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Styrke, Johan
Publications (10 of 11) Show all publications
Cazzaniga, W., Ventimiglia, E., Alfano, M., Robinson, D., Lissbrant, I. F., Carlsson, S., . . . Stattin, P. (2019). Mini Review on the Use of Clinical Cancer Registers for Prostate Cancer: The National Prostate Cancer Register (NPCR) of Sweden. FRONTIERS IN MEDICINE, 6, Article ID 51.
Open this publication in new window or tab >>Mini Review on the Use of Clinical Cancer Registers for Prostate Cancer: The National Prostate Cancer Register (NPCR) of Sweden
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2019 (English)In: FRONTIERS IN MEDICINE, ISSN 2296-858X, Vol. 6, article id 51Article, review/survey (Refereed) Published
Abstract [en]

Given the increasing prevalence of cancer, it is vital to systematically collect data in order to monitor disease trends and quality of cancer care. For this purpose, clinical cancer registries have been developed in some countries. These registers are intended to be used as a basis for quality assurance and quality improvement, but they also constitute a rich resource of real world data for research. The aim of thismini-review was to describe the structure and the organization of the National Prostate Cancer Register (NPCR) with some examples on how data in NPCR have affected prostate cancer care in Sweden.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2019
Keywords
National Prostate Cancer Register (NPCR) of Sweden, Prostate Cancer data Base Sweden (PCBaSe), clinical cancer register, prostate cancer, online registration, report
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-158097 (URN)10.3389/fmed.2019.00051 (DOI)000462652600002 ()
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Inkiläinen, A., Styrke, J., Ljungberg, B. & Strigård, K. (2018). Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study. Scandinavian journal of urology, 52(1), 54-58
Open this publication in new window or tab >>Occurrence of abdominal bulging and hernia after open partial nephrectomy: a retrospective cohort study
2018 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 52, no 1, p. 54-58Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Abdominal bulging and incisional hernia are known sequelae after open partial nephrectomy (OPN) via a flank incision. Precise rates are not known. The aims of this study were to determine the rates of bulging and hernia after OPN, and to examine potential risk factors.

MATERIALS AND METHODS: A retrospective review was undertaken of 197 consecutive patients operated on with OPN via a flank incision between 2004 and 2014. After exclusion, 184 patients remained. Medical records and radiological images from the preoperative work-up, and follow-up after surgery at 3, 12 and 24 months, were reviewed.

RESULTS: A visible bulge was noted in 36 of the 184 patients at clinical examination. Only 20 cases (12%) remained at the last follow-up. Radiological changes interpreted as a bulge were initially seen in 50 patients, while only 35 (19%) remained at the last radiological examination. Clinical incisional hernia was reported in five patients (3%), and radiological hernia was seen in 10 patients (5%). Patients who developed a hernia had a higher body mass index (30 vs 26 kg/m(2), p = 0.02). Other demographic variables showed no significant correlation.

CONCLUSIONS: Bulging is a common sequela after flank incision. The rate of incisional hernia after flank incision is comparable to rates after other forms of abdominal surgery. Further studies are required to evaluate the psychological and physiological effects of bulging, the pain and weakness caused, and the cosmetic embarrassment suffered by the patient.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Bulge, flank incision, incisional hernia, open partial nephrectomy, renal cell carcinoma
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-140297 (URN)10.1080/21681805.2017.1376352 (DOI)000425799400010 ()28934886 (PubMedID)
Available from: 2017-10-04 Created: 2017-10-04 Last updated: 2018-09-28Bibliographically approved
Styrke, J., Henriksson, H., Ljungberg, B., Hasan, M., Silfverberg, I., Einarsson, R., . . . Sherif, A. (2017). Evaluation of the diagnostic accuracy of UBC(®) Rapid in bladder cancer: a Swedish multicentre study. Scandinavian journal of urology, 51(4), 293-300
Open this publication in new window or tab >>Evaluation of the diagnostic accuracy of UBC(®) Rapid in bladder cancer: a Swedish multicentre study
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2017 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, no 4, p. 293-300Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to determine the diagnostic accuracy of UBC(®) Rapid - a urine-based marker for bladder cancer - in patients with bladder cancer and controls, and to compare the test results across risk groups.

MATERIALS AND METHODS: This prospective phase II study was conducted at four Swedish hospitals. UBC Rapid was evaluated in four groups: A, newly diagnosed bladder cancer (n = 94); B, follow-up of non-muscle-invasive bladder cancer (n = 75); C, benign urinary tract diseases (n = 51); and D, healthy controls (n = 50). Tumours were divided into high risk (carcinoma in situ, TaG3, T1, T2 and T3) and low risk (low malignant potential, TaG1 and TaG2). Urine samples were quantitatively analysed by UBC Rapid. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated based on optimal cut-off (receiver operator characteristics curve analysis). A linear regression compared the UBC Rapid results in the different risk groups.

RESULTS: The optimal cut-off was 8.1 μg/l. The median UBC Rapid values were 9.3 μg/l [interquartile range (IQR) 30.9] and 4.3 μg/l (IQR 7.8) in patients with positive and negative cystoscopy, respectively (p < .001). The value for group A was 15.6 μg/l (IQR 37.9), group B 5.6 μg/l (IQR 8.6), group C 5.1 μg/l (IQR 9.0) and group D 3.3 μg/l (IQR 7.1). Sensitivity was 70.8%, specificity 61.4%, PPV 71.3% and NPV 60.8%. The high-risk group had significantly higher UBC Rapid values than the low-risk group: 20.5 μg/l (IQR 42.2), sensitivity 79.2% and specificity 61.4% versus 7.0 μg/l (IQR 9.9), sensitivity 60.0% and specificity 61.4% (p = .039).

CONCLUSIONS: The UBC Rapid urine-based marker for bladder cancer gave higher values in patients with positive than in those with negative cystoscopy. The diagnostic accuracy was better in patients with high-risk than in those with low-risk tumours, and was better during primary detection than during surveillance.

Keywords
Disease monitoring, UBC® Rapid point-of-care systems, primary disease, urinary bladder cancer
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-133970 (URN)10.1080/21681805.2017.1313309 (DOI)000405483400011 ()28422550 (PubMedID)
Available from: 2017-04-24 Created: 2017-04-24 Last updated: 2018-06-09Bibliographically approved
Styrke, J., Stålnacke, B.-M., Bylund, P.-O., Sojka, P. & Björnstig, U. (2014). Neck injury after whiplash trauma in a defined population in Northern Sweden: long term sick leave and costs of low productivity. Epidemiology: Open Access, 4(4), Article ID 1000170.
Open this publication in new window or tab >>Neck injury after whiplash trauma in a defined population in Northern Sweden: long term sick leave and costs of low productivity
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2014 (English)In: Epidemiology: Open Access, ISSN 2161-1165, Vol. 4, no 4, article id 1000170Article in journal (Refereed) Published
Abstract [en]

Background: Neck injuries following whiplash trauma can lead to long-term sequelae. Population-based studies covering traffic and non-traffic whiplash trauma are rare. The aim was to describe the incidence of neck injuries following whiplash trauma during one year, from a well-defined area served by a single hospital, and the resulting long-term sick leave during a five-year follow-up. Possible risk factors for sick leave and the cost of lost productivity were also studied.

Methods: From the injury register of Umeå University Hospital, the year 2001’s data set of soft tissue neck injuries and fractures was extracted. Those injured by whiplash trauma were included. The Swedish Social Insurance Agency provided five-year post-injury data on sick leave in 2006. Epidemiological aspects were described, a logistic regression was conducted to find risk factors for long-term sick leave, and the cost of lost productivity was calculated.

Results: Four hundred and seventeen cases were included. The incidence was 383 per 100,000 person-year. In 14% of 18-64 year olds, sick leave was granted for more than two weeks and the median number of sick days in this group was 298. Old age, having a Whiplash Associated Disorders (WAD) grade of 1, being injured in traffic and being injured at velocity exceeding 50 km/h were significant risk factors for sick leave. A few (6%) had fractures, however, their average sick-leave time was not significantly longer than the sick leave of those with only soft tissue injuries. The cost to society for lost productivity was estimated at 4.4 million Euros during the five-year follow-up.

Conclusion: Neck injuries following whiplash trauma arise from both traffic and non-traffic injury events and affect people of all ages. Consequently long-term sick leave occur in a minority of the patients, commonly among older persons and persons injured in traffic. The costs to society from lost productivity is high.

Keywords
Neck injury, Whiplash injury, Sick leave, Epidemiology, Cost of illness
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-120706 (URN)10.4172/2161-1165.1000170 (DOI)
External cooperation:
Available from: 2016-05-18 Created: 2016-05-18 Last updated: 2018-06-07Bibliographically approved
Åhman, S., Saveman, B.-I., Styrke, J., Björnstig, U. & Stålnacke, B.-M. (2013). Long-term follow-up of patients with mild traumatic brain injury: a mixed-methods study. Journal of Rehabilitation Medicine, 45(8), 758-764
Open this publication in new window or tab >>Long-term follow-up of patients with mild traumatic brain injury: a mixed-methods study
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2013 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 8, p. 758-764Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To characterize the long-term consequences of mild traumatic brain injury regarding post-concussion symptoms, post-traumatic stress, and quality of life; and to investigate differences between men and women.

DESIGN: Retrospective mixed-methods study.Subjects/patients and methods: Of 214 patients with mild traumatic brain injury seeking acute care, 163 answered questionnaires concerning post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire; RPQ), post-traumatic stress (Impact of Event Scale; IES), and quality of life (Short Form Health Survey; SF-36) 3 years post-injury. A total of 21 patients underwent a medical examination in connection with the survey. The patients were contacted 11 years later, and 10 were interviewed. Interview data were analysed with content analysis.

RESULTS: The mean total RPQ score was 12.7 (standard deviation; SD 12.9); 10.5 (SD 11.9) for men and 15.9 (SD 13.8) for women (p = 0.006). The 5 most common symptoms were fatigue (53.4%), poor memory (52.5%), headache (50.9%), frustration (47.9%) and depression (47.2%). The mean total IES score was 9.6 (SD 12.9) 7.1 (SD 10.3) for men and 13.0 (SD 15.2) for women (p = 0.004). In general, the studied population had low scores on the Short Form Health Survey (SF-36). The interviews revealed that some patients still had disabling post-concussion symptoms and consequences in many areas of life 11 years after the injury event.

CONCLUSION: Long-term consequences were present for approximately 50% of the patients 3 years after mild traumatic brain injury and were also reported 11 years after mild traumatic brain injury. This needs to be taken into account by healthcare professionals and society in general when dealing with people who have undergone mild traumatic brain injury.

Place, publisher, year, edition, pages
Stiftelsen Rehabiliteringsinformation, 2013
Keywords
traumatic brain injury, brain concussion, post-concussion symptoms, post-traumatic stress disorder
National Category
Health Sciences
Identifiers
urn:nbn:se:umu:diva-83023 (URN)10.2340/16501977-1182 (DOI)000326357500010 ()24002311 (PubMedID)
Available from: 2013-11-15 Created: 2013-11-15 Last updated: 2018-06-08Bibliographically approved
Styrke, J., Sojka, P., Björnstig, U., Bylund, P.-O. & Stålnacke, B.-M. (2013). Sex-differences in symptoms, disability, and life satisfaction three years after mild traumatic brain injury: a population-based cohort study. Journal of Rehabilitation Medicine, 45(8), 749-757
Open this publication in new window or tab >>Sex-differences in symptoms, disability, and life satisfaction three years after mild traumatic brain injury: a population-based cohort study
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2013 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 8, p. 749-757Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate sex differences in symptoms, structure of symptoms, disability and life satisfaction 3 years after mild traumatic brain injury. Secondary aims were to find risk factors for adverse outcome.

DESIGN: Population-based cohort study.Patients: The cohort comprised 137,000 inhabitants at risk in a defined population served by a single hospital in northern Sweden. Patients attending the emergency department following a mild traumatic brain injury in 2001 were included.

METHODS: Of 214 patients aged 18–64 years, 163 answered a questionnaire on symptoms, disability, and life-satisfaction 3 years post-injury. The instruments were analysed with descriptive statistics. A principal component analysis of the Rivermead Post-Concussion Symptoms Questionnaire was conducted. Risk factors were identified using logistic regression.

RESULTS: Post-concussion syndrome was found in 50% of the women and 30% of the men. Disability was found in 52% of the women and 37% of the men, and 57% of the women and 56% of the men were satisfied with their lives. For both genders, high frequency of symptoms was a risk factor for disability and low life satisfaction. Back pain was a risk factor for disability. Living alone was a risk factor for low levels of life satisfaction. The principal component analysis revealed differences between the sexes.

CONCLUSION: There are sex differences in outcome 3 years after mild traumatic brain injury. Women and men should be analysed separately.

Place, publisher, year, edition, pages
Stiftelsen Rehabiliteringsinformation, 2013
Keywords
traumatic brain injury, minor head injury, sex differences, post-concussion syndrome, follow-up studies, quality of life, principal component analysis, odds ratio
National Category
Surgery
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-61422 (URN)10.2340/16501977-1215 (DOI)000326357500009 ()24002310 (PubMedID)
Available from: 2012-11-13 Created: 2012-11-13 Last updated: 2018-06-08Bibliographically approved
Styrke, J., Stålnacke, B.-M., Bylund, P.-O., Sojka, P. & Björnstig, U. (2012). A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in Northern Sweden. PM&R, 4(10), 739-747
Open this publication in new window or tab >>A 10-year incidence of acute whiplash injuries after road traffic crashes in a defined population in Northern Sweden
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2012 (English)In: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, no 10, p. 739-747Article in journal (Refereed) Published
Abstract [en]

Objective

To examine the annual incidence of acute whiplash injuries after road traffic crashes in a geographic catchment area in Northern Sweden during the period 2000-2009.

Design

Descriptive epidemiology determined by prospectively collected data from a defined population.

Setting

The study was conducted at a public hospital in Sweden.

Participants

The population of the hospital's catchment area (136,600 inhabitants in 1999 and 144,500 in 2009).

Methods

At the emergency department, all injured persons (approximately 11,000 per year) were asked to answer a questionnaire about the injury incident. Data from the medical records also were analyzed. From 2000-2009, 15,506 persons were injured in vehicle crashes. Persons who were subject to an acute neck injury within whiplash-associated disorder grades 1-3 were included. The overall and annual incidences were calculated as incidence. Age, gender, type of injury event, and direction of impact were described. The incidences were compared with national statistics on insurance claims from 2003, 2007, and 2008 to detect changes in the proportions of claims.

Main Outcome Measures

The annual incidence of acute whiplash injuries. Secondary outcome measures were types of injury events, age and gender distribution, changes in the proportion of rear-end crashes during 2000-2009, and changes in the proportion of insurance claims during 2003-2008.

Results

During 2000-2009, 3297 cases of acute whiplash injury were encountered. The overall incidence was 235/100,000/year. The average yearly increase in incidence was 1.0%. Women comprised 51.9% and men 48.1% of the injured. Car occupants (86.4%) and bicycle riders (6.1%) were most frequently injured. The proportion of rear-end crashes decreased from 55% to 45% from 2000-2009. The proportion of insurance claims significantly decreased between 2003 and 2008 (P < .0001, χ2 test).

Conclusion

The incidence of emergency department visits attributable to acute whiplash injuries after road traffic crashes have been relatively stable during the past decade in our area, except in 2007 and 2008, when a peak occurred.

Place, publisher, year, edition, pages
New York, NY, USA: Elsevier, 2012
Keywords
Whiplash Injuries, Epidemiology, Traffic accidents
National Category
Surgery
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-61413 (URN)10.1016/j.pmrj.2012.05.010 (DOI)
Available from: 2012-11-15 Created: 2012-11-13 Last updated: 2018-06-08Bibliographically approved
Styrke, J. (2012). Traumatic brain injuries and whiplash injuries: epidemiology and long-term consequences. (Doctoral dissertation). Umeå: Umeå Universitet
Open this publication in new window or tab >>Traumatic brain injuries and whiplash injuries: epidemiology and long-term consequences
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

The incidence of traumatic brain injuries (TBI) is about 500 cases per 100,000 inhabitants per year, a majority of which are mild TBI (MTBI). The incidence of whiplash injuries is about 300/100,000/year. There are several similarities between MTBI and whiplash injuries with regard to the causes of injury (traffic crashes and falls), the demographic profile of the injured (mostly young persons), and the type of symptoms exhibited by some of the injured (for example head/neck pain, fatigue, irritability, impaired cognitive functioning, and depression). 

Main aim

To investigate the epidemiology and long-term consequences in terms of symptoms, disability, and life satisfaction in cases of TBI and whiplash injuries in a well-defined population.

Material and methods

Data on frequencies and characteristics of TBI and whiplash injuries were extracted from the injury database at the emergency department (ED) of Umeå University Hospital (UUH). The results were presented as descriptive epidemiology.

The 18-65 year-old persons who sustained an MTBI or whiplash injury in 2001, were provided a questionnaire three and five years after injury respectively, in which questions were asked about:

  • Symptoms; Rivermead Post Concussion Symptoms Questionnaire (RPQ)
  • Disability; Rivermead Head Injury Follow Up Questionnaire (RHFUQ)
  • Life satisfaction; LiSat-11

A local reference population was used for comparison of the RPQ. A national cohort was used as reference for LiSat-11. Data on sick leave for the cases of whiplash injuries were analysed to calculate the cost to society for loss of productivity.

Results

In 2001, the incidence of TBI was 354/100,000/year. The mean age was 23 and 55% were men. Ninety-seven percent of the injuries were classified as mild (Glasgow coma scale 13-15). The main causes were falls (55%) and traffic related injury events (30%). In 8% of the cases (17% of the elderly persons) an intracranial bleeding was detected by using CT.

The 3-year follow-up of the MTBI patients showed that women had more symptoms and disability (~50%) than men (~30%). Both women and men had more symptoms and lower life satisfaction compared with the reference population.

The incidence of traffic-related whiplash injuries in adults was 235/100,000/year and the annual incidences were relatively stable during 2000-2009. Combining the incidences with national insurance data showed that the proportion of insurance claims decreased during the period.

When looking at whiplash trauma following all causes of injury in 2001, traffic crashes caused 61% of the injuries and falls caused 14%. Neck fractures occurred in 3% of the cases.

Five years after whiplash injury, the injured persons had more symptoms and lower life satisfaction than the references. Sick leave ≥15 days was granted in 14% of the cases of whiplash injuries. The median number of sick days was 298 and the cost of loss of productivity during the follow-up was 5.6 million USD.

The frequencies of symptoms were relatively alike when comparing subjects with whiplash injuries to subjects with MTBI.

Conclusion

TBI and whiplash injuries are common, especially among young people, and the injuries render long-term symptoms, disability, and impaired life satisfaction in up to 50% of the cases. Symptoms exhibited are alike between the two types of injuries. The cost to society for loss of productivity is high, and there is a need for enhanced preventive measures aiming at reducing traffic-related injuries, sports injuries, alcohol-related injuries, and falls. Physical, mental, and social factors are important and should be addressed when examining and treating patients with persisting symptoms following TBI and whiplash injuries.

Abstract [sv]

Bakgrund

Skallskador utgör ett stort folkhälsoproblem, särskilt eftersom många som skadas är unga. Skallskador är också, parallellt med självmord, den vanligaste dödsorsaken hos ungdomar och unga vuxna. De flesta av skadorna klassas som ”lätta” i akutskedet men trots det så kommer en del av patienterna att drabbas av kvarstående besvär, t ex smärta, koncentrationssvårigheter, depression och nedsatt livstillfredsställelse.

Whiplashskador är nästan lika vanligt förekommande som skallskador och uppkommer framförallt i trafikolyckor. Även fall- och sportskador orsakar emellertid ett betydande antal whiplashskador. I normalfallet avtar de akuta symptomen inom några veckor men en del av patienterna anger att de får kvarstående besvär. Ett flertal skademekanismer i nackens vävnader är kända men tyvärr svåra att verifiera eller utesluta.

Huvudsyfte

Att undersöka förekomsten av skallskador och whiplashskador i en väldefinierad population samt beskriva restsymptom, funktions-nedsättningar och livstillfredsställelse hos de drabbade tre till fem år efter skadan.

Material och metod

Förekomsten av skadorna (Studie I, III och IV)

Studierna baseras på skadedatabasen vid Norrlands Universitetssjukhus i Umeå (NUS). I skadedatabasen registreras alla patienter som söker till akutmottagningen efter en skadehändelse, ca 10 000 fall per år. När patienterna anmäler sig i receptionen tilldelas de en skadejournal som de själva fyller i i väntan på att bli undersökta. När patienter inkommer med svårare skador får anhöriga i möjligaste mån fylla i journalen. Primärvårdens jour har under åren för studiens genomförande varit belägen på akutmottagningen under kvällar, nätter och helger vilket inneburit att de få skadefall som konsekvent missats har varit lättare skador som behandlats dagtid på vårdcentralerna i upptagningsområdet.

 

Långtidsuppföljning (Studie II, III och V)

En uppföljande enkätundersökning bestående av ett antal validerade frågeformulär skickades till alla skall- och whiplashskadade patienter i arbetsför ålder tre respektive fem år efter skadehändelsen. De frågeformulär som analyserades var:

  • För symptom: Rivermead Post Concussion Symptoms Questionnaire (RPQ)
  • För funktionsnedsättning: Rivermead Head Injury Follow Up Questionnaire (RHFUQ)
  • För livstillfredsställelse: Life Satisfaction-11 (LiSat-11)
  • För smärta (hos de whiplashskadade): Visual Analogue Scale (VAS)

 Resultaten från RPQ och LiSat-11 jämfördes med sedan tidigare tillgängligt material från åldersmatchade referenspopulationer.

När det gäller de whiplashskadade genomfördes en femårsuppföljning avseende sjukskrivning. Data från Försäkringskassan analyserades och samhällskostnaden för produktionsbortfall beräknades baserat på den genomsnittliga kostnaden för en årsarbetare.

Resultat

Förekomsten av skallskador vid NUS under 2001 var 354 skadade per 100 000 invånare. Medelåldern på de skadade var 23 år och 55% var män. Andelen lätta skallskador var 97%. Fallolyckor orsakade flest skador (55%) och trafikolyckor var näst vanligast (30%). Minst 17% av patienterna (ofta medelålders personer) var alkoholpåverkade. Hos 8% av patienterna (17% av personer över 65 år) upptäcktes blödningar i hjärnan.

I uppföljningen efter tre år noterades att de skallskadade patienterna i arbetsför ålder hade högre symptomfrekvens och lägre livstillfredsställelse än referenspopulationerna. Kvinnorna rapporterade högre förekomst av symptom och funktionsnedsättning än männen. Funktionsnedsättning av varierande grad samt så kallat postkommotionellt syndrom (med förekomst av minst tre specificerade symptom) fanns hos ca 50% av kvinnorna och hos ca 30% av männen.

Medelförekomsten av whiplashskador till följd av trafikolyckor var under 2000-2009 235 fall per 100 000 invånare och år. Sammantaget var förekomsten relativt stabil under perioden; en ökning med 1% per år noterades. När siffrorna matchades mot data från Försäkringsförbundet noterades en minskning av andelen försäkringsärenden under perioden.

2001 års incidens av akuta whiplashskador efter alla typer av skadehändelser var 383 skadade per 100 000 invånare. Könsfördelningen var 56% män / 44% kvinnor och medelåldern var 32 år. Trafikolyckor orsakade 61% av whiplashskadorna medan fallolyckor stod för 14%. Frakturer i nacken var ovanliga och hittades hos 3% av patienterna.

I femårsuppföljningen av whiplashpatienter i arbetsför ålder noterades att de hade högre frekvens (ca 50%) av symptom samt lägre livstillfredsställelse än referenspopulationerna. Funktionsnedsättning av varierande grad fanns hos ca 50% av patienterna. Kvinnorna skattade sin smärta högre än männen men i övrigt fanns ingen könsskillnad beträffande förekomsten av symptom, funktionsnedsättning och livstillfredsställelse. Vid jämförelse mellan whiplashskadade och skallskadade noterades att förekomsten av symptom med några få undantag inte skilde sig åt mellan grupperna.

Fjorton procent av de whiplashskadade blev sjukskrivna i mer än 14 dagar. Sjukskrivningens medianlängd var 298 dagar och i 3% av fallen fortskred sjukskrivningen under hela 5-årsperioden. Trafikskadade sjukskrevs oftare än fallskadade och noterbart är också att nackfrakturer ej resulterade i längre sjukskrivningar än mjukdelsskador. Samhällskostnaden för produktionsbortfall var i snitt ca 600 000 kr per sjukskrivning.

Konklusion

Avhandlingen bidrar med nya grunddata som ytterligare förstärker bilden av att skallskador och whiplashskador är vanliga och att det framförallt är unga personer som drabbas. Grad och typ av kvarstående besvär är likartade efter båda skadetyper. Samhällskostnaden för skadorna är hög och lämpliga områden för skadepreventivt arbete tycks vara fallskadeprevention, trafikskadeprevention, skadeprevention inom hästsport, fotboll och ishockey samt prevention av alkoholrelaterade skador.

Både fysiska, psykologiska och sociala faktorer inverkar på läkningsförloppet och symptombilden efter skadorna och det är viktigt att utvärdera och behandla patienterna med utgångspunkt från detta.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2012. p. 49
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1526
Keywords
Traumatic Brain Injuries, Whiplash Injuries;, Epidemiology;, Follow-up Studies, Cohort Studies
National Category
Surgery
Research subject
Epidemiology; Surgery; Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-61412 (URN)978-91-7459-495-9 (ISBN)
Public defence
2012-12-07, Hörsal B, Tandläkarhögskolan, Norrlands Universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2012-11-16 Created: 2012-11-13 Last updated: 2018-06-08Bibliographically approved
Styrke, J., Stålnacke, B.-M., Sojka, P. & Björnstig, U. (2007). Traumatic brain injuries in a well-defined population: epidemiological aspects and severity. Journal of Neurotrauma, 24(9), 1425-1436
Open this publication in new window or tab >>Traumatic brain injuries in a well-defined population: epidemiological aspects and severity
2007 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 24, no 9, p. 1425-1436Article in journal (Refereed) Published
Abstract [en]

The aim was to describe epidemiological and medical aspects of 449 cases of traumatic brain injury (TBI) from a well-defined geographical area with a population of 137,000 inhabitants. An episode of disturbed consciousness was a prerequisite for inclusion in the study. The incidence of TBI was 354/100,000 inhabitants. Median age was 23 years, range 0–91 years; 55% were men and 45% were women; 33% children 0–14 years, 50% adults 15–64 years, and 17% elderly persons 65–91 years old. Severity classification was based on Glasgow Coma Scale (GCS) on arrival; mild TBI 97% (GCS 13–15), moderate 1% (GCS 9–12), and severe 2% (GCS 3–8). The most common injury events were falls (55%) and vehicle-related events (30%). The percentage of falls was high among children and elderly persons but among adults vehicle-related injury events were also prominent. At least 17% of all patients were under the influence of alcohol, especially adult male bicyclists. CT was performed on 163 cases (36%) revealing 34 cases with intracranial hemorrhage (ICH) which is 21% of the examined or 8% of all the injured. The rate of ICH increased with increasing age (from 3% among children to 17% among the elderly persons) and also increased with decreasing GCS from 6% in the group of mild TBI to 60% among those with severe TBI. Attention should be directed to acute management of mild TBI in order to detect potentially dangerous ICH as well as to preventive actions against falls and vehicle related accidents.

Place, publisher, year, edition, pages
New York, NY, USA: Mary Ann Liebert, Inc., 2007
Keywords
Epidemiology, Head trauma, Traumatic brain injury
National Category
Surgery
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-5956 (URN)10.1089/neu.2007.0266 (DOI)17892405 (PubMedID)
Available from: 2012-11-15 Created: 2008-01-28 Last updated: 2018-06-09Bibliographically approved
Styrke, J., Sojka, P., Björnstig, U. & Stålnacke, B.-M. Symptoms, disability, and life satisfaction five years after whiplash injuries: a population-based cohort study.
Open this publication in new window or tab >>Symptoms, disability, and life satisfaction five years after whiplash injuries: a population-based cohort study
(English)Article in journal (Refereed) Submitted
Abstract [en]

Objective

To study symptoms and disabilities five years after participants sustained whiplash injuries using questionnaires designed for mild traumatic brain injury. A second aim was to study life satisfaction and a third aim was to investigate differences between women and men regarding these variables.

Design

Population-based cohort study

Methods

In total 186 persons (100 women and 86 men) aged 18-64 answered questionnaires on pain intensity (Visual Analogue Scale) symptoms (Rivermead Post Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire RHFUQ) and life satisfaction (LiSat-11) five years post injury.

Results

The most common symptoms reported on the RPQ were fatigue (41%), poor memory (39%), and headache (37%). The presence of three symptoms or more was reported by 54% of the women and 50% of the men. Inability to sustain previous workload (44%) and fatigue at work (43%) were the most frequently reported disabilities on the RHFUQ. Only 39% were satisfied with their somatic health and 60% with their mental health. Women reported significantly higher pain intensity than men. No significant differences between women and men regarding symptoms, disabilities, and life satisfaction were found.

Conclusion

These findings highlight the importance of assessing and quantifying symptoms in addition to neck pain in persons with long-term problems after whiplash injury and may provide a possibility to identify subgroups to tailor rehabilitation interventions. The high proportions of disability and low life satisfaction have to be taken into account when managing persons with chronic whiplash associated disorder. 

Keywords
Whiplash Injuries, Post-Concussion Symptoms, Life Satisfaction
National Category
Surgery
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-61421 (URN)
Available from: 2012-11-13 Created: 2012-11-13 Last updated: 2018-06-08Bibliographically approved
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