Children born to methadone maintained mothers are at high risk of adverse socio-emotional and behavioural outcomes. However, existing studies inadequately report the extent of maternal methadone and other drug use, focus on a narrow range of outcomes, and have given little consideration to the possible impact of child protection and placement experiences. As part of a prospective longitudinal study, mothers of 53 methadone-exposed (ME) children and 54 non-exposed comparison children were interviewed at four time-points from term to the child turning 4.5-years. Detailed information about infant clinical, maternal and family background characteristics was recorded. The nature of all child out-of-home placements was reported at regular intervals using life history calendar methods. At 4.5 years, all caregivers completed the Strengths and Difficulties Questionnaire (SDQ) and were interviewed using the Developmental and Well-Being Assessment (DAWBA) to examine the extent of child socio-emotional and behavioural adjustment problems as well as risk for a range of clinical disorders. By age 4.5 years, ME children were rated by their caregivers as having higher levels of emotional (p = .01), peer-relationship (p = .01), hyperactivity/inattention (p = .01), conduct (p = .01) and total problems (p = .01) than comparison children on the SDQ. Between-groups differences persisted for conduct problems (p = .003) and total difficulties (p = .006) even after controlling for a range of covariates associated with maternal methadone maintenance therapy, including single motherhood, maternal educational achievement, family socioeconomic status (SES), and other drug use in pregnancy. On the DAWBA, children in the ME group were also significantly more at risk than comparison children for externalising disorders spanning ADHD (p = .02), hyperkinesis (p =.01), oppositional defiant disorder (p < .001), and conduct disorder (p = .007). Examination of all study children‟s family situation at 3-monthly intervals over the first 4.5-years revealed that 43% of children in the ME group had experienced at least one foster care placement (range: 1 – 7). In contrast, no comparison children had any placement experience (p < .01). Within the methadone group, maternal risk factors that predicted the likelihood of child placement included maternal methadone dose in pregnancy (p <.01), SES (p = .03), maternal depression (p <.01) and the extent of tobacco (p = .01) and illicit substance use while pregnant (p = .05). ME children exposed to placement showed some increased risk for internalising disorders such as separation anxiety disorder (p = .35) and specific phobia disorder (p = .35), whereas ME children remaining in their biological mothers‟ care tended to have an increased risk for externalising disorders such as ADHD, hyperkinesis and oppositional defiant disorder, although these differences did not reach statistical significance (ps < .05). Child placement did not appear to be independently contributing to the later mental health risks for ME children, at least to age 4.5-years. Rather, a very similar set of maternal psychosocial risk factors were associated with both out-of-home placement and child adjustment problems, thus highlighting the importance of socio-environmental adversity leading to both child removal from parental care and externalising behaviour problems. Further longer-term follow-up of ME children will be important to fully understand the emerging relationships between out-of-home care and the mental health outcomes of ME children. These study findings have important clinical and public health implications. First, the increased risk for socio-emotional and behavioural adjustment problems and disorder as observed among the ME group suggests that appropriate clinical support is needed to address the problems experienced by these children, with the preschool years being a timely opportunity for early targeted interventions. Second, given that high risk ME children are also a population likely to encounter considerable early environmental instability, public healthcare protocols should be introduced to meet the specific developmental needs of young ME children as they transition through and adjust to the placement process.

Eighty-four patients who were endoscopically confirmed to have healed duodenal ulcers were entered into this 1 year, double-blind, placebo-controlled trial of sucralfate, lg twice daily, in the prevention of duodenal ulcer recurrence. Patients remained in the study until recurrence of ulceration was endoscopically confirmed. Sixty-one patients could be evaluated for efficacy of treatment. Within 6 months, 23 of 31 placebo patients (74%) and 6 of 30 sucralfate patients (20%) had ulcer recurrence. At 12 months, 25 of 31 placebo patients (80%) and 8 of 30 receiving sucralfate (27%) had ulcer recurrence. The lower rate of ulcer recurrence in patients receiving sucralfate was significant (p = 0.0001). Survival curves also showed that sucralfate was significantly more effective in preventing relapse (p = 0.0001). Three patients were judged as experiencing drug-related side effects, two of which were in the placebo group. The results indicate that sucralfate is significantly more effective than placebo in the prevention of recurrence of duodenal ulcer disease.

Syftet med studien är att beskriva tandhygienisternas uppfattning om parodontal stödbehandling och få en inblick hur behandlingen fungerar i praktiken.För att få ett bredare faktaunderlag till ämnet bearbetades litteratur från referenslitteratur och tidskrifter. Studien bygger på en kvalitativ innehållsanalys, för att kunna utföra intervjuerna begränsades området, där Malmö var mest praktiskt i förhållande till tiden. För att begränsa studien ytterligare gjordes djupintervjuer med totalt tre tandhygienister som arbetar inom folktandvården samt privat sektor. Till grund för intervjuerna utarbetades en intervjuguide fram, för att ta del utav informanternas kunskaper och erfarenheter. Resultatet visar att parodontal stödbehandling definieras och beskrivs på olika sätt men överlag har tandhygienisterna samma uppfattningar om vad som ingår i parodontal stödbehandling och när det är indicerat. Men de är medvetna om att alla gör på sitt sätt och att det kan skilja sig i arbetsgången. En viktig del i den parodontala stödbehandlingen är sammanfattningsvis att patienten koopererar för att bibehålla gott behandlingsresultat för att sjukdomen inte ska progrediera. Fler studier krävs för att resultatet ska vara tillförlitligt och för att påvisa om fördelar finns med parodontal stödbehandling. Detta arbete är en inblick i tandhygienistens uppfattning om parodontal stödbehandling.

Digitalis in one of the most frequently prescribed drugs, especially to elderly people. The prescription of cardiac glucosides (1978) was studied by using statistics from Apoteksbolaget (the National Corpora­tion of Swedish Pharmacies). There was a threefold difference in the sales of cardiac glucosides per 1000 inhabitants in the different primary care areas. Digoxin was prescribed to 90-98 per cent of the patients, with considerable variations in the dosages. Many other factors besides the cardio-vascular morbidity were likely to cause these differences. Maintenance digitalis therapy has lately been questioned. In a retro­spective study, digitalis was discontinued in 141 geriatric patients without contraindications to digitalis withdrawal. Digoxin treatment seemed to be unnecessary in 108 patients (81 per cent), followed up two months after digoxin withdrawal. A long-term study (mean: 20,5 months) was carried out in these 108 patients. Digitalis therapy was reinstituted in 30 of 99 patients, equally distributed on the basis of clear, possible or uncertain indications. Significantly more patients (p&lt; 0,001) with atrial fibrillation compared with sinus rhythm were restarted. A prospective, randomized, double-blind placebo- controlled study in 39 out of 66 geriatric patients confirmed the results of the retrospective study. During a two-month period 32 of 37 patients (86 per cent) managed without digitalis. Eighteen out of 66 patients (27 per cent) presented contraindications to digoxin with­drawal. Those who needed digitalis were restarted mainly during the first nonth (mean: 18 days) following digoxin withdrawal. Digitalis intoxication has been studied earlier, mainly in hospitalized patients. A clinical examination and ECG of a random sample of out­patients treated with digoxin shewed that about 5 per cent were certainly intoxicated and about 2 per cent suspected of being intoxi­cated. Elderly patients are said to be more sensitive to digitalis. Eleven per cent of 66 geriatric patients were found, without doubt, to be digitalis intoxicated. The mean serum digoxin concentration was significantly higher in eight toxic patients compared with non-toxic patients, but 75 per cent of the toxic patients had serum digoxin con­centrations within or below therapeutic range. Five of these intoxi­cated patients did not need maintenance digitalis therapy. A questionnaire of 361 patients in Skellefteå and Uppsala revealed that about 45 per cent had taken digitalis for more than five years. Approximately 85 per cent took one tablet daily and stated compliance. About one fifth did not know why they were taking digoxin and about half of the patients were uncertain if they were improved, by digitalis therapy. Although digitalis intoxication is such an important clinical problem, some 55 per cent did not know about digitalis's side-effects and some 50 per cent stated that no or insufficient information had been given. Only 15 per cent were satisfied with the information they had received. A significant negative correlation between digoxin dosages and the age of the patients was found. / <p>Diss. Umeå : Umeå universitet, 1983, härtill 7 uppsatser</p> / digitalisering@umu