Neurogenic bladder-sphincter dysfunction (NBSD) constitutes the major reason for morbidity in children with spina bifida. The aim of this study was to identify risk factors for renal damage in children with NBSD followed according to the Swedish national guidelines.
Records and cystometries from 6 to 16 years (median 11) follow up of 41 consecutive children born 1993-2003 with NBSD were evaluated. The children were divided into a high pressure group (baseline pressure above 30 cmH(2)O at maximal clean intermittent catheterization volume in at least two cystometries) and a low pressure group. Most children (34/41) were followed from birth.
Although renal scarring on DMSA-scintigraphy was found in 5/41 children, all but one had normal renal function. Two already had renal scars on entering the follow-up program at age 2.5 and 3 years. Renal scarring was more frequent in the high pressure group (P
To determine the time to and key factors associated with decision to update comparative effectiveness of reviews of drugs based on periodic scans of new evidence.
Based on periodic scans of new evidence, we analyzed 69 decisions on whether to update for 41 comparative effectiveness reviews conducted for the Drug Effectiveness Review Project. We used the Kaplan-Meier product limit method to estimate mean time to update and generalized estimating equation logistic regression to estimate associations between updating decisions and review topic or characteristics of new evidence.
Mean time to update was 24.9 months. Significant predictors of a decision to update were identification of a new drug (odds ratio [OR]: 5.71; 95% confidence interval [CI]: 1.68-19.44) and the number of new relevant trials (OR: 1.06; 95% CI: 1.03-1.10). Compared with nonpsychiatric topics, psychiatric topics were most rapidly developing (mean new relevant citations: 38.4 vs. 8.2; P=0.0127) and were updated at a faster pace (mean survival time: 10.2 vs. 27.5 months; P
Evaluate the internal construct validity of the Australian/Canadian (AUSCAN) index for hand osteoarthritis (HOA) and identify the physical function instrument with best performance.
AUSCAN, AIMS-2 (Arthritis Impact Measurement Scale 2), and Functional Index of HOA (FIHOA) were self-completed by 209 HOA patients (mean [standard deviation] age 61.6 [5.7] years) at baseline and 128 at follow-up. Rasch analysis was performed.
AUSCAN pain, physical function, and stiffness subscales comprised three constructs. AUSCAN scale performance was improved after removal of "Pain at rest" from the pain scale and division of physical function into two scales of high precision and grip strength tasks. AIMS-2 hand/finger subscale and FIHOA were improved after removal of one and two items, respectively and collapse of two AIMS-2 response categories. AUSCAN physical function scale showed better targeting to the sample and higher person reliability compared with FIHOA and especially AIMS-2 because of less "severe" items concerning grip strength tasks as opposed to precision tasks.
The AUSCAN subscales, AIMS-2 hand/finger scale, and FIHOA were not unidimensional. However, deletion of misfitting items improved scale performance. The revised AUSCAN physical function and FIHOA scales are preferable for measurement of grip strength and precision tasks, respectively.
We present an overview of the injuries seen at the emergency department of a regional hospital in northern Sweden and the variations in the injury pattern with age, sex and time.
Data consisting of all injuries sustained by those 0-19 years of age seen at the emergency department of Umeå University Hospital between 1998 and 2008 (41,330 injury events) were analysed with respect to injury type, mechanism, activity, age and sex. Rates were calculated using population data from Statistics Sweden.
The rate of injury related visits to the emergency department was 110/1000 person years. The most common causes of visits to the emergency department were minor injuries such as contusions, abrasions and open wounds. 12% of the injuries resulted in admission to a ward. Variations in type of injury, mechanism and activity at injury were noted, in particular with age, but also with sex. We noted a 31% rate increase of visits to the hospital's emergency department between 1998 and 2008, rate ratio 1.31 (1.27-1.38). There was no significant increase in the rate of injuries resulting in hospitalisation.
Our results give an estimate of the rate of all injuries and subsets of injuries resulting in visits to the only hospital emergency department within a well defined catchment area. It was not possible to determine whether the increased rate of visits to the ED was due to an increase in the actual rate of injuries within the catchment area. The variations seen in different age groups reflect the hazards associated with different periods in growth and the ability to cope with these. The results point to areas where improved preventive measures may be implemented or where further research may be of value.
To analyze the regular dental care behavior and prevalence of edentulism in adult Danes, reported in sequential cross-sectional oral health surveys by the application of a marginal approach to consider the possible clustering effect of birth cohorts.
Data from four sequential cross-sectional surveys of non-institutionalized Danes conducted from 1975-2005 comprising 4330 respondents aged 15+ years in 9 birth cohorts were analyzed. The key study variables were seeking dental care on an annual basis (ADC) and edentulism. For the analysis of ADC, survey year, age, gender, socio-economic status (SES) group, denture-wearing, and school dental care (SDC) during childhood were considered. For the analysis of edentulism, only respondents aged 35+ years were included. Survey year, age, gender, SES group, ADC, and SDC during childhood were considered as the independent factors. To take into account the clustering effect of birth cohorts, marginal logistic regressions with an independent correlation structure in generalized estimating equations (GEE) were carried out, with PROC GENMOD in SAS software.
The overall proportion of people seeking ADC increased from 58.8% in 1975 to 86.7% in 2005, while for respondents aged 35 years or older, the overall prevalence of edentulism (35+ years) decreased from 36.4% in 1975 to 5.0% in 2005. Females, respondents in the higher SES group, in more recent survey years, with no denture, and receiving SDC in all grades during childhood were associated with higher probability of seeking ADC regularly (P
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The butyrophilin-like 2 (BTNL2) gene is located on chromosome 6p21.3 close to the HLA-class II genes. An association has been reported between sarcoidosis and a single nucleotide polymorphism in BTNL2, rs2076530, also termed the A allele.
To evaluate whether patients with sarcoidosis carry the A allele more frequently than healthy subjects.
The series comprised 87 ethnic Danes with sarcoidosis and 113 healthy control subjects. Analysis of rs2076530 was performed by Taqman assay, polymerase chain reaction and sequencing of genomic DNA.
Sarcoidosis patients had a higher frequency of the A allele than controls (73.9% vs 55.8%) (P
There is limited experience with implementation of chronic obstructive pulmonary disease (COPD) rehabilitation in primary care settings. We aimed to evaluate the implementation of a COPD rehabilitation programme in a primary care setting and compare the effects with those obtained in a secondary health-care setting.
The same outpatient multidisciplinary 7-week rehabilitation programme was implemented in a primary (day care nursery) and a secondary (hospital) health-care setting. Disease-specific quality of life (QoL) and endurance shuttle walking time (ESWT) was assessed at the start and end of the programme. Additionally, QoL was assessed again at a 3-months follow-up.
No serious problems or adverse events were encountered during the training/rehabilitation sessions. A total of 48 patients (81.3%) and 75 patients (84.2%) completed the 7-week rehabilitation programme in the primary and secondary settings, respectively. Within both centres, we found statistically significant improvements of ESWT and total St. George's Respiratory Questionnaire score. The improvement of ESWT was significantly greater in the secondary care setting than in the primary care setting.
we found that it was possible to implement a COPD rehabilitation programme in a Danish primary care setting. In this non-randomised study, improvements of QoL and ESWT obtained in the primary care setting were reasonably similar to those obtained in the secondary care setting.
Smoking remains a significant health problem. Smoking interventions are important but selection of successful quitters can be difficult.
To characterise smokers with emphasis on two constructs of the transtheoretical model, the stages of change and decisional balance.
A random sample from adults aged 40 and over in Reykjavik, Iceland, and Uppsala, Sweden. Smokers were defined as being in the stage of pre-contemplation (not thinking of quitting within the next 6 months), contemplation (thinking of quitting within the next 6 months) or preparation (thinking of quitting within the next 30 days, having managed to quit for at least 24 h within the last 12 months).
A total of 226 participants were smokers: 72 (32%) were in the pre-contemplation stage, 126 (56%) in the contemplation stage and 28 (12%) in the preparation stage. A younger age, higher body mass index (BMI) and higher educational level were significantly related to being in a more advanced stage. A significant association was observed between decisional balance and stages of change such that decreased importance of the positive aspects of smoking and increased importance of the negative aspects of smoking were independently associated with an increased readiness to quit.
The motivated smoker is likely to be young and educated with an above average BMI. A smoker in the contemplation stage is likely to maintain the negative aspects of smoking at a high level. Decreasing the value of the pros of smoking may facilitate the shift towards the stage of preparation.
Out-of-pocket expenses of drug therapy may negatively affect adherence. We aimed to analyse 1-year discontinuation rates between cohorts initiating therapy with either generic simvastatin or non-generic atorvastatin.
Statin-naìve initiators of atorvastatin and generic simvastatin in April-June 2003, and corresponding cohorts in 2005, were identified through the nationwide Finnish prescription register. Persistence with statin therapy was followed for 365 days, considering the treatment to have been discontinued when the tablet-free gap between two consecutive refills exceeded 90 days. Using multivariate-adjusted logistic regression, odds ratios (OR) for discontinuation associated with initiating with simvastatin vs. atorvastatin were estimated separately for each year.
In the year 2003, 5838 persons initiated treatment with atorvastatin and 5644 with generic simvastatin. In the year 2005, the respective numbers were 5228 and 10 987. Soon after the introduction of generic substitution in 2003, there was no difference in the risk of discontinuation between the comparator groups [OR 0·97, 95% confidence interval (CI) 0·89-1·05]. Two years later, persons initiating with generic simvastatin were 20% less likely to discontinue statin therapy (OR 0·80; 95% CI 0·74-0·83). Among persons whose medicinal costs were almost completely reimbursed towards the end of the initiation year, the OR was 1·14 (95% CI 0·76-1·64, P = 0·033 for interaction).
We found that lower out-of-pocket expenses associated with the initiating statin had a positive impact on persistence with therapy. The finding does not seem to apply to persons with minor copayments towards the end of the initiation year.