Sundsvall, Sweden
Sundsvall, Sweden

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Vogt H.,Linköping University | Braback L.,Sundsvall Hospital | Kling A.-M.,Unit for Statistics and Surveillance | Grunewald M.,Public Health Agency of Sweden | Nilsson L.,Linköping University
Pediatrics | Year: 2014

BACKGROUND AND OBJECTIVES: Childhood immunization may influence the development of asthma, possibly due to lack of infections or a shift in the T-helper cell type 1/T-helper cell type 2/regulatory T cells balance. We therefore investigated whether pertussis immunization in infancy is associated with asthma medication in adolescence.METHODS: After 14 years of no general pertussis vaccination, almost 82,000 Swedish children were immunized for pertussis in a vaccination trial between June 1, 1993, and June 30, 1994. In a follow-up analysis of almost 80,000 children, their data were compared with those of ∼100,000 nonvaccinated children, born during a 5-month period before and a 7-month period after the vaccination trial. Data for the main outcome variable (ie, dispensed prescribed asthma medication for each individual in the cohort during 2008-2010) were obtained from the national prescription database. Multivariate regression models were used to calculate the effect size of vaccination on dispensed asthma medication (odds ratios [OR], 95% confidence intervals [CI]). Approaches similar to intention-to-treat and per-protocol methods were used.RESULTS: The prevalence rates of various asthma medications for study patients at 15 years of age differed between 4.6% and 7.0%. The crude ORs for any asthma medication and antiinflammatory treatment in pertussis-vaccinated children after intention-to-treat analysis were 0.97 (95% CI: 0.93-1.00) and 0.94 (95% CI: 0.90-0.98), respectively. Corresponding adjusted ORs were 0.99 (95% CI: 0.95-1.03) and 0.97 (95% CI: 0.92-1.01). Similar ORs were found after per-protocol analysis.CONCLUSIONS: Pertussis immunization in infancy does not increase the risk of asthma medication use in adolescents. Our study presents evidence that pertussis immunization in early childhood can be considered safe with respect to long-term development of asthma. Copyright © 2014 by the American Academy of Pediatrics.

Vogt H.,Linköping University | Lindstrom K.,Sachs Childrens Hospital | Braback L.,Sundsvall Hospital | Braback L.,Umeå University | And 2 more authors.
Pediatrics | Year: 2011

OBJECTIVE: Preterm birth is associated with respiratory morbidity later in life, including asthma. Previous studies have mainly focused on asthma in early childhood in children born extremely preterm. In this study, we examined the risk of asthma in a national cohort of school-children grouped according to degree of immaturity expressed as completed gestational weeks at birth. METHODS: This was a register study in a Swedish national cohort of 1 100 826 children 6 to 19 years old. Retrieval of at least 1 prescription of inhaled corticosteroids (ICS) during 2006 was used as the main indicator for asthma. Logistic regression was used to test hypotheses, with adjustment for multiple socioeconomic and perinatal indicators. RESULTS: Degree of immaturity, expressed as completed gestational weeks at birth, had an inverse dose-response relationship with ICS use. Compared with children born between 39 and 41 weeks' gestation, the odds ratio for ICS use increased with the degree of prematurity, from 1.10 (95% confidence interval: 1.08-1.13) for children born in weeks 37 to 38, to 2.28 (95% confidence interval: 1.96-2.64) for children born in weeks 23 to 28, after adjustment for confounders. The increase in ICS use with decreasing gestational age at delivery was similar in boys and girls, and declined with older age. CONCLUSION: Preterm birth increased the risk of ICS use in these 6- to 19-year-olds by degree of immaturity, from extremely preterm to early term birth. Copyright © 2011 by the American Academy of Pediatrics.

Rautiainen S.,Karolinska Institutet | Lindblad B.E.,Karolinska Institutet | Lindblad B.E.,Sundsvall Hospital | Morgenstern R.,Karolinska Institutet | Wolk A.,Karolinska Institutet
American Journal of Clinical Nutrition | Year: 2010

Background: Experimental animal studies have shown adverse effects of high-dose vitamin C supplements on age-related cataract. Objective: We examined whether vitamin C supplements (≈1000 mg) and multivitamins containing vitamin C (≈60 mg) are associated with the incidence of age-related cataract extraction in a populationbased, prospective cohort of women. Design: Our study included 24,593 women aged 49-83 y from the Swedish Mammography Cohort (follow-up from September 1997 to October 2005). We collected information on dietary supplement use and lifestyle factors with the use of a self-administrated questionnaire. Cataract extraction cases were identified by linkage to the cataract extraction registers in the geographical study area. Results: During the 8.2 y of follow-up (184,698 person-years), we identified 2497 cataract extraction cases. The multivariable hazard ratio (HR) for vitamin C supplement users compared with that for nonusers was 1.25 (95% CI: 1.05, 1.50). The HR for the duration of >10 y of use before baseline was 1.46 (95% CI: 0.93, 2.31). The HR for the use of multivitamins containing vitamin C was 1.09 (95% CI: 0.94, 1.25). Among women aged ≥65 y, vitamin C supplement use increased the risk of cataract by 38% (95% CI: 12%, 69%). Vitamin C use among hormone replacement therapy users compared with that among nonusers of supplements or of hormone replacement therapy was associated with a 56% increased risk of cataract (95% CI: 20%, 102%). Vitamin C use among corticosteroid users compared with that among nonusers of supplements and corticosteroids was associated with an HR of 1.97 (95% CI: 1.35, 2.88). Conclusion: Our results indicate that the use of vitamin C supplements may be associated with higher risk of age-related cataract among women. © 2010 American Society for Nutrition.

Svedberg U.,Sundsvall Hospital | Johanson G.,Karolinska Institutet
Annals of Occupational Hygiene | Year: 2013

More than 500 million ocean freight container units are shipped annually between countries an continents. Residual levels of fumigants, as well as naturally occurring off-gassing chemicals emanating from the goods, constitute safety risks, which may affect uniformed workers upon entering the container. The aim of this study was to assess workers' exposure during stripping of containers and is the first study of its kind. First, an experimental tracer gas method was investigated to determine its usefulness to approximate real exposures from gaseous fumigants and off-gassing volatile organic compounds (VOCs). Nitrous oxide was injected and left to distribute in the closed containers. The distribution of the tracer gas and initial (arrival) concentrations of off-gassing volatiles were measured prior to opening the containers. Second, personal exposure (breathing zone) and work zone air monitoring of both tracer gas and VOCs were carried out during stripping. Adsorbent tubes, bag samples, and direct-readings instruments (photoionization detector and Fourier transform infrared spectrometry) were used. The distribution studies with nitrous oxide, and the high correlation between the former and VOCs (r2 ∼ 0.8) during stripping, showed that the tracer gas method may well be used to approximate real exposures in containers. The average breathing zone and work zone concentrations during stripping of naturally ventilated 40-foot containers were 1-7% of the arrival concentrations; however, peaks up to 70% were seen during opening. Even if average exposures during stripping are significantly lower than arrival concentrations, they may still represent serious violations of occupational exposure limits in high-risk containers. The results from this and previous studies illustrate the need to establish practices for the safe handling of ocean freight containers. Until comprehensive recommendations are in place, personnel that need to enter such containers should, in addition to appropriate personal protective equipment, have access to equipment for measuring contaminants and for applying forced ventilation when necessary. © The Author 2013. Published by Oxford University Press.

Sayed-Noor A.S.,Sundsvall Hospital
Journal of surgical orthopaedic advances | Year: 2012

The technical description of a new surgical method (Pedersen-Noor operation) to treat refractory external snapping hip [coxa saltans externa (CSE)] is presented. The method consists of distal lengthening of the iliotibial band by Z-plasty under local anesthesia and on an outpatient basis. Five patients with refractory CSE were treated with the new method. Postoperatively, the outcome was evaluated by phone interview and physical examination, 3 to 4 months and 1 year postoperatively, respectively. The snapping disappeared in all five patients. No postoperative complications were reported. Three patients were very satisfied and two patients were satisfied with the result of the operation. All five patients would recommend the operation to another patient with similar symptoms. The described method is simple, economic, and effective and can be recommended in the treatment of refractory CSE.

Israelsson L.A.,Umeå University | Millbourn D.,Sundsvall Hospital
Langenbeck's Archives of Surgery | Year: 2012

Background: The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. Results: The suture technique monitored through the suture length-to-wound length ratio is of major importance for the development of wound complications. The risk of wound dehiscence is low with a high ratio. The ratio must be higher than 4; otherwise, the risk of developing an incisional hernia is increased four times. With a ratio higher than 4, both the rate of wound infection and incisional hernia are significantly lower if closure is done with small stitches placed 5 to 8 mm from the wound edge than with larger stitches placed more than 10 mm from the wound edge. Conclusions: Midline incisions should be closed in one layer by a continuous suture technique. A monofilament suture material should be used and be tied with self-locking knots. Excessive tension should not be placed on the suture. Wounds must always be closed with a suture length-to-wound length ratio higher than 4. The only way to ascertain this is to measure, calculate and document the ratio at every wound closure. A high ratio should be accomplished with many small stitches placed 5 to 8 mm from the wound edge at very short intervals. © 2012 Springer-Verlag Berlin Heidelberg.

Millbourn D.,Sundsvall Hospital | Wimo A.,Sundsvall Hospital | Israelsson L.A.,Sundsvall Hospital
Hernia : the journal of hernias and abdominal wall surgery | Year: 2014

PURPOSE: Suturing with small stitches instead of with large reduces the risk for surgical site infection and incisional hernia in continuously closed midline abdominal incisions. The purpose was to analyse if using small stitches generated cost savings.METHODS: Between 2001 and 2006 closure of midline incisions using small stitches was, in a randomised trial, compared with the use of large stitches. In 2011 all patients included in the randomised trial, who until then, had had an incisional hernia repair, were recorded. The cost for an open incisional hernia repair with mesh reinforcement during 2010 was calculated. The analysis included both direct and indirect costs.RESULTS: Of 321 patients closed with small stitches incisional hernia occurred in 11 and 3 needed repair. Of 370 patients closed with large stitches herniation occurred in 45 and 14 needed repair. The direct cost per hernia repair was 59,909 Swedish krona (SEK) and the indirect cost was 26,348 SEK. Suturing time with small stitches was 4.6 min longer, increasing the cost for the index operation by 1,076 SEK. From the societal perspective (direct and indirect costs), using small stitches generated a cost reduction of 1,339 SEK for each patient. From the perspective of the public payer (direct costs) the cost reduction was 601 SEK. Using small stitches generated cost savings from a societal perspective if the suturing time was not prolonged over 10.3 min.CONCLUSIONS: Using small stitches when closing midline abdominal incisions with a continuous single-layer technique generates cost savings.

Sjalander S.,Sundsvall Hospital | Sjalander A.,Sundsvall Hospital | Svensson P.J.,Lund University | Friberg L.,Karolinska University Hospital
Europace | Year: 2014

Aims Oral anticoagulation is the recommended treatment for stroke prevention in patients with atrial fibrillation. Notwithstanding, many patients are treated with acetylsalicylic acid (ASA) as monotherapy. Our objective was to investigate if atrial fibrillation patients benefit from ASA as monotherapy for stroke prevention. Methods and results Retrospective study of patients with a clinical diagnosis of atrial fibrillation between 1 July 2005 and 1 January 2009 in the National Swedish Patient register, matched with data from the National Prescribed Drugs register. Endpoints were ischaemic stroke, thrombo-embolic event, intracranial haemorrhage, and major bleeding. The study population consisted of 115 185 patients with atrial fibrillation, of whom 58 671 were treated with ASA as monotherapy and 56 514 were without any antithrombotic treatment at baseline. Mean follow-up was 1.5 years. Treatment with ASA was associated with higher risk of ischaemic stroke and thrombo-embolic events compared with no antithrombotic treatment. Conclusion Acetylsalicylic acid as monotherapy in stroke prevention of atrial fibrillation has no discernable protective effect against stroke, and may even increase the risk of ischaemic stroke in elderly patients. Thus, our data support the new European guidelines recommendation that ASA as monotherapy should not be used as stroke prevention in atrial fibrillation. © 2013 Published on behalf of the European Society of Cardiology. All rights reserved.

Kadum B.,Sundsvall Hospital | Mafi N.,Sundsvall Hospital | Norberg S.,Sundsvall Hospital | Sayed-Noor A.S.,Sundsvall Hospital
Archives of Orthopaedic and Trauma Surgery | Year: 2011

Background: Shoulder arthroplasty surgery has undergone remarkable progress. New concepts like reverse and stemless shoulder prostheses have been widely used. The Total Evolutive Shoulder System (TESS®) is a new innovative system that provides the surgeon with different prosthetic versions. The purpose of the present study was to evaluate our short-term results and complications of the TESS. Patients and methods: 56 consecutive patients were operated with one of the two versions of TESS (anatomical or reverse) between October 2007 and December 2009. Preoperative and postoperative evaluation of the function and life quality was achieved by the Quick Disability of the Arm, Shoulder and Hand (DASH) index and EQ-5D self-report questionnaire, respectively. Radiographic follow-up by anteroposterior, axillary and lateral views was done. The anterosuperior approach was used in all cases. We compared the outcome in fracture patients with other categories. Results: 49 patients were available for 9-24 months (mean 14) clinical and radiographic postoperative follow-up. The mean of quick DASH improved from 56 preoperatively to 34 postoperatively (p < 0.001) and EQ-5D from 0.36 preoperatively to 0.73 postoperatively (p < 0.001). The complications were few and we had no radiolucencies or scapular notching during the study period. Fracture patients did worse compared to other categories. Conclusions: TESS prosthesis showed promising short-term results with few complications. The reverse version could be implanted without stem if initial stability was adequate. Long-term follow-up is required to confirm the results of this innovative system in the long run. © 2011 Springer-Verlag.

Israelsson L.A.,Umeå University | Israelsson L.A.,Sundsvall Hospital | Millbourn D.,Sundsvall Hospital
Surgical Clinics of North America | Year: 2013

The development of wound complications is closely related to the surgical technique at wound closure. The risk of the suture technique affecting the development of wound dehiscence and incisional hernia can be monitored through the suture length to wound length ratio. Midline incisions should be closed in one layer by a continuous-suture technique using a monofilament suture material tied with self-locking knots. Excessive tension should not be placed on the suture. Closure must always be with a suture length to wound length ratio higher than 4. © 2013 Elsevier Inc.

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