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- Abraham-Nordling, M, et al.
(författare)
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The value of preoperative computed tomography combined with ultrasound in the investigation of small indeterminate liver lesions in patients with colorectal cancer
- 2017
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 58:11, s. 1288-1293
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Tidskriftsartikel (refereegranskat)abstract
- Computed tomography (CT) is used routinely for the preoperative detection of colorectal cancer (CRC) metastases. When small indeterminate focal liver lesions are detected that are too small to characterize (TSTC) on CT, additional imaging is usually needed, resulting in a potential delay in obtaining a complete diagnostic work-up. Purpose To determine the diagnostic accuracy of ultrasound (US) of the liver performed in direct conjunction to CT in the preoperative investigation among patients with newly diagnosed CRC when indeterminate liver lesions were found on CT. Material and Methods Preoperative investigations with CT and consecutive US where CT had shown at least one focal liver lesion in 74 patients diagnosed with CRC between June 2009 and February 2012 were retrospectively reviewed. Either histopathological findings or a combination of imaging and clinical follow-up one to three years after surgery was used as the reference. Results Liver metastases were diagnosed with CT/US in 13 out of 74 patients (17.6%). In one patient, a liver cyst was preoperatively regarded as liver metastasis by a combined CT/US. The sensitivity and specificity for the CT with consecutive US procedure was 100% (13/13) and 98.4% (60/61). Conclusion US performed in conjunction with CT in patients with indeterminate focal liver lesions on CT is an accurate work-up for detection of liver metastases in patients with newly diagnosed CRC. Although our results are promising, they cannot be considered safely generalizable to all hospitals.
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| 5. |
- Hjern, F., et al.
(författare)
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Cohort study of corticosteroid use and risk of hospital admission for diverticular disease
- 2015
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Ingår i: British Journal of Surgery. - : WILEY-BLACKWELL. - 0007-1323 .- 1365-2168. ; 102:1, s. 119-124
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medication has been suggested as a potential risk factor for diverticular disease. The objective of this study was to investigate the association between the intake of corticosteroids, indometacin or aspirin and diverticular disease. Method: This was a prospective population-based cohort study of middle-aged women in the Swedish Mammography Cohort. Use of corticosteroids (oral or inhaled), indometacin or aspirin in 1997 was determined from questionnaires. Cases of diverticular disease were identified from the Swedish national registers until the end of 2010. The relative risk (RR) of diverticular disease requiring hospital admission according to the use of medication was estimated using Cox proportional hazards models, adjusted for age, body mass index, physical activity, fibre intake, diabetes, hypertension, alcohol, smoking and education. Results: A total of 36 586 middle-aged women in the Swedish Mammography Cohort were included, of whom 674 (18 per cent) were hospitalized with diverticular disease at least once. Some 72 per cent of women reported intake of oral corticosteroids and 85 per cent use of inhaled corticosteroids. In multivariable analysis, women who reported oral corticosteroid intake had a 37 per cent (RR 137, 95 per cent c.i. 106 to 178; P=0012) increased risk of diverticular disease compared with those who reported no intake at all. Use of inhaled corticosteroids was associated with an even more pronounced increase in risk of 71 per cent (RR 171, 136 to 214; P<0001). There was a significant dose-response relationship, with the risk increasing with longer duration of inhaled corticosteroids (P for trend<0001). Use of indometacin (25 per cent of women) or aspirin (442 per cent) did not influence the risk. Conclusion: There was a significant relationship between corticosteroids (especially inhaled) and diverticular disease requiring hospital admission.
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- Julihn, A., et al.
(författare)
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Socioeconomic Determinants, Maternal Health, and Caries in Young Children
- 2018
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Ingår i: JDR clinical and translational research. - : SAGE Publications. - 2380-0852 .- 2380-0852 .- 2380-0844. ; 3:4, s. 395-404
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Maternal health during pregnancy plays a part in child health, and several conditions have been associated with adverse child outcomes.Objectives: To determine the socioeconomic determinants and maternal health factors associated with dental caries in young children.Methods: This cross-sectional study is part of a register-based cohort study including all children who were born from 2000 to 2003 and were residing in Stockholm County, Sweden, at age 3 y (n = 73,658). The study followed the cohort until individuals were 7 y old. The final study cohort comprised all children examined at 3 and 7 y (n = 65,259). Data on socioeconomic conditions, maternal health, and maternal health behavior were extracted from Swedish national registries. The multivariate analyses used 2 outcomes: caries experience at age 3 and 7 y (deft > 0 [decayed, extracted, and filled teeth]).Results: The results of this study show that socioeconomic and maternal health behaviors during pregnancy are important determinants of oral health in their preschool offspring. When all significant risk factors were present, the cumulative probability of being diagnosed with dental caries at age 7 y was 75%.Conclusion: This study also showed that maternal obesity and smoking during pregnancy were predictors of dental caries in preschool children. Strategies must be developed for increasing maternal motivation and self-efficacy and providing mothers with knowledge and caries-preventive tools.Knowledge Transfer Statement: The results of this study inform clinicians about the importance of including a more detailed history regarding maternal health and maternal health behaviors during pregnancy to assess caries risk in preschool children. Education, income, and other socioeconomic factors are difficult to modify in the short term. Therefore, strategies must be developed to increase parental motivation and self-efficacy to give parents the determination, knowledge, and tools for prevention.
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- Malmborg, Petter, et al.
(författare)
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Effects of Childhood-onset Inflammatory Bowel Disease on School Performance : A Nationwide Population-based Cohort Study Using Swedish Health and Educational Registers
- 2019
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Ingår i: Inflammatory Bowel Diseases. - : Oxford University Press (OUP). - 1078-0998 .- 1536-4844. ; 25:10, s. 1663-1673
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Childhood-onset inflammatory bowel disease (IBD) might negatively impact academic school performance. We conducted a nationwide study to examine the association between childhood-onset IBD and school results. METHODS: Our study population was selected from Swedish health registers. In the National Patient Register (1990 to 2013), we identified 2827 children with IBD: Crohn's disease (CD), n = 1207, and ulcerative colitis (UC), n = 1370. Patients were matched with 10 reference individuals by age, sex, birth year, and place of residence (n = 28,235). Final compulsory school grades (0 to 320 grade points) and qualification for high school (yes or no) were obtained through the National School Register. Regression models controlling for socioeconomic factors were used to analyze the association of IBD with school performance. RESULTS: Children with IBD had a lower final grade point average (adjusted mean grade difference [AMGD] -4.9, 95% confidence interval [CI] -7.1 to -2.6) but not a significantly higher risk to not qualify for high school (odds ratio [OR] 1.14, CI 0.99-1.31). The results were similar in children with UC (AMGD -5.5, CI -8.7 to -2.3) and CD (AMGD -4.7, CI -8.2 to -1.2). Underperformance was more common in subsets of IBD children characterized by markers associated with long-standing active disease (eg, >30 inpatient days [AMGD-18.1, CI -25.8 to -10.4]). CONCLUSION: Most children with IBD achieve comparable results in the final year of compulsory school as their healthy peers. Care should be improved for the subgroup of children for which IBD has a stronger negative impact on school performance.
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- Sköldberg, Filip, et al.
(författare)
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Incidence and lifetime risk of hospitalization and surgery for diverticular disease
- 2019
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 106:7, s. 930-939
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies on incidence rates of first-time colonic diverticular disease are few, and population-based estimates of lifetime risk are lacking. In this observational study, the incidence, admission rates and lifetime risks of hospitalization and surgery for diverticular disease were investigated.Methods: Considering the entire Swedish population as an open cohort, incidence and admission rates, and lifetime risk estimates (considering death as a competing risk) of hospitalization and surgery for diverticular disease were calculated using data from cross-linked national registers and population statistics from 1987 to 2010.Results: In total, there were 144 107 hospital admissions for diverticular disease in 95 049 individual patients. Of these, 17 599 were admissions with bowel resection or stoma formation in 16 824 patients. The total number of person-years in the population during the study period was 213 949 897. Age-standardized incidence rates were 47.4 (95 per cent c. i. 47.1 to 47.7) for first-time hospitalization with diverticular disease and 8.4 (8.2 to 8.5) per 100 000 person-years for diverticular disease surgery. The corresponding admission rates (including readmissions) were 70.8 (70.4 to 71.2) and 8.7 (8.6 to 8.9) per 100 000 person-years. Following an increase in 1990-1994, rates stabilized. Based on incidence and mortality rates from 2000 to 2010, the estimated remaining lifetime risk of hospitalization from 30 years of age was 3.1 per cent in men and 5.0 per cent in women. The corresponding risk of surgery was 0.5 per cent in men and 0.8 per cent in women.Conclusion: Diverticular disease is a common reason for hospital admission, particularly in women, but rates are stable and the lifetime risk of surgery is low.
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- Tiefenthal, M., et al.
(författare)
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Laparoscopic and open right-sided colonic resection in daily routine practice. A prospective multicentre study within an Enhanced Recovery After Surgery (ERAS) protocol
- 2016
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 18:2, s. 187-194
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Tidskriftsartikel (refereegranskat)abstract
- AimThe study compared the outcome of laparoscopic and open surgery in daily practice when performed in a strict Enhanced Recovery After Surgery (ERAS) environment. MethodTwo-hundred and ninety-two consecutive patients who received elective surgery, in three Swedish ERAS centres, for cancer or adenoma in the right colon in the period 1 January 2011 to 31 December 2012, were prospectively registered in a Web-based ERAS database. Peri-operative data were collected from the database and patient charts. The primary end-points included postoperative recovery and morbidity. The secondary objective was to identify preoperative variables that influenced the selection of patients for laparoscopic or open surgery. ResultsOne-hundred and twenty-three (42%) patients were selected for laparoscopic surgery. The overall preoperative ERAS-compliance rate was 87% and no significant difference was seen between the surgical techniques. In multivariate analysis, patients treated with laparoscopy had significantly earlier pain control (2.43.2days vs 4.2 +/- 5.9days; P=0.016) and a shorter length of hospital stay (LOS) (4days vs 6days; P=0.002) compared with open surgery. There was no significant difference in the complication rate [18.7% vs 21.3%; OR=1.0 (95% CI: 0.5-2.0)], the number of lymph nodes removed or the rate of R0 resection between laparoscopic and open surgery. Tumours selected for laparoscopy weregenerally smaller, had a lower T-stage and were predominantly situated in the caecum and the ascending colon compared with those of patients selected for open surgery. ConclusionThe use of laparoscopy in routine right-sided colectomy in an ERAS environment, with data on outcome corrected for selection bias, may result in faster recovery compared with open surgery.
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| 14. |
- Wettergren, Björn, et al.
(författare)
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Child Health Systems in Sweden
- 2016
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Ingår i: Journal of Pediatrics. - New York, USA : Elsevier. - 0022-3476 .- 1097-6833. ; 177:Suppl., s. S187-S202
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Tidskriftsartikel (refereegranskat)abstract
- On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.
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