| 11. |
- Hafström, Anna, et al.
(författare)
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Improved Balance Confidence and Stability for Elderly After 6 Weeks of a Multimodal Self-Administered Balance-Enhancing Exercise Program : A Randomized Single Arm Crossover Study
- 2016
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Ingår i: Gerontology and Geriatric Medicine. - : SAGE Publications. - 2333-7214. ; 2, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To develop and assess the efficacy of a multimodal balance-enhancing exercise program (BEEP) designed to be regularly self-administered by community-dwelling elderly. The program aims to promote sensory reweighting, facilitate motor control, improve gaze stabilization, and stimulate continuous improvement by being constantly challenging. Method: Forty participants aged 60 to 80 years performed 6 weeks of BEEP training, on average for 16 min four times weekly, in a randomized one-arm crossover design. Results: One-leg standing time improved 32% with eyes open (EO), 206% with eyes closed (EC) on solid surface, and 54% EO on compliant surface (p < .001). Posturography confirmed balance improvements when perturbed on solid and compliant surfaces with EO and EC (p ≤ .033). Walking, step stool, and Timed Up and Go speeds increased (p ≤ .001), as did scores in Berg Balance and balance confidence scales (p ≤ .018). Discussion: Multimodal balance exercises offer an efficient, cost-effective way to improve balance control and confidence in elderly.
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| 12. |
- Hafström, Anna, et al.
(författare)
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Increased visual dependence and otolith dysfunction with alcohol intoxication
- 2007
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Ingår i: NeuroReport. - 1473-558X. ; 18:4, s. 391-394
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Tidskriftsartikel (refereegranskat)abstract
- dAlcohol intoxication affects the vestibular system and balance control in many ways. We have investigated how acute, moderate (blood alcohol concentrations of 0.06 +/- 0.01%), and high (0.10 +0.02%) alcohol intoxication affects the ability to perceive the visual horizontal and vertical and the visual field dependence measured with the rod and frame tests in 24 healthy participants. Alcohol ingestion impaired the ability to use gravitational vestibular cues when determining the visual vertical and horizontal, and caused increased visual field dependence. With conflicting gravitational and visual information, alcohol seems to promote a reweighting in balance control from a vestibular to a more visual dependency. Furthermore, the results indicate that alcohol intoxication at these levels start instigating a decompensation of minute subdinical vestibular asymmetries.
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| 13. |
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| 14. |
- Hafström, Anna, et al.
(författare)
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Outcome for sinonasal malignancies : a population-based survey
- 2022
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 279:5, s. 2611-2622
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Sinonasal malignancies (SNM) represent a rare and complex group of cancers that includes a wide range of histopathological subtypes. Data from population-based cohorts are scarce but warranted as a basis for randomized controlled treatment trials (RCTs). Our aim was to assess overall and histology subset-specific outcomes for SNM patients treated at a tertiary referral centre. Methods: A retrospective, population-based, consecutive cohort of patients with SNMs diagnosed from 2001 through 2019 was examined. Outcome was analysed in relation to age, gender, site, stage, histopathology, and treatment. Results: Two-hundred and twenty-six patients were identified, whereof 61% presented with stage IV disease. 80% completed treatment with curative intent, which comprised surgery with neoadjuvant (29%) or adjuvant (37%) radiotherapy, monotherapy with surgery (22%), definitive chemoradiotherapy (7%), or radiotherapy (5%). Median follow-up was 106 months. The 5- and 10-year overall survival rates were 57% and 35%, respectively. Median overall survival was 76 months (esthesioneuroblastoma: 147 months; adenocarcinoma: 117; salivary carcinoma: 88; mucosal melanoma: 69; squamous cell carcinoma: 51, undifferentiated carcinoma: 42; neuroendocrine carcinoma: 9; and NUT-carcinoma 5). The 5- and 10-year disease-free survival rates were 63% and 54%, respectively, and disease-specific survival 83% and 66%. Increasing age, stage IVB, melanoma histopathology, and treatment with definitive chemoradiotherapy emerged as significant independent prognostic risk factors for disease-specific mortality (p ≤ 0.001). Conclusion: The results indicate a seemingly good outcome in comparison to previous reports, particularly for mucosal melanoma, adenocarcinoma, and undifferentiated carcinoma. The study provides additional background for future RCTs focusing on histology subset-specific treatment for SNM.
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| 15. |
- Hafström, Anna, et al.
(författare)
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Patients with cutaneous head and neck melanoma, particularly elderly with more advanced primary tumors, seem to benefit from initial CT staging before considering a sentinel lymph node biopsy
- 2020
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 140:9, s. 795-802
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Tidskriftsartikel (refereegranskat)abstract
- Background: The role of CT scanning at the time of diagnosis for patients with primary cutaneous head and neck melanoma (cHNM) clinically asymptomatic for metastatic disease remains unclear. Aim: To determine the positive yield of initial CT scanning before considering sentinel lymph node biopsy (SLNB) staging. Materials and methods: A retrospective review was performed on 170 consecutive patients with cHNM referred to a tertiary head and neck academic center for SLNBs from 2014 through 2018. Results: Initial CTs identified occult melanoma metastases in 7.1% and other advanced malignancies in 4.7%. The overall CT yield for patients >65 years (n = 115) was 13.9%, and 5.5% for patients <65 (only occult melanoma metastases). The SLNB yield did not differ between older (11.5%) and younger patients (10.2%). Patients with more advanced primary tumors were upstaged more often by both staging procedures. Multivariate analysis indicated a true-positive CT finding as the strongest prognostic factor for OS (p<.001). Conclusions and significance: The CT yield was >11% and higher for older than for younger patients. The findings suggest that CT imaging may be considered before SLNB staging, potentially identifying metastatic melanoma disease as well as other occult malignancies, enabling especially older patients to bypass the SLNB procedure.
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| 16. |
- Hafström, Anna
(författare)
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Perceived and functional balance control is negatively affected by diminished touch and vibration sensitivity in relatively healthy older adults and elderly
- 2018
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Ingår i: Gerontology and Geriatric Medicine. - : SAGE Publications. - 2333-7214. ; 4, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Severe diminished foot somatosensation, for example, caused by neuropathies and advanced aging, contributes to balance deficits and increased fall risk. However, little is known about somatosensory impairment and functional and subjective balance problems in relatively healthy elderly. Method: Vibration perception thresholds (VPTs) were assessed with a biothesiometer and tactile pressure sensation thresholds (TPSTs) with 20 monofilaments in 34 relatively healthy community-dwelling older adults (M = 69.4 years). Balance was evaluated with functional balance tests and questionnaires. A stepwise regression analysis was performed to determine the extent to which VPTs, TPSTs, and age could explain balance impairments. Results: High VPTs had negative effects on Berg Balance Scale and Dizziness Handicap Inventory scores (p ≤ .011), as did high TPSTs on walking speed and Figure-8 test (p ≤ .001). With visual information available, one-leg standing time (OLST) was significantly affected by ipsilateral VPTs on solid and TPSTs on compliant surface (p ≤ .002). Without visual information, age was the only factor with a main effect on OLST (p < .001). Age had no significant correlations with TPSTs or VPTs. Discussion: Somatosensation appears to be very important for perceived as well as functional balance control in older adults. Our findings have important clinical implications when assessing balance impairment and impending fall risk.
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| 17. |
- Hafström, Anna, et al.
(författare)
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Predictors of survival in advanced oral cancers after salvage surgery with free tissue flap reconstruction
- 2023
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 280:6, s. 2953-2964
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify prognostic factors for patients with advanced persistent, recurrent, or 2nd primary oral cavity squamous cell carcinoma (OCSCC) potentially unsuitable for salvage surgery with free tissue flap (FTF) reconstruction. Materials and methods: A population-based cohort of 83 consecutive patients with advanced OCSCC who underwent salvage surgery with FTF reconstruction at a tertiary referral centre between 1990 and 2017. Retrospective uni- and multivariable analyses were performed to identify factors affecting all-cause mortality (ACM), i.e., overall survival (OS), as well as disease-specific mortality (DSM), i.e., disease-specific survival (DSS) after salvage surgery. Results: Median disease-free interval until recurrence was 15 months with recurrent stage I/II in 31% and III/IV in 69%. Median age at salvage surgery was 67 years (range 31–87) and the median follow-up (alive patients) 126 months. At 2, 5, and 10 years after salvage surgery, respectively, DSS rates were 61%, 44%, and 37% and OS rates 52%, 30%, and 22%. Median DSS was 26 and OS 43 months. Multivariable analysis identified recurrent clinical regional (cN-plus) disease [HR 3.57; p <.001] and elevated gamma-glutamyl transferase (GGT) [HR 3.30; p =.003] as independent pre-salvage predictors for poor OS after salvage, whereas initial cN-plus [HR 2.07; p =.039] and recurrent cN-plus disease [HR 5.14; p <.001] predicted poor DSS. Among post-salvage factors, extranodal extension according to histopathology [HR ACM 6.11; HR DSM 9.99; p <.001] as well as positive [HR ACM 4.98; DSM 7.51; p < 0.001] and narrow surgical margins [HR ACM 2.12; DSM HR 2.80; p < 0.01] emerged as independent factors for poor survival. Conclusion: While salvage surgery with FTF reconstruction is the primary curative option for patients with advanced recurrent OCSCC, the present findings may help guide discussions with patients who have advanced recurrent regional disease and high GGT preoperatively, especially if there is a small chance of reaching surgical radicality.
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| 18. |
- Hafström, Anna, et al.
(författare)
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Sentinel lymph node biopsy staging for cutaneous malignant melanoma of the head and neck.
- 2016
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 1651-2251 .- 0001-6489. ; 136:3
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion Sentinel lymph node biopsies (SLNBs) can be performed safely and with reasonable accuracy in HNM patients. The outcome provides important prognostic information concerning DFS and further treatment. However, one must recognize that SLNB is a multidisciplinary procedure with a learning curve for all. Objectives To evaluate efficacy of performing SLNBs in a series of consecutive patients with cutaneous head and neck melanoma (HNM) ≥ T1b from introduction of the procedure and 10 years onward. Method End-points comprised of SLNB outcome, disease-free survival (DFS), and overall survival (OS). Results SNs were harvested in 128 of 160 patients (median Breslow = 2.0 mm, 29% ulcerated); success rate = 80.0%, or 92.1% if excluding patients where SLNBs were omitted due to non-localization on pre-operative imaging or because of SN-location in the parotid basin. Ten patients (7.8%) had positive SLNBs and were offered early completion neck dissections. Of the 146 patients available for follow-up (median = 27 months), 15.8% had recurrent disease. The risk of a regional nodal recurrence after a negative SLNB was 7.5%. SN-negative patients had improved DFS c.f. SN-positive patients (p < 0.001). A positive SLNB was the most important prognostic predictor of decreased DFS (hazard ratio = 5.70; p < 0.005), but had no significant impact on OS.
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| 20. |
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