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  • 1.
    Gheorghiade, Mihai
    et al.
    Northwestern University Feinberg School of Medicine, Chicago, USA.
    Greene, Stephen J
    Duke University Medical Center, Durham, North Carolina, USA.
    Butler, Javed
    Stony Brook University, Stony Brook, New York, USA.
    Filippatos, Gerasimos
    Athens University Hospital Attikon and Kapodistrian University of Athens, Athens, Greece.
    Lam, Carolyn S P
    National Health Center, Singapore and Duke, National University of Singapore, Singapore.
    Maggioni, Aldo P
    Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy.
    Ponikowski, Piotr
    Medical University, Wroclaw, Poland.
    Shah, Sanjiv J
    Northwestern University Feinberg School of Medicine, Chicago, USA.
    Solomon, Scott D
    Brigham and Women's Hospital Boston, Massachusetts, USA.
    Kraigher-Krainer, Elisabeth
    Charite University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany.
    Samano, Eliana T
    Bayer, Sao Paulo, Brazil.
    Müller, Katharina
    Bauer Pharma, Wuppertal, Germany.
    Roessig, Lothar
    Bauer Pharma, Wuppertal, Germany.
    Burkert, Pieske
    Charité University Medicine Berlin–Campus Virchow Klinikum and German Heart Center Berlin, Germany.
    Effect of Vericiguat, a Soluble Guanylate Cyclase Stimulator, on Natriuretic Peptide Levels in Patients With Worsening Chronic Heart Failure and Reduced Ejection Fraction: The SOCRATES-REDUCED Randomized Trial.2015In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 314, no 21, 2251-2262 p.Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Worsening chronic heart failure (HF) is a major public health problem.

    OBJECTIVE: To determine the optimal dose and tolerability of vericiguat, a soluble guanylate cyclase stimulator, in patients with worsening chronic HF and reduced left ventricular ejection fraction (LVEF).

    DESIGN, SETTING, AND PARTICIPANTS: Dose-finding phase 2 study that randomized 456 patients across Europe, North America, and Asia between November 2013 and January 2015, with follow-up ending June 2015. Patients were clinically stable with LVEF less than 45% within 4 weeks of a worsening chronic HF event, defined as worsening signs and symptoms of congestion and elevated natriuretic peptide level requiring hospitalization or outpatient intravenous diuretic.

    INTERVENTIONS: Placebo (n = 92) or 1 of 4 daily target doses of oral vericiguat (1.25 mg [n = 91], 2.5 mg [n = 91], 5 mg [n = 91], 10 mg [n = 91]) for 12 weeks.

    MAIN OUTCOMES AND MEASURES: The primary end point was change from baseline to week 12 in log-transformed level of N-terminal pro-B-type natriuretic peptide (NT-proBNP). The primary analysis specified pooled comparison of the 3 highest-dose vericiguat groups with placebo, and secondary analysis evaluated a dose-response relationship with vericiguat and the primary end point.

    RESULTS: Overall, 351 patients (77.0%) completed treatment with the study drug with valid 12-week NT-proBNP levels and no major protocol deviation and were eligible for primary end point evaluation. In primary analysis, change in log-transformed NT-proBNP levels from baseline to week 12 was not significantly different between the pooled vericiguat group (log-transformed: baseline, 7.969; 12 weeks, 7.567; difference, -0.402; geometric means: baseline, 2890 pg/mL; 12 weeks, 1932 pg/mL) and placebo (log-transformed: baseline, 8.283; 12 weeks, 8.002; difference, -0.280; geometric means: baseline, 3955 pg/mL; 12 weeks, 2988 pg/mL) (difference of means, -0.122; 90% CI, -0.32 to 0.07; ratio of geometric means, 0.885, 90% CI, 0.73-1.08; P = .15). The exploratory secondary analysis suggested a dose-response relationship whereby higher vericiguat doses were associated with greater reductions in NT-proBNP level (P < .02). Rates of any adverse event were 77.2% and 71.4% among the placebo and 10-mg vericiguat groups, respectively.

    CONCLUSIONS AND RELEVANCE: Among patients with worsening chronic HF and reduced LVEF, compared with placebo, vericiguat did not have a statistically significant effect on change in NT-proBNP level at 12 weeks but was well-tolerated. Further clinical trials of vericiguat based on the dose-response relationship in this study are needed to determine the potential role of this drug for patients with worsening chronic HF.

    TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01951625.

  • 2.
    Galiè, Nazzareno
    et al.
    University of Bologna, Italy.
    Barberà, Joan A
    University of Barcelona and Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain.
    Frost, Adaani E
    Baylor College of Medicine, Houston, USA.
    Ghofrani, Hossein-Ardeschir
    University of Giessen and Marbury Lung Center, Giessen, Germany.
    Hoeper, Marius M
    Hanover Medical School and German Center of Lung Research, Hanover, Germany.
    McLaughlin, Vallerie V
    University of Michigan, USA.
    Peacock, Andrew J
    Regional Heart and Lung Center, Glasgow, Scotland.
    Simonneau, Gérald
    University Paris-Sud, Paris, France.
    Vachiery, Jean-Luc
    Hospital Erasme, Brussels, Belgium.
    Grünig, Ekkehard
    University Hospital Heidelberg, Heidelberg, Germany.
    Oudiz, Ronald J
    UCLA Medical Center, Torrance,USA.
    Vonk-Noordegraaf, Anton
    University Medical Center, Amsterdam, Netherlands.
    White, R James
    University of Rochester, NY, USA.
    Blair, Christiana
    Gilead Sciences, Foster City.
    Gillies, Hunter
    Gilead Sciences, Foster City.
    Miller, Karen L
    Gilead Sciences, Foster City.
    Harris, Julia H N
    GlaxoSmith Kline, Uxbridge, UK.
    Langley, Jonathan
    GlaxoSmith Kline, Uxbridge, UK.
    Rubin, Lewis J
    University of California at San Diego, USA.
    Initial Use of Ambrisentan plus Tadalafil in Pulmonary Arterial Hypertension2015In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 373, no 9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Data on the effect of initial combination therapy with ambrisentan and tadalafil on long-term outcomes in patients with pulmonary arterial hypertension are scarce.

    METHODS: In this event-driven, double-blind study, we randomly assigned, in a 2:1:1 ratio, participants with World Health Organization functional class II or III symptoms of pulmonary arterial hypertension who had not previously received treatment to receive initial combination therapy with 10 mg of ambrisentan plus 40 mg of tadalafil (combination-therapy group), 10 mg of ambrisentan plus placebo (ambrisentan-monotherapy group), or 40 mg of tadalafil plus placebo (tadalafil-monotherapy group), all administered once daily. The primary end point in a time-to-event analysis was the first event of clinical failure, which was defined as the first occurrence of a composite of death, hospitalization for worsening pulmonary arterial hypertension, disease progression, or unsatisfactory long-term clinical response.

    RESULTS: The primary analysis included 500 participants; 253 were assigned to the combination-therapy group, 126 to the ambrisentan-monotherapy group, and 121 to the tadalafil-monotherapy group. A primary end-point event occurred in 18%, 34%, and 28% of the participants in these groups, respectively, and in 31% of the pooled-monotherapy group (the two monotherapy groups combined). The hazard ratio for the primary end point in the combination-therapy group versus the pooled-monotherapy group was 0.50 (95% confidence interval [CI], 0.35 to 0.72; P<0.001). At week 24, the combination-therapy group had greater reductions from baseline in N-terminal pro-brain natriuretic peptide levels than did the pooled-monotherapy group (mean change, -67.2% vs. -50.4%; P<0.001), as well as a higher percentage of patients with a satisfactory clinical response (39% vs. 29%; odds ratio, 1.56 [95% CI, 1.05 to 2.32]; P=0.03) and a greater improvement in the 6-minute walk distance (median change from baseline, 48.98 m vs. 23.80 m; P<0.001). The adverse events that occurred more frequently in the combination-therapy group than in either monotherapy group included peripheral edema, headache, nasal congestion, and anemia.

    CONCLUSIONS: Among participants with pulmonary arterial hypertension who had not received previous treatment, initial combination therapy with ambrisentan and tadalafil resulted in a significantly lower risk of clinical-failure events than the risk with ambrisentan or tadalafil monotherapy. (Funded by Gilead Sciences and GlaxoSmithKline; AMBITION ClinicalTrials.gov number, NCT01178073.).

  • 3. Klompstra, Leonie
    et al.
    Jaarsma, TinyStrömberg, Anna
    Playing exergames by heart failure patients.2013Conference proceedings (editor) (Refereed)
    Abstract [en]

    Purpose: Regular daily exercise is recognized as important in patients with heart failure (HF), but adherence to exercise recommendations is low. It is important to search for alternative approaches to motivate patients with HF to be more active. The use of exergames (games to improve physical exercise) might be an encouragement for HF patients, especially for people who may be reluctant to engage in more traditional forms of exercise, such as going to the gym or take a walk outside. The aim of this study is to assess the self-reported time playing on the Wii exergame platform when patients get access to the Wii at home for 12 weeks and the factors related to the time playing.

    Methods: As part of a feasibility study, the Wii was installed in the home of HF patients for a period of 12 weeks and patients were instructed to exergame 20 minutes a day (e.g. virtual bowling or tennis). Patients completed a diary which contained questions about the amount of minutes exergaming, heart failure symptoms and perceived exertion. At baseline and 12 weeks the physical capacity was assessed by 6minute walking test. We compared patients who played more than the median amount of minutes on the Wii with patients who played less than the median time.

    Results:  Thirty-two HF patients (age 64 ± 14, 10 female) were included. The mean time exergaming was 28 (±13) minutes a day (median of 27 minutes). Two patients stopped exergaming during the study. Men played more minutes a day on the Wii (31 minutes) than women (20 minutes), (t =2.243, p <.033) which could not be explained by age. Both male and female patients decreased in time exergaming, comparing the first 6 weeks access to the Wii with the last 6 weeks, but no differences were found in the amount of minutes decrease in exergaming (-5±9) between man and women. Patients who played more than the median time were significant lower educated, had a lower NYHA class and had more often grandchildren than patients who exergamed less than the median time.  No association could be found between the groups in exercise capacity, motivation, self-efficacy, symptoms experience, perceived exertion with time exergaming.

    Conclusion: Patients with HF played a considerable time active games on the Wii during 12 months of access to the Wii. Although women exergamed less than men, they did not decrease more in playing then men during the study. Patients who increased more than the median amount of minutes exergaming had a lower educational level, lower NYHA class, and more patients had grandchildren than patients who exergamed less. Access to exergames seem to be a promising to keep HF patients motivated to be active and to provide social facilitation with grandchildren. 

  • 4.
    Wiklund, Tea
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Arbetsterapeutiska interventioner för vuxna med depression och ångestsyndrom: en litteraturstudie2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Depression and anxiety disorders are among the most common mental disorders and lead to serious activity limitations in work, leisure and self-care.  In spite of this, there are few systematic reviews on occupational therapy interventions for this client group. The study aim was to describe occupational therapy interventions for adults with depression or anxiety disorders. A systematic review was conducted in Pubmed, PsycInfo, Scopus and Cinahl. Eighteen articles were included. The articles were analyzed in accordance with Friberg (2012). Three main themes were identified: 1) To help clients gain insight into their life situation, 2) To teach clients how to manage and prevent symptoms, and 3) Occupation as means in the intervention. The findings have implications for how therapists can choose, communicate and carry out interventions as well as for future research. The importance of therapeutic strategies in the interventions was also discussed.

  • 5.
    Seki, Satomi
    et al.
    University of Tokyo.
    Kato, Naoko
    University of Tokyo.
    Ito, Naomi
    University of Tokyo.
    Kinugawa, Koichiro
    University of Tokyo.
    Ono, Minoru
    University of Tokyo.
    Motomura, Noboru
    University of Tokyo.
    Yao, Atsushi
    University of Tokyo.
    Watanabe, Masafumi
    University of Tokyo.
    Imai, Yasushi
    University of Tokyo.
    Takeda, Norihiko
    University of Tokyo.
    Inoue, Masashi
    University of Tokyo.
    Hatano, Masaru
    University of Tokyo.
    Kazuma, Kazuma
    University of Tokyo.
    Validity and reliability of Seattle angina questionnaire Japanese version in patients with coronary artery disease2010In: Asian Nurs Res (Korean Soc Nurs Sci), Vol. 4, no 2, 57-63 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease. METHODS: Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects' medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed. RESULTS: A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach's alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items. CONCLUSIONS: The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use.

  • 6.
    Christiansson, Åsa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Evaluation of the attachment scale in the Trauma Symptom Inventory-2: Parental experiences of traumatic events and close relationships2013Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study was to evaluate the psychometric properties of the attachment scale added in the newly developed self-rating questionnaire Trauma Symptom Inventory-2 (TSI-2). Participants were recruited from the Swedish parent-infant unit Hagadal (N=58). Reliability analyses concluded Cronbach´s α .92 for attachment total scale, .88 for avoidance subscale, and .91 for rejection sensitivity subscale. Convergent validity analyses concluded moderate to strong correlations between TSI-2 attachment scale and subscales, and Experiences in Close Relationships (ECR) total scale and subscales (r= .34 - .68, p ≤ .01). Criterion validity analyses concluded that adverse childhood circumstances measured by Linköping Youth Life Experiences Scale (LYLES) signficantly estimated 17 % of variance in TSI-2 attachment scale scores. Preliminary support for reliability and validity of the TSI-2 attachment scale was obtained. No previous trauma symptom rating instrument has included information about adult attachment styles. The present findings point to the benefits of such inclusion.

  • 7.
    Palmqvist, Lisa
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Arts and Sciences.
    Executive functions and Planning in everyday life: Assistive Technologies for Cognition and their lack of support for children with Attention Deficit / Hyperactive Disorder2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The evaluation of how Assistive Technologies for Cognition (ATC) serve their purpose in providing support for children with Attention Deficit/Hyperactive Disorder (AD/HD) is limited and it is not clear how to best support the cognitive functions in order to help the individual increase task performance in everyday life. This thesis sought to scrutinise how families with at least one child diagnosed with AD/HD incorporate ATCs in their daily life in order to cope with appurtenant difficulties. An online survey, answered by 92 caregivers for children with AD/HD, attended to the cognitive abilities in need of support, the usage of ATCs, and how ATCs supported the executive functions in everyday planning. The results reveal that children encounter difficulty in dealing with cognitive ability, executive functioning and causal inference when it comes to planning in everyday life situations, which relates to lower levels of independence. Executive functioning and causal inference is negatively correlated to number of symptoms of AD/HD. The ATC is not satisfactorily supporting the cognitive functions, which results in another person by default being the one who sets up the ATC, and the child merely follows the instruction. The results has been processed into a table containing concepts which is suggested to be considered both when developing, as well as evaluating, ATCs for children with AD/HD. 

  • 8.
    Salgado Willner, Helen
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Huvudhalscancer och livskvalitet: Patientens skattning av livskvalitet innan och efter strålbehandling2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Each year 1200-1300 patients are diagnosed with head neck cancer. Treatment that involves radiotherapy can cause severe side effects for example trismus that affects quality of life.

    Purpose: To study health-related quality of life in patients who have undergone radiation treatment for head and neck cancer and participated in a intervention group who received training intended to prevent trismus or in a control group who received standard treatment.

    Method: This is a prospective study in which data is collected from 66 patients participating in a randomized study aiming to evaluate a training program to prevent trismus. Thirty three participated in the intervention group and thirty three in the control group. Both patient groups assessed health related quality of life (HRQOL) with EORTC QLQ C30 and QLQ-H&N35, at start and end of the radiation treatment, and at 3 and 6-months after completing radiation treatment.

    Results: There is no difference between the intervention and control groups regarding symptoms, functional status and global health, except for intake of nutritional supplements.  For both groups almost all scales measuring HRQOL deteriorated under the radiation treatment. However, 3 and 6 months after end of radiotherapy HRQOL had improved and had returned to the baseline values. The only exceptions were dry mouth, sticky saliva, problems with social eating, senses and physical ability.

    Conclusion: Radiation therapy for head and neck cancer affects patients HRQOL both in the short and long term. Medical staff needs strategies to manage patients ' functional and symptomatic deterioration throughout the treatment period and try to prevent or relieve the symptoms that may still remain several months after radiotherapy.

  • 9.
    Prabahar, Jasila
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Localization of Stroke Using Microwave Technology and Inner product Subspace Classifier2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Stroke or “brain attack” occurs when a blood clot carried by the blood vessels from other part of the body blocks the cerebral artery in the brain or when a blood vessel breaks and interrupts the blood flow to parts of the brain. Depending on which part of the brain is being damaged functional abilities controlled by that region of the brain is lost. By interpreting the patient’s symptoms it is possible to make a coarse estimate of the location of the stroke, e.g. if it is on the left or right hemisphere of the brain. The aim of this study was to evaluate if microwave technology can be used to estimate the location of haemorrhagic stroke.

    In the first part of the thesis, CT images of the patients for whom the microwave measurement are taken is analysed and are used as a reference to know the location of bleeding in the brain. The X, Y and Z coordinates are calculated from the target slice (where the bleeding is more prominent). Based on the bleeding coordinated the datasets are divided into classes. Under supervised learning method the ISC algorithm is trained to classify stroke in the left and right hemispheres; stroke in the anterior and posterior part of the brain and the stroke in the inferior and superior region of the brain. The second part of the thesis is to analyse the classification result in order to identify the patients that were being misclassified.

    The classification results to classify the location of bleeding were promising with a high sensitivity and specificity that are indicated by the area under the ROC curve (AUC). AUC of 0.86 was obtained for bleedings in the left and right brain and an AUC of 0.94 was obtained for bleeding in the inferior and superior brain. The main constraint was the small size of the dataset and few availability of dataset with bleeding in the front brain that leads to imbalance between classes. After analysis it was found that bleedings that were close to the skull and few small bleedings that are deep inside the brain are being misclassified. Many factors can be responsible for misclassification like the antenna position, head size, amount of hair etc.

    The overall results indicate that SDD using ISC algorithm has high potential to distinguish bleedings in different locations. It is expected that the results will be more stable with increased patient dataset for training.

  • 10.
    Frankenstein, Katri
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Lundberg, Loviisa
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    LAURA: Kognitiv beteendeterapi för kvinnor med psykisk ohälsa till följd av en traumatisk förlossning: En randomiserad kontrollerad studie av internetadministrerad vägledd självhjälpsbehandling2014Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The purpose of this randomized controlled study was to investigate the effect of internet- administered guided self-help for women suffering from psychological problems following traumatic childbirth. The eight-week treatment program consisted of written chapters based on cognitive behavioral therapy. 56 participants were randomly assigned to a treatment group (n = 28) or a waiting list group (n = 28).The results showed that post-traumatic symptoms decreased as a result of the treatment, with large within-group effects measured by both the Traumatic Event Scale (TES) (d = 1.33) and the Impact of Event Scale-Revised (IES-R) (d = 1.3). The difference between the groups was only significant when measured by the IES-R in which case the between-group effect was large (d = 0.97). The proportion of the participants who showed clinically significant improvement was considerably greater in the treatment group than in the waiting list group. For other measured outcomes, the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and the Quality of Life Inventory (QOLI), the difference between the groups were not significant,however the treatment group showed significant improvements between pre-and post measurements on all accounts.LAURA is most likely the first study to examine the treatment of psychological problems following traumatic childbirth. The results are promising and overall show that internet-administered cognitive behavioral therapy reduces post-traumatic symptoms following a traumatic childbirth, indicating a decrease in symptoms of anxiety and depression, and an improvement in quality of life.

  • 11.
    Jaber, Zeinab
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, The Institute of Technology.
    Enklare sjukvårdsrådgivning med mobil app: designförslag och utvärdering2014Independent thesis Basic level (degree of Bachelor), 10,5 credits / 16 HE creditsStudent thesis
    Abstract [en]

    There are different options for seeking healthcare advice, such as calling a health care provider or by searching for information about different symptoms online. The most common option people today use for healthcare advice, is by calling ta healthcare center, mainly 1177. There is however no easy accessible option for mobile technology. This study serves to examine the needs and possibilities for a healthcare service application for a mobile phone. Furthermore, the study serves to examine what additional features such service shall hold. Based on whether there is a need and what function there should exist, the study serves to develop a mobile application that meets the need and requirements.

    The result of the study, shows that there is a need for an additional option for healthcare services. The needs can be achieved through the development of a mobile application. Furthermore, the results indicates which features deemed to be necessary by the potential users. The design process, proceeds from a goal-oriented design method and where the application is developed along the key design principles of a behaviour-change system. The study also has defined target group that serves as the primary users. The primary users serves as the primary tools for the design development, and has been used for data collection through interviews and testing sessions.

    Based on the results, a prototype could be designed, developed and also evaluated. This led to a final design of the product that also reached up to the users’ needs and expectation.

  • 12.
    Carlsson, Anders
    Linköping University, Department of Physics, Chemistry and Biology, Chemistry. Linköping University, The Institute of Technology.
    Identification of potential plasma biomarkers of inflammation in farmers with musculoskeletal disorders: A proteomic study2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In this thesis we look for potential chronic inflammation biomarkers because studies have shown that farmers with musculoskeletal disorders might be affected by the environment to develop musculoskeletal disorders. Animal farmers are highly exposed to dust, aerosols, molds and other toxins in the air and environment leading to musculoskeletal disorders, respiratory disorders, airway symptoms and febrile reactions. There is reason to believe that the farmers have a constant or chronic inflammation that develops into musculoskeletal disorders. By using a proteomic approach with Two-dimensional Gel Electrophoresis and silver staining our goal was to find biomarkers by quantifying protein spots that differ significantly from farmers with musculoskeletal disorders compared to rural controls. In our study we found 8 significant proteins, two from Alpha-2-HS-glycoprotein, one from Apolipoprotein A1, three from Haptoglobin, one from Hemopexin and 1 from Antithrombin. All 5 proteins are involved in inflammation response in some way and some proteins are linked to chronic inflammation. Out of the 5 proteins Alpha-2-HS-glycoprotein, Apolipoprotein A1 and Hemopexin seem like the most likely proteins to investigate further as potential inflammation biomarkers.

  • 13.
    Wallin, Annika
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Samuelsson, Karin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Ätstörningsspecifik reflektiv funktion: samband med affektmedvetenhet, självskattad anknytningsstil och ätstörningssymtom2013Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Syftet var att utvärdera en ny intervju, SRF-ED, Symptomspecific Reflective Functioning - Eating Disorders. Intervjun blev validerad i förhållande till ätstörningssymtom, anknytningsstil och affektmedvetenhet. Sammanlagt deltog 22 personer, 21 kvinnor och en man. De intervjuades med SRF-ED samt ACI-S/O (Affect Consciousness Interview – Self/Others) och fyllde i självskattningsformulären ENR kortform (Erfarenheter i Nära Relationer) och EDE-Q version 6,0 (Eating Disorder Examination Questionnaire). Resultaten visade att det fanns ett signifikant samband mellan SRF-ED och medvetenhet om äckel, skattat på ACI-S/O. Ju högre medvetenhet om äckel desto högre reflektiv förmåga. Studien fann inga samband mellan SRF-ED och övriga affekter, ENR eller EDE-Q. Den ätstörningsspecifika reflekterande förmågan förefaller inte generellt ha samband med affektmedvetenhet, anknytning och graden avätstörningssymtom. Signifikanta korrelationer fanns mellan affektmedvetenhet, anknytningsstil och ätstörningssymtom.

  • 14.
    Alonso Orozco, Fabiola
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
    Finite Element Method Modelling and Simulations for Comparisonbetween Deep Brain Stimulation Electrodes2012Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The Deep Brain Stimulation (DBS) is an invasive therapy that alleviates the symptoms of several neurological disorders by electrically stimulating specific regions of the brain, generally within the basal ganglia. Until now Medtronic DBS system is the only approved by the Food and Drug Administration, nevertheless European and Australian countries  have recently approved St. Jude DBS systems to treat Parkinson’s disease and related movement disorders.

         Traditionally, voltage-controlled stimulation (the type of systems provided by Medtronic) has been used and clinicians are familiar with its settings; however the knowledge about systems based in current-controlled stimulation (St. Jude systems) is rather scarce. One of the key factors for a successful therapy is the optimal selection of the electrical parameters for stimulation. Due to the critical zone where the surgery is performed, modeling and simulations of DBS systems have been extensively used to observe how the electric field is distributed in the brain tissue and ultimately to help the clinicians to select the best parameters.

         In this thesis two finite element models of the DBS systems mentioned above have been developed; five examinations were designed, based on the physical and electrical differences between the systems, to observe and quantitatively compare the electric field distribution.

        The aim of this thesis was to investigate the differences between two representative models of each company but moreover to contribute with information regarding current-controlled stimulation.

    The results obtained are expected to be useful for further investigations where the magnitude and distribution of the electric field generated by this type of electrodes are needed.

  • 15.
    Åberg, Nils
    et al.
    Sahlgren’s Academy, University of Gothenburg, The Queen Silvia Children’s Hospital, Gothenburg, Sweden.
    Dahl, Å
    Department of Plant and Environmental Sciences, University of Gothenburg, Gothenburg, Sweden.
    Benson, M
    Sahlgren’s Academy, University of Gothenburg, The Queen Silvia Children’s Hospital, Gothenburg, Sweden.
    A nasally applied cellulose powder in seasonal allergic rhinitis (SAR) in children and adolescents; reduction of symptoms and relation to pollen load.2011In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 22, no 6, 594-9 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: A nasally applied cellulose powder is increasingly used in many countries as a remedy for allergic rhinitis. The absence of side effects makes the treatment particularly attractive in children. The efficacy in pollen allergic children, however, is not studied, nor is the relation to various pollen exposures.

    METHODS: During the birch pollen season in 2009, a double blind, placebo-controlled study was conducted in 53 subjects, aged 8-18 yr, with allergic rhinitis attributed to birch pollen. All children were on daily oral antihistamine. Reminders and reporting of symptom scores were made by SMS on mobile phones. Pollen was collected in a volumetric trap from which figures of pollen concentrations from 1979 to 2009 were available.

    RESULTS: There was a significant reduction in total symptom scores from the nose (Placebo 7.29, Active 6.07, p = 0.033) and specifically for running nose (Placebo 2.56, Active 2.03, p = 0.017). All symptoms from the nose, eyes and lower airways were lower in the active group but reached significance only as earlier. The best effect was seen after days with low or moderate pollen counts (≤100/m(3)), the predominating pollen load over 31 yr in the area. No clinically significant adverse effects were seen.

    CONCLUSIONS: The product reduces symptoms of SAR in children and adolescents. Original data on pollen concentrations over 31 yr are presented with levels mainly in the low range favouring the observed efficacy profile. SMS communication on mobile phone for reminders and recording symptom scores was an excellent logistics tool.

  • 16.
    Naeslund, Elin
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Stroke Lesion Segmentation for tDCS2011Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
    Abstract [en]

    Transcranial direct current stimulation (tDCS), together with speech therapy, is known to relieve the symptoms of aphasia. Knowledge about amount of current to apply and stimulation location is needed to ensure the best result possible. Segmented tissues are used in a finite element method (FEM) simulation and by creating a mesh, information to guide the stimulation is gained. Thus, correct segmentation is crucial. Manual segmentation is known to produce the most accurate result, although it is not useful in the clinical setting since it currently takes weeks to manually segment one image volume. Automatic segmentation is faster, although both acute stroke lesions and nectrotic stroke lesions are known to cause problems.

    Three automatic segmentation routines are evaluated using default settings and two sets of tissue probability maps (TPMs). Two sets of stroke patients are used; one set with acute stroke lesions (which can only be seen as a change in image intensity) and one set with necrotic stroke lesions (which are cleared out and filled with cerebrospinal fluid (CSF)). The original segmentation routine in SPM8 does not produce correct segmentation result having problems with lesion and paralesional areas. Mohamed Seghier’s ALI, an automatic segmentation routine developed to handle lesions as an own tissue class, does not produce satisfactory result. The new segmentation routine in SPM8 produces the best results, especially if Chris Rorden’s (professor at The Georgia Institute of Technology) improved TPMs are used. Unfortunately, the layer of CSF is not continuous. The segmentation result can still be used in a FEM simulation, although the result from the simulatation will not be ideal.

    Neither of the automatic segmentation routines evaluated produce an acceptable result (see Figure 5.7) for stroke patients. Necrotic stroke lesions does not affect the segmentation result as much as the acute dito, especially if there is only a small amount of scar tissue present at the lesion site. The new segmentation routine in SPM8 has the brightest future, although changes need to be made to ensure anatomically correct segmentation results. Post-processing algorithms, relying on morphological prior constraints, can improve the segmentation result further.

  • 17.
    Eriksson, Sabina
    Linköping University, Department of Physics, Chemistry and Biology, Molecular genetics .
    Studies of peripheral tolerance in AIRE deficient mice2011Independent thesis Basic level (degree of Bachelor), 10,5 credits / 16 HE creditsStudent thesis
    Abstract [en]

    Autoimmune Polyendocrine Syndrome Type 1(APS I) is a monogenic autosomal recessive autoimmune disorder which is the result of mutations in the autoimmune regulator (AIRE) gene. Symptoms of the disease include circulation of multiple organ specific autoantibodies, which leads to the breakdown of several tissues, including the adrenal cortex and the parathyroid glands. The patients also develop a number of non-endocrine disorders. This study has investigated the peripheral tolerance mechanisms controlled by the AIRE gene in Aire deficient mice, an animal model of the disease. The B cell Activating Factor (BAFF), which is a cytokine involved in B cell survival and growth, is elevated in Aire-/- mice, resulting in an increased release of autoantibodies and B cell proliferation. Therefore the BAFF level differences between TCR-/- and B6 mice was studied, and the results showed significantly higher levels of BAFF in TCR-/- mice. This is not in accordance with earlier studies. ICOS and ICOSL are involved in the activation of follicular T helper cells. The expression of ICOSL on different subpopulations of DC from mice was studied to evaluate the possible influence of AIRE expression on the T cells in the spleen. The results showed that ICOSL is significantly higher expressed in peripheral 33D1+ DCs in Aire-/- mice, showing that AIRE has a role in the over-activation of the follicular T helper cells, which can lead to autoantibody production and inflammation. These results show that AIRE is involved in peripheral tolerance.

  • 18.
    Bengtsson, Louise
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology.
    Sjölund, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology.
    Logopedisk afasiintervention: -en studie av journalanteckningar ur ett historiskt perspektiv2011Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    A historical study of intervention for aphasia may provide information on how speech and language pathologists work with people with aphasia. Aphasia is seen as an umbrella term for symptoms of language disorders caused by aquired brain injury. The overall aim of the present study was to describe and analyze the development of intervention for aphasia during the periods 1990-1999 and 2000-2010.

    The study was conducted by analysis of 83 medical records from two hospitals in Sweden during a period of 20 years. These decades were compared to each other and yo current litteraturein search for differences and trends in aphasia intervention.

    The Results of the present study revealed that intervention mainly focused on recovering the linguistic ability in both the 1990s and 2000s. Intervention and literature focusing on communication seem to increase during the 2000s. In the 2000s, speech and language pathologists begin to report on working with cognitive abilities. The results of the present study cannot be generalized but may give an insight in aphasia intervention from a historical perspective in Sweden.

     

  • 19.
    Gerdin, Martina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology.
    Hadvall, Emmy
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology.
    Imitation som intervention: En behandlingsstudie om hur Intensiv Imitation påverkar samspel och kommunikation hos en flicka med Rett syndrom2011Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Rett syndrome is a congenital neurological syndrome, which in the classic phenotype only affects girls. The symptoms include lack of speech, stereotypic movements of hands, dyspraxia and mental retardation, and these symptoms lead to communicative impairments. The purpose of this study was to examine whether the intervention method Intensive Imitation affected interaction/communication and initiative in a girl with Rett syndrome. The design of the study was a Single Subject Experimental Design with a three-week long intervention period where the girl participated daily in 30- minute sessions of Intensive Imitation together with the test conductor. Interaction, communication and initiatives were observed and analyzed before (Baseline A), during and after (Baseline B) the intervention period. The results showed that the girl’s total amount of communicative contributions increased between Baseline A and Baseline B, especially regarding the amount of produced vocalizations. However, there were some variations in the amount of contributions during the entire period. The girl increased her eye gazing towards her communicative partner, especially during the intervention sessions. There were no increase in the amount of communicative initiatives between Baseline A and Baseline B. However, the amount of initiatives increased between the first and the last observation. Intensive Imitation had a positive effect on eye gazing, vocalizations and communicative contributions, but this study cannot show any stable improvement regarding the girl’s communication and interaction.

  • 20.
    Eiderbrant, Kristina
    Linköping University, Department of Clinical and Experimental Medicine.
    Development of quantitative PCR methods for diagnosis of bacterial vaginosis and vaginal yeast infection2011Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Vaginitis is a vaginal infection which affects many women all over the world. The disorder is characterized by an infection of the vaginal area which can cause problems like abnormal vaginal discharge, itching and redness.

    The two most common causes of vaginitis are bacterial vaginosis and Candida vaginitis. The prevalence of bacterial vaginosis in Sweden is around 10-20 % and approximately 75 % of all women will once in their lifetime suffer from vaginal yeast infection.

    The clinical symptoms of vaginal infections are not specific and the diagnosis methods of bacterial vaginosis and Candida vaginitis are subjective and depended on the acuity of the clinician. Due to the lack of standardized and objective diagnostic tools, misdiagnosis and consequently incorrect treatment may occur.

    As vaginal infections and symptoms impact greatly of women´s quality of life and vaginitis have been associated with serious public health consequences, it is essential to diagnose and treat the conditions correctly. Hence, there is a great need of better methods of diagnosing these conditions.

    The aim of this master thesis was to develop quantitative species-specific real-time PCR assays to use in diagnosing the two most common causes of vaginitis i.e. bacterial vaginosis and Candida vaginitis.

    Potential markers for bacterial vaginosis (Atopobium vaginae, BVAB2, Gardnerella vaginalis, Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus iners, Megasphaera type 1, Megasphaera type 2, Mobiluncus curtisii, Mobiluncus mulieris and Leptotrichia/Sneathia species) and Candida vaginitis (Candida albicans, Candida glabrata, Candida parapsilosis and Candida tropicalis) were chosen. Primers and probes were designed and tested on reference strains and vaginal samples. Single- and multiplex PCR reactions were successfully optimized with the designed oligonucleotides. Furthermore, standard curves with excellent linearity were created and covered more than five orders of magnitude. These developed quantitative species-specific real-time PCR assays will, in a prospective medical validation, quantify 300 vaginal samples from women visiting the RFSU Clinic in Stockholm.

  • 21. Jaarsma, Tiny
    et al.
    Lesman-Leegte, Ivonne
    Hillege, Hans L
    Veeger, Nic J
    Sanderman, Robbert
    van Veldhuisen, Dirk J
    Depression and the usefulness of a disease management program in heart failure: insights from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.2010In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 55, no 17, 1837-43 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Our aim was to study the possible role of depressive symptoms in the effectiveness of a disease management program (DMP) in heart failure (HF) patients. BACKGROUND: Disease management programs are recommended in current HF guidelines, but certain patient groups, such as those with depression, might be less responsive to such programs. METHODS: From the data of a large multicenter study, in which we examined the effect of a DMP in HF patients, we investigated a potential interaction between depressive symptoms at baseline and the effect of such a program. RESULTS: Of the 958 HF patients (37% female; age 71 +/- 11 years; New York Heart Association functional class II to IV), 377 (39%) reported depressive symptoms at baseline. During 18 months of follow-up, the primary end point (composite of all-cause mortality and HF readmission) occurred in 39% of the nondepressed patients and 42% of depressed patients. In the overall sample, there was no significant effect of DMP on the composite primary end point. The effect of the DMP was significantly different in nondepressed than in depressed HF patients. A significant effect modification by depressive symptoms was observed in evaluating the effect of the DMP on all-cause mortality and HF readmission (p = 0.03). In patients without depressive symptoms, DMP resulted in a trend for lower incidence of the primary end point (hazard ratio: 0.8, 95% confidence interval: 0.61 to 1.04), whereas the reverse was observed in patients with depressive symptoms (hazard ratio: 1.3, 95% confidence interval: 0.95 to 1.98). CONCLUSIONS: Depressive symptoms in patients with HF have a major effect on the usefulness of DMP. Identification of depressive symptoms before enrollment in a DMP might lead to more accurate use of a DMP, because depressive patients might not benefit from a general program. (Netherlands Heart Foundation Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure; ISRCTN98675639).

  • 22. Luttik, Marie Louise
    et al.
    Lesman-Leegte, I
    Jaarsma, Tiny
    Quality of life and depressive symptoms in heart failure patients and their partners: the impact of role and gender.2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 7, 580-5 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Partners of heart failure (HF) patients are important in the course and management of the disease. It is unclear whether HF affects the quality of life (QoL) of partners as much as it affects the QoL of patients. METHODS AND RESULTS: The study aims to determine the influence of role (patient or partner) and gender on quality of life (QoL) and depressive symptoms in HF patients and their partners. Using a cross-sectional design, data on demographics, QoL, and depressive symptoms were collected from 393 HF patients (age, 68+/-11; 76% male) and their partners (age, 67+/-12; 24% male) using questionnaires (Medical Outcome Study 36-item General Health Survey [RAND-36], Cantril Ladder of Life, and Center for Epidemiologic Studies Depression Scale) that were send at home. At a group level HF, patients reported a significantly worse QoL and more depressive symptoms compared with their partners. When examining the influence of role and gender a significant interaction between role and gender was found. QoL in terms of general well-being of female HF partners and female HF patients did not differ (7.0 vs. 6.9), whereas male partners had a significantly higher well-being compared to male HF patients (7.6 vs. 6.8). Most of the RAND-36 domains were explained by role (either being a patient or a partner) with patients having lower scores compared with their partners. However, the RAND-36 domain mental health was mainly explained by gender, with women reporting worse mental health compared with men, independent of their role as a patient or a partner. The same trend was found for the presence of depressive symptoms. CONCLUSIONS: Females, either as patients or as partners are vulnerable in their response to HF in terms of their QoL. The QoL of male partners does not seem to be negatively affected. Supporting couples who are dealing with HF requires different interventions for male and female patients and their partners.

  • 23. Luttik, Marie Louise
    et al.
    Jaarsma, Tiny
    Lesman, Ivonne
    Sanderman, Robbert
    Hagedoorn, Mariët
    Quality of life in partners of people with congestive heart failure: gender and involvement in care.2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 7, 1442-51 p.Article in journal (Refereed)
    Abstract [en]

    AIM: This paper is a report of a study conducted to investigate quality of life in partners of people with congestive heart failure in comparison to individuals living with a healthy partner. BACKGROUND: Congestive heart failure is a chronic debilitating disease with severe symptoms and complex treatment. The support of partners is essential in the management of congestive heart failure. Living with a chronic illness generally affects the quality of life of patients and their partners. METHOD: Data were collected using a cross-sectional, comparative design between October 2002 and February 2005 with 303 partners of people with congestive heart failure. Reference data were collected in 304 age- and gender-matched individuals living with a healthy partner, drawn from the general population. All respondents completed questionnaires at home on quality of life and general well-being. Analysis of variance was used to analyse the data. FINDINGS: Overall, differences in quality of life between partners of people with heart failure and matched controls were small. However, substantial variation in the quality of life of partners was found by exploring the role of gender and involvement in care. Quality of life scores varied strongly for male and female partners who had to perform caregiving tasks. The performance of these caregiving tasks was negatively associated with the quality of life of female partners but not with that of male partners. CONCLUSION: Female partners especially should not be overlooked when they become involved in personal care tasks. Nurses should not be reluctant to involve male partners in caring for women with heart failure.

  • 24. Lesman-Leegte, Ivonne
    et al.
    Jaarsma, Tiny
    Coyne, James C
    Hillege, Hans L
    Van Veldhuisen, Dirk J
    Sanderman, Robbert
    Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls.2009In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 15, no 1, 17-23 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Comparisons of heart failure (HF) patients with an unselected healthy sample in terms of quality of life (QoL) and depressive symptoms might prove misleading. We compared QoL and depressive symptoms of a HF population with an age- and gender-matched sample of community dwelling elderly. METHODS AND RESULTS: Data were collected from 781 HF patients (36% female; age 72 +/- 9; New York Heart Association II-IV) and 781 age- and gender-matched community-dwelling elderly. Participants completed the Medical Outcome Study 36-item General Health Survey, the Cantril's Ladder of life, and the Center for Epidemiological Studies-Depression scale (CES-D). Analysis of variance techniques with Welch F test and chi-square tests were used to describe differences in QoL and depressive symptoms between different groups. For both men and women with HF, QoL was reduced and depressive symptoms were elevated when compared with their elderly counterparts (CES-D >or=16: 39% vs. 21%, P < .001). HF patients had more chronic conditions-specifically diabetes and asthma/chronic obstructive pulmonary disease. Impaired QoL and depressive symptoms were most prevalent among HF patients with comorbidities. Prevalence was also higher in HF patients in the absence of these conditions. CONCLUSIONS: HF has a large impact on QoL and depressive symptoms, especially in women with HF. Differences persist, even in the absence of common comorbidities. Results demonstrate the need for studies of representative HF patients with direct comparisons to age- and gender-matched controls.

  • 25. Remme, Willem J
    et al.
    McMurray, John J V
    Hobbs, F D Richard
    Cohen-Solal, Alain
    Lopez-Sendon, José
    Boccanelli, Alessandro
    Zannad, Faiez
    Rauch, Bernhard
    Keukelaar, Karen
    Macarie, Cezar
    Ruzyllo, Witold
    Cline, Charles
    Awareness and perception of heart failure among European cardiologists, internists, geriatricians, and primary care physicians.2008In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 29, no 14, 1739-52 p.Article in journal (Refereed)
    Abstract [en]

    AIMS: To assess awareness of heart failure (HF) management recommendations in Europe among cardiologists (C), internists and geriatricians (I/G), and primary care physicians (PCPs). METHODS AND RESULTS: The Study group on HF Awareness and Perception in Europe (SHAPE) surveyed randomly selected C (2041), I/G (1881), and PCP (2965) in France, Germany, Italy, the Netherlands, Poland, Romania, Spain, Sweden, and the UK. Each physician completed a 32-item questionnaire about the diagnosis and treatment of HF (left ventricular ejection fraction <40%). This report provides an analysis of HF awareness among C, I/G, and PCP. Seventy-one per cent I/G and 92% C use echocardiography, and 43% I/G and 82% C use echo-Doppler as a routine diagnostic test (both P < 0.0001). In contrast, 75% PCP use signs and symptoms to diagnose HF. Fewer I/G would use an angiotensin-converting enzyme (ACE)-inhibitor in >90% of their patients (64 vs. 82% C, P < 0.0001), whereas only 47% PCP would routinely prescribe an ACE-inhibitor. Worsening HF was considered a risk of ACE-inhibitor therapy by 35% PCP. I/G and PCP consistently do not prescribe target ACE-inhibitor doses (P < 0.0001 vs. C). Only 39% I/G would use a beta-blocker in >50% of their patients (vs. 73% C, P < 0.0001). Also, only 5% PCP would always, and 35% often, prescribe a beta-blocker and reach target doses in only 7-29%. Moreover, 34% PCP and 26% I/G vs. 11% C (P < 0.0001) do not start a beta-blocker in patients with mild HF, who are already on an ACE-inhibitor and are on diuretic. In mild, stable HF, 39% PCP and 18% I/G would only prescribe diuretics, vs. 7% C (P < 0.0001). In patients with worsening HF in sinus rhythm and on an optimal ACE-inhibitor, beta-blockade and diuretics, significantly more C would add spironolactone, but I/G would more often add digoxin. CONCLUSION: Although each physician group lacks complete adherence to guideline-recommended management strategies, these are used significantly less well by I, G, and PCPs, indicating the need for education of these essential healthcare providers.

  • 26. van der Wal, Martje H L
    et al.
    Jaarsma, Tiny
    Moser, Debra K
    van Gilst, Wiek H
    van Veldhuisen, Dirk J
    Qualitative examination of compliance in heart failure patients in The Netherlands.2010In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 39, no 2, 121-30 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Noncompliance with pharmacological and nonpharmacological recommendations is a problem in many heart failure (HF) patients, leading to worse symptoms and readmission. Although knowledge is available regarding factors related to compliance with HF regimens, little is known about patients' perspectives. We investigated patients' reasons and motivations for compliance with HF regimens from their perspective, and we studied how patients manage these recommendations in daily life. The health belief model was used as a framework for this study. METHODS: A qualitative descriptive study was used, and 15 HF patients were interviewed about reasons for compliance, barriers to compliance, interventions that helped them comply with medications, sodium restriction, fluid restriction, and daily weighing. RESULTS: The most commonly reported reasons for compliance included fear of hospitalization and HF symptoms. Barriers to compliance were mainly related to the negative aspects of a regimen, e.g., taste of the food and thirst. Most patients tried to make their lifestyle changes part of the daily routine. Several problems and misunderstandings with the regimen were evident. Patients themselves offered many tips that helped them comply with the regimen. CONCLUSIONS: To improve compliance in HF patients, patient-tailored interventions must be targeted at specific problems and patients' beliefs regarding the regimen, and aim at implementing the regimen into daily life. Healthcare providers need to emphasize the benefits of compliance, motivate patients to comply, and focus on individual barriers to compliance, knowledge deficits, and misunderstandings regarding the regimen. More specific advice about medications and diet is needed. Group interventions, including tips patients themselves provide, might also be useful in helping patients implement the HF regimen in their daily lives.

  • 27. van der Wal, Martje H L
    et al.
    Jaarsma, Tiny
    Moser, Debra K
    van Veldhuisen, Dirk J
    Development and testing of the Dutch Heart Failure Knowledge Scale.2005In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, no 4, 273-7 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Heart failure (HF) knowledge as well as compliance are considered to be underlying mechanisms of the effects of HF management programs. However, there are no valid and reliable measurement instruments available which measures knowledge of HF patients. AIM: To develop a reliable and valid instrument, which measures the knowledge, patients have on their disease and the HF-related health care regimen. METHODS: The HF knowledge scale was developed in 3 phases; (1) concept analysis and first construction, (2) revision of items and (3) testing for validity and reliability. RESULTS: The Dutch HF knowledge scale is a 15-item, self-administered questionnaire that covers items concerning HF knowledge in general, knowledge on HF treatment (including diet and fluid restriction) and HF symptoms and symptom recognition. Face validity as well as content and construct validity was tested in HF patients in 19 hospitals in the Netherlands. The scale was able to differentiate between HF patients with high and low level of HF knowledge. Cronbach's alpha of the knowledge scale in this population (n=902) was .62. CONCLUSION: The instrument is a valid and reliable scale that can be used in research to gain insight in the effect of education and counselling of HF patients. After additional testing, the instrument seems to be a valid and reliable scale to be used in clinical practice to measure HF knowledge.

  • 28. Jaarsma, Tiny
    et al.
    Beattie, James M
    Ryder, Mary
    Rutten, Frans H
    McDonagh, Theresa
    Mohacsi, Paul
    Murray, Scott A
    Grodzicki, Thomas
    Bergh, Ingrid
    Metra, Marco
    Ekman, Inger
    Angermann, Christiane
    Leventhal, Marcia
    Pitsis, Antonis
    Anker, Stefan D
    Gavazzi, Antonello
    Ponikowski, Piotr
    Dickstein, Kenneth
    Delacretaz, Etienne
    Blue, Lynda
    Strasser, Florian
    McMurray, John
    Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology.2009In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 11, no 5, 433-43 p.Article in journal (Refereed)
    Abstract [en]

    Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in heart failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for heart failure patients and promoting the development of heart failure-orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.

  • 29. Lesman-Leegte, Ivonne
    et al.
    van Veldhuisen, Dirk J
    Hillege, Hans L
    Moser, Debra
    Sanderman, Robbert
    Jaarsma, Tiny
    Depressive symptoms and outcomes in patients with heart failure: data from the COACH study.2009In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 11, no 12, 1202-7 p.Article in journal (Refereed)
    Abstract [en]

    AIMS: To study the prognostic value of depressive symptoms on heart failure (HF) readmission and mortality, in a large and clinically relevant population of hospitalized HF patients adjusted for disease severity by B-type natriuretic peptide (BNP) level. METHODS AND RESULTS: We studied 958 patients enrolled after hospitalization for HF; 37% female; mean age 71 +/- 11 years; New York Heart Association class II (51%) or III/IV (49%). Left ventricular ejection fraction: 33% +/- 14%, and median BNP level: 454 pg/mL (75% CI, 195-876 pg/mL). In total, 377 patients (39%) had depressive symptoms [Centre for Epidemiological Studies Depression Scale (CES-D) score >or=16] and 200 (21%) had severe depressive symptoms (score >or=24). During 18 months of follow-up, 386 (40%) patients reached the primary endpoint of death or readmission for HF. In multivariate analyses, CES-D was significantly associated with the primary endpoint [hazard ratio (HR) 1.13, P = 0.02], and also with both individual components of the primary endpoint [HF readmission (HR 1.165, P = 0.02) and mortality (HR 1.169, P = 0.02)]. Patients with severe depressive symptoms had a >40% higher risk for HF readmission or death. CONCLUSION: In patients with HF, depression is independently associated with poor outcomes. These findings highlight the need for continued exploration of whether improvements in depression lead to better cardiovascular outcomes. The study was registered at clinical trial (www.trialregister.nl): NCT 98675639.

  • 30. Huzen, Jardi
    et al.
    van der Harst, Pim
    de Boer, Rudolf A
    Lesman-Leegte, Ivonne
    Voors, Adriaan A
    van Gilst, Wiek H
    Samani, Nilesh J
    Jaarsma, Tiny
    van Veldhuisen, Dirk J
    Telomere length and psychological well-being in patients with chronic heart failure.2010In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 39, no 2, 223-7 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: psychological stress and depressive symptoms have been implicated with accelerated ageing and increased progression of diseases. Shorter telomere length indicates a more advanced biological age. It is unknown whether psychological well-being is associated with telomere length in patients with the somatic condition of chronic heart failure (CHF). DESIGN: a cross-sectional analysis was used. SETTING: patients were admitted to the hospital with signs and symptoms of CHF. OBJECTIVE: the study aimed to assess the association between telomere length and psychological well-being in patients with CHF. METHODS: telomere length was determined by quantitative polymerase chain reaction in 890 patients with New York Heart Association functional class II to IV CHF. We evaluated the perceived mental health by the validated RAND-36 questionnaire. Depressive symptoms were assessed by the Centre for Epidemiologic Studies Depression scale (CES-D), and the presence of type D personality was evaluated by the DS14. RESULTS: a lower perceived mental health on the RAND-36 score was associated with shorter telomere length. Adjustment for age and gender did not change our findings (standardised beta, 0.11; P-value, 0.002). Telomere length was not associated with the CES-D or DS14 score. CONCLUSION: decreased perceived mental health is associated with shorter leukocyte telomere length in patients with CHF. Future work should determine whether psychological stress accelerates biological ageing.

  • 31. Lesman-Leegte, Ivonne
    et al.
    Jaarsma, Tiny
    Sanderman, Robbert
    Linssen, Gerard
    van Veldhuisen, Dirk J
    Depressive symptoms are prominent among elderly hospitalised heart failure patients.2006In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 8, no 6, 634-40 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There are limited data on the prevalence of depressive symptoms in hospitalised elderly HF patients and demographic and clinical characteristics associated with depressive symptoms are not known. METHODS: A sample of 572 HF patients (61% male; age 71+/-12 years; LVEF 34%+/-15) was recruited from 17 Dutch hospitals during HF admission. Depressive symptoms were assessed by the CES-D. Demographic, clinical variables and HF symptoms were collected from patient chart and interview. RESULTS: Forty one percent of the patients had symptoms of depression with women significantly more often reporting depressive symptoms than men 48% vs. 36% (chi(2)=8.1, p<0.005). HF patients with depressive symptoms reported more clinical HF symptoms than patients without depressive symptoms. Even after deleting HF related symptoms (sleep disturbances and loss of appetite) from the CES-D scale, 36% of patients were still found to have symptoms of depression. Multivariable logistic regression analyses revealed that depressive symptoms were associated with female gender (odds 1.68, 95% CI 1.14-2.48), COPD (odds 2.11, 95% CI 1.35-3.30), sleep disturbance (odds 3.45, 95% CI 2.03-5.85) and loss of appetite (odds 2.61, 95% CI 1.58-4.33). CONCLUSIONS: Depressive symptoms are prominent in elderly hospitalised HF patients especially in women. Depressive symptoms are associated with more pronounced symptomatology, despite the fact that other indices of severity of left ventricular dysfunction are similar.

  • 32. van der Wal, Martje H L
    et al.
    Jaarsma, Tiny
    van Veldhuisen, Dirk J
    Non-compliance in patients with heart failure; how can we manage it?2005In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 7, no 1, 5-17 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Because of the improvement of the pharmacological and non-pharmacological treatment in heart failure (HF) patients, the HF related therapeutic regimen is becoming more complicated. Non-compliance with this regimen can result in worsening HF symptoms, sometimes leading to hospitalisation. AIMS: The aims of this systematic literature review are (1) to describe the consequences of non-compliance in HF patients; (2) to summarise the degree of compliance in the various aspects of the therapeutic regimen; and (3) to review interventions that are recommended to improve compliance in HF patients. METHODS: A literature search of the MEDLINE and CINAHL database from 1988 to June 2003 was performed. Studies on compliance with life style recommendations according to the HF Guidelines of the European Society of Cardiology and the American Heart Association/American College of Cardiology were included. CONCLUSION: Non-compliance with medication and other lifestyle recommendations is a major problem in patients with HF. Evidence based interventions to improve compliance in patients with HF are scarce. Interventions that can increase compliance and prevent HF related readmissions in order to improve the quality of life of patients with HF need to be developed and tested.

  • 33. van der Wal, Martje H L
    et al.
    Jaarsma, Tiny
    Moser, Debra K
    van Gilst, Wiek H
    van Veldhuisen, Dirk J
    Unraveling the mechanisms for heart failure patients' beliefs about compliance.2007In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 36, no 4, 253-61 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Compliance with medication, diet, and monitoring symptoms is a problem in heart failure (HF) patients. Noncompliance can lead to worsening symptoms and is associated with personal beliefs about compliance. To intervene effectively, knowledge of factors related to patients' beliefs about compliance is needed. OBJECTIVES: The aims of this study are to: (1) gain insight into patients' beliefs about compliance; (2) examine the association of demographic variables and depressive symptoms to beliefs; (3) assess compliance with medication, diet, and daily weighing; and (4) examine the association of compliance to patients' beliefs. METHODS: Nine hundred fifty-four HF patients completed questionnaires on beliefs about medication and diet; 297 patients also completed a questionnaire on beliefs about symptom monitoring. Most important barriers and benefits were assessed as well as differences in beliefs between subgroups and the association between compliance and beliefs. RESULTS: The most important barriers were diuresis during the night (57%), the taste of food (51%), and limited ability to go out (33%). A barrier related to failure to weigh daily was forgetfulness (26%). Patients with depressive symptoms and patients with a low level of HF knowledge experienced more barriers to compliance with the HF regimen. Self-reported compliance with medication was almost 99%, compliance with diet 77%, and with daily weighing 33%. CONCLUSIONS AND IMPLICATIONS: In order to improve compliance, it is important that interventions should be directed to those patients who experience more barriers to compliance, such as patients with depressive symptoms and patients with a low level of knowledge on the HF regimen. Improvement of knowledge, therefore, will remain an important issue in HF management programs.

  • 34. Lesman-Leegte, Ivonne
    et al.
    Jaarsma, Tiny
    Sanderman, Robbert
    Hillege, Hans L
    van Veldhuisen, Dirk J
    Determinants of depressive symptoms in hospitalised men and women with heart failure.2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 2, 121-6 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Depressive symptoms are prominent and related to an increased risk on cardiovascular disease outcomes and all cause mortality in HF patients. AIM: To intervene effectively, factors related to depressive symptoms in men and women should be identified. METHODS: Depressive symptoms of 921 hospitalised HF patients (61% male; age 71+/-11; LVEF 33%+/-14, NYHA II-IV) were assessed by the Center for Epidemiological Studies-Depression scale (CES-D). RESULTS: Overall 40% of the patients had depressive symptoms (CES-D >or=16), which were more common in women than in men (47% versus 36%, p<0.001). Multivariable analysis in men revealed that depressive symptoms were related to age (OR 0.84, 95% CI 0.71-0.98, p=0.03, per 10 years), physical health (OR 0.76, 95% CI 0.71-0.83, p<0.001, per 10 units) and HF symptoms. In women depressive symptoms were also related to NYHA II-III versus IV (OR 0.60, 95% CI 0.37-0.95, p<0.03) and COPD (OR 2.33, 95% CI 1.20-4.53, p<0.012). CONCLUSION: Depressive symptoms are more common in women than in men. In both men and women depressive symptoms are related to age and physical health. For clinical factors: In men only HF symptoms, but in women also NYHA and COPD were related to depressive symptoms.

  • 35. van der Wal, Martje H L
    et al.
    Jaarsma, Tiny
    Adherence in heart failure in the elderly: problem and possible solutions.2008In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 125, no 2, 203-8 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As a result of the improvement of pharmacological and non-pharmacological treatment of heart failure patients, the heart failure regimen is becoming more complicated, especially for elderly patients with co-morbid diseases. Non-adherence to this regimen is a problem in many heart failure patients, leading to worsening symptoms, rehospitalization and decreased quality of life. AIM: This paper gives an overview of literature on adherence to pharmacological and non-pharmacological treatment in elderly heart failure patients. The paper addresses the definition of adherence and the extent and significance of the problem of non-adherence in elderly heart failure patients. Factors contributing to non-adherence, focused on the elderly are outlined and finally interventions to improve adherence in this elderly heart failure patient group are described. CONCLUSION: Non-adherence to medication and lifestyle recommendations is a major problem in elderly heart failure patients. Five dimensions that affect adherence are described consisting of social and economic factors, factors related to the health care system, to the condition of the patient, the therapy and factors related to the patient. Since non-adherences is a multidimensional problem, interventions need to be directed to all factors that are related to adherence in elderly heart failure patients. A multidisciplinary approach in a heart failure team is crucial to improve adherence in this vulnerable patient group. Effectiveness of interventions to improve adherence in elderly heart failure patients needs to be further tested.

  • 36. Metra, Marco
    et al.
    Ponikowski, Piotr
    Dickstein, Kenneth
    McMurray, John J V
    Gavazzi, Antonello
    Bergh, Claes-Hakan
    Fraser, Alan G
    Jaarsma, Tiny
    Pitsis, Antonis
    Mohacsi, Paul
    Böhm, Michael
    Anker, Stefan
    Dargie, Henry
    Brutsaert, Dirk
    Komajda, Michel
    Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology.2007In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 9, no 6-7, 684-94 p.Article in journal (Refereed)
    Abstract [en]

    Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition. Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction<30%, pseudonormal or restrictive mitral inflow pattern at Doppler-echocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance<300 m or a peak oxygen uptake<12-14 ml/kg/min; 5) history of >1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

  • 37.
    Zbornikova, V.
    Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Long term follow-up of unilateral occlusion of the internal carotid artery including repeated tests of vasomotor reactivity by transcranial Doppler2006In: Neurological Research, ISSN 0161-6412, Vol. 28, no 2, 220-224 p.Article in journal (Refereed)
    Abstract [en]

    Background: Early study on pathological flow pattern in the ophthalmic artery (OA), connected with impaired vasomotor reactivity (VMR) ana low pulsatility index (PI) in the anterior cerebral artery (ACA) on the occluded side, suggested collateral exhaustion. We undertook this study to evaluate whether the occurence of new strokes is predicted by special haemodynamic features. Method: A total of 27 patients (22 men and five women), aged 63 ± 15 years (mean ± SD) with longstanding occlusion of the internal carotid artery (ICA), confirmed by duplex scanning were studied. They had minimal neurological deficit and were followed-up for mean 4.3 ± 1.8 (mean ± SD) years by repeated clinical and 3-D transcranial Doppler (3-D TCD) examinations with azetazolamide test of vasomotor reactivity (VMR). Results: During follow-up, seven patients had new strokes (five minor strokes and two major ones), two ipsilateral and four contralateral to the ICA occlusion and one in the posterior circulation. Four patients died, All patients experiencing a new stroke had previous symptoms and pathological flow patterns in the OA, Le retrograde or isoelectric flow were noted in six of them. One patient with contralateral stroke experienced occlusion of the ICA located above the origin of the OA with anterograde flow, otherwise none of 11 patients with anterograde flow had a new stroke (p<0.05, Fisher exact text). During the follow-up, the initial mean velocity (MV) in the middle cerebral artery (MCA) on the occluded side in six patients with a new stroke in the anterior circulation, was 26.83 ± 10.50 cm/s, which was significantly different from that of patients without a new stroke (45.80 ± 12.8 cm/s) (p<0.01). MV in the ICA on the non-occluded side at the last examination was greater than that at the first examination (p<0.05) and increased after the use of acetazolamide only on this side (p<0.05), while PI decreased bilateraly (p<0.001 and 0.05). Resting MV both in the MCA on the occluded and ACA on the non-occluded side slightly decreased, while MV in the posterior cerebral artery (PCA) increased on the occluded siae (p<0.083) compared with that at the start of the follow-up. VMR in the ACA decreased slightly both on the non-occluded and occluded side (?-6.9 and ?-5.3 respectively), while impaired VMR = 77% was not significantly connected with new strokes. Conclusion: During the follow up, new strokes had appeared on both sides and in vertebrobasilar territory and were connected with pathological flow pattern in the OA and low MV in the MCA at the first examination. © 2006 W. S. Maney & Son Ltd.

  • 38. Jacobsson, A
    et al.
    Pihl-Lindgren, E
    Halmstad Cent Hosp, Dept Med, Cardiac Care Unit, S-30185 Halmstad, Sweden Halmstad Univ, Sch Social & Hlth Sci, Halmstad, Sweden Linkoping Univ, Dept Med & Care, Linkoping, Sweden.
    Fridlund, B
    Halmstad Cent Hosp, Dept Med, Cardiac Care Unit, S-30185 Halmstad, Sweden Halmstad Univ, Sch Social & Hlth Sci, Halmstad, Sweden Linkoping Univ, Dept Med & Care, Linkoping, Sweden.
    Malnutrition in patients suffering from chronic heart failure, the nurse's care2001In: European Journal of Heart Failure, ISSN 1388-9842, Vol. 3, no 4, 449-456 p.Article, review/survey (Refereed)
    Abstract [en]

    Chronic heart failure is associated with a bad prognosis with considerably shortened survival and repeated hospitalisations. Patients suffering from heart failure also have symptoms that can affect their food intake, for example, tiredness when strained, breathing difficulties and gastrointestinal symptoms like nausea, loss of appetite and ascites. Pharmacological therapy can lead to a loss of appetite, which will make the intake of food inadequate to fill the required energy and nutritional needs. The nurse's interest in and knowledge of diet issues can improve these patients' nutritional status, The aim of this literature review was to describe the nurse's interventions regarding malnutrition in patients suffering from chronic heart failure. The literature search gave 13 articles, which were analysed, and sentences whose content was related to the aim were identified. Three areas of content appeared, drug treatment and consequences, gastrointestinal effects, and information and education. The results show that the nutritional status of these patients can be significantly improved by means of simple nursing interventions. Future research should focus on controlled experimental studies to evaluate differences in body weight, body mass index and quality of life between patients suffering from chronic heart failure, who are taking part in a fully enriched nutrition intervention, and patients suffering from chronic heart failure, who are eating their normal diet. (C) 2001 European Society of Cardiology. All rights reserved.

  • 39.
    Bergh, AL
    et al.
    Univ Gothenburg, Dept Hlth Sci, Gothenburg, Sweden Sahlgrens Univ Hosp, Dept Internal Med, Ctr Diabet, S-41345 Gothenburg, Sweden.
    Persson, LO
    Univ Gothenburg, Dept Hlth Sci, Gothenburg, Sweden Sahlgrens Univ Hosp, Dept Internal Med, Ctr Diabet, S-41345 Gothenburg, Sweden.
    Attvall, S
    Univ Gothenburg, Dept Hlth Sci, Gothenburg, Sweden Sahlgrens Univ Hosp, Dept Internal Med, Ctr Diabet, S-41345 Gothenburg, Sweden.
    Psychometric properties of the Swedish version of the Well-Being Questionnaire in a sample of patients with diabetes type 12000In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 28, no 2, 137-145 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of the present investigation was to further test the psychometric properties of a Swedish version of the Well-Being Questionnaire (WBQ) in order to determine whether it could be suitable for measuring health-related quality of life among type 1 diabetic patients. Methods: In total, 94 patients who fulfilled the inclusion criteria were selected for the study and of these 85% participated. Reliability was tested with Cronbach's alpha coefficient and the internal validity by means of principal component analysis and multitrait analysis. To test the external validity, comparisons were made with two other questionnaires, the Short form-36 and a Swedish Mood Adjective Check List. Results: The results show that, above all, the Swedish version of the WBQ measures psychological well-being, and thus must also be complemented with scales that measure other consequences of the illness and/or treatment, i.e. physical symptoms. The questionnaire has low discriminatory validity between subscales, which casts doubt on the appropriateness of using the four subscales as separate measures. The two scales measuring anxiety and depression are not sensitive enough for use among type 1 diabetics without complications and high or normal levels of psychological well-being. Conclusions: The Well-Being Questionnaire alone does not give any more information about subjective health status among type 1 diabetic patients than, for example, the generic SF-36.

  • 40.
    Johnsson, F
    et al.
    Lund Univ, Dept Surg, S-22100 Lund, Sweden Ostfold Cty Hosp, Dept Med, Sarpsborg, Norway Holbaek Cty Hosp, Dept Med, Holbaek, Denmark Linkoping Cty Hosp, Dept Med, Linkoping, Sweden Wyeth Lederle Nordiska, Stockholm, Sweden.
    Moum, B
    Lund Univ, Dept Surg, S-22100 Lund, Sweden Ostfold Cty Hosp, Dept Med, Sarpsborg, Norway Holbaek Cty Hosp, Dept Med, Holbaek, Denmark Linkoping Cty Hosp, Dept Med, Linkoping, Sweden Wyeth Lederle Nordiska, Stockholm, Sweden.
    Vilien, M
    Lund Univ, Dept Surg, S-22100 Lund, Sweden Ostfold Cty Hosp, Dept Med, Sarpsborg, Norway Holbaek Cty Hosp, Dept Med, Holbaek, Denmark Linkoping Cty Hosp, Dept Med, Linkoping, Sweden Wyeth Lederle Nordiska, Stockholm, Sweden.
    Grove, O
    Lund Univ, Dept Surg, S-22100 Lund, Sweden Ostfold Cty Hosp, Dept Med, Sarpsborg, Norway Holbaek Cty Hosp, Dept Med, Holbaek, Denmark Linkoping Cty Hosp, Dept Med, Linkoping, Sweden Wyeth Lederle Nordiska, Stockholm, Sweden.
    Simren, M
    Östergötlands Läns Landsting, Local Health Care Services in the East of Östergötland, Department of Internal Medicine VHN.
    Thoring, M
    Lund Univ, Dept Surg, S-22100 Lund, Sweden Ostfold Cty Hosp, Dept Med, Sarpsborg, Norway Holbaek Cty Hosp, Dept Med, Holbaek, Denmark Linkoping Cty Hosp, Dept Med, Linkoping, Sweden Wyeth Lederle Nordiska, Stockholm, Sweden.
    On-demand treatment in patients with oesophagitis and reflux symptoms: Comparison of lansoprazole and omeprazole2002In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, Vol. 37, no 6, 642-647 p.Article in journal (Refereed)
    Abstract [en]

    Background: There are few data on how patients on maintenance treatment of reflux oesophagitis take their medication. This study was designed to investigate the dosing patterns of patients on on-demand treatment and to compare lansoprazole with omeprazole in this regard. Methods: Patients with reflux oesophagitis, initially treated until absence of symptoms, took capsules of either lansoprazole (30 mg) or omeprazole (20 mg) for 6 months, they were instructed to take the medication only when reflux symptoms occurred. In order to document dosing patterns, the medication was dispensed in bottles supplied with a Medication Event Monitoring System recording date and time the bottles were opened. There were regular follow-up visits with assessment of symptoms. Results: Three-hundred patients were eligible for analysis according to 'all patients treated'. A dosing pattern was found of an increased intake mornings and evenings and constant intervals between intakes. Although there was no correlation between oesophagitis grade or initial symptoms and the amount of medication consumed, the patients had significantly fewer reflux symptoms the more medication they consumed. There was no difference in the number of capsules consumed between the lansoprazole (0.73 capsules/day) and omeprazole groups (0.71 capsules/day). Nor was there any difference between the groups in reflux symptoms during the course of the study. Conclusion: Despite rigorous instructions to take medication on demand, the results suggest that it is patient habits more so than symptoms that determine the frequency and interval of medication intake. Symptoms are not therefore decisive for the amount of medication consumed.

  • 41.
    Ringsberg, KC
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lepp, M
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Finnstrom, B
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Experiences by patients with asthma-like symptoms of a problem-based learning health education programme2002In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 19, no 3, 290-293 p.Article in journal (Refereed)
    Abstract [en]

    Background. Eighteen patients with asthma-like symptoms but negative asthma tests, randomly selected, participated in a problem-based learning health education programme. The programme had a multidisciplinary approach and included exercises inspired by cognitive behavioural therapy. Objective. The aim of this study was to describe how the patients experienced the programme. Methods. After termination of the programme, semi-structured interviews with a phenomenographic approach were conducted with 15 of the participants. Results. Two categories emerged, with three sub-categories each. In these, the informants described how they felt solidarity with the group, received confirmation from the other participants and had increased their self-confidence. They had started to look upon themselves and the disorder from a different perspective, they could describe the disorder in words and they had started to use new, conscious coping strategies. Conclusions. Patients with asthma-like symptoms benefit from taking part in a problem-based learning health education programme. It helps them to reflect upon themselves and the disorder and to use new strategies to cope with it.

  • 42.
    Tegelberg, A
    et al.
    Cent Hosp Vasteras, Dept Stomatognath Physiol, SE-72189 Vasteras, Sweden Specialist Ctr Oral Rehabil, TMD Unit, Linkoping, Sweden Univ Gothenburg, Fac Odontol, Dept Stomatognath Physiol, Gothenburg, Sweden.
    List, T
    Cent Hosp Vasteras, Dept Stomatognath Physiol, SE-72189 Vasteras, Sweden Specialist Ctr Oral Rehabil, TMD Unit, Linkoping, Sweden Univ Gothenburg, Fac Odontol, Dept Stomatognath Physiol, Gothenburg, Sweden.
    Wahlund, K
    Cent Hosp Vasteras, Dept Stomatognath Physiol, SE-72189 Vasteras, Sweden Specialist Ctr Oral Rehabil, TMD Unit, Linkoping, Sweden Univ Gothenburg, Fac Odontol, Dept Stomatognath Physiol, Gothenburg, Sweden.
    Wenneberg, B
    Cent Hosp Vasteras, Dept Stomatognath Physiol, SE-72189 Vasteras, Sweden Specialist Ctr Oral Rehabil, TMD Unit, Linkoping, Sweden Univ Gothenburg, Fac Odontol, Dept Stomatognath Physiol, Gothenburg, Sweden.
    Temporomandibular disorders in children and adolescents: A survey of dentists' attitudes, routine and experience2001In: Swedish Dental Journal, ISSN 0347-9994, Vol. 25, no 3, 119-127 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to survey the experience and routine of, attitudes toward, and need for specialist resources in the treatment of temporomandibular disorders (TMD) in children and adolescents among public dentists. A questionnaire study was conducted in three counties in Sweden: Ostergotland, Vastmanland, and Goteborg. The questionnaire was sent to 286 Public Dental Service dentists. It contained questions on demographic issues, quality assurance, clinical experience and expertise, attitudes, and the need for specialist resources. Eighty-seven per cent (250) of the dentists answered the questionnaire. The dentists in the three areas reported good routine and safety in occlusal splint treatments (74%-81%), occlusal equilibration (28%-55%), jaw exercise (25%-29%), and medication treatments (3%-55%). Good experience concerning diagnostics and therapy decision was reported by 25%-50% of the dentists. A significantly greater portion of the dentists in Vastmanland had attended courses in TMD compared with the two other counties (p=0.001). Registrations of quality variables such as verbal and/or written case histories with questions on facial pain and tension-type headache (1%-39%) and measurements of jaw openings were performed less frequently in the three counties (0%-5%). Fifty-five per cent of the dentists had a positive attitude toward the care of children and adolescents with TMD. A large need for specialist resources with the possibility to send referrals or to consult was reported by 98%-100% of the respondents, to participate in continuing education by 97%-98%, and to do auscultation by 61%-82%. In conclusion, many of the dentists lacked routines for making diagnoses, deciding therapy, and judging treatment results. Good routines were reported only in occlusal splint therapy. The majority of the dentists had a positive attitude toward the care of children and adolescents with TMD-related symptoms. The majority of the dentists reported a great need for TMD specialists.

  • 43.
    Yeomans, N
    et al.
    Univ Melbourne, Western Hosp, Dept Med, Footscray, Vic 3011, Australia AstraZeneca R&D Molndal, Molndal, Sweden Univ Nottingham Hosp, Div Gastroenterol, Nottingham NG7 2UH, England Linkoping Univ, Dept Biomed & Surg, S-58183 Linkoping, Sweden Linkoping Univ, Dept Internal Med, S-58183 Linkoping, Sweden Univ Bergen, Dept Publ Hlth & Primary Hlth Care, N-5020 Bergen, Norway.
    Wilson, I
    Univ Melbourne, Western Hosp, Dept Med, Footscray, Vic 3011, Australia AstraZeneca R&D Molndal, Molndal, Sweden Univ Nottingham Hosp, Div Gastroenterol, Nottingham NG7 2UH, England Linkoping Univ, Dept Biomed & Surg, S-58183 Linkoping, Sweden Linkoping Univ, Dept Internal Med, S-58183 Linkoping, Sweden Univ Bergen, Dept Publ Hlth & Primary Hlth Care, N-5020 Bergen, Norway.
    Langstrom, G
    Univ Melbourne, Western Hosp, Dept Med, Footscray, Vic 3011, Australia AstraZeneca R&D Molndal, Molndal, Sweden Univ Nottingham Hosp, Div Gastroenterol, Nottingham NG7 2UH, England Linkoping Univ, Dept Biomed & Surg, S-58183 Linkoping, Sweden Linkoping Univ, Dept Internal Med, S-58183 Linkoping, Sweden Univ Bergen, Dept Publ Hlth & Primary Hlth Care, N-5020 Bergen, Norway.
    Hawkey, C
    Univ Melbourne, Western Hosp, Dept Med, Footscray, Vic 3011, Australia AstraZeneca R&D Molndal, Molndal, Sweden Univ Nottingham Hosp, Div Gastroenterol, Nottingham NG7 2UH, England Linkoping Univ, Dept Biomed & Surg, S-58183 Linkoping, Sweden Linkoping Univ, Dept Internal Med, S-58183 Linkoping, Sweden Univ Bergen, Dept Publ Hlth & Primary Hlth Care, N-5020 Bergen, Norway.
    Naesdal, J
    Univ Melbourne, Western Hosp, Dept Med, Footscray, Vic 3011, Australia AstraZeneca R&D Molndal, Molndal, Sweden Univ Nottingham Hosp, Div Gastroenterol, Nottingham NG7 2UH, England Linkoping Univ, Dept Biomed & Surg, S-58183 Linkoping, Sweden Linkoping Univ, Dept Internal Med, S-58183 Linkoping, Sweden Univ Bergen, Dept Publ Hlth & Primary Hlth Care, N-5020 Bergen, Norway.
    Walan, A
    Wiklund, I
    Quality of life in chronic NSAID users: a comparison of the effect of omeprazole and misoprostol2001In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, Vol. 30, no 6, 328-334 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To compare the impact on quality of life (QoL) of omeprazole and misoprostol during healing, and omeprazole, misoprostol, and placebo during maintenance treatment in chronic NSAID users with NSAID-associated gastroduodenal lesions. Methods: Validated baseline and follow-up QoL questionnaires were completed by 610 patients (healing: after 4.8 weeks: maintenance: after 6 months). Results: Patients with arthritis being treated with NSAIDs have a poor QoL. Rheumatoid arthritis causes more joint problem. and physical mobility limitations than osteoarthritis. Chronic NSAID use causes heartburn and dyspepsia. QoL improved on both treatments (about equally on two general QOL scales), but omeprazole relieved gastrointestinal symptoms more than misoprostol, particularly reflux. abdominal pain and indigestion symptoms, During maintenance, both treatments maintained QoL, but misoprostol induced diarrhoea, Conclusion: QoL in arthritis patient, on chronic NSAID treatment is destroyed. Omeprazole is superior to misoprostol for relief and prevention of NSAID-associated gastrointestinal symptoms allowing continued NSAID treatment without compromising the patients' QoL.

  • 44.
    Jones Alsarraf, Jeanette
    et al.
    Linköping University, Department of Behavioural Sciences and Learning.
    Nilsson, Yvonne
    Linköping University, Department of Behavioural Sciences and Learning.
    Reflecting around the functions behind depression: A correlational study of depression, mentalization and attachment2009Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Major Depression is a common and complex disorder that is often difficult to treat. Mentalization, facilitated by secure attachment, has been found to serve as a protective function against Borderline Personality Disorder. The aim of the current study was to investigate whether mentalization has the same protective function against depression and to analyze the connection between mentalization and self-rated attachment. Furthermore, the relation between Anxious/Avoidant attachment patterns and the anaclitic/introjective sub-types of depression were examined. Twenty participants with Major Depressive Disorder were interviewed with the Depression Specific Reflective Function Interview (DSRF) and SCID-I. They also completed the self-report questionnaires Experiences in Close Relationships (ECR), Depressive Experiences Questionnaire (DEQ) and Montgomery Åsberg Depression Rating Scale (MADRS). The results revealed a relation between high mentalization ability as measured by DSRF and low levels of depression and between an anxious attachment pattern and introjective depression. Moreover, low scores on DSRF combined with high levels of anaclitic and introjective symptoms accounted for 65% of observer rated depression severity. The results suggest that depression treatment might benefit from focusing on increasing the mentalizing ability and reducing anxious attachment patterns and from an awareness of the symptoms characterized by both the introjective and anaclitic sub-types of depression.

  • 45.
    Xia, H.H.-X.
    et al.
    Department of Medicine, University of Sydney, Nepean Hospital, Penrith, NSW, Australia.
    Talley, N.J.
    Department of Medicine, University of Sydney, Nepean Hospital, Penrith, NSW, Australia, Department of Medicine, University of Sydney, Nepean Hospital, PO Box 63, Penrith, NSW 2751, Australia.
    Blum, A.L.
    Division of Gastroenterology, Ctr. Hosp. Universitaire Vaudois, Lausanne, Switzerland.
    O'Morain, C.A.
    Department of Gastroenterology, Meath Hospital, Trinity College, Dublin, Ireland.
    Stolte, M.
    Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany.
    Bolling-Sternevald, E.
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Mitchell, H.M.
    Sch. of Biotech./Biomol. Sciences, University of New South Wales, Sydney, NSW, Australia.
    Clinical and pathological implications of IgG antibody responses to Helicobacter pylori and its virulence factors in non-ulcer dyspepsia2003In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 17, no 7, 935-943 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To determine whether pre-treatment antibody response to Helicobacter pylori virulence factors predicts eradication success and symptom relief 12 months after triple therapy in non-ulcer dyspepsia. Methods: H. pylori-positive patients with non-ulcer dyspepsia received 1-week omeprazole-based triple therapy, or omeprazole plus placebos. Symptoms were assessed using a validated Likert scale. Gastric biopsies taken before and 12 months after treatment were used for histological examination. Pre-treatment blood samples were used for the detection of anti-H. pylori immunoglobulin G (IgG) antibodies, and specific IgG antibodies to 19.5-, 26.5-, 30-, 35-, 89- (VacA) and 116-KDa (CagA) antigens of H. pylori. Results: IgG antibodies to the six antigens were detected in 62%, 96%, 88%, 47%, 54% and 78% of patients, respectively. The presence of antibody to 19.5-, 26.5- or 30-kDa antigen was associated with an increased anti-H. pylori IgG absorbance index. IgG absorbance indices were greater in those with H. pylori eradication (vs. persistent infection). The prevalence of antibodies to the six antigens was not significantly different between those with symptom relief vs. those without. The 19.5kDa antigen (P = 0.018) and VacA (P = 0.001) were independent risk factors for body gastritis. Conclusions: An increased pre-treatment anti-H. pylori IgG absorbance index may be a useful predictor of the success of eradication therapy. Although the 19.5-kDa antigen and VacA were associated with body gastritis, none of the six antigens tested predicted symptom relief after triple therapy.

  • 46.
    Ringsberg, K.C.
    et al.
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bjarneman, P.
    Bjärneman, P., Asthma and Allergy Centre Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Lowhagen, O.
    Löwhagen, O., Asthma and Allergy Centre Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Oden, A.
    Odén, A., Consultant Statistician, Valler, 442 92 Romelanda, Sweden.
    Toren, K.
    Torén, K., Occupational and Environmental Medicine, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.
    Differences in trigger factors and symptoms between patients with asthma-like symptoms and patients with asthma: Development of a basis for a questionnaire2002In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 96, no 5, 305-311 p.Article in journal (Refereed)
    Abstract [en]

    Patients with asthma-like symptoms but with negative asthma tests are often misdiagnosed as having asthma and treated as asthmatics. They describe their trigger factors and symptoms very similar to those of patients with asthma. The aim of the study was to analyze differences in symptoms and trigger factors between asthma-like patients and asthmatics in order to elaborate a basis for a questionnaire for epidemiological and clinical use. A questionnaire with 54 questions about trigger factors and 137 questions about symptoms was sent to 40 patients with asthma-like symptoms and 40 with asthma, all consecutively selected from patients referred to an out-patient clinic for asthma and allergy for investigation of suspected asthma. Data were analyzed statistically in two steps using multiple logistic regression analysis. Significant differences were seen in several trigger factors and symptoms after the first analysis. After the second analysis, seven out of the 54 trigger factors and 22 out of the 137 symptoms emerged as those that most significantly discriminated between the two patient groups. These trigger factors and symptoms can be the basis of a new questionnaire with high discriminating power. Before using it, it is important to evaluate the best combination of variables, add some demographic variables and to test the reliability and validity of this new questionnaire. © 2002 Elsevier Science Ltd.

  • 47. Rolny, P.
    et al.
    Sadik, R.
    Div. of Gastroentology/Hepatology, Department of Medicine, University of Gothenburg, 41685 Gothenburg, Sweden.
    Longer term outcome of steroid refractory ulcerative colitis treated with intravenous cyclosporine without subsequent oral cyclosporine maintenance therapy2002In: International Journal of Colorectal Disease, ISSN 0179-1958, Vol. 17, no 2, 67-69 p.Article in journal (Refereed)
    Abstract [en]

    Background and aims: Intravenous cyclosporine (Cy) is increasingly used in patients with severe ulcerative colitis who fail to respond to corticosteroids. However, in spite of subsequent oral Cy maintenance therapy almost one-half of the initial responders need colectomy within a year. In light of the drug's limited efficacy and potential toxicity use of oral long-term Cy can be questioned. Patients and methods: Nineteen patients with steroid refractory severe ulcerative colitis were treated intravenously with Cy. Results: Of the 19 patients 14 (76%) achieved remission. Six of the patients (46%) remained in remission for 12-61 months. Eight patients experienced one to four flares during the year after treatment. However, except for one patient who needed another course of intravenous Cy, all responded to corticosteroids. The duration of remission since the last flare in these patients (five received azathioprin) was 10-36 months. None of the patients needed colectomy because of symptoms. Conclusion: These preliminary data suggest that a course of intravenous Cy can turn corticosteroid-refractory ulcerative colitis to corticosteroids responsive. The outcome of patients not receiving oral Cy maintenance therapy appears to be satisfactory. Azathioprin maintenance therapy can probably be reserved for select patients.

  • 48.
    Norda, R.
    et al.
    Department of Transfusion Medicine and Immunohemotherapy, Örebro Medical Center Hospital, SE 701 85 Örebro, Sweden.
    Berseus, O.
    Stegmayr, B.
    Department of Internal Medicine, Division of Nephrology, University Hospital, Umeå, Sweden.
    Adverse events and problems in therapeutic hemapheresis. A report from the Swedish registry2001In: Transfusion and apheresis science, ISSN 1473-0502, Vol. 25, no 1, 33-41 p.Article in journal (Refereed)
    Abstract [en]

    Background: Since 1996 adverse events (AE) in therapeutic apheresis (TA) have been more extensively registered in Sweden. This report analyzes the extent and relation of AEs to procedures and diagnoses. Materials and methods: Reporting of TA performed in Sweden was centralized. A separate system for the registration of AE in TA was established and the data received were entered into a central database for registration and analyses. Fifteen of all 35 apheresis units reported both TA and AE during 1996-1999. These centers performed 75% of all TA procedures. Adverse events included medical symptoms, vascular access problems, technical and other problems. Results: More than 14,000 procedures were registered during the observation period. No fatalities occurred. AEs occurred in 3.7% (1996), 4.6% (1997), 4.2% (1998) and 4.4% (1999) of procedures. Interventions during the adverse event were performed in about 65% of the events. Apheresis procedures were interrupted due to an adverse event in about 1%. Adverse events occurred in 5.6% of plasma exchanges, 1.9% of plasma modulations and 6.8% of cytapheresis procedures. Paresthesia was registered in 22% and hypotensive events in 20.5%. Other more frequent symptoms were urticaria (14.4%), shivering (7.4%) and nausea (7.4%). AEs were most frequent in patients with Goodpasture's syndrome (12.5%), TTP/HUS (10.5%) and GuillainBarré syndrome (11.0%). Conclusion: AEs are few, often mild and less common in plasma modulation than plasma exchange. AEs are more frequent during TA of patients with certain diagnoses such as TTP/HUS. Copyright © 2001 Elsevier Science Ltd.

  • 49.
    Moller, H.
    et al.
    Möller, H., Department of Orthopaedic Surgery, Karolinska University, Huddinge University Hospital, Stockholm, Sweden, Department of Orthopaedic Surgery, Huddinge University Hospital, S-141 86 Huddinge, Sweden.
    Sundin, A.
    Hedlund, R.
    Department of Orthopaedic Surgery, Karolinska University, Huddinge University Hospital, Stockholm, Sweden.
    Symptoms, signs, and functional disability in adult spondylolisthesis2000In: Spine, ISSN 0362-2436, Vol. 25, no 6, 683-690 p.Article in journal (Refereed)
    Abstract [en]

    Study Design. A cross-sectional clinical study. Objectives. To determine whether there are specific symptoms, signs, and functional disability associated with adult spondylolisthesis. Summary of Background Data. In spite of the common occurrence of adult spondylolisthesis, the symptoms, signs, and disability associated with it have not been analyzed in a large, well-defined group of patients. Methods. The symptoms, signs, and disability of 111 consecutive patients with adult spondylolisthesis, before randomized treatment with fusion or physiotherapy, were compared with those of 39 patients with nonspecific low back pain before lumbar fusion. The patients completed a questionnaire covering clinical history and symptoms and submitted a pain drawing. The signs were documented. Functional disability and pain were quantified by 12-function and 2-pain visual analog scales, respectively. Results. Sixty-two percent of the patients reported low back pain as well as sciatica, 7% sciatica only, and 31% low back pain only. Specific signs were infrequent. A positive straight leg raising test result in 12% and an L5 sensory disturbance in 13% were the most common. The symptoms were similar in patients with spondylolisthesis and chronic low back pain, but the chronic low back pain group reported more functional disability. Patients with a nonorganic pain drawing (widespread, nonspecific pain) were more often blue collar workers, were more often and longer on sick leave, and reported reduced mental condition, sexual function, functional ability, and more pain than patients with an organic pain drawing (localized, specific pain). Conclusions. The clinical pattern and functional disability in adult spondylolisthesis and in low back pain of nonspecific origin are similar. Sciatica in adult spondylolisthesis is typically not associated with a positive straight leg raising test result.

  • 50. Wilson, I.
    et al.
    Langstrom, G.
    Långström, G., AstraZeneca RandD Mölndal, Molndal, Sweden.
    Wahlqvist, P.
    AstraZeneca RandD Mölndal, Molndal, Sweden.
    Walan, A.
    AstraZeneca RandD Mölndal, Molndal, Sweden, Department of Internal Medicine, University of Linkoping, Sweden.
    Wiklund, I.
    AstraZeneca RandD Mölndal, Molndal, Sweden, Department of Public Health and Primary Health Care, University of Bergen, Norway.
    Naesdal, J.
    AstraZeneca RandD Mölndal, Molndal, Sweden.
    Management of gastroduodenal ulcers and gastrointestinal symptoms associated with nonsteroidal anti-inflammatory drug therapy: A summary of four comparative trials with omeprazole, ranitidine, misoprostol, and placebo2001In: Current Therapeutic Research: Clinical and Experimental, ISSN 0011-393X, Vol. 62, no 12, 835-850 p.Article in journal (Refereed)
    Abstract [en]

    Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in the treatment of systemic diseases such as rheumatoid arthritis but are associated with a range of adverse gastrointestinal (GI) side effects, including dyspepsia, peptic ulcer, and ulcer complications. Several studies have compared the relative efficacy and tolerability of omeprazole, ranitidine, and misoprostol in the management of NSAID-associated GI adverse events. Objective: The purpose of this paper is to summarize and evaluate the results of 4 clinical studies that compared the efficacy and tolerability of omeprazole, misoprostol, and ranitidine in the acute and maintenance treatment of NSAID-associated gastroduodenal ulcers and GI symptoms. Methods: The 4 trials, which included 1822 patients being treated continuously with NSAIDs, studied omeprazole (20 and 40 mg once daily) as acute treatment for healing gastroduodenal ulcers and erosions and as prophylaxis (20 mg once daily) over 3 to 6 months. Comparators were misoprostol 200 µg 4 times daily or ranitidine 150 mg twice daily in the acute phases and misoprostol 200 µg twice daily, ranitidine 150 mg twice daily, or placebo in the prophylactic phases. Results: Gastric and duodenal ulcer healing rates were higher with omeprazole than with either misoprostol (P = 0.004 for gastric ulcers, P < 0.001 for duodenal ulcers) or ranitidine (P < 0.001 for gastric ulcers, P = 0.032 for duodenal ulcers). A significantly larger percentage of patients taking misoprostol had the number of gastric or duodenal erosions reduced from >10 to <5 compared with patients taking omeprazole (P < 0.001), whereas a significantly larger percentage of patients taking omeprazole achieved the same reduction in number of erosions compared with patients taking ranitidine (P = 0.008). More patients taking omeprazole remained in remission than patients taking misoprostol (P = 0.001), ranitidine (P = 0.004), or placebo (P < 0.001). More patients taking misoprostol (16.9%) or ranitidine (14.1%) discontinued treatment because of adverse events, lack of efficacy, or other reasons compared with patients taking omeprazole (9.9% and 10.2% in 2 studies). Conclusions: Omeprazole was more effective in healing and prophylaxis of NSAID-associated gastroduodenal ulceration and symptoms than misoprostol and ranitidine in chronic NSAID users, and was better tolerated than misoprostol.

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