| 1. |
- Randell, Eva, et al.
(författare)
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Complementary elements of support after gastric-bypass surgery perceived by adults with previous type 2 diabetes : A qualitative study 2 years after bariatric surgery
- 2023
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Ingår i: Clinical Obesity. - : John Wiley & Sons. - 1758-8103 .- 1758-8111.
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Tidskriftsartikel (refereegranskat)abstract
- Bariatric surgery is the most medically and cost-effective treatment for adults with obesity and type 2 diabetes mellitus (T2DM). Our findings suggest initial improvements in health-related quality of life that may decline as support from follow-up care ends. How patients experience long-term support is not well described. This study therefore aimed to investigate how adults with previous T2DM perceived different sources of support 2 years after bariatric surgery. In this qualitative study individual interviews were conducted with 13 adults (10 women) 2 years after surgery. Using thematic analysis, one overarching theme (compiling complementary elements of support after gastric-bypass surgery), four themes and nine subthemes emerged. The results show that support was given and received from various sources, support needs varied over time depending on where the patient was in the process and that the sources of support were complementary. To conclude, our results show that support needs change in adults who have undergone bariatric surgery. Long-term professional and day-to-day support from family and other networks are essential and complementary elements of support. Health care staff should consider these findings, especially during the early follow-up period.
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| 2. |
- Shannon, Michelle M., et al.
(författare)
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Can the physical environment itself influence neurological patient activity?
- 2019
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 41:10, s. 1177-1189
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate if a changed physical environment following redesign of a hospital ward influenced neurological patient physical and social activity. Methods: A “before and after” observational design was used that included 17 acute neurological patients pre-move (median age 77 (IQR 69–85) years Ward A and 20 post-move (median age 70 (IQR 57–81) years Ward B. Observations occurred for 1 day from 08.00–17.00 using Behavioral Mapping of patient physical and social activity, and location of that activity. Staff and ward policies remained unchanged throughout. An Environmental Description Checklist of each ward was also completed. Results: Behavioral Mapping was conducted pre-/post-move with a total of 801 Ward A and 918 Ward B observations. Environmental Description Checklists showed similarities in design features in both neurological wards with similar numbers of de-centralized nursing stations, however there were more single rooms and varied locations to congregate in Ward B (30% more single-patient rooms and separate allied health therapy room). Patients were alone >60% of time in both wards, although there was more in bed social activity in Ward A and more out of bed social activity in Ward B. There were low amounts of physical activity outside of patient rooms in both wards. Significantly more physical activity occurred in Ward B patient rooms (median = 47%, IQR 14–74%) compared to Ward A (median = 2% IQR 0–14%), Wilcoxon Rank Sum test z = −3.28, p = 0.001. Conclusions: Overall, patient social and physical activity was low, with little to no use of communal spaces. However we found more physical activity in patient rooms in the Ward B environment. Given the potential for patient activity to drive brain reorganization and repair, the physical environment should be considered an active factor in neurological rehabilitation and recovery.Implications for Rehabilitation Clinicians should include consideration of the impact of physical environment on physical and social activity of neurological patients when designing therapeutic rehabilitation environments. Despite architectural design intentions patient and social activity opportunities can be limited. Optimal neurological patient neuroplasticity and recovery requires sufficient environmental challenge, however current hospital environments for rehabilitation do not provide this.
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| 3. |
- Hagström, Emil, et al.
(författare)
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Plasma parathyroid hormone and risk of congestive heart failure in the community
- 2010
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 12:11, s. 1186-1192
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Tidskriftsartikel (refereegranskat)abstract
- In experimental studies parathyroid hormone (PTH) has been associated with underlying causes of heart failure (HF) such as atherosclerosis, left ventricular hypertrophy, and myocardial fibrosis. Individuals with increased levels of PTH, such as primary or secondary hyperparathyroidism patients, have increased risk of ischaemic heart disease and HF. Moreover, increasing PTH is associated with worse prognosis in patients with overt HF. However, the association between PTH and the development HF in the community has not been reported. In a prospective, community-based study of 864 elderly men without HF or valvular disease at baseline (mean age 71 years, the ULSAM study) the association between plasma (P)-PTH and HF hospitalization was investigated adjusted for established HF risk factors (myocardial infarction, hypertension, diabetes, electrocardiographic left ventricular hypertrophy, smoking, and hypercholesterolaemia) and variables reflecting mineral metabolism (S-calcium, S-phosphate, P-vitamin D, S-albumin, dietary calcium and vitamin D intake, physical activity, glomerular filtration rate, and blood draw season). During follow-up (median 8 years), 75 individuals were hospitalized due to HF. In multivariable Cox-regression analyses, higher P-PTH was associated with increased HF hospitalization (hazard ratio for 1-SD increase of PTH, 1.41, 95% CI 1.12-1.77, P = 0.003). Parathyroid hormone also predicted hospitalization in participants without apparent ischaemic HF and in participants with normal P-PTH. In a large community-based sample of elderly men, PTH predicted HF hospitalizations, also after accounting for established risk factors and mineral metabolism variables. Our data suggest a role for PTH in the development of HF even in the absence of overt hyperparathyroidism.
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| 4. |
- Hansson, Jonas, et al.
(författare)
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Biomarkers of Extracellular Matrix Metabolism (MMP-9 and TIMP-1) and Risk of Stroke, Myocardial Infarction, and Cause-Specific Mortality : Cohort Study
- 2011
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Ingår i: PLoS ONE. - San Francisco : Public Library of Science (PLoS). - 1932-6203. ; 6:1, s. e16185-
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Turnover of the extracellular matrix in all solid organs is governed mainly by a balance between the degrading matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). An altered extracellular matrix metabolism has been implicated in a variety of diseases. We investigated relations of serum levels of MMP-9 and TIMP-1 to mortality risk from an etiological perspective.Design: The prospective Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, followed from 1991-1995 for up to 18.1 years. A random population-based sample of 1,082 71-year-old men, no loss to follow-up. Endpoints were all-cause (n = 628), cardiovascular (n = 230), non-cardiovascular (n = 398) and cancer mortality (n = 178), and fatal or non-fatal myocardial infarction (n = 138) or stroke (n = 163).Results: Serum MMP-9 and TIMP-1 levels were associated with risk of all-cause mortality (Cox proportional hazard ratio [HR] per standard deviation 1.10, 95% confidence interval [CI] 1.03-1.19; and 1.11, 1.02-1.20; respectively). TIMP-1 levels were mainly related to risks of cardiovascular mortality and stroke (HR per standard deviation 1.22, 95% CI 1.09-1.37; and 1.18, 1.04-1.35; respectively). All relations except those of TIMP-1 to stroke risk were attenuated by adjustment for cardiovascular disease risk factors. Relations in a subsample without cardiovascular disease or cancer were similar to those in the total sample.Conclusion: In this community-based cohort of elderly men, serum MMP-9 and TIMP-1 levels were related to mortality risk. An altered extracellular matrix metabolism may be involved in several detrimental pathways, and circulating MMP-9 or TIMP-1 levels may be relevant markers thereof.
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| 5. |
- Melhus, Håkan, et al.
(författare)
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Plasma 25-Hydroxyvitamin D Levels and Fracture Risk in a Community-Based Cohort of Elderly Men in Sweden
- 2010
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 95:6, s. 2637-2645
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Tidskriftsartikel (refereegranskat)abstract
- Context: Blood levels of 25-hydroxyvitamin D [25(OH)D] is the generally accepted indicator of vitamin D status, but no universal reference level has been reached. Objective: The objective of the study was to determine the threshold at which low plasma 25(OH)D levels are associated with fractures in elderly men and clarify the importance of low levels on total fracture burden. Design and Participants: In the Uppsala Longitudinal Study of Adult Men, a population-based cohort (mean age, 71 yr, n = 1194), we examined the relationship between 25(OH)D and risk for fracture. Plasma 25(OH)D levels were measured with high-pressure liquid chromatography-mass spectrometry. Setting: The study was conducted in the municipality of Uppsala in Sweden, a country with a high fracture incidence. Main Outcome Measure: Time to fracture was measured. Results: During follow-up (median 11 yr), 309 of the participants (26%) sustained a fracture. 25(OH)D levels below 40 nmol/liter, which corresponded to the fifth percentile of 25(OH)D, were associated with a modestly increased risk for fracture, multivariable-adjusted hazard ratio 1.65 (95% confidence interval 1.09-2.49). No risk difference was detected above this level. Approximately 3% of the fractures were attributable to low 25(OH)D levels in this population. Conclusions: Vitamin D insufficiency is not a major cause of fractures in community-dwelling elderly men in Sweden. Despite the fact that cutaneous synthesis of previtamin D during the winter season is undetectable at this northern latitude of 60 degrees , only one in 20 had 25(OH)D levels below 40 nmol/liter, the threshold at which the risk for fracture started to increase. Genetic adaptations to limited UV light may be an explanation for our findings.
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| 6. |
- Michaëlsson, Karl, et al.
(författare)
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Plasma vitamin D and mortality in older men : a community-based prospective cohort study
- 2010
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Ingår i: American Journal of Clinical Nutrition. - : Elsevier BV. - 0002-9165 .- 1938-3207. ; 92:4, s. 841-848
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vitamin D status is known to be important for bone health but may also affect the development of several chronic diseases, including cancer and cardiovascular diseases, which are 2 major causes of death. Objective: We aimed to examine how vitamin D status relates to overall and cause-specific mortality. Design: The Uppsala Longitudinal Study of Adult Men, a community-based cohort of elderly men (mean age at baseline: 71 y; n = 1194), was used to investigate the association between plasma 25-hydroxyvitamin D [25(OH)D] and mortality. Total plasma 25(OH)D was determined with HPLC atmospheric pressure chemical ionization mass spectrometry. Proportional hazards regression was used to compute hazard ratios (HRs). Results: During follow-up (median: 12.7 y), 584 (49%) participants died. There was a U-shaped association between vitamin D concentrations and total mortality. An approximately 50% higher total mortality rate was observed among men in the lowest 10% (<46 nmol/L) and the highest 5% (>98 nmol/L) of plasma 25(OH)D concentrations compared with intermediate concentrations. Cancer mortality was also higher at low plasma concentrations (multivariable-adjusted HR: 2.20; 95% CI: 1.44, 3.38) and at high concentrations (HR: 2.64; 95% CI: 1.46, 4.78). For cardiovascular death, only low (HR: 1.89; 95% CI: 1.21, 2.96) but not high (HR: 1.33; 95% CI: 0.69, 2.54) concentrations indicated higher risk. Conclusions: Both high and low concentrations of plasma 25(OH)D are associated with elevated risks of overall and cancer mortality. Low concentrations are associated with cardiovascular mortality.
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| 7. |
- Persson, Marie, et al.
(författare)
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Operational strategies to manage non-elective orthopaedic surgical flows : A simulation modelling study
- 2017
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Ingår i: BMJ Open. - London : BMJ Publishing Group. - 2044-6055. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To explore the value of simulation modelling in evaluating the effects of strategies to plan and schedule operating room (OR) resources aimed at reducing time to surgery for non-elective orthopaedic inpatients at a Swedish hospital. Methods We applied discrete-event simulation modelling. The model was populated with real world data from a university hospital with a strong focus on reducing waiting time to surgery for patients with hip fracture. The system modelled concerned two patient groups that share the same OR resources: hip-fracture and other non-elective orthopaedic patients in need of surgical treatment. We simulated three scenarios based on the literature and interaction with staff and managers: (1) baseline; (2) reduced turnover time between surgeries by 20â €..min and (3) one extra OR during the day, Monday to Friday. The outcome variables were waiting time to surgery and the percentage of patients who waited longer than 24â €..hours for surgery. Results The mean waiting time in hours was significantly reduced from 16.2â €..hours in scenario 1 (baseline) to 13.3â €..hours in scenario 2 and 13.6â €..hours in scenario 3 for hip-fracture surgery and from 26.0â €..hours in baseline to 18.9â €..hours in scenario 2 and 18.5â €..hours in scenario 3 for other non-elective patients. The percentage of patients who were treated within 24â €..hours significantly increased from 86.4% (baseline) to 96.1% (scenario 2) and 95.1% (scenario 3) for hip-fracture patients and from 60.2% (baseline) to 79.8% (scenario 2) and 79.8% (scenario 3) for patients with other non-elective patients. Conclusions Healthcare managers who strive to improve the timelines of non-elective orthopaedic surgeries may benefit from using simulation modelling to analyse different strategies to support their decisions. In this specific case, the simulation results showed that the reduction of surgery turnover times could yield the same results as an extra OR. © 2017 Published by the BMJ Publishing Group Limited.
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| 8. |
- Katsogiannos, Petros, et al.
(författare)
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Quality of life after gastric bypass surgery in patients with type 2 diabetes : patients’ experiences during 2 years of follow-up
- 2020
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Ingår i: Diabetology & Metabolic Syndrome. - : Springer Science and Business Media LLC. - 1758-5996. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTo examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods.MethodsThirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed.ResultsSignificant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme “Finding a balance between the experience of the new body weight and self-confidence”.ConclusionsThe improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.
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| 9. |
- Salmelin, A., et al.
(författare)
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Fetal monitoring with computerized ST analysis during labor : A systematic review and meta-analysis
- 2013
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - Hoboken, USA : Wiley. - 0001-6349 .- 1600-0412. ; 92:1, s. 28-39
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Tidskriftsartikel (refereegranskat)abstract
- Background. Computerized ST analysis of fetal electrocardiography (ECG) combined with cardiotochography (CTG) has been introduced for intrapartum monitoring and is the prevailing method when ST analysis (STAN®) is used. Objective. To assess the evidence that computerized ST analysis during labor reduces the incidence of fetal metabolic acidosis, hypoxic ischemic encephalopathy, cesarean section, instrumental vaginal delivery or the number of instances where fetal scalp blood sampling is used as compared with CTG only. Methods. Search of PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL and CRD databases. Selection criteria. CTG only compared with CTG + computerized ST analysis. Data collection and analysis. Studies were assessed using pre-designed templates. Meta-analyses of included randomized controlled trials were performed using a random effects model. Results. Risk ratio for cord metabolic acidosis with STAN® was 0.96 [95% confidence interval (CI) 0.49-1.88]. Risk ratio for cesarean sections or instrumental vaginal deliveries for fetal distress was 0.93 (95%CI 0.80-1.08) and for fetal scalp blood sampling 0.55 (95%CI 0.40-0.76). Encephalopathy cases were not assessed due to their low incidence. Conclusions. There is not enough scientific evidence to conclude that computerized ST analysis reduces the incidence of metabolic acidosis. Cesarean sections and instrumental vaginal deliveries due to fetal distress or other indications are the same, regardless of method, but STAN® reduces the number of instances which require scalp blood sampling. © 2012 The Authors © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
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| 10. |
- Askling, Carl, et al.
(författare)
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A new hamstring test to complement the common clinical examination before return to sport after injury
- 2010
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Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer-Verlag. - 0942-2056 .- 1433-7347. ; 18:12, s. 1788-1803
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim was to introduce and evaluate the reliability and validity of an active hamstring flexibility test as a complement to common clinical examination when determining safe return to sport after hamstring injury. METHODS: Eleven healthy subjects (28 years) were tested on repeated occasions, and 11 athletes (21 years) with MRI-verified acute hamstring strain were tested when common clinical examination revealed no signs of remaining injury, i.e. there was no differences between the legs in palpation pain, manual strength tests, and passive straight leg raise. Flexibility, i.e. highest range of motion of three consecutive trials, was calculated from electrogoniometer data during active ballistic hip flexions and conventional passive slow hip-flexions in a supine position. A VAS-scale (0-100) was used to estimate experience of insecurity during active tests. RESULTS: No significant test-retest differences were observed. Intra-class correlation coefficients ranged 0.94-0.99 and coefficients of variation 1.52-4.53%. Active flexibility was greater (23%) than passive flexibility. In the athletes, the injured leg showed smaller (8%) active, but not passive, flexibility than the uninjured leg. Average insecurity estimation was 52 (range 28-98) for the injured and 0 for the uninjured leg, respectively. CONCLUSION: The new test showed high reliability and construct validity; furthermore, it seems to be sensitive enough to detect differences both in active flexibility and in insecurity after acute hamstring strains at a point in time when the commonly used clinical examination fails to reveal injury signs. Thus, the test could be a complement to the common clinical examination before the final decision to return to sport is made.
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