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Impaired isometric muscle strength was previously reported in adults with Fontan circulation. However, it is unclear if this impairment is present in children and adolescents with Fontan circulation. We investigated isometric muscle strength of the lower limb in patients (6–18 years) with Fontan circulation in comparison with healthy controls.
In this cross-sectional study, 43 patients (6–18 years) with Fontan circulation and 43 age- and sex-matched controls were included. Isometric knee extension and plantar flexion muscle strength were assessed using dynamometry (Newton, N). Lean mass of the legs was assessed with dual-energy X-ray absorptiometry. Analyses were performed on group level (n = 43), and for subgroups that included children aged 6–12 years (n = 18) and adolescents aged 13–18 years (n = 25).
On group level, the patients with Fontan circulation had impaired isometric knee extension strength in comparison with the controls (p = 0.03). In subgroup analyses, impaired isometric knee extension strength was present in the adolescents (p = 0.009) but not in the children groups. For plantar flexion, there was no difference between patients and controls. There was no difference in lean mass between patients and controls (9.6 ± 4.3 kg vs. 10.8 ± 5.6 kg, p = 0.31). However, the lean mass was highly correlated to isometric knee extension strength (patients r = 0.89, controls r = 0.96, p < 0.001) and isometric plantar flexion strength (patients r = 0.7, controls r = 0.81, p < 0.001).
The finding of impaired isometric knee extension muscle strength in adolescents (13–18 years) with Fontan circulation and no corresponding impairment in the children group (6–12 years) could imply that isometric muscle strength gets more impaired with age.
A co-existence of chemical dependence and other psychiatric syndromes is commonly referred to as “dual-diagnosis.” This categorization is commonly made by social workers in several European countries assigned the primary responsibility for the care of drug and alcohol dependence. Here, we examined the validity of this categorization through systematic, structured patient evaluation following a minimum of 3 weeks of abstinence from drugs and alcohol. Less than one-third of patients originally labelled as suffering from “dual-diagnosis” by the social services did in fact obtain any Axis I DSM IIIR diagnosis, and less than half of the patients had any psychiatric diagnosis other than dependence. Syndromes commonly discussed in the context of self-medication, i.e., unipolar depression and anxiety syndromes, were not over-represented compared to a population sample, while chronic psychoses and bipolar syndromes were highly significantly more common. We conclude that the dual-diagnosis concept, unless substantiated through stringent diagnostic procedures by psychiatrically trained personnel, may be of questionable utility in caring for patients presenting with psychiatric symptoms and substance dependence. A systematic individual evaluation in an alcohol- and drug-free state of sufficient duration is necessary to obtain a basis for an adequate individual treatment plan.
Norwood surgery has been available in Sweden since 1993. In this national cohort study, we analysed transplantation-free survival after Norwood surgery for hypoplastic left heart syndrome with aortic atresia.
Patients were identified from the complete national cohort of live-born with hypoplastic left heart syndrome/aortic atresia 1993–2010. Analysis of survival after surgery was performed using Cox proportional hazards models for the total cohort and for birth period and gender separately. Thirty-day mortality and inter-stage mortality were analysed. Patients were followed until September 2016.
The 1993–2010 cohort consisted of 208 live-born infants. Norwood surgery was performed in 121/208 (58%). The overall transplantation-free survival was 61/121 (50%). The survival was higher in the late period (10-year survival 63%) than in the early period (10-year survival 40%) (p = 0.010) and lower for female (10-year survival 34%) than for male patients (10-year survival 59%) (p = 0.002). Inter-stage mortality between stages I and II decreased from 23 to 8% (p = 0.008). For male patients, low birthweight in relation to gestational age was a factor associated with poor outcome.
The survival after Norwood surgery for hypoplastic left heart syndrome/aortic atresia improved by era of surgery, mainly explained by improved survival between stages I and II. Female gender was a significant risk factor for death or transplantation. For male patients, there was an increased risk of death when birthweight was lower than expected in relation to gestational age.
To determine the accuracy of 12 previously validated short versions of the Geriatric Depression Scale (GDS) to detect major depressive disorder (MDD) in a high-risk population with and without global cognitive impairment.
Five hospitals, Western Sweden.
Older adults (age ≥70 years, n = 60) assessed at a home visit 1 year after hospital care in connection with suicide attempt.
Depression symptoms were rated using the established 15-item GDS. Eleven short GDS versions identified by a recent systematic review were derived from this administered version. Receiver operating characteristic curves and area under the curve (AUC) for the identification of MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were obtained for each version. The Youden Index optimal criterion was used to determine the appropriate cutoffs. Analyses were repeated after stratification by cognitive status (Mini Mental State Examination score ≤24 and >24) for the best performing GDS short versions and the established 15-item GDS.
The 7-item GDS according to Broekman et al. (2011), with a cutoff 3, was the most accurate among the 12 short versions (AUC 0.90, 95% confidence interval 0.80–1.00), identifying MDD with sensitivity 88% and specificity 81%. The cutoff score remained consistent in the presence of global cognitive impairment, which was not the case for the standardized 15-item GDS.
The Broekman 7-item GDS had high accuracy to detect MDD in this prospective clinical cohort at high risk for MDD. Further testing of GDS short versions in diverse settings is required.
Little is known about the long-term outcome of anorexia nervosa.
To study the 30-year outcome of adolescent-onset anorexia nervosa.
All 4291 individuals born in 1970 and attending eighth grade in 1985 in Gothenburg, Sweden were screened for anorexia nervosa. A total of 24 individuals (age cohort for anorexia nervosa) were pooled with 27 individuals with anorexia nervosa (identified through community screening) who were born in 1969 and 1971–1974. The 51 individuals with anorexia nervosa and 51 school- and gender-matched controls were followed prospectively and examined at mean ages of 16, 21, 24, 32 and 44. Psychiatric disorders, health-related quality of life and general outcome were assessed.
At the 30-year follow-up 96% of participants agreed to participate. There was no mortality. Of the participants, 19% had an eating disorder diagnosis (6% anorexia nervosa, 2% binge-eating disorder, 11% other specified feeding or eating disorder); 38% had other psychiatric diagnoses; and 64% had full eating disorder symptom recovery, i.e. free of all eating disorder criteria for 6 consecutive months. During the elapsed 30 years, participants had an eating disorder for 10 years, on average, and 23% did not receive psychiatric treatment. Good outcome was predicted by later age at onset among individuals with adolescent-onset anorexia nervosa and premorbid perfectionism.
This long-term follow-up study reflects the course of adolescent-onset anorexia nervosa and has shown a favourable outcome regarding mortality and full symptom recovery. However, one in five had a chronic eating disorder.
Atrial septal defect is the third most common CHD. A hemodynamically significant atrial septal defect causes volume overload of the right side of the heart. Preterm children may suffer from both pulmonary and cardiac comorbidities, including altered myocardial function. The aim of this study was to compare the rate of adverse events following atrial septal defect closure in preterm- and term-born children.
We performed a retrospective cohort study including children born in Sweden, who had a surgical or percutaneous atrial septal defect closure at the children’s hospitals in Lund and Stockholm, between 2000 and 2014, assessing time to the first event within 1 month or 1 year. We analysed differences in the number of and the time to events between the preterm and term cohort using the Kaplan–Meier survival curve, a generalised model applying zero-inflated Poisson distribution and Gary-Anderson’s method.
Overall, 413 children were included in the study. Of these, 93 (22.5%) were born prematurely. The total number of adverse events was 178 (110 minor and 68 major). There was no difference between the cohorts in the number of events, whether within 1 month or within a year, between major (p = 0.69) and minor (p = 0.84) events or frequencies of multiple events (p = 0.92).
Despite earlier procedural age, larger atrial septal defects, and higher comorbidity than term children, preterm children appear to have comparable risk for complications during the first year after surgical or percutaneous closure.
Biological proxies from the Sokli Eemian (Marine Isotope Stage 5e) paleolake sequence from northeast Finland have previously shown that, unlike many postglacial records from boreal sites, the lake becomes increasingly eutrophic over time. Here, principal components (PC) were extracted from a high resolution multi-element XRF core scanning dataset to describe minerogenic input from the wider catchment (PC1), the input of S, Fe, Mn, and Ca-rich detrital material from the surrounding Sokli Carbonatite Massif (PC2), and chemical weathering (PC3). Minerogenic inputs to the lake were elevated early in the record and during two abrupt cooling events when soils and vegetation in the catchment were poor. Chemical weathering in the catchment generally increased over time, coinciding with higher air temperatures, catchment productivity, and the presence of acidic conifer species. Abiotic edaphic processes play a key role in lake ontogeny at this site stemming from the base cation- and nutrient-rich bedrock, which supports lake alkalinity and productivity. The climate history at this site, and its integrated effects on the lake system, appear to override development processes and alters its long-term trajectory.
Several genome-wide association studies and case–control studies have
associated the single nucleotide polymorphism (SNP) rs1006737, situated in
CACNA1C encoding the alpha 1C subunit of the L-type
voltage-gated calcium channel, with bipolar disorder and other psychiatric
disorders. However, the causal pathway linking genetic variants in
CACNA1C with increased risk for developing brain
disorders remains unclear. Here, we explored the association between the
rs1006737 SNP and cerebrospinal fluid (CSF) markers. We found a significant
association between the risk allele in rs1006737 and a decreased CSF
hyperphosphorylated tau/total tau ratio in patients with bipolar disorder,
thus linking variation in the CACNA1C gene to a
neurochemical marker of neuroaxonal plasticity in those with this
Different types of bondwire interconnect for differential chip-to-antenna and single-ended chip-to-chip interfaces are investigated. Two differential compensation structures for various lengths of interconnects are designed and experimentally evaluated using dedicated transmit and receive radar modules operating across a 110–156 GHz band. Measurement results demonstrate that a fractional bandwidth of 7.5% and a minimum insertion loss of 0.2 dB can be achieved for differential interconnects as long as 0.8 mm. Design and measurement results of an extremely wideband low-loss single-ended chip-to-chip bondwire interconnect that features 1.5 dB bandwidth from DC to 170 GHz and insertion loss of less than 1 dB at 140 GHz are presented as well. The results show that the well-established wire-bonding techniques are still an attractive solution even beyond 100 GHz. Reproducibility and scalability of the proposed solutions are assessed as well.
We investigated extra-cardiac clinical symptoms and signs in the rare Jervell and Lange-Nielsen Syndrome, characterised by impaired KCNQ1 function, a gene essential for gastric acid secretion.
All Swedish Jervell and Lange-Nielsen cases with double KCNQ1 mutations (14 cases) were investigated by medical record review, an interview, and were offered laboratory testing for iron-deficiency anaemia and gastrointestinal markers.
A history of iron-deficiency anaemia in 12 of 14 patients and subjective gastrointestinal symptoms in 13 of 14 patients was revealed. Previous endoscopy in five cases had revealed no case of coeliac or inflammatory bowel disease but three cases of mucosal hyperplasia/dysplasia. Current signs of anaemia or iron substitution were present in 9 of 12 tested cases. Elevated levels of gastrin in seven of nine cases, pepsinogen in six of seven cases, and faecal calprotectin in nine of nine cases were present. A significant correlation between elevated gastrin levels and concurrent iron-deficiency and/or anaemia was revealed (p-value 0.039).
A high frequency of extra-cardiac clinical symptoms and previous medical investigations was found. We propose that the Jervell and Lange-Nielsen Syndrome phenotypically includes gastrointestinal symptoms/signs and secondary iron-deficiency anaemia owing to hypochlorhydria on the basis of KCNQ1 mutations. The resultant elevated gastrin level is a potential risk factor for later gastrointestinal cancer. Clinical monitoring with regard to developing anaemia and hypergastrinaemia should be considered in the Jervell and Lange-Nielsen Syndrome.
Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient.
A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed.
Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news.
Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.
This paper presents two compact slot array antennas for the 79 GHz automotive band integrated into a 28 µm thick benzocyclobutene (BCB) substrate attached to a 325 µm thick 5–20 Ω cm bulk resistivity silicon wafer. The two antennas are a transmit (TX) 1 × 8 slot array antenna with a size of 1 × 23 mm and a receive (RX) 8 × 8 slot array antenna with a size of 15 × 23 mm. Promising performance has been measured with the TX and RX subarray antennas (gain >4 dBi) with good matching to 50 Ω (RL > 10 dB) in the frequency range 70–90 GHz. By using a metal cavity, mounted on the back of the antenna, potential parallel plate or cavity modes could be reduced and the gain could also be increased by 2 dB. The measured and the simulated results are consistent.
As a result of the implementation of the Takeover Directive, a new Act Concerning Public Takeover Bids in the Stock Market (SFS 2006:451) entered into force on 1 July 2006 (the ‘Takeover Act’). However, the Takeover Act is merely framework legislation. Under the Swedish Securities Market Act (SFS 2007:528), Swedish stock exchanges and other regulated markets must have rules for public takeover bids in respect of shares listed on the exchange. Such rules must comply with the Takeover Directive. The principal stock exchange for this purpose is the OMX Nordic Exchange Stockholm (the ‘OMX Nordic Exchange’), which adopted the latest edition of its Rules Concerning Public Takeover Bids in the Stock Market on 1 July 2007 (the ‘Takeover Rules’).
Under the Takeover Act, a public takeover bid may only be launched by a party that has made an undertaking to the stock exchange that operates the regulated market on which the offeree company is listed to (i) comply with the rules adopted by the stock exchange for such bids, and (ii) accept any sanctions which may be imposed by the stock exchange where such rules are infringed.
The Swedish Securities Council (Aktiemarknadsnämnden) (the ‘Securities Council’) oversees compliance with good practice on the Swedish securities market. Under the Takeover Rules, the Securities Council is empowered to issue statements and rulings on points of interpretation of the Takeover Rules, as well as to grant exemptions from the Rules. In addition, the Swedish Financial Supervisory Authority (Finansinspektionen) (the ‘SFSA’) has empowered the Securities Council to issue statements and rulings on matters under the Takeover Act, including granting waivers from the requirement to make a mandatory bid.
Autonomic nervous control of the heart can be studied by analysing variability in heart rate. Although earlier studies have shown reduced variability in patients with the Fontan circulation, we are not aware of any previous study examining longitudinal changes in such children. We have examined 13 patients who had undergone total cavopulmonary connection, and 37 healthy controls matched for age and gender. The examinations included complete echocardiography, and 24-hour ambulatory electrocardiogram for analysis of the parameters for variability in heart rate. After the Fontan procedure, three follow-up examinations were performed at a mean of 4.4 years, 5.6 and 7.2 years. Reduced variability was found in those with the Fontan circulation. A significant difference was found between patients and their controls with respect to high-frequency power at the second, p equal to 0.05, and third, p equal to 0.03, examination. The ratio of low-to-high-frequency components progressively increased in those with the Fontan circulation, a phenomenon that led to a significant difference, p equal to 0.03, at the third examination. Our study shows that, in patients with the Fontan circulation, routine ambulatory electrocardiographic monitoring including analysis of variability in heart rate, detects over time a progressive sympatovagal imbalance.
This paper shows the potentialities of merging the MEMS and micromachining with SiGe technologies in order to speed up the performances of next generation of front end in term of flexibility, reconfigurability and adaptability. MEMS technologies are presented based on Benzo-Cyclo-Butene (BCB) materials and Bulk Acoustic Wave (BAW) materials. Special attention is paid to ensure a full compatibility between IC and MEMS. We have shown that very innovative functions could be considered by using this MEMSIC concept.
By combining ion track technology with ordinary low-resolution printed circuitboard lithography it is possible at low cost to create high aspect ratios via connectors, as solid plugs or consisting of bundles of sub-micron connector wires at a small total cross-section.
Ion track enabled microwave circuits in flexible printed circuit boards are suggested to be used in applications like inductors, ferromagnetic resonance microwave filters, circulators and magnetoresistive sensors. In this paper we demonstrate this technology with integrated printed circuitboard devices in two different flexible polyimide-based foils (Espandex and Kapton HN), using the ultra-high-density vias and the sub-micron wires.
Comúnmente, se hace referencia a una coexistencia de la dependencia química y otros síndromes psiquiátricos como “diagnóstico dual”. Hacen esta categorización por lo general los trabajadores sociales en varios países europeos que tienen asignada la responsabilidad primaria de la asistencia de la dependencia de drogas y alcohol. Examinamos aquí la validez de esta categorización por medio de la evaluación sistemática estructurada del paciente después de un mínimo de 3 semanas de abstinencia de drogas y alcohol. Menos de un tercio de los pacientes a quienes los servicios sociales etiquetaron originalmente como aquejados de “diagnóstico dual” obtuvieron realmente un diagnóstico del Eje I del DSM-III-R, y menos de la mitad de los pacientes tenía un diagnóstico psiquiátrico diferente al de dependencia. Los síndromes analizados comúnmente en el contexto de la automedicación, por ejemplo, los síndromes de depresión unipolar y de ansiedad, no tenían una representación mayor comparado con una muestra de la población, mientras que las psicosis crónicas y los síndromes bipolares eran más comunes de manera muy significativa. Concluimos que el concepto de diagnóstico dual, a menos que se substancie mediante procedimientos diagnósticos estrictos por personal adiestrado psiquiátricamente, puede ser de utilidad cuestionable en la atención a los pacientes que acuden con síntomas psiquiátricos y dependencia de sustancias. Se necesita una evaluación individual sistemática en un estado libre de alcohol y drogas de duración suficiente para obtener una base para un plan de tratamiento individual adecuado.