution of unilateral or bilateral lymph node metastases (with reference to the aorta) present on pre- and/or postchemotherapy computed tomography (CT) scans. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The distribution and rate of teratoma or cancer in unilateral or bilateral retroperitoneal fields and the location and rate of retroperitoneal recurrence were measured. RESULTS AND LIMITATIONS: In total, 65% of the patients had unilateral retroperitoneal lymph node metastases (RLNMs) on CT scans. Patients with unilateral RLNMs had a low risk of contralateral teratoma or cancer (1.6% for right- and 2.6% for left-sided NSGCT) or retroperitoneal recurrence (0% for right- and 4% for left-sided NSGCT). A weakness of the study is that the pathology specimen could not be fully designated to one specific area for some of the patients. CONCLUSIONS: Men with postchemotherapy residual disease of 10-49 mm and unilateral metastases on pre- and postchemotherapy CT scans have a low risk of contralateral disease and should be considered for a unilateral template resection. PATIENT SUMMARY: The surgeon can use computed tomography (CT) scans in deciding on the extent of lymph node dissection in patients with testicular cancer.
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| 12. |
- Holmberg, Dag, et al.
(författare)
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Absorption and radiation impedance of finite absorbing patches
- 2003
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Ingår i: Acta Acustica united with Acustica. - 1436-7947. ; 89:3, s. 406-415
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Tidskriftsartikel (refereegranskat)abstract
- A variational formulation is used to calculate the sound absorption in order to incorporate the interaction between several absorbing patches of arbitrary shape. In particular, this formulation is applied to small periodic patches. The absorption characteristics are governed by the radiation impedance, Z(r), which is a function of the absorber's geometry and the incidence angle, together with the surface impedance of the absorber. The behaviour of Z(r) is evaluated numerically for a number of typical configurations, and the effect on the statistical absorption coefficient, alpha(stat) is calculated. The evaluations stress that alpha(stat) is regulated by the interaction between Z(r) and the impedance of the absorber. A comparison is made of results from measurements and calculations performed on the measurement set-up.
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| 13. |
- Holmberg, Dag
(författare)
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Absorption Characteristics of Periodically Perforated Suspended Ceilings
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The sound absorption characteristics of resonant absorbers, implemented as perforated suspended inner ceilings attached with thin porous layers, are investigated. Several existing theories model the principal absorption mechanisms, but the interaction with the outer sound field influences the absorption in ways that can be modelled with new approaches. The effect of arranging the absorbing surfaces in various patterns is modelled with a variational model. Periodic effects, depending on correspondence of projected wavelength and the dimensions of the periodic cells for certain incidence angles and frequencies, is modelled with an approach that formerly has been used on periodically reinforced floors. The model presupposes reflection from absorbing points and is therefore intended for small perforations. In this way an efficient mathematical treatment is gained at the expense of generality. This model is then extended to incorporate the backing field, which makes it possible to handle lateral waves within the absorber and therefore non-locally reacting absorbers. In order to evaluate the presented theories, the static flow resistance, R, of the compound absorber (thin porous layer and rigid facing) has to be known. Since R of a compound absorber in many cases is hard to estimate from a R-value measured on separate samples of the porous layer, a new device for measurements of R. on compound absorbers was implemented. The device, which has a simple and robust construction, is intended for measurements on standard tiles of perforated plaster boards attached with a thin porous layer, but, by changing measurement interface, measurements can also be performed on the sole thin porous layer.
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| 14. |
- Holmberg, Dag, et al.
(författare)
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Aspirin or statin use in relation to survival after surgery for esophageal cancer : a population-based cohort study
- 2023
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Ingår i: BMC Cancer. - : BioMed Central (BMC). - 1471-2407. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Adjuvant postoperative treatment with aspirin and statins may improve survival in several solid tumors. This study aimed to assess whether these medications improve the survival after curatively intended treatment (including esophagectomy) for esophageal cancer in an unselected setting.Methods: This nationwide cohort study included nearly all patients who underwent esophagectomy for esophageal cancer in Sweden from 2006 to 2015, with complete follow-up throughout 2019. Risk of 5-year disease-specific mortality in users compared to non-users of aspirin and statins was analyzed using Cox regression, providing hazard ratios (HR) with 95% confidence intervals (CI). The HRs were adjusted for age, sex, education, calendar year, comorbidity, aspirin/statin use (mutual adjustment), tumor histology, pathological tumor stage, and neoadjuvant chemo(radio)therapy.Results: The cohort included 838 patients who survived at least 1 year after esophagectomy for esophageal cancer. Of these, 165 (19.7%) used aspirin and 187 (22.3%) used statins during the first postoperative year. Neither aspirin use (HR 0.92, 95% CI 0.67-1.28) nor statin use (HR 0.88, 95% CI 0.64-1.23) were associated with any statistically significant decreased 5-year disease-specific mortality. Analyses stratified by subgroups of age, sex, tumor stage, and tumor histology did not reveal any associations between aspirin or statin use and 5-year disease-specific mortality. Three years of preoperative use of aspirin (HR 1.26, 95% CI 0.98-1.65) or statins (HR 0.99, 95% CI 0.67-1.45) did not decrease the 5-year disease-specific mortality.Conclusions: Use of aspirin or statins might not improve the 5-year survival in surgically treated esophageal cancer patients.
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| 15. |
- Holmberg, Dag
(författare)
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Barrett's esophagus and the risk of adenocarcinoma
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Barrett’s esophagus is the precursor lesion of esophageal adenocarcinoma, a tumor with increasing incidence and poor prognosis. The overall aim of the thesis was to assess risk and prognosis in patients with Barrett’s esophagus and esophageal adenocarcinoma. Four studies were conducted based on data from Swedish nationwide registers and medical records from 71 Swedish hospitals. Study I was a population-based cohort study which assessed the risk of esophageal adenocarcinoma among patients with Barrett’s esophagus. Among 7,932 study participants with Barrett’s esophagus (median age 66 years, 68% men), 89 developed esophageal adenocarcinoma. After excluding prevalent adenocarcinomas (70%), 27 adenocarcinomas developed over a period of 18,415 person-years, which corresponded to an incidence rate of 1.5 (95% CI 0.9-2.0) cases per 1,000 person-years at risk and a standardized incidence ratio of 9.4 (95% CI 6.2-13.6). Study II was a population-based, nested case-control study designed to identify a prediction model for progression from Barrett’s esophagus to adenocarcinoma or high-grade dysplasia. All adenocarcinoma and high-grade dysplasia in patients with Barrett’s esophagus in Sweden were included as cases (n=279). Four randomly selected non-progressors per case were included as controls (n=1,089). For the included patients, endoscopy and histopathology records were collected and reviewed. Older age, male sex and longer Barrett’s esophagus segment length were associated with increased risk of adenocarcinoma/high-grade dysplasia. In contrast, hiatal hernia and esophagitis were not associated with tumor progression. A model based on age, sex and segment length predicted 71% of adenocarcinoma/high-grade dysplasia. Study III was a population-based cohort study which evaluated the adherence to surveillance and treatment guidelines for Barrett’s esophagus. All patients with dysplastic Barrett’s esophagus in Study II were included and followed for median 3.9 years using nationwide registers. Among 211 participants (71% low-grade dysplasia, 29% high-grade dysplasia), 84% had a follow-up endoscopy, 17% received endoscopic therapy and 8% underwent esophagectomy. However, 60% were not managed in accordance with clinical guidelines, mainly due to under-surveillance. Risk factors for deviation from surveillance and treatment recommended in guidelines were low-grade dysplasia compared to high-grade dysplasia and longer segment length compared to shorter segment length, while treatment in surgical compared to gastroenterological departments was associated with recommended surveillance and treatment. Study IV was a population-based cohort study which assessed whether endoscopy screening improves the prognosis of esophageal adenocarcinoma. Among 6,600 study participants with adenocarcinoma (mean age 70 years, 79% male) followed for 9,138 person-years, 7% had a history of gastroesophageal reflux disease and 9% underwent endoscopy before cancer diagnosis. The 5-year mortality was decreased in patients with history of gastroesophageal reflux disease (HR 0.71, 95% CI 0.64-0.80), and this decrease was only slightly attenuated by adjustment for prior endoscopy (HR 0.79, 95% CI 0.70-0.90). The 5-year mortality was unchanged in patients with 1-2 screening endoscopies (compared to patients without screening endoscopy), while those with ≥3 endoscopies for gastroesophageal reflux disease had improved survival in esophageal adenocarcinoma (HR 0.55, 95% CI 0.36-0.85). To conclude, the overall risk of adenocarcinoma in Barrett’s esophagus is low, but it is possible to predict a clearly higher risk of tumor progression based on a few clinically available risk factors, enabling tailored endoscopy surveillance in these patients. Currently, adherence to recommended surveillance and treatment guidelines is poor, and efforts to implement these guidelines in clinical practice are needed. Use of endoscopy screening has a limited impact on survival in adenocarcinoma unless performed frequently.
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| 16. |
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| 17. |
- Holmberg, Dag, et al.
(författare)
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Incidence and Mortality in Upper Gastrointestinal Cancer After Negative Endoscopy for Gastroesophageal Reflux Disease
- 2022
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Ingår i: Gastroenterology. - : Elsevier BV. - 0016-5085 .- 1528-0012. ; 162:2, s. 431-438.e4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Gastroesophageal reflux disease (GERD) is associated with an increased risk of cancer of the upper gastrointestinal tract. This study aimed to assess whether and to what extent a negative upper endoscopy in patients with GERD is associated with decreased incidence and mortality in upper gastrointestinal cancer (ie, esophageal, gastric, or duodenal cancer).METHODS: We conducted a population-based cohort study of all patients with newly diagnosed GERD between July 1, 1979 and December 31, 2018 in Denmark, Finland, Norway, and Sweden. The exposure, negative upper endoscopy, was examined as a time-varying exposure, where participants contributed unexposed person-time from GERD diagnosis until screened and exposed person-time from the negative upper endoscopy. The incidence and mortality in upper gastrointestinal cancer were assessed using parametric flexible models, providing adjusted hazard ratios (HRs) with 95% confidence intervals (CIs).RESULTS: Among 1,062,740 patients with GERD (median age 58 years; 52% were women) followed for a mean of 7.0 person-years, 5324 (0.5%) developed upper gastrointestinal cancer and 4465 (0.4%) died from such cancer. Patients who had a negative upper endoscopy had a 55% decreased risk of upper gastrointestinal cancer compared with those who did not undergo endoscopy (HR, 0.45; 95% CI, 0.43-0.48), a decrease that was more pronounced during more recent years (HR, 0.34; 95% CI, 0.30-0.38 from 2008 onward), and was otherwise stable across sex and age groups. The corresponding reduction in upper gastrointestinal mortality among patients with upper endoscopy was 61% (adjusted HR, 0.39; 95% CI, 0.37-0.42). The risk reduction after a negative upper endoscopy in incidence and mortality lasted for 5 and at least 10 years, respectively.CONCLUSIONS: Negative upper endoscopy is associated with strong and long-lasting decreases in incidence and mortality in upper gastrointestinal cancer in patients with GERD.
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| 18. |
- Holmberg, Dag, et al.
(författare)
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Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries : population based cohort study
- 2023
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Ingår i: BMJ. British Medical Journal. - : BMJ Publishing Group Ltd. - 0959-8146 .- 0959-535X. ; 382, s. e076017-
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Tidskriftsartikel (refereegranskat)abstract
- Objective To assess the incidence rate of oesophageal adenocarcinoma among patients with non-erosive gastro-oesophageal reflux disease compared with the general population.Design Population based cohort study.Setting All patients in hospital and specialised outpatient healthcare in Denmark, Finland, and Sweden from 1 January 1987 to 31 December 2019.Participants 486 556 adults (>18 years) who underwent endoscopy were eligible for inclusion: 285 811 patients were included in the non-erosive gastro-oesophageal reflux disease cohort and 200 745 patients in the validation cohort with erosive gastro-oesophageal reflux disease.Exposures Non-erosive gastro-oesophageal reflux disease was defined by an absence of oesophagitis and any other oesophageal diagnosis at endoscopy. Erosive gastro-oesophageal reflux disease was examined for comparison reasons and was defined by the presence of oesophagitis at endoscopy.Main outcome measures The incidence rate of oesophageal adenocarcinoma was assessed for up to 31 years of follow-up. Standardised incidence ratios with 95% confidence intervals were calculated by dividing the observed number of oesophageal adenocarcinomas in each of the gastro-oesophageal reflux disease cohorts by the expected number, derived from the general populations in Denmark, Finland, and Sweden of the corresponding age, sex, and calendar period.Results Among 285 811 patients with non-erosive gastro-oesophageal reflux disease, 228 developed oesophageal adenocarcinomas during 2 081 051 person-years of follow-up. The incidence rate of oesophageal adenocarcinoma in patients with non-erosive gastro-oesophageal reflux disease was 11.0/100 000 person-years. The incidence was similar to that of the general population (standardised incidence ratio 1.04 (95% confidence interval 0.91 to 1.18)), and did not increase with longer follow-up (1.07 (0.65 to 1.65) for 15-31 years of follow-up). For validity reasons, we also analysed people with erosive oesophagitis at endoscopy (200 745 patients, 1 750 249 person-years, and 542 oesophageal adenocarcinomas, corresponding to an incidence rate of 31.0/100 000 person-years) showing an increased overall standardised incidence ratio of oesophageal adenocarcinoma (2.36 (2.17 to 2.57)), which became more pronounced with longer follow-up.Conclusions Patients with non-erosive gastro-oesophageal reflux disease seem to have a similar incidence of oesophageal adenocarcinoma as the general population. This finding suggests that endoscopically confirmed non-erosive gastro-oesophageal reflux disease does not require additional endoscopic monitoring for oesophageal adenocarcinoma.
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| 19. |
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| 20. |
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| 21. |
- Holmberg, Per, 1964, et al.
(författare)
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On the emergence of the L1 research field : A comparative study of PhD abstracts in the Nordic countries 2000–2017
- 2019
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Ingår i: L1-Educational Studies in Language and Literature. - : Universiteit van Amsterdam. - 1567-6617 .- 1573-1731. ; 19, s. 1-27
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Tidskriftsartikel (refereegranskat)abstract
- Research of L1 education is recently established in the Nordic countries. Since the turn of the century we have seen the emergence of national and Nordic research networks, conference and publication series, research programs, and the designation of positions as professors and associate professors. Studies of Nordic L1 research have taken stock of the disciplinary sub fields, but empirical studies of the L1 school subject as a unitary field are still in demand. The aim of this study is to investigate the emergence of Nordic L1 research and its present profile(s) through PhD research. The present study examines the abstracts of Danish, Finnish, Norwegian and Swedish L1 PhD dissertations defended between 2000 and 2017. The re-sults point to a growing field. A general observation is that the research focuses on reading and writing, whereas oral and aesthetical expressions are minor topics. Another result is a set of national differences which are related to governmental policy documents and school curricula. Further, the research has be-come more internationally oriented during recent years. The L1 research is characterized as a profession-alized region (Bernstein, 2003) with strong didactization (Ongstad, 2004), and a potential for powerful disciplinary knowledge (Lambert, 2017).
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| 22. |
- Nyholm, Dag, et al.
(författare)
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Comparison of apomorphine and levodopa infusions in four patients with Parkinson's disease with symptom fluctuations.
- 2009
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 119:5, s. 345-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Motor fluctuations in patients with advanced Parkinson's disease may be successfully treated with subcutaneous apomorphine infusion or intraduodenal levodopa/carbidopa infusion. No comparative trials of these two alternatives were performed. AIMS OF THE STUDY: We present a subanalysis from a randomized crossover clinical trial where levodopa infusion as monotherapy was compared with any other combination of pharmacotherapy in fluctuating patients. Four patients used apomorphine infusion and oral levodopa in the comparator arm. The results of these four patients are presented in detail. METHODS: The duration of the trial was 3 + 3 weeks. Patients were video-recorded half-hourly on two non-consecutive days of both treatment arms. Blinded video ratings were used. Patient self-assessments of motor function and quality-of-life (QoL) parameters were captured using an electronic diary. RESULTS: Ratings in moderate to severe "off" state ranged 0-44% on apomorphine infusion and 0-6% on levodopa infusion. Moderate to severe dyskinesias were not recorded in any of the treatments. QoL was reported to be improved in all patients on duodenal levodopa infusion. CONCLUSIONS: Monotherapy with duodenal infusion of levodopa was more efficacious and brought greater QoL than combination therapy with apomorphine infusion in these fluctuating patients.
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| 23. |
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| 24. |
- Pålhagen, S. E., et al.
(författare)
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Interim analysis of long-term intraduodenal levodopa infusion in advanced Parkinson disease
- 2012
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Ingår i: Acta Neurologica Scandinavica. - : John Wiley & Sons. - 0001-6314 .- 1600-0404. ; 126:6, s. e29-e33
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Tidskriftsartikel (refereegranskat)abstract
- Background - This interim 12-month analysis is a part of an open-label, observational, prospective study on health outcomes and cost impact of levodopa/carbidopa intestinal gel (LCIG, Duodopa) in Parkinson disease (PD). The specific aim was to investigate clinical and health-related quality of life (HRQoL) effects in routine care. Methods - Unified PD rating scale (UPDRS) was the primary efficacy measurement. PD QoL questionnaire 39 (PDQ-39) assessed HRQoL. Subjects were assessed at baseline, andgt;= 3 months after surgery, and then every 3 months. Results - Twenty-seven treatment-naive subjects when started with LCIG showed a decrease in UPDRS score that was statistically significant throughout the year: UPDRS total score (mean +/- SD), baseline = 52.1 +/- 16.1, N = 27, month 0 (first visit; at least 3 months after permanent LCIG) = 43.1 +/- 16.7, N = 27, P = 0.003; month 12 = 42.5 +/- 22.6, n = 25, P = 0.017. PDQ-39 results also showed a tendency for improvement: PDQ-39 (mean +/- SD), baseline = 33.6 +/- 10.8, N = 27, month 0 = 27.1 +/- 11.8, N = 27, P = 0.001; 12 months = 28.8 +/- 12.8, n = 23, P = 0.126. Conclusions - LCIG provides functional improvement beginning at first visit that is sustained for 12 months.
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- Pålhagen, Sven E., et al.
(författare)
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Levodopa-carbidopa intestinal gel (LCIG) treatment in routine care of patients with advanced Parkinsons disease: An open-label prospective observational study of effectiveness, tolerability and healthcare costs
- 2016
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Ingår i: Parkinsonism & Related Disorders. - : ELSEVIER SCI LTD. - 1353-8020 .- 1873-5126. ; 29, s. 17-23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Continuous infusion of levodopa-carbidopa intestinal gel (LCIG) can effectively manage motor and non-motor complications in advanced Parkinsons disease (PD). Healthcare costs, quality of life (QoL), effectiveness, and tolerability were assessed in routine care treatment with LCIG. Methods: The seventy-seven patients enrolled in this prospective, open-label, 3-year study in routine medical care were LCIG-naive (N = 37), or had previous LCIG treatment for amp;lt;2 (N = 22), or amp;gt;= 2 (N = 18) years. Healthcare costs were collected monthly. PD symptoms and QoL were assessed with the Unified Parkinsons Disease Rating Scale (UPDRS), 39-item Parkinsons Disease Questionnaire (PDQ-39), and EuroQoL 5-Dimension Visual Analog Scale (EQ-5D VAS); LCIG dose, safety, and tolerability were monitored. Results: Mean monthly costs per patient ( 8226 5952) were similar across cohorts, remained steady during 3-year follow-up, and increased with PD severity and QoL impairment. In LCIG-naive patients, significant improvements compared to baseline were observed on the UPDRS total score and PDQ-39 summary index score through 18 months (n = 24; UPDRS, p = 0.033; PDQ-39, p = 0.049). Symptom control was maintained during 3-year follow-up in LCIG-experienced cohorts. Small changes in mean daily LCIG dose were observed. Adverse events were common and generally related to the device, procedure, levodopa, or laboratory evaluations. Conclusions: Costs in LCIG-treated patients were stable over 3 years. LCIG treatment led to significant improvements in motor function and QoL over 18 months in LCIG-naive patients and no worsening was observed in LCIG-experienced patients over 3 years despite natural PD progression over time. The longterm safety was consistent with the established LCIG profile. (C) 2016 AbbVie Inc. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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