Purpose. This study aimed to investigate the relationship between interpersonal sensitivity and relational aggression with the mediating role of resilience in married people with multiple sclerosis (MS). Materials and methods. This research was a cross-sectional analytical correlation study. In this study, 234 people with MS were selected by convenience sampling method and responded to the research questionnaires. In order to collect data, the couple relationship aggression and victimization scale (CRAViS), interpersonal sensitivity scale (IPSM), and resilience scale (CD-RISC) were used. Results. The results showed that the proposed model has good processing (2/df=1.29, CFI=.98, RMSEA=.03). Path analysis results showed that interpersonal sensitivity didn't have a significant direct effect on communicative aggression (β=.132, p=.096); But interpersonal sensitivity has a negative and significant effect on resilience (β=-.803, p=.001) and resilience has a negative and significant effect (β=-.575, p=.001) on communicative aggression. Based on this, it can be said that resilience plays a full mediating role between interpersonal sensitivity and relational aggression (β=.461, p=.001). Conclusion. Overall, it can be concluded that interpersonal sensitivity, due to its negative on resilience, can increase aggressive behaviors in people who suffer from MS, based on this, the implementation of educational and therapeutic in-terventions for the Improvement of interpersonal sensitivity and resilience is suggested.
The purpose of this study was to investigate the resistance to breathing (RES) in heat and moisture exchanging devices (HME) intended for use during physical activity in the cold. RES was investigated for seventeen HMEs, including different types of filters. In addition, the influence of headwind on RES was tested using four representative HMEs. HMEs were mounted to the face of an artificial head manufactured from ABS plastic. The HMEs were connected to a mechanical lung simulator, which delivered standardised inspiratory and expiratory air flow rates ((Formula presented.), L/s). The delta pressure (Δp, Pa) between ambient air and the air inside the HME was measured, whereupon RES was calculated. The results showed significant (p < 0.05) differences in RES between HMEs from different manufacturers, while the difference was smaller, and in some cases not significant (p > 0.05), between different models/filters within the same brand. The results also showed that RES was highly influenced by different ventilations and headwind conditions. RES increased with increased (Formula presented.) and, when a headwind was introduced, RES decreased during inspiration and increased during expiration. Calculations showed that the oxygen and energy cost for breathing through an HME was very small for most of the tested models. The effect of HME dead space on pulmonary gas fractions depends on the tidal volume. At large tidal volumes and ventilations, the effect of HMEs on pulmonary gas fractions becomes relatively small.
The Adaptive Gain Integrating Pixel Detector (AGIPD) is an X-ray imager, custom designed for the European X-ray Free-Electron Laser (XFEL). It is a fast, low-noise integrating detector, with an adaptive gain amplifier per pixel. This has an equivalent noise of less than 1keV when detecting single photons and, when switched into another gain state, a dynamic range of more than 10(4)photons of 12keV. In burst mode the system is able to store 352 images while running at up to 6.5MHz, which is compatible with the 4.5MHz frame rate at the European XFEL. The AGIPD system was installed and commissioned in August 2017, and successfully used for the first experiments at the Single Particles, Clusters and Biomolecules (SPB) experimental station at the European XFEL since September 2017. This paper describes the principal components and performance parameters of the system.
The major aims of this study were to examine (1) the association between fear of hypoglycemia (FOH) in adults with type 1 diabetes with demographic, psychological (anxiety and depression), and disease-specific clinical factors (hypoglycemia history and unawareness, A(1c)), including severe hypoglycemia (SH), and (2) differences in patient subgroups categorized by level of FOH and risk of SH. Questionnaires were mailed to 764 patients with type 1 diabetes including the Swedish translation of the Hypoglycemia Fear Survey (HFS) and other psychological measures including the Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale, and Fear of Complications Scale. A questionnaire to assess hypoglycemia history was also included and A(1c) measures were obtained from medical records. Statistical analyses included univariate approaches, multiple stepwise linear regressions, Chi-square t tests, and ANOVAs. Regressions showed that several clinical factors (SH history, frequency of nocturnal hypoglycemia, self-monitoring) were significantly associated with FOH but R (2) increased from 16.25 to 39.2 % when anxiety measures were added to the model. When patients were categorized by level of FOH (low, high) and SH risk (low, high), subgroups showed significant differences in non-diabetes-related anxiety, hypoglycemia history, self-monitoring, and glycemic control. There is a strong link between FOH and non-diabetes-related anxiety, as well as hypoglycemia history. Comparison of patient subgroups categorized according to level of FOH and SH risk demonstrated the complexity of FOH and identified important differences in psychological and clinical variables, which have implications for clinical interventions.
Bakgrund: Ordet abort kommer från det latinska ordet aboriri som betyder att förgås eller att gå ned. Ungefär hälften av alla kvinnor i Sverige gör någon gång en abort. Enligt den svenska abortlagen har kvinnan ett fritt val till abort och måste själv komma fram till det bästa beslutet. I denna process förtjänar hon stöd och respekt, oavsett hur hon valt att hantera sitt moderskap. Syfte: Syftet med denna litteraturstudie var att belysa kvinnors upplevelser samt behov av omvårdnad vid inducerad abort. Metod: Studien genomfördes som en litteraturstudie där 16 artiklar inkluderades och som granskades. Resultat: Resultatet visade att de vanligaste orsakerna till att kvinnor genomförde en inducerad abort var på grund av ekonomiska skäl, en ostabil relation och arbetsförhållanden. Kvinnors upplevelser vid inducerad abort var att de kände både positiva och negativa känslor. De positiva var bland annat; lättnad, ökad självkänsla och personlig mognad. De negativa känslorna var bland andra; skuld, oro och nedstämdhet. När det gällde behovet av stöd från vårdpersonalen kände de att personalen var stöttande och informativa men även att de kunde vara kalla och ignorerande. Slutsats: Det behövs mer forskning inom området, behov av stöd till kvinnor som genomgår en inducerad abort, för att vårdpersonalen ska kunna bemöta kvinnorna på bästa möjliga sätt.
A diagnosis/antibiotic prescribing study was performed in 5 counties in Sweden for 1 week in November 2000. As part of this study, the characteristics and clinical management of patients with upper respiratory tract infections (n = 2899) in primary care were analyzed. Almost half of the patients were aged < 15 y and one-fifth of the patients consulted out of hours. Of all patients seeking primary care for upper respiratory tract infections, 56.0% were prescribed an antibiotic. Almost all patients who were given the diagnoses streptococcal tonsillitis, acute otitis media or acute sinusitis were prescribed antibiotics, compared to 10% of patients with common cold or acute pharyngitis. The most frequently prescribed antibiotic was penicillin V (79.2%) and this was even more pronounced out of hours, when the diagnoses otitis media and streptococcal tonsillitis were more frequently used. In patients with common cold and acute pharyngitis, the percentage who received antibiotics increased with increasing length of symptoms and increasing CRP levels. In patients with acute pharyngitis or streptococcal tonsillitis, antibiotics were prescribed less frequently provided streptococcal tests were performed. The management of patients with upper respiratory tract infections in general practice seems to be in good agreement with current Swedish guidelines. However, the study indicates some areas for improvement. The diagnosis of acute sinusitis seems to have been overestimated and used only to justify antibiotic treatment.
A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in the y 2000 and 2002, respectively. As part of the study, the characteristics and clinical management of patients who received diagnoses of urinary tract infections (UTIs) (n = 1564) in primary care, were analysed. 85% of the visits were by women, and 74% of all consultations were diagnosed as lower UTIs. One or more diagnostic tests were performed in 98% of the women with suspected lower or recurrent UTIs and 95% were prescribed an antibiotic. The most commonly prescribed antibiotics for lower UTIs were trimethoprim followed by pivmecillinam and a quinolone. The study indicated a change in antibiotic prescribing with improved adherence to the national recommendations. There was an increase of prescribed nitrofurantoin and a decrease of prescribed quinolones to women with lower UTIs between the studied y. Furthermore, 3-d treatment with trimethoprim increased although the prescribed duration was mostly 7 d. In contrast to the guidelines, few urine cultures were performed. The study highlights the necessity of updating the guidelines for the management of lower UTIs in general practice.
A diagnosis-prescribing study was performed in 5 Swedish counties during 1 week in November in 2000 and repeated in 2002. The aim of the present study was to analyse data for children 0-15y of age who consulted a general practitioner with symptoms of an infection. During the 2 weeks studied, 4049 children were consulted. Respiratory tract infections (RTI) were the predominant diagnoses, above all among the youngest children, while the proportion of urinary tract infections and skin infections increased with increasing age. Between the y 2000 and 2002, the proportion of children allocated the diagnosis streptococcal tonsillitis and pneumonia decreased (p<0.01 and p<0.001, respectively) while the proportion of common cold increased (p<0.001). Antibiotic prescribing decreased from 55% to 48% (p<0.001) for respiratory infections between the years studied. The only significant changes in type of antibiotics prescribed were the increase of isoxazolylpenicillins (p<0.001) used for skin infection and the decrease of macrolides (p=0.001). A diagnostic test was used in more than half of the consultations. Of children allocated a RTI diagnosis, 36% were prescribed antibiotics when a C-reactive protein test was performed compared to 58% in those not tested. Further studies are needed in general practice to determine the optimal use of near-patient tests in children with RTI.
A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in 2000 and 2002 respectively. As a part of the study, the use and results of C-reactive protein (CRP) tests in relation to duration of symptoms and antibiotic prescribing in 6778 patients assigned a diagnosis of respiratory tract infections were analysed. In almost half (42%) of the patients, a CRP test was performed. The majority of CRP tests (69%) were performed in patients assigned diagnosis upper respiratory tract infection, where the test is not recommended. Overall, there was a minor decrease in antibiotic prescribing when CRP was used (41%), in comparison to 44% of the patients where no CRP was performed (p < 0.01). Patients assigned diagnoses implying a bacterial aetiology were prescribed antibiotics irrespective of result of CRP or length of symptoms before consultation. For patients assigned viral diagnoses, antibiotic prescribing increased with increasing duration of symptoms and increasing value of CRP. The use of CRP decreased antibiotic prescribing in patients assigned to viral diagnoses and with longstanding symptoms (p < 0.001). However, 59% of the patients assigned viral diagnoses with CRP > or = 25 received antibiotics, which seems to indicate a misinterpretation of CRP and a non-optimal use of antibiotics.
The extent and depth of traumatic brain injury (TBI) remains a major determining factor together with the type of structural insult and its location, whether mild, moderate or severe, as well as the distribution and magnitude of inflammation and loss of cerebrovascular integrity, and the eventual efficacy of intervention. The influence of exercise intervention in TBI is multiple, ranging from anti-apoptotic effects to the augmentation of neuroplasticity. Physical exercise diminishes cerebral inflammation by elevating factors and agents involved in immunomodulatory function, and buttresses glial cell, cerebrovascular, and blood-brain barrier intactness. It provides unique non-pharmacologic intervention that incorporate different physical activity regimes, whether dynamic or static, endurance or resistance. Physical training regimes ought necessarily to be adapted to the specific demands of diagnosis, type and degree of injury and prognosis for individuals who have suffered TBI. © 2012 John Wiley & Sons A/S.
Introduction and importance: Mix epithelial and stromal tumor (MEST) is a benign biphasic renal lesion composed of solid as well as cystic components lining tubular and cystic spaces of kidney. There are very few cases of such variety have been reported with perspective to renal involvement. Herein we have reported a rare case of MEST involving left renal tissue and sparing surrounding tissues. Case presentation: A 20 years old female presented to surgical outpatient department with complaint of amenorrhea and left flank pain as well as heaviness for 1 year. Patient was vitally stable and cooperative. On physical examination left flank mass was palpated and ultrasound and CT scan imaging was also showing left renal mass confined to upper, middle and lower portion of the kidney while renal capsule, adrenal gland and ureter were spared. On histological examination showed multi-cystic structures with variably sized simple cysts lined by hobnailed epithelium with clear cells. Septa show ovarian type fibrous stroma with variable inflammation and immature nephrogenic elements. A final diagnosis of MEST was made. Therefore, radical nephrectomy with trans-peritoneal approach was done. Clinical discussion: MEST is a benign tumor of renal tissue that is confined to the renal parenchyma rather than involvement of surrounding structures as occurred in our case. Due to benign nature of the disease involvement of renal capsule and adrenal gland is less likely. The choice of treatment is radical nephrectomy through transperitoneal approach. Conclusion: MEST is a rare diagnosis thought case now start reporting since last decade, however, it's still a rare entity to be reported. USG and CT scan are investigating modalities along with histopathological correlation to reach the diagnosis.
We report a case of retropharyngeal liposarcoma in a 53-year-old female, who had complaints of neck swelling accompanied with dysphagia, orthopnea and dysphonia. Clinical examination revealed huge multinodular swelling in front of neck with bilateral extension, more prominent on left side and moving with deglutition. The diagnosis of retropharyngeal liposarcoma was established following CT scan, MRI and incisional biopsy. Surgical excision of mass along with near total thyroidectomy was performed. Postoperative hospital stay was uneventful. She remained well in follow-up period of 1 year as well. In conclusion, retropharyngeal liposarcoma is a rare tumor. A review of the literature explores the reasons behind the late presentation as well as the difficulties in diagnosis and treatment of this rare tumor.
Despite its high prevalence, individuals suffering from skin-picking disorder (SPD) face limited access to treatment due to several factors, including geographical and economic barriers, as well as a shortage of properly trained therapists. Offering Internet-delivered therapy could be a solution to these barriers. This study aimed to evaluate the efficacy of therapist-guided Internet-delivered acceptance-enhanced behavior therapy (iBT) for SPD compared to a wait-list control condition. Participants randomized to the intervention group received 10 weeks of iBT (n = 35), while those in the control group were placed on a wait-list (n = 35). The primary outcome was the Skin Picking Scale—Revised (SPS-R). Mixed-model regression analyses demonstrated a significantly greater improvement in SPD symptoms in the iBT group compared to the control group at posttreatment (between-group difference −5.1 points, F = 9.69, p <.001). The between-group effect size was in the large range, with a bootstrapped d of 1.3 (95% CI [0.92, 1.69]). At posttreatment, 43% of the participants in the iBT group were classified as responders, and 31% were in remission, compared to 0% responders and 3% in remission in the control group. At the 6-month follow-up, the SPD symptoms had increased compared to posttreatment. However, the improvement from pretreatment remained significant. Participants reported a high level of satisfaction and credibility of the treatment, and a perceived good level of working alliance. Compared to wait-list control, iBT is an efficacious treatment for SPD at posttreatment and follow-up, with the potential to substantially increase the availability and access to evidence-based treatment for this disorder. Replication studies, particularly those comparing iBT to an active control, are warranted.
Introduction. In palliative cancer care, when approaching death, swallowing difficulties and the burden of tablet intake frequently makes us reconsider each individual drug prescribed. Through the last two decades the routine of always combining a strong opioid with paracetamol has been widely spread in Sweden. Clinical experience has challenged this routine as many patients seem to manage equally well without paracetamol. To find out whether this might be of clinical importance, we wanted to perform a more systematic registration. Material and methods. Thirty-four incurable cancer patients with well controlled pain (NRS 4), treated by specialised palliative home care teams, with ongoing medication with the strong opioid paracetamol combination was recruited to this prospective clinical study. The effect of completely stopping paracetamol medication was evaluated four days later at follow-up. Results. At follow-up nine patients (26%) felt more pain compared to when they entered the study, two patients (6%) felt less pain and 23 (68%) felt no difference. When asked about their preference about future paracetamol treatment 18 patients (53%) wanted to stop taking it, six patients (18%) wanted to continue with regular paracetamol medication as before, and ten patients (29%) wanted to take paracetamol as needed. No clinical predictors of paracetamol response could be identified. Discussion. The results of this study indicate that a critical evaluation, in every patient, of the subjective additive analgesic effect of paracetamol in concurrent strong opioid therapy is advisable and that stopping paracetamol medication not necessarily implies increased pain. Rather in some patients the cessation of paracetamol medication is experienced as a relief as pain control is maintained with a lesser tablet burden.
Every day millions of children world-wide take antibiotics against acute otitis media despite the fact that this treatment has not been shown to benefit the otherwise healthy, average AOM patient. Treatment differs greatly between similar, developed countries. These differences do not seem to be based on rational causes but on differences in mentality and culture. An adoptions of Dutch guidelines for AOM in the USA should result in 400.000 fewer US children on antibiotics during one average day! The incidence of severe complications (mastoiditis, meningitis) must be carefully monitored but there is no evidence that these complications are more common in the Netherlands than in the USA. The number of patients who die due to bacteria made antibiotic-resistant by overuse of antibiotics when treating AOM in children is unknown, but is most probably significant (this is never included in "good versus harm" calculations). We know little about what treatment is best for children suffering from AOM in poor countries, but it is probably wise to be more aggressive there and to adapt a freer usage of antibiotics than is advisable in rich countries.
Peer reviewed. Also published in Hungarian (translated by Tamas Nyeste) and Swedish (translated by I. Axelsson).
One million newborn infants die every year by bacterial infections, which often have entered the body via the umbilicus. A Cochrane systematic review on "Topical umbilical cord care at birth" by J Zupan and P Garner is reviewed. Zupan and Garner conclude that simply to keep the umbilical cord dry and clean is sufficient for healthy, term neonates in rich countries; disinfectants do not offer any advantage. However, cleaning the umbilical cord with disinfectants may reduce the risk of serious bacterial infections in babies in poor countries or in neonatal wards. Observational studies in poor countries indicate that the life of numerous infants can be saved if pregnant women are vaccinated against tetanus and disinfectants are substituted for harmful cord care traditions. This Cochrane review is credible, but it should be updated and considered tentative since no data on sepsis are included. The search strategy should be better described and observational studies (case control and cohort studies) from poor countries should be included since there are no randomized control trials from these countries.
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Summary of PhD thesis in biochemistry (physiological chemistry). (The 6 papers were cited 628 times 1974-2004.)
b) Printed book: p. 23-26 i Axelsson I et al., Lungsjukdomar - Öppen vård.
Axelsson I. ; also published electronically: http:// ).
b) Printed book: p. 40-46 i Axelsson I et al., Lungsjukdomar - Öppen vård. Göteborg: Internetmedicin.se, 2004.
a) Electronic version: www.internetmedicin.se, Göteborg 2001; latest update in November 2004. b) Printed book: p. 31-35 i Axelsson I et al., Lungsjukdomar - Öppen vård. Internetmedicin.se, 2004.
[Letter about the Thalidomide disaster].