| 11. |
- Jonsson, Pernilla, 1978, et al.
(författare)
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Epidemiology of medication overuse headache in the general Swedish population
- 2011
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Ingår i: Cephalalgia. - : SAGE Publications. - 0333-1024 .- 1468-2982. ; 31:9, s. 1015-1022
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim was to estimate the prevalence of medication overuse headache (MOH) in Sweden and to analyze the occurrence of this disorder in different population groups. Methods: A total of 44,300 randomly selected individuals (55% women), aged 15 years and above, were interviewed in a national telephone survey, using a standardized questionnaire including the International Headache Society criteria for MOH and questions about sociodemographic factors, headache history and medication use. Results: In Sweden, 3.2% (95% confidence interval (CI) 3.1–3.4), n¼1428) suffer from chronic daily headache (CDH) and out of those, 56% (n¼799) have MOH. The prevalence of MOH is 1.8% (95% CI 1.7–1.9). The mean age of onset was higher among men than women as well as among those with tension-type headache as primary headache compared to those who originally had migraine. A multivariate analysis showed that socioeconomic factors such as having a low level of education and/or a low household income were associated with MOH. Conclusions: This is the first Swedish population-based study of MOH and we conclude that MOH is a significant public health problem in Sweden, as it is in other parts of the world.
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| 12. |
- Linde, Mattias, 1966, et al.
(författare)
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Adherence to migraine prophylaxis at a Swedish tertiary clinic. A cross-sectional study of influence of disease features
- 2007
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Ingår i: The 13th Congress of the International Headache Society, Stockholm, juni 2007.
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Konferensbidrag (refereegranskat)abstract
- Introduction The efficacy of mainly the more recently developed prophylactic treatments of migraine have been well established in a large number of randomised controlled trials. However, such trials tend to focus on the effects of the drug in an ideal setting and rather underestimate the impact of non-compliance, which generally escapes detection by the physician. This poorly understood phenomenon was further looked at in a naturalistic setting. Methods A consecutive sample of 175 migraineurs (85% women, mean age 4512, range 19-79 years) with a current prescription of pharmacological prophylaxis were studied at a Swedish headache specialist clinic. Adherence was self-reported with the Medication Adherence Report Scale (MARS, possible range of scores 5-25). Logistic regression analysis was performed to analyze the association between MARS and frequency of attacks, number of days with migraine per month, attack duration, presence of prodrome (68%), presence of aura (41%, some or all attacks), mean intensity of pain, and recovery between attacks. Results The mean frequency of migraine was 6.5 days / month, and 68% did not recover completely interictally. The mean MARS score was 22.52.8. One third (35%) was not highly adherent. Neither demographic characteristics, nor any of the studied disease specific variables were significantly associated with adherence. Discussion The full benefit of prophylactic migraine medication cannot be realised at currently achieved levels of adherence. Characteristics of the headaches per se are the starting point of patients’ decision-making. However, the present study indicates that other factors play a more important role in this complicated process.
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| 13. |
- Stadil, Tatjana, et al.
(författare)
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Surgical treatment and major complications within the first year of life in newborns with long-gap esophageal atresia gross type A and B : a systematic review
- 2019
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Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 0022-3468 .- 1531-5037. ; 54:11, s. 2242-2249
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Forskningsöversikt (refereegranskat)abstract
- Background: The surgical repair of long-gap esophageal atresia (LGEA) is still a challenge and there is no consensus on the preferred method of reconstruction. We performed a systematic review of the surgical treatment of LGEA Gross type A and B with the primary aim to compare the postoperative complications related to the different methods within the first postoperative year.Methods: Systematic literature review on the surgical repair of LGEA Gross type A and B within the first year of life published from January 01, 1996 to November 01, 2016.Results: We included 57 artides involving a total of 326 patients of whom 289 had a Gross type A LGEA. Delayed primary anastomosis (DPA) was the most applied surgical method (68.4%) in both types, followed by gastric pull-up (GPU) (83%). Anastomotic stricture (53.7%), gastro-esophageal reflux (GER) (32.2%) and anastomotic leakage (22.7%) were the most common postoperative complications, with stricture and GER occurring more often after DPA (61.9% and 40.8% respectively) compared to other methods (p < 0.001).Conclusion: The majority of patients in this review were managed by DPA and postoperative complications were common despite the surgical method, with anastomotic stricture and GER being most common after DPA.
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| 14. |
- Jacobsson, Lars, et al.
(författare)
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ADHD : Diagnostik och behandling, vårdens organisation och patientens delaktigheten systematisk litteraturöversikt
- 2013
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Rapport (refereegranskat)abstract
- ADHD En funktionsnedsättning med debut i baranåren. Kärmsymtom karaktäriseras av uppmärksamhetsproblem, impulsivitet ioch hyperaktivitet.I ett antal fall sker en normalisering eller mognadsprocess, i andra fall kan någon form av psykisk ohälsa förekommma samtidigt. Den diagnostiska utredningen är omfattande, och både instrument för diagnostik och den diagnostiska processen bör undersökas bättre.Många olika insatser och behandlingar, förutom läkemedel förekommer idag, men kunskapen om eras nytta, risker och kostnader måste förbättras. Vissa läkemedel lindrar ADHD symtom vid korttidsbehandling, men nyttan av långtidsbehandling går inte att bedöma. Vanliga biverjkningar av dessa läkemedel är illamående och nedsatt aptit, för barn viktminskning och pulsökning.
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| 15. |
- Jonsson, Pernilla, 1978
(författare)
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Problematic medication use in headache - Epidemiology and qualitative aspects of medication overuse headache and non-adherence to prophylactic migraine treatment
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim was to analyze problematic medication use among persons with headache, focusing on overuse of acute medications, with subsequent medication overuse headache (MOH), and on underuse of prophylactic medication. Methods: Data in Studies I and II came from a population survey in which 44 300 Swedes were interviewed by telephone about headache and medication use. In Study III, a questionnaire concerning adherence and beliefs about medicines was distributed to 174 consecutive migraine patients at a headache clinic. Study IV was a qualitative study, using grounded theory, in which 14 individual interviews were conducted with persons who fulfilled the diagnostic criteria for MOH. Results: The prevalence of MOH in Sweden was 1.8% (95% C.I. 1.7–1.9). It was 2.8 times more common among women than among men and inversely associated with socioeconomic status. Fewer than half of those with MOH had made a headache-related visit to a physician during the previous year, and almost half used only over-the-counter (OTC) medications to treat their headaches. The proportion only using OTC medications was particularly high among the young. There were several differences indicating that the use of medications and the rate of health care contacts were unequal in relation to educational level. As for use of prophylactic medications, approximately one third of the migraineurs were considered non-adherent. The participants in the qualitative study perceived headaches as something that threatened to ruin their lives, and despite extensive efforts, they were unable to find any effective aid other than the acute medication. Because of this, the acute medication became indispensable to them. Conclusion: Both overuse of acute medication and underuse of prophylactic medication are significant problems among persons with headache. Since both problems may lead to increased headaches, it is likely that many persons with headache carry an unnecessarily high disease burden.
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| 16. |
- Ascher, Henry, 1953, et al.
(författare)
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Stöd till ensamkommande barn och unga – effekter, erfarenheter och upplevelser
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Begreppet ensamkommande barn innefattar enligt svensk lag asylsökande barn under 18 år som vid ankomsten till mottagarlandet är skilda från såväl föräldrar som annan vuxen person som kan anses ha trätt in i föräldrarnas ställe, eller barn som efter ankomsten står utan sådan ställföreträdare. Vår systematiska genomgång av den vetenskapliga litteraturen har inte funnit några kontrollerade studier som har undersökt eller jämfört effekter av olika stödjande insatser för ensamkommande barn och unga. Vår systematiska genomgång av forskning som på olika sätt belyser ensamkommande barns och ungas erfarenheter och upplevelser av vad som främjar och hämmar deras sociala integrering, psykiska och fysiska hälsa och funktionsförmåga, har resulterat i sju övergripande teman (teman på nivå tre*): – Säkerhet och kontroll: En grundläggande förutsättning. Ensamkommande barns och ungas erfarenheter av trauma och förlust, i kombination med osäkerhet om framtiden, innebär en brist på grundläggande trygghet, kontroll och säkerhet. Det präglar starkt tillvaron och påverkar välbefinnandet och förmågan att hantera sin vardag och sina svårigheter samt att kunna se en framtid. – Det nya landet: Både möjligheter och svårigheter. Ensamkommande barn och unga uttrycker en stark motivation att utbilda sig, att anpassa sig till det nya landet och att ta vara på de möjligheter som finns. Samtidigt beskrivs strukturella och sociala hinder samt svårigheter kopplade till att befinna sig i en ny kulturell och samhällelig kontext. Allt detta kan hämma en positiv utveckling av hälsa, integration och funktionsförmåga. – Att hantera svårigheter: En balans mellan olika strategier. Copingstrategier (strategier för att med tankar och beteenden hantera svårigheter) såsom undvikande, flykt och positivt tänkande, kan fungera främjande men ibland också hindrande för hälsa, integration och funktionsförmåga. Religion kan upplevas som betydelsefull för välmående och förmåga att hantera svårigheter. – Vardagsmiljöer: Stödjande relationer, inflytande i boende och tillgång till skola och aktiviteter är viktigt. Ensamkommande barn och unga framhåller stöd, goda relationer och eget inflytande i boendet samt måltider i boendet som viktiga, oberoende av boendeform. Skolan upplevs som viktig för inlärning, välmående och relationer. Betydelsen av stöd och råd från vuxna i skola och i förhållande till skola och utbildning understryks. När det gäller skolan som plats för att utveckla relationer med jämnåriga beskrivs både positiva och negativa erfarenheter. Fritidsaktiviteter beskrivs som viktiga för att må bra, för att bygga sociala relationer och återskapa mening i tillvaron. – Relationer: Stöd och vägledning från vuxna är betydelsefullt, kontakt med jämnåriga viktigt men också svårt. Ensamkommande barn och unga lyfter betydelsen av vägledning, stöd, kontinuitet men också möjligheter till inflytande och självständighet i relation till vuxna. Relationer till jämnåriga upplevs som viktigt men också svårt. Relationer till biologisk familj innebär både saknad och stöd. Beroende på kvaliteten i de olika relationerna kan de fungera hämmande eller främjande för välbefinnande och utveckling. – Socialtjänst och hälso- och sjukvård: Varierande uppfattningar om och erfarenheter av stöd och behov. Ensamkommande barn och unga upplever socialtjänsten som viktig för grundläggande stöd, men också att stödet inte är tillräckligt. De uttrycker varierande uppfattningar om och erfarenheter av psykologiskt stöd från hälso- och sjukvården. – Identitet och tillhörighet: Att få ihop det förflutna, nuet och framtiden. Ensamkommande barn och unga strävar efter att både bevara modersmål och kultur och att anpassa sig till det nya landet samt att bevara relationer till personer i ursprungslandet och att stödja dem. De kan kämpa med att få ihop sin tillhörighet. Religion kan vara ett sätt att skapa en kontinuitet i tillvaron. * Teman på nivå tre är formulerade så att de centrala budskapen ska framgå. De har använts för att ordna och presentera resultatet på ett enkelt och läsvänligt sätt. Temana har kondenserats utifrån samtliga andra nivåns teman, oavsett evidensstyrka.
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| 17. |
- Bergström, Martin, et al.
(författare)
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Interventions in Foster Family Care: A Systematic Review
- 2020
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Ingår i: Research on social work practice. - : SAGE Publications. - 1049-7315 .- 1552-7581. ; 30:1, s. 3-18
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers. Method: A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods. Results: In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes. Discussion: These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
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| 18. |
- Chen, Yao, et al.
(författare)
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Thyroid hormone enhances nitric oxide mediated bacterial clearance and promotes survival after meningococcal infection
- 2012
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:7
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Tidskriftsartikel (refereegranskat)abstract
- Euthyroid sick syndrome characterized by reduced levels of thyroid hormones (THs) is observed in patients with meningococcal shock. It has been found that the level of THs reflects disease severity and is predictive for mortality. The present study was conducted to investigate the impact of THs on host defense during meningococcal infection. We found that supplementation of thyroxine to mice infected with Neisseria meningitidis enhanced bacterial clearance, attenuated the inflammatory responses and promoted survival. In vitro studies with macrophages revealed that THs enhanced bacteria-cell interaction and intracellular killing of meningococci by stimulating inducible nitric oxide synthase (iNos)-mediated NO production. TH treatment did not activate expression of TH receptors in macrophages. Instead, the observed TH-directed actions were mediated through nongenomic pathways involving the protein kinases PI3K and ERK1/2 and initiated at the membrane receptor integrin alpha v beta 3. Inhibition of nongenomic TH signaling prevented iNos induction, NO production and subsequent intracellular bacterial killing by macrophages. These data demonstrate a beneficial role of THs in macrophage-mediated N. meningitidis clearance. TH replacement might be a novel option to control meningococcal septicemia.
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| 19. |
- Gerhardsson, Lars, 1952, et al.
(författare)
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Vibration related symptoms and signs in quarry and foundry workers
- 2021
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Ingår i: International Archives of Occupational and Environmental Health. - : Springer Science and Business Media LLC. - 0340-0131 .- 1432-1246. ; 94, s. 1041-1048
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The development of vascular and neurosensory findings were studied in two groups of long-term exposed quarry and foundry workers with different vibration exposures, working conditions and work tasks. Methods The study included 10 quarry workers (mean age 43 yrs., mean exposure time 16 yrs.) and 15 foundry workers (35 yrs.; 11 yrs.) at two plants in Sweden. All participants completed a basic questionnaire and passed a medical examination including a number of neurosensory tests, e.g. the determination of vibration (VPT) and temperature (TPT) perception thresholds as well as a musculoskeletal examination of the neck, shoulders, arms and hands. Results A high prevalence of neurosensory findings (40%) was found among the quarry workers. Both groups, however, showed a low prevalence of vibration white fingers (VWF). Foundry workers showed significantly better sensitivity than quarry workers for all monofilament tests (p <= 0.016), TPT warmth in dig 2 (p = 0.048) and 5 dexter (p = 0.008), and in dig 5 sinister (p = 0.005). They also showed a better VPT performance in dig 5 dexter (p = 0.031). Conclusions Despite high vibration exposure, the prevalence of VWF was low. The high prevalence of neurosensory findings among the quarry workers may depend on higher A(8) vibration exposure and higher exposure to high-frequency vibrations. An age-effect and exposure to cold could also be contributing factors. The nervous system seems to be more susceptible to high-frequency vibrations than the vascular system. For neurosensory injuries, the current ISO 5349-1 standard is not applicable.
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| 20. |
- Hedenrud, Tove, et al.
(författare)
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Beliefs about medicines and adherence among Swedish migraineurs
- 2008
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 42:1, s. 39-45
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The problem of low adherence to drug therapy is as prevalent in migraine as in any other disorder, with important consequences for the patient, such as impaired quality of life and absence from work. Beliefs about medicines have been identified as one of the most significant factors for adherence.OBJECTIVE: To analyze whether beliefs about medicines and medication-related factors are associated with adherence to prophylactic drug therapy among migraineurs at a Swedish tertiary care clinic.METHODS: A questionnaire was distributed to migraineurs visiting a tertiary care clinic in Sweden. All participants had recently been prescribed prophylactic medicine. The questionnaire was comprised of background questions, questions about disease characteristics, perceived effects, and adverse effects of migraine medications used, the Beliefs about Medicines questionnaire, and the Medication Adherence Report Scale. Medication-related variables, collected from patients' records with consent, were also included. Logistic regression analysis was performed to analyze the association between beliefs about medicines, medication-related variables, and adherence to prophylactic drugs.RESULTS: Of the 174 participants in the study, 64% were considered to be adherent to their prescribed prophylactic medicine. Users of beta-blockers were significantly more adherent compared with patients using other drugs (eg, tricyclic antidepressants [TCAs] or antiepileptics); the reverse was true for patients taking TCAs. Respondents with the lowest level of education (CONCLUSIONS: About one-third of the migraineurs did not adhere to their prophylactic drugs. Beliefs about medicines and medication-related factors could not predict nonadherence. We recommend further research on medication-related variables in relation to adherence among migraineurs.
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