Bell's palsy : study design, prognosis and quality-of-life

Background: Bell’s palsy is an acute peripheral facial nerve dysfunction with unknown etiology, causing weakness or paralysis of the mimic muscles of the face. The disease can cause disfi gurement of the face, impair the ability to eat, drink and speak, and seriously affect the patient’s quality of life. Physicians have searched for tests or clinical signs that can predict the outcome of Bell’s palsy but none have proven powerful enough. Studies also show several methodological differences and interpretation of results is diffi cult. In addition, validated instruments measuring quality of life aspects in these patients in Swedish have not been available. Aims: To examine the effect of different analysis methods on a Bell’s palsy study, to fi nd prognostic clinical signs for non-recovery in Bell’s palsy using the Sunnybrook facial grading scale, and to translate and validate the Facial Disability Index (FDI) and Facial Clinimetric Evaluation (FaCE) scale questionnaires in Swedish. Data: Data for papers I-III were extracted from a prospective, controlled multicenter study including 829 patients with Bell’s palsy. Patients were randomized to treatment with prednisolone and/or valacyclovir or placebo. In paper IV, 93 patients with stable peripheral facial palsy had their facial function assessed with House- Brackmann and Sunnybrook scales and answered FDI and FaCE-scale questionnaires on two occasions with a 2-week interval. Results and conclusions: The choice of statistical method and defi nition of complete recovery substantially infl uence the calculated rate of recovery. These results emphasize the caution that must be exercised when interpreting clinical results in reported Bell’s palsy studies. Early deterioration in Sunnybrook scores between baseline and fi rst follow-up at days 11-17 is found to be a negative prognostic factor for complete recovery at 12 months. Early prednisolone treatment reduces this deterioration and improves outcome in patients with early deterioration. Sunnybrook grading at 1 month can accurately predict non-recovery (Sunnybrook< 70) at 12 months in Bell’s palsy. A prediction model and a simple-to-use risk curve for identifying patients at risk for sequelae based on the Sunnybrook score at 1 month are presented and both can be used in clinical practice. The Swedish versions of the FDI and FaCE-scale show high reliability and validity, and the questionnaires can be used for clinical evaluation and for studies on patients with peripheral facial palsy in Sweden

Substantial Decrease in Comorbidity 5 Years After Gastric Bypass : A Population-based Study From the Scandinavian Obesity Surgery Registry

OBJECTIVE:: To evaluate effect on comorbid disease and weight loss 5 years after Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity in a large nationwide cohort. BACKGROUND:: The number patients having surgical procedures to treat obesity and obesity-related disease are increasing. Yet, population-based, long-term outcome studies are few. METHODS:: Data on 26,119 individuals [75.8% women, 41.0 years, and body mass index (BMI) 42.8?kg/m] undergoing primary RYGB between May 1, 2007 and June 30, 2012, were collected from 2 Swedish quality registries: Scandinavian Obesity Surgery Registry and the Prescribed Drug Registry. Weight, remission of type 2 diabetes mellitus, hypertension, dyslipidemia, depression, and sleep apnea, and changes in corresponding laboratory data were studied. Five-year follow-up was 100% (9774 eligible individuals) for comorbid diseases. RESULTS:: BMI decreased from 42.8?±?5.5 to 31.2?±?5.5?kg/m at 5 years, corresponding to 27.7% reduction in total body weight. Prevalence of type 2 diabetes mellitus (15.5%–5.9%), hypertension (29.7%–19.5%), dyslipidemia (14.0%–6.8%), and sleep apnea (9.6%–2.6%) was reduced. Greater weight loss was a positive prognostic factor, whereas increasing age or BMI at baseline was a negative prognostic factor for remission. The use of antidepressants increased (24.1%–27.5%). Laboratory status was improved, for example, fasting glucose and glycated hemoglobin decreased from 6.1 to 5.4?mmol/mol and 41.8% to 37.7%, respectively. CONCLUSIONS:: In this nationwide study, gastric bypass resulted in large improvements in obesity-related comorbid disease and sustained weight loss over a 5-year period. The increased use of antidepressants warrants further investigation

Morbidly Obese Patients—Who Undergoes Bariatric Surgery?

Treatment seeking patients with severe obesity might choose between specialized medical treatment and surgical treatment. Knowledge of what distinguishes patients that choose either treatment is sparse, with greater understanding also needed on what consequences this choice has for the prevalence, remission and new onset of comorbidities, as well as for the bioavailability of drugs. This has prompted the studies in Gunn Signe Jakobsen and her coauthors work on treatment seeking patients with severe obesity focusing on the prevalence of comorbidities, changes in the use of drugs for hypertension, diabetes and dyslipidaemia, as well as changes in bioavailability of atorvastatin. The methods used in the studies in the thesis; "Bariatric surgery and specialized medical treatment for severe obesity Impact on cardiovascular risk factors and postsurgical pharmacokinetics of atorvastatin "; are a cross-sectional study, a registry based cohort study and a prospective pharmacokinetic study. The results of the studies presented were: - The type and number of comorbidities associated with morbid obesity did not necessarily impact upon choice of treatment, but there was an increased odds for choosing surgery for patients with higher BMI, younger age and earlier onset of obesity. - Patients opting for bariatric surgery as opposed to specialized medical treatment had higher odds of experiencing remission, and significantly lower odds for new-onset of drug treated hypertension, diabetes and dyslipidaemia. Bariatric surgery seemed to not only induce remission but was also effective in preventing disease. - The bioavailability of atorvastatin was increased after bariatric surgery, with a normalization in the long term. This knowledge can give a better understanding of the population of patients seeking treatment for severe obesity and should be included in the shared decision process when helping the patient identify their preferences for treatment of severe obesity in the context of their values

Obesity surgery and risk of colorectal and other obesity-related cancers: An English population-based cohort study

Background: The association between obesity surgery (OS) and cancer risk remains unclear. We investigated this association across the English National Health Service. A population-based Swedish study has previously suggested that OS may increase the risk of developing colorectal cancer (CRC). Methods: A retrospective observational study of individuals who underwent OS (surgery cohort) or diagnosed with obesity, but had no OS (no-surgery cohort) (1997–2013) were identified using Hospital Episode Statistics. Subsequent diagnosis of CRC, breast, endometrial, kidney and lung cancer, as well as time ‘at risk’, were determined by linkage to National Cancer Registration & Analysis Service and Office of National Statistics data, respectively. Standardised incidence ratios (SIR) in relation to OS were calculated. Results: 1 002 607 obese patients were identified, of whom 3.9% (n = 39 747) underwent OS. In the no-surgery obese population, 3 237 developed CRC (SIR 1.12 [95% CI 1.08–1.16]). In those who underwent OS, 43 developed CRC (SIR 1.26 [95% CI 0.92–1.71]). The OS cohort demonstrated decreased breast cancer risk (SIR 0.76 [95% CI 0.62–0.92]), unlike the no surgery cohort (SIR 1.08 [95% CI 1.04–1.11]). Increased risk of endometrial and kidney cancer was observed in surgery and no-surgery cohorts. Conclusions: CRC risk is increased in individuals diagnosed as obese. Prior obesity surgery was not associated with an increased CRC risk. However, the OS population was small, with limited follow-up. Risk of breast cancer after OS is reduced compared with the obese no-surgery population, while the risk of endometrial and kidney cancers remained elevated after OS

The management and survival outcomes of nasopharyngeal cancer in the Nordic countries

Peer reviewe

Gut Hormones and Appetite Control: A Focus on PYY and GLP-1 as Therapeutic Targets in Obesity

The global obesity epidemic has resulted in significant morbidity and mortality. However, the medical treatment of obesity is limited. Gastric bypass is an effective surgical treatment but carries significant perioperative risks. The gut hormones, peptide tyrosine tyrosine (PYY) and glucagon-like peptide 1 (GLP-1), are elevated following gastric bypass and have been shown to reduce food intake. They may provide new therapeutic targets. This review article provides an overview of the central control of food intake and the role of PYY and GLP-1 in appetite control. Key translational animal and human studies are reviewed

Can medical therapy mimic the clinical efficacy or physiological effects of bariatric surgery?

The number of bariatric surgical procedures performed has increased dramatically. This review discusses the clinical and physiological changes, and in particular, the mechanisms behind weight loss and glycaemic improvements, observed following the gastric bypass, sleeve gastrectomy and gastric banding bariatric procedures. The review then examines how close we are to mimicking the clinical or physiological effects of surgery through less invasive and safer modern interventions that are currently available for clinical use. These include dietary interventions, orlistat, lorcaserin, phentermine/topiramate, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, pramlintide, dapagliflozin, the duodenal–jejunal bypass liner, gastric pacemakers and gastric balloons. We conclude that, based on the most recent trials, we cannot fully mimic the clinical or physiological effects of surgery; however, we are getting closer. A ‘medical bypass' may not be as far in the future as we previously thought, as the physician's armamentarium against obesity and type 2 diabetes has recently got stronger through the use of specific dietary modifications, novel medical devices and pharmacotherapy. Novel therapeutic targets include not only appetite but also taste/food preferences, energy expenditure, gut microbiota, bile acid signalling, inflammation, preservation of β-cell function and hepatic glucose output, among others. Although there are no magic bullets, an integrated multimodal approach may yield success. Non-surgical interventions that mimic the metabolic benefits of bariatric surgery, with a reduced morbidity and mortality burden, remain tenable alternatives for patients and health-care professionals

Grupphandledning - ett sätt att utveckla samverkan mellan särskola och grundskola?

Inledning Målet "en skola för alla", känns i många avseenden avlägset. Om målet verkligen är att skapa en skola där "alla" får delta helt och fullt utifrån sina förutsättningar krävs det att alla som arbetar i skolan får det stöd och skaffar sig den kompetens som krävs för att kunna möta den stora variationen av elevers olikheter. Utifrån egna erfarenheter som lärare och specialpedagog i grundskolan och i särskolan har jag frågat mig hur samverkan mellan dessa skolformer kan utvecklas. Denna studie beskriver hur pedagogiskt yrkesverksamma från särskola och grundskola talar om samverkan och om hur deras tal om detta förändras under de två terminer som handledningen pågår. Syfte Studiens syfte är att följa och dokumentera en handledningsprocess, där pedagogiskt yrkesverksamma från särskola och grundskola talar om samverkan mellan de båda skolformerna. Ambitionen är att studera i vilken mån grupphandledning kan användas för att utveckla samverkan, vilka frågor de pedagogiskt yrkesverksamma vill diskutera och på vilket sätt diskussionen förändras under studiens gång. Metod Det empiriska materialet består i huvudsak av en och samma enkät som använts i början och i slutet av studien, anteckningar i reflektionsdagböcker från tio handledningstillfällen och tio bandade handledningssamtal. Studiens teoretiska ram utgår från forskning om handledning och från ett sociokulturellt perpspektiv på lärande. Reslutat Studien visar att de fem deltagarna i handledningsgruppen upplever att handledning kan vara ett verktyg för att skapa kunskap kring och utveckla olika former för samverkan mellan särskola och grundskola. Möjligheten att i handledning över tid skapa och utveckla trygga och goda relationer där också värderingsfrågor får en central roll talar för att handledning är ett forum för utveckling och lärande. Man kan konstatera att just tiden är en viktig faktor för att handledningsprocessen ska få en fördjupad dimension som i förlängningen kan leda till nya didaktiska ställningstaganden med hjälp av reflektion. För att de pedagogiskt yrkesverksamma ska få möjlighet att genom handledning utveckla samverkan krävs en organisation som stödjer de pedagogiskt yrkesverksamma i detta avseende och skapar utrymme för reflekterande samtal i form av handledning