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Carlén, A., Nylander, E., Åström Aneq, M. & Gustafsson, M. (2019). ST/HR variables in firefighter exercise ECG: relation to ischemic heart disease. Physiological Reports, 7(2), Article ID e13968.
Open this publication in new window or tab >>ST/HR variables in firefighter exercise ECG: relation to ischemic heart disease
2019 (English)In: Physiological Reports, E-ISSN 2051-817X, Vol. 7, no 2, article id e13968Article in journal (Refereed) Published
Abstract [en]

Exercise electrocardiography (ExECG) is regularly performed by Swedish firefighters by law. Heart rate-corrected analysis of ST segment variables (ST/HR) has shown improved prediction of ischemic heart disease (IHD) compared to ST depression alone. This has not previously been extensively studied in asymptomatic persons with a low probability of IHD. We therefore evaluated the predictive performance of ST/HR analysis in firefighter ExECG. ExECG was studied in 521 male firefighters. During 8.4 ± 2.1 years, 2.3% (n = 12) were verified with IHD by catheterization or myocardial scintigraphy (age 51.5 ± 5.5 years) and were compared with firefighters without imaging proof of IHD (44.2 ± 10.1 years). The predictive value of ST depression, ST/HR index, ST/HR slope, and area and rotation of the ST/HR loop was calculated as age-adjusted odds ratios (OR), in 10 ECG leads. Predictive accuracy was analyzed with receiver operating characteristics (ROC) analysis. ST/HR index ≤-1.6 μV/bpm and ST/HR slope ≤-2.4 μV/bpm were associated with increased IHD risk in three individual leads (all OR > 1.0, P < 0.05). ST/HR loop area lower than the fifth percentile of non-IHD subjects indicated IHD risk in V4, V5, aVF, II, and -aVR (P < 0.05). ST depression ≤-0.1 mV was associated with IHD only in V4 (OR, 9.6, CI, 2.3-40.0). ROC analysis of each of these variables yielded areas under the curve of 0.72 or lower for all variables and leads. Clockwise-rotated ST/HR loops was associated with increased risk in most leads compared to counterclockwise rotation. The limited clinical value of ExECG in low-risk populations was emphasized, but if performed, ST/HR analysis should probably be given more importance.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Electrocardiography, ST depression, ST/HR variables, low risk
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-159752 (URN)10.14814/phy2.13968 (DOI)000457188800007 ()30688031 (PubMedID)2-s2.0-85060598157 (Scopus ID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-26Bibliographically approved
Carlén, A., Åström Aneq, M., Nylander, E. & Gustafsson, M. (2017). Loaded treadmill walking and cycle ergometry to assess work capacity: a retrospective comparison in 424 firefighters.. Clinical Physiology and Functional Imaging, 37(1), 37-44
Open this publication in new window or tab >>Loaded treadmill walking and cycle ergometry to assess work capacity: a retrospective comparison in 424 firefighters.
2017 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 1, p. 37-44Article in journal (Refereed) Published
Abstract [en]

The fitness of firefighters is regularly evaluated using exercise tests. We aimed to compare, with respect to age and body composition, two test modalities for the assessment work capacity. A total of 424 Swedish firefighters with cycle ergometer (CE) and treadmill (TM) tests available from Jan 2004 to Dec 2010 were included. We compared results from CE (6 min at 200 W, 250 W or incremental ramp exercise) with TM (6 min at 8° inclination, 4·5 km h(-1) or faster, wearing 24-kg protective equipment). Oxygen requirements were estimated by prediction equations. It was more common to pass the TM test and fail the supposedly equivalent CE test (20%), than vice versa (0·5%), P<0·001. Low age and tall stature were significant predictors of passing both CE and TM tests (P<0·05), while low body mass predicted accomplishment of TM test only (P = 0·006). Firefighters who passed the TM but failed the supposedly equivalent CE test within 12 months had significantly lower body mass, lower BMI, lower BSA and shorter stature than did those who passed both tests. Calculated oxygen uptake was higher in TM tests compared with corresponding CE tests (P<0·001). Body constitution affected approval differently depending on the test modality. A higher approval rate in TM testing suggests lower cardiorespiratory requirements compared with CE testing, even though estimated oxygen uptake was higher during TM testing. The relevance of our findings in relation to the occupational demands needs reconsidering.

National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-120004 (URN)10.1111/cpf.12265 (DOI)000390688200006 ()26096157 (PubMedID)
Note

Funding agencies: ALF grants; County Council of Ostergotland, Sweden; Olav Axelssons memorial fund

Available from: 2015-07-02 Created: 2015-07-02 Last updated: 2019-08-21
Mourad, G., Strömberg, A., Jonsbu, E., Gustafsson, M., Johansson, P. & Jaarsma, T. (2016). Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain: -a pilot randomized controlled study. In: Abstract book: . Paper presented at EuroHeartCare Aten, Grekland 15-16 April 2016 (pp. S44-S44). Sage Publications, 15 (S1), Article ID P116.
Open this publication in new window or tab >>Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain: -a pilot randomized controlled study
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2016 (English)In: Abstract book, Sage Publications, 2016, Vol. 15 (S1), p. S44-S44, article id P116Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background: Patients with recurrent episodes of non-cardiac chest pain (NCCP) suffer from cardiac anxiety as they misinterpret the pain as being cardiac-related and avoid physical activity that they think could threaten their life. This could lead to increased healthcare utilization and costs. These patients might benefit from help and support to evaluate the perception and management of their chest pain. 

Objective: To test the feasibility of a short guided Internet-delivered cognitive behavioural intervention and the effects on chest pain, cardiac anxiety, fear of body sensations and depressive symptoms in patients with NCCP compared to usual care.

Methods: A pilot randomized controlled study was conducted. Fifteen patients, 9 men and 6 women between the age of 22 and 76 (median age of 66 years, q1-q3 57-73) were randomly assigned to either intervention (n=7) or control (n=8) group. Patients had recurrent NCCP and suffered from cardiac anxiety or fear of body sensations. The intervention consisted of a 4-session guided Internet-delivered cognitive behavioural therapy program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. All patients completed a web-based questionnaire on socio-demographic variables, chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. 

Results: Five out of the 7 patients in the intervention group completed all sessions as planned and two completed only parts of the program. The program was perceived as user-friendly with comprehensible language, adequate and varied content, and manageable homework assignments. The patients were engaged in the program for about 45-60 minutes per day and about 22 minutes’ therapist time was required to guide, support and give feedback to each patient throughout the program. Participating in the program empowered and motivated many of the patients to be active and complete the program. In general, patients in both the intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but there were no significant differences between the groups. 

Conclusions: A short guided Internet-delivered cognitive behavioural therapy program was feasible. Patients in both the intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. Patients should be followed-up for longer periods to measure the long-term effects of the intervention.

Place, publisher, year, edition, pages
Sage Publications, 2016
Series
European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:liu:diva-142713 (URN)10.1177/1474515116634263 (DOI)
Conference
EuroHeartCare Aten, Grekland 15-16 April 2016
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2019-06-27Bibliographically approved
Mourad, G., Strömberg, A., Jonsbu, E., Gustafsson, M., Johansson, P. & Jaarsma, T. (2015). Guided Internet-delivered cognitive behavioral therapy in patients with non-cardiac chest pain: a pilot randomized controlled study.
Open this publication in new window or tab >>Guided Internet-delivered cognitive behavioral therapy in patients with non-cardiac chest pain: a pilot randomized controlled study
Show others...
2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Patients with recurrent episodes of non-cardiac chest pain (NCCP) may suffer from cardiac anxiety and avoidance behavior, leading to increased healthcare utilization. These patients might benefit from help and support to evaluate the perception and management of their chest pain.

Objective: To test the feasibility of a short guided Internet-delivered CBT intervention and the effects on chest pain, cardiac anxiety, fear of body sensations and depressive symptoms in patients with NCCP compared to usual care.

Methods: A pilot randomized controlled study was conducted. Fifteen patients, nine men and six women with a median age of 66 years (range 22-76), were randomly assigned to either intervention (n=7) or control (n=8) group. Patients had recurrent episodes of non-cardiac chest pain and suffered from cardiac anxiety and/or fear of body sensations. The intervention consisted of a four-session guided Internet-delivered CBT program containing psychoeducation, physical activity, and relaxation. The control group received usual care. All patients completed a web-based questionnaire on socio-demographic variables, chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms.

Results: Five out of the seven patients in the intervention group completed all sessions as planned and two joined only parts of the program. The program was perceived as userfriendly with understandable language, adequate and varied content, and manageable homework assignments. The patients were engaged in the program for about 60 minutes per day and about 22 minutes’ therapist time was required to guide, support and give feedback to each patient through the program. Participating in the program, particularly being guided and supported, empowered and motivated many of the patients to be active and complete the program. In general, patients in both intervention and control groups improved with regard to chest pain frequency, cardiac  anxiety, fear of body sensations, and depressive symptoms, but there were no significant differences between the groups.

Conclusions: A short guided Internet-delivered CBT program was feasible. Patients in both intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. Patients should be followed-up for longer periods to measure the long-term effects of the intervention.

Keywords
Cardiac anxiety; cognitive behavioral therapy; fear of body sensations; Internet-delivered; non-cardiac chest pain; randomized controlled study
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-122591 (URN)
Available from: 2015-11-10 Created: 2015-11-10 Last updated: 2019-06-27Bibliographically approved
Gustafsson, M., Alehagen, U. & Johansson, P. (2015). Imaging congestion with a pocket ultrasound device - prognostic implications in patients with chronic heart failure.. Journal of Cardiac Failure, 21(7), 548-554
Open this publication in new window or tab >>Imaging congestion with a pocket ultrasound device - prognostic implications in patients with chronic heart failure.
2015 (English)In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 21, no 7, p. 548-554Article in journal (Refereed) Published
Abstract [en]

AIMS: Venous congestion is common in patients with chronic heart failure (HF). We used a pocket-sized ultrasound imaging device (PID) to assess the patient's congestive status and related our findings to prognosis.

METHODS AND RESULTS: 104 consecutive outpatients from an HF outpatient clinic were studied. Interstitial lung water (ILW), pleural effusion (PE) and the diameter of the vena cava inferior (VCI) were assessed using a PID. ILW was assessed by demonstration of B-lines (comet tail artefact (CTA). Out of the 104 patients, 28 had CTA, and eight had PE. Median VCI diameter was 18 mm, ±14/22 mm (quartiles). Each of these parameters correlated weakly (r= 0.26-0.37, p< 0.05) with the HF biomarker NT-proBNP. During the median follow-up time of 530 days, 14 hospitalizations deaths and 7 deaths were registered. Findings of CTA, PE or a composite of both, increased the risk of death or hospitalization (hazard ratio 3-4, p< 0.05). After adjustment for age, cardiac systolic function and NT-proBNP, this difference remained significant for CTA alone and CTA + PE combined, but not for PE alone.

CONCLUSION: By using a handheld ultrasound device, signs of pulmonary congestion could be demonstrated. When found, these had a significant prognostic impact in clinically stable HF.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-115148 (URN)10.1016/j.cardfail.2015.02.004 (DOI)000358105900003 ()25725475 (PubMedID)
Available from: 2015-03-10 Created: 2015-03-10 Last updated: 2017-12-04
de Geer, L., Oscarsson, A. & Gustafsson, M. (2015). Lung ultrasound in quantifying lung water in septic shock patients. Paper presented at 35th International Symposium on Intensive Care and Emergency Medicine, 17-20 March 2015, Brussels, Belgium. Critical Care, 19(1), 140
Open this publication in new window or tab >>Lung ultrasound in quantifying lung water in septic shock patients
2015 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 19, no 1, p. 140-Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Quantification of lung ultrasound (LUS) artifacts (B-lines) is used to assess pulmonary congestion in emergency medicine and cardiology [1,2]. We investigated B-lines in relation to extravascular lung-water index (EVLWI) from invasive transpulmonary thermodilution in septic shock patients. Our aim was to evaluate the role of LUS in an intensive care setting.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-117727 (URN)10.1186/cc14220 (DOI)
Conference
35th International Symposium on Intensive Care and Emergency Medicine, 17-20 March 2015, Brussels, Belgium
Available from: 2015-05-07 Created: 2015-05-07 Last updated: 2017-12-04Bibliographically approved
Gustafsson, M., Alehagen, U. & Johansson, P. (2015). Pocket-sized ultrasound examination of fluid imbalance in patients with heart failure: A pilot and feasibility study of heart failure nurses without prior experience of ultrasonography.. European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 14(4), 294-302
Open this publication in new window or tab >>Pocket-sized ultrasound examination of fluid imbalance in patients with heart failure: A pilot and feasibility study of heart failure nurses without prior experience of ultrasonography.
2015 (English)In: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, ISSN 1873-1953, Vol. 14, no 4, p. 294-302Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Detecting fluid imbalance in patients with chronic heart failure can be challenging. Use of a pocket-sized ultrasound device (PSUD) in addition to physical examination can be helpful to assess this important information.

AIM: To evaluate the feasibility for nurses without prior experience of ultrasonography to examine fluid imbalance by the use of a PSUD on heart failure patients.

METHOD: Four heart failure nurses and an expert cardiologist participated. The nurses underwent a four-hour PSUD training programme. One hundred and four heart failure outpatients were included. The examinations obtained information of pulmonary congestion, pleural effusion and the diameter of the vena cava inferior.

RESULTS: Examinations took nine minutes on average. In 28% and 14% of the patients, pulmonary congestion and pleural effusion respectively were found by the nurses. The sensitivities and specificities for nurses' findings were 79% and 91%, and, 88% and 93% respectively. The inter-operator agreement between the nurses and the cardiologist reached a substantial level (kappa values: 0.71 and 0.66). The inter-operator agreement for vena cava inferior reached a fair level (kappa value=0.39). Bland-Altman plots of the level of agreement revealed a mean difference of vena cava inferior diameter of 0.11 cm, while the 95% lower and upper limits ranged from -0.78 cm to 1.00 cm.

CONCLUSION: After brief training, heart failure nurses can reliably identify pulmonary congestion and pleural effusion with a PSUD. Assessment of vena cava inferior was less valid. PSUD readings, when added to the history and a physical examination, can improve nurse assessment of fluid status in patients with heart failure.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-113918 (URN)10.1177/1474515114559435 (DOI)000357949600003 ()25376773 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-08-11
Gustafsson, M. (2013). Arbetsprov hos rök- och kemdykare (1ed.). In: Lennart Jorfeldt, Olle Pahlm (Ed.), Kliniska arbetsprov: metoder för diagnos och prognos (pp. 433-438). Lund, Sverige: Studentlitteratur
Open this publication in new window or tab >>Arbetsprov hos rök- och kemdykare
2013 (Swedish)In: Kliniska arbetsprov: metoder för diagnos och prognos / [ed] Lennart Jorfeldt, Olle Pahlm, Lund, Sverige: Studentlitteratur, 2013, 1, p. 433-438Chapter in book (Other academic)
Abstract [sv]

Kliniska arbetsprov – metoder för diagnos och prognos är en vidareutveckling av en serie kompendier och böcker om arbetsprov med första utgåvan 1987. Titeländringen från Det kliniska arbetsprovet till den nya markerar att fältet breddats. Ursprungligen var arbetsprovet inriktat på bedömning av fysisk arbetsförmåga och på hjärtischemidiagnostik med EKG. Under senare år har i allt större utsträckning tillkommit nya diagnostiska modaliteter, inte som ­ersättning för EKG utan som komplement. Exempel är myokardskintigrafi, lungmekanik, analys av andnings- och blodgaser, ekokardiografi, dator­tomografi och magnetresonanstomografi. Dessa modaliteter beskrivs i detalj 
i boken och deras roll i patientutredningar värderas och diskuteras.

Boken vänder sig till alla som i sin vardagsgärning utför och bedömer arbetsprov, remitterar patienter till arbetsprov eller tar emot och utnyttjar undersökningsresultat; således ett brett spektrum av sjukvårdspersonal. Boken fyller också ett centralt behov i olika grundutbildningar, i första hand för BMA med inriktning mot klinisk fysiologi, sjukgymnaster och läkare.

Kliniska arbetsprov – metoder för diagnos och prognos är en lärobok och ett ­referensverk. Som lärobok kan den läsas som en ”läxbok” från pärm till pärm, men den är även anpassad för dem som enligt moderna pedagogiska ­principer vill fördjupa sina kunskaper kring ett problem och tillgodogöra sig ett begränsat avsnitt.

Place, publisher, year, edition, pages
Lund, Sverige: Studentlitteratur, 2013 Edition: 1
Keywords
Exercise test, Physiology, Klinisk fysiologi
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-103816 (URN)978-91-44-08383-4 (ISBN)9-1440-8-383-1 (ISBN)
Available from: 2014-01-28 Created: 2014-01-28 Last updated: 2014-10-13Bibliographically approved
Loitto, V.-M., Forslund, T., Sundqvist, T., Magnusson, K.-E. & Gustafsson, M. (2002). Neutrophil leukocyte motility requires directed water influx. Journal of Leukocyte Biology, 71(2), 212-222
Open this publication in new window or tab >>Neutrophil leukocyte motility requires directed water influx
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2002 (English)In: Journal of Leukocyte Biology, ISSN 0741-5400, E-ISSN 1938-3673, Vol. 71, no 2, p. 212-222Article in journal (Refereed) Published
Abstract [en]

The ability of neutrophils to sense and move to sites of infection is essential for our defense against pathogens. For motility, lamellipodium extension and stabilization are prerequisites, but how cells form such membrane protrusions is still obscure. Using contrast-enhanced video microscopy and Transwell® assays, we show that water-selective aquaporin channels regulate lamellipodium formation and neutrophil motility. Addition of anti-aquaporin-9 antibodies, HgCl2, or tetraethyl ammonium inhibited the function(s) of the channels and blocked motility-related shape changes. On human neutrophils, aquaporin-9 preferentially localized to the cell edges, where N-formyl peptide receptors also accumulated, as assessed with fluorescence microscopy. To directly visualize water fluxes at cell edges, cells were loaded with high dilution-sensitive, self-quenching concentrations of fluorophore. In these cells, motile regions always displayed increased fluorescence compared with perinuclear regions. Our observations provide the first experimental support for motility models where water fluxes play a pivotal role in cell-volume increases accompanying membrane extensions.

Keywords
aquaporins, anti-aquaporin antibodies, microscopy, HgCl2
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13606 (URN)
Available from: 2001-05-25 Created: 2001-05-25 Last updated: 2017-12-13
Gustafsson, M., Landtblom, A.-M. & Lundberg, P. (2000). Absolut kvantifiering av metaboliter i hjärnans vita substans hos patienter med MS och normal magnetkamerundersökning. In: : . Paper presented at Svenska läkaresällskapets riksstämma, Stockholm.
Open this publication in new window or tab >>Absolut kvantifiering av metaboliter i hjärnans vita substans hos patienter med MS och normal magnetkamerundersökning
2000 (Swedish)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:liu:diva-117300 (URN)
Conference
Svenska läkaresällskapets riksstämma, Stockholm
Available from: 2015-04-23 Created: 2015-04-23 Last updated: 2020-02-21
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3756-207X

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