Aggression in the general Swedish population,measured with a new self-rating inventory: The Aggression Questionnaire - revised Swedish version (AQ-RSV)

The aim of the present study was to develop a Swedish self-rating instrument for clinical aggression research based on the American Aggression Questionnaire (AQ), which measures physical aggression, verbal aggression, anger, and hostility. To test this adapted Aggression Questionnaire - revised Swedish version (AQ-RSV), it was mailed to 781 randomly selected individuals, aged 20-40 year. A total of 497 (64%) evaluable AQ-RSV inventories were obtained and analyzed statistically. Drop-out analysis showed that non-responders were most often male and significantly older than responders. Among the responders, AQ-RSV showed significant sex differences in all aggression subscales except Hostility. Aggression was found to vary with age, geographical region, and size of home community. The AQ and the AQ-RSV were comparable in correlations between the four aggression subscales and in alpha coefficients, which indicated considerable internal consistency. Development of the aggression-measuring instrument for Swedish conditions is important not only to study subtraits of aggression but to enable analyses of their relationships to neurobiological and psychiatric variables.     

Mental health of Bosnian refugee children: A comparison of clinician appraisal with parent,child and teacher reports

Aim: To compare clinical assessments of mental disorders with the Hopkins Symptom Check List-25 (HSCL-25) in a population-based sample consisting of middle-aged and elderly subjects. Background: The Lundby Study is a prospective cohort study that evaluated mental disorders and personality traits in an unselected Swedish population. The study commenced in 1947, with follow-ups in 1957, 1972 and 1997 (n?=?3563). Method: Psychiatrists evaluated participants for mental disorders at several field investigations. In 1997, participants were also asked to complete the HSCL-25. Subjects with diagnoses of schizophrenia, dementia and certain other conditions were excluded leaving 1189 subjects aged 40–96 years. Diagnostic assessments by psychiatrists were compared with the results of the HSCL-25. Sensitivity and specificity were calculated at two cut-off levels of the HSCL-25 (1.55 and 1.75), and receiver operating characteristic (ROC) curves were plotted. The performance of the HSCL-25 was analysed with regard to anxiety and depression subscales. Results: The concordance of HSCL-25 with clinical best-estimate diagnoses was low. The anxiety subscale discriminated better than the depressive subscale. Conclusions: The correspondence between the clinical diagnoses made by psychiatrists and the HSCL-25 was not acceptable at a cut-off level 1.55. The HSCL-25 is limited in its ability to identify clinical syndromes. The HSCL-25 should be applied only as a preliminary screen for emotional distress and anxiety syndromes.     

Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS)

Background and purpose

A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused.

Patients and methods

The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman’s correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach’s alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37).

Results

For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88–0.95), Cronbach’s alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00.

Interpretation

SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery.A self-administered ankle questionnaire based on the validated Oxford-12 questionnaire for total hip replacement has been constructed by the New Zealand National Joint Registry. The aim was to collect patient-based data after total ankle replacement (TAR) as an amendment to medically recorded joint-specific data and it proved to be useful, particularly in the prediction of failures (Hosman et al. 2007). However, the original version of the questionnaire has not been validated.Already existing self-administrated foot and ankle scores contain numerous questions and can be complicated to use. For osteoarthritis and inflammatory arthritis of the ankle, there are few validated instruments and they are seldom used (Budiman-Mak et al. 1991, Button and Pinney 2004, Naal et al. 2010). None can be regarded as the gold standard. The generic, self-administered questionnaires short form 36 (SF-36) (Sullivan et al. 1995, Patel et al. 2007) and EuroQol (EQ-5D) (EuroQol Group 1990) are useful when evaluating general health, but they may be less effective when evaluating joint-specific disability.Thus, there is a need for a simple, self-administered and ankle-specific score that is capable of evaluating pain and functional status in patients with osteoarthritis and inflammatory arthritis of the ankle, and the outcome of surgical interventions—not least when collecting data for national surgical registers. We therefore assessed the validity, the reliability, and the responsiveness of the modified Swedish version of the New Zealand total ankle replacement questionnaire, here called the self-reported foot and ankle score (SEFAS), in relation to 3 established self-administered scoring systems. The reason for choosing the foot and ankle outcome score (FAOS) for comparison was that this region-specific score is the only one available in Swedish and the reason for choosing the generic scores SF-36 and EQ-5D was because they are widely used.     

A 1‐Year Randomized,Double‐Blind,Placebo‐Controlled Study of Intravenous Ibandronate on Bone Loss Following Renal Transplantation

The clinical profile of ibandronate as add‐on to calcitriol and calcium was studied in this double‐blind, placebo‐controlled trial of 129 renal transplant recipients with early stable renal function (≤ 28 days posttransplantation, GFR ≥ 30 mL/min). Patients were randomized to receive i.v. ibandronate 3 mg or i.v. placebo every 3 months for 12 months on top of oral calcitriol 0.25 mcg/day and calcium 500 mg b.i.d. At baseline, 10 weeks and 12 months bone mineral density (BMD) and biochemical markers of bone turnover were measured. The primary endpoint, relative change in BMD for the lumbar spine from baseline to 12 months was not different, +1.5% for ibandronate versus +0.5% for placebo (p = 0.28). Ibandronate demonstrated a significant improvement of BMD in total femur, +1.3% versus ?0.5% (p = 0.01) and in the ultradistal radius, +0.6% versus ?1.9% (p = 0.039). Bone formation markers were reduced by ibandronate, whereas the bone resorption marker, NTX, was reduced in both groups. Calcium and calcitriol supplementation alone showed an excellent efficacy and safety profile, virtually maintaining BMD without any loss over 12 months after renal transplantation, whereas adding ibandronate significantly improved BMD in total femur and ultradistal radius, and also suppressed biomarkers of bone turnover. Ibandronate was also well tolerated.     

New algorithm for valganciclovir dosing in pediatric solid organ transplant recipients

CMV infections are common after SOT. v‐GCV is increasingly used in children. The aim of this study was to evaluate presently used dosing algorithms. Data from 104 pediatric SOT recipients (kidney, liver, and heart) aged 0.3–16.9 yr and receiving v‐GCV once a day were used for model development and validation with the Pmetrics package for R. Monte Carlo simulations were performed to compare the probability of a GCV AUC 40–60 mg*h/L with the different algorithms across a range of ages, weights, and GFRs. GCV pharmacokinetics was well described by the non‐parametric model. Clearance was dependent on GFR and Cockcroft‐Gault estimates improved the model fit over Schwartz. Simulations showed that our new algorithm, where v‐GCV dose is: Weight [kg]*(0.07*GFR [mL/min]+k), where k = 5 for GFR ≤ 30 mL/min, k = 10 for GFR > 30 mL/min and weight > 30 kg and k = 15 for GFR > 30 mL/min and weight ≤ 30 kg, outperformed the other algorithms. Thirty‐three percent of all patients achieve an exposure above and 21% within the therapeutic window. We propose a simple algorithm for initial v‐GCV dosing that standardizes plasma drug exposure better than current algorithms. Subsequent TDM is strongly suggested to achieve individual drug levels within the therapeutic window.     

Decreasing early mortality in acute myeloid leukaemia in Sweden 1997–2014: improving performance status is a major contributing factor

Severe bacterial infection is a major complication causing morbidity and mortality in β-thalassaemia/HbE patients. Innate immunity constitutes the first line of defence against bacterial infection. This study aimed to comprehensively investigate the innate immune phenotype and function related to factors predisposing to infection in non-transfusion-dependent (NTD) β°-thalassaemia/HbE patients. Twenty-six patients and 17 healthy subjects were recruited to determine complement activity (C3, C4, mannose-binding lectin and CH50) and surface receptor expression including markers of phagocytosis (CD11b, CD16 and C3bR), inflammation (C5aR) and migration (CD11b, CXCR1 and CXCR2) on neutrophils and monocytes. In addition, phagocytosis and oxidative burst activity of neutrophils and monocytes against Escherichia coli and neutrophil migration were examined. Decreased C3 and surface expression of CD11b and C3bR on neutrophils were found in patients. However, phagocytosis of neutrophils in patients was still in the normal range. Interestingly, patients displayed a significant reduction of surface expression of CXCR2 [1705 ± 217 mean fluorescent intensity (MFI)] on neutrophils, leading to impaired neutrophil migration (9·2 ± 7·7%) when compared to neutrophils from healthy subjects (2261 ± 627 MFI and 27·8 ± 9% respectively). Moreover, surface expression of CXCR2 on neutrophils was associated with splenectomy status, serum ferritin and haemoglobin levels. Therefore, impaired neutrophil migration could contribute to the increased susceptibility to infection seen in NTD β°-thalassaemia/HbE patients.     

Fundamentals of randomized clinical trials in wound care: Design and conduct

The care for chronic and acute wounds is a substantial problem around the world. This has led to a plethora of products to accelerate healing. Unfortunately, the quality of studies evaluating the efficacy of such wound care products is frequently low. Randomized clinical trials are universally acknowledged as the study design of choice for comparing treatment effects, as they eliminate several sources of bias. We propose a framework for the design and conduct of future randomized clinical trials that will offer strong scientific evidence for the effectiveness of wound care interventions. While randomization is a necessary feature of a robust comparative study, it is not sufficient to ensure a study at low risk of bias. Randomized clinical trials should also ensure adequate allocation concealment and blinding of outcome assessors, apply intention‐to‐treat analysis, and use patient‐oriented outcomes. This article proposes strategies for improving the evidence base for wound care decision making.