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R Emblem

Publications and source records attributed to R Emblem.

At least 19 recordsLinked to original sources
PubMed2006

Prenatal diagnosis of congenital malformations and parental psychological distress--a prospective longitudinal cohort study.

OBJECTIVE: To test whether postnatal psychological distress in parents of babies with congenital malformations is reduced by prenatal diagnosis. METHODS: A prospective observational longitudinal cohort study was conducted at two Norwegian hospitals. We included 293 parents of babies with congenital malformations (prenatal detection rate: 36.5%) referred for neonatal surgery and 249 parents of healthy babies (comparison group). Parental psychological responses were assessed on three postnatal occasions by psychometric instruments (GHQ-28, STAI-X1, and IES). RESULTS: Significantly increased psychological distress (GHQ-28) was reported by parents who received prenatal diagnosis as compared to postnatal diagnosis; acutely 28.9 versus 24.4, P = 0.006 (comparison group: 19.6); at 6 weeks 26.8 versus 21.5, P < 0.001 (comparison group: 17.7); and at 6 months 22.6 versus 18.7, P = 0.015 (comparison group: 16.6). Mothers consistently reported higher levels of distress than fathers. Multiple linear regression analysis showed that prenatal diagnosis and being a mother significantly predicted severity of acute psychological distress. At 6 weeks and 6 months, mortality and associated anomalies were significant independent predictors of psychological distress. CONCLUSION: Controlling for other covariates, we found that prenatal diagnosis of congenital malformations was a significant independent predictor of acute parental psychological distress after birth.

Adult↗
PubMed2001

Are patients with Hirschsprung's disease prediabetic?

Hirschsprung's disease (HD) is considered a focal disease usually confined to the distal colon and rectum. However, autonomic dysfunction and dysmotility in the upper gastrointestinal tract have been reported, suggesting that this disease is not only confined to the distal gastrointestinal tract. This study examines the fasting and postprandial levels of glucose and insulin in adult patients with HD to elucidate whether there might also be an endocrine involvement in this disease. Sixteen patients with surgically treated HD during early childhood and 17 healthy subjects were studied. All subjects ingested a caloric liquid meal containing glucose, lactose, maize oil, and water (2,020 kJ) after an overnight fast. Blood samples were collected at regular intervals for insulin and glucose analyses. Fasting levels of both glucose (P <.05) and insulin (P <.02) were significantly higher in patients compared with healthy controls. Peak concentration of insulin following meal intake was significantly higher in the patient group (P <.05), and peak concentration of glucose tended to be higher in patients compared with controls (P =.06). There was no correlation between body mass index and serum levels of glucose or insulin. The present study shows that adult patients treated for HD during childhood have an impaired glucose and insulin homeostasis, indicating a mild degree of insulin resistance. This may imply susceptibility towards development of non-insulin-dependent diabetes mellitus.

Adolescent↗
PubMed2000

Congenital diaphragmatic hernia: a meta-analysis of mortality factors.

PURPOSE: The aim of this study was to review all available studies reported in the English-language literature from 1975 through 1998, and by meta-analysis assess the importance of prenatal diagnosis, associated malformations, side of hernia, timing of surgery, and study population on mortality rates in patients with congenital diaphragmatic hernia (CDH). METHODS: One-hundred-two studies were identified, and 51 studies (2,980 patients) fulfilled the prespecified inclusion criteria. Studies were grouped according to study population into: (I) fetuses diagnosed prenatally; (II) neonates admitted to a treatment center; and (III) population-based studies. RESULTS: Pooled total mortality rate was significantly higher in category I than in category III (75.6% v 58.2%, P < .001). Pooled hidden postnatal mortality rate (deaths before admittance to a treatment center) in population-based studies was 34.9%. Prenatally diagnosed patients in both category II and III had significantly higher mortality rates than those diagnosed postnatally. Mortality rates were significantly higher among CDH infants with associated major malformations compared with isolated CDH in all 3 categories. An increased mortality rate in right-sided CDH was found in category II and III. CONCLUSIONS: Prenatal diagnosis of CDH, presence of associated major malformations, and the study population have a major influence on mortality rate. The very high mortality rate in studies of fetuses with a prenatal diagnosis of CDH should be taken into account in prenatal counselling.

Abnormalities, Multiple↗
PubMed1999

Mental health, psychosocial functioning, and quality of life in patients with bladder exstrophy and epispadias - an overview.

Although there has been only limited clinical research on mental or psychosocial implications in patients with bladder exstrophy and epispadias, questions have been raised as to whether their life is of such questionable quality that a termination of pregnancy should be considered. A systematic overview of outcome studies published over the past three decades was carried out. In all, 1208 abstracts and 52 papers were read; only 10 (0.8%) papers focused on the mental or psychosocial outcome, but with diverse findings. However, most of the studies suffered from serious methodological deficiencies. Physical, mental, and psychosocial problems revealed in studies with reliable and valid instruments have clinical implications and underline the need for the further development of surgical and psychosocial interventions. Multicenter studies with a multimodal, prospective, and longitudinal design, based on semistructured interviews and specific questionnaires related to the disorder, are appropriate.

Abortion, Therapeutic↗
PubMed1998

Long-term functional, manometric, and endosonographic evaluation of patients operated upon with the Duhamel technique.

Long-term functional results, anal endosonography (AES), and anal canal manometry were recorded in 48 patients aged 10 to 24 years (median 18) operated upon with the Duhamel technique for Hirschsprung's disease; 60.4% had perfect fecal control, 31.3% occasional staining and/or gas incontinence, and 8.3% constant fecal soiling, and 10.4% complained of constipation. Compared to normals, the patients had significantly reduced anal canal resting and squeeze pressures. AES visualized scar tissue in both the internal and external anal sphincter.

Adolescent↗
PubMed1998

Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung's disease and low anorectal anomalies.

BACKGROUND/PURPOSE: Recent studies of adolescents with Hirschsprung's disease (HD) and low anorectal anomalies (LARA) showed persistent impairment of fecal control in both groups, but very different mental and psychosocial outcome. METHODS: To explore possible reasons for these differences, 19 adolescents with HD (aged 10 to 20 years; median, 16) operated on by the Duhamel technique were compared with 17 adolescents with LARA (aged 12 to 20 years; median, 15). The 36 adolescents were assessed for treatment procedures, bowel function, and mental and psychosocial outcome by data collected from medical records, physical examination, semistructured interview, and standardized questionnaires. The parents of 30 adolescents were also interviewed and completed questionnaires. RESULTS: Duration of anal invasive treatment procedure and current bowel function were associated with mental and psychosocial outcome. The treatment variable, duration of anal dilation, was the most significant predictor of the adolescents's mental health (R2 = .41, P < .01), whereas chronic family difficulties and parental warmth together with the current bowel function variables, fecal and flatus continence function, best explained the variance in psychosocial outcome (R2 = .77, P < .0001). Thus, the differences in treatment procedures and continence function between the HD and LARA groups may partially explain differences in mental and psychosocial outcome. CONCLUSIONS: These findings suggest that anal dilatation and continence dysfunction may have negative impact on mental health and psychosocial functioning. Indications for and ways of performing the procedure of dilation, and the treatment of persistent incontinence problems, are questioned.

Adaptation, Psychological↗
PubMed1998

Consequences of prenatal ultrasound diagnosis: a preliminary report on neonates with congenital malformations.

OBJECTIVE: The aim of the present study was to examine the sensitivity of prenatal ultrasound diagnosis in neonates referred for surgery, and to test whether a prenatal versus postnatal diagnosis influenced mode of delivery and neonatal outcome of these infants. PATIENTS: Thirty-six consecutive neonates with congenital diaphragmatic hernia, abdominal wall defects, bladder exstrophy and meningomyelocele were included. RESULTS: The sensitivity of prenatal ultrasound for diagnosis of the congenital malformations was 7/36 (19%) at 17-18th week of gestation, and overall 13/36 (36%). Overall sensitivity was 2/8 in neonates with congenital diaphragmatic hernia, 6/12 in neonates with abdominal wall defects, 5/13 in neonates with meningomyelocele, whereas none of three cases with bladder exstrophy were detected prenatally. No significant improvement in neonatal morbidity was found comparing the prenatally and postnatally diagnosed groups. The neonatal survival rate was 10/13 (77%) in the prenatally diagnosed group and 22/23 (96%) in the postnatally diagnosed group (p=0.12). CONCLUSIONS: The sensitivity of prenatal ultrasound in diagnosing the congenital malformations under study in a low risk population was 19% at 17-18th week of gestation and 36% throughout the pregnancy. Prenatal diagnosis altered management of labor, but caused no improvement in neonatal outcome.

Congenital Abnormalities↗
PubMed1998

Somatic function, mental health and psychosocial functioning in 22 adolescents with bladder exstrophy and epispadias.

PURPOSE: We report the long-term somatic outcome, mental health and psychosocial adjustment in adolescents with bladder exstrophy and epispadias. MATERIALS AND METHODS: A total of 22 adolescents 11 to 20 years old (median age 14.5), including 19 with bladder exstrophy and 3 with epispadias, were assessed for urogenital status, stoma, renal and bowel function, anorectal physiology, mental health and psychosocial functioning by physical examinations, semistructured interviews and standardized questionnaires. The parents of 21 patients were interviewed and completed questionnaires. Information was also obtained on control groups. RESULTS: Of the 22 patients 9 (41%) had no urinary diversion and were urinary incontinent, 6 (27%) had persistent fecal staining and anal canal pressures that were lower than the controls, 10 (59%) were dissatisfied with the penile appearance and 11 (50%) met the criteria for psychiatric diagnoses. The main predictors of mental health were parental warmth and patient genital appraisal in the 11 to 14-year age group, and parental warmth and urinary continence function in the 15 to 20-year age group. Psychosocial dysfunction was predicted by fecal incontinence in the younger group and worries about future sexual relationships in the older group. CONCLUSIONS: The present multimodal outcome study revealed that adolescents with bladder exstrophy and epispadias had significant physical and mental problems. Genital malformation, and urinary and fecal incontinence may have a negative impact on mental health and psychosocial functioning. Our findings emphasize the need to include psychosocial experts on health care teams to reveal the amount of distress caused by these anomalies and to offer psychosocial support.

Adolescent↗
PubMed1997

[The Norwegian Patient Insurance System. Documentation of patient information and use of medical experts in cases of injuries].

Claims for compensation for surgical injuries submitted to the Norwegian System of Compensation for Injuries to Patients were analysed with respect to the written documentation of the case, patient information and the medical experts involved. Documentation of the indication for treatment, the surgical procedures and the injury were good, and acceptable in more than 90% of the case reports. Preoperative information on the patient was only documented in the report in 5% of the cases. There has been some discussion on the way in which medical experts used in the evaluation of patients claims are selected. In order to increase the legitimation of the medical experts we suggest that the Norwegian System of Compensation for Injuries to Patients and the Norwegian Board of Health should consider using the same set of rules for selecting experts. To improve the quality of patients' treatment and for security reasons, the System of Compensations of Injuries to Patients' data on documentation of patient information and categorized reports on the medical errors should be periodically reported to the hospitals.

Clinical Competence↗
PubMed1997

[Surgical injuries registered in the Norwegian system for patient injuries. Possibilities of the use of the material for quality improvement in Norwegian hospitals].

328 surgical "errors" reported to the Norwegian System of Compensation for Injuries to Patients were analysed in order to find out how the errors can be exploited for the purpose of quality improvement. In 8% of the cases the patients had been treated as emergency cases. 7% of the patients had been treated as out-patients. 30% of the patients had become more than 15% permanently disabled as a consequence of the "error". The Norwegian System of Compensation for Injuries to Patients operates with five different categories of errors defined by medical specialty, of which surgery is one. We found that among "surgical errors" 16% of the patients had been treated by an anaesthetist or by a specialist in internal medicine, and 13% had been treated by a gynaecologist. There were several recurring "errors" such as nerve injuries and complications related to general atherosclerosis. A system for categorising errors with a view to quality improvement should be different from other systems of categorisation. We suggest a system based on not only five but all medical specialties. Data from such a system could be used to prepare "pedagogic reports" that can be sent to the managers of services and education in each medical specialty. Thus, by turning surgical errors into "medical treasures", the errors can be exploited to promote quality improvement.

Clinical Competence↗
PubMed1997

Anorectal anomalies: anorectal manometric function and anal endosonography in relation to functional outcome.

To assess the relation between continence and the manometric and endosonographic state of the anorectal segment after surgery for anorectal anomalies (ARA), 33 adolescents operated upon for ARA and 14 controls were examined. Seventeen patients had low and 16 intermediate or high ARA. Fecal continence was recorded, and anal canal manometry was performed by microtransducer. The sphincter muscle complex and its relation to the anal opening was visualized by anal endosonography (ES). Ten patients had perfect continence, 10 had staining, and 13 had soiling. The anal canal resting and squeeze pressures were significantly different in all three groups, and continence function was significantly correlated to anal canal pressures. By anal ES, the internal (IAS) and the external anal sphincters (EAS) were identified with various amounts of scar tissue in all patients. In patients with high or intermediate anomalies the IAS was missing in the lower part of the anal canal, and abundant scar tissue was identified in the EAS in all patients. In patients with good continence function, the EAS was better preserved than in patients with major incontinence. The position of the anus in the EAS muscle complex was assessed, and varying degrees of eccentrically placed anal canals were identified. Continence function after surgery for ARA is thus correlated to anal canal pressures and ES images. ES, which is painless and suitable for use in children, is a valuable tool for assessing perianal structures, and the findings may serve as a helpful guide for corrective surgery.

Adolescent↗
PubMed1997

Bowel function, mental health, and psychosocial function in adolescents with Hirschsprung's disease.

Congenital intestinal malformations are uncommon and may pose lasting somatic difficulties. Patients with anorectal anomalies have a high frequency of persistent faecal dysfunction and psychosocial problems. This study examined whether adolescents with Hirschsprung's disease have more psychosocial problems than their healthy peers. Nineteen adolescents (mean age 15.7 years) with Hirschsprung's disease were assessed for bowel function, anorectal physiology, mental health, and psychosocial functioning by physical examinations, semistructured interview, and standardised questionnaires. The adolescents were compared with controls. The parents of 13 adolescents with Hirschsprung's disease were interviewed and completed questionnaires. Thirty two per cent of the adolescents with Hirschsprung's disease had significant impairment of continence, but no more psychopathology (16%) nor psychosocial dysfunction as a group than their healthy peers. Faecal incontinence was associated with poorer psychosocial functioning and parental criticism. The fact that a significant number of patients with Hirschsprung's disease have incontinence into adulthood indicates the need for parental counselling, encouraging realistic expectations about continence.

Adolescent↗
PubMed1996

Somatic function, mental health, and psychosocial adjustment of adolescents with anorectal anomalies.

Thirty-three adolescents (aged 12 to 20 years; median, 15) with a corrected low (n = 17) or high (n = 16) anorectal anomaly were assessed using anorectal physiological examination, semistructured interviews [Child Assessment Schedule [CAS]), and questionnaires (Child Behavior Checklist [CBCL], Youth Self-Report [YSR]). Seven patients, all of whom had low malformations, were totally continent. Twenty-three (70%) had persistent dysfunction with staining (n = 12) or intermittent/constant soiling (n = 11). Twenty-four (73%) had flatus incontinence. Fecal incontinence correlated negatively with anal canal resting pressure (r = - .58, P = <.001) and squeeze pressure (r = -.54, P < .01). Three adolescents had a permanent colostomy. Nineteen patients (58%) met the criteria for a psychiatric diagnosis, and impairment of psychosocial function was found in 24 (73%). The degree of psychosocial impairment correlated significantly with fecal incontinence (F = -.37, P < .05) and flatus incontinence (r = -.49, P < .01). Continence of flatus correlated significantly with mental health symptom scores (YSR: r = .52, P < .01; CAS:r = .53, P < .01). The findings indicated that, in addition to soiling, staining as well as fear of flatus are associated with psychiatric and psychosocial dysfunction among patients with anorectal malformations. Optimal treatment of patients with low and high anorectal anomalies requires somatic and psychological care and follow-up into adulthood.

Adaptation, Psychological↗
PubMed1995

[The relation between patient volume and quality of care. Results of a survey].

A report on the relation between patient volume and quality of treatment has been evaluated by health administrators. The majority supports that adequate patient volume is important for quality of treatment and for quality assurance. The implementation of these concepts in the organizing of health services is advocated. There is a relation between every single administrator's attitude towards the volume-quality concept and the number of beds in their own hospital. Clinical audit by means of registers and more national control of the hospital service is supported.

Attitude of Health Personnel↗
PubMed1994

[Better results with early surgical intervention in biliary atresia. Icterus in infants older than 14 days should be investigated!].

The average survival of patients with biliary atresia that remains untreated is 12 months. Early portoenterostomy, and subsequent liver transplantation if necessary, have improved survival dramatically. The success rate after portoenterostomy is inversely related to age at primary operation, and the results after liver transplantation are best in children who receive the transplant after the age of one year. Thus, early portoenterostomy will buy time and bring the patient into a group with a better prognosis if liver transplantation is performed later. Among infants older than two weeks of age with neonatal jaundice, patients with conjugated hyperbilirubinemia must be identified and referred for investigation. In this case ultrasonography is most important for discovering biliary atresia.

Age Factors↗