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Biomedical subjects

S Sörensen

Publications and source records attributed to S Sörensen.

At least 19 recordsLinked to original sources
PubMed2004

The Fenyö-Lindberg scoring system for appendicitis increases positive predictive value in fertile women--a prospective study in 455 patients randomized to either laparoscopic or open appendectomy.

BACKGROUND: Suspected appendicitis is one of the most common indications for acute laparotomy or laparoscopy. The negative laparotomy and laparoscopy rates are high, often in the range of 15-30%, and especially high in some groups of patients such as women of child-bearing age and young patients. Different scoring systems have been introduced in order to improve diagnostic accuracy. The aim of the present study was to analyse the outcome of the Fenyö-Lindberg scoring system in a prospectively randomized multicenter trial and to analyze how well the score performed in stratified subgroups. METHODS: The variables of the Fenyö-Lindberg scoring system were collected in a prospective study comparing laparoscopic and open surgery in suspected appendicitis and with four participating centers. None of the hospitals had used the scoring system previously. Since surgeons were unfamiliar with the score, they could not use it as a diagnostic aid. When comparing the score with the clinical outcome, retrospectively, the investigators interpreting the score were blinded regarding the surgical outcome. RESULTS: Positive predictive value (PPV) of the Fenyö-Lindberg score was higher than that of the surgeon's clinical diagnosis in the patient cohort [0.90 vs 0.79 (p < 0.001)]. The score demonstrated an improvement of PPV in women [0.83 vs 0.70 (p < 0.01)]. PPV was increased in women between 15 and 50 years of age. In women aged 15-30 years and 31-50 years PPV increased from 0.69 to 0.82 and 0.68 to 0.86, respectively (p < 0.01). Both the sensitivity (0.77) and the specificity (0.69) of the score were, however, low. CONCLUSION: The Fenyö-Lindberg score is an inexpensive clinical tool that may improve the diagnostic accuracy for acute appendicitis in women of childbearing age, which is a group of patients where the diagnostic accuracy usually is low and where the arsenal of diagnostic tools such as computed tomography is limited because of radiation. The low specificity of the score in women of childbearing age must, however, be kept in mind.

Adolescent↗
PubMed2004

Associations of caregiver stressors and uplifts with subjective well-being and depressive mood: a meta-analytic comparison.

The present meta-analytic study gives a systematic review of research on depression and the subjective well-being of caregivers. We integrate results from 60 studies on informal caregivers' subjective well-being (e.g., positive affect, life-satisfaction) and contrast them with the result of studies on caregiver depression. Analyses were based on a two-factor model of subjective well-being that distinguishes between positive and negative dimensions of well-being (e.g., happiness and depression). The strongest effects were domain-specific: uplifts of caregiving were associated with subjective well-being and caregiving stressors were associated with depression. In addition, weaker effects that crossed domains were present: uplifts were weakly associated with depressive symptoms. In addition, lower levels of caregivers' subjective well-being were weakly related to care receivers' physical and cognitive impairments, as well as behaviour problems, but not to the amount of caregiving. Type of care recipients' illness and the measure of well-being moderated, in part, the association between stressors/uplifts and subjective well-being.

Aged↗
PubMed2004

Oral bacteria and clinical variables in dependent individuals at a special facility.

The oral health of dependent residents at special facilities has often been reported as being poor, but it is difficult to relate oral health to general health and define the need for oral health care. Microbiological analyses of the oral flora have been suggested as a suitable method for evaluating oral health in this group of patients. A study was performed at a nursing facility where 33 individuals participated. The aim was to describe their oral flora in relation to other health variables and to classify the residents on different risk levels. An oral examination of the residents was made at the facility, together with a 3-day food record and an oral microbiological analysis. The analysis classified the residents in different categories according to both acid-producing bacteria and the flora correlated with a reduction in general health. The categories were based on previous studies conducted at the Department of Microbiology (Faculty of Odontology in Göteborg). The present study revealed that the level for acid-producing bacteria was high in 12 individuals and the micriobial level according to decreased general health was high in seven individuals. A high level of acid-producing bacteria was related to functional impairment, which was in turn related to nutritional problems and help with oral hygiene. The microbial level according to the reduction in general health did not significantly correlate with other variables.

Adult↗
PubMed2001

Laparoscopic vs open appendectomy in overweight patients.

BACKGROUND: Laparoscopic appendectomy (LA) has been associated with a faster recovery and less postoperative pain than the open technique. However, few data are available on the clinical outcome of LA in overweight patients. METHODS: A group of 106 patients with a body mass index (BMI) > 26.4, representing the upper quintile of 500 prospectively randomized patients, were included in the study. They were randomized to undergo either laparoscopic or open appendectomy (OA). Operating and anesthesia times, postoperative pain, complications, hospital stay, functional index (1 week postoperatively), sick leave, and time to full recovery were documented. RESULTS: In OA, the operating time for overweight patients was significantly longer than that for patients in the normal weight range (40 vs 35 min, p < 0.05). In LA, there was no difference in operating time between the normal and overweight patients. Overweight patients who underwent LA had longer operating and anesthesia times than their OA counterparts (55 vs 40 min, p < 0.001; and 125 vs 100 min, p < 0.001, respectively). Postoperative pain was significantly greater in overweight patients who underwent OA than in those treated with the laparoscopic technique. Postoperative pain was also significantly greater in overweight patients subjected to OA than in patients of normal weight after 4 weeks; the clinical significance may, however, be of less importance since the values are low (0.26 vs 0.09, p < 0.05). There were no significant differences between the two operating techniques in terms of complications. Hospital stay was longer for overweight patients than for normal-weight patients undergoing OA (3.0 vs 2.0, p < 0.01). The functional index did not differ between any group of patients. Sick leave was longer for overweight patients who underwent OA than for normal-weight patients treated with the same technique (17 vs 13 days, p < 0.01). In the laparoscopic group, however, there were no differences between the overweight and normal-weight patients. Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group (22 vs 15 days, p < 0.001). CONCLUSION: In this study, overweight patients who were submitted to LA had less postoperative pain and a faster postoperative recovery than overweight patients who had OA. LA also abolished some of the negative effects that overweight had on operating time, hospital stay, and sick leave with the open technique. However, anesthesia and operating times were significantly longer in LA for both overweight patients and those with a normal BMI.

Adolescent↗
PubMed2001

Lumbar puncture in pediatric oncology: conscious sedation vs. general anesthesia.

BACKGROUND: Lumbar punctures (LP) generally have been performed with conscious sedation (CS) but are increasingly performed using general anesthesia (GA) owing to the belief that this is less distressing. The aim of this study was to compare these two methods concerning distress, discomfort, pain, well-being and security after the LP, and problems with the LP. PROCEDURE: Twenty-five children with cancer participated in this prospective, randomized, crossover study. Children, parents, and nurses completed a visual analogue scale questionnaire to evaluate the efficacy of CS and GA. In addition, sedation and anesthesia protocols were reviewed. RESULTS: The two methods seemed to be equivalent concerning distress, discomfort, pain, well-being and security after the procedure, and procedure problems. Most children (80%), parents (66%), and nurses (58%) preferred LP in CS. However, the LP was not performed in CS in five cases because the child did not cooperate. Younger children less often preferred CS. CONCLUSIONS: Outcomes for CS and GA in LP were similar. Although there were failures with the CS model, most preferred it to GA. LP in CS also saved time and medical resources. An alternative approach would be to have a pediatric anesthesiologist available at the oncology ward for these elective LPs to provide the sedation or anesthesia required by each individual.

Adolescent↗
PubMed2001

Conversion from laparoscopic to open appendicectomy: a possible drawback of the laparoscopic technique?

OBJECTIVE: To analyse the reasons for, and outcome of, conversion from laparoscopic to open appendicectomy and to identify factors that may predict the need for conversion. DESIGN: Subgroup analysis from a randomised multicentre study. SETTING: One university hospital and four county hospitals, Sweden. SUBJECTS: A total of 500 patients were randomised to laparoscopic (n = 244) or open (n = 256) appendicectomy. Thirty operations (12%) were converted to open appendicectomy. MAIN OUTCOME MEASURES: Reasons for conversion, outcome, and preoperative predictive variables. RESULTS: Difficult anatomy or the presence of an abscess were the main reasons for conversion (25/30). The incidence of perforated appendicitis was higher among patients who required conversion compared with both the open and laparoscopic group. Operating time, anaesthetic time, and duration of hospital stay were longer after conversion. Time to full recovery and length of sick leave were also longer, except for patients with perforated appendicitis. There was no difference in the complication rate. No predictive factors were identified. CONCLUSION: The main reasons for conversion were difficult anatomy and the presence of an abscess. After conversion patients recovered more slowly than those operated on laparoscopically or by primary open operation.

Adolescent↗
PubMed2001

Gender differences in self-concept and psychological well-being in old age: a meta-analysis.

Because of women's higher risk of being widowed, having health problems, and needing care, one might expect them to have a more negative self-concept and lower subjective well-being (SWB). However, women may also have greater access to sources of SWB (e.g., relations to adult children) and may engage in processes to protect the self (e.g., lowered aspirations). Meta-analysis was used to synthesize findings from 300 empirical studies on gender differences in life satisfaction, happiness, self-esteem, loneliness, subjective health, and subjective age in late adulthood. Older women reported significantly lower SWB and less positive self-concept than men on all measures, except subjective age, although gender accounted for less than 1% of the variance in well-being and self-concept. Smaller gender differences in SWB were found in younger than in older groups. Statistically controlling for gender differences in widowhood, health, and socioeconomic status decreased gender differences in SWB. Cohort differences in SWB are reported as well.

Aged↗
PubMed2001

Developing a measure of older adults' preparation for future care needs.

We developed a measure of preparation for future care needs (PFCN) which consists of three parts: a) attitudes regarding the usefulness of planning for future care needs and toward the risk of needing help or care in the future; b) processes of preparation (becoming aware of future care needs, avoidance of preparation, gathering information, developing preferences, concrete planning); and c) contents of planning for short- and long-term care needs. Validity data of the questionnaire are reported based on 590 older adults (65-92 years). Engaging in preparation processes was associated with habitual decision styles, higher satisfaction with preparation, and greater knowledge of services. Greater vulnerability to needing future care was associated with higher expectations of needing care and more preparation. Internal consistency and stability of the measure based on 96 seniors was acceptable for almost all scales.

Aged↗
PubMed2000

Preparation for future care needs: styles of preparation used by older Eastern German, United States, and Canadian women.

Many older persons have chronic conditions and limitations in their everyday functioning. While some individuals prepare for their future care needs, many others do not. Using semi-structured, qualitative interviews, discourse about dealing with the risk for needing help or care in the future was investigated in 23 East German, 10 U.S., and 12 Canadian elderly community-dwelling women (> or =65 years). Eighty percent had thought about future care needs; 64% had made general plans for their future care. Four preparation styles were identified in the three social-structural contexts: Avoidance of preparation, thinking without planning, short-term planning, and long-term planning. Individuals using these styles differed in their subjective assessment of preparation as well as in objective personal conditions. More similarities than differences were found between German, U.S. and Canadian women in the use of these styles. Results suggest that limited resources, system instability, and personal characteristics contribute to the choice of planning style.

Journal Article↗
PubMed2000

Influences of socioeconomic status, social network, and competence on subjective well-being in later life: a meta-analysis.

Meta-analysis is used to synthesize findings from 286 empirical studies on the association of socioeconomic status (SES), social network, and competence with subjective well-being (SWB) in the elderly. All three aspects of life circumstances are positively associated with SWB. Income is correlated more strongly with well-being than is education. The quality of social contacts shows stronger associations with SWB than does the quantity of social contacts. Whereas having contact with friends is more strongly related to SWB than having contact with adult children, there are higher associations between life satisfaction and quality of contact with adult children when compared with quality of friendships. Moderating influences of gender and age on the effects of SES, social network, and competence on SWB are also investigated.

Aged↗
PubMed2000

Hyposalivation and iron stores among individuals with and without active dental caries.

The aims of the study were to investigate frequencies of low unstimulated whole saliva (UWS) levels and low serum ferritin (S-f) levels among individuals with active dental caries (ADC) and dental caries inactive (DCI) individuals and to compare the relationship between UWS and S-f levels. In this descriptive study, 48 ADC patients and 48 DCI individuals were compared. The two groups were matched regarding age and sex (30 females and 18 males in each group, age range 15-40 years). In the ADC group, 32 individuals (67%) had low (< or = 0.20 ml/min) UWS levels compared with 13 individuals (27%) in the DCI group. This difference was statistically significant (P < 0.001). The mean values of UWS were significantly lower in the ADC group compared to the DCI group (mean ml/min +/- SD) 0.20 +/- 0.13 and 0.33 +/- 0.24, respectively (P = 0.002). There were significant differences for females but not for males when comparing frequencies of low UWS levels (P < 0.001) and mean UWS levels (P = 0.002). There was no difference in S-f levels between the two groups. Neither was any correlation between UWS and S-f found. In conclusion, the significant negative relationship found between UWS and ADC indicates that a suppressed defense for dental caries activity could play a more important role in ADC than previously presumed, especially among females. The absence of a correlation between UWS and S-f might indicate that saliva secretion will not be stimulated by iron supplementation.

Adolescent↗
PubMed2000

Preparation for future care needs by West and East German older adults.

OBJECTIVES: We evaluated a model of the process of preparation for future care needs. This model predicted that less concrete preparation activities (e.g., becoming aware and gathering information) would predict more concrete ones (e.g., deciding on preferences and making concrete plans), and that attitudes (expectations of needing care and negative beliefs about the usefulness of planning) would mediate the effect of vulnerability (age, ADL/IADL deficits) and resources (socioeconomic status. social network) on preparation activities. METHODS: The Preparation for Future Care Needs Measure was used to assess two attitudes toward preparation (Cronbach's a range: .66-.86),. four planning processes (Cronbach's a range: .75-.86), and the content of planning for future care needs. In addition, demographic variables, social network, and ADL/IADL limitations were assessed. Using path analysis, the model was first developed on a West German sample (n = 280), and then validated on an East German sample (n = 294). RESULTS: The best-fitting path models suggested that more concrete preparation activities were predicted by less concrete ones, but not always in the expected sequence. Gathering information, deciding on preferences, and age predicted concrete planning. Indicators of vulnerability were mediated by expectations of needing care in the future and several preparation activities, especially becoming aware and gathering information. Negative beliefs about the usefulness of planning inhibited gathering information and concrete planning. DISCUSSION: The results suggest that preparation for future care needs may be conceptualized as a successive process. Some individuals, however, may skip steps in the preparation process. For example, relatives may offer to provide care before the older adult has to decide among her or his options.

Activities of Daily Living↗
PubMed2000

Midazolam nasal spray reduces procedural anxiety in children.

OBJECTIVE: Anxiety and pain even in minor procedures are still great problems in pediatrics, not least in pediatric oncology. Conscious sedation is indicated when other means to overcome a child's fear fail. The aim of this study was to investigate whether intranasal administration of midazolam given before insertion of a needle in a subcutaneously implanted central venous port could reduce anxiety, discomfort, pain, and procedure problems. METHOD: Forty-three children with cancer participated in this randomized, double-blind, placebo-controlled, crossover study in which nasal administration of midazolam spray,.2 mg/kg body weight, was compared with placebo. Children, parents, and nurses completed a visual analog scale questionnaire to evaluate efficacy. RESULTS: Parents and nurses reported reduced anxiety, discomfort, and procedure problems for children in the midazolam group and would prefer the same medication at next procedure. They also reported pain reduction. Children reported reduced anxiety and procedure problems but reduction of pain and discomfort was not significant. No serious or unexpected side effects occurred. Nasal discomfort was the most common side effect (17/38 approximately 45%) and the primary reason for dropouts (8/43 approximately 19%). Anxiety varied with age but not with gender. When anxiety increased, the differences between midazolam and placebo increased. CONCLUSION: Nasal midazolam spray offers relief to children anxious about procedures, such as insertion of a needle in a subcutaneously implanted intravenous port, venous blood sampling, venous cannulation, etc. Its use, however, may be limited by nasal discomfort in some patients for whom rectal and oral routes might be alternatives.

Administration, Intranasal↗
PubMed2000

Oral health care--a low priority in nursing. In-depth interviews with nursing staff.

In this study we examined how nursing home staff experienced assisting patients with oral health care. The results of a previous questionnaire indicated that oral health care is a low priority in nursing. The 22 in-depth interviews administered in this study showed that the quality of the oral health care received by the patients depended on several factors. It was found that often there were no specific routines for assisting oral health care in the nursing homes and that other activities were given higher priority. Assisting oral health care was described as passing a barrier, where the main problem was to gain access to the oral cavity. It was concluded that nursing staff working with geriatric patients need to be better educated in oral health care and should be seen by themselves and others as part of a team, where oral health care is clearly defined and included among other daily nursing activities.

Aged↗
PubMed1999

Prospective randomized multicentre study of laparoscopic versus open appendicectomy.

BACKGROUND: A prospective randomized multicentre study was performed to compare the outcome of laparoscopic and open appendicectomy in patients with suspected acute appendicitis. METHODS: A total of 523 patients was randomized, but because of 23 withdrawals the outcome in 500 patients is reported, 244 in the laparoscopic group and 256 in the open group. RESULTS: Patients having laparoscopic appendicectomy recovered more quickly than those having open surgery (13 versus 21 days, P < 0.001). There was no significant difference in duration of sick leave after operation (laparoscopic group 11 days versus open group 14 days). Postoperative pain (at 24 h, 7 days and 14 days) was less after laparoscopic operations and a functional index 1 week after operation was more favourable in these patients (P < 0.001). Operating time was significantly longer in the laparoscopic group (60 versus 35 min, P < 0.01). Hospital stay and complications did not differ between the groups. Thirty laparoscopic procedures (12 per cent) were converted to open appendicectomy. CONCLUSION: Laparoscopic appendicectomy is as safe as open appendicectomy and has the advantage of allowing a quicker recovery.

Acute Disease↗
PubMed1999

Pain in paediatric oncology: interviews with children, adolescents and their parents.

Pain diagnostics and treatment are crucial components in the care of children with cancer. This study evaluated the extent and causes of pain, the use of methods for monitoring pain intensity, principles of pain management and adverse effects of pain treatment. In addition, care, support and information given to children and parents were evaluated. Structured interviews were conducted with 55 children with malignant disease and their parents. Pain was a common symptom and a major problem during different phases of cancer treatment and pain evaluation was unsystematic. Pain due to treatment and procedures was a greater problem than pain due to the malignant disease itself, and two thirds of the pain experienced by these children seemed to have iatrogenic origin. Younger children and children with short disease duration were more concerned about procedural pain. Parents and children thought that more efficient pain treatment was often possible. Parents claimed to judge their child's pain better than professionals, and children and parents wanted more information on different aspects of pain and pain treatment. Pain identification and treatment can be substantially improved through increased use of methods for pain evaluation and through giving enhanced information to families about pain and pain treatment.

Adolescent↗