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Biomedical subjects

E Svensson

Publications and source records attributed to E Svensson.

At least 19 recordsLinked to original sources
PubMed2002

Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer.

BACKGROUND: Knowledge of prognostic factors following resection of rectal cancer may be used in the selection of patients for adjuvant therapy. This study examined the prognostic impact of the circumferential resection margin on local recurrence, distant metastasis and survival rates. METHODS: A national population-based rectal cancer registry included all 3319 new patients from November 1993 to August 1997. Some 686 patients underwent total mesorectal excision with a known circumferential margin. This shortest radial resection margin was measured in fixed specimens. None of the patients had adjuvant radiotherapy. RESULTS: Following potentially curative resection and after a median follow-up of 29 (range 14--60) months, the overall local recurrence rate was 7 per cent (46 of 686 patients): 22 per cent among patients with a positive resection margin and 5 per cent in those with a negative margin (margin greater than 1 mm). Forty per cent of patients with a positive margin developed distant metastasis, compared with 12 per cent of those with a negative margin. With decreasing circumferential margin there was an exponential increase in the rates of local recurrence, metastasis and death. CONCLUSION: The circumferential margin has a significant and major prognostic impact on the rates of local recurrence, distant metastasis and survival. Information on circumferential margin is important in the selection of patients for postoperative adjuvant therapy.

Adenocarcinoma↗
PubMed2001

Construction of a single global scale for multi-item assessments of the same variable.

Complex health-related concepts are commonly measured by means of multi-item scales or questionnaires. As the item scales of an instrument cover different aspects of the same variable, a single global response value is required of the concept to be measured. In this paper, different approaches that take into account the non-metric properties of ordered categorical data when aggregating multi-item scales into global scaling were suggested. A single score of equally important items is easily defined by the median. When the multi-items are constructed to identify the most serious sign of a particular state, the maximum categorical level of the items could be an appropriate single score of the variable. By means of the joint response scheme over two aspects of the same variable, a global scale with an optional number of ordered categories could be defined. Some of the multi-item scales of the Short-Form Health Survey (SF-36) and Euro-QoL were used for illustrations to the proposed approaches.

Health Surveys↗
PubMed2001

[Quality assurance of drug prescription in primary health care. A new database software makes the drug therapy surveillance easier].

Quality assurance of drug prescription is a pre-requisite for rational drug use. From 22 health-care centres in the south-western area of the Stockholm County Council region, drug-prescription data were obtained from the patients' computerised medical recordings. This could be done with the aid of a specially designed database program. The drug-prescription data from the 22 health-care centres were collected and compiled in a central unit. Thereafter the results were brought back to the health-care centres, in which the quality assurance of drug prescription could be started.

Community Health Centers↗
PubMed2001

Density-dependent competition and selection on immune function in genetic lizard morphs.

Density-dependent territorial interactions have been suggested to cause immunosuppression and thereby decrease fitness, but empirical support from natural populations is lacking. Data from a natural lizard population (Uta stansburiana) showed that breeding females surrounded by many territorial neighbors had suppressed immune function. Furthermore, variation in immunological condition had different effects on the fitness of the two heritable female throat-color morphs in this population. These interactive fitness effects caused correlational selection between female throat color and immune responsiveness. Population genetic theory predicts that this should have lead to the buildup and preservation of a genetic correlation between female morphotype and immunological condition. Accordingly, the throat color of a female was genetically correlated (r(A) = -1.36; SE = 0.55) with her daughter's immune responsiveness.

Journal Article↗
PubMed2001

Gating and braking of short- and long-term modulatory effects by interactions between colocalized neuromodulators.

Spinal locomotor networks in the lamprey are modulated by tachykinin neuropeptides. A single 10 min application of the tachykinin substance P evokes a short-term ( approximately 1 hr) presynaptic facilitation of glutamate release and the postsynaptic potentiation of NMDA responses. The latter effect induces a long-term (>24 hr) protein synthesis-dependent increase in the frequency of network activity. Tachykinins are contained in a ventromedial spinal plexus into which the medial dendrites of network neurons project. Neurons in this plexus also contain colocalized dopamine and 5-HT. Here, dynamic plasticity evoked by modulator interactions has been examined by investigating the effects of 5-HT and dopamine on specific cellular, synaptic, and network effects of substance P. Preapplied 5-HT blocked the substance P-mediated increase in the network burst frequency and the potentiation of NMDA-evoked cellular responses that underlies its induction. 5-HT also blocked the presynaptic facilitation of glutamatergic synaptic transmission by substance P. The presynaptic, but not postsynaptic, effect of 5-HT was reduced by the protein phosphatase 2B inhibitor cypermethrin. Dopamine did not directly modulate the effects of substance P. However, it reduced the presynaptic interactive effect of 5-HT and thus gated the presynaptic potentiation of glutamatergic inputs by substance P. However, the substance P-mediated potentiation of NMDA responses was not gated by dopamine, and thus the long-term network modulation was not induced. Neuromodulator effects and their interactions can thus be modulated. By selecting components from the modulatory repertoire of substance P, these interactions evoke dynamic changes in short- and long-term synaptic and network plasticity.

Animals↗
PubMed2001

Development of an ADL instrument targeting elderly persons with age-related macular degeneration.

BACKGROUND: In order to estimate the needs of early intervention in a health education program, an ADL instrument measuring feelings of (in)security was needed. The instrument was intended to detect early signs of decline and to evaluate ADL performance among persons with AMD. An evaluative instrument must have a high level of responsiveness, which is the ability to detect true changes over time but must also show a high level of intra-individual agreement in a test-retest assessment. PURPOSE: The purpose of this study was to develop an ADL instrument for evaluative purposes and to establish the reliability and the responsiveness of the instrument. METHOD: The target group comprised all persons referred by an ophthalmologist for low vision rehabilitation, 65 years and older, living at home, with aged-related macular degeneration as the primary diagnosis and with distance visual acuity of the better eye with best correction not lower than 0.1. A non-parametric statistical method that is developed for paired ordered parametrical data was applied in order to measure the systematic and occasional intra-rater disagreement separately and to measure the responsiveness. CONCLUSION: The test-retest study showed that the ADL-instrument had a high level of test-retest stability, which is a condition for responsiveness. The instrument was found to be responsive. It could therefore detect true longitudinal changes and be used for evaluative purposes targeting elderly with AMD.

Activities of Daily Living↗
PubMed2001

Astheno-emotional disorder after aneurysmal SAH: reliability, symptomatology and relation to outcome.

OBJECTIVES: Neuropsychiatric symptoms commonly found after aneurysmal SAH are covered in the astheno-emotional disorder (AED) of Lindqvist & Malmgrens diagnostic system for organic psychiatry. This study aims to describe the reliability and symptomatology of AED and its relationship with social outcome. MATERIAL AND METHODS: Patients referred due to aneurysmal SAH (n=78) were assessed after 1-6 months for AED inter-rater reliability (n=36) and after 12 months for AED severity grade, symptomatology and Glasgow Outcome Scale (GOS) (n=63). RESULTS: There was no systematic error in diagnosing and grading AED, and the agreement was 85% and 67% respectively (kappa=0.65 and 0.52). Fatigability, concentration difficulties and memory difficulties were the most frequent symptoms of AED. The relationship between AED and "moderate disability" of GOS was highly significant (P<0.00006). CONCLUSIONS: AED affects social outcome, and can be diagnosed with high reliability even without neuropsychological testing. Use of the AED diagnosis for evaluation of organic mental symptoms is encouraged.

Adult↗
PubMed2001

Pain assessment in children with juvenile chronic arthritis: a matter of scaling and rater.

UNLABELLED: Twenty-six children with juvenile chronic arthritis and their parents participated in the study. We compared the assessments of pain perceived by the children on a visual analogue scale (VAS) with assessments on a 4-point verbal descriptor scale (VDS-4). In children aged 10 y and older, the pain assessment results of the children and the parents were compared. The discordance in paired data from the scale comparisons and from the inter-rater comparisons was evaluated using a statistical method developed for ordinal data. The preference of scale and motivation of the older children were summarized. CONCLUSION: The parents and children used the VAS and the VDS-4 differently. The children showed a higher inter-scale discordance compared with the parents and they gave their pain a higher rating on the VAS but a lower rating on the VDS-4 than their parents. The VAS was preferred by the children but did not show the most reliable results.

Adolescent↗
PubMed2001

Measures of order consistency between paired ordinal data: application to the Functional Independence Measure and Sunnaas index of ADL.

The aim was to evaluate the inter-item consistency between corresponding items in the Functional Independent Measure (FIM) and Sunnaas index of ADL (SI) by means of a statistical approach that takes account of the nonmetric properties of ordinal data. The ADL dependence in 204 stroke patients was assessed by interview 3 months after the onset of stroke. The result showed that the inter-item consistency between the FIM and SI were high for many items, but operational differences between some FIM and SI items were also identified. The statistical evaluation demonstrated that some of the ordered categorical levels of the seven-point item scales in the FIM could be aggregated into four levels without loss of information.

Activities of Daily Living↗
PubMed2001

Antimicrobial susceptibility patterns of enterococci in intensive care units in Sweden evaluated by different MIC breakpoint systems.

Three hundred and twenty-two (322) clinical isolates were collected from patients admitted to intensive care units (ICUs) at eight Swedish hospitals between December 1996 and December 1998. Of the isolates, 244 (76%) were Enterococcus faecalis, 74 (23%) were Enterococcus faecium and four (1%) were other Enterococcus spp. MICs of ampicillin, imipenem, meropenem, piperacillin/tazobactam, ciprofloxacin, trovafloxacin, clinafloxacin, gentamicin, streptomycin, vancomycin, teicoplanin, quinupristin/dalfopristin, linezolid and evernimicin were determined by Etest. Susceptible and resistant isolates were defined according to the species-related MIC breakpoints of the British Society for Antimicrobial Chemotherapy (BSAC), the National Committee for Clinical Laboratory Standards (NCCLS) and the Swedish Reference Group for Antibiotics (SRGA). Tentative breakpoints were applied for new/experimental antibiotics. Multidrug resistance among enterococci in ICUs is not uncommon in Sweden, particularly among E. faecium, and includes ampicillin resistance and concomitant resistance to fluoroquinolones. Almost 20% of E. faecalis isolates showed high-level resistance to gentamicin and concomitant resistance to fluoroquinolones. Vancomycin-resistant enterococci were only found sporadically. Among the new antimicrobial agents, linezolid and evernimicin showed the best activity against all enterococcal isolates. There was good concordance between the BSAC, NCCLS and SRGA breakpoints in detecting resistance. When applying the SRGA breakpoints for susceptibility, isolates were more frequently interpreted as intermediate. This might indicate earlier detection of emerging resistance using the SRGA breakpoint when the native population is considered susceptible, but with the risk that isolates belonging to the native susceptible population will be incorrectly interpreted as intermediate.

Anti-Bacterial Agents↗
PubMed2001

Condition, genotype-by-environment interaction, and correlational selection in lizard life-history morphs.

We compared reproductive allocation and variation in condition and survivorship of two heritable female throat color morphs (orange and yellow) in a free-living population of side-blotched lizards (Uta stansburiana). Using path analysis and structural equation modeling, we investigated how variation in the social environment affected clutch size and egg mass and two condition traits (postlaying mass, immunological condition) and how these traits in turn affected female field survival. In the presence of many neighbors, both morphs increased their clutch sizes, although these effects were only significant in yellow females. In addition, yellow females increased their egg mass in the presence of many orange neighbors. Orange females surrounded by many orange neighbors showed sign of stress in the form of immunosuppression, whereas this effect was less pronounced in yellow females. The morphs also differed in the impact of variation in clutch size and egg mass on both condition traits. Finally, female morphotype and immune responsiveness affected fitness interactively, and hence these two traits showed signs of fitness epistasis: Selection gradients on this trait were opposite in sign in the two morphs. The correlational selection gradient (gamma throat x antibody response) between female throat color and antibody responsiveness was -0.365. Our data thus reveal important interactive effects such as genotype-by-environment interaction toward the social environment and morph-specific trade-offs as well as the occurrence of correlational selection. We discuss the use of naturally occurring and conspicuous genetic polymorphisms in field studies of selection and life-history allocation.

Animals↗
PubMed2001

Construct validity of ILAR and EULAR criteria in juvenile idiopathic arthritis: a population based incidence study from the Nordic countries. International League of Associations for Rheumatology. European League Against Rheumatism.

OBJECTIVE: New classification criteria (ILAR) have been proposed for juvenile idiopathic arthritis (JIA). They are more descriptive than those formerly used [American College of Rheumatology (ACR), European League Against Rheumatism (EULAR)], but require validation against classifications already in use. We validated the ILAR criteria in relation to the EULAR criteria in a prospective, incidence, and population based setting, and analyzed their feasibility. METHODS: Construct validity of ILAR and EULAR classification criteria refers to how closely the 2 instruments are related and how each of them operates in classifying subgroups/categories. Twenty doctors in 5 Nordic countries collected data from the incidence cases within their catchment areas during an 18 month period beginning July 1, 1997. Clinical and serological data from the first year of disease were collected. RESULTS: A total of 322 patients were included. Classification according to the ILAR criteria was possible in 321 patients; 290 patients had a disease duration > or = 3 months and were classified according to the EULAR criteria. One child could only be classified according to the EULAR criteria. Thus, 31/322 (9.6%) children were classified according to the ILAR criteria only. Forty-eight of 321 (15%) patients did not fit into any category and 6% (20/321) fulfilled criteria for2 categories. In the ILAR classification 5 out of 7 categories/subgroups have 2 to 5 specified exclusion criteria that highly discriminate the definition of each patient. In our study the exclusion criteria were fulfilled to only a small extent. CONCLUSION: The EULAR and ILAR criteria differ concerning the operational definitions of the subvariables involved, which complicates their comparison. By using ILAR rather than EULAR criteria the number of cases with juvenile arthritis increased by 10%, considering the first half-year after onset. The validity of the ILAR criteria is low since they often exclude patients from subgroup classification and the possibility of having more than one diagnosis is not negligible. The specified exclusion criteria for some of the subgroups are difficult to fulfill in clinical work and variables involved could be questioned with regard to their consistency.

Adolescent↗
PubMed2000

Concordance between ratings using different scales for the same variable.

Qualitative variables are commonly measured by means of different types of rating scales that produce ordered categorical data. The number of response categories in a scale can be chosen arbitrarily according to different operational definitions of the attribute to be measured. In the present paper classical measures based on the difference between the probabilities of concordant and discordant pairs of classifications were compared with a novel approach for assessment of order consistency between rating scales. In the new approach, illustrated by an assessment of pain, the concordant and discordant pairs are related to the pattern of total order consistency, irrespective of the scaling and the categorical distributions. The level of order consistency between a visual analogue scale (VAS) and a discrete scale for the same variable was evaluated. The non-linear properties of VAS assessments were demonstrated. The inter-scale consistency between the discrete scale and different approaches to grouping VAS responses into discrete scales showed that equidistant rescaling of VAS assessments resulted in an inter-scale bias.

Calibration↗
PubMed2000

Parallel reliability of the functional independence measure and the Barthel ADL index.

PURPOSE: The aim of this study was to evaluate the concordance between the assessments of ADL according to the Functional Independence Measure (FIM) and the Barthel ADL index (BI) by means of a rank-invariant statistical method. METHOD: The construct validity, also called parallel reliability, of FIM and BI was assessed on the item level. Two different approaches to condensing the FIM assessments into 2-4 scale steps on the item level in order to calibrate the two ADL instruments were compared. One was determined by the theoretical operational definitions and the other defined by the empirical definitions. The 204 assessments of elderly persons were made three months after stroke by means of interviews. RESULTS: The parallel reliability of the FIM and the BI on the item level was strong, both according to the theoretical cut-off levels defined by the operational definitions and the empirical cut-off levels defined by the marginal distributions. CONCLUSIONS: The concordance between FIM and BI was high. There was a slight difference in favour of the operational definitions. The clinical key elements are to have a critical attitude towards ADL instruments; how they are constructed and operationalized. These are important elements in the quality assurance in the everyday work.

Activities of Daily Living↗
PubMed2000

Density cycles and an offspring quantity and quality game driven by natural selection.

A long-standing hypothesis posits that natural selection can favour two female strategies when density cycles. At low density, females producing many smaller progeny are favoured when the intrinsic rate of increase, r, governs population growth. At peak density, females producing fewer, high-quality, progeny are favoured when the carrying capacity, K, is exceeded and the population crashes. Here we report on the first example of a genetic r versus K selection game that promotes stable population cycles in lizards. Decade-long fitness studies and game theory demonstrated that two throat-colour morphs were refined by selection in which the strength of natural selection varied with density. Orange-throated females, r strategists, produced many eggs and were favoured at low density. Conversely, yellow-throated females, K strategists, produced large eggs and were favoured at high density. Progeny size should also be under negative frequency-dependent selection in that large progeny will have a survival advantage when rare, but the advantage disappears when they become common. We confirmed this prediction by seeding field plots with rare and common giant hatchlings. Thus, intrinsic causes of frequency- and density-dependent selection promotes an evolutionary game with two-generation oscillations.

Animals↗
PubMed2000

Visual function in school-aged children born before 29 weeks of gestation: a population-based study.

The aim of this study was to assess visual function, including visual perception, in a geographically-based population of school-aged children, with a median age of 7.2 years (range 5.1 to 9.3 years), born before 29 weeks of gestation to mothers living in Goteborg, Sweden. Fifty-one preterm children participated in the study, six of whom had known brain lesions. Visual acuity, visual fields, stereoacuity, and visual perception were tested. The Test of Visual Perceptual Skills Revised (TVPS-R, Gardner 1996) was used to measure visual perception, and the results were compared with those of 50 term (control) subjects. Six percent of the preterm children were visually impaired, with a visual acuity of less than 0.3 (6/18), while 42% of all the preterm children and 34% of those without known brain lesions had a total score below the 5th centile of the reference material for the test, compared with 14% of the control subjects. In conclusion, visual-perceptual problems seem to be common among very preterm children and should be screened for and assessed before the children start school.

Child↗
PubMed2000

Ocular fundus abnormalities in children born before 29 weeks of gestation: a population-based study.

PURPOSE: Preterm birth has been found to be associated with increased morbidity of the central nervous and vascular tissues. To investigate the influence of preterm birth on the optic disc and retinal vessels, we examined the ocular fundus in school-aged children born very preterm. METHODS: A prospective, population-based study was performed in 50 very preterm children (median age 7 years, range 5-9 years) with a median gestational age at birth of 27 weeks (range 24-28 weeks) and a median birth weight of 1055 g (range 450-1520 g). The ocular fundus was examined by ophthalmoscopy in 50 children, and the optic nerve and retinal vessel morphology was evaluated by digital image analysis of ocular fundus photographs in 45 of these children. RESULTS: The median optic disc area was significantly smaller (p = 0.0002) in the preterm children compared with a reference group. There was no difference in cup area and, consequently, the rim area was significantly smaller (p = 0.0002) in the preterm children. Children with early signs of brain lesions commonly had a rim area below the median of the reference group. Preterm children also commonly had an abnormal retinal vascular pattern that was independent of a previous history of retinopathy of prematurity. CONCLUSION: Very preterm birth was associated with subnormal optic disc and rim areas and an abnormal vascular pattern. The findings clearly demonstrate the effect of preterm birth on the development of these structures. The long term clinical prognosis of these findings has yet to be determined.

Adolescent↗