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  • 51.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Child Protection in Sweden: Are routine assesments reliable?2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 11, p. 1474-1480Article in journal (Refereed)
    Abstract [en]

    Aim: To study the validity of the decision not to investigate mandatory reports of suspected child maltreatment.

    Methods: Written files of 220 reports indicating possible child maltreatment were analysed and re-evaluated. As a measure of the justification for the decisions, a 5-y follow-up study was done.

    Results: We determined that 76% of the reports still indicated child maltreatment after the initial assessment was done. In the follow-up study, 45% of the children had been investigated. The social worker used the family as the only source of information in 74% of the cases, in 6% someone outside the family was contacted, and in 11% no further information in addition to the report was collected. In 9%, data on information sources were missing.

    Conclusion: The findings are rather discouraging, as they challenge the belief that a report is a means of ensuring that maltreatment does not continue. The study shows that, depending upon the way in which the initial assessments are made, maltreated children may run a risk of not being identified, even though the maltreatment has been reported. This suggests that there may be a need for national guidelines concerning the reporting of maltreatment.

  • 52.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    The Impact of Socio-economic load in Family Service organized child protection2007Article in journal (Refereed)
  • 53.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Who suspects and report child maltreatment to Social Services in Sweden?: Is there a reliable mandatory reporting process?2007In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 10, no 2, p. 209-223Article in journal (Refereed)
    Abstract [en]

    This article deals with the mandatory report process in Sweden. The components that are analysed are who makes the reports, what is reported and the outcome for the reports. Data were collected in a Swedish county in the year 2000 by means of locating every report made to the Social Services during one year (1998). The net sample consisted of 1,570 reports regarding 1,051 children. A follow-up study was carried out in 2003 of all the children for whom a report in 1998 did not lead to an investigation being initiated. We found in these study indicators that the process might not be secure. The professionals reported 1% of the children in the municipality; 22% of the reports from professionals were not investigated. The five-year follow-up study shows that 53% of the children that these reports concerned had been the subject of an investigation. This could be an indicator that children continue to be maltreated after being reported since the assessments are not accurate. In this study, 67% of 'crime reports' were 'not indicating' child maltreatment. There should be a questioning of 'crime reports' automatically entering the mandated report process as, if registered nationally, this could lead to a deflation of mandatory reports. Administration needs to change introducing a national form for filing reports.

  • 54. Order onlineBuy this publication >>
    Crafoord, Kristina
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Genital prolapse surgery: A study of methods, clinical outcome and impact of pelvic floor muscle function2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objective: To evaluate whether a shift in the extent of genital prolapse surgery occurred between 1983 and 1993. If such a shift occurred, the need for subsequent prolapse surgery; the prevalence of symptoms of pelvic floor dysfunction (PFD) in women six years after vaginal prolapse surgery. And also to analyze predictive factors and the subjective and objective outcomes of prolapse surgery at long term follow up. To evaluate whether neurophysiologic findings of the pelvic floor muscles and anorectal manometry measurements respectively are associated with pre- and postoperative symptoms and the extent of prolapse.

    Methods/material: A retrospective study of 542 consecutive patients, operated on for genital prolapse, with primary surgery during 1983 and 1993 in three Swedish hospitals was conducted. Data were obtained from the patient records and were analyzed with emphasis on demographic, clinical and surgical data. A postal questionnaire with validated questions concerning symptoms of PFD was in 1999 sent to women operated in 1993 for primary POP and no subsequent POP surgery.

    A prospective study of 42 women with genital prolapse, stage 2-3, scheduled for vaginal prolapse surgery was carried out. Preoperatively the women were examined with anorectal manometry, pudendal nerve neurography and concentric needle electromyography of the pubococcygeus muscles and the external anal sphincter muscle. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated six years postoperatively.

    Results: A shift from complete to selective repairs was seen between the two time periods, and posterior repair was often omitted in the latter period. The prevalence of subsequent prolapse surgery increased in the 1990s and the increase was more common in women with a selective repair than in those with complete repair. At long term, PFD-symptoms commonly occurred and were found to be associated with the extent of the prolapse surgery. Symptoms of prolapse and bowel emptying improved significantly after POP surgery in the prospective study. The cure rates of rectocele and apical descent were high, but low concerning cystocele. The results of the neurophysiologic investigations and anal sphincter pressures showed associations with the symptoms and the extent of the prolapse; the individual characteristics showed no discriminatory values.

    Conclusion: The extent of the surgical prolapse procedures changed between the two study periods and the extent of subsequent surgery also was greater in the second period. Symptoms of PFD and recurrence of prolapse, especially of the anterior compartment, were frequently seen. Prolapse and bowel symptoms were associated with the function of pelvic floor muscles but neither the results of the neurophysiologic nor the anorectal manometry measurements of the pelvic floor muscles were found to predict anatomical or subjective outcomes of POP surgery. More knowledge is needed of the pathophysiology of PFD in order to develop better means of prevention and to optimize treatment of POP. Development of new methods for identifying all defects of the pelvic floor and surgical techniques for restitution is also warranted for improving outcome of surgical treatment of genital prolapse.

    List of papers
    1. Primary surgery of genital prolapse: a shift in treatment tradition.
    Open this publication in new window or tab >>Primary surgery of genital prolapse: a shift in treatment tradition.
    2006 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 9, p. 1104-1108Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10-year period.

    METHODS: A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data.

    RESULTS: The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001).

    CONCLUSION: The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2006
    Keywords
    Genital prolapse, pelvic floor dysfunction, pelvic surgery, posterior repair, retrospective study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17399 (URN)10.1080/00016340500470168 (DOI)16929416 (PubMedID)
    Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2019-06-28Bibliographically approved
    2. Genital prolapse surgery after a shift in treatment tradition: an analysis of subsequent prolapse surgery
    Open this publication in new window or tab >>Genital prolapse surgery after a shift in treatment tradition: an analysis of subsequent prolapse surgery
    2008 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 4, p. 449-456Article in journal (Refereed) Published
    Abstract [en]

    Objective: To determine whether the shift in treatment tradition of genital prolapse surgery was followed by a change in the occurrence of subsequent prolapse surgery, and to analyze the complementary and recurrent surgery with respect to the size of the prolapse and the extent of the primary surgery.

    Methods: A retrospective study of patients consecutively operated with primary prolapse surgery in three Swedish hospitals in two time periods: 261 patients in 1983 (Period I) and 281 patients in 1993 (Period II). Clinical data were obtained from the patient records. A follow-up period of 6 years was used for both periods.

    Results: Subsequent prolapse surgery was seen significantly more often in Period II than in Period I (7.7 versus 2.7%), and after selective repairs compared with complete repairs (7.7 versus 3.2%). Despite a significant reduction in the use of posterior repair between the time periods, no significant increase was seen in complementary posterior repairs compared with complementary repair in any of the other compartments. Size of the prolapse at the primary surgery or hysterectomy did not seem to influence the occurrence of subsequent prolapse surgery. The postoperative complication rate was significantly higher after complete repairs than after selective repair, and especially when posterior repair was included in the operation.

    Conclusion: Subsequent prolapse surgery is slightly more common after selective repair than after complete repair. However, selective repairs are encumbered with a lower complication rate. The results of this study appear to be in favor of a restrictive use of 'prophylactic' posterior repair.

    Place, publisher, year, edition, pages
    Informa, 2008
    Keywords
    Pelvic organ prolapse, prolapse surgery, recurrence, subsequent surgery
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17411 (URN)10.1080/00016340801986763 (DOI)18382873 (PubMedID)
    Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2019-06-28Bibliographically approved
    3. Factors associated with symptoms of pelvic floor dysfunction six years after primary operation of genital prolapse
    Open this publication in new window or tab >>Factors associated with symptoms of pelvic floor dysfunction six years after primary operation of genital prolapse
    Show others...
    2008 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 9, p. 910-915Article in journal (Refereed) Published
    Abstract [en]

    Objective: To determine prevalence of pelvic floor dysfunction (PFD) symptoms in women six years after primary pelvic organ prolapse (POP) surgery and analyze predictive factors for these symptoms. DESIGN: Cross-sectional observational study.

    Setting: Three Swedish hospitals.

    Sample: Women who underwent primary POP surgery in 1993 and had no subsequent POP surgery during the following six years.

    Methods: Clinical data from patient records and a postal questionnaire concerning symptoms of PFD completed in 1999.

    Main outcome measures: Prevalence of PFD symptoms, predictive factors.

    Results: Urinary incontinence episodes > or =weekly were reported by 41%, feeling of vaginal bulging by 18% and solid stool incontinence by 15%. Thirty nine percent were sexually active; 15% refrained completely from sexual activity because of own discomfort or pain and 46% had no sexual activity due to lack of or sick partner. Discomfort or pain during sexual activity was experienced by 42%. Previous incontinence surgery and urinary incontinence prior to POP surgery were predictive factors for urinary incontinence. Anterior repair was protective for the postoperative symptoms of incomplete bladder and bowel emptying and vaginal bulging. Posterior repair was a risk factor for incomplete bowel emptying and solid stool incontinence. The association between posterior repair and discomfort or pain during sexual activity was not significant.

    Conclusion: The prevalence of PFD symptoms six years after primary POP surgery seemed high. The extent of POP surgery was predictive for postoperative symptoms of urinary and bowel dysfunction but not for discomfort or pain during sexual activity.

    Place, publisher, year, edition, pages
    Informa/Talor & Francis, 2008
    Keywords
    Genital prolapse, pelvic floor dysfunction, pelvic organ prolapse surgery, predictive factor, symptom
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17413 (URN)10.1080/00016340802311243 (DOI)18720035 (PubMedID)
    Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2019-06-28Bibliographically approved
    4. Pelvic floor neuropathy in relation to symptoms, anatomy and outcome of vaginal prolapse surgery: a neurophysiologic study
    Open this publication in new window or tab >>Pelvic floor neuropathy in relation to symptoms, anatomy and outcome of vaginal prolapse surgery: a neurophysiologic study
    (English)Manuscript (Other academic)
    Abstract [en]

    The aims of this study were to analyze whether neurophysiologic findings of pelvic floor muscles could predict preoperative symptoms of pelvic floor dysfunction and the extent and degree of pelvic organ prolapse and to investigate associations between neurophysiologic findings and the anatomic and subjective outcome of surgery. Forty two women with prolapse stage 2-3 were preoperatively examined with pudendal nerve neurography and concentric needle electromyography of the pubococcygeus and the external anal sphincter muscles. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated median six years postoperatively. The electromyographic findings of the pelvic muscles showed some associations with symptoms of pelvic floor dysfunction but none with degree of prolapse; no discriminatory values were obtained. EMG findings could not predict the outcome of pelvic organ prolapse surgery in terms of changes in symptoms of pelvic floor dysfunction or anatomical outcome.

    Keywords
    EMG; Genital prolapse surgery, Neuromuscular damage, Outcome, Pelvic floor neuropathy, Pudendal nerve latency
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17415 (URN)
    Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2010-01-14Bibliographically approved
    5. The predictive value of anorectal manometry on subjective and objective findings and outcome of pelvic organ prolapse surgery: A prospective study
    Open this publication in new window or tab >>The predictive value of anorectal manometry on subjective and objective findings and outcome of pelvic organ prolapse surgery: A prospective study
    (English)Manuscript (Other academic)
    Abstract [en]

    The objectives were to evaluate associations between anal sphincter pressure and a) stage of prolapse and b) bowel and prolapse symptoms; and to determine the predictive value of the manometric measurements on symptomatic and anatomical outcomes of prolapse surgery-. Forty two women with prolapse stage 2-3 participated in the study. Pre- and postoperative evaluation of the patients was done by using a symptom questionnaire and doing clinical examinations and anorectal manometry. The vaginal prolapse surgery always included at the very least posterior colporrhaphy. Median follow-up time was 6.4 years. The symptoms vaginal protrusion and feeling of incomplete bowel emptying were associated with levels of anal sphincter pressure. Anorectal manometric measurements could not predict the subjective and anatomical outcomes of POP surgery. Symptoms of prolapse and bowel emptying “sensations” were significantly reduced. The cure rates of rectocele and apical descensus were high, whereas the cure rate was low for cystocele.

    Keywords
    Anorectal manometry Bowel dysfunction; Fecal incontinence; Genital prolapse surgery, Outcome
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-17416 (URN)
    Available from: 2009-03-23 Created: 2009-03-23 Last updated: 2010-01-14Bibliographically approved
    Download full text (pdf)
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  • 55.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery UHL.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Pelvic organ prolapse and anorectal manometry: a prospective study2012In: Urogynaecologia International Journal, ISSN 1121-3086, E-ISSN 2038-8314, Vol. 26, no 1, p. 12-16Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to evaluate associations between anal sphincter pressure and stage of prolapse and bowel and prolapse symptoms among women undergoing prolapse surgery and to determine whether anal sphincter pressure could predict symptomatic and anatomical outcomes of prolapse surgery. Fortytwo women with pelvic organ prolapse (POP) stage 2-3 were included in this prospective longitudinal study. Pre- and postoperative evaluation by means of a symptom questionnaire, clinical examination and anorectal manometry. The vaginal prolapse surgery included at the very least posterior colporrhaphy. Analysis of variance and covariance and logistic regression models were used for statistical analyses. The anal sphincter pressure at rest and squeeze was significantly lower in women with the symptom vaginal protrusion than in the women without the symptom. No associations were found between anal sphincter pressure and the extent or degree of prolapse or subjective and anatomical outcomes of POP surgery. The prolapse symptom vaginal protrusion is associated with a low anal sphincter pressure but the anal sphincter pressure does not seem to predict the outcome of POP surgery, neither regarding symptoms nor anatomy.

  • 56.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Hallböök, Olof
    Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    The predictive value of anorectal manometry on subjective and objective findings and outcome of pelvic organ prolapse surgery: A prospective studyManuscript (Other academic)
    Abstract [en]

    The objectives were to evaluate associations between anal sphincter pressure and a) stage of prolapse and b) bowel and prolapse symptoms; and to determine the predictive value of the manometric measurements on symptomatic and anatomical outcomes of prolapse surgery-. Forty two women with prolapse stage 2-3 participated in the study. Pre- and postoperative evaluation of the patients was done by using a symptom questionnaire and doing clinical examinations and anorectal manometry. The vaginal prolapse surgery always included at the very least posterior colporrhaphy. Median follow-up time was 6.4 years. The symptoms vaginal protrusion and feeling of incomplete bowel emptying were associated with levels of anal sphincter pressure. Anorectal manometric measurements could not predict the subjective and anatomical outcomes of POP surgery. Symptoms of prolapse and bowel emptying “sensations” were significantly reduced. The cure rates of rectocele and apical descensus were high, whereas the cure rate was low for cystocele.

  • 57.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Lindehammar, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Pelvic floor neuropathy in relation to symptoms, anatomy and outcome of vaginal prolapse surgery: a neurophysiologic studyManuscript (Other academic)
    Abstract [en]

    The aims of this study were to analyze whether neurophysiologic findings of pelvic floor muscles could predict preoperative symptoms of pelvic floor dysfunction and the extent and degree of pelvic organ prolapse and to investigate associations between neurophysiologic findings and the anatomic and subjective outcome of surgery. Forty two women with prolapse stage 2-3 were preoperatively examined with pudendal nerve neurography and concentric needle electromyography of the pubococcygeus and the external anal sphincter muscles. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated median six years postoperatively. The electromyographic findings of the pelvic muscles showed some associations with symptoms of pelvic floor dysfunction but none with degree of prolapse; no discriminatory values were obtained. EMG findings could not predict the outcome of pelvic organ prolapse surgery in terms of changes in symptoms of pelvic floor dysfunction or anatomical outcome.

  • 58.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Johansson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Factors associated with symptoms of pelvic floor dysfunction six years after primary operation of genital prolapse2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 9, p. 910-915Article in journal (Refereed)
    Abstract [en]

    Objective: To determine prevalence of pelvic floor dysfunction (PFD) symptoms in women six years after primary pelvic organ prolapse (POP) surgery and analyze predictive factors for these symptoms. DESIGN: Cross-sectional observational study.

    Setting: Three Swedish hospitals.

    Sample: Women who underwent primary POP surgery in 1993 and had no subsequent POP surgery during the following six years.

    Methods: Clinical data from patient records and a postal questionnaire concerning symptoms of PFD completed in 1999.

    Main outcome measures: Prevalence of PFD symptoms, predictive factors.

    Results: Urinary incontinence episodes > or =weekly were reported by 41%, feeling of vaginal bulging by 18% and solid stool incontinence by 15%. Thirty nine percent were sexually active; 15% refrained completely from sexual activity because of own discomfort or pain and 46% had no sexual activity due to lack of or sick partner. Discomfort or pain during sexual activity was experienced by 42%. Previous incontinence surgery and urinary incontinence prior to POP surgery were predictive factors for urinary incontinence. Anterior repair was protective for the postoperative symptoms of incomplete bladder and bowel emptying and vaginal bulging. Posterior repair was a risk factor for incomplete bowel emptying and solid stool incontinence. The association between posterior repair and discomfort or pain during sexual activity was not significant.

    Conclusion: The prevalence of PFD symptoms six years after primary POP surgery seemed high. The extent of POP surgery was predictive for postoperative symptoms of urinary and bowel dysfunction but not for discomfort or pain during sexual activity.

  • 59.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Genital prolapse surgery after a shift in treatment tradition: an analysis of subsequent prolapse surgery2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 4, p. 449-456Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether the shift in treatment tradition of genital prolapse surgery was followed by a change in the occurrence of subsequent prolapse surgery, and to analyze the complementary and recurrent surgery with respect to the size of the prolapse and the extent of the primary surgery.

    Methods: A retrospective study of patients consecutively operated with primary prolapse surgery in three Swedish hospitals in two time periods: 261 patients in 1983 (Period I) and 281 patients in 1993 (Period II). Clinical data were obtained from the patient records. A follow-up period of 6 years was used for both periods.

    Results: Subsequent prolapse surgery was seen significantly more often in Period II than in Period I (7.7 versus 2.7%), and after selective repairs compared with complete repairs (7.7 versus 3.2%). Despite a significant reduction in the use of posterior repair between the time periods, no significant increase was seen in complementary posterior repairs compared with complementary repair in any of the other compartments. Size of the prolapse at the primary surgery or hysterectomy did not seem to influence the occurrence of subsequent prolapse surgery. The postoperative complication rate was significantly higher after complete repairs than after selective repair, and especially when posterior repair was included in the operation.

    Conclusion: Subsequent prolapse surgery is slightly more common after selective repair than after complete repair. However, selective repairs are encumbered with a lower complication rate. The results of this study appear to be in favor of a restrictive use of 'prophylactic' posterior repair.

  • 60.
    Crafoord, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Nilsson, Kerstin
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Primary surgery of genital prolapse: a shift in treatment tradition.2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 9, p. 1104-1108Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of complete repairs in genital prolapse surgery has been questioned because of the possible adverse effects of the surgery on the urogenital and sexual function and selective repairs have been advocated. The aims of this study were to establish information about genital prolapse surgery and to analyze whether a shift from extensive prolapse surgery with complete repairs to selective repairs occurred during a 10-year period.

    METHODS: A retrospective study of 610 consecutive patients operated upon for genital prolapse during 1983 (Period I) and 1993 (Period II) in a sample of three Swedish hospitals was conducted. Data were obtained from the patient records. 542 women had primary surgery and were analyzed with emphasis on demographic, clinical, and surgical data.

    RESULTS: The demographic and clinical data of the patients showed no significant differences between the two periods. In Period I, 69% of the patients underwent complete repair compared with 37% in Period II (p<0.001). The proportion of prolapse operations without posterior colporrhaphy increased significantly from the first to the second period from 14 to 43% (p<0.001).

    CONCLUSION: The surgery for genital prolapse seems to have changed from complete repairs towards selective repairs and posterior colporrhaphy was more often avoided in the second period. The implication of this shift in surgical treatment on pelvic floor function is not known. Further studies are needed to disclose the effect of the surgery on pelvic floor function and dysfunction in the long term.

  • 61.
    Dahlgren, Eva
    et al.
    Gothenburg University.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Long-term outcome of porcine skin graft in surgical treatment of recurrent pelvic organ prolapse. An open randomized controlled multicenter study2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 12, p. 1393-1401Article in journal (Refereed)
    Abstract [en]

    Objective. To determine the long-term objective and subjective outcomes of use of a porcine skin graft (Pelvicol(TM)) compared with conventional colporrhaphy in recurrent pelvic organ prolapse surgery and to analyze risk factors and safety. Design. Open randomized controlled multicenter study. Setting. Eight Swedish hospitals. Population. 135 consecutive women with recurrent cystocele and/or rectocele admitted for vaginal prolapse surgery; 132 completed the study, 64 were randomly allocated to receive conventional colporrhaphy and 68 to Pelvicol. Methods. Conventional anterior and posterior colporrhaphy and colporrhaphy with use of Pelvicol(TM) mesh reinforcement. Clinical evaluation by means of pelvic organ prolapse quantification (POP-Q) and symptom questionnaire preoperatively, three months and three years postoperatively. Main outcome measures. Anatomical and subjective outcome.? Recurrence was defined as POP-Q=stage 2. Results. At three-month follow-up, early recurrence/surgical failures occurred significantly more often in the Pelvicol(TM) group, but at the three-year follow-up the recurrence rates were similar. The recurrence rates in the anterior compartment were 5762% and 4423% in the posterior compartment for the colporrhaphy and Pelvicol(TM) groups, respectively. Symptoms were substantially and equally reduced in the two groups after surgery. Sexual activity and function did not seem to be affected adversely in any group. The complication rate was low. Risk factors for anatomical recurrence were age, body mass index and preoperative stage of the prolapse. Conclusions. With the surgical technique used in this study, Pelvicol(TM) did not provide advantages over conventional colporrhaphy in recurrent pelvic organ prolapse concerning anatomical and subjective outcomes.

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  • 62.
    Dahlgren, Lars Owe
    et al.
    Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Biographical-Item: Nils-Holger Areskog IN MEMORIAM in JOURNAL OF INTERPROFESSIONAL CARE, vol 25, issue 2, pp 161-1622011Other (Other academic)
    Abstract [en]

    n/a

  • 63.
    Danielsson, Anna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fagerholm, Siri
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Öst, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Franck, Niclas
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences.
    Kjölhede, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Nyström, Fredrik H
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Short-Term Overeating Induces Insulin Resistance in Fat Cells in Lean Human Subjects2009In: Molecular medicine (Cambridge, Mass. Print), ISSN 1076-1551, E-ISSN 1528-3658, Vol. 15, no 7-8, p. 228-234Article in journal (Refereed)
    Abstract [en]

    Insulin resistance and type 2 diabetes (T2D) are closely linked to obesity. Numerous prospective studies have reported on weight gain, insulin resistance, and insulin signaling in experimental animals, but not in humans. We examined insulin signaling in adipocytes from lean volunteers, before and at the end of a 4-wk period of consuming a fast-food, high-calorie diet that led to weight gain. We also examined adipocytes from patients with T2D. During the high-calorie diet, subjects gained 10% body weight and 19% total body fat, but stayed lean (body mass index = 24.3 kg/m2) and developed moderate systemic insulin resistance. Similarly to the situation in T2D subjects, in subjects on the high-calorie diet, the amount of insulin receptors was reduced and phosphorylation of IRS1 at tyrosine and at serine-307 (human sequence, corresponding to murine serine-302) were impaired. The amount of insulin receptor substrate protein-1 (IRS1) and the phosphorylation of IRS1 at serine-312 (human sequence, corresponding to murine serine-307) were unaffected by the diet. Unlike the T2D subjects, in subjects on the high-calorie diet, likely owing to the ongoing weight-gain, phosphorylation of MAP-kinases ERK1/2 became hyperresponsive to insulin. To our knowledge this study is the first to investigate insulin signaling during overeating in humans, and it demonstrates that T2D effects on intracellular insulin signaling already occur after 4 wks of a high-calorie diet and that the effects in humans differ from those in laboratory animals.

  • 64.
    Danielsson, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Öst, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Lystedt, Erika
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Gustavsson, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Insulin resistance in human adipocytes occurs downstream of IRS1 after surgical cell isolation but at the level of phosphorylation of IRS1 in type 2 diabetes2005In: The FEBS Journal, ISSN 1742-464X, E-ISSN 1742-4658, Vol. 272, no 1, p. 141-151Article in journal (Refereed)
    Abstract [en]

    Insulin resistance is a cardinal feature of type 2 diabetes and also a consequence of trauma such as surgery. Directly after surgery and cell isolation, adipocytes were insulin resistant, but this was reversed after overnight incubation in 10% CO2 at 37 °C. Tyrosine phosphorylation of the insulin receptor and insulin receptor substrate (IRS)1 was insulin sensitive, but protein kinase B (PKB) and downstream metabolic effects exhibited insulin resistance that was reversed by overnight incubation. MAP-kinases ERK1/2 and p38 were strongly phosphorylated after surgery, but was dephosphorylated during reversal of insulin resistance. Phosphorylation of MAP-kinase was not caused by collagenase treatment during cell isolation and was present also in tissue pieces that were not subjected to cell isolation procedures. The insulin resistance directly after surgery and cell isolation was different from insulin resistance of type 2 diabetes; adipocytes from patients with type 2 diabetes remained insulin resistant after overnight incubation. IRS1, PKB, and downstream metabolic effects, but not insulin-stimulated tyrosine phosphorylation of insulin receptor, exhibited insulin resistance. These findings suggest a new approach in the study of surgery-induced insulin resistance and indicate that human adipocytes should recover after surgical procedures for analysis of insulin signalling. Moreover, we pinpoint the signalling dysregulation in type 2 diabetes to be the insulin-stimulated phosphorylation of IRS1 in human adipocytes.

  • 65.
    Danielsson, K.G.
    et al.
    Karolinska Institutet.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sverige utmärker sig negativt vad gäller reproduktiv hälsa: Brett åtgårdsprogram behövs för att minska aborterna2009In: Läkartidningen, ISSN 0023-7205, Vol. 106, no 3, p. 92-93Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 66.
    Dekeyser, Linda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Agnaförs, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Self-reported mental health in 12-year-old second-generation immigrant children in Sweden2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 6, p. 389-395Article in journal (Refereed)
    Abstract [en]

     Today 29.3% of all newborns in Sweden are second-generation immigrants. Studies on mental health among these children are few, inconclusive and vary widely with regard to the informant used and the age of the immigrant. The majority of previous studies focus on study groups that cover a wide age span but since mental health varies considerably during the pre-adolescent and adolescent years, more age-specific studies are needed. Additional focus on the health and well-being of these children is necessary if a well-functioning society is to develop. Aim: To investigate whether and how second-generation immigrant children in Sweden differ from non-immigrant children in their presentation of self-reported mental health at the age of 12. Methods: Second-generation immigrant children (n = 142) from a birth cohort in southern Sweden, subjects of the SESBiC-study (the South East Sweden Birth Cohort-study) were compared with non-immigrant children (n = 1036) from the same cohort in their presentation of self-reported mental health at the age of 12 using the Strengths and Difficulties Questionnaire. Gender, family structure and parents educational level were controlled for. Results: Second-generation immigrant children did not differ from the non-immigrant children in their own presentation of mental health at the age of 12 in any of the categories of immigrant groups. Conclusion: It is a promising sign for future integration that second-generation immigrant childrens self-reported mental health at the age of 12 was quite similar to that of non-immigrant children.

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  • 67.
    DeKeyser, Nicholas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Premature birth and low birthweight are associated with a lower rate of reproduction in adulthood: a Swedish population-based registry study2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 4, p. 1170-1178Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate if individuals born with sub-optimal birth characteristics have reduced probability of reproducing in adulthood. less thanbrgreater than less thanbrgreater thanUsing population-based registries, the authors included 522 216 males and 494 692 females born between 1973 and 1983 and examined their reproductive status as of 2006. Outcome measure was the hazard ratio (HR) of reproducing. Adjustments were made for socio-economic factors. less thanbrgreater than less thanbrgreater thanMales and females born very premature displayed a reduced probability of reproducing [HR 0.78, 95 confidence interval (CI): 0.700.86 for males; HR 0.81, CI: 0.750.88 for females]. Likewise for very low birthweight (HR 0.83, CI: 0.710.95 for males; HR 0.80, 95 CI: 0.720.89 for females). Individuals born large for gestational age (LGA) displayed no significant changes. Males born small for gestational age (SGA) had a 9 lower reproductive rate (CI: 0.890.94) and that reduction increased as the individuals aged. Women born SGA tended to start reproducing at an earlier age. less thanbrgreater than less thanbrgreater thanThe results suggest that being born with low birthweight, premature or SGA (for males) is associated with a reduced probability of reproducing as an adult. LGA shows no statistically significant relationship with future reproduction.

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  • 68.
    DeKeyser, Nicholas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Monfils-Gustavsson, Wiktor
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Claesson, Ing-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Total cost comparison of standard antenatal care with a weight gain restriction programme for obese pregnant women2011In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 125, no 5, p. 311-317Article in journal (Refereed)
    Abstract [en]

    Objective: To perform a cost comparison of a weight gain restriction programme for obese pregnant women with standard antenatal care, and to identify if there were differences in healthcare costs within the intervention group related to degree of gestational weight gain or degree of obesity at programme entry. Study design: A comparison of mean healthcare costs for participants of an intervention study at antenatal care clinics with controls in south-east Sweden. Methods: In total, 155 women in an intervention group attempted to restrict their gestational weight gain to less than7 kg. The control group comprised 193 women. Mean costs during pregnancy, delivery and the neonatal period were compared with the costs of standard care. Costs were converted from Swedish Kronor to Euros ((sic)). Results: Healthcare costs during pregnancy were lower in the intervention group. There was no significant difference in total healthcare costs (i.e. sum of costs during pregnancy, delivery and the neonatal period) between the intervention group and the control group. Within the intervention group, the subgroup that gained 4.5-9.5 kg had the lowest costs. The total cost, including intervention costs, was (sic)1283 more per woman/ infant in the intervention group compared with the control group (P = 0.025). The degree of obesity at programme entry had no bearing on the outcome. Conclusions: The weight gain restriction programme for obese pregnant women was effective in restricting gestational weight gain to less than7 kg, but had a higher total cost compared with standard antenatal care.

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  • 69.
    Ekerfelt, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Lidström, Charlotte
    Matthiesen, Leif
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Sharma, Surendra
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Spontaneous secretion of interleukin-4, interleukin-10 and interferon-gamma by first trimester decidual mononuclear cells2002In: American Journal of reproductive immunology, ISSN 8755-8920, Vol. 47, no 3, p. 159-166Article in journal (Refereed)
    Abstract [en]

    PROBLEM: A T-helper cell type 2 (Th2) cytokine dominated microenvironment has been predicted to be crucial for successful pregnancy. However, little information is available about local cytokine secretion in the human decidua. We determined the spontaneous secretion of interleukin-4 (IL-4), interferon-γ (IFN-γ) and IL-10 by decidual mononuclear cells at the single cell level and compared it with their secretion by peripheral blood mononuclear cells (PBMC) in the first trimester of pregnancy.

    METHODS OF STUDY: The cytokine secretion from decidual and blood cells was detected by a sensitive enzyme-linked immunosorbent spot-forming cell (ELISPOT)-assay.

    RESULTS: Cells secreting IL-4 (median 153, range 8–530), IL-10 (median 188, range 32–1600) and IFN-γ (median 123, range 15–1140) were detected in all decidual and blood samples. The cytokine secretion showed a co-linear pattern in both the blood and decidua, i.e. when one cytokine was secreted at high levels, the others followed the trend. No correlation was found between the number of cytokine secreting cells in blood and decidua for any of the cytokines.

    CONCLUSIONS: Interleukin-4 and IL-10 are locally secreted in the decidua early during normal pregnancy, probably counteracting the fetal rejecting effects of co-expressed IFN-γ. The cytokine secretion by blood cells does not generally reflect the local secretion pattern during first trimester pregnancy.

  • 70. Order onlineBuy this publication >>
    Ekholm Selling, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Birth-characteristics, hospitalisations, and childbearing: Epidemiological studies based on Swedish register data2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In the past decades there has been an improvement in the medical treatment of children born preterm or with reduced foetal growth. This has resulted in a much higher survival rate of these children, but also in a higher number of surviving children with chronic conditions. These changes have, in turn, increased interest in investigating the connection between birth-characteristics and outcomes in later life. The overall aim of the present thesis was to study the relations between birth-characteristics, subsequent hospitalisations, and childbearing by means of data available in Swedish population-based registries.

    The study population in this thesis consisted of women (and men in Paper III) born in 1973-75 according to the Medical Birth Register and the Total Population Register. Information available in other registries, such as the Hospital Discharge Register, was obtained by individual record linkage.

    In Paper I, 148,281 women, alive and living in Sweden at 13 years of age, were included. Of the women, 4.1% were born preterm and 5.4% were born small for gestational age, and approximately 30% of all women had given birth between 13 and 27 years of age. We found that reduced foetal growth and possibly preterm birth were related to the likelihood of giving birth during the study period. The intergenerational effects of preterm birth and reduced foetal growth were investigated in Paper II and the study population consisted of 38,720 mother-offspring pairs. An intergenerational effect of reduced foetal growth was found, and reduced foetal growth in the mother also increased the risk for preterm birth in the child.

    Paper III was concerned with 304,275 men and women living in Sweden at 13 years of age. Of these men and women, 30% were hospitalised during adolescence and early adulthood (i.e. between 12 and 23 years of age). We found that men and women born small for gestational age or preterm were more likely to be hospitalised, and that those born small for gestational age seemed to be more at risk compared to those born preterm. Finally, in Paper IV, the relation between hospitalisations during adolescence and the likelihood of giving birth was studied in 142,998 women living in Sweden at 20 years of age. We found that a majority of the causes of hospitalisation during adolescence were positively connected to the likelihood of giving birth between 20 and 27 years of age. The relations presented in Papers I-IV were evident although socio-economic characteristics were adjusted for.

    List of papers
    1. The probability of giving birth among women who were born preterm or with impaired fetal growth: A Swedish population-based registry study
    Open this publication in new window or tab >>The probability of giving birth among women who were born preterm or with impaired fetal growth: A Swedish population-based registry study
    2005 (English)In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 161, no 8, p. 725-733Article in journal (Refereed) Published
    Abstract [en]

    The primary aim of this study was to investigate whether women born prematurely or with impaired fetal growth have a reduced probability of giving birth. Using Swedish population-based registries, the authors identified 148,281 women born in 1973–1975 for follow-up until 2001. Of these women, 4.1% were born preterm and 0.32% very preterm, 0.29% were born with a very low birth weight, and 5.4% were small for gestational age. Outcome measures were the hazard ratios for giving birth during the study period. Adjustments were made for socioeconomic factors. Very-low-birth-weight women displayed a reduced probability of giving birth (hazard ratio = 0.74, 95% confidence interval: 0.60, 0.91), most apparent among women aged 25 or more years. There were also tendencies of reduced hazard ratios of giving birth among women born preterm or very preterm in this age interval. Women born small for gestational age (below –2 standard deviations) seemed to be more likely to have given birth (hazard ratio = 1.09, 95% confidence interval: 1.04, 1.14), but when a more extreme group of small-for-gestational-age women (below –3 standard deviations) was defined, the association was less evident (hazard ratio = 1.04, 95% confidence interval: 0.94, 1.16). The results suggest that very-low-birth-weight women and, possibly, women born preterm or very preterm have a reduced probability of giving birth, while the results regarding small for gestational age are less clear.

    Keywords
    infant, small for gestational age; infant, very low birth weight; premature birth; registries; reproduction; women
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14625 (URN)10.1093/aje/kwi096 (DOI)
    Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2017-12-13
    2. Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs
    Open this publication in new window or tab >>Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs
    2006 (English)In: British Journal of Obstetrics and Gynaecology, ISSN 0306-5456, E-ISSN 1365-215X, Vol. 113, no 4, p. 430-440Article in journal (Refereed) Published
    Abstract [en]

    Objective To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.

    Design Population-based cohort study.

    Settings Mother–first-born offspring pairs recorded in the Swedish Medical Birth Registry.

    Population Children born before 2001 to 38 720 women born in 1973–75.

    Methods The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother–offspring pairs and on the pairs for which information on neither of the included background variables was missing (n= 24 520).

    Main outcome measures Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<−2 SD of the Swedish standard).

    Results Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95–1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11–3.41 and OR 1.30, 95% CI 1.05–1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively.

    Conclusions The present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.

    Keywords
    preterm infant, registries, reproduction, small-for-gestational-age infant, women
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14626 (URN)10.1111/j.1471-0528.2006.00872.x (DOI)
    Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2017-12-13
    3. Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age
    Open this publication in new window or tab >>Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age
    Show others...
    2008 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 19, no 1, p. 63-70Article in journal (Refereed) Published
    Abstract [en]

    Background: Preterm birth and reduced intrauterine growth appear to be related to morbidity in childhood and later adulthood. We studied whether the risk of all-cause hospitalization in adolescence and early adulthood differed between individuals who were born preterm or small for gestational age (SGA) compared with those bom at term and appropriate for gestational age.

    Methods: Using Swedish registries, we followed 304,275 men and women born in 1973-1975 for any hospitalizations occurring in 1987-1996. Preterm birth was defined as <37 weeks of gestation and SGA as babies smaller than 2 standard deviations below the mean weight for gestational length, according to Swedish standards. We created 3 mutually exclusive categories: "preterm" (<37 weeks and not SGA), "SGA" (SGA and not preterm), and "both preterm and SGA." The comparison group was all term births not SGA. Childhood socioeconomic characteristics were accounted for in the analyses.

    Results: The overall risk of hospitalization was higher for men and women bom SGA (adjusted odds ratio = 1.16; 95% confidence interval = 1.12-1.21), for those born preterm (1.06; 1.02-1.10), and for those born both preterm and SGA (1.42; 1.26-1.59). In addition to higher risks for previously reported adverse health outcomes, such as neurodevelopment sequelae and congenital anomalies, men and women born SGA or preterm were more likely to be hospitalized due to unspecified symptoms. SGA also appeared to be associated with genitourinary diseases and drug use.

    Conclusions: Men and women born SGA or preterm were at higher risk for hospitalization during adolescence and early adulthood, with men and women born SGA more at risk than those bom preterm.

    Identifiers
    urn:nbn:se:liu:diva-14627 (URN)
    Available from: 2007-08-24 Created: 2007-08-24 Last updated: 2019-06-28
    4. Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.
    Open this publication in new window or tab >>Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.
    Show others...
    2009 (English)In: Acta paediatrica, ISSN 0803-5253, Vol. 98, no 3, p. 561-6Article in journal (Refereed) Published
    Abstract [en]

    Aim: To examine the effect of hospitalization during adolescence on the likelihood of giving birth.

    Methods: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth.

    Results: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter.

    Conclusion: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

    Keywords
    Adolescent, Birth Rate, Cohort Studies, Female, Morbidity
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16654 (URN)10.1111/j.1651-2227.2008.01120.x (DOI)19006525 (PubMedID)
    Note

    The definitive version is available at www.blackwell-synergy.com: Katarina Ekholm Selling, John Carstensen, Orvar Finnström, Ann Josefsson and Gunilla Sydsjö, Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study., 2009, Acta paediatrica , (98), 3, 561-6. http://dx.doi.org/10.1111/j.1651-2227.2008.01120.x Licencing: Stiftelsen för Acta Paediatrica and Blackwell Publishing

    Available from: 2009-02-18 Created: 2009-02-09 Last updated: 2019-06-28Bibliographically approved
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  • 71.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Hospitalization in adolescence affects the likelihood of giving birth: a Swedish population-based register study.2009In: Acta paediatrica, ISSN 0803-5253, Vol. 98, no 3, p. 561-6Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the effect of hospitalization during adolescence on the likelihood of giving birth.

    Methods: 142 998 women born in 1973-75 were followed with the help of the Swedish Medical Birth Register (MBR) and the Swedish Total Population Register (TPR) up until the end of 2000 with respect to their likelihood of giving birth. All analyses were adjusted for parental socio-economic characteristics and factors related to the studied women's own birth.

    Results: The likelihood of giving birth between 20 and 27 years of age was positively affected by hospitalization at least once during adolescence according to the Swedish Hospital Discharge Register (HDR); adjusted hazard ratio (HR) = 1.32, 95% confidence interval: 1.29-1.35. Women hospitalized due to genitourinary diseases, respiratory diseases, abdominal problems and abuse of alcohol and drugs were more likely to have given birth during the study period, while hospitalizations according to cerebral palsy and congenital malformations tended to decrease childbearing. Women hospitalized due to psychiatric diseases had an increase likelihood of given birth at 20-24 years but a reduced thereafter.

    Conclusion: A majority of the causes of hospitalization during adolescence increased the likelihood of giving birth between ages 20 to 27.

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  • 72.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hospitalizations in adolescence and early adulthood among Swedish men and women born preterm or small for gestational age2008In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 19, no 1, p. 63-70Article in journal (Refereed)
    Abstract [en]

    Background: Preterm birth and reduced intrauterine growth appear to be related to morbidity in childhood and later adulthood. We studied whether the risk of all-cause hospitalization in adolescence and early adulthood differed between individuals who were born preterm or small for gestational age (SGA) compared with those bom at term and appropriate for gestational age.

    Methods: Using Swedish registries, we followed 304,275 men and women born in 1973-1975 for any hospitalizations occurring in 1987-1996. Preterm birth was defined as <37 weeks of gestation and SGA as babies smaller than 2 standard deviations below the mean weight for gestational length, according to Swedish standards. We created 3 mutually exclusive categories: "preterm" (<37 weeks and not SGA), "SGA" (SGA and not preterm), and "both preterm and SGA." The comparison group was all term births not SGA. Childhood socioeconomic characteristics were accounted for in the analyses.

    Results: The overall risk of hospitalization was higher for men and women bom SGA (adjusted odds ratio = 1.16; 95% confidence interval = 1.12-1.21), for those born preterm (1.06; 1.02-1.10), and for those born both preterm and SGA (1.42; 1.26-1.59). In addition to higher risks for previously reported adverse health outcomes, such as neurodevelopment sequelae and congenital anomalies, men and women born SGA or preterm were more likely to be hospitalized due to unspecified symptoms. SGA also appeared to be associated with genitourinary diseases and drug use.

    Conclusions: Men and women born SGA or preterm were at higher risk for hospitalization during adolescence and early adulthood, with men and women born SGA more at risk than those bom preterm.

  • 73.
    Ekholm Selling, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Intergenerational effects of preterm birth and reduced intrauterine growth: A population-based study of Swedish mother-offspring pairs2006In: British Journal of Obstetrics and Gynaecology, ISSN 0306-5456, E-ISSN 1365-215X, Vol. 113, no 4, p. 430-440Article in journal (Refereed)
    Abstract [en]

    Objective To estimate the intergenerational effects of preterm birth and reduced intrauterine growth.

    Design Population-based cohort study.

    Settings Mother–first-born offspring pairs recorded in the Swedish Medical Birth Registry.

    Population Children born before 2001 to 38 720 women born in 1973–75.

    Methods The relationships between the mother's and the child's birth characteristics were estimated using logistic regression analysis. Adjustments were made for smoking habits, body mass index (BMI), and current and childhood socio-economic conditions. Analyses were performed on all mother–offspring pairs and on the pairs for which information on neither of the included background variables was missing (n= 24 520).

    Main outcome measures Preterm birth (<37 weeks of gestation) and small for gestational age (SGA) (<−2 SD of the Swedish standard).

    Results Mothers who themselves had been born preterm were not significantly more likely to deliver their own children preterm, compared with those who had been born at term (adjusted OR 1.24, 95% CI 0.95–1.62). Also, preterm birth in the mothers did not influence the occurrence of SGA in the children. However, the odds ratio for giving birth to SGA and preterm children, respectively, was higher among SGA mothers (OR 2.68, 95% CI 2.11–3.41 and OR 1.30, 95% CI 1.05–1.61). Mothers whose intrauterine growth was moderately reduced but who did not meet the criterion of being born SGA were also at higher risk of giving birth to both preterm and SGA children, respectively.

    Conclusions The present study showed evidence of intergenerational effects of reduced intrauterine growth even when socio-economic factors as well as BMI and smoking were adjusted for. There was, however, no consistent intergenerational effect of preterm birth.

  • 74.
    Ekholm (Selling), Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medicine and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    The probability of giving birth among women who were born preterm or with impaired fetal growth: A Swedish population-based registry study2005In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 161, no 8, p. 725-733Article in journal (Refereed)
    Abstract [en]

    The primary aim of this study was to investigate whether women born prematurely or with impaired fetal growth have a reduced probability of giving birth. Using Swedish population-based registries, the authors identified 148,281 women born in 1973–1975 for follow-up until 2001. Of these women, 4.1% were born preterm and 0.32% very preterm, 0.29% were born with a very low birth weight, and 5.4% were small for gestational age. Outcome measures were the hazard ratios for giving birth during the study period. Adjustments were made for socioeconomic factors. Very-low-birth-weight women displayed a reduced probability of giving birth (hazard ratio = 0.74, 95% confidence interval: 0.60, 0.91), most apparent among women aged 25 or more years. There were also tendencies of reduced hazard ratios of giving birth among women born preterm or very preterm in this age interval. Women born small for gestational age (below –2 standard deviations) seemed to be more likely to have given birth (hazard ratio = 1.09, 95% confidence interval: 1.04, 1.14), but when a more extreme group of small-for-gestational-age women (below –3 standard deviations) was defined, the association was less evident (hazard ratio = 1.04, 95% confidence interval: 0.94, 1.16). The results suggest that very-low-birth-weight women and, possibly, women born preterm or very preterm have a reduced probability of giving birth, while the results regarding small for gestational age are less clear.

  • 75.
    Enblom, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Vårdal Institute, Lund, Sweden; .
    Bergius Axelsson, Beata
    Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Steineck, Gunnar
    Department of Oncology, Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Gothenburg, Sweden; Department of Oncology and Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology.
    One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient2009In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 17, no 1, p. 23-32Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the prevalence of nausea and vomiting during radiotherapy and to compare quality of life, psychological and functional status in patients experiencing or not experiencing nausea.

    Materials and methods: A cross-sectional selection of 368 cancer patients treated with radiotherapy answered a questionnaire (=93% answering rate) regarding nausea, vomiting, actual use of and interest in antiemetic treatment, quality of life and psychological and functional status during the preceding week of radiotherapy. Mean age was 60 years and 66% were women.

    Main results: Nausea was experienced by 39% ( 145) and vomiting by 7% ( 28) of patients in general, by 63% in abdominal or pelvic fields and by 48% in head/neck/brain fields. Abdominal/pelvic field (Relative risk (RR) 2.0), age <= 40 years (RR 1.9) and previous nausea in other situations (RR 1.8) implied an increased risk for nausea. Antiemetics were used by 17% and 78% were interested in or wanted more information about acupuncture treatment against nausea. Of the 145 nauseous patients only 25% felt that antiemetics had helped them and 34% would have liked additional treatment, although the nausea intensity was mild in 72%. The nauseous patients reported lower well-being and quality of life, lower satisfaction with aspects of daily living and more frequent anxiety and depressed mood than the patients without nausea.

    Conclusions: Of all patients undergoing radiotherapy, 39% experienced nausea and one third of them would have liked more treatment against the nausea. This study stresses the importance to identify and adequately treat patients with increased risk for nausea related to radiotherapy.

  • 76.
    Enblom, Anna
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Steineck, Gunnar
    Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Can individuals identify if needling was performed with an acupuncture needle or a non-penetrating sham needle?2008In: Complementary Therapies in Medicine, ISSN 0965-2299, E-ISSN 1873-6963, Vol. 16, no 5, p. 288-94Article in journal (Refereed)
    Abstract [en]

    A control treatment in acupuncture research must be credible, regardless if the needling is performed by one or by several therapists.

    Objective: To investigate if individuals could identify whether needling had been given with an acupuncture needle or a sham needle and if the therapist influenced this ability.

    Design: Eighty individuals were randomized to one single needling given by one of four physiotherapists using either an invasive needle or a non-penetrating telescopic sham needle.

    Results: An equal proportion of individuals, 27 (68%), in the acupuncture group and the sham group answered incorrectly or was not sure at all regarding needling type but the proportion varied between the therapists from 55 to 80% (ns). Bang's blinding index was 0.20 (95% CI 0.03-0.36) in the acupuncture group and 0.10 (95% CI 0.09-0.29) in the sham group (interpretation: 20 and 10% identified needling type beyond statistical chance). Acupuncture was on a four-grade scale rated as median "mildly painful" and sham as "not painful" (ns). Pain ratings varied from median "not" to "mildly painful" in the therapists (p = 0.01).

    Conclusions: Two thirds of individuals needled by acupuncture as well as sham could not identify needling type and only 10-20% of the individuals were unblinded beyond chance. The therapists, not the needling type, influenced how painful the needling was perceived. IMPLICATIONS: To achieve blinding success in acupuncture efficacy studies using the sham needle, the needling procedure must be strictly standardized in order to minimize differences between the therapists.

  • 77.
    Enblom, Anna
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Johnsson, Anna
    Department of Oncology, University Hospital, Lund, Sweden.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Onelöv, Erik
    Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden.
    Steineck, Gunnar
    Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Acupuncture Compared To Placebo Acupuncture in Radiotherapy-induced Nausea: a Randomized Controlled Study2012In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 23, no 5, p. 1353-1361Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate if verum (real) acupuncture is effective against nausea and vomiting during radiotherapy.

    PATIENTS AND METHODS: We randomised blinded cancer patients to verum; penetrating “deqi” creating acupuncture (n=109) in the antiemetic acupuncture point PC6 (three cm above the wrist), or sham (n=106) with a non-penetrating sham needle at a non-acupuncture point six cm above the wrist 2-3 times/week. The patients daily during the radiotherapy period documented nausea and vomiting. Primary endpoint was number of patients with at least one episode of nausea during the whole radiotherapy period. RESULTS: Data was provided by 205 patients (95 %). In the verum acupuncture group, 70 % experienced nausea at least once during the radiotherapy period (p=0.12 compared to the sham group) (mean number of days of 10.1), 25 % vomited and 42 % used antiemetic drugs at least once. In the sham group 62 % experienced nausea (mean number of days 8.7), 28 % vomited and 37 % consumed antiemetic drugs. Ninety five percent in the verum and 96 % in the sham acupuncture group believed that the treatment had been effective against nausea. In both groups 67 % experienced positive effects on relaxation, mood, sleep or pain-reduction, and 89 % wished to receive the treatment again.

    CONCLUSION: Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea, but in this study nearly all patients in both groups experienced that the treatment was effective for nausea.

  • 78.
    Enblom, Anna
    et al.
    Vårdalinstitutet Lund, Klinisk neurovetenskap Karolinska Institutet, Omvårdnad Hälsouniversitetet Linköping.
    Johnsson, Anna
    Onkologiska kliniken, Lunds Universitetssjukhus.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Steineck, Gunnar
    Klinisk cancerepidemiologi Karolinska Institutet, Klinisk cancerepidemiologi Sahlgrenska akademin.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology UHL.
    The Nonpenetrating Telescopic Sham Needle may Blind Patients with Different Characteristics and Experiences when Treated by several Therapists.2011In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, E-ISSN 1741-4288, p. 1-12Article in journal (Refereed)
    Abstract [en]

    Background. Little is known which factors influence the blinding in acupuncture studies. Aim. To investigate if blinding variedbetween patients with different characteristics receiving verum or sham acupuncture.

    Methods. We randomised cancer patientsto verum (n = 109) or sham acupuncture (n = 106) with a nonpenetrating telescopic sham needle for nausea. Level of blindingwas compared between different sub-groups of patients using Bang’s blinding index (BI) ranged −1 to 1 (−1 = all state theopposite treatment, 1 = all identify treatment).

    Results. Most patients in the verum (74 of 95; 78%, BI 0.72) and the sham (68 of95; 72%, BI −0.60). acupuncture group believed they had received verum acupuncture. The probability for a patient to believehe/she received verum acupuncture was related to the received needling type (P = .003) and to the patient’s belief in receivedtreatment effects (P = .008). Hospital (P = .425), therapist (P = .434), previous acupuncture experience (P = .578), occurrenceof nausea (P = .157), gender (P = .760), and age (P = .357) did not affect blinding.

    Conclusions. Blinding was successfullyachieved irrespective of age, gender, acupuncture experience, treatment effect, or in which hospital or by which therapist thepatient received treatment. Patients with higher belief in the effect of the treatment were more likely to believe they had receivedverum acupuncture.

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  • 79.
    Enblom, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lekander, Mats
    Karolinska Institute.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Johnsson, Anna
    Lund University Hospital.
    Onelov, Erik
    Karolinska Institute.
    Ingvar, Martin
    Karolinska Institute.
    Steineck, Gunnar
    Karolinska Institute.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Getting the Grip on Nonspecific Treatment Effects: Emesis in Patients Randomized to Acupuncture or Sham Compared to Patients Receiving Standard Care2011In: PLOS ONE, ISSN 1932-6203, Vol. 6, no 3Article in journal (Refereed)
    Abstract [en]

    Background: It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than standard care. Methodology/Principal Findings: Cancer patients receiving radiotherapy over abdominal/pelvic regions were randomized to verum (penetrating) acupuncture (n = 109; 99 provided data) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106; 101 provided data) performed with a telescopic non-penetrating needle at a sham point 2-3 times/week during the whole radiotherapy period. The acupuncture cohort was compared to a reference cohort receiving standard care (n = 62; 62 provided data). The occurrence of emesis in each group was compared after a mean dose of 27 Gray. Nausea and vomiting were experienced during the preceding week by 37 and 8% in the verum acupuncture group, 38 and 7% in the sham acupuncture group and 63 and 15% in the standard care group, respectively. The lower occurrence of nausea in the acupuncture cohort (verum and sham) compared to patients receiving standard care (37% versus 63%, relative risk (RR) 0.6, 95 % confidence interval (CI) 0.5-0.8) was also true after adjustment for potential confounding factors for nausea (RR 0.8, CI 0.6 to 0.9). Nausea intensity was lower in the acupuncture cohort (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p = 0.002). The acupuncture cohort expected antiemetic effects from their treatment (95%). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (RR 1.6; Cl 1.2-2.4). Conclusions/Significance: Patients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving standard care, possibly through a general care effect or due to the high level of patient expectancy.

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  • 80.
    Enblom, Anna
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Lekander, Mats
    Department of Clinical Neuroscience, Osher Centre for Integrative Medicine.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Johnsson, Anna
    Department of Oncology, Division of Physiotherapy, University Hospital, Lund, Sweden.
    Onelöv, Erik
    Department of Oncology, Division of Clinical Cancer Epidemiology, Karoliniska Institute, Stockholm, Sweden.
    Ingvar, Martin
    Department of Clinical Neuroscience, Osher Centre for Integrative Medicine.
    Steineck, Gunnar
    Department of Oncology, Division of Clinical Cancer Epidemiology, Karoliniska Institute, Stockholm, Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Radiotherapy-induced Emesis in Patients Treated with Acupuncture, Sham Acupuncture or Standard Care: Effects of Unspecific Acupuncture Mechanisms2010Article in journal (Other academic)
    Abstract [en]

    Background: It is not known if acupuncture or sham reduces radiotherapy-induced emesis more than standard care.

    Methods: Cancer patients were randomized to verum (skin penetrating) acupuncture (n = 109) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106) performed with a telescopic nonpenetrating needle at a sham point during the whole radiotherapy period. The verum and sham treated patients were compared to a reference cohort receiving standard care only (n = 62). All patients received radiotherapy over abdominal or pelvic regions. The occurrence of emesis in each group was compared using replies documented in questionnaires after a mean dose of 27 Gray.

    Findings: Nausea (p=0.001) and vomiting were experienced during the preceding week by 37 and 7%, respectively, in the verum group, 38 and 7% in the sham group and 63 and 15% in the standard care group. The nausea intensity in the acupuncture cohort was lower (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p=0.002). Almost all the verum and sham treated patients (95%) expected antiemetic effects from their treatment. Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (relative risk 1.6; 95 % confidence interval 1.2-2.4).

    Interpretations: Both verum acupuncture and nonpenetrating sham acupuncture seem to reduce nausea and vomiting during radiotherapy, possibly by psychobiological mechanisms related to the extra care and expectancy.

  • 81.
    Enblom, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Tomasson, Annica
    Östergötlands Läns Landsting.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Steineck, Gunnar
    Karolinska Institute, Stockholm.
    Börjeson, Sussanne
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology UHL.
    Pilot testing of methods for evaluation of acupuncture for emesis during radiotherapy: a randomised single subject experimental design2011In: ACUPUNCTURE IN MEDICINE, ISSN 0964-5284, Vol. 29, no 2, p. 94-102Article in journal (Refereed)
    Abstract [en]

    Background Many acupuncture studies are of weak methodological quality, possibly due to lack of pilot testing. This pilot study tested design features, including test of feasibility, compliance to treatment and data collection, level of blinding success and the patients potential perceived effects of the treatment, in preparation for an efficacy study. Method A modified single subject experimental design was conducted. 10 cancer patients were randomised to verum penetrating acupuncture or non-penetrating sham needles for 30 min 2-3 times/week during radiotherapy over abdomen/pelvis. They answered test-retested emesis questions (r=0.527-1.0) covering nausea, vomiting, use of antiemetics, wellbeing and activities of daily living. Results Overall, the patients completed 98% of the 345 emesis-questionnaire days and 101 of the 115 offered treatments. All patients believed they received verum acupuncture. 10 patients experienced antiemetic effects, seven relaxation, five pain-reduction and five experienced sleep improvement. Two types of nausea questions showed absolute concordance (r=1.0) (n of observations=456). Nausea was experienced by one of five verum acupuncture treated patients (duration median 0% of the radiotherapy-days) and four of five sham acupuncture treated patients (duration median 24% of the radiotherapy-days). Patients experiencing nausea rated decreased wellbeing and performance of daily activities compared to patients free from nausea. Conclusions All patients were blinded, complied with verum/sham treatments and data-collection, and believed they had effects of the received treatment. The methods for verum/sham treatment and data collection may thus be used in an adequately powered randomised controlled study of the effect of acupuncture for radiotherapy-induced emesis.

  • 82. Order onlineBuy this publication >>
    Eriksson, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Bacterial Vaginosis: Diagnosis, Prevalence, and Treatment2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Bacterial Vaginosis (BV) is a disorder of unknown etiology, characterized by a foul smelling vaginal discharge, loss or reduction of the normal vaginal Lactobacilli, and overgrowth of other anaerobic bacteria. Thus, it presents a formidable problem for clinicians as well as microbiologists researching its etiology, clinical course, treatment, and epidemiology. The present work focuses on the unresolved issues of the epidemiology and treatment of BV in order to provide valid methods for treatment studies of this condition and to describe the prevalence of BV in defined populations.

    The first study validates the use of PAP-stained smears in the diagnosis of BV. The study assesses the methods of Amsel’s clinical criteria and Nugent criteria on Gram-stain smears, against Pap-stained smears and also validates different observers. The result shows that the PAP-staining of vaginal smears is a good method in BV diagnosis; the kappa value is 0.86 (interobserver weighted kappa index) compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. This enables population based studies on archived PAP-stained smears from the screening of cervical cancer.

    In the second study, we use the knowledge gained from study one to investigate the prevalence of BV in a cohort from the population of Åland. The prevalences of BV on the Åland Islands were: 15.6 %, 11.9 %, 8.7 %, and 8.6% in 1993, 1998, 2003, and 2008, respectively. This means that the prevalence of BV decreased between1993-2008 from 15.6% to 8.6%. The confidence intervals are not overlapping, thus indicating a significant decrease in prevalence from 1993 to 2008.

    The third study is a prospective, double-blind placebo controlled treatment study of BV. After conventional treatment with clindamycin, the patients were treated with adjuvant treatment of Lactobacilli-loaded tampons or placebo. The study showed no differences between the treatment and the placebo group, indicating that the tampon does not work at all. There are a variety of possible explanations for the result, which are analyzed in this thesis.

    The fourth study aimed to evaluate whether clindamycin is retained for a long time in the vaginal mucosa, thus disturbing the Lactobacilli in an attempt to reimplant Lactobacilli in the probiotic treatment studies. In conventional treatment, it is also useful to know whether clindamycin is retained, especially when considering the pressure from antibiotics on the antimicrobial sensitivity pattern. In the study, we found that the clindamycin disappears rapidly.

    Conclusion: BV research requires effort from many different scientific disciplines and the riddle of this condition and its treatment can only be resolved by concerted actions in research and treatment. The vision for the future includes, among other factors, better molecular biology based diagnostic tools, and knowledge of population based bacterial floras.

    List of papers
    1. Validation of the use of Pap-stained vaginal smears for diagnosis of bacterial vaginosis
    Open this publication in new window or tab >>Validation of the use of Pap-stained vaginal smears for diagnosis of bacterial vaginosis
    Show others...
    2007 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 115, no 7, p. 809-813Article in journal (Refereed) Published
    Abstract [en]

    Papanicolaou-stained cervicovaginal smears (Pap smears) are used to screen for cervical cancer. Since there is a lack of consensus in published reports respecting the efficacy of Pap-stained smears in BV diagnostics, there is a need to validate their use for diagnosis of BV. Slides from the international BV00 workshop were Pap stained and independently analyzed by four investigators under a phase-contrast microscope. All workshop slides - whether Pap-stained, Gram-stained or rehydrated air-dried smears - were scored according to the same Nugent classification. The diagnostic accuracy of Pap smears for diagnosis of BV had a sensitivity of 0.85 and a specificity of 0.92, with a positive and negative predictive value of 0.84 and 0.93, respectively. The interobserver weighted kappa index was 0.86 for Pap-stained smears compared to 0.81 for Gram-stained smears, and 0.70 for rehydrated air-dried smears using the mean Nugent score as the criterion standard. Provided that the samples are taken from equivalent locations (the vaginal fornix) and analyzed according to the same scoring criteria, there is no discernable difference in the diagnostic accuracy of the three smear-staining methods. The Pap-stained vaginal smears can be used as a wholly adequate alternative to Gram-stained smears for BV diagnosis. © Apmis 2007.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-38583 (URN)10.1111/j.1600-0463.2007.apm_607.x (DOI)44808 (Local ID)44808 (Archive number)44808 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2018-03-19Bibliographically approved
    2. The prevalence of BV in the population on the Åland Islands during a 15-year period
    Open this publication in new window or tab >>The prevalence of BV in the population on the Åland Islands during a 15-year period
    2010 (English)In: APMIS, ISSN 0903-4641, Vol. 118, no 11, p. 903-908Article in journal (Refereed) Published
    Abstract [en]

    The aim of the study was to describe the prevalence and age distribution of bacterial vaginosis (BV) during an observation period of 15 years in a population study with cross-sectional samples of adult women living on the Aland Islands. The Aland Islands form an archipelago in the Baltic Sea and are a province of Finland. Every fifth year, specific age groups in the adult female population are invited to participate in a screening program for early diagnosis of cervical cancer using a papanicolaou (PAP)-stained vaginal smear. Women in the age groups of 20, 25, 30, 35, 40, 45, 50, 55, and 60 years are called each year. BV diagnosis of the PAP-stained smears uses the classification according to Nugent. The PAP-stained smears from the screening program of cervical cancer 1993, 1998, 2003, and 2008 were used in this study. A total of 3456 slides were investigated and 271 women could be followed for the 15-year observation period. The prevalence of BV declined from 15.6% in 1993 to 8.6% in 2008. The highest prevalence occurred among the age groups of 35 and 50 years. Among the 271 women who could be followed for the 15-year observation period, two-third showed normal/intermediate flora and one-third were infected with BV at least once. As this is a cross-sectional population study spanning 15 years, the prevalence of BV in the female adult population of the Aland Islands can be estimated. The prevalence has declined between 1993 and 2008 from 15.6% to 8.6%.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2010
    Keywords
    BV, prevalence, population study, diagnostics, PAP smear
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-61210 (URN)10.1111/j.1600-0463.2010.02678.x (DOI)000283161100012 ()
    Available from: 2010-11-05 Created: 2010-11-05 Last updated: 2011-06-08Bibliographically approved
    3. A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules
    Open this publication in new window or tab >>A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules
    2005 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 85, no 1, p. 42-46Article in journal (Refereed) Published
    Abstract [en]

    The expected 4-week cure rate after conventional treatment of bacterial vaginosis are only 65-70%. In an attempt to improve the cure rate by adding probiotic lactobacilli we performed a double-blind placebo-controlled study of adjuvant lactobacilli treatment after an open treatment with vaginal clindamycin ovules. Women with bacterial vaginosis as defined by Amsel's criteria were treated with clindamycin ovules. Vaginal smears were collected and analysed according to Nugent's criteria. During the following menstruation period the women used, as an adjuvant treatment, either lactobacilli-prepared tampons or placebo tampons. The lactobacilli tampons were loaded with a mixture of freeze-dried L. fermentum, L. casei var. rhamnosus and L. gasseri. The cure rate was recorded after the second menstruation period. There was no improvement in the cure rate after treatment with lactobacilli-containing tampons compared to placebo tampons, the cure rates as defined by Amsel's criteria were 56% and 62%, respectively, and 55% and 63%, as defined by Nugent's criteria. This is the first study to report cure rates for women with 'intermediate' wet smear ratings according to Nugent's classification and this group had an overall cure rate of 44%. The cure rate of treatment of bacterial vaginosis was not improved by using lactobacilli-prepared tampons for one menstruation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-24622 (URN)10.1080/00015550410022249 (DOI)6803 (Local ID)6803 (Archive number)6803 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    4. Vaginal retention of locally administered clindamycin
    Open this publication in new window or tab >>Vaginal retention of locally administered clindamycin
    2011 (English)In: APMIS, ISSN 0903-4641, Vol. 119, no 6, p. 373-376Article in journal (Refereed) Published
    Abstract [en]

    Since bacterial vaginosis (BV) is characterized by a lack of, or very few, lactobacilli and high numbers of small, mostly anaerobic bacteria, an obvious treatment modality would be eradication of the BV-associated bacterial flora followed by reintroduction of lactobacilli vaginally. As probiotic treatment with lactobacilli is one tool for improving the cure rate when treating BV, it is necessary to know the length of time after treatment that clindamycin can be found in the vagina and if this could interfere with the growth of the probiotic lactobacilli. We evaluated the vaginal concentration of clindamycin in 12 women for 8 days to obtain data on the concentration of clindamycin in the vagina after intravaginal treatment with the drug. The participants were examined five times between two menstrual periods: before treatment, the day after treatment was finished, and 3, 5 and 8 days post-treatment. The first day post-treatment clindamycin 0.46 x 10-3 to 8.4 x 10-3 g/g vaginal fluid (median 2.87 x 10-3) was found. Thereafter, the concentration of clindamycin decreased rapidly. In 10 patients clindamycin was found after 3 days. A very low concentration was still present 5 days after treatment in four patients. After 8 days no clindamycin was found. Clindamycin is rapidly eliminated from the vagina, within 3-8 days, after local administration. Our results indicate that treatment with probiotic lactobacilli could be problematic if carried out within 5 days after cessation of clindamycin treatment.

    Place, publisher, year, edition, pages
    Blackwell Publishing Ltd, 2011
    Keywords
    Treatment, clindamycin, bacterial vaginosis, concentration
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-68694 (URN)10.1111/j.1600-0463.2011.02742.x (DOI)000290626500007 ()
    Available from: 2011-05-27 Created: 2011-05-27 Last updated: 2012-03-25Bibliographically approved
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    Bacterial Vaginosis: Diagnosis, Prevalence, and Treatment
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  • 83.
    Eriksson, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Carlsson, Bodil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Forsum, Urban
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Larsson, P-G
    Department of Obstetrics and Gynecology, Central Hospital of Sko¨vde, Sweden.
    A double-blind treatment study of bacterial vaginosis with normal vaginal lactobacilli after an open treatment with vaginal clindamycin ovules2005In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 85, no 1, p. 42-46Article in journal (Refereed)
    Abstract [en]

    The expected 4-week cure rate after conventional treatment of bacterial vaginosis are only 65-70%. In an attempt to improve the cure rate by adding probiotic lactobacilli we performed a double-blind placebo-controlled study of adjuvant lactobacilli treatment after an open treatment with vaginal clindamycin ovules. Women with bacterial vaginosis as defined by Amsel's criteria were treated with clindamycin ovules. Vaginal smears were collected and analysed according to Nugent's criteria. During the following menstruation period the women used, as an adjuvant treatment, either lactobacilli-prepared tampons or placebo tampons. The lactobacilli tampons were loaded with a mixture of freeze-dried L. fermentum, L. casei var. rhamnosus and L. gasseri. The cure rate was recorded after the second menstruation period. There was no improvement in the cure rate after treatment with lactobacilli-containing tampons compared to placebo tampons, the cure rates as defined by Amsel's criteria were 56% and 62%, respectively, and 55% and 63%, as defined by Nugent's criteria. This is the first study to report cure rates for women with 'intermediate' wet smear ratings according to Nugent's classification and this group had an overall cure rate of 44%. The cure rate of treatment of bacterial vaginosis was not improved by using lactobacilli-prepared tampons for one menstruation.

  • 84.
    Eriksson, Katarina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Larsson, Per-Göran
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Maud
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine.
    Forsum, Urban
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Microbiology.
    Vaginal retention of locally administered clindamycin2011In: APMIS, ISSN 0903-4641, Vol. 119, no 6, p. 373-376Article in journal (Refereed)
    Abstract [en]

    Since bacterial vaginosis (BV) is characterized by a lack of, or very few, lactobacilli and high numbers of small, mostly anaerobic bacteria, an obvious treatment modality would be eradication of the BV-associated bacterial flora followed by reintroduction of lactobacilli vaginally. As probiotic treatment with lactobacilli is one tool for improving the cure rate when treating BV, it is necessary to know the length of time after treatment that clindamycin can be found in the vagina and if this could interfere with the growth of the probiotic lactobacilli. We evaluated the vaginal concentration of clindamycin in 12 women for 8 days to obtain data on the concentration of clindamycin in the vagina after intravaginal treatment with the drug. The participants were examined five times between two menstrual periods: before treatment, the day after treatment was finished, and 3, 5 and 8 days post-treatment. The first day post-treatment clindamycin 0.46 x 10-3 to 8.4 x 10-3 g/g vaginal fluid (median 2.87 x 10-3) was found. Thereafter, the concentration of clindamycin decreased rapidly. In 10 patients clindamycin was found after 3 days. A very low concentration was still present 5 days after treatment in four patients. After 8 days no clindamycin was found. Clindamycin is rapidly eliminated from the vagina, within 3-8 days, after local administration. Our results indicate that treatment with probiotic lactobacilli could be problematic if carried out within 5 days after cessation of clindamycin treatment.

  • 85.
    Ernerudh, Jan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Mjösberg, Jenny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology.
    Regulatory T Helper Cells in Pregnancy and their Roles in Systemic versus Local Immune Tolerance2011In: AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, ISSN 1046-7408, Vol. 66, p. 31-43Article, review/survey (Refereed)
    Abstract [en]

    Problem During pregnancy, the maternal immune system needs to adapt in order not to reject the semi-allogenic fetus. Method In this review, we describe and discuss the role of regulatory T (Treg) cells in fetal tolerance. Results Treg cells constitute a T helper lineage that is derived from thymus (natural Treg cells) or is induced in the periphery (induced Treg cells). Treg cells are enriched at the fetal-maternal interface, showing a suppressive phenotype. In contrast, Treg cells are not increased in the circulation of pregnant women, and the suppressive capacity is similar to that in nonpregnant women. However, aberrations in Treg frequencies and functions, both systemically and in the uterus, may be involved in the complications of pregnancy. Conclusion Treg cells seem to have distinguished roles locally versus systemically, based on their distribution and phenotype.

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    fulltext
  • 86.
    Ernerudh, Jan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Forsberg, Anna
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Straka, E
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Johansson, Ewa
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Bhai Mehta, Ratnesh
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Svensson, J
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Matthiesen, Leif
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Boij, R
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Mjösberg, Jenny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    T helper cells and T helper cell plasticity in pregnancy in JOURNAL OF REPRODUCTIVE IMMUNOLOGY, vol 90, issue 2, pp 131-1312011In: JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Elsevier , 2011, Vol. 90, no 2, p. 131-131Conference paper (Refereed)
    Abstract [en]

    n/a

  • 87.
    Falk, Gabriella
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ivarsson, Ann Britt
    School of Health and Medical Sciences, rebro University, rebro, Sweden.
    Contraceptive counselling to teenagers at abortion visits: A qualitative content analysis2009In: The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, ISSN 1473-0782, Vol. 14, no 5, p. 357-364Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Contraceptive counselling at the time of an abortion is crucial for preventing new unintended pregnancies especially in teenagers. What is discussed on this occasion should be recorded in the patient's file. In this study we examined what was documented in medical records (MRs) about previous contraceptive use and further plans as a reflection of what was discussed between the gynaecologist and the teenager. METHODS: Thirty-six MRs were consecutively selected in 2006. The study design was descriptive, retrospective and qualitative. Data were analysed using qualitative content analysis. The text areas were transcribed and analysed in several steps. RESULTS: Two themes were generated from the analysis: 'Contraceptive methods previously used' and 'Plan for future contraceptive use'. Information on previous contraceptive use was absent in ten MRs. In five MRs data about future contraceptive use were missing and eight teenagers had not started a contraceptive method at follow-up. CONCLUSION: The MR often lacked information about contraception; this could be a reflection of insufficient contraceptive counselling at the abortion-visit. Both contraceptive counselling and documentation thereof must be improved to enhance contraceptive use in teenagers.

  • 88.
    Falk, Gabriella
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Ivarsson, Ann-Britt
    University of Örebro.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Teenagers´ Struggles with Contraceptive Use: What improvements can adults make?2010In: EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE, ISSN 1362-5187, Vol. 15, no 4, p. 271-279Article in journal (Refereed)
    Abstract [en]

    Objective: To study experiences with contraceptives of teenagers at an out-patient abortion clinic and to explore the reasons behind their choices.

    Methods: Twelve teenagers who had applied for induced abortion were interviewed three to four weeks after abortion. The interviews comprised open questions about contraceptive experiences focusing on hindrance for contraceptive use. Qualitative content analysis was used.

    Results: One theme was identified: Struggling with feelings of uncertainty and patterns of behaviour. Three categories emerged from the analysis. Uncertainty dealt with decisions and behaviours that varied with time and between the different individuals. Influences on contraceptive use dealt with the persons that the participants had discussed contraceptives with, how they acquired knowledge about contraceptive use and the nature of their behaviour. Anxiety dealt with the side effects of contraception and feelings of fear related to contraceptive use.

    Conclusion: The participants had feelings of uncertainty, anxiety and fear towards contraceptive use which led to non use and inconsistent use. Guidance from health care providers and access to youth clinics varied and was not satisfactory. Parents were supportive of contraceptive use but not active in the process of getting their child to start using it. Friends and the Internet were the main sources for acquiring information.

  • 89.
    Faresjö, Tomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine.
    Wilhelmsson, Margaretha
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Pelling, Staffan
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlgren, Lars-Ove
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Does interprofessional education jeopardize medical skills?2007In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 21, no 5, p. 573-576Article in journal (Refereed)
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    FULLTEXT01
  • 90.
    Forsberg, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Straka, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Johansson, E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Mehta, Ratnesh
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jenmalm, Maria C
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Mjösberg, Jenny
    Tytgat Institute for Intestinal and Liver Research, Academic, Medical Center, Amsterdam, Netherlands.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Plasticity and flexibility of T cells in human pregnancy in JOURNAL OF REPRODUCTIVE IMMUNOLOGY, vol 90, issue 2, pp 149-1492011In: JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Elsevier , 2011, Vol. 90, no 2, p. 149-149Conference paper (Refereed)
    Abstract [en]

    Introduction:Pregnancy challenges the immune system. Thus, tolerance to the semi-allogenic fetus must be supported while the mother and fetus still must be protected against infectious agents. Pregnancy is associated with a Th2 deviated immune system, away from a harmful Th1 associated immunity, although this may be a simplified view. Regulatory T cells (Tregs) are enriched in the uterus, but occur at normal frequency in the circulation. It has become increasingly evident that Tregs and T helper cells are not stably committed lineages but are plastic, showing close relationships between subsets. We hypothesize that an increased T cell flexibility in pregnancy can help to explain the paradox of simultaneous tolerance and strong antimicrobial responses. Our aim was to investigate whether the plasticity concept is applicable for the Treg subset, and if it involves the entire T helper population.

    Material and methods: Isolated Tregs (CD4dimCD25high) and control cells (CD4+CD25−) from second trimester pregnant (n = 14) and non-pregnant women (n = 14) were stimulated for 24 h with plate-bound anti-CD3/anti-CD28. Signature gene and protein expression of each T cell subset was measured using transcription factor expression by real time-PCR and multiplex bead array of cell culture supernatants, respectively. The whole PBMC fraction is also used in ongoing experiments and either stimulated with plate-bound anti-CD3/anti-CD28 or with the Th1, Th2 and Th17 deviating microbial agents PPD (Th1), TT (Th2) and C. albicans hyphae (Th17). After culturing, the cells are stained for intracellular transcription factors associated with Th1, Th2, Th17 and Treg immunity.

    Results: Stimulated Tregs from pregnant compared to non-pregnant women showed significantly higher levels of markers for Treg cells (Foxp3 mRNA), Th2 cells (GATA-3 mRNA and IL4 protein) and a tendency to increase in markers of Th17 (RORC mRNA and IL-17 protein), whereas Th1 markers (Tbet mRNA and IFN-γ) showed no difference between pregnant and non-pregnant women. Further, ongoing studies may reveal if the entire T helper population shows a higher degree of responsiveness during pregnancy.

    Conclusions: Our results imply an increased plasticity of the Treg population during pregnancy, suggesting that Treg cells are able to switch to a Th2/Th17-like phenotype, depending on current demands of tolerance or infectious threats.

  • 91.
    Forsum, Urban
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Jakobsson, Tell
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Ison, C.
    Dept. of Medical Microbiology, Imperial College School of Medicine at St. Mary's, London, UK.
    Keane, F.
    Dept. of GU Medicine & Sexual Health, Royal Cornwall Hospital, Treliske, Truro, Great Britain.
    McDonald, H.
    Microbiology & Infectious Diseases Dept, Women's & Children's Hospital, North Adelaide, Australia.
    Moi, H.
    Olafia-kliniken, Oslo, Norway.
    Platz-Christensen, J-J.
    Dept. of Obstetrics and Gynaecology, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
    Schwebke, J.
    Dept. of Obstetrics and Gynaecology, University of Alabama at Birmingham, USA.
    Larsson, P. G.
    Dept. of Obstetrics and Gynaecology, Kärnsjukhuset, Skövde, Sweden.
    Schmidt, H.
    General Practice, Aalborg, Denmark.
    Beverly, A.
    Dept. of Obstetrics and Gynaecology, University of Alabama at Birmingham, USA.
    Bjørnerem, A.
    Dept. of Obstetrics and Gynaecology, Regionssjukhuset, Tromsö, Norway.
    Carlsson, Bodil
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Csango, P.
    Dept. of Microbiology, Vest-Agder Sykehus, Kristiansand, Norway.
    Donders, G.
    Dept. of Gynaecology, Gasthuisberg University Hospital, Leuven, Belgium.
    Hay, P.
    Dept. of Genito-Urinary Medicine, St. George's Hospital, London, UK.
    An international study of the inter-observer variation between the interpretations of vaginal smear criteria of Bacterial Vaginosis2002In: APMIS, ISSN 1600-0463, Vol. 110, no 11, p. 811-818Article in journal (Refereed)
    Abstract [en]

    An international workshop on vaginal smear-based diagnosis of bacterial vaginosis was organized where 13 investigators scoring 258 slides with smears from vaginal fluid. Interobserver reproducibility of interpretations of Nugent scores, Hay/Ison scores and wet smear scores for the diagnosis of bacterial vaginosis was shown to be high. Detailed analysis of individual scoring results however indicated that basic standards of quality control to ensure robust individual readings of slides must be adhered to.

  • 92. Order onlineBuy this publication >>
    Frisk, Jessica
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Acupuncture treatment for hot flushes in women with breast cancer and men with prostate cancer2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The group of women and men with a history of cancer and distressing hot flushes and sweating is growing. The flushes negatively affect Health Related Quality of Life (HRQoL), perhaps partially by disturbing sleep. Treatments that are effective, tolerable and safe need to be developed. There are a number of treatment alternatives that are often not very effective or associated with more or less serious side-effects. Based on theories on the mechanisms behind hot flushes and acupuncture, treatment with acupuncture has been tried in menopausal women with hot flushes and in a few studies in women with breast cancer (BCa).

    Aim: The general aim of the research leading to this thesis was to evaluate the effect of acupuncture on hot flushes, HRQoL and sleep in men with prostate cancer (PCa) and women with BCa. To evaluate the effect in women with BCa of 12 weeks of electrostimulated acupuncture (EA) and two years of hormone therapy (HT) on number of, and distress caused by, hot flushes, and on HRQoL and sleep. To evaluate whether acupuncture therapy could be used to treat hot flushes in men with PCa treated with castration therapy, and then to evaluate in men with PCa and hot flushes the effect of 12 weeks of traditional acupuncture (TA) or EA on number of, and distress caused by, hot flushes and on urinary excretion of CGRP, HRQoL and sleep.

    Subjects and methods: Forty-five women with a history of BCa were randomized to oral HT for two years or EA for 12 weeks and were followed up till two years after start of therapy. Thirty-eight men with PCa and hot flushes were treated with acupuncture. Seven men were treated with EA for 10 to 12 weeks in a pilot study. After positive results from this study 31 men were randomized between EA and TA for 12 weeks and followed up till nine months after end of treatment. Hot flushes, HRQoL and sleep were monitored by means of log books and validated questionnaires.

    Results: The pilot study showed that 10 to 12 weeks of EA in men with PCa reduced number of hot flushes to below 50% of baseline with persistent effects at a follow up three months later. The two randomized studies showed that treatment with acupuncture in women with a history of BCa, and men with PCa was associated with a decrease in both the number of and distress caused by hot flushes by at least 50%. HT almost eliminated the hot flushes. There was no difference in reduction of hot flushes between men receiving EA or TA. Reduction of the number of hot flushes and distress caused by hot flushes probably leads to decreased disturbances at night, and was associated in women with a significant improvement in HRQoL and sleep variables. The improvement in HRQoL was as great in women treated with EA as in women receiving HT although the latter group had a more substantial reduction in number of flushes than the EA group suggesting that EA might have other effects in addition to those on hot flushes. In the men HRQoL did not change significantly. We saw very few and non-serious side-effects in the acupuncture groups and no signs that acupuncture activated the cancer or ovarian/testicular function.

    Conclusions: Acupuncture reduced the number of hot flushes and distress caused by hot flushes with at least 50% in women and men with hot flushes and a cancer disease and also improved HRQoL and sleep at least in women. Acupuncture should be further evaluated in these patient groups and could be a treatment alternative in patients with troublesome symptoms.

    List of papers
    1. Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: A pilot study
    Open this publication in new window or tab >>Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: A pilot study
    Show others...
    1999 (English)In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 161, no 3, p. 853-856Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: Most men who undergo castration therapy for prostatic carcinoma will have vasomotor symptoms that usually persist for years. Vasomotor symptoms are elicited from the thermoregulatory center, possibly due to a decrease in hypothalamic opioid activity induced by low sex steroid concentrations. Acupuncture treatment in women, which stimulates hypothalamic opioid activity, alleviates vasomotor symptoms. We report on men treated with acupuncture for relief of vasomotor symptoms after castration therapy.

    MATERIALS AND METHODS: We asked 7 men with vasomotor symptoms due to castration therapy to receive acupuncture treatment 30 minutes twice weekly for 2 weeks and once a week for 10 weeks. Effects on flushes were recorded in logbooks.

    RESULTS: Of the 7 men 6 completed at least 10 weeks of acupuncture therapy and all had a substantial decrease in the number of hot flushes (average 70% after 10 weeks). At 3 months after the last treatment the number of flushes was 50% lower than before therapy. Therapy was discontinued after 10 weeks because of a femoral neck fracture in 1 man and after 3 weeks due to severe back pain in 1.

    CONCLUSIONS: Acupuncture may be a therapeutic alternative in men with hot flushes after castration therapy and merits further evaluation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25941 (URN)10.1016/S0022-5347(01)61789-0 (DOI)000078492300030 ()10387 (Local ID)10387 (Archive number)10387 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
    2. Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial
    Open this publication in new window or tab >>Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial
    Show others...
    2008 (English)In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 11, no 2, p. 166-174Article in journal (Refereed) Published
    Abstract [en]

    Objective: To evaluate the effects of electro-acupuncture (EA) and hormone therapy (HT) on vasomotor symptoms in women with a history of breast cancer.

    Methods: Forty-five women were randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months. The number of and distress caused by hot flushes were registered daily before, during and up to 24 months after start of treatment.

    Results: In 19 women who completed 12 weeks of EA, the median number of hot flushes/24 h decreased from 9.6 (interquartile range (IQR) 6.6-9.9) at baseline to 4.3 (IQR 1.0-7.1) at 12 weeks of treatment (p < 0.001). At 12 months after start of treatment, 14 women with only the initial 12 weeks of EA had a median number of flushes/24 h of 4.9 (IQR 1.8-7.3), and at 24 months seven women with no other treatment than EA had 2.1 (IQR 1.6-2.8) flushes/24 h. Another five women had a decreased number of flushes after having additional EA. The 18 women with HT had a baseline median number of flushes/24 h of 6.6 (IQR 4.0-8.9), and 0.0 (IQR 0.0-1.6; p = 0.001) at 12 weeks.

    Conclusion: Electro-acupuncture is a possible treatment of vasomotor symptoms for women with breast cancer and should be further studied for this group of women.

    Keywords
    Acupuncture, Breast Neoplasms, Hot Flushes, Hormone Replacement Therapy, Menopause
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12622 (URN)10.1080/13697130801958709 (DOI)
    Note

    Original publication: J. Frisk, S. Carlhäll, A. -C. Källström, L. Lindh-Åstrand, A. Malmström and M. Hammar, Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial, 2008, Climacteric, (11), 2, 166-174. Copyright © Taylor & Francis Group, an informa business

    Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2018-01-03Bibliographically approved
    3. Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes
    Open this publication in new window or tab >>Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes
    Show others...
    2012 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 4, p. 715-724Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: Evaluate effects of electro-acupuncture (EA) and hormone therapy (HT) on health-related quality-of-life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms.

    METHODS: Forty-five women, randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months, were followed for up to 2 years. Distress caused by, and numbers of, hot flushes, hours slept and times woken up/night, Psychological and General Well-being Index (PGWB) and Women's Health Questionnaire (WHQ) were registered before and during treatment and at 6, 9, 12, 18 and 24 months after start of treatment.

    RESULTS: After 12 weeks of EA (n = 19), WHQ improved from 0.32 (IQR 0.23-0.53) at baseline to 0.24 (IQR 0.12-0.39; p < 0.001) and PGWB from 78 (IQR 53-89) to 79 (IQR 68-93; p = 0.002). All sleep parameters improved and Hot Flush Score (HFS) decreased by 80%. At 12 months, WHQ, PGWB and all sleep parameters remained significantly improved (n = 14) and HFS decreased by 65%. After 12 weeks of HT (n = 18), WHQ improved from 0.29 (IQR 0.15-0.44) at baseline to 0.15 (IQR 0.05-0.22; p = 0.001), PGWB from 75 (IQR 59-88) to 90 (62-97; p = 0.102) and three of five sleep parameters improved.

    CONCLUSION: Both EA and HT increased HRQoL and sleep, probably through decreasing numbers of and distress by hot flushes. Although flushes decreased less in the EA group than in the HT group, HRQoL improved at least to the same extent maybe due to other effects of EA, not induced by HT, e.g. on anxiety, vitality and sleep, supported by subscale analyses. EA should be further evaluated as treatment for women with breast cancer and climacteric complaints, since HT no longer can be recommended for these women.

    Place, publisher, year, edition, pages
    Springer, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-68804 (URN)10.1007/s00520-011-1134-8 (DOI)000301525700006 ()21468626 (PubMedID)
    Note
    funding agencies|Medical research council of South-East of Sweden||Swedish Medical Research Council| K2002-72X-12651-O5C |County Council of Ostergotland||Available from: 2011-06-07 Created: 2011-06-07 Last updated: 2017-12-11Bibliographically approved
    4. Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer—A Prospective Multicenter Study with Long-Term Follow-Up
    Open this publication in new window or tab >>Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer—A Prospective Multicenter Study with Long-Term Follow-Up
    Show others...
    2009 (English)In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 55, no 1, p. 156-163Article in journal (Refereed) Published
    Abstract [en]

    Background: Hot flushes are common and distressing among men with castrational treatment for prostate cancer. Of the few treatments, most have side effects.

    Objective: Assess changes in hot flushes of electrostimulated (EA) and traditional acupuncture (TA).

    Design, Setting, and Participants: Thirty-one men with hot flushes due to prostate cancer treatment were recruited from three urological departments in Sweden, from 2001 to 2004.

    Intervention: Thirty-one men were randomized to EA (4 electrostimulated needle points) or TA (12 needle points) weekly for 12 wk.

    Measurements: Primary outcome: number of and distress from hot flushes in 24h and change in “hot flush score.” Secondary outcome: change in 24-h urine excretion of CGRP (calcitonin gene–related peptide).

    Results and Limitations: Twenty-nine men completed the treatment. Hot flushes per 24h decreased significantly, from a median of 7.6 (interquartile range [IQR], 6.0–12.3) at baseline in the EA group to 4.1 (IQR, 2.0–6.5) (p=0.012) after 12 wk, and from 5.7 (IQR, 5.1–9.5) in the TA group to 3.4 (IQR1.8–6.3) (p=0.001). Distress by flushes decreased from 8.2 (IQR, 6.5–10.7) in the EA group to 3.3 (IQR, 0.3–8.1) (p=0.003), and from 7.6 (IQR, 4.7–8.3) to 3.4 (IQR, 2.0–5.6) (p=0.001) in the TA group after 12 wk, (78% and 73% reduction in “hot flush score,” respectively). The effect lasted up to 9 mo after treatment ended. CGRP did not change significantly. Few, minor side effects were reported.

    Limitations: small number of patients; no placebo control, instead a small group controlled for 6 wk pretreatment.

    Conclusions: EA and TA lowered number of and distress from hot flushes. The hot flush score decreased 78% and 73%, respectively, in line with or better than medical regimens for these symptoms. Acupuncture should be considered an alternative treatment for these symptoms, but further evaluation is needed, preferably with a non- or placebo-treated control group.

    Keywords
    Hot flushes, Prostate neoplasms, Acupuncture, Castration
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12621 (URN)10.1016/j.eururo.2008.02.002 (DOI)
    Note
    Original publication: Jessica Frisk, Anna-Clara Spetz, Hans Hjertberg, Bill Petersson, Mats Hammar, Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer—A Prospective Multicenter Study with Long-Term Follow-Up, 2008, European Urology. Copyright: Elsevier B.V., http://www.elsevier.com/ Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2017-12-13
    5. The effect of acupuncture on Health Related Quality of Life and sleep
    Open this publication in new window or tab >>The effect of acupuncture on Health Related Quality of Life and sleep
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Hot flushes are well-known, disturbing side effects of Androgen  Deprivation Therapy (ADT) in men with advanced prostate cancer, and the hot flushes negatively affect HRQoL and sleep. Acupuncture has been shown effective and without side effects, as treatment for hot flushes in men with (ADT). The effect on flushes lasts up to nine months after treatment has ended, but little is known about its effect on HRQoL and sleep. This study adds knowledge about the association between hot flushes, HRQoL and sleep. It shows that the number of hot flushes /night decrease significantly for up to 12 months. It concludes however, that there are many other factors that affect the patients general HRQoL, and perhaps that is one reason why we cannot show an improvement in general HRQoL.

    Objective:

    • To evaluate the effect of electro-acupuncture (EA) and traditional acupuncture (TA)on HRQoL and sleep in men with castrationally treated prostate cancer and hotflushes.

    Patients:

    • thirty-one men were randomized to traditional acupuncture (TA; n=16) or electrostimulated acupuncture (EA;n=15) for 12 weeks, with a study period of 12 months.

    Methods:

    • TA or EA was given for 30 minutes, twice a week for two weeks, and then once a week for 10 weeks. The patients were seen at the outpatient clinic before treatment, after 12 weeks of treatment, and at 6, 9, and 12 months follow up.
    • Log books , where the patients recorded number of and distress by hot flushes, tiredness, depressed mood, number of hours slept/night , and times woken up/night, were filled in before treatment, daily during the 12 weeks of treatment, and then one week before the 6, 9, and 12 months follow up visit.
    • Psychological and General Well-Being Index (PGWB) measured HRQoL at baseline, 12 weeks of treatment, and 6, 9 and 12 months follow up.
    • A six week waiting list with eight patients served as a control for changes in log-bookdata

    Results:

    • The number of hot flushes/night decreased significantly in both groups at all measuring points, except at nine months in the TA group.
    • No changes in hot flushes and times woken up/night during a six weeks pretreatment waiting list in eight patients, but significant changes in these patients after four weeks of treatment.
    • HRQoL, measured by log-book data and PGWB did neither improve nor deteriorate over 12 months. (A clinically significant change in PGWB was seen in 8/29 patients after 12 weeks of treatment, and a deterioration in 11/29).
    • The patients reported no change in hours slept/night, and times woken up/night decreased significantly only in the EA group after 12 weeks of treatment.
    • There is a strong association between numbers of hot flushes, sleep and HRQoL.

    Conclusion:

    • HF are associated with HRQoL and sleep, and EA/TA decrease hot flush numbers and distress, and thereby possibly increase sleep quality. This may sustain HRQoL.
    • HRQoL neither improved nor deteriorated during 12 months follow up, which may in this patient group, be explained by other factors, probably related to the advanced PCa, that have negative impact on HRQoL.
    • EA/TA merits further evaluation regarding the effects on HRQoL with a rigid measure of signs of disease progression, and also using a prostate cancer or hormone deprivation specific HRQoL questionnaire.
    Keywords
    Hot flushes, Prostate cancer, acupuncture, HRQoL, sleep
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-68805 (URN)
    Available from: 2011-06-07 Created: 2011-06-07 Last updated: 2011-08-30Bibliographically approved
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    Acupuncture treatment for hot flushes in women with breast cancer and men with prostate cancer
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  • 93.
    Frisk, Jessica
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery VHN.
    Managing hot flushes in men after prostate cancer-A systematic review2010In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 65, no 1, p. 15-22Article, review/survey (Refereed)
    Abstract [en]

    Context and objective: The aim of this study was to describe hot flushes in men with prostate cancer, and their treatment methods. Method: A systematic review was conducted of the literature indexed between 1966 and 2009 on the MEDLINE, the ISI Web of Knowledge, Cinahl and PsycINFO. Of 252 articles identified, 32 were selected for consideration of their complete texts, of which five were subject to detailed analysis. Results: Diethylstilbestrol, megestrol acetate and cyproterone acetate have the strongest effect, giving a 75% or larger decrease of the number of hot flushes, but they may have severe or bothersome side-effects. Gabapentin has an uncertain effect. Clonidine is not proven effective for hot flushes. Long-term effects were not evaluated in any of the studies. SSRI/SNRI and acupuncture may have a moderate effect on hot flushes but are not proven in any RCTs. Conclusion: Hot flushes are common and bothersome symptoms in men with prostate cancer and those taking anti-androgen treatment, and reduce quality of life. Few treatments are available and some are avoided for these patients. Additional prospective treatment studies are needed, with long-term follow-up, in order to evaluate the effects and risks of treatments. Treatments with few or no severe side-effects should be prioritised in future investigations. Experimental studies are also needed to elucidate the mechanism behind hot flushes in men and to suggest routes for the development of new treatments.

  • 94.
    Frisk, Jessica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Carlhäll, S.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Källström, Ann-Christin
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Lindh-Åstrand, Lotta
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Malmström, Annika
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland. Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Long-term follow-up of acupuncture and hormone therapy on hot flushes in women with breast cancer: a prospective, randomized, controlled multicenter trial2008In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 11, no 2, p. 166-174Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the effects of electro-acupuncture (EA) and hormone therapy (HT) on vasomotor symptoms in women with a history of breast cancer.

    Methods: Forty-five women were randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months. The number of and distress caused by hot flushes were registered daily before, during and up to 24 months after start of treatment.

    Results: In 19 women who completed 12 weeks of EA, the median number of hot flushes/24 h decreased from 9.6 (interquartile range (IQR) 6.6-9.9) at baseline to 4.3 (IQR 1.0-7.1) at 12 weeks of treatment (p < 0.001). At 12 months after start of treatment, 14 women with only the initial 12 weeks of EA had a median number of flushes/24 h of 4.9 (IQR 1.8-7.3), and at 24 months seven women with no other treatment than EA had 2.1 (IQR 1.6-2.8) flushes/24 h. Another five women had a decreased number of flushes after having additional EA. The 18 women with HT had a baseline median number of flushes/24 h of 6.6 (IQR 4.0-8.9), and 0.0 (IQR 0.0-1.6; p = 0.001) at 12 weeks.

    Conclusion: Electro-acupuncture is a possible treatment of vasomotor symptoms for women with breast cancer and should be further studied for this group of women.

    Download full text (pdf)
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  • 95.
    Frisk, Jessica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Hjertberg, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Peterson, Björn
    Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Spetz, Anna-Clara
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    The effect of acupuncture on Health Related Quality of Life and sleepManuscript (preprint) (Other academic)
    Abstract [en]

    Hot flushes are well-known, disturbing side effects of Androgen  Deprivation Therapy (ADT) in men with advanced prostate cancer, and the hot flushes negatively affect HRQoL and sleep. Acupuncture has been shown effective and without side effects, as treatment for hot flushes in men with (ADT). The effect on flushes lasts up to nine months after treatment has ended, but little is known about its effect on HRQoL and sleep. This study adds knowledge about the association between hot flushes, HRQoL and sleep. It shows that the number of hot flushes /night decrease significantly for up to 12 months. It concludes however, that there are many other factors that affect the patients general HRQoL, and perhaps that is one reason why we cannot show an improvement in general HRQoL.

    Objective:

    • To evaluate the effect of electro-acupuncture (EA) and traditional acupuncture (TA)on HRQoL and sleep in men with castrationally treated prostate cancer and hotflushes.

    Patients:

    • thirty-one men were randomized to traditional acupuncture (TA; n=16) or electrostimulated acupuncture (EA;n=15) for 12 weeks, with a study period of 12 months.

    Methods:

    • TA or EA was given for 30 minutes, twice a week for two weeks, and then once a week for 10 weeks. The patients were seen at the outpatient clinic before treatment, after 12 weeks of treatment, and at 6, 9, and 12 months follow up.
    • Log books , where the patients recorded number of and distress by hot flushes, tiredness, depressed mood, number of hours slept/night , and times woken up/night, were filled in before treatment, daily during the 12 weeks of treatment, and then one week before the 6, 9, and 12 months follow up visit.
    • Psychological and General Well-Being Index (PGWB) measured HRQoL at baseline, 12 weeks of treatment, and 6, 9 and 12 months follow up.
    • A six week waiting list with eight patients served as a control for changes in log-bookdata

    Results:

    • The number of hot flushes/night decreased significantly in both groups at all measuring points, except at nine months in the TA group.
    • No changes in hot flushes and times woken up/night during a six weeks pretreatment waiting list in eight patients, but significant changes in these patients after four weeks of treatment.
    • HRQoL, measured by log-book data and PGWB did neither improve nor deteriorate over 12 months. (A clinically significant change in PGWB was seen in 8/29 patients after 12 weeks of treatment, and a deterioration in 11/29).
    • The patients reported no change in hours slept/night, and times woken up/night decreased significantly only in the EA group after 12 weeks of treatment.
    • There is a strong association between numbers of hot flushes, sleep and HRQoL.

    Conclusion:

    • HF are associated with HRQoL and sleep, and EA/TA decrease hot flush numbers and distress, and thereby possibly increase sleep quality. This may sustain HRQoL.
    • HRQoL neither improved nor deteriorated during 12 months follow up, which may in this patient group, be explained by other factors, probably related to the advanced PCa, that have negative impact on HRQoL.
    • EA/TA merits further evaluation regarding the effects on HRQoL with a rigid measure of signs of disease progression, and also using a prostate cancer or hormone deprivation specific HRQoL questionnaire.
  • 96.
    Frisk, Jessica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Källström, Ann-Christin
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Wall, Najme
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Long term follow up of acupuncture and hormone therapy on hot flushes and well-being in women with breast cancer - a prospective, randomized multi centre trial in CANCER RESEARCH, vol 69, issue 2, pp 204S-204S2009In: CANCER RESEARCH, 2009, Vol. 69, no 2, p. 204S-204SConference paper (Refereed)
    Abstract [en]

    n/a

  • 97.
    Frisk, Jessica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Källström, Ann-Christine
    Clinical Department of Surgery, Division of Oncology, Helsingborg Hospital, Helsingborg, Sweden.
    Wall, Najme
    Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology UHL.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes2012In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 20, no 4, p. 715-724Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Evaluate effects of electro-acupuncture (EA) and hormone therapy (HT) on health-related quality-of-life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms.

    METHODS: Forty-five women, randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months, were followed for up to 2 years. Distress caused by, and numbers of, hot flushes, hours slept and times woken up/night, Psychological and General Well-being Index (PGWB) and Women's Health Questionnaire (WHQ) were registered before and during treatment and at 6, 9, 12, 18 and 24 months after start of treatment.

    RESULTS: After 12 weeks of EA (n = 19), WHQ improved from 0.32 (IQR 0.23-0.53) at baseline to 0.24 (IQR 0.12-0.39; p < 0.001) and PGWB from 78 (IQR 53-89) to 79 (IQR 68-93; p = 0.002). All sleep parameters improved and Hot Flush Score (HFS) decreased by 80%. At 12 months, WHQ, PGWB and all sleep parameters remained significantly improved (n = 14) and HFS decreased by 65%. After 12 weeks of HT (n = 18), WHQ improved from 0.29 (IQR 0.15-0.44) at baseline to 0.15 (IQR 0.05-0.22; p = 0.001), PGWB from 75 (IQR 59-88) to 90 (62-97; p = 0.102) and three of five sleep parameters improved.

    CONCLUSION: Both EA and HT increased HRQoL and sleep, probably through decreasing numbers of and distress by hot flushes. Although flushes decreased less in the EA group than in the HT group, HRQoL improved at least to the same extent maybe due to other effects of EA, not induced by HT, e.g. on anxiety, vitality and sleep, supported by subscale analyses. EA should be further evaluated as treatment for women with breast cancer and climacteric complaints, since HT no longer can be recommended for these women.

  • 98.
    Frisk, Jessica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Östergötland.
    Spetz, Anna-Clara
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hjertberg, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Petersson, Bill
    Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Two Modes of Acupuncture as a Treatment for Hot Flushes in Men with Prostate Cancer—A Prospective Multicenter Study with Long-Term Follow-Up2009In: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 55, no 1, p. 156-163Article in journal (Refereed)
    Abstract [en]

    Background: Hot flushes are common and distressing among men with castrational treatment for prostate cancer. Of the few treatments, most have side effects.

    Objective: Assess changes in hot flushes of electrostimulated (EA) and traditional acupuncture (TA).

    Design, Setting, and Participants: Thirty-one men with hot flushes due to prostate cancer treatment were recruited from three urological departments in Sweden, from 2001 to 2004.

    Intervention: Thirty-one men were randomized to EA (4 electrostimulated needle points) or TA (12 needle points) weekly for 12 wk.

    Measurements: Primary outcome: number of and distress from hot flushes in 24h and change in “hot flush score.” Secondary outcome: change in 24-h urine excretion of CGRP (calcitonin gene–related peptide).

    Results and Limitations: Twenty-nine men completed the treatment. Hot flushes per 24h decreased significantly, from a median of 7.6 (interquartile range [IQR], 6.0–12.3) at baseline in the EA group to 4.1 (IQR, 2.0–6.5) (p=0.012) after 12 wk, and from 5.7 (IQR, 5.1–9.5) in the TA group to 3.4 (IQR1.8–6.3) (p=0.001). Distress by flushes decreased from 8.2 (IQR, 6.5–10.7) in the EA group to 3.3 (IQR, 0.3–8.1) (p=0.003), and from 7.6 (IQR, 4.7–8.3) to 3.4 (IQR, 2.0–5.6) (p=0.001) in the TA group after 12 wk, (78% and 73% reduction in “hot flush score,” respectively). The effect lasted up to 9 mo after treatment ended. CGRP did not change significantly. Few, minor side effects were reported.

    Limitations: small number of patients; no placebo control, instead a small group controlled for 6 wk pretreatment.

    Conclusions: EA and TA lowered number of and distress from hot flushes. The hot flush score decreased 78% and 73%, respectively, in line with or better than medical regimens for these symptoms. Acupuncture should be considered an alternative treatment for these symptoms, but further evaluation is needed, preferably with a non- or placebo-treated control group.

  • 99. Gaddlin, P-O
    et al.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Most very low birth weight subjects do well as adults2009In: ACTA PAEDIATRICA, ISSN 0803-5253, Vol. 98, no 9, p. 1513-1520Article in journal (Refereed)
    Abstract [en]

    Aim: To study health, quality of life, educational level and occupation in very low birth weight (VLBW) children in early adulthood and the relationship of the findings to neonatal risk factors and later handicap. Methods: This is a prospective long-term follow-up study of a regional cohort of 20-year-old VLBW subjects (n = 77) of all surviving VLBW children (n = 86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden. Postal questionnaires were used: 1. A study-specific form, 2. Medical Outcomes Study, Short Form (SF-36), 3. Sense of Coherence. Results: VLBW subjects did not differ significantly from their controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and Sense of Coherence. Sixteen had cerebral palsy, attention deficit hyperactivity disorder or isolated mental retardation, and these subjects differed significantly from controls on SF-36 in physical functioning and physical health score, but not on Sense of Coherence. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birth weight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical function. Conclusion: The 20-year old VLBW subjects reported perceived health and managed transition to adulthood similar to controls. Handicapped subjects had poorer self-perceived physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health.

  • 100.
    Gottvall, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ginstman, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    External cephalic version of non-cephalic presentation; is it worthwhile?2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 12, p. 1443-1445Article in journal (Refereed)
    Abstract [en]

    A retrospective study of 186 consecutive external cephalic versions (ECV) late in the third trimester was done. Logistic regression analysis of background factors leading to a successful ECV showed that multiparity, a larger amount of amniotic fluid, measured as amniotic fluid index, and a transverse fetal position were each significantly correlated with a successful version. The total success rate was 62%, and after a successful ECV 84% of the fetuses were delivered vaginally. No severe complications were registered during the ECVs, and all babies had normal Apgar scores at delivery. Attempting ECV at least once or even twice seems to be appropriate because a successful ECV can decrease the rate of cesarean section in this group of patients and by so doing may also decrease the risk of cesarean section in future pregnancies.

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