Lind M.,Uddevalla Hospital |
Lind M.,Gothenburg University |
Olsson M.,Chalmers University of Technology |
Rosengren A.,Gothenburg University |
And 2 more authors.
Diabetologia | Year: 2012
Aims/hypothesis The aim of this study was to examine the relationship between glycaemic control and hospitalisation for heart failure in patients with type 2 diabetes. Methods Patients included in the Swedish National Diabetes Register (NDR) during 1998-2003 were followed until hospitalisation for heart failure, death or 31 December 2009. Unadjusted and adjusted incidence rates for heart failure were estimated by Poisson regression and relative risk was estimated by Cox regression. Results In 83,021 patients with type 2 diabetes, 10,969 (13.2%) were hospitalised with a primary or secondary diagnosis of heart failure during a mean follow-up of 7.2 years. The incidence increased by male sex (p<0.001), older age (p<0.001) and longer diabetes duration (p< 0.001). In Cox regression adjusting for risk factors of heart failure the HR per each percentage unit higher HbA1c (10 mmol/mol) for heart-failure hospitalisation was 1.12 (95% CI 1.10, 1.14). By category of HbA1c the HR for heart failure hospitalisation was: HbA1c 6.0 to <7.0% (42 to <53 mmol/mol), 0.91 (95% CI 0.84, 0.98); HbA1c 7.0 to <8.0% (53 to <64 mmol/mol), 0.99 (95% CI 0.91, 1.07); HbA1c 8.0 to <9.0% (64 to <75 mmol/mol), 1.10 (95% CI 1.01, 1.20); HbA1c 9.0 to <10.0% (75 to <86 mmol/mol), 1.27 (95% CI 1.15, 1.41); HbA 1c =10.0 % (=86 mmol/mol), 1.71 (1.51, 1.93) (reference HbA 1c <6% [42 mmol/mol]). The HR for patients with HbA1c 7.0 to <8.0%(53 to <64mmol/ mol) compared with patients with HbA 1c 6.0 to <7.0% (42 to <53 mmol/mol) was 1.09 (95% CI 1.03, 1.14). Conclusions/interpretation Poor glycaemic control (HbA1c <7% [53 mmol/mol]) is associated with an increased risk of hospitalisation for heart failure in patients with type 2 diabetes. © Springer-Verlag 2012.
Ljungberg M.,Sahlgrenska University Hospital |
Sorbo A.,Uddevalla Hospital |
Esbjornsson E.,Sahlgrenska University Hospital
Brain Injury | Year: 2011
Background: Magnetic resonance diffusion tensor imaging (MR-DTI) is used increasingly to detect diffuse axonal injury (DAI) after traumatic brain injury (TBI). Primary objective: The primary objective was to investigate the changes in the diffusion properties of the corpus callosum in the acute phase and 6 months after TBI and to examine the correlation between DTI parameters and clinical outcome. Research design: Longitudinal prospective study. Methods and procedures: MR-DTI was performed in eight patients with suspected DAI within 11 days and at 6 months post-injury. Six controls were also examined. Fractional anisotropy (FA), trace and parallel and perpendicular diffusivity of the corpus callosum were analysed. The main outcome was the extended Glasgow Outcome Scale score, assessed at 6 months. Main outcomes and results: A significant reduction in FA in the corpus callosum was seen in the acute phase in patients compared with the healthy controls. There was no significant change in the parallel or perpendicular eigenvalues or trace. At 6 months, a significant reduction in FA and a significant increase in trace and perpendicular eigenvalues were noticed compared with controls. Conclusions: The diffusion properties of the corpus callosum correlated with clinical outcome in this longitudinal investigation. © 2011 Informa UK Ltd. All rights reserved.
Lagerkvist A.-L.,Gothenburg University |
Johansson U.,Central Hospital |
Johansson A.,Uddevalla Hospital |
Bager B.,Central Hospital |
Uvebrant P.,Gothenburg University
Developmental Medicine and Child Neurology | Year: 2010
Aim: The aim of this investigation was to study the incidence of obstetric brachial plexus palsy (OBPP), to prospectively follow the recovery process, to assess the functional outcome at 18 months of age, and to find early prognostic indicators. Method: Of the 38 749 children born between 1999 and 2001 in western Sweden, 114 (70 males, 44 females) had an OBPP. Ninety-eight children were examined on six occasions at up to 18 months of age. Muscle strength, range of motion, hand preference, and functional abilities were noted, and the severity of the OBPP was classified. Results: The incidence of OBPP was 2.9 per 1000 live births, and the incidence of persisting OBPP was 0.46 per 1000. At 3 months of age, the predictive value of regained elbow flexion for complete recovery was 100%, 99% of shoulder external rotation, and 96% of forearm supination. Most of the 18 children with persisting OBPP could perform functional activities but asymmetries were noted. Five children had a mild, 11 had a moderate, and two had a severe impairment. Three had undergone nerve surgery, one with a mild and two with a severe persisting impairment. Interpretation: Most children with an OBPP recover completely. Muscle strength at 3 months of age can be used to predict outcome. © The Authors. Journal compilation © Mac Keith Press 2009.
Hanas R.,Uddevalla Hospital |
de Beaufort C.,DECCP |
Hoey H.,Trinity College Dublin |
Anderson B.,Baylor College of Medicine
Pediatric Diabetes | Year: 2011
Type 1 diabetes is treated with insulin, which has traditionally been delivered by vial and syringe. However, for many patients, dosing inaccuracy, pain, anxiety, inconvenience, and social acceptability present barriers to this method of administration (1-5). This has contributed to the increased popularity of alternative insulin delivery systems, including pen delivery devices (4, 6). Evidence suggests that discreet devices, such as insulin pens, facilitate adherence to intensive insulin therapy regimens, help improve lifestyle flexibility, and reduce injection pain compared with the conventional syringe-based regimens, as shown in studies in adults and adolescents (7). In addition, compared with the vial and syringe method of insulin administration, pens may provide more accurate dosing - which is particularly important in children - thereby improving short-term blood glucose control and potentially improving long-term outcomes (5, 8). Children, in particular, may benefit from insulin pens that are simple to use as adherence issues may be more evident in this patient group (9). Pens for insulin delivery in children with type 1 diabetes have been used for a long time in Europe, and have recently gained in popularity in many other places around the world (4, 10). Furthermore, the conventional vial and syringe method of insulin delivery is beginning to be considered as obsolete (11). Moreover, there is a continued drive to improve insulin pen technology, to refine and enhance the functionality and usability of these pens. However, despite recent advances in pen design and function, the selection of pens available especially for children is limited. © 2011 John Wiley & Sons A/S.
Ganesh A.,Sultan Qaboos University |
Pirouznia S.,Uddevalla Hospital |
Ganguly S.S.,Sultan Qaboos University |
Fagerholm P.,Linköping University |
Lithander J.,Uddevalla Hospital
Acta Ophthalmologica | Year: 2011
Purpose: To determine the incidence of consecutive exotropia (XT) following successful surgical correction of childhood esotropia (ET) and identify factors associated with its development. Material and Methods: This is a retrospective study of 85 patients with ET, aged 2-24, who underwent strabismus surgery by a single surgeon between 1958 and 1969 in Sweden, until they were successfully aligned to ET within 10 prism dioptre, after primary or reoperation(s). The charts of these patients were reviewed, and data regarding age at onset of strabismus, surgery performed and outcome were recorded. The patients were recalled for a complete orthoptic examination in 2001-2003. Results: The incidence of consecutive XT in this cohort was 21% (18/85). Patients who had undergone multiple surgeries had a higher risk of developing consecutive XT compared to those successfully aligned with one surgery (p = 0.00036). Restriction of adduction and convergence postoperatively was associated with a high risk of consecutive XT (p = 0.0437). The incidence of consecutive XT did not vary with the level of visual acuity in the operated eye (p = 0.6428). Age of onset, age at surgery and amount of surgery did not appear to influence the risk for developing consecutive XT (p > 0.05). Conclusion: This 40-year postoperative follow-up of patients with childhood ET who underwent strabismus surgery by a single surgeon in Sweden showed that multiple surgeries and presence of postoperative adduction deficit were the most important factors influencing the incidence of consecutive XT after surgery. Presence of uncorrected amblyopia did not alter the prognosis for long-term development of consecutive XT. © 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.
Enander R.,Lidkoping Hospital SkaS Hospital Group |
Gundevall C.,Kungsbacka Hospital |
Stromgren A.,Kungsbacka Hospital |
Chaplin J.,Gothenburg University |
Hanas R.,Uddevalla Hospital
Pediatric Diabetes | Year: 2012
Aim: Carbohydrate counting (CC) is widely used in insulin pumps. The primary objectives of this study were improvement of HbA1c and meal-related plasma glucose (PG) levels when using CC. Methods: Forty patients with pump treatment, aged 13.8±3.4yr (range 5.0-19.5) and diabetes duration 8.0±3.8 (1.8-16.8) years completed a 1-yr multi-center study. HbA1c at start was 7.6±0.9% Diabetes Control and Complications Trial (DCCT), 59±10mmol/mol International Federation for Clinical Chemistry and Laboratory Medicine (IFCC). They were randomized into (A) control group, (B) manual CC, and (C) CC with a bolus calculator in the pump for calculations. (B) and (C) received education in CC while (A) received equal hours of traditional dietary education. Glucose meters were downloaded at visits and the standard deviation (PG-SD) calculated. PG measurements from before and 2 h after meals were registered separately. Results: We found no difference in HbA1c between the groups. Group C had a non-significant decrease in PG-SD (p=0.056) compared to start, and a significantly higher number of post-meal PG between 4 and 8mmol/L at 12months compared to group A (55.3% vs. 30.6%, p=0.014). The frequency of hypoglycemia was reduced for the whole study group (p=0.01), but with no significant difference between groups. (A) significantly increased their basal-insulin dosage at 12months. In (C), all subjects wanted to continue CC after the study. The insulin:carbohydrate ratio correlated significantly to the insulin-dose/24h (p=0.003) and the correction factor to the insulin-dose/24h (p=0.035) and age (p<0.001). Conclusions: We conclude that CC using a bolus calculator may help decrease PG-fluctuations and increase post-meal PG values within target. © 2012 John Wiley & Sons A/S.
Lind M.,Gothenburg University |
Lind M.,Uddevalla Hospital
Primary Care Diabetes | Year: 2012
Glucagon-like peptide 1 (GLP-1) analogues and dipeptidyl peptidase-4 (DPP-4) inhibitors are two classes of treatments for type 2 diabetes, which enhance the well-known 'incretin effect' of increased insulin secretion in response to food intake. This concise review introduces both types of incretin-based therapies and focuses on the extra-pancreatic effect of GLP-1 on body weight. As well as improving glycaemic control in subjects with type 2 diabetes, these treatments have the additional benefits of improving weight management in these patients, with GLP-1 receptor agonists causing weight loss and DPP-4 inhibitors being weight neutral. © 2012 Primary Care Diabetes Europe.
Mollborg P.,Uddevalla Hospital |
Alm B.,Gothenburg University
Acta Paediatrica, International Journal of Paediatrics | Year: 2010
Background: Following the change from prone to supine in preferred sleeping position, the incidence of Sudden Infant Death Syndrome (SIDS) in Sweden fell from 1.1 per 1000 live births in 1992 to 0.41 in 1995. After a further small decline, we have been experiencing a plateau at around 0.25 since 2000. Aim: To identify the changes that have occurred in the epidemiology of SIDS since the end of the Nordic Epidemiological SIDS Study in 1995. Methods: Data from the Medical Birth Register of Sweden, covering the years 1995-2005, were used. Sleeping position is not included in the register. Results: The incidence of SIDS has remained low in Sweden. Independent risk factors were smoking during early pregnancy, parents not living together, low maternal age, high parity and short gestational age. The odds ratio for smoking has continued to increase and the median age of death has continued to decrease since the previous study. We found no signs of seasonality in the current material. Conclusions: Age at death continued to decrease. The high incidence during weekends persisted. Seasonality was not significant. There was no evidence of a changing effect from risk factors in the studied period. © 2009 Foundation Acta Pædiatrica.
O'Riordan S.M.P.,University College London |
Danne T.,Diabetes Center for Children and Adolescents |
Hanas R.,Uddevalla Hospital |
Peters C.J.,University College London |
Hindmarsh P.,University College London
Diabetic Medicine | Year: 2014
Aim: Estimated average glucose has been used to transform HbA1c into a glucose measure that might better inform patients of their glycaemic control. The data set used to obtain the estimated average glucose equation was derived in adults with Type 1 and Type 2 diabetes, along with normal healthy control subjects, and requires testing in children. Methods: This was a cross-sectional study of 234 children and young people (106 male) with Type 1 diabetes aged 4.0-23.5 years who underwent continuous glucose monitoring over a 5-day period along with a measure of HbA1c. Regression analysis was used to determine estimated average glucose and agreement was assessed with the average glucose estimated from the Nathan equation: Nathan average glucose equation = 1.59 (HbA1c%) - 2.59. Results: Mean HbA1c was 76 mmol/mol (25.1) [9.1 (2.3)%] and mean continuous glucose monitoring tissue glucose was 10.4 (2.6) mmol/l. The relationship between continuous glucose monitoring tissue glucose and HbA1c was described by the paediatric equation: paediatric estimated average glucose = 0.49 (HbA1c%) + 5.95 (r = 0.45; P < 0.001). The mean paediatric estimated average glucose was 10.4 (1.1) mmol/l compared with that from the Nathan average glucose equation of 11.9 (3.7) mmol/l (P < 0.001). Overall, the paediatric estimated average glucose was 2.7 mmol/l lower than the Nathan estimated average glucose, with a 95% limit of agreement of ± 0.5 mmol/l. The agreement was very close with HbA1c values below 80 mmol/mol (9.5%). Conclusion: These data suggest that the Nathan estimated average glucose could be used in children and young people with Type 1 diabetes. Caution should still be exercised in the estimates derived for average glucose as the data set is skewed in both Nathan and paediatric average glucose estimates in opposite directions because of the differences in average HbA1c. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.
Hellstrom M.-K.,Uddevalla Hospital |
Ramberg P.,Gothenburg University
International Journal of Dental Hygiene | Year: 2014
Aim: The aim was to evaluate the clinical effect of a dentifrice containing 0.3% Magnolia extract on dental plaque and gingivitis. Material and methods: The trial was a 6-month double-blind, stratified, randomized and 2-armed parallel group study. Forty-six subjects in the test group brushed their teeth with a dentifrice containing 0.3% Magnolia extract and 48 subjects in the control group brushed with a placebo dentifrice. Plaque and gingivitis were assessed at baseline, 3 and 6 months. Results: There was a significantly larger gingivitis reduction in the Magnolia group than in the control group (0.26 ± 0.11 versus 0.11 ± 0.12) (P < 0.001). There was a greater increase in the total number of healthy gingival units Gingival Index (GI score 0) in the Magnolia group than in the control group (149% versus 31%) and a larger reduction in inflamed gingival units (GI score 2/3) (60% versus 30%). Furthermore, at sites with similar amounts of plaque, less clinical signs of gingival inflammation were observed in the Magnolia group than in the control group. Conclusion: Six months' unsupervised use of a dentifrice containing 0.3% Magnolia extract resulted in significantly greater gingivitis reduction than a corresponding control dentifrice. © 2013 John Wiley & Sons A/S.