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  • 1.
    Aaltonen, Kristina E.
    et al.
    Lund University, Sweden.
    Rosendahl, Ann H.
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Olsson, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Malmstrom, Per
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Hartman, Linda
    Lund University, Sweden; Regional Cancer Centre South, Sweden.
    Ferno, Marten
    Lund University, Sweden.
    Association between insulin-like growth factor-1 receptor (IGF1R) negativity and poor prognosis in a cohort of women with primary breast cancer2014In: BMC Cancer, ISSN 1471-2407, Vol. 14, no 794Article in journal (Refereed)
    Abstract [en]

    Background: Resistance towards endocrine therapy is a great concern in breast cancer treatment and may partly be explained by the activation of compensatory signaling pathways. The aim of the present study was to investigate if the insulin-like growth factor-1 receptor (IGF1R) signaling pathway was activated or deregulated in breast cancer patients and to explore if any of the markers were prognostic, with or without adjuvant tamoxifen. This signaling pathway has been suggested to cause estrogen independent cell growth and thus contribute to resistance to endocrine treatment in estrogen receptor (ER) positive breast cancer. Methods: The protein expression of IGF1R, phosphorylated Mammalian Target of Rapamycin (p-mTOR) and phosphorylated S6 ribosomal protein (p-S6rp) were investigated by immunohistochemistry using tissue microarrays in two patient cohorts. Cohort I (N = 264) consisted of mainly postmenopausal women with stage II breast cancer treated with tamoxifen for 2 years irrespective of ER status. Cohort II (N = 206) consisted of mainly medically untreated, premenopausal patients with node-negative breast cancer. Distant disease-free survival (DDFS) at 5 years was used as end-point for survival analyses. Results: We found that lower IGF1R expression was associated with worse prognosis for tamoxifen treated, postmenopausal women (HR = 0.70, 95% CI = 0.52 - 0.94, p = 0.016). The effect was seen mainly in ER-negative patients where the prognostic effect was retained after adjustment for other prognostic markers (adjusted HR = 0.49, 95% CI = 0.29 - 0.82, p = 0.007). Expression of IGF1R was associated with ER positivity (p less than 0.001) in the same patient cohort. Conclusions: Our results support previous studies indicating that IGF1R positivity reflects a well differentiated tumor with low metastatic capacity. An association between lack of IGF1R expression and worse prognosis was mainly seen in the ER-negative part of Cohort I. The lack of co-activation of downstream markers (p-mTOR and p-S6rp) in the IGF1R pathway suggested that the prognostic effect was not due to complete activation of this pathway. Thus, no evidence could be found for a compensatory function of IGF1R signaling in the investigated cohorts.

  • 2.
    Aardal-Eriksson, Elisabeth
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Mobäck, Caroline
    Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Jakobsson, Sandra
    Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Germany.
    Hoffmann, Johannes J. M. L.
    Abbott GmbH and Co KG, Germany.
    Iron depletion in blood donors - Have extended erythrocyte and reticulocyte parameters diagnostic utility?2015In: Transfusion and apheresis science, ISSN 1473-0502, E-ISSN 1878-1683, Vol. 53, no 1, 76-81 p.Article in journal (Refereed)
    Abstract [en]

    Background: Blood donation is associated with iron depletion, but donor iron status is not usually investigated, as such tests are cumbersome and costly. It would therefore be desirable to have simple, fast and inexpensive tests that give information on a donors risk of developing iron depletion. In a pilot study we investigated whether novel erythrocyte and reticulocyte parameters can serve this goal. Methods: In regular blood donors extended red cell parameters were measured using the Abbott CELL-DYN Sapphire hematology analyzer and conventional biochemical tests of iron status. Donors were compared with a regionally matched group of non-donating controls. Results: In the controls, the reference ranges of extended RBC parameters were well comparable to published data. Donors had significantly more microcytic RBC than controls (median 0.9 vs 0.6%), lower serum ferritin concentration (median 43 vs 91 mg/L) and higher soluble transferrin receptor/ferritin index (median 1.60 vs 1.27). Overall 18-28% of the donors were iron depleted. Moreover, 3.3% of donors had iron-restricted erythropoiesis. Microcytic RBC and reticulocyte mean cell hemoglobin content predicted iron depletion with 70% and 64% sensitivities and specificities of 72% and 78%, respectively. When combined these two parameters increased the sensitivity to 82%. Conclusions: Our results in Swedish blood donors confirm a high prevalence of iron depletion, despite iron supplementation used by about half of the donors. Microcytic RBC and MCHr appeared to be helpful in identifying iron-depleted donors, who might benefit from iron supplementation. We recommend larger prospective investigations in order to confirm and extend the findings of this pilot study. (C) 2015 Elsevier Ltd. All rights reserved.

  • 3.
    Aase, Audun
    et al.
    Norwegian Institute Public Heatlh, Norway.
    Hajdusek, Ondrej
    Academic Science Czech Republic, Czech Republic.
    Oines, Oivind
    Norwegian Vet Institute, Norway.
    Quarsten, Hanne
    Sorlandet Hospital Health Enterprise, Norway.
    Wilhelmsson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Herstad, Tove K.
    Norwegian Institute Public Heatlh, Norway.
    Kjelland, Vivian
    University of Agder, Norway; Sorlandet Hospital Health Enterprise, Norway.
    Sima, Radek
    Academic Science Czech Republic, Czech Republic.
    Jalovecka, Marie
    Academic Science Czech Republic, Czech Republic.
    Lindgren, Per-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. County Hospital Ryhov, Sweden.
    Aaberge, Ingeborg S.
    Norwegian Institute Public Heatlh, Norway.
    Validate or falsify: Lessons learned from a microscopy method claimed to be useful for detecting Borrelia and Babesia organisms in human blood2016In: INFECTIOUS DISEASES, ISSN 2374-4235, Vol. 48, no 6, 411-419 p.Article in journal (Refereed)
    Abstract [en]

    Background A modified microscopy protocol (the LM-method) was used to demonstrate what was interpreted as Borrelia spirochetes and later also Babesia sp., in peripheral blood from patients. The method gained much publicity, but was not validated prior to publication, which became the purpose of this study using appropriate scientific methodology, including a control group. Methods Blood from 21 patients previously interpreted as positive for Borrelia and/or Babesia infection by the LM-method and 41 healthy controls without known history of tick bite were collected, blinded and analysed for these pathogens by microscopy in two laboratories by the LM-method and conventional method, respectively, by PCR methods in five laboratories and by serology in one laboratory. Results Microscopy by the LM-method identified structures claimed to be Borrelia- and/or Babesia in 66% of the blood samples of the patient group and in 85% in the healthy control group. Microscopy by the conventional method for Babesia only did not identify Babesia in any samples. PCR analysis detected Borrelia DNA in one sample of the patient group and in eight samples of the control group; whereas Babesia DNA was not detected in any of the blood samples using molecular methods. Conclusions The structures interpreted as Borrelia and Babesia by the LM-method could not be verified by PCR. The method was, thus, falsified. This study underlines the importance of doing proper test validation before new or modified assays are introduced.

  • 4.
    Abate, E.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. University of Gondar, Ethiopia.
    Elias, D.
    University of Southern Denmark, Denmark.
    Getachew, A.
    University of Gondar, Ethiopia.
    Alemu, S.
    University of Gondar, Ethiopia.
    Diro, E.
    University of Gondar, Ethiopia.
    Britton, S.
    Karolinska Hospital, Sweden.
    Aseffa, A.
    Armauer Hansen Research Institute, Ethiopia.
    Stendahl, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Schön, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Kalmar County Hospital, Sweden.
    Effects of albendazole on the clinical outcome and immunological responses in helminth co-infected tuberculosis patients: a double blind randomised clinical trial2015In: International Journal of Parasitology, ISSN 0020-7519, E-ISSN 1879-0135, Vol. 45, no 2-3, 133-140 p.Article in journal (Refereed)
    Abstract [en]

    Despite several review papers and experimental studies concerning the impact of chronic helminth infection on tuberculosis in recent years, there is a scarcity of data from clinical field studies in highly endemic areas for these diseases. We believe this is the first randomised clinical trial investigating the impact of albendazole treatment on the clinical and immunological outcomes of helminth co-infected tuberculosis patients. A randomised, double-blind, placebo-controlled trial of albendazole (400 mg per day for 3 days) in helminth-positive tuberculosis patients was conducted in Gondar, Ethiopia. The primary outcome was clinical improvement (Delta TB score) after 2 months. Among secondary outcomes were changes in the levels of eosinophils, CD4+ T cells, regulatory T cells, IFN-gamma, IL-5 and IL-10 after 3 months. A total of 140 helminth co-infected tuberculosis patients were included with an HIV co-infection rate of 22.8%. There was no significant effect on the primary outcome (Delta TB score: 5.6 +/- 2.9 for albendazole versus 5.9 +/- 2.5 for placebo, P = 0.59). The albendazole-treated group showed a decline in eosinophil cells (P = 0.001) and IL-10 (P = 0.017) after 3 months. In an exploratory analysis after 12 weeks, the albendazole treated group showed a trend towards weight gain compared with the placebo group (11.2 +/- 8.5 kg versus 8.2 +/- 8.7 kg, P = 0.08)). The reductions in eosinophil counts and IL-10 show that asymptomatic helminth infection significantly affects host immunity during tuberculosis and can be effectively reversed by albendazole treatment. The clinical effects of helminth infection on chronic infectious diseases such as tuberculosis merit further characterisation. (C) 2014 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved.

  • 5.
    Abbas, Ashraf H.
    et al.
    Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Adly, Osama A.
    Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
    Elbadawy, Mohamed A.
    Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
    Moati, Taha Ali
    General Surgery department, Suez Canal University, Ismailia, Egypt.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Aesthetic Outcome After Reconstruction of Complex SoftTissue Defects with Free Antero-Lateral Thigh Flap UsingSimple Equipment2015In: Journal of surgery, ISSN 2330-0914, Vol. 3, no 2-1, 36-41 p.Article in journal (Refereed)
    Abstract [en]

    Aim: We aimed to assess the aesthetic outcome of surgical reconstruction by free ALT flap using binocular single-refraction magnifying glasses and a modified post- operative surveillance protocol. Methods: 16 patients were operated for free antero-lateral thigh flap to reconstruct complex soft tissue defects with a close clinical follow up protocol for post operative care depending on the attending personnel in the Plastic surgery unit, Suez Canal University hospital, Ismailia, Egypt. Aesthetic outcome was assessed using a questionnaire based on Posch et al. 2005, including the following items colour, contour, presence of hair, overall appearance and donor site scar. Results: The patients’ assessed aesthetic outcome was acceptable in majority of the cases; median score was 4 for all assessed items. Complete flap loss occurred in one case, other complications as arterial thrombosis and hematomas and infection were detected and managed accordingly with flap salvage in the 3 complicated cases. Conclusion: The result suggests that the proposed protocol is sufficient as an alternative. The aesthetic outcome assessed by the patient and the failure rate was in line with other studies.

  • 6.
    Abbott, Allan
    Karolinska Institute, Sweden.
    The Coping Strategy Questionnaire2010In: Journal of Physiotherapy, ISSN 1836-9553, E-ISSN 1836-9561, Vol. 56, no 1, 63-63 p.Article in journal (Other academic)
  • 7.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska University Hospital, Karolinska Institute, Stockholm , Sweden.
    Hedlund, Rune
    Department of Orthopaedics, Institute for Clinical Science, University of Gothenburg, Gothenburg, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Patient’s experience post-lumbar fusion regarding back problems, recovery and expectations in terms of the international classification of functioning, disability and health.2011In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, no 15-16, 1399-1408 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To describe within the context of the International Classification of Functioning, Disability and Health (ICF), patient's experiences post-lumber fusion regarding back problems, recovery and expectations of rehabilitation and to contrast with the content of outcome measures and the ICF low back pain (LBP) core sets.

    METHODS:

    The study has a cross-sectional and retrospective design and involves 20 lumbar fusion patients. Using the ICF, qualitative content analysis of semi-structured interviews 3-6 months post-surgery was performed. This was compared with the ICF related content of the Oswestry Disability Index (ODI), Medical Outcome Study Short Form 36 (SF-36), European Quality of Life Questionnaire (EQ5D) and the ICF LBP core sets.

    RESULTS:

    Patient's experiences were most frequently linked to psychological, sensory, neuromusculoskeletal and movement related body function chapters of the ICF. The most frequently linked categories of activity and participation were mobility, domestic activities, family relationships, work, recreation and leisure. Environmental factors frequently linked were the use of analgesics, walking aids, family support, social security systems, health care systems and labour market employment services.

    CONCLUSIONS:

    This study highlights important ICF related aspects of patient's experiences post-lumber fusion. The use of the comprehensive ICF core sets is recommended in conjunction with ODI, SF-36 and the EQ5D for a broader analysis of patient outcomes post-lumbar fusion.

  • 8.
    Abbott, Allan
    et al.
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden; Bond University, Gold Coast, Australia.
    Möller, Hans
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    Gerdhem, Paul
    Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Stockholm, Sweden.
    CONTRAIS: CONservative TReatment for Adolescent Idiopathic Scoliosis: a randomised controlled trial protocol2013In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 14, 261Article in journal (Refereed)
    Abstract [en]

    Background:

    Idiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis.

    Methods/design:

    Patients: Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25–40 degrees will be included. A total of 135 participants will be randomly allocated in groups of 45 patients each to receive one of the three interventions.Interventions: All three groups will receive a physical activity prescription according to the World Health Organisation recommendations. One group will additionally wear a hyper-corrective night-time brace. One group will additionally perform postural scoliosis-specific exercises.Outcome: Participation in the study will last until the curve has progressed, or until cessation of skeletal growth. Outcome variables will be measured every 6 months. The primary outcome variable, failure of treatment, is defined as progression of the Cobb angle more than 6 degrees, compared to the primary x-ray, seen on two consecutive spinal standing x-rays taken with 6 months interval. Secondary outcome measures include the SRS-22r and EQ5D-Y quality of life questionnaires, the International Physical Activity Questionnaire (IPAQ) short form, and Cobb angle atend of the study.

    Discussion:This trial will evaluate which of the tested conservative treatment approaches that is the most effective for patients with adolescent idiopathic scoliosis.

    Trial registration: NCT01761305

  • 9.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Karolinska University Hospital; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Hedlund, Rune
    Department for Orthopaedics, Institute for Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Early rehabilitation targeting cognition, behaviour and motor function after lumbar fusion: A randomized controlled trial2010In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 35, no 8, 848-857 p.Article in journal (Refereed)
    Abstract [en]

    Study Design - Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up.

    Objective - To investigate the effectiveness of a psychomotor therapy focusing on cognition, behavior, and motor relearning compared with exercise therapy applied during the first 3 months after lumbar fusion.

    Summary of Background Data - Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery.

    Methods - The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion because of 12 months of symptomatic spinal stenosis, spondylosis, degenerative/isthmic spondylolisthesis, or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal, and leg muscle functional strength and endurance, stretching, and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviors, and motor control. Rated questionnaires investigating functional disability, pain, health-related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, and coping were assessed at 3, 6, 12 months, and 2 to 3 years after surgery.

    Results - Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges.

    Conclusion - The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.

  • 10.
    Abbott, Allan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. Department of Physical Therapy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Orthopaedics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Hedlund, Rune
    Department for Orthopaedics, Institute for Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Leg pain and psychological variables predict outcome 2-3 years after lumber fusion surgery2011In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 20, no 10, 1626-1634 p.Article in journal (Refereed)
    Abstract [en]

    Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

  • 11.
    Abbott, Allan
    et al.
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden.
    Tyni-Lenné, Raija
    Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
    Hedlund, Rune
    Institute for Clinical Sciences, Department for Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    The influence of psychological factors on pre-operative levels of pain intensity, disability and HRQOL in lumbar spinal fusion surgery patients2010In: Physiotherapy, ISSN 0031-9406, E-ISSN 1873-1465, Vol. 96, no 3, 213-221 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.

    DESIGN:

    Cross-sectional, correlation study.

    SETTING:

    Orthopaedic outpatient setting in a tertiary hospital.

    PARTICIPANTS:

    One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.

    MEASURES:

    Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.

    RESULTS:

    The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.

    CONCLUSIONS:

    This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.

    Copyright 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  • 12.
    Abd Al Qahar Al-Kubaisy, Waqar
    et al.
    MARA University of Technology, Sungai Buloh, Malaysia; MARA University of Technology UiTM, Malaysia.
    Jawad Obaid, Kadhim
    MARA University of Technology, Sungai Buloh, Malaysia.
    Aini Mohd Noor, Nor
    MARA University of Technology, Sungai Buloh, Malaysia; MARA University of Technology UiTM, Shah Alam, Selangor, Malaysia.
    Shamsidah Binti Nik Ibrahim, Nik
    MARA University of Technology, Sungai Buloh, Malaysia.
    Albu-Kareem Al-Azawi, Ahmed
    Östergötlands Läns Landsting.
    Hepatitis C virus prevalence and genotyping among hepatocellular carcinoma patients in Baghdad2014In: Asian Pacific Journal of Cancer Prevention, ISSN 1513-7368, Vol. 15, no 18, 7725-7730 p.Article in journal (Refereed)
    Abstract [en]

    Hepatocellular carcinoma (HCC) is the third most common cause for cancer death in the world, now being especially linked to chronic hepatitis C virus (HCV) infection. This case-control study consisting of 65 HCC patients and 82 patients with other malignant tumours as controls was conducted to determine the association of HCV markers with HCC. Serum of each participant was obtained for detection of HCV Ab and RNA by DNA enzyme immunoassay (DEIA). Twenty six per cent (26.0%) of HCC patients had positive anti-HCV which was significantly greater than the control group (p=0.001). HCC patients significantly have a risk of exposure to HCV infection almost 3 times than the control group (OR=2.87, 95% C.I=1.1-7). Anti-HCV seropositive rate was significantly (p=0.03) higher among old age HCC patients and increases with age. Males with HCC significantly showed to have more than 9 times risk of exposure to HCV infection (OR=9.375, 95 % CI=1.299-67.647) than females. HCV-RNA seropositive rate was (70.8%) significantly higher among HCC patients compared to (22.2%) the control group (p=0.019). The most prevalent genotype (as a single or mixed pattern of infection) was HCV-1b. This study detected a significantly higher HCV seropositive rate of antibodies and RNA in HCC patients.

  • 13.
    Abdalla, Maie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Suez Canal University, Egypt.
    Landerholm, Kalle
    Ryhov County Hospital, Sweden.
    Andersson, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Andersson, Roland
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Ryhov County Hospital, Sweden.
    Myrelid, Pär
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Risk of Rectal Cancer After Colectomy for Patients With Ulcerative Colitis: A National Cohort Study2017In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 15, no 7, 1055-1060 p., e2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND amp; AIMS: Patients with ulcerative colitis (UC) have an increased risk of rectal cancer, therefore reconstruction with an ileal pouch-anal anastomosis (IPAA) generally is preferred to an ileorectal anastomosis (IRA) after subtotal colectomy. Similarly, completion proctectomy is recommended for patients with ileostomy and a diverted rectum, although this approach has been questioned because anti-inflammatory agents might reduce cancer risk. We performed a national cohort study in Sweden to assess the risk of rectal cancer in patients with UC who have an IRA, IPAA, or diverted rectum after subtotal colectomy.

    METHODS: We collected data from the Swedish National Patient Register for a cohort of 5886 patients with UC who underwent subtotal colectomy with an IRA, IPAA, or diverted rectum from 1964 through 2010. Patients who developed rectal cancer were identified from the Swedish National Cancer Register. The risk of rectal cancer was compared between this cohort and the general population by standardized incidence ratio analysis.

    RESULTS: Rectal cancer occurred in 20 of 1112 patients (1.8%) who received IRA, 1 of 1796 patients (0.06%) who received an IPAA, and 25 of 4358 patients (0.6%) with a diverted rectum. Standardized incidence ratios for rectal cancer were 8.7 in patients with an IRA, 0.4 in patients with an IPAA, and 3.8 in patients with a diverted rectum. Risk factors for rectal cancer were primary sclerosing cholangitis in patients with an IRA (hazard ratio, 6.12), and colonic severe dysplasia or cancer before subtotal colectomy in patients with a diverted rectum (hazard ratio, 3.67).

    CONCLUSIONS: In an analysis of the Swedish National Patient Register, we found that the risk for rectal cancer after colectomy in patients with UC is low, in relative and absolute terms, after reconstruction with an IPAA. An IRA and diverted rectum are associated with an increased risk of rectal cancer, compared with the general population, but the absolute risk is low. Patients and their health care providers should consider these findings in making decisions to leave the rectum intact, perform completion proctectomy, or reconstruct the colon with an IRA or IPAA.

  • 14.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Olofsson, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 3, e0174579Article in journal (Refereed)
    Abstract [en]

    Patients and Methods: Surgically managed burn patients admitted between 2010-14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay.less thanbr /greater thanResults: Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, pless than0.01). The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65). Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean) 12 and 17 days (pless than0.001, R2 0.51).less thanbr /greater thanConclusion: Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.

  • 15.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. a Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Improvement in mortality at a National Burn Centre since 2000: Was it the result of increased resources?2017In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 25, e6727Article in journal (Refereed)
    Abstract [en]

    Abstract The aim of this study was to find out whether the charging costs (calculated using interventional burn score) increased as mortality decreased. During the last 2 decades, mortality has declined significantly in the Linköping Burn Centre. The burn score that we use has been validated as a measure of workload and is used to calculate the charging costs of each burned patient. We compared the charging costs and mortality in 2 time periods (2000–2007 and 2008–2015). A total of 1363 admissions were included. We investigated the change in the burn score, as a surrogate for total costs per patient. Multivariable regression was used to analyze risk-adjusted mortality and burn score. The median total body surface area % (TBSA%) was 6.5% (10–90 centile 1.0–31.0), age 33 years (1.3–72.2), duration of stay/ TBSA% was 1.4 days (0.3–5.3), and 960 (70%) were males. Crude mortality declined from 7.5% in 2000–2007 to 3.4% in 2008–2015, whereas the cumulative burn score was not increased (P=.08). Regression analysis showed that risk-adjusted mortality decreased (odds ratio 0.42, P=.02), whereas the adjusted burn score did not change (P=.14, model R2 0.86). Mortality decreased but there was no increase in the daily use of resources as measured by the interventional burn score. The data suggest that the improvements in quality obtained have been achieved within present routines for care of patients (multidisciplinary/ orientated to patients’ safety).

    Abbreviation: TBSA% = total body surface area %.

  • 16.
    Abdelrahman, Islam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt.
    Moghazy, Amr
    Suez Canal University, Egypt.
    Abbas, Ashraf
    Suez Canal University, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Suez Canal University, Egypt.
    Adly, Osama
    Suez Canal University, Egypt.
    Elbadawy, Mohamed
    Suez Canal University, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy2016In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 69, no 8, 1121-1127 p.Article in journal (Refereed)
    Abstract [en]

    Distal half leg complex wounds are usually a formidable problem that necessitates either local or free flap coverage. The aim of this study was to compare cost billing charges in free Gracilis flap (fGF) and local fasciocutaneous perforator flap (lFPF) in reconstructing complex soft tissue leg and foot defects. Patients and methods: Thirty consecutive adult (amp;gt; 15-year-old) patients with soft tissue defects in the leg and/or foot requiring tissue coverage with a flap in the period between 2012 and 2015 were randomly assigned (block randomization) to either an fGF or lFPF procedure. The outcome measures addressed were total billed charges costs, perioperative billed charges cost, partial or complete flap loss, length of hospital stay, inpatient postsurgical care duration, complications, operating time and number of operative scrub staff. Results: One patient suffered from complete flap loss in each group. Reconstruction with lFPF showed total lower billed charges costs by 62% (2509 USD) (p amp;lt; 0.001) and perioperative billed charges cost by 54% (779 USD) (p amp;lt; 0.001), and shorter total hospital stay (36.5 days; p amp;lt; 0.001), inpatient postsurgical care duration (6.4 days; p amp;lt; 0.001), operating time (4.3 h; p amp;lt; 0.001) and fewer scrub staff (2.2 persons; p amp;lt; 0.001). Conclusion: These results suggest that neither flap is totally superior to the other; the choice should instead be based on the outcome sought and logistics. lFPF requires lower billed charges cost and resource use and saves operative time and personnel and reduces length of hospital stay. Our approach changed towards using perforator flaps in medium-sized defects, keeping the free flap option for larger defects. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  • 17.
    Abdelrahman, Islam Mohamedy
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Elmasry, Moustafa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Plastic Surgery Unit, Surgery Department, Suez Canal University, Ismailia, Egypt.
    Steinvall, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery.
    Sjöberg, Folke
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Hand and Plastic Surgery. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping.
    Response to comments on: A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy2017In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 70, no 9, 1307-1308 p.Article in journal (Other academic)
  • 18.
    Abednazari, Hossin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. PEAS Institute, Linköping.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Almroth, Gabriel
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Nilsson, Ingela
    Kalmar County Hospital, Sweden.
    Nayeri, Fariba
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Hepatocyte growth factor is a reliable marker for efficient anti-bacterial therapy within the first day of treatment2014In: Advances in Bioscience and Biotechnology, ISSN 2156-8456, E-ISSN 2156-8502, Vol. 5, no 10, 823-830 p.Article in journal (Refereed)
    Abstract [en]

    Rapid diagnosis and choice of appropriate antibiotic treatment might be life-saving in serious infectious diseases. Still the available markers that can evaluate and monitor the diagnosis and treatment are few. Hepatocyte growth factor (HGF) has been studied as a potent regenerative factor produced and released during injuries such as infectious diseases. Monitoring of HGF levels might predict therapy results better than C-reactive protein (CRP) within the first day of treatment in pneumonia. For further investigation of previous observations we aimed to study HGF as a first-day marker in over-representing infectious diseases in comparison to procalcitonin (PCT), CRP and body temperature. Fifty-one patients with community acquired infectious diseases were included consequently at admittance and the serum samples were collected before and within 18 - 24 hours of treatment. HGF levels decreased significantly in case of efficient antibiotic therapy and HGF was shown to be better than PCT, CRP and body temperature to evaluate treatment. In patients with pneumonia, monitoring of HGF was most reasonable. HGF might be used as a therapeutic marker within the first day of empiric antibiotic treatment during infection.

  • 19.
    Abelius, Martina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Enke, Uta
    University Hospital Jena, Germany.
    Varosi, Frauke
    University Hospital Jena, Germany.
    Hoyer, Heike
    University Hospital Jena, Germany.
    Schleussner, Ekkehard
    University Hospital Jena, Germany.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Markert, Udo R.
    University Hospital Jena, Germany.
    Placental immune response to apple allergen in allergic mothers2014In: Journal of Reproductive Immunology, ISSN 0165-0378, E-ISSN 1872-7603, Vol. 106, 100-109 p.Article in journal (Refereed)
    Abstract [en]

    The immunological milieu in the placenta may be crucial for priming the developing foetal immune system. Early imbalances may promote the establishment of immune-mediated diseases in later life, including allergies. The initial exposure to allergens seems to occur in utero, but little is known about allergen-induced placental cytokine and chemokine release. The release of several cytokines and chemokines from placenta tissue after exposure to mast cell degranulator compound 48/80 or apple allergen in placentas from allergic and healthy mothers was to be analysed. Four placentas from women with apple allergy and three controls were applied in a placental perfusion model with two separate cotyledons simultaneously perfused with and without apple allergen (Mal d 1). Two control placentas were perfused with compound 48/80. In outflow, histamine was quantified spectrophotofluorometrically, IL-2, IL-4, IL-6, IL-10, TNF and IFN-gamma by a cytometric multiplex bead array and IL-13 and CXCL10, CXCL11, CCL17 and CCL22 with an in-house multiplex Luminex assay. Compound 48/80 induced a rapid release of histamine, CXCL10, CXCL11, CCL17 and CCL22, but not of the other factors. Apple allergen induced a time-dependent release of IL-6 and TNF, but not of histamine, in placentas of women with apple allergy compared with the unstimulated cotyledon. CCL17 levels were slightly increased after allergen stimulation in control placentas. Allergens can induce placental cytokines and chemokines distinctly in allergic and healthy mothers. These mediators may affect the prenatal development of the immune system and modify the risk of diseases related to immune disorders in childhood such as allergies.

  • 20.
    Abelius, Martina S
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Janefjord, Camilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Matthiesen, Leif
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Helsingborg Hospital, Helsingborg.
    Duchén, Karel
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Nilsson, Lennart J
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    The Placental Immune Milieu is Characterized by a Th2- and Anti-Inflammatory Transcription Profile, Regardless of Maternal Allergy, and Associates with Neonatal Immunity2015In: American Journal of Reproductive Immunology, ISSN 1046-7408, E-ISSN 1600-0897, Vol. 73, no 5, 445-459 p.Article in journal (Refereed)
    Abstract [en]

    PROBLEM: How maternal allergy affects the systemic and local immunological environment during pregnancy and the immune development of the offspring is unclear.

    METHOD OF STUDY: Expression of 40 genes was quantified by PCR arrays in placenta, peripheral blood mononuclear cells (PBMC), and cord blood mononuclear cells (CBMC) from 7 allergic and 12 non-allergic women and their offspring.

    RESULTS: Placental gene expression was dominated by a Th2-/anti-inflammatory profile, irrespectively of maternal allergy, as compared to gene expression in PBMC. p35 expression in placenta correlated with fetal Tbx21 (ρ = -0.88, P < 0.001) and IL-5 expression in PBMC with fetal galectin1 (ρ = 0.91, P < 0.001). Increased expression of Th2-associated CCL22 in CBMC preceded allergy development.

    CONCLUSIONS: Gene expression locally and systemically during pregnancy was partly associated with the offspring's gene expression, possibly indicating that the immunological milieu is important for fetal immune development. Maternal allergy was not associated with an enhanced Th2 immunity in placenta or PBMC, while a marked prenatal Th2 skewing, shown as increased CCL22 mRNA expression, might contribute to postnatal allergy development.

  • 21.
    Aboulaich, Nabila
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Expanding role of caveolae in control of adipocyte metabolism: proteomics of caveolae2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The primary function of adipose tissue is to store energy in the form of triacylglycerol, which is hydrolyzed to fatty acids to supply other tissues with energy. While insulin promotes the storage of triacylglycerol, catecholamines stimulate its hydrolysis. The development of type II diabetes is strongly associated with obesity, indicating a role of triacylglycerol metabolism in the pathogenesis of diabetes. Caveolae are plasma membrane invaginations found in most cells but are highly abundant in adipocytes. Insulin receptors are localized in caveolae and their function depends on intact caveolae structures. In the present thesis work, mass spectrometry-based methodology allowed identification of a number of new proteins and their posttranslational modifications in caveolae of human adipocytes. Variable N-terminal acetylation and phosphorylation of caveolin-1α and caveolin-1β were identified, which might regulate the function of caveolae. The transcription regulator protein PTRF was identified as the major caveolae associated protein. Specific proteolytic modifications of PTRF at the cytosolic surface of caveolae and phosphorylation on nine serine and one threonine residues were identified. Moreover, insulin induced translocation of PTRF from the plasma membrane to the nucleus. PTRF was previously shown to regulate the activity of both RNA polymerase I and polymerase II, thus a role of PTRF in mediating the anabolic action of insulin on protein synthesis and gene transcription is proposed.

    PTRF was also involved in an extranuclear function in the hormonal regulation of triacylglycerol metabolism in caveolae. PTRF was colocalized with the triacylglycerol regulator proteins perilipin and hormone-sensitive lipase (HSL) in the triacylglycerol-synthesizing caveolae subclass. We showed that, while perilipin was translocated to the plasma membrane, both PTRF and HSL were translocated from the plasma membrane to the cytosol as a complex in response to insulin. The perilipin recruited to the plasma membrane was highly threonine phosphorylated. By mass spectrometry, three phosphorylated threonine residues were identified and were located in an acidic domain in the lipid droplet targeting domain of perilipin. The insulin-induced recruitment of perilipin to the plasma membrane might, therefore be phosphorylation-dependent. Isoproterenol, which stimulates hydrolysis of triacylglycerol, induced a complete depletion of perilipin B from the plasma membrane, suggesting a function of perilipin B to protect newly synthesized triacylglycerol in caveolae from being hydrolyzed by HSL. The location of PTRF and HSL was not affected by isoproterenol, indicating that insulin is acting against a default presence of PTRF and HSL in caveolae.

    Taken together, this thesis expands our knowledge about caveolae and provided valuable information about their involvement in novel roles, particularly in the hormonal regulation of triacylglycerol metabolism.

    List of papers
    1. Vectorial proteomics reveal targeting, phosphorylation and specific fragmentation of polymerase I and transcript release factor (PTRF) at the surface of caveolae in human adipocytes
    Open this publication in new window or tab >>Vectorial proteomics reveal targeting, phosphorylation and specific fragmentation of polymerase I and transcript release factor (PTRF) at the surface of caveolae in human adipocytes
    2004 (English)In: The Biochemical journal, ISSN 1470-8728, Vol. 383, no Pt 2, 237-248 p.Article in journal (Refereed) Published
    Abstract [en]

    Caveolae, the specialized invaginations of plasma membranes, formed sealed vesicles with outwards-orientated cytosolic surface after isolation from primary human adipocytes. This morphology allowed differential, vectorial identification of proteins at the opposite membrane surfaces by proteolysis and MS. Extracellular-exposed caveolae-specific proteins CD36 and copper-containing amine oxidase were concealed inside the vesicles and resisted trypsin treatment. The cytosol-orientated caveolins were efficiently digested by trypsin, producing peptides amenable to direct MS sequencing. Isolation of peripheral proteins associated with the cytosolic surface of caveolae revealed a set of proteins that contained nuclear localization signals, leucine-zipper domains and PEST (amino acid sequence enriched in proline, glutamic acid, serine and threonine) domains implicated in regulation by proteolysis. In particular, PTRF (polymerase I and transcript release factor) was found as a major caveolae-associated protein and its co-localization with caveolin was confirmed by immunofluorescence confocal microscopy. PTRF was present at the surface of caveolae in the intact form and in five different truncated forms. Peptides (44 and 45 amino acids long) comprising both the PEST domains were sequenced by nanospray-quadrupole-time-of-flight MS from the full-length PTRF, but were not found in the truncated forms of the protein. Two endogenous cleavage sites corresponding to calpain specificity were identified in PTRF; one of them was in a PEST domain. Both cleavage sites were flanked by mono- or diphosphorylated sequences. The phosphorylation sites were localized to Ser-36, Ser-40, Ser-365 and Ser-366 in PTRF. Caveolae of human adipocytes are proposed to function in targeting, relocation and proteolytic control of PTRF and other PEST-domain-containing signalling proteins.

    Keyword
    Caveolae, human adipocyte, MS, PEST sequence, polymerase I and transcript release factor (PTRF), proteolysis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19145 (URN)10.1042/BJ20040647 (DOI)15242332 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2009-06-12Bibliographically approved
    2. N-terminal processing and modifications of caveolin-1 in caveolae from human adipocytes
    Open this publication in new window or tab >>N-terminal processing and modifications of caveolin-1 in caveolae from human adipocytes
    Show others...
    2004 (English)In: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, E-ISSN 1090-2104, Vol. 320, no 2, 480-486 p.Article in journal (Refereed) Published
    Abstract [en]

    Caveolin, the principal structural protein of caveolae membrane domains, has a cytosol-exposed N-terminal part that was cleaved off by trypsin treatment of caveolae vesicles isolated from primary human adipocytes. Sequencing of the released tryptic peptides by nanospray quadrupole time-of-flight mass spectrometry revealed that both caveolin-1alpha and caveolin-1beta were processed by excision of the starting methionines. The N-terminus of the mature caveolin-1alpha was acetylated, while caveolin-1beta was found in acetylated as well as in non-acetylated forms. Fractional phosphorylation of serine-36 in the mature caveolin-1alpha and of the homologous serine-5 in caveolin-1beta was identified. This is the first experimental evidence for in vivo phosphorylation of caveolin-1 at the consensus site for phosphorylation by protein kinase C. The phosphorylation was found in both the acetylated and non-acetylated variants of caveolin-1beta. This variability in modifications is consistent with critical involvement of the N-terminal domain of caveolin in the regulation of caveolae.

    Keyword
    Human adipocyte, Caveolin-1; Caveolae, Protein phosphorylation, N-terminal acetylation, Mass spectrometry
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19146 (URN)10.1016/j.bbrc.2004.05.196 (DOI)15219854 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2016-03-09Bibliographically approved
    3. Hormonal control of reversible translocation of perilipin B to the plasma membrane in primary human adipocytes
    Open this publication in new window or tab >>Hormonal control of reversible translocation of perilipin B to the plasma membrane in primary human adipocytes
    2006 (English)In: Journal of Biological Chemistry, ISSN 0021-9258, Vol. 281, no 17, 11446-11449 p.Article in journal (Refereed) Published
    Abstract [en]

    In adipocytes, perilipin coats and protects the central lipid droplet, which stores triacylglycerol. Alternative mRNA splicing gives rise to perilipin A and B. Hormones such as catecholamines and insulin regulate triacylglycerol metabolism through reversible serine phosphorylation of perilipin A. It was recently shown that perilipin was also located in triacylglycerol-synthesizing caveolae of the plasma membrane. We now report that perilipin at the plasma membrane of primary human adipocytes was phosphorylated on a cluster of threonine residues (299, 301, and 306) within an acidic domain that forms part of the lipid targeting domain. Perilipin B comprised <10% of total perilipin but was the major isoform associated with the plasma membrane of human adipocytes. This association was controlled by insulin and catecholamine: perilipin B was specifically depleted from the plasma membrane in response to the catecholamine isoproterenol, while insulin increased the amount of threonine phosphorylated perilipin at the plasma membrane. The reversible translocation of perilipin B to and from the plasma membrane in response to insulin and isoproterenol, respectively, suggests a specific function for perilipin B to protect newly synthesized triacylglycerol in the plasma membrane.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19147 (URN)10.1074/jbc.C500461200 (DOI)16527823 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2009-06-12Bibliographically approved
    4. Association and insulin regulated translocation of hormone-sensitive lipase with PTRF
    Open this publication in new window or tab >>Association and insulin regulated translocation of hormone-sensitive lipase with PTRF
    2006 (English)In: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, Vol. 350, no 3, 657-661 p.Article in journal (Refereed) Published
    Abstract [en]

    Polymerase I and transcript release factor (PTRF) is in human adipocytes mainly localized at the plasma membrane. This localization was under control of insulin, which translocated PTRF to the cytosol and nucleus, indicating a novel role for PTRF in insulin transcriptional control. In the plasma membrane PTRF was specifically bound to a triacylglycerol-metabolizing subclass of caveolae containing hormone-sensitive lipase (HSL). In response to insulin PTRF was translocated to the cytosol in parallel with HSL. PTRF and HSL were quantitatively immunoprecipitated from the cytosol by antibodies against either PTRF or HSL. The findings indicate also a novel extranuclear function for PTRF in the control of lipolysis.

    Keyword
    Hormone-sensitive lipase, Polymerase I and transcript release factor, Adipocyte, Human, Insulin, Translocation, Protein complex, Caveolae, Lipid metabolism, Transcriptional control
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-19148 (URN)10.1016/j.bbrc.2006.09.094 (DOI)17026959 (PubMedID)
    Available from: 2009-06-12 Created: 2009-06-12 Last updated: 2009-07-06Bibliographically approved
  • 22.
    Abrahamsson, Annelie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Dabrosin, Charlotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Tissue specific expression of extracellular microRNA in human breast cancers and normal human breast tissue in vivo2015In: OncoTarget, ISSN 1949-2553, E-ISSN 1949-2553, Vol. 6, no 26, 22959-22969 p.Article in journal (Refereed)
    Abstract [en]

    Extracellular circulating microRNAs (miRNAs) have been suggested to be biomarkers for disease monitoring but data are inconsistent, one reason being that blood miRNA is of heterogeneous origin. Here, we sampled extracellular microRNAs locally in situ using microdialysis. Three different cohorts of women were included; postmenopausal women with ongoing breast cancer investigated within the cancer and in normal adjacent breast tissue, postmenopausal women investigated in their normal healthy breast and subcutaneous fat before and after six weeks of tamoxifen therapy, premenopausal women during the menstrual cycle. Samples were initially screened using TaqMan array cards with subsequently absolute quantification. 124 miRNA were expressed in microdialysates. After absolute quantifications extracellular miRNA-21 was found to be significantly increased in breast cancer. In addition, the levels were significantly higher in pre-menopausal breast tissue compared with postmenopausal. In breast tissue of pre-menopausal women miRNA-21 exhibited a cyclic variation during the menstrual cycle and in postmenopausal women six weeks of tamoxifen treatment decreased miRNA-21 suggesting that this miRNA may be important for breast carcinogenesis. None of these changes were found in plasma or microdialysates from subcutaneous fat. Our data revealed tissue specific changes of extracellular circulating miRNAs that would be otherwise unraveled using blood samples.

  • 23.
    Abrahamsson, Annelie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Rzepecka, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences.
    Dabrosin, Charlotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Increased nutrient availability in dense breast tissue of postmenopausal women in vivo2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, 42733Article in journal (Refereed)
    Abstract [en]

    Metabolic reprogramming is a hallmark of cancer. Nutrient availability in the tissue microenvironment determines cellular events and may play a role in breast carcinogenesis. High mammographic density is an independent risk factor for breast cancer. Whether nutrient availability differs in normal breast tissues with various densities is unknown. Therefore we investigated whether breast tissues with various densities exhibited differences in nutrient availability. Healthy postmenopausal women from the regular mammographic screening program who had either predominantly fatty breast tissue (nondense), n = 18, or extremely dense breast tissue (dense), n = 20, were included. Microdialysis was performed for the in vivo sampling of amino acids (AAs), analyzed by ultra-high performance liquid chromatography with tandem mass spectroscopy, glucose, lactate and vascular endothelial growth factor (VEGF) in breast tissues and, as a control, in abdominal subcutaneous (s.c.) fat. We found that dense breast tissue exhibited significantly increased levels of 20 proteinogenic AAs and that 18 of these AAs correlated significantly with VEGF. No differences were found in the s.c. fat, except for one AA, suggesting tissue-specific alterations in the breast. Glucose and lactate were unaltered. Our findings provide novel insights into the biology of dense breast tissue that may be explored for breast cancer prevention strategies.

  • 24.
    Abrahamsson, Annelie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Rzepecka, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Romu, Thobias
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Borga, Magnus
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Dahlqvist Leinhard, Olof
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Lundberg, Peter
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Kihlberg, Johan
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Dabrosin, Charlotta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Dense breast tissue in postmenopausal women is associated with a pro-inflammatory microenvironment in vivo2016In: Oncoimmunology, ISSN 2162-4011, E-ISSN 2162-402X, Vol. 5, no 10, e1229723Article in journal (Refereed)
    Abstract [en]

    Inflammation is one of the hallmarks of carcinogenesis. High mammographic density has been associated with increased risk of breast cancer but the mechanisms behind are poorly understood. We evaluated whether breasts with different mammographic densities exhibited differences in the inflammatory microenvironment.Postmenopausal women attending the mammography-screening program were assessed having extreme dense, n = 20, or entirely fatty breasts (nondense), n = 19, on their regular mammograms. Thereafter, the women were invited for magnetic resonance imaging (MRI), microdialysis for the collection of extracellular molecules in situ and a core tissue biopsy for research purposes. On the MRI, lean tissue fraction (LTF) was calculated for a continuous measurement of breast density. LTF confirmed the selection from the mammograms and gave a continuous measurement of breast density. Microdialysis revealed significantly increased extracellular in vivo levels of IL-6, IL-8, vascular endothelial growth factor, and CCL5 in dense breast tissue as compared with nondense breasts. Moreover, the ratio IL-1Ra/IL-1 was decreased in dense breasts. No differences were found in levels of IL-1, IL-1Ra, CCL2, leptin, adiponectin, or leptin:adiponectin ratio between the two breast tissue types. Significant positive correlations between LTF and the pro-inflammatory cytokines as well as between the cytokines were detected. Stainings of the core biopsies exhibited increased levels of immune cells in dense breast tissue.Our data show that dense breast tissue in postmenopausal women is associated with a pro-inflammatory microenvironment and, if confirmed in a larger cohort, suggests novel targets for prevention therapies for women with dense breast tissue.

  • 25.
    Abrahamsson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Editorial Material: Not all probiotic strains prevent necrotising enterocolitis in premature infants in LANCET, vol 387, issue 10019, pp 624-6252016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10019, 624-625 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 26.
    Abrahamsson, Thomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Jakobsson, H.E.
    Karolinska Institute, Stockholm, Sweden.
    Andersson, A.F.
    KTH Royal Institute of Technology, Stockholm, Sweden.
    Björksten, B.
    Karolinska Institute, Stockholm, Sweden; Örebro University, Sweden .
    Engstrand, L.
    Karolinska Institute, Stockholm, Sweden; KTH Royal Institute of Technology, Stockholm, Sweden.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Low gut microbiota diversity in early infancy precedes asthma at school age2014In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 44, no 6, 842-850 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Low total diversity of the gut microbiota during the first year of life is associated with allergic diseases in infancy, but little is known how early microbial diversity is related to allergic disease later in school age.

    OBJECTIVE:

    To assess microbial diversity and characterize the dominant bacteria in stool during the first year of life in relation to the prevalence of different allergic diseases in school age, such as asthma, allergic rhinoconjunctivitis (ARC) and eczema.

    METHODS:

    The microbial diversity and composition was analysed with barcoded 16S rDNA 454 pyrosequencing in stool samples at 1 week, 1 month and 12 months of age in 47 infants which were subsequently assessed for allergic disease and skin prick test reactivity at 7 years of age (ClinicalTrials.gov ID NCT01285830).

    RESULTS:

    Children developing asthma (n = 8) had a lower diversity of the total microbiota than non-asthmatic children at 1 week (P = 0.04) and 1 month (P = 0.003) of age, whereas allergic rhinoconjunctivitis (n = 13), eczema (n = 12) and positive skin prick reactivity (n = 14) at 7 years of age did not associate with the gut microbiota diversity. Neither was asthma associated with the microbiota composition later in infancy (at 12 months). Children having IgE-associated eczema in infancy and subsequently developing asthma had lower microbial diversity than those that did not. There were no significant differences, however, in relative abundance of bacterial phyla and genera between children with or without allergic disease.

    CONCLUSION AND CLINICAL RELEVANCE:

    Low total diversity of the gut microbiota during the first month of life was associated with asthma but not ARC in children at 7 years of age. Measures affecting microbial colonization of the infant during the first month of life may impact asthma development in childhood.

  • 27.
    Abrahamsson, Thomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Rautava, Samuli
    University of Turku, Finland; Turku University Hospital, Finland.
    Moore, Aideen M.
    University of Toronto, Canada.
    Neu, Josef
    University of Florida, FL USA.
    Sherman, Philip M.
    University of Toronto, Canada.
    Editorial Material: The Time for a Confirmative Necrotizing Enterocolitis Probiotics Prevention Trial in the Extremely Low Birth Weight Infant in North America Is Now! in JOURNAL OF PEDIATRICS, vol 165, issue 2, pp 389-3942014In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 165, no 2, 389-394 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 28.
    Abrahamsson, Thomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sherman, Philip M.
    University of Toronto, Canada .
    Editorial Material: Multifaceted Effects of Human Milk Oligosaccharides2014In: Journal of Infectious Diseases, ISSN 0022-1899, Vol. 209, no 3, 323-324 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 29.
    Abrahamsson, Thomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Wu, Richard Y.
    University of Toronto, Canada.
    Sherman, Philip M.
    University of Toronto, Canada.
    Microbiota in Functional Gastrointestinal Disorders in Infancy: Implications for Management2017In: INTESTINAL MICROBIOME: FUNCTIONAL ASPECTS IN HEALTH AND DISEASE, KARGER , 2017, Vol. 88, 107-115 p.Conference paper (Refereed)
    Abstract [en]

    The complex and diverse intestinal microbiome is recognized as important in promoting human health. An altered gut microflora, referred to as dysbiosis, is increasingly recognized as having an etiologic role in a variety of conditions, including functional gastrointestinal disorders: colic in infants and irritable bowel syndrome in older children. Probiotics are defined as live microorganisms that, if ingested in sufficient amounts, restore microbial homeostasis and have a benefit on health. Randomized controlled trials indicate that probiotics can be effective in a variety of intestinal conditions, including colic and irritable bowel syndrome. Probiotics may promote gut microbial diversity, but timing of the intervention appears crucial. Strain-specific effects on colonization resistance, epithelial barrier integrity, modulation of signal transduction, impacts on innate and adaptive immune responses, and effects on visceral hyperalgesia likely explain the observed variability in various probiotic strains. In the future, probiotics are likely to be chosen for use in a defined clinical setting based on underlying mechanism(s) of action. The precise component of the probiotic agent mediating observed effects is the subject of current research. Unresolved issues relate to optimal dosages, timing of ingestion, single versus combination formulations, maintenance of viability in storage, and the merits of employing probiotic- derived products. (C) 2017 Nestec Ltd., Vevey/S. Karger AG, Basel

  • 30.
    Abrahamsson, Thomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. University of Toronto, Canada.
    You Wu, Richard
    University of Toronto, Canada.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Gut microbiota and allergy: the importance of the pregnancy period2015In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 77, no 1, 214-219 p.Article, review/survey (Refereed)
    Abstract [en]

    Limited microbial exposure is suggested to underlie the increase of allergic diseases in affluent countries, and bacterial diversity seems to be more important than specific bacteria taxa. Prospective studies indicate that the gut microbiota composition during the first months of life influences allergy development, and support the theory that factors influencing the early maturation of the immune system might be important for subsequent allergic disease. However, recent research indicates that microbial exposure during pregnancy may be even more important for the preventative effects against allergic disease. This review gives a background of the epidemiology, immunology, and microbiology literature in this field. It focuses on possible underlying mechanisms such as immune-regulated epigenetic imprinting and bacterial translocation during pregnancy, potentially providing the offspring with a pioneer microbiome. We suggest that a possible reason for the initial exposure of bacterial molecular patterns to the fetus in utero is to prime the immune system and/or the epithelium to respond appropriately to pathogens and commensals after birth.

  • 31.
    Abrate, Alberto
    et al.
    IRCCS Osped San Raffaele, Italy.
    Buono, Roberta
    IRCCS Osped San Raffaele, Italy.
    Canu, Tamara
    IRCCS Osped San Raffaele, Italy.
    Esposito, Antonio
    IRCCS Osped San Raffaele, Italy.
    Del Maschio, Alessandro
    IRCCS Osped San Raffaele, Italy.
    Luciano, Roberta
    IRCCS Osped San Raffaele, Italy; IRCCS Osped San Raffaele, Italy.
    Bettiga, Arianna
    IRCCS Osped San Raffaele, Italy.
    Colciago, Giorgia
    IRCCS Osped San Raffaele, Italy.
    Guazzoni, Giorgio
    IRCCS Osped San Raffaele, Italy.
    Benigni, Fabio
    IRCCS Osped San Raffaele, Italy.
    Hedlund, Petter
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Pharmacology. IRCCS Osped San Raffaele, Italy.
    Altaner, Cestmir
    Slovak Academic Science, Slovakia; St Elisabeth Cancer Institute, Slovakia.
    Montorsi, Francesco
    IRCCS Osped San Raffaele, Italy.
    Cavarretta, Ilaria T. R.
    IRCCS Osped San Raffaele, Italy.
    Mesenchymal stem cells expressing therapeutic genes induce autochthonous prostate tumour regression2014In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 50, no 14, 2478-2488 p.Article in journal (Refereed)
    Abstract [en]

    Mesenchymal stem cells (MSC) as vehicles of therapeutic genes represent a unique tool to activate drugs within a neoplastic mass due to their property to home and engraft into tumours. In particular, MSC expressing the cytosine deaminase:: uracil phosphoribosyltransferase (CD-MSC) have been previously demonstrated to inhibit growth of subcutaneous prostate cancer xenografts thanks to their ability to convert the non-toxic 5-fluorocytosine into the antineoplastic 5-fluorouracil. Since both the immune system and the tumour microenvironment play a crucial role in directing cancer progression, in order to advance towards clinical applications, we tested the therapeutic potential of this approach on animal models that develop autochthonous prostate cancer and preserve an intact immune system. As cell vectors, we employed adipose-tissue and bone-marrow MSC. CD-MSC toxicity on murine prostate cancer cells and tumour tropism were verified in vitro and ex-vivo before starting the preclinical studies. Magnetic Resonance Imaging was utilised to follow orthotopic tumour progression. We demonstrated that intravenous injections of CD-MSC cells, followed by intraperitoneal administration of 5-fluorocytosine, caused tumour regression in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model, which develops aggressive and spontaneous prostate cancer. These results add new insights to the therapeutic potential of specifically engineered MSC in prostate cancer disease.

  • 32.
    Abtahi, Jahan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Henefalk, G.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Maxillofacial Unit.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Randomised trial of bisphosphonate-coated dental implants: Radiographic follow-up after five years of loading2016In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 45, no 12, 1564-1569 p.Article in journal (Refereed)
    Abstract [en]

    The results of a randomised trial with bisphosphonate-coated dental implants have been reported previously. Each patient received one coated and one uncoated implant in a double-blind split-mouth design study. After 6 months of osseointegration, resonance frequency analysis indicated better fixation of the coated implants. Reduced marginal bone resorption was also shown. However, it was not known whether the advantage of the bisphosphonate coating would persist over time. The radiographic results at 5 years after implant installation are reported herein. A blinded investigator measured marginal resorption on fresh radiographs obtained for 14 of the 16 patients (two had died) and compared these with the post-implantation images. Non-parametric statistics were used. All implants functioned well. The median marginal bone loss for control implants was found to be 0.70 mm, which is less than usually reported in the literature. The bisphosphonate-coated implants showed even less resorption (median 0.20 mm). The median difference within each pair of implants after 5 years of use was 0.34 mm (95% confidence interval 0.00-0.75 mm; P = 0.04). The present data suggest that bisphosphonate-coated implants enable prolonged preservation of the marginal bone.

  • 33.
    Abtahi, Jahan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences.
    Tengvall, Pentti
    Linköping University, Department of Physics, Chemistry and Biology, Applied Physics. Linköping University, The Institute of Technology. Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Bisphosphonate coating might improve fixation of dental implants in the maxilla: A pilot study2010In: International Journal of Oral and Maxillofacial Surgery, ISSN 0901-5027, E-ISSN 1399-0020, Vol. 39, no 7, 673-677 p.Article in journal (Refereed)
    Abstract [en]

    This pilot study evaluates the clinical stability of bisphosphonate-coated dental implants placed using a two-stage surgical procedure in five patients. Each patient received seven regular Branemark implants, one of which was coated with bisphosphonate in a fibrinogen matrix. The coated implant was inserted where the bone was expected to have the least favourable quality. The level of the marginal bone around each implant was measured by intraoral periapical radiographs and implant stability was recorded using resonance frequency measurements. Frequency values (ISQ) were obtained peroperatively before flap closure and after 6 months at abutment connection. At abutment connection the bisphosphonate-coated implants were removed en bloc in two patients for histological examination. An animal experiment had previously confirmed that gamma-sterilization did not reduce bioactivity of the bisphosphonate coating. In each patient, the bisphosphonate-coated implant showed the largest improvement in ISQ level of all implants. Their values at the start tended to be lower, and the absolute value at 6 months did not differ. No complications occurred with the coated implants. Histology showed no abnormalities. Improvement in ISQ values was an expected effect of the bisphosphonate coating, but could be due to the choice of insertion site. This finding warrants a randomized blinded study.

  • 34.
    Abuzeid, Nadir
    et al.
    Medical and Aromat Plants Research Institute, Sudan; Omdurman Islamic University, Sudan.
    Kalsum, Sadaf
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Koshy, Richin John
    Larsson, Marie C
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Glader, Mikaela
    Andersson, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Raffetseder, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Pienaar, Elsje
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Eklund, Daniel
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Alhassan, Muddathir S.
    Medical and Aromat Plants Research Institute, Sudan.
    AlGadir, Haidar A.
    Medical and Aromat Plants Research Institute, Sudan.
    Koko, Waleed S.
    Medical and Aromat Plants Research Institute, Sudan.
    Schon, Thomas
    Kalmar County Hospital, Sweden.
    Ahmed Mesaik, M.
    University of Kebangsaan Malaysia, Malaysia; University of Karachi, Pakistan.
    Abdalla, Omer M.
    University of Karachi, Pakistan.
    Khalid, Asaad
    Medical and Aromat Plants Research Institute, Sudan.
    Lerm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Antimycobacterial activity of selected medicinal plants traditionally used in Sudan to treat infectious diseases2014In: Journal of Ethnopharmacology, ISSN 0378-8741, E-ISSN 1872-7573, Vol. 157, 134-139 p.Article in journal (Refereed)
    Abstract [en]

    Ethnopharmacological relevance: The emergence of multidrug-resistant strains of Mycobacterium tuberculosis underscores the need for continuous development of new and efficient methods to determine the susceptibility of isolates of Mycobacterium tuberculosis in the search for novel antimycobacterial agents. Natural products constitute an important source of new drugs, and design and implementation of antimycobacterial susceptibility testing methods are necessary to evaluate the different extracts and compounds. In this study we have explored the antimycobacterial properties of 50 ethanolic extracts from different parts of 46 selected medicinal plants traditionally used in Sudan to treat infectious diseases. Materials and methods: Plants were harvested and ethanolic extracts were prepared. For selected extracts, fractionation with hydrophilic and hydrophobic solvents was undertaken. A luminometry-based assay was used for determination of mycobacterial growth in broth cultures and inside primary human macrophages in the presence or absence of plant extracts and fractions of extracts. Cytotoxicity was also assessed for active fractions of plant extracts. Results: Of the tested extracts, three exhibited a significant inhibitory effect on an avirulent strain of Mycobacterium tubercluosis (H37Ra) at the initial screening doses (125 and 6.25 mu g/ml). These were bark and leaf extracts of Khaya senegalensis and the leaf extract of Rosmarinus officinalis L. Further fractions of these plant extracts were prepared with n-hexane, chloroform, ethyl acetate, n-butanol, ethanol and water, and the activity of these extracts was retained in hydrophobic fractions. Cytotoxicity assays revealed that the chloroform fraction of Khaya senegalensis bark was non-toxic to human monocyte-derived macrophages and other cell types at the concentrations used and hence, further analysis, including assessment of IC50 and intracellular activity was done with this fraction. Conclusion: These results encourage further investigations to identify the active compound(s) within the chloroform fraction of Khaya senegalensis bark. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

  • 35.
    Adolfsson, Ann-Sofie
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences.
    Miscarriage: Women’s Experience and its Cumulative Incidence2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Many women experience miscarriage every year. Every fourth woman who has given birth reports that she has previous experience of miscarriage. In a study of all women in the Swedish Medical Birth Register 1983-2003, we found that the number of cases of self reported miscarriage had increased in Sweden during this 21 year period. This increase can be explained by the introduction of sensitive pregnancy tests around 1990, as well as an increase in the mean age of the mothers, by approximately 3 years, during the observation period. The risk of miscarriage is 13% with the first child. With subsequent pregnancies, the risk of miscarriage is 8%, 6% and 4% with the second, third and fourth child, respectively.

    Thirteen of these women who had suffered a recent miscarriage were interviewed four months later, and their feelings of guilt and emptiness were explored. Their experience was that they wanted their questions to be answered, and that they wanted others to treat them as the mothers to be that they felt themselves to be. They also experienced the need for time to grieve their loss.

    Measurement of grief by means of the Perinatal Grief Scale (PGS) is used in research but has also been proposed for clinical use. We have translated this psychological instrument to Swedish, back-translated and tested it in a small pilot study. In a randomized controlled study, women with early miscarriage were allocated, either to a structured visit (study group) or a regular visit (control group) to a midwife. The structured visit was conducted according to the Swanson caring theory. We could conclude that the structured visit had no significant effect on grief compared to the regular visit, as measured using the PGS. However, women with the sub-diagnosis missed abortion have significantly more grief four months after early miscarriage, regardless of visit type.

    We also performed a content analysis of the tape-recorded structured follow-up visit. The code-key used was Bonanno and Kaltman’s general grief categorization. Women’s expression of grief after miscarriage was found to be very similar to the grief experienced following the death of a relative. Furthermore, the grief was found to be independent of number of children, women’s age, or earlier experience of miscarriage.

    Conclusions: Every fourth woman who gives birth reports that she has also experienced early miscarriage. The experience of these women is that they have suffered a substantial loss and their reaction is grief similar to that experienced following the death of a relative.

    List of papers
    1. Cumulative incidence of previous spontaneous abortion in Sweden 1983-2003: A register study
    Open this publication in new window or tab >>Cumulative incidence of previous spontaneous abortion in Sweden 1983-2003: A register study
    2006 (English)In: Acta obstetricia et gynecologica Scandinavica, ISSN 0001-6349, Vol. 85, no 6, 741-747 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim. The aim of this study is to find out how common miscarriages are among women who have delivered a child.

    Methods. The numbers of deliveries and miscarriages were extracted from the Swedish Medical Birth Register between 1983 and 2003. Linear regression was performed in order to investigate whether the increasing mean age of mothers or differences in pregnancy identification methods could explain the increased frequency of miscarriage.

    Results. The reported number of miscarriages increased each year during the 21-year period, with a marked increase between 1991 and 1993 and only a slight increase during the final 10 years. For primiparous women, the frequency of reported miscarriages per delivery increased from 8.6% in 1983 to 13.9% in 2003. The corresponding figures for 2-parous women showed an increase from 14.5% to 21.3% respectively. Women aged 30-34 years had an odds ratio of 1.43 (95% CI 1.40-1.45) to suffer spontaneous abortion compared to the age group 25-29 years. Linear regression showed that an increase in mean age at delivery could only partly explain the increase in the frequency of reported miscarriages. A possible explanation could be differences in methods of identifying early pregnancy.

    Conclusion. Of all women who deliver a child, nearly 20% have experienced previous miscarriage. The increased mean age of women could only explain a small portion of the seen increase in miscarriage. The marked increase from 1991 to 1993 is interesting. Possible reasons for the increase are discussed.

    Keyword
    Miscarriage; register study; retrospective study; spontaneous abortion; Medical Birth Register
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13806 (URN)10.1080/00016340600627022 (DOI)
    Available from: 2006-04-03 Created: 2006-04-03
    2. Guilt and emptiness: Women’s experiences of miscarriage
    Open this publication in new window or tab >>Guilt and emptiness: Women’s experiences of miscarriage
    2004 (English)In: Health Care for Women International, ISSN 0739-9332, Vol. 25, no 6, 543-560 p.Article in journal (Refereed) Published
    Abstract [en]

    Women who lose an early pregnancy are shocked when they are first given the information that they have miscarried. Later they feel guilt and emptiness. Heideggerian interpretive phenomenology has been used with 13 women from southwest Sweden to uncover their lived experience of miscarriage. Women plan their future with a child during early pregnancy. When miscarriage occurs it is not a gore, an embryo, or a fetus they lose, it is their child. They feel that they are the cause of the miscarriage through something they have done, eaten, or thought. They feel abandonment and they grieve for their profound loss; they are actually in bereavement.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13807 (URN)10.1080/07399330490444821 (DOI)
    Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2013-09-12
    3. Translation of the short version of the Perinatal Grief Scale into Swedish
    Open this publication in new window or tab >>Translation of the short version of the Perinatal Grief Scale into Swedish
    2006 (English)In: Scandinavian journal of caring sciences, ISSN 1471-6712, Vol. 20, no 3, 269-273 p.Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Women's emotions and grief after miscarriage are influenced not only by the context in which the miscarriage occurred but also by their past experience, the circumstances around the miscarriage and their future prospects. Their emotions therefore express a specific form of grief. Normally the time needed to work through the loss varies. A number of different scales, measuring women's emotions and grief after miscarriage have been published. One instrument that measures the specific grief, such as the grief after miscarriage is the Perinatal Grief Scale (PGS) that was designed to measure grief after perinatal loss and has good reliability and validity.

    Aims: The purpose of this study was to translate the PGS into Swedish and to use the translation in a small pilot study.

    Material and method: The original short version of the PGS was first translated from English into Swedish and then back-translated into English, using different translators. During translation and back-translation, not only the linguistic and grammatical aspects were considered but also cultural differences. The Likert 5-point and a 10-point scale were tested in a pilot study where 12 volunteers anonymously answered the PGS twice. The intra-personal correlations were compared and analysed with weighted κ-coefficient.

    Findings: In all, five different versions were tested before the final Swedish version was established. The weighted κ-coefficient for the volunteers was 0.58, which is regarded as representing good reproducibility.

    Conclusion: The PGS was translated successfully into Swedish and could be used in a Swedish population. As this work is rather time-consuming we therefore wish to publish the Swedish version so that it may be used by other researchers.

    Keyword
    translation, Perinatal Grief Scale, miscarriage, grief, spontaneous abortion
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13808 (URN)10.1111/j.1471-6712.2006.00404.x (DOI)
    Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2010-05-17
    4. Effect of a structured follow-up visit to a midwife on women with early miscarriage: A randomized study
    Open this publication in new window or tab >>Effect of a structured follow-up visit to a midwife on women with early miscarriage: A randomized study
    2006 (English)In: Acta obstetricia et gynecologica Scandinavica, ISSN 0001-6349, Vol. 85, no 3, 330-335 p.Article in journal (Refereed) Published
    Abstract [en]

    Background. Women's grief after miscarriage is substantial and important. Women who experience early miscarriage do not constitute a homogenous group. The aim of this study is to measure whether a structured follow-up visit to a midwife (group 1) at 21-28 days after early miscarriage could reduce the women's grief, measured using the perinatal grief scale Swedish short version (PGS) after a further 3 months (i.e. 4 months after the miscarriage), compared to a regular follow-up visit to a midwife (group 2). Methods. We performed an open randomized study of women who experienced early miscarriage (n = 88). The midwife's attitude in group 1 came from Swanson science theory of midwifery. In group 2, the women were offered only the ordinary type of consultation at a regular visit. A questionnaire with the PGS was used in both groups. Four months after the miscarriage, a second questionnaire with the same perinatal grief scale was sent by post. Results. There was a 30% greater reduction in grief in group 1 than that in group 2, when comparing the first and second measurements (not significant). The biggest differences were in the subscales active grief and difficulty in coping. Women with the subdiagnosis missed abortions had, as a group, significantly higher PGS scores at both visits, especially in active grief and difficulty in coping, regardless of the type of follow-up visit. Conclusions. A structured follow-up visit did not, in comparison with a regular follow-up visit, imply any significant reduction in grief as measured using the PGS scale. However, the subgroup missed abortion had more extensive grief than the other women with miscarriage. Structured follow-up visits are not imperative for all women with early miscarriage.

    Keyword
    Early miscarriage; grief; midwife; support; treatment
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13809 (URN)10.1080/00016340500539376 (DOI)
    Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2013-09-12
    5. Applicability of general grief theory to Swedish women’s experiences after early miscarriage, with factor analysis of Bonanno´s taxonomy, using the Perinatal Grief Scale.
    Open this publication in new window or tab >>Applicability of general grief theory to Swedish women’s experiences after early miscarriage, with factor analysis of Bonanno´s taxonomy, using the Perinatal Grief Scale.
    2010 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, Vol. 115, no 3, 201-209 p.Article in journal (Refereed) Published
    Abstract [en]

    Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief.

    Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks.

    Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage.

    Conclusion. Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.

    Keyword
    Content analysis, factor analysis, general grief theory, miscarriage, perinatal grief scale, women
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13810 (URN)10.3109/03009731003739851 (DOI)000281013000008 ()
    Note
    On the day of the defence day the status of this article was Submitted.Available from: 2006-04-03 Created: 2006-04-03 Last updated: 2010-09-03
  • 36.
    Adolfsson, Elin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    Persson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology .
    Prosodiska aspekter av nonordsproduktion hos barn med cochleaimplantat och barn med språkstörning2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Prosody can be defined as the rythmic, dynamic and melodic aspects of speech. Without prosody, speech would sound monotonous and communication could be obstructed. The aim of the present study was to examine prosodic aspects of nonword repetition by children with cochlear implants and children with language impairment. Previous studies of prosody in these groups have not in detail described what kinds of errors that occur and therefore this is interesting to investigate.

    The present study is based on previously collected data of nonword repetition among a total of 41 children, all participating in previous studies. Of these children, 27 were children with language impairment aged between 4:6-7:6 years. Fourteen were children with CI aged between 3:0-13:4. The recorded data was transcribed and analyzed group wise and the mean value of the groups were calculated.

    Children with CI showed prosodic problems in nonword repetition to a greater extent than children with language impairment did. Both children with language impairment and children with CI had difficulties with number of syllables, stress, tonal word accent and quantity of vowel. However, the children with CI generally made errors to a greater extent as well as more types of errors, compared to the children with language impairment. All children with CI made some type of prosodic error whilst 11 out of 27 of the language impaired children produced all the words prosodically correct. Children who were implanted at an older age showed greater difficulties with prosody than children who were implanted at a younger age.

  • 37.
    Adolfsson, Elin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology.
    Persson, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology.
    Äldreriktat tal på boenden för äldre: Förekomst och karaktäristik2011Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The term elderspeak refers to the adjustments of communication towards elderly people which are similar to those made towards young children. The adjustments are made within several language domains, and are a part of the communicative environment of the elders. The subject is relatively uninvestigated, and few, if any, studies have been conducted on the subject in Sweden. Thus the aim of the present study was to investigate the possible occurrence of elderspeak, and to describe its characteristics.

    The present study is based upon five participants working at different forms of geriatric institutions. Conversations between a caregiver and a resident and conversations between a caregiver and a colleague were recorded and broadly transcribed. The recordings were cut into separate files according to the purpose of respective analysis. The study was carried out with a data-driven perspective and previously established aspects of elderspeak and child directed speech was searched for.

    The present study established that caregivers to a varying extent adjusted their communication within several language domains. The adjustments mainly took place within the prosodic domain but they also took place within the grammatical domain. Adjustments within the pragmatic domain were found to some extent, but no adjustments within the semantic domain were found. Tendencies to adjustments of the speech were present in the majority of the participants. The present study suggests the following additions to the aspects of the elderspeak phenomenon; frequent use of name, less hesitation phenomena and less frequent simultaneous speech. 

  • 38.
    Adolfsson, Emelie
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    Lithium formate EPR dosimetry for accurate measurements of absorbed dose in radiotherapy2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Lithium formate has shown to be a material with properties suitable for electron paramagnetic resonance (EPR) dosimetry, among them up to 7 times higher sensitivity compared to alanine, which is a well-established EPR detector material for dose determinations in radiotherapy.

    The aim of this thesis was to further investigate the properties of lithium formate and develop the dosimetry system towards applications in radiotherapy. The intrinsic efficiency for energies of relevance to brachytherapy and the signal stability were investigated. The dosimetry system was expanded to include a smaller dosimeter model, suitable for measurements in dose gradient regions. An individual sensitivity correction method was applied to the smaller dosimeters to be able to perform dose determinations with the same precision as for the larger ones. EPR dosimetry in general is time consuming and effort was spent to optimize the signal readout procedure regarding measurement time and measurement precision.

    The system was applied in two clinical applications chosen for their high demands on the dosimetry system: 1) a dosimetry audit for external photon beam therapy and 2) dose verification measurements around a low energy HDR brachytherapy source.

    The conclusions drawn from this thesis were: dose determinations can be performed with a standard uncertainty of 1.8-2.5% using both the original size dosimeters and the new developed smaller ones. The dosimetry system is robust and useful for applications when high measurement precision and accuracy is prioritized. It is a good candidate for dosimetry audits, both in external beam therapy and brachytherapy.

    List of papers
    1. Response of lithium formate EPR dosimeters at photon energies relevant to the dosimetry of brachytherapy
    Open this publication in new window or tab >>Response of lithium formate EPR dosimeters at photon energies relevant to the dosimetry of brachytherapy
    Show others...
    2010 (English)In: Medical physics (Lancaster), ISSN 0094-2405, Vol. 37, no 9, 4946-4959 p.Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE:

    To investigate experimentally the energy dependence of the detector response of lithium formate EPR dosimeters for photon energies below 1 MeV relative to that at 60Co energies. High energy photon beams are used in calibrating dosimeters for use in brachytherapy since the absorbed dose to water can be determined with high accuracy in such beams using calibrated ion chambers and standard dosimetry protocols. In addition to any differences in mass-energy absorption properties between water and detector, variations in radiation yield (detector response) with radiation quality, caused by differences in the density of ionization in the energy imparted (LET), may exist. Knowledge of an eventual deviation in detector response with photon energy is important for attaining high accuracy in measured brachytherapy dose distributions.

    METHODS:

    Lithium formate EPR dosimeters were irradiated to known levels of air kerma in 25-250 kV x-ray beams and in 137Cs and 60Co beams at the Swedish Secondary Standards Dosimetry Laboratory. Conversions from air kerma free in air into values of mean absorbed dose to the detectors were made using EGSnrc MC simulations and x-ray energy spectra measured or calculated for the actual beams. The signals from the detectors were measured using EPR spectrometry. Detector response (the EPR signal per mean absorbed dose to the detector) relative to that for 60Co was determined for each beam quality.

    RESULTS:

    Significant decreases in the relative response ranging from 5% to 6% were seen for x-ray beams at tube voltages < or = 180 kV. No significant reduction in the relative response was seen for 137Cs and 250 kV x rays.

    CONCLUSIONS:

    When calibrated in 60Co or MV photon beams, corrections for the photon energy dependence of detector response are needed to achieve the highest accuracy when using lithium formate EPR dosimeters for measuring absorbed doses around brachytherapy sources emitting photons in the energy range of 20-150 keV such as 169Yb and electronic sources.

    Place, publisher, year, edition, pages
    American Association of Physicists in Medicine, 2010
    Keyword
    lithium formate EPR, brachytherapy, dosimetry, detector response, kV x rays
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-59955 (URN)10.1118/1.3475938 (DOI)000281906000046 ()20964214 (PubMedID)
    Available from: 2010-10-01 Created: 2010-10-01 Last updated: 2015-03-20Bibliographically approved
    2. Investigation of signal fading in lithium formate EPR dosimeters using a new sensitive method
    Open this publication in new window or tab >>Investigation of signal fading in lithium formate EPR dosimeters using a new sensitive method
    Show others...
    2012 (English)In: Physics in Medicine and Biology, ISSN 0031-9155, E-ISSN 1361-6560, Vol. 57, no 8, 2209-2217 p.Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to investigate signal fading in lithium formate electron paramagnetic resonance (EPR) dosimeters used for clinical applications in radiotherapy. A new experimental method for determination of signal fading, designed to resolve small changes in signal from slowly decaying unstable radicals, was used. Possible signal fading in lithium formate due to different storage temperatures was also tested. Air humidity was kept at a constant level of 33% throughout the experiments. The conclusion drawn from the investigations was that the EPR signal from lithium formate is stable during at least 1 month after irradiation and is not sensitive to variations in storage temperature andlt;40 degrees C when kept at a relative air humidity of 33%. This makes lithium formate a suitable dosimeter for transfer dosimetry in clinical audits.

    Place, publisher, year, edition, pages
    Institute of Physics (IOP), 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-77095 (URN)10.1088/0031-9155/57/8/2209 (DOI)000302567100008 ()22456424 (PubMedID)
    Note

    Funding Agencies|Swedish Cancer foundation (CF)|100443|FORSS|86231|

    Available from: 2012-05-04 Created: 2012-05-04 Last updated: 2015-03-20Bibliographically approved
    3. Optimisation of an EPR dosimetry system for robust and high precision dosimetry
    Open this publication in new window or tab >>Optimisation of an EPR dosimetry system for robust and high precision dosimetry
    Show others...
    2014 (English)In: Radiation Measurements, ISSN 1350-4487, Vol. 70, 21-28 p.Article in journal (Refereed) Published
    Abstract [en]

    Clinical applications of electron paramagnetic resonance (EPR) dosimetry systems demand high accuracy causing time consuming analysis. The need for high spatial resolution dose measurements in regions with steep dose gradients demands small sized dosimeters. An optimization of the analysis was therefore needed to limit the time consumption. The aim of this work was to introduce a new smaller lithium formate dosimeter model (diameter reduced from standard diameter 4.5 mm to 3 mm and height from 4.8 mm to 3 mm). To compensate for reduced homogeneity in a batch of the smaller dosimeters, a method for individual sensitivity correction suitable for EPR dosimetry was tested. Sensitivity and repeatability was also tested for a standard EPR resonator and a super high Q (SHQE) one. The aim was also to optimize the performance of the dosimetry system for better efficiency regarding measurement time and precision. A systematic investigation of the relationship between measurement uncertainty and number of readouts per dosimeter was performed. The conclusions drawn from this work were that it is possible to decrease the dosimeter size with maintained measurement precision by using the SHQE resonator and introducing individual calibration factors for dosimeter batches. It was also shown that it is possible reduce the number of readouts per dosimeter without significantly decreasing the accuracy in measurements.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keyword
    EPR; ESR; Lithium formate; High precision dosimetry; High spatial resolution dosimetry
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:liu:diva-111088 (URN)10.1016/j.radmeas.2014.08.013 (DOI)000345110700005 ()
    Available from: 2014-10-07 Created: 2014-10-07 Last updated: 2015-03-20Bibliographically approved
    4. A system for remote dosimetry audit of 3D-CRT, IMRT and VMAT based on lithium formate dosimetry
    Open this publication in new window or tab >>A system for remote dosimetry audit of 3D-CRT, IMRT and VMAT based on lithium formate dosimetry
    Show others...
    2014 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 113, no 2, 279-282 p.Article in journal (Refereed) Published
    Abstract [en]

    The aim of this work was to develop and test a remote end-to-end audit system using lithium formate EPR dosimeters. Four clinics were included in a pilot study, absorbed doses determined in the PTV agreed with TPS calculated doses within ±5% for 3D-CRT and ±7% (k=1) for IMRT/VMAT dose plans.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keyword
    Dosimetry audit; remote audit; end-to-end; EPR; ESR; lithium formate
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:liu:diva-111089 (URN)10.1016/j.radonc.2014.11.027 (DOI)000347657200021 ()
    Available from: 2014-10-07 Created: 2014-10-07 Last updated: 2015-03-20Bibliographically approved
    5. Measurement of absorbed dose to water around an electronic brachytherapy source: Comparison of two dosimetry systems: lithium formate EPR dosimeters and radiochromic EBT2 film
    Open this publication in new window or tab >>Measurement of absorbed dose to water around an electronic brachytherapy source: Comparison of two dosimetry systems: lithium formate EPR dosimeters and radiochromic EBT2 film
    Show others...
    2015 (English)In: Physics in Medicine and Biology, ISSN 0031-9155, E-ISSN 1361-6560, Vol. 60, no 9, 3869-3882 p.Article in journal (Refereed) Published
    Abstract [en]

    Interest in high dose rate (HDR) electronic brachytherapy operating at 50 kV is increasing. For quality assurance it is important to identify dosimetry systems that can measure the absorbed doses in absolute terms which is difficult in this energy region. In this work a comparison is made between two dosimetry systems, EPR lithium formate dosimeters and radiochromic EBT2 film.

    Both types of dosimeters were irradiated simultaneously in a PMMA phantom using the Axxent EBS. Absorbed dose to water was determined at distances of 10 mm, 30 mm and 50 mm from the EBS. Results were traceable to different primary standards as regards to absorbed dose to water (EPR) and air kerma (EBT2). Monte Carlo simulations were used in absolute terms as a third estimate of absorbed dose to water.

    Agreement within the estimated expanded (k = 2) uncertainties (5% (EPR), 7% (EBT2)) was found between the results at 30 mm and 50 mm from the x-ray source. The same result was obtained in 4 repetitions of irradiation, indicating high precision in the measurements with both systems. At all distances, agreement between EPR and Monte Carlo simulations was shown as was also the case for the film measurements at 30mm and 50mm. At 10mm the geometry for the film measurements caused too large uncertainty in measured values depending on the exact position (within sub-mm distances) of the EBS and the 10 mm film results were exculded from comparison.

    This work has demonstrated good performance of the lithium formate EPR dosimetry system in accordance with earlier experiments at higher photon energies (192Ir HDR brachytherapy). It was also highlighted that there might be issues regarding the energy dependence and intrinsic efficiency of the EBT2 film that need to be considered for measurements using low energy sources.

    Place, publisher, year, edition, pages
    Institute of Physics Publishing (IOPP), 2015
    Keyword
    Electronic brachytherapy, EPR, lithium formate, radiochromic film, intrinsic efficiency
    National Category
    Radiology, Nuclear Medicine and Medical Imaging
    Identifiers
    urn:nbn:se:liu:diva-111090 (URN)10.1088/0031-9155/60/9/3869 (DOI)000354104700030 ()
    Available from: 2014-10-07 Created: 2014-10-07 Last updated: 2016-04-24Bibliographically approved
  • 39.
    Adolfsson, Emelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Gustafsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Biomedical Engineering.
    Lund, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    Optimisation of an EPR dosimetry system for robust and high precision dosimetry2014In: Radiation Measurements, ISSN 1350-4487, Vol. 70, 21-28 p.Article in journal (Refereed)
    Abstract [en]

    Clinical applications of electron paramagnetic resonance (EPR) dosimetry systems demand high accuracy causing time consuming analysis. The need for high spatial resolution dose measurements in regions with steep dose gradients demands small sized dosimeters. An optimization of the analysis was therefore needed to limit the time consumption. The aim of this work was to introduce a new smaller lithium formate dosimeter model (diameter reduced from standard diameter 4.5 mm to 3 mm and height from 4.8 mm to 3 mm). To compensate for reduced homogeneity in a batch of the smaller dosimeters, a method for individual sensitivity correction suitable for EPR dosimetry was tested. Sensitivity and repeatability was also tested for a standard EPR resonator and a super high Q (SHQE) one. The aim was also to optimize the performance of the dosimetry system for better efficiency regarding measurement time and precision. A systematic investigation of the relationship between measurement uncertainty and number of readouts per dosimeter was performed. The conclusions drawn from this work were that it is possible to decrease the dosimeter size with maintained measurement precision by using the SHQE resonator and introducing individual calibration factors for dosimeter batches. It was also shown that it is possible reduce the number of readouts per dosimeter without significantly decreasing the accuracy in measurements.

  • 40.
    Adolfsson, Emelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    Gustafsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Biomedical Engineering.
    Lund, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Olsson, Sara
    Medical Physics and Technology, Växjö Central Hospital, Växjö, Sweden.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    A system for remote dosimetry audit of 3D-CRT, IMRT and VMAT based on lithium formate dosimetry2014In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 113, no 2, 279-282 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this work was to develop and test a remote end-to-end audit system using lithium formate EPR dosimeters. Four clinics were included in a pilot study, absorbed doses determined in the PTV agreed with TPS calculated doses within ±5% for 3D-CRT and ±7% (k=1) for IMRT/VMAT dose plans.

  • 41.
    Adolfsson, Emelie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    White, Shane
    Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands.
    Landry, Guillaume
    Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands.
    Lund, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences.
    Gustafsson, Håkan
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Biomedical Engineering.
    Verhaegen, Frank
    Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands.
    Reniers, Brigitte
    Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center, The Netherlands.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Alm Carlsson, Gudrun
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Measurement of absorbed dose to water around an electronic brachytherapy source: Comparison of two dosimetry systems: lithium formate EPR dosimeters and radiochromic EBT2 film2015In: Physics in Medicine and Biology, ISSN 0031-9155, E-ISSN 1361-6560, Vol. 60, no 9, 3869-3882 p.Article in journal (Refereed)
    Abstract [en]

    Interest in high dose rate (HDR) electronic brachytherapy operating at 50 kV is increasing. For quality assurance it is important to identify dosimetry systems that can measure the absorbed doses in absolute terms which is difficult in this energy region. In this work a comparison is made between two dosimetry systems, EPR lithium formate dosimeters and radiochromic EBT2 film.

    Both types of dosimeters were irradiated simultaneously in a PMMA phantom using the Axxent EBS. Absorbed dose to water was determined at distances of 10 mm, 30 mm and 50 mm from the EBS. Results were traceable to different primary standards as regards to absorbed dose to water (EPR) and air kerma (EBT2). Monte Carlo simulations were used in absolute terms as a third estimate of absorbed dose to water.

    Agreement within the estimated expanded (k = 2) uncertainties (5% (EPR), 7% (EBT2)) was found between the results at 30 mm and 50 mm from the x-ray source. The same result was obtained in 4 repetitions of irradiation, indicating high precision in the measurements with both systems. At all distances, agreement between EPR and Monte Carlo simulations was shown as was also the case for the film measurements at 30mm and 50mm. At 10mm the geometry for the film measurements caused too large uncertainty in measured values depending on the exact position (within sub-mm distances) of the EBS and the 10 mm film results were exculded from comparison.

    This work has demonstrated good performance of the lithium formate EPR dosimetry system in accordance with earlier experiments at higher photon energies (192Ir HDR brachytherapy). It was also highlighted that there might be issues regarding the energy dependence and intrinsic efficiency of the EBT2 film that need to be considered for measurements using low energy sources.

  • 42.
    Adolfsson, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Editorial Material: Is surgery for the subacromial pain syndrome ever indicated? in ACTA ORTHOPAEDICA, vol 86, issue 6, pp 639-6402015In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 86, no 6, 639-640 p.Article in journal (Other academic)
    Abstract [en]

    n/a

  • 43.
    Adolfsson, Lars
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Nestorson, Jens
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Scheer, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Extensive soft tissue lesions in redislocated after simple elbow dislocations2017In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 26, no 7, 1294-1297 p.Article in journal (Refereed)
    Abstract [en]

    Background: The majority of simple elbow dislocations (no associated fractures) can be treated nonoperatively with a short period of immobilization followed by guided aftercare. This case series describes the soft tissue injuries in a rare subset of patients in whom the elbow redislocated despite adequate immobilization. Methods: During a 6-year period, 8 patients were identified. They were all treated with reduction and casting in 90 degrees of flexion or more. At 1 week of follow-up, redislocation had occurred in all patients and open soft tissue repair was performed. The injuries were documented and the patients were followed up clinically and with radiographs. Results: Extensive soft tissue injuries, including both collateral ligament injuries and muscle origin avulsions from either or both sides, were found in all patients. The functional result at follow-up was satisfactory in all patients. Conclusion: Vast soft tissue injuries including both collateral ligaments and muscle origins should be expected in the event of early severe instability of a dislocated elbow joint. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

  • 44.
    Aerts, Joel
    et al.
    University of Liege, Belgium; University of Paris 07, France.
    Ballinger, James R.
    Guy's and St Thomas' Hospital, London, UK.
    Behe, Martin
    ETH PSI USZ Paul Scherrer Institute, Villigen-PSI, Switzerland.
    Decristoforo, Clemens
    Innsbruck Medical University, Austria.
    Elsinga, Philip H.
    University of Groningen, Netherlands.
    Faivre-Chauvet, Alain
    CHU Nantes, France.
    Mindt, Thomas L.
    University Hospital Basel, Switzerland.
    Kolenc Peitl, Petra
    University Medical Centre Ljubljana, Slovenia.
    Todde, Sergio C.
    University of Milano-Bicocca, Italy.
    Koziorowski, Jacek
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Guidance on current good radiopharmacy practice for the small-scale preparation of radiopharmaceuticals using automated modules: a European perspective2014In: Journal of labelled compounds & radiopharmaceuticals, ISSN 0362-4803, E-ISSN 1099-1344, Vol. 57, no 10, 615-620 p.Article in journal (Refereed)
    Abstract [en]

    This document is meant to complement Part B of the EANM Guidelines on current good radiopharmacy practice (cGRPP) in the preparation of radiopharmaceuticals issued by the Radiopharmacy Committee of the European Association of Nuclear Medicine, covering small-scale in-house preparation of radiopharmaceuticals with automated modules. The aim is to provide more detailed and practice-oriented guidance to those who are involved in the small-scale preparation of radiopharmaceuticals, which are not intended for commercial purposes or distribution.

  • 45.
    Aerts, Marc
    et al.
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Minalu, Girma
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Bösner, Stefan
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Buntinx, Frank
    Department of Public Health and Primary Care, KU Leuven, Belgium; Department of General Practice, Maastricht University, The Netherlands..
    Burnand, Bernard
    Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland..
    Haasenritter, Jörg
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Herzig, Lilli
    Institute of Family Medicine, University of Lausanne, Switzerland..
    Knottnerus, J André
    Department of General Practice, Maastricht University, The Netherlands..
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Renier, Walter
    Department of Public Health and Primary Care, KU Leuven, Belgium.
    Sox, Carol
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, USA..
    Sox, Harold
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH , USA; Patient-Centered Outcomes Research Institute, Washington, USA..
    Donner-Banzhoff, Norbert
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.2017In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 81, 120-128 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care.

    STUDY DESIGN AND SETTING: Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies.

    RESULTS: The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%).

    CONCLUSIONS: Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action.

  • 46.
    Agebratt, Christian
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Ström, Edvin
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Romu, Thobias
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Dahlqvist Leinhard, Olof
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Borga, Magnus
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Leandersson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    A Randomized Study of the Effects of Additional Fruit and Nuts Consumption on Hepatic Fat Content, Cardiovascular Risk Factors and Basal Metabolic Rate2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, e0147149- p.Article in journal (Refereed)
    Abstract [en]

    Background

    Fruit has since long been advocated as a healthy source of many nutrients, however, the high content of sugars in fruit might be a concern.

    Objectives

    To study effects of an increased fruit intake compared with similar amount of extra calories from nuts in humans.

    Methods

    Thirty healthy non-obese participants were randomized to either supplement the diet with fruits or nuts, each at +7 kcal/kg bodyweight/day for two months. Major endpoints were change of hepatic fat content (HFC, by magnetic resonance imaging, MRI), basal metabolic rate (BMR, with indirect calorimetry) and cardiovascular risk markers.

    Results

    Weight gain was numerically similar in both groups although only statistically significant in the group randomized to nuts (fruit: from 22.15±1.61 kg/m2 to 22.30±1.7 kg/m2, p = 0.24 nuts: from 22.54±2.26 kg/m2 to 22.73±2.28 kg/m2, p = 0.045). On the other hand BMR increased in the nut group only (p = 0.028). Only the nut group reported a net increase of calories (from 2519±721 kcal/day to 2763±595 kcal/day, p = 0.035) according to 3-day food registrations. Despite an almost three-fold reported increased fructose-intake in the fruit group (from 9.1±6.0 gram/day to 25.6±9.6 gram/day, p<0.0001, nuts: from 12.4±5.7 gram/day to 6.5±5.3 gram/day, p = 0.007) there was no change of HFC. The numerical increase in fasting insulin was statistical significant only in the fruit group (from 7.73±3.1 pmol/l to 8.81±2.9 pmol/l, p = 0.018, nuts: from 7.29±2.9 pmol/l to 8.62±3.0 pmol/l, p = 0.14). Levels of vitamin C increased in both groups while α-tocopherol/cholesterol-ratio increased only in the fruit group.

    Conclusions

    Although BMR increased in the nut-group only this was not linked with differences in weight gain between groups which potentially could be explained by the lack of reported net caloric increase in the fruit group. In healthy non-obese individuals an increased fruit intake seems safe from cardiovascular risk perspective, including measurement of HFC by MRI.

  • 47.
    Ageno, Walter
    et al.
    University of Insubria, Italy.
    Buller, Harry R.
    Academic Medical Centre, Netherlands.
    Falanga, Anna
    Hospital Papa Giovanni XXIII, Italy; Hospital Papa Giovanni XXIII, Italy.
    Hacke, Werner
    Heidelberg University, Germany.
    Hendriks, Jeroen
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. University of Adelaide, Australia.
    Lobban, Trudie
    Arrhythmia Alliance and AF Assoc, England.
    Merino, Jose
    University of La Paz, Spain.
    Milojevic, Ivan S.
    Gen Hospital Cuprija, Serbia.
    Moya, Francisco
    Vithas Xanit Int Hospital, Spain.
    Bart van der Worp, H.
    University of Medical Centre Utrecht, Netherlands.
    Randall, Gary
    SAFE, England.
    Tsioufis, Konstantinos
    University of Athens, Greece.
    Verhamme, Peter
    University of Leuven, Belgium.
    John Camm, A.
    St Georges University of London, England; Imperial Coll, England.
    Managing reversal of direct oral anticoagulants in emergency situations Anticoagulation Education Task Force White Paper2016In: Thrombosis and Haemostasis, ISSN 0340-6245, Vol. 116, no 6, 1003-1010 p.Article in journal (Refereed)
    Abstract [en]

    Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there is a definite need for a reversal agent (e.g. in cases of life-threatening bleeding, bleeding into a closed space or organ, persistent bleeding despite local haemostatic measures, and need for urgent interventions and/or interventions that carry a high risk for bleeding), when reversal agents may be helpful, and when a reversal agent is generally not needed. Key stakeholders who require 24-7/around-the-clock access to these agents vary among hospitals; however, from a practical perspective the emergency department is recommended as an appropriate location for these agents. Clearly, the advent of new agents requires standardised protocols for treating bleeding on an institutional level.

  • 48.
    Agholme, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Macias, Brandon
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Hamang, Matt
    Lilly Research Labs, IN USA .
    Lucchesi, Jonathan
    Lilly Research Labs, IN USA .
    Adrian, Mary D.
    Lilly Research Labs, IN USA .
    Kuhstoss, Stuart
    Lilly Research Labs, IN USA .
    Harvey, Anita
    Lilly Research Labs, IN USA .
    Sato, Masahiko
    Lilly Research Labs, IN USA .
    Aspenberg, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Efficacy of a Sclerostin Antibody Compared to a Low Dose of PTH on Metaphyseal Bone Healing2014In: Journal of Orthopaedic Research, ISSN 0736-0266, E-ISSN 1554-527X, Vol. 32, no 3, 471-476 p.Article in journal (Refereed)
    Abstract [en]

    We compared the effect of a sclerostin antibody to that of a clinically relevant dose of parathyroid hormone (PTH) in a rat model for metaphyseal bone healing. Screws of steel or poly methyl methacrylate (PMMA) were inserted bilaterally into the proximal tibia of young male rats. During 4 weeks the animals then received injections of either phosphate buffered saline (control), sclerostin antibody (25mg/kg, twice weekly) or PTH (5 mu g/kg, daily). The healing response around the screws was then assessed by mechanical testing and X-ray microtomography (mu CT). To distinguish between effects on healing and general effects on the skeleton, other untraumatized bone sites and serum biomarkers were also assessed. After 4 weeks of treatment, PTH yielded a 48% increase in screw pull-out force compared to control (p=0.03), while the antibody had no significant effect. In contrast, the antibody increased femoral cortical and vertebral strength where PTH had no significant effect. mu CT showed only slight changes that were statistically significant for the antibody mainly at cortical sites. The results suggest that a relatively low dose of PTH stimulates metaphyseal repair (screw fixation) specifically, whereas the sclerostin antibody has wide-spread effects, mainly on cortical bone, with less influence on metaphyseal healing.

  • 49.
    Agholme, Lotta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Geriatric Medicine in Norrköping.
    Nath, Sangeeta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Domert, Jakob
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Kågedal, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Health Sciences.
    Hallbeck, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Proteasome Inhibition Induces Stress Kinase Dependent Transport Deficits – Implications for Alzheimer’s Disease2014In: Molecular and Cellular Neuroscience, ISSN 0890-8508, E-ISSN 1095-9327, Vol. 58, 29-39 p.Article in journal (Refereed)
    Abstract [en]

    Alzheimer’s disease (AD) is characterized by accumulation of two misfolded and aggregated proteins, β-amyloid and hyperphosphorylated tau. Both cellular systems responsible for clearance of misfolded and aggregated proteins, the lysosomal and the proteasomal, have been shown to be malfunctioning in the aged brain and more so in AD patients. This malfunction could be the cause of β-amyloid and tau accumulation, eventually aggregating in plaques and tangles. We have investigated how decreased proteasome activity affects AD related pathophysiological changes of microtubule transport and stability, as well as tau phosphorylation. To do this, we used our recently developed neuronal model where human SH-SY5Y cells obtain neuronal morphology and function through differentiation. We found that exposure to low doses of the proteasome inhibitor MG-115 caused disturbed neuritic transport, together with microtubule destabilization and tau phosphorylation. Furthermore, reduced proteasome activity activated several kinases implicated in AD pathology, including JNK, c-Jun and ERK 1/2. Restoration of the microtubule transport was achieved by inhibiting ERK 1/2 activation, and simultaneous inhibition of both ERK 1/2 and c-Jun reversed the proteasome inhibition-induced tau phosphorylation. Taken together, this study suggests that a decrease in proteasome activity can, through activation of c-Jun and ERK 1/2, result in several events contributing to AD pathology. Restoring proteasome function or inhibiting ERK 1/2 and c-Jun could therefore be used as novel treatments against AD.

  • 50.
    Agnafors, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Västra Götalandsregionen, Södra Älvsborgs Sjukhus, Barn- och ungdomspsykiatriska kliniken.
    A Biopsychosocial and Long Term Perspective on Child Behavioral Problems: Impact of Risk and Resilience2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Mental health has become a prominent issue in society. Yet, much remains unknown about the etiology of psychiatric disorders. The aim of the present thesis was to investigate the association between biological, psychological and social factors of risk and resilience and behavioral problems in a birth cohort of Swedish children. 1723 mothers and their children were followed from birth to the age of 12 as part of the South East Sweden Birth Cohort Study (the SESBiC study). Information was gathered through register data, standardized questionnaires and DNA samples.

    In study I, stability of maternal symptoms of depression and the impact on child behavior at age 12 were investigated. The prevalence of depressive symptoms was found to be 12.0 % postpartum. Symptoms of postpartum depression significantly increased the risk for subsequent depressive symptoms 12 years later in women. Children whose mothers reported concurrent symptoms of depression and anxiety had an increased risk for both internalizing and externalizing problems at age 12, but no long term effect on child behavior was seen for postpartum depressive symptoms. The greatest risk was seen for children whose mothers reported symptoms of depression on both occasions. In study II, the impact of gene-environment interaction of 5-HTTLPR and BDNF Val66Met and experience of life events together with symptoms of maternal depression and anxiety on child behavior at age 12 was studied. A main effect of 5-HTTLPR was noticed, but no geneenvironment effects were shown. Similarly to study I, concurrent symptoms of maternal depression and anxiety were an important predictor of child behavioral problems. A high degree of psychosocial stress around childbirth was found to have long lasting detrimental effects on child behavior, increasing the risk for internalizing problems at age 12. Study III investigated the impact of geneenvironment interactions of 5-HTTLPR and BDNF Val66Met and life events together with symptoms of maternal depression and birth characteristics on behavioral problems at age 3. Symptoms of postpartum depression were found to predict internalizing as well as externalizing problems in children three years later. Child experience of life events was a stable predictor of behavioral problems across the scales similar to sociodemographic factors such as parental immigration status and unemployment. No gene-environment interaction effects of 5-HTTLPR or BDNF Val66Met were shown. Study IV used the risk factors identified in studies I-III to investigate factors of resilience to behavioral problems at age 12. The l/l genotype of 5-HTTLPR was associated with a lower risk for behavioral problems at age 12, especially for children facing low adversity. Good social functioning was found to be a general resource factor, independent of the level of risk, while an easy temperament was associated with resilience for children with a high degree of adversity. However, effect sizes were small.

    In summary, the results from the present thesis emphasize the importance of maternal mental health and sociodemographic factors for child mental health at ages 3 and 12, which must be taken into account in clinical settings. Moreover, it adds to the null-findings of the gene-environment effect of 5-HTTLPR and BDNF Val66Met on behavioral problems in children, but indicates a main effect of 5-HTTLPR on internalizing symptoms at age 12.

    List of papers
    1. Symptoms of Depression Postpartum and 12 years Later-Associations to Child Mental Health at 12 years of Age
    Open this publication in new window or tab >>Symptoms of Depression Postpartum and 12 years Later-Associations to Child Mental Health at 12 years of Age
    2013 (English)In: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 17, no 3, 405-414 p.Article in journal (Refereed) Published
    Abstract [en]

    Children of depressed mothers have been shown to express behaviour problems to a greater extent than children of non-depressed mothers. The purpose of this study was to examine the persistence of depressive symptoms in mothers and to evaluate the relative importance of symptoms of postpartum depression (PPD) and concurrent maternal symptoms of depression, on child behaviour at age 12. A birth cohort of 1,707 children and their mothers was followed from 3 months after birth to 12 years after birth. Self-reported symptoms of depression in mothers were assessed at baseline and 12-year follow-up where 893 mothers (52.3 %) and their children participated. The mothers reports on the behaviour of their children at age 12 were used. Multivariate analysis was used to assess factors that increased the risk of child behaviour problems. At baseline, 10.4 % scored above the cutoff for symptoms of postpartum depression. At follow up, 18.2 % scored above the cutoff for depressive symptoms. Multivariate analysis showed that ongoing maternal symptoms of depression, as distinct from PPD-symptoms, was the strongest predictor of child behaviour problems at age 12. The gender of the child and socio-demographic factors at baseline were additional factors that affected the risk of behaviour problems in the 12 year old children. Children of mothers who reported symptoms of depression, both postpartum and at follow-up, were at a greater risk of behaviour problems compared to children of women with no depressive symptoms on either occasion. Our findings indicate that recurrent and ongoing maternal depressive symptoms significantly increase the risk of child behaviour problems as reported by mothers, while symptoms of PPD do not seem to result in an increased risk of behaviour problems in 12 year olds. High maternal socio-demographic life stress at childbirth constitutes an important risk factor for later child behaviour problems.

    Place, publisher, year, edition, pages
    Springer Verlag (Germany), 2013
    Keyword
    CBCL, Children, Mental health, Postpartum depression, SESBiC-study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-90750 (URN)10.1007/s10995-012-0985-z (DOI)000316021200003 ()
    Available from: 2013-04-05 Created: 2013-04-05 Last updated: 2016-01-22
    2. Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems - a longitudinal study.
    Open this publication in new window or tab >>Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems - a longitudinal study.
    Show others...
    2013 (English)In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 7, no 1, 10- p.Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Depression is a common and disabling condition with a high relapse frequency. Maternal mental health problems and experience of traumatic life events are known to increase the risk of behavior problems in children. Recently, genetic factors, in particular gene-by-environment interaction models, have been implicated to explain depressive etiology. However, results are inconclusive.

    METHODS: Study participants were members of the SESBiC-study. A total of 889 mothers and their children were followed during the child's age of 3 months to 12 years. Information on maternal depressive symptoms was gathered postpartum and at a 12 year follow-up. Mothers reported on child behavior and traumatic life events experienced by the child at age 12. Saliva samples were obtained from children for analysis of 5-HTTLPR and BDNF Val66Met polymorphisms.

    RESULTS: Multivariate analysis showed a significant association between maternal symptoms of depression and anxiety, and internalizing problems in 12-year-old children (OR 5.72, 95% CI 3.30-9.91). Furthermore, carriers of two short alleles (s/s) of the 5-HTTLPR showed a more than 4-fold increased risk of internalizing problems at age 12 compared to l/l carriers (OR 4.73, 95% CI 2.14-10.48). No gene-by-environment interaction was found and neither depressive symptoms postpartum or traumatic experiences during childhood stayed significant in the final model.

    CONCLUSIONS: Concurrent maternal symptoms of depression and anxiety are significant risk factors for behavior problems in children, which need to be taken into account in clinical practice. Furthermore, we found a main effect of 5-HTTLPR on internalizing symptoms in 12-year-old children, a finding that needs to be confirmed in future studies.

    Place, publisher, year, edition, pages
    BioMed Central, 2013
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-104869 (URN)10.1186/1753-2000-7-10 (DOI)23518193 (PubMedID)
    Available from: 2014-02-28 Created: 2014-02-28 Last updated: 2016-01-22Bibliographically approved
    3. Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects
    Open this publication in new window or tab >>Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects
    Show others...
    2016 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16Article in journal (Refereed) Published
    Abstract [en]

    Background: The early environment is important for child development and wellbeing. Gene-by-environment studies investigating the impact of the serotonin transporter genelinked polymorphic region (5-HTTLPR) and the Brain Derived Neurotrophic Factor (BDNF) Val66Met polymorphisms by life events on mental health and behaviour problems have been inconclusive. Methodological differences regarding sample sizes, study population, definitions of adversities and measures of mental health problems obstacle their comparability. Furthermore, very few studies included children. The aim of this study was to examine the associations between a broad range of risk factors covering pregnancy and birth, genetic polymorphism, experience of multiple life events and psychosocial environment, and child behaviour at age three, using a comparably large, representative, population-based sample.

    Methods: A total of 1,106 children, and their mothers, were followed from pregnancy to age three. Information on pregnancy and birth-related factors was retrieved from the Medical Birth Register. Questionnaires on depressive symptoms, child behaviour and child experiences of life events were filled in by the mothers. Child saliva samples were used for genotyping the 5-HTTLPR and BDNF Val66Met polymorphisms. Multiple logistic regression was used to investigate the association between psychological scales and genetic polymorphisms.

    Results: Symptoms of postpartum depression increased the risk of both internalizing and externalizing problems. Experience of multiple life events was also a predictor of behavioural problems across the scales. No gene-by-environment or gene-bygene-by-environment interactions were found. Children of immigrants had an increased risk of internalizing problems and parental unemployment was significantly associated with both internalizing and externalizing type of problems.

    Conclusion: This study shows the importance of the psychosocial environment for psychosocial health in preschool children, and adds to  the literature of null-findings of gene-by-environment effects of 5-HTTLPR and BDNF in children

    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-124207 (URN)10.1186/s12887-016-0614-x (DOI)000377535800002 ()
    Note

    Funding agencies:Funding was obtained from the Swedish Council for Working Life and Social Research (FAS), the Swedish Research Council (VR), the Clas Groschinsky Memorial Foundation, Stockholm, Samariten Foundation, Stockholm, the Hallsten Research Foundation and ALF, County Council of Ostergotland.

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    Available from: 2016-01-22 Created: 2016-01-22 Last updated: 2016-07-06Bibliographically approved
    4. A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve
    Open this publication in new window or tab >>A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve
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    2016 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience in the context of child behavior. Biological factors are seldom considered in psychosocial models of resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on behavior at preadolescence. Data from 889 children and their mothers were used. A cumulative adversity score was created by combining maternal symptoms of depression, psychosocial risk and children’s experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament and social functioning, and maternal sense of coherence. Results show that the l/l genotype of the serotonin transporter linked polymorphic region (5-HTTLPR) was associated with lower internalizing scores, especially for children exposed to low adversity. An easy temperament was associated with resilient outcomes for children exposed to high adversity. Child social functioning was found to be more of a general resource variable buffering risk in both high and low adversity groups. The results support a multiple level model of resilience indicating effects, though small, of both biological and psychosocial factors. The present findings call for both preventive actions and further studies on biopsychosocial models in resilience research.

    Keyword
    Child, genotype, longitudinal, mental health, resilience
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-124208 (URN)
    Available from: 2016-01-22 Created: 2016-01-22 Last updated: 2016-01-22Bibliographically approved
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