| 1. |
- Andernord, Daniel, et al.
(författare)
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Surgical Predictors of Early Revision Surgery After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register on 13,102 Patients.
- 2014
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 42:7, s. 1574-1582
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:An important objective of anterior cruciate ligament (ACL) registries is to detect and report early graft failure and revision surgery after ACL reconstruction. PURPOSE:To investigate surgical variables and identify predictors of revision surgery after ACL reconstruction. STUDY DESIGN:Prospective cohort study; Level of evidence, 2. METHODS:This prospective cohort study was based on data from the Swedish National Knee Ligament Register during the years 2005 through 2011. Eight surgical variables were investigated: graft selection, graft width, single-bundle or double-bundle techniques, femoral graft fixation, tibial graft fixation, injury-to-surgery interval, injuries to menisci, and injuries to cartilage. The primary endpoint was the 2-year incidence of revision surgery. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated and adjusted for confounders by use of multivariate statistics. RESULTS:A total of 13,102 patients were included (5541 women [42%] and 7561 men [58%]; P < .001). Hamstring tendon autografts accounted for 90% (11,764 patients) of all reconstructions, of which 96% were performed with a single-bundle technique (11,339 patients). Patellar tendon autografts accounted for the remaining 10% (1338 patients). At index reconstruction, observed injuries to menisci and cartilage were common (40% and 28%, respectively). The overall 2-year incidence of revision surgery was 1.60% (women, 1.57%; men, 1.63%; P = .854). Patients with metal interference screw fixation of a semitendinosus tendon autograft on the tibia had a significantly reduced risk of early revision surgery (RR = 0.32; 95% CI, 0.12-0.90; P = .031). CONCLUSION:Metal interference screw fixation of a semitendinosus tendon autograft on the tibia was an independent predictor of significantly lower 2-year incidence of revision surgery. Graft selection, graft width, a single-bundle or a double-bundle technique, femoral graft fixation, the injury-to-surgery interval, and meniscus injury were not predictors of early revision surgery.
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| 2. |
- Aydin-Schmidt, Berit, et al.
(författare)
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Usefulness of Plasmodium falciparum-specific rapid diagnostic tests for assessment of parasite clearance and detection of recurrent infections after artemisinin-based combination therapy.
- 2013
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Ingår i: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Rapid diagnostic test (RDT) is an important tool for parasite-based malaria diagnosis. High specificity of RDTs to distinguish an active Plasmodium falciparum infection from residual antigens from a previous infection is crucial in endemic areas where residents are repeatedly exposed to malaria. The efficiency of two RDTs based on histidine-rich protein 2 (HRP2) and lactate dehydrogenase (LDH) antigens were studied and compared with two microscopy techniques (Giemsa and acridine orange-stained blood smears) and real-time polymerase chain reaction (PCR) for assessment of initial clearance and detection of recurrent P. falciparum infections after artemisinin-based combination therapy (ACT) in a moderately high endemic area of rural Tanzania.
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| 3. |
- Beer, Netta, et al.
(författare)
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High effective coverage of vector control interventions in children after achieving low malaria transmission in Zanzibar, Tanzania.
- 2013
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Ingår i: Malaria journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: Background: Formerly a high malaria transmission area, Zanzibar is now targeting malaria elimination. A major challenge is to avoid resurgence of malaria, the success of which includes maintaining high effective coverage of vector control interventions such as bed nets and indoor residual spraying (IRS). In this study, caretakers' continued use of preventive measures for their children is evaluated, following a sharp reduction in malaria transmission. Methods: A cross-sectional community-based survey was conducted in June 2009 in North A and Micheweni districts in Zanzibar. Households were randomly selected using two-stage cluster sampling. Interviews were conducted with 560 caretakers of under-five-year old children, who were asked about perceptions on the malaria situation, vector control, household assets, and intention for continued use of vector control as malaria burden further decreases. Results: Effective coverage of vector control interventions for under-five children remains high, although most caretakers (65%; 363/560) did not perceive malaria as presently being a major health issue. Seventy percent (447/643) of the under-five children slept under a long-lasting insecticidal net (LLIN) and 94% (607/643) were living in houses targeted with IRS. In total, 98% (628/643) of the children were covered by at least one of the vector control interventions. Seasonal bed-net use for children was reported by 25% (125/508) of caretakers of children who used bed nets. A high proportion of caretakers (95%; 500/524) stated that they intended to continue using preventive measures for their under-five children as malaria burden further reduces. Malaria risk perceptions and different perceptions of vector control were not found to be significantly associated with LLIN effective coverage. Conclusions: While the majority of caretakers felt that malaria had been reduced in Zanzibar, effective coverage of vector control interventions remained high. Caretakers appreciated the interventions and recognized the value of sustaining their use. Thus, sustaining high effective coverage of vector control interventions, which is crucial for reaching malaria elimination in Zanzibar, can be achieved by maintaining effective delivery of these interventions.
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| 4. |
- Bergman, Eva, 1959-, et al.
(författare)
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Relative growth estimated from self-administered symphysis fundal measurements
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:2, s. 179-185
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To establish absolute-and relative-growth reference curves for the detection of intrauterine growth restriction from weekly self-administered symphysis-fundus (SF) measurements and to assess the influence of fetal sex, maternal obesity and parity. Design. Prospective longitudinal study. Setting. Pregnant women from six primary antenatal care centres. Population. Three hundred women with singleton ultrasound dated pregnancies. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were obtained. A linear mixed longitudinal model was used to estimate the absolute SF growth using the natural logarithm (lnSF). Relative lnSF growth was calculated as the lnSF measurement in one gestational week subtracted by the lnSF measurement in the previous gestational week. The influence of fetal sex, maternal obesity and parity was assessed in regression models and by a graphical display. Main Outcome Measures. Absolute lnSF and relative lnSF growth curves and influence of fetal sex, maternal obesity and parity on these. Results. SF measurements from 191 women were used to establish an SF-growth reference. The absolute lnSF growth was influenced by maternal obesity, and for fetal sex and parity, borderline significance was recorded; while there was no evidence that the relative lnSF growth could depend on these variables. Conclusions. Weekly self-administered SF measurements can be obtained and used to estimate SF growth. Relative growth of the lnSF height seems to be independent of fetal sex, maternal obesity and parity.
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| 5. |
- Bergman, Eva, 1959-, et al.
(författare)
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Self-administered symphysis-fundus measurements analyzed with a novel statistical method for detection of intrauterine growth restriction : a clinical evaluation
- 2011
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 90:8, s. 890-896
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To assess the ability of self-administered symphysis fundus measurements used with the Shiryaev-Roberts statistical method (SR method) to identify growth-restricted (IUGR) fetuses and compare it with the traditional SF method (symphysis fundus measurements used with a population-based reference curve). Design. Longitudinal study. Setting. Pregnant women attending primary antenatal care centres. Population. From a population of 1 888 women with singleton ultrasound-dated pregnancies, we analyzed data from 1 122 women. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were analyzed according to the SR method. Neonatal morbidity and small for gestational age (SGA) were used as proxies for IUGR. Small for gestational age was defined as a birthweight less than two standard deviations (SD) and <10th percentile. We assessed the sensitivity of the SR and the SF methods to detect neonatal morbidity and SGA. Main Outcome Measures. Birth-related mortality, respiratory distress, hypoglycemia, Apgar score <= 6 at five minutes, pH <= 7.00 in the umbilical artery, neonatal care, preterm delivery, operative delivery for fetal distress and SGA. Results. For the SR method, the sensitivity for neonatal morbidity was between 6.0 and 36.4%, for SGA <2SD 36.8%, and for SGA <10th percentile 20.9%. The SF method had a sensitivity between 6.0 and 13.8% for neonatal morbidity, 52.3% for SGA <2SD and 28.6% for SGA <10th percentile. Conclusions. The SR and the SF methods had low sensitivities for neonatal morbidity.
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| 6. |
- Dale, Richard Allan, 1965, et al.
(författare)
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Alcohol environment, gender and nonfatal injuries in young people. An ecological study of fourteen swedish municipalities (2000-2005).
- 2012
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Ingår i: Substance abuse treatment, prevention, and policy. - 1747-597X. ; 7:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Sweden has had a restrictive alcohol policy, but there are gender and geographical differences in alcohol consumption and injury rates within the country. Whether and how the Swedish alcohol environment influences gender differences in injuries in young people is still unclear. Thus, the aim of this study was to analyse the associations between the local alcohol environment and age- and gender-specific nonfatal injury rates in people up to 24 years in Sweden. METHODS: The local alcohol environment from 14 municipalities was studied using indicators of alcohol access, alcohol consumption and alcohol-related crimes. A comprehensive health care register of nonfatal injuries was used to estimate mean annual rates of nonfatal injuries by gender and age group (2000--2005). Pearson's correlation coefficients were used to analyse linear associations. RESULTS: Associations were shown for both alcohol access and alcohol consumption with injury rates in boys aged 13--17 years; no other associations were observed between alcohol access or per capita alcohol consumption and nonfatal childhood injuries. The prevalence of crimes against alcohol laws was associated with injury rates in children of both genders aged 6--17 years. CONCLUSIONS: This study found no strong area-level associations between alcohol and age and gender specific nonfatal injuries in young people. Further, the strength of the area-level associations varied by age, gender and type of indicator used to study the local alcohol environment.
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| 7. |
- Elfving, Kristina, et al.
(författare)
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Real-time PCR threshold cycle (Ct) cut-offs help to identify agents causing acute childhood diarrhea in Zanzibar.
- 2014
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Ingår i: Journal of clinical microbiology. - 1098-660X. ; 52:3, s. 916-923
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Tidskriftsartikel (refereegranskat)abstract
- Molecular assays might improve identification of causes of acute diarrheal disease, but may lead to more frequent detection of asymptomatic infections. In the present study real-time PCR targeting 14 pathogens was applied on rectal swabs from 330 children aged 2-59 months in Zanzibar, 165 with acute diarrhea and 165 asymptomatic controls. At least one pathogen was detected in 94% of patients and 84% of controls, with higher rates in patients for norovirus genogroup II (20% vs. 2.4%, p<0.0001), rotavirus (10% vs. 1.8%, p=0.003) and Cryptosporidium (30% vs. 11%, p<0.0001). Detection rates did not differ significantly for enterotoxigenic Escherichia coli (ETEC)-estA (33% vs. 24%), ETEC-eltB (44% vs. 46%), Shigella (35% vs. 33%), and Campylobacter (35% vs. 33%), but for these agents Ct (threshold cycle) values were lower (pathogen loads were higher) in sick children than in controls. In multivariate analysis, Ct values for norovirus genogroup II, rotavirus, Cryptosporidium, ETEC-estA and Shigella were independently associated with diarrhea. We conclude that this real-time PCR allows convenient detection of essentially all diarrheagenic agents, and provides Ct values that may be critical for interpretation of results for pathogens with similar detection rates in patients and controls. The results indicate that assessment of pathogen load may improve identification of agents causing gastroenteritis in children.
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| 8. |
- Gerdin, M., et al.
(författare)
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Early Hospital Mortality among Adult Trauma Patients Significantly Declined between 1998-2011: Three Single-Centre Cohorts from Mumbai, India
- 2014
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Traumatic injury causes more than five million deaths each year of which about 90% occur in low-and middle-income countries (LMIC). Hospital trauma mortality has been significantly reduced in high-income countries, but to what extent similar results have been achieved in LMIC has not been studied in detail. Here, we assessed if early hospital mortality in patients with trauma has changed over time in an urban lower middle-income setting. Methods: We conducted a retrospective study of patients admitted due to trauma in 1998, 2002, and 2011 to a large public hospital in Mumbai, India. Our outcome measure was early hospital mortality, defined as death between admission and 24-hours. We used multivariate logistic regression to assess the association between time and early hospital mortality, adjusting for patient case-mix. Injury severity was quantified using International Classification of Diseases-derived Injury Severity Score (ICISS). Major trauma was defined as ICISS, 0.90. Results: We analysed data on 4189 patients out of which 86.5% were males. A majority of patients were between 15 and 55 years old and 36.5% had major trauma. Overall early hospital mortality was 8.9% in 1998, 6.0% in 2002, and 8.1% in 2011. Among major trauma patients, early hospital mortality was 13.4%, in 1998, 11.3% in 2002, and 10.9% in 2011. Compared to trauma patients admitted in 1998, those admitted in 2011 had lower odds for early hospital mortality (OR = 0.56, 95% CI = 0.41-0.76) including those with major trauma (OR = 0.57, 95% CI = 0.41-0.78). Conclusions: We observed a significant reduction in early hospital mortality among patients with major trauma between 1998 and 2011. Improved survival was evident only after we adjusted for patient case-mix. This finding highlights the importance of risk-adjustment when studying longitudinal mortality trends.
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| 9. |
- Gerdin, M., et al.
(författare)
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Predicting Early Mortality in Adult Trauma Patients Admitted to Three Public University Hospitals in Urban India: A Prospective Multicentre Cohort Study
- 2014
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 9:9
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Tidskriftsartikel (refereegranskat)abstract
- Background: In India alone, more than one million people die yearly due to trauma. Identification of patients at risk of early mortality is crucial to guide clinical management and explain prognosis. Prediction models can support clinical judgement, but existing models have methodological limitations. The aim of this study was to derive a vital sign based prediction model for early mortality among adult trauma patients admitted to three public university hospitals in urban India. Methods: We conducted a prospective cohort study of adult trauma patients admitted to three urban university hospitals in India between October 2013 and January 2014. The outcome measure was mortality within 24 hours. We used logistic regression with restricted cubic splines to derive our model. We assessed model performance in terms of discrimination, calibration, and optimism. Results: A total of 1629 patients were included. Median age was 35, 80% were males. Mortality between admission and 24 hours was 6%. Our final model included systolic blood pressure, heart rate, and Glasgow coma scale. Our model displayed good discrimination, with an area under the receiver operating characteristics curve (AUROCC) of 0.85. Predicted mortality corresponded well with observed mortality, indicating good calibration. Conclusion: This study showed that routinely recorded systolic blood pressure, heart rate, and Glasgow coma scale predicted early hospital mortality in trauma patients admitted to three public university hospitals in urban India. Our model needs to be externally validated before it can be applied in the clinical setting.
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| 10. |
- Godman, B., et al.
(författare)
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Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources? Findings from across Europe and their implications
- 2014
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Ingår i: Bmc Medicine. - : Springer Science and Business Media LLC. - 1741-7015. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Generic atypical antipsychotic drugs offer health authorities opportunities for considerable savings. However, schizophrenia and bipolar disorders are complex diseases that require tailored treatments. Consequently, generally there have been limited demand-side measures by health authorities to encourage the preferential prescribing of generics. This is unlike the situation with hypertension, hypercholaesterolaemia or acid-related stomach disorders. The objectives of this study were to compare the effect of the limited demand-side measures in Western European countries and regions on the subsequent prescribing of risperidone following generics; to utilise the findings to provide future guidance to health authorities; and where possible, to investigate the utilisation of generic versus originator risperidone and the prices for generic risperidone. Methods: Principally, this was a segmented regression analysis of retrospective time-series data of the effect of the various initiatives in Belgium, Ireland, Scotland and Sweden following the introduction of generic risperidone. The study included patients prescribed at least one atypical antipsychotic drug up to 20 months before and up to 20 months after generic risperidone. In addition, retrospective observational studies were carried out in Austria and Spain (Catalonia) from 2005 to 2011 as well as one English primary care organisation (Bury Primary Care Trust (PCT)). Results: There was a consistent steady reduction in risperidone as a percentage of total selected atypical antipsychotic utilisation following generics. A similar pattern was seen in Austria and Spain, with stable utilisation in one English PCT. However, there was considerable variation in the utilisation of generic risperidone, ranging from 98% of total risperidone in Scotland to only 14% in Ireland. Similarly, the price of generic risperidone varied considerably. In Scotland, generic risperidone was only 16% of pre-patent loss prices versus 72% in Ireland. Conclusion: Consistent findings of no increased prescribing of risperidone post generics with limited specific demand-side measures suggests no 'spillover' effect from one class to another encouraging the preferential prescribing of generic atypical antipsychotic drugs. This is exacerbated by the complexity of the disease area and differences in the side-effects between treatments. There appeared to be no clinical issues with generic risperidone, and prices inversely reflected measures to enhance their utilisation.
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