Mesfin Kassaye Tessma

Early hyperglycemia is a risk factor for death and white matter reduction in preterm infants.

OBJECTIVE: The objective of this study was to determine whether hyperglycemia during the first week of life in extremely preterm (EPT) infants was associated with increased mortality rates and with cerebral injury, as assessed with MRI of the brain, at term-equivalent age. METHODS: All 143 EPT infants (gestational ages of <27 weeks) who were born at Karolinska University Hospital between January 2004 and December 2006 and were alive at 24 hours were eligible. Of the 118 surviving infants, 24 were excluded for various reasons. MRI was performed for the 94 included survivors at term age, with a 1.5-T system, and scans were scored for gray matter/white matter (WM) abnormalities. Of the 25 infants who died before term age, 6 were excluded because of missing glucose documentation and the remaining 19 were included. Hyperglycemia was defined as plasma glucose levels of >8.3 mmol/L. RESULTS: Hyperglycemia occurring on the first day of life was identified as an independent risk factor for death (adjusted odds ratio: 3.7 [95% confidence interval: 1.3–10.6]; P = .01). Hyperglycemia occurring on the first day of life also was a risk factor for WM reduction, as determined through MRI, at term-equivalent age (adjusted odds ratio: 3.1 [95% confidence interval: 1.0–9.2]; P = .04). CONCLUSION: In this population-based cohort of EPT infants, hyperglycemia on the first day of life was associated with increased mortality rates and brain damage, as reflected by WM reduction at term age.

Virtual patient simulation for learning and assessment: Superior results in comparison with regular course exams

Background: Our study aimed to observe the differences in assessment results between virtual patient simulation (VPS) and regular course exams in an Internal Medicine course for undergraduate medical students. Methods: Four cohorts of students (n = 216) used: a VPS or lectures for learning (terms 1 and 2); VPS and lectures or only lectures (term 3); and a paired set-up with both VPS and lectures (term 4). The assessment results, measured with both a VPS-based exam and a paper-based exam, were compared. A scoring rubric (0–6), developed and validated for the purpose of the trial, was applied to both types of assessment. Mean score differences of the results were compared for the four cohorts. Results: Both VPS and regular examination results were significantly higher in the VPS group compared to regular exam group (p < 0.001) in terms 1, 2 and 3. The paired mean difference in term 4 was 0.66 (95% confidence interval (CI) 0.50, 0.83; p < 0.001) for haematology and 0.57 (95% CI 0.45, 0.69; p < 0.001) for cardiology. Conclusion: Our findings suggest that using VPS both for learning and for assessment supports learning. VPS are better than traditional assessment methods when the virtual application is used for both learning and evaluation.

Virtual patient simulation: Knowledge gain or knowledge loss?

Background: Virtual patients (VPs), high-fidelity simulators and standardized patients are powerful educational interventions leading to effective learning and supporting knowledge retention. Aim: This study explored the variations in retention with VP versus regular learning activities. Method: We conducted a randomized controlled study on early and delayed assessment results of 49 students using VP for learning and examination of haematology and cardiology topics in an Internal Medicine course, by means of a 0–10 scoring rubric. Results: The mean difference for early assessment with VP (study – control mean score) was 1.43 (95% confidence interval (CI) 0.96, 1.91; p < 0.001) for haematology and 1.34 (95% CI 0.93, 1.76; p < 0.001) for cardiology. In regular exams, the mean score difference was 2.21 (95% CI 1.3, 3.1; p < 0.001) and 1.52 (95% CI 0.76, 2.28; p < 0.001), respectively. With delayed assessments, the difference in mean score for Web-SP was 1.48 (95% CI 1.09, 1.86; p < 0.001), haematology and 1.16 (95% CI 0.74, 1.58; p < 0.001), cardiology; for regular exams the figures were 1.96 (95% CI 0.93, 2.98; p < 0.001) and 1.74 (95% CI 0.89, 2.58; p < 0.001). The effect size ranged from 0.5 to 0.8. Conclusion: Our results indicate better retention with VP than with traditional learning methods.

As time goes by: Stakeholder opinions on the implementation and use of a virtual patient simulation system.

Background: Stakeholder opinions on the implementation of a particular virtual patient application might prove important for decision-making and implementation efforts in general. This study aimed to capitalize on experiences originated from two post-implementation settings of Web-based Simulation of Patients (Web-SP). Method: We conducted a cross-sectional survey of stakeholder opinions (39 students, teachers, course directors, and university leaders) on the implementation and use of Web-SP in Colombia and Sweden, using a mixed method approach. Results: The respondents did not show equal preference in rating the ranking of the order of importance included in the variables (Friedmans Chi square: 26.5 to 115.1, df = 6, p < 0.001, Kendalls coefficient of concordance ranging from 0.11 to 0.50). The answers provided as free comments supported the statistical findings on the importance of end-user customization, need for authenticity in software design, and use of virtual patient simulations in a curricular context, for clinical reasoning development. Conclusions: Virtual Patient design should allow extensive editing, support case authenticity and enhance clinical reasoning abilities, in an effort for ensuring accountability and sustainable development of the field.

Gender specific variations in the description, intensity and location of Angina Pectoris: A cross-sectional study

BACKGROUND Some research suggests that men and women may experience Angina Pectoris (AP) differently. More research is needed to characterize AP symptoms by gender and to familiarize health care providers with them, to enable proper education, diagnostic evaluation and timely management. OBJECTIVE This study examines gender differences in the description, intensity and location of AP in patients with CHD. DESIGN A cross-sectional study was performed to compare AP patients according to gender. SETTINGS This study was performed on patients residing in Tehran, who were being treated in a hospital and were admitted to cardiac units. PARTICIPANTS Five hundred patients with AP were selected. The participants were patients with AP who were diagnosed with CHD based on documented results from an angiography. METHOD Outpatients who were admitted to the cardiac units were screened. Informed consent was obtained from all study participants, who then completed the Iranian version of the AP characteristics questionnaire. RESULTS Women were significantly more likely to feel pain in the left arm and hand, odds ratio 1.5 (95% CI=1.0-2.1, P=0.04), left scapula, odds ratio 2.3 (95% CI=1.6-3.5, P<0.001), and neck, odds ratio 2.8 (95% CI=1.9-4.1, P<0.0001), while controlling for demographic and clinical factors. Women were significantly more likely to choose the possible pain descriptors for describing their AP and reported significantly greater intensity than men for all the pain descriptors. Significantly higher scores for sensory, affective, total and NRS (Numeric Rating Scale) scores were observed in women (P<0.001). Multiple linear regression analyses revealed that gender remained a statistically significant predictor of pain scores and NRS, while controlling for demographic and clinical factors. CONCLUSION Women and men differ with respect to description, intensity and location of AP. Educating the general public and informing health care providers about gender variation in AP may help to decrease delays in seeking medical care.

Clinical characterisation at onset of childhood psoriasis - a cross sectional study in Sweden.

Epidemiological data in childhood psoriasis are accumulating. However, reliable information captured at onset is lacking. In a cross sectional study we recruited 109 children < 16 years within 12 months of psoriasis onset and explored the clinical characteristics. Pre-pubertal children, especially boys, more often had inverse involvement (OR = 2.8, 95% CI = 1.1, 7.1, p ≤ 0.05). HLA-C*06 was positively associated with facial lesions (OR = 3.8, 95% CI = 1.5, 9.7, p < 0.01) and guttate phenotype and was more common in pubertal children. A high PASI score was not associated with overweight or early age at onset, and gender did not influence disease onset. Psoriasis can be difficult to diagnose in children, especially in pre-pubertals. Thorough examination of facial and genital areas can help in establishing the diagnosis. Our published genetic data in combination with the clinical findings presented herein indicate that puberty may separate different populations of childhood psoriasis.

Factors of importance for self-reported mental health and depressive symptoms among ages 60-75 in urban Iran and Sweden.

BACKGROUND Depression is a common experience affecting 121 million people around the world. In high income countries, depression is one of the most common psychiatric conditions among the elderly. Studies show that immigrants are particularly at risk for mental ill health. AIM This study investigates the self-reported mental health among two Iranian groups; one born and residing in Iran and one consisting of Iranian immigrants in Sweden, as well as native Swedes living in Sweden. The study also aims to explore and compare self-reported depressive symptoms among three groups. METHODS This study is based on a cross-sectional design measuring self-reported health with a study specific questionnaire. The programme SPSS V.17.0 was used for all statistical analyses. FINDINGS 1088 participants were approached (668 Iranians in Iran; 105 immigrated Iranians in Sweden; and 305 Swedes in Sweden). Factors effecting self-reported mental health was self-reported health, smoking, satisfaction with social life and also a sense of connection to ones cultural roots and traditions. Also demographic variables such as group belonging (Swedes vs. Iranians), sex and satisfaction with Income were shown to be important when performing the regression analysis. In the chi-square analysis the Iranian samples reported depressive symptoms to a larger extent than the Swedish group in all aspects of self-reported depressive symptoms. Self-reported depressive symptoms were reported to a greater extend in women compared to men. Our findings indicate that the Iranian populations living in both Tehran and Stockholm report depressive symptoms to an extent that merits concern. The findings indicate that Iranians living in Tehran and Iranians who have immigrated to Sweden require more attention regarding mental health care. Health care providers in both countries should be aware of the current state of mental health among Iranians in both Sweden and Iran.

Predictors of sustained maternal milk feeds in extremely preterm infants

Objective:To investigate the predictors of maternal milk feeds (MMFs) in extremely preterm (EPT) infants during neonatal stay.Study Design:Maternal characteristics, obstetrical data and infant characteristics were correlated to MMFs in 97 EPT infants during the first 6 weeks of life and at hospital discharge.Result:High MMFs (>90%) at second week predicted sustained MMFs the first 6 weeks of life; nonuniversity education and non-Nordic origin were unfavorable predictors. The proportion of MMFs the first 6 weeks of life and maternal age were positively associated with MMFs at discharge, whereas overweight was an unfavorable predictor. High MMFs at second week, assisted reproduction technology and employment were predictive factors for exclusive MMFs at discharge.Conclusion:High MMFs at week 2 promote sustained MMFs in EPT infants and exclusive MMFs at discharge. Mothers who are either young, overweight, non-Nordic or without university education may need special interventions to establish successful lactation.

Migration status and self-reported health among high school students in Stockholm: A cross-sectional study

This article aims to determine the self-reported health status of Swedish high school students with respect to gender and immigrant background. The sample was randomly selected from high school students aged 15–19, and 446 students participated in this study. The Nottingham Health Profile (NHP) was used for capturing health status. The results showed that the most common problem was related to energy level (23%) and the least to physical mobility (1%). The proportion for other domains ranged from 2% to 14%. Self-reported health problems were more common among immigrants than native Swedes. Female students reported more problems on all aspects of health than males. Female gender and first-generation immigrants were found to be important factors associated with feelings of ill health among the target population. Gender disparity was more important among the students with an immigrant background.

Effectiveness, costs and cost-effectiveness of chiropractic care and physiotherapy compared with information and advice in the treatment of non-specific chronic low back pain: study protocol for a randomised controlled trial

BackgroundLow back pain is a global public health problem and a leading cause of disability all over the world. The lifetime prevalence of low back pain is 70–80% and a significant proportion of people affected develop chronic low back pain (CLBP). Besides a severe negative impact on people’s health and health-related quality of life, CLBP is associated with substantial costs for society. Medical costs for the management of CLBP and costs for production losses due to absenteeism from work are sizeable. Pharmaceuticals, physical activity, manipulation, and multidisciplinary rehabilitation interventions are examples of widely used treatments for CLBP. However, the scientific basis to recommend the use of one treatment over another is limited and more research is needed to study the effects, costs and cost-effectiveness of treatments for CLBP in clinical practice.The aim of the study is to evaluate the effectiveness (back pain-related functional limitation, back pain intensity, general health, health-related quality of life, and working status), costs (medical costs and costs for production losses) and cost-effectiveness of chiropractic care and physiotherapy when added to information and advice in the treatment of patients with non-specific CLBP in Sweden.Methods/designThis is a pragmatic randomised controlled trial, where participants are recruited through six primary care rehabilitation units (PCRUs) in Stockholm County Council, Sweden. Individuals with non-specific CLBP are individually randomised to one of four treatment groups: ‘information and advice’; ‘physiotherapy, and information and advice’; ‘chiropractic care, and information and advice’; or ‘chiropractic care, physiotherapy, and information and advice’. A sample size of 600 participants will be recruited during a period of 33 months. A computer-based questionnaire is used to collect data on back pain-related functional limitation (Oswestry Disability Index), pain intensity (Numeric Rating Scale), general health (self-rated health), health-related quality of life (EQ-5D-3L), and working status (measured as percentage of full-time work). Data will be collected at baseline, and at 3, 6, and 12 months after baseline.DiscussionThe results from our study should be considered when producing evidence-based guidelines and recommendations on which treatment strategies to use for CLBP.Trial registrationISRCTN registry, ID: ISRCTN15830360. Registered prospectively on 2 February 2017.