Landstinget Gävleborg
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Interdisciplinary differences regarding understanding the International Classification of Functioning, Disability and Health (ICF) concepts activity/participation may hinder its unifying purpose. In the ICF model, functioning (and disability) is described as a tripartite concept: 1) Body structures/functions, 2) Activities, and 3) Participation. Activities refer to an individual perspective on disability that does not tally with the basic structure of social models. To review how activity and participation are actually used in studies of intellectual disability (ID). Based on 16 papers, four different usages of activity/participation were found. 1) Theoretical reference to tripartite ICF concept with attempts to use it. 2) Theoretical reference to tripartite ICF concept without actual use of activities. 3) "Atheoretical" approach with implicit focus on participation. 4) Theoretical reference to bipartite concept with corresponding use of terms. The highlighted studies have in common a focus on participation. However, the usage of the term "activity" differs both within and between studies. Such terminology will probably confuse interdisciplinary communication rather than facilitating it. Also, the use of an explicit underlying theory differs, from references to a tripartite to references to a bipartite concept of disability. This paper is focused on ID, but the discussed principles regarding the ICF and interdisciplinary disability theory are applicable to other diagnostic groups within rehabilitation practices.
Early clinical diagnosis of chronic knee and hip osteoarthritis is important for prevention and treatment. A physiotherapist diagnoses clinical osteoarthritis using national guidelines in the context of patients’ needs, providing information, supervised exercise, self-administered tests for strength and aerobic fitness, lifelong physical activity on prescription, and a collaborative approach to dealing with weight loss. It is important to treat risk factors for cardiovascular disease and premature death. Osteoarthritis in knee and hip reduces the patient’s physical activity, strength and fitness, and increases sedentary behavior. A better understanding of sarcopenia helps practitioners identify implications for osteoarthritis patients. Today one of the recommended assessments of leg function for patients with osteoarthritis is a 30-second sit to stand test. Together with a test of controlled knee bending, these tests could be used by all personnel and also be suitable for self-testing.
Therapists meet special challenges in their contact with depressed boys. There is a lack of knowledge on how therapists create therapeutic alliance with reluctant boys. How do experienced therapists create alliance and gain success in their contact with weakly motivated boys? The aim of this study was to explore factors contributing to success in therapeutic encounters with depressed boys using a grounded theory approach. Qualitative interviews were performed with therapists from Child and Youth Psychiatry, School Health Care, Social Service, and Youth Clinics about their contact with depressed boys. The results show that two core categories proved important for success. The notion of the male role (“boys don't cry”), both from therapist and boys, was of importance in the contact. Secondly, that alliance cannot be built on mere words (“words are not enough”); activity and creativity are needed. Conclusions show that active and creative therapists succeed in creating therapeutic alliance with depressed boys.
Objective: To explore brain pathology after mild traumatic brain injury by repeated magnetic resonance examination. Design: A prospective follow-up study. Subjects: Nineteen patients with mild traumatic brain injury presenting with Glasgow Coma Scale (GCS) 14-15. Methods: The patients were examined on day 2 or 3 and 3-7 months after the injury. The magnetic resonance protocol comprised conventional T1- and T2-weighted sequences including fluid attenuated inversion recovery (FLAIR), two susceptibility-weighted sequences to reveal haemorrhages, and diffusion-weighted sequences. Computer-aided volume comparison was performed. Clinical outcome was assessed by the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), Hospital Anxiety and Depression Scale (HADS) and Glasgow Outcome Scale Extended (GOSE). Results: At follow-up, 7 patients (37%) reported ≥ 3 symptoms in RPQ, 5 reported some anxiety and 1 reported mild depression. Fifteen patients reported upper level of good recovery and 4 patients lower level of good recovery (GOSE 8 and 7, respectively). Magnetic resonance pathology was found in 1 patient at the first examination, but 4 patients (21%) showed volume loss at the second examination, at which 3 of them reported < 3 symptoms and 1 ≥ 3 symptoms, all exhibiting GOSE scores of 8. Conclusion: Loss of brain volume, demonstrated by computer-aided magnetic resonance imaging volumetry, may be a feasible marker of brain pathology after mild traumatic brain injury.
The aim of this study was to describe essential competencies relevant for professional renal nursing in Sweden. A Delphi study with four rounds was conducted from November 2008 to April 2009. A national sample of renal nurses was used to achieve consensus about the core competencies required. The 43 competencies were reviewed for face validity by external experts representing general nursing, renal nursing, stakeholders and nephrologists. The core competencies were categorised in nine areas according to their structure; nursing and medical science, information and teaching, examinations and therapies, promoting health and preventing ill health, palliative care, safety and quality, care environment, research and development and management and cooperation in the patient care pathway. Altogether these categories represent a national description of competence in renal nursing.
The aims of this study were to evaluate the community-based prevalence of atrial fibrillation (AF) in a western society using a geographically well-defined population in the northern part of Sweden as a reference and to estimate the proportion of patients eligible for oral anticoagulation (OAC) prophylactic therapy according to the stroke risk indices CHADS2 and CHA2 DS2 -VASc. Bleeding risk was assessed using the HAS-BLED score. The study population was recruited from AURICULA, a Swedish national quality register for patients receiving anticoagulation treatment. All patients with the diagnosis AF in the catchment area are registered in AURICULA. Of the 65 532 inhabitants in the catchment area, 1616 were diagnosed with AF (1200 cases were characterized as chronic AF). Thus, the overall prevalence of AF was 2.5%. The prevalence increased with age from 6.3% in patients over 55 years of age to 13.8% in those over 80 years. The prevalence was higher in men than in women in all age groups. Overall, 56.3% and 85.1% of the population were at high risk of stroke (≥2 points) according to CHADS2 and CHA2 DS2 -VASc, respectively. In addition, 26.9% had an increased bleeding risk according to HAS-BLED. Within this large Caucasian population, we identified the highest community-based prevalence of AF to date. The prevalence was strongly associated with increasing age and male gender. Using CHA2 DS2 -VASc instead of CHADS(2) widened the indication for OAC prophylactic therapy of AF in this population.
One concern regarding resurfacing arthroplasty is the viability of the diminished femoral head and the postoperative risk of collapse, or a femoral neck fracture. (18)F-fluoride positron emission tomography (F-PET) enables us to assess bone viability despite there being a covering metal component. By F-PET studies, we recently showed the absence of metabolism in the remaining part of femoral heads, 1-4 years after surgery in 11 of 46 consecutive cases. We now present the further development of bone metabolism in these 11 cases. 10 patients (11 chips) with previously shown loss of femoral head metabolism were evaluated by radiography and repeated F-PET scans, 3-6.5 years after surgery. The size of the area with low (18)F-fluoride PET uptake in the femoral head was compared to that in earlier PET images. No patients had any clinical symptoms; nor was any necrotic bone area visible in plain radiographs. On F-PET scans, 2 patients showed a diminished area with low uptake, 4 were unchanged, and 5 had enlarged areas. Bone metabolism surrounding a volume of bone with no metabolic activity changes dynamically even 5 years after surgery. The presence of bone with minor uptake of F-tracer, indicating low or no bone metabolism, with further progression in 5 of 11 cases leads us to conclude that resurfacing THA should be used restrictively.
Excessive fluid overload is common in hemodialysis patients. Understanding fluid intake behavior in relation to used cognitive coping style would serve the fluid restriction consultation. The aim of this study was to explore whether hemodialysis patients' fluid intake behavior differs as a function of used coping style. Secondary analysis of data from 51 hemodialysis patients regarding cognitive coping style (assessed by the Threatening Medical Situations Inventory) and fluid intake behavior were used. The participants' mean age was 62.9 years (range 27-84), they had received dialysis treatment for 3.9 years on average (range 0-22), 63% were male and they had gained 3.6% (±1.3) of their dry body weight during the interdialytic period. There was a significant difference in fluid intake behavior between coping groups (F = 3.899, d.f. 2, P = 0.027). The difference (P = 0.028) was isolated between patients with cognitive blunting style and patients with neutral coping style. Identification of hemodialysis patients using cognitive avoidance strategies can be advantageous in renal care. Fluid advice provided may have to be adjusted to the used coping style, especially for patients with a blunting coping style. However, the findings need to be confirmed, and the effect of individualized counseling needs to be evaluated in forthcoming studies.
Periodontal disease has been associated with cardiovascular disorders with an atherosclerotic background, and number of teeth (NT) has been suggested as a possible risk indicator for cardiovascular disease. The objective of this study is to investigate whether NT was related to the intima-media thickness (IMT) and to atherosclerotic plaque in carotid arteries in an elderly population. In a population-based study including 1,016 participants aged 70 years, the NT was self-reported by 947 of the participants. Carotid artery IMT was evaluated by ultrasound. The occurrence of plaque was also measured. Logistic regression was used to analyze the associations between NT and the number of carotid arteries with plaque. A significant inverse relationship was found between the NT and the number of carotid arteries with plaque after adjustment for age, sex, smoking, body mass index, waist/hip ratio, blood glucose, triglycerides, cholesterol, C-reactive protein, leukocyte count, blood pressure, and Framingham risk score, with odds ratio of 0.89, 95% confidence interval of 0.82 to 0.98, and P = 0.016. The relationship was fairly linear, suggesting a dose-response relationship. When NT was divided into quintiles using the first one as referent, the relationship persisted for all quintiles except for the second one. However, no relationship to IMT was seen. The present study further emphasizes that tooth loss could be an easily obtained risk indicator for atherosclerosis.
This study was undertaken to examine the influence of partial demineralization of xenogenous dentin on bone formation in an osteoconductive environment. Sixty dentin blocks, 2-3 mm thick and 4 mm in diameter, were prepared from developing teeth of young pigs. Forty blocks were demineralized in 24% ethylenediaminetetraacetic acid (pH 7.0) for 1, 2, 6 or 12 h. Forty adult rats divided into eight groups with five rats in each group were used. A sagittal midcranial incision was made from the occipital to the frontal region. Through a subperiostal dissection, a pocket was created on each side of the skull. One demineralized block was placed on one side, and a non-demineralized block was placed on the contralateral side, or the pocket was left empty as controls. Thus, eight experimental groups with five rats in each were formed. Resorption increased significantly with increasing degree of demineralization while bone formation increased significantly with increasing degree of demineralization, provided inflammation was compensated for. This suggests an important role for inflammation or infection control during the healing period of osteogenic implants to optimize osseous integration in an osteoconductive environment. Partial demineralization of xenogenous dentin blocks may provide a method for optimizing the integration of dentin onlays in an osteoconductive environment, thus stabilizing the implant and slowing down replacement resorption.
The aim of this trial was to evaluate and compare perceived pain, discomfort, and jaw function impairment between orthodontic treatments combined with skeletal anchorage and treatment using conventional anchorage with headgear or transpalatal bar. A total of 120 adolescent patients in order to start orthodontic treatment were consecutively recruited and randomized into three groups with different anchorage. Group A underwent installation of a skeletal anchorage (Onplant or Orthosystem implant), group B received headgear, and group C a transpalatal bar. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment from baseline to the end of treatment. Pain scores overall peaked on day 2 and were almost back to baseline on day 7. The site with the highest pain scores during treatment was incisors in contact but with no differences between groups. Pain intensity from molars was significantly less in the skeletal anchorage group A compared to the transpalatal bar group C the first 4 days in treatment and with no sign differences compared to headgear. The results confirm that there were very few significant differences between patients' perceptions of skeletal and conventional anchorage systems during orthodontic treatment. Consequently, these new appliances were well accepted by the patients in a long time perspective and can thus be recommended.
In spite of no clinical signs of facial paresis, a pathological lip force (LF) will strongly influence swallowing capacity (SC). Stroke patients with impaired SC suffer a subclinical facial paresis. The results support earlier findings that LF training can be used to treat dysphagia. Lip muscle training with an oral screen can improve both LF and SC in stroke patients, irrespective of the presence or absence of facial palsy. The aim was therefore to study the influence of LF on SC. This prospective study included 22 stroke patients, aged 38–90 years, with dysphagia, 12 with initial unilateral facial paresis and 45 healthy subjects, aged 25–87 years. All were investigated with a Lip Force Meter (LF100), and with an SC test. A significant correlation was found between LF/SC (p = 0.012) in stroke patients but not in healthy subjects. LF/SC was not age-related in stroke patients. LF was not age-dependent in healthy subjects, but SC decreased with increasing age (p < 0.0001). However, SC did not reach a pathological value and a regression analysis showed that 73% of the variation in SC is attributable to LF and age.
Objective: The purpose of the present study was to histologically and histomorphometrically evaluate the long-term tissue response to deproteinized bovine bone (DPBB) particles used in association with autogenous bone and to compare particle size after 6 months and 11 years, in the same patients, in order to determine possible resorption. Material and methods: Twenty consecutive patients (14 women and six men) with a mean age of 62 years (range 48–69 years) with severe atrophy of the posterior maxilla were included in this study. Thirty maxillary sinuses with <5 mm subantral alveolar bone were augmented with a mixture of 80% DPBB and 20% autogenous bone. Eleven years (mean 11.5 years) after augmentation, biopsies were taken from the grafted areas of the 11 patients who volunteered to participate in this new surgical intervention. The following histomorphometrical measurements were performed in these specimens: total bone area in percentage, total area of the DPBB, total area of marrow space, the degree of DPBB–bone contact (percentage of the total surface length for each particle), the length of all DPBB particles and the area of all DPBB particles. The length and the area of the particles were compared with samples harvested from the same patients at 6 months (nine samples) and pristine particles from the manufacturer. Results: The biopsies consisted of 44.7±16.9% lamellar bone, 38±16.9% marrow space and 17.3±13.2% DPBB. The degree of DPBB to bone contact was 61.5±34%. There were no statistically significant differences between the length and area of the particles after 11 years compared with those measured after 6 months in the same patients or to pristine particles from the manufacturer. Conclusion: DPBB particles were found to be well integrated in lamellar bone, after sinus floor augmentation in humans, showing no significant changes in particle size after 11 years. To cite this article: Mordenfeld A, Hallman M, Johansson CB, Albrektsson T. Histological and histomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone. Clin. Oral Impl. Res. 21, 2010; 961–970. doi: 10.1111/j.1600-0501.2010.01939.x
The rate of subjective health complaints among Swedish children is increasing by age and over time, and more so than among children in other Scandinavian countries. In contrast, the somatic health and prerequisites for wellbeing are excellent. This paradoxical situation, The Enigma of the Welfare State, is the focus of this viewpoint. We argue that one important background factor may be late adverse effects of the welfare society itself and some of its inherent values. We have identified several possible pathways. We have given them names of diseases – on the society level – like health obsession, stress panic, welfare apathy and hyper-individualism. Together with other factors such as a dysfunctional school and an unsatisfactory labour market for youth, these diseases are involved in an interplay that is constantly inducing anxiety and low self-esteem. Conclusion: The gradually deteriorating self-reported health among Swedish youth may, to some degree, be explained as a late adverse effect of the welfare society itself and its inherent values.
That oral health is related to the development of different cardiovascular disorders is reported in a number of studies. This study investigates if different parameters of oral health are associated with future mortality in different cardiovascular disorders in a dose-dependent manner. A total of 7,674 subjects (3,300 males and 4,374 females; age range 20 to 89 years) received a dental examination by specialists in periodontology between the years 1976 and 2002. Number of remaining teeth, severity of periodontal disease, number of deepened periodontal pockets, and bleeding on probing were evaluated in relation to cause of death. During a median follow-up period of 12 years, 629 of the subjects died. For 299 subjects the cause of mortality was cardiovascular disease (CVD); 167 of these subjects died from coronary heart disease (CHD); 83 died from stroke; and 49 died from aortic aneurysm or congestive heart failure. The causes of death for the remaining 330 subjects were other than CVD. After adjustment for age, gender, and smoking, number of remaining teeth predicted in a dose-dependent manner all-cause mortality and mortality in CVD and in CHD (P <0.0001 for all), but not mortality from stroke (P = 0.15). Cox regression analysis revealed a seven-fold increased risk for mortality from CHD in subjects with <10 teeth compared to those with >25 teeth. Severity of periodontal disease, number of deepened periodontal pockets, and bleeding on probing were not related to mortality in a dose-dependent manner after adjustment for confounders. This fairly large, prospective study with a long follow-up period presents for the first time a dose-dependent relationship between number of teeth and both all-cause and CVD mortality, indicating a link between oral health and CVD, and that the number of teeth is a proper indicator for oral health in this respect.
Non-contrast computed tomography (NCT) has become an important diagnostic tool in acute abdominal pain, but the drawback is the increased radiation dose compared to abdominal plain film (APF). To evaluate whether NCT, including low-dose computed tomography (LDCT, using 50 mAs), provides more diagnostic information than APF in patients presenting with acute non-traumatic abdominal pain and if the use of CT can reduce the total number of additional radiograms. A second aim was to compare the diagnostic outcome between standard-dose computed tomography (SDCT) and LDCT. During 2000, 2002, and 2004 a total of 222 patients were retrospectively reviewed, and 86 patients had APF, 60 had SDCT, and 76 had LDCT. The radiological report of each patient was compared with the final diagnosis obtained from the medical record within 30 days. Additional radiograms were registered, and a total radiation dose excluding or including APF or NCT was calculated. NCT gave a correct diagnosis in 50%, compared to 20% with APF (P < 0.001). The total number of additional radiograms was substantially lower in the computed tomography (CT) group compared to the APF group (P < 0.001), and the average sum of radiation dose was similar for APF and LDCT. NCT was found to be significantly better at providing diagnostic information than APF in patients presenting with acute abdominal pain. It reduced the number of additional radiograms, but the total patient dose remained somewhat higher in the CT group even when using LDCT with 50 mAs.
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40 members
Mats Hallman
  • Maxillofacial Surgery/ specialized dentistry
Mary Hägg
  • Otorhinolaryngology, Hudiksvall Hospital, Sweden
Anders Holmlund
  • Department of Periodontology
Gunilla Norrman
  • the Pediatric clinic Hudiksvall
Hampus Stigbrand
  • Department of Orthopedics
Gävle, Sweden