| 1. |
|
|
| 2. |
- Busch, K., et al.
(author)
-
Nationwide prevalence of inflammatory bowel disease in Sweden : a population-based register study
- 2014
-
In: Alimentary Pharmacology and Therapeutics. - : Wiley-Blackwell. - 0269-2813 .- 1365-2036. ; 39:1, s. 57-68
-
Journal article (peer-reviewed)abstract
- Background: Regional studies on inflammatory bowel disease (IBD) suggest an increasing prevalence over time, but no nationwide estimate has been published so far.Aim: To estimate the IBD prevalence in 2010 in Sweden overall, by disease, and in specific patient segments.Methods: Patients were identified according to international classification codes for ulcerative colitis and Crohn's disease in in-patient care (1987-2010), day surgery and nonprimary out-patient care (1997-2010) in the nationwide Swedish Patient Register.Results: Requiring two or more diagnoses of IBD in nonprimary care, a total of 61344 individuals with physician-diagnosed IBD were alive in Sweden in 2010 (mean age 50years; 51% men), corresponding to a prevalence of 0.65% (95% CI, 0.65-0.66). The prevalence increased with age, and peaked in women at ages 50-59years and in men at ages 60-69years. Adding the requirement of IBD as main (vs. main or contributory) diagnosis code, or diagnosis from an internal medicine/gastroenterology/surgery department did not change the prevalence estimate. Prevalence of actively treated disease (defined as two or more IBD-related visits, of which one occurred in 2010, plus at least one dispensed prescription of IBD-related drugs in 2010) was 0.27% (95% CI, 0.27-0.28).Conclusions: The Swedish nationwide register-based IBD prevalence was higher compared with previous Swedish and international estimates. While prevalence estimates were robust across different case definitions, once two or more visits were required, only about one-third of prevalent patients were drawing resources from specialised care in 2010.
|
|
| 3. |
- Ekbom, T, et al.
(author)
-
Did Franz Kafka suffer from cluster headache?
- 2004
-
In: Cephalalgia : an international journal of headache. - : SAGE Publications. - 0333-1024. ; 24:4, s. 309-311
-
Journal article (other academic/artistic)
|
|
| 4. |
- Janson, A., et al.
(author)
-
A randomized controlled trial comparing intensive non-surgical treatment with bariatric surgery in adolescents aged 13–16 years (AMOS2): Rationale, study design, and patient recruitment
- 2020
-
In: Contemporary Clinical Trials Communications. - : Elsevier BV. - 2451-8654. ; 19
-
Journal article (peer-reviewed)abstract
- Background: Previous non-randomized studies show similar outcomes in adolescents and adults after bariatric surgery. We describe the study protocol, recruitment, and selected baseline data of patients in a randomized multi-center study, the Adolescent Morbid Obesity Surgery 2 (AMOS2). Methods: Three clinics in Sweden collaborated in designing the study and recruitment of patients from August 1, 2014 to June 30, 2017. Patients were selected among adolescents 13–16 years of age attending third-level obesity care for at least one year. Patients were randomized 1:1 to bariatric surgery (predominantly Roux-en-Y gastric bypass) or intensive non-surgical treatment starting with an eight-week low-calorie-diet. Results: Fifty adolescents (37 girls) were randomized, 25 (19 girls) to bariatric surgery. Mean age was 15.7 years (range 13.3–16.9), weight 122.6 kg (range 95–183.3), Body Mass Index (BMI) 42.6 kg/m2 (range 35.7–54.9) and BMI-SDS 3.45 (range 2.9–4.1). One patient had type 2 diabetes mellitus, and 12/45 (27%) had elevated liver enzymes. There were no significant differences between the groups. For the 39 eligible patients who were offered but declined inclusion, BMI was not different from included patients. However, patients who declined were younger, 15.2 years (p = 0.021). A sex difference was also noted with more of eligible girls, 37/53 (69.8%), than boys, 13/36 (36.1%), wanting to participate in the study (p = 0.002). Conclusions: This clinical trial, randomizing adolescents with severe obesity to bariatric surgery or intensive non-surgical treatment, aims at informing about whether it is beneficial to undergo bariatric surgery in early adolescence. It will also enlighten the outcome of comprehensive non-surgical treatment. The study was registered at www.clinicalTrials.gov number NCT02378259. © 2020
|
|
| 5. |
|
|
| 6. |
- Ludvigsson, Jonas F., 1969-, et al.
(author)
-
Prevalence of paediatric inflammatory bowel disease in Sweden : a nationwide population-based register study
- 2017
-
In: BMC Gastroenterology. - London, England : BioMed Central. - 1471-230X. ; 17
-
Journal article (peer-reviewed)abstract
- Background: We evaluated the impact of different case definition algorithms on the prevalence of paediatric inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC) and to compare the occurrence of certain diseases compared to matched controls.Methods: Paediatric patients (<18 years) were identified via ICD codes for UC and CD in Swedish registers between 1993 and 2010 (n = 1432). Prevalence was defined as >= 2 IBD-related visits. Prevalence of treated children in 2010 was defined as >= 2 IBD-related visits with one visit and >= 1 dispensed IBD-related drug prescription in 2010. To test the robustness of the estimates, prevalence was also calculated according to alternative case definitions. The presence of rheumatic, hepatobiliary, pancreatic, and dermatologic diseases were compared with age-/sex-/county-of-residence- matched general population controls.Results: The IBD prevalence was 75/100,000 (CD: 29/100,000; UC: 30/100,000; patients with IBD-U: 16/100,000). Prevalence of treated disease in 2010 was 62/100,000 (CD: 23/100,000; UC: 25/100,000; patients with IBD-U: 13/100,000). When age restrictions were employed, the prevalence estimate decreased (<17y: 61/100,000, <16y: 49/100,000 and <15y: 38/100,000).Compared to general population controls (n = 8583), children with IBD had a higher prevalence of dermatologic (4.7% vs. 0.6%), hepatobiliary (including primary sclerosing cholangitis) (5.5% vs. 0.1%), pancreatic (1.7% vs. 0%) and rheumatic diseases (7.2% vs. 1.2%; all P < 0.01).Conclusions: The overall prevalence of paediatric IBD in Sweden was similar to that in earlier regional cohorts. IBD patients had a higher prevalence of comorbid conditions than matched general population controls.
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
|
|
| 10. |
- Adami, Johanna, et al.
(author)
-
Cancer risk following organ transplantation : a nationwide cohort study in Sweden
- 2003
-
In: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 89:7, s. 1221-1227
-
Journal article (peer-reviewed)abstract
- A substantial excess risk of lymphomas and nonmelanoma skin cancer has been demonstrated following organ transplantation. Large sample size and long follow-up time may, however, allow more accurate risk estimates and detailed understanding of long-term cancer risk. The objective of the study was to assess the risk of cancer following organ transplantation. A nationwide cohort study comprising 5931 patients who underwent transplantation of kidney, liver or other organs during 1970-1997 in Sweden was conducted. Complete follow-up was accomplished through linkage to nationwide databases. We used comparisons with the entire Swedish population to calculate standardised incidence ratios (SIRs), and Poisson regression for multivariate internal analyses of relative risks (RRs) with 95% confidence intervals (CI). Overall, we observed 692 incident first cancers vs 171 expected (SIR 4.0; 95% CI 3.7-4.4). We confirmed marked excesses of nonmelanoma skin cancer (SIR 56.2; 95% CI 49.8-63.2), lip cancer (SIR 53.3; 95% CI 38.0-72.5) and of non-Hodgkin's lymphoma (NHL) (SIR 6.0; 95% CI 4.4-8.0). Compared with patients who underwent kidney transplantation, those who received other organs were at substantially higher risk of NHL (RR 8.4; 95% CI 4.3-16). Besides, we found, significantly, about 20-fold excess risk of cancer of the vulva and vagina, 10-fold of anal cancer, and five-fold of oral cavity and kidney cancer, as well as two- to four-fold excesses of cancer in the oesophagus, stomach, large bowel, urinary bladder, lung and thyroid gland. In conclusion, organ transplantation entails a persistent, about four-fold increased overall cancer risk. The complex pattern of excess risk at many sites challenges current understanding of oncogenic infections that might become activated by immunologic alterations.
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
|
|
| 14. |
- Birkhofer, Klaus, et al.
(author)
-
A framework to identify indicator species for ecosystem services in agricultural landscapes
- 2018
-
In: Ecological Indicators. - : Elsevier BV. - 1470-160X .- 1872-7034. ; 91, s. 278-286
-
Journal article (peer-reviewed)abstract
- Improving our understanding of the relationships between biodiversity and the delivery of ecosystem services is crucial for the development of sustainable agriculture. We introduce a novel framework that is based on the identification of indicator species for single or multiple ecosystem services across taxonomic groups based on indicator species analyses. We utilize multi-species community data (unlike previous single species approaches) without giving up information about the identity of species in our framework (unlike previous species richness approaches). We compiled a comprehensive community dataset including abundances of 683 invertebrate, vertebrate and plant species to identify indicator species that were either positively or negatively related to biological control, diversity of red-listed species or crop yield in agricultural landscapes in southern Sweden. Our results demonstrate that some taxonomic groups include significantly higher percentages of indicator species for these ecosystem services. Spider communities for example included a higher percentage of significant positive indicator species for biological control than ground or rove beetle communities. Bundles of indicator species for the analysed ecosystem service potentials usually included species that could be linked to the respective ecosystem service based on their functional role in local communities. Several of these species are conspicuous enough to be monitored by trained amateurs and could be used in bundles that are either crucial for the provision of individual ecosystem services or indicate agricultural landscapes with high value for red-listed species or crop yields. The use of bundles of characteristic indicator species for the simultaneous assessment of ecosystem services may reduce the amount of labour, time and cost in future assessments. In addition, future analysis using our framework in other ecosystems or with other subsets of ecosystem services and taxonomic groups will improve our understanding of service-providing species in local communities. In any case, expert knowledge is needed to select species from the identified subsets of significant indicator species and these species should be validated by existing data or additional sampling prior to being used for ecosystem service monitoring.
|
|
| 15. |
- Birkhofer, Klaus, et al.
(author)
-
Relationships between multiple biodiversity components and ecosystem services along a landscape complexity gradient
- 2018
-
In: Biological Conservation. - : Elsevier BV. - 0006-3207 .- 1873-2917. ; 218, s. 247-253
-
Journal article (peer-reviewed)abstract
- The assessment of effects of anthropogenic disturbance on biodiversity (BD) and ecosystem services (ES) and their relationships are key priorities of the Intergovernmental Panel for Biodiversity and Ecosystem Services. Agricultural landscapes and their associated BD provide multiple ES and it is crucial to understand how relationships between ES and BD components change along gradients of landscape complexity. In this study, we related eight ES potentials to the species richness of five invertebrate, vertebrate and plant taxonomic groups in cereal farming systems. The landscape complexity gradient ranged from areas dominated by annually tilled arable land to areas with high proportions of unfertilized, non-rotational pastures and uncultivated field borders. We show that after accounting for landscape complexity relationships between yield and bird richness or biological control became more positive, but relationships between bird richness and biological control became less positive. The relationship between bird and plant richness turned from positive to negative. Multidiversity (overall biodiversity), was positively related to landscape complexity, whereas multifunctionality (overall ES provision), was not significantly related to either one of these. Our results suggest that multidiversity can be promoted by increasing landscape complexity; however; we found no support for a simultaneous increase of several individual ES, BD components or multifunctionality. These results challenge the assumption that bio-diversity-friendly landscape management will always simultaneously promote multiple ES in agricultural landscapes. Future studies need to verify this pattern by using multi-year data, larger sets of ES and BD components and a study design that is appropriate to address larger spatial scales and relationships in several regions.
|
|
| 16. |
- Brissman, M., et al.
(author)
-
Physical Fitness and Body Composition Two Years after Roux-En-Y Gastric Bypass in Adolescents
- 2017
-
In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 27:2, s. 330-337
-
Journal article (peer-reviewed)abstract
- We have previously shown promising results 2 years after Roux-en-Y gastric bypass surgery, within the Adolescence Morbid Obesity Surgery study (AMOS). The aim of the current study was to describe the 2-year outcome in cardiorespiratory fitness, body composition, and functional capacity in the Stockholm subset of the AMOS study. Forty-one adolescents (10 male, 31 female, age 14-18 years, body mass index 35-69 kg center dot m(-2)) were included. In addition to anthropometric measurements, participants performed a submaximal bicycle test, 6-min walk test, dual-energy X-ray absorptiometry, and a short interview at baseline, 1 and 2 years after surgery. Relative improvements in maximal oxygen consumption (VO(2)max) per kilogram body mass (+62 %) and per kilogram fat-free mass (+21 %), as well as walking distance (+13 %) were observed after 1 year, and persisted 2 years after surgery. Despite a reduction of fat-free mass (-15 %), absolute VO(2)max was maintained across the full group (+8 %, p = ns) and significantly increased in non-smokers. Body mass and fat mass were significantly decreased (-45.4 and -33.3 kg, respectively). Self-reported physical activity was significantly increased, and pain associated with movement was reduced. In adolescents with obesity, Roux-en-Y gastric bypass improved VO(2)max more than could be explained by fat mass loss alone. In combination with improved functional capacity and body composition, these results suggest that surgery in adolescence might add specific benefits of importance for future health.
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
- Bröms, Gabriella, et al.
(author)
-
Paediatric infections in the first 3 years of life after maternal anti-TNF treatment during pregnancy
- 2020
-
In: Alimentary Pharmacology and Therapeutics. - : John Wiley & Sons. - 0269-2813 .- 1365-2036. ; 52:5, s. 843-854
-
Journal article (peer-reviewed)abstract
- Background: Most anti‐tumour necrosis factor (anti‐TNF) agents are transferred across the placenta and may increase paediatric susceptibility to infections.Aims: To assess the risk of paediatric infections after maternal anti‐TNF treatment.Methods: Population‐based cohort study in Denmark, Finland and Sweden 2006‐2013 in which 1027 children born to women with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis or inflammatory bowel disease, treated with anti‐TNF, and 9346 children to women with nonbiologic systemic treatment, were compared to 1 617 886 children of the general population. Children were followed for 3 years.Results: Adjusted by maternal age, parity, smoking, body mass index, country and calendar year, the incidence rate ratios with 95% confidence interval (CI) for hospital admissions for infection in the first year were 1.43 (1.23‐1.67) for anti‐TNF and 1.14 (1.07‐1.21) for non‐biologic systemic treatment, and 1.29 (1.11‐1.50) and 1.09 (1.02‐1.15), respectively, when additionally adjusting for adverse birth outcomes. There was a slight increase in antibiotic prescriptions in the second year for anti‐TNF, 1.19 (1.11‐1.29), and for non‐biologic systemic treatment, 1.10 (1.07‐1.13). There was no difference among anti‐TNF agents, treatment in the third trimester, or between mono/combination therapy with non‐biologic systemic treatment.Conclusions: Both anti‐TNF and non‐biologic systemic treatment were associated with an increased risk of paediatric infections. However, reassuringly, the increased risks were present regardless of treatment in the third trimester, with combination of treatments, and were not persistent across the first 3 years of life. Our findings may indicate a true risk, but could also be due to unadjusted confounding by disease severity and healthcare‐seeking behaviour. This may in turn shift the risk‐benefit equation towards continuation of treatment even in the third trimester.
|
|
| 21. |
|
|
| 22. |
|
|
| 23. |
|
|
| 24. |
|
|
| 25. |
|
|
| 26. |
|
|
| 27. |
|
|
| 28. |
|
|
| 29. |
- Eberhardson, M., et al.
(author)
-
Anti-TNF treatment in Crohn's disease and risk of bowel resection-a population based cohort study
- 2017
-
In: Alimentary Pharmacology and Therapeutics. - : John Wiley & Sons. - 0269-2813 .- 1365-2036. ; 46:6, s. 589-598
-
Journal article (peer-reviewed)abstract
- Background: TNF inhibitors (TNFi) have been shown to reduce the need for surgery in Crohn's disease, but few studies have examined their effect beyond the first year of treatment.Aim: To conduct a register-based observational cohort study in Sweden 2006-2014 to investigate the risk of bowel resection in bowel surgery naive TNFi-treated Crohn's disease patients and whether patients on TNFi >= 12 months are less likely to undergo bowel resection than patients discontinuing treatment before 12 months.Methods: We identified all individuals in Sweden with Crohn's disease through the Swedish National Patient Register 1987-2014 and evaluated the incidence of bowel resection after first ever dispensation of adalimumab or infliximab from 2006 and up to 7 years follow-up.Results: We identified 1856 Crohn's disease patients who had received TNFi. Among these patients, 90% treatment retention was observed at 6 months after start of TNFi and 65% remained on the drug after 12 months. The cumulative rates of surgery in Crohn's disease patients exposed to TNFi years 1-7 were 7%, 13%, 17%, 20%, 23%, 25% and 28%. Rates of bowel resection were similar between patients with TNFi survival < 12 months and >= 12 months respectively (P=.27). No predictors (eg, sex, age, extension or duration of disease) for bowel resection were identified.Conclusions: The risk of bowel resection after start of anti-TNF treatment is higher in regular health care than in published RCTs. Patients on sustained TNFi treatment beyond 12 months have bowel resection rates similar to those who discontinue TNFi treatment earlier.
|
|
| 30. |
- Eberhardson, Michael, et al.
(author)
-
Tumour necrosis factor inhibitors in Crohn's disease and the effect on surgery rates
- 2022
-
In: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 24:4, s. 470-483
-
Journal article (peer-reviewed)abstract
- Aim: Surgery is an important therapeutic option for Crohn's disease. The need for first bowel surgery seems to have decreased with the introduction of tumour necrosis factor inhibitors (TNFi; adalimumab or infliximab). However, the impact of TNFi on the need for intestinal surgery in Crohn's disease patients irrespective of prior bowel resection is not known. The aim of this work is to compare the incidence of bowel surgery in Crohn's disease patients who remain on TNFi treatment versus those who discontinue it. Method: We performed a nationwide register-based observational cohort study in Sweden of all incident and prevalent cases of Crohn's disease who started first-line TNFi treatment between 2006 and 2017. Patients were categorized according to TNFi treatment retention less than or beyond 1 year. The study cohort was evaluated with regard to incidence of bowel surgery from 12 months after the first ever TNFi dispensation. Results: We identified 5003 Crohn's disease patients with TNFi exposure: 3748 surgery naïve and 1255 with bowel surgery prior to TNFi initiation. Of these patients, 7% (n = 353) were subjected to abdominal surgery during the first 12 months after the start of TNFi and were subsequently excluded from the main analysis. A majority (62%) continued TNFi for 12 months or more. Treatment with TNFi for less than 12 months was associated with a significantly higher surgery rate compared with patients who continued on TNFi for 12 months or more (hazard ratio 1.26, 95% CI 1.09–1.46; p = 0.002). Conclusion: Treatment with TNFi for less than 12 months was associated with a higher risk of bowel surgery in Crohn's disease patients compared with those who continued TNFi for 12 months or more.
|
|
| 31. |
- Ekbom, K, et al.
(author)
-
Age at onset and sex ratio in cluster headache: observations over three decades
- 2002
-
In: Cephalalgia : an international journal of headache. - : SAGE Publications. - 0333-1024. ; 22:2, s. 94-100
-
Journal article (peer-reviewed)abstract
- Five hundred and fifty-four patients with episodic cluster headache (ECH) and chronic cluster headache (CCH) were examined between 1963 and 1997. Mean age at onset was significantly higher in women with CCH compared with women with ECH and in men with ECH or CCH. In women with CCH age at onset was evenly distributed from 10 to 69 years, whereas in men with CCH and in both sexes with ECH, there was a peak when they were in their 20s. In women with ECH a second peak of onset occurred in their 50s. Although not statistically significant, primary CCH started later in women (mean 50.8 years) than secondary CCH (mean 35.5 years). There was a significant variation in the male : female ratio with respect to age at onset, being largest between 30 and 49 years of age (ECH 7.2 : 1; CCH 11.0 : 1) and lowest after 50 (ECH 2.3 : 1; CCH 0.6 : 1). During the observation period of more than 30 years there was a trend towards a decreasing male preponderance; the male: female ratio was significantly higher among patients with onset before rather than after 1970. The proportion of episodic vs. chronic CH did not change during the study period. The nature of the sex- and age-related pattern of cluster headache onset remains to be elucidated but mechanisms associated with sex hormone regulation, perhaps of hypothalamic origin, may be involved, as well as environmental factors related to lifestyle.
|
|
| 32. |
|
|
| 33. |
- Ekbom, K, et al.
(author)
-
Cluster headache - Aetiology, diagnosis and management
- 2002
-
In: Drugs. - : Springer Science and Business Media LLC. - 0012-6667. ; 62:1, s. 61-69
-
Journal article (peer-reviewed)abstract
- Cluster headache is characterised by repeated attacks of strictly unilateral pain in the orbital region associated with local autonomic symptoms or signs. The attacks are brief but of a very severe, almost excruciating intensity. For unknown reasons males are affected more often than females. Recent studies suggest that an autosomal dominant gene has a role in some families with cluster headache. Hormonal studies indicate a dysfunction in the central nervous system. Neuro-imaging has revealed primary defects in the hypothalamic grey matter. Local homolateral dilatation in the intracranial segment of the internal carotid and ophthalmic arteries during attacks is the result of a generic neurovascular activation, probably mediated by trigeminal parasympathetic reflexes. Sumatriptan 6mg subcutaneously is the drug of choice in the treatment of acute attacks. Inhalation of 100% oxygen can also be recommended. In the prophylactic treatment, verapamil is the first option. Other drugs that can be considered are corticosteroids, which may induce a remission of frequent, severe attacks, and lithium. Oral ergotamine tartrate may be sufficient for patients with night attacks and/or short, rather mild to moderately severe cluster headache periods. Third line drugs are serotonin inhibitors (methysergide and pizotifen) and valproic acid. Patients should he encouraged to keep headache diaries and be carefully instructed about the nature and treatment of the headaches. Alcohol can bring on extra attacks and should not be consumed during active periods of cluster headache.
|
|
| 34. |
- Ekbom, K
(author)
-
Cluster headache: an overview
- 1999
-
In: Italian journal of neurological sciences. - : Springer Science and Business Media LLC. - 0392-0461. ; 20:22 Suppl, s. S1-S3
-
Journal article (peer-reviewed)
|
|
| 35. |
- Ekbom, K, et al.
(author)
-
Cluster headache and aura
- 2009
-
In: Headache. - : Wiley. - 1526-4610. ; 49:5, s. 786-787
-
Journal article (other academic/artistic)
|
|
| 36. |
|
|
| 37. |
|
|
| 38. |
- Ekbom, K, et al.
(author)
-
Effects of midazolam and nitrous oxide on endocrine and metabolic measurements in children
- 2012
-
In: Hormone research in paediatrics. - : S. Karger AG. - 1663-2826 .- 1663-2818. ; 77:5, s. 309-319
-
Journal article (peer-reviewed)abstract
- <b><i>Objective:</i></b> Pain, stress as well as drugs may affect metabolic and endocrine measurements, especially in stressed children. The aim was to study how release of glucose and stress hormones are affected when procedural sedation with nitrous oxide or midazolam are used for establishing intravenous access in obese and lean children. <b><i>Methods:</i></b> In a prospective, double-blind, randomized study 90 children, 60 obese and 30 growth-retarded (GR), aged 5–18 years, with reported anxiety or difficulties connected with i.v. access, were randomized to 1 of 3 groups: oral midazolam (0.3 mg/kg, max. 15 mg), 50% nitrous oxide (N<sub>2</sub>O), and 10% N<sub>2</sub>O. In addition, all children received anesthesia cream (EMLA®) locally 1 h before i.v. access. Blood samples were drawn at 4 time points during 30 min after establishing venous access and, when feasible, after 24 h. The 24-hour sample was regarded as obtained during unstressed condition. The effect of procedural sedation was analyzed. Children’s evaluations of pain (Numeric Rating Scale) and procedure (Likert Scale) were correlated with mean values of cortisol and glucose after i.v. access. For the metabolic and hormone control measurements, 60 children aged 4–18 years (40 obese and 20 GR) served as controls. These children underwent a 24-hour blood sampling and did not receive sedation. The control samples were drawn 10–12 h after i.v. access. <b><i>Results:</i></b> After midazolam, significantly lower cortisol levels were found compared to both 50% N<sub>2</sub>O and 10% N<sub>2</sub>O and to unstressed controls. The growth hormone levels decreased with time in the midazolam group compared to 50 and 10% N<sub>2</sub>O, where the effect of time was reversed. Glucose levels among GR children increased from 0 to 30 min, whereas the opposite was found in obese children regardless of treatment. A post hoc analysis demonstrated significant correlations between children’s evaluations of the procedure and mean values of cortisol (r = –0.53), growth hormone (r = –0.52), and norepinephrine (r = –0.5) in children treated with a very low dose of N<sub>2</sub>O (10%). <b><i>Conclusions: </i></b>When sedation is insufficient during i.v. access, and blood sampling pain and stress affect hormone values, treatment with N<sub>2</sub>O or midazolam influence the glucose and stress hormone levels differently. These differences need to be accounted for when results are used for diagnosis and clinical decisions.
|
|
| 39. |
|
|
| 40. |
|
|
| 41. |
|
|
| 42. |
|
|
| 43. |
|
|
| 44. |
- Ekbom, K
(author)
-
Pain and Stress Response during Intravenous Access in Children with Congenital Adrenal Hyperplasia: Effects of EMLA and Nitrous Oxide Treatment
- 2017
-
In: Pain research and treatment. - : Hindawi Limited. - 2090-1542 .- 2090-1550. ; 2017, s. 1793241-
-
Journal article (peer-reviewed)abstract
- Background. Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires regularly blood samples for optimal treatment. The management of CAH in children is complex when intravenous access is one of the most stressful procedures for children. The purpose of this pilot study was to investigate the effects of nitrous oxide inhalation (N2O) in combination with cutaneous application of local anesthetics (EMLA) for improving intravenous access in children with CAH.Method. Ten children (7–14 years) were studied. The children received two intravenous procedures: one with EMLA and one with EMLA + N2O. The order of priority was randomized. The outcomes were the children’s pain experience (0–10) and an evaluation of satisfaction (1–5) after the procedure. Heart rate, blood pressure, saturation, and analyses of 17-hydroxyprogesterone (17-OHP), norepinephrine, and glucose were analyzed.Results. Higher pain scores, heart rate, and glucose levels were reported after EMLA, compared to EMLA + N2O, but 17-OHP levels remained unchanged. The children’s satisfaction with the intravenous procedure was more positive for EMLA + N2O.Conclusions. EMLA + N2O offers the possibility of improving the intravenous procedure for anxious children with CAH. Although the quality of care was better with N2O treatment, it was not possible to demonstrate that this is a prerequisite for valid 17-OHP measurements.
|
|
| 45. |
|
|
| 46. |
- Ekbom, K, et al.
(author)
-
Periods of cluster headache induced by nitrate therapy and spontaneous remission of angina pectoris during active clusters
- 2004
-
In: Cephalalgia : an international journal of headache. - : SAGE Publications. - 0333-1024. ; 24:2, s. 92-98
-
Journal article (peer-reviewed)abstract
- Glyceryl trinitrate (GTN) is known to induce single extra attacks of cluster headache (CH) during active cluster periods, most probably via actions of nitric oxide (NO). Induction of whole periods of CH by organic nitrates has, however, attracted little attention in the literature. We report on eight patients with episodic CH and coexistent effort-induced angina pectoris. Cases 1-6 had been free of their headaches for many years but got recurrence of CH within a few weeks after the administration of long-acting organic nitrates (isosorbide-dinitrate, isosorbide-5-mononitrate or slow-release GTN) aimed at treating their chest pains. These nitrate-induced headache periods were more severe and had a longer duration than the previous spontaneous ones. Furthermore, one of the subjects and two additional cases experienced a marked reduction of their anginal attacks during successive CH periods. Exercise time to effort-induced angina was increased in all three patients and one of them revealed a markedly elevated threshold for eliciting ischaemic cardiac symptoms by standardized physical exercise on a cycle ergometer. We hypothesize whether extra CH periods elicited by sustained nitrate therapy and remission of angina pectoris during active clusters are caused by central mechanisms involving inhibition of sympathetic tone and effects on both cranial vessels and cardiac functions.
|
|
| 47. |
- Ekbom, K, et al.
(author)
-
Restless legs syndrome
- 2009
-
In: Journal of internal medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 266:5, s. 419-431
-
Journal article (peer-reviewed)
|
|
| 48. |
|
|
| 49. |
|
|
| 50. |
|
|
