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Isacsson, G., Schumann, M., Nohlert, E., Mejersjö, C. & Tegelberg, Å. (2019). Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia - A multicentre randomised controlled trial. Journal of Oral Rehabilitation, 46(1), 5-13
Open this publication in new window or tab >>Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia - A multicentre randomised controlled trial
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2019 (English)In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 46, no 1, p. 5-13Article in journal (Refereed) Published
Abstract [en]

Background: Temporomandibular joint (TMJ) arthralgia is a painful condition assumed to be associated with local inflammation.

Objective: The objective of the present study was to determine the efficacy for reducing pain of a single-dose intra-articular (IA) injection of methylprednisolone to the TMJ. The hypothesis was that methylprednisolone would effectively reduce TMJ pain.

Methods: This randomised, double-blind, parallel-group, multicentre, controlled study included visits for enrolment, treatment and 4-week follow-up. The study included patients 18 years and older who had been diagnosed with unilateral TMJ arthralgia. All participants were randomly assigned to receive 1 mL IA injections of methylprednisolone or saline. The primary outcome was change in recorded pain intensity on a visual analogue scale (VAS) at maximum jaw opening, analysed in the per protocol population.

Results: In total, 54 patients were randomly assigned to single-dose IA injections with methylprednisolone (n = 27) or saline (n = 27). Between baseline and the 4-week follow-up, VAS-rated pain intensity at maximum jaw opening decreased from a mean of 61.0 (95% confidence interval [CI]: 50.1; 70.7) to 33.9 (95% CI: 21.6; 46.2) in the methylprednisolone group and from 59.6 (95% CI: 50.7; 65.9) to 33.9 (95% CI: 23.8; 43.9) in the saline group. The between-group difference was not significant (P = 0.812). Treatment-related adverse events were doubled in the methylprednisolone group.

Conclusion: Methylprednisolone provided no additional benefit for reducing pain, but caused more harm compared with saline following a single-dose IA injection in patients with TMJ arthralgia.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
arthralgia, corticosteroids, injection, intra-articular, pain management, temporomandibular joint
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-372872 (URN)10.1111/joor.12718 (DOI)000453587800002 ()30240024 (PubMedID)
Available from: 2019-01-10 Created: 2019-01-10 Last updated: 2019-01-10Bibliographically approved
Widarsson, M., Nohlert, E., Öhrvik, J. & Kerstis, B. (2019). Parental stress and depressive symptoms increase the risk of separation among parents with children less than 11 years of age in Sweden. Scandinavian Journal of Public Health, 47(2), 207-214
Open this publication in new window or tab >>Parental stress and depressive symptoms increase the risk of separation among parents with children less than 11 years of age in Sweden
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 2, p. 207-214Article in journal (Refereed) Published
Abstract [en]

Aims: Parental separations have become more frequent in recent decades. In Western countries, about 25% of children experience parental separation. There is a need to explore the risk factors for separation to give children an optimal childhood. The objective of the present study was to examine parental stress and depressive symptoms during early parenthood and their association with parental separation.

Methods: Four hundred and seven couples completed questionnaires on depressive symptoms for 3 months and parental stress for 18 months after childbirth. Total parental stress and five sub-areas were investigated. To study the separation rate, parents' addresses were recorded 9 to 11 years after childbirth.

Results: Twenty-nine percent of the parents were separated 9 to 11 years after childbirth. Separation was associated with depressive symptoms at 3 months (mothers p = .002, fathers p = .025) and total parental stress at 18 months after childbirth (mothers p = .010, fathers p = .005). The sub-areas of parental stress, Spouse relationship problems (mothers p = <.001, fathers p = .001) and fathers' Social isolation (p = .005), were associated with separation. In multivariable regression analyses of the parents' separation rate 9 to 11 years after childbirth, the only significant predictor was mothers' Spouse relationship problems (p < .001).

Conclusions: The knowledge that parental stress and depressive symptoms are risk factors for separation may simplify professional support for parents in early parenting. Courses for new and expectant parents can use this knowledge to increase parents' awareness.

Keywords
After childbirth, couples, dyadic consensus, parenthood, social isolation, spouse relationship problems
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-381828 (URN)10.1177/1403494817724312 (DOI)000462758700016 ()28803506 (PubMedID)
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-04-17Bibliographically approved
Isacsson, G., Nohlert, E., Fransson, A. M., Bornefalk Hermansson, A., Wiman Eriksson, E., Ortlieb, E., . . . Tegelberg, Å. (2019). Use of bibloc and monobloc oral appliances in obstructive sleep apnoea: a multicentre, randomized, blinded, parallel-group equivalence trial. European Journal of Orthodontics, 41(1), 80-88
Open this publication in new window or tab >>Use of bibloc and monobloc oral appliances in obstructive sleep apnoea: a multicentre, randomized, blinded, parallel-group equivalence trial
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2019 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, no 1, p. 80-88Article in journal (Refereed) Published
Abstract [en]

Background: The clinical benefit of bibloc over monobloc appliances in treating obstructive sleep apnoea (OSA) has not been evaluated in randomized trials. We hypothesized that the two types of appliances are equally effective in treating OSA.

Objective: To compare the efficacy of monobloc versus bibloc appliances in a short-term perspective.

Patients and methods: In this multicentre, randomized, blinded, controlled, parallel-group equivalence trial, patients with OSA were randomly assigned to use either a bibloc or a monobloc appliance. One-night respiratory polygraphy without respiratory support was performed at baseline, and participants were re-examined with the appliance in place at short-term follow-up. The primary outcome was the change in the apnoea–hypopnea index (AHI). An independent person prepared a randomization list and sealed envelopes. Evaluating dentist and the biomedical analysts who evaluated the polygraphy were blinded to the choice of therapy.

Results: Of 302 patients, 146 were randomly assigned to use the bibloc and 156 the monobloc device; 123 and 139 patients, respectively, were analysed as per protocol. The mean changes in AHI were −13.8 (95% confidence interval −16.1 to −11.5) in the bibloc group and −12.5 (−14.8 to −10.3) in the monobloc group. The difference of −1.3 (−4.5 to 1.9) was significant within the equivalence interval (P = 0.011; the greater of the two P values) and was confirmed by the intention-to-treat analysis (P = 0.001). The adverse events were of mild character and were experienced by similar percentages of patients in both groups (39 and 40 per cent for the bibloc and monobloc group, respectively).

Limitations: The study shows short-term results with a median time from commencing treatment to the evaluation visit of 56 days and long-term data on efficacy and harm are needed to be fully conclusive.

Conclusion: In a short-term perspective, both appliances were equivalent in terms of their positive effects for treating OSA and caused adverse events of similar magnitude.

Trial registration: Registered with ClinicalTrials.gov (#NCT02148510).

National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-351365 (URN)10.1093/ejo/cjy030 (DOI)000460616900010 ()29771314 (PubMedID)
Available from: 2018-05-25 Created: 2018-05-25 Last updated: 2019-03-25Bibliographically approved
Nohlert, E., Öhrvik, J. & Helgason, A. R. (2018). Self-perceived ability to cope with stress and depressive mood without smoking predicts successful smoking cessation 12 months later in a quitline setting: a secondary analysis of a randomized trial. BMC Public Health, 18, Article ID 1066.
Open this publication in new window or tab >>Self-perceived ability to cope with stress and depressive mood without smoking predicts successful smoking cessation 12 months later in a quitline setting: a secondary analysis of a randomized trial
2018 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, article id 1066Article in journal (Refereed) Published
Abstract [en]

Background: Telephone-based smoking cessation services ('quitlines') are both effective and cost-effective. Knowledge of modifiable baseline factors in real-life settings with heterogeneous participants is essential for the development and improvement of treatment protocols to assist in telephone-based smoking cessation. The aim was to assess if self-perceived abilities to cope measured at baseline, would predict abstinence at the 12-month follow-up at the Swedish National Tobacco Quitline (SNTQ). Methods: The data were retrieved from a previous randomized controlled trial comparing the effectiveness of proactive and reactive service at the SNTQ. Included were 612 clients calling the SNTQ between February 2009 and September 2010. Outcome measures were self-reported point prevalence and 6-month continuous abstinence at the 12-month follow-up. Plausible predictors of smoking cessation were assessed at the first call and in a baseline questionnaire. Self-perceived abilities at baseline were measured by two questions: (1) How likely is it that you will be smoke-free in one year? and (2) How likely are you to be able to handle stress and depressive mood without smoking? The associations between potential predictors and outcome (smoke-free at 12-month follow-up) were assessed by logistic regression analysis. Results: Of the two potential predictors for abstinence at 12-month follow-up, only the perceived ability to handle stress and depressive mood without smoking remained significant in the adjusted analyses (Odds Ratio, OR 1.13, 95% CI 1.00-1.27 for point prevalence and OR 1.16, 95% CI 1.01-1.33 for 6-month continuous abstinence according to intention-to-treat). The overall strongest predictor in the adjusted analyses was smoking status in the week before baseline (OR 3.30, 95% CI 1.79-6.09 for point prevalence and OR 3.97, 95% CI 2.01-7.83 for 6-month continuous abstinence). Conclusions: The perceived ability to handle stress and depressive mood without smoking at baseline predicted the subjects' abstinence at the 12-month follow-up. An assessment of/adjustment for stress and depressive mood coping skills may be appropriate in future smoking cessation treatment and research. The treatment protocol can be tailored to individual differences and needs for optimal support.

Keywords
Depressive mood, Point prevalence, Self-efficacy, Self-perceived abilities, Single-item assessment, 6-month continuous abstinence, Tobacco
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-364201 (URN)10.1186/s12889-018-5973-9 (DOI)000443369000002 ()30153814 (PubMedID)
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung FoundationThe Swedish Heart and Lung AssociationSwedish Cancer SocietyStockholm County Council
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2018-10-30Bibliographically approved
Nohlert, E., Öhrvik, J. & Helgason, Á. R. (2018). Self-perceived ability to cope with stress without smoking predicts successful smoking cessation 12 months later in a quitline setting: A Randomized Trial. Paper presented at 17Th World Conference On Tobacco Or Health, 7-9 March 2018, Cape Town, South Africa.. Tobacco Induced Diseases, 16, 118-119
Open this publication in new window or tab >>Self-perceived ability to cope with stress without smoking predicts successful smoking cessation 12 months later in a quitline setting: A Randomized Trial
2018 (English)In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 16, p. 118-119Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
European Publishing, 2018
National Category
Substance Abuse
Identifiers
urn:nbn:se:uu:diva-358112 (URN)10.18332/tid/83845 (DOI)000431841800311 ()
Conference
17Th World Conference On Tobacco Or Health, 7-9 March 2018, Cape Town, South Africa.
Note

Supplement: 1

Meeting Abstract: PS-709-4

Available from: 2018-08-24 Created: 2018-08-24 Last updated: 2018-08-24Bibliographically approved
Adern, B., Minston, A., Nohlert, E. & Tegelberg, Å. (2018). Self-reportance of temporomandibular disorders in adult patients attending general dental practice in Sweden from 2011 to 2013. Acta Odontologica Scandinavica, 76(7), 530-534
Open this publication in new window or tab >>Self-reportance of temporomandibular disorders in adult patients attending general dental practice in Sweden from 2011 to 2013
2018 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 76, no 7, p. 530-534Article in journal (Refereed) Published
Abstract [en]

Objectives: The study aim was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) and acceptance or nonacceptance of such disorders in adult patients attending all public dental health services in the County of Sormland, Sweden, during a 3-year period, 2011-2013.

Methods: Two questions were asked about TMD and the voluntary mouth-opening capacity was measured. The results were registered in a score 0-3. The registration was completed with a question about each patient's acceptance or nonacceptance of their condition.

Results: More than 73,000 registrations of the TMD condition were performed in general dental clinics from 2011 to 2013. The mean prevalence of a TMD score of 1-3 was 5% and was consistent over these years. Seventy percent of these patients were women. The peak prevalence of TMD was registered in patients aged 30-45years (38%), and the frequency declined in older age groups. Reduced voluntary mouth-opening capacity (<= 35 mm) was found in less than 2% of the participants. About one-fifth of the patients with a TMD-score of 1-3 did not accept their condition and wanted professional care. The frequency of nonacceptance of the condition increased with the severity of symptom score: 15%, 27%, and 49% for scores 1, 2, and 3, respectively.

Conclusions: This study shows that the prevalence of self-reported TMD in adult patients was consistent from 2011 to 2013 and should be considered as a public health issue in Sweden. Patients with more severe TMD pain symptoms wanted care more frequent. The annual clinical calibrations should be continued to achieve an acceptable level of registration.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Acceptance, general dentistry, implementation, pain, prevalence, TMD
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-363639 (URN)10.1080/00016357.2018.1487076 (DOI)000445863000013 ()29932779 (PubMedID)
Available from: 2018-10-18 Created: 2018-10-18 Last updated: 2018-10-18Bibliographically approved
Isacsson, G., Nohlert, E., Fransson, A., WimanEriksson, E., Ortlieb, E., Fodor, C., . . . Bornefalk Hermansson, A. (2017). Bibloc and monobloc oral appliances in the treatment of obstructive sleep apnoea: a multicenter, randomized, blinded, parallel-group trial. Paper presented at The 2017 joint congress of World Association of Sleep Medicine (WASM) and World Sleep Federation (WSF), October 7-11, 2017, Prague, Czech Republic.. Sleep Medicine, 40(Supplement 1), E142-E143
Open this publication in new window or tab >>Bibloc and monobloc oral appliances in the treatment of obstructive sleep apnoea: a multicenter, randomized, blinded, parallel-group trial
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2017 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Supplement 1, p. E142-E143Article in journal (Refereed) Published
National Category
Dentistry
Identifiers
urn:nbn:se:uu:diva-339868 (URN)10.1016/j.sleep.2017.11.416 (DOI)000444558902416 ()
Conference
The 2017 joint congress of World Association of Sleep Medicine (WASM) and World Sleep Federation (WSF), October 7-11, 2017, Prague, Czech Republic.
Available from: 2018-01-23 Created: 2018-01-23 Last updated: 2019-03-25Bibliographically approved
Malmström, B., Nohlert, E., Ewald, U. & Widarsson, M. (2017). Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation. Acta Paediatrica, 106(8), 1273-1279
Open this publication in new window or tab >>Simulation-based team training improved the self-assessed ability of physicians, nurses and midwives to perform neonatal resuscitation
2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 8, p. 1273-1279Article in journal (Refereed) Published
Abstract [en]

Aim: The use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation. Methods: We evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005 to 2007. Results: The response rate was 84%. Improvements in the participants self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p < 0.001). Professionally inexperienced personnel showed a significant improvement in the technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003). Conclusion: A full-day course on simulation-based team training with video-supported debriefing improved the participants' self-assessed ability to perform neonatal resuscitation.

Place, publisher, year, edition, pages
WILEY, 2017
Keywords
Behavioural skills, Multiprofessional team training, Neonatal resuscitation program, Simulation-based training, Video-assisted debriefing
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-329898 (URN)10.1111/apa.13861 (DOI)000405233800011 ()28370414 (PubMedID)
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2018-03-28Bibliographically approved
Kerstis, B., Nohlert, E., Öhrvik, J. & Widarsson, M. (2016). Association between depressive symptoms and parental stress among mothers and fathers in early parenthood: A Swedish cohort study. Upsala Journal of Medical Sciences, 121(1), 60-64
Open this publication in new window or tab >>Association between depressive symptoms and parental stress among mothers and fathers in early parenthood: A Swedish cohort study
2016 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 1, p. 60-64Article in journal (Refereed) Published
Abstract [en]

Aim To determine whether there is an association between depressive symptoms and parental stress among mothers and fathers during early parenthood in Sweden. Methods In this study, 401 mothers and 396 fathers (393 couples) were included; the Edinburgh Postnatal Depression Scale and the Sense of Coherence Scale were measured 3 months after childbirth, and the Swedish Parenthood Stress Questionnaire and the Sense of Coherence Scale after 18 months. Complete data for multivariable analysis were available for 264 mothers and 252 fathers. Results The mothers estimated greater total depressive symptoms and parental stress than the fathers did. Both the mothers and the fathers had the greatest level of stress in the sub-area 'Role restriction'. The mothers had the lowest level of stress in the sub-area 'Social isolation' and the fathers in the sub-area 'Incompetence'. The mothers perceived greater levels of stress than the fathers did in all sub-areas except for 'Social isolation', where the fathers perceived higher stress. There was an association between the parents' depressive symptoms and parental stress. The parents' own depressive symptoms at 3 months and sense of coherence and the partners' parental stress at 18 months were positively associated with the parental stress at 18 months in univariable and multivariable analyses. Conclusions Understanding the relationship between depressive symptoms and parental stress is important for health professionals so they can offer parents adequate support in early parenthood to optimize the conditions for raising a child. This knowledge should also be communicated to the parents.

Keywords
Gender, Fathers, Sense of coherence, Parental role models, Mothers
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-283805 (URN)10.3109/03009734.2016.1143540 (DOI)000372123700009 ()26947219 (PubMedID)
Available from: 2016-04-14 Created: 2016-04-14 Last updated: 2017-11-30Bibliographically approved
Nohlert, E., Öhrvik, J. & Helgason, A. R. (2016). Non-responders in a quitline evaluation are more likely to be smokers: a drop-out and long-term follow-up study of the Swedish National Tobacco Quitline. Tobacco Induced Diseases, 14, Article ID 5.
Open this publication in new window or tab >>Non-responders in a quitline evaluation are more likely to be smokers: a drop-out and long-term follow-up study of the Swedish National Tobacco Quitline
2016 (English)In: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 14, article id 5Article in journal (Refereed) Published
Abstract [en]

Background: A previous randomized controlled trial (RCT) of the Swedish National Tobacco Quitline detected no significant differences in smoking cessation outcomes between proactive and reactive services at 12-month follow-up. However, the response rate was only 59 % and non-responders were over-represented in the proactive service. We performed a drop-out analysis to assess the smoking status of initial responders and non-responders. Methods: At 29-48 months after the first call, a postal questionnaire with six questions was sent to 150 random clients from the RCT database, with equal numbers from the proactive and reactive services as well as responders and non-responders at 12-month follow-up. Clients who did not return the questionnaire were contacted by telephone. The outcome measures were point prevalence (PP) and 6-month continuous abstinence (CA), and their associations with response status at 12 months were assessed by logistic regression. Results: The response rate was 74 % (111/150). Abstinence was significantly higher among initial responders than non-responders (PP 54 % vs. 32 %, p=.023 and CA 49 % vs. 21 %, p=.003). The odds ratios for initial responders vs. initial non-responders were, for PP = 2.5 (95 % CI 1.1-5.6, p=.024), and for CA = 3.7 (95 % CI 1.5-8.9, p=.004), after adjusting for proactive/reactive service. Conclusions: Non-responders to a 12-month follow-up smoking cessation questionnaire in a quitline setting were more likely to be smokers 1.5-3 years later. We propose a conservative correction factor of 0.8 for self-reported abstinence in telephone-based cessation studies if the response rate is approximately 55-65 %.

Keywords
Effectiveness, Intention-to-treat, Non-response, Per protocol, Proactive, Reactive, Responder-only analysis, Smoking, Telephone, Questionnaire
National Category
Substance Abuse Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-277978 (URN)10.1186/s12971-016-0070-2 (DOI)000369136400001 ()26843854 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Heart Lung FoundationSwedish Cancer SocietySwedish Research CouncilForte, Swedish Research Council for Health, Working Life and WelfareStockholm County Council
Available from: 2016-03-02 Created: 2016-02-23 Last updated: 2017-11-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-1771-4635

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