Health-related quality of life, assessed with a disease-specific questionnaire, in Swedish adults suffering from well-diagnosed food allergy to staple foods

BACKGROUND: Our aim was to investigate the factors that affect health related quality of life (HRQL) in adult Swedish food allergic patients objectively diagnosed with allergy to at least one of the staple foods cow’s milk, hen’s egg or wheat. The number of foods involved, the type and severity of symptoms, as well as concomitant allergic disorders were assessed. METHODS: The disease-specific food allergy quality of life questionnaire (FAQLQ-AF), developed within EuroPrevall, was utilized. The questionnaire had four domains: Allergen Avoidance and Dietary Restrictions (AADR), Emotional Impact (EI), Risk of Accidental Exposure (RAE) and Food Allergy related Health (FAH). Comparisons were made with the outcome of the generic questionnaire EuroQol Health Questionnaire, 5 Dimensions (EQ-5D). The patients were recruited at an outpatient allergy clinic, based on a convincing history of food allergy supplemented by analysis of specific IgE to the foods in question. Seventy-nine patients participated (28 males, 51 females, mean-age 41 years). RESULTS: The domain with the most negative impact on HRQL was AADR, assessing the patients’ experience of dietary restrictions. The domain with the least negative impact on HRQL was FAH, relating to health concerns due to the food allergy. One third of the patients had four concomitant allergic disorders, which had a negative impact on HRQL. Furthermore, asthma in combination with food allergy had a strong impact. Anaphylaxis, and particularly prescription of an epinephrine auto-injector, was associated with low HRQL. These effects were not seen using EQ-5D. Analyses of the symptoms revealed that oral allergy syndrome and cardiovascular symptoms had the greatest impact on HRQL. In contrast, no significant effect on HRQL was seen by the number of food allergies. CONCLUSIONS: The FAQLQ-AF is a valid instrument, and more accurate among patients with allergy to staple foods in comparison to the commonly used generic EQ-5D. It adds important information on HRQL in food allergic adults. We found that the restrictions imposed on the patients due to the diet had the largest negative impact on HRQL. Both severity of the food allergy and the presence of concomitant allergic disorders had a profound impact on HRQL

Asthma treatment in primary care : Studies of variability and health economic aspects

Background: Most asthma patients in Sweden are treated in primary care, but little is known about economic aspects of asthma treatment in that setting and about the regional variation in the use of antiasthmatics drugs and the adherence to national guidelines for the treatment of asthma. General aims: To analyze treatment of asthma patients in terms of classification of severity, quality of life, variation in utilization, clinical practice and costs from a societal perspective. Methods: A prospective cross-sectional design was used to study the pharmaceutical costs of asthma and their relationship to quality of life, asthma severity, clinical practice and lungfunction and to compare different approaches to classifying asthma severity, all in primary care. A prospective cluster-randomized controlled trial was carried out in primary care to study the effect of information and monitoring on asthma control. To study regional variations in antiasthmatics, a registry study based on the Swedish National Prescribed Drug Register was performed. In all studies, the population consists of adult patients. However, in the registry study, there was an upper limit of 44 years of age to exclude patients with COPD-patients. Results and conclusions: There are large variations in costs of pharmaceuticals for asthma treatment between primary care centers in Stockholm as well as between different Swedish regions. Asthma severity explains only a small part of the variations in pharmaceutical costs and does not account for the differences between centers. When different approaches used to classify severity were tested, no strategy tested strategies was superior. Adherence to guidelines is low among caregivers. There is room for improvement of both asthma control and quality of life of asthma patients treated in primary care. Adding structured information and monitoring by diary can improve the patient s outcome

A survey of the current use of peripherally inserted central venous catheter (PICC) in Swedish oncology departments

<p>A zipped folder containing pre-processed data from a Sentinel-1 SAR image by using the Sentinel Application Platform (SNAP), ver. 3.0.3, distributed by the European Space Agency (ESA). The reference wind components provided by the Numerical Weather Model (NWM) SKYRON is also added in the folder.</p> <p>These Earth Observation (EO) data can be used as inputs to the SARWIND LGMod algorithm, ver. 4.01, developed by Rana Fabio Michele (2014-2016), with the aim at retrieving the sea surface wind field by exploiting the single co-polarized Sentinel-1 image available.</p> <p>In particular, the latter is the Sentinel-1, Extra Wide Swath Mode, Ground Range, Multi-look, Detected, Medium Resolution, Vertical polarisation on transmit, Vertical polarisation on receive, Descending orbit, C-band SAR image, acquired on the 31st Dec 2014, 05:51:53.</p

Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature

Background. The use of central venous lines carries a significant risk for serious complications and high economic costs. Lately, the peripherally inserted central venous catheter (PICC) has gained in popularity due to presumed advantages over other central venous lines. The aim of this systematic literature review was to identify scientific evidence justifying the use of PICC. Material and methods. The literature review was performed according to the principles of Cochrane Collaboration. The electronic literature search included common databases up to March 2011. Only those studies rated as high or moderate quality were used for grading of evidence and conclusions. Results. The search resulted in 827 abstracts, 48 articles were read in full text, and 11 met the inclusion criteria. None of the articles was classified as high quality and two had moderate quality. The results of these two studies indicate that PICC increases the risk for deep venous thrombosis (DVT), but decreases the risk for catheter occlusion. The quality of scientific evidence behind these conclusions, however, was limited. Due to the lack of studies with sufficiently high quality, questions such as early complications, patient satisfaction and costs could not be answered. Discussion. We conclude that although PICCs are frequently used in oncology, scientific evidence supporting any advantage or disadvantage of PICC when comparing PICC with traditional central venous lines is limited, apart from a tendency towards increased risk for DVT and a decreased risk for catheter occlusion with PICC

Aromatase inhibitors alone or sequentially combined with tamoxifen in postmenopausal early breast cancer compared with tamoxifen or placebo - Meta-analyses on efficacy and adverse events based on randomized clinical trials

Tamoxifen (TAM) and aromatase inhibitors (AI) are adjuvant therapy options for postmenopausal women with estrogen receptor positive (ER+) breast cancer. This systematic review of seven randomized controlled studies comparing TAM and AI, and one study comparing extended therapy with an AI with placebo after about 5 years of tamoxifen, aims to assess long-term clinical efficacy and adverse events. The literature review was performed according to the principles of the Cochrane Collaboration. The search included common databases up to 2013-01-14. Studies of high or moderate quality were used for grading of evidence. Revman™ software was utilized for meta-analyses of published data. Disease free survival (DFS) and overall survival (OS) were improved with AI monotherapy compared to TAM with high and moderate quality of evidence respectively. Sequenced therapy with AI → TAM (or vice versa) improved DFS compared with TAM with moderate quality of evidence, but did not improve OS (low quality of evidence). However, if only studies on sequenced AI therapy with randomization before endocrine therapy were considered, no improvement of DFS could be found. Fractures are more frequently associated with AI whereas the risk of endometrial cancer and venous thromboembolism are higher with TAM. For cardiovascular events no difference was found between AI (mono- or sequenced therapy) and TAM, whereas sequenced therapy compared with AI had lower risk of cardiovascular events (moderate level of evidence). AIs are superior to TAM as adjuvant hormonal therapy for postmenopausal ER-positive breast cancer. TAM can be considered for individual patients due to the different toxicity profile compared with AI. Cardiovascular events related to AI treatment deserve further attention