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Unmet Palliative Care Needs Among Patients With End-Stage Kidney Disease: A National Registry Study About the Last Week of Life.

https://arctichealth.org/en/permalink/ahliterature301199
Source
J Pain Symptom Manage. 2018 02; 55(2):236-244
Publication Type
Journal Article
Date
02-2018
Author
Lena Axelsson
Anette Alvariza
Jenny Lindberg
Joakim Öhlén
Cecilia Håkanson
Helene Reimertz
Carl-Johan Fürst
Kristofer Årestedt
Author Affiliation
Center for Collaborative Palliative Care, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden; Sophiahemmet University, Stockholm, Sweden. Electronic address: lena.axelsson@shh.se.
Source
J Pain Symptom Manage. 2018 02; 55(2):236-244
Date
02-2018
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Bereavement
Communication
Disease Management
Female
Humans
Kidney Failure, Chronic - epidemiology - therapy
Male
Middle Aged
Pain - epidemiology
Palliative Care
Prevalence
Registries
Renal Dialysis
Sweden
Terminal Care
Young Adult
Abstract
End-stage kidney disease (ESKD) is characterized by high physical and psychological burden, and therefore, more knowledge about the palliative care provided close to death is needed.
To describe symptom prevalence, relief, and management during the last week of life, as well as end-of-life communication, in patients with ESKD.
This study was based on data from the Swedish Register of Palliative Care. Patients aged 18 or older who died from a chronic kidney disease, with or without dialysis treatment (International Classification of Diseases, Tenth Revision, Sweden; N18.5 or N18.9), during 2011 and 2012 were selected.
About 472 patients were included. Of six predefined symptoms, pain was the most prevalent (69%), followed by respiratory secretion (46%), anxiety (41%), confusion (30%), shortness of breath (22%), and nausea (17%). Of patients with pain and/or anxiety, 32% and 44%, respectively, were only partly relieved or not relieved at all. Of patients with the other symptoms, a majority (55%-84%) were partly relieved or not relieved at all. End-of-life discussions were reported in 41% of patients and 71% of families. A minority died in specialized palliative care: 8% in hospice/inpatient palliative care and 5% in palliative home care. Of all patients, 19% died alone. Bereavement support was offered to 38% of families.
Even if death is expected, most patients dying with ESKD had unmet palliative care needs regarding symptom management, advance care planning, and bereavement support.
PubMed ID
28941964 View in PubMed
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Case fatality of acute coronary events is improving even among elderly patients; the FINAMI study 1995-2012.

https://arctichealth.org/en/permalink/ahliterature301200
Source
Ann Med. 2018 02; 50(1):35-45
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-2018
Author
Heli Koukkunen
Aki S Havulinna
Seppo Lehto
Matti Ketonen
Juha Mustonen
Juhani K Airaksinen
Olavi Ukkola
Y Antero Kesäniemi
Veikko Salomaa
Author Affiliation
a Department of Medicine , Kuopio University Hospital , Kuopio , Finland.
Source
Ann Med. 2018 02; 50(1):35-45
Date
02-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Acute Coronary Syndrome - complications - epidemiology - mortality
Aged
Aged, 80 and over
Female
Finland - epidemiology
Humans
Incidence
Male
Mortality - trends
Myocardial Infarction - epidemiology - mortality
Abstract
To examine trends in incidence and 28-day case fatality of myocardial infarction (MI) in persons aged 75-99 years in four areas of Finland.
The Finnish Acute Myocardial Infarction (FINAMI) register is a population-based MI register study, which during 1995-2012 recorded 30561 suspected acute coronary syndromes in persons aged =75 years. Of them, 16229 fulfilled the American Heart Association criteria for a definite, probable or possible MI or coronary death. This age-group contributed 56.8% of all MIs of which 62.7% occurred in women. The incidence of MI decreased by -3.3%/year (95% CI -4.2; -2.4) in women aged 75-84 years, and by -1.2%/year (-1.9; -0.5) in women aged 85-99 years, but among men in these age-groups, only a non-significant reduction occurred. The 28-day case fatality of MI was high. In the age-group 75-84 years, it decreased non-significantly by -1.6%/year in men, and significantly by -2.4%/year (-3.9; -0.8) in women. In the age-group 85-99 years, the decrease was more remarkable: -5.1%/year (-7.8; -2.3) and -3.9%/year (-5.5; -2.2), respectively.
In Finland, more than half of MIs occur in the age-group 75-99 years, and most of them in women. The incidence of MI decreased significantly in elderly women but non-significantly in elderly men. The 28-day case fatality decreased especially in the age-group 85-99 years. Key Messages In Finland, more than one half of all myocardial infarctions (MIs) occur in the age-group of 75 years or older. Furthermore, 62.7% of MIs among elderly patients occur among women, although 58.0% of the elderly population are women. The incidence of MI decreased significantly in elderly women but not in elderly men. The 28-day case fatality in elderly patients was high but decreased significantly during the study period 1995-2012. This study provides population-based data on treatment strategies and trends in incidence, event rate, mortality and case fatality of MI in elderly individuals. Elderly patients with acute coronary syndromes still present a remarkable burden to the healthcare system in Finland as well as in many other developed countries. Especially considering the modern trend of reducing hospital resources and shifting patient care to outpatient clinics, the epidemiology of MI in elderly patients remains an important issue for the future planning of the healthcare system.
PubMed ID
28927303 View in PubMed
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Traumatic Spinal Injuries in Northern Finland.

https://arctichealth.org/en/permalink/ahliterature301201
Source
Spine (Phila Pa 1976). 2018 Jan 01; 43(1):E45-E51
Publication Type
Journal Article
Date
Jan-01-2018
Author
Ville Niemi-Nikkola
Nelli Saijets
Henriikka Ylipoussu
Pietari Kinnunen
Juha Pesälä
Pirkka Mäkelä
Markku Alen
Mauri Kallinen
Aki Vainionpää
Author Affiliation
Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
Source
Spine (Phila Pa 1976). 2018 Jan 01; 43(1):E45-E51
Date
Jan-01-2018
Language
English
Publication Type
Journal Article
Keywords
Accidental Falls
Accidents, Traffic
Adolescent
Adult
Aged
Aged, 80 and over
Female
Finland - epidemiology
Hospitalization
Humans
Incidence
Lumbar Vertebrae - injuries - surgery
Male
Medical Records
Middle Aged
Retrospective Studies
Spinal Fractures - epidemiology - etiology - surgery
Spinal Injuries - epidemiology - etiology - surgery
Young Adult
Abstract
A retrospective epidemiological study.
To reveal incidence and epidemiological features of traumatic spinal injuries (TSI) in Northern Finland.
In Finland the annual incidence of traumatic spine fractures requiring inpatient care has been found to be 27/100,000, while international incidences have varied across the range of 16-64/100,000. More specific epidemiological data from Finland is not available. Internationally, the most common mechanisms of injury are road traffic as well as low and high falls. Associated injuries occur in 30% to 55% of cases.
The study sample included patients with traumatic spinal injury admitted to Oulu University Hospital (OYS) with injury between the January 1, 2007 and December 31, 2011. Patient information was collected from the hospital care register, including all inpatient and outpatient visits and surgical procedures. Traumatic spinal column and spinal cord injuries were identified using International Classification of Diseases 10th revision or Nordic Classification of Surgical Procedures codes and all patient records were manually reviewed.
Nine hundred seventy-one patients met the criteria for TSI. The mean annual incidence of hospitalized traumatic spinal injuries was 26/100,000 in the whole of Northern Finland and 35/100,000 in the OYS main responsibility area. The most frequent etiology of TSI was low falls, which accounted for 35.8% of the injuries, followed by road traffic and high falls. Lumbar spine was the most common site of the fracture. Spinal surgery was performed in 376 (38.7%) cases. Three hundred eight patients (31.7%) suffered from associated injuries, 101 (10.4%) had a spinal cord injury, and 71 (7.3%) a brain injury.
Low falls in elderly and road traffic injuries in younger age groups were the most common etiology of traumatic spinal injuries in Northern Finland and should be given more attention in primary prevention.
3.
PubMed ID
28441317 View in PubMed
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Patient safety in nursing homes in Sweden: nurses' views on safety and their role.

https://arctichealth.org/en/permalink/ahliterature301202
Source
J Health Serv Res Policy. 2017 10; 22(4):204-210
Publication Type
Journal Article
Date
10-2017
Author
Frieda Andersson
Katarina Hjelm
Author Affiliation
1 Lecturer, Department of Medical and Health Sciences, Linköping University, Sweden.
Source
J Health Serv Res Policy. 2017 10; 22(4):204-210
Date
10-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Attitude of Health Personnel
Female
Humans
Male
Middle Aged
Nurse's Role - psychology
Nursing Homes
Nursing Staff - psychology - statistics & numerical data
Patient Safety
Qualitative Research
Sweden
Abstract
Objective Knowledge about patient safety in nursing homes is limited. The aim of this study was to describe what patient safety means to nurses working in nursing homes for the elderly and how these nurses address patient safety. Method Qualitative study of semi-structured interviews with 15 nurses aged 27-62 years. Qualitative content analysis was applied. Results Nurses describe the meaning of patient safety in terms of proper care and treatment, and a sense of security. Based on nurses' description of patient safety, several factors were identified as prerequisites to achieve safe health care: competence; clear information transfer between health care organizations; continuity of care and appropriate environment. Barriers to patient safety were described as lack of sufficient resources; lack of communication and negative attitudes to incident reporting. To a great extent, nurses' work for patient safety consists of efforts to compensate for defects and ensure good health care in their daily work, since work with patient safety is not a management priority. Conclusion Patient safety needs to be clarified and prioritized in nursing homes, and there is a need to understand nurses' role among other care givers and the need for shared routines among care givers.
PubMed ID
28429988 View in PubMed
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The challenging process of disclosing bullying victimization: A grounded theory study from the victim's point of view.

https://arctichealth.org/en/permalink/ahliterature301203
Source
J Health Psychol. 2018 07; 23(8):1110-1118
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2018
Author
Ylva Bjereld
Author Affiliation
University of Gothenburg, Sweden.
Source
J Health Psychol. 2018 07; 23(8):1110-1118
Date
07-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Bullying - psychology
Crime Victims - psychology
Female
Grounded Theory
Humans
Male
Qualitative Research
Sweden
Truth Disclosure
Young Adult
Abstract
School children are usually encouraged to tell an adult whether they are being bullied. Despite this encouragement, a significant percentage of bullied students do not disclose victimization. Previous research has often failed to include this group of hidden victims, thereby limiting the available knowledge about victimization disclosure. This study aimed to investigate the process of disclosing bullying victimization from the victim's point of view. Interviews with Swedish youth who had been or currently were victims of bullying in school were carried out and analyzed with grounded theory methods using two-step coding.
PubMed ID
27153857 View in PubMed
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Perceived child eating behaviours and maternal migrant background.

https://arctichealth.org/en/permalink/ahliterature301179
Source
Appetite. 2018 06 01; 125:302-313
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Date
06-01-2018
Author
Maria Somaraki
Karin Eli
Kimmo Sorjonen
Carl-Erik Flodmark
Claude Marcus
Myles S Faith
Christine Persson Osowski
Anna Ek
Paulina Nowicka
Author Affiliation
Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
Source
Appetite. 2018 06 01; 125:302-313
Date
06-01-2018
Language
English
Publication Type
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Africa, Northern
Asia
Child
Child Behavior
Child, Preschool
Cross-Cultural Comparison
Emigrants and Immigrants
Ethnic Groups
Europe
Feeding Behavior
Female
Humans
Male
Middle East
Mother-Child Relations
Mothers
Obesity - epidemiology
Perception
Residence Characteristics
South America
Sweden - epidemiology
Transients and Migrants
Abstract
The Child Eating Behaviour Questionnaire (CEBQ) is a well-established instrument in the study of obesity-related eating behaviours among children. However, research using the CEBQ in multicultural samples is limited. This study aims to identify and examine differences in child eating behaviours as reported by Swedish-born and non-Swedish-born mothers living in Sweden. Mothers (n?=?1310, 74 countries of origin, mean age 36.5 years, 63.6% with higher education, 29.2% with overweight or obesity) of children aged 3-8 years (mean age 4.8 years, 18.1% with overweight or obesity) completed the CEBQ. Responses were analysed using CEBQ subscales Food Responsiveness, Emotional Overeating, Enjoyment of Food, and Desire to Drink, clustering into Food Approach, and subscales Satiety Responsiveness, Slowness in Eating, Emotional Undereating, and Food Fussiness, clustering into Food Avoidance. Data were compared across seven regional groups, divided by maternal place of birth: (1) Sweden (n?=?941), (2) Nordic and Western Europe (n?=?68), (3) Eastern and Southern Europe (n?=?97), (4) the Middle East and North Africa (n?=?110), (5) East, South and Southeast Asia (n?=?52), (6) Sub-Saharan Africa (n?=?16), and (7) Central and South America (n?=?26). Crude, partly and fully adjusted linear regression models controlled for child's age, gender and weight status, and mother's education, weight status and concern about child weight. The moderation effect of maternal concern about child weight was examined through interaction analyses. Results showed that while Food Approach and Food Avoidance behaviours were associated with maternal migrant background, associations for Food Fussiness were limited. Notably, mothers born in the Middle East and North Africa reported higher frequencies of both Food Approach (except for Enjoyment of Food) and Food Avoidance. The study highlights the importance of examining how regionally-specific maternal migrant background affects mothers' perceptions of child eating behaviours.
PubMed ID
29438715 View in PubMed
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Use of pain medication before and after lumbar discectomy: longitudinal analysis of a nation-wide cohort.

https://arctichealth.org/en/permalink/ahliterature301180
Source
Minerva Chir. 2018 Jun; 73(3):280-287
Publication Type
Journal Article
Date
Jun-2018
Author
Mikhail Saltychev
Katri Laimi
Juho Rantakokko
Ryan Mattie
Zachary Mccormick
Ville Aalto
Mika Kivimäki
Jussi Vahtera
Author Affiliation
Department of Physical and Rehabilitation Medicine, Turku University Hospital, University of Turku, Turku, Finland - mikhail.saltychev@gmail.com.
Source
Minerva Chir. 2018 Jun; 73(3):280-287
Date
Jun-2018
Language
English
Publication Type
Journal Article
Keywords
Adolescent
Adult
Aged
Analgesics - therapeutic use
Diskectomy
Drug Utilization
Female
Finland
Humans
Low Back Pain - drug therapy
Lumbar Vertebrae - surgery
Male
Microsurgery
Middle Aged
Occupations
Pain, Postoperative - drug therapy
Prospective Studies
Young Adult
Abstract
Previous studies have suggested that variation in results of lumbar discectomy depends on careful selection of patients. Numerous factors have been suggested to explain this variation with no direct examinations on this issue. The objective was to examine the use of pain medication before and after lumbar discectomy in patients with back pain.
Prospective occupational cohort study (N.=151,618) with linkage to national registers. Of the cohort members, 1538 (age 44 years) underwent discectomy. Records from purchases of pain medication were obtained during a 3-year period before and after hospital discharge.
Purchases of pain medication increased during the follow-up period from 9.7±28.7 to 17.3±17.3 defined daily doses. Three groups were identified: 1) with constant, relatively low pain medication use; 2) with high use combined with further increases in purchases until the time of surgery and only a slight decrease thereafter; and 3) with a sharp rise in medication use before surgery and a return to no pain medication use approximately six months after the discharge. Non-manual profession (OR=1.34, 95% CI: 1.06 to 1.69) and open surgery technique increased (OR=1.32, 95% CI: 1.04 to 1.67) the probability of being included into the third group.
The greater decline in the use of pain medication after discectomy was associated with a sharp rise of that use within six months before surgery. This suggests that lumbar discectomy may benefit especially those with acute or subacute pain within the six-month window.
PubMed ID
29397636 View in PubMed
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Interaction between physical activity and television time on blood pressure level: cross-sectional data from 45?000 individuals.

https://arctichealth.org/en/permalink/ahliterature301181
Source
J Hypertens. 2018 05; 36(5):1041-1050
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
05-2018
Author
Kristina Beijer
Erik Lampa
Johan Sundström
Peter M Nilsson
Sölve Elmståhl
Nancy L Pedersen
Lars Lind
Author Affiliation
Department of Medical Sciences, Uppsala University, Uppsala.
Source
J Hypertens. 2018 05; 36(5):1041-1050
Date
05-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Age Factors
Aged
Blood pressure
Cohort Studies
Cross-Sectional Studies
Exercise - physiology
Female
Humans
Male
Middle Aged
Screen Time
Sex Factors
Sweden
Television
Abstract
The aim was to investigate if there is an interaction between sitting time and leisure time physical activity on blood pressure and if there are age differences and sex differences in this respect.
Linear regression analysis on cross-sectional data was performed in more than 45?000 men and women from two Swedish cohort studies, EpiHealth (45-75 years) and LifeGene (18-45 years). Self-reported leisure time physical activity was given in five levels from low (level 1) to vigorous physical activity (level 5) and television time was used as a proxy measure of sitting time.
High physical activity was associated with lower DBP (P?=?0.001), but not SBP. Active middle-aged men had lower DBP (-1.1?mmHg; 95% CI -1.7 to -0.4) compared with inactive participants. Prolonged television time was associated with higher SBP (P?
PubMed ID
29369146 View in PubMed
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Rare and Common Variants Conferring Risk of Tooth Agenesis.

https://arctichealth.org/en/permalink/ahliterature301182
Source
J Dent Res. 2018 05; 97(5):515-522
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Date
05-2018
Author
L Jonsson
T E Magnusson
A Thordarson
T Jonsson
F Geller
B Feenstra
M Melbye
E A Nohr
S Vucic
B Dhamo
F Rivadeneira
E M Ongkosuwito
E B Wolvius
E J Leslie
M L Marazita
B J Howe
L M Moreno Uribe
I Alonso
M Santos
T Pinho
R Jonsson
G Audolfsson
L Gudmundsson
M S Nawaz
S Olafsson
O Gustafsson
A Ingason
U Unnsteinsdottir
G Bjornsdottir
G B Walters
M Zervas
A Oddsson
D F Gudbjartsson
S Steinberg
H Stefansson
K Stefansson
Author Affiliation
1 deCODE genetics/Amgen, Reykjavik, Iceland.
Source
J Dent Res. 2018 05; 97(5):515-522
Date
05-2018
Language
English
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Keywords
Anodontia - epidemiology - etiology - genetics
Female
Genome-Wide Association Study
Humans
Iceland - epidemiology
Male
Polymorphism, Single Nucleotide - genetics
Risk factors
Abstract
We present association results from a large genome-wide association study of tooth agenesis (TA) as well as selective TA, including 1,944 subjects with congenitally missing teeth, excluding third molars, and 338,554 controls, all of European ancestry. We also tested the association of previously identified risk variants, for timing of tooth eruption and orofacial clefts, with TA. We report associations between TA and 9 novel risk variants. Five of these variants associate with selective TA, including a variant conferring risk of orofacial clefts. These results contribute to a deeper understanding of the genetic architecture of tooth development and disease. The few variants previously associated with TA were uncovered through candidate gene studies guided by mouse knockouts. Knowing the etiology and clinical features of TA is important for planning oral rehabilitation that often involves an interdisciplinary approach.
PubMed ID
29364747 View in PubMed
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Cost of Illness for Five Major Foodborne Illnesses and Sequelae in Sweden.

https://arctichealth.org/en/permalink/ahliterature301183
Source
Appl Health Econ Health Policy. 2018 04; 16(2):243-257
Publication Type
Journal Article
Date
04-2018
Author
Kristian Sundström
Author Affiliation
AgriFood Economics Centre, Lund University, Scheelevägen 15 D, 223 63, Lund, Sweden. kristian.sundstrom@agrifood.lu.se.
Source
Appl Health Econ Health Policy. 2018 04; 16(2):243-257
Date
04-2018
Language
English
Publication Type
Journal Article
Keywords
Campylobacter Infections - complications - economics - epidemiology
Cost of Illness
Dysentery, Bacillary - complications - economics - epidemiology
Escherichia coli Infections - complications - economics - epidemiology
Female
Foodborne Diseases - complications - economics - epidemiology
Health Care Costs - statistics & numerical data
Humans
Incidence
Male
Models, Economic
Salmonella Food Poisoning - complications - economics - epidemiology
Sweden - epidemiology
Yersinia Infections - complications - economics - epidemiology
Abstract
The main objective of this study was to derive cost estimates of five major foodborne illnesses (campylobacteriosis, salmonellosis, enterohemorrhagic Escherichia coli (EHEC), yersiniosis and shigellosis) in Sweden. These estimates provide a necessary contribution to perform future cost-benefit analyses aimed at reducing the burden of foodborne disease. A secondary aim was to obtain estimates of the true number of cases that occur in the community, thus providing necessary ground for calculating costs.
The true number of cases for each foodborne illness was simulated by multiplying the reported number of cases by sequential multipliers, one for each potential source of information loss about a case. This assessment of the true number of cases was then used to estimate the number of cases of sequelae for each illness. An incidence-based analysis was then used to calculate direct medical and non-medical costs, as well as indirect costs. Data for estimating the true number of cases for each illness were primarily based on an expert panel, while the derivation of costs mainly utilized national registries, databases and published literature.
The estimated number of cases was between 7- and 11-fold higher than the reported number of cases, indicating the importance of taking information loss into account when calculating costs. By far the most common pathogen of the five was campylobacter, with an estimated 101,719 (90% credibility interval [CI] 59,640-158,025) human cases occurring annually. For salmonella, 19,678 (90% CI 8394-40,456) cases were estimated to occur each year, while the other three pathogens were less common, with a yearly incidence of approximately 2500-5500 cases each. The total cost for the five pathogens (including sequelae) amounted to €142 million annually. Campylobacter was the most costly pathogen, representing 69% of the total costs. Salmonellosis and EHEC constituted 18 and 9% of these costs, respectively, while yersiniosis and shigellosis represented approximately 2% each. Costs for sequelae were significant and accounted for approximately 50% of the total costs.
Our simulations indicated that campylobacter infection was more common and more costly than salmonella, EHEC, yersinia and shigella combined. Estimated costs for all illnesses were highly influenced by (1) considering potential information losses about cases in the population (which increased costs 7- to 11-fold), and (2) taking account of post-infection sequelae (which doubled the costs).
PubMed ID
29313242 View in PubMed
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Clinical Application and Psychometric Properties of a Norwegian Questionnaire for the Self-Assessment of Communication in Quiet and Adverse Conditions Using Two Revised APHAB Subscales.

https://arctichealth.org/en/permalink/ahliterature301184
Source
J Am Acad Audiol. 2018 01; 29(1):25-34
Publication Type
Comparative Study
Journal Article
Date
01-2018
Author
Peder O Laugen Heggdal
Øyvind Nordvik
Jonas Brännström
Flemming Vassbotn
Anne Kari Aarstad
Hans Jørgen Aarstad
Author Affiliation
Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
Source
J Am Acad Audiol. 2018 01; 29(1):25-34
Date
01-2018
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Adult
Age Factors
Aged
Analysis of Variance
Case-Control Studies
Communication
Female
Hearing Aids - statistics & numerical data
Hearing Loss - diagnosis - psychology - rehabilitation
Humans
Linear Models
Male
Middle Aged
Norway
Psychometrics
Self-Assessment
Severity of Illness Index
Sex Factors
Surveys and Questionnaires
Abstract
Difficulty in following and understanding conversation in different daily life situations is a common complaint among persons with hearing loss. To the best of our knowledge, there is currently no published validated Norwegian questionnaire available that allows for a self-assessment of unaided communication ability in a population with hearing loss.
The aims of the present study were to investigate a questionnaire for the self-assessment of communication ability, examine the psychometric properties of this questionnaire, and explore how demographic variables such as degree of hearing loss, age, and sex influence response patterns.
A questionnaire based on the subscales of the Norwegian translation of the Abbreviated Profile of Hearing Aid Benefit was applied to a group of hearing aid users and normal-hearing controls.
A total of 108 patients with bilateral hearing loss, and 101 controls with self-reported normal hearing.
The psychometric properties were evaluated. Associations and differences between outcome scores and descriptive variables were examined. A regression analysis was performed to investigate whether descriptive variables could predict outcome.
The measures of reliability suggest that the questionnaire has satisfactory psychometric properties, with the outcome of the questionnaire correlating to hearing loss severity, thus indicating that the concurrent validity of the questionnaire is good.
The findings indicate that the proposed questionnaire is a valid measure of self-assessed communication ability in both quiet and adverse listening conditions in participants with and without hearing loss.
PubMed ID
29309021 View in PubMed
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Labour Market Segregation and Gender Differences in Sickness Absence: Trends in 2005-2013 in Finland.

https://arctichealth.org/en/permalink/ahliterature301185
Source
Ann Work Expo Health. 2018 04 18; 62(4):438-449
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-18-2018
Author
Taina Leinonen
Eira Viikari-Juntura
Kirsti Husgafvel-Pursiainen
Lauri J Virta
Mikko Laaksonen
Ilona Autti-Rämö
Svetlana Solovieva
Author Affiliation
Finnish Institute of Occupational Health, Työterveyslaitos, Finland.
Source
Ann Work Expo Health. 2018 04 18; 62(4):438-449
Date
04-18-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Female
Finland
Humans
Logistic Models
Male
Middle Aged
Occupations - statistics & numerical data
Sex Factors
Sick Leave - statistics & numerical data - trends
Socioeconomic Factors
Abstract
Women have higher sickness absence rate than men, but less is known of changes in this difference over time. We examined gender differences in sickness absence trends focusing on gender segregation in the labour market.
We used large nationwide register data on Finnish wage earners aged 25-59 and generalized estimation equations based on repeated logistic regression to estimate the annual risk of sickness absence lasting at least 2 weeks.
Between 2005 and 2013, the age-adjusted proportion (%) of employees with all-cause sickness absence decreased from the initial levels of 10.6 among men and 15.1 among women by 16.7 and 13.6%, respectively. Among both genders, the largest decrease in sickness absence coincided with the peak of the economic recession in 2009. In sickness absence due to all causes and musculoskeletal diseases, also the excess decrease among men mainly occurred in 2009, and in sickness absence due to mental disorders 2 years later. In sickness absence due to all causes and musculoskeletal diseases, the increasing gender difference was mainly attributable to a larger decrease in sickness absence at the time of the recession in male-dominated groups, such as in manual and manufacturing work, than in other sectors and occupational classes. In mental disorders, the increasing gender difference was partly attributable to a later smaller decrease in sickness absence among female-dominated lower non-manual and lower income employment groups. The increasing gender differences did not result from differential distributional changes in employment or sociodemographic factors among the employed male and female populations. In fact, widening of the gender gap in sickness absence due to all causes and musculoskeletal diseases would have been even larger without faster increase among women in the educational level and in non-manual employment.
Sickness absence decreased especially in male-dominated employment groups, resulting in a larger decrease in absences among men compared with women. More research is needed to ascertain whether these differential changes are attributable, for example, to reduced willingness to seek medical advice or increased presenteeism in male-dominated groups, or to increased work pressures in female-dominated groups. Selection mechanisms, i.e. men's increased ill-health-related exit from work through other routes than sickness absence, also cannot be ruled out.
PubMed ID
29300819 View in PubMed
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[Interrelation between the melatonin level and indicators of aging and fibrosis in men in the European part of the Arctic zone of Russian Federation.]

https://arctichealth.org/en/permalink/ahliterature301186
Source
Adv Gerontol. 2018; 31(6):925-932
Publication Type
Journal Article
Author
L B Kim
A N Putyatina
G S Russkikh
O B Tsypysheva
Author Affiliation
Federal Research Center of Fundamental and Translational Medicine, 2 srt. Timakova, Novosibirsk 630117, Russian Federation; e-mail: lenkim@centercem.ru.
Source
Adv Gerontol. 2018; 31(6):925-932
Language
Russian
Publication Type
Journal Article
Keywords
Aging - physiology
Antioxidants
Fibrosis - epidemiology
Humans
Hydroxyproline
Male
Melatonin - metabolism
Russia - epidemiology
Abstract
The results of the correlation analysis between the metabolite melatonin - 6-sulfatoxymelatonin (6-SMT) in the urine and the indicators of aging, interstitial fibrosis, the system of antioxidant protection in men in the Arctic are presented. Negative correlation of medium strength between 6-SMT with calendar age, biological age and molecular marker of aging p16INK4a in leukocytes was noted. A relationship of 6-SMT to fibrosis indices was found. It manifested itself in a negative correlation with sulfated glycosaminoglycans in the urine, with collagen markers: free hydroxyproline, peptide-linked hydroxyproline, and total hydroxyproline. Age-related decrease in the level of 6-SMT may be associated with an age-related increase in interstitial fibrosis in northerners. A positive correlation of medium strength between 6-SMT and hormones: free testosterone level (r=0,53, p=0,0002), total testosterone (r=0,43, p=0,003) and cortisol (r=0,33, p=0,007) was shown. Negative correlations of 6-SMT with the content of ceruloplasmin (r=-0,63, p=0,001) and SCORE scale (r=-0,52, p=0,001) indicate the relationship between melatonin and the antioxidant defense system and the risk of cardiovascular pathology.The results of the correlation analysis between the metabolite melatonin - 6-sulfatoxymelatonin (6-SMT) in the urine and the indicators of aging, interstitial fibrosis, the system of antioxidant protection in men in the Arctic are presented. Negative correlation of medium strength between 6-SMT with calendar age, biological age and molecular marker of aging p16INK4a in leukocytes was noted. A relationship of 6-SMT to fibrosis indices was found. It manifested itself in a negative correlation with sulfated glycosaminoglycans in the urine, with collagen markers: free hydroxyproline, peptide-linked hydroxyproline, and total hydroxyproline. Age-related decrease in the level of 6-SMT may be associated with an age-related increase in interstitial fibrosis in northerners. A positive correlation of medium strength between 6-SMT and hormones: free testosterone level (r=0,53, p=0,0002), total testosterone (r=0,43, p=0,003) and cortisol (r=0,33, p=0,007) was shown. Negative correlations of 6-SMT with the content of ceruloplasmin (r=-0,63, p=0,001) and SCORE scale (r=-0,52, p=0,001) indicate the relationship between melatonin and the antioxidant defense system and the risk of cardiovascular pathology.
???????????? ?????????? ??????????????? ??????? ????? ??????????? ?????????? — 6-?????????????????????? (6-????) ? ???? ? ???????????? ????????, ????????????????? ???????, ??????? ??????????????? ?????? ? ?????? ? ???????. ???????? ????????????? ?????????? ??????? ???? ????? 6-???? ? ???????????, ????????????? ????????? ? ???????????? ???????? ???????? p16INK4a ? ??????????. ?????????? ??????????? 6-???? ? ???????????? ???????. ??? ?????????? ? ????????????? ?????????? ? ????????????????? ???????????????????? ? ????, ? ????????? ????????? — ????????? ????????????????, ????????-????????? ???????????????? ? ????? ????????????????. ?????????? ???????? ?????? 6-???? ????? ???? ????????? ? ?????????? ????????? ????????????????? ??????? ? ???????. ???????? ????????????? ????? ??????? ???? 6-???? ? ?????????: ??????? ?????????? ???????????? (r=0,53, p=0,0002), ?????? ???????????? (r=0,43, p=0,003) ? ????????? (r=0,33, p=0,007). ????????????? ?????????? 6-???? ? ??????????? ?????????????? (r=–0,63, p=0,001) ? ?????? SCORE (r=–0,52, p=0,001) ??????????????? ? ??????????? ?????????? ? ???????? ??????????????? ?????? ? ?????? ???????? ????????-?????????? ?????????.
PubMed ID
30877822 View in PubMed
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[Organization of psychiatric assistance to pensioners of the Ministry of internal affairs of Russia.]

https://arctichealth.org/en/permalink/ahliterature301187
Source
Adv Gerontol. 2018; 31(6):887-891
Publication Type
Journal Article
Author
V A Sidorenko
Y V Bogdasarov
A G Soloviev
E G Ichitovkina
M B Zlokazova
A M Epstein
A A R?ssokha
Author Affiliation
Department for Material-Technical and Medical Support of the Ministry of Internal Affairs of Russia, 26 Raspletina str., Moscow 123060, Russian Federation.
Source
Adv Gerontol. 2018; 31(6):887-891
Language
Russian
Publication Type
Journal Article
Keywords
Humans
Mental Disorders - therapy
Mental Health Services - organization & administration
Pensions
Police - psychology
Retirement
Russia
Abstract
For the purpose of systematization of the directions of rendering psychiatric help to pensioners of law-enforcement bodies (OVD) of the Russian Federation with mental disorders, the analysis of the existing normative legal acts regulating psychiatric examination of employees of Department of internal Affairs of the Russian Federation at dismissal on retirement and attachment on medical care in departmental healthcare institutions is carried out. It is shown that the provision of specialized psychiatric and psychotherapeutic assistance to pensioners of internal Affairs of the Russian Federation is carried out mainly in the municipal health care system, there is no monitoring of the mental state of pensioners of internal Affairs of the Russian Federation, including combatants with post-stress disorders. Within the framework of the project Of the concept of development of the psychiatric service of the Ministry of internal Affairs of Russia, it is proposed to systematize approaches to the organization of psychiatric care for pensioners of the Ministry of internal Affairs of the Russian Federation with mental disorders in the structure of departmental health care, with the improvement of the regulatory legal framework for the organization of psychiatric care, which will ensure the provision of high-quality psychiatric care.
??? ?????????????? ??????????? ???????? ??????????????? ?????? ??????????? ??????? ?????????? ??? (???) ?? c ???????????? ?????????????? ???????? ?????? ???????????? ??????????-???????? ?????, ???????????? ??????????????? ??????????????????? ??????????? ??? ??? ?????????? ?? ?????? ?? ??????? ??? ? ???????????? ?? ??????????? ???????????? ? ????????????? ??????????? ???????????????. ????????, ??? ???????? ?????????? ??????????????? ? ???????????????????? ?????? ??????????? ??? ?????????????? ??????????????? ? ??????????? ????????????? ??????? ???????????????, ??????????? ?????????? ???????????? ????????? ??????????? ???, ? ??? ????? ? ?????????? ?????? ???????? ? ??????????????? ???????????. ? ?????? ?????????? ??????? ????????? ???????? ??????????????? ?????? ??? ?????? ?????????? ????????????????? ??????? ? ??????????? ??????????????? ?????? ??????????? ??? ? ???????????? ?????????????? ? ????????? ?????????????? ???????????????, ? ?????????????????? ??????????? ???????? ???? ?? ??????????? ???????? ??????????????? ??????, ??????? ????? ????????????? ???????? ???????????? ??????????????? ?????? ? ???????? ????????????? ?????????? ???????????????.
PubMed ID
30877818 View in PubMed
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[The development of the geriatric service in the Republic Sakha (Yakutia).]

https://arctichealth.org/en/permalink/ahliterature301188
Source
Adv Gerontol. 2018; 31(6):870-877
Publication Type
Journal Article
Author
O V Tatarinova
Z P Gorokhova
K K Sozonova
E G Muchina
M E Okhlopkov
Author Affiliation
Yakut science center of complex medical problems, 4 Sergelyakhskoe shosse, Yakutsk 677000, Russian Federation; e-mail: tov3568@mail.ru.
Source
Adv Gerontol. 2018; 31(6):870-877
Language
Russian
Publication Type
Journal Article
Keywords
Aged
Geriatrics - organization & administration
Health status
Humans
Life expectancy
Russia
Abstract
The medical and demographic data on the health status of older citizens in the Republic Sakha (Yakutia) in 2000-2017 and the analysis of medical care for elderly patients in 2015-2017 demonstrated the urgent need to expand primary health care (including at home) and to organize specialized medical care for older citizens (including geriatric service) in one of the largest regions of Russia. The main directions of implementation in the Republic Sakha (Yakutia) of the Strategy of actions in the interests of the older generation of the Russian Federation until 2025 are given: the formation of the legislative basis, the creation of a three-level geriatric service, the introduction of new technologies for the provision of medical care to elderly residents of the Republic, training of personal. Measures are planned to implement the regional program «Older generation» of the National project «Demography» in order to improve the current medical and demographic situation and increase the life expectancy of the older generation and the whole population of Yakutia.
??????-??????????????? ?????? ? ????????? ???????? ??????? ???????? ????????? ? ?????????? ???? (??????) ?? 2000–2017 ??. ? ?????? ??????????? ?????? ??????? ????????? ?? 2015–2017 ??. ?????????????????? ????????????? ??????????? ? ?????????? ????????? ??????-?????????? ?????? (? ??? ????? ?? ????) ? ? ??????????? ?????????????????? ??????????? ?????? ????????? ???????? ????????? (? ??? ????? ?????????????? ??????) ? ????? ?? ?????????? ???????? ??????. ????????? ???????? ??????????? ?????????? ? ?????????? ???? (??????) ????????? ???????? ? ????????? ??????? ???????? ????????? ?? ?? 2025 ?.: ???????????? ??????????-???????? ????, ???????? ????????????? ?????????????? ??????, ????????? ????? ?????????? ???????? ??????????? ?????? ??????? ??????? ??????????, ?????????? ??????. ???????? ??????????? ?? ?????????? ???????????? ????????? «??????? ?????????» ????????????? ??????? «??????????», ???????????? ?? ????????? ??????????? ??????-??????????????? ???????? ? ?????????? ????????????????? ????? ???????? ????????? ?, ? ???????? ?????, ????? ????????? ??????.
PubMed ID
30877816 View in PubMed
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Silica exposure in a mining exploration operation.

https://arctichealth.org/en/permalink/ahliterature301189
Source
Arch Environ Occup Health. 2018; 73(6):351-354
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
2018
Author
V H Arrandale
S Kalenge
P A Demers
Author Affiliation
a Occupational Cancer Care Ontario , Cancer Care Ontario , Toronto , CANADA.
Source
Arch Environ Occup Health. 2018; 73(6):351-354
Date
2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Air Pollutants, Occupational - analysis
Dust - analysis
Environmental monitoring
Humans
Inhalation Exposure - analysis
Mining
Occupational Exposure - analysis
Ontario
Silicon Dioxide - analysis
Abstract
Though there is extensive research on occupational exposure in production mines, there is limited information on exposure during the exploration phase of mining.
Air samples were collected in a core processing facility in Northern Ontario, Canada. All samples were analyzed for respirable dust (NIOSH 0600) and respirable crystalline silica (NIOSH 7602). Mean exposure levels were estimated and differences in exposure between work areas were investigated.
Sixteen personal and nine area air samples were collected. Respirable dust exposure ranged from
PubMed ID
29283843 View in PubMed
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The influence of postpartum PTSD on breastfeeding: A longitudinal population-based study.

https://arctichealth.org/en/permalink/ahliterature301190
Source
Birth. 2018 06; 45(2):193-201
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
06-2018
Author
Susan Garthus-Niegel
Antje Horsch
Susan Ayers
Juliane Junge-Hoffmeister
Kerstin Weidner
Malin Eberhard-Gran
Author Affiliation
Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine of the Technische Universität Dresden, Dresden, Germany.
Source
Birth. 2018 06; 45(2):193-201
Date
06-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adult
Breast Feeding - statistics & numerical data
Female
Humans
Infant
Infant, Newborn
Logistic Models
Male
Multivariate Analysis
Norway - epidemiology
Postpartum Period - psychology
Pregnancy
Prospective Studies
Risk factors
Stress Disorders, Post-Traumatic - epidemiology - psychology
Surveys and Questionnaires
Abstract
In most Western countries, breastfeeding rates are lower than what is recommended by the World Health Organization. Depression has been shown to influence breastfeeding outcomes; however, there is very little research on the role of postpartum posttraumatic stress disorder (PTSD). This study examined to what extent maternal postpartum PTSD predicted breastfeeding initiation, exclusive breastfeeding during the first 6 months, and continuation up to 1 and 2 years.
The study is part of the large, population-based Akershus Birth Cohort. Data from the hospital's birth record and questionnaire data from 8 weeks and 2 years postpartum were used (n = 1480). All breastfeeding variables significantly correlated with postpartum PTSD were entered into stepwise logistic regression analyses.
Although most mothers (97.1%) initiated breastfeeding, considerably fewer adhered to the World Health Organization's breastfeeding guidelines about exclusive breastfeeding during the first 6 months (13.4%) or continued breastfeeding for 12 or 24 months postpartum (37.7% and 4.2%, respectively). Even after adjustment for important confounding variables, maternal postpartum PTSD was significantly associated with not initiating breastfeeding (aOR 5.98 [95% CI 1.79-19.97]). Postpartum PTSD was also significantly related to not continuing breastfeeding up to 12 months, although this association did not hold after adjusting for confounding variables.
Identifying women at risk of not initiating breastfeeding is crucial to prevent a negative influence on infant development and the development of the mother-infant bond. Early screening and treatment of women at risk of developing postpartum PTSD might be a way forward.
PubMed ID
29265443 View in PubMed
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Testing Pneumonia Vaccines in the Elderly: Determining a Case Definition for Pneumococcal Pneumonia in the Absence of a Gold Standard.

https://arctichealth.org/en/permalink/ahliterature301191
Source
Am J Epidemiol. 2018 06 01; 187(6):1295-1302
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
06-01-2018
Author
Jukka Jokinen
Marja Snellman
Arto A Palmu
Annika Saukkoriipi
Vincent Verlant
Thierry Pascal
Jeanne-Marie Devaster
William P Hausdorff
Terhi M Kilpi
Author Affiliation
Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
Source
Am J Epidemiol. 2018 06 01; 187(6):1295-1302
Date
06-01-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Bacteriological Techniques - methods - statistics & numerical data
Community-Acquired Infections - diagnosis - microbiology - prevention & control
Female
Finland - epidemiology
Humans
Latent Class Analysis
Male
Pneumococcal Vaccines - therapeutic use
Pneumonia, Pneumococcal - diagnosis - microbiology - prevention & control
Sensitivity and specificity
Streptococcus pneumoniae - growth & development - immunology
Treatment Outcome
Abstract
Clinical assessments of vaccines to prevent pneumococcal community-acquired pneumonia (CAP) require sensitive and specific case definitions, but there is no gold standard diagnostic test. To develop a new case definition suitable for vaccine efficacy studies, we applied latent class analysis (LCA) to the results from 7 diagnostic tests for pneumococcal etiology on clinical specimens from 323 elderly persons with radiologically confirmed pneumonia enrolled in the Finnish Community-Acquired Pneumonia Epidemiology study during 2005-2007. Compared with the conventional use of LCA, which is mainly to determine sensitivities and specificities of different tests, we instead used LCA as an appropriate instrument to predict the probability of pneumococcal etiology for each CAP case based on individual test profiles, and we used the predictions to minimize the sample size that would be needed for a vaccine efficacy trial. When compared with the conventional laboratory criteria of encapsulated pneumococci in culture, in blood culture or high-quality sputum culture, or urine antigen positivity, our optimized case definition for pneumococcal CAP resulted in a trial sample size that was almost 20,000 subjects smaller. We believe that the novel application of LCA detailed here to determine a case definition for pneumococcal CAP could also be similarly applied to other diseases without a gold standard.
PubMed ID
29253067 View in PubMed
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Association of Maternal Psychosocial Stress With Increased Risk of Asthma Development in Offspring.

https://arctichealth.org/en/permalink/ahliterature301192
Source
Am J Epidemiol. 2018 06 01; 187(6):1199-1209
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Date
06-01-2018
Author
Maria C Magnus
Rosalind J Wright
Espen Røysamb
Christine L Parr
Øystein Karlstad
Christian M Page
Per Nafstad
Siri E Håberg
Stephanie J London
Wenche Nystad
Author Affiliation
Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
Source
Am J Epidemiol. 2018 06 01; 187(6):1199-1209
Date
06-01-2018
Language
English
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Antidepressive Agents - therapeutic use
Asthma - drug therapy - epidemiology - psychology
Child
Cohort Studies
Depressive Disorder, Major - complications - drug therapy
Female
Humans
Life Change Events
Maternal Exposure - adverse effects
Mothers - psychology
Norway - epidemiology
Personal Satisfaction
Pregnancy
Pregnancy Complications - drug therapy - psychology
Prenatal Exposure Delayed Effects - psychology
Registries
Risk factors
Stress, Psychological - complications - drug therapy
Abstract
Prenatal maternal psychosocial stress might influence the development of childhood asthma. Evaluating paternal psychosocial stress and conducting a sibling comparison could provide further insight into the role of unmeasured confounding. We examined the associations of parental psychosocial stress during and after pregnancy with asthma at age 7 years in the Norwegian Mother and Child Cohort Study (n = 63,626; children born in 2000-2007). Measures of psychosocial stress included lifetime major depressive symptoms, current anxiety/depression symptoms, use of antidepressants, anxiolytics, and/or hypnotics, life satisfaction, relationship satisfaction, work stress, and social support. Childhood asthma was associated with maternal lifetime major depressive symptoms (adjusted relative risk (aRR) = 1.19, 95% confidence interval (CI): 1.09, 1.30), in addition to symptoms of anxiety/depression during pregnancy (aRR = 1.17, 95% CI: 1.06, 1.29) and 6 months after delivery (aRR = 1.17, 95% CI: 1.07, 1.28). Maternal negative life events during pregnancy (aRR = 1.10, 95% CI: 1.06, 1.13) and 6 months after delivery (aRR = 1.14, 95% CI: 1.11, 1.18) were also associated with asthma. These associations were not replicated when evaluated within sibling groups. There were no associations with paternal psychosocial stress. In conclusion, maternal anxiety/depression and negative life events were associated with offspring asthma, but this might be explained by unmeasured maternal background characteristics that remain stable across deliveries.
PubMed ID
29244063 View in PubMed
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Validating performance of TRISS, TARN and NORMIT survival prediction models in a Norwegian trauma population.

https://arctichealth.org/en/permalink/ahliterature301193
Source
Acta Anaesthesiol Scand. 2018 Feb; 62(2):253-266
Publication Type
Journal Article
Validation Studies
Date
Feb-2018
Author
N O Skaga
T Eken
S Søvik
Author Affiliation
Division of Emergencies and Critical Care, Department of Anaesthesiology, Oslo University Hospital Ullevål, Oslo, Norway.
Source
Acta Anaesthesiol Scand. 2018 Feb; 62(2):253-266
Date
Feb-2018
Language
English
Publication Type
Journal Article
Validation Studies
Keywords
Adult
Aged
Aged, 80 and over
Algorithms
Female
Humans
Injury Severity Score
Male
Middle Aged
Models, Statistical
Norway - epidemiology
Predictive value of tests
Reproducibility of Results
Trauma Centers
Trauma Severity Indices
Triage - statistics & numerical data
Wounds and Injuries - mortality
Wounds, Penetrating - classification - mortality
Abstract
Anatomic injury, physiological derangement, age, injury mechanism and pre-injury comorbidity are well-founded predictors of trauma outcome. Statistical prediction models may have poorer discrimination, calibration and accuracy when applied in new locations. We aimed to compare the TRISS, TARN and NORMIT survival prediction models in a Norwegian trauma population.
Consecutive patients admitted to Oslo University Hospital Ullevål within 24 h after injury, with Injury Severity Score = 10, proximal penetrating injuries, or received by trauma team, were studied. Original NORMIT coefficients were updated in a derivation dataset (NORMIT 2; n = 5923; 2005-2009). TRISS, TARN and NORMIT prediction models were evaluated in the validation dataset (n = 6348; 2010-2013) using two different AIS editions for injury coding. Exclusion due to missing data was 0.26%. Outcome was 30-day mortality. Validation included AUROC, scaled Brier statistics, and calibration plots.
The NORMIT models had significantly better discrimination, calibration, and overall fit than the TRISS 09, TARN 09 and TARN 12 models. The updated NORMIT 2 had higher numerical values of AUROC and scaled Brier than the original NORMIT, but with overlapping 95%CI. Overlapping 95%CI for AUROCs and Discrimination slopes indicated that the TARN and TRISS models performed similarly. Calibration plots showed tight and consistent predictions over all Ps strata for NORMIT 2 run on AIS'98 coded data, and only little deterioration when AIS'08 data was substituted.
In a Norwegian trauma population, the updated Norwegian survival prediction model in trauma (NORMIT 2) performed better than well-established British and US alternatives. External validation of these three models in other Nordic populations is warranted.
PubMed ID
29119562 View in PubMed
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