| 1. |
- Kennedy, Beatrice, 1982-, et al.
(author)
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App-based COVID-19 syndromic surveillance and prediction of hospital admissions in COVID Symptom Study Sweden
- 2022
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In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 13:1
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Journal article (peer-reviewed)abstract
- The app-based COVID Symptom Study was launched in Sweden in April 2020 to contribute to real-time COVID-19 surveillance. We enrolled 143,531 study participants (≥18 years) who contributed 10.6 million daily symptom reports between April 29, 2020 and February 10, 2021. Here, we include data from 19,161 self-reported PCR tests to create a symptom-based model to estimate the individual probability of symptomatic COVID-19, with an AUC of 0.78 (95% CI 0.74-0.83) in an external dataset. These individual probabilities are employed to estimate daily regional COVID-19 prevalence, which are in turn used together with current hospital data to predict next week COVID-19 hospital admissions. We show that this hospital prediction model demonstrates a lower median absolute percentage error (MdAPE: 25.9%) across the five most populated regions in Sweden during the first pandemic wave than a model based on case notifications (MdAPE: 30.3%). During the second wave, the error rates are similar. When we apply the same model to an English dataset, not including local COVID-19 test data, we observe MdAPEs of 22.3% and 19.0% during the first and second pandemic waves, respectively, highlighting the transferability of the prediction model.
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| 2. |
- Ehrencrona, Carolina, 1986, et al.
(author)
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Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? – An emulated trial
- 2024
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In: BMC Cancer. - 1471-2407. ; 24
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Journal article (peer-reviewed)abstract
- Background: High rates of negative intrusivethoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors. Methods: Data on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1year after diagnosis, trial 2 had follow-up 2years after diagnosis, baseline in both trials was 12months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression. Results: Trial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2. Conclusions: The emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group. Trial registration: The three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).
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| 3. |
- Grimby-Ekman, Anna, 1967, et al.
(author)
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Prediction models for planning health care resources. During the first wave of the Covid-19 pandemic 2020
- 2022
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Reports (other academic/artistic)abstract
- Due to the Covid-19 pandemic, has emphasized a need for planning health care resources based on only a few aggregated data points and little knowledge of the data-generating process. In the first part of the report, we present the process of our work in spring 2020 during the first wave and especially during the first part with the high demands on health care resources. In the second part of the report, we discuss the logistic growth model (LGM), one of our models used to predict the peak height and the peak timing. We present some different approaches to use the LGM, and compare these to a different data set, Belgium data. For the Swedish regional data, the LGM on raw observations gave a good estimate on the peak height. The adjusted LGM, using cumulative new inpatient beds, fitted the Swedish regional data to a satisfying degree. For the Belgium data, the LGM on raw observations gave a good estimate on peak height and timing. The adjusted LGM, using cumulative new inpatient beds, did not work for the Belgium data as it gave a too early peak time and a too low peak height. The experience from our work, in combination with now existing literature, the process in a similar future situation would include better knowledge on how to find and combine data to get as reliable forecasts as possible and to use creativity in combination with theoretical competence.
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| 4. |
- Löfstrand, Jonas, 1981, et al.
(author)
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Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study.
- 2024
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In: The British journal of surgery. - 1365-2168. ; 111:1
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Journal article (peer-reviewed)abstract
- Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome.This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS).A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction.Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
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| 5. |
- Eriksson, Stefanie, et al.
(author)
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Texture Analysis of Magnetic Resonance Images Enables Phenotyping of Potentially Painful Annular Fissures.
- 2022
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In: Spine. - 1528-1159. ; 47:5, s. 430-437
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Journal article (peer-reviewed)abstract
- Retrospective analysis of prospectively collected data.To investigate whether intervertebral disc (IVD) image features, extracted from magnetic resonance (MR) images, can depict the extension and width of annular fissures and associate them to pain.Annular fissures are suggested to be associated with low back pain (LBP). Magnetic resonance imaging (MRI) is a sensitive method, yet fissures are sometimes unobservable in T2-weighted MR-images, even though fissure information is present in the image. Image features can mathematically be calculated from MR-images and might reveal fissure characteristics.44 LBP patients who underwent MRI, low-pressure discography (<50psi) and computed tomography (CT) sequentially in one day, were reviewed. After semi-automated segmentation of 126 discs, image features were extracted from the T2-weighted images. The number of image features were reduced with principle component analysis (PCA). CT-discograms were graded and dichotomized regarding extension and width of fissures. IVDs were divided into fissures extending to outer annulus vs. short/no fissures. Fissure width was dichotomized into narrow (<10%) vs. broad fissures (>10%), and into moderately broad (10%-50%) vs. very broad fissures (>50%). Logistic regression was performed to investigate if image features could depict fissure extension to outer annulus and fissure width. As a sub-analysis, the association between image features used to depict fissure characteristics and discography-provoked pain-response were investigated.Fissure extension could be depicted with sensitivity/specificity=0.97/0.77 and area under curve (AUC)=0.97. Corresponding results for width depiction were sensitivity/specificity=0.94/0.39 and 0.85/0.62, and AUC=0.86 and 0.81 for narrow vs. broad and moderately broad vs. very broad fissures respectively. Pain prediction with image features used for depicting fissure characteristics showed sensitivity/specificity=0.90/0.36, 0.88/0.4, 0.93/0.33; AUC=0.69, 0.75 and 0.73 respectively.Standard MR-images contains fissure information associated to pain that can be depicted with image features, enabling non-invasive phenotyping of potentially painful annular fissures.Level of Evidence: 2.
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| 6. |
- Grimby-Ekman, Anna, 1967, et al.
(author)
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Multidimensional health changes after a multimodal pain rehabilitation program: a registry-based study
- 2021
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In: Pain Reports. - : Ovid Technologies (Wolters Kluwer Health). - 2471-2531. ; 6:2
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Journal article (peer-reviewed)abstract
- Introduction: Chronic pain is treated with multimodal rehabilitation programs, targeting improvement in several health aspects. These treatments must be evaluated multidimensionally, which is a methodological challenge. Objectives: This study investigated factors (demographic, pain-related, and individual- vs group-based treatment) predicting successful outcomes after multimodal pain rehabilitation programs. Methods: Data from 3 outpatient clinics were retrieved from the Swedish Quality Registry for Pain Rehabilitation, for 314 patients (218 women). Outcome variables were dichotomized as binary change (improved or not improved) based on clinical thresholds. Total improvement grouped outcomes into 0 to 2, 3 to 4, and 5 to 6 improved variables. Binary logistic regression analyses investigated the association between the baseline predictors and change variables. Results: Patients improving after treatment ranged from 34% (pain intensity) to 80% (depression) for women and 34% to 76% for men, respectively. Total improvement outcome was consistent (after treatment and 1 year) with 28% of patients improving on 5 to 6 outcomes. The baseline predictor related to most improved outcomes was pain intensity, with positive correlation to improvement in pain intensity (P < 0.001) and negative correlation with improvements in anxiety (P = 0.075) and depression (P = 0.002). Individual-based treatment, compared with group-based treatment, was associated with improvement in pain intensity (P = 0.008). Conclusions: About a third of patients improved in several outcomes by the end of a multimodal program, with most improvement for depression and least for pain intensity. Generally, patients with more severe health status at baseline improve most directly after treatment, but these findings could not suggest treatment adjustments that would improve overall success rates.
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| 7. |
- Grimby-Ekman, Anna, 1967, et al.
(author)
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Pain intensity and pressure pain thresholds after a light dynamic physical load in patients with chronic neck-shoulder pain
- 2020
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
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Journal article (peer-reviewed)abstract
- Background To investigate the development of pain intensity and pressure pain thresholds during and 24 h after a light dynamic physical load among patients with chronic neck-shoulder pain. Methods Twenty-six patients with chronic neck-shoulder pain and 12 healthy controls were included. The participants arm-cycled on an ergometer. Effort was rated with the Borg Rating of Perceived Exertion scale (RPE), and pain intensity with an numeric rating scale (NRS). Pressure pain thresholds were measured by an algometer. Participants started a pain diary 1 week before the physical exercise and continued until 1 week after. Pain intensity was assessed before, during and the following two evenings after arm-cycling. Pressure pain thresholds were assessed before, 15 min after, 105 min after and 24 h after. Results The chronic pain group showed increased pain intensity during, and the following two evenings after the arm cycling, and decreased pain thresholds immediately after the arm cycling involving painful regions. In the patient group there were no impact on pain thresholds in the neck the following day. Conclusions Patients with chronic neck-shoulder pain reported increased pain intensity during and in the evenings after a light dynamic load involving painful regions. In addition, they showed decreased pain thresholds close to the exercise, indicating mechanical hyperalgesia.
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| 8. |
- Larsson, Maria E H, 1969, et al.
(author)
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Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain (PREVSAM): a randomised controlled trial protocol
- 2020
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
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Journal article (peer-reviewed)abstract
- BackgroundMusculoskeletal pain is globally a leading cause of physical disability. Many musculoskeletal-related pain conditions, such as low back pain, often resolve spontaneously. In some individuals, pain may recur or persist, leading to ong-term physical disability, reduced work capacity, and sickness absence. Early identification of individuals in which this may occur, is essential for preventing or reducing the risk of developing persistent musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate effects of an early intervention, the PREVSAM model, on the prevention of sickness absence and development of persistent pain in at-risk patients with musculoskeletal pain.MethodsEligible participants are adults who seek health care for musculoskeletal pain and who are at risk of developing persistent pain, physical disability, and sickness absence. Participants may be recruited from primary care rehabilitation centres or primary care healthcare centres in Region Vastra Gotaland. Participants will be randomised to treatment according to the PREVSAM model (intervention group) or treatment as usual (control group). The PREVSAM model comprises an interdisciplinary, person-centred rehabilitation programme, including coordinated measures within primary health care, and may include collaboration with participants' employers. The primary outcome sickness absence is operationalised as the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness absence during the intervention and follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported short-term sickness absence, work ability, pain, self-efficacy, health-related quality of life, risk for sickness absence, anxiety and depression symptoms and physical disability at 1 and 3months after inclusion (short-term follow-up), and at 6 and 12months (long-term follow-up). A cost-effectiveness analysis is planned and drug consumption will be investigated.DiscussionThe study is expected to provide new knowledge on the effectiveness of a comprehensive rehabilitation model that incorporates early identification of patients with musculoskeletal pain at risk for development of sickness absence and persistent pain. The study findings may contribute to more effective rehabilitation processes of this large patient population, and potentially reduce sickness absence and costs.Trial registrationClinicalTrials.gov Protocol ID: NCT03913325, Registered April 12, 2019.Version 2, 10 July 2020.Version 2 changes: Clarifications regarding trial aim and inclusion process.
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| 9. |
- Lind, Josefine, et al.
(author)
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Insomnia Symptoms and Chronic Pain among Patients Participating in a Pain Rehabilitation Program-A Registry Study
- 2021
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In: Journal of Clinical Medicine. - : MDPI AG. - 2077-0383. ; 10:18
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Journal article (peer-reviewed)abstract
- Insomnia and chronic pain are prevalent health complaints. Previous research has shown that they are closely associated, but their interaction and causality are not completely understood. Further research is needed to uncover the extent to which a treatment strategy focusing on one of the conditions affects the other. This study aimed to map the prevalence of insomnia symptoms among patients in interdisciplinary pain rehabilitation program (IPRP) and investigate associations between the degree of insomnia at baseline and the treatment outcome regarding pain intensity, physical function, social function, mental well-being, anxiety, and depression. Of the 8515 patients with chronic pain, aged 15-81 who were registered in the Swedish Quality Registry for Pain Rehabilitation during 2016-2019 and participated in IPRP, 7261 had follow-up data after treatment. Logistic regression analysis was used to investigate associations. The prevalence of clinical insomnia, according to Insomnia Severity Index (ISI), among chronic pain patients in IPRP was 66%, and insomnia symptoms were associated with both country of birth and educational level. After IPRP, the prevalence of clinical insomnia decreased to 47%. There were statistically significant associations between the degree of insomnia symptoms before IPRP and physical function (p < 0.001), social function (p = 0.004) and mental well-being (p < 0.001). A higher degree of insomnia symptoms at baseline was associated with improvement after IPRP. In conclusion, IPRP seem to have beneficial effects on insomnia symptoms in chronic pain patients. Nevertheless, almost half of the patients still suffer from clinical insomnia after IPRP. The possible effect of systematic screening and treatment of insomnia for improving the effect of IPRP on pain is an important area for future research.
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| 10. |
- Lindegård, A., et al.
(author)
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Can biofeedback training in combination with ergonomic information reduce pain among young adult computer users with neck and upper extremity symptoms? : A randomized controlled intervention study
- 2024
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In: Applied Ergonomics. - : Elsevier. - 0003-6870 .- 1872-9126. ; 114
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Journal article (peer-reviewed)abstract
- The aim of this randomized controlled study was to explore if an intervention with biofeedback training in combination with ergonomic discussions, could improve working technique and work postures, and reduce pain intensity and perceived exertion in young adult computer users with ongoing neck and upper extremity symptoms. 39 participants were divided into an intervention group and a control group. The intervention consisted of 4 sessions during a three-month period. Working technique, working postures, rated perceived exertion, pain intensity, and duration of computer use were measured at baseline and follow ups after 6 and 12 months. The intervention did not significantly improve working technique and working postures, nor reduce pain intensity and perceived exertion in the intervention group compared to the control group. However, there was a statistically significant reduction in reported pain intensity in the neck/shoulder for the whole group. Also, there was a trend that time spent with computer work without breaks was more reduced in the intervention group than in the control group.
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