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  • 201. Lilliengren, Peter
    et al.
    Falkenström, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Sandell, Rolf
    Mothander, Pia Risholm
    Werbart, Andrzej
    Secure Attachment to Therapist, Alliance, and Outcome in Psychoanalytic Psychotherapy With Young Adults2015In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 62, no 1, p. 1-13Article in journal (Refereed)
    Abstract [en]

    Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning, and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning, whereas the alliance predicted deterioration when both variables were modeled together. Although limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of posttreatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.

  • 202. Lindberg, Magnus
    et al.
    Berg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Some Observations on Reporting Quality of Life in Treatment of Psoriasis in Outpatient Clinics2013In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 93, no 2, p. 210-211Article in journal (Refereed)
  • 203. Lindberg, Magnus
    et al.
    Bingefors, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Meding, Birgitta
    Berg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Hand eczema and health-related quality of life; a comparison of EQ-5D and the Dermatology Life Quality Index (DLQI) in relation to the hand eczema extent score (HEES)2013In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 69, no 3, p. 138-143Article in journal (Refereed)
    Abstract [en]

    Background. Health-related quality of life (HRQoL) is associated with the extent and severity of hand eczema. We still lack a consensus about which HRQoL instrument to use as the standard, and how to measure the extent and severity of hand eczema. Objectives. To compare the Dermatology Life Quality Index (DLQI) with EQ-5D (a standardized instrument for use as a measure of health outcome), and to evaluate how the Hand Eczema Extent Score (HEES) relates to these instruments. Methods. Ninety-three patients (61 females) were included. The HEES was recorded by a dermatologist, and the DLQI and EQ-5D by the patients. The results were analysed with factor analysis and non-parametric statistics. Results. The DLQI and EQ-5D showed decreased HRQoL. Using factor analysis, we could not establish an association between the DLQI and EQ-5D. There were, however, correlations between the DLQI and the HEES (0.31), the EQ(index) and the HEES (-0.32), the DLQI and the EQ(VAS) (-0.62), and the DLQI and the EQ(index) (-0.67) (the EQ(VAS) and the EQ(index) are calculated from EQ-5D). Conclusions. We could not link factors in the DLQI to EQ-5D, which has previously been done for SF-36 (Short Form 36). On the basis of this, we cannot recommend EQ-5D over SF-36 for hand eczema studies. The DLQI correlates with the EQ(VAS) and the EQ(index), and can probably be used as an approximation for EQ-5D. Our findings with the HEES are interesting, as it can be used by patients.

  • 204.
    Lindblad, Ida
    et al.
    The Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Engström, Ann-Charlotte
    Child and Youth Psychiatry, Stockholm County Council, Södertälje, Sweden.
    Nylander, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Endocrinology.
    Fernell, Elisabeth
    The Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Adolescents with type 1 diabetes mellitus and attention-deficit/hyperactivity disorder require specific support from healthcare professionals2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 1994-1997Article in journal (Refereed)
    Abstract [en]

    AIM: Managing type 1 diabetes mellitus requires efficient cognitive and executive skills, and adolescents who have attention-deficit/hyperactivity disorder (ADHD) may face specific challenges. This study explored young people's experiences of diabetes treatment and care.

    METHOD: In a population-based study, comprising 175 patients aged 5-16 years with type 1 diabetes mellitus in two Swedish counties, we found that eight also met criteria for ADHD. Six of these, aged 14.5-16 years, participated 2013-2014 in interviews that targeted aspects of their diabetes treatment. Conducted by two psychologists, these used the inductive qualitative, semi-structured interview format.

    RESULTS: The two boys and four girls all reported difficulties in creating routines for their diabetes treatment and that problems were aggravated during stress. They had been criticised by their parents and the diabetes team when their blood levels indicated inadequate diabetes control. They requested ongoing information, involvement of their friends, group meetings and easy access to the healthcare system during difficult times.

    CONCLUSION: Patients with type 1 diabetes mellitus and concomitant ADHD faced problems with their diabetes management, especially during stressful situations. Diabetes care provision should pay particular attention to patients with co-existing neuropsychiatric and neurodevelopmental disorders such as ADHD.

  • 205. Lindbäck, Camilla
    et al.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Mälardalens högskola.
    To be on sick-leave due to heart failure: a qualitative perspective2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 18-19, p. 1732-1738Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the present study was to explore and describe meanings of being on sick leave due to heart failure.

    Methods: The study was conducted in Sweden during 2011-2012. Five men and one woman, aged 46 to 62, were interviewed. A reflective life-world research approach based on phenomenological philosophy was used. The result of the analysis is presented in three themes.

    Results: To be on sick leave due to heart failure implies a life situation characterized by anxiety, insecurity and uncertainty. When rehabilitation professionals do not take on their professional responsibility, sick listed people with heart failure perceive they are dismissed and abandoned. If rehabilitation professionals take on their professional responsibility it can be experienced as supportive.

    Conclusions: People who are on sick leave due to heart failure are abandoned by rehabilitation professionals and they lack opportunities to participate in their own sick leave/rehabilitation processes. Rehabilitation professionals need to take more responsibility and allow the patients to participate by connecting and recognizing patients as equal human beings. The present results can be used by rehabilitation professionals to reflect on and discuss the needs of people on sick leave due to heart failure. Implications for Rehabilitation Heart failure is a chronic condition implying a complicated life-situation. People with heart failure experience abandonment by rehabilitation professionals and lack participation in their own rehabilitation process. In order to support people on sick leave due to heart failure collaboration and coordination between rehabilitation professionals are needed.

  • 206.
    Lindqvist, Karin
    et al.
    Erica Fdn, Odengatan 9, S-11424 Stockholm, Sweden.
    Falkenström, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Linkoping, Sweden.
    Sandell, Rolf
    Lund Univ, Lund, Sweden.
    Holmqvist, Rolf
    Linkoping Univ, Linkoping, Sweden.
    Ekeblad, Annika
    Linkoping Univ, Linkoping, Sweden.
    Thorén, Agneta
    Erica Fdn, Odengatan 9, S-11424 Stockholm, Sweden.
    Multilevel Exploratory Factor Analysis of the Feeling Word Checklist-242017In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 24, no 7, p. 907-918Article in journal (Refereed)
    Abstract [en]

    Emotional reactions are a vital part of the therapeutic relationship. The Feeling Word Checklist-24 (FWC-24) is an instrument asking the clinician (or the patient) to report to what degree he or she has experienced various feelings during a therapeutic interaction. The aim of this study was to assess the factor structure of the clinician-rated FWC-24 when taking dependencies in the data into account. The sample was deliberately heterogeneous and consisted of 4,443 ratings made by 101 psychotherapists working with different psychotherapy methods in relation to 191 patients of different ages, genders, and with different primary diagnoses. A random intercept-only model revealed large intraclass correlation coefficients at the therapist level, indicating that a multilevel analysis was warranted. A two-level exploratory factor analysis with therapists as the between level and patients plus sessions as the within level was conducted. The items from FWC-24 were found to be best represented by four factors on the between level and four factors on the within level. The factor structures were largely similar on the two levels and were labeled Engaged, Inadequate, Relaxed, and Moved. The different factors explained different amounts of variance on different levels, indicating that some factors are more therapist dependent and some more patient dependent.

  • 207.
    Lipcsey, Miklós
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bellomo, R
    Hemodynamic management of septic shock2015In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 81, no 11, p. 1262-1272Article in journal (Refereed)
    Abstract [en]

    We present a review of the hemodynamic management of septic shock. Although substantial amount of evidence is present in this area, most key decisions on the management of these patients remain dependent on physiological reasoning and on pathophysiological principles rather than randomized controlled trials. During primary (early) resuscitation, restoration of adequate arterial pressure and cardiac output using fluids and vasopressor and/or inotropic drugs is guided by basic hemodynamic monitoring and physical examination in the emergency department. When more advanced level of monitoring is present in these patients, i.e. during secondary resuscitation (later phase in the emergency department and in the ICU), hemodynamic management can be guided by more advanced measurements of the macro--circulation. Our understanding of the microcirculation in septic shock is limited and reliable therapeutic modalities to optimize it do not yet exist. No specific hemodynamic treatment strategy, be it medications including fluids, monitoring devices or treatment algorithms has yet been proved to improve outcome. Moreover, there is virtually no data on the optimal management of the resolution phase of septic shock. Despite these gaps in knowledge, the data from observational studies and trials suggests that mortality in septic shock has been generally decreasing during the last decade.

  • 208. Liu, Hien Duong
    et al.
    Ahn, Kwang Woo
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA..
    Hu, Zhen-Huan
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA..
    Beitinjaneh, Amer
    Univ Miami, Sylvester Canc Ctr, Dept Hematol & Oncol, Miami, FL USA..
    Rizzieri, David
    Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA..
    Grunwald, Michael R.
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA..
    Sabloff, Mitchell
    Univ Ottawa, Dept Med, Div Hematol, Ottawa, ON, Canada.;Ottawa Hosp Res Inst, Ottawa, ON, Canada..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden..
    Bajel, Ashish
    Royal Melbourne Hosp, Dept Haematol & Bone Marrow Transplant, Parkville, Vic, Australia..
    Bredeson, Christopher
    Ottawa Hosp Res Inst, Ottawa, ON, Canada.;Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada..
    Daly, Andrew
    Tom Baker Canc Clin, Dept Med, Calgary, AB, Canada.;Tom Baker Canc Clin, Dept Oncol, Calgary, AB, Canada..
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan..
    Majhail, Navneet
    Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA..
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL USA..
    Gupta, Vikas
    Univ Hlth Network, Princess Margaret Canc Ctr, Blood & Marrow Transplant Program, Toronto, ON, Canada..
    Gerds, Aaron
    Cleveland Clin, Taussig Canc Inst, Hematol Oncol & Blood Disorders, Cleveland, OH 44106 USA..
    Malone, Adriana
    Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA..
    Tallman, Martin
    Mem Sloan, Dept Med, Leukemia Serv, New York, NY USA..
    Reshef, Ran
    Columbia Univ, Med Ctr, Blood & Marrow Transplantat Program, New York, NY USA.;Columbia Univ, Med Ctr, Columbia Ctr Translat Immunol, New York, NY USA..
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Pediat Bone Marrow Transplant, Bristol, Avon, England..
    Copelan, Edward
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA..
    Gergis, Usama
    New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med Oncol, Hematol Malignancies & Bone Marrow Transplant, New York, NY USA..
    Savoie, Mary Lynn
    Tom Baker Canc Clin, Div Hematol & Hematol Malignancies, Calgary, AB, Canada..
    Ustun, Celalettin
    Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN 55455 USA..
    Litzow, Mark R.
    Mayo Clin Rochester, Div Hematol, Rochester, MN USA.;Mayo Clin Rochester, Transplant Ctr, Rochester, MN USA..
    Cahn, Jean-Yves
    Univ Hosp, Dept Hematol, Grenoble, France..
    Kindwall-Keller, Tamila
    Univ Virginia Hlth Syst, Div Hematol Oncol, Charlottesville, VA USA..
    Akpek, Gorgun
    Banner MD Anderson Canc Ctr, Stem Cell Transplantat & Cellular Therapy Program, Gilbert, AZ USA..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Aljurf, Mahmoud
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia..
    Rowe, Jacob M.
    Shaare Zedek Med Ctr, Dept Hematol, Jerusalem, Israel..
    Wiernik, Peter H.
    Our Lady Mercy Med Ctr, Bronx, NY USA..
    Hsu, Jack W.
    Shands HealthCare, Dept Med, Div Hematol & Oncol, Gainesville, FL USA.;Univ Florida, Gainesville, FL USA..
    Cortes, Jorge
    Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Leukemia, Houston, TX 77030 USA..
    Kalaycio, Matt
    Cleveland Clin Fdn, Dept Hematol & Med Oncol, 9500 Euclid Ave, Cleveland, OH 44195 USA..
    Maziarz, Richard
    Oregon Hlth & Sci Univ, Knight Canc Inst, Adult Blood & Marrow Stem Cell Transplant Program, Portland, OR 97201 USA..
    Sobecks, Ronald
    Cleveland Clin Fdn, Dept Hematol & Med Oncol, 9500 Euclid Ave, Cleveland, OH 44195 USA..
    Popat, Uday
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Houston, TX 77030 USA..
    Alyea, Edwin
    Dana Farber Canc Inst, Ctr Hematol Oncol, Boston, MA 02115 USA..
    Saber, Wael
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia2017In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 23, no 5, p. 767-775Article in journal (Refereed)
    Abstract [en]

    Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for patients with chronic myelomonocytic leukemia (CMML); however, few data exist regarding prognostic factors and transplantation outcomes. We performed this retrospective study to identify prognostic factors for post-transplantation outcomes. The CMML-specific prognostic scoring system (CPSS) has been validated in subjects receiving nontransplantation therapy and was included in our study. From 2001 to 2012, 209 adult subjects who received HCT for CMML were reported to the Center for International Blood and Marrow Transplant Research. The median age at transplantation was 57 years (range, 23 to 74). Median follow-up was 51 months (range, 3 to 122). On multivariate analyses, CPSS scores, Karnofsky performance status (KPS), and graft source were significant predictors of survival (P = .004, P = .01, P = .01, respectively). Higher CPSS scores were not associated with disease-free survival, relapse, or transplantation-related mortality. In a restricted analysis of subjects with relapse after HCT, those with intermediate-2/high risk had a nearly 2-fold increased risk of death after relapse compared to those with low/intermediate-1 CPSS scores. Respective 1-year, 3-year, and 5-year survival rates for low/intermediate-1 risk subjects were 61% (95% confidence interval [CI], 52% to 72%), 48% (95% CI, 37% to 59%), and 44% (95% CI, 33% to 55%), and for intermediate-2/high risk subjects were 38% (95% CI, 28% to 49%), 32% (95% CI, 21% to 42%), and 19% (95% CI, 8% to 29%). We conclude that higher CPSS score at time of transplantation, lower KPS, and a bone marrow graft are associated with inferior survival after HCT. Further investigation of CMML disease-related biology may provide insights into other risk factors predictive of post-transplantation outcomes. (C) 2017 American Society for Blood and Marrow Transplantation.

  • 209. Loden, Marie
    et al.
    Nilsson, Gert
    Parvardeh, Masomeh
    Carne, Kristina Neimert
    Berg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    No skin reactions to mineral powders in nickel-sensitive subjects2012In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 66, no 4, p. 210-214Article in journal (Refereed)
    Abstract [en]

    Background. Cosmetic products are known to be able to induce contact dermatitis. Contact dermatitis may also be induced by nickel, and it is estimated that up to 17% of women are allergic to nickel.

    Objectives. The aim of the present study was to investigate whether nickel sensitized individuals react to make-up products containing pigments with nickel as an impurity.

    Patients/Materials/Methods. Twenty-three individuals with a clinical history of nickel allergy and/or with positive patch test reactions to nickel were exposed to mineral make-up products and individual pigments dispersed in alkylbenzoate (50%) in small Finn Chambers (R) for 48 hr. The skin reactions were evaluated visually and with a non-invasive instrument that quantifies skin erythema.

    Results. The results showed that 74% of the included individuals showed a visible reaction to the positive control nickel sulfate, and a significant correlation was found between the visual and instrumental readings. However, none of the nickel sensitive individuals reacted to the test products. A subgroup analysis of the 50% most sensitive individuals also confirmed the absence of skin reactions to the powders.

    Conclusions. The bioavailability of the trace amounts of nickel in the particles was below the level needed to elicit an eczematous reaction in any of the nickel-sensitized individuals.

  • 210.
    Lopez-Fauqued, Marta
    et al.
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Campora, Laura
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Delannois, Frederique
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    El Idrissi, Mohamed
    GSK, Rixensart, Belgium.
    Oostvogels, Lidia
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium;CureVac AG, Tubingen, Germany.
    De Looze, Ferdinandus J.
    AusTrials Pty Ltd, Sherwood, Qld, Australia;Univ Queensland, Sch Med, Brisbane, Qld, Australia.
    Diez-Domingo, Javier
    Fdn Fomento Invest Sanitaria & Biomed, Vaccine Res Unit, Valencia, Spain.
    Heineman, Thomas C.
    GSK, King Of Prussia, PA USA;Halozyme Therapeut, San Diego, CA USA.
    Lal, Himal
    GSK, King Of Prussia, PA USA;Pfizer Vaccine Inc, Collegeville, PA USA.
    McElhaney, Janet E.
    Hlth Sci North Res Inst, Sudbury, ON, Canada.
    McNeil, Shelly A.
    Dalhousie Univ, Canadian Ctr Vaccinol, Halifax, NS, Canada;Dalhousie Univ, IWK Hlth Ctr, Halifax, NS, Canada;Dalhousie Univ, Nova Scotia Hlth Author, Halifax, NS, Canada.
    Yeo, Wilfred
    Univ Wollongong, Sch Med, Wollongong, NSW, Australia.
    Tavares-Da-Silva, Fernanda
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Ahonen, Anitta
    Univ Tampere, Jarvenpaa Vaccine Clin, Tampere, Finland.
    Avelino-Silva, Thiago Junquera
    Univ Sao Paulo, Sch Med, Sao Paulo, Brazil.
    Fernando Barba-Gomez, Jose
    Inst Dermatol Jalisco, Guadalajara, Jalisco, Mexico.
    Berglund, Johan
    Blekinge Inst Technol, Karlskrona, Sweden.
    Brotons Cuixart, Carlos
    EAP Sardenya, Barcelona, Spain.
    Caso, Covadonga
    Hosp Clin San Carlos, Madrid, Spain.
    Chlibek, Roman
    Univ Def, Fac Mil Hlth Sci, Brno, Czech Republic.
    Choi, Won Suk
    Korea Univ, Coll Med, Seoul, South Korea.
    Cunningham, Anthony L.
    Univ Sydney, Westmead Inst Med Res, Sydney, NSW, Australia.
    Desole, Maria Guiseppina
    Serv Igiene Pubbl, Sassari, Italy.
    Eizenberg, Peter
    Doctors Ivanhoe, Ivanhoe, Australia.
    Esen, Meral
    Univ Clin Tubingen, Inst Tropenmed, Tubingen, Germany.
    Espie, Emmanuelle
    GSK, Brussels, Belgium.
    Gervais, Pierre
    Q&T Res Sherbrooke, Sherbrooke, PQ, Canada.
    Ghesquiere, Wayne
    Univ British Columbia, Vancouver, BC, Canada.
    Godeaux, Olivier
    GSK, Brussels, Belgium.
    Gorfinkel, Iris
    York Univ, N York, ON, Canada.
    Hui, David Shu Cheong
    Prince Wales Hosp, Hong Kong, Peoples R China.
    Hwang, Shinn-Jang
    Taipei Vet Gen Hosp, Taipei, Taiwan;Natl Yang Ming Univ, Sch Med, Taipei, Taiwan.
    Korhonen, Tiina
    Univ Tampere, Sch Med, Vaccine Res Ctr, Tampere, Finland.
    Kovac, Martina
    GSK, New York, NY USA.
    Ledent, Edouard
    GSK, Rixensart, Belgium.
    Leung, Edward
    Hong Kong Assoc Gerontol, Hong Kong, Peoples R China.
    Levin, Myron J.
    Univ Colorado, Anschutz Med Campus, Aurora, CO USA.
    Narejos Perez, Silvia
    CAP Centelles, Centelles, Spain.
    Neto, Jose Luiz
    Inst AZ Pesquisa & Ensino, Curitiba, Parana, Brazil.
    Pauksen, Karlis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Poder, Airi
    Kliiniliste Uuringute Keskus, Tartu, Estonia.
    Rodriguez de la Pinta, Maria Luisa
    Hosp Puerta de Hierro, Madrid, Spain.
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Schwarz, Tino F.
    Standort Juliusspital, Wurzburg, Germany.
    Smetana, Jan
    Univ Def, Fac Mil Hlth Sci, Brno, Czech Republic.
    Staniscia, Tommaso
    Univ G dAnnunzio, Chieti, Italy.
    Tinoco, Juan Carlos
    Hosp Gen Durango, Durango, Mexico.
    Toma, Azhar
    Manna Res, Toronto, ON, Canada.
    Vastiau, Ilse
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Vesikari, Timo
    Univ Tampere, Tampere, Finland.
    Volpi, Antonio
    AO Univ Policlin Tor Vergata, Rome, Italy.
    Watanabe, Daisuke
    Kobe Univ, Grad Sch Med, Kobe, Hyogo, Japan.
    Weckx, Lily Yin
    Univ Fed Sao Paulo, Sao Paulo, Brazil.
    Zahaf, Toufik
    GSK, Brussels, Belgium.
    Safety profile of the adjuvanted recombinant zoster vaccine: Pooled analysis of two large randomised phase 3 trials2019In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 37, no 18, p. 2482-2493Article in journal (Refereed)
    Abstract [en]

    Background: The ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) phase 3 clinical trials showed that the adjuvanted recombinant zoster vaccine (RZV) was >= 90% efficacious in preventing herpes zoster in adults. Here we present a comprehensive overview of the safety data from these studies.

    Methods: Adults aged >= 50 (ZOE-50) and >= 70 (ZOE-70) years were randomly vaccinated with RZV or placebo. Safety analyses were performed on the pooled total vaccinated cohort, consisting of participants receiving at least one dose of RZV or placebo. Solicited and unsolicited adverse events (AEs) were collected for 7 and 30 days after each vaccination, respectively. Serious AEs (SAEs) were collected from the first vaccination until 12 months post-last dose. Fatal AEs, vaccination-related SAEs, and potential immune-mediated diseases (pIMDs) were collected during the entire study period.

    Results: Safety was evaluated in 14,645 RZV and 14,660 placebo recipients. More RZV than placebo recipients reported unsolicited AEs (50.5% versus 32.0%); the difference was driven by transient injection site and solicited systemic reactions that were generally seen in the first week post-vaccination. The occurrence of overall SAEs (RZV: 10.1%; Placebo: 10.4%), fatal AEs (RZV: 4.3%; Placebo: 4.6%), and pIMDs (RZV: 1.2%; Placebo: 1.4%) was balanced between groups. The occurrence of possible exacerbations of pIMDs was rare and similar between groups. Overall, except for the expected local and systemic symptoms, the safety results were comparable between the RZV and Placebo groups irrespective of participant age, gender, or race.

    Conclusions: No safety concerns arose, supporting the favorable benefit-risk profile of RZV. 

  • 211.
    Ludvigsson, Maria Landen
    et al.
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Motala, Sweden..
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.;Cty Council Sormland, Katrineholm, Sweden..
    Dedering, Asa
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Phys Therapy, Stockholm, Sweden..
    Peolsson, Anneli
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    One- And Two-Year Follow-Up Of A Randomized Trial Of Neck Specific Exercise With Or Without A Behavioural Approach Compared With Prescription Of Physical Activity In Chronic Whiplash Disorder2016In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 1, p. 56-64Article in journal (Refereed)
    Abstract [en]

    Objective: To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash. Design: Follow-up of a randomized, assessor blinded, clinical trial. Patients: A total of 216 volunteers with chronic whiplash associated disorders, grades 2 or 3. Methods: Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years. Results: Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p <= 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p < 0.001), but at 2 years the difference was not significant. Conclusion: After 1-2 years, participants with chronic whiplash who were randomized to neck-specific exercise, with or without a behavioural approach, remained more improved than participants who were prescribed general physical activity.

  • 212.
    Ludvigsson, Maria Landen
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden;Linkoping Univ, Dept Rehabil, Cty Council Ostergotland, Rehab Vast, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden .
    Peolsson, Anneli
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash: Analyses of a randomized clinical trial2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 12409Article in journal (Refereed)
    Abstract [en]

    Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.

  • 213. Ludvigsson, Maria Landén
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    O'Leary, Shaun
    Dedering, Asa
    Peolsson, Anneli
    The Effect of Neck-specific Exercise with, or without a Behavioral Approach, on Pain, Disability and Self-efficacy in Chronic Whiplash-associated Disorders: A Randomized Clinical Trial2015In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 31, no 4, p. 249-303Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:: The aim of this study was to compare the effect on self-rated pain, disability and self-efficacy of three interventions for the management of chronic Whiplash Associated Disorders (WAD): physiotherapist-led neck-specific exercise, physiotherapist-led neck-specific exercise with the addition of a behavioral approach, or prescription of physical activity.

    METHODS:: Two hundred and sixteen volunteers with chronic WAD participated in this randomized, assessor blinded, clinical trial of three exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index) and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at three and six months.

    RESULTS:: The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the two neck-specific exercise groups (29-48%) compared to the prescription of physical activity group (5%) at three months. At six months 39-44% of the patients in the two neck-specific groups and 28% in the prescription of physical activity group reported substantial pain reduction. Reduction of disability was also larger in the two neck-specific exercise groups at both three and six months (P<0.02). Self-efficacy was only improved in the neck-specific exercise group without a behavioral approach (P=0.02). However there were no significant differences in any outcomes between the two physiotherapist-led neck-specific exercise groups.

    DISCUSSION:: Neck-specific exercise resulted in superior outcomes compared to prescription of physical activity in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

  • 214.
    Lyckner, S
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Böregård, I-L
    Zetterlund, E-L
    Chew, M S
    Validation of the Swedish version of Quality of Recovery score -15: a multicentre, cohort study.2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Quality of recovery (QoR) after surgery is often focused on morbidity, mortality and physiological changes, while well-being and emotional state are other important aspects that are often ignored. QoR is poorly investigated in clinical settings and a psychometrically tested questionnaire, QoR-15, has recently been developed. QoR-15 has not been validated for Swedish conditions. The aim of this study was to translate, adapt and validate QoR-15 to Swedish conditions (QoR-15swe).

    METHODS: A translation and cultural adaption was performed resulting in a Swedish version of the instrument, QoR-15swe. Patients answered the QoR-15swe before surgery, 24 and 48 h after surgery. Feasibility, validity, reliability and responsiveness of the QoR-15swe were evaluated.

    RESULTS: The QoR-15swe was feasible in 85.5% of the eligible patients. Construct validity was good, with significant correlations between QoR-15swe score and, ASA-PS class, grade of surgery, length of surgery and time in the post-anaesthesia care unit. The instrument demonstrated good internal consistency with an inter-item Cronbach's α of 0.83-0.87, and inter-dimension Cronbach's α was acceptable 0.71-0.76. Test-retest repeatability was also good with Cronbach's alpha > 0.99 and an interclass correlation coefficient of 0.992 (CI: 0.981-0.997). There were no floor and ceiling effects. Responsiveness assessed by Cliff's effect size was -0.23 indicating a moderate ability to detect change at 24 h postoperatively.

    CONCLUSION: We have translated and culturally adapted the QoR-15 into Swedish. The score demonstrated acceptable validity, reliability and responsiveness. The QoR-15swe is a clinically acceptable and feasible outcome measure after surgery in a Swedish population.

  • 215.
    Lännerström, Linda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Sick Leave Questions in Telephone Nursing: Perspectives of Persons on Sick Leave and Registered Nurses in Primary Health Care2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim and methods: To explore experiences of being on sick leave by interviewing 16 persons on sick leave and using a phenomenological approach. To explore registered nurses’ work in the care of persons on sick leave by performing three focus group discussions with registered nurses. To explore the effect and experiences of an educational intervention in social insurance medicine with registered nurses by studying the effect of a randomized controlled study with 100 registered nurses and by interviewing 12 registered nurses who participated in the intervention.

    Findings: The essential meaning of being on long-term sick leave was losing one’s independence. This loss was connected to mostly negative experiences of being absent from work, the social insurance rules, and experiences in encounters with many professionals.

    The registered nurses’ work in handling sick leave questions included assessing, dispositioning, supporting, and collaborating actions. They expressed lacking competence, had different understandings of their role, and experienced stress connected to contradictory demands in their roles as carers, co-workers, and distributors of organizational resources.

    The short educational intervention in social insurance medicine seemed to have had an effect, but due to the small study population, the effect was inconclusive. The process evaluation showed that the educational intervention was perceived to have contributed to registered nurses gaining role clarity in their work with sick leave questions. The registered nurses described increasing their knowledge and skills as well as taking on more of the traditional actions related to telephone nursing, for example giving more information and being more attentive, coaching, and encouraging towards patients.

    Conclusions: Being on long-term sick leave can be experienced negatively, and can be connected to several dimensions of life. Registered nurses at the studied primary health care centres had a role in the care of patients on sick leave, but had different understandings of their role that affected how they handled telephone calls with them. The educational intervention failed to show a conclusive effect due to the rather small study population. However, the registered nurses experienced that participating had enhanced their competence.

    List of papers
    1. Losing independence: the lived experience of being long-term sick-listed
    Open this publication in new window or tab >>Losing independence: the lived experience of being long-term sick-listed
    2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 745-Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Sickness absence is a multifaceted problem. Much is known about risk factors for being long-term sick-listed, but there is still little known about the various aftermaths and experiences of it. The aim of this qualitative study was to describe, analyze and understand long-term sickness-absent people's experiences of being sick-listed.

    METHODS: The design was descriptive and had a phenomenological approach. Sixteen long-term sickness-absent individuals were purposively sampled from three municipalities in Sweden in 2011, and data were collected through semi-structured, individual interviews. The interview questions addressed how the participants experienced being sick-listed and how the sick-listing affected their lives. Transcribed interviews were analysed using Giorgi's phenomenological method.

    RESULTS: The interviews revealed that the participants' experiences of being sick-listed was that they lost their independence in the process of stepping out of working society, attending the mandatory steps in the rehabilitation chain and having numerous encounters with professionals. The participants described that their life-worlds were radically changed when they became sick-listed. Their experiences of their changing life-worlds were mostly highly negative, but there were also a few positive experiences. The most conspicuous findings were the fact that stopping working brought with it so many changes, the participants' feelings of powerlessness in the process, and their experiences of offensive treatment by and/or encounters with professionals.

    CONCLUSIONS: Sick-listed persons experienced the process of being on long-term sickness absent as very negative. The negative experiences are linked to consequences of stopping to work, consequences of social insurance rules and to negative encounters with professionals handling the sickness absence. The positive experiences of being sick-listed were few in the present study. There is a need to further examine the extent of these negative experiences are and how they affect sick-listed people's recovery and return to work. Long-term sickness absence; sick leave; experiences; interviews; phenomenology; Sweden.

    Keywords
    long-term sickness absence, sick leave, experiences, interviews, phenomenology, Sweden
    National Category
    Other Basic Medicine
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-205547 (URN)10.1186/1471-2458-13-745 (DOI)000323311900001 ()23938128 (PubMedID)
    Available from: 2013-08-19 Created: 2013-08-19 Last updated: 2018-10-04Bibliographically approved
    2. Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres
    Open this publication in new window or tab >>Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres
    2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 857-863Article in journal (Refereed) Published
    Abstract [en]

    Introduction:

    Over the last decade Swedish health care has focused on improving the management of sick-listing issues. At primary health care centres sick-listing is mainly dealt with by the patient’s physician but when patients have requests related to sick-listing and contact the telephone advisory service nurses will be involved. The aim of this study was to describe nurses’ experiences of managing sick-listing issues in telephone advisory services in a primary health care setting.

    Methods:

    The study was a qualitative focus group study. Data collection was conducted in three focus group conversations in a county in central Sweden in 2009. The conversations were recorded, transcribed and analyzed using qualitative content analysis. The study included fourteen nurses, purposively sampled as having current experience of telephone advisory services at primary health care centres.

    Findings:

    The management of sick-listing issues was described by the nurses as Nurses Actions which were affected by Enabling conditions and Obstructing conditions. The Nurses’ Actions included making an assessment for appropriate action, making an appointment and/or giving information and guidance to the patient and/or monitoring patient’s rights. Enabling conditions included documentation, routines, supportive co-operation and training in insurance medicine. The obstructing conditions were related to patients’ expectations, co-operation with other professionals, lack of training and the nurses’ professional role.

    Conclusion:

    The nurses experienced stress and difficulties related to being gatekeepers and related to the act of balancing different demands from patients, co-workers and the organisation. This in combination with the lack of training caused the nurses to state that they did not want responsibility for managing sick-listing issues. Sufficient documentation, education, routines, support of and discussions with other professionals at the primary health care centre could be ways of improving nurses’ and other professionals’ management of sick-listing issues.

    Keywords
    sick listing, telephone advisory services, primary health care, nursing, focus group, qualitative content analysis
    National Category
    Medical and Health Sciences
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-185457 (URN)10.1111/j.1471-6712.2012.01093.x (DOI)000328140200010 ()
    Available from: 2012-11-25 Created: 2012-11-25 Last updated: 2018-10-04Bibliographically approved
    3. The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.
    Open this publication in new window or tab >>The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Identifiers
    urn:nbn:se:uu:diva-362239 (URN)
    Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-10-04
    4. Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention
    Open this publication in new window or tab >>Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention
    2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 2, p. 236-244Article in journal (Refereed) Published
    Abstract [en]

    Aim

    To describe how a short educational intervention in social insurance medicine was experienced by Registered Nurses and what changes it brought to their work with sick leave questions in telephone nursing.

    Design

    Qualitative explorative interview study.

    Methods

    Interviews with 12 purposively sampled Registered Nurses were conducted and analysed using manifest content analysis.

    Results

    The intervention increased Registered Nurses’ knowledge of the sick leave process and changed their work habits as they now have more of the skills needed to handle sick leave questions. In this way, they gained role clarity in their work with sick leave questions. The new knowledge included rules and regulations, actors’ roles and patients’ experiences. Learning from peers, reflecting and having the opportunity to ask questions were also described as increasing their knowledge. The skills following the participation were described as knowing what to say and do and knowing where to turn for support.

    Keywords
    cluster randomized controlled study, educational intervention, interviews, sick leave, social insurance medicine, telephone nursing
    National Category
    Nursing
    Identifiers
    urn:nbn:se:uu:diva-361653 (URN)10.1002/nop2.201 (DOI)000461835600004 ()30918675 (PubMedID)
    Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2019-05-07Bibliographically approved
  • 216.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Holmström, Inger K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Possible causes of experiencing problems with sick leave questions in telephone nursing2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 4, p. 249-253Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Registered nurses at primary health care centres in Sweden receive about 20 million telephone calls annually. Questions related to sick leave occur regularly. Previous studies conclude that those calls often are perceived as problematic. The aim of this study was to explore factors associated with problems regarding sick leave questions in telephone nursing.

    METHODS: A questionnaire was distributed to all registered nurses (n = 185) working with telephone nursing in 26 Swedish primary health care centres, of whom 114 (61.6%) responded. Based on the results of a Spearman correlation analysis a logistic regression analysis was performed of significant exposure variables on outcome (perceived problems).

    RESULTS: Significant exposure variables were: experience of telephone nursing, age, being educated in social insurance medicine, and frequency of telephone calls with sick leave questions. Young age was associated with more problems than old age. Those having education in social insurance medicine reported fewer problems than those who had not, and so did those having few telephone calls with sick leave questions as compared with those who had many.

    CONCLUSIONS: Young age, lack of education in insurance medicine, and high frequency of sick leave questions increased the perceived problem level in telephone nursing.

  • 217.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens Högskola, Akademien för hälsa, vård och välfärd Mälardalen University School of health, care and social welfare.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.Manuscript (preprint) (Other academic)
  • 218.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    von Celsing, Anna-Sophia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Registered nurses' work with sick leave questions by telephone in primary health care2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 5/6, p. 641-647Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe registered nurses' work with sick leave questions by telephone.

    BACKGROUND:

    In Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses' work with sick leave questions has not been studied, except for two qualitative interview studies.

    DESIGN:

    A descriptive cross-sectional study.

    METHODS:

    A questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis.

    RESULTS:

    Response rate was 62% (n = 114). Registered nurses (n = 105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n = 78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were 'often' booking appointments with physicians (n = 67) and 'seldom' providing information on social insurance rules ('never' n = 51). The registered nurses expressed a great need for more education.

    CONCLUSION:

    Registered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine.

    RELEVANCE TO CLINICAL PRACTICE:

    There is a need to educate and train registered nurses in social insurance medicine to provide high-quality nursing for patients on or at risk for sick leave.

  • 219.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Losing independence: the lived experience of being long-term sick-listed2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 745-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sickness absence is a multifaceted problem. Much is known about risk factors for being long-term sick-listed, but there is still little known about the various aftermaths and experiences of it. The aim of this qualitative study was to describe, analyze and understand long-term sickness-absent people's experiences of being sick-listed.

    METHODS: The design was descriptive and had a phenomenological approach. Sixteen long-term sickness-absent individuals were purposively sampled from three municipalities in Sweden in 2011, and data were collected through semi-structured, individual interviews. The interview questions addressed how the participants experienced being sick-listed and how the sick-listing affected their lives. Transcribed interviews were analysed using Giorgi's phenomenological method.

    RESULTS: The interviews revealed that the participants' experiences of being sick-listed was that they lost their independence in the process of stepping out of working society, attending the mandatory steps in the rehabilitation chain and having numerous encounters with professionals. The participants described that their life-worlds were radically changed when they became sick-listed. Their experiences of their changing life-worlds were mostly highly negative, but there were also a few positive experiences. The most conspicuous findings were the fact that stopping working brought with it so many changes, the participants' feelings of powerlessness in the process, and their experiences of offensive treatment by and/or encounters with professionals.

    CONCLUSIONS: Sick-listed persons experienced the process of being on long-term sickness absent as very negative. The negative experiences are linked to consequences of stopping to work, consequences of social insurance rules and to negative encounters with professionals handling the sickness absence. The positive experiences of being sick-listed were few in the present study. There is a need to further examine the extent of these negative experiences are and how they affect sick-listed people's recovery and return to work. Long-term sickness absence; sick leave; experiences; interviews; phenomenology; Sweden.

  • 220.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kaminsky, Elenor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola, Västerås, Sweden.
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola, Västerås, Sweden.
    Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 2, p. 236-244Article in journal (Refereed)
    Abstract [en]

    Aim

    To describe how a short educational intervention in social insurance medicine was experienced by Registered Nurses and what changes it brought to their work with sick leave questions in telephone nursing.

    Design

    Qualitative explorative interview study.

    Methods

    Interviews with 12 purposively sampled Registered Nurses were conducted and analysed using manifest content analysis.

    Results

    The intervention increased Registered Nurses’ knowledge of the sick leave process and changed their work habits as they now have more of the skills needed to handle sick leave questions. In this way, they gained role clarity in their work with sick leave questions. The new knowledge included rules and regulations, actors’ roles and patients’ experiences. Learning from peers, reflecting and having the opportunity to ask questions were also described as increasing their knowledge. The skills following the participation were described as knowing what to say and do and knowing where to turn for support.

  • 221.
    Lövvik, Tone S.
    et al.
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Gynaecol & Obstet, Trondheim, Norway.
    Carlsen, Sven M.
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Endocrinol, Trondheim, Norway.
    Salvesen, Öyvind
    Norwegian Univ Sci & Technol, Dept Publ Hlth & Nursing, Trondheim, Norway.
    Steffensen, Berglind
    Univ Hosp Iceland, Dept Obstet & Gynaecol, Reykjavik, Iceland.
    Bixo, Marie
    Umea Univ, Dept Clin Sci, Umea, Sweden.
    Gomez-Real, Francisco
    Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway;Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Lönnebotn, Marianne
    Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Hestvold, Kristin, V
    Vestre Viken Hosp Trust, Womens Clin, Drammen, Norway.
    Zabielska, Renata
    Vestfold Hosp Trust, Womens Clin, Tonsberg, Norway.
    Hirschberg, Angelica L.
    Karolinska Univ Hosp, Dept Gynecol & Reprod Med, Stockholm, Sweden;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Trouva, Anastasia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Thorarinsdottir, Solveig
    Telemark Hosp Trust, Womens Clink, Skien, Norway.
    Hjelle, Sissel
    Alesund Hosp, Womens Clin, Alesund, Norway.
    Berg, Ann Hilde
    Innlandet Hosp Trust, Womens Clink, Lillehammer, Norway.
    Andrae, Frida
    Nordlands Hosp Trust, Womens Clin, Bodo, Norway.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Mohlin, Johanna
    Umea Univ, Dept Clin Sci, Umea, Sweden;Sadersjukhuset, Stockholm, Sweden.
    Underdal, Maria
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Gynaecol & Obstet, Trondheim, Norway.
    Vanky, Eszter
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Gynaecol & Obstet, Trondheim, Norway.
    Use of metformin to treat pregnant women with polycystic ovary syndrome (PregMet2): a randomised, double-blind, placebo-controlled trial2019In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 7, no 4, p. 256-266Article in journal (Refereed)
    Abstract [en]

    Background: Women with polycystic ovary syndrome (PCOS) have an increased risk of pregnancy complications. Epi-analysis of two previous randomised controlled trials that compared metformin with placebo during pregnancy in women with PCOS showed a significant reduction in late miscarriages and preterm births in the metformin group. The aim of this third randomised trial (PregMet2) was to test the hypothesis that metformin prevents late miscarriage and preterm birth in women with PCOS.

    Methods: PregMet2 was a randomised, placebo-controlled, double-blind, multicentre trial done at 14 hospitals in Norway, Sweden, and Iceland. Singleton pregnant women with PCOS aged 18-45 years were eligible for inclusion. After receiving information about the study at their first antenatal visit or from the internet, women signed up individually to participate in the study. Participants were randomly assigned (1: 1) to receive metformin or placebo by computer-generated random numbers. Randomisation was in blocks of ten for each country and centre; the first block had a random size between one and ten to assure masking. Participants were assigned to receive oral metformin 500 mg twice daily or placebo during the first week of treatment, which increased to 1000 mg twice daily or placebo from week 2 until delivery. Placebo tablets and metformin tablets were identical and participants and study personnel were masked to treatment allocation. The primary outcome was the composite incidence of late miscarriage (between week 13 and week 22 and 6 days) and preterm birth (between week 23 and week 36 and 6 days), analysed in the intention-to-treat population. Secondary endpoints included the incidence of gestational diabetes, preeclampsia, pregnancy-induced hypertension, and admission of the neonate to the neonatal intensive care unit. We also did a post-hoc individual participant data analysis of pregnancy outcomes, pooling data from the two previous trials with the present study. The study was registered with ClinicalTrials. gov, number NCT01587378, and EudraCT, number 2011-002203-15.

    Findings: The study took place between Oct 19, 2012, and Sept 1, 2017. We randomly assigned 487 women to metformin (n=244) or placebo (n=243). In the intention-to-treat analysis, our composite primary outcome of late miscarriage and preterm birth occurred in 12 (5%) of 238 women in the metformin group and 23 (10%) of 240 women in the placebo group (odds ratio [OR] 0.50, 95% CI 0.22- 1.08; p = 0.08). We found no significant differences for our secondary endpoints, including incidence of gestational diabetes (60 [25%] of 238 women in the metformin group vs 57 [24%] of 240 women in the placebo group; OR 1.09, 95% CI 0.69-1.66; p=0.75). We noted no substantial between-group differences in serious adverse events in either mothers or offspring, and no serious adverse events were considered drug-related by principal investigators. In the post-hoc pooled analysis of individual participant data from the present trial and two previous trials, 18 (5%) of 397 women had late miscarriage or preterm delivery in the metformin group ]compared with 40 (10%) of 399 women in the placebo group (OR 0.43, 95% CI 0.23-0.79; p=0.004). Interpretation In pregnant women with PCOS, metformin treatment from the late first trimester until delivery might reduce the risk of late miscarriage and preterm birth, but does not prevent gestational diabetes. 

  • 222. Mahindra, Anuj
    et al.
    Raval, Girindra
    Mehta, Paulette
    Brazauskas, Ruta
    Zhang, Mei-Jie
    Zhong, Xiaobo
    Bird, Jennifer M
    Freytes, César O
    Hale, Gregory A
    Herzig, Roger
    Holmberg, Leona A
    Kamble, Rammurti T
    Kumar, Shaji
    Lazarus, Hillard M
    Majhail, Navneet S
    Marks, David I
    Moreb, Jan S
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Saber, Wael
    Savani, Bipin N
    Schiller, Gary J
    Tay, Jason
    Vogl, Dan T
    Waller, Edmund K
    Wiernik, Peter H
    Wirk, Baldeep
    Lonial, Sagar
    Krishnan, Amrita Y
    Dispenzieri, Angela
    Brandenburg, Nancy A
    Gale, Robert Peter
    Hari, Parameswaran
    New Cancers after Autotransplantations for Multiple Myeloma2015In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 4, p. 738-745Article in journal (Refereed)
    Abstract [en]

    We describe baseline incidence and risk factors for new cancers in 4161 persons receiving autotransplants for multiple myeloma in the United States from 1990 to 2010. Observed incidence of invasive new cancers was compared with expected incidence relative to the US population. The cohort represented 13,387 person-years at-risk. In total, 163 new cancers were observed, for a crude incidence rate of 1.2 new cancers per 100 person-years and cumulative incidences of 2.6% (95% confidence interval [CI], 2.09 to 3.17), 4.2% (95% CI, 3.49 to 5.00), and 6.1% (95% CI, 5.08 to 7.24) at 3, 5, and 7 years, respectively. The incidence of new cancers in the autotransplantation cohort was similar to age-, race-, and gender-adjusted comparison subjects with an observed/expected (O/E) ratio of 1.00 (99% CI, .81 to 1.22). However, acute myeloid leukemia and melanoma were observed at higher than expected rates with O/E ratios of 5.19 (99% CI, 1.67 to 12.04; P = .0004), and 3.58 (99% CI, 1.82 to 6.29; P < .0001), respectively. Obesity, older age, and male gender were associated with increased risks of new cancers in multivariate analyses. This large data set provides a baseline for comparison and defines the histologic type specific risk for new cancers in patients with MM receiving postautotransplantation therapies, such as maintenance.

  • 223. Malki, Ninoa
    et al.
    Hägg, Sara
    Tiikkaja, Sanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Koupil, Ilona
    Sparén, Pär
    Ploner, Alexander
    Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990-1994 and 2005-2009.2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e026192Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Case-fatality rates (CFRs) for myocardial infarction (MI) and ischaemic stroke (IS) have decreased over time due to better prevention, medication and hospital care. It is unclear whether these improvements have been equally distributed according to socioeconomic position (SEP) and sex. The aim of this study is to analyse differences in short-term and long-term CFR for MI and IS by SEP and sex between the periods 1990-1994 to 2005-2009 for the entire Swedish population.

    DESIGN: Population-based cohort study based on Swedish national registers.

    METHODS: We used logistic regression and flexible parametric models to estimate short-term CFR (death before reaching the hospital or on the disease event day) and long-term CFR (1 year case-fatality conditional on surviving short-term) across five distinct SEP groups, as well as CFR differences (CFRDs) between SEP groups for both MI and IS from 1990-1994 to 2005-2009. : Result S: Overall short-term CFR for both MI and IS decreased between study periods. For MI, differences in short-term and long-term CFR between the least and most favourable SEP group were generally stable, except in long-term CFR among women; intermediate SEP groups mostly managed to catch up with the most favourable SEP group. For IS, short-term CFRD generally decreased compared with the most favourable group; but long-term CFRD were mostly stable, except for an increase for older subjects.

    CONCLUSION: Despite a general decline in CFR for MI and IS across all SEP groups and both sexes as well as some reductions in CFRD, we found persistent and even increasing CFRD among the least advantaged SEP groups, older patients and women. We speculate that targeted prevention rather than treatment strategies have the potential to reduce these inequalities.

  • 224. Marks, David I
    et al.
    Woo, Kwang Ahn
    Zhong, Xiaobo
    Appelbaum, Frederick R
    Bachanova, Veronika
    Barker, Juliet N
    Brunstein, Claudio G
    Gibson, John
    Kebriaei, Partow
    Lazarus, Hillard M
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Perales, Miguel-Angel
    Pidala, Joseph
    Savani, Bipin
    Rocha, Vanderson
    Eapen, Mary
    Unrelated umbilical cord blood transplant for adult acute lymphoblastic leukemia in first and second complete remission: a comparison with allografts from adult unrelated donors.2014In: Haematologica (online), ISSN 0390-6078, E-ISSN 1592-8721, Vol. 99, no 2, p. 322-8Article in journal (Refereed)
    Abstract [en]

    Allogeneic hematopoietic cell transplantation has an established role in the treatment of adults with acute lymphoblastic leukemia whose survival when recipients of grafts from adult unrelated donors approaches that of recipients of grafts from sibling donors. Our aim was to determine the role of mismatched unrelated cord blood grafts in transplantation for 802 adults with acute lymphoblastic leukemia in first or second complete remission. Using Cox regression we compared outcomes after 116 mismatched single or double cord blood transplants, 546 peripheral blood progenitor cell transplants and 140 bone marrow transplants. The characteristics of the recipients and their diseases were similar except cord blood recipients were younger, more likely to be non-Caucasians and more likely to have a low white blood cell count at diagnosis. There were differences in donor-recipient human leukocyte antigen-match depending on the source of the graft. Most adult donor transplants were matched at the allele-level considering human leukocyte antigens-A, -B, -C and -DRB1. In contrast, most cord blood transplants were mismatched and considered antigen-level matching; 57% were mismatched at two loci and 29% at one locus whereas only 29% of adult donor transplants were mismatched at one locus and none at two loci. There were no differences in the 3-year probabilities of survival between recipients of cord blood (44%), matched adult donor (44%) and mismatched adult donor (43%) transplants. Cord blood transplants engrafted slower and were associated with less grade 2-4 acute but similar chronic graft-versus-host disease, relapse, and transplant-related mortality. The survival of cord blood graft recipients was similar to that of recipients of matched or mismatched unrelated adult donor grafts and so cord blood should be considered a valid alternative source of stem cells for adults with acute lymphoblastic leukemia in the absence of a matched unrelated adult donor.

  • 225.
    Marusik, C
    et al.
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Frykholm, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Ericson, Katharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical and experimental pathology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Diagnosis of Placental Mesenchymal Dysplasia with a focus on magnetic resonance imaging (MRI)2017In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 49, no 3, p. 410-412Article in journal (Refereed)
  • 226.
    Mauri, Davide
    et al.
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;PACMeR Athens, Evidence Based Dept, Athens, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Tsali, Lampriani
    PACMeR Athens, Evidence Based Dept, Athens, Greece.
    Polyzos, Nikolaos P.
    Hosp Univ Dexeus, Barcelona, Spain.
    Valachis, Antonis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Zafeiria, Georgia
    Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Kalopita, Konstantina
    Alexandra Gen Hosp, Dept Anaesthesiol & Pain Med, Athens, Greece.
    Tsiara, Anna
    Univ Athens, Dept Med Oncol, Athens, Greece.
    Yerolatsite, Melina
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Zarkavelis, Georgios
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Kampletsas, Eleftherios
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Mouzaki, Ioanna
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Ntellas, Panagiotis
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Hills, Panagiotis
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Pentheroudakis, Georgios
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, TK-45500 Ioannina, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Facing internet fake-medicine and web para-pharmacy in the total absence of official recommendations from medical societies2019In: Balkan Union of Oncology. Journal, ISSN 1107-0625, Vol. 24, no 4, p. 1314-1325Article in journal (Refereed)
    Abstract [en]

    Purpose: Internet fake information, parapharmacy and counterfeit drugs are a market of hundreds of billion dollars. Misleading internet data decrease patients' compliance to medical care, promote use of questionable and detrimental practices, and jeopardize patient outcome. This is particularly harmful among cancer patients, especially when pain and nutritional aspects are considered. Provision of Web recommendations for the general audience (patients, relatives, general population) from official medical-providers might be useful to outweigh the detrimental internet information produced by non-medical providers. Methods: 370 oncology and anesthesiology related societies were analyzed. Our objective was to evaluate the magnitude of web-recommendation for cancer cachexia and cancer pain for the general audience provided by official medical organizations' web sites at global level. Results: Magnitude of web-recommendations at global level was surprisingly scant both for coverage and consistency. Seven official medical societies provided updated web-recommendation for cancer cachexia to their patients/family members, and 15 for cancer pain. Scantiness was unrelated by continent, developmental index, oncology tradition, economic-geographic area and society type scrutinized. Conclusions: Patients need expert advice when exposed to fake internet information largely dominated by paramedical market profits. In this era of "new media" the patients' net-education represents a new major educational challenge for medical societies.

  • 227.
    Mauri, Davide
    et al.
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece.
    Zafeiri, Georgia
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece.
    Yerolatsite, Melina
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece.
    Tsali, Lampriani
    Gen Hosp Arta, Dept Internal Med, Arta, Greece.
    Zarkavelis, Georgios
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece.
    Tsiare, Anna
    Alexandra Gen Hosp, Dept Med Oncol, Athens, Greece.
    Polyzos, Nikolaos P.
    Hosp Univ Dexeus, Barcelona, Spain.
    Valachis, Antonis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kalopita, Konastantina
    Alexandra Gen Hosp, Dept Anaesthesiol & Pain Med, Athens, Greece.
    Kampletsas, Eleftherios
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece.
    Papadaki, Alexandra
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece;EMEKEN, Ioannina, Greece.
    Peponi, Evangelia
    Univ Hosp Ioannina, Dept Radiotherapy, Ioannina, Greece.
    Kapoulitsa, Fani
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece.
    Filis, Panagiotis
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece.
    Pentheroudakis, Georgios
    Univ Hosp Ioannina, Dept Med Oncol, Ioannina 45500, Greece;EMEKEN, Ioannina, Greece.
    Global coverage and consistency of guideline recommendations for cancer cachexia on the Web in 2011 and 20182019In: Contemporary Oncology / Wspólczesna Onkologia, ISSN 1428-2526, Vol. 23, no 2, p. 100-109Article in journal (Refereed)
    Abstract [en]

    Introduction: Cancer cachexia is a common associate of cancer and has a negative impact on both patients' quality of life and overall survival. Nonetheless its management remains suboptimal in clinical practice. Provision of medical recommendations in websites is of extreme importance for medical decision making and translating evidence into clinical practice. Aim of the study: To scrutinize the magnitude, consistency and changes over time of cancer-cachexia recommendations for physicians on the Web among oncology related societies. Intercontinental, continental, national and socioeconomic variations were further analyzed. Material and methods: Web identification of oncology related societies and prospective analyses of relative Web guideline recommendations for physicians on cancer-cachexia at different time-points. Results: In June 2011, we scrutinized 144,000 Web pages. We identified 275 societies, of which 270 were eligible for analyses: 67 were international (African, American, Asian, European, Oceania and Intercontinental), 109 belonged to the top 10 countries with the highest development index and 94 pertained to 10 countries with a long lasting tradition in medical oncology. Conclusions: The magnitude of cancer cachexia recommendations for physicians on the Web at a global level was scant both for coverage and consistency, and at any time-point considered: 3.7% (10/270) in 2011 and 8.1% (22/270) in 2018. The proportion of societies giving evidence-based and updated recommendations for cancer cachexia for physicians was only 1.1% (3/270) in 2011 and 2.96% (8/270) in 2018. Continent, national highest developmental index, oncology tradition and economic-geographic areas were not found to influence Web guideline provision.

  • 228. McClune, Brian L.
    et al.
    Ahn, Kwang Woo
    Wang, Hai-Lin
    Antin, Joseph H.
    Artz, Andrew S.
    Cahn, Jean-Yves
    Deol, Abhinav
    Freytes, Cesar O.
    Hamadani, Mehdi
    Holmberg, Leona A.
    Jagasia, Madan H.
    Jakubowski, Ann A.
    Kharfan-Dabaja, Mohamed A.
    Lazarus, Hillard M.
    Miller, Alan M.
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Pedersen, Tanya L.
    Pidala, Joseph
    Pulsipher, Michael A.
    Rowe, Jacob M.
    Saber, Wael
    van Besien, Koen W.
    Waller, Edmund K.
    Aljurf, Mahmoud D.
    Akpek, Goergun
    Bacher, Ulrike
    Chao, Nelson J.
    Chen, Yi-Bin
    Cooper, Brenda W.
    Dehn, Jason
    de Lima, Marcos J.
    Hsu, Jack W.
    Lewis, Ian D.
    Marks, David I.
    McGuirk, Joseph
    Cairo, Mitchell S.
    Schouten, Harry C.
    Szer, Jeffrey
    Ramanathan, Muthalagu
    Savani, Bipin N.
    Seftel, Matthew
    Socie, Gerard
    Vij, Ravi
    Warlick, Erica D.
    Weisdorf, Daniel J.
    Allotransplantation for Patients Age >= 40 Years with Non-Hodgkin Lymphoma: Encouraging Progression-Free Survival2014In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 20, no 7, p. 960-968Article in journal (Refereed)
    Abstract [en]

    Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age >= 40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age >= 65; P = .0008). Fewer patients aged >= 65 had previous autografting (26% versus 24% versus 9%; P = .002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age >= 65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age >= 65; P < .0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age >= 55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age >= 55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.

  • 229. Medina, Doris M Rivera
    et al.
    Valencia, Alejandra
    de Velasquez, Alet
    Huang, Li-Min
    Prymula, Roman
    García-Sicilia, Jose
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    David, Marie Pierre P
    Descamps, Dominique
    Hardt, Karin
    Dubin, Gary
    Safety and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine: a randomized, controlled trial in adolescent girls2010In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 46, no 5, p. 414-421Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    Immunization of girls against oncogenic human papillomavirus (HPV) types before sexual debut is important for cervical cancer prevention. This phase III blinded, randomized, controlled trial in adolescent girls assessed safety of the HPV-16/18 AS04-adjuvanted vaccine.

    METHODS:

    Girls (mean age 12 years) in 12 countries received the HPV-16/18 L1 virus-like particle AS04-adjuvanted vaccine (N = 1,035) or hepatitis A virus vaccine as control (N = 1,032) at 0, 1, and 6 months. The primary objective was to compare the occurrence of serious adverse events (SAEs) between groups. HPV-16 and HPV-18 antibody titers were assessed by enzyme-linked immunosorbent assay post-vaccination.

    RESULTS:

    Up to study month 7, 11 girls in the HPV-16/18 vaccine group reported 14 SAEs and 13 girls in the control group reported 15 SAEs. The difference in SAE incidence between groups was .20% (95% CI, -.78, 1.20). No SAE in the HPV-16/18 vaccine group was considered related to vaccination or led to withdrawal. The incidence of solicited local and general symptoms up to 7 days post-vaccination was moderately higher with the HPV-16/18 vaccine than with control. The incidence of unsolicited symptoms, new onset of chronic diseases, and medically significant conditions was similar between groups. All girls seroconverted for both antigens after three doses of the HPV-16/18 vaccine; geometric mean titers were 19,882.0 and 8,262.0 EU/mL for anti-HPV-16 and -18 antibodies, respectively, in initially seronegative girls.

    CONCLUSIONS:

    The HPV-16/18 AS04-adjuvanted vaccine was generally well tolerated and immunogenic when administered to young adolescent females, the primary target of organized vaccination programs.

  • 230.
    Mehta, Rohtesh S.
    et al.
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX 77030 USA.
    Holtan, Shernan G.
    Univ Minnesota, Minneapolis, MN USA.
    Wang, Tao
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Div Biostat, Inst Hlth & Equ, Milwaukee, WI 53226 USA.
    Hemmer, Michael T.
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Spellman, Stephen R.
    Ctr Int Blood & Marrow Transplant Res, Be Match Natl Marrow Donor Program, Minneapolis, MN USA.
    Arora, Mukta
    Univ Minnesota, Dept Med, Med Ctr, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA.
    Couriel, Daniel R.
    Utah Blood & Marrow Transplant Program, Salt Lake City, UT USA.
    Alousi, Amin M.
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX 77030 USA.
    Pidala, Joseph
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Abdel-Azim, Hisham
    Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Transplantat, Los Angeles, CA USA.
    Ahmed, Ibrahim
    Childrens Mercy Hosp & Clin, Dept Hematol Oncol & Bone Marrow Transplantat, Kansas City, MO USA.
    Aljurf, Mahmoud
    King Faisal Specialist Hosp & Res Ctr, Dept Oncol, Riyadh, Saudi Arabia.
    Askar, Medhat
    Baylor Univ, Med Ctr, Dallas, TX USA.
    Auletta, Jeffery J.
    Nationwide Childrens Hosp, Div Hematol Oncol Bone Marrow Transplantat, Columbus, OH USA;Nationwide Childrens Hosp, Div Infect Dis, Blood & Marrow Transplant Program, Columbus, OH USA;Nationwide Childrens Hosp, Host Def Program, Columbus, OH USA.
    Bhatt, Vijaya
    Nebraska Med Ctr, Omaha, NE USA.
    Bredeson, Christopher
    Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada;Ottawa Hosp, Res Inst, Ottawa, ON, Canada.
    Chhabra, Saurabh
    Med Coll Wisconsin, Dept Med, Div Hematol Oncol, Milwaukee, WI 53226 USA.
    Gadalla, Shahinaz
    NCI, Div Canc Epidemiol & Genet, Clin Genet Branch, NIH, Rockville, MD USA.
    Gajewski, James
    Oregon Hlth & Sci Univ, Portland, OR 97201 USA.
    Gale, Robert Peter
    Imperial Coll London, Hematol Res Ctr, Dept Med, Div Expt Med, London, England.
    Gergis, Usama
    New York Presbyterian Hosp, Dept Med Oncol, Hematol Malignancies & Bone Marrow Transplant, Weill Cornell Med Ctr, New York, NY USA.
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Div Hematol Oncol Bone Marrow Transplantat, Dept Med, Madison, WI 53792 USA.
    Hildebrandt, Gerhard C.
    Univ Kentucky, Markey Canc Ctr, Lexington, KY USA.
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan.
    Kitko, Carrie
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
    Khandelwal, Pooja
    Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Cincinnati, OH 45229 USA.
    MacMillan, Margaret L.
    Univ Minnesota, Blood & Marrow Transplant Program, Minneapolis, MN USA.
    Majhail, Navneet
    Cleveland Clin, Blood & Marrow Transplant Program, Taussig Canc Inst, Cleveland, OH 44106 USA.
    Marks, David, I
    Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.
    Mehta, Parinda
    Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Cincinnati, OH 45229 USA.
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.
    Pawarode, Attaphol
    Univ Michigan, Sch Med, Dept Internal Med, Blood & Marrow Transplantat Program,Div Hematol O, Ann Arbor, MI USA.
    Diaz, Miguel Angel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.
    Prestidge, Tim
    Starship Childrens Hosp, Blood & Canc Ctr, Auckland, New Zealand.
    Qayed, Muna
    Emory Univ, Sch Med, Dept Pediat, Atlanta, GA USA.
    Rangarajan, Hemalatha
    Nationwide Childrens Hosp, Columbus, OH USA.
    Ringden, Olle
    Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
    Seo, Sachiko
    Natl Canc Res Ctr East, Dept Hematol & Oncol, Chiba, Japan.
    Shah, Ami
    Lucille Packard Childrens Hosp, Stanford Sch Med, Div Stem Cell Transplantat & Regenerat Med, Palo Alto, CA 94304 USA.
    Shah, Niketa
    Yale New Haven Med Ctr, 20 York St, New Haven, CT 06504 USA.
    Schultz, Kirk R.
    Univ British Columbia, British Columbias Childrens Hosp, Dept Pediat Hematol Oncol & Bone Marrow Transplan, Vancouver, BC, Canada.
    Solh, Melhem
    Northside Hosp, Blood & Marrow Transplant Grp Georgia, Atlanta, GA USA.
    Spitzer, Thomas
    Massachusetts Gen Hosp, Boston, MA 02114 USA.
    Szer, Jeffrey
    Royal Melbourne Hosp, Dept Clin Haematol & Bone Marrow Transplantat, Parkville, Vic, Australia.
    Teshima, Takanori
    Kyushu Univ Hosp, Sapporo, Hokkaido, Japan.
    Verdonck, Leo F.
    Isala Clin, Dept Hematol Oncol, Zwolle, Netherlands.
    Williams, Kirsten M.
    Childrens Natl Hlth Syst, Childrens Res Inst, Washington, DC USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Wagner, John
    Thomas Jefferson Univ, Dept Med Oncol, Philadelphia, PA 19107 USA.
    Yared, Jean A.
    Univ Maryland, Dept Med, Blood & Marrow Transplantat Program, Div Hematol Oncol, Baltimore, MD 21201 USA.
    Weisdorf, Daniel J.
    Univ Minnesota, Minneapolis, MN USA.
    GRFS and CRFS in alternative donor hematopoietic cell transplantation for pediatric patients with acute leukemia2019In: BLOOD ADVANCES, ISSN 2473-9529, Vol. 3, no 9, p. 1441-1449Article in journal (Refereed)
    Abstract [en]

    We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P < .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P < .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors.

  • 231. Menditto, Enrica
    et al.
    Costa, Elisio
    Midão, Luis
    Bosnic-Anticevich, Sinthia
    Novellino, Ettore
    Bialek, Slawomir
    Briedis, Vitalis
    Mair, Alpana
    Rajabian-Soderlund, Rojin
    Arnavielhe, Sylvie
    Bedbrook, Anna
    Czarlewski, Wienczyslawa
    Annesi-Maesano, Isabella
    Anto, Josep M.
    Devillier, Philippe
    De Vries, Govert
    Keil, Thomas
    Sheikh, Aziz
    Orlando, Valentina
    Larenas-Linnemann, Désirée
    Cecchi, Lorenzo
    De Feo, Giulia
    Illario, M.
    Stellato, Christiana
    Fonseca, Joao
    Malva, Joao
    Morais-Almeida, Mario
    Pereira, Ana Maria
    Todo-Bom, Ana Maria
    Kvedariene, Violeta
    Valiulis, Arunas
    Bergmann, Karl Christian
    Klimek, Ludger
    Mösges, Ralph
    Pfaar, Oliver
    Zuberbier, Torsten
    Cardona, Vicky
    Mullol, Joaquim
    Papadopoulos, Nikos G.
    Prokopakis, Emmanuel P.
    Bewick, Mike
    Ryan, Dermot
    Roller-Wirnsberger, Regina E.
    Tomazic, Peter Valentin
    Cruz, Alvaro A.
    Kuna, Piotr
    Samolinski, Boleslaw
    Fokkens, Wytske J.
    Reitsma, Sietze
    Bosse, Isabelle
    Fontaine, Jean-François
    Laune, Daniel
    Haahtela, Tari
    Toppila-Salmi, Sanna
    Bachert, Claus
    Hellings, Peter W.
    Melén, Erik
    Wickman, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bindslev-Jensen, Carsten
    Eller, Esben
    O'Hehir, Robyn E.
    Cingi, Cemal
    Gemicioğlu, Bilun
    Kalayci, Omer
    Ivancevich, Juan Carlos
    Bousquet, Jean
    Adherence to treatment in allergic rhinitis using mobile technology: the MASK Study2019In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 49, no 4, p. 442-460Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mobile technology may help to better understand the adherence to treatment MASK-rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient-centered ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries.

    OBJECTIVES: To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App.

    METHODS: An observational cross-sectional study was carried out on all users who filled in the Allergy Diary from January 1, 2016 to August 1, 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach.

    RESULTS: 12,143 users were registered. 6,949 users reported at least one VAS data rec