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- de Groot, Kirsten, et al.
(författare)
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Pulse Versus Daily Oral Cyclophosphamide for Induction of Remission in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis A Randomized Trial
- 2009
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Ingår i: Annals of Internal Medicine. - 0003-4819. ; 150:10, s. 3-670
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Tidskriftsartikel (refereegranskat)abstract
- Background: Current therapies for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis are limited by toxicity. Objective: To compare pulse cyclophosphamide with daily oral cyclophosphamide for induction of remission. Design: Randomized, controlled trial. Random assignments were computer-generated; allocation was concealed by faxing centralized treatment assignment to providers at the time of enrollment. Patients, investigators, and assessors of outcomes were not blinded to assignment. Setting: 42 centers in 12 European countries. Patients: 149 patients who had newly diagnosed generalized ANCA-associated vasculitis with renal involvement but not immediately life-threatening disease. Intervention: Pulse cyclophosphamide, 15 mg/kg every 2 to 3 weeks (76 patients), or daily oral cyclophosphamide, 2 mg/kg per day (73 patients), plus prednisolone. Measurement: Time to remission (primary outcome); change in renal function, adverse events, and cumulative dose of cyclophosphamide (secondary outcomes). Results: Groups did not differ in time to remission (hazard ratio, 1.098 [95% CI, 0.78 to 1.55]; P = 0.59) or proportion of patients who achieved remission at 9 months (88.1% vs. 87.7%). Thirteen patients in the pulse group and 6 in the daily oral group achieved remission by 9 months and subsequently had relapse. Absolute cumulative cyclophosphamide dose in the daily oral group was greater than that in the pulse group (15.9 g [interquartile range, 11 to 22.5 g] vs. 8.2 g [interquartile range, 5.95 to 10.55 g]; P < 0.001). The pulse group had a lower rate of leukopenia (hazard ratio, 0.41 [CI, 0.23 to 0.71]). Limitations: The study was not powered to detect a difference in relapse rates between the 2 groups. Duration of follow-up was limited. Conclusion: The pulse cyclophosphamide regimen induced remission of ANCA-associated vasculitis as well as the daily oral regimen at a reduced cumulative cyclophosphamide dose and caused fewer cases of leukopenia. Primary Funding Source: The European Union.
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| 2. |
- Flossmann, Oliver, et al.
(författare)
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Development of comprehensive disease assessment in systemic vasculitis
- 2007
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Ingår i: Annals of the Rheumatic Diseases. - : Oxford University Press (OUP). - 1468-2060. ; 66:3, s. 283-292
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Tidskriftsartikel (refereegranskat)abstract
- The systemic vasculitides are multisystem disorders with considerable mortality and morbidity and frequent relapses. In the absence of reliable serological markers, accurate clinical tools are required to assess disease activity and damage for treatment decisions, and for the performance of clinical trials. This article reviews and summarises the development and use of disease assessment tools for determining activity and damage in systemic vasculitis and reports ongoing initiatives for further development of disease assessment tools. A literature search was conducted using PubMed and reference lists for vasculitis, assessment, clinical trials, outcome and prognosis. The findings indicate that comprehensive disease assessment in vasculitis requires documentation of disease activity, chronic irreversible damage and impairment of function.
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| 5. |
- Rasmussen, Kirsten, et al.
(författare)
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Untreated ADHD in Adults Are There Sex Differences in Symptoms, Comorbidity, and Impairment?
- 2009
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Ingår i: Journal of Attention Disorders. - : SAGE Publications. - 1557-1246 .- 1087-0547. ; 12:4, s. 353-360
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyze sex differences among adult, never-treated patients referred for central stimulant treatment of ADHD. Method: Data for 600 consecutive patients from northern Norway referred for evaluation by an expert team during 7 years were analyzed. General background information, diagnostic and social history, and symptom profiles were compared between previously never-treated men and women. Results: The sex ratio was skewed. Of the previously untreated patients, more than 20% fell outside society's ordinary vocational activities or social benefit system. Most patients had the combined form, one third the inattentive type, and only 2% the hyperactive/impulsive subtype. Abuse and criminality were more common among men, and affective, eating, and somatization disorders were more common among women. Otherwise few sex differences were found. Conclusion: AD/HD symptom intensity and subtypes did not differ between the sexes and was to age. Symptom intensity was linked with criminality, abuse, and other psychiatric problems, differentially for two sexes. (J. of Att. Dis. 2009; 12(4) 353-360)
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| 6. |
- Strand, Susanne, 1972-
(författare)
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Violence risk assessment in male and female mentally disordered offenders : differences and similarities
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- When assessing the risk of violence, increasing interest has been shown in bringing science and practice closer together. Moving from clinical intuition in the first generation of risk assessment via actuarial scales in the second generation to the structured professional judgments where risk assessments are today produces better, more valid results when assessing the risk of violence. One of the best predictors of violence is gender. Approximately 10% of the violent criminality can be attributed to women; even so, it is increasing, especially among young women. It is therefore important to examine risk assessments from a gender perspective. Another important factor when assessing the risk of violence is psychopathy and there are indications that there might be gender differences in this diagnosis. Thus, a special interest has been focused on psychopathy in this thesis. The purpose with this work is to explore the similarities and differences in assessing risk for violence in male and female mentally disordered offenders, while the overall aim is to validate the violence risk assessment instrument HCR-20 for Swedish offender populations. The risk assessments for all six studies in this thesis were made by trained personnel using the HCR-20 instrument, where psychopathy was diagnosed with the screening version of the Psychopathy Checklist (PCL:SV). The study populations were both male and female mentally disordered offenders in either the correctional or the forensic setting.The findings show that both the validity and the reliability of the HCR-20 and the PCL:SV were good and the clinical and risk management subscales were found to have better predictive validity than the historical scale. Another finding was that there were more similarities than differences between genders in the HCR-20, while the opposite applied to the PCL:SV, where the antisocial behavior was performed in a different manner. Moreover, it was found that the gender of the assessor might be a factor to take into account when assessing the risk of violence in women, where the recommendation was that at least one assessor should be female. The conclusions were that the HCR-20 and the PCL:SV can be used In Swedish offender populations with valid results. For female offenders, there are differences in the antisocial behavior that is assessed in order to diagnose psychopathy and these differences tend to underestimate psychopathy among female offenders. Furthermore, the gender of the assessor might be of greater importance than has previously been realized. The overall conclusion was that this thesis supports the structural professional judgment method of making risk assessments in order to prevent violence in the community.
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