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  • 1.
    Adamic, M.
    et al.
    Dermatol Ctr Parmova, Ljubljana, Slovenia.
    Pavlovic, M. D.
    Dermatol Ctr Parmova, Ljubljana, Slovenia; Fac Med, Univ Maribor, Maribor, Slovenia.
    Rubin, A. Troilius
    Ctr Laser & Vasc Anomalies, Dept Dermatol, Skåne Univ Hosp, Malmö, Sweden.
    Palmetun-Ekback, M.
    Region Örebro län. Dept Dermatol, Örebro University Hospital, Örebro, Sweden.
    Boixeda, P.
    Dept Dermatol, Laser Serv, Ramon & Cajal Hosp, Univ Alcala De Henares, Madrid, Spain.
    Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology2015Ingår i: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 29, nr 9, s. 1661-1678Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimLasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. MethodsThese guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. ResultsLasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects.

  • 2.
    Ekbäck, Gunnar
    et al.
    Department of Dentistry, Örebro County Council, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit Östergötland County Council, Linköping University, Linköping, Sweden; Department of Oral Public Health, Malmö University, Malmö, Sweden.
    Ekbäck, Maria Palmetun
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Drug and Therapeutic Committee, Örebro County Council, Örebro, Sweden.
    Ekbäck, Gustav
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Unell, Lennart
    Department of Oral Public Health, Malmö University, Malmö, Sweden; Post Graduate Dental Education Centre, Örebro County Council, Örebro, Sweden.
    Johansson, Ann-Katrin
    Department of Clinical Dentistry – Cariology, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway.
    Reporting dental caries disease in longitudinal studies - a suggestion2016Ingår i: Swedish Dental Journal, ISSN 0347-9994, Vol. 40, nr 2, s. 173-179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In general, most infectious and/or lifestyle-related diseases are defined as being present when sufficient signs or symptoms occurs in an individual. The term "sufficient" is a relative concept and a disease can therefore be measured with different degrees of certainty. These symptoms are commonly defined in such a way that it is possible to determine the incidence and prevalence of the disease and also the proportion of individuals that are cured from the disease. If dental caries is an individual disease which can be compared to other diseases regarding incidence and prevalence, it is important to determine for how long an individual must be free from new signs of the disease before being considered cured or free from the disease and to define the "sufficient" signs or symptoms needed for a diagnose. Based on these thoughts, the purpose of this study was to calculate caries incidence and prevalence in a group of adolescents from a definition of dental caries based on ICD-10. This study included all 12 year olds in 1990 who attended a clinical dental examination in 1990-1995 in Orebro County, Orebro, Sweden, yearly during these six years. Dental caries disease at the individual level was defined as Ko2.1 (dentinal caries) according to ICD-bo while freedom of caries was defined as the absence of Ko2.1 during a three-year period. In this study the yearly prevalence was 12%, the three year cumulative incidence was 18% and the incidence rate 13%. Results of this study highlight the poor outcomes in curing caries disease in this age-group, according to the criteria in this study, as only 17% of the children with caries at the outset of the study were free from the disease three years later. Defining both a practical level to measure signs of dental caries, and the period an individual must be free from them to be classified as cured from the disease create new opportunities to compare and communicate the disease of dental caries with other diseases. This way of registration is also of advantage for planning purposes as there the centre of interest must be the individual patient and not the tooth or surface.

  • 3.
    Ekbäck, Maria Palmetun
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hirsutism and quality of life with aspects on social support, anxiety and depression2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Hirsutism is excessive hair growth in women. The prevalence is estimated at 5%. The aim of this thesis was to describe different aspects of how life is affected for women suffering from hirsutism. Both qualitative and quantitative methods were used. Study I showed that hirsutism deeply affects women’s experiences of their bodies in a negative way and was experienced as a life sorrow. In Study II the patient-physician relationship was described. The patient-physician relationship from the patient’s perspective was suboptimal, as most meetings included feelings of being rejected and even humiliation. In Study III the aim was to translate and psychometrically evaluate an instrument that measures perceived social support, “The Multidimensional Scale of Perceived Social Support” (MSPSS). The translation was performed according to WHO:s official process, and validation was performed in a sample that consisted of 281 participants, 127 women with hirsutism (main sample) and 154 nursing students. MSPSS had good psychometric properties with regard to factor structure, construct validity, internal consistency and reproducibility. Study IV described different aspects of HRQoL in the main sample, the correlation of anxiety, depression, level of hairiness, age and BMI. The F-G scores were dichotomized into minor (F-G ≤14) and major (F-G≥15) hair growth. Higher levels of hair growth were significantly correlated to a lower level of QoL measured by DLQI, EQ-5D and symptoms of both anxiety and depression measured by HADS. Study V investigated if social support was associated with quality of life and outcome of HRQoL compared to a reference group of women (n=1115). SF-36, the MSPSS and the F-G scale were used. Compared to the reference group, women with hirsutism reported lower quality of life in all dimensions of SF-36 (p<0.01) The dimension most affected was vitality (VT=41.2), which had a lower value than has been reported for patients with MS and myasthenia gravis. A Multiple Regression Analysis showed a significant relation between quality of life and social support, indicating its importance for the ability to adapt, in spite of low quality of life.

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  • 4.
    Ekbäck, Maria Palmetun
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Dermatology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Benzein, Eva
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Lindberg, Magnus
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Dermatology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Årestedt, Kristofer
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden; Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden; Palliative Research Centre, Ersta Sköndal University College and Ersta hospital, Stockholm, Sweden.
    Health-Related Quality of Life, Depression and Anxiety Correlate with the Degree of Hirsutism2013Ingår i: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 227, nr 3, s. 278-284Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Hirsutism has a negative impact on women’s quality of life. The relation between quality of life, anxiety, depression and the level of hairiness has not been described.

    Aims: To investigate the correlations between the levels of hairiness, quality of life, anxiety and depression. Methods: 200 patients from Malmö, Örebro and Uppsala, who had been in contact with the clinics for problems with excessive hair growth, were invited to answer a self-administered questionnaire including sociodemographic questions, EQ- 5D index score, Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS) and Ferriman- Gallwey scale (F-G); of these, 127 women participated in the study.

    Results: The mean values were: EQ-5D index 0.73 (SD = 0.27), EQ visual analogue scale 61.0 (SD = 22.6), HADSanxiety 9.5 ± 5.3 and HADS-depression 6.5 ± 4.6. The mean DLQI was 11.8 ± 8.4, indicating a very large effect on patients’ lives. All were significantly correlated with the amount of hairiness.  

    Conclusions: Higher levels of hair growth were significantly correlated with a lower level of quality of life and symptoms of both anxiety and depression.

  • 5.
    Ekbäck, Maria Palmetun
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Department of Pharmacology and Therapeutics, Örebro County Council, Örebro, Sweden.
    Lindberg, Magnus
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Dermatology, University Hospital Örebro, Örebro, Sweden.
    Benzein, Eva
    Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden.
    Årestedt, Kristofer
    Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Palliative Research Centre, Ersta Sköndal University College and Hospital, Stockholm, Sweden .
    Social support: an important factor for quality of life in women with hirsutism2014Ingår i: Health and Quality of Life Outcomes, E-ISSN 1477-7525, Vol. 12, artikel-id 183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Women with hirsutism have reported imparied health and health-related quality of life (HRQoL). Social support is a factor that might increase HRQoL in chronic diseases, but little is known about this association among women with hirsutism.

    Aim: The aim of the study was to describe social support and explore its association with HRQoL among women with hirsutism. A further aim was to compare HRQoL in women with hirsutism with a Swedish normal population.

    Methods: A questionnaire including socio-demographic questions, Short-Form Health Survey (SF-36), the Multidimensional Scale of Perceived Social Support (MSPSS), and a self-estimation of hairiness using the Ferriman-Gallway scale (F-G scale) was answered by 127 women with hirsutism.

    Results: Multiple regression analyses showed significant associations between social support and all health dimensions in the SF-36, also after the model was adjusted for age, hairiness and body mass index. Compared to the normal Swedish population, women with hirsutism reported significantly lower HRQoL in all dimensions of the SF-36 (p < 0.01).

    Conclusions: There is a significant positive association between social support and HRQoL, demonstrating its importance for the ability to adapt to problems associated with hirsutism. As women with hirsutism reported poorer HRQoL compared to the normal population, social support may be a factor to consider in clinical practice.

  • 6.
    Ekbäck, Maria Palmetun
    et al.
    Region Örebro län. Dept Dermatol, Örebro University Hospital, Örebro, Sweden; Drug & Therapeut Committee, Örebro University Hospital, Örebro, Sweden.
    Troilius, Agneta
    Laser & Vascular Anomalies, Dermatol Dept, Skåne Univ Hosp, Malmö, Sweden.
    Laser therapy for refractory discoid lupus erythematosus when everything else has failed2013Ingår i: Journal of Cosmetic & Laser Therapy, ISSN 1476-4172, E-ISSN 1476-4180, Vol. 15, nr 5, s. 260-265Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Discoid lupus erythematosus (DLE) is restricted to the skin, mostly the face, often chronic and disfiguring. Standard medical therapies include topical corticosteroids and antimalarials. This is a retrospective long-term follow-up of refractory DLE treated with different lasers and intense pulsed light (IPL). Methods and materials : Sixteen patients with histologically confirmed DLE participated in this study. Two men and fourteen women, aged 28-69 years, mean age 54 years, were treated at the laser units of the Departments of Dermatology at the University Hospital of Orebro from 2001 and at Skane University Hospital in Malmo, Sweden from 1999. Several therapies, including first- and secondline treatments and even cryotherapy, had been used without response. Many patients had marked scarring. Pulsed dye laser (PDL) and IPL were used with low fluencies. Results: Of 16 patients, 14 were improved regarding itching, erythema, scaling, scarring and pain. There was no scarring as a side effect of laser therapy or IPL. Two patients were not satisfied: one because of long healing time, and the other because of post inflammatory hyper pigmentation. Conclusion: IPL and PDL is a safe adjunctive therapy to conventional treatment of DLE. In the effort to prevent severe scarring and disfigurement it should be used as early as possible.

  • 7.
    Ekbäck, Maria [Palmetun]
    et al.
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Department of Medicine, Örebro University, Örebro, Sweden.
    Uggla, Bertil
    Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
    Paraneoplastic pemphigus associated with chronic lymphocytic leukaemia: treatment with alemtuzumab2012Ingår i: Leukemia Research, ISSN 0145-2126, E-ISSN 1873-5835, Vol. 36, nr 8, s. E190-E191Artikel i tidskrift (Refereegranskat)
  • 8.
    Ekbäck, Maria [Palmetun]
    et al.
    Örebro universitet, Hälsoakademin.
    Wijma, Klaas
    Benzein, Eva
    "It is always on my mind": women's experiences of their bodies when living with hirsutism2009Ingår i: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 30, nr 5, s. 358-372Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Many women suffer from excessive hair growth, often in combination with polycystic ovarian syndrome (PCOS). It is unclear how hirsutism influences such women's experiences of their bodies. Our aim is to describe and interpret women's experiences of their bodies when living with hirsutism. Interviews were conducted with 10 women with hirsutism. We used a qualitative latent content analysis. Four closely intertwined themes were disclosed: the body was experienced as a yoke, a freak, a disgrace, and as a prison. Hirsutism deeply affects women's experiences of their bodies in a negative way.

  • 9.
    Ekbäck, Maria [Palmetun]
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. University hospital Örebro, Örebro, Sweden; Örebro County Council, Örebro, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Kalmar, Sweden; Linköping University, Linköping, Sweden; ; Ersta Sköndal University College and Ersta hospital, Stockholm, Sweden.
    Benzein, Eva
    Linnaeus University, Kalmar, Sweden.
    Lindberg, Magnus
    Örebro universitet, Institutionen för hälsovetenskap och medicin. University hospital Örebro, Örebro, Sweden.
    Social support and quality of life among women diagnosed with hirsutismManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: Women with hirsutism report more anxiety, depression and lower quality of life. However, their social situation with a family and employment does not differ from other women. Social support is a factor that might increase quality of life in chronic diseases. Little is known about social support and skin diseases.

    Objectives: The aim was to evaluate the relation between health-related quality of life and social support among women with hirsutism.

    Methods: A questionnaire including socio-demographic questions, Short Form 36 (SF-36), the Multidimensional Scale of Perceived Social Support (MSPSS) and a self-estimation of hairiness using the Ferriman-Gallway scale (F-G scale) was filled out by 127. MSPSS has three sub-scales (family, friends, significant others) and a total score, that was used for calculation.

    Results: Compared to a Swedish population based reference group women with hirsutism reported lower quality of life in all dimensions of SF-36 (p<0.01). Multiple regression analysis showed a significant correlation between the MSPSS and SF-36 in the initial and adjusted model.

    Conclusions: There is a significant positive relation between quality of life and social support, demonstrating its importance for the ability to adapt to problems associated with hirsutism. It can be postulated that social support is important for the quality of life in chronic skin diseases wich merits further investigations.

  • 10.
    Evenhamre, Karolina
    et al.
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Ekbäck, Maria Palmetun
    Region Örebro län. Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Department of Medical Sciences, Faculty of Medicine, Örebro University, Örebro, Sweden.
    Lindberg, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Correlations Between Disease-specific DLQI and Generic WHOQOL-BREF Quality of Life Instruments in a Clinical Population with Mixed Dermatological Diagnoses: A Pilot Study2017Ingår i: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 97, nr 2, s. 270-272Artikel i tidskrift (Refereegranskat)
  • 11.
    Palmetun-Ekbäck, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Dermatology.
    Benzein, Eva
    Linnaeus University, Kalmar, Sweden.
    Lindberg, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Årestedt, Kristofer
    Linnaeus University, Kalmar, Sweden; Linköping University, Linköping, Sweden; Ersta Sköndal University College and Ersta hospital, Stockholm, Sweden.
    The Swedish version of the multidimensional scale of perceived social support (MSPSS): a pshycometric evaluation study in women with hirsutism and nursing students2013Ingår i: Health and Quality of Life Outcomes, E-ISSN 1477-7525, Vol. 11, nr 1, artikel-id 168Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Multidimensional Scale of Perceived Social Support (MSPSS) is a short instrument, developed to assess perceived social support. The original English version has been widely used. The original scale has demonstrated satisfactory psychometric properties in different settings, but no validated Swedish version has been available. The aim was therefore to translate, adapt and psychometrically evaluate the Multidimensional Scale of Perceived Social Support for use in a Swedish context.

    Method: In total 281 participants accepted to join the study, a main sample of 127 women with hirsutism and a reference sample of 154 nursing students. The MSPSS was translated and culturally adapted according to the rigorous official process approved by WHO. The psychometric evaluation included item analysis, evaluation of factor structure, known-group validity, internal consistency and reproducibility.

    Results: The original three-factor structure was reproduced in the main sample of women with hirsutism. An equivalent factor structure was demonstrated in a cross-validation, based on the reference sample of nursing students. Known-group validity was supported and internal consistency was good for all scales (alpha = 0.91-0.95). The test-retest showed acceptable to very good reproducibility for the items (kappa(w) = 0.58-0.85) and the scales (ICC = 0.89-0.92; CCC = 0.89-0.92).

    Conclusion: The Swedish version of the MSPSS is a multidimensional scale with sound psychometric properties in the present study sample. The simple and short format makes it a useful tool for measuring perceived social support.

  • 12.
    Wallén, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Sweden.
    Bruze, Gustaf
    Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
    Ottosson, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Marcus, Claude
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Sundström, Johan
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Szabo, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Olbers, Torsten
    Institute of Clinical and Experimental Medicine and Wallenberg Centre for Molecular Medicine, University of Linköping and Department of Surgery, Vrinnevi, Norrköping, Sweden.
    Ekbäck, Maria Palmetun
    Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Sweden.
    Näslund, Ingmar
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Neovius, Martin
    Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
    Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention2023Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 277, nr 3, s. e552-e560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. SUMMARY OF

    BACKGROUND DATA: Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups.

    METHODS: Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention.

    RESULTS: During the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98).

    CONCLUSIONS: Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.

  • 13.
    Wallén, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Pharmacology and Therapeutic Department, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Szabo, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Ekbäck, Maria Palmetun
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Pharmacology and Therapeutic Department.
    Näslund, Ingmar
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ottosson, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Näslund, Erik
    Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Impact of socioeconomic status on new chronic opioid use after gastric bypass surgery2023Ingår i: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 19, nr 12, s. 1375-1381Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Socioeconomic status may influence weight loss, postoperative complications, and health-related quality of life after bariatric surgery. Chronic use of opioid analgesics is a known risk after bariatric surgery, but whether socioeconomic factors are associated with new chronic use of opioid analgesics has not been investigated in depth.

    OBJECTIVES: The aim of this study was to identify socioeconomic factors associated with the development of new chronic use of opioid analgesics after gastric bypass surgery.

    SETTING: All hospitals performing bariatric surgery in Sweden.

    METHODS: This was a retrospective cohort study with prospectively collected data including all primary gastric bypass procedures in Sweden between 2007 and 2015. Data were collected from the Scandinavian Obesity Surgery Registry, the Swedish Prescribed Drug Register, and Statistics Sweden. The primary outcome was new chronic opioid use.

    RESULTS: Of the 44,671 participants, 1438 patients became new chronic opioid users. Longer education (secondary education; odds ratio [OR] = .71; 95% CI, .62-.81) or higher education (OR = .45; 95% CI, .38-.53), higher disposable income (20th-50th percentile: OR = .75; 95% CI, .66-.85; 50th-80th percentile: OR = .50; 95% CI, .43-.58; and the highest 80th percentile: OR = .40; 95% CI, .32-.51) were significantly associated with lower risk for new chronic opioid use. Being a second-generation immigrant (OR = 1.54; 95% CI, 1.24-1.90), being on a disability pension or early retirement (OR = 3.04; 95% CI, 2.67-3.45), receiving social benefits (OR = 1.88; 95% CI, 1.59-2.22), being unemployed for <100 days (OR = 1.25; 95% CI, 1.08-1.45), being unemployed for >100 days (OR = 1.41; 95% CI, 1.16-1.71), and being divorced or a widow or widower (OR = 1.35; 95% CI, 1.17-1.55) were significantly associated with a higher risk for chronic opioid use.

    CONCLUSION: Given that long-term opioid use has detrimental effects after bariatric surgery, it is important that information and follow-up are optimized for patients with shorter education, lower income, and disability pension or early retirement because they are at an increased risk of new chronic opioid analgesics use.

  • 14.
    Wallén, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Läkemedelscentrum, Universitetssjukhuset, Örebro, Sweden.
    Szabo, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Palmetun-Ekbäck, Maria
    Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Läkemedelscentrum, Universitetssjukhuset, Örebro, Sweden; Department of Dermatology, University Hospital of Örebro, Örebro, Sweden.
    Näslund, Ingmar
    Department of Surgery, University Hospital of Örebro, Örebro, Sweden.
    Use of Opioid Analgesics Before and After Gastric Bypass Surgery in Sweden: a Population-Based Study2018Ingår i: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, nr 11, s. 3518-3523Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Little is known regarding the use of opioid analgesics among patients who have undergone bariatric surgery. The Roux-en-Y gastric bypass (RYGB) procedure has been shown to significantly increase the rate of absorption of and exposure to morphine, raising concerns regarding the potentially increased risk of side-effects and the development of substance-use disorder.

    Objectives: The aim of this study was to describe the pattern of opioid use over time following RYGB and to see if the pattern differs between patients with a high opioid consumption (HOC) prior to surgery and those with a low consumption (LOC).

    Setting: University Hospital of Örebro, Sweden.

    Methods: The study was a descriptive retrospective population-based cohort study where two registers with complete coverage were cross-matched.

    Results: The study population comprised 35,612 persons (1628 HOC, and 33,984 LOC). After surgery, the number of HOC patients increased to 2218. Mean daily opioid consumption in the total population and the LOC group increased after surgery (p <.0005). In the HOC group, there was no difference between mean daily consumption before and after surgery.

    Conclusion: In this nationwide study, we have showed that there is an increase in consumption of opioid analgesics after gastric bypass surgery in Sweden. The increase in the number of individuals with high opioid consumption in the total population was mainly due to an increase in the group of patients with a low consumption prior to surgery.

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