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Frölund, M., Falk, L., Ahrens, P. & Jensen, J. S. (2019). Detection of ureaplasmas and bacterial vaginosis associated bacteria and their association with non-gonococcal urethritis in men. PLoS ONE
Open this publication in new window or tab >>Detection of ureaplasmas and bacterial vaginosis associated bacteria and their association with non-gonococcal urethritis in men
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203Article in journal (Refereed) Published
Abstract [en]

No aetiology is found in up to 40% of men with symptomatic urethritis. Male partners of women with bacterial vaginosis (BV) may be at higher risk of non-gonococcal urethritis (NGU). The aim of this study was to examine the role of BV associated bacteria in first-void urine (FVU) in 97 asymptomatic men without urethritis (controls) and 44 men (cases) with NGU including 20 men with idiopathic urethritis (IU) attending a Swedish STD-clinic between January and October 2010. BV-associated bacteria and ureaplasmas were detected by quantitative PCR assays. All BV associated bacteria, except Megasphaera-like type 1, were strongly positively correlated with Uurealyticum p<0.005 and even stronger with the combined Uurealyticum and Uparvum load (p<0.0005) suggesting that ureaplasma induced elevated pH may stimulate the growth of BV associated bacteria. No statistically significant differences were found between IU cases and controls in the prevalence or load of BV associated bacteria or ureaplasmas. In multiple logistic regression, Megasphaera-like type 1 was associated with IU (p = 0.03), but most positive FVU samples contained very few bacteria and the finding may not be clinically relevant.

Place, publisher, year, edition, pages
San Francisco, CA, United States: Public Library of Science, 2019
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-156363 (URN)10.1371/journal.pone.0214425 (DOI)000463314500031 ()30946763 (PubMedID)2-s2.0-85063929258 (Scopus ID)
Note

Funding agencies:  ALF-Grant [LIO-205751]; County Council of Ostergotland, Sweden; ALF-Grant from County Council of Ostergotland, Sweden [LIO-205751, LIO-60221, LIO-60311]

Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-06-12Bibliographically approved
Wijkman, M., Sandberg, K., Kleist, M., Falk, L. & Enthoven, P. (2018). The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.. The Journal of Clinical Hypertension, 20, 56-64
Open this publication in new window or tab >>The exaggerated blood pressure response to exercise in the sub-acute phase after stroke is not affected by aerobic exercise.
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2018 (English)In: The Journal of Clinical Hypertension, ISSN 1524-6175, E-ISSN 1751-7176, Journal of Clinical Hypertension, Vol. 20, p. 56-64Article in journal (Refereed) Published
Abstract [en]

The prevalence of an exaggerated exercise blood pressure (BP) response is unknown in patients with subacute stroke, and it is not known whether an aerobic exercise program modulates this response. The authors randomized 53 patients (27 women) with subacute stroke to 12 weeks of twice-weekly aerobic exercise (n = 29) or to usual care without scheduled physical exercise (n = 24). At baseline, 66% of the patients exhibited an exaggerated exercise BP response (peak systolic BP ≥210 mm Hg in men and ≥190 mm Hg in women) during a symptom-limited ergometer exercise test. At follow-up, patients who had been randomized to the exercise program achieved higher peak work rate, but peak systolic BP remained unaltered. Among patients with a recent stroke, it was common to have an exaggerated systolic BP response during exercise. This response was not altered by participation in a 12-week program of aerobic exercise.

Place, publisher, year, edition, pages
Hoboken, United States: Le Jacq Communications, Inc., 2018
National Category
Cardiac and Cardiovascular Systems Physiotherapy
Identifiers
urn:nbn:se:liu:diva-144586 (URN)10.1111/jch.13157 (DOI)000426039300010 ()29338111 (PubMedID)2-s2.0-85040842943 (Scopus ID)
Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2019-04-03Bibliographically approved
Strömfors, L., Wilhelmsson, S., Falk, L. & Höst, G. E. (2017). Experiences among children and adolescents of living with spina bifida and their visions of the future. Disability and Rehabilitation, 39(3), 261-271
Open this publication in new window or tab >>Experiences among children and adolescents of living with spina bifida and their visions of the future
2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 3, p. 261-271Article in journal (Refereed) Published
Abstract [en]

Purpose: Transitioning to independence may be problematic for persons with spina bifida (SB). Experiences of young persons with SB may provide insights into this group's needs for support. Therefore, the aim of this study was to investigate children'€™s and adolescents' experiences of living with SB, their social and emotional adjustment, and their thoughts about becoming independent adults. Method: Semi-structured interviews were conducted with young persons with SB (N = 8, age range 10 - 17 years). Social and emotional problems were assessed using Beck Youth Inventories. The interview transcripts were analyzed using qualitative content analysis. Results: Three main themes were found: being a person with SB; everyday living as a person with SB; and preparing for life as an adult with SB. Indications of emotional and social problems were most prominent among participants with milder physical disability. Conclusions: The findings indicate that young persons with SB may overestimate their independence. Other potentially problematic areas were lack of motivation, planning and preparedness for becoming independent. Research on transition to independence in this group should consider assistance at an early age in planning and executing strategies for independence. In addition, the potentially difficult situation for young persons with mild SB should be investigated further.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
spina bifida, independence, qualitative content analysis, children, adolescents, adjustment
National Category
Social Work Occupational Therapy
Identifiers
urn:nbn:se:liu:diva-125792 (URN)10.3109/09638288.2016.1146355 (DOI)000392480400006 ()26939640 (PubMedID)
Note

Funding agencies: Swedish Inheritance Fund, County Council of Ostergotland; Research Fund of the Linkoping University Hospital

Available from: 2016-03-04 Created: 2016-03-04 Last updated: 2018-04-18Bibliographically approved
Horner, P. J., Karla, B., Falk, L., van der Meijden, W. & Moi, H. (2016). 2016 European Guideline on the management of non-gonococcal urethritis. International Journal of STD and AIDS (London), 27(11), 928-937
Open this publication in new window or tab >>2016 European Guideline on the management of non-gonococcal urethritis
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2016 (English)In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 27, no 11, p. 928-937Article in journal (Refereed) Published
Abstract [en]

We present the updated International Union against Sexually Transmitted Infections guideline for the management of non-gonococcal urethritis in men. This guideline recommends confirmation of urethritis in symptomatic men before starting treatment. It does not recommend testing asymptomatic men for the presence of urethritis. All men with urethritis should be tested for Chlamydia trachomatis and Neisseria gonorrhoeae and ideally M. genitalium using a NAAT as this is highly likely to improve clinical outcomes. If a NAAT is positive for gonorrhoea, a culture should be performed before treatment. In view of the increasing evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium azithromycin 1 g is no longer recommended as first line therapy, which should be doxycycline 100 mg bd for 7 days. If azithromycin is to be prescribed an extended of 500 mg, then 250 mg daily for 4 days is to be preferred over 1 g stat. In men with persistent NGU, M. genitalium NAAT testing is recommended if not previously undertaken, as is Trichomonas vaginalis NAAT testing in populations where T. vaginalis is detectable in >2% of symptomatic women.

Place, publisher, year, edition, pages
Sage Publications, 2016
Keywords
Chlamydia (Chlamydia trachomatis); non-gonococcal urethritis
National Category
Dermatology and Venereal Diseases Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-128227 (URN)10.1177/0956462416648585 (DOI)000384444000001 ()27147267 (PubMedID)
Available from: 2016-05-23 Created: 2016-05-23 Last updated: 2017-11-30Bibliographically approved
Sandberg, K., Kleist, M., Falk, L. & Enthoven, P. (2016). Effects of Twice-Weekly Intense Aerobic Exercise inQ1 Early Subacute Stroke: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 97(8), 1244-1253
Open this publication in new window or tab >>Effects of Twice-Weekly Intense Aerobic Exercise inQ1 Early Subacute Stroke: A Randomized Controlled Trial
2016 (English)In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 97, no 8, p. 1244-1253Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To examine the effects of 12 weeks of twice-weekly intensive aerobic exercise on physical function and quality of life after subacute stroke.

DESIGN:

Randomized controlled trial.

SETTING:

Ambulatory care.

PARTICIPANTS:

Patients (N=56; 28 women) aged ≥50 years who had a mild stroke (98% ischemic) and were discharged to independent living and enrolled 20 days (median) after stroke onset.

INTERVENTIONS:

Sixty minutes of group aerobic exercise, including 2 sets of 8 minutes of exercise with intensity up to exertion level 14 or 15 of 20 on the Borg rating of perceived exertion scale, twice weekly for 12 weeks (n=29). The nonintervention group (n=27) received no organized rehabilitation or scheduled physical exercise.

MAIN OUTCOME MEASURES:

Primary outcome measures included aerobic capacity on the standard ergometer exercise stress test (peak work rate) and walking distance on the 6-minute walk test (6MWT). Secondary outcome measures included maximum walking speed for 10m, balance on the timed Up and Go (TUG) test and single leg stance (SLS), health-related quality of life on the European Quality of Life Scale (EQ-5D), and participation and recovery after stroke on the Stroke Impact Scale (SIS) version 2.0 domains 8 and 9. Participants were evaluated pre- and postintervention. Patient-reported measures were also evaluated at 6-month follow-up.

RESULTS:

The following improved significantly more in the intervention group (pre- to postintervention): peak work rate (group × time interaction, P=.006), 6MWT (P=.011), maximum walking speed for 10m (P<.001), TUG test (P<.001), SLS right and left (eyes open) (P<.001 and P=.022, respectively), and SLS right (eyes closed) (P=.019). Aerobic exercise was associated with improved EQ-5D scores (visual analog scale, P=.008) and perceived recovery (SIS domain 9, P=.002). These patient-reported improvements persisted at 6-month follow-up.

CONCLUSIONS:

Intensive aerobic exercise twice weekly early in subacute mild stroke improved aerobic capacity, walking, balance, health-related quality of life, and patient-reported recovery.

Place, publisher, year, edition, pages
Saunders Elsevier, 2016
Keywords
Exercise; Quality of life; Randomized controlled trial [publication type]; Rehabilitation; Stroke
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-128225 (URN)10.1016/j.apmr.2016.01.030 (DOI)000381244200005 ()26903147 (PubMedID)
Note

Funding agencies: Swedish Stroke Association, Stockholm, Sweden; Henry and Ella Margareta Stahl Foundation, Norrkoping, Sweden; Medical Research Council of Southeast Sweden, Sweden; Research and Development Council, Local Health Care, Norrkoping, Sweden

Available from: 2016-05-23 Created: 2016-05-23 Last updated: 2019-01-15
Falk, L., Enger, M. & Jensen, J. S. (2015). Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women.. Journal of Antimicrobial Chemotherapy, 70(11), 3134-3140
Open this publication in new window or tab >>Time to eradication of Mycoplasma genitalium after antibiotic treatment in men and women.
2015 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 70, no 11, p. 3134-3140Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

The objectives of this study were to evaluate the time to a Mycoplasma genitalium-negative test after start of treatment and to monitor if and when antibiotic resistance developed.

METHODS:

Sexually transmitted disease (STD) clinic attendees with suspected or verified M. genitalium infection were treated with azithromycin (5 days, 1.5 g; n = 85) or moxifloxacin (n = 5). Subjects with symptomatic urethritis or cervicitis of unknown aetiology were randomized to either doxycycline (n = 49) or 1 g of azithromycin as a single dose (n = 51). Women collected vaginal specimens and men collected first-catch urine 12 times during 4 weeks. Specimens were tested for M. genitalium with a quantitative MgPa PCR and for macrolide resistance-mediating mutations with a PCR targeting 23S rRNA.

CLINICAL TRIALS REGISTRATION:

NCT01661985.

RESULTS:

Ninety M. genitalium cases were enrolled. Of 56 patients with macrolide-susceptible strains before treatment with azithromycin (1.5 g, n = 46; 1 g single oral dose, n = 10), 54 (96%) had a negative PCR test within 8 days. In four patients, M. genitalium converted from macrolide susceptible to resistant after a 10 day lag time with negative tests (azithromycin 1.5 g, n = 3; 1 g single oral dose, n = 1). Moxifloxacin-treated subjects (n = 4) were PCR negative within 1 week. Six of eight (75%) remained positive despite doxycycline treatment.

CONCLUSIONS:

PCR for M. genitalium rapidly became negative after azithromycin treatment. Macrolide-resistant strains were detected after initially negative tests. Test of cure should be recommended no earlier than 3-4 weeks.

Place, publisher, year, edition, pages
Oxford University Press, 2015
Keywords
Mycoplasma genitalium, eradication, antibiotic resistance
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-120684 (URN)10.1093/jac/dkv246 (DOI)000368245500029 ()26283670 (PubMedID)
Funder
Medical Research Council of Southeast Sweden (FORSS)
Available from: 2015-08-20 Created: 2015-08-20 Last updated: 2017-12-04
Strömfors, L., Falk, L., Wilhelmsson, S. & Höst, G. E. (2014). Condition-related knowledge among children and adolescents with spina bifida in a Swedish county. Scandinavian Journal of Disability Research, 16(2), 127-140
Open this publication in new window or tab >>Condition-related knowledge among children and adolescents with spina bifida in a Swedish county
2014 (English)In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 16, no 2, p. 127-140Article in journal (Refereed) Published
Abstract [en]

Spina bifida is a congenital birth defect, resulting in physical and cognitive dysfunctions. Condition-related knowledge among children and adolescents with spina bifida is essential to facilitate independent management of their condition. The aim was to describe the condition-related knowledge among children and adolescents with spina bifida in a Swedish county. Thirteen persons with spina bifida (10 to 17 years) participated. Condition-related knowledge was assessed (n = 13) using a questionnaire (KOSB) and a semi-structured interview (n = 8). Interview data were analyzed using qualitative content analysis. The participants had well-developed knowledge concerning proper bladder management, but were lacking knowledge of signs of shunt malfunctioning and etiology. Some participants were uninterested in learning about their condition, despite being aware that they lacked knowledge. The findings indicate potential areas that may be included in local educational initiatives. It should be considered that persons with spina bifida may not be motivated to learn more about their condition.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2014
Keywords
spina bifida, children, adolescents, condition knowledge, qualitative content analysis
National Category
Psychology
Identifiers
urn:nbn:se:liu:diva-84979 (URN)10.1080/15017419.2012.735202 (DOI)
Available from: 2012-10-29 Created: 2012-10-29 Last updated: 2017-12-07
Falk, L., Hegic, S., Wilson, D. & Wiréhn, A.-B. (2014). Home-sampling as a Tool in the Context of Chlamydia trachomatis Partner Notification: A Randomized Controlled Trial. Acta Dermato-Venereologica, 94(1), 72-74
Open this publication in new window or tab >>Home-sampling as a Tool in the Context of Chlamydia trachomatis Partner Notification: A Randomized Controlled Trial
2014 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 94, no 1, p. 72-74Article in journal (Other academic) Published
Place, publisher, year, edition, pages
Society for the Publication of Acta Dermato - Venereologica, 2014
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-95424 (URN)10.2340/00015555-1624 (DOI)000329482200015 ()
Available from: 2013-07-03 Created: 2013-07-03 Last updated: 2019-02-11
Bergfors, E., Hermansson, G., Nyström Kronander, U., Falk, L., Valter, L. & Trollfors, B. (2014). How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study. European Journal of Pediatrics, 173(10), 1297-1307
Open this publication in new window or tab >>How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study
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2014 (English)In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 173, no 10, p. 1297-1307Article in journal (Refereed) Published
Abstract [en]

The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. Conclusion: Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2014
Keywords
Itching nodule, Granuloma, Contact allergy, Aluminium, Adsorbed vaccines, Child health care
National Category
Pediatrics
Identifiers
urn:nbn:se:liu:diva-107372 (URN)10.1007/s00431-014-2318-2 (DOI)000342227700004 ()24752308 (PubMedID)
Available from: 2014-06-11 Created: 2014-06-11 Last updated: 2017-12-05
Falk, L. (2012). Challenges of treatment for urethritis and cervicitis, (SY06:5). Paper presented at 9th European Academy of Dermatology and Venereology Spring Symposium, June 6-10, 2012, Verona, Italien.
Open this publication in new window or tab >>Challenges of treatment for urethritis and cervicitis, (SY06:5)
2012 (English)Conference paper, Oral presentation only (Other academic)
Abstract [en]

Challenges of treatment for urethritis and cervicitis

 

Urethritis in men caused by gonorrhoea is symptomatic. Non-gonorrhoic-urethritis (NGU) i.e. caused by Chlamydia trachomatis, Mycoplasma genitalium and occasionally other bacteria is in most cases an asymptomatic infection. Swartz’ definition of microscopic urethritis > 4 polymorphonucleated leucocytes (PML) per high power field (HPF) in > 4 HPF is the general accepted, but has limitations and is dependant on the sampling, microscope, the physician and the patient as well. Cervicitis is even more cumbersome since it is even more often asymptomatic. Other factors such as which contraception method is used, concurrent infections (bacterial vaginosis, candidosis), the microscope and the physician, may have a great impact. Brunham proposed as definition observed mucopurulent discharge from the cervix orifice combined with > 10 PML per HPF in stained endocervical smear. Lindner proposed sign of friability of the portio cervicis. Weström found a correlation of more PML than vaginal epithelial cells in wet mount. The variety of definitions causes problem in comparing scientific studies and at the clinic as well. The intention to treat also means testing and treatment of a current sexual partner as well.

 

The ever emerging decreased susceptibility of various antibiotics especially against Neisseria gonorrhoeae and M. genitalium makes it even more important to choose whether to treat immediately without having positive tests or to miss a treatment of a potential serious infection. N. gonorrhoeae is visible microscopically in urethral stains from men, but can be missed in smears from endocervix and urethra in women. Cefixim 400 mg stat is the recommended first line antibiotic treatment. Ceftriaxone 500 mg is under consideration to become the first treatment of choice due to emerging decreased susceptibility. M.genitalium will be discussed in another speech by Jørgen Skov Jensen. There are some few reports of antibiotic resistance of Chlamydia trachomatis but this infection is generally still eradicated by tetracycline and macrolide treatment. In an NGU and or unspecific cervicitis doxycycline 100 mg bid for one week is the first treatment of choice. Azithromycin 1 g stat should be used with precaution. If there are persisting signs and or symptoms after doxycycline treatment, azithromycin 500 mg day 1 and 250 mg following four days should be prescribed. Bacterial vaginosis may give symptoms and signs of cervicitis and is also a very common concurrent infection in women with C. trachomatis and M.genitalium as well and treatment with metronidazole or clindamycin should be considered. The fast ways of communication via the Internet and the easy accessible and legal way of an individual to buy antibiotics just for safe or to avoid attending a clinic is a big threat now and even more in the future because of the potential rapid increasing antibiotic resistance of many bacterial infections including STIs

Keywords
uretrit, cervicit, behandling
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-90227 (URN)
Conference
9th European Academy of Dermatology and Venereology Spring Symposium, June 6-10, 2012, Verona, Italien
Available from: 2013-03-21 Created: 2013-03-21 Last updated: 2015-09-22
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8336-9767

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