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E Svensson

Publications and source records attributed to E Svensson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Astheno-emotional disorder after aneurysmal SAH: reliability, symptomatology and relation to outcome.

OBJECTIVES: Neuropsychiatric symptoms commonly found after aneurysmal SAH are covered in the astheno-emotional disorder (AED) of Lindqvist & Malmgrens diagnostic system for organic psychiatry. This study aims to describe the reliability and symptomatology of AED and its relationship with social outcome. MATERIAL AND METHODS: Patients referred due to aneurysmal SAH (n=78) were assessed after 1-6 months for AED inter-rater reliability (n=36) and after 12 months for AED severity grade, symptomatology and Glasgow Outcome Scale (GOS) (n=63). RESULTS: There was no systematic error in diagnosing and grading AED, and the agreement was 85% and 67% respectively (kappa=0.65 and 0.52). Fatigability, concentration difficulties and memory difficulties were the most frequent symptoms of AED. The relationship between AED and "moderate disability" of GOS was highly significant (P<0.00006). CONCLUSIONS: AED affects social outcome, and can be diagnosed with high reliability even without neuropsychological testing. Use of the AED diagnosis for evaluation of organic mental symptoms is encouraged.

Adult↗
PubMed2001

Construction of a global assessment scale of family function, using a questionnaire.

Self-report questionnaires are commonly used in family research, but very little attention is paid to the specific measurement properties of the ordered categorical data recorded. The item responses of self-report questionnaires consist of ordered categories. The main property of this type of data is that the labels do not represent a mathematical value but only an order, i.e., one set of labels can be replaced by another set of increasing numbers of symbols. The non-additivity of categorical data means that sum scores cannot be used as a global assessment of the variable. The aims of this study were to further develop the third version of the self-report questionnaire Family Adaptability and Cohesion, Evaluation Scales (FACES), for use in Sweden and to construct a global scale of family function for the variables cohesion and adaptability. The statistical methods used take account of the rank-invariant properties of ordered categorical data.

Adaptation, Psychological↗
PubMed2001

Pain assessment in children with juvenile chronic arthritis: a matter of scaling and rater.

UNLABELLED: Twenty-six children with juvenile chronic arthritis and their parents participated in the study. We compared the assessments of pain perceived by the children on a visual analogue scale (VAS) with assessments on a 4-point verbal descriptor scale (VDS-4). In children aged 10 y and older, the pain assessment results of the children and the parents were compared. The discordance in paired data from the scale comparisons and from the inter-rater comparisons was evaluated using a statistical method developed for ordinal data. The preference of scale and motivation of the older children were summarized. CONCLUSION: The parents and children used the VAS and the VDS-4 differently. The children showed a higher inter-scale discordance compared with the parents and they gave their pain a higher rating on the VAS but a lower rating on the VDS-4 than their parents. The VAS was preferred by the children but did not show the most reliable results.

Adolescent↗
PubMed2001

Measures of order consistency between paired ordinal data: application to the Functional Independence Measure and Sunnaas index of ADL.

The aim was to evaluate the inter-item consistency between corresponding items in the Functional Independent Measure (FIM) and Sunnaas index of ADL (SI) by means of a statistical approach that takes account of the nonmetric properties of ordinal data. The ADL dependence in 204 stroke patients was assessed by interview 3 months after the onset of stroke. The result showed that the inter-item consistency between the FIM and SI were high for many items, but operational differences between some FIM and SI items were also identified. The statistical evaluation demonstrated that some of the ordered categorical levels of the seven-point item scales in the FIM could be aggregated into four levels without loss of information.

Activities of Daily Living↗
PubMed2001

Antimicrobial susceptibility patterns of enterococci in intensive care units in Sweden evaluated by different MIC breakpoint systems.

Three hundred and twenty-two (322) clinical isolates were collected from patients admitted to intensive care units (ICUs) at eight Swedish hospitals between December 1996 and December 1998. Of the isolates, 244 (76%) were Enterococcus faecalis, 74 (23%) were Enterococcus faecium and four (1%) were other Enterococcus spp. MICs of ampicillin, imipenem, meropenem, piperacillin/tazobactam, ciprofloxacin, trovafloxacin, clinafloxacin, gentamicin, streptomycin, vancomycin, teicoplanin, quinupristin/dalfopristin, linezolid and evernimicin were determined by Etest. Susceptible and resistant isolates were defined according to the species-related MIC breakpoints of the British Society for Antimicrobial Chemotherapy (BSAC), the National Committee for Clinical Laboratory Standards (NCCLS) and the Swedish Reference Group for Antibiotics (SRGA). Tentative breakpoints were applied for new/experimental antibiotics. Multidrug resistance among enterococci in ICUs is not uncommon in Sweden, particularly among E. faecium, and includes ampicillin resistance and concomitant resistance to fluoroquinolones. Almost 20% of E. faecalis isolates showed high-level resistance to gentamicin and concomitant resistance to fluoroquinolones. Vancomycin-resistant enterococci were only found sporadically. Among the new antimicrobial agents, linezolid and evernimicin showed the best activity against all enterococcal isolates. There was good concordance between the BSAC, NCCLS and SRGA breakpoints in detecting resistance. When applying the SRGA breakpoints for susceptibility, isolates were more frequently interpreted as intermediate. This might indicate earlier detection of emerging resistance using the SRGA breakpoint when the native population is considered susceptible, but with the risk that isolates belonging to the native susceptible population will be incorrectly interpreted as intermediate.

Anti-Bacterial Agents↗
PubMed2001

Condition, genotype-by-environment interaction, and correlational selection in lizard life-history morphs.

We compared reproductive allocation and variation in condition and survivorship of two heritable female throat color morphs (orange and yellow) in a free-living population of side-blotched lizards (Uta stansburiana). Using path analysis and structural equation modeling, we investigated how variation in the social environment affected clutch size and egg mass and two condition traits (postlaying mass, immunological condition) and how these traits in turn affected female field survival. In the presence of many neighbors, both morphs increased their clutch sizes, although these effects were only significant in yellow females. In addition, yellow females increased their egg mass in the presence of many orange neighbors. Orange females surrounded by many orange neighbors showed sign of stress in the form of immunosuppression, whereas this effect was less pronounced in yellow females. The morphs also differed in the impact of variation in clutch size and egg mass on both condition traits. Finally, female morphotype and immune responsiveness affected fitness interactively, and hence these two traits showed signs of fitness epistasis: Selection gradients on this trait were opposite in sign in the two morphs. The correlational selection gradient (gamma throat x antibody response) between female throat color and antibody responsiveness was -0.365. Our data thus reveal important interactive effects such as genotype-by-environment interaction toward the social environment and morph-specific trade-offs as well as the occurrence of correlational selection. We discuss the use of naturally occurring and conspicuous genetic polymorphisms in field studies of selection and life-history allocation.

Animals↗
PubMed2001

Construct validity of ILAR and EULAR criteria in juvenile idiopathic arthritis: a population based incidence study from the Nordic countries. International League of Associations for Rheumatology. European League Against Rheumatism.

OBJECTIVE: New classification criteria (ILAR) have been proposed for juvenile idiopathic arthritis (JIA). They are more descriptive than those formerly used [American College of Rheumatology (ACR), European League Against Rheumatism (EULAR)], but require validation against classifications already in use. We validated the ILAR criteria in relation to the EULAR criteria in a prospective, incidence, and population based setting, and analyzed their feasibility. METHODS: Construct validity of ILAR and EULAR classification criteria refers to how closely the 2 instruments are related and how each of them operates in classifying subgroups/categories. Twenty doctors in 5 Nordic countries collected data from the incidence cases within their catchment areas during an 18 month period beginning July 1, 1997. Clinical and serological data from the first year of disease were collected. RESULTS: A total of 322 patients were included. Classification according to the ILAR criteria was possible in 321 patients; 290 patients had a disease duration > or = 3 months and were classified according to the EULAR criteria. One child could only be classified according to the EULAR criteria. Thus, 31/322 (9.6%) children were classified according to the ILAR criteria only. Forty-eight of 321 (15%) patients did not fit into any category and 6% (20/321) fulfilled criteria for2 categories. In the ILAR classification 5 out of 7 categories/subgroups have 2 to 5 specified exclusion criteria that highly discriminate the definition of each patient. In our study the exclusion criteria were fulfilled to only a small extent. CONCLUSION: The EULAR and ILAR criteria differ concerning the operational definitions of the subvariables involved, which complicates their comparison. By using ILAR rather than EULAR criteria the number of cases with juvenile arthritis increased by 10%, considering the first half-year after onset. The validity of the ILAR criteria is low since they often exclude patients from subgroup classification and the possibility of having more than one diagnosis is not negligible. The specified exclusion criteria for some of the subgroups are difficult to fulfill in clinical work and variables involved could be questioned with regard to their consistency.

Adolescent↗
PubMed2000

Concordance between ratings using different scales for the same variable.

Qualitative variables are commonly measured by means of different types of rating scales that produce ordered categorical data. The number of response categories in a scale can be chosen arbitrarily according to different operational definitions of the attribute to be measured. In the present paper classical measures based on the difference between the probabilities of concordant and discordant pairs of classifications were compared with a novel approach for assessment of order consistency between rating scales. In the new approach, illustrated by an assessment of pain, the concordant and discordant pairs are related to the pattern of total order consistency, irrespective of the scaling and the categorical distributions. The level of order consistency between a visual analogue scale (VAS) and a discrete scale for the same variable was evaluated. The non-linear properties of VAS assessments were demonstrated. The inter-scale consistency between the discrete scale and different approaches to grouping VAS responses into discrete scales showed that equidistant rescaling of VAS assessments resulted in an inter-scale bias.

Calibration↗
PubMed2000

Parallel reliability of the functional independence measure and the Barthel ADL index.

PURPOSE: The aim of this study was to evaluate the concordance between the assessments of ADL according to the Functional Independence Measure (FIM) and the Barthel ADL index (BI) by means of a rank-invariant statistical method. METHOD: The construct validity, also called parallel reliability, of FIM and BI was assessed on the item level. Two different approaches to condensing the FIM assessments into 2-4 scale steps on the item level in order to calibrate the two ADL instruments were compared. One was determined by the theoretical operational definitions and the other defined by the empirical definitions. The 204 assessments of elderly persons were made three months after stroke by means of interviews. RESULTS: The parallel reliability of the FIM and the BI on the item level was strong, both according to the theoretical cut-off levels defined by the operational definitions and the empirical cut-off levels defined by the marginal distributions. CONCLUSIONS: The concordance between FIM and BI was high. There was a slight difference in favour of the operational definitions. The clinical key elements are to have a critical attitude towards ADL instruments; how they are constructed and operationalized. These are important elements in the quality assurance in the everyday work.

Activities of Daily Living↗
PubMed2000

Density cycles and an offspring quantity and quality game driven by natural selection.

A long-standing hypothesis posits that natural selection can favour two female strategies when density cycles. At low density, females producing many smaller progeny are favoured when the intrinsic rate of increase, r, governs population growth. At peak density, females producing fewer, high-quality, progeny are favoured when the carrying capacity, K, is exceeded and the population crashes. Here we report on the first example of a genetic r versus K selection game that promotes stable population cycles in lizards. Decade-long fitness studies and game theory demonstrated that two throat-colour morphs were refined by selection in which the strength of natural selection varied with density. Orange-throated females, r strategists, produced many eggs and were favoured at low density. Conversely, yellow-throated females, K strategists, produced large eggs and were favoured at high density. Progeny size should also be under negative frequency-dependent selection in that large progeny will have a survival advantage when rare, but the advantage disappears when they become common. We confirmed this prediction by seeding field plots with rare and common giant hatchlings. Thus, intrinsic causes of frequency- and density-dependent selection promotes an evolutionary game with two-generation oscillations.

Animals↗
PubMed2000

Visual function in school-aged children born before 29 weeks of gestation: a population-based study.

The aim of this study was to assess visual function, including visual perception, in a geographically-based population of school-aged children, with a median age of 7.2 years (range 5.1 to 9.3 years), born before 29 weeks of gestation to mothers living in Goteborg, Sweden. Fifty-one preterm children participated in the study, six of whom had known brain lesions. Visual acuity, visual fields, stereoacuity, and visual perception were tested. The Test of Visual Perceptual Skills Revised (TVPS-R, Gardner 1996) was used to measure visual perception, and the results were compared with those of 50 term (control) subjects. Six percent of the preterm children were visually impaired, with a visual acuity of less than 0.3 (6/18), while 42% of all the preterm children and 34% of those without known brain lesions had a total score below the 5th centile of the reference material for the test, compared with 14% of the control subjects. In conclusion, visual-perceptual problems seem to be common among very preterm children and should be screened for and assessed before the children start school.

Child↗
PubMed2000

Ocular fundus abnormalities in children born before 29 weeks of gestation: a population-based study.

PURPOSE: Preterm birth has been found to be associated with increased morbidity of the central nervous and vascular tissues. To investigate the influence of preterm birth on the optic disc and retinal vessels, we examined the ocular fundus in school-aged children born very preterm. METHODS: A prospective, population-based study was performed in 50 very preterm children (median age 7 years, range 5-9 years) with a median gestational age at birth of 27 weeks (range 24-28 weeks) and a median birth weight of 1055 g (range 450-1520 g). The ocular fundus was examined by ophthalmoscopy in 50 children, and the optic nerve and retinal vessel morphology was evaluated by digital image analysis of ocular fundus photographs in 45 of these children. RESULTS: The median optic disc area was significantly smaller (p = 0.0002) in the preterm children compared with a reference group. There was no difference in cup area and, consequently, the rim area was significantly smaller (p = 0.0002) in the preterm children. Children with early signs of brain lesions commonly had a rim area below the median of the reference group. Preterm children also commonly had an abnormal retinal vascular pattern that was independent of a previous history of retinopathy of prematurity. CONCLUSION: Very preterm birth was associated with subnormal optic disc and rim areas and an abnormal vascular pattern. The findings clearly demonstrate the effect of preterm birth on the development of these structures. The long term clinical prognosis of these findings has yet to be determined.

Adolescent↗
PubMed2000

Experimental excursions on adaptive landscapes: density-dependent selection on egg size.

Theories of density-dependent natural selection suggest that intraspecific competition will favor juveniles of high competitive ability. Empirical evidence has been provided from laboratory selection experiments, but field studies are lacking due to the logistical difficulties of experimentally manipulating population densities in natural settings. Here, we present data from a decade-long experimental field study of side-blotched lizards, Uta stansburiana that overcomes these difficulties. We tested the hypothesis that density-dependent natural selection causes egg size to increase from early to late clutches in this and many other species. Using a novel combination of environmental manipulations of hatchling density and phenotypic manipulations of egg size, we demonstrate that the nature of selection on egg size changes dramatically in the absence of older competitors. The strength of selection on egg size among later-clutch hatchlings released in areas without competitors from early clutches became almost doubled in magnitude, compared to that among hatchlings released in the presence of older competitors. These experimental findings demonstrate density-dependent natural selection on egg size; however, they contradict the classical idea that egg size increases during the reproductive season because of competition between early and late hatchlings. The results indicate that competitive age or size asymmetries between early and late hatchlings can override within-cohort asymmetries due to egg size. We suggest that competition could be an important mediator of oscillating selection pressures in this and other systems. Finally, we discuss the utility of "double-level," simultaneous experimental manipulation of both phenotypic traits that are targets of selection (e.g., egg size) as well the environmental agents of selection (e.g., population density).

Adaptation, Physiological↗
PubMed2000

Standardized ultrasound method for assessing detrusor muscle thickness in children.

PURPOSE: We standardized transabdominal ultrasound measurement of bladder wall thickness in children and evaluated its reliability. MATERIALS AND METHODS: Using ultrasonography we measured the thickness of the low echogenic layer of the ventral and dorsal bladder walls at increasing degrees of bladder fullness in the setting of voiding cystourethrography. For assessing intra-observer variability an observer blinded to the numerical values of the measurements studied 38 patients 0.2 to 13.7 years old (median age 1. 5). Measurements were performed as pairs of replicates at well-defined sites with reference to the urachal remnant, and rectal impression and/or contour. For assessing interobserver variability 3 independent observers measured the same child. Eight children 0.3 to 10.5 years old (median age 6.4) were evaluated at 2 degrees of bladder fullness per child. RESULTS: The thickness of the low echogenic layer of the ventral and dorsal walls was 0.4 to 2.9 (median 0.9) and 0.4 to 2.8 mm. (median 1.1). The dorsal wall was slightly thicker than the ventral wall. The intra-observer and interobserver variability of measurements (standard deviation) was 0. 2 mm. for each wall part. There was a small systematic difference among observers. CONCLUSIONS: It is possible to determine the thickness of the low echogenic layer of the bladder wall with a systematic and anatomically defined method of acceptably reliable measurements. The ventral and dorsal walls should continue to be measured until more is known about their pathological appearance.

Adolescent↗
PubMed1999

Optic nerve hypoplasia with isolated tortuosity of the retinal veins: a marker of endocrinopathy.

OBJECTIVE: To investigate whether children with optic nerve hypoplasia and pituitary hormone insufficiencies have specific ocular fundus characteristics that may facilitate early diagnosis and treatment. DESIGN: From May 15, 1995, through December 15, 1997, 17 children (8 girls and 9 boys, aged 0.3 to 13 years) with optic nerve hypoplasia were referred to the Department of Pediatric Ophthalmology, Children's Hospital, Göteborg, Sweden, and divided into 2 groups dependent on the presence (n = 8) or absence (n = 9) of pituitary deficiency. Morphological characteristics of the ocular fundus were evaluated by digital image analysis of fundus photographs, and the morphological characteristics of the brain structures were studied by magnetic resonance imaging. RESULTS: An isolated venous tortuosity noted among the children with optic nerve hypoplasia and endocrinopathy was the morphological ocular fundus variable that discriminated between the 2 groups of patients with optic nerve hypoplasia. Both groups of children demonstrated significantly reduced optic disc, cup, and neuroretinal rim area and few vascular branching points. CONCLUSION: Optic nerve hypoplasia with isolated tortuosity of the retinal veins may potentially help the ophthalmologist in identifying children who should undergo a thorough diagnostic workup of endocrine function.

Adolescent↗
PubMed1999

The clinical and morphologic spectrum of optic nerve hypoplasia.

PURPOSE: The purpose of this study was to characterize the clinical and morphologic spectrum of all children referred for optic nerve hypoplasia to a tertiary referral hospital in Sweden during a 9-year period. SUBJECTS AND METHODS: A retrospective review was undertaken of the charts of 117 children (age range, 0.25-16 years), treated at the Children's Hospital, Göteberg between 1988 and 1996, after the diagnosis of optic nerve hypoplasia. Ocular fundus morphologic condition was evaluated by digital image analysis of fundus photographs in 50 children, and neuroimaging was performed in 57 children. RESULTS: Of the 117 children with optic nerve hypoplasia, 66 (56%) were boys and 51 (44%) were girls. Preterm birth occurred in 24 (20%), and 14 (12%) were born small for gestational age. Additional diagnoses, such as fetal alcohol syndrome, septo-optic dysplasia, perinatal adverse events, and neuropsychiatric disorders, were made in 88%; 7% had unilateral optic nerve hypoplasia. Most of the children had small optic disc, cup, and neuroretinal rim areas, as well as retinal vascular abnormalities; 75% were visually impaired, and a high incidence of nystagmus and strabismus was found among these children. CONCLUSION: This study indicates that optic nerve hypoplasia has a wide clinical and morphologic spectrum and is associated with a broad range of disorders of the central nervous system. It is suggested that differences in the etiology and timing of the lesion as well as associated lesions may explain this spectrum of optic nerve hypoplasia in children.

Adolescent↗
PubMed1999

Diagnostic value of magnetic resonance imaging and planimetric measurement of optic disc size in confirming optic nerve hypoplasia.

PURPOSE: This study set out to evaluate magnetic resonance imaging (MRI) and measurement of optic disc size as diagnostic tools for confirming the diagnosis of optic nerve hypoplasia (ONH) in children with impaired growth. METHODS: MRI was performed to study the size of the intracranial visual pathways, and image analysis measurements of fundus photographs were performed to determine the size of the optic disc. Results from these investigations were compared with those using the gold standard for diagnosis of ONH, which was the clinical eye examination (visual function, ophthalmoscopic signs, or both). Forty children (median age, 9 years; range, 3 to 19 years) with impaired growth were included in the study. RESULTS: The prevalence of ONH among the children was 15%. MRI classification of the visual pathways had a higher positive predictive value than image analysis measurement of the optic disc size (1.0 vs 0.6). CONCLUSIONS: MRI is a good tool for confirming the diagnosis of ONH and may thus facilitate early detection. On the other hand, a small optic disc per se is not a definite indicator of ONH but should encourage further investigation with MRI, especially if there is a clinical suspicion of ONH.

Adolescent↗