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- Bondesson, E., et al.
(author)
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Comorbidity between pain and mental illness - Evidence of a bidirectional relationship
- 2018
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In: European Journal of Pain. - : Wiley. - 1090-3801. ; 22:7, s. 1304-1311
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Journal article (peer-reviewed)abstract
- Background: Pain from various locations in the body and mental illness are common and the comorbidity between the two is well-known although the temporal relationship remains to be determined. Our aim was to follow patients over time to study if pain (here dorsalgia/abdominal pain) or fibromyalgia lead to an increased risk of developing mental illness (here depression/anxiety) and/or the reverse, that is whether patients with mental illness have an increased risk to develop pain or fibromyalgia, compared to the rest of the population. Methods: This prospective cohort study used the Skåne Healthcare Register, covering all care in the region of Skåne, southern Sweden (population ~1.3 million). The cohort included healthcare consultations in primary care, outpatient specialized care and inpatient care between 2007 and 2016 for all patients without prior registered diagnosis of mental illness or pain, aged 18 or older (n = 504,365). Results: The incidence rate ratio (IRR) for developing mental illness after pain was 2.18 (95% CI = 2.14-2.22) compared to without pain. IRR for developing pain after mental illness was 2.02 (95% CI = 1.98-2.06) compared to without mental illness. Corresponding IRR for developing mental illness after fibromyalgia was 4.05 (95% CI = 3.58-4.59) and for developing fibromyalgia after mental illness 5.54 (95% CI = 4.99-6.16). Conclusions: This study shows a bidirectional influence of similar magnitude of pain and mental illness, respectively. In monitoring patients with pain or mental illness, a focus on both conditions is thus important to develop appropriate, targeted interventions and may increase the likelihood of improved outcomes. Significance: We followed a population-based cohort over a period of 10 years, including incident cases of both exposure and outcome and found a bidirectional relationship between pain and mental illness. Clinicians need to pay attention on both conditions, in patients seeking care due to mental illness or pain.
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- Ogink, H., et al.
(author)
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A strategic tool to improve long-term health outcomes in clinical practice: SHOR driver and association diagram
- 2020
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In: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 32:1, s. 20-27
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Journal article (peer-reviewed)abstract
- Quality problem or issue: An over-arching principle of healthcare governance in Sweden is to achieve as much health for as many patients as possible given the available resources. With high life expectancy and increased years lived with non-communicable diseases, more effective interventions in prevention and control of non-communicable diseases are needed in order to ensure high-quality healthcare. Initial assessment: Few publications have described a generic and resource-effective method of implementing the perspective of health outcomes in relation to costs in a clinical Swedish university hospital context. To fill this gap, a generic method was developed at Sahlgrenska University hospital in Gothenburg, Sweden. Choice of solution: A System-based driver and association diagram of Health Outcomes in relation to available Resources (SHOR) was developed. The SHOR driver and association diagram comprised different perspectives: health, patient, process, research and cost perspectives. It enabled the translation from long-term health outcomes to applications in clinical practice. Implementation: Three patient groups exemplify the use and implementation of the method of SHOR association and driver diagram; bipolar disorder (psychiatry), primiparous women with spontaneous onset of labour, (obstetric care) and chronic obstructive pulmonary disease (somatic care). Evaluation:The SHOR driver and association diagram enabled a structure to monitor and support quality development towards maximised health outcomes in relation to available resources and associated total costs for a specific patient group. Lessons learned :This method has connected clinical practice, management and research and has been used for both strategic and operational purposes.
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- Grunewald, C, et al.
(author)
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Exhaled oral and nasal nitric oxide during L-arginine infusion in preeclampsia
- 1998
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In: Gynecologic and obstetric investigation. - : S. Karger AG. - 0378-7346 .- 1423-002X. ; 46:4, s. 232-237
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Journal article (peer-reviewed)abstract
- <b>Objective: </b>To determine the effects of the nitric oxide (NO) precursor <i>L</i>-arginine on the airway NO concentration in patients with preeclampsia. <b>Methods:</b> NO was measured by a noninvasive chemiluminescence technique in air sampled directly from nasal and oral cavities during expiration before and during <i>L</i>-arginine infusion in 9 preeclamptic and 10 control pregnancies. Maternal blood pressure and heart rate were simultaneously recorded, and blood was sampled for analyses of cyclic guanosine monophosphate (cGMP) and nitrate. <b>Results: </b>Basal nasal and orally exhaled NO and the increment in nasal NO concentration during <i>L</i>-arginine infusion were similar in both groups. Basal plasma and platelet cGMP concentrations were similar in both groups. Following <i>L</i>-arginine infusion, plasma cGMP levels were significantly higher in preeclamptics (p < 0.01), while platelet cGMP was unaffected in both groups. Basal plasma nitrate was significantly higher in preeclamptics (p < 0.01), and this difference was not altered following infusion. Blood pressure and heart rate remained unaffected by the procedure in both groups. <b>Conclusions:</b> Blood pressure did not decrease in the preeclamptics following <i>L</i>-arginine infusion, despite a significant increase in nasal NO sampled during breathhold and a concomitant increase in plasma cGMP, possibly reflecting an endogenous NO production. These results do not support the idea of a generalized decrease in NO production being a major cause of hypertension in preeclampsia.
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