Biomedical subjects

Elisabeth Svensson

Publications and source records attributed to Elisabeth Svensson.

At least 19 recordsLinked to original sources

PubMed2006

Frailty modelling of colorectal cancer incidence in Norway: indications that individual heterogeneity in risk is related to birth cohort.

Some cancer types level off or decrease in incidence at older age groups, not following the Weibull hazard rate. This stagnation can be explained by the frailty model, which describes the population effect of mixing individuals who are susceptible, with high risk of cancer, with those that are "non-susceptible", with a low risk of cancer even in the oldest age groups. The aim of the study was to apply a frailty model on colorectal cancer incidence data for the Norwegian population aged 40-99 years, diagnosed 1956-2000. The model provided an acceptable fit to the data. The estimated proportion of susceptibles increased from about 5% to about 24% from the first cohort (1851-1855) to the last cohort (1946-1950), in line with the rise in incidence of the disease during this period. According to the frailty modelling, the estimated number of genetic events necessary for a malignant lesion to develop in the colorectum is seven to eight, which accords with the present knowledge regarding colorectal carcinogenesis. The frailty phenomenon may thus be present in this cancer form. The findings indicate that it is possible to model the development of colorectal cancer in the population based on large heterogeneity in risk between individuals, in such a manner that a small group of individuals are susceptible to develop the disease, whereas the remaining majority have a low susceptibility.

Adult↗

PubMed2006

Corticotropin releasing factor in urine--a possible biochemical marker of fibromyalgia. Responses to massage and guided relaxation.

The purpose of this preliminary study was to evaluate the relationship between a possible biochemical marker of stress, 24-h urinary concentrations of Corticotropin Releasing Factor-Like Immunoreactivity (CRF-LI), and ratings of stress-related symptoms like depression and anxiety, as well as to evaluate pain and emotional reactions in patients with fibromyalgia (FM). Another purpose was to study the effects of massage and guided relaxation, with respect to change in the same variables. Urine sampling and ratings were performed before treatments, after and 1 month after completed treatments. Concentrations of CRF-LI was analysed with radioimmnoassay technique. For the assessment of depression, anxiety and pain the CPRS-A questionnaire was used and for rated pain and emotional reactions the NHP questionnaire was used. The 24-h urinary concentration of the CRF-LI was found to be related to depression, mood and inability to take initiative. After treatment the urinary CRF-LI concentrations and the rated levels of pain and emotional reactions were found to have decreased. In conclusion, the 24-h urinary CRF-LI concentration may be used as a biochemical marker of stress-related symptoms such as depression in patients with FM and possibly also other conditions characterized by chronic pain. Therapies such as massage and guided relaxation may be tried for the amelioration of pain and stress but further studies are required.

Anxiety↗

PubMed2006

Decrease of pregnant women's pelvic pain after acupuncture: a randomized controlled single-blind study.

BACKGROUND: The efficacy of acupuncture on low-back and/or pelvic pain in late pregnancy is reviewed in few reports. Our aim was to evaluate the effects of two different acupuncture stimulation modes on pelvic pain intensity and some emotional symptoms due to the pain condition. METHODS: In a prospective randomized controlled single-blind study, pregnant women with pelvic pain, median gestational age 26 weeks (range 18-35), were given 10 acupuncture treatments. Needles were inserted subcutaneously over acupuncture points without further stimulation (superficial, n=22), or intramuscular and stimulated repeatedly until a perceived sensation of numbness, de qi, (deep, n=25). Self-reported pain intensity at rest and during daily activities was assessed on a visual analog scale. The variables pain, emotional reactions, and loss of energy were assessed according to the Nottingham Health Profile questionnaire. Changes in assessed variables were analyzed with a nonparametric statistical method allowing for analysis of systematic group changes separated from additional individual changes. RESULTS: After acupuncture stimulation, significant systematic group changes towards lower levels of pain intensity at rest and in daily activities as well as in rated emotional reaction and loss of energy were seen. The results also showed additional individual changes in most variables. In this study, no differences between the effects induced by the superficial and deep acupuncture stimulation modes were observed. CONCLUSION: Acupuncture stimulation that is individually designed may be a valuable treatment to ameliorate suffering in the condition of pelvic pain in late pregnancy.

Activities of Daily Living↗

PubMed2006

Hand function in Charcot Marie Tooth: test retest reliability of some measurements.

OBJECTIVE: To evaluate the reliability of some measurements of hand function in people with Charcot Marie Tooth disease. DESIGN: Test retest study. SETTING: University, hospitals/clinics in northern Sweden. SUBJECTS: Twenty people with Charcot Marie Tooth disease. MAIN OUTCOME MEASURES: Measures of (1) dexterity; Box and Block Test and Nine-Hole Peg Test, (2) strength; Grippit instrument (grip and pinch), (3) tactile sensation; Shape Texture Identification Test. Statistics used: intraclass correlation (ICC 2.1), limits of agreement, coefficient of repeatability, coefficient of variation, and linear weighted kappa. RESULTS: The ICC for the Box and Block Test was very high (0.95). The limits of agreement, coefficient of repeatability (CR) (11.5 blocks/min) and coefficient of variation (CV) (8.4%) were acceptable. There was bias towards a better result on the second occasion. For the Nine-Hole Peg Test, the reliability was good if performance was within 2 min (ICC =0.99, CR = 4.3 s, CV = 3.9%). Grip strength proved to be reliable (ICC = 0.99, CR = 26.7 N, CV = 6.6%), while pinch strength was less reliable. The kappa value of the Shape Texture Identification Test was 0.87, which was considered very good although the test has limitations in terms of how well it can describe patients either performing very well or very poorly. CONCLUSIONS: The tested instruments can all be used to evaluate hand function in people with Charcot Marie Tooth. Certain factors, however, like limited time aspects for the Nine-Hole Peg Test and the number of trials used, should be taken into consideration. Pinch strength evaluation should be interpreted with caution.

Adult↗

PubMed2005

Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups.

BACKGROUND: Rating scales like the visual analogue scale, VAS, and the verbal rating scale, VRS, are often used for pain assessments both in clinical work and in research, despite the lack of a gold standard. Interchangeability of recorded pain intensity captured in the two scales has been discussed earlier, but not in conjunction with taking the influence of pain etiology into consideration. METHODS: In this cross-sectional study, patients with their pain classified according to its etiology (chronic/idiopathic, nociceptive and neuropathic pain) were consecutively recruited for self-assessment of their actual pain intensity using a continuous VAS, 0-100, and a discrete five-category VRS. The data were analyzed with a non-parametric statistical method, suitable for comparison of scales with different numbers of response alternatives. RESULTS: An overlapping of the VAS records relative the VRS categories was seen in all pain groups. Cut-off positions for the VAS records related to the VRS categories were found lower in patients with nociceptive pain relative patients suffering from chronic/idiopathic and neuropathic pain. When comparing the VAS records transformed into an equidistant five-category scale with the VRS records, systematic disagreements between the scales was shown in all groups. Furthermore, in the test-retest a low percentage of the patients agreed to the same pain level on the VAS while the opposite hold for the VRS. CONCLUSION: The pain intensity assessments on VAS and VRS are in this study, not interchangeable due to overlap of pain records between the two scales, systematic disagreements when comparing the two scales and a low percentage intra-scale agreement. Furthermore, the lower VAS cut-off positions relative the VRS labels indicate different meaning of the rated pain intensity depending on pain etiology. It is also indicated that the scales have non-linear properties and that the two scales probably have different interpretation. Our findings are in favor of using the VRS in pain intensity assessments but if still the VAS is preferred, the VAS data should be analyzed as continuous using statistical methods suitable for ordinal data. Furthermore, our findings indicate a risk to over or under estimate the patient's perceived pain when interpreting condensed VAS data.

Adult↗

PubMed2004

Gender differences in electrical pain threshold responses to transcutaneous electrical nerve stimulation (TENS).

Gender differences in pain perception have been frequently discussed, but the documented gender-related pain-alleviating effects of non-pharmacological methods are sparse. In this study we aimed to investigate changes in electrical sensory thresholds and electrical pain thresholds, in response to high frequency transcutaneous electrical nerve stimulation, TENS, for 20 min in healthy women (n=29) and men (n=29). The thresholds were assessed pre-, during-, and post-TENS. The pattern of change in thresholds was evaluated with a rank-based statistical method regarding the level of systematic change, expressed as relative position (RP) and additional individual changes, expressed as relative rank variance (RV), with its 95% confidence intervals. Equal levels of systematic changes towards increased electrical sensory thresholds were seen in women and men post-TENS (RP, 0.35; 95% CI, 0.07, 0.63, and RP, 0.36; 95% CI, 0.17, 0.53, respectively). At the same point of time, systematic changes towards increased electrical pain thresholds were only seen in women (RP, 0.43; 95% CI, 0.27, 0.60), while they were unchanged in men (RP, -0.01; 95% CI, -0.13, 0.10). Significant additional individual variations were found in the women's responses of assessed electrical sensory and pain thresholds but not in the men's. It is concluded that both women and men responded with a significant increase of the electrical sensory threshold to high frequency TENS, but only women responded with increase of the electrical pain thresholds. The individual variation of the responses was greater in the women than in the men.

Adult↗

PubMed2004

Effect of problem-based learning on stages of change for exercise behaviour in patients with coronary artery disease.

BACKGROUND AND PURPOSE: Physical activity plays an important part in preventing coronary artery disease and is targeted in most rehabilitation and education programmes. The aim of the present study was to evaluate stages of change for exercise behaviour in patients with a recent event of coronary artery disease. METHOD: A randomized two-group, pre--post-test design was used. Fifty-seven subjects were included in the problem-based learning intervention group and 61 subjects were included in the traditional rehabilitation control group. Data were analysed by intention-to-treat. A single-item five-category scale, based on the 'Stages of Change' model was used to measure the level of exercise behaviour. The statistical analysis used two non-parametric approaches for ordered categorical data. RESULTS: There was a significant systematic change over time towards the extreme scale categories in both groups. This suggested that individuals who were inactive before the intervention regressed, whereas individuals with some interest in physical activity remained static or improved. No significant differences between groups were found. CONCLUSION: Problem-based learning did not significantly influence patients' progression through exercise behaviour stages. Rehabilitation teams should be observant of inactive participants and their greater risk of regression.

Coronary Artery Disease↗

PubMed2004

Non-parametric evaluation of memory changes at group and individual level following temporal lobe resection for pharmaco-resistant partial epilepsy.

Group versus individual verbal and visuospatial memory outcome following epilepsy surgery was evaluated by a non-parametric method in 25 left and 29 right temporal lobectomy patients. Twenty-five controls were assessed twice. Analyses of change at an individual level evaluated by this statistical approach based on paired-ranks were compared to results with a method based on distances (Reliable Change). The left temporal lobectomy group deteriorated in the two verbal memory variables (p < 0.01 and 0.05). High levels of individual changes unexplained by group patterns were disclosed in the three memory variables analyzed in the patients. Significant individual change, although less pronounced, also occurred in the controls. Group versus individual outcome was adequately distinguished by the non-parametric method. To properly analyze memory change after epilepsy surgery, evaluation at group and individual level ought to combined.

Adult↗

PubMed2003

Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth.

OBJECTIVE: Insulin-like growth factor I (IGF-I) is necessary for normal development of retinal blood vessels in mice and humans. Because retinopathy of prematurity (ROP) is initiated by abnormal postnatal retinal development, we hypothesized that prolonged low IGF-I in premature infants might be a risk factor for ROP. DESIGN: We conducted a prospective, longitudinal study measuring serum IGF-I concentrations weekly in 84 premature infants from birth (postmenstrual ages: 24-32 weeks) until discharge from the hospital. Infants were evaluated for ROP and other morbidity of prematurity: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). RESULTS: Low serum IGF-I values correlated with later development of ROP. The mean IGF-I +/- SEM level during postmenstrual ages 30-33 weeks was lowest with severe ROP (25 +/- 2.41 micro g/L), 29 +/- 1.76 micro g/L with moderate ROP, and 33 +/- 1.72 micro g/L with no ROP. The duration of low IGF-I also correlated strongly with the severity of ROP. The interval from birth until serum IGF-I levels reached >33 micro g/L was 23 +/- 2.6 days for no ROP, 44 +/- 4.8 days for moderate ROP, and 52 +/- 7.5 days for severe ROP. Each adjusted stepwise increase of 5 micro g/L in mean IGF-I during postmenstrual ages 30 to 33 weeks decreased the risk of proliferative ROP by 45%. Other complications (NEC, BPD, IVH) were correlated with ROP and with low IGF-I levels. The relative risk for any morbidity (ROP, BPD, IVH, or NEC) was increased 2.2-fold (95% confidence interval: 1.41-3.43) if IGF-I was <or=33 micro g/L at 33 weeks' postmenstrual age. CONCLUSIONS: These results indicate that persistent low serum concentrations of IGF-I after premature birth are associated with later development of ROP and other complications of prematurity. IGF-I is at least as strong a determinant of risk for ROP as postmenstrual age at birth and birth weight.

Birth Weight↗

PubMed2003

Statistical methods for repeated qualitative assessments on scales.

Assessments of auditory communication are commonly performed with questionnaires or multi-item instruments. The item responses generate ordered categorical data. The aim of the work reported here was to present a statistical approach that takes account of the non-metric properties of data from rating scales for description of multi-item assessments and for evaluation of change in a study concerning the function of and satisfaction with hearing aids. A small data set from an ongoing study at the Ahlsén Research Institute, Orebro University Hospital was used in the worked examples. The use of individual and median group profiles provided an interpretable description of the data. By means of the ranking approach, which ties the ranks to the pairs of data, the systematic group change in hearing function was evaluated separately from the additional individual changes. The use and misuse of parametric statistical methods on ordered categorical data are also discussed.

Data Interpretation, Statistical↗

PubMed2002

Long-term follow-up of children with bacterial meningitis with emphasis on behavioural characteristics.

UNLABELLED: The sequelae and behaviour in children several years after an episode of bacterial meningitis were studied. All children in Sweden aged 0-4 years with bacterial meningitis between 1987 and 1989 caused by Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis were identified. After exclusion of 16 children who died, 12 with severe concomitant diseases, ten with severe neurological damage obvious already at discharge from hospital and 34 with unknown address, questionnaires were sent to the parents of the remaining 463 children The nearest-age siblings were used as a comparison group. The questionnaires included questions concerning general health, schooling, motor function, speech, hearing and behaviour (inattention, hyperactivity and impulsiveness). The children were 6-14 years old when the questionnaires were completed. Questionnaires were completed for 304 pairs of patients and siblings and for 154 patients without siblings. The majority of post-meningitic children were healthy and attended normal school but they had more hearing impairment, headaches and problems with balance than their siblings. When the distributions of answers regarding behaviour were compared, the post-meningitic children had significantly more symptoms in the fields of inattention, hyperactivity and impulsiveness than their siblings. CONCLUSION: Except for hearing impairment, severe sequelae after bacterial meningitis which are not discovered at discharge do not appear later. Children who appear well after bacterial meningitis have more non-specific symptoms like headache, and more signs and symptoms indicating inattention, hyperactivity and impulsiveness than their siblings.

Child Behavior Disorders↗

PubMed2002

Progression of fibrosis in untreated patients with hepatitis C virus infection.

BACKGROUND/METHODS: In order to evaluate the progression of liver fibrosis associated with Hepatitis C virus (HCV) infection, two liver biopsy specimens obtained prior to antiviral therapy from 98 patients with HCV were scored and evaluated using statistical methods appropriate for ordered categorical data. RESULTS/CONCLUSIONS: Greater progression of fibrosis was seen with increasing time between the biopsies. Likewise, the change in fibrosis score was significantly more pronounced in the 11 patients whose first biopsy was obtained within the first year after acquiring HCV. A multivariate logistic regression analysis of possible explanatory factors for the fibrosis outcome showed that interface hepatitis in both biopsies, the time interval between the biopsies, and age at first biopsy were associated with change in the fibrosis score. In addition we found that higher age at the time of infection was associated with development of cirrhosis, that moderate intake of alcohol was associated with fibrosis progression, and that an inflammatory response in the form of moderate interface hepatitis in the first biopsy was not necessarily associated with greater progression of fibrosis if the second biopsy showed mild interface hepatitis. However, having moderate interface hepatitis later in the course of infection as reflected by the second biopsy may be detrimental. If moderate interface hepatitis early in the course of the disease is followed by less interface hepatitis later there is less fibrosis; and if moderate interface hepatitis persists, there is more fibrosis eventually.

Adult↗

PubMed2002

Liver transplant recipients' ability to cope during the first 12 months after transplantation--a prospective study.

Little is known about the coping style and coping strategies among liver transplant recipients. The aim of this study was to evaluate the change in the sense of coherence and coping strategies among liver transplant recipients before and during the first year after liver transplantation. The aim was also to study whether or not there was any relationship between the sense of coherence and the coping strategies. Thirty-five patients met the inclusion criteria. Twenty-six-patients gave their verbal consent to participate in this longitudinal study and 21 patients (80%) completed the follow-up study. The Sense of Coherence scale (SOC) was used for investigation of coping style. The Jalowiec Coping Scale (JCS-40) was used to assess general coping behaviour. The Ethics Committee gave approval to perform this study. The group was heterogeneous regarding the change in the sense of coherence with pronounced individual changes in meaningfulness during the first 3 months and in comprehensibility 6-12 months after liver transplantation. The group showed a homogeneous pattern of change in coping strategies. Confrontational coping strategy was commonly used during the period. A relationship was found between comprehensibility and palliative coping. This prospective study indicated that coping style, assessed by the SOC scale, changed primarily at an individual level during the first year after liver transplantation while changes in coping strategies, according to JSC-40, were in common for the group. The usual coping strategy during the first posttransplant year was confrontational coping.

Adaptation, Psychological↗

PubMed2002

Evaluation of individual and group changes in social outcome after aneurysmal subarachnoid haemorrhage: a long-term follow-up study.

Sixty-three patients operated on for an acute aneurysmal subarachnoid haemorrhage were evaluated comprehensively over 5 years. The level of social outcome was assessed by a Swedish eight-point version of the Glasgow Outcome Scale (S-GOS) at 0, 3, 6, 12, 24 and 60 months after discharge from a neurosurgical department. Stepwise comparisons of long-term changes in common to the group of patients were analysed separately from the level of individual changes of ordered categorical response variable of social outcome by a statistical method that takes account of the non-metric properties of the data. This study showed that the pattern of recovery was homogeneous, except for the first 3 months, where a considerably heterogeneous pattern of change was seen. A significant improvement in social outcome in common for the group was seen during the first 6 months and the recovery for the group did not continue beyond 1 year after discharge.

Acute Disease↗

PubMed2002

Patient acceptance of CT colonography and conventional colonoscopy: prospective comparative study in patients with or suspected of having colorectal disease.

PURPOSE: To prospectively evaluate, by means of self-assessed questionnaires, patient acceptance of computed tomographic (CT) colonography compared with that of conventional colonoscopy, when performed in patients with or suspected of having colorectal disease. MATERIALS AND METHODS: One hundred eleven patients underwent CT colonography followed immediately by conventional colonoscopy. Patient acceptance was evaluated with questionnaires, and the proportions of patients who favored one examination were compared. The main variables were overall impression, discomfort during air filling or instrumentation, and perceived pain, evaluated by using ordered verbal descriptor scales after each examination. The preference for either examination was evaluated after completion of both examinations. RESULTS: Of the 68 patients who favored one examination, 56 (82%) preferred CT colonography (P <.00001). Concerning overall impression of problems or discomfort in connection with the examination, 49 (69%) of 71 with a preference considered colonoscopy to be more difficult (P =.002). CT colonography was regarded as "not painful" by 62 (57%) of 108 patients compared with 28 (26%) for colonoscopy, and a larger proportion of patients rated pain as higher during colonoscopy than during CT colonography (95% CI: 30%, 56%). Discomfort from air filling of the colon was the major complaint about CT colonography. CONCLUSION: CT colonography was considered less painful and less difficult overall than colonoscopy and was the preferred examination.

Adult↗

PubMed2002

Low gestational age associated with abnormal retinal vascularization and increased blood pressure in adult women.

The objective was to investigate any possible relationship between functional and structural vascular changes in women with low gestational age and/or low birth weight by analyzing the retinal vascular pattern in women with thoroughly documented blood pressure. Retinal vessel morphology was evaluated by digital image analysis of ocular fundus photographs in 47 subjects, aged 23-30 y. The women were allocated into three groups: 1) those born preterm and appropriate for gestational age (AGA), with a median gestational age at birth of 30 wk and a median birth weight of 1250 g (n = 14); 2) those born small for gestational age (SGA) but full term (median 40 wk), with a median birth weight of 2130 g (n = 17), and 3) those born full term, AGA, and with a median birth weight of 3640 g (n = 16). Women born preterm had significantly higher length index for arterioles compared with the other two groups (median 1.11 and 1.08, respectively, p = 0.005). In addition, the preterm-born women had significantly fewer number of vascular branching points compared with the controls (median 27 and 30, respectively, p = 0.03). The abnormal retinal vascularization observed in ex-preterm women together with an increased casual blood pressure observed in these subjects suggests that being born preterm does have effects on the vascular system that persist into adult life. In addition, it demonstrates that preterm birth seems to affect the vascular system both functionally and structurally, which, in adulthood, could result in a lower threshold for the development of vascular disease.

Adult↗

PubMed2002

IGF-I is critical for normal vascularization of the human retina.

Experimental and clinical studies suggest that GH and IGF-I may be involved in neovascularization of the retina in diabetes and retinopathy of prematurity. However, the role of GH and IGF-I has not been well established in normal retinal vessel development in humans. Therefore, we examined retinal vessel morphology by digital image analysis of ocular fundus photographs in 13 patients with genetic defects of the GH/IGF-I axis and low levels of IGF-I during and after normal retinal vessel growth. Eleven patients (four females and seven males aged 10-49 yr) had defects of the GH receptor (Laron syndrome). One male (20 yr) had a partial deletion of the IGF-I gene, and one female (14 yr) had a single allele deletion of the IGF-I receptor gene. Patients with defects in the GH/IGF-I axis had significantly less retinal vascularization as evidenced by lower number of vascular branching points (median 23, range 16-25), compared with the reference group of 100 normal controls (median 28, range 19-40, P < 0.001). All 13 individuals had vascular branching points below the median of the reference group. This is the first study to provide genetic evidence for a role of the GH and IGF-I system in retinal vascularization in humans.

Adolescent↗

PubMedDate not supplied

Evaluation of variations in sensory and pain threshold assessments by electrocutaneous stimulation.

Assessed sensory and pain thresholds can change consequently to disturbances associated with ongoing pain. Such assessments could be an additional method in the daily clinical evaluation of perceived pain. To study the test-retest variability within-day and between-day of such procedures a newly developed instrument producing electrocutaneous stimulation, PainMatcher (PM), was used to assess the electrical sensory thresholds (EST) and pain thresholds (EPT) in healthy volunteers and in patients with pain. The produced data were considered ordinal and analyzed with rank-invariant statistics with properties of analyzing systematic disagreement, bias, and individual variations. The percentage agreements within +/- 1PM value for EST were in the two groups of healthy volunteers and patients in pain 94% and 92%, and for EPT assessments 49% and 78%, respectively. The variability in the EST assessments is possibly explained by a slight bias while the individual variations were negligible between the two occasions. The assessed EPT were unbiased in both groups while individual variations were significant among the healthy volunteers but negligible among the patients in pain. The EST was found to be increased in pain patients compared to healthy volunteers, p < 0.03, and the EPT decreased in pain patients compared to healthy volunteers, p < 0.001. The results in this study indicate stable and reliable assessments of EST and EPT except for a possible bias. The threshold assessment procedure followed in this study may be a valuable tool in the clinical evaluation of sensory and pain assessments in pain patients.

Case-Control Studies↗