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Biomedical subjects

I Wiklund

Publications and source records attributed to I Wiklund.

At least 91 records · Page 5Linked to original sources
PubMed1995

Relationship between quality of life and exercise test findings after coronary artery bypass surgery.

We studied the correlation between quality of life and exercise testing in 554 patients 2 years after coronary artery bypass surgery. Quality of life constitutes a person's perceptions of physical and mental functional capacity, health and symptoms. Traditionally, evaluations after coronary bypass surgery have focused on physical performance, medication and anginal symptoms, which cannot be said to represent quality of life. We used the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-being Index for evaluation of quality of life. Significant correlations were found between quality of life and exercise capacity (P < 0.0001), and quality of life and chest pain at exercise for all questionnaires (P < 0.0001). Significant correlations, although of small or moderate magnitude, were found between exercise capacity, chest pain and most subscales of quality of life, with the highest correlation coefficients for dimensions reflecting physical abilities and pain. We conclude that quality of life correlates significantly with exercise capacity and chest pain during exercise 2 years after coronary bypass surgery. However, only dimensions of pain and physical performance are reasonably well correlated with exercise test results. Several aspects of quality of life are only weakly related to exercise test results and may escape identification in an exercise test.

Activities of Daily Living↗
PubMed1995

Prognosis and gender differences in chest pain patients discharged from an ED.

A large proportion of patients evaluated for chest pain in the emergency department (ED) will be sent home because the probability of acute myocardial infarction, unstable angina, or other severe disease processes is determined to be sufficiently low. Patients who came to the ED at Sahlgrenska Hospital, Göteborg during a 21-month period because of chest pain were registered and followed up for one year. Survivors after one year were asked to complete a mailed questionnaire regarding different kinds of symptoms. Of 5,362 patients evaluated in the ED, 2,175 were sent home on their first visit. Fifty-four percent were men and 46% were women. The one-year mortality rate was 3% in men and 3% in women. Recurrent chest pain, dyspnea, and psychological symptoms were more frequently reported by patients with known cardiac disease than by patients without cardiac disease. Female patients with and without cardiac disease reported significantly more frequent recurrent chest pain, dyspnea, and psychological and psychosomatic complaints than male patients with and without cardiac disease. These data suggest that there are specific gender differences between men and women who are discharged from the ED after being evaluated for chest pain. In particular, psychological gender differences may exist and need to be addressed when evaluating patients with chest pain.

Adolescent↗
PubMed1995

Coenzyme Q10 as an adjunctive in the treatment of chronic congestive heart failure. The Q10 Study Group.

Seventy-nine patients with stable chronic congestive heart failure were randomized into a double-blind, crossover placebo controlled study with 3-month treatment periods, where either 100 mg coenzyme Q10 (CoQ10) or placebo was added to conventional therapy. Mean patient age was 61 +/- 10 years, ejection fraction at rest was 22% +/- 10%, and maximal exercise tolerance was 91 +/- 30 W. The follow-up examinations included ejection fraction (primary objective), exercise test, and quality of life questions. Ejection fraction at rest, during a slight volume load, and during a submaximal supine exercise increased slightly compared with placebo: 24% +/- 12% versus 23% +/- 12% (NS), 25% +/- 13% versus 23% +/- 12% (P < .05), and 23% +/- 11% versus 22% +/- 11% (NS). Maximal exercise capacity increased from 94 +/- 31 W during the placebo period to 100 +/- 34 W during the CoQ10 period (P < .05). Total score for the quality of life assessment increased significantly from 107 +/- 23 during the placebo period to 113 +/- 22 during the CoQ10 period (P < .05). The results indicate that oral long-term treatment with 100 mg CoQ10 in patients with congestive heart failure only slightly improves maximal exercise capacity and the quality of life and that the clinical importance of this needs to be further evaluated.

Aged↗
PubMed1995

Quality of life in adults with growth hormone (GH) deficiency: response to treatment with recombinant human GH in a placebo-controlled 21-month trial.

We examined the effect of GH supplementation on the psychological capacity and sense of well-being in 36 patients with adult-onset GH deficiency (GHD). Recombinant human GH was given in a 21-month cross-over, double blind trial, and quality of life was assessed by using three self-rating questionnaires: the Hopkins Symptom Check List (HSCL), the Nottingham Health Profile (NHP), and the Psychological General Well-Being index. In addition, at the final examination the spouses completed a short questionnaire concerning their partner. Before treatment, the patients had lowered quality of life as determined by the HSCL and NHP inventories, and a correlation between the duration of GHD and the reported symptoms was observed. Upon treatment, the HSCL score was lower (better) after placebo administration (mean +/- SD, 84 +/- 21.3) than at baseline (89 +/- 18.9; P = NS) and fell to 80.2 +/- 18.5 (P < 0.001) when active drug was given. The subscales regarding anxiety, fearfulness, and cognition were the most sensitive. It was apparent that the effect determined after GH therapy in part was due to a placebo effect. With NHP, the dimensions of energy and emotions responded most to treatment. Further, the spouses observed their partners to be improved in several aspects of mood and behavior (P < 0.05 to P < 0.0001) when active drug was given. The data thus demonstrate that GH, which is known to have multiple somatic effects, produces an improvement in the quality of life of adults with GHD.

Adult↗
PubMed1995

Occurrence and clinical features of sensitization to Pityrosporum orbiculare and other allergens in children with atopic dermatitis.

One hundred and nineteen consecutive cases of children with atopic dermatitis aged 4-16 years (73 girls) from a pediatric dermatology outpatient clinic were included in a study of atopic sensitization. Structured interviews and clinical investigations were performed. IgE antibodies to common inhalant allergens, Pityrosporum orbiculare, Candida albicans, Tricophyton rubrum and Staphylococcus aureus were detected. Specific IgE antibodies frequently occurred to pollens, animal epithelia, C. albicans, house dust mites and moulds, whereas specific IgE antibodies to potential skin allergens were less prevalent. Twenty-six children (21.8%) had IgE antibodies to P. orbiculare, 14 (11.8%) to T. rubrum and 3 (2.5%) to S. aureus. Atopic dermatitis in children with one or several RAST positivities was worse, with a more chronic course, higher total eczema score, more frequent distribution in the head-neck-face regions and more itch compared to the children without serum detectable IgE antibodies. Severe itch disturbing nightly sleep was the only clinical feature that characterised P. orbiculare-positive cases. Allergy to P. orbiculare appears to be of little importance in early childhood atopic dermatitis but is likely to carry a poor prognosis.

Adolescent↗
PubMed1995

A quality of life perspective on who benefits from estradiol replacement therapy.

STUDY OBJECTIVE: To examine who may benefit from estrogen replacement therapy from a quality of life (QoL) perspective, taking both disease-specific and general aspects at baseline into account. DESIGN: A double-blind multi-center randomized placebo-controlled prospective study. The subjects were randomized to receive either transdermal estradiol or placebo for 12 weeks. QoL measures were disease-specific and generic. LOCATION: University hospital, teaching hospital and private practice. MATERIAL: Post-menopausal volunteering Swedish women (n = 223) with mild to severe climacteric symptoms, as clinically evaluated by the Kupperman's Index. RESULTS: All QoL assessments showed highly significant improvement in the estradiol group in comparison with the placebo group. The women receiving placebo treatment also improved, but their improvement reached a peak at six weeks of treatment and then declined. In the estradiol group the improvement continued throughout the 12 weeks. After 12 weeks of treatment the change in the placebo-treated group was smaller on the disease-specific scales than on the generic scales and the Kupperman's Index. A high correlation was seen between the baseline score for a certain QoL assessment and the change in this score during treatment. The most striking result was that the mean change in QoL for the two groups was statistically significant for almost any pre-treatment QoL status. CONCLUSIONS: Women with slightly, moderately or severely diminished QoL status would benefit from estrogen treatment during the climacteric period. A similar tendency was seen in women with mild symptoms at baseline.

Double-Blind Method↗
PubMed1995

Well-being and gastrointestinal symptoms among patients referred to endoscopy owing to suspected duodenal ulcer.

BACKGROUND: Few studies have evaluated quality of of life (QoL) in patients with upper gastrointestinal diseases, and there is a lack of validated measures for use in gastroenterology. METHODS: The applicability and relevance of self-administered questionnaires such as the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptoms referred to endoscopy because of suspected duodenal ulcer were evaluated. RESULTS: In total, 1526 patients with suspected duodenal ulcer were screened for inclusion in a clinical study. On the basis of medical history and endoscopy, 1424 patients who completed the questionnaire before endoscopy were classified in five diagnostic groups: oesophagitis, gastric ulcer, duodenal ulcer, negative endoscopy, and gastritis duodenitis. Irrespective of diagnosis, all patient groups reported a considerable decrease in their general well-being (mean score, 85, compared with 105 in healthy populations) with no significant differences between the groups. The results of the GSRS, however, showed statistically significant differences between the groups in dimensions depicting Abdominal pain, Reflux, Indigestion, and Diarrhoea Syndrome. CONCLUSIONS: The results of the study showed that, irrespective of endoscopic findings, patients complaining of upper gastrointestinal symptoms have a low degree of general well-being. The symptoms profiles in the different diagnostic groups vary considerably.

Duodenal Ulcer↗
PubMed1995

Aspects of quality of life in gastrointestinal disease: some methodological issues.

Quality of Life assessments have many applications in clinical trials. In the evaluation of gastrointestinal disease for example. Quality of Life outcomes provide a useful tool for assessing treatment response. There are a number of standard measures currently available that may be utilized to determine Quality of Life. In clinical trials the use of questionnaires allows the clinician to assess the impact of disease and its subsequent treatment upon the patient's daily life. In order to facilitate comparison of data between studies, it is important that the measures selected are well validated. Patients with gastrointestinal problems do not only experience symptoms. The symptoms have an adverse impact on well-being and ability to enjoy day-to-day activities. It is important to provide appropriate treatment for the large and heterogeneous population with gastrointestinal complaints who have a poor Quality of Life.

Female↗
PubMed1995

Managing hypertension in general practice: can we do better?

Two surveys of hypertension treatment in Europe have revealed major differences between doctor perception, patient belief and the reality of BP control. The first survey (part of the Cardiomonitor Study) investigated 23,339 cardiovascular patients treated by 1471 doctors in Italy, Spain, France, the UK and Germany. The second survey researched attitudes to treatment among 301 general practitioners and 300 patients in Italy, France and the UK. Cardiomonitor revealed that hypertension was poorly controlled, with only 37% of patients achieving target BP. In contrast, the second survey revealed that doctors believed that target BP was reached in the majority (76%) of their treated patients with hypertension, while an even higher percentage of patients (95%) believed their BP to be well controlled. There were significant discrepancies in the perceived reasons for treatment failure between doctors and patients. Most doctors considered poor compliance with therapy to be the main reason for failure to achieve target BP. In contrast, most patients reported good compliance, blaming poor efficacy or side-effects for treatment failure. Objective studies suggest that compliance is lower than patients report and can be reduced by factors that affect quality of life, such as side-effects of treatment, complex dosing regimens, changes in therapy and concern about poorly controlled disease. This argues for effective, well-tolerated antihypertensive drugs that can be taken once daily, enabling quality of life to be maintained throughout treatment.

Antihypertensive Agents↗
PubMed1994

Prognosis, severity of symptoms, and aspects of well-being among patients in whom myocardial infarction was ruled out.

In a high proportion of patients hospitalized due to suspected acute myocardial infarction (AMI) the diagnosis cannot be confirmed. The majority of these patients have ischemic heart disease and are at risk for subsequent cardiac events. The aim of this study was to describe the severity of symptoms and various aspects of well-being 1 year after hospitalization due to suspected AMI in surviving patients in whom the diagnosis was not confirmed, and to relate the observations to those found among survivors of a confirmed AMI. All patients admitted to Sahlgrenska Hospital, Göteborg, due to suspected AMI and who were alive after 1 year were asked to answer a questionnaire including questions regarding cardiovascular, psychiatric, and psychological symptoms. Patients in whom AMI was not confirmed reported more cardiovascular symptoms, for example, chest pain (p < 0.001), dyspnea (p < 0.01), palpitations (p < 0.001), and fatigue (p < 0.01) when compared with patients who suffered confirmed AMI. The majority of psychosomatic and psychological parameters evaluated were also more frequently reported by these patients and their quality of life seems to be worse compared with survivors of AMI.

Activities of Daily Living↗
PubMed1994

Prepubertal children with short stature have a different perception of their well-being and stature than their parents.

The well-being of children with short stature has commonly been assessed by questioning the children's parents and teachers. Few studies have included questionnaires completed by the children themselves. The aim of this study to compare how short children and their parent perceive the height and well-being of the child. A total of 80 prepubertal children who were investigated for short stature at the Children's Hospital, Göteborg, Sweden were included in the study. The Silhouette Apperception Technique (SAT) was used to estimate the perception by the child and his/her parents of the child's present stature, as well as their expectations of the child's final stature. The mean ratings of the parents' and children's perception of the child's present stature indicate that both children and parents tend to overestimate it. The mean rating of the children's expectations of final height suggests that the children have high and unrealistic expectations of achieving a tall stature. A visual analogue (VA) scale was used to assess aspects of well-being. Although the children in this study did not seem to have a negative perception of their own well-being, their parents rated the children's well-being lower. The correlation between the ratings of parents and children were comparatively low on both the SAT and the VA scale, indicating that conclusions about how children perceive their height and well-being cannot be based solely on the opinions of proxy respondents such as parents.

Adolescent↗
PubMed1994

A new self-assessment questionnaire to measure well-being in children, particularly those of short stature.

The impact of short stature on children is commonly assessed in terms of psychosocial consequences. Proxy respondents and formal behavioural performance tests constitute standard methods in the evaluation of growth hormone therapy in children of short stature. Therefore, a self-administered, short and simple adjective check-list was developed and tested on 342 children of both sexes, aged 9-13 years. Six dimensions covering alertness, self-esteem, mood, elation, stability and vitality were derived after factor analysis. High internal consistency reliability was found for all dimensions. Modest correlations with height, reaching statistical significance for alertness, mood and vitality, were observed. Girls described themselves as having lower self-esteem and vitality than boys, while boys had lower scores for elation. It was concluded that the measure was relevant and potentially useful in children with short stature.

Adolescent↗
PubMed1994

Moricizine and quality of life in the Cardiac Arrhythmia Suppression Trial II (CAST II).

The Cardiac Arrhythmia Suppression Trial II (CAST II) was a double-masked placebo-controlled randomized trial that compared the survival effects of moricizine to placebo in postmyocardial infarction arrhythmia patients. The quality-of-life outcome measures were designed prospectively for CAST and were previously shown to have high reliability and clinical discriminative validity. The CAST quality-of-life instrument detected significant differences between moricizine and placebo. In particular, moricizine was most strongly associated with inferior social activity and satisfaction scores (p = .014) and lower scores for overall contentment with life (p = .007). Moreover, the quality-of-life measures improved significantly for both the moricizine and placebo treatment groups after entry into the clinical trial. These results indicate that the CAST quality-of-life instrument is sensitive for assessing pharmacological therapies in the treatment of heart disease.

Aged↗
PubMed1994

Decreased psychological well-being in adult patients with growth hormone deficiency.

OBJECTIVE: Besides effects on body composition, bone mineral content and lipid metabolism, GH seems to influence quality of life, according to previous studies of limited numbers of patients with GH deficiency of childhood and adult origin. In this study psychological well-being was assessed in a large number of patients with GH deficiency of adult origin. DESIGN: A follow-up study of patients with hypopituitarism on routine replacement therapy with L-thyroxine, cortisone acetate and sex steroids. PATIENTS: Eighty-six patients (51 men, mean age 55.4 years and 35 women, mean age 54.9 years) diagnosed as having growth hormone deficiency on the basis of low IGF-I concentration or a maximum GH response less than 5 mU/l after an insulin/glucagon tolerance test. MEASUREMENTS: Quality of life was measured with a self-rating questionnaire, the Nottingham Health Profile, and the results were compared with the results from 86 controls matched for age, gender, marital status and socioeconomic class. Furthermore, the observed and expected number of disablement pensions were calculated. RESULTS: The mean total score of the patients was higher, i.e. worse (P < 0.05), than that of the matching controls, indicating a higher level of perceived health problems among the patients. There were higher scores (poorer life quality) for energy (P < 0.001), social isolation (P < 0.01), emotional reaction (P = 0.056) and sex life (P < 0.001) among patients compared with controls. Finally, the observed number of disablement pension among the patients tended to be higher than expected (19 vs 12.4, P = 0.09). CONCLUSIONS: Adult patients with GH deficiency have a decreased psychological well-being in terms of energy, social isolation and emotional reaction and a disturbed sex life compared with normals. Furthermore, there is a tendency to a higher frequency of early retirement.

Adult↗
PubMed1994

Quality of life and cost-effectiveness in the treatment of hypertension.

By and large, the results of the different studies on quality of life in hypertension suggest that among beta-blockers only the nonselective beta-blocker propranolol has a negative effect on well-being, being associated with depression and side-effects. The findings on diuretics are comparatively few, and mainly observed as an adverse impact on sexual function. If one broadens the treatment scenario to include mortality and morbidity, evidence of a beneficial impact has only been proven for beta-blockers and diuretics. With the primary aim of antihypertensive drug therapy given as a reduction in cardiovascular risk factors, the aim with regard to quality of life is that quality of life be maintained. The new guidelines on the management of mild hypertension issued in the United States highlight the danger of relaxing the concern for risk reduction and costs in favour of surrogate end-points, even though these may carry great significance in the individual patient.

Antihypertensive Agents↗
PubMed1994

Health-related quality of life in old age. A study among 76-year-old Swedish urban citizens.

Health-related quality of life was measured in terms of energy, pain, emotions, sleep, social isolation and mobility with the Nottingham Health Profile (NHP). Five hundred and sixty-five ambulant 76-year-olds in a Swedish city participated and the results were analysed in relation to health and socio-demographic factors. The majority of the subjects lived independently and felt healthy, despite the fact that many had some diagnosed disease or disorder. In general, the sample reported a satisfactory quality of life. Impaired quality of life was correlated to observed and perceived illness, institutionalization, widowhood, loneliness and financial discontent. Women reported more pain, emotional, sleep and mobility problems than men. Mobility problems had the most negative impact on daily activities, whereas sleeping problems had none.

Activities of Daily Living↗
PubMed1994

Prognosis and symptoms one year after discharge from the emergency department in patients with acute chest pain.

BACKGROUND: A high proportion of patients admitted to a medical emergency department due to chest pain are directly sent home, since the initial suspicion of acute myocardial infarction (AMI) can be quickly ruled out. AIM: To describe the outcome of such patients during 1 year of follow-up in terms of mortality, development of AMI, and especially severity of symptoms 1 year after discharge. METHODS: All patients who during 21 months were admitted to the medical emergency department at Sahlgrenska Hospital, Göteborg, Sweden, due to chest pain, and who could be directly sent home, were prospectively followed up for 1 year. Their outcome was compared with patients who had chest pain and were hospitalized for AMI during the same time. RESULTS: Patients with chest pain directly sent home (n = 2,102) had a median age of 52 years (age range, 16 to 96 years), and 54 percent were men. The mortality during 1 year was 3 percent, and 3 percent developed AMI. As compared with patients with AMI, those who were directly sent home less frequently reported various cardiovascular symptoms, with the exception for chest pain at rest and palpitations. On the other hand, various emotional and psychosomatic symptoms were more frequently reported by patients who were directly sent home than by patients with AMI. CONCLUSION: Patients who came to a medical emergency department due to chest pain, and who were sent home, had a low risk of death and development of infarction during the following year. Survivors after 1 year do, however, more frequently report emotional and psychosomatic symptoms than survivors of AMI.

Acute Disease↗