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AIM: We evaluated the effect on body mass index standard deviation score (BMI-SDS) of a combined treatment (Web-COP) for children with obesity, including a web-based component targeting their parents. METHODS: This randomised controlled trial recruited children 5-12 years of age with obesity (International Obesity Task Force BMI [IOTF-BMI] ≥30 kg/m2 ) from school health care and outpatient paediatric clinics in in Northern Sweden from 1 June 2019 to 21 June 2020. The children were randomised to Web-COP, an intervention with group sessions and a 12-week web-based component, or standard care. The primary outcome was the change in IOTF BMI-SDS after 6 months. RESULTS: In total, 75 children (33 girls), mean age 9.5 years, were randomised, and 65/75 (87%) children and their parents completed the study, 35/39 (90%) in the Web-COP intervention and 30/36 (83%) in the standard care group. BMI-SDS at 6 months was changed from 3.08 to 2.81 in the intervention group compared to an increase from 3.07 to 3.16 in the standard care group, representing a significant difference between groups (p < 0.001). In the intervention group, 14/30 (47%) reduced their BMI-SDS ≥0.25, compared to none in the standard care group. CONCLUSION: The parent-focused intervention significantly improved BMI-SDS in children with obesity as compared to children in standard care.
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Obesidade Infantil , Criança , Feminino , Humanos , Índice de Massa Corporal , Internet , Pais , Obesidade Infantil/terapia , Suécia , Masculino , Pré-EscolarRESUMO
OBJECTIVES: To investigate if prophylactic antibiotics (PA) in conjunction with myringoplasty of clean and uninfected ears entails a reduction of postoperative infections within 6 weeks after surgery, and whether it affects the healing rate of the tympanic membrane (TM) at follow-up, 6-24 months after surgery. DESIGN: A retrospective cohort study of prospectively collected data. SETTING: Data extracted from The Swedish Quality Register for Ear Surgery (SwedEar), the years 2013-2019. PARTICIPANTS: All patients in SwedEar with a registered clean conventional myringoplasty (tympanoplasty type I) including a follow-up visit. MAIN OUTCOME MEASURES: The effect of PA use on TM healing rate at follow-up and postoperative infection within 6 weeks of surgery. RESULTS: In the study group (n = 1665) 86.2% had a healed TM at follow-up. There was no significant difference between the groups that had PA administered (87.2%) or not (86.1%). A total of 8.0% had a postoperative infection within 6 weeks. Postoperative infection occurred in 10.2% of the group that received PA (n = 187) compared with 7.7% of the group that did not receive PA. However, this difference was not statistically significant. Postoperative infection within 6 weeks significantly lowered the frequency of healed TMs. CONCLUSION: PA administered during clean conventional myringoplasty does not improve the chance of having a healed TM at follow up, nor decrease the risk of having a postoperative infection within 6 weeks after surgery.
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Antibacterianos , Miringoplastia , Infecção da Ferida Cirúrgica , Perfuração da Membrana Timpânica , Membrana Timpânica , Cicatrização , Humanos , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Estudos de Coortes , Miringoplastia/efeitos adversos , Miringoplastia/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Suécia/epidemiologia , Resultado do Tratamento , Perfuração da Membrana Timpânica/tratamento farmacológico , Perfuração da Membrana Timpânica/epidemiologia , Perfuração da Membrana Timpânica/cirurgia , Membrana Timpânica/efeitos dos fármacos , Membrana Timpânica/lesões , Membrana Timpânica/cirurgia , Seguimentos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Cicatrização/efeitos dos fármacosRESUMO
PURPOSE: Work ability can be measured by the work ability index (WAI), and work-related questions measuring productivity loss in terms of quality and quantity of work. Dentists have high occupational risk of musculoskeletal pain and the exposure of ergonomic strain is already high during dental education. The aim was to evaluate work ability and productivity among dentists, and to identify gender differences and associations with sleep, stress, and reported frequent pain. METHODS: The study population comprised 187 dentists (123 women and 64 men) who had been working as dentists between 5 and 12 years. Participants completed a questionnaire regarding sleep, stress, presence of pain at different sites, work ability assessed by WAI, and productivity in terms of quality and quantity of work. RESULTS: Poor sleep quality and high level of stress were reported by 31% and 48.1% of participants, respectively, with no gender differences and no association with age. The prevalence of frequent pain ranged 6.4-46.5% with shoulders being the most prevalent site. Thirty-three percent reported reduced work ability. Poor sleep, high amount of stress, and multi-site pain were associated with decreased work ability. CONCLUSIONS: A high prevalence of pain was shown among dentists. Decreased work ability in terms of productivity loss was associated with poor sleep quality, high amount of stress, and multi-site pain. Preventive actions at the workplace should promote good musculoskeletal health, and measures taken, both individual and organizational, to minimize the risk of high, persistent stress and work-related pain.
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Odontólogos , Dor Musculoesquelética/epidemiologia , Estresse Ocupacional , Sono , Adulto , Estudos de Coortes , Ergonomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , SuéciaRESUMO
Normal jaw opening-closing involves simultaneous jaw and head-neck movements. We previously showed that, in men, integrated jaw-neck movements during jaw function are altered by induced masseter muscle pain. The aim of this study was to investigate possible sex-related differences in integrated jaw-neck movements following experimental masseter muscle pain. We evaluated head-neck and jaw movements in 22 healthy women and 16 healthy men in a jaw opening-closing task. The participants performed one control trial and one trial with masseter muscle pain induced by injection of hypertonic saline. Jaw and head movements were registered using a three-dimensional optoelectronic recording system. There were no significant sex-related differences in jaw and head movement amplitudes. Head movement amplitudes were significantly greater in the pain trials for both men and women. The proportional involvement of the neck motor system during jaw movements increased in pain trials for 13 of 16 men and for 18 of 22 women. Thus, acute pain may alter integrated jaw-neck movements, although, given the similarities between men and women, this interaction between acute pain and motor behaviour does not explain sex differences in musculoskeletal pain in the jaw and neck regions.
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Movimentos da Cabeça , Mandíbula , Músculo Masseter/fisiologia , Adulto , Eletromiografia , Feminino , Humanos , Arcada Osseodentária , Masculino , Movimento , Pescoço , DorRESUMO
PURPOSE: The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. METHODS: This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. RESULTS: We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome. CONCLUSIONS: Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.
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Artroplastia de Substituição/métodos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Qualidade de Vida , Radiografia , Ombro , Resultado do TratamentoRESUMO
AIM: To analyse how health risk behaviours (HRB) are clustered and associated with parental background and family wealth among Swedish boys and girls. METHODS: Data were collected from Health Behaviour in School-aged Children (HBSC), a global cross-sectional survey for 1997/98, 2001/02, and 2005/06. A total of 11,972 boys and girls in grades 5, 7, and 9 participated in the study. The pupils were categorised in subgroups according to parental background: Swedish (80.0%), mixed (10.6%), and foreign (9.4%). Cluster analyses were used to identify HRB profiles. Multinomial logistic regression analysis was used to estimate associations between cluster allocation, parental background, and family affluence. RESULTS: In total 11,232 pupils were identified and allocated to five cluster profiles, half of them in the cluster profile of low-risk behaviour. The most disadvantaged cluster was multiple HRB, which was characterised by high prevalence of smoking, drunkenness, low physical activity, and high soft-drink consumption. The cluster profile of multiple HRB was associated with both mixed background and foreign background in girls and with mixed background in boys. The cluster profile of inadequate tooth brushing was associated with foreign background in both boys and girls. The cluster profiles of multiple HRB and inadequate tooth brushing were associated with low family affluence in girls. CONCLUSIONS: The cluster profiles of multiple HRB and inadequate tooth brushing were associated with parental foreign extraction in boys and girls and with low family affluence in girls. Prevention programmes based on identified clusters of HRB, including consideration of impact of socio-demographic indicators, are needed.
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Comportamentos Relacionados com a Saúde , Assunção de Riscos , Estudos Transversais , Feminino , Humanos , Masculino , Pais , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Suécia/epidemiologiaRESUMO
OBJECTIVE: To measure the interobserver reliability and intraobserver reproducibility of post total hip arthroplasty (THA) leg length discrepancy (LLD) measurement on radiographs as well as to evaluate its accuracy by comparing it with LLD measurement on computed tomographic scanogram (CT-scanogram). MATERIALS AND METHODS: In this prospective study, postoperative LLD measurements in ten THA patients were made by four observers on anteroposterior radiographs of the pelvis (inter-teardrop line to the tip of lesser trochanter) and compared to LLD measurements made on CT-scanogram scout views of the lower limb. Two observers repeated the LLD measurements on radiographs 8 weeks after the first measurements. The interobserver reliability of the LLD measurement on plain radiographs was evaluated by comparing the measurements of the four observers and the intraobserver reproducibility by comparing the two repeated measurements made by the two observers. RESULTS: We found excellent interobserver reliability (mean ICC 0.83) and intraobserver reproducibility (ICC 0.90 and 0.88) of the LLD measurements on plain radiographs. There was a moderate to excellent agreement, but with wide variation of measurements among the four observers, when plain radiographic measurement was compared with CT-scanogram (ICC 0.58, 0.60, 0.71, and 0.82). CONCLUSION: Despite the excellent interobserver reliability and intraobserver reproducibility of LLD measurement on radiographs, clinicians should be aware of its limited accuracy when compared to CT-scanogram.
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Artroplastia de Quadril/efeitos adversos , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/etiologia , Tomografia Computadorizada por Raios X , Filme para Raios X , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To evaluate the validity, interobserver reliability, and intraobserver reproducibility of a digital templating system, the Mdesk™ in preoperative templating in cemented and reverse hybrid total hip arthroplasty (THA). MATERIALS AND METHODS: Validity was evaluated by comparing the planned cup size, stem size, CCD angles, and neck length with the components used in 129 patients operated with cemented and reverse hybrid THA. The reliability was measured by comparing the templating results of two surgeons with each other (interobserver) and the results of two templatings carried out by first surgeon (intraobserver). The leg length discrepancy was measured before and after the operation to assess the templating ability to correct it. RESULTS: The Mdesk™ system showed good validity (kappa value ranged from 0.64 to 0.96), especially when one size over and under the planned size were included. No difference between cemented and cementless stems was found. The interobserver reliability ranged from fair (kappa 0.23) to substantial (kappa 0.61) while the intraobserver reproducibility ranged from substantial (kappa 0.70) to excellent (kappa 0.82). Templating and intraoperative measures succeeded to restore the leg length. CONCLUSIONS: The Mdesk™ system has comparable validity and reliability with other templating systems used in clinical practice. We recommend that the same surgeon who does the preoperative radiographic templating to also perform the operation. Further studies are required to evaluate the results of succeeded templating in the long run.
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Artroplastia de Quadril/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Intensificação de Imagem Radiográfica/métodos , Técnica de Subtração , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Masculino , Cuidados Pré-Operatórios , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , SoftwareRESUMO
Low levels of secretory IgA (SIgA) and transient IgA deficiency have been associated with an increased risk for allergy, but data are conflicting. The aim was to assess the relationship between salivary SIgA antibody levels at 1 yr and wheezing at age four in a birth cohort, in particular the possible protective role of salivary SIgA in sensitized children. Saliva samples were obtained from all children (n=67) with a positive skin prick test (SPT) at 1 yr and 212 children with a negative SPT. In all, 200 of these children responded to questionnaires at 4 yrs and 183 were skin prick tested at that age. The levels of salivary SIgA and salivary IgA antibodies to the most common food allergen egg and inhalant allergen cat were analyzed by ELISA. Serum was analyzed for IgE antibodies to egg and cat. Development of late-onset wheezing was associated with low SIgA levels in children with positive SPT to at least one allergen both at 1 and 4 yrs of age (p=0.04), as well as in children with circulating IgE antibodies to egg or cat at 1 yr (p=0.02). None of nine persistently sensitized children with SIgA levels in the upper quartile developed wheezing, when compared to 10/20 children with lower levels (p=0.01). Older siblings, more than three infections during infancy, at least one smoking parent, and male gender, were all associated with SIgA in the upper quartile. In conclusion, high levels of SIgA antibodies in sensitized infants were associated with significantly less late-onset wheezing, supporting a protective role against development of asthmatic symptoms. Recurrent infections and other factors supporting an increased microbial pressure during infancy were associated with high levels of salivary SIgA.
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Hipersensibilidade Imediata/complicações , Imunoglobulina A Secretora/análise , Imunoglobulina E/sangue , Sons Respiratórios/etiologia , Saliva/imunologia , Alérgenos/administração & dosagem , Alérgenos/efeitos adversos , Alérgenos/imunologia , Animais , Gatos/imunologia , Pré-Escolar , Estudos de Coortes , Ovos/efeitos adversos , Feminino , Humanos , Hipersensibilidade Imediata/imunologia , Imunoglobulina A Secretora/imunologia , Lactente , Masculino , Sons Respiratórios/imunologia , Testes CutâneosRESUMO
BACKGROUND: Internet-based treatments have proven effective for various health issues. There is a need to scale up interventions targeting children with obesity, also in less densely populated areas where the prevalence in many countries is higher than in urban areas. The aim of this study was to design and implement an internet-based program as an add-on to standard treatment for childhood obesity. METHODS: Web-Childhood Obesity Prevention (Web-COP) was a prospective feasibility study with a pre- post- design. The intervention consisted of four group-based education sessions at the clinic, physical activity on prescription, and a new 12-week internet-based program. Web-COP was offered to children with obesity (International Obesity Task Force Body Mass Index (IOTF-BMI) ≥ 30 kg/m2) and their parents in two counties in Northern Sweden from August 2018 to June 2019. The primary outcome was change in BMI standard deviation score (BMI-SDS). RESULTS: The study included 55 children 5-13 years of age. The internet-based component was well received, and retention rate was 51/55 (92.7%). Data was analysed for 51 children. Mean BMI-SDS was 3.3 at start and decreased by 0.2, 0.3, and 0.4 at two, four, and six months from baseline. Using a continuous algorithm, 42/51 (81%), children lowered their BMI-SDS and 33/51 (65%) lowered their BMI. CONCLUSION: Adding group sessions and an internet-based program to standard care was feasible and two thirds of included children with obesity reduced their BMI.
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BACKGROUND: The aim of this study was to test whether a reciprocal dose-response relation exists between frequency/severity of spinal pain and temporomandibular disorders (TMD). METHODS: A total of 616 subjects with varying severity of spinal pain or no spinal pain completed a questionnaire focusing on symptoms in the jaw, head and spinal region. A subset of the population (n = 266) were sampled regardless of presence or absence of spinal pain. We used two different designs, one with frequency/severity of spinal pain, and the other, with frequency/severity of TMD symptoms as independent variable. All 616 participants were allocated to four groups, one control group without spinal pain and three spinal pain groups. The subjects in the subset were allocated to one control group without TMD symptoms and three TMD groups. Odds ratios (ORs) were calculated for presence of frequent TMD symptoms in the separate spinal pain groups as well as for frequent spinal pain in the separate TMD groups. RESULTS: The analysis showed increasing ORs for TMD with increasing frequency/severity of spinal pain. We also found increasing ORs for spinal pain with increasing frequency/severity of TMD symptoms. CONCLUSION: This study shows a reciprocal dose-response-like relationship between spinal pain and TMD. The results indicate that these two conditions may share common risk factors or that they may influence each other. Studies on the temporal sequence between spinal pain and TMD are warranted.
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Dor Lombar/fisiopatologia , Medição da Dor/métodos , Transtornos da Articulação Temporomandibular/fisiopatologia , Adulto , Idoso , Comorbidade , Feminino , Humanos , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Cervicalgia/fisiopatologia , Razão de Chances , Fatores de Risco , Dor de Ombro/epidemiologia , Dor de Ombro/fisiopatologia , Inquéritos e Questionários , Suécia/epidemiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto JovemRESUMO
Introduction: Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes. The strategies used to screen for GDM vary both internationally and nationally. Therefore, we investigated the performance of the capillary random plasma glucose (RPG) test, maternal body mass index (BMI) and maternal age in predicting GDM. Methods: In a retrospective cohort study, we included pregnant women without pre-existing diabetes or metabolic disease who gave birth in Västernorrland County, Sweden, in 2015-2016. Values for RPG in gestational weeks 23-28 were obtained from obstetric medical records for each pregnancy. The development of GDM was confirmed by evaluating data in the obstetric records. The ability of RPG, maternal BMI, and age to predict GDM was assessed with receiver-operating characteristic curves. Results: In total, 4,698 pregnancies were included in the final statistical analysis. RPG was fairly effective in screening (area under the curve [AUC] 0.73; 95% confidence interval [CI] 0.66-0.80), and BMI performed slightly better (AUC 0.75; 95% CI 0.68-0.82), whereas maternal age performed poorly (AUC 0.61; 95% CI 0.53-0.68). Combining RPG ≥7 and BMI ≥27.9 yielded the best overall sensitivity (75.4%), specificity (70.1%), and AUC (0.75; 95% CI 0.68-0.82). Conclusions: Our results show that the sensitivity of capillary RPG alone in predicting GDM is fair. The combination of RPG with maternal BMI or age showed greater sensitivity. However, none of the screening factors (RPG, BMI, and maternal age), alone or combined, showed sufficiently good performance in predicting GDM.
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BACKGROUND: The evaluation of tenderness associated with greater trochanteric pain (GTP) syndrome is amenable to bias and depends on the examiner's experience. In this study, we tested whether the use of an electronic pressure algometer enhanced the reliability of this evaluation. PATIENTS AND METHODS: Pressure-pain threshold (PPT) was measured with an electronic algometer in 18 patients who developed GTP after total hip arthroplasty and in matched controls. Both groups were evaluated with visual analog scale. RESULTS: The PPT measurements showed large interindividual variability across patients. The correspondence of the PPT measurements in asymptomatic patients was good. We found good validity for the algometer used. The PPT ratio of 0.8 (affected vs. unaffected side) can be used as a cut-off ratio. The PPT measurements at the greater trochanter (local pain) were significantly lower than at the ilio-tibial band (radiated pain). There was no correlation between PPT measurements and visual analog scales. Despite the acceptable sensitivity and specificity of pressure algometer, because of low positive predictive value and large interindividual variability, pressure algometer has a limited value as a screening test. CONCLUSIONS: The examination of tenderness associated with GTP is facilitated by the used algometer. It is the intraindividual body-side PPT differences that yield the most sensitive measurement for the assessment of deep pain. A cut-off value of 0.8 can be used for diagnostic purposes. Interindividual differences might be considerable and could mask pathologic diagnostic findings.
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Artroplastia de Quadril/efeitos adversos , Medição da Dor/instrumentação , Medição da Dor/métodos , Limiar da Dor , Dor/diagnóstico , Dor/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Fêmur/patologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Cold extremities have been noted in non-walking children with cerebral damage compared with healthy controls. Whether this is a general problem in children with cerebral palsy (CP) and associated with other symptoms is unknown. This study describes accompanying symptoms such as cold extremities, constipation, pain, sleeping disorders and impaired well-being in children with CP as well as treatment the children have undergone. Associations between cold extremities and other symptoms borne by the children were analysed and discussed. From information in postal surveys received from parents of children with CP, 107 children (60 boys and 47 girls) aged 5-13 years, mean 11 years 8 months (SD 2 years 11 months), were described and analysed. Besides neurological impairments, many children had cold extremities and pain, sleeping disorders, constipation, and impaired well-being. Most children had had one or more of these symptoms for over 1 year but the symptoms were largely untreated. Non-walkers generally had more symptoms than walkers. Although pain, constipation, and sleeping disorders may have different underlying causes in children with CP, these symptoms might also be mediated or aggravated by dysfunction in the autonomic nervous system. To improve the child's well-being, early recognition and treatment of accompanying symptoms is important.
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Temperatura Corporal/fisiologia , Paralisia Cerebral/fisiopatologia , Extremidades/fisiologia , Adolescente , Adulto , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Coleta de Dados , Extremidades/irrigação sanguínea , Feminino , Nível de Saúde , Humanos , Masculino , Tono Muscular/fisiologia , Dor/etiologia , Pais , Transtornos do Sono-Vigília/etiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Improvement in sleep parameters in relation to acupuncture treatment is often found and referred to as being a positive side-effect in the treatment of other illnesses. There is a lack of randomized studies, which primarily study the direct effect of acupuncture on sleep. OBJECTIVES: To investigate whether or not auricular acupuncture has an effect on sleep parameters among people with insomnia. DESIGN: A single-blind, randomized pilot study where the treatment group received auricular acupuncture treatment (AAT) on active points and the control group received AAT on sham points during a 6-week treatment period. SETTING: Participants were recruited from the psychiatric outpatient clinics in the geographical area connected to a local hospital in central Sweden. SUBJECTS: In all, 28 women were included in the study, with 14 in each group. Their mean and median age was 53 years. OUTCOME MEASURES: Sleep parameters were obtained by using the Karolinska Sleep Diary. RESULTS: No statistically significant differences were observed between the groups relating to parameters associated with the definition of insomnia. The treatment group experienced that it was easier to wake up in the morning compared with the control group (repeated-measures analysis of variance, p = 0.04). Both groups showed a statistically significant recovery in subjective sleep parameters during the study period (weeks 1-6) compared with baseline values (week 0). CONCLUSIONS: Only modest evidence was found supporting the hypothesis that AAT may have an effect on insomnia. Least improvements were found in total sleep time and number of awakenings, 2 parameters directly associated with the definition of insomnia. AAT may have a role in the treatment of insomnia, especially in combination with other treatments such as cognitive behavioral therapy. This study provides an example of how to perform studies using alternative therapies for sleep disorders.
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Pontos de Acupuntura , Acupuntura Auricular/métodos , Satisfação do Paciente , Distúrbios do Início e da Manutenção do Sono/terapia , Saúde da Mulher , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Polissonografia , Qualidade de Vida , Autoeficácia , Método Simples-CegoRESUMO
BACKGROUND: A combination of warfarin, aspirin and clopidogrel is indicated after percutaneous coronary intervention (PCI) in some patients, despite the higher risk of bleeding inferred by this triple therapy. OBJECTIVES: Whether the treatment quality of warfarin measured by iTTR (individual time within therapeutic INR range) is associated with bleeding complications during triple therapy after PCI. METHODS: A retrospective register study consisting of 601 triple treated PCI patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). The cohort was cross-matched with the Swedish Patient Registry for background characteristics and bleeding complications up to 6 months after PCI using ICD10 codes, the Prescribed Drug Registry for ongoing medications, and the national oral anticoagulation registry Auricula for warfarin treatment quality. The patients were grouped into four iTTR groups: <50%, 50-69.9%, 70-84.9% and >85% as well as iTTR above or below 70%. RESULTS: Of 601 patients, 39 (6.5%) had a bleeding complication (type 2 according to BARC). Bleeding was more common for iTTR<70% compared to iTTR>70%, 28 (9.3%) vs. 11 (3.7%) (p = 0.005). The bleeding frequency increased gradually from the best group, iTTR>85% with four bleeders (3.3%) up to 17 bleeders (13.3%) in the worst group with iTTR<50% (p = 0.003), with a corresponding bleeding rate per 100 treatment years of 8.0 and 44.9, respectively. In multivariate analysis low BMI, HR 1.11 (95% CI 1.01-1.22), a medical history of anemia HR 3.17 (1.16-8.69) and iTTR < 70% HR 2.86 (1.25-6.53) increased the risk of bleeding. CONCLUSION: Triple therapy after PCI confers a high risk of bleeding events. Warfarin treatment quality measured by iTTR as well as a medical history of anemia are strong independent predictors of bleeding in these patients. Physicians should pay more attention to iTTR after PCI.
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Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Fármacos Hematológicos/uso terapêutico , Intervenção Coronária Percutânea , Hemorragia Pós-Operatória/epidemiologia , Varfarina/uso terapêutico , Idoso , Aspirina/efeitos adversos , Clopidogrel/efeitos adversos , Quimioterapia Combinada/efeitos adversos , Feminino , Seguimentos , Fármacos Hematológicos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Varfarina/efeitos adversosRESUMO
BACKGROUND/AIM: Early identification of lactate levels may have a large impact on triage classification and assist in identifying critically ill patients. A handheld device provides a rapid and timesaving measurement of lactate levels adapted to work in a prehospital care setting. I.e., the device is small, fast, and easy-to-use. The aim of this study was to evaluate the Accutrend Plus handheld lactate analyzer in comparison to the reference in-hospital method. METHODS: Patients triaged as minimum yellow according to the RETTS System (Rapid Emergency Triage and Treatment System) and transported to hospital by ambulance were selected and a written consent to participate was obtained prior to inclusion in the study. Capillary (CAP) and venous (VEN) blood were analyzed with Accutrend Plus (AP). Venous blood samples were analyzed at the local hospital laboratory (GEM premier 4000) within 20 min from sampling. All sampling was conducted by two registered nurses specially trained in prehospital care. RESULTS: 480 lactate measurements were performed in 160 patients. The mean difference between measurements in capillary blood compared with the reference method was 0.7 mmol/L and for venous blood 0.9 mmol/L. The limits of agreement from the Bland-Altman plot was - 0.9 to + 2.5 mmol/L and and - 0.1 to + 1.9 mmol/L, for CAP and VEN compared with GEM. CONCLUSION: Our results shows low accuracy and low precision with VEN / CAP measurements of lactate compared to reference GEM.
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Gasometria/instrumentação , Estado Terminal , Serviços Médicos de Emergência , Ácido Láctico/sangue , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES/HYPOTHESIS: Data from patients registered for myringoplasty during 2002 to 2012 in the Swedish National Quality Registry for Myringoplasty. STUDY DESIGN: Both conventional myringoplasty and fat-graft techniques were used aimed at healing the tympanic membrane in noninfected ears. METHODS: Analysis was performed on data in a national database collected from 32 ear, nose, and throat clinics. Surgical procedures and outcomes, and patient satisfaction from a questionnaire were studied. RESULTS: The database was comprised of 3,775 surgical procedures, with follow-up available for analysis. One-third were children under the age of 15 years. The most common indication for surgery was infection prophylaxis. The overall healing rate of the tympanic membrane after surgery was 88.5%, with a high mean patient satisfaction. Complications registered were postoperative infection, tinnitus, or taste disturbance that occurred in 5.8% of patients. CONCLUSIONS: Swedish results for a large number of patients who completed myringoplasty are presented. The success rate in this study is comparable to other studies, and good patient-reported outcome measures of myringoplasty are presented. Databases for surgical procedures and clinical audits are systematic processes for continuous learning in healthcare. This study shows that clinical databases can be utilized to analyze national results of surgical procedures. LEVEL OF EVIDENCE: 2b Laryngoscope, 127:2389-2395, 2017.
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Miringoplastia/métodos , Satisfação do Paciente , Sistema de Registros , Perfuração da Membrana Timpânica/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Suécia/epidemiologia , Resultado do Tratamento , Perfuração da Membrana Timpânica/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Primary hyperparathyroidism is often diagnosed by high calcium levels in blood. It is well known that calcium levels are dependent on vitamin D and Parathyroid hormone (PTH). Since vitamin D has a seasonal variation the calcium levels might also be influenced by seasonal variation. If a seasonal variation in calcium levels exists, this must be considered in the investigation of suspected hyperparathyroidism. The aim of the present study was to investigate the possible influence and magnitude of the seasonal variation of vitamin D and PTH on calcium levels. METHOD: In the present study the individual seasonal variation of 25-hydroxyvitamin D [25(OH)D], PTH and calcium in 69 healthy volunteers living at latitudes with extremely variable seasonal exposure to sunlight have been investigated. RESULTS: As expected the 25(OH)D levels were significantly higher (42%) in summer compared to winter. PTH levels were significantly lower (7%) in summer than in winter. The mean serum concentration of calcium was 1% higher in August than in February, however not statistically significant. A good agreement between summer and winter calcium values was confirmed by Bland-Altman analysis. CONCLUSION: This study did not show any clinically important influence of seasonal variation of 25(OH)D and PTH on calcium that may influence a clinician's decision to investigate suspected hyperparathyroidism.
Assuntos
Cálcio/sangue , Hormônio Paratireóideo/sangue , Estações do Ano , Luz Solar , Vitamina D/análogos & derivados , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/efeitos da radiação , Vitamina D/sangue , Vitamina D/efeitos da radiaçãoRESUMO
INTRODUCTION: Every year about 2500 patients in Sweden undergo surgery due to heart valve disease. A mechanical heart valve prosthesis causes risk of thromboembolic stroke or thrombus formation in the valve while anticoagulant treatment increases the risk of bleeding. Treatment quality with warfarin is crucial for patients with mechanical valve prostheses. It has previously been shown that poorly controlled warfarin treatment increases mortality in this patient group. TTR (Time in Therapeutic Range) on warfarin has been shown to affect the risk of complications in atrial fibrillation, but has not been studied in patients with mechanical heart valves. Our aim is to evaluate the impact of TTR on the risk of complications in this patient group. MATERIALS AND METHODS: A non-randomized, prospective study of 534 adults with mechanical heart valve prostheses from Malmö and Sundsvall registered in the Swedish National Quality Registry Auricula between 01.01.2008 and 31.12.2011. Quartiles regarding individual TTR levels were compared regarding risk of complications. RESULTS: The risk of complications was significantly higher at lower TTR levels for all complications (p=0.005), bleeding (p=0.01) and death (p=0.018) but not for thromboembolism. In multivariate analysis the risk was significantly increased at lower TTR levels for bleeding and all complications but not for death or thromboembolism. CONCLUSION: Patients with a lower warfarin treatment quality measured by TTR have a higher risk of complications such as severe bleeding or death. A TTR of 83% or higher at the individual level should be obtained for best outcome.