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- Øzhayat, Esben Boeskov, et al.
(author)
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Patients' experience of partial tooth loss and expectations to treatment : a qualitative study in Danish and Swedish patients
- 2016
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In: Journal of Oral Rehabilitation. - : Blackwell Munksgaard. - 1365-2842 .- 0305-182X. ; 43:3, s. 180-189
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Journal article (peer-reviewed)abstract
- Knowledge of impairments, wishes and expectations is essential to make correct decisions regarding oral rehabilitation. The purpose of this study was to investigate discomforts, wishes and expectations in patients' with partial edentulism before entering oral rehabilitation. In Copenhagen, Denmark, and Malmo, Sweden, respectively, 20 patients with partial edentulism seeking rehabilitation were interviewed in a semistructured qualitative manner. The interviews were transcribed and analysed yielding overall domains. Six themes appeared as overall domains: (i) experienced impairments, (ii) experienced social awareness, (iii) expectation to treatment, (iv) expectation to durability/survival, (v) coping strategies dealing with the tooth loss including explanations of the tooth loss and (vi) modifications to experienced impairment. The impairments were mostly experienced as problems in social settings. Most participants expressed a simple wish to function normally; a fixed solution was preferred. Many Danish participants accepted a removable solution whereas only few Swedish participants did so. The domains coping strategies' and modifications' were not part of the chosen topics of interest, indicating a high wish of the participants to explain their tooth loss and how they coped with it. In conclusion, a large degree of social impairment was found in the patient group along with several coping strategies. The impairments were modified by a number of factors indicating that highly individualised care and treatment is needed. A state of normality was described as the primary treatment wish with a higher acceptance of removable solutions in Denmark than in Sweden. For final decision-making, surrounding factors seemed to influence the patients' choices.
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- Aad, G., et al.
(author)
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- 2014
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swepub:Mat__t
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- Abe, O, et al.
(author)
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Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials
- 2005
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In: The Lancet. - 1474-547X. ; 365:9472, s. 1687-1717
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Journal article (peer-reviewed)abstract
- Background Quinquennial overviews (1985-2000) of the randomised trials in early breast cancer have assessed the 5-year and 10-year effects of various systemic adjuvant therapies on breast cancer recurrence and survival. Here, we report the 10-year and 15-year effects. Methods Collaborative meta-analyses were undertaken of 194 unconfounded randomised trials of adjuvant chemotherapy or hormonal therapy that began by 1995. Many trials involved CMF (cyclophosphamide, methotrexate, fluorouracil), anthracycline-based combinations such as FAC (fluorouracil, doxombicin, cyclophosphamide) or FEC (fluorouracil, epirubicin, cyclophosphamide), tamoxifen, or ovarian suppression: none involved taxanes, trastuzumab, raloxifene, or modem aromatase inhibitors. Findings Allocation to about 6 months of anthracycline-based polychemotherapy (eg, with FAC or FEC) reduces the annual breast cancer death rate by about 38% (SE 5) for women younger than 50 years of age when diagnosed and by about 20% (SE 4) for those of age 50-69 years when diagnosed, largely irrespective of the use of tamoxifen and of oestrogen receptor (ER) status, nodal status, or other tumour characteristics. Such regimens are significantly (2p=0 . 0001 for recurrence, 2p<0 . 00001 for breast cancer mortality) more effective than CMF chemotherapy. Few women of age 70 years or older entered these chemotherapy trials. For ER-positive disease only, allocation to about 5 years of adjuvant tamoxifen reduces the annual breast cancer death rate by 31% (SE 3), largely irrespective of the use of chemotherapy and of age (<50, 50-69, &GE; 70 years), progesterone receptor status, or other tumour characteristics. 5 years is significantly (2p<0 . 00001 for recurrence, 2p=0 . 01 for breast cancer mortality) more effective than just 1-2 years of tamoxifen. For ER-positive tumours, the annual breast cancer mortality rates are similar during years 0-4 and 5-14, as are the proportional reductions in them by 5 years of tamoxifen, so the cumulative reduction in mortality is more than twice as big at 15 years as at 5 years after diagnosis. These results combine six meta-analyses: anthracycline-based versus no chemotherapy (8000 women); CMF-based versus no chemotherapy (14 000); anthracycline-based versus CMF-based chemotherapy (14 000); about 5 years of tamoxifen versus none (15 000); about 1-2 years of tamoxifen versus none (33 000); and about 5 years versus 1-2 years of tamoxifen (18 000). Finally, allocation to ovarian ablation or suppression (8000 women) also significantly reduces breast cancer mortality, but appears to do so only in the absence of other systemic treatments. For middle-aged women with ER-positive disease (the commonest type of breast cancer), the breast cancer mortality rate throughout the next 15 years would be approximately halved by 6 months of anthracycline-based chemotherapy (with a combination such as FAC or FEC) followed by 5 years of adjuvant tamoxifen. For, if mortality reductions of 38% (age <50 years) and 20% (age 50-69 years) from such chemotherapy were followed by a further reduction of 31% from tamoxifen in the risks that remain, the final mortality reductions would be 57% and 45%, respectively (and, the trial results could well have been somewhat stronger if there had been full compliance with the allocated treatments). Overall survival would be comparably improved, since these treatments have relatively small effects on mortality from the aggregate of all other causes. Interpretation Some of the widely practicable adjuvant drug treatments that were being tested in the 1980s, which substantially reduced 5-year recurrence rates (but had somewhat less effect on 5-year mortality rates), also substantially reduce 15-year mortality rates. Further improvements in long-term survival could well be available from newer drugs, or better use of older drugs.
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- Andrews, Geoffrey, et al.
(author)
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The Grey Escape : investigating older people's use of the free bus pass
- 2012
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In: Transportation planning and technology (Print). - : Informa UK Limited. - 0308-1060 .- 1029-0354. ; 35:1, s. 3-15
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Journal article (peer-reviewed)abstract
- Since 2008 most older people in England have benefited from unlimited area-wide free travel by bus after the morning peak period. The official policy rhetoric supporting implementation of the measure drew significantly on the need to reduce social exclusion amongst older people. However, despite a substantial increase in the number of concessionary journeys in England and the associated cost liabilities for local authorities and possibly also operators, there is currently only limited understanding of the wide ranging effects on bus use of providing a free pass, and in particular to whom benefits from the policy accrue. In part, this circumstance results from a methodological focus by evaluation studies hitherto that has emphasised aggregate-level data, often at the expense of the very rich contextual information about how the individual benefits from using a pass. This article presents insights into the perceptions, motivations and decisions relating to use of free bus passes, highlighting the existence of both tangible and intangible benefits which arise. It offers a fresh insight into previously undefined uses and benefits derived from possessing and using a concessionary bus pass. This article concludes by noting possible policy implications of the research in the context of the UK's ageing population and for other international contexts where the transport intervention of free bus travel is being considered.
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- Biffi, Annalisa, et al.
(author)
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Adherence to Antidepressants and Mortality in Elderly Patients with Cardiovascular Disease
- 2018
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In: Clinical drug investigation. - : Springer Science and Business Media LLC. - 1173-2563 .- 1179-1918. ; 38:7, s. 593-602
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Journal article (peer-reviewed)abstract
- Background and ObjectiveConflicting findings from studies evaluating the association between use of antidepressant drugs and mortality have been reported. We tested the hypothesis that better adherence to antidepressant therapy may reduce mortality.MethodsThe cohort included 29,845 individuals aged >= 65 years from several Italian health units who were newly treated with antidepressant drugs after hospital discharge with a diagnosis for cardiovascular disease during 2008-2010. These individuals were observed from the first prescription until the end of data availability (i.e. 2012-2014, depending on the local database). During this period, information on (1) prescription of antidepressants and other medications and (2) death from any cause (outcome) was recorded. Proportional hazards models were fitted to estimate the association between better adherence to antidepressants (defined as proportion of days covered > 75%) and outcome, by adjusting and stratifying for several covariates.ResultsPatients with better adherence to antidepressants had a reduced mortality of 9% (95% CI 3-14). Patients who did not use other medicaments during follow-up had reduced mortality associated with better adherence to antidepressants of 21% (- 1-38), 14% (7-20), 20% (13-26) and 13% (7-19) for no users of antihypertensive agents, lipid-lowering agents, other cardiovascular drugs and antidiabetics, respectively.ConclusionsBetter adherence to antidepressants is associated with reduced all-cause mortality, mainly in patients who did not use other pharmacological treatments. Behavioural changes to enhance adherence among the elderly with cardiovascular disease might offer important benefits in reducing their mortality.
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| 10. |
- Bitsch, Bertram, et al.
(author)
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The structure of protoplanetary discs around evolving young stars
- 2015
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In: Astronomy & Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 575
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Journal article (peer-reviewed)abstract
- The formation of planets with gaseous envelopes takes place in protoplanetary accretion discs on time scales of several million years. Small dust particles stick to each other to form pebbles, pebbles concentrate in the turbulent flow to form planetesimals and planetary embryos and grow to planets, which undergo substantial radial migration. All these processes are influenced by the underlying structure of the protoplanetary disc, specifically the profiles of temperature, gas scale height, and density. The commonly used disc structure of the minimum mass solar nebula (MMSN) is a simple power law in all these quantities. However, protoplanetary disc models with both viscous and stellar heating show several bumps and dips in temperature, scale height, and density caused by transitions in opacity, which are missing in the MMSN model. These play an important role in the formation of planets, since they can act as sweet spots for forming planetesimals via the streaming instability and affect the direction and magnitude of type-I migration. We present 2D simulations of accretion discs that feature radiative cooling and viscous and stellar heating, and they are linked to the observed evolutionary stages of protoplanetary discs and their host stars. These models allow us to identify preferred planetesimal and planet formation regions in the protoplanetary disc as a function of the disc's metallicity, accretion rate, and lifetime. We derive simple fitting formulae that feature all structural characteristics of protoplanetary discs during the evolution of several Myr. These fits are straightforward for applying to modelling any growth stage of planets where detailed knowledge of the underlying disc structure is required.
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