| 1. |
- Alme, Tomas Nordheim, et al.
(author)
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Chronic fatigue syndromes: real illnesses that people can recover from
- 2023
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In: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 41:4, s. 372-376
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Journal article (peer-reviewed)abstract
- The Oslo Chronic Fatigue Consortium consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brains response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.
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| 2. |
- Courteille, Olivier, et al.
(author)
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Learning through a virtual patient vs. recorded lecture : a comparison of knowledge retention in a trauma case
- 2018
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In: International Journal of Medical Education. - : IJME. - 2042-6372. ; 9, s. 86-92
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Journal article (peer-reviewed)abstract
- Objectives: To compare medical students' and residents' knowledge retention of assessment, diagnosis and treatment procedures, as well as a learning experience, of patients with spinal trauma after training with either a Virtual Patient case or a video-recorded traditional lecture. Methods: A total of 170 volunteers (85 medical students and 85 residents in orthopedic surgery) were randomly allocated (stratified for student/resident and gender) to either a video-recorded standard lecture or a Virtual Patient-based training session where they interactively assessed a clinical case portraying a motorcycle accident. The knowledge retention was assessed by a test immediately following the educational intervention and repeated after a minimum of 2 months. Participants' learning experiences were evaluated with exit questionnaires. A repeated-measures analysis of variance was applied on knowledge scores. A total of 81% (n = 138) of the participants completed both tests. Results: There was a small but significant decline in first and second test results for both groups (F-(1,F-135) = 18.154, p = 0.00). However, no significant differences in short-term and long-term knowledge retention were observed between the two teaching methods. The Virtual Patient group reported higher learning experience levels in engagement, stimulation, general perception, and expectations. Conclusions: Participants' levels engagement were reported in favor of the VP format. Similar knowledge retention was achieved through either a Virtual Patient or a recorded lecture.
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| 3. |
- Allvin, Kerstin, 1970, et al.
(author)
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Elevated serum levels of estradiol, dihydrotestosterone, and inhibin B in adult males born small for gestational age
- 2008
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In: Journal of Clinical Endocrinology & Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 93:4, s. 1464-9
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Journal article (peer-reviewed)abstract
- CONTEXT: Prenatal growth restriction may affect future fertility in both females and males. Studies have shown that growth-retarded male rats have different sexual behavior and disturbed steroidogenesis. OBJECTIVE: We hypothesized that adult human males born small for gestational age (SGA) have an altered sex hormone profile. DESIGN, SETTING, AND PATIENTS: Twenty-five adult males born SGA with median birth weight -2.2 sd scores (SDS) and birth length -2.4 SDS were studied. Median age was 23.1 yr and final height -0.5 SDS. They were compared with 44 male controls with median age 20.5 yr and final height 0.4 SDS. MAIN OUTCOME MEASURE: The primary outcome before the study started was 17beta-estradiol (E(2)) levels in SGA males. RESULTS: The SGA group showed significantly higher median levels of E(2), 17.9 pg/ml (P < 0.001), and dihydrotestosterone (DHT), 0.543 ng/ml (P < 0.05), compared with controls, 12.6 pg/ml and 0.423 ng/ml, respectively. Testosterone (T) levels did not differ between groups. E(2) to T ratio correlated negatively to birth weight (r = -0.40, P < 0.01) and birth length (r = -0.44, P < 0.001). DHT to T ratio correlated negatively to birth weight (r = -0.51, P < 0.001) and birth length (r = -0.38, P < 0.01). Males born SGA also had significantly higher median levels of inhibin B, 164 pg/ml (P < 0.05), compared with controls, 137 pg/ml. Inhibin B correlated negatively to birth length (r = -0.34, P < 0.01). CONCLUSION: SGA males of normal stature have higher levels of E(2), DHT, and inhibin B than controls, indicating a disturbed steroid synthesis or metabolism. Aromatase activity, calculated as E(2) to T ratio, and 5alpha-reductase activity, calculated as DHT to T ratio, is negatively correlated to size at birth.
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| 4. |
- Dasgupta, Indranil, et al.
(author)
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Validating the use of bioimpedance spectroscopy for assessment of fluid status in children.
- 2018
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In: Pediatric nephrology. - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 33:9, s. 1601-1607
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Journal article (peer-reviewed)abstract
- Bioimpedance spectroscopy (BIS) with a whole-body model to distinguish excess fluid from major body tissue hydration can provide objective assessment of fluid status. BIS is integrated into the Body Composition Monitor (BCM) and is validated in adults, but not children. This study aimed to (1) assess agreement between BCM-measured total body water (TBW) and a gold standard technique in healthy children, (2) compare TBW_BCM with TBW from Urea Kinetic Modelling (UKM) in haemodialysis children and (3) investigate systematic deviation from zero in measured excess fluid in healthy children across paediatric age range.TBW_BCM and excess fluid was determined from standard wrist-to-ankle BCM measurement. TBW_D2O was determined from deuterium concentration decline in serial urine samples over 5days in healthy children. UKM was used to measure body water in children receiving haemodialysis. Agreement between methods was analysed using paired t test and Bland-Altman method comparison.In 61 healthy children (6-14years, 32 male), mean TBW_BCM and TBW_D2O were 21.1±5.6and 20.5±5.8L respectively. There was good agreement between TBW_BCM and TBW_D2O (R2=0.97). In six haemodialysis children (4-13years, 4 male), 45 concomitant measurements over 8months showed good TBW_BCM and TBW_UKM agreement (mean difference -0.4L, 2SD=±3.0L). In 634 healthy children (2-17years, 300 male), BCM-measured overhydration was -0.1±0.7L (10-90th percentile -0.8 to+0.6L). There was no correlation between age and OH (p=0.28).These results suggest BCM can be used in children as young as 2years to measure normally hydrated weight and assess fluid status.
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| 5. |
- Decker, Ralph, 1968, et al.
(author)
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Metabolic outcome of GH treatment in prepubertal short children with and without classical GH deficiency
- 2010
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In: Clinical Endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 73:3, s. 346-354
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Journal article (peer-reviewed)abstract
- Context: Few studies have evaluated the metabolic outcomes of growth hormone (GH) treatment in idiopathic short stature (ISS). Moreover, children with ISS appear to need higher GH doses than children with GH deficiency (GHD) to achieve the same amount of growth, and may therefore be at increased risk of adverse events during treatment. The individualized approach using prediction models for estimation of GH responsiveness, on the other hand, has the advantage of narrowing the range of growth response, avoiding too low or high GH doses. Design: Short prepubertal children with either isolated GHD (39) or ISS (89) participated in a 2-year randomized trial of either individualized GH treatment with six different GH doses (range, 17-100 mug/kg/day) or a standard dose (43 mug/kg/day). Objective: To evaluate if individualized GH treatment reduced the variance of the metabolic measures as shown for growth response, and to compare changes in metabolic variables in children with ISS and GHD. Hypothesis: Individualized GH dose reduces the range of metabolic outcomes, and metabolic outcomes are similar in children with ISS and GHD. Results: We observed a narrower variation for fasting insulin (-34.2%) and for HOMA (-38.9%) after two years of individualized GH treatment in comparison to standard GH dose treatment. Similar metabolic changes were seen in ISS and GHD. Delta (Delta) height SDS correlated with Deltainsulin-like growth factor I (IGF-I), Deltaleptin and Deltabody composition. Principal component analysis identified an anabolic and a lipolytic component. Anabolic variables [Deltalean body mass (LBM) SDS and DeltaIGF-I SDS] clustered together and correlated strongly with Deltaheight SDS and GH dose, whereas lipolytic variables [Deltafat mass SDS and Deltaleptin] were clustered separately from anabolic variables. Regression analysis showed GH dose-dependency in ISS, and to a lesser degree in GHD, for DeltaLBM SDS and Deltaheight SDS, but not for changes in fat mass. Conclusions: Individualized GH dosing during catch-up growth reduces the variance in insulin and HOMA and results in equal metabolic responses irrespective of the diagnosis of GHD or ISS.
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| 6. |
- Fors, Hans, 1956
(author)
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Body composition and bone density in children and adolescents. Relation to growth hormone
- 2002
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Doctoral thesis (other academic/artistic)abstract
- The regulation of growth, body composition and bone mineralisation during childhood and adolescence is a complex and multifactorial process. Growth hormone (GH) is essential for normal growth; in addition, it influences bone mineralisation and body composition in both children and adults. Leptin is a hormone secreted by adipose tissue which is involved in the regulation of both appetite and energy expenditure. Furthermore, it may also play an important role in hypothalamic-pituitary functions, such as the regulation of GH secretion. Thus, measurements of body composition have become important in clinical endocrinology and endocrine research in order to assess the metabolic effects of hormones and nutritional status on skeletal, adipose and lean tissues. Aim: The general aim of the thesis was to study the relationships among GH secretion, leptin concentration and body composition measured by dual energy X-ray absorptiometry (DXA) and bioelectric impedance (BIA). Furthermore, to evaluate the effect of GH treatment and discontinuation of GH treatment on body composition. Additionally, the aim was to evaluate two different methods for body composition measurements. Results: The main findings from the four papers that form the basis of this thesis are outlined below. Paper I: Seventy-one children were investigated. They were healthy and had different GH secretory capacities before the planned start of GH treatment. Relationships between GH secretion, leptin concentration and body composition, measured by DXA, were studied. A strong positive correlation between leptin levels and body fat, a significant negative correlation between leptin levels and GH secretion, and a significant negative correlation between body fat and GH secretion were found.Paper II: Changes in body composition in relation to changes in leptin concentration were studied during the first year of GH therapy in 33 prepubertal children. Height increased from -2.33 to -1.73 SDS. After 1 year of GH treatment, total body fat decreased by 3%, lean tissue mass increased by 2.9% and total bone mineral density (BMD) increased significantly. Total body BMD SDS was not increased significantly compared with reference values. Serum leptin levels decreased and there was a correlation between the change in body fat and the change in serum leptin levels during the 1 year of GH treatment.Paper III: Forty adolescents treated with GH for more than 3 years and 16 matched controls were studied. The consequences of discontinuing GH treatment on bone mineralisation were examined over a period of 2 years. There were no differences between GH-deficient, GH-sufficient and control subjects either at baseline or after 2 years in bone mineral content (BMC) and BMD measurements. However, biochemical bone markers decreased over the 2 years in the GH treated cohort.Paper IV: Fat-free mass, body fat mass and percentage fat were measured in 61 healthy children to determine the level of agreement between body composition measurements by DXA and single and multifrequency bioelectrical impedance spectroscopy. The estimates were highly correlated between the methods. However, a Bland-Altman comparison showed wide limits of agreement between the methods.Conclusions: The study support the existing evidence for a close correlation between leptin and body fat. Furthermore, the study demonstrate correlations between leptin, body fat and GH secretion. Specific regional fat depots have different relationships with leptin and markers of GH secretion. Leptin may be involved in the hypothalamic regulation of GH secretion. GH treatment affects body composition and bone mineralisation. The present swedish treatment of GH-deficient children to final height results in a normal BMD. Furthermore, DXA and bioelectric impedance methods should not be used interchangeably to measure body composition in children.
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| 7. |
- Fors, Ronny, et al.
(author)
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Lifestyle and nickel allergy in a Swedish adolescent population : effects of piercing, tattooing and orthodontic appliances
- 2012
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In: Acta Dermato-Venereologica. - : Society for the Publication of Acta Dermato - Venereologica. - 0001-5555 .- 1651-2057. ; 92:6, s. 664-668
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Journal article (peer-reviewed)abstract
- The aim of this study was to estimate the prevalence of life-style practices in adolescents and their association with nickel allergy. Upper secondary school pupils (n = 4,376; 15-23 years) were patch-tested for nickel aller-gy, follow-ing completion of a questionnaire (answered by 6,095). Almost 86% girls and 21% of boys reported piercing. More girls (6%) than boys (3%) had a tattoo. Twenty-six percent of the girls and 18% of the boys were regular smokers. Vegetarian/vegan diets were reported by 20% of girls and by 6% of boys. Piercing, female gender, and vocational programme increased the risk of nickel allergy, whereas orthodontic appliance treat-ment prior to piercing reduced the risk of nickel allergy. Pupils in vocational programmes had the highest prevalence of nickel allergy. Lifestyle behaviours are interconnected and cluster in subgroups of adolescents. Female sex, piercing and choice of educational programme are prominent lifestyle markers. A trend shift is observed, where more girls than boys report tattooing.
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| 8. |
- Fors, Ronny, et al.
(author)
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Nickel allergy : prevalence in a population of Swedish youths from patch test and questionnaire data
- 2008
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In: Contact Dermatitis. - Copenhagen : Munksgaard. - 0105-1873 .- 1600-0536. ; 58:2, s. 80-87
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Journal article (peer-reviewed)abstract
- Background: The prevalence of body piercing and orthodontic treatment has increased during recent decades. Such changes in lifestyle may influence the occurrence of nickel allergy.Objectives: The aim of this study was to describe the prevalence of nickel allergy in a Swedish youth population.Methods: In a cross-sectional survey, 6095 adolescents answered a questionnaire on their lifestyle and medical history, and 4439 consented to patch testing for contact allergy. Patch test results were adjusted for dropouts by a missing value analysis.Results: The prevalence of self-reported dermatitis from contact with metal items was 14.8%. Patch testing showed nickel sensitization in 9.9% of the subjects, and in significantly more girls than boys, 13.3% versus 2.5%, respectively. Taking the dropout into account, the estimated true prevalence of nickel sensitivity evaluated by test reading at D4 is 11.8% in girls and 1.6% in boys.Conclusions: The prevalence of nickel sensitization was higher for girls and slightly lower for boys compared with previous Swedish data. Self-reported information on metal dermatitis as an estimate of nickel allergy has low validity. When possible, missing value analysis should be performed to account for dropouts.
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| 9. |
- Fors, Ronny, et al.
(author)
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Nickel allergy in relation to piercing and orthodontic appliances : a population study
- 2012
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In: Contact Dermatitis. - : John Wiley & Sons. - 0105-1873 .- 1600-0536. ; 67:6, s. 342-350
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Journal article (peer-reviewed)abstract
- Background. Studies have shown conflicting results on the association between nickel exposure from orthodontic appliances and nickel sensitization.Objectives & Method. In a cross-sectional study, we investigated the association between nickel sensitization and exposure to orthodontic appliances and piercings. 4376 adolescents were patch tested following a questionnaire asking for earlier piercing and orthodontic treatment. Exposure to orthodontic appliances was verified in dental records.Results. Questionnaire data demonstrated a reduced risk of nickel sensitization when orthodontic treatment preceded piercing (OR 0.46; CI 0.27–0.78). Data from dental records demonstrated similar results (OR 0.61, CI 0.36–1.02), but statistical significance was lost when adjusting for background factors. Exposure to full, fixed appliances with NiTi-containing alloys (OR 0.31, CI 0.10–0.98) as well as a pooled ‘high nickel-releasing’ appliance group (OR 0.56, CI 0.32–0.97) prior to piercing was associated with a significantly reduced risk of nickel sensitization.Conclusion. High nickel-containing orthodontic appliances preceding piercing reduces the risk of nickel sensitization by a factor 1.5–2. The risk reduction is associated with estimated nickel release of the appliance and length of treatment. Sex, age at piercing and number of piercings are also important risk indicators. Research on the role of dental materials in the development of immunological tolerance is needed.
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| 10. |
- Jarfelt, Marianne, 1962, et al.
(author)
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Bone mineral density and bone turnover in young adult survivors of childhood acute lymphoblastic leukaemia
- 2006
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In: Eur J Endocrinol. ; 154:2, s. 303-9
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Treatment for childhood leukaemia induces many risk factors for development of decreased bone mineral density (BMD). Physical activity is also known to affect BMD. The aim was to study BMD and markers of bone turnover in a well-defined group of survivors of acute lymphoblastic leukaemia (ALL) who had all reached final height as well as peak bone mass, taking both previous treatment and physical activity into consideration. DESIGN: All patients treated for ALL before the onset of puberty in the region of western Sweden, between 1973 and 1985, in first remission were included. Thirty-five out of forty-seven patients aged 20-32 years participated. Nineteen patients had received cranial radiotherapy, and the median follow-up time was 20 years. METHODS: BMD was assessed using dual-energy X-ray absorbtiometry (DEXA). Serum concentrations of markers of bone turnover were analysed. Physical performance was measured using a performance exercise capacity stress test. RESULTS: BMD was slightly reduced in lumbar spine (-0.4 SD), but not in femoral neck or total body. BMD in femoral neck was correlated to physical performance and dose of corticosteroid, but no correlation was found with spontaneous growth hormone (GH) secretion. Markers of bone turnover were also correlated to physical performance, but not to GH secretion. CONCLUSIONS: Physical fitness seems to be the most important factor in developing and preserving normal bone mineral density in ALL patients. We propose that lifestyle education promoting physical activity is encouraged from an early point in time for these patients.
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| 11. |
- Larsson, Ingrid, 1963, et al.
(author)
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Body composition through adult life : Swedish reference data on body composition
- 2015
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In: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 69:7, s. 837-842
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Journal article (peer-reviewed)abstract
- Background/Objectives:The prevalence of obesity, defined as body mass index (BMI) greater than or equal to30 kg/m2, differs between populations; however, there is a need for data on description on body composition in reference populations of different ages and from different countries. The objective of this study was to pool dual-energy X-ray absorptiometry (DXA) body composition reference data from population-based Swedish cohorts.Subjects/Methods:Four population-based cross-sectional cohort studies including 1424 adult Swedes were divided into five age groups (20–29, 30–39, 40–49, 50–61 and 75 years of age); BMI 24.6±3.9 kg/m2 were pooled. Body composition was measured with DXA.Results:The difference in BMI from the youngest to the oldest age group was 3.2 and 4.3 kg/m2 in men and women, respectively (P<0.001, both sexes), and fat mass (FM) was 9.9 and 9.1% higher in the oldest compared with the youngest men and women (P<0.001, both sexes). Fat-free mass (FFM) remained stable up to 60 years of age in men (P=0.83) and was lower at 75 years of age compared with the younger ages. In women, FFM was lower from age 60. From youngest to oldest age groups, height-adjusted FM differed from 4.6 to 7.8 kg/m2 in men and from 6.8 to 10.8 kg/m2 in women (P<0.001, both sexes).Conclusions:Our results provide reference data on body composition in Swedish populations. BMI and FM were higher among older age groups compared with the younger ones. FFM remained stable up to 60 years of age and was lower first among the 75 years of age.
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| 12. |
- Liu, Fang, 1975, et al.
(author)
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Effect of Boron on Carbide Coarsening at 873 K (600°C) in 9 to 12 pct Chromium Steels
- 2012
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In: Metallurgical and Materials Transactions A: Physical Metallurgy and Materials Science. - : Springer Science and Business Media LLC. - 1073-5623. ; 43:11, s. 4053-4062
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Journal article (peer-reviewed)abstract
- The addition of small amounts of boron to 9 to 12 pct chromium steels has been found to decrease their creep rate at 823 K to 923 K (550 °C to 650 °C). In this article, the behavior of boron during austenitizing, tempering, and isothermal heat treatment at 873 K (600 °C) is studied using high-resolution microscopy and microanalysis as well as using atomistic modeling. It was found that increasing the boron content from 9 to 40 ppm decreased the coarsening constant of M23C6 by a factor of almost 2. Most of the added boron was incorporated in M23C6. Atomistic modeling showed that boron diffusion in ferrite is dominated by an interstitial mechanism at 873 K (600 °C). However, the generation of vacancies when carbide precipitates dissolve may promote a distribution with substitutional boron atoms. The absence of a fast mechanism for the transition from substitutional to interstitial occupancy will make the slow substitutional boron diffusion in the matrix rate controlling for the coarsening process.
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| 13. |
- Ludvigsson, Johnny, et al.
(author)
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GAD65 antigen therapy in recently diagnosed type 1 diabetes mellitus
- 2012
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In: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 366:5, s. 433-442
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Journal article (peer-reviewed)abstract
- BACKGROUND: The 65-kD isoform of glutamic acid decarboxylase (GAD65) is a major autoantigen in type 1 diabetes. We hypothesized that alum-formulated GAD65 (GAD-alum) can preserve beta-cell function in patients with recent-onset type 1 diabetes.METHODS: We studied 334 patients, 10 to 20 years of age, with type 1 diabetes, fasting C-peptide levels of more than 0.3 ng per milliliter (0.1 nmol per liter), and detectable serum GAD65 autoantibodies. Within 3 months after diagnosis, patients were randomly assigned to receive one of three study treatments: four doses of GAD-alum, two doses of GAD-alum followed by two doses of placebo, or four doses of placebo. The primary outcome was the change in the stimulated serum C-peptide level (after a mixed-meal tolerance test) between the baseline visit and the 15-month visit. Secondary outcomes included the glycated hemoglobin level, mean daily insulin dose, rate of hypoglycemia, and fasting and maximum stimulated C-peptide levels.RESULTS: The stimulated C-peptide level declined to a similar degree in all study groups, and the primary outcome at 15 months did not differ significantly between the combined active-drug groups and the placebo group (P=0.10). The use of GAD-alum as compared with placebo did not affect the insulin dose, glycated hemoglobin level, or hypoglycemia rate. Adverse events were infrequent and mild in the three groups, with no significant differences.CONCLUSIONS: Treatment with GAD-alum did not significantly reduce the loss of stimulated C peptide or improve clinical outcomes over a 15-month period.
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| 14. |
- Ly, Helena-Jamin, et al.
(author)
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A prediction model could foresee adequate height response in children eligible for growth hormone treatment
- 2022
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 111:2, s. 346-353
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Journal article (peer-reviewed)abstract
- Aim Prediction models may be useful in accurately identifying children who will benefit from growth hormone (GH) treatment. We aimed to validate the Gothenburg prediction model for this purpose. Methods The study included prepubertal children with GH deficiency who started treatment with GH during 2004-2016 at Queen Silvia Children's Hospital, Gothenburg, based on a first-year growth prediction of >= 0.7 SDS in height according to the Gothenburg prediction model on a GH dose of 33 mu g/kg/day. Observed heights retrieved from medical charts were compared with predicted heights. Results The study included 121 patients (64% boys) with at least one year of data after the start of GH treatment. The median (range) GH dose was 30 (10-43) mu g/kg/day for the first year and age at start of treatment was 5.32 (3-11.8) years. The model correctly excluded poor responders resulting in 119/121 (98%) patients having a height gain of at least >= 0.5 SDS in a year. However, the model underestimated relatively low predictions and overestimated relatively high predictions, with a residual standard deviation of 0.31 SDS. Conclusion By using a validated prediction model for GH in a clinical context, unnecessarily treating short children with an expected poor height outcome can be avoided.
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| 15. |
- Ly, Helena-Jamin, et al.
(author)
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Comparison of two prediction models in a clinical setting to predict growth in prepubertal children on recombinant growth hormone
- 2023
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In: Growth Hormone & Igf Research. - : Elsevier BV. - 1096-6374. ; 68
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Journal article (peer-reviewed)abstract
- Objective: Prediction models that calculate the growth response in children on recombinant growth hormone (GH) have shown to be helpful tools in deciding who should start treatment, as identifying GH deficiency can be a challenge. The aim of the study is to compare two prediction models; the KIGS (Pfizer International Growth Study) prediction models which are more accessible and the Gothenburg model which has previously been clinically validated. Design: All prepubertal patients who commenced GH treatment at Queen Silvia Children's Hospital in Gothenburg during a 13-year-period were candidates for the study. Children were excluded if suspected syndrome, malignant disease, chronic disease, or poor adherence to treatment were found. The KIGS model and the Gothenburg model were used to make predictions. Data was obtained from medical charts for the period from birth to the end of the first year of treatment. The predicted height outcome was compared against observed.Results: The study included 123 prepubertal children (76 males). The average age at treatment start and standard deviation (SD) was 5.7 (1.8) years. Correlation analyses were performed between predicted growth by both the Gothenburg and KIGS models versus the first year observed growth response showing strong correlations of r = 0.990 and r = 0.991 respectively with studentized residuals of 0.10 (0.81) for the Gothenburg model and 0.03 (0.96) for the KIGS model.Conclusion: We found that both the Gothenburg model and the KIGS model are equivalent when applying to our clinical cohort. Both models are very precise, hence it is encouraged to use either based on accessibility for the clinic.
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| 16. |
- Osterbrand, M., et al.
(author)
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Prevalence of Premature Thelarche at 18 Months of Age: A Population- and Hospital-Based Study of Prevalence and Incidence in Girls Born at Northern Alvsborg County Hospital in Sweden
- 2019
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In: Hormone Research in Paediatrics. - : S. Karger AG. - 1663-2818 .- 1663-2826. ; 91:3, s. 203-209
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Journal article (peer-reviewed)abstract
- Objective: The aim of this work was to investigate the prevalence of premature thelarche (PT) in 18-month-old girls, and the incidence of clinically evaluated PT for girls aged 18-36 months. Methods: In the prevalence substudy, a prospective population-based cohort of 3,140 girls born at Northern Alvsborg county hospital (NAL) in Trollhattan, Sweden, was followed for 2 years. Girls with breast development at the 18-month health check were referred to one pediatric center in NAL for evaluation. All girls with PT were included and followed for clinical outcome and 17 beta-estradiol. The prospective incidence substudy covered 8 years in a 10-year period and included all girls aged 18-36 months born at NAL who were clinically evaluated for PT. Results: The prevalence of PT at 18 months in our cohort was 1.6/1,000. The 5 girls with PT no longer showed symptoms at the follow-up 3-6 months later. The incidence was 1.1/1,000 for girls aged 18-36 months and 1.0/1,000 for girls aged 18-30 months who were clinically evaluated for their PT. Conclusion: This is the first prospective population-based study of PT and it shows a prevalence of PT at age 18 months of 1.6/1,000. The incidence of clinically evaluated PT was 1.1/1,000. Our result is in line with other studies reporting the incidence of PT from medical records (0.4-40/1,000). The outcome of PT in our study, as in the other studies, is that the great majority of girls show only benign symptoms. (C) 2019 S. Karger AG, Basel
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| 17. |
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| 18. |
- Skogsberg, L., et al.
(author)
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Improved treatment satisfaction but no difference in metabolic control when using continuous subcutaneous insulin infusion vs. multiple daily injections in children at onset of type 1 diabetes mellitus
- 2008
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In: Pediatric Diabetes. - : Hindawi Limited. - 1399-5448 .- 1399-543X. ; 9:5, s. 472-9
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of this study was to compare safety, metabolic control, and treatment satisfaction in children/adolescents at onset of type 1 diabetes mellitus who were treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). RESEARCH DESIGN AND METHODS: Seventy-two children/adolescents (7-17 yr of age) were enrolled in this open, randomized, parallel, multicenter study. Approximately half of the patients were treated with MDI (natural protamine hagedorn [NPH] insulin twice daily and rapid-acting insulin three to -four times daily, n = 38) by pen, and the other half received CSII (n = 34). The patients were followed for 24 months with clinical visits at the entry of the study and after 1, 6, 12, and 24 months. During these visits, hemoglobin A1c, insulin doses, weight, and height were registered. Severe episodes of hypoglycemia and ketoacidosis as well as technical problems were recorded. In addition, the patients/parents answered the Diabetes Treatment Satisfaction Questionnaire. RESULTS: There was no significant difference in metabolic control between the treatment groups. Treatment satisfaction was significantly higher in the group treated with CSII compared with the MDI group (p
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| 19. |
- Wahlgren, Carl-Fredrik, et al.
(author)
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Evaluation of an interactive case simulation system in dermatology and venereology for medical students
- 2006
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In: BMC Medical Education. - : BioMed Central. - 1472-6920. ; 6
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Journal article (peer-reviewed)abstract
- BackgroundMost of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning.MethodsThrough continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination.ResultsThe questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination.ConclusionWe created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination.
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| 20. |
- Österbrand, Martin, 1966, et al.
(author)
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17beta-Estradiol and Gonadotropin Levels for the Diagnosis of the Benign Form of Breast Development in Girls Aged up to 4 Years in Real-Life Clinical Practice
- 2017
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In: Hormone Research in Paediatrics. - : S. Karger AG. - 1663-2826 .- 1663-2818. ; 87:5, s. 315-323
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Journal article (peer-reviewed)abstract
- BACKGROUND: Early onset of breast development in a young girl is usually a benign and isolated prepubertal condition, i.e., premature thelarche (PT), but can sometimes be progressive and the first sign of pubertal precocity (PP). Serum 17beta-estradiol (17beta-E2) level is a possible marker to differentiate between benign and pathological forms of breast development. We defined an upper serum 17beta-E2 level for benign, "classic" PT for girls aged 9-48 months. METHODS: Serum 17beta-E2 was analysed with a highly sensitive extraction radioimmunoassay (RIA). Gonadotropins, Tanner breast stage, growth, other investigations, and clinical outcome were assessed in 125 girls with breast development, in a population-based study in West Sweden. RESULTS: A total of 125 of 128 girls had a benign form of breast development with a mean serum 17beta-E2 level of 15.2 pmol/L and a mean + 2 SD of 31 pmol/L, which was regarded as the upper limit for benign PT; 3 girls with PP had 17beta-E2 levels above 70 pmol/L. CONCLUSION: This is the first study to define an upper serum 17beta-E2 level associated with benign PT. Girls aged 9-48 months with PT and Tanner breast stage 2 have 17beta-E2 levels below 32 pmol/L using extraction RIA. LH below the detection limit (0.1 IU/L) and measurable FSH support benign PT.
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| 21. |
- Österbrand, M., 1966, et al.
(author)
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Pharmacological treatment for pubertal progression in boys with delayed or slow progression of puberty: A small-scale randomized study with testosterone enanthate and testosterone undecanoate treatment.
- 2023
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In: Frontiers in endocrinology. - 1664-2392. ; 14
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Journal article (peer-reviewed)abstract
- The use of testosterone enanthate (TE), 50-75 mg intramuscularly (i.m.)/month, for the treatment of boys with delayed puberty or slow progression to induce puberty is the standard of care (SoC) in Sweden. This treatment is empirical and has not been scientifically evaluated. Replacement therapy in hypogonadal boys/young men in Sweden after induction is mainly performed with testosterone undecanoate (TU), 1,000 mg/3 months. TE is only available on license. TE was deregistered in Sweden in 2006. Therefore, this study was initiated to compare the two products.To clinically evaluate pubertal progression with six injections of TE, 75 mg i.m./month (1/3-1/5 of adult dose), compared with two injections of TU, 250 mg i.m./3 months (1/4 of adult dose).In the Pubertal Replacement in Boys Study (PRIBS), boys aged 14-16 years in West Sweden with pubertal delay were randomized in a parallel study to TE or TU for pubertal progression. Inclusion criteria were morning testosterone levels of 0.5-3 nmol/L and testicular volume ≤6 ml. Between June 2014 and Nov 2019, 27 boys were included.The primary outcome was testicular enlargement ≥8 ml after 12 months. TU treatment was considered clinically similar if the number of boys with testicular enlargement ≥8 ml was 80%-125% of the number of boys with TE. Fisher's exact chi-square test was used for this analysis.Both treatments were well tolerated. Twelve of 14 (86%) TU-treated boys reached the primary outcome and 12/12 in the TE group. Fisher's exact chi-square testing indicated a one-sided p-value of 0.28 (the two-sided p-value was 0.483). The TU treatment was considered not clinically different from SoC. A post-hoc study showed 25% power. Therefore, no evidence-based conclusion can be drawn from the results even if the clinical data support a similar effect of the treatments.The present small-scale study supports that both TE and TU had similar effects in terms of pubertal progression.https://www.clinicaltrials.gov/ct2/home, identifier NCT05417035; https://www.clinicaltrialsregister.eu/ctrsearch/search, identifier EUDRACTEudraCT nr 2012-002337-11.
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