| 1. |
- Aalykke, Marianne, et al.
(författare)
-
Participants and Non-participants in the Scand-Ankle study - An alcohol cessation intervention at the time of fracture surgery
- 2015
-
Ingår i: Clinical Health Promotion. - 2226-5864. ; 5:2, s. 49-53
-
Tidskriftsartikel (refereegranskat)abstract
- Background Clinical experience indicates that patients declining participation in randomised clinical trials (RCTs) at the time of surgery are older, less healthy and of lower social status than patients accepting to participate, compromising the external validity of the RCT and bringing the non-participants in higher risk at surgery. To our knowledge, no studies exist on patients with hazardous alcohol consumption who decline participation in RCTs at the time of surgery. The aim was to compare characteristics of the participants and non-participants in the Scand-Ankle RCT. Method The Scand-Ankle study is a RCT that investigates the effect of a 6-week gold standard alcohol intervention (GSP-A) on postoperative complications in patients drinking >21 units/week and undergoing ankle fracture surgery. This study included eligible patients that declined to participate in the Scand-Ankle RCT but gave informed consent to follow-up in their medical record (N=67). Their perioperative patient characteristics were obtained from their medical record and the characteristics were compared to the patients enrolled in the study so far (N=61). Results The baseline characteristics showed no differences between participants and non-participants, but some tendencies towards the non-participants being older, having severak co-morbidities and higher ASA scores. None of the variables of interest in relation to postoperative complications (age over 70 years, comorbidity, daily smoking, ASA scores, fracture type, BMI, alcohol) were significant predictors for non-participation. Conclusion No differences were found between participants and non-participants and no patient characteristics could significantly predict participation.
|
|
| 2. |
|
|
| 3. |
- Arnaud, Nicolas, et al.
(författare)
-
Moderators of outcome in a web-based substance use intervention for adolescents.
- 2015
-
Ingår i: SUCHT. - : Hogrefe Publishing Group. - 0939-5911 .- 1664-2856. ; 61:6, s. 377-387
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: In this article we explore the moderators of effectiveness of WISEteens (Web-based brief Intervention for SubstancE using teens), a fully automated web-based brief motivational intervention targeting risky substance use among adolescents. Based on previous studies, we examined the differential effects on drinking of sex, readiness to change, self-efficacy, alcohol risk status, and parental monitoring as hypothesized moderators. Methods: We analyzed completers data from a two-armed RCT study with follow-up assessment after 3 months, including N = 211 self-enrolled adolescents (16 – 18 years) who screened positive for at-risk substance use in Sweden, Belgium, the Czech Republic, and Germany. The trial compared a single-session brief motivational intervention to an assessment-only control group with AUDIT-C scores for drinking frequency, quantity, and frequency of binge drinking in the past month as study outcome. Results: The analyses revealed a statistically significant moderation effect for sex on drinking in the previous month, with a stronger effect for males. In contrast, readiness to change, self-efficacy, alcohol risk status, and parental monitoring did not moderate the effects. Conclusions: Although the trial was limited by large dropout, our findings imply that web-based interventions can be particularly effective for male adolescents, although the effects of WISEteens were largely independent of other individual characteristics. Web-based brief intervention should integrate gender-specific components to raise effectiveness for females.
|
|
| 4. |
- Baldus, Christiane, et al.
(författare)
-
Risky Sexual Behaviour and Sexual Victimization among Young People with Risky Substance Use in Europe-Perspectives from Belgium, Sweden, the Czech Republic, and Germany
- 2023
-
Ingår i: International Journal of Environmental Research and Public Health. - 1660-4601. ; 20:21
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Research indicates that among the risks associated with young people's alcohol and illicit drug use are sexual risks. However, insights into co-occurrence of substance use and sexual risks in adolescent samples and possible differences across countries are limited. METHODS: A sample of 1449 adolescents from Belgium, Sweden, the Czech Republic, and Germany screened positive for risky alcohol/illicit drug use in a web-based intervention against alcohol and illicit drug use. They also reported incidents of sex while being drunk and/or high on drugs, condomless sex on these occasions, and sexualized touching and sexual victimization while being drunk or high on drugs. RESULTS: In the sample, 21.5% of the participants reported sexualized touching, 9.9% being victim to sexual assault, and 49.8% having had sex while being drunk and/or high on drugs; of the latter, 48.3% had condomless sex. Reports on having had sex while being drunk and/or high on drugs were associated with higher levels of past 30-day binge drinking. Being a victim of sexual assault was associated with past 30-day binge drinking only in young men. CONCLUSION: When devising preventive interventions against risky substance use in adolescents, an additional focus should be set on integrating steps against sexual risks.
|
|
| 5. |
- Bradley, KA, et al.
(författare)
-
Alcohol Screening and Risk of Postoperative Complications on Male VA Patients Undergoing Major Non-cardiac Surgery
- 2011
-
Ingår i: Journal of General Internal Medicine. - : Springer Science and Business Media LLC. - 0884-8734 .- 1525-1497. ; 26:2, s. 162-169
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients who misuse alcohol are at increased risk for surgical complications. Four weeks of preoperative abstinence decreases the risk of complications, but practical approaches for early preoperative identification of alcohol misuse are needed. OBJECTIVE: To evaluate whether results of alcohol screening with the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) questionnaire—up to a year before surgery—were associated with the risk of postoperative complications. DESIGN: This is a cohort study. SETTING AND PARTICIPANTS: Male Veterans Affairs (VA) patients were eligible if they had major noncardiac surgery assessed by the VA’s Surgical Quality Improvement Program (VASQIP) in fiscal years 2004-2006, and completed the AUDIT-C alcohol screening questionnaire (0-12 points) on a mailed survey within 1 year before surgery. MAIN OUTCOME MEASURE: One or more postoperative complication(s) within 30 days of surgery based on VASQIP nurse medical record reviews. RESULTS Among 9,176 eligible men, 16.3% screened positive for alcohol misuse with AUDIT-C scores ≥ 5, and 7.8% had postoperative complications. Patients with AUDIT-C scores ≥ 5 were at significantly increased risk for postoperative complications, compared to patients who drank less. In analyses adjusted for age, smoking, and days from screening to surgery, the estimated prevalence of postoperative complications increased from 5.6% (95% CI 4.8–6.6%) in patients with AUDIT-C scores 1–4, to 7.9% (6.3–9.7%) in patients with AUDIT-Cs 5–8, 9.7% (6.6–14.1%) in patients with AUDIT-Cs 9–10 and 14.0% (8.9–21.3%) in patients with AUDIT-Cs 11–12. In fully-adjusted analyses that included preoperative covariates potentially in the causal pathway between alcohol misuse and complications, the estimated prevalence of postoperative complications increased significantly from 4.8% (4.1–5.7%) in patients with AUDIT-C scores 1–4, to 6.9% (5.5–8.7%) in patients with AUDIT-Cs 5-8 and 7.5% (5.0–11.3%) among those with AUDIT-Cs 9–10. CONCLUSIONS: AUDIT-C scores of 5 or more up to a year before surgery were associated with increased postoperative complications.
|
|
| 6. |
- Egholm, Julie Weber Melchior, et al.
(författare)
-
Minor effect of patient education for alcohol cessation intervention on outcomes after acute fracture surgery : A randomized trial of 70 patients
- 2022
-
Ingår i: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 424-431
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: High alcohol intake is associated with increased risk of postoperative complications. Alcohol cessation intervention is recommended prior to elective surgery. We investigated short- and long-term effects of perioperative intensive alcohol intervention in relation to acute ankle fracture surgery.PATIENTS AND METHODS: 70 patients requiring ankle fracture surgery and consuming ≥ 21 drinks weekly (1 drink = 12 g ethanol) were randomized to a manual-based 6-week intensive standardized alcohol cessation program, the Gold Standard Program (GSP-A), or treatment as usual (TAU), on the day of operation. GSP-A included 5 personal meetings, patient education, and motivational and pharmacological support (alcohol withdrawal prophylaxis, B vitamins, and low-dose disulfiram). Complications requiring treatment were measured after 6 weeks and 1 year. Alcohol intake was validated by biomarkers. Quality of life (QoL) was measured by the SF-36. Hospital costs were obtained from the National Hospital Costs Register.RESULTS: Postoperatively, complete alcohol cessation was higher in the GSP-A than in the TAU group (18/35 vs. 5/35, number needed to treat = 3, p ≤ 0.001), but not lowrisk consumption in the long term (10/35 vs. 7/33, p = 0.5). Number of complications in the short and long term (12/35 vs. 14/33, 16/35 vs. 18/33), the SF-36 score, or hospital costs in the short and long term (€6,294 vs. €8,024, €10,662 vs. €12,198), were similar between the groups.INTERPRETATION: Despite an effect on alcohol cessation and a positive tendency as regards the other outcomes, the postoperative complications, QoL, and costs were similar. Better perioperative strategies for acute surgical patients with high alcohol intake therefore need to be developed.
|
|
| 7. |
- Egholm, Julie W.M., et al.
(författare)
-
Perioperative alcohol cessation intervention for postoperative complications
- 2018
-
Ingår i: Cochrane Database of Systematic Reviews. - 1361-6137. ; 2018:11
-
Forskningsöversikt (refereegranskat)abstract
- Background: Risky consumption of alcohol is a global problem. More than 3.3 million deaths annually are associated with risky use of alcohol, and global alcohol consumption continues to increase. People who have high alcohol consumption often require planned and emergency surgical procedures. Risky drinking is associated with increased postoperative complications such as infections, cardiopulmonary complications, and bleeding episodes. Alcohol causes disorders of the liver, pancreas, and nervous system. Stopping consumption of alcohol can normalize these organ systems to some degree and may reduce the occurrence of complications after surgery. This review was first published in 2012 and was updated in 2018. Objectives: To assess the effects of perioperative alcohol cessation interventions on rates of postoperative complications and alcohol consumption. Search methods: We searched the following databases up until 21 September 2018: Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; CINAHL via EBSCOhost; and two trials registers. We scanned the reference lists and citations of included trials and any identified relevant systematic reviews for further references to additional trials. When necessary, we contacted trial authors to ask for additional information. Selection criteria: We included all randomized controlled trials (RCTs) that evaluated the effects of perioperative alcohol cessation interventions on postoperative complications and alcohol consumption. We included participants with risky consumption of alcohol who were undergoing all types of elective or acute surgical procedures under general or regional anaesthesia or sedation, who were offered a perioperative alcohol cessation intervention or no intervention. We defined 'risky drinking' as alcohol consumption equivalent to more than 3 alcoholic units (AU)/d or 21 AU/week (with 1 AU containing 12 grams of ethanol) with or without symptoms of alcohol abuse or dependency. This corresponds to the amount of alcohol associated with increased postoperative complication rates in most clinical studies. Data collection and analysis: We used guidance provided in the Cochrane Handbook for Systematic Reviews of Interventions. We presented main outcomes as dichotomous variables in a meta-analysis. When data were available, we conducted subgroup and sensitivity analyses to explore the risk of bias. Primary outcome measures were postoperative complications and in-hospital and 30-day mortality. Secondary outcomes were successful quitting at the end of the programme, postoperative alcohol use, and length of hospital stay. We assessed the quality of evidence using the GRADE approach. Main results: We included in this updated review one new study (70 participants), resulting in a total of three RCTs (140 participants who drank 3 to 40 AU/d). All three studies were of moderate to good quality. All studies evaluated the effects of intensive alcohol cessation interventions, including pharmacological strategies for alcohol withdrawal symptoms, patient education, and relapse prophylaxis. We identified one ongoing study. Overall, 53 of the 122 participants from three studies who underwent surgery developed any type of postoperative complication that required treatment. Of 61 participants in the intervention groups, 20 had complications, compared with 33 of 61 participants in the control groups (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.40 to 0.96). Results show differences between the three clinical studies regarding outcome measurement and intensity of the interventions. However, all alcohol cessation programmes were intensive and included pharmacological therapy. The overall quality of evidence for this outcome is moderate. In-hospital and 30-day postoperative mortality rates were low in the three studies. Researchers reported one death among 61 participants in the intervention groups, and three deaths among 61 participants in the control groups (RR 0.47, 95% CI 0.07 to 2.96). The quality of evidence for this outcome is low. Investigators describe more successful quitters at the end of the intervention programme than among controls. Forty-one out of 70 participants in the intervention groups successfully quit drinking compared with only five out of 70 participants in the control groups (RR 8.22, 95% CI 1.67 to 40.44). The quality of evidence for this outcome is moderate. All three studies reported postoperative alcohol consumption (grams of alcohol/week) at the end of the programme as median and range values; therefore it was not possible to estimate the mean and the standard deviation (SD). We performed no meta-analysis. All three studies reported length of stay, and none of these studies described a significant difference in length of stay. Data were insufficient for review authors to perform a meta-analysis. No studies reported on the prevalence of participants without risky drinking in the longer term. Authors' conclusions: This systematic review assessed the efficacy of perioperative alcohol cessation interventions for postoperative complications and alcohol consumption. All three studies showed a significant reduction in the number of participants who quit drinking alcohol during the intervention period. Intensive alcohol cessation interventions offered for four to eight weeks to participants undergoing all types of surgical procedures to achieve complete alcohol cessation before surgery probably reduced the number of postoperative complications. Data were insufficient for review authors to assess their effects on postoperative mortality. No studies reported an effect on length of stay, and no studies addressed the prevalence of risky drinking in the longer term. Included studies were few and reported small sample sizes; therefore one should be careful about drawing firm conclusions based on these study results. All three studies were conducted in Denmark, and most participants were men. The included participants may represent a selective group, as they could have been more motivated and/or more interested in participating in clinical research or otherwise different, and effects may have been overestimated for both intervention and control groups in these studies. Trial results indicate that these studies are difficult to perform, that strong research competencies are necessary for future studies, and that further evaluation of perioperative alcohol cessation interventions in high-quality randomized controlled trials is needed. Once published and assessed, the one 'ongoing' study identified may alter the conclusions of this review.
|
|
| 8. |
- Eriksson, Sebastian, et al.
(författare)
-
Review: Experiences and preferences of counselling about living habits in healthcare – a systematic review of studies on the patient perspective
- 2013
-
Ingår i: Clinical Health Promotion. - 2226-5864. ; 3:2
-
Forskningsöversikt (refereegranskat)abstract
- Background Recent policy in Sweden states that patients in every part of health care are to be presented with health counselling concerning living habits: tobacco, alcohol, an inactive lifestyle and eating habits. This review aims to investigate experiences and preferences of counselling about living habits from the patient’s perspective. Method A literature review of six major databases using a wide approach to detect studies of different methodologies, patient categories, health care settings and intervention types. Inclusion criteria were studies in any setting/category concerning patients’ experience of discussing living habits with a health care practitioner (HCP). Results came to merit synthesis and quality appraisal using only instruments for qualitative studies. Results 21 studies are presented. With one exception all originate from primary care. Themes are presented under headlines: encouragement, empowerment & support; doctor-patient relationship; individualization & involvement; stigma; time and on-going support; empathy; and attitudes not favoured by patients. Most studies are of good quality with the most common remark of not having discussed chosen methodology or not having discussed the researcher’s role in outcome. Results are discussed in relation to Motivational Interviewing, Self-Determination Theory and Social Cognitive Theory. A review of qualitative studies had to take special emphasis to search strategy, quality appraisal and synthesis. Conclusion/implication This review provides an overview of published studies in the field of patient experience. Further study is needed to widen the scope beyond Primary care and to secure findings in more controlled settings.
|
|
| 9. |
- Freiburghaus, Tove, et al.
(författare)
-
The right to smoke and the right to smoke-free surroundings : International comparison of smoke-free psychiatric clinic implementation experiences
- 2021
-
Ingår i: BJPsych Open. - : Royal College of Psychiatrists. - 2056-4724. ; 7:3
-
Tidskriftsartikel (refereegranskat)abstract
- Background In Scandinavia, people with a severe mental disorder have a reduced life expectancy of 15-20 years compared with the general public. Smoking is a major contributor, and smoke-free policies are increasingly adopted in psychiatric clinics around the world. We compared potential facilitators and barriers among staff and management, for the implementation of smoke-free psychiatric clinics. Aims To investigate the attitudes and experiences regarding smoke-free policies among managers and staff involved in the implementation processes of smoke-free psychiatric clinics at hospitals in Malmö (Sweden) and Barcelona (Spain). Method We used a qualitative methodology, with 15 semi-structured interviews. The interviews were conducted with each participant individually, and were subsequently transcribed. The data were analysed with systematic text condensation. Results There were notable differences in how the smoke-free policies were carried out and experienced, and attitudes regarding the policy changes differed in the two settings. Key differences were the views on the right to smoke in compulsory care and to stay in smoke-free surroundings supported by smoking cessation intervention; the prioritisation of staff facilitation of smoking breaks; and views on smoking and smoke-free psychiatry. In contrast, participants agreed on the importance of staff education and management support. A smoking ban by law and belonging to a network of smoke-free hospitals were also relevant. Conclusions Staff education, and support from staff and management for the patients' right to stay in smoke-free surroundings, facilitated successful implementation of smoke-free policies in the psychiatric clinics, whereas supporting the right to smoke was a barrier.
|
|
| 10. |
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
|
|
| 14. |
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Hedin, Gita, et al.
(författare)
-
Contributory factors for teen insomnia symptoms : A prospective cohort study in Sweden
- 2022
-
Ingår i: Frontiers in Neuroscience. - : Frontiers Media S.A.. - 1662-4548 .- 1662-453X. ; 16, s. 1-8
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectivesInsufficient sleep is a public health problem that impacts the mental and physical health of children and adolescents. Complaints of insomnia are particularly pervasive among adolescents. This longitudinal study investigates factors that contribute to teen insomnia symptoms. DesignFive-year prospective follow-up study. SettingSchool-based. ParticipantsA total of 522 children (49.8% girls) aged 9.4 +/- 1.3 years at baseline; 14.4 +/- 0.7 years at follow-up. MeasurementsThe dependent variable of insomnia symptoms at follow-up was assessed with the Minimal Insomnia Symptom Scale-Revised. The independent variables at baseline were the perceived family financial situation, tiredness at school, problems waking up, short sleep duration, sleeping difficulties, having a bedroom Television (TV), and time spent with a TV/computer. Multivariate binary logistic regression analyses were used to examine whether the independent variables at baseline predicted insomnia symptoms at follow-up. ResultsPerceived quite bad/very bad family financial situation (OR 3.1; CI 1.4-6.7) and short sleep duration (<10 h) (OR 2.3; CI 1.0-5.3) among girls at baseline were associated with insomnia symptoms at follow-up. Having problems waking up among boys at baseline was associated with insomnia symptoms at follow-up (OR 4.9; CI 1.6-14.4). ConclusionShort sleep duration, problems waking up, and perceived bad family financial situation during childhood were linked with adolescent insomnia symptoms. The sex-based differences in these associations warrant further investigation to effectively mitigate adolescent insomnia.
|
|
| 18. |
|
|
| 19. |
- Hedin, Gita, et al.
(författare)
-
Facilitators and Barriers for a Good Night's Sleep Among Adolescents
- 2020
-
Ingår i: Frontiers in Neuroscience. - : Frontiers Media S.A.. - 1662-4548 .- 1662-453X. ; 14, s. 1-8
-
Tidskriftsartikel (refereegranskat)abstract
- Background Sleep deprivation among adolescents is a major public health issue. Although previous studies have described their sleep habits and the consequences thereof, the voices of adolescents themselves are rarely heard. The aim of this study was to investigate adolescents' experiences regarding what they perceived as facilitators and barriers for a good night's sleep. Methods A qualitative focus group study with Swedish adolescents (n = 45) aged 16-18 years was performed with seven focus groups and analyzed using qualitative content analysis. Results Three categories were identified in the analysis regarding facilitators and barriers for achieving a good night's sleep: (1) Striving for a sense of well-being, (2) Tiring yourself out, and (3) Regulating electronic media availability. The adolescents thought that sleep was important in order to be able to cope with everyday life and to allow physical recovery. Overall, the adolescents were knowledgeable regarding commonly recommended strategies for improving sleep, but they had trouble finding a balance between sleep and other activities. Electronic media was used to obtain a sense of belonging and to communicate with others, which in itself was described as important for the adolescents' well-being. However, communicating with friends and family during the night conflicted with achieving a good night's sleep. Parental behaviors (late work habits, internet rules) were also perceived as important for adolescents' sleep habits. Conclusions An understanding of the dilemma of finding a balance between sleep and other activities may aid future sleep-promoting interventions for adolescents, incorporating the impact from social factors' on the adolescents' sleep.
|
|
| 20. |
- Hedin, Gita, et al.
(författare)
-
Insomnia in Relation to Academic Performance, Self-Reported Health, Physical Activity, and Substance Use Among Adolescents
- 2020
-
Ingår i: International Journal of Environmental Research and Public Health. - Basel : MDPI. - 1661-7827 .- 1660-4601. ; 17:17
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: Insomnia affects up to one in four adolescents and has been shown to have a negative impact on their mental and physical health. This study aimed to investigate the association between insomnia, academic performance, self-reported health, physical activity, school start time, and substance use among adolescents. Methods: A survey with a cross-sectional design was completed by adolescents (15-17 years old; n = 1504) in southern Sweden. The Minimal Insomnia Symptoms Scale (MISS) was used to operationalize insomnia. A multiple logistic regression analysis was used to analyze the relationship between insomnia and self-reported health, failed school courses, substance use, school start time, family financial situation, screen time, and gender. Results: Insomnia (MISS >= 6) was associated with poor self-reported health (OR: 4.35), failed school courses (OR: 1.47), and use of alcohol and/or cigarettes (OR: 1.43). When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity (<= 1 time/week) and poor self-reported health was strongly associated with insomnia (OR: 18.87). Conclusions: Insomnia was associated with other problems that in themselves are risk factors for poor health. This highlights the need for a holistic health-promoting approach to prevent insomnia, such as efforts to promote physical activity, school success, and the reduction of alcohol/cigarette use.
|
|
| 21. |
- Hedin, Gita, et al.
(författare)
-
Kort sömnlängd, problem med att vakna och upplevd dålig familjeekonomi under barndomen är kopplade till symtom på insomni hos ungdomar : en longitudinell studie
- 2024
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Otillräcklig sömn är ett folkhälsoproblem som påverkar den psykiska och fysiska hälsan hos barn och ungdomar. Klagomål om sömnbesvär är särskilt vanligt bland ungdomar. Denna longitudinella studie syftade till att undersöka huruvida sömnlängd, väckningssvårigheter, trötthet i skolan och familjens ekonomiska situation bland flickor och pojkar på låg- och mellanstadiet (6-10 år) kan förutsäga symptom på insomni hos tonåringar på högstadiet och gymnasiet (14-16 år). Barn på lågstadiet och mellanstadiet (n = 522, 49,8 % flickor) i södra Sverige besvarade ett frågeformulär vid baslinjemätningen (9,4 år, SD 1,28 år) och vid uppföljning på högstadiet och gymnasiet (ålder 14,3, SD 0,69). Logistiska regressionsanalyser användes för att undersöka om trötthet i skolan, problem med att vakna, kort sömnlängd och upplevd familjeekonomi vid baslinjen förutspådde symptom på insomni vid uppföljning. Resultatet visade att upplevd ganska dålig/mycket dålig familjeekonomisk situation (OR 3,3) och kort sömnlängd (< 10 timmar) (OR2,3) bland flickor vid baslinjen var associerade med symtom på insomni vid uppföljningen. Att ha problem med att vakna bland pojkar vid baslinjen var associerat med symtom på insomni vid uppföljning (OR: 3,6). Kort sömnlängd, problem med att vakna och upplevd dålig familjeekonomi under barndomen var kopplade till symtom på insomni hos ungdomar. Skillnader mellan flickor och pojkar i föreliggande studier motiverar ytterligare studier för att effektivt kunna ge stöd till ungdomar med sömnbesvär.
|
|
| 22. |
|
|
| 23. |
- Hedin, Gita, et al.
(författare)
-
Measurement properties of the minimal insomnia symptom scale (MISS) in adolescents
- 2022
-
Ingår i: Sleep Science and Practice (SSP). - : BioMed Central. - 2398-2683. ; :6
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The Minimal Insomnia Symptom Scale (MISS) is a three-item screening instrument that has been found to be psychometrically sound and capable of screening for insomnia among adults and older people. This study aimed to test the measurement properties of the MISS together with an additional item focusing on daytime functioning among adolescents using the Rasch measurement model.Methods: A cross-sectional design was used, and data from adolescents (age 13–17 years, n = 3022) were analyzed using the Rasch measurement model.Results: The MISS had good measurement properties. When adding the item “daytime disturbance”, the measurement properties deteriorated. When replacing the original MISS item “not rested by sleep” with the item “daytime disturbance”, the measurement properties slightly improved. We label this new scale the MISS-Revised (MISS-R). The reliability was better for the MISS-R (0.55) compared to the MISS (0.50). The optimal cut-off was found to be > 6 points, both for the MISS and the MISS-R.Conclusions: This study provides general support that both the MISS as well as the MISS-R have good fit to the Rasch model. At this stage, neither the MISS nor the MISS-R can be advocated over the other for use among adolescents, although the MISS-R had slightly better reliability than the MISS. Additional studies are needed to determine the clinically optimal cut-score for identification of insomnia.
|
|
| 24. |
|
|
| 25. |
|
|
| 26. |
- Hovhannisyan, Karen, et al.
(författare)
-
Compliance with the Very Integrated Program (VIP) for smoking cessation, nutrition, physical activity and comorbidity education among patients in treatment for alcohol and drug addiction
- 2019
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 16:13
-
Tidskriftsartikel (refereegranskat)abstract
- Meeting adherence is an important element of compliance in treatment programmes. It is influenced by several factors one being self-efficacy. We aimed to investigate the association between self-efficacy and meeting adherence and other factors of importance for adherence among patients with alcohol and drug addiction who were undergoing an intensive lifestyle intervention. The intervention consisted of a 6-week Very Integrated Programme. High meeting adherence was defined as >75% participation. The association between self-efficacy and meeting adherence were analysed. The qualitative analyses identified themes important for the patients and were performed as text condensation. High self-efficacy was associated with high meeting adherence (ρ = 0.24, p = 0.03). In the multivariate analyses two variables were significant: avoid complications (OR: 0.51, 95% CI: 0.29-0.90) and self-efficacy (OR: 1.28, 95% CI: 1.00-1.63). Reflections on lifestyle change resulted in the themes of Health and Wellbeing, Personal Economy, Acceptance of Change, and Emotions Related to Lifestyle Change. A higher level of self-efficacy was positively associated with meeting adherence. Patients score high on avoiding complications but then adherence to the intervention drops. There was no difference in the reflections on lifestyle change between the group with high adherence and the group with low adherence.
|
|
| 27. |
- Hovhannisyan, Karen, et al.
(författare)
-
Evaluation of Very Integrated Program (VIP) : Health promotion for patients with alcohol and drug addiction - A randomized trial
- 2020
-
Ingår i: Alcoholism. - : Wiley. - 0145-6008 .- 1530-0277. ; 44:7, s. 1456-1467
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Compared to the general population, patients with alcohol and drug addiction have an increased risk of additional hazardous lifestyles and suffer from more chronic diseases, adding to their already significantly higher morbidity and mortality. The objective of this study was to test the efficacy of the Very Integrated Program (VIP) on treatment and health outcomes for patients diagnosed with alcohol and drug addiction.METHODS: Parallel randomized clinical trial with intervention as add-on to addiction care as usual. A total of 322 patients aged 18 years or older were identified, and the study requirements were fulfilled by 219 patients, 7 of whom participated in a pilot. The intervention was a 6-week intensive, tailored, educational program that included motivational interviewing, a smoking cessation program, dietary and physical activity counseling, and patient education. The main outcome measures were substance-free days, time to relapse and treatment adherence assessed after 6 weeks and 12 months. Secondary outcomes were lifestyle factors, symptoms of comorbidity, and quality of life. Missing data were imputed conservatively by using data closest to the follow-up date and baseline values in patients with no follow-up.RESULTS: The 212 patients (intervention, n=113; control, n=99) were randomized, and 202 had complete data for primary outcomes. After 6 weeks, there were no significant differences between the groups regarding primary or secondary outcomes. At the 12-month follow-up, the patients in the control group had significantly more total substance-free days (139 days; ranging 0-365 vs. 265; 0-366, p=0.021) - specifically among the patients with drug addiction - and higher physical and mental quality of life (45 vs 58, p= 0.049 and 54 vs. 66, p=0.037), but not in the per-protocol analysis (60 vs. 46, p=0.52 and 70 vs. 66, p=0.74). The sensitivity analyses did not support significant differences between the groups.CONCLUSION: Overall, adding VIP intervention did not improve outcome of the alcohol or drug addiction care or the lifestyle compared to the addiction care alone. This patient group is still in need of effective programs and new intervention research is required to develop that.
|
|
| 28. |
- Hovhannisyan, Karen, et al.
(författare)
-
Very Integrated Program (VIP): Smoking and other lifestyles, co-morbidity and quality of life in patients undertaking treatment for alcohol and drug addiction in Sweden.
- 2018
-
Ingår i: Clinical Health Promotion. - : Clinical Health Promotion Centre. - 2226-5864. ; 8:1, s. 14-19
-
Tidskriftsartikel (refereegranskat)abstract
- Background Most patients with alcohol and drug addiction have other risky lifestyles and non-communicable diseases (NCDs), adding to their morbidity and pre-mortality. Those are, however, potentially preventable. The aim was to identify and compare the patients in treatment for alcohol and drug addiction and identify important factors for high risk. Methods Data was collected prospectively by interviews, questionnaires, examinations and laboratory tests regarding demographics, smoking, overweight, malnutrition, sedentary lifestyle, heart, lung and liver diseases, diabetes and quality of life. High-risk was identified by >2 NCDs and risky lifestyles. Results 322 (192 and 130) patients participated, aged 52 years in median (ranging 24-80) and 67% men. Only 7% had no other risky lifestyles and NCDs. 62% were smokers, 11% in risk of malnutrition, 36% physical inactive and BMI was 27 (17-50). Furthermore, 41% had cardiovascular illness, 27% liver and 25% respiratory diseases, and 7% diabetes. After adjustment for confounders, drug addiction was significantly associated to younger age (46 vs. 56 years; OR 0.92 [CI 0.89-0.94]), unemployment (85% vs 66%; 0.35 [0.17-0.72]) and liver disease (49% vs. 12%; 0.21 [0.11-0.40]). The high-risk group was significantly older and more often unemployed. Health-related quality of life was not different between the groups. Conclusion The large majority of patients in treatment for alcohol and drug addiction have common risky lifestyles and NCD comorbidity. They also have similar conditions, including quality of life. This may be important when planning a future very intergrated program (VIP) of health promotion.
|
|
| 29. |
- Højgaard, B, et al.
(författare)
-
The potential of smoking cessation programmes and a smoking ban in public places: comparing gain in life ex-pectancy and cost effectiveness.
- 2011
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 39:8, s. 785-796
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Interventions aimed at reducing the number of smokers are generally believed to be cost effective. However as the cost of the interventions should be paid up front whereas the gains in life years only appear in the future--the budgetary consequences might be a barrier to implementing such interventions. AIMS: The aim of the present paper was to assess the long-term cost effectiveness as well as the short-term (10 years) budget consequences of cessation programmes and a smoking ban in enclosed public places. METHODS: We develop a population-based Markov model capable of analyzing both interventions and assess long-term costs effectiveness as well as short-term budgetary consequences and outcome gains. The smoking cessation programme model was based on data from the Danish National Smoking Cessation Database (SCDB), while the model of the smoking ban was based on effect estimates found in the literature. RESULTS: On a population level the effect of a smoking ban has the largest potential compared with the effect of smoking cessation programmes. Our results suggest that smoking cessation programmes are cost saving and generate life-years, whereas the costs per life-year gained by a smoking ban are 40,645 to 64,462 DKK (100 DKK = €13.4). These results are conservative as they do not include the healthcare cost saving related to reduced passive smoking. CONCLUSIONS: Our results indicate that smoking cessation programmes and a smoking ban in enclosed public places both in the short term and the long term are cost-effective strategies compared with the status quo.
|
|
| 30. |
|
|
| 31. |
- Jørgensen, CH, et al.
(författare)
-
The Efficacy of Disulfiram for the Treatment of Alcohol Use Disorder.
- 2011
-
Ingår i: Alcoholism: Clinical and Experimental Research. - : Wiley. - 0145-6008. ; 35:10, s. 1749-1758
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Alcohol use disorders (AUD) involving hazardous, harmful, and addictive misuse of alcohol are widespread in most parts of the world. The aim of this study was to review the effect of disulfiram in the treatment of patients with AUD. The effect of disulfiram was evaluated according to the primary outcome of an intake of alcohol below 30 and 20 g/d for men and women, respectively, as well as secondary outcomes such as days until relapse, alcohol intake, and numbers of drinking days. Methods: A systematic review of the literature was conducted using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL). Results: Eleven randomized controlled trials were included with a total of 1,527 patients. They compared disulfiram treatment with placebo, none or other abstinence-supportive treatments. Overall, 6 studies reported of a significant better effect on abstinence for patients treated with disulfiram. Six of 9 studies measuring secondary outcomes reported that patients treated with disulfiram had significantly more days until relapse and fewer drinking days, respectively. The quality of the included studies was moderate. Heterogeneity was significant in most of the meta-analyses, but valid results were found regarding the effect of disulfiram versus placebo over 12 months and unsupervised disulfiram versus other or no treatment. The vast majority of significant studies were of shorter duration, while only 3 studies of 12 months were significant regarding more days until relapse and/or reduction in drinking days. Conclusions: Supervised treatment with disulfiram has some effect on short-term abstinence and days until relapse as well as number of drinking days when compared with placebo, none, or other treatments for patients with alcohol dependency or abuse. Long-term effect on abstinence has not been evaluated yet. However, there is a need for more homogeneous and high-quality studies in the future regarding the efficacy of disulfiram.
|
|
| 32. |
|
|
| 33. |
|
|
| 34. |
- Kehlet, Mette, et al.
(författare)
-
The Gold Standard Program for Smoking Cessation is Effective for Participants Over 60 Years of Age.
- 2015
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 12:3, s. 2574-2587
-
Tidskriftsartikel (refereegranskat)abstract
- Tobacco smoking is more prevalent among the elderly than among the young, and the elderly also have the most frequent contact with the health care system. The aim of this study was to evaluate the effectiveness of the Gold Standard Program, which is an intensive six-week smoking cessation program, on continuous self-reported abstinence rates after six months, on participants over the age of 60 years in a real life setting.
|
|
| 35. |
- Larsson Lindahl, Marianne, et al.
(författare)
-
Case management in aftercare of involuntarily committed patients with substance abuse. A randomized trial.
- 2013
-
Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 67:3, s. 197-203
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined the impact of case management on substance abuse and use of service after discharge from court-ordered institutional care. Methods: Court-ordered patients with substance abuse (n = 36) were randomly assigned to either strengths based case management or treatment-as-usual during 6 months in aftercare. Data was collected at intake, at conclusion of intervention and at 6 month's follow-up with a follow-up rate of 94%. Results: Case management interventions were well received by the patients with no drop-out during intervention. Patients with the support of a case manager seemed to sustain abstinence in a higher degree compared with treatment-as-usual but no differences were detected in regard to use of care. A subgroup analysis showed that patients with a continuous drug abuse did have access to care from both social welfare and hospital care systems. Conclusions: Case management may be useful in order to retain abstinence in aftercare following court-ordered treatment. The social welfare and hospital care systems seem to provide care irrespective of case manager intervention. The study design, interventions and assessments instruments were well received by patients but needs to be replicated with a larger population. Clinical implications: The 100% retention in the case management support group indicates that patients were satisfied with this type of intervention and the methodology seems to be useful in order to retain abstinence.
|
|
| 36. |
|
|
| 37. |
- Laugesen, Monika, et al.
(författare)
-
Smoking Cessation Rates among Patients with Rheumatoid Arthritis and Osteoarthritis Following the 'Gold Standard Programme' (GSP): : A Prospective Analysis from the Danish Smoking Cessation Database
- 2022
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 19:10
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Smoking cessation may be very difficult, even if smoking aggravates the prognosis of a disease, which has been shown to be the case for persons with rheumatoid arthritis (RA). In contrast, an association in patients with osteoarthritis (OA) is still disputed. The primary objective was to compare smokers diagnosed with RA and OA to controls, regarding smoking cessation rates after following the intensive ‘Gold Standard Programme’ (GSP). Secondary objectives included the identification of significant prognostic factors for successful quitting. (2) Methods: In total, 24,652 patients were included in this prospective cohort study, after attending the national GSP for smoking cessation intervention 2006–2016, as registered in the Danish Smoking Cessation Database. Data were linked to the National Patient Register. Hereof, 227 patients (1%) were diagnosed with seropositive RA and 2899 (12%) with OA. Primary outcome was continuous abstinence six months after the planned quitting date. (3) Results: In total, 16,969 (69%) of the patients participated in the follow-up interviews. The adjusted odds ratios for successful quitting were similar to the control group for both RA (1.28, 95% CI: 0.90–1.80) and OA patients (0.92, 0.82–1.03). The outermost, strongest positive factor for successful quitting was compliance, defined as attending ≥75% of the meetings.To a lesser degree, attending an individual intervention was a positive predictor, while being heavy smokers, disadvantaged smokers, women, living with a smoker, and if GSP was recommended by health professionals were negative predictors. (4) Conclusions: The odds ratios for quitting were similar to controls for both RA and OR patients. Additional research is needed to determine effectiveactions towards increased attendance at the programmes.
|
|
| 38. |
- Lauridsen, Susanne Vahr, et al.
(författare)
-
Complications and health-related quality of life after robot-assisted versus open radical cystectomy : A systematic review and meta-analysis of four RCTs
- 2017
-
Ingår i: Systematic Reviews. - : Springer Science and Business Media LLC. - 2046-4053. ; 6:1
-
Forskningsöversikt (refereegranskat)abstract
- Background: Radical cystectomy is associated with high rates of perioperative morbidity. Robotic-assisted radical cystectomy (RARC) is widely used today despite limited evidence for clinical superiority. The aim of this review was to evaluate the effect of RARC compared to open radical cystectomy (ORC) on complications and secondary on length of stay, time back to work and health-related quality of life (HRQoL). Methods: The databases PubMed, The Cochrane Library, Embase and CINAHL were searched. A systematic review according to the PRISMA guidelines and cumulative analysis was conducted. Randomized controlled trials (RCTs) that examined RARC compared to ORC were included in this review. We assessed the quality of evidence using the Cochrane Collaboration's 'Risk of bias' tool and Grading of Recommendations Assessment, Development and Evaluation approach. Data were extracted and analysed. Results: The search retrieved 273 articles. Four RCTs were included involving overall 239 patients. The quality of the evidence was of low to moderate quality. There was no significant difference between RARC and ORC in the number of patients developing complications within 30 or 90 days postoperatively or in overall grade 3-5 complications within 30 or 90 days postoperatively. Types of complications differed between the RARC and the ORC group. Likewise, length of stay and HRQoL at 3 and 6 months did not differ. Conclusion: Our review presents evidence for RARC not being superior to ORC regarding complications, LOS and HRQoL. High-quality studies with consistent registration of complications and patient-related outcomes are warranted. Systematic review registration: PROSPERO CRD42016038232.
|
|
| 39. |
- Lauridsen, Susanne Vahr, et al.
(författare)
-
Effect of a Smoking and Alcohol Cessation Intervention Initiated Shortly Before Radical Cystectomy—the STOP-OP Study : A Randomised Clinical Trial
- 2022
-
Ingår i: European Urology Focus. - : Elsevier BV. - 2405-4569. ; 8:6, s. 1650-1658
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Evidence concerning the reduction of postoperative complications due to smoking and alcohol drinking in patients undergoing radical cystectomy is incomplete. Objective: To evaluate the efficacy of a 6-wk smoking and/or alcohol cessation intervention, initiated shortly before surgery and continued until 4 wk after, in reducing complications. Design, setting, and participants: Between 2014 and 2018, we enrolled 104 patients with high-risk bladder cancer who were daily smokers or consuming at least 3 units of alcohol daily in a multicentre randomised clinical trial. Intervention: Patients were randomised to a 6-wk intensive smoking and/or alcohol cessation intervention or treatment as usual. Outcome measurements and statistical analysis: The primary endpoint was the number of patients developing any postoperative complication, or death, within 30 d after surgery. The secondary endpoints were successful quitters, health-related quality of life, length of stay, time back to habitual activity, and mortality. An intention-to-treat analysis was applied to evaluate treatment effect. Results and limitations: There were some differences in baseline demographic and lifestyle characteristics. Postoperatively, 64% in the intervention group versus 70% in the control group (risk ratio [RR] 0.91, confidence interval [CI] 0.68–1.21, p = 0.51) developed complications. Significantly fewer patients developed three or more complications after 30 d (RR 0.39; CI 0.18–0.84, p = 0.01). The rates of successful quitting were 51% in the intervention group and 27% in the control group (RR 2, CI 1.14–3.51, p = 0.01). The external validity of this trial may be limited because 53% of eligible patients refused participation. Conclusions: Despite a significant effect on the quit rate at completion of the intervention, this multimodal prehabilitation did not show a significant difference regarding our primary outcome postoperative complications. Patient summary: A 6-wk smoking and alcohol cessation intervention in relation to bladder cancer surgery did not reduce postoperative complications, but it was effective in supporting people to quit in the short term.
|
|
| 40. |
- Lauridsen, Susanne Vahr, et al.
(författare)
-
Smoking and alcohol cessation intervention in relation to radical cystectomy : A qualitative study of cancer patients' experiences
- 2017
-
Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 17:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite smoking and risky alcohol drinking being modifiable risk factors for cancer as well as postoperative complications, perioperative cessation counselling is often ignored. Little is known about how cancer patients experience smoking and alcohol interventions in relation to surgery. Therefore the aim of this study was to explore how bladder cancer patients experience a perioperative smoking and alcohol cessation intervention in relation to radical cystectomy. Methods: A qualitative study was conducted in two urology out-patient clinics. We conducted semi-structured in-depth interviews with 11 purposively sampled persons who had received the smoking and alcohol cessation intervention. The analysis followed the steps contained in the thematic network analysis. Results: Two global themes emerged: "smoking and alcohol cessation was experienced as an integral part of bladder cancer surgery" and "returning to everyday life was a barrier for continued smoking cessation/alcohol reduction". Participants described that during hospitalization their focus shifted to the operation and they did not experience craving to smoke or drink alcohol. Concurrent with improved well-being or experiencing stressful situations, the risk of relapse increased when returning to everyday life. Conclusions: The smoking and alcohol cessation intervention was well received by the participants. Cancer surgery served as a kind of refuge and was a useful cue for motivating patients to quit smoking and to reconsider the consequences of risky drinking. These results adds to the sparse evidence of what supports smoking and alcohol cessation in relation to bladder cancer patients undergoing major surgery and point to the need to educate healthcare professionals in offering smoking and alcohol cessation interventions in hospitals. The study also provides knowledge about the intervention in the STOP-OP study and will help guide the design of future smoking and alcohol cessation studies aimed at cancer patients undergoing surgery.
|
|
| 41. |
- Lauridsen, Susanne Vahr, et al.
(författare)
-
STOP smoking and alcohol drinking before OPeration for bladder cancer (the STOP-OP study), perioperative smoking and alcohol cessation intervention in relation to radical cystectomy : Study protocol for a randomised controlled trial
- 2017
-
Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 18:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: To evaluate the effect of a smoking-, alcohol- or combined-cessation intervention starting shortly before surgery and lasting 6 weeks on overall complications after radical cystectomy. Secondary objectives are to examine the effect on types and grades of complications, smoking cessation and alcohol cessation, length of hospital stay, health-related quality of life and return to work or habitual level of activity up to 12 months postoperatively. Methods/design: The study is a multi-institutional randomised clinical trial involving 110 patients with a risky alcohol intake and daily smoking who are scheduled for radical cystectomy. Patients will be randomised to the 6-week Gold Standard Programme (GSP) or treatment as usual (control). The GSP combines patient education and pharmacologic strategies. Smoking and alcohol intake is biochemically validated (blood, urine and breath tests) at the weekly meetings and at follow-up. Discussion: Herein, we report the design of the STOP-OP study, objectives and accrual up-date. This study will provide new knowledge about how to prevent smoking and alcohol-related postoperative complications at the time of bladder cancer surgery. Till now 77 patients have been enrolled. Patient accrual is expected to be finalised before the end of 2017 and data will be published in 2018. Trial registration: ClinicalTrials.gov, ID: NCT02188446. Registered on 28 May 2014.
|
|
| 42. |
- Lauridsen, Susanne Vahr, et al.
(författare)
-
The gold standard program (GSP) for smoking cessation : a cohort study of its effectiveness among smokers with and without cancer
- 2023
-
Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 62:7, s. 774-781
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Smoking cessation treatment is an important prognostic factor for survival after a cancer diagnosis, especially for tobacco-related cancers. After being diagnosed with lung cancer, approximately 50% of patients continue smoking or frequently relapse after a quit attempt. Given the importance of smoking cessation treatment for cancer survivors, the objective was to compare the effectiveness of a 6-week intensive smoking cessation intervention, the Gold Standard Program (GSP), among cancer survivors compared with smokers without cancer. Second, we compared successful quitting among socioeconomically disadvantaged cancer survivors with that among nondisadvantaged cancer survivors.MATERIALS AND METHODS: This was a cohort study based on 38,345 smokers from the Danish Smoking Cessation Database (2006-2016). Linkage to the National Patient Register was used to identify cancer survivors undergoing the GSP after being diagnosed with cancer (except nonmelanoma skin cancer). Linkage to the Danish Civil Registration System was used to identify participants who died, went missing, or emigrated before the follow-up. Logistic regression models were applied to evaluate effectiveness.RESULTS AND CONCLUSION: Six percent (2438) of the included smokers were cancer survivors at the time they undertook the GSP. Their 6-month successful quitting showed no difference compared to that of smokers without cancer, neither before nor after adjustment; 35% versus 37% in crude rates and an aOR of 1.13 (95% CI: 0.97-1.32). Likewise, the results for disadvantaged compared to nondisadvantaged cancer survivors were not significantly different (32% versus 33% and an adjusted aOR of 0.87 (95% CI 0.69-1.11)). Overall, an intensive smoking cessation program seems effective in helping both people without cancer and cancer survivors become successful quitters.
|
|
| 43. |
- Lindström, David, et al.
(författare)
-
Rökfrihet vid kirurgiska ingrepp. Rökstopp minskar komplikationsrisken drastiskt
- 2010
-
Ingår i: Läkartidningen. - 0023-7205. ; 107:43, s. 2634-2635
-
Forskningsöversikt (refereegranskat)abstract
- Rökare drabbas oftare av postoperativa komplikationer än icke-rökare. Framför allt inom sårläkningsområdet är dokumentationen omfattande. Detta gäller även efter mindre rutiningrepp som bråckoperation eller appendektomi. De studier som undersökt snus har inte påvisat någon ökad risk för postoperativa komplikationer hos snusare. Intensivt rökstoppsprogram på 4–8 veckor inför operation medför kraftig reduktion av postoperativa komplikationer. Preoperativ rökavvänjning leder också till signifikant ökad långsiktig rökfrihet. Tolkningen av detta blir att operationstillfället är ett mycket gynnsamt tillfälle att erbjuda rökavvänjning. De beräkningar som finns publicerade av kostnadseffektiviteten av intensiv preoperativ rökavvänjning visar på måttliga besparingar på ca 100 euro per patient.
|
|
| 44. |
|
|
| 45. |
|
|
| 46. |
|
|
| 47. |
|
|
| 48. |
- Neumann, Tim, et al.
(författare)
-
Gold standard program for heavy smokers in a real-life setting.
- 2013
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 10:9, s. 4186-4199
-
Tidskriftsartikel (refereegranskat)abstract
- Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1-6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23-1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05-1.11); and being compliant (attending the planned meetings OR 4.36-4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1-6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising.
|
|
| 49. |
- Neumann, Tim, et al.
(författare)
-
The Gold Standard Programme: smoking cessation interventions for disadvantaged smokers are effective in a real-life setting
- 2013
-
Ingår i: Tobacco Control. - : BMJ. - 1468-3318 .- 0964-4563. ; 22:6, s. 9-9
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates. Design Observational prospective cohort study. Setting GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database. Participants Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits. Interventions 6-week manualised GSP smoking cessation interventions performed by certified staff. Main outcome measures 6months of continuous abstinence, response rate: 80%. Results Continuous abstinence of the 16?377 responders was 34% (of all 20?588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable format' stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63). Conclusions Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP.
|
|
| 50. |
- Nicklasson, Johanna, et al.
(författare)
-
Identification of Alcohol Use Prior to Major Cancer Surgery : Timeline Follow Back Interview Compared to Four Other Markers
- 2024
-
Ingår i: Cancers. - 2072-6694. ; 16:12, s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The postoperative complication rate is 30-64% among patients undergoing muscle-invasive and recurrent high-risk non-muscle-invasive bladder cancer surgery. Preoperative risky alcohol use increases the risk. The aim was to evaluate the accuracy of markers for identifying preoperative risky alcohol.METHODS: Diagnostic test sub-study of a randomized controlled trial (STOP-OP trial), based on a cohort of 94 patients scheduled for major bladder cancer surgery. Identification of risky alcohol use using Timeline Follow Back interviews (TLFB) were compared to the AUDIT-C questionnaire and three biomarkers: carbohydrate-deficient transferrin in plasma (P-CDT), phosphatidyl-ethanol in blood (B-PEth), and ethyl glucuronide in urine (U-EtG).RESULTS: The correlation between TLFB and AUDIT-C was strong (ρ = 0.75), while it was moderate between TLFB and the biomarkers (ρ = 0.55-0.65). Overall, sensitivity ranged from 56 to 82% and specificity from 38 to 100%. B-PEth showed the lowest sensitivity at 56%, but the highest specificity of 100%. All tests had high positive predictive values (79-100%), but low negative predictive values (42-55%).CONCLUSIONS: Despite high positive predictive values, negative predictive values were weak compared to TLFB. For now, TLFB interviews seem preferable for preoperative identification of risky alcohol use.
|
|
