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  • 1.
    Abbasi, Mojdeh
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication. Linköping University, Faculty of Medicine and Health Sciences. Macquarie Univ, Australia.
    Gupta, Vivek
    Macquarie Univ, Australia.
    Chitranshi, Nitin
    Macquarie Univ, Australia.
    Moustardas, Petros
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Sensory Organs and Communication. Linköping University, Faculty of Medicine and Health Sciences.
    Ranjbaran, Reza
    Shiraz Univ Med Sci, Iran.
    Graham, Stuart L.
    Macquarie Univ, Australia.
    Molecular Mechanisms of Glaucoma Pathogenesis with Implications to Caveolin Adaptor Protein and Caveolin-Shp2 Axis2023In: Aging and Disease, ISSN 2152-5250Article, review/survey (Refereed)
    Abstract [en]

    Glaucoma is a common retinal disorder characterized by progressive optic nerve damage, resulting in visual impairment and potential blindness. Elevated intraocular pressure (IOP) is a major risk factor, but some patients still experience disease progression despite IOP-lowering treatments. Genome-wide association studies have linked variations in the Caveolin1/2 (CAV-1/2) gene loci to glaucoma risk. Cav-1, a key protein in caveolae membrane invaginations, is involved in signaling pathways and its absence impairs retinal function. Recent research suggests that Cav-1 is implicated in modulating the BDNF/TrkB signaling pathway in retinal ganglion cells, which plays a critical role in retinal ganglion cell (RGC) health and protection against apoptosis. Understanding the interplay between these proteins could shed light on glaucoma pathogenesis and provide potential therapeutic targets.

  • 2.
    Adedeji, Dickson O.
    et al.
    Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Norrköping. Karolinska Inst, Sweden.
    Holleman, Jasper
    Karolinska Inst, Sweden.
    Juster, Robert-Paul
    Univ Montreal, Canada.
    Udeh-Momoh, Chinedu T.
    Karolinska Inst, Sweden; Imperial Coll London, England.
    Kareholt, Ingemar
    Karolinska Inst, Sweden; Jonkoping Univ, Sweden; Stockholm Univ, Sweden.
    Hagman, Goran
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Aspo, Malin
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Adagunodo, Sofia
    Memory Clin Zentralschweiz, Switzerland.
    Hakansson, Krister
    Karolinska Inst, Sweden.
    Kivipelto, Miia
    Karolinska Inst, Sweden; Imperial Coll London, England; Karolinska Univ Hosp, Sweden; Univ Eastern Finland, Finland.
    Solomon, Alina
    Karolinska Inst, Sweden; Imperial Coll London, England; Karolinska Univ Hosp, Sweden; Univ Eastern Finland, Finland.
    Sindi, Shireen
    Karolinska Inst, Sweden; Imperial Coll London, England; Care Sci & Soc NVS, Sweden.
    Longitudinal study of Alzheimers disease biomarkers, allostatic load, and cognition among memory clinic patients2023In: Brain, Behavior, and Immunity - Health, E-ISSN 2666-3546, Vol. 28, article id 100592Article in journal (Refereed)
    Abstract [en]

    Background: Allostatic load (AL) is defined as the cumulative dysregulation of neuroendocrine, immunological, metabolic, and cardiovascular systems that increases the susceptibility to stress-related health problems. Several dementia and Alzheimers disease (AD) risk factors have been identified, yet little is known about the role of AL and its associations with AD biomarkers (e.g., beta-amyloid (A & beta;) or tau) and cognitive function among memory clinic patients. Hence, this study aims to assess the association between AL and AD biomarkers, cognitive performance, and cognitive decline after 3-years of follow-up.Methods: Data from 188 memory clinic patients were derived from the Cortisol and Stress in AD (Co-STAR) study in Sweden. Participants underwent baseline assessments including blood tests for AL measures (including cortisol, thyroid stimulating hormone, cobalamin, homocysteine, leukocytes, glycated hemoglobin, albumin, high-density and low-density lipoprotein cholesterol, triglycerides, and creatinine), cerebrospinal fluid (CSF) sampling for AD biomarkers and neuropsychological tests including five cognitive domains. Linear regressions were conducted, adjusting for age, sex, and education.Results: Higher AL was associated with lower CSF A & beta;1-42 levels (& beta; =-0.175, p = 0.025), reflecting higher brain levels of A & beta;1-42. Stratified analyses suggested a significant association among women but not men, although the AL-sex interaction was not statistically significant. AL was not significantly associated with T-tau level (& beta; =-0.030, p = 0.682) and P-tau level (& beta; = 0.091, p = 0.980). There were no significant associations between AL and cognition or cognitive decline after 3 years.Conclusion: This study showed that higher AL was associated with increased brain amyloid accumulation. This suggests that AL may play a role in AD/dementia pathophysiology. Potential sex-related differences should be assessed in further larger studies.

  • 3.
    Alehagen, Urban
    et al.
    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 Cardiology in Linköping.
    Wågsäter, Dick
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Gender difference and genetic variance in lipoprotein receptor-related protein 1 is associated with mortality2019In: BIOMEDICAL REPORTS, ISSN 2049-9434, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Cardiovascular diseases are an important health resource problem and studies have shown a genetic association between single nucleotide polymorphisms (SNPs) and cardiovascular diseases. According to the literature, lipoprotein receptor-related protein 1 (LRP1) is associated with coronary artery disease. The aim of the present study was to evaluate a possible association between different genotypes of LRP1 and all-cause and cardiovascular mortality from a gender perspective. In the present study, 489 elderly community-living people were invited to participate. Clinical examination, echocardiography and blood sampling including SNP analyses of LRP1 (rs1466535) were performed, including the T/T, C/T and C/C genotypes, and the participants were followed for 6.7 years. During the follow-up period, 116 (24%) all-cause and 75 (15%) cardiovascular deaths were registered. In the female population, the LRP1 of the T/T or C/T genotype exhibited a 5.6-fold increased risk of cardiovascular mortality and a 2.8-fold increased risk of all-cause mortality compared with the C/C genotype. No such genotype differences could be seen in the male population. Gender differences could be seen regarding the risk of mortality in the different genotypes. Females with the LRP1 T/T or C/T genotypes exhibited a significantly increased risk of both all-cause and cardiovascular mortality compared with the C/C genotypes. Therefore, more individualized cardiovascular prevention and treatment should be prioritized. However, since this was a small study, the observations should only be regarded as hypothesis-generating.

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  • 4.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Carlbring, Per
    Stockholm University, Sweden.
    Internet-Assisted Cognitive Behavioral Therapy2017In: Psychiatric Clinics of North America, ISSN 0193-953X, E-ISSN 1558-3147, Vol. 40, no 4, p. 689-+Article in journal (Refereed)
    Abstract [en]

    Internet-assisted cognitive behavioral therapy (ICBT) is a way to deliver cognitive behavioral therapy (CBT) that has been found to generate similar effects as face-to-face CBT in some studies. Results have been replicated by different research groups. This article presents the treatment format and reviews evidence for mood and anxiety disorders. Future developments are discussed, including the lack of theories specific for the treatment format and ways to handle comorbidity. Although some programs have been implemented, there is a need for further studies in clinical settings. Overall, clinician-assisted ICBT is becoming one of the most evidence-based forms of psychological treatment.

  • 5.
    Andersson, Lars
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    World without LTC institutions: challenge or fiction?2009In: The Dignity and Hazard of Elderly / [ed] Vladimir Spidla & Michael Kocab, Prag: Office of the Government of the Czech Republic , 2009, 1, p. 65-66Chapter in book (Other academic)
  • 6.
    Antelius, Eleonor
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Dementia in the age of migration: cross-cultural perspectives2017In: Living with dementia: relations, responses and agency in everyday life / [ed] Lars-Christer Hydén, Eleonor Antelius, Basingstoke: Palgrave Macmillan, 2017, Vol. Sidorna 29-48, p. 29-48Chapter in book (Refereed)
  • 7.
    Ardo, Jessica
    et al.
    Univ Calif Irvine, CA USA.
    Lee, Jung-Ah
    Univ Calif Irvine, CA USA.
    Hildebrand, Janett A.
    Univ Southern Calif, CA 90007 USA.
    Guijarro, Diana
    Univ Calif Irvine, CA USA.
    Ghasemazadeh, Hassan
    Washington State Univ, WA USA.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Evangelista, Lorraine S.
    Univ Texas Med Branch, TX 77555 USA.
    Codesign of a cardiovascular disease prevention text message bank for older adults2021In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 104, no 11, p. 2772-2784Article in journal (Refereed)
    Abstract [en]

    Objective: Develop and validate a text message bank to support healthier lifestyle behaviors in older adults at risk for cardiovascular disease utilizing a codesign approach. Methods: Initially, the researchers, based on literature, developed a bank of 68 SMS text messages focusing on healthy eating (24 messages), physical activity (24 messages), and motivational feedback (20 messages), based on a scoping review of the literature on promoting behavioral change to engage in healthy lifestyle behaviors. In the next step, a panel of five experts analyzed every subset of SMS text messages. Further validation was conducted by nine older adults (>= 60 years). The user demographics, telephone literacy, understanding, and appeal for every SMS text message were evaluated using a 31-item questionnaire. Results: Participants provided an acceptable understanding of the critical concept found in the 49 SMS text message (physical activity M = 1.73 +/- 0.18; diet M = 1.73 +/- 0.26; motivation M = 1.85 +/- 0.25; range 0-2). The average ratings for physical activity (i.e., likability), healthy eating, and motivation were 8.62 +/- 0.64, 8.57 +/- 0.76, and 8.40 +/- 0.83, respectively (range 0-10). Conclusion: Co-designers were able to identify the technological and content requirements for each text message and infographic to enhance understanding and appeal. Practice implications: A feasibility study will need to be conducted as a next step to testing the effectiveness of text messages in a mobile-based intervention to promote healthy behaviors in older adults at high CVD risk. (C) 2021 Elsevier B.V. All rights reserved.

  • 8.
    Bauckneht, Matteo
    et al.
    IRCCS Osped Policlin San Martino, Italy.
    Chincarini, Andrea
    Natl Inst Nucl Phys INFN, Italy.
    Brendel, Matthias
    Ludwig Maximilians Univ Munchen, Germany.
    Rominger, Axel
    Ludwig Maximilians Univ Munchen, Germany; Univ Hosp Bern, Switzerland.
    Beyer, Leonie
    Ludwig Maximilians Univ Munchen, Germany.
    Bruffaerts, Rose
    Katholieke Univ Leuven, Belgium; Univ Hosp Leuven, Belgium; Hasselt Univ, Belgium.
    Vandenberghe, Rik
    Katholieke Univ Leuven, Belgium; Univ Hosp Leuven, Belgium.
    Kramberger, Milica G.
    Univ Med Ctr Ljubljana, Slovenia; Univ Ljubljana, Slovenia.
    Trost, Maja
    Univ Med Ctr Ljubljana, Slovenia; Univ Ljubljana, Slovenia.
    Garibotto, Valentina
    Univ Geneva, Switzerland; Univ Geneva, Switzerland.
    Nicastro, Nicolas
    Geneva Univ Hosp, Switzerland; Univ Cambridge, England.
    Frisoni, Giovanni B.
    Geneva Univ Hosp, Switzerland.
    Lemstra, Afina W.
    Vrije Univ Amsterdam, Netherlands.
    Berckel, Bart N. M.
    Vrije Univ Amsterdam, Netherlands.
    Pilotto, Andrea
    Univ Brescia, Italy; Isidoro Hosp, Italy.
    Padovani, Alessandro
    Univ Brescia, Italy.
    Ochoa-Figueroa, Miguel A.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Davidsson, Anette
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Camacho, Valle
    Univ Autonoma Barcelona, Spain.
    Peira, Enrico
    Natl Inst Nucl Phys INFN, Italy; Univ Genoa, Italy.
    Arnaldi, Dario
    Univ Genoa, Italy; IRCCS Osped Policlin San Martino, Italy.
    Pardini, Matteo
    Univ Genoa, Italy; IRCCS Osped Policlin San Martino, Italy.
    Donegani, Maria Isabella
    Univ Genoa, Italy.
    Raffa, Stefano
    Univ Genoa, Italy.
    Miceli, Alberto
    Univ Genoa, Italy.
    Sambuceti, Gianmario
    IRCCS Osped Policlin San Martino, Italy; Univ Genoa, Italy.
    Aarsland, Dag
    Stavanger Univ Hosp, Norway; Kings Coll London, England.
    Nobili, Flavio
    Univ Genoa, Italy; IRCCS Osped Policlin San Martino, Italy.
    Morbelli, Silvia
    IRCCS Osped Policlin San Martino, Italy; Univ Genoa, Italy.
    Associations among education, age, and the dementia with Lewy bodies (DLB) metabolic pattern: A European-DLB consortium project2021In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 17, no 8, p. 1277-1286Article in journal (Refereed)
    Abstract [en]

    Introduction We assessed the influence of education as a proxy of cognitive reserve and age on the dementia with Lewy bodies (DLB) metabolic pattern. Methods Brain 18F-fluorodeoxyglucose positron emission tomography and clinical/demographic information were available in 169 probable DLB patients included in the European DLB-consortium database. Principal component analysis identified brain regions relevant to local data variance. A linear regression model was applied to generate age- and education-sensitive maps corrected for Mini-Mental State Examination score, sex (and either education or age). Results Age negatively covaried with metabolism in bilateral middle and superior frontal cortex, anterior and posterior cingulate, reducing the expression of the DLB-typical cingulate island sign (CIS). Education negatively covaried with metabolism in the left inferior parietal cortex and precuneus (making the CIS more prominent). Discussion These findings point out the importance of tailoring interpretation of DLB biomarkers considering the concomitant effect of individual, non-disease-related variables such as age and cognitive reserve.

  • 9.
    Bielsten, Therese
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hellström, Ingrid
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Ersta Skondal Bracke Univ Coll, Sweden.
    An extended review of couple-centred interventions in dementia: Exploring the what and why - Part B2019In: Dementia, ISSN 1471-3012, E-ISSN 1741-2684, Vol. 18, no 7-8, p. 2450-2473Article, review/survey (Refereed)
    Abstract [en]

    This scoping review is an extended version of a narrative review of couple-centred interventions in dementia shared in part A and the previous publication in this edition. The rationale for expanding study A emerged through the fact that most dyadic interventions have samples consisting of a majority of couples. The exclusion of interventions with samples of mixed relationships in part A therefore contributed to a narrow picture of joint dyadic interventions for couples in which one partner has a dementia. The aim of this second review is to explore the what (types of interventions) and the why (objectives and outcome measures) of dyadic interventions in which sample consists of a majority of couples/spouses and in which people with dementia and caregivers jointly participate. Method A five-step framework for scoping reviews guided the procedure. Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science. Results Twenty-one studies with various types of psychosocial interventions were included. The main outcome measure for people with dementia was related to cognitive function, respectively caregiver burden and depression for caregivers. Conclusions The findings of this extended review of joint dyadic interventions in dementia are in line with the findings of part A regarding the negative approach of outcomes, lack of a genuine dyadic approach, lack of tailored support, neglect of interpersonal issues and the overlook of the views of people with dementia. This review also recognises that measures of caregiver burden, as well as relationship quality should be considered in samples of mixed relationships due to the different significance of burden and relationship quality for a spouse as opposed to an adult child or friend.

  • 10.
    Borgström Bolmsjö, Beata
    et al.
    Lund University, Sweden.
    Molstad, Sigvard
    Lund University, Sweden.
    Gallagher, Martin
    University of Sydney, Australia.
    Chalmers, John
    University of Sydney, Australia.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ödeshög.
    Midlov, Patrik
    Lund University, Sweden.
    Risk factors and consequences of decreased kidney function in nursing home residents: A longitudinal study2017In: Geriatrics & Gerontology International, ISSN 1444-1586, E-ISSN 1447-0594, Vol. 17, no 5, p. 791-797Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the present study was to study the renal function and the relationship of deterioration in renal function with major outcomes in elderly nursing home residents. A second aim was to compare the internationally recommended formulae for estimated glomerular filtration rate (eGFR) consisting of both creatinine and cystatin C in a nursing home population. Methods: A total of 429 patients from 11 nursing homes were included during 2008-2011. GFR was estimated, from formulae based on both creatinine and cystatin C, at baseline and after 1 and 2 years. The patients were divided into groups based on chronic kidney disease level, and comparisons were made for mortality, morbidity, the use of medications and between the different formulae for eGFR. Results: Survival was lower in the groups with lower renal function. Over 60% of the residents had impaired renal function. Those with impaired renal function were older, had a higher number of medications and a higher prevalence of heart failure. Higher number of medications was associated with a greater risk of rapid decline in renal function with an odds ratio of 1.2 (95% confidence interval 1.06-1.36, P = 0.003). The compared eGFR formulae based on both cystatin C and creatinine were in excellent concordance with each other. Conclusions: Decreased renal function was associated with increased mortality. A majority of nursing home residents had declining renal function, which should be considered when prescribing medications. The more medications, the higher the risk for rapidly declining renal function.

  • 11.
    Borland, Emma
    et al.
    Lund University, Malmö, Sweden; Skåne University Hospital, Sweden.
    Nägga, Katarina
    Lund University, Malmö, Sweden.
    Nilsson, Peter M
    Lund University, Malmö, Sweden.
    Minthon, Lennart
    Lund University, Malmö, Sweden.
    Nilsson, Erik D
    Lund University, Malmö, Sweden.
    Palmqvist, Sebastian
    Lund University, Malmö, Sweden; Skåne University Hospital, Sweden.
    The Montreal Cognitive Assessment: Normative Data from a Large Swedish Population-Based Cohort.2017In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 59, no 3, p. 893-901Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Montreal Cognitive Assessment (MoCA) has a high sensitivity for detecting cognitive dysfunction. Swedish normative data does not exist and international norms are often derived from populations where cognitive impairment has not been screened for and not been thoroughly assessed to exclude subjects with dementia or mild cognitive impairment.

    OBJECTIVE: To establish norms for MoCA and develop a regression-based norm calculator based on a large, well-examined cohort.

    METHODS: MoCA was administered on 860 randomly selected elderly people from a population-based cohort from the EPIC study. Cognitive dysfunction was screened for and further assessed at a memory clinic. After excluding cognitively impaired participants, normative data was derived from 758 people, aged 65-85.

    RESULTS: MoCA cut-offs (-1 to -2 standard deviations) for cognitive impairment ranged from <25 to <21 for the lowest educated and <26 to <24 for the highest educated, depending on age group. Significant predictors for MoCA score were age, sex and level of education.

    CONCLUSION: We present detailed normative MoCA data and cut-offs according to the DSM-5 criteria for cognitive impairment based on a large population-based cohort of elderly individuals, screened and thoroughly investigated to rule out cognitive impairment. Level of education, sex, and age should be taken in account when evaluating MoCA score, which is facilitated by our online regression-based calculator that provide percentile and z-score for a subject's MoCA score.

  • 12.
    Bransvik, Vanja
    et al.
    Lund Univ, Sweden.
    Granvik, Eva
    Skane Univ Hosp, Sweden.
    Minthon, Lennart
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Nordstrom, Peter
    Umea Univ, Sweden.
    Nägga, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden.
    Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study2021In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 5, no 6, p. 1101-1109Article in journal (Refereed)
    Abstract [en]

    Objectives: Behavioural and psychological symptoms of dementia (BPSD) are common in patients with dementia. In the elderly population, comorbidities frequently coexist with dementia and mortality in dementia is high. The aim of this study was to investigate the impact of BPSD on mortality in severe dementia. Methods: This study of 11,448 individuals was based on linked information from the Swedish BPSD registry, the National Patient Register and the Cause of Death register. BPSD was assessed with the Neuropsychiatric Inventory (NPI). Cox proportional hazards regressions were performed for survival analysis. To study different degrees of BPSD, data was categorized into groups: no (NPI, 0 points), mild (NPI, 1-3 points on amp;gt;= 1 item), moderate (NPI, 4-8 points on amp;gt;= 1 item) and severe (NPI, 9-12 points on amp;gt;= 1 item) BPSD based on the highest score on any of the BPSD assessed (NPI items). Results: The presence of moderate or severe BPSD was associated with a stepwise increased risk of mortality (hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.08-1.60 and HR 1.74; 95% CI 1.44-2.12, respectively) compared with individuals with no BPSD. In addition, there was an association between total NPI score and mortality (HR 1.01; 95% CI 1.007-1.010). The results remained significant after multivariable adjustment for age, sex, dementia diagnosis, medication, previous myocardial infarction, hip fracture and stroke. Conclusions: The results show a stepwise increase in mortality risk with increased BPSD, highlighting the importance of adequate management of BPSD to reduce mortality in dementia.

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  • 13.
    Broström, Anders
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Jonkoping Univ, Sweden.
    Wahlin, Ake
    Jonkoping Univ, Sweden.
    Alehagen, Urban
    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 Cardiology in Linköping.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Johansson, Peter
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Sex-specific associations between self-reported sleep duration, depression, anxiety, fatigue and daytime sleepiness in an older community-dwelling population2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 290-298Article in journal (Refereed)
    Abstract [en]

    PurposeThe purpose of this study was to explore whether associations between self-reported sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness differed in older community-dwelling men and women. DesignCross-sectional. MethodsA community-dwelling sample of 675 older men and women (mean age 77.7years, SD 3.8years) was used. All participants underwent a clinical examination by a cardiologist. Validated questionnaires were used to investigate sleep duration, depressive symptoms, anxiety, fatigue and daytime sleepiness. Subjects were divided into short sleepers (6hours), n=231; normal sleepers (7-8hours), n=338; and long sleepers (9hours), n=61. ancovas were used to explore sex-specific effects. ResultsDepressive symptoms were associated with short sleep in men, but not in women. Fatigue was associated with both short and long sleep duration in men. No sex-specific associations of sleep duration with daytime sleepiness or anxiety were found. ConclusionNurses investigating sleep duration and its correlates, or effects, in clinical practice need to take sex into account, as some associations may be sex specific. Depressive symptoms and fatigue can be used as indicators to identify older men with sleep complaints.

  • 14.
    Byman, Elin
    et al.
    Lund Univ, Sweden.
    Nägga, Katarina
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Lund Univ, Sweden.
    Gustavsson, Anna-Marta
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Andersson-Assarsson, Johanna
    Univ Gothenburg, Sweden.
    Hansson, Oskar
    Lund Univ, Sweden.
    Sonestedt, Emily
    Lund Univ, Sweden.
    Wennstrom, Malin
    Lund Univ, Sweden.
    Alpha-amylase 1A copy number variants and the association with memory performance and Alzheimers dementia2020In: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Vol. 12, no 1, article id 158Article in journal (Refereed)
    Abstract [en]

    Background Previous studies have shown that copy number variation (CNV) in the alpha (alpha)-amylase gene (AMY1A) is associated with body mass index, insulin resistance, and blood glucose levels, factors also shown to increase the risk of Alzheimers dementia (AD). We have previously demonstrated the presence of alpha-amylase in healthy neuronal dendritic spines and a reduction of the same in AD patients. In the current study, we investigate the relationship between AMY1A copy number and AD, memory performance, and brain alpha-amylase activity. Methods and materials The association between AMY1A copy number and development of AD was analyzed in 5422 individuals (mean age at baseline 57.5 +/- 5.9, females 58.2%) from the Malmo diet and cancer study genotyped for AMY1A copy number, whereof 247 where diagnosed with AD during a mean follow-up of 20 years. Associations between AMY1A copy number and cognitive performance where analyzed in 791 individuals (mean age at baseline 54.7 +/- 6.3, females 63%), who performed Montreal Cognitive Assessment (MoCA) test. Correlation analysis between alpha-amylase activity or alpha-amylase gene expression and AMY1A copy number in post-mortem hippocampal tissue from on demented controls (n = 8) and AD patients (n = 10) was also performed. Results Individuals with very high ( &gt;= 10) AMY1A copy number had a significantly lower hazard ratio of AD (HR = 0.62, 95% CI 0.41-0.94) and performed significantly better on MoCA delayed word recall test, compared to the reference group with AMY1A copy number 6. A trend to lower hazard ratio of AD was also found among individuals with low AMY1A copy number (1-5) (HR = 0.74, 95% CI 0.53-1.02). A tendency towards a positive correlation between brain alpha-amylase activity and AMY1A copy number was found, and females showed higher brain alpha-amylase activity compared to males. Conclusion Our study suggests that the degree of alpha-amylase activity in the brain is affected by AMY1A copy number and gender, in addition to AD pathology. The study further suggests that very high AMY1A copy number is associated with a decreased hazard ratio of AD and we speculate that this effect is mediated via a beneficial impact of AMY1A copy number on episodic memory performance.

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  • 15.
    Calvo, Noelia
    et al.
    Univ Toronto, Canada.
    Einstein, Gillian
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Univ Toronto, Canada; Rotman Res Inst, Canada; Womens Coll Res Inst, Canada; Univ Toronto, Canada.
    Steroid hormones: risk and resilience in womens Alzheimer disease2023In: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 15, article id 1159435Article, review/survey (Refereed)
    Abstract [en]

    More women have Alzheimer disease (AD) than men, but the reasons for this phenomenon are still unknown. Including women in clinical research and studying their biology is key to understand not just their increased risk but also their resilience against the disease. In this sense, women are more affected by AD than men, but their reserve or resilience mechanisms might delay symptom onset. The aim of this review was to explore what is known about mechanisms underlying womens risk and resilience in AD and identify emerging themes in this area that merit further research. We conducted a review of studies analyzing molecular mechanisms that may induce neuroplasticity in women, as well as cognitive and brain reserve. We also analyzed how the loss of steroid hormones in aging may be linked to AD. We included empirical studies with human and animal models, literature reviews as well as meta-analyses. Our search identified the importance of 17-b-estradiol (E2) as a mechanism driving cognitive and brain reserve in women. More broadly, our analysis revealed the following emerging perspectives: (1) the importance of steroid hormones and their effects on both neurons and glia for the study of risk and resilience in AD, (2) E2s crucial role in womens brain reserve, (3) womens verbal memory advantage as a cognitive reserve factor, and (4) E2s potential role in linguistic experiences such as multilingualism and hearing loss. Future directions for research include analyzing the reserve mechanisms of steroid hormones on neuronal and glial plasticity, as well as identifying the links between steroid hormone loss in aging and risk for AD.

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  • 16.
    Chehrehnegar, Negin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Shati, Mohsen
    Iran Univ Med Sci IUMS, Iran.
    Esmaeili, Mahdieh
    Univ Social Welf & Rehabil Sci, Iran.
    Foroughan, Mahshid
    Univ Social Welf & Rehabil Sci, Iran.
    Executive function deficits in mild cognitive impairment: evidence from saccade tasks2022In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 26, no 5, p. 1001-1009Article in journal (Refereed)
    Abstract [en]

    Objectives: Early detection of mild cognitive impairment (MCI) is necessary to prevent irreversible brain damage caused by incipient Alzheimers disease. It has been showing that amnestic MCI (a-MCI) subjects exhibit subtle deficits in executive function that can be tested using saccade eye movements. Eye-tracking technology is a sensitive method to measure cognitive impairments in dementia and MCI. Methods In this study, we used eye-tracking technology to explore saccade impairments to distinguish between a-MCI and the variants of reference controls. 21 patients with AD, 40 patients with a-MCI, and 59 normal participants were recruited in current study. We measured saccade reaction time, saccade errors, saccade omission, and uncorrected saccades using anti-saccade and pro-saccade tasks with gap and overlap procedures. These parameters were used as markers of executive function and visual attention deficits.Results: The findings revealed that more errors, more omissions, and fewer corrections characterized the saccade behavior of the a-MCI group compared to the reference group. These eye-tracking characteristics can be considered as inhibitory control and working memory deficits in a-MCI subjects. Our results thus demonstrate the applicability of the anti-saccade task as a cognitive marker in a-MCI. Conclusion The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of executive function in aging with cognitive impairments.

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  • 17.
    Clouston, Sean A. P.
    et al.
    SUNY Stony Brook, NY 11794 USA; SUNY Stony Brook, NY 11794 USA.
    Terrera, Graciela Muniz
    Univ Edinburgh, Scotland.
    Rodgers, Joseph Lee
    Vanderbilt Univ, TN USA.
    OKeefe, Patrick
    Oregon Hlth & Sci Univ, OR 97201 USA.
    Mann, Frank D.
    SUNY Stony Brook, NY 11794 USA; SUNY Stony Brook, NY 11794 USA.
    Lewis, Nathan A.
    Univ Victoria, Canada.
    Wänström, Linda
    Linköping University, Department of Computer and Information Science, The Division of Statistics and Machine Learning. Linköping University, Faculty of Arts and Sciences.
    Kaye, Jeffrey
    Oregon Hlth & Sci Univ, OR 97201 USA; NIA Layton Aging & Alzheimers Dis Ctr, OR USA.
    Hofer, Scott M.
    Oregon Hlth & Sci Univ, OR 97201 USA; Univ Victoria, Canada.
    Cohort and Period Effects as Explanations for Declining Dementia Trends and Cognitive Aging2021In: Population and Development Review, ISSN 0098-7921, E-ISSN 1728-4457, Vol. 47, no 3, p. 611-637Article in journal (Refereed)
    Abstract [en]

    Studies have reported that the age-adjusted incidence of cognitive impairment and dementia have decreased over the past two decades. Aging is the predominant risk factor for Alzheimers disease and related dementias and for neurocognitive decline. However, aging alone cannot explain changes in the overall age-adjusted incidence of dementia. The objective of this position paper was to describe the potential for cohort and period effects in cognitive decline and incidence of dementia. Cohort effects have long been reported in demographic literature, but starting in the early 1980s researchers began reporting large historical cohort trends in cognitive function. At the same time, period effects have emerged in the form of economic factors and stressors in early and midlife that may result in reduced cognitive dysfunction. Recognizing that aging individuals today were once children and adolescents and that research has clearly noted that childhood cognitive performance are associated with old-age cognitive performance, this review proposes the need to connect these cohort effects with differences in late-life functioning.

  • 18.
    Dahlin, Lars
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Perez, Raquel
    Lund Univ, Sweden.
    Nyman, Erika
    Linköping University, Department of Biomedical and Clinical Sciences, 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.
    Zimmerman, Malin
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Merlo, Juan
    Lund Univ, Sweden; Reg Skane, Sweden.
    Carpal Tunnel Syndrome and Ulnar Nerve Entrapment Are Associated with Impaired Psychological Health in Adults as Appraised by Their Increased Use of Psychotropic Medication2022In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, no 13, article id 3871Article in journal (Refereed)
    Abstract [en]

    We aimed to study psychological health, as approximated by the use of psychotropic drugs, in a population diagnosed and surgically treated for carpal tunnel syndrome (CTS) or ulnar nerve entrapment (UNE), or both, also considering the demographic and socioeconomic factors of the individuals. Linking data from five large national registers, use of psychotropics (at least one dispensation during the first year after the surgery or the baseline date) was examined in around 5.8 million people 25-80 years old residing in Sweden 2010. Among these individuals, 9728 (0.17%), 890 (0.02%) and 149 (0.00%) were identified as diagnosed and surgically treated for CTS, UNE, or both, respectively. As much as 28%, 34% and 36% in each group, respectively, used psychotropic drugs, compared with 19% in the general population. Regression analyses showed a general higher risk for use of psychotropics related to these nerve compression disorders, to higher age, being a woman, and having low income or low occupational qualification level. Individuals born outside of Sweden had a lower risk. We conclude that surgically treated individuals with a nerve compression disorder have an increased risk of impaired psychological health. Caregivers should be aware of the risk and provide necessary attention.

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  • 19.
    Dahlqvist, Jenny
    et al.
    Region Östergötland, Local Health Care Services in East Östergötland, Department of Geriatric Medicine in Norrköping.
    Ekdahl, Anne
    Lund Hosp, Sweden; KI, Sweden.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Does comprehensive geriatric assessment (CGA) in an outpatient care setting affect the causes of death and the quality of palliative care? A subanalysis of the age-FIT study2019In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 10, no 3, p. 455-462Article in journal (Refereed)
    Abstract [en]

    Key summary pointsAimDoes comprehensive geriatric assessment (CGA) affect the causes of death and the quality of palliative care when patients receive care at the end of life when in an outpatient care setting compared to usual care?FindingsCGA does not affect the causes of death. CGA affects the frequency of referral to specialised palliative care teams, but CGA does not affect the quality of palliative care given to the patients. These effects are measured in outpatient care settings and in comparison with usual care.MessageFurther studies are needed to evaluate the CGA effects on causes of death and palliative care quality in outpatient care settings. AbstractPurposeThe purposes of this study were to retrospectively study whether comprehensive geriatric assessment (CGA) given to community-dwelling old patients with high health care usage has effects regarding: (1) the cause of death and (2) the quality of the provided palliative care when compared to patients without CGA-based care.MethodThis study includes secondary data from a randomised controlled trial (RCT) with 382 participants that took place in the periods 2011-2013. The present study examines all electronical medical records (EMR) from the deceased patients in the original study regarding cause of death [intervention group (IG) N=51/control group (CG) N=66] and quality of palliative care (IG N=33/CG N=41). Descriptive and comparative statistics were produced and the significance level was set at pamp;lt;0.05.ResultsThe causes of death in both groups were dominated by cardiovascular and cerebrovascular diseases with no statistical difference between the groups. Patients in the intervention group had a higher degree of support from specialised palliative care teams than had the control group (p=0.01).ConclusionThe present study in an outpatient context cannot prove any effects of CGA on causes of death. The study shows that CGA in outpatient care means a higher rate of specialised palliative care, but the study cannot show any effects on the palliative quality parameters measured. Further studies with statistical power are needed.

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  • 20.
    de Oliveira, Jade
    et al.
    Univ Fed Rio Grande do Sul, Brazil.
    Moreira, Eduardo Luiz Gasnhar
    Univ Fed Santa Catarina, Brazil.
    Fabro de Bem, Andreza
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Univ Brasilia, Brazil; Fundacao Oswaldo Cruz, Brazil.
    Beyond cardiovascular risk: Implications of Familial hypercholesterolemia on cognition and brain function2024In: Ageing Research Reviews, ISSN 1568-1637, E-ISSN 1872-9649, Vol. 93, article id 102149Article in journal (Refereed)
    Abstract [en]

    Familial hypercholesterolemia (FH) is a metabolic condition caused mainly by a mutation in the low-density lipoprotein (LDL) receptor gene (LDLR), which is highly prevalent in the population. Besides being an important causative factor of cardiovascular diseases, FH has been considered an early risk factor for Alzheimer's disease. Cognitive and emotional behavioral impairments in LDL receptor knockout (LDLr-/-) mice are associated with neuroinflammation, blood-brain barrier dysfunction, impaired neurogenesis, brain oxidative stress, and mitochondrial dysfunction. Notably, today, LDLr-/- mice, a widely used animal model for studying cardiovascular diseases and atherosclerosis, are also considered an interesting tool for studying dementia. Here, we reviewed the main findings in LDLr-/- mice regarding the relationship between FH and brain dysfunctions and dementia development.

  • 21.
    Deka, Pallav
    et al.
    Michigan State Univ, MI 48824 USA.
    Blesa, Jesus
    Univ Valencia, Spain; Univ Valencia, Spain.
    Pathak, Dola
    Michigan State Univ, MI 48824 USA.
    Sempere-Rubio, Nuria
    Univ Valencia, Spain.
    Iglesias, Paula
    Univ Valencia, Spain.
    Mico, Lydia
    Univ Valencia, Spain.
    Soriano, Jose Miguel
    Univ Valencia, Spain; Univ Valencia, Spain.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Marques-Sule, Elena
    Univ Valencia, Spain.
    Combined Dietary Education and High-Intensity Interval Resistance Training Improve Health Outcomes in Patients with Coronary Artery Disease2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 18, article id 11402Article in journal (Refereed)
    Abstract [en]

    Background: Reducing cardiovascular risk through lifestyle changes that include a heart-healthy diet and regular exercise is recommended in the rehabilitation of patients with coronary artery disease (CAD). We pilot-tested the effectiveness of a dietary-education and high-intensity interval resistance training (DE-HIIRT) program on healthy food choices and associated anthropometric variables in patients with established CAD. Methods: A total of 22 participants, aged 60.0 +/- 7.2 years, were enrolled in the study. Over 3 months, under the guidance and supervision of a physiotherapist, participants performed the resistance exercises 2x/week in a group setting (cohort of 11). Participants additionally attended three sessions of dietary education led by a dietician. Participants demonstrated their knowledge and understanding of dietary education by picking heart-healthy foods by reading food labels. Outcomes included change in diet (measured using the tricipital skinfold thickness Mediterranean Diet Adherence questionnaire (MEDAS-14) and the Food Consumption Frequency Questionnaire (FCFQ)) and anthropometric measurements (body composition, body circumference, and tricipital skinfold thickness). A paired t-test was performed to analyze the differences between the baseline and post-intervention results. Results: Participants significantly increased their consumption of vegetables (p = 0.04) and lowered their consumption of sweet snacks (p = 0.007), pastries (p = 0.02), and processed food (p = 0.05). Significant improvements in body mass index (p = 0.001), waist circumference (p = 0.0001), hip circumference (p = 0.04), and body fat (p = 0.0001) were also achieved. Conclusion: Making lifestyle changes that include both diet and exercise is essential in the management of CAD. The HIIRT program combined with dietary changes shows promise in achieving weight-loss goals in this population and needs to be further investigated with appropriate study designs.

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  • 22. Order onlineBuy this publication >>
    Dong, Huan-Ji
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Health Maintenance in Very Old Age: Medical Conditions, Functional Outcome and Nutritional Status2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to provide better understanding of the underlying factors related to health maintenance in very old people, with a focus on medical conditions, functional outcome and nutritional status. Data were gathered from the ELSA 85 project (Elderly in Linköping Screening Assessment). The ELSA 85 project was started in 2007 with a population-based survey of 85-year-old individuals (n = 650) residing in Linköping municipality, Sweden. During the study period from 2007 to 2010, we conducted surveys by postal questionnaire, home visits, geriatric clinic visits, and reviews of electronic medical records as well as the database of health service consumption. A series of cross-sectional analyses were performed on multimorbidity, health service consumption, activities of daily living (ADLs), physical functioning and nutritional status.

    Of 650 eligible individuals, 496 (78% of those alive) completed the questionnaire (Paper I). Despite the prevalence of multimorbidity (68%) and frequent use of assistive technology for mobility (40%), the majority managed self-care (85%), usual activities (74%) and had high self-rated health (>60/100, visual analogue scale). Factors associated with in-patient care were an increased number of general practitioner visits, more use of assistive technology, community assistance, multimorbidity (≥2 chronic diseases) and/or heart failure and arrhythmia.

    Cluster analyses (n = 496, Paper II) revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to ageing (one for men and two for women). Heart failure in men (odds ratio [OR], 2.4; 95% confidence interval [CI], 1–5.7) and women (OR, 3; 95% CI, 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency room visits. Men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.7) and women’s cardiopulmonary cluster (OR, 1.7; 95% CI, 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR, 1.6; 95% CI, 1–2.4) and one of the women’s ageing clusters (OR, 0.5; 95% CI, 0.3–0.8) showed interaction effects on hospitalization.

    In Paper III, overweight (body mass index [BMI], 25–29.9 kg/m2) and obese (BMI, ≥30 kg/m2) individuals (n = 333) perceived more difficulty performing instrumental ADL (IADL) and had more comorbidities than their normal weight counterparts (BMI, 18.5–24.9 kg/m2). After controlling for socio-demographic factors, obese but not overweight individuals were more likely to perceive increased difficulty in performing outdoor activities (OR, 2.1; 95% CI, 1.1–4) and cleaning (OR, 2.2; 95% CI, 1.2–4.2) than their normal weight counterparts. Although obesity was also associated with multimorbidity (OR, 3; 95% CI, 1.2–8), the health service cost of each case of multimorbidity (n = 251) was highest in individuals of normal weight and nearly three times as much as in obese individuals (ratio, 2.9; 95% CI, 1.1–8.1).

    In Paper IV, 88-year-old obese women (n = 83) had greater absolute waist circumference, fat mass (FM) and fat-free mass (FFM), and lower handgrip strength (HS) corrected for FFM and HS-based ratios (HS/weight (Wt), HS/BMI, HS/FFM and HS/FM) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, the HS-based ratios explained more variance in physical functioning in Short Form-36 (R2, 0.52–0.54) than other single anthropometric or body composition parameters (R2, 0.45–0.51). Waist circumference, HS, and two HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty.

    In conclusion, the ELSA 85 population showed a fairly positive image of healthy perception, good functional ability as well as low use of health care among the majority of participants. Patterns of cardiac and pulmonary conditions were better associated than any single morbidity with hospitalization. Heart failure as a single morbidity was better associated than multimorbidity patterns with emergency room visits. For 85-year-olds, being obese, as opposed to overweight, was associated with self-reported activity limitations and comorbidities. Overweight elderly living in their own homes in this population had similar well-being to those of normal weight. In the cohort of 88-year-olds, obese women had high waist circumference, but their HS was relatively low in relation to their Wt and FFM. These parameters were better than BMI for predicting physical function and independent daily living.

    List of papers
    1. Health-related factors associated with hospitalization for old people: Comparisons of elderly aged 85 in a population cohort study
    Open this publication in new window or tab >>Health-related factors associated with hospitalization for old people: Comparisons of elderly aged 85 in a population cohort study
    Show others...
    2012 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 54, no 2, p. 391-397Article in journal (Refereed) Published
    Abstract [en]

    The aim of this population-based study was to (1) describe living conditions and actual health care utilization among 85 year olds; (2) determine factors that affect hospital admissions in this age. The study was conducted on 85-year-old residents in Linkoping municipality, Sweden. The data collected included medical records, health care utilization during the preceding 12 months and a postal questionnaire on assistance, assistive technology, functional impairment, feelings of loneliness, worries and health-related quality of life measured by the EQ-5D. Out of 650 eligible individuals, 496 (78% of those alive) participated. Despite the prevalence of multi-morbidity (68%) and mental discomfort, the majority managed self-care (85%), usual activities (74%) and had high (andgt;60/100) self-rated health evaluated by a visual analog scale (VAS). The non-hospitalized group reported a better health status than the hospitalized group in terms of medical aspects, living conditions and subjective estimation. Factors associated with in-patient care were an increased number of general practitioner visits, more assistive technology, community assistance, multimorbidity and/or diagnosed congestive heart failure and arrhythmia.

    Place, publisher, year, edition, pages
    Elsevier, 2012
    Keywords
    Population study, Hospitalization, Health care service, postal questionnaire
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76812 (URN)10.1016/j.archger.2011.04.023 (DOI)000301647400064 ()
    Note

    Funding Agencies|Health Research Council of the South-East of Sweden|FORSS-8888FORSS-11636FORSS-31811|County of Ostergotland|LIO-11877LIO-31321LIO-79951|Janne Elgqvist Family Foundation||

    Available from: 2012-04-20 Created: 2012-04-20 Last updated: 2021-12-29
    2. Multimorbidity patterns of and use of health services by Swedish 85-year-olds: an exploratory study
    Open this publication in new window or tab >>Multimorbidity patterns of and use of health services by Swedish 85-year-olds: an exploratory study
    2013 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 13, no 120Article in journal (Refereed) Published
    Abstract [en]

    Background

    As life expectancy continues to rise, more elderly are reaching advanced ages (≥80 years). The increasing prevalence of multimorbidity places additional demands on health-care resources for the elderly. Previous studies noted the impact of multimorbidity on the use of health services, but the effects of multimorbidity patterns on health-service use have not been well studied, especially for very old people. This study determines patterns of multimorbidity associated with emergency-room visits and hospitalization in an 85-year-old population.

    Methods

    Health and living conditions were reported via postal questionnaire by 496 Linköping residents aged 85 years (189 men and 307 women). Diagnoses of morbidity were reviewed in patients’ case reports, and the local health-care register provided information on the use of health services. Hierarchical cluster analysis was applied to evaluate patterns of multimorbidity with gender stratification. Factors associated with emergency-room visits and hospitalization were analyzed using logistic regression models.

    Results

    Cluster analyses revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to aging (one for men and two for women). Heart failure in men (OR = 2.4, 95% CI = 1–5.7) and women (OR = 3, 95% CI = 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency-room visits. Men's cardiac cluster (OR = 1.6; 95% CI = 1–2.7) and women's cardiopulmonary cluster (OR = 1.7, 95% CI = 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR = 1.6, 95% CI = 1–2.4) and one of the women’s aging clusters (OR = 0.5, 95% CI = 0.3–0.8) showed interaction effects on hospitalization.

    Conclusion

    In this 85-year-old population, patterns of cardiac and pulmonary conditions were better than a single morbidity in explaining hospitalization. Heart failure was superior to multimorbidity patterns in explaining emergency-room visits. A holistic approach to examining the patterns of multimorbidity and their relationships with the use of health services will contribute to both local health care policy and geriatric practice.

    Place, publisher, year, edition, pages
    BioMed Central, 2013
    Keywords
    Multimorbidity, 85-year-old, Emergency-room visit, Hospitalization
    National Category
    Geriatrics
    Identifiers
    urn:nbn:se:liu:diva-102219 (URN)10.1186/1471-2318-13-120 (DOI)000328479800001 ()
    Available from: 2013-12-04 Created: 2013-12-04 Last updated: 2021-12-29Bibliographically approved
    3. Health Consequences Associated with Being Overweight or Obese: A Swedish Population-Based Study of 85-Year-Olds
    Open this publication in new window or tab >>Health Consequences Associated with Being Overweight or Obese: A Swedish Population-Based Study of 85-Year-Olds
    2012 (English)In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 60, no 2, p. 243-250Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To determine whether being overweight or obese is associated with significant health outcomes in an 85-year-old population. less thanbrgreater than less thanbrgreater thanDESIGN: A cross-sectional population-based study. less thanbrgreater than less thanbrgreater thanSETTING: Linkoping, Sweden. less thanbrgreater than less thanbrgreater thanPARTICIPANTS: Three hundred thirty-eight people born in 1922 were identified using the local authoritys register. less thanbrgreater than less thanbrgreater thanMEASUREMENTS: Data related to sociodemographic characteristics, health-related quality of life (HRQoL), assistance use, and the presence of diseases were collected using a postal questionnaire. Anthropometry and functional status were assessed during home and geriatric clinic visits. Diseases were double-checked in the electronic medical records, and information about health service consumption was obtained from the local healthcare register. less thanbrgreater than less thanbrgreater thanRESULTS: Overweight (body mass index (BMI) 25.0-29.9 kg/m(2)) and obese (BMI andgt;= 30.0 kg/m(2)) participants perceived more difficulty performing instrumental activities of daily living (IADLs) and had more comorbidity than their normal-weight counterparts (BMI 18.5-24.9 kg/m(2)), but their overall HRQoL and health service costs did not differ from those of normal-weight participants. After controlling for sociodemographic factors, being overweight did not influence IADLs or any comorbidity, but obese participants were more likely to perceive greater difficulty in performing outdoor activities (odds ratio (OR) = 2.1, 95% confidence interval (CI) = 1.1-4) and cleaning (OR = 2.2, 95% CI = 1.2-4.2) than their normal-weight counterparts. Although obesity was also associated with multimorbidity (OR = 3, 95% CI = 1.2-8), the health service cost of each case of multimorbidity (n = 251) was highest in normalweight participants and nearly three times as much as in obese participants (ratio: 2.9, 95% CI = 1.1-8.1). less thanbrgreater than less thanbrgreater thanCONCLUSION: For 85-year-olds, being obese, as opposed to overweight, is associated with self-reported activity limitations and comorbidities. Overweight older adults living in their own homes in this population had well-being similar to that of those with normal weight.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2012
    Keywords
    health consequences, overweight, obesity, 85-year-olds
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-76197 (URN)10.1111/j.1532-5415.2011.03827.x (DOI)000300677400007 ()
    Note

    Funding Agencies|Health Research Council of the South-East of Sweden||County of Ostergotland||Janne Elgqvist Family Foundation||

    Available from: 2012-03-31 Created: 2012-03-30 Last updated: 2021-12-29
    4. Obese very old women have low relative handgrip strength, poor physical function, and difficulty in daily living
    Open this publication in new window or tab >>Obese very old women have low relative handgrip strength, poor physical function, and difficulty in daily living
    2015 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 1, p. 20-25Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To investigate how anthropometric and body composition variables, and handgrip strength (HS) affect physical function and independent daily living in 88-year-old Swedish women.

    Participants: A cross-sectional analysis of 83 community-dwelling women, who were 88 years old with normal weight (n=30), overweight (n=29), and obesity (n=24) in Linköping, Sweden, was performed.

    Measures: Assessments of body weight (Wt), height, waist circumference (WC), and arm circumference were performed by using an electronic scale and measuring tape. Tricep skinfold thickness was measured by a skinfold calliper. Fat mass (FM) and fat-free mass (FFM) were measured by bioelectrical impedance analysis, and HS was recorded with an electronic grip force instrument. Linear regression was used to determine the contributions of parameters as a single predictor or as a ratio with HS to physical function (Short Form-36, SF-36PF) and instrumental activities of daily living (IADL).

    Results: Obese women had greater absolute FM and FFM, and lower HS corrected for FFM and HS-based ratios (i.e., HS/Wt, HS/body mass index [BMI]) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, HS-based ratios explained more variance in SF-36PF scoring (R2: 0.52–0.54) than single anthropometric and body composition variables (R2: 0.45–0.51). WC, HS, and HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty.

    Conclusion: Obese very old women have a high WC, but their HS is relatively low in relation to their Wt and FFM. These parameters are better than BMI for predicting physical function and independent daily living.

    Place, publisher, year, edition, pages
    Springer, 2015
    Keywords
    Very old; Handgrip strength; Body composition; Physical function; Instrumental activities of daily living
    National Category
    Geriatrics
    Identifiers
    urn:nbn:se:liu:diva-105215 (URN)10.1007/s12603-014-0512-6 (DOI)000348024800003 ()
    Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2021-12-29Bibliographically approved
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    Health Maintenance in Very Old Age: Medical Conditions, Functional Outcome and Nutritional Status
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  • 23.
    Dong, Huan-Ji
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Marcusson, 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, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Unosson, Mitra
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Obese very old women have low relative handgrip strength, poor physical function, and difficulty in daily living2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 1, p. 20-25Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate how anthropometric and body composition variables, and handgrip strength (HS) affect physical function and independent daily living in 88-year-old Swedish women.

    Participants: A cross-sectional analysis of 83 community-dwelling women, who were 88 years old with normal weight (n=30), overweight (n=29), and obesity (n=24) in Linköping, Sweden, was performed.

    Measures: Assessments of body weight (Wt), height, waist circumference (WC), and arm circumference were performed by using an electronic scale and measuring tape. Tricep skinfold thickness was measured by a skinfold calliper. Fat mass (FM) and fat-free mass (FFM) were measured by bioelectrical impedance analysis, and HS was recorded with an electronic grip force instrument. Linear regression was used to determine the contributions of parameters as a single predictor or as a ratio with HS to physical function (Short Form-36, SF-36PF) and instrumental activities of daily living (IADL).

    Results: Obese women had greater absolute FM and FFM, and lower HS corrected for FFM and HS-based ratios (i.e., HS/Wt, HS/body mass index [BMI]) than their normal weight and overweight counterparts. After adjusting for physical activity levels and the number of chronic diseases, HS-based ratios explained more variance in SF-36PF scoring (R2: 0.52–0.54) than single anthropometric and body composition variables (R2: 0.45–0.51). WC, HS, and HS-based ratios (HS/Wt and HS/FFM) were also associated with the number of IADL with no difficulty.

    Conclusion: Obese very old women have a high WC, but their HS is relatively low in relation to their Wt and FFM. These parameters are better than BMI for predicting physical function and independent daily living.

  • 24.
    Dong, Huan-Ji
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuroscience. Linköping University, Faculty of Health Sciences.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    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.
    Multimorbidity patterns of and use of health services by Swedish 85-year-olds: an exploratory study2013In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 13, no 120Article in journal (Refereed)
    Abstract [en]

    Background

    As life expectancy continues to rise, more elderly are reaching advanced ages (≥80 years). The increasing prevalence of multimorbidity places additional demands on health-care resources for the elderly. Previous studies noted the impact of multimorbidity on the use of health services, but the effects of multimorbidity patterns on health-service use have not been well studied, especially for very old people. This study determines patterns of multimorbidity associated with emergency-room visits and hospitalization in an 85-year-old population.

    Methods

    Health and living conditions were reported via postal questionnaire by 496 Linköping residents aged 85 years (189 men and 307 women). Diagnoses of morbidity were reviewed in patients’ case reports, and the local health-care register provided information on the use of health services. Hierarchical cluster analysis was applied to evaluate patterns of multimorbidity with gender stratification. Factors associated with emergency-room visits and hospitalization were analyzed using logistic regression models.

    Results

    Cluster analyses revealed five clusters: vascular, cardiopulmonary, cardiac (only for men), somatic–mental (only for men), mental disease (only for women), and three other clusters related to aging (one for men and two for women). Heart failure in men (OR = 2.4, 95% CI = 1–5.7) and women (OR = 3, 95% CI = 1.3–6.9) as a single morbidity explained more variance than morbidity clusters in models of emergency-room visits. Men's cardiac cluster (OR = 1.6; 95% CI = 1–2.7) and women's cardiopulmonary cluster (OR = 1.7, 95% CI = 1.2–2.4) were significantly associated with hospitalization. The combination of the cardiopulmonary cluster with the men’s cardiac cluster (OR = 1.6, 95% CI = 1–2.4) and one of the women’s aging clusters (OR = 0.5, 95% CI = 0.3–0.8) showed interaction effects on hospitalization.

    Conclusion

    In this 85-year-old population, patterns of cardiac and pulmonary conditions were better than a single morbidity in explaining hospitalization. Heart failure was superior to multimorbidity patterns in explaining emergency-room visits. A holistic approach to examining the patterns of multimorbidity and their relationships with the use of health services will contribute to both local health care policy and geriatric practice.

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  • 25.
    Dong, Huan-Ji
    et al.
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Wressle, Ewa
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Marcusson, Jan
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Unaltered image of health maintenance: An observation of non-participants in a swedish cohort study of 85 to 86 years olds2015In: Journal of Frailty & Aging, ISSN 2260-1341, E-ISSN 2273-4309, Vol. 4, no 2, p. 93-99Article in journal (Refereed)
    Abstract [en]

    Background: Selection bias is often inevitable in epidemiologic studies. It is not surprising that study conclusions based on participants’ health status are frequently questioned. Objective: This study aimed to assess whether the non-participants affected the characteristics of a general population of the very old people. Design, Setting and Participants: Prospective, cross-sectional (N=650, aged 85 years old) analysis and 1-year follow-up (n=273), in Linköping, Sweden. Measurements: We analysed data on health-related factors from a postal questionnaire, a home visit and a clinic visit at baseline and at the 1-year follow-up. We calculated the effect size to evaluate the degree of differences between the groups. Results: A greater proportion of non-participants resided in sheltered accommodation or nursing homes (participants vs non-response vs refusal, 11% vs 22% vs 40, P<0.001, φ=0.24). During the home visit or clinic visit, a higher proportion of dropouts reported mid-severe problems in EQ-5D domains (mobility and self-care) and limitations in personal activities of daily living, but the differences between participants and dropouts were very small (φ<0.2). No significant difference was found between the groups with regard to emergency room visits or hospital admissions, despite the fact that more participants than dropouts (φ=0.23) had multimorbidities (≥2 chronic diseases). Living in sheltered accommodation or a nursing home (odds ratio (OR), 2.8; 95% confidence interval (CI), 1.5-5), female gender (OR, 1.8; 95% CI, 1.1-3.1) and receiving more home visits in primary care (OR, 1.03; 95% CI, 1-1.06) contributed positively to drop out in the data collection stages over the study period. Conclusion: Non-participants were not considered to be a group with worse health. Mobility problems may influence very old people when considering further participation, which threatens attrition.

  • 26.
    Dragioti, Elena
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Levin, Lars-Åke
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Dong, Huan-Ji
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Association between Participation Activities, Pain Severity, and Psychological Distress in Old Age: A Population-Based Study of Swedish Older Adults2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 6, article id 2795Article in journal (Refereed)
    Abstract [en]

    Although chronic pain is common in old age, previous studies on participation activities in old age seldom consider pain aspects and its related consequences. This study analyses associations between participation activities, pain severity, and psychological distress in an aging population of Swedish older adults (N = 6611). We examined older adults participation in five common leisure activities using the Multidimensional Pain Inventory (MPI), sociodemographic factors, pain severity, weight status, comorbidities, and pain-related psychological distress (anxiety, depression, insomnia severity, and pain catastrophising). We found that gender, body mass index (BMI) levels, and psychological distress factors significantly affected older adults participation in leisure activities. Pain severity and multimorbidity were not significantly associated with older adults participation in leisure activities nor with gender stratification in generalised linear regression models. The potentially modifiable factors, such as high levels of BMI and psychological distress, affected activity participation in men and women differently. Health professionals and social workers should consider gender and target potentially modifiable factors such as weight status and psychological distress to increase older adults participation in leisure activities.

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  • 27. Order onlineBuy this publication >>
    Edvardsson, Maria
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Finspång, Health care Center Finspång.
    Circulating levels and assessment of clinical laboratory analytes, in >80-year-old, apparently healthy, moderately healthy, and frail individuals2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Blood samples are often used to investigate the possible presence of disease and to make treatment decisions. In the interpretation of the results, comparison either with previous values from the same individual or with a set of appropriate group-based reference intervals are used. Current reference intervals for common laboratory analytes are often based on measurements from apparently healthy persons aged 18–65 years. Age is accompanied by a general decline in organ functions and it is difficult to determine whether a change in levels of laboratory analytes in an elderly individual can be attributed to age alone, independent of environmental or disease processes. Frailty can be seen as a consequence of age-related multifactorial deterioration – physical, cognitive and sensory – resulting in vulnerability and lack of adaptability to internal stressors such as infection or new medication and/or external stressors such as fall at home. Consensus about the definition of “frail” and “frailty” is missing, both nationally and internationally, the question arises whether different definitions of “frailty” affect the interpretation of analytes when comparing different groups of elderly.

    The overarching aim of the thesis was to interpret and assess circulating levels of some clinical laboratory analytes in relation to conventional reference values in ≥80-year-old, “apparently healthy”, “moderately healthy”, and “frail” individuals.

     Data originated from other studies, in which blood samples were collected from individuals ≥80-year-old. Comparisons in Paper I of levels of some laboratory analytes, from 138 nursing home residents (NHRs), was made with blood from reference populations, both blood donor and the NORIP study. The results indicated differences for some immunological (complement factor 3 and 4, immunoglobulin G and M) and chemical analytes (alanine aminotransferase (ALT), phosphate, albumin, sodium, creatinine and urea), but no differences in levels occurred for aspartate aminotransferase (AST), gamma-glutamyltransferase (γ-GT) or lactate dehydrogenase (LDH). It was unclear whether the differences were due to differences in age between the elderly and the reference populations or whether the elderly individuals had chronic diseases and were on medication. In Paper II, 569 individuals elderly individuals ≥80 years old were classified as “healthy”, “moderately healthy”, and “frail”, based on diseases, medications and physical and cognitive abilities. Statistical differences between the groups were found for the investigated analytes; albumin, ALT, AST, creatinine and γ-GT. In Paper IV, individuals from Paper II (n=569) were divided into two groups and thereafter divided into “apparently healthy”, “moderately healthy”, and “frail”. One group was subdivided into “apparently healthy”, “moderately healthy” and “frail” based on physical and cognitive abilities and the other group was divided based on the frailty index (FI). There was no statistical difference found between “apparently healthy” and “moderately healthy" groups, regardless of classification model used. Among “frail” individuals, differences in levels occurred for three out of the five investigated analytes: ALT, creatinine and g-GT, with lower levels occurring when the FI classification model was used. No differences in levels occurred for albumin or AST in “frail” individuals, regardless of classification model used. The aim of Paper III was to study whether 1-year changes in complete blood count (CBC) (including haemoglobin (Hb), red blood cell (RBC), erythrocyte volume fraction (EVF), mean corpuscular volume (MCV), mean corpuscular Hb concentration (MCHC), white blood cell (WBC) and platelet count (PLT)), C-reactive protein (CRP) and interleukin (IL)-1β, IL-1RA, IL-6, IL-8 and IL-10 are associated with survival in elderly NHRs aged >80 years. Elevated levels of CRP and IL-8 during 1-year follow-up were associated with reduced length of survival in elderly NHRs. Based on the present thesis it is clear that there is need for reference intervals that consider both age and health status in elderly individuals. A reasonable conclusion when interpreting levels of analytes in elderly individuals with disease or frailty is that individual evaluation based on the individual’s previous levels, is recommended.

    List of papers
    1. Clinical use of conventional reference intervals in the frail elderly
    Open this publication in new window or tab >>Clinical use of conventional reference intervals in the frail elderly
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    2015 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 2, p. 229-235Article in journal (Refereed) Published
    Abstract [en]

    Rationale, aims and objectives

    Reference intervals provided by the laboratory are commonly established by measuring samples from apparently healthy subjects in the ages 18–65 years, excluding elderly individuals with chronic diseases and medication. The aim of our study was to establish whether current reference intervals for immune parameters and chemical biomarkers are valid for older individuals including those with chronic diseases, so-called frail elderly.

    Methods

    Data from our cohort of 138 non-infected nursing home residents (NHR), mean age 86.8 years, range 80–98, were compared with raw data, as basis for the development of reference intervals, obtained from reference populations, like blood donors (IgA, IgG, IgM, C3 and C4) and from the Nordic Reference Interval Project (NORIP) (alanine aminotransferase, albumin, aspartate aminotransferase, creatinine, gamma-glutamyl transferase, lactate dehydrogenase, phosphate, sodium and urea). Immune parameters were measured by nephelometry and in NORIP the measurements were performed by means of different routine methods, in more than 100 laboratories.

    Results

    Only nine individuals (7%) of NHR were found to be free from chronic disease. C3, C4 (P < 0.001) and IgG levels (P < 0.05) were higher, while IgM levels (P < 0.001) were lower in NHR compared with reference blood donors. Levels of alanine aminotransferase, phosphate (P < 0.001), albumin (P < 0.05) and sodium (P < 0.01) were lower while creatinine and urea levels were higher (P < 0.001) in NHR compared with NORIP subjects.

    Conclusion

    Comparing laboratory results from elderly people with conventional reference intervals can be misleading or even dangerous, as normal conditions may appear pathological, or vice versa and thus lead to unnecessary or even harmful treatment.

    Keywords
    ageing; biomarker; clinical practice; nursing home resident
    National Category
    Other Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-117172 (URN)10.1111/jep.12294 (DOI)000351871200009 ()25494854 (PubMedID)
    Available from: 2015-04-21 Created: 2015-04-21 Last updated: 2020-01-16
    2. Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals
    Open this publication in new window or tab >>Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals
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    2018 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 56, no 3, p. 471-478Article in journal (Refereed) Published
    Abstract [en]

    Background: Reference intervals are widely used as decision tools, providing the physician with information about whether the analyte values indicate ongoing disease process. Reference intervals are generally based on individuals without diagnosed diseases or use of medication, which often excludes elderly. The aim of the study was to assess levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and gamma-glutamyl transferase (gamma-GT) in frail, moderately healthy and healthy elderly indivuduals. Methods: Blood samples were collected from individuals amp;gt; 80 years old, nursing home residents, in the Elderly in Linkoping Screening Assessment and Nordic Reference Interval Project, a total of 569 individuals. They were divided into three cohorts: frail, moderately healthy and healthy, depending on cognitive and physical function. Albumin, ALT, AST, creatinine and gamma-GT were analyzed using routine methods. Results: Linear regression predicted factors for 34% of the variance in albumin were activities of daily living (ADL), gender, stroke and cancer. ADLs, gender and weight explained 15% of changes in ALT. For AST levels, ADLs, cancer and analgesics explained 5% of changes. Kidney disease, gender, Mini Mental State Examination (MMSE) and chronic obstructive pulmonary disease explained 25% of the variation in creatinine levels and MMSE explained three per cent of gamma-GT variation. Conclusions: Because a group of people are at the same age, they should not be assessed the same way. To interpret results of laboratory tests in elderly is a complex task, where reference intervals are one part, but far from the only one, to take into consideration.

    Place, publisher, year, edition, pages
    WALTER DE GRUYTER GMBH, 2018
    Keywords
    aging; analyte; clinical interpretation; frail; reference interval
    National Category
    Clinical Laboratory Medicine
    Identifiers
    urn:nbn:se:liu:diva-145114 (URN)10.1515/cclm-2017-0311 (DOI)000423681100022 ()28988219 (PubMedID)
    Note

    Funding Agencies|Landstinget i Ostergotland Sverige [LIO-359661]

    Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2019-09-09
    3. Elevated levels of CRP and IL-8 are related to reduce survival time: 1-year follow-up measurements of different analytes in frail elderly nursing home residents
    Open this publication in new window or tab >>Elevated levels of CRP and IL-8 are related to reduce survival time: 1-year follow-up measurements of different analytes in frail elderly nursing home residents
    Show others...
    2019 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 5, p. 288-292Article in journal (Refereed) Published
    Abstract [en]

    There are only few studies with specific focus on predictors of survival in nursing home residents (NHRs). The aim was to study whether 1-year changes in complete blood count (including hemoglobin, red blood cells, erythrocyte volume fraction, mean corpuscular volume, mean corpuscular hemoglobin concentration, white blood cells count and platelet count), C-reactive protein and interleukin-1 beta (IL-1 beta), IL-1Ra, IL-6, IL-8 and IL-10, are associated with 8-year survival in elderly NHRs, aged amp;gt;= 80 years. Complete blood count, C-reactive protein and interleukins were measured at baseline, after 6 and 12 months from 167 NHRs aged 80-101 years, mean age 88 +/- 4.5 years, 75% of whom were women. Dates of death were collected from the National Death Register 8 years after baseline. Levels of hemoglobin, red blood cells and mean corpuscular hemoglobin concentration were lower after 1-year, but higher for mean corpuscular volume and IL-1 beta, compared to baseline or 6 month follow-up. In the Cox regression model with a time-dependent covariate, raised levels of C-reactive protein and IL-8 were associated with reduced survival time. Elevated levels of C-reactive protein and IL-8 during 1-year follow-up were related to reduce lengths of survival in elderly NHRs.

    Place, publisher, year, edition, pages
    TAYLOR & FRANCIS LTD, 2019
    Keywords
    Aging; frailty; blood cell count; c-reactive protein; interleukins; survival
    National Category
    Hematology
    Identifiers
    urn:nbn:se:liu:diva-158342 (URN)10.1080/00365513.2019.1609695 (DOI)000469576100001 ()31074311 (PubMedID)
    Note

    Funding Agencies|Research Council of Southeast Sweden; Futurum County Council of Jonkoping, Sweden

    Available from: 2019-06-28 Created: 2019-06-28 Last updated: 2020-05-02
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  • 28.
    Edvardsson, Maria
    et al.
    Region Östergötland, Primary Care Center, Primary Health Care Center Finspång. Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences.
    Sund-Levander, Märtha
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Milberg, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Ernerudh, Jan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Wressle, Ewa
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Linköping University, Department of Health, Medicine and Caring Sciences.
    Marcusson, Jan
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine.
    Grodzinsky, Ewa
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences.
    Classification of ≥80-year-old individuals into healthy, moderately healthy, and frail based on different frailty scores affects the interpretation of laboratory results2022In: Asian Journal of Medical Sciences, ISSN 2091-0576, E-ISSN 2091-0576, Vol. 13, no 9, p. 63-71Article in journal (Refereed)
    Abstract [en]

    Background: Interpretation laboratory analyses are crucial when assessing the patient’s condition. Reference intervals from apparently healthy and disease-free individuals may cause problems when outcomes from elderly patients with chronic diseases and on medications are being interpreted. Elderly individuals are a heterogeneous group ranging from individuals managing their daily life independently to individuals with diseases and impairment, in need of nursing care around the clock, that is, frail; a term widely used although there is no consensus on the definition.

    Aims and Objectives: The aim of the study was to study the effect of classification of elderly into healthy, moderately healthy, and frail, based on activities of daily living (ADL) and Mini-Mental State Examination (MMSE) or frailty index (FI), on the interpretation of outcomes regarding: Albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, and gamma-glutamyltransferase (γ-GT) levels.

    Materials and Methods: Individuals ≥80 years (n=568) were classified either on ADL and MMSE or number of deficits, (FI).

    Results: Individuals classified as frail based on FI had lower mean levels for ALT, creatinine and γ-GT than individuals classified based on ADL and MMSE (P<0.05).

    Conclusion: The model to define health status to some extent affected laboratory analyte levels in ≥80 years old, classified as healthy, moderately healthy, and frail based on ADL and MMSE versus FI.

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  • 29.
    Eek, Martina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Everyday technology and 86-year-old individuals in Sweden2011In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 2, no 6, p. 123-129Article in journal (Refereed)
    Abstract [en]

    Purpose

    The aim was to investigate everyday technology use in the homes of 86-year-old individuals in Sweden regarding usage, benefits or perceived problems and to study their perception of the technical development and its influence on daily living.

     

    Method

    The design was both quantitative and qualitative. An interview was conducted at a home visit performed by an occupational therapist using a questionnaire including questions on demographics and everyday technology. In addition, a qualitative part was performed based on an interview guide. Two hundred seventy four people participated.

     

    Results

    The results indicate that watching TV was important for almost all 86-year-old individuals. This medium, combined with reading newspapers, was important for obtaining news. The most common problems in usage of everyday technology were related to visual or hearing impairments or operating difficulties. References to the Internet for further information were perceived as problematic for individuals without access to a computer. Another difficulty was automated telephone services. Cognitive deficits impeded everyday technology use and increased perceived problems.

     

    Conclusions

    Access to information and services are important elements in order to be an active participant in the society. Everyday technology is an area that should be addressed by occupational therapists in order to facilitate daily living.

  • 30.
    Eek, Tom
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Neurologiska kliniken i Linköping.
    Larsson, Maria
    Stockholm Univ, Sweden.
    Dizdar Segrell, Nil
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Neurologiska kliniken i Linköping.
    Odor Recognition Memory in Parkinsons Disease: A Systematic Review2021In: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 13, article id 625171Article, review/survey (Refereed)
    Abstract [en]

    Olfactory impairment is a central non-motor symptom in Parkinsons disease (PD). Previous studies have demonstrated that olfactory dysfunction is associated with mental illness and impaired cognition. The frequently investigated olfactory functions are odor detection, discrimination, and identification. However, few studies have focused on odor recognition memory (ORM). ORM tasks involves episodic memory which therefore can facilitate the detection of dementia among patients with PD and consequently adjust their treatment. Thus, the aim of this systematic review is to summarize the existing research on ORM in PD. Databases and reference lists were used for data collection. Studies were included in the review if they met the eligibility criteria derived from the PICOS-framework. Quality evaluation of the studies was based on the STROBE-statement. Six studies with small samples were included in the analysis which demonstrated the scarce research on the subject. The studies targeting ORM were heterogenous and involved two main tasks: odor recognition and odor matching. The synthesis of the data demonstrated that PD patients performed significantly lower than controls on both tasks, especially on odor matching task. Only the odor recognition task exhibited a difference between patients with PD vs. Alzheimers disease (AD). PD patients performed significantly better than AD patients. The findings based on the available limited data support the notion that odor recognition task can be of importance in identifying Parkinsons disease dementia (PDD). To investigate this hypothesis, future research needs to include larger samples of PD, PDD and AD patients executing the same odor recognition task.

  • 31.
    Ekdahl, A. W.
    et al.
    Karolinska Institute, Sweden.
    Odzakovic, Elzana
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Hellström, Ingrid
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    LIVING UNNOTICED: COGNITIVE IMPAIRMENT IN OLDER PEOPLE WITH MULTIMORBIDITY2016In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 20, no 3, p. 275-279Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the correlation between MMSE &lt;= 23 and the presence of a diagnosis of dementia in the medical record in a population with multimorbidity. Design, setting, and participants: This cross-sectional study was part of the Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT; N = 382). Participants were community dwelling, aged &gt;= 75 years, had received inpatient hospital care at least three times during the past 12 months, and had three or more concomitant diagnoses according to the International Classification of Diseases, 10th revision. Measurements: The Mini Mental State Examination (MMSE) was administered at baseline. Medical records of participants with MMSE scores &lt; 24 were examined for the presence of dementia diagnoses and two years ahead. Results: Fifty-three (16%) of 337 participants with a measure of MMSE had a MMSE scores &lt; 24. Six of these 53 (11%) participants had diagnoses of dementia (vascular dementia, n = 4; unspecified dementia, n = 1; Alzheimers disease, n = 1) according to medical records; 89% did not. Conclusions: A MMSE-score &lt; 24 is not well correlated to a diagnosis of dementia in the medical record in a population of elderly with multimorbidity. This could imply that cognitive decline and the diagnosis of dementia remain undetected in older people with multimorbidity. Proactive care of older people with multimorbidity should focus on cognitive decline to detect cognitive impairment and to provide necessary help and support to this very vulnerable group.

  • 32.
    Ekdahl, Anne
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Geriatric Medicine in Norrköping.
    Andersson, Lars
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Center of Palliative Care.
    They do what they think is the best for me: Frail elderly patients' preferences for participation in their care during hospitalization.2010In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 80, no 2, p. 233-240Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To deepen the knowledge of frail elderly patients' preferences for participation in medical decision making during hospitalization. METHODS: Qualitative study using content analysis of semi-structured interviews.

    RESULTS: Patient participation to frail elderly means information, not the wish to take part in decisions about their medical treatments. They view the hospital care system as an institution of power with which they cannot argue. Participation is complicated by barriers such as the numerous persons involved in their care who do not know them and their preferences, differing treatment strategies among doctors, fast patient turnover in hospitals, stressed personnel and linguistic problems due to doctors not always speaking the patient's own language.

    CONCLUSION: The results of the study show that, to frail elderly patients, participation in medical decision making is primarily a question of good communication and information, not participation in decisions about medical treatments.

    PRACTICE IMPLICATIONS: More time should be given to thorough information and as few people as possible should be involved in the care of frail elderly. Linguistic problems should be identified to make it possible to take the necessary precautions to prevent negative impact on patient participation.

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  • 33.
    Ekdahl, Anne
    et al.
    Lunds universitet, Sverige.
    Ekerstad, Niklas
    FoU-enheten, NU-sjukvården, Sverige.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Johanzon, Madelene
    Centralsjukhuset Karlstad, Sverige.
    Metzner, Carina
    Karolinska universitetssjukhuset, Sverige.
    Strandberg, Timo
    Helsingfors universitet och universitetssjukhus, Finland; Uleåborgs universitet, Finland.
    Wilhelmson, Katarina
    Sahlgrenska universitetssjukhuset, Sverige.
    Cederholm, Tommy
    Uppsala universitet, Sverige; Tema åldrande, Karolinska universitetssjukhuset, Sverige.
    Skörhetsbegreppet viktigt för att förstå den äldre patientens behov [Frailty]2020In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117Article, review/survey (Refereed)
    Abstract [en]

    Frailty is a concept that is better than multimorbidity at identifying older people in need of special multidimensional care. Frailty denotes a state of accelerated biological aging in which the body gradually loses the ability to handle physical, mental and social stress. It is a dynamic condition which can be partly prevented and treated with physical exercise, nutrition and appropriate medication.  They are many validated and simple screening tools for frailty. Some of these screening tools can assess the degree of frailty and thereby provide a risk stratification in for example a medical emergency. This can be used to support decisions to offer relevant medical intervention to chronologically old but biologically young people as well as to refrain from treatment in chronologically young but biologically older people.

  • 34.
    Ekerstad, Niklas
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. FoU-enheten, NU-sjukvården, Sverige.
    Cederholm, Tommy
    institutionen för folkhälso- och vårdvetenskap, Uppsala universitet, Sverige.
    Boström, Anne-Marie
    institutionen för neurobiologi, vårdvetenskap och samhälle, Karolinska institutet, Sverige; de två sista Tema inflammation och åldrande, Karolinska universitetssjukhuset, Sverige.
    de Geer, Lina
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, ANOPIVA US. Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology.
    Ekdahl, Anne
    sektionen för geriatrik, Helsingborgs lasarett; institutionen för kliniska vetenskaper Helsingborg, Lunds universitet, Sverige.
    Guidetti, Susanne
    institutionen för neurobiologi, vårdvetenskap och samhälle, arbetsterapi, Karolinska institutet; Tema kvinnohälsa och hälsoprofessioner, Karolinska universitetssjukhuset, Sverige.
    Janzon, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Clinical frailty scale – skörhet ärett sätt att skatta biologisk ålder: [Clinical Frailty Scale - a proxy estimate of biological age]2022In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 119, article id 22040Article, review/survey (Refereed)
    Abstract [en]

    The term frailty denotes a multi-dimensional syndrome characterised by reduced physiological reserves and increased vulnerability. Frailty may be used as a marker of biological age, distinct from chronological age. There are several instruments for frailty assessment. The Clinical Frailty Scale (CFS) is probably the most commonly used in the acute care context. It is a 9-level scale, derived from the accumulated deficit model of frailty, which combines comorbidity, disability, and cognitive impairment. The CFS assessment is fast and easy to implement in daily clinical practice. The CFS is relevant for risk stratification, and may also be used as a screening instrument to identify frail patients suitable for further geriatric evaluation, i.e. a comprehensive geriatric assessment (CGA). By providing information on long-term prognosis, it may improve informed decision-making on an individual basis.

  • 35.
    Ekerstad, Niklas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU NAL Uddevalla Hospital Grp, Sweden.
    Dahlin Ivanoff, Synneve
    University of Gothenburg, Sweden.
    Landahl, Sten
    University of Gothenburg, Sweden.
    Ostberg, Goran
    NU Hospital Grp, Sweden.
    Johansson, Maria
    NU Hospital Grp, Sweden.
    Andersson, David
    University of Gothenburg, Sweden.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Karlson, Bjorn W.
    University of Gothenburg, Sweden.
    Acute care of severely frail elderly patients in a CGA-unit is associated with less functional decline than conventional acute care2017In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, p. 1239-1248Article in journal (Refereed)
    Abstract [en]

    Background: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. Results: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P amp;lt; 0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P amp;lt; 0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170). Conclusion: Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.

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  • 36.
    Ekerstad, Niklas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. NU NAL Uddevalla Hospital Grp, Sweden.
    Karlson, Björn W.
    University of Gothenburg, Sweden.
    Dahlin Ivanoff, Synneve
    University of Gothenburg, Sweden.
    Landahl, Sten
    University of Gothenburg, Sweden.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Heintz, Emelie
    Karolinska Institute, Sweden.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Is the acute care of frail elderly patients in a comprehensive geriatric assessment unit superior to conventional acute medical care?2017In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. Design: This is a clinical, prospective, randomized, controlled, one-center intervention study. Setting: This study was conducted in a large county hospital in western Sweden. Participants: The study included 408 frail elderly patients, aged amp;gt;= 75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. Intervention: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. Measurements: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. Results: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.14-0.79), ambulation (OR =0.19, 95% CI = 0.1-0.37), dexterity (OR =0.38, 95% CI =0.19-0.75), emotion (OR =0.43, 95% CI =0.22-0.84), cognition (OR =0.076, 95% CI =0.033-0.18) and pain (OR =0.28, 95% CI =0.15-0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] = 0.55, 95% CI = 0.32-0.96), and the two groups did not differ significantly in terms of hospital care costs (Pamp;gt;0.05). Conclusion: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.

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  • 37.
    Ekerstad, Niklas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg, Sweden.
    Karlsson, Björn
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Andersson, David
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Heintz, Emelie
    Department of Learning, Informatics, Management and Ethics (LIME), QRC Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Alwin, Jenny
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Short-term Resource Utilization and Cost-Effectiveness of Comprehensive Geriatric Assessment in Acute Hospital Care for Severely Frail Elderly Patients2018In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 19, no 10, p. 871-878.e2Article in journal (Refereed)
    Abstract [en]

    Objective

    The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective.

    Design

    Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups.

    Intervention

    Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit.

    Setting and Participants

    A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female.

    Measures

    The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up.

    Results

    We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was −3226 US dollars (95% CI: −6167 to −285).

    Conclusion

    The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months.

  • 38.
    Erhag, Hanna Falk
    et al.
    Univ Gothenburg, Sweden; Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Guonadottir, Gudny
    Sahlgrens Univ Hosp, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Cederholm, Tommy
    Uppsala Univ, Sweden; Karolinska Univ Hosp, Sweden.
    Ekerstad, Niklas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. NU Hosp Grp, Sweden.
    Religa, Dorota
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Nellgard, Bengt
    Univ Gothenburg, Sweden.
    Wilhelmson, Katarina
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    The Association Between the Clinical Frailty Scale and Adverse Health Outcomes in Older Adults in Acute Clinical Settings - A Systematic Review of the Literature2023In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 18, p. 249-261Article, review/survey (Refereed)
    Abstract [en]

    Background: Frail older adults experience higher rates of adverse health outcomes. Therefore, assessing pre-hospital frailty early in the course of care is essential to identify the most vulnerable patients and determine their risk of deterioration. The Clinical Frailty Scale (CFS) is a frailty assessment tool that evaluates pre-hospital mobility, energy, physical activity, and function to generate a score that ranges from very fit to terminally ill.Purpose: To synthesize the evidence of the association between the CFS degree and all-cause mortality, all-cause readmission, length of hospital stay, adverse discharge destination, and functional decline in patients &gt;65 years in acute clinical settings. Design: Systematic review with narrative synthesis.Methods: Electronic databases (PubMed, EMBASE, CINAHL, Scopus) were searched for prospective or retrospective studies reporting a relationship between pre-hospital frailty according to the CFS and the outcomes of interest from database inception to April 2020. Results: Our search yielded 756 articles, of which 29 studies were included in this review (15 were at moderate risk and 14 at low risk of bias). The included studies represented 26 cohorts from 25 countries (N = 44166) published between 2011 and 2020. All included studies showed that pre-hospital frailty according to the CFS is an independent predictor of all adverse health outcomes included in the review.Conclusion: A primary purpose of the CFS is to grade clinically increased risk (i.e. risk stratification). Our results report the accumulated knowledge on the risk-predictive performance of the CFS and highlight the importance of routinely including frailty assessments, such as the CFS, to estimate biological age, improve risk assessments, and assist clinical decision-making in older adults in acute care. Further research into the potential of the CFS and whether implementing the CFS in routine practice will improve care and patients quality of life is warranted.

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  • 39. Order onlineBuy this publication >>
    E:son Jennersjö, Pär
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Risk factors in type 2 diabetes with emphasis on blood pressure, physical activity and serum vitamin D2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Type 2 diabetes is a common chronic disease with a two-fold increased risk for cardiovascular morbidity and mortality and has an increasing prevalence worldwide. This thesis is based on a study conducted in primary health care in Östergötland and Jönköping, Sweden. The aim of the thesis was to evaluate new risk markers to identify patients with high risk of developing cardiovascular disease in middle-aged men and women with type 2 diabetes.

    Methods

    Data from the cohort study CArdiovascular Risk in type 2 DIabetes – a Prospective study in Primary care (CARDIPP) was used. In paper III data were also used from CARDIPP-Revisited where all participants in the CARDIPP study were invited four years after the baseline investigation for a re-investigation. In paper IV data were used from CAREFUL which is a control group of 185 subjects without diabetes. The investigation included a standard medical history including data on diabetes duration and on-going medication. Anthropometric data were recorded and both office and ambulatory blood pressure were measured. The patients filled out a detailed questionnaire and physical activity was measured by using waist-mounted pedometers. Pedometer-determined physical activity was classified in four groups: Group 1: <5000 steps/day (‘sedentary’); Group 2: 5000-7499 steps/day (‘low active’); Group 3: 7500-9999 steps/day (‘somewhat active’); Group 4: and ≥10 000 steps/day (‘active’). Blood samples were drawn for routine analyses and also frozen for later analyses. The investigations at the departments of physiology included echocardiography, measurements of the carotid intima-media thickness, applanation tonometry and measurements of  sagittal abdominal diameter.

    Results

    Paper 1:

    Patients with a non-dipping systolic blood pressure pattern showed higher left ventricular mass index and pulse wave velocity (PWV) compared with patients with ≥10% decline in nocturnal systolic blood pressure. Patients with <10% decline in nocturnal systolic blood pressure had higher BMI and sagittal abdominal diameter, lower GFR and higher albumin:creatinine ratio and also higher levels of NT-proBNP than patients with a dipping pattern of the nocturnal blood pressure.

    Paper 2:

    The number of steps/day were inversely significantly associated with BMI, waist circumference and sagittal abdominal diameter, levels of CRP, levels of interleukin-6 and PWV.

    Paper 3:

    At the 4-year follow-up the change in PWV (ΔPWV) from baseline was calculated. The group with the lowest steps/day had a significantly higher increase in ΔPWV compared with the group with the highest steps/day. The associations between baseline steps/day and ΔPWV remained after further adjustment in a multivariate linear regression statistically significant (p=0.005). 23% of the variation in the study could be explained by our model. Every 1000 extra steps at baseline reduced the change in ΔPWV by 0.103 m/s between baseline and follow-up.

    Paper 4:

    Low vitamin D levels were associated with significantly increased risk for premature mortality in men with type 2 diabetes. High levels of parathyroid hormone were associated with significantly increased risk for premature mortality in women with type 2 diabetes. These relationships were still statistically significant also when two other well-established risk markers for mortality, PWV and carotid intima-media thickness, were added to the analyses.

    Conclusions

    Ambulatory blood pressure recording can by addressing the issue of diurnal blood pressure variation, explore early cardiovascular organ damage and microvascular complications that goes beyond effects of standardised office blood pressure measurements. Pedometer-determined physical activity may serve as a surrogate marker for inflammation and subclinical organ damage in patients with type 2 diabetes. There is novel support for the durable vascular protective role of a high level of daily physical activity, which is independent of BMI and systolic blood pressure. The use of pedometers is feasible in clinical practice and provides objective information not only about physical activity but also the future risk for subclinical organ damage in middle-aged people with type 2 diabetes. Our results indicate that low vitamin D levels in men or high parathyroid hormone levels in women give independent prognostic information of an increased risk for total mortality.

    List of papers
    1. Circadian blood pressure variation in patients with type 2 diabetes - relationship to macro- and microvascular subclinical organ damage
    Open this publication in new window or tab >>Circadian blood pressure variation in patients with type 2 diabetes - relationship to macro- and microvascular subclinical organ damage
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    2011 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 5, no 3, p. 167-173Article in journal (Refereed) Published
    Abstract [en]

    Aims

    To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes.

    Methods

    Cross-sectional data from 663 patients with type 2 diabetes, aged 55–66 years, were analysed. Nurses measured office BP and ambulatory BP during 24 h. Individuals with ≥10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries.

    Results

    We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p < 0.001).

    Conclusions

    We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.

    Place, publisher, year, edition, pages
    Elsevier, 2011
    Keywords
    Type 2 diabetes mellitus ambulatory blood pressure arterial stiffness microalbuminuria diurnal blood pressure variation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-75571 (URN)10.1016/j.pcd.2011.04.001 (DOI)000304279600004 ()
    Note

    funding agencies|Medical Research Council of Southeast Sweden||Center for Medical Image Science and Visualization (CMIV)||Linkoping University||GE Healthcare||Swedish Heart-Lung Foundation||Swedish Research Council| 12661 |

    Available from: 2012-03-08 Created: 2012-03-08 Last updated: 2021-12-28Bibliographically approved
    2. Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in Type 2 diabetes
    Open this publication in new window or tab >>Pedometer-determined physical activity is linked to low systemic inflammation and low arterial stiffness in Type 2 diabetes
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    2012 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 9, p. 1119-1125Article in journal (Refereed) Published
    Abstract [en]

    Diabet. Med. 29, 11191125 (2012) Abstract Aims The aim of this study was to explore the association between pedometer-determined physical activity versus measures of obesity, inflammatory markers and arterial stiffness in people with Type 2 diabetes. Methods We analysed data from 224 men and 103 women with Type 2 diabetes, aged 5466 years. Physical activity was measured with waist-mounted pedometers during three consecutive days and the number of steps/day were calculated and classified in four groups: andlt; 5000 steps/day, 50007499 steps/day, 75009999 steps/day and andgt;= 10000 steps/day. Blood samples were analysed for lipids, HbA1c, inflammatory markers including C-reactive protein and interleukin-6. Nurses measured blood pressure and anthropometrics. Aortic pulse wave velocity was measured with applanation tonometry over the carotid and femoral arteries. Results Mean steps/day was 7683 +/- 3883 (median 7222, interquartile range 486910 343). There were no differences in age, diabetes duration, blood pressure, lipids or glycaemic control between the four groups of pedometer-determined physical activity. Subjects with higher steps/day had lower BMI (28.8 vs. 31.5 kg/m2, P andlt; 0.001), waist circumference (101.7 vs. 108.0 cm, P andlt; 0.001), lower levels of C-reactive protein (1.6 vs. 2.6 mg/l, P = 0.007), lower levels of interleukin-6 (1.9 vs. 3.8 pg ml, P andlt; 0.001) and lower pulse wave velocity (10.2 vs. 11.0 m/s, P = 0.009) compared with less physically active people. Conclusions We conclude that physical activity measured with pedometer was associated not only with less abdominal obesity, but also with decreased systemic low-grade inflammation as well as with low arterial stiffness, in people with Type 2 diabetes.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2012
    Keywords
    arterial stiffness, exercise, inflammation, obesity, pedometer, Type 2 diabetes
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81816 (URN)10.1111/j.1464-5491.2012.03621.x (DOI)000307470200021 ()
    Note

    Funding Agencies|Medical Research Council of Southeast Sweden||Center for Medical Image Science and Visualization (CMIV), Linkoping University||GE Healthcare||Swedish Heart-Lung Foundation||Swedish Research Council|12661|

    Available from: 2012-09-26 Created: 2012-09-24 Last updated: 2021-10-04Bibliographically approved
    3. Pedometer-determined physical activity level and change in arterial stiffness in Type 2 diabetes over 4 years
    Open this publication in new window or tab >>Pedometer-determined physical activity level and change in arterial stiffness in Type 2 diabetes over 4 years
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    2016 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 33, no 7, p. 992-997Article in journal (Refereed) Published
    Abstract [en]

    Aim To explore prospectively the correlation between the level of pedometer-determined physical activity at the start of the study and the change in pulse wave velocity from baseline to 4 years later in people with Type 2 diabetes.

    Methods We analysed data from 135 men and 53 women with Type 2 diabetes, aged 54–66 years. Physical activity was measured with waist-mounted pedometers on 3 consecutive days and the numbers of steps/day at baseline were classified into four groups: <5000 steps/day, 5000–7499 steps/day, 7500–9999 steps/day and ≥10 000 steps/day. Pulse wave velocity was measured using applanation tonometry over the carotid and femoral arteries at baseline and after 4 years.

    Results The mean (±sd; range) number of steps/day was 8022 (±3765; 956–20 921). The participants with the lowest level of physical activity had a more pronounced increase in the change in pulse wave velocity compared with the participants with the highest. When change in pulse wave velocity was analysed as a continuous variable and adjusted for sex, age, diabetes duration, HbA1c, BMI, systolic blood pressure, pulse wave velocity at baseline, β-blocker use, statin use, unemployment, smoking and diabetes medication, the number of steps/day at baseline was significantly associated with a less steep increase in change in pulse wave velocity (P=0.005). Every 1000 extra steps at baseline corresponded to a lower increase in change in pulse wave velocity of 0.103 m/s.

    Conclusions We found that a high level of pedometer-determined physical activity was associated with a slower progression of arterial stiffness over 4 years in middle-aged people with Type 2 diabetes.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2016
    National Category
    Endocrinology and Diabetes General Practice Geriatrics Sport and Fitness Sciences Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:liu:diva-125910 (URN)10.1111/dme.12873 (DOI)000379930900018 ()26227869 (PubMedID)
    Note

    Funding agencies: Medical Research Council of Southeast Sweden; Centre for Medical Image Science and Visualization (CMIV), Linkoping University; GE Healthcare; Swedish Heart-Lung Foundation; Swedish Research Council [12661]; King Gustaf V and Queen Victoria Freemason Found

    Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2021-10-04Bibliographically approved
    4. A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D-3 and parathyroid hormone levels in patients with type 2 diabetes
    Open this publication in new window or tab >>A prospective observational study of all-cause mortality in relation to serum 25-OH vitamin D-3 and parathyroid hormone levels in patients with type 2 diabetes
    Show others...
    2015 (English)In: Diabetology and Metabolic Syndrome, ISSN 1758-5996, E-ISSN 1758-5996, Vol. 7, no 53Article in journal (Refereed) Published
    Abstract [en]

    Background: Low levels of vitamin D have been related to increased mortality and morbidity in several non-diabetic studies. We aimed to prospectively study relationships between serum 25-OH vitamin D-3 (vitamin D) and of serum parathyroid hormone (PTH) to total mortality in type 2 diabetes. We also aimed to compare the levels of these potential risk-factors in patients with and without diabetes. Methods: The main study design was prospective and observational. We used baseline data from 472 men and 245 women who participated in the "Cardiovascular Risk factors in Patients with Diabetes-a Prospective study in Primary care" study. Patients were 55-66 years old at recruitment, and an age-matched non-diabetic sample of 129 individuals constituted controls for the baseline data. Carotid-femoral pulse-wave velocity (PWV) was measured with applanation-tonometry and carotid intima-media thickness (IMT) with ultrasound. Patients with diabetes were followed for all-cause mortality using the national Swedish Cause of Death Registry. Results: Levels of vitamin D were lower in patients with diabetes than in controls, also after correction for age and obesity, while PTH levels did not differ. Nine women and 24 men died during 6 years of median follow up of the final cohort (n = 698). Vitamin D levels were negatively related to all-cause mortality in men independently of age, PTH, HbA1c, waist circumference, 24-h systolic ambulatory-blood pressure (ABP) and serum-apoB (p = 0.049). This finding was also statistically significant when PWV and IMT were added to the analyses (p = 0.028) and was not affected statistically when medications were also included in the regression-analysis (p = 0.01). In the women with type 2 diabetes, levels of PTH were positively related with all-cause mortality in the corresponding calculations (p = 0.016 without PWV and IMT, p = 0.006 with PWV and IMT, p = 0.045 when also adding medications to the analysis), while levels of vitamin D was without statistical significance (p greater than 0.9). Conclusions: Serum vitamin D in men and serum PTH in women give prognostic information in terms of total-mortality that are independent of regular risk factors in addition to levels of ABP, IMT and PWV.

    Place, publisher, year, edition, pages
    BioMed Central, 2015
    Keywords
    Arteriosclerosis; Calcium; Mortality; Parathyroid hormone; Type 2 diabetes; Vitamin D
    National Category
    Endocrinology and Diabetes
    Identifiers
    urn:nbn:se:liu:diva-120044 (URN)10.1186/s13098-015-0049-9 (DOI)000356219100001 ()26078787 (PubMedID)
    Note

    Funding Agencies|Medical Research Council of Southeast Sweden; Futurum; King Gustaf V and Queen Victoria Freemason Foundation; GE Healthcare; Swedish Heart-Lung Foundation; Swedish Research Council [12661]; County Council of Ostergotland; Linkoping University, Department of Medical and Health Sciences

    Available from: 2015-07-06 Created: 2015-07-06 Last updated: 2021-10-04
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  • 40.
    Esteban-Cornejo, Irene
    et al.
    Northeastern Univ, MA 02115 USA; Univ Granada, Spain.
    Mora-Gonzalez, Jose
    Univ Granada, Spain.
    Cadenas-Sanchez, Cristina
    Univ Granada, Spain.
    Contreras-Rodriguez, Oren
    Bellvitge Biomed Res Inst IDIBELL, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Verdejo-Roman, Juan
    Univ Granada, Spain.
    Henriksson, Pontus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Granada, Spain; Karolinska Inst, Sweden.
    Migueles, Jairo H.
    Univ Granada, Spain.
    Rodriguez-Ayllon, Maria
    Univ Granada, Spain.
    Molina-Garcia, Pablo
    Univ Granada, Spain.
    Suo, Chao
    Monash Univ, Australia.
    Hillman, Charles H.
    Northeastern Univ, MA 02115 USA.
    Kramer, Arthur F.
    Northeastern Univ, MA 02115 USA; Univ Illinois, IL USA.
    Erickson, Kirk I
    Univ Pittsburgh, PA 15260 USA.
    Catena, Andres
    Univ Granada, Spain.
    Verdejo-Garcia, Antonio
    Monash Univ, Australia.
    Ortega, Francisco B.
    Univ Granada, Spain; Karolinska Inst, Sweden.
    Fitness, cortical thickness and surface area in overweight/obese children: The mediating role of body composition and relationship with intelligence2019In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 186, p. 771-781Article in journal (Refereed)
    Abstract [en]

    Cortical thickness and surface area are thought to be genetically unrelated and shaped by independent neurobiological events suggesting that they should be considered separately in morphometric analyses. Although the developmental trajectories of cortical thickness and surface area may differ across brain regions and ages, there is no consensus regarding the relationships of physical fitness with cortical thickness and surface area as well as for its subsequent influence on intelligence. Thus, this study examines: (i) the associations of physical fitness components (i.e., cardiorespiratory fitness, speed-agility and muscular fitness) with overall and regional cortical thickness and surface area; (ii) whether body composition indicators (i.e., body mass index, fat-free mass index and fat mass index) mediate these associations; and (iii) the association of physical fitness and cortical thickness with intelligence in overweight/obese children. A total of 101 overweight/obese children aged 8-11 years were recruited in Granada, Spain. The physical fitness components were assessed following the ALPHA health-related fitness test battery. T1-weighted images were acquired with a 3.0 Tesla Siemens Magnetom Tim Trio system. We used FreeSurfer software version 5.3.0 to assess cortical thickness (mm) and surface area (mm(2)). The main results showed that cardiorespiratory fitness and speed-agility were related to overall cortical thickness (beta = 0.321 and beta = 0.302, respectively; both P amp;lt; 0.05), and in turn, cortical thickness was associated with higher intelligence (beta = 0.198, P amp;lt; 0.05). Muscular fitness was not related to overall cortical thickness. None of the three physical fitness components were related to surface area (p amp;gt; 0.05). The associations of cardiorespiratory fitness and speed-agility with overall cortical thickness were mediated by fat mass index (56.86% amp; 62.28%, respectively). In conclusion, cardiorespiratory fitness and speed-agility, but not muscular fitness, are associated with overall cortical thickness, and in turn, thicker brain cortex is associated with higher intelligence in overweight/obese children. Yet, none of the three physical fitness components were related to surface area. Importantly, adiposity may hinder the benefits of cardiorespiratory fitness and speed-agility on cortical thickness. Understanding individual differences in brain morphology may have important implications for educators and policy makers who aim to determine policies and interventions to maximize academic learning and occupational success later in life.

  • 41.
    Fan, Chuanwen
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Sichuan Univ, Peoples R China; Sichuan Univ, Peoples R China; Sichuan Univ, Peoples R China; Sichuan Univ, Peoples R China.
    Lu, Ran
    Sichuan Univ, Peoples R China.
    Fang, Chao
    Sichuan Univ, Peoples R China; Sichuan Univ, Peoples R China.
    Zhang, Xue-Li
    Orebro Univ, Sweden.
    Lv, Zhao-Ying
    Sichuan Univ, Peoples R China; Sichuan Univ, Peoples R China.
    Li, Yuan
    Sichuan Univ, Peoples R China; Sichuan Univ, Peoples R China.
    Zhang, Hong
    Orebro Univ, Sweden.
    Zhou, Zong-Guang
    Sichuan Univ, Peoples R China; Sichuan Univ, Peoples R China.
    Mo, Xian-Ming
    Sichuan Univ, Peoples R China.
    Sun, Xiao-Feng
    Linköping University, Department of Biomedical and Clinical Sciences, 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 Oncology.
    Expression profile, molecular functions, and prognostic significance of miRNAs in primary colorectal cancer stem cells2021In: Aging, ISSN 1945-4589, E-ISSN 1945-4589, Vol. 13, no 8, p. 12067-12085Article in journal (Refereed)
    Abstract [en]

    MicroRNAs (miRNAs) are known to drive the pathogenesis of colorectal cancer (CRC) via the regulation of cancer stem cells (CSCs). We studied the miRNA expression profile of primary CSCs isolated from patients with CRC (pCRCSCs). Compared to pCRCSC-derived differentiated cells, 98 differentially expressed miRNAs were identified in pCRCSCs. Target genes encoding pCRCSC-related miRNAs were identified using a combination of miRNA target databases and miRNA-mRNA regulatory networks from the same patient. The pCRCSC-related miRNA target genes were associated with pathways contributing to malignant phenotypes, including I-kappa B kinase/NF-kappa B signaling, signal transduction by p53 class mediator, Ras signaling, and cGMP-PKG signaling. The pCRCSC-related miRNA expression signature was independently associated with poor overall survival in both the training and validation cohorts. We have thus identified several pCRCSC-related miRNAs with oncogenic potential that could serve as prognostic biomarkers for CRC.

  • 42.
    Fitzsimmons-Craft, Ellen E.
    et al.
    Washington Univ, MO 63110 USA.
    Taylor, C. Barr
    Stanford Univ, CA 94305 USA; Palo Alto Univ, CA USA.
    Newman, Michelle G.
    Penn State Univ, PA 16802 USA.
    Zainal, Nur Hani
    Penn State Univ, PA 16802 USA.
    Rojas-Ashe, Elsa E.
    Palo Alto Univ, CA USA.
    Lipson, Sarah Ketchen
    Boston Univ, MA USA.
    Firebaugh, Marie-Laure
    Washington Univ, MO 63110 USA.
    Ceglarek, Peter
    Univ Michigan, MI 48109 USA.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Palo Alto Univ, CA USA.
    Jacobson, Nicholas C.
    Dartmouth Coll, NH 03755 USA; Dartmouth Coll, NH 03755 USA.
    Graham, Andrea K.
    Northwestern Univ, IL 60611 USA.
    Kim, Hyungjin Myra
    Univ Michigan, MI 48109 USA.
    Eisenberg, Daniel
    Univ Calif Los Angeles, CA USA.
    Wilfley, Denise E.
    Washington Univ, MO 63110 USA.
    Harnessing mobile technology to reduce mental health disorders in college populations: A randomized controlled trial study protocol2021In: Contemporary Clinical Trials, ISSN 1551-7144, E-ISSN 1559-2030, Vol. 103, article id 106320Article in journal (Refereed)
    Abstract [en]

    About a third of college students struggle with anxiety, depression, or an eating disorder, and only 20?40% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach to detect mental health problems and engage college students in services. We have developed a transdiagnostic, low-cost mobile mental health targeted prevention and intervention platform that uses population-level screening to engage college students in tailored services that address common mental health problems. We will test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20+ colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or an eating disorder and who are not currently engaged in mental health services (N = 7884) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). We will test whether the mobile mental health platform, compared to referral, is associated with improved uptake, reduced clinical cases, disorder-specific symptoms, and improved quality of life and functioning. We will also test mediators, predictors, and moderators of improved mental health outcomes, as well as stakeholder-relevant outcomes, including cost-effectiveness and academic performance. This population-level approach to service engagement has the potential to improve mental health outcomes for the millions of students enrolled in U.S. colleges and universities.

  • 43.
    Flank, P
    et al.
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Fahlström, M
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Boström, C
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Lewis, JE
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Levi, Richard
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Wahman, K
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury.2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 9, p. 886-890Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.andlt;br /andgt;Design: Descriptive, cross-sectional study.andlt;br /andgt;Subjects: A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (≥ 1 year) post-traumatic spinal cord injury with paraplegia.andlt;br /andgt;Methods: Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.andlt;br /andgt;Results: One out of 5 persons reported undertaking physical activity ≥  30 min/day. Persons who were physically active ≥ 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity ≥ 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.andlt;br /andgt;Conclusion: Self-reported physical activity ≥ 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.

  • 44.
    Flank, P
    et al.
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden..
    Wahman, K
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Levi, Richard
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Fahlström, M
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury.2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 5, p. 440-443Article in journal (Refereed)
    Abstract [en]

    Objective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries.andlt;br /andgt;Design: Cross-sectional study.andlt;br /andgt;Subjects: A total of 135 individuals, age range 18-79 years, with chronic (≥ 1 year) post-traumatic paraplegia.andlt;br /andgt;Methods: Body mass index was stratified into 6 categorical groups. Cardiovascular disease risk factors for hypertension, diabetes mellitus and a serum lipid profile were analysed and reported by body mass index category.andlt;br /andgt;Results: More than 80% of the examined participants had at least one cardiovascular disease risk factor irrespective of body mass index level. Hypertension was highly prevalent, especially in men. Dyslipidaemia was common at all body mass index categories in both men and women.andlt;br /andgt;Conclusion: Higher body mass index values tended to associate with more hypertension and diabetes mellitus, whereas dyslipidaemia was prevalent across all body mass index categories. Studies that intervene to reduce weight and or percentage body fat should be performed to determine the effect on reducing modifiable cardiovascular disease risk factors.

  • 45.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Psykiatriska kliniken inkl beroendekliniken.
    Adolescents Selling Sex and Sex as Self-Injury2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There are today only a few population-based studies in the world investigating the prevalence of and associated risk-factors with adolescents selling sex and so far no earlier population-based study has been found investigating adolescents motives for selling sex. Further, to use sex in means of self-injury (SASI) is a behaviour that has been highlighted in Sweden the last years but it is a new field of research and a behaviour in need of conceptualization.

    The aim of this thesis was to investigate the prevalence of, associated risk factors with, motives for and manifestations of adolescents selling sex and the use of sex as self-injury (SASI). For the thesis, two nationally representative cross-sectional population surveys with third year students at Swedish high schools were collected in 2009 (n = 3498, mean age 18.3 +/- 0.6 years, response rate 60.4%) and in 2014 (n = 5839, mean age 18.0 +/- 0.6 years, response rate 59.7%). Further, the motives and manifestations of SASI were investigated in an anonymous self-selected, open-ended questionnaire published on websites of non-governmental organizations offering help and support to women and adolescents (n = 199, mean age 27.9 +/- 9.3 years). Quantitative and qualitative methods were used for data analyses.

    In the 2009 population-based survey, 1.5% (n = 51) of the adolescents reported having sold sex on at least one occasion, but in 2014 the prevalence was slightly lower at 0.9% (n = 51). SASI was reported by 3.2% of girls (n = 100) and 0.8% of boys (n = 20). Both selling sex and SASI were associated with various adverse factors such as experience of sexual abuse, emotional and physical abuse, poor mental health and self-injury. Adolescents selling sex had sought help and support for different problems and worries to a greater extent compared to peers. Contact with healthcare for various psychiatric problems such as suicide attempts, depression and eating disorders was common for adolescents using SASI. Further analysis showed that adolescents selling sex are a heterogeneous group in regard to underlying motives for selling sex, which included emotional and material reasons as well as pleasure. Depending on their underlying motives, adolescents selling sex were found to differ in regard to compensation received, age of the buyer, means of contact with the buyer, sexual orientation, experience of sexual abuse and the use of SASI. By using data from an open-ended questionnaire, SASI was described as deliberate or self-inflicted sexual situations that could include psychological and physical harm. SASI was used as a way to regulate negative feelings, such as anxiety, or to get positive or negative confirmation and the behaviour could be hard to stop.

    In conclusion, selling sex and SASI occurs among Swedish adolescents and the behaviours are associated with sexual, physical and emotional abuse and poor mental health, including trauma symptoms. In regard of the motives and manifestations of SASI, the behaviour could be compared to direct self-injurious behaviours. Data from this thesis suggest that more attention should be paid in healthcare to recognizing adolescents selling sex and SASI in order to prevent further traumatization and victimization.

    List of papers
    1. Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support - a study of a Swedish national sample
    Open this publication in new window or tab >>Adolescents selling sex: Exposure to abuse, mental health, self-harm behaviour and the need for help and support - a study of a Swedish national sample
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    2013 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 2, p. 81-88Article in journal (Refereed) Published
    Abstract [en]

    Selling sex is not uncommon among adolescents and we need to increase our knowledge of how this affects them. The aim of this study was to investigate adolescents who sell sex regarding sexual, mental and physical abuse, mental health as estimated by using the Hopkins Symptom Check List-25 (HSCL-25), self-harm behaviour and the adolescents' experience of receiving help and support. The study was carried out on a national representative sample of adolescents (mean age 18.3 years) in Swedish high schools in the final year of their 3-year programme. The study had 3498 participants and a response rate of 60.4%. Of the adolescents, 1.5% stated that they had sold sexual services. The selling of sex was associated with a history of sexual, mental and physical abuse. Poorer mental health and a higher degree of self-harm behaviour were reported among the adolescents who had sold sex. Help and support was sought to a greater extent by adolescents who had sold sex but these adolescents were not as satisfied with this help and support as the other adolescents. Adolescents that sell sex are a group especially exposed to sexual, mental and physical abuse. They have poorer metnal health and engage in more self-harm behaviour than other adolescents. They are in need of more help and support than other adolescents ant it is reasonable to assert that more resources, research and attention should be directed to this group to provide better help and support in the future.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2013
    Keywords
    adolescents, child abuse, help and support, mental health, self-harm behaviour, selling sex
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:liu:diva-91850 (URN)10.3109/08039488.2012.679968 (DOI)000316956800001 ()
    Available from: 2013-05-03 Created: 2013-05-03 Last updated: 2021-05-18Bibliographically approved
    2. Adolescents motives for selling sex in a welfare state - A Swedish national study
    Open this publication in new window or tab >>Adolescents motives for selling sex in a welfare state - A Swedish national study
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    2018 (English)In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 81, p. 286-295Article in journal (Refereed) Published
    Abstract [en]

    In addition to money or other compensation, other motives for selling sex may be important in a welfare country such as Sweden. The aim of this study was to carry out an exploratory investigation of adolescents motives for selling sex in a population-based survey in Sweden. A total of 5839 adolescents from the third year of Swedish high school, mean age 18.0 years, participated in the study. The response rate was 59.7% and 51 students (0.9%) reported having sold sex. Exploratory factor analysis and hierarchical cluster analysis were used to identify groups of adolescents according to underlying motives for selling sex. Further analyses were carried out for characteristics of selling sex and risk factors. Three groups of adolescents were categorized according to their motives for selling sex: Adolescents reporting; 1) Emotional reasons, being at a greater risk of sexual abuse, using sex as a means of self-injury and having a non-heterosexual orientation. 2) Material but no Emotional reasons, who more often receive money as compensation and selling sex to a person over 25 years of age, and 3) Pleasure or no underlying motive for selling sex reported, who were mostly heterosexual males selling sex to a person under 25 years of age, the buyer was not known from the Internet, the reward was seldom money and this group was less exposed to penetrative sexual abuse or using sex as a means of self-injury. In conclusion, adolescents selling sex are a heterogeneous group in regard to underlying motives.

    Place, publisher, year, edition, pages
    PERGAMON-ELSEVIER SCIENCE LTD, 2018
    Keywords
    Selling sex; Adolescent; Child sexual exploitation; Motives; Prostitution
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-149697 (URN)10.1016/j.chiabu.2018.04.030 (DOI)000436375800026 ()29775872 (PubMedID)
    Note

    Funding Agencies|Ministry of Health and Social Affairs/the Childrens Welfare Foundation Sweden; County of Stockholm, Sweden

    Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2021-05-18
    3. Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health
    Open this publication in new window or tab >>Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health
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    2017 (English)In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 11, no 1Article in journal (Refereed) Published
    Abstract [en]

    Sex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury.

    Place, publisher, year, edition, pages
    BioMed Central, 2017
    National Category
    Neurosciences Rheumatology and Autoimmunity Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-134927 (URN)10.1186/s13034-017-0146-7 (DOI)000395328600001 ()
    Available from: 2017-03-02 Created: 2017-03-02 Last updated: 2024-01-17Bibliographically approved
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    Adolescents Selling Sex and Sex as Self-Injury
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  • 46.
    Gervais, Nicole J.
    et al.
    Univ Toronto, Canada; Rotman Res Inst, Canada.
    Gravelsins, Laura
    Univ Toronto, Canada.
    Brown, Alana
    Univ Toronto, Canada.
    Reuben, Rebekah
    Univ Toronto, Canada.
    Karkaby, Laurice
    Univ Toronto, Canada.
    Baker-Sullivan, Elizabeth
    Univ Toronto, Canada.
    Mendoza, Leanne
    Univ Toronto, Canada.
    Lauzon, Claire
    Univ Toronto, Canada.
    Almey, Anne
    Univ Toronto, Canada; McGill Univ, Canada.
    Foulkes, William D.
    McGill Univ, Canada; Jewish Gen Hosp, Canada.
    Bernardini, Marcus Q.
    Univ Hlth Network, Canada.
    Jacobson, Michelle
    Univ Hlth Network, Canada.
    Velsher, Lea
    North York Gen Hosp, Canada.
    Rajah, M. Natasha
    McGill Univ, Canada.
    Olsen, Rosanna K.
    Univ Toronto, Canada; Rotman Res Inst, Canada.
    Grady, Cheryl
    Univ Toronto, Canada; Rotman Res Inst, Canada; Univ Toronto, Canada.
    Einstein, Gillian
    Linköping University, Department of Thematic Studies, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences. Univ Toronto, Canada; Rotman Res Inst, Canada; Womens Coll Res Inst, Canada.
    Scene memory and hippocampal volume in middle-aged women with early hormone loss2022In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 117, p. 97-106Article in journal (Refereed)
    Abstract [en]

    The present study explored whether early midlife bilateral salpingo-oophorectomy (BSO), a female specific risk factor for dementia, is associated with reduced medial temporal lobe structure and function. Younger middle-aged women with the BRCA1/2 mutation and a BSO prior to spontaneous menopause (SM) were recruited. We determined the performance of women with BSO not taking estradiol-based hormone therapy ( n = 18) on a task measuring object and scene recognition and quantified medial temporal lobe subregion volumes using manually segmented high-resolution T2-weighted MRI scans. Comparisons were made to those with BSO taking estradiol-based hormone therapy ( n = 20), age-matched premenopausal controls ( n = 28), and older women in SM not taking hormone therapy matched for duration of hormone deprivation ( n = 17). Reduced hippocampal integrity specific to the BSO group not taking hormone therapy was observed, reflected by significantly smaller dentate gyrus/CA2/CA3 volumes and lower scene recognition memory performance. These findings show that hippocampal subfield volume may be useful for identifying early midlife changes in women at elevated risk for dementia.

  • 47.
    Glans, Isabelle
    et al.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Sonestedt, Emily
    Lund Univ, Sweden.
    Nägga, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Lund Univ, Sweden.
    Gustavsson, Anna-Marta
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Gonzalez-Padilla, Esther
    Lund Univ, Sweden.
    Borne, Yan
    Lund Univ, Sweden.
    Stomrud, Erik
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Melander, Olle
    Lund Univ, Sweden.
    Nilsson, Peter M.
    Lund Univ, Sweden.
    Palmqvist, Sebastian
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Hansson, Oskar
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Association Between Dietary Habits in Midlife With Dementia Incidence Over a 20-Year Period2023In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 100, no 1, p. E28-E37Article in journal (Refereed)
    Abstract [en]

    Background and ObjectivesDementia cases are expected to triple during the next 30 years, highlighting the importance of finding modifiable risk factors for dementia. The aim of this study was to investigate whether adherence to conventional dietary recommendations or to a modified Mediterranean diet are associated with a subsequent lower risk of developing all-cause dementia, Alzheimer disease (AD), vascular dementia (VaD), or with future accumulation of AD-related beta-amyloid (A beta) pathology.MethodsBaseline examination in the prospective Swedish population-based Malmo Diet and Cancer Study took place in 1991-1996 with a follow-up for incident dementia until 2014. Nondemented individuals born 1923-1950 and living in Malmo were invited to participate. Thirty thousand four hundred forty-six were recruited (41% of all eligible). Twenty-eight thousand twenty-five had dietary data and were included in this study. Dietary habits were assessed with a 7-day food diary, detailed food frequency questionnaire, and 1-hour interview. Main outcomes were incident all-cause dementia, AD, or VaD determined by memory clinic physicians. Secondary outcome was A beta-accumulation measured using CSF A beta 42 (n = 738). Cox proportional hazard models were used to examine associations between diet and risk of developing dementia (adjusted for demographics, comorbidities, smoking, physical activity, and alcohol).ResultsSixty-one percent were women, and the mean (SD) age was 58.1 (7.6) years. One thousand nine hundred forty-three (6.9%) were diagnosed with dementia (median follow-up, 19.8 years). Individuals adhering to conventional dietary recommendations did not have lower risk of developing all-cause dementia (hazard ratio [HR] comparing worst with best adherence, 0.93, 95% CI 0.81-1.08), AD (HR 1.03, 0.85-1.23), or VaD (HR 0.93, 0.69-1.26). Neither did adherence to the modified Mediterranean diet lower the risk of developing all-cause dementia (HR 0.93 0.75-1.15), AD (HR 0.90, 0.68-1.19), or VaD (HR 1.00, 0.65-1.55). The results were similar when excluding participants developing dementia within 5 years or those with diabetes. No significant associations were found between diet and abnormal A beta accumulation, conventional recommendations (OR 1.28, 0.74-2.24) or modified Mediterranean diet (OR 0.85, 0.39-1.84).DiscussionIn this 20-year follow-up study, neither adherence to conventional dietary recommendations nor to modified Mediterranean diet were significantly associated with subsequent reduced risk for developing all-cause dementia, AD dementia, VaD, or AD pathology.

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  • 48.
    Golding, Leigh
    et al.
    Australasian Coll Sport and Exercise Phys, Australia.
    Gillingham, Rory Giles
    Royal Prince Alfred Hosp, Australia.
    Perera, Nirmala
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Oxford, England; Nottingham Univ Hosp NHS Trust, England; La Trobe Univ, Australia.
    The prevalence of depressive symptoms in high-performance athletes: a systematic review2020In: Physician and sportsmedicine, ISSN 0091-3847, E-ISSN 2326-3660, Vol. 48, no 3, p. 247-258Article, review/survey (Refereed)
    Abstract [en]

    Objective: To provide an up-to-date overview of the prevalence of depressive symptoms in high-performance athletes and describe the tools used to assess for these in order to identify knowledge gaps and potential future research priorities.

    Data sources: PubMed, EMBASE, SPORTDiscus, PsychINFO, and Cochrane were systematically searched from December 1993 to December 2018. Peer-reviewed original research articles reporting the prevalence of depression among high-performance athletes aged ≥ 17 years were included.

    Study selection: Sixteen studies satisfied the inclusion criteria, and seven had a low risk of bias.

    Data extraction: The Center for Epidemiologic Studies Depression Scale (CES-D) was the most commonly used tool to assess for depressive symptoms. The prevalence of those with high depression symptom cutoff scores ranged from 6.7% to 34.0%.

    Data synthesis: Higher levels of competition, injuries, > 3 concussions, and female sex were identified as potential risk factors for depression. Female athletes and athletes playing individual sports had high risk of having elevated depression symptom scores.

    Conclusions: Prevention of mental illness in high-performance sports is a novel and emerging field of research interest. This review highlights the prevalence of high depression symptom scores among high-performance athletes. The data collection methods, sample size, sport and athlete population, and tools used to assess depression vary across studies; thus, findings cannot be generalized. This review establishes the need for data collection enhancements with robust longitudinal study designs and standardized depression assessment tools to guide the development of evidence-based mental wellbeing interventions.

  • 49.
    Gustavsson, Anna-Märta
    et al.
    Lund University, Malmö, Sweden.
    Stomrud, Erik
    Lund University, Malmö, Sweden.
    Abul-Kasim, Kasim
    Lund University, Malmö, Sweden.
    Minthon, Lennart
    Lund University, Malmö, Sweden.
    Nilsson, Peter M
    Lund University, Malmö, Sweden.
    Hansson, Oskar
    Lund University, Malmö, Sweden.
    Nägga, Katarina
    Lund University, Malmö, Sweden.
    Cerebral Microbleeds and White Matter Hyperintensities in Cognitively Healthy Elderly: A Cross-Sectional Cohort Study Evaluating the Effect of Arterial Stiffness2015In: Central and Eastern European Migration Review, ISSN 1664-5456, E-ISSN 2053-8871, Vol. 5, no 2, p. 41-51Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Arterial stiffness reflects the ageing processes in the vascular system, and studies have shown an association between reduced cognitive function and cerebral small vessel disease. Small vessel disease can be visualized as white matter hyperintensities (WMH) and lacunar infarcts but also as cerebral microbleeds on brain magnetic resonance imaging (MRI). We aimed to investigate if arterial stiffness influences the presence of microbleeds, WMH and cognitive function in a population of cognitively healthy elderly.

    METHODS: The study population is part of the Swedish BioFinder study and consisted of 208 individuals without any symptoms of cognitive impairment, who scored >27 points on the Mini-Mental State Examination. The participants (mean age, 72 years; 59% women) underwent MRI of the brain with visual rating of microbleeds and WMH. Arterial stiffness was measured with carotid-femoral pulse wave velocity (cfPWV). Eight cognitive tests covering different cognitive domains were performed.

    RESULTS: Microbleeds were detected in 12% and WMH in 31% of the participants. Mean (±standard deviation, SD) cfPWV was 10.0 (±2.0) m/s. There was no association between the presence of microbleeds and arterial stiffness. There was a positive association between arterial stiffness and WMH independent of age or sex (odds ratio, 1.58; 95% confidence interval, 1.04-2.40, p < 0.05), but the effect was attenuated when further adjustments for several cardiovascular risk factors were performed (p > 0.05). Cognitive performance was not associated with microbleeds, but individuals with WMH performed slightly worse than those without WMH on the Symbol Digit Modalities Test (mean ± SD, 35 ± 7.8 vs. 39 ± 8.1, p < 0.05). Linear regression revealed no direct associations between arterial stiffness and the results of the cognitive tests.

    CONCLUSIONS: Arterial stiffness was not associated with the presence of cerebral microbleeds or cognitive function in cognitively healthy elderly. However, arterial stiffness was related to the presence of WMH, but the association was attenuated when multiple adjustments were made. There was a weak negative association between WMH and performance in one specific test of attention. Longitudinal follow-up studies are needed to further assess the associations.

  • 50.
    Gustavsson, Anna-Märta
    et al.
    Lund University, Malmö, Sweden; Skåne University Hospital, Malmö, Sweden.
    van Westen, Danielle
    Lund University, Lund, Sweden.
    Stomrud, Erik
    Lund University, Malmö, Sweden; Skåne University Hospital, Malmö, Sweden.
    Engström, Gunnar
    Lund University, Malmö, Sweden.
    Nägga, Katarina
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics. Lund University, Malmö, Sweden.
    Hansson, Oskar
    Lund University, Malmö, Sweden; Skåne University Hospital, Malmö, Sweden.
    Midlife Atherosclerosis and Development of Alzheimer or Vascular Dementia2020In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 87, no 1, p. 52-62Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate whether midlife atherosclerosis is associated with different dementia subtypes and related underlying pathologies.

    METHODS: Participants comprised the cardiovascular cohort of the Swedish prospective population-based Malmö Diet and Cancer Study (N = 6,103). Carotid plaques and intima media thickness (IMT) were measured at baseline (1991-1994). Dementia incidence until 2014 was obtained from national registers. Diagnoses were reviewed and validated in medical records. In a cognitively unimpaired subcohort (n = 330), β-amyloid42 and tau were quantified in cerebrospinal fluid (CSF), and white matter hyperintensity volume, lacunar infarcts, and cerebral microbleeds were estimated on magnetic resonance imaging (2009-2015).

    RESULTS: During 20 years of follow-up, 462 individuals developed dementia (mean age at baseline = 57.5 ± 5.9 years, 58% women). Higher IMT in midlife was associated with an increased hazard ratio (HR) of all-cause dementia (adjusted HR = 1.14 [95% confidence interval (CI) = 1.03-1.26]) and vascular dementia (adjusted HR = 1.32 [95% CI = 1.10-1.57]) but not Alzheimer disease (AD) dementia (adjusted HR = 0.95 [95% CI = 0.77-1.17]). Carotid plaques were associated with vascular dementia when assessed as a 3-graded score (adjusted HR = 1.90 [95% CI = 1.07-3.38]). In the cognitively unimpaired subcohort (53.8 ± 4.6 years at baseline, 60% women), higher IMT in midlife was associated with development of small vessel disease (adjusted odds ratio [OR] = 1.47 [95% CI = 1.05-2.06]) but not significantly with abnormal CSF AD biomarkers (adjusted OR = 1.28 [95% CI = 0.87-1.90] for Aβ42 and 1.35 [95% CI = 0.86-2.13] for Aβ42 /p-tau). Carotid plaques revealed no significant association with any of the underlying brain pathologies.

    INTERPRETATION: Our findings support an association between midlife atherosclerosis and development of vascular dementia and cerebral small vessel disease but not between atherosclerosis and subsequent AD dementia or AD pathology. ANN NEUROL 2019.

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