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  • 12501.
    Ågren, Susanna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Luttik, Marie Louise A.
    Hanze University of Appl Science, Netherlands.
    Caregiving tasks and caregiver burden; effects of an psycho-educational intervention in partners of patients with post-operative heart failure2015Inngår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 44, nr 4, s. 270-275Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the effects of a psycho-educational intervention on caregiver burden in partners of patients with postoperative heart failure. Background: Since partners of cardiac surgery patients play a significant role in the patients recovery, it is important to address their needs during hospitalization and after discharge. Methods: Forty-two patients with postoperative heart failure and their partners participated in a randomized controlled pilot study. Dyads in the intervention group received psycho-educational support from a multidisciplinary team. Dyads in the control group received usual care. Results: No significant differences were found in the performance of caregiving tasks and perceived caregiver burden in the control versus the intervention group. Conclusion: A pilot study exploring the effects of a psycho-educational intervention in patients and their partners did not reveal significant effects with regard to reduced feelings of burden in partners. Alleviating caregiver burden in partners may need a more intense or specific approach. (C) 2015 Elsevier Inc. All rights reserved.

    Fulltekst (pdf)
    fulltext
  • 12502.
    Åhammar, Simon
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Reumatologiska kliniken i Östergötland.
    Martinsson, Klara
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Ziegelasch, Michael
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Reumatologiska kliniken i Östergötland.
    Kastbom, Alf
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Reumatologiska kliniken i Östergötland.
    Prognostic value of serum protein electrophoresis constituents for arthritis development in anti-citrullinated protein antibody-positive patients with musculoskeletal pain2024Inngår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectivePredictors of arthritis development in patients with anti-citrullinated protein antibodies (ACPAs) and musculoskeletal symptoms are needed for risk stratification and to improve clinical outcomes. The aim of this study was to assess the relationship between serum protein electrophoresis (SPE) constituents and the development of clinical arthritis in ACPA-positive patients with musculoskeletal pain.MethodWe prospectively followed 82 ACPA-positive patients with musculoskeletal pain but no baseline arthritis during a median of 72 months (interquartile range 57-81 months). The primary outcome was arthritis development, as judged by clinical examination. SPE constituents were evaluated in baseline sera by immunoturbidimetric methods. Serum levels of the analysed proteins (albumin, orosomucoid, alpha 1-anti-trypsin, haptoglobin, and immunoglobulins IgA, IgG, and IgM) were related to arthritis development by Cox regression analyses.ResultsDuring the follow-up period, 39/82 patients (48%) progressed to arthritis. Median baseline levels of orosomucoid and alpha 1-anti-trypsin were higher in patients who developed arthritis than in those who did not (p = 0.04), while median albumin levels were significantly lower (p = 0.03). Immunoglobulin levels did not differ between the groups. Univariable analysis demonstrated a significantly increased risk of arthritis with elevated baseline haptoglobin [hazard ratio (HR) 2.53, 95% confidence interval (CI) 1.32-4.85, p = 0.005] and orosomucoid levels (HR 2.63, 95% CI 1.09-6.31, p = 0.03). However, neither remained significant in multivariable analysis adjusting for elevated C-reactive protein (CRP) levels.ConclusionSPE does not add prognostic value for arthritis development in ACPA-positive patients with musculoskeletal pain.

  • 12503. Bestill onlineKjøp publikasjonen >>
    Åhlund, Kristina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Physical Fitness in Hospitalized Frail Elderly Patients2020Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Demographic research shows that the proportion of older people in society is increasing. More people age well, but there are also more people getting old with disability and multimorbidity. The large diversity in functioning illustrates the heterogeneity of aging. Accelerated aging may lead to frailty, which is a geriatric syndrome, often used as a marker of biologic age and associated with decreased physiologic reserves, increased vulnerability and the risk of adverse health out- comes. Frail elderly people are frequent visitors within emergency hospital care and physical decline is common. Unfortunately, elderly patients with substantial multimorbidity are often excluded from clinical trials.

    Physical fitness comprises a set of measurable health- and skill-related outcomes, such as cardiorespiratory endurance and muscle strength. A decrease in physical fitness may affect the prognosis negatively. However, previous research indicates that it may be possible to reverse frailty and improve physical fitness. It is therefore of the utmost interest to identify frailty and study how care is best provided, in order to prevent, reduce and postpone adverse health consequences.

    The overall aim of this thesis is to study physical fitness in a group of frail elderly patients, within clinical hospital health care. The patients’ physical fitness will be evaluated and compared in different care settings during and after hospitalization. The aim is also to study the long-term consequences of changes in physical fitness in relation to mortality. To better understand the underlying factors for partici- pation in physical activity and exercise, patients’ perceptions of the phenomena will be explored.

    This thesis consists of four papers based on two studies comprising frail elderly patients with substantial multimorbidity, in connection with an in-hospital episode.

    Paper 1 was an observational study with a cross-sectional design (n=408). Different components of physical fitness were measured during an index hospital stay and the results showed that hospitalized frail elderly patients performed below previously described age-related reference values. Furthermore, physical fitness was associated with the degree of frailty, rather than the chronological age.

    Paper 2 was a prospective controlled trial, with two parallel groups. The patients included in the intervention group (n=206) were cared for at an emergency medical care unit providing care according to Comprehensive Geriatric Assessment and care (CGA). The control group (n=202) was cared for at conventional emergency medical care units. The multi-professional care approach at the CGA unit was shown to be beneficial, in terms of a greater proportion of patients who preserved or improved their function during the first three months after discharge from hospital, compared with conventional care.

    Paper 3 had a prospective approach when evaluating the association between physical fitness and oneyear mortality in those 390 patients discharged alive from a hospital care episode. The results showed that physical fitness during in-hospital care and the change in physical fitness during the first months after discharge were associated with one-year mortality.

    In Paper 4, the patients’ perspective in terms of physical activity and exercise was explored. The theme of “Meaningfulness and risk of harm in an aging body” emerged, followed by the three categories of physical activity as part of daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise.

    These studies highlight the importance of a greater focus on physical fitness in hospitalized elderly patients. A careful assessment and a multi-professional approach may lead to beneficial results and better survival even in a group of frail elderly patients with severe multimorbidity. To increase physical activity and exercise in this group of patients, health care probably needs to improve the means of communicating the benefits and goals of exercise and facilitating them so that the risk of harm is reduced.  

    Delarbeid
    1. Physical Performance Impairments and Limitations Among Hospitalized Frail Older Adults
    Åpne denne publikasjonen i ny fane eller vindu >>Physical Performance Impairments and Limitations Among Hospitalized Frail Older Adults
    2018 (engelsk)Inngår i: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 41, nr 4, s. 230-235Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Background and purpose: Early rehabilitation is important for frail older adults due to reduced reserve capacity and physical fitness. To facilitate individualized rehabilitation programs, we need tools to make it possible to assess physical fitness in relation to frailty, instead of chronological age. The purpose of this study was, in a Swedish context, to describe measures of physical fitness in hospitalized frail older adults in relation to their degree of frailty. Methods: This was a cross-sectional study. A total of 408 frail older adults, mean age 86.6 years (75-99 years), in need of emergency medical inpatient care, were included in the NAL-Uddevalla (NU) hospital group in Sweden. During the hospital stay, physical fitness was assessed using 4 different tests: hand-grip strength, the Timed Up and Go Test, 5-time sit-to-stand test, and 6-minute walk test. In the analyses, the physical fitness outcomes were related to the degree of frailty using the FRail Elderly Support ResearcH group screening instrument and previously used cutoffs or age-related reference values for older adults. Results and Discussion: This study showed that most hospitalized frail older adults perform far lower than previously described age-related reference values relating to physical fitness. An increased degree of frailty contributes to reduced physical fitness in tests assessing strength and endurance. Conclusions: A frail-related screening instrument may be useful in the evaluation of physical fitness in hospitalized frail older adults and may facilitate the development of realistic, individualized rehabilitation programs beneficial to an early start on the emergency medical ward.

    sted, utgiver, år, opplag, sider
    LIPPINCOTT WILLIAMS & WILKINS, 2018
    Emneord
    emergency medical care; frailty; physical fitness; physical therapy
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-153391 (URN)10.1519/JPT.0000000000000127 (DOI)000450885400006 ()28252472 (PubMedID)
    Merknad

    Funding Agencies|NU Hospital Group, Department of Research and Development

    Tilgjengelig fra: 2018-12-17 Laget: 2018-12-17 Sist oppdatert: 2023-12-28
    2. Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients
    Åpne denne publikasjonen i ny fane eller vindu >>Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients
    2017 (engelsk)Inngår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, s. 1929-1939Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Introduction: Frail elderly people often use emergency care. During hospitalization, physical decline is common, implying an increased risk of adverse health outcomes. Comprehensive Geriatric Assessment (CGA) has been shown to be beneficial for these patients in hospital care. However, there is very limited evidence about the effects on physical fitness. The aim was to compare effects on physical fitness in the acute care of frail elderly patients at a CGA unit versus conventional care, 3 months after discharge. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted. Patients aged $ 75 years, assessed as frail and in need of inpatient care, were assigned to a CGA unit or conventional care. Measurements of physical fitness, including handgrip strength (HS), timed up-and-go (TUG), and the 6-minute walk test (6-MWT) were made twice, at the hospital index care period and at the 3-month follow-up. Data were analyzed as the mean change from index to the 3-month follow-up, and dichotomized as decline versus stability/improvement in physical fitness. Results: In all, 408 participants, aged 85.7 +/- 5.4 years, were included. The intervention group improved significantly in all components of physical fitness. The controls improved in TUG and declined in HS and 6-MWT. When the changes were dichotomized the intervention group declined to a lesser extent; HS pamp;lt;0.001, 6-MWT pamp;lt;0.001, TUG pamp;lt;0.003. The regression analysis showed the following odds ratios (ORs) for how these outcomes were influenced by the intervention; HS OR 4.4 (confidence interval [CI] 95% 2.2-9.1), 6-MWT OR 13.9 (CI 95% 4.2-46.2), and TUG OR 2.5 (CI 95% 1.1-5.4). Conclusion: This study indicates that the acute care of frail elderly patients at a CGA unit is superior to conventional care in terms of preserving physical fitness at 3 months follow-up. CGA management may positively influence outcomes of great importance for these patients, such as mobility, strength, and endurance.

    sted, utgiver, år, opplag, sider
    DOVE MEDICAL PRESS LTD, 2017
    Emneord
    frail elderly; comprehensive geriatric assessment; physical fitness; outcomes
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-143250 (URN)10.2147/CIA.S149665 (DOI)000415128600002 ()
    Merknad

    Funding Agencies|NU Hospital Group, Department of Research and Development

    Tilgjengelig fra: 2017-11-27 Laget: 2017-11-27 Sist oppdatert: 2023-12-28
    3. Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden
    Åpne denne publikasjonen i ny fane eller vindu >>Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden
    Vise andre…
    2019 (engelsk)Inngår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, s. 577-586Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis.

    Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty.

    Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p<0.001) and HRHS2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032).

    Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.

    sted, utgiver, år, opplag, sider
    Auckland, New Zealand: Dove Medical Press Ltd.(Dovepress), 2019
    Emneord
    frail elderly; mortality; physical fitness; six-minute walk test; handgrip strength test; in-hospital rehabilitation
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-156220 (URN)10.2147/CIA.S198591 (DOI)000462319100001 ()30936688 (PubMedID)
    Merknad

    Funding Agencies|NU Hospital Group, Department of Research and Development

    Tilgjengelig fra: 2019-04-09 Laget: 2019-04-09 Sist oppdatert: 2023-12-28bibliografisk kontrollert
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  • 12504.
    Åhlund, Kristina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. NU Hospital Grp, Sweden.
    Bäck, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Sahlgrens University Hospital, Sweden.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Ekerstad, Niklas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. NU Hospital Grp, Sweden.
    Effects of comprehensive geriatric assessment on physical fitness in an acute medical setting for frail elderly patients2017Inngår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, s. 1929-1939Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Frail elderly people often use emergency care. During hospitalization, physical decline is common, implying an increased risk of adverse health outcomes. Comprehensive Geriatric Assessment (CGA) has been shown to be beneficial for these patients in hospital care. However, there is very limited evidence about the effects on physical fitness. The aim was to compare effects on physical fitness in the acute care of frail elderly patients at a CGA unit versus conventional care, 3 months after discharge. Patients and methods: A clinical, prospective, controlled trial with two parallel groups was conducted. Patients aged $ 75 years, assessed as frail and in need of inpatient care, were assigned to a CGA unit or conventional care. Measurements of physical fitness, including handgrip strength (HS), timed up-and-go (TUG), and the 6-minute walk test (6-MWT) were made twice, at the hospital index care period and at the 3-month follow-up. Data were analyzed as the mean change from index to the 3-month follow-up, and dichotomized as decline versus stability/improvement in physical fitness. Results: In all, 408 participants, aged 85.7 +/- 5.4 years, were included. The intervention group improved significantly in all components of physical fitness. The controls improved in TUG and declined in HS and 6-MWT. When the changes were dichotomized the intervention group declined to a lesser extent; HS pamp;lt;0.001, 6-MWT pamp;lt;0.001, TUG pamp;lt;0.003. The regression analysis showed the following odds ratios (ORs) for how these outcomes were influenced by the intervention; HS OR 4.4 (confidence interval [CI] 95% 2.2-9.1), 6-MWT OR 13.9 (CI 95% 4.2-46.2), and TUG OR 2.5 (CI 95% 1.1-5.4). Conclusion: This study indicates that the acute care of frail elderly patients at a CGA unit is superior to conventional care in terms of preserving physical fitness at 3 months follow-up. CGA management may positively influence outcomes of great importance for these patients, such as mobility, strength, and endurance.

    Fulltekst (pdf)
    fulltext
  • 12505.
    Åhlund, Kristina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Department of Physiotherapy, NU Hospital Group, Trollhättan, Sweden.
    Ekerstad, Niklas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
    Bäck, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Karlson, Bjorn W.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla, Sweden.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden2019Inngår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, s. 577-586Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Physical deterioration in connection with a care episode is common. The aim of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the association between physical fitness measurements and 1-year mortality and 2) the association between preserved physical fitness during the first three months after discharge from emergency hospital care and 1-year prognosis.

    Methods: Frail elderly patients (≥75 years) in need of inpatient emergency medical care were included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength test, HS) were assessed during the hospital stay and at a three-month follow-up. The results were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, gender, comorbidity and frailty.

    Results: This study comprised 408 frail elderly hospitalized patients of whom 390 were evaluable (mean age 85.7 years, Charlson’s index mean 6.8). The three-month mortality was 11.5% and the 1-year mortality was 37.9%. After adjustments, the Cox-regression analysis showed that both 6MWT and HS were associated with 1-year mortality, HR6MWT 3.31 (95% CI 1.89–5.78, p<0.001) and HRHS2.39 (95% CI 1.33–4.27, p=0.003). The 0–3-month change in the 6MWT and the HS were associated with 1-year mortality, where patients who deteriorated had a poorer prognosis than those with improved fitness, HR6MWT 3.80 (95% CI 1.42–10.06, p=0.007) and HRHS 2.21 (95% CI 1.07–4.58, p=0.032).

    Conclusion: In frail elderly patients with a severe comorbidity burden, physical fitness in connection with emergency hospital care was independently associated with 1-year mortality. Moreover, a change in physical fitness during the first months after hospital care was important for the long-term prognosis. These results emphasize the importance of providing hospital care designed to prevent physical deterioration in frail elderly patients.

    Fulltekst (pdf)
    fulltext
  • 12506.
    Åhlund, Kristina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. NU Hosp Grp, Sweden.
    Ekerstad, Niklas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. NU Hosp Grp, Sweden.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten.
    Bäck, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Sahlgrens Univ Hosp, Sweden.
    Physical Performance Impairments and Limitations Among Hospitalized Frail Older Adults2018Inngår i: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 41, nr 4, s. 230-235Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and purpose: Early rehabilitation is important for frail older adults due to reduced reserve capacity and physical fitness. To facilitate individualized rehabilitation programs, we need tools to make it possible to assess physical fitness in relation to frailty, instead of chronological age. The purpose of this study was, in a Swedish context, to describe measures of physical fitness in hospitalized frail older adults in relation to their degree of frailty. Methods: This was a cross-sectional study. A total of 408 frail older adults, mean age 86.6 years (75-99 years), in need of emergency medical inpatient care, were included in the NAL-Uddevalla (NU) hospital group in Sweden. During the hospital stay, physical fitness was assessed using 4 different tests: hand-grip strength, the Timed Up and Go Test, 5-time sit-to-stand test, and 6-minute walk test. In the analyses, the physical fitness outcomes were related to the degree of frailty using the FRail Elderly Support ResearcH group screening instrument and previously used cutoffs or age-related reference values for older adults. Results and Discussion: This study showed that most hospitalized frail older adults perform far lower than previously described age-related reference values relating to physical fitness. An increased degree of frailty contributes to reduced physical fitness in tests assessing strength and endurance. Conclusions: A frail-related screening instrument may be useful in the evaluation of physical fitness in hospitalized frail older adults and may facilitate the development of realistic, individualized rehabilitation programs beneficial to an early start on the emergency medical ward.

  • 12507.
    Åhlund, Kristina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. NU Hosp Grp, Sweden.
    Öberg, Birgitta
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Ekerstad, Niklas
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. NU Hosp Grp, Sweden.
    Bäck, Maria
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Sahlgrens Univ Hosp, Sweden.
    A balance between meaningfulness and risk of harm - frail elderly patients perceptions of physical activity and exercise - an interview study2020Inngår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, nr 1, artikkel-id 490Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundThere is growing evidence of the benefits of physical activity and exercise for frail elderly patients with comorbidity. In order to improve participation in physical activity and exercise interventions, there is a need to increase our understanding of the patients perspective.AimThe aim of this study is to explore the perceptions of physical activity and exercise among frail elderly patients with a severe comorbidity burden.MethodFace-to-face, in-depth interviews were conducted with eighteen frail elderly patients with a severe comorbidity burden, median age 85.5years (min-max 75-94). The interviews were transcribed verbatim and analyzed according to content analysis inspired by Krippendorf.ResultsAn overall theme, defined as "Meaningfulness and risk of harm in an aging body" was identified, followed by three main categories, labeled physical activity in daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise, and eight sub-categories.ConclusionThis study suggests that, in frail elderly patients with severe multimorbidity, physical activity and exercise is a balance between what is perceived as meaningful and the risk of harm. Patients perceived aging as an inevitable process that they needed to accept and gradually adapt their physical activities in daily life to match. As patients said they were unclear about the benefits and risks of exercise and referred to their previous life and experiences when describing physical activity and exercise, it is likely that the communication relating to this within the healthcare system needs to be further developed To promote physical activity and exercise to maintain or improve physical fitness in this frail population, healthcare providers need to use extended, personalized information to tailor the type of physical activities, goals and prerequisites for each patient.

    Fulltekst (pdf)
    fulltext
  • 12508.
    Åhman, Rasmus
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Forsberg Siverhall, Pontus
    Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Snygg, Johan
    Sahlgrens Univ Hosp, Sweden.
    Fredrikson, Mats
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Enlund, Gunnar
    Uppsala Univ Hosp, Sweden.
    Björnström, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Chew, Michelle
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken US.
    Determinants of mortality after hip fracture surgery in Sweden: a registry-based retrospective cohort study2018Inngår i: Scientific Reports, E-ISSN 2045-2322, Vol. 8, artikkel-id 15695Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Surgery for hip fractures is associated with high mortality and morbidity. The causes of poor outcome are not fully understood and may be related to other factors than the surgery itself. The relative contributions of patient, surgical, anaesthetic and structural factors have seldom been studied together. This study, a retrospective registry-based cohort study of 14 932 patients undergoing hip fracture surgery in Sweden from 1st of January 2014 to 31st of December 2016, aimed to identify important predictors of mortality post-surgery. The independent predictive power of our included variables was examined using Cox proportional hazards modeling with all-cause mortality at longest follow-up as the outcome. Twelve independent variables were considered as interrelated exposures and their individual adjusted effect within a single model were evaluated. Kaplan-Meier curves were also generated. Crude mortality rates were 8.2% at 30 days (95% CI 7.7-8.6%) and 23.6% at 365 days (95% CI 22.9-24.2%). Of the 12 factors entered into the Cox regression analysis, age (aHR1.06, p amp;lt; 0.001), male gender (aHR 1.45, p amp;lt; 0.001), ASA-PS-class (ASA 1amp;2 reference; ASA 3 aHR 2.12; ASA 4 aHR 4.79; ASA 5 aHR 12.57 respectively, p amp;lt; 0.001) and PACU-LOS (aHR 1.01, p amp;lt; 0.001) were significantly associated with mortality at longest follow-up (up to 3 years). University hospital status was protective (aHR 0.83, p amp;lt; 0.001) in the same model. Age, gender and ASA-PS-class were strong predictors of mortality after surgery for hip fractures in Sweden. University hospital status and length of stay in the postoperative care unit were also identified as modifiable risk factors after multivariable adjustment and require confirmation in future studies.

    Fulltekst (pdf)
    fulltext
  • 12509.
    Åhsberg, Josefine
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för molekylär medicin och virologi. Linköpings universitet, Medicinska fakulteten.
    Xiao, Pingnan
    Karolinska Inst, Sweden.
    Okuyama, Kazuki
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Somasundaram, Rajesh
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för molekylär medicin och virologi. Linköpings universitet, Medicinska fakulteten.
    Strid, Tobias
    Lund Univ, Sweden.
    Qian, Hong
    Lund Univ, Sweden.
    Sigvardsson, Mikael
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för molekylär medicin och virologi. Linköpings universitet, Medicinska fakulteten. Lund Univ, Sweden.
    Letter: Progression of progenitor B-cell leukemia is associated with alterations of the bone marrow micro-environment in HAEMATOLOGICA, vol 105, issue 3, pp2020Inngår i: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 105, nr 3Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    n/a

    Fulltekst (pdf)
    fulltext
  • 12510.
    Åkerberg, Daniel
    et al.
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Björnsson, Bergthor
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Ansari, Daniel
    Lund University, Sweden; Skåne University Hospital, Sweden.
    Factors influencing receipt of adjuvant chemotherapy after surgery for pancreatic cancer: a two-center retrospective cohort study2017Inngår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, nr 1, s. 56-60Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The addition of adjuvant chemotherapy after surgical resection has improved survival rates for patients with pancreatic ductal adenocarcinoma (PDAC). However, outside clinical trials, many operated patients still do not receive adjuvant chemotherapy due to clinical and tumor-related factors. The aim of this study was to investigate factors that may influence the receipt of adjuvant chemotherapy and the effect on long-term survival. Materials and methods: Patients undergoing macroscopically curative resection for PDAC at the University Hospitals in Lund and Linkoping, Sweden, between 1 January 2007 and 31 December 2015, were retrospectively reviewed. Clinical and pathological data were compared between adjuvant and non-adjuvant chemotherapy groups and factors affecting chemotherapy receipt were analyzed by multiple logistic regression. Multivariable Cox regression analysis was performed to select predictive variables for survival. Results: A total of 233 patients were analyzed. Adjuvant chemotherapy was administered to 167 patients (71.7%). The likelihood of receiving adjuvant chemotherapy decreased with age, OR 0.91, 95% CI 0.86-0.95, pamp;lt;.001. Moreover, patients with severe postoperative complications (Clavien-Dindo grade amp;gt;= III) were less likely to receive adjuvant chemotherapy, OR 0.31, 95% CI 0.14-0.71, p=.005. The presence of lymph node metastases on histopathological reporting was associated with increased likelihood of initiating adjuvant chemotherapy, OR 2.19, 95% CI 1.09-4.40, p=.028. Adjuvant chemotherapy was an independent factor for prolonged survival on multivariable Cox regression analysis, HR 0.45 (95% CI 0.31-0.65), pamp;lt;.001. Conclusions: Age, postoperative complications and the presence of lymph node metastases affect the likelihood of receiving adjuvant chemotherapy after PDAC surgery.

  • 12511.
    Åkerlund, Anna
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk mikrobiologi. Cty Hosp Ryhov, Sweden.
    Jonasson, Emma
    Cent Hosp Vaxjo, Sweden; EUCAST Dev Lab, Sweden.
    Matuschek, Erika
    EUCAST Dev Lab, Sweden.
    Serrander, Lena
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk mikrobiologi.
    Sundqvist, Martin
    Orebro Univ, Sweden.
    Kahlmeter, Gunnar
    Cent Hosp Vaxjo, Sweden; EUCAST Dev Lab, Sweden.
    EUCAST rapid antimicrobial susceptibility testing (RAST) in blood cultures: validation in 55 European laboratories2020Inngår i: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 75, nr 11, s. 3230-3238Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: When bloodstream infections are caused by resistant bacteria, rapid antimicrobial susceptibility testing (RAST) is important for adjustment of therapy. The EUCAST RAST method, directly from positive blood cultures, was validated in a multi-Laboratory study in Europe. Methods: RAST was performed in 40 Laboratories in northern Europe (NE) and 15 in southern Europe (SE) from clinical blood cultures positive for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus or Streptococcus pneumoniae. Categorical results at 4, 6 and 8 h of incubation were compared with results for EUCAST standard 16-20 h disc diffusion. The method, preliminary breakpoints and the performance of the Laboratories were evaluated. Results: The total number of isolates was 833/318 in NE/SE. The number of zone diameters that could be read (88%, 96% and 99%) and interpreted (70%, 81% and 85%) increased with incubation time (4, 6 and 8 h). The categorical agreement was acceptable, with total error rates in NE/SE of 2.4%/4.9% at 4 h, 1.1%/3.5% at 6 h and 1.1%/3.3% at 8 h. False susceptibility at 4, 6 and 8 h of incubation was below 0.3% and 1.1% in NE and SE, respectively, and the corresponding percentages for false resistance were below 1.9% and 2.8%. After fine-tuning breakpoints, more zones could be interpreted (73%, 89% and 93%), with only marginally affected error rates. Conclusions: The EUCAST RAST method can be implemented in routine Laboratories without major investments. It provides reliable antimicrobial susceptibility testing results for relevant bloodstream infection pathogens after 4-6 h of incubation.

    Fulltekst (pdf)
    fulltext
  • 12512.
    Åkerlund, Anna
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk mikrobiologi. Division of Clinical Microbiology, Laboratory Medicine, Jönköping, Region Jönköping County.
    Petropoulos, Alexandros
    Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Malmros, Karin
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Tängdén, Thomas
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Giske, Christian G.
    Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden .
    Blood culture diagnostics: a Nordic multicentre survey comparison of practices in clinical microbiology laboratories2022Inngår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 28, nr 5, s. 731.e1-731.e7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Accurate and rapid microbiological diagnostics are crucial to tailor treatment and improve outcomes in patients with severe infections. This study aimed to assess blood culture diagnostics in the Nordic countries and to compare them with those of a previous survey conducted in Sweden in 2013.

    Methods: An online questionnaire was designed and distributed to the Nordic clinical microbiology laboratories (CMLs) (n = 76) in January 2018.

    Results: The response rate was 64% (49/76). Around-the-clock incubation of blood cultures (BCs) was supported in 82% of the CMLs (40/49), although in six of these access to the incubators around the clock was not given to all of the cabinets in the catchment area, and 41% of the sites (20/49) did not assist with satellite incubators. Almost half (49%, 24/49) of the CMLs offered opening hours for ≥10 h during weekdays, more commonly in CMLs with an annual output ≥30 000 BCs. Still, positive BCs were left unprocessed for 60-70% of the day due to restrictive opening hours. Treatment advice was given by 23% of CMLs (11/48) in ≥75% of the phone contacts. Rapid analyses (species identification and susceptibility testing with short incubation), performed on aliquots from positive cultures, were implemented in 18% of CMLs (9/49). Compared to 2013, species identification from subcultured colonies (<6 h) had become more common.

    Conclusions: CMLs have taken action to improve aspects of BC diagnostics, implementing satellite incubators, rapid species identification and susceptibility testing. However, the limited opening hours and availability of clinical microbiologists are confining the advantages of these changes.

    Fulltekst (pdf)
    fulltext
  • 12513.
    Åkerlund, Anna
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk mikrobiologi.
    Serrander, Lena
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk mikrobiologi.
    Sundqvist, Martin
    Orebro Univ, Sweden.
    Short incubation of disc diffusion for Streptococcus pneumoniae and Haemophilus influenzae to reduce time to susceptibility report2023Inngår i: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 78, nr 10, s. 2563-2571Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Rapidly instituted antimicrobial therapy is important in severe infections, and reduced time to the antimicrobial susceptibility testing (AST) report is thus of importance. Disc diffusion (DD) is a cheap, rapidly adaptable, flexible and comprehensive method for phenotypic AST. Previous studies have shown that early reading of inhibition zones for non-fastidious species is possible.Objectives To evaluate zone reading after short incubation of DD in Haemophilus influenzae (n = 73) and Streptococcus pneumoniae (n = 112).Methods The readability was evaluated and susceptibility interpretation (SIR) was performed, using the EUCAST 18 & PLUSMN; 2 h incubation breakpoint table (version 12.0), after 6 and 8 h of incubation. Categorical agreement (CA) and error rates were calculated using standard DD and broth microdilution as reference.Results The proportion of readable zones in H. influenzae was 19% (6 h) and 89% (8 h). The CA was 98% after 8 h. The corresponding readability in S. pneumoniae was 63%/98% and CA was 95%/97% after 6 and 8 h, respectively. Early reading of the screening discs (benzylpenicillin 1 unit in H. influenzae and oxacillin 1 & mu;g in S. pneumoniae) correctly identified 18/22 of the H. influenzae isolates and all the readable S. pneumoniae isolates with reduced & beta;-lactam susceptibility. For non-& beta;-lactam agents, very major errors were most common for quinolones in S. pneumoniae. Introduction of areas of technical uncertainty (ATUs) reduced the error rate to & LE;1.1%.Conclusions We conclude that shortened incubation is feasible for H. influenzae and S. pneumoniae. To reduce the risk of false categorization a buffer zone (i.e. ATU) near the breakpoints must be used.

    Fulltekst (pdf)
    fulltext
  • 12514.
    Åkerlund, Anna
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten.
    Sundqvist, Martin
    Universitetssjukhuset, Örebro, Sweden.
    Hanberger, Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Infektionskliniken i Östergötland.
    Åhrén, Christina
    regionala Strama, Västra Götalandsregionen, Göteborg, Sweden.
    Serrander, Lena
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Infektionskliniken i Östergötland.
    Giske, Christian G
    Karolinska universitetssjukhuset, Solna, Sweden.
    Svarstiderna kan kortas vid mikrobiologisk diagnostik av sepsis: Bättre öppettider på laboratorier och aktiv rådgivning ger snabbare terapi2015Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, nr 7, artikkel-id C73SArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Snabbt insatt adekvat antibiotikabehandling är livräddande vid allvarliga bakteriella infektioner. 

    Snabb mikrobiologisk diagnostik krävs i och med ökande antibiotikaresistens och kommer att ge medicinska vinster.

    En enkät till landets mikrobiologiska laboratorier visar på stora skillnader avseende tillgänglighet, snabbhet och kommunikation med svarsmottagande enhet vad gäller positiva blododlingar.

    För snabbare svar krävs att mikrobiologiska laboratorier erbjuder mer generösa öppettider, effektivare transportsystem och patientnära blododlingsinkubatorer samt tidig och aktiv rådgivning till behandlande läkare.

    n/a

  • 12515. Bestill onlineKjøp publikasjonen >>
    Åkerlund, Ida
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Injury Prevention in Youth Male and Female Floorball Players: Effects, Compliance, and Experiences of the Knee Control Programme2024Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: Floorball is one of the most popular team ball sports in Northern Europe, particularly among youths. The injury incidence is high, as is the case in other pivoting youth team ball sports, such as football. The injury prevention exercise programme (IPEP) Knee Control is developed to reduce injuries in team ball sports. Though, programme effects and implementation factors in floorball has not been evaluated.

    The overall aim of this thesis was to evaluate the effects of the Knee Control IPEP and explore players’ and coaches’ experiences of using Knee Control in youth floorball.

    Methods: Study A was a cluster-randomised controlled trial (RCT) evaluating the effects of Knee Control in reducing floorball injuries. The RCT comprised of 48 clusters (clubs) with male and female floorball players (12–17 years) on the community level who were randomised into either an intervention or control group. Seventeen clusters (31 teams with 301 players) in the intervention group and 12 clusters (16 teams with 170 players) in the control group were included for analyses. During a pre-season implementation workshop, the intervention group coaches were instructed to use Knee Control and a standard running warm-up before every training session during the season. Control teams continued usual training. Teams were followed during a competitive season (26 weeks). Player exposure to floorball and occurrence of acute and gradual onset injuries were reported weekly via a web-based player survey using the Oslo Sports Trauma Research Centre overuse injury questionnaire. Team and player compliance to Knee Control was reported monthly by coaches. Players were divided into three compliance groups based on their average weekly number of Knee Control sessions: high (≥2 sessions), intermediate (≥1 to <2 sessions), and low dose (<1 session). Additionally, players and coaches in the intervention group answered a post-season survey on experiences using Knee Control.

    Study B was a qualitative study exploring facilitators and barriers of Knee Control use and how to overcome the barriers. Semi-structured focus group discussions, six with players (11–17 years old, n =42), and two with coaches (n =12) were conducted.

    Results: In Study A, the intervention group had a 35% lower incidence rate of injuries overall (adjusted incidence rate ratio (IRR), 0.65; 95% confidence interval (CI), 0.52– 0.81) and 45% lower incidence of acute injuries (adjusted IRR, 0.55; 95% CI, 0.37–0.83) than the control group. There was no difference in the prevalence of gradual onset injuries. Male players in the high dose group had consistently lower injury incidence and prevalence compared to the low dose group, while no differences between the three compliance groups were seen in female players. Common facilitators of Knee Control use among coaches were support and education for coaches and high player motivation, and common barriers were that injury prevention training was time-consuming, a lack of space to execute the exercises, and a lack of player motivation. Players and coaches who intended to maintain use of Knee Control had higher belief in their ability to use Knee Control.

    Study B showed that player-perceived improved performance and making preventive training a natural part of floorball could be promoting factors for IPEP use. Promoting factors for coaches were described as support from the federation and club and collaboration with other coaches. To overcome barriers, players and coaches gave examples of how to adapt and progress the preventive training to the team by starting at an early age and keeping it simple.

    Conclusions: Knee Control was effective in preventing injuries, especially acute injuries, in Swedish youth floorball players. Male players had a clear dose-response relationship between Knee Control dose and injury rate reduction. Players found the Knee Control exercises necessary for injury prevention, but perceived them as boring, while coaches felt uncertain of their competence to use Knee Control and wished for support. Ideas on how to overcome barriers for IPEP use were to create a good structure and routines for preventive training, and to tailor the preventive training to the team, thus increasing player motivation.

    Delarbeid
    1. Forty-five per cent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12-17 years) who used an injury prevention exercise programme: two-armed parallel-group cluster randomised controlled trial
    Åpne denne publikasjonen i ny fane eller vindu >>Forty-five per cent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12-17 years) who used an injury prevention exercise programme: two-armed parallel-group cluster randomised controlled trial
    2020 (engelsk)Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, nr 17, s. 1028-+Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Objective To study whether an injury prevention exercise programme would reduce the number of injuries in youth floorball players. Methods 81 youth community level floorball teams (48 clusters=clubs) with female and male players (12-17 years) were cluster-randomised into an intervention or control group. Intervention group coaches were instructed to use the Swedish Knee Control programme and a standard running warm-up before every training session, and the running warm-up before every match, during the season. Control teams continued usual training. Teams were followed during the 2017/2018 competitive season (26 weeks). Player exposure to floorball and occurrence of acute and overuse injuries were reported weekly via a web-based player survey using the Oslo Sports Trauma Research Centre Questionnaire. Results 17 clusters (301 players) in the intervention group and 12 clusters (170 players) in the control group were included for analyses. There were 349 unique injuries in 222 players. The intervention group had a 35% lower incidence of injuries overall than the control group (adjusted incidence rate ratio (IRR) 0.65, 95% CI 0.52 to 0.81). The absolute risk reduction was 6.6% (95% CI 3.2 to 10.0), and the number needed to treat was 152 hours of floorball exposure (95% CI 100 to 316). Intervention group teams had a 45% lower incidence of acute injuries (adjusted IRR 0.55, 95% CI 0.37 to 0.83). There was no difference in the prevalence of overuse injuries (adjusted prevalence rate ratio 0.96, 95% CI 0.73 to 1.26). Conclusion The Knee Control injury prevention programme reduced acute injuries in youth floorball players; there was no effect on overuse injuries.

    sted, utgiver, år, opplag, sider
    BMJ PUBLISHING GROUP, 2020
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-169972 (URN)10.1136/bjsports-2019-101295 (DOI)000566993800007 ()31992545 (PubMedID)
    Merknad

    Funding Agencies|Swedish Research CouncilSwedish Research Council [2015-02414]; Swedish Research Council for Sport Science [P2018-0167]

    Tilgjengelig fra: 2020-09-28 Laget: 2020-09-28 Sist oppdatert: 2024-04-15
    2. High compliance with the injury prevention exercise programme Knee Control is associated with a greater injury preventive effect in male, but not in female, youth floorball players
    Åpne denne publikasjonen i ny fane eller vindu >>High compliance with the injury prevention exercise programme Knee Control is associated with a greater injury preventive effect in male, but not in female, youth floorball players
    Vise andre…
    2022 (engelsk)Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 30, nr 4, s. 1480-1490Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Purpose Evaluate team and player compliance with the Knee Control injury prevention exercise programme, study the association between player compliance and injury rates, and compare coach demographics, baseline prevention expectancies, and programme utilisation between teams with high and low compliance. Methods Prospective one-season cohort study based on a cluster randomised controlled trial on 301 (107 female) floorball players aged 12-17 years. Floorball exposure and injuries were self-reported weekly by players using the Oslo Sports Trauma Research Center questionnaire. Team and player compliance to Knee Control was reported monthly by coaches. Additionally, coaches answered pre- and post-season surveys. Teams were divided into a high (&gt;= 80%) or low (&lt; 80%) compliance group based on their use of Knee Control during the season. Players were divided into three compliance groups based on their average weekly number of Knee Control sessions; high (&gt;= 2 sessions), intermediate (&gt;= 1 to &lt; 2 sessions), and low dose (&lt; 1 session). Results Mean team compliance for the high and low compliance groups were 95% (range 82-100) and 50% (range 13-66), respectively. Mean +/- SD weekly Knee Control dose in the three player compliance groups were 2.4 +/- 0.3, 1.4 +/- 0.3, and 0.7 +/- 0.3 sessions, respectively. There were no differences in total injury incidence between the player compliance groups, but players in the high-dose group had a 35% lower prevalence of injuries overall [adjusted prevalence rate ratio (PRR) 0.65, 95% CI 0.48-0.89] and 60% lower prevalence of substantial injuries (adjusted PRR 0.40, 95% CI 0.26-0.61) compared with the low-dose group. Male players in the high-dose group had consistently lower injury incidence and prevalence, while no between compliance group differences were seen in female players. There were no differences in sex, years of coaching experience, or baseline prevention expectancies in general between coaches for teams in the high vs. low compliance groups, but teams in the high compliance group had a better utilisation fidelity. Conclusion There was a clear dose-response relationship between more frequent Knee Control use and lower injury rates in male floorball players, but not in female players. Teams with higher compliance also showed a better utilisation fidelity with the programme.

    sted, utgiver, år, opplag, sider
    Springer, 2022
    Emneord
    Adherence; Athletic injury; Fidelity; Implementation; Neuromuscular training
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-180034 (URN)10.1007/s00167-021-06644-2 (DOI)000669162900001 ()34213586 (PubMedID)
    Merknad

    Funding Agencies|Linkoping University; Swedish Research CouncilSwedish Research CouncilEuropean Commission [2015-02414]; Swedish Research Council for Sport Science [P2018-0167]

    Tilgjengelig fra: 2021-10-08 Laget: 2021-10-08 Sist oppdatert: 2024-04-15
    3. Perceptions, facilitators, and barriers regarding use of the injury prevention exercise programme Knee Control among players and coaches in youth floorball: a cross-sectional survey study
    Åpne denne publikasjonen i ny fane eller vindu >>Perceptions, facilitators, and barriers regarding use of the injury prevention exercise programme Knee Control among players and coaches in youth floorball: a cross-sectional survey study
    Vise andre…
    2023 (engelsk)Inngår i: BMC SPORTS SCIENCE MEDICINE AND REHABILITATION, ISSN 2052-1847, Vol. 15, nr 1, artikkel-id 56Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    BackgroundYouth participation in team ball sports is associated with a risk of both acute and gradual onset injuries but today there are several efficacious injury prevention exercise programmes (IPEPs). However, there is limited research about how to implement those programmes and the perceived barriers and facilitators among end-users.ObjectiveTo investigate perceptions of the IPEP Knee Control and facilitators and barriers to programme use among coaches and youth floorball players, and explore factors associated with planned maintenance of Knee Control.MethodsThis cross-sectional study is a sub-analysis of data from the intervention group of a cluster randomised controlled trial. Perceptions about Knee Control and facilitators and barriers to programme use were evaluated with surveys pre-intervention and post-season. 246 youth floorball players aged 12-17 years, and 35 coaches that reported no use of IPEPs during the preceding year were included. Descriptive statistics and univariate and multivariate ordinal logistic regression models were undertaken with the dependent variables: coaches planned maintenance and players opinions of maintenance of Knee Control. Independent variables were perceptions, facilitators and barriers regarding use of Knee Control and other potential influencing factors.Results88% of the players believed that Knee Control can reduce injury risk. Common facilitators to Knee Control use among coaches were support, education and high player motivation, and common barriers were that injury prevention training was time-consuming, lack of space to execute the exercises and lack of player motivation. Players who planned to maintain use of Knee Control had higher outcome expectancies and belief in ones ability to use Knee Control (action self-efficacy). Coaches who planned to maintain Knee Control had higher action self-efficacy and to a lesser extent considered that Knee Control takes too much time.ConclusionsSupport, education, and high player motivation are key facilitators, while lack of time and space for injury prevention training and boring exercises are key barriers for coaches and players to use Knee Control. High action self-efficacy among coaches and players seems to be a prerequisite for maintained use of IPEPs.

    sted, utgiver, år, opplag, sider
    BMC, 2023
    Emneord
    Athletic injuries; Implementation; Injury prevention; Neuromuscular training; Self-efficacy; Team sports
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-194491 (URN)10.1186/s13102-023-00660-0 (DOI)000984428400002 ()37055800 (PubMedID)
    Merknad

    Funding Agencies|Sport Without Injury ProgrammE (SWIPE); Swedish Research Council [VR 2015-02414]; Swedish Research Council for Sport Science; [CIF P2018-0167]

    Tilgjengelig fra: 2023-06-12 Laget: 2023-06-12 Sist oppdatert: 2024-05-03
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  • 12516.
    Åkerlund, Ida
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Sonesson, Sofi
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Lindblom, Hanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Waldén, Markus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. GHP Ortho & Spine Ctr Skane, Sweden.
    Hägglund, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Perceptions, facilitators, and barriers regarding use of the injury prevention exercise programme Knee Control among players and coaches in youth floorball: a cross-sectional survey study2023Inngår i: BMC SPORTS SCIENCE MEDICINE AND REHABILITATION, ISSN 2052-1847, Vol. 15, nr 1, artikkel-id 56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundYouth participation in team ball sports is associated with a risk of both acute and gradual onset injuries but today there are several efficacious injury prevention exercise programmes (IPEPs). However, there is limited research about how to implement those programmes and the perceived barriers and facilitators among end-users.ObjectiveTo investigate perceptions of the IPEP Knee Control and facilitators and barriers to programme use among coaches and youth floorball players, and explore factors associated with planned maintenance of Knee Control.MethodsThis cross-sectional study is a sub-analysis of data from the intervention group of a cluster randomised controlled trial. Perceptions about Knee Control and facilitators and barriers to programme use were evaluated with surveys pre-intervention and post-season. 246 youth floorball players aged 12-17 years, and 35 coaches that reported no use of IPEPs during the preceding year were included. Descriptive statistics and univariate and multivariate ordinal logistic regression models were undertaken with the dependent variables: coaches planned maintenance and players opinions of maintenance of Knee Control. Independent variables were perceptions, facilitators and barriers regarding use of Knee Control and other potential influencing factors.Results88% of the players believed that Knee Control can reduce injury risk. Common facilitators to Knee Control use among coaches were support, education and high player motivation, and common barriers were that injury prevention training was time-consuming, lack of space to execute the exercises and lack of player motivation. Players who planned to maintain use of Knee Control had higher outcome expectancies and belief in ones ability to use Knee Control (action self-efficacy). Coaches who planned to maintain Knee Control had higher action self-efficacy and to a lesser extent considered that Knee Control takes too much time.ConclusionsSupport, education, and high player motivation are key facilitators, while lack of time and space for injury prevention training and boring exercises are key barriers for coaches and players to use Knee Control. High action self-efficacy among coaches and players seems to be a prerequisite for maintained use of IPEPs.

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  • 12517.
    Åkerlund, Ida
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Waldén, Markus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Hassleholm Kristianstad Ystad Hosp, Sweden.
    Sonesson, Sofi
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Hägglund, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Forty-five per cent lower acute injury incidence but no effect on overuse injury prevalence in youth floorball players (aged 12-17 years) who used an injury prevention exercise programme: two-armed parallel-group cluster randomised controlled trial2020Inngår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 54, nr 17, s. 1028-+Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To study whether an injury prevention exercise programme would reduce the number of injuries in youth floorball players. Methods 81 youth community level floorball teams (48 clusters=clubs) with female and male players (12-17 years) were cluster-randomised into an intervention or control group. Intervention group coaches were instructed to use the Swedish Knee Control programme and a standard running warm-up before every training session, and the running warm-up before every match, during the season. Control teams continued usual training. Teams were followed during the 2017/2018 competitive season (26 weeks). Player exposure to floorball and occurrence of acute and overuse injuries were reported weekly via a web-based player survey using the Oslo Sports Trauma Research Centre Questionnaire. Results 17 clusters (301 players) in the intervention group and 12 clusters (170 players) in the control group were included for analyses. There were 349 unique injuries in 222 players. The intervention group had a 35% lower incidence of injuries overall than the control group (adjusted incidence rate ratio (IRR) 0.65, 95% CI 0.52 to 0.81). The absolute risk reduction was 6.6% (95% CI 3.2 to 10.0), and the number needed to treat was 152 hours of floorball exposure (95% CI 100 to 316). Intervention group teams had a 45% lower incidence of acute injuries (adjusted IRR 0.55, 95% CI 0.37 to 0.83). There was no difference in the prevalence of overuse injuries (adjusted prevalence rate ratio 0.96, 95% CI 0.73 to 1.26). Conclusion The Knee Control injury prevention programme reduced acute injuries in youth floorball players; there was no effect on overuse injuries.

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  • 12518.
    Åkerlund, Ida
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Waldén, Markus
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Hassleholm Kristianstad Hosp, Sweden.
    Sonesson, Sofi
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Lindblom, Hanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Hägglund, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    High compliance with the injury prevention exercise programme Knee Control is associated with a greater injury preventive effect in male, but not in female, youth floorball players2022Inngår i: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 30, nr 4, s. 1480-1490Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose Evaluate team and player compliance with the Knee Control injury prevention exercise programme, study the association between player compliance and injury rates, and compare coach demographics, baseline prevention expectancies, and programme utilisation between teams with high and low compliance. Methods Prospective one-season cohort study based on a cluster randomised controlled trial on 301 (107 female) floorball players aged 12-17 years. Floorball exposure and injuries were self-reported weekly by players using the Oslo Sports Trauma Research Center questionnaire. Team and player compliance to Knee Control was reported monthly by coaches. Additionally, coaches answered pre- and post-season surveys. Teams were divided into a high (&gt;= 80%) or low (&lt; 80%) compliance group based on their use of Knee Control during the season. Players were divided into three compliance groups based on their average weekly number of Knee Control sessions; high (&gt;= 2 sessions), intermediate (&gt;= 1 to &lt; 2 sessions), and low dose (&lt; 1 session). Results Mean team compliance for the high and low compliance groups were 95% (range 82-100) and 50% (range 13-66), respectively. Mean +/- SD weekly Knee Control dose in the three player compliance groups were 2.4 +/- 0.3, 1.4 +/- 0.3, and 0.7 +/- 0.3 sessions, respectively. There were no differences in total injury incidence between the player compliance groups, but players in the high-dose group had a 35% lower prevalence of injuries overall [adjusted prevalence rate ratio (PRR) 0.65, 95% CI 0.48-0.89] and 60% lower prevalence of substantial injuries (adjusted PRR 0.40, 95% CI 0.26-0.61) compared with the low-dose group. Male players in the high-dose group had consistently lower injury incidence and prevalence, while no between compliance group differences were seen in female players. There were no differences in sex, years of coaching experience, or baseline prevention expectancies in general between coaches for teams in the high vs. low compliance groups, but teams in the high compliance group had a better utilisation fidelity. Conclusion There was a clear dose-response relationship between more frequent Knee Control use and lower injury rates in male floorball players, but not in female players. Teams with higher compliance also showed a better utilisation fidelity with the programme.

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  • 12519.
    Åkerlund, Sofia
    et al.
    Hoglandssjukhuset Nassjo, Sweden.
    Seifert, Oliver
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Ryhov Cty Hosp, Sweden.
    Assarsson, Johan
    Jonkoping Cty Council, Sweden.
    Jerkovic Gulin, Sandra
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Ryhov Cty Hosp, Sweden.
    Significant Association between Obsessive-Compulsive Disorder and Atopic Dermatitis-a Retrospective Population-Based Case-Control Study2023Inngår i: DERMATOLOGY PRACTICAL & CONCEPTUAL, ISSN 2160-9381, Vol. 13, nr 1, artikkel-id e2023053Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Atopic dermatitis (AD) is a global health problem. There are no data on the association of AD with obsessive-compulsive disorder (OCD).Objectives: This study aimed to map a wide spectrum of different diseases among patients with atopic dermatitis compared to healthy controls in the Region of Jonkoping County, Sweden with special focus on OCD.Methods: We conducted a retrospective case control study from January 1st 2013 until December 31st 2021 using an electronic medical records database covering the entire population of the County of Jonkoping. ICD-10 codes were used to identify patients with AD. Individuals without AD served as controls. A total number of 398,874 citizens under the age of 90 was included in this study and among these 2,946 individuals were diagnosed with AD. Regression analysis was performed to describe the risk for comorbidities in patients with AD compared to controls, adjusted for age and gender. Results: We found an association between obsessive-compulsive disorder (OCD) in patients with AD (adjusted odd ratio 2.0, 95% confidence interval 1.5-2.7, p&lt;0.001). Other results are in the line with other studies.Conclusion: Pointing to previous studies, the cause of AD and OCD share several gene-environmental mechanisms and this association should be further studied on larger populations. The results of the present study underline the need for dermatologists to be aware of OCD and to screen for this condition in AD patients because early diagnosis and treatment may improve outcome.

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  • 12520.
    Åkerman, Ingrid
    et al.
    Barnafrid – Nationellt kunskapscentrum, Linköping.
    Jonsson, Linda
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barnafrid. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Kunskapsbehov inom socialtjänsten om våld mot barn2017Rapport (Annet vitenskapelig)
    Abstract [sv]

    Syftet med den aktuella studien var att skapa ett underlag för hur ett socialtjänstnätverk i Barnafrids regi skulle kunna utvecklas. Därför undersöktes socialsekreterares uppfattning av hur de ser på den kompetens de redan har samt vad de är i behov av för vidare kunskap gällande våld och andra övergrepp mot barn. Ytterligare frågeställningar rörde vilken typ av kunskapsstöd som behövs, vilka kommunikativa lösningar kunskapen ska paketeras i samt hur de önskar att ett nätverk för socialtjänsten ska utformas. Nedan sammanfattas några huvuddrag från rapporten:

    • Det finns ett stort behov av kunskap bland svenska socialsekreterare om våld och andra övergrepp mot barn. Behovet beskrevs som något större bland socialsekreterare från mindre kommuner (< 50 000 invånare) och från socialsekreterare anställda kortare tid inom socialtjänsten (0-2 år).
    • Det behövs både generell kunskap om våld mot barn men också fördjupad kunskap inom mer specifika områden såsom nyanlända familjer, ensamkommande barn, hedersrelaterad våldsproblematik samt arbetsverktyg för risk och skyddsbedömningar.
    • Deltagarna önskade lättillgängliga manualer och guidelines som stöd i akuta eller särskilda situationer. Att kunna ta del av information via regionala konferenser/utbildningsdagar samt via en uppdaterad hemsida var prioriterat. Även kunskapspåfyllning via nationella föreläsningar var efterfrågat.
    • Mer än hälften av de svarande upplevde behov av en konsultationstelefon dit man kan ringa och få råd och stöd i svåra och komplicerade ärenden.
    • Mindre prioriterat var kunskap genom webbutbildningar, appar, frågelåda med svar via mejl och chattforum med andra verksamma.

    Sammanfattningsvis visar studien att det viktigaste är att socialsekreterare kan känna sig trygga och säkra när de utför sitt arbete. Det innebär ett arbete där barnets bästa alltid sätts i främsta rummet! Utifrån resultaten från denna studie kvarstår en hel del arbete för att uppnå det.

    Denna studie liksom tidigare undersökningar (se t.ex. Barnskyddsutredningen, 2009; Socialstyrelsen, 2016) pekar på brister och behov, såväl i grundutbildning, introduktionsutbildning som på specialistutbildning för de som ansvarar för myndighetsutövning inom den svenska sociala barn- och ungdomsvården. Personal inom socialtjänsten måste få kontinuerlig tillgång till en flora av olika former av kunskap som innebär både teoretisk och praktisk kunskap om hur man arbetar med barn som utsatts för våld. Utifrån resultaten bedömer vi också att det bland annat finns ett behov av såväl ett kunskapsbaserat socialtjänstnätverk som en konsultationstelefon. Detta är något Barnafrid – Nationellt kunskapscentrum mot våld och andra övergrepp mot barn vore en naturlig värd för i en framtid.

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  • 12521. Bestill onlineKjøp publikasjonen >>
    Åkerman, Linda
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Aspects of the Pre-Diabetic Period in Type 1 Diabetes2016Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Type 1 diabetes (T1D) is an autoimmune disease characterized by insulin deficiency, due to immune-mediated destruction of beta cells. Current knowledge regarding the period preceding disease onset comes, to a large extent, from studying risk cohorts based on relatives of T1D-patients, as they have an increased disease risk. Among T1D patients in general, however, few have the disease in their immediate family. It is therefore important to study risk cohorts from the general population as well. An ongoing autoimmune reaction can often be seen in the blood long before disease onset, by detection of autoantibodies directed towards beta cell antigens. By autoantibody screening among participants in the ABIS (All Babies in the South-east of Sweden) cohort, we could identify a group of children from the general population with increased risk for T1D, positive for multiple autoantibodies. They were enrolled in a 2-year prospective follow-up aiming to characterize the prediabetic period and to identify factors indicative of progression/non-progression to T1D. We assessed glucose homeostasis and autoantibody titers over time, and searched for risk-biomarkers by analyzing the expression of immune-related genes (Th1-Th2-Th3) in peripheral blood mononuclear cells (PBMC) from these children, in comparison to healthy children and newly diagnosed T1D patients. In the same groups we also compared serum micro RNA (miRNA) profiles, knowing that miRNA molecules have desirable biomarker properties. We found that two specific autoantibodies, IA2A and ZnT8A, were detected at higher concentrations in risk-individuals who progressed to overt T1D during or after the follow-up period, compared to those who still have not. We also observed disturbed glucose homeostasis long before onset in the progressors, but it was seen among those who remain symptom free as well. Further, we found support for the possible role of insulin resistance as an accelerator of the disease process. For gene expression and serum miRNA, few differences were observed between risk-individuals and healthy children overall. However, for PBMC gene expression and serum miRNA both, there were associations to beta cell function and glucose homeostasis, and for miRNA also to islet autoantibodies. Although specific profiles for prediction of disease onset or identification of risk-individuals could not be found, these results are interesting and deserve to be evaluated further. As part of another sub-study within ABIS, the effects of physical activity on glucose homeostasis were assessed in healthy schoolchildren. The level of physical activity, measured by pedometers, was related to insulin resistance and beta cell-stress, and decreased physical activity was associated with increased insulin resistance and load on the insulin-producing beta cells, already at school-age.

    Delarbeid
    1. Low C-peptide levels and decreased expression of TNF and CD45 in children with high risk of type 1 diabetes
    Åpne denne publikasjonen i ny fane eller vindu >>Low C-peptide levels and decreased expression of TNF and CD45 in children with high risk of type 1 diabetes
    2013 (engelsk)Inngår i: Clinical Immunology, ISSN 1521-6616, E-ISSN 1521-7035, Vol. 148, nr 1Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Type 1 diabetes (T1D) patients have numeral and functional defects in peripheral immune cells, but the pre-diabetic period is fairly uncharacterized. Our aim was to analyze expression of immunological markers in T1D high risk children and relate it to clinical/immunological parameters. Children from ABIS (All Babies in Southeast Sweden) with greater than= 2 diabetes related autoantibodies were considered at high risk. Age-matched controls and new-onset T1D patients were included. Expression of genes related to immune cell function and different arms of the immune system was assessed in peripheral blood mononuclear cells using PCR array. Risk children had lower TNF and CD45, and although there were few differences between the groups, expression of many genes differed when comparing children with regard to residual insulin secretion. Hence, expression of immune related genes seemed related not only to the autoimmune process but rather to residual beta-cell function, which was decreased already during the pre-diabetic phase.

    sted, utgiver, år, opplag, sider
    Elsevier, 2013
    Emneord
    Type 1 diabetes; Gene expression; PBMC; T1D high risk; T1D autoantibodies; PCR array
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-96458 (URN)10.1016/j.clim.2013.03.011 (DOI)000320427300002 ()
    Tilgjengelig fra: 2013-08-23 Laget: 2013-08-20 Sist oppdatert: 2017-12-06
    2. Physical Activity, Blood Glucose and C-Peptide in Healthy School-Children, a Longitudinal Study
    Åpne denne publikasjonen i ny fane eller vindu >>Physical Activity, Blood Glucose and C-Peptide in Healthy School-Children, a Longitudinal Study
    2016 (engelsk)Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 11, nr 6, s. e0156401-Artikkel i tidsskrift (Fagfellevurdert) Published
    Abstract [en]

    Aim To further elucidate the relationship between physical activity and several risk factors for development of diabetes (glucose, C-peptide and obesity) over time. Methods A prospective longitudinal study where physical activity was measured on 199 children from Kalmar and Linkoping at age 8, and the same 107 children from Linkoping again at age 12. Anthropometric data was collected and blood was analyzed for C-peptide and f-glucose. The children in the study were representative for the general Swedish child population, and on an average lean. Results High physical activity was related to lower C-peptide at age 8 and 12. This correlation was especially pronounced in boys, who also were more physically active than girls at both time points. The association seen at 8 years of age was similar at age 12 in most children. Children with higher BMI Z-Score had a higher fasting C-peptide (age 12) but linear regression showed that children with more steps per day were less likely to have a higher fasting C-peptide irrespective of BMI. Longitudinal follow-up showed that a decrease in physical activity increased insulin resistance and beta-cell load. Conclusions Already in young children, physical activity improves insulin sensitivity and decreases the need of C-peptide over time. This seems to become even more pronounced with increasing age when children are followed longitudinally. Low physical activity increases the load on insulin producing beta-cells, might increase the risk for both type 1- and 2 diabetes.

    sted, utgiver, år, opplag, sider
    PUBLIC LIBRARY SCIENCE, 2016
    HSV kategori
    Identifikatorer
    urn:nbn:se:liu:diva-130132 (URN)10.1371/journal.pone.0156401 (DOI)000377561000012 ()27270732 (PubMedID)
    Merknad

    Funding Agencies|Swedish Child Diabetes Foundation (Barndiabetesfonden); Novo Nordisk Foundation; Research Council of South-east Sweden (FORSS); Swedish Research Council [K2005-72X-11242-11A]; ALF/County Council of Ostergotland

    Tilgjengelig fra: 2016-07-12 Laget: 2016-07-11 Sist oppdatert: 2021-06-14
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    Aspects of the Pre-Diabetic Perios in Type 1 Diabetes
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  • 12522.
    Åkerman, Linda
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Casas, Rosaura
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Tavira Iglesias, Beatriz
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Skoglund, Camilla
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Serum miRNA levels are related to glucose homeostasis and islet autoantibodies in children with high risk for type 1 diabetes2018Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 13, nr 1, artikkel-id e0191067Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Micro RNAs (miRNAs) are promising disease biomarkers due to their high stability. Their expression in serum is altered in type 1 diabetes, but whether deviations exist in individuals with high risk for type 1 diabetes remains unexplored. We therefore assessed serum miRNAs in high-risk individuals (n = 21) positive for multiple islet autoantibodies, age-matched healthy children (n = 17) and recent-onset type 1 diabetes patients (n = 8), using Serum/Plasma Focus microRNA PCR Panels from Exiqon. The miRNA levels in the high-risk group were similar to healthy controls, and no specific miRNA profile was identified for the high-risk group. However, serum miRNAs appeared to reflect glycemic status and ongoing islet auto-immunity in high-risk individuals, since several miRNAs were associated to glucose homeostasis and autoantibody titers. High-risk individuals progressing to clinical disease after the sampling could not be clearly distinguished from non-progressors, while miRNA expression in the type 1 diabetes group deviated significantly from high-risk individuals and healthy controls, perhaps explained by major metabolic disturbances around the time of diagnosis.

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  • 12523.
    Åkerman, Linda
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Ludvigsson, Johnny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Barn- och ungdomskliniken i Linköping.
    Swartling, Ulrica
    Lund University, Sweden.
    Casas, Rosaura
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Characteristics of the pre-diabetic period in children with high risk of type 1 diabetes recruited from the general Swedish populationThe ABIS study2017Inngår i: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 33, nr 6, artikkel-id e2900Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundThere is a need for increased understanding of the pre-diabetic period in individuals with high risk of type 1 diabetes from the general population. MethodsHigh-risk children (n=21) positive for multiple islet autoantibodies were identified by autoantibody screening within the All Babies in Southeast Sweden study. The children and their parents were enrolled in a 2-year prospective follow-up study aiming to characterize the pre-diabetic period. Blood samples were collected every 6months for measurement of C-peptide, HbA1c, fasting glucose, and autoantibodies. Human leukocyte antigen-genotype was determined, and oral glucose tolerance test was performed every 12months. ResultsDespite positivity for multiple autoantibodies, 9 out of 21 individuals had low-risk human leukocyte antigen-genotypes. Children who progressed to manifest diabetes (progressors, n=12) had higher levels of IA2A and ZnT8A than children who did not (non-progressors, n=9). Impaired glucose tolerance and impaired fasting glucose was observed to the same extent in progressors and non-progressors, but HbA1c increased over time in progressors in spite of increased C-peptide. ConclusionsAutoantibodies to IA2 and ZnT8 may be useful discriminators for disease progression in at-risk children from the general population. Dysglycemia was observed long before diagnosis, and difficulties in maintaining glucose homeostasis despite increased C-peptide indicate that insulin resistance might be an important accelerator of disease in risk individuals.

  • 12524.
    Åkesson, Julia
    et al.
    Linköpings universitet, Institutionen för fysik, kemi och biologi, Bioinformatik. Linköpings universitet, Tekniska fakulteten. Systems Biology Research Centre, School of Bioscience, University of Skövde, Skövde, Sweden.
    Hojjati, Sara
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Hellberg, Sandra
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Raffetseder, Johanna
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Khademi, Mohsen
    Neuroimmunology Unit, Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Rynkowski, Robert
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurologiska kliniken i Linköping.
    Kockum, Ingrid
    Neuroimmunology Unit, Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Altafini, Claudio
    Linköpings universitet, Institutionen för systemteknik, Reglerteknik. Linköpings universitet, Tekniska fakulteten.
    Lubovac-Pilav, Zelmina
    Systems Biology Research Centre, School of Bioscience, University of Skövde, Skövde, Sweden.
    Mellergård, Johan
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för neurobiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurologiska kliniken i Linköping.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Piehl, Fredrik
    Neuroimmunology Unit, Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Olsson, Tomas
    Neuroimmunology Unit, Department of Clinical Neuroscience, Center for Molecular Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Ernerudh, Jan
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Gustafsson, Mika
    Linköpings universitet, Institutionen för fysik, kemi och biologi, Bioinformatik. Linköpings universitet, Tekniska fakulteten.
    Proteomics reveal biomarkers for diagnosis, disease activity and long-term disability outcomes in multiple sclerosis2023Inngår i: Nature Communications, E-ISSN 2041-1723, Vol. 14, nr 1, artikkel-id 6903Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sensitive and reliable protein biomarkers are needed to predict disease trajectory and personalize treatment strategies for multiple sclerosis (MS). Here, we use the highly sensitive proximity-extension assay combined with next-generation sequencing (Olink Explore) to quantify 1463 proteins in cerebrospinal fluid (CSF) and plasma from 143 people with early-stage MS and 43 healthy controls. With longitudinally followed discovery and replication cohorts, we identify CSF proteins that consistently predicted both short- and long-term disease progression. Lower levels of neurofilament light chain (NfL) in CSF is superior in predicting the absence of disease activity two years after sampling (replication AUC = 0.77) compared to all other tested proteins. Importantly, we also identify a combination of 11 CSF proteins (CXCL13, LTA, FCN2, ICAM3, LY9, SLAMF7, TYMP, CHI3L1, FYB1, TNFRSF1B and NfL) that predict the severity of disability worsening according to the normalized age-related MS severity score (replication AUC = 0.90). The identification of these proteins may help elucidate pathogenetic processes and might aid decisions on treatment strategies for persons with MS.

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  • 12525.
    Ånfors, Samuel
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Dept Rehabil Med, Jönköping, Region Jönköping County, Sweden; Lund Univ, Sweden.
    Kammerlind, Ann-Sofi
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken. Futurum, Region Jönköping County, Sweden.
    Nilsson, Maria H.
    Lund Univ, Sweden; Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Test-retest reliability of physical activity questionnaires in Parkinsons disease2021Inngår i: BMC Neurology, E-ISSN 1471-2377, Vol. 21, nr 1, artikkel-id 399Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background People with Parkinsons disease are less physically active than controls. It is important to promote physical activity, which can be assessed using different methods. Subjective measures include physical activity questionnaires, which are easy and cheap to administer in clinical practice. Knowledge of the psychometric properties of physical activity questionnaires for people with Parkinsons disease is limited. The aim of this study was to evaluate the test-retest reliability of physical activity questionnaires in individuals with Parkinsons disease without cognitive impairment. Methods Forty-nine individuals with Parkinsons disease without cognitive impairment participated in a test-retest reliability study. At two outpatient visits 8 days apart, the participants completed comprehensive questionnaires and single-item questions: International Physical Activity Questionnaire-Short Form (IPAQ-SF), Physical Activity Scale for the Elderly (PASE), Saltin-Grimby Physical Activity Level Scale (SGPALS) and Health on Equal Terms (HOET). Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), limits of agreement, weighted kappa or the Svensson method. Results Several of the physical activity questionnaires had relatively low test-retest reliability, including the comprehensive questionnaires (IPAQ-SF and PASE). Total physical activity according to IPAQ-SF had an ICC value of 0.46 (95% confidence interval [CI], 0.21-0.66) and SEM was 2891 MET-min/week. The PASE total score had an ICC value of 0.66 (95% CI, 0.46-0.79), whereas the SEM was 30 points. The single-item scales of SGPALS-past six months (SGPALS-6 m) and HOET question 1 (HOET-q1) with longer time frames (6 or 12 months, respectively) showed better results. Weighted kappa values were 0.64 (95% CI, 0.45-0.83) for SGPALS-6 m and 0.60 (95% CI, 0.39-0.80) for HOET-q1, whereas the single-item questions with a shorter recall period had kappa values &lt; 0.40. Conclusions Single-item questions with a longer time frame (6 or 12 months) for physical activity were shown to be more reliable than multi-item questionnaires such as the IPAQ-SF and PASE in individuals with Parkinsons disease without cognitive impairments. There is a need to develop a core outcome set to measure physical activity in people with Parkinsons disease, and there might be a need to develop new physical activity questionnaires.

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  • 12526.
    Årestedt, Kristofer
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Linnaeus Univ, Sweden.
    Alvariza, Anette
    Ersta Skondal Bracke Univ Coll, Sweden; Dalens Hosp, Sweden.
    Boman, Kurt
    Res Unit, Sweden; Umea Univ, Sweden.
    Ohlen, Joakim
    Univ Gothenburg, Sweden.
    Goliath, Ida
    Karolinska Inst, Sweden.
    Håkanson, Cecilia
    Ersta Skondal Bracke Univ Coll, Sweden; Sophiahemmet Univ, Sweden.
    Furst, Carl Johan
    Lund Univ, Sweden; Reg Skåne, Sweden.
    Brännstrom, Margareta
    Umeå Univ, Sweden.
    Symptom Relief and Palliative Care during the Last Week of Life among Patients with Heart Failure: A National Register Study2018Inngår i: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 21, nr 3, s. 361-367Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Heart failure is a disease with high morbidity, mortality, and physical and psychological burden. More knowledge about the care provided for patients with heart failure close to death is needed. Objective: The aim was to describe key aspects of palliative care during the last week of life in patients with heart failure, as reported by healthcare professionals. Design: This is a national register study. Setting/Subjects: The study included 3981 patients with diagnosed heart failure as the underlying cause of death. Measurements: Data were obtained from the Swedish Register of Palliative Care, a national quality register that focuses on patients last week of life, independent of diagnosis or care setting. The register includes information about care interventions connected with key aspects of palliative care. Data are reported retrospectively by a nurse or physician at the healthcare unit where the patient dies. Results: Only 4.2% of patients with heart failure received specialized palliative care. In their last week of life, symptom prevalence was high, validated scales were seldom used, and symptoms were unsatisfactorily relieved. Around one-fifth (17%) of the patients in the study died alone. Less than half of family members had been offered bereavement support (45%). Moreover, one-third (28%) of the patients and more than half (61%) of the family members were reported to have had end-of-life discussions with a physician during the illness trajectory. Conclusion: The results indicate inadequate palliative care for patients with heart failure during their last week of life.

  • 12527.
    Årestedt, Liselott
    et al.
    Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Martinsson, Caroline
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Hjelm, Carina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Uhlin, Fredrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Njurmedicinska kliniken US. Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia.
    Eldh, Ann Catrine
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Patient participation in dialysis care: a qualitative study of patients’ and health professionals’ perspectives2019Inngår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, nr 6, s. 1285-1293Artikkel i tidsskrift (Fagfellevurdert)
    Fulltekst (pdf)
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  • 12528.
    Åsberg, Katarina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Evaluating the effectiveness of a brief digital procrastination intervention targeting university students in Sweden: study protocol for the Focus randomised controlled trial2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 7, artikkel-id e072506Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction The concept of procrastination can be described as a conscious, yet irrational, postponement of important tasks or decisions-despite awareness that the delay may lead to negative consequences. Procrastination behaviours are common among university students and is often described as a failure of self-regulation, and the behaviour is associated with stress, symptoms of depression and anxiety, poorer academic performance and negative effects on overall health and well-being.Methods and analysis A two-arm, parallel groups (1:1), single-blind randomised controlled trial will be conducted to assess the effectiveness of a brief digital procrastination intervention (Focus) among university students in Sweden. The intervention consists of a screening and feedback component based on Pure Procrastination Scale (PPS) score, allowing intervention participants to assess their current procrastination behaviours and receive behaviour change advice. Participants in the control group will be shown their total PPS score without any further feedback. Monte Carlo simulations (assuming a standardised effect of 0.35 Cohens d of the intervention on the primary outcome, to at least 80% of the time estimate a posterior probability of effect of at least 95%) indicated that data from 1000 participants are required for analysis, meaning that 2000 participants are required to be randomised when assuming a 50% attrition rate. The primary outcome will be procrastination behaviour measured at 2 months postrandomisation. Secondary outcomes will be anxiety and stress symptoms and lifestyle behaviours. Outcomes will be analysed using multilevel regression models estimated using Bayesian inference.Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2022-08-24 (dnr 2022-00353). Students will be asked to give informed consent before participation and after having been given information about the study. The results will be submitted for publication in open access, peer-reviewed journals.

  • 12529.
    Åsberg, Katarina
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Perioperative digital behaviour change interventions for reducing alcohol consumption, improving dietary intake, increasing physical activity and smoking cessation: a scoping review2021Inngår i: Perioperative Medicine, E-ISSN 2047-0525, Vol. 10, artikkel-id 18Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Evidence suggests that unhealthy lifestyle behaviours are modifiable risk factors for postoperativecomplications. Digital behaviour change interventions (DBCIs), for instance text messaging programs and smartphoneapps, have shown promise in achieving lifestyle behaviour change in a wide range of clinical populations, and it maytherefore be possible to reduce postoperative complications by supporting behaviour change perioperatively usingdigital interventions. This scoping review was conducted in order to identify existing research done in the area ofperioperative DBCIs for reducing alcohol consumption, improving dietary intake, increasing physical activity andsmoking cessation.Main text: This scoping review included eleven studies covering a range of surgeries: bariatric, orthopaedic, cancer,transplantation and elective surgery. The studies were both randomised controlled trials and feasibility studies andinvestigated a diverse set of interventions: one game, three smartphone apps, one web-based program and five textmessage interventions. Feasibility studies reported user acceptability and satisfaction with the behaviour changesupport. Engagement data showed participation rates ranged from 40 to 90%, with more participants being activelyengaged early in the intervention period. In conclusion, the only full-scale randomised controlled trial (RCT), textmessaging ahead of bariatric surgery did not reveal any benefits with respect to adherence to preoperative exerciseadvice when compared to a control group. Two of the pilot studies, one text message intervention, one game,indicated change in a positive direction with respect to alcohol and tobacco outcomes, but between groupcomparisons were not done due to small sample sizes. The third pilot-study, a smartphone app, found between groupchanges for physical activity and alcohol, but not with respect to smoking cessation outcomes.

    Conclusion: This review found high participant satisfaction, but shows recruitment and timing-delivery issues, as wellas low retention to interventions post-surgery. Small sample sizes and the use of a variety of feasibility outcomemeasures prevent the synthesis of results and makes generalisation difficult. Future research should focus on definingstandardised outcome measures, enhancing patient engagement and improving adherence to behaviour change priorto scheduled surgery.

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  • 12530.
    Åsberg, Katarina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Blomqvist, Jenny
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Lundgren, Oskar
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Henriksson, Hanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Pontus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    Löf, Marie
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Digital multiple health behaviour change intervention targeting online help seekers: protocol for the COACH randomised factorial trial2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 7, artikkel-id e061024Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction Unhealthy lifestyle behaviours continue to be highly prevalent, including alcohol consumption, unhealthy diets, insufficient physical activity and smoking. There is a lack of effective interventions which have a large enough reach into the community to improve public health. Additionally, the common co-occurrence of multiple unhealthy behaviours demands investigation of efforts which address more than single behaviours. Methods and analysis The effects of six components of a novel digital multiple health behaviour change intervention on alcohol consumption, diet, physical activity and smoking (coprimary outcomes) will be estimated in a factorial randomised trial. The components are designed to facilitate behaviour change, for example, through goal setting or increasing motivation, and are either present or absent depending on allocation (ie, six factors with two levels each). The study population will be those seeking help online, recruited through search engines, social media and lifestyle-related websites. Included will be those who are at least 18 years of age and have at least one unhealthy behaviour. An adaptive design will be used to periodically make decisions to continue or stop recruitment, with simulations suggesting a final sample size between 1500 and 2500 participants. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 months and 4 months postrandomisation. Ethics and dissemination Approved by the Swedish Ethical Review Authority on 2021-08-11 (Dnr 2021-02855). Since participation is likely motivated by gaining access to novel support, the main concern is demotivation and opportunity cost if the intervention is found to only exert small effects. Recruitment began on 19 October 2021, with an anticipated recruitment period of 12 months.

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  • 12531.
    Åsberg, Katarina
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Eldh, Ann Catrine
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Löf, Marie
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Department of Biosciences and Nutrition, Karolinska Institute, Solna, Sweden.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    A balancing act–finding one´s way to health and well-being: A qualitative analysis of interviews with Swedish university students on lifestyle and behavior change2022Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 17, nr 10, artikkel-id e0275848Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction Unhealthy lifestyle behaviors such as unhealthy diets, low physical activity levels, smoking, and harmful alcohol consumption are common in student populations, which constitute a large group of young adults. As unhealthy lifestyle behaviors are associated with future disease and premature mortality, most commonly from cardiovascular disease and cancers, it is from a public health perspective important to understand such behaviors in young adult populations. The objective of this study was to investigate university students experiences of health, health-related behaviors, and the barriers and facilitators for behavior change in terms of health promotion in everyday life. Materials and methods This qualitative study was conducted at a middle-sized university in Sweden. Students represented different faculties and were recruited via non-probability convenience sampling using means such as the snowball technique and social media. The 21 interviews with 24 students, individually or in groups, were transcribed verbatim prior to a qualitative analysis inspired by phenomenological hermeneutics. Results Our interviews showed that university student life is associated with new health-related challenges, for example study-related stress and procrastination implies a lack of energy to engage in healthy routines such as physical activity, and a limited budget affects food choices. While adapting to a new context, students explore personal strategies such as taking on changes in manageable steps, seeking social support, and avoiding disturbances to maintaining health and quality of life. Conclusions Experiences of health while becoming and being a university student can be described as a transition-a balancing act of walking a slack line-during which students seek to manage a healthy balance. In the past, interventions have to some extent been designed to address university students behaviors; however, our study aids an understanding of their needs. Future interventions should highlight the transitions they are experiencing and the challenges of student life.

    Fulltekst (pdf)
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  • 12532.
    Åsberg, Katarina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Eldh, Ann Catrine
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Uppsala Univ, Sweden.
    Löf, Marie
    Karolinska Inst, Sweden.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    "Simply complicated": Uncovering the processes of lifestyle behavior change among college and university students with access to a digital multiple lifestyle intervention2024Inngår i: Digital Health, E-ISSN 2055-2076, Vol. 10, artikkel-id 20552076241245905Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background One approach to promoting healthy lifestyle behaviors is to target students with digital interventions. One of these is the digital intervention Buddy. This study aimed to understand why college and university students' chose to participate in a digital multiple lifestyle behavior intervention trial (Buddy), and their subsequent experiences of the behavior-change process.Methods College and university students taking part in a trial of the Buddy intervention were individually interviewed after completing the 4-month intervention. Participants were guided to narrate their experiences and actions that followed signing up. Altogether, 50 interviews were conducted via telephone. The verbatim transcribed texts were analyzed qualitatively.Results The analysis generated seven personas, which illustrated the students' different levels of engagement with the intervention and the behavior-change process. These were: the Occupied, the Kickstarter, the Aimless, the Reflective, the Goal-oriented, the Compliant, and the Personally developed. Buddy worked best for students who had clear ideas about what they wanted to change and why, and who were aware of their needs, and those who could translate information and reflection into action and had the mental and physical energy needed to make changes.Conclusions The progress of behavior change depends on the interaction between the digital mode of delivery, the intervention materials of Buddy, the individual's expectations, needs, and skills, and their current life situation. This suggests that designing lifestyle interventions could benefit from more often considering the various personas' different intentions, knowledge, and contexts. By doing so, interventions are likely to emerge that can better match different needs in the target population.

  • 12533.
    Åsberg, Katarina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Lundgren, Oskar
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Henriksson, Hanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Henriksson, Pontus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    Löf, Marie
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Karolinska Inst, Sweden.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students: protocol for the Buddy randomised factorial trial2021Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 11, nr 12, artikkel-id e051044Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction The time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions. Methods and analysis A factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation. Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study. Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023.

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  • 12534.
    Åsberg, Katarina
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Löf, Marie
    Karolinska Inst, Sweden.
    Bendtsen, Marcus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Effects of a single session low-threshold digital intervention for procrastination behaviors among university students (Focus): Findings from a randomized controlled trial2024Inngår i: Internet Interventions, ISSN 2214-7829, Vol. 36, artikkel-id 100741Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Procrastination behaviors are common among university students, and have been found to be associated with stress, symptoms of depression, anxiety, and poorer academic performance. There is a need for interventions that can reach students at scale, and therefore this study aimed to estimate the effects of a single session low-threshold digital intervention (Focus) for procrastination behaviors among university students in Sweden. Methods and analysis: A two-arm, parallel groups (1:1), single blind randomized controlled trial was conducted between February 8 to April 26, 2023. The study used email to invite university students across Sweden to participate in the trial. Both the intervention and the control group were invited to assess their current procrastination behaviors using the Pure Procrastination Scale (PPS). The intervention group immediately received feedback and behavior change advice by means of an interactive website, while the control group was shown their total PPS score without any further feedback. Students were included in the study if they scored 20 points or more on the PPS. Our primary outcome was procrastination behavior measured at 2 months post-randomization. Analyses were conducted using multilevel regression models estimated with Bayesian inference. Results: A total of 2209 participants (intervention: 1109, control: 1100) were randomized. The average age of participants was 26.4 years (SD = 7.8) and 65 % were women (n = 1442). The mean PPS score at baseline was 35.6 points (of a maximum of 60). Primary outcome data were available for 45 % (n = 498) of the intervention group and 55 % (n = 601) of the control group. The evidence suggested no marked difference between groups regarding any of the outcomes, although there was weak evidence of lower physical activity in the intervention group. Qualitative findings from open-ended responses uncovered a variety of views on procrastination and perceived problems that may follow. Those not feeling supported by Focus explained having troubles adopting the advice given and converting their intentions into action without more continuous support. Conclusions: Access to a single session of feedback and behavior change advice by means of an interactive website did not produce differential self-reported procrastination among university students who took the opportunity to self-assess their behaviors. The findings are limited by assessment reactivity due to screening at baseline and attrition to follow-up.

  • 12535.
    Åstrand, Anna
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Guerrieri, Davide
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, SE-58758 Linkoping, Sweden.
    Vikingsson, Svante
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, SE-58758 Linkoping, Sweden.
    Kronstrand, Robert
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, SE-58758 Linkoping, Sweden.
    Green, Henrik
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, SE-58758 Linkoping, Sweden.
    In vitro characterization of new psychoactive substances at the mu-opioid, CB1, 5HT(1A), and 5-HT2A receptors-On-target receptor potency and efficacy, and off-target effects2020Inngår i: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 317, artikkel-id 110553Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    New psychoactive substances (NPS) appear on the recreational market on a monthly basis, with unclear toxicology, resulting in an increasing number of fatalities. Identification of drug targets and potencies is crucial for understanding and treating intoxications and for scheduling processes. In this study 60 NPS and metabolites belonging to opioids, cannabinoids and serotonergic hallucinogens classes were screened for in vitro activation of the mu-opioid, CB1, 5-HT1A and 5-HT2A receptors using the AequoZen cell system. Fentanyl and NBOMe analogues were chosen for full dose-response characterization of the mu-opioid and 5-HT2A receptors, respectively. Most substances activated their corresponding target receptor. The most potent mu-opioid receptor agonists were 2-fluorofentanyl (EC50 = 1.0 nM), carfentanil (EC50 = 2.7 nM) and acrylfentanyl (EC50 = 2.8 nM) and in total a &gt;1500-fold difference was seen among the tested compounds. Moreover, furanylfentanyl, 4-methoxybutyrylfentanyl and valerylfentanyl acted as partial agonists of the mu-receptor. On the 5-HT2A receptor, bromo-dragonfly showed the highest potency (EC50 = 0.05 nM, 400 times more potent than LSD), followed by most NBOMe compounds with EC50 values ranging from 0.11 nM (for 25N-NBOMe) to 1.3 nM (for 25T4-NBOMe)). Off-target activation of the mu-opioid receptor was identified for piperazines, phenethylamines (in particular NBOMe and 2C compounds) and tryptamines. Moreover, the synthetic cannabinoid metabolite 3-carboxy indole PB-22 activated the 5-HT2A receptor. Bromo-dragonfly was the only compound that activated all four receptors. These results highlight the possible interplay of known and unknown NPS targets and unveil its complexity. Moreover, the detailed, quantitative information presented facilitates our further understanding of NPS toxicology. (c) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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  • 12536.
    Åstrand, Anna
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten.
    Toreskog, Amanda
    Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Watanabe, Shimpei
    Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Kronstrand, Robert
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Green, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Vikingsson, Svante
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Correlations between metabolism and structural elements of the alicyclic fentanyl analogs cyclopropyl fentanyl, cyclobutyl fentanyl, cyclopentyl fentanyl, cyclohexyl fentanyl and 2,2,3,3-tetramethylcyclopropyl fentanyl studied by human hepatocytes and LC-QTOF-MS2019Inngår i: Archives of Toxicology, ISSN 0340-5761, E-ISSN 1432-0738, Vol. 93, nr 1, s. 95-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Recently, a number of fentanyl analogs have been implicated in overdose deaths in Europe and in the US. So far, little is known of the molecular behavior of the structurally related subgroup; the alicyclic fentanyls. In this study, reference standards of cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, and 2,2,3,3-tetramethylcyclopropyl fentanyl (TMCPF) at a final concentration of 5 mu M were incubated with cryopreserved human hepatocytes (1x10(6) cells/mL) for 0, 1, 3 and 5h. The metabolites formed were identified by liquid chromatography-quadrupole time-of-flight mass spectrometry analysis. The most abundant biotransformation found was N-dealkylation (formation of normetabolites) and oxidation of the alicyclic rings. As ring size increased, the significance of N-dealkylation decreased in favor of alicyclic ring oxidation. An example of this was cyclopropyl fentanyl, with a three-carbon ring, whose normetabolite covered 82% of the total metabolic peak area and no oxidation of the alicyclic ring was observed. In contrast, TMCPF, with a seven-carbon ring structure, rendered as much as 85% of its metabolites oxidized on the alicyclic ring. Other biotransformations found included oxidation of the piperidine ethyl moiety and/or the phenethyl substructure, glucuronidation as well as amide hydrolysis to form metabolites identical to despropionyl fentanyl. Taken together, this study provides a base for understanding the metabolism of a number of structurally related fentanyl analogs formed upon intake.

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  • 12537.
    Åstrand, Anna
    et al.
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi.
    Vikingsson, Svante
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. National Board of Forensic Medicine, Sweden.
    Jakobsen, Ingrid
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Örebro University Hospital, Sweden.
    Björn, Niclas
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi.
    Kronstrand, Robert
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. National Board of Forensic Medicine, Sweden.
    Gréen, Henrik
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. National Board of Forensic Medicine, Sweden.
    Activation of the μ-opioid receptor by alicyclic fentanyls: Changes from high potency full agonists to low potency partial agonists with increasing alicyclic substructure2021Inngår i: Drug Testing and Analysis, ISSN 1942-7603, E-ISSN 1942-7611, Vol. 13, nr 1, s. 169-174Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fentanyl analogs represent an important group of new psychoactive substances and knowing their efficacy and potency might assist in interpreting observed concentrations. The potency of fentanyl analogs can be estimated from in vitro studies and can be used to establish structure-activity relationships. In this study, recombinant CHO-K1 cells (AequoScreen) expressing the human μ-opioid receptor were used to establish dose-response curves via luminescent analysis for cyclopropyl-, cyclobutyl-, cyclopentyl-, cyclohexyl-, and 2,2,3,3-tetramethylcyclopropylfentanyl (TMCPF), on three separate occasions, using eight different concentrations in an eight-fold serial dilution in triplicates starting at ~60 μM. Fentanyl was used as a full agonist reference while morphine and buprenorphine were included for comparison. Cyclopropylfentanyl (EC50 = 4.3 nM), cyclobutylfentanyl (EC50 = 6.2 nM), and cyclopentylfentanyl (EC50 = 13 nM) were full agonists slightly less potent than fentanyl (EC50 = 1.7 nM). Cyclohexylfentanyl (EC50 = 3.1 μM, efficacy 48%) and TMCPF (EC50 = 1.5 μM, efficacy 65%) were partial agonists less potent than morphine (EC50 = 430 nM). Based on the results, cyclopropyl-, cyclobutyl-, and cyclopentylfentanyl would be expected to induce intoxication or cause fatal poisonings at similar concentrations to fentanyl, while the toxic or fatal concentrations of cyclohexylfentanyl and TMCPF would be expected to be much higher.

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  • 12538.
    Åstrand, Anna
    et al.
    Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Artillerigatan 12, S-58758 Linkoping, Sweden.
    Vikingsson, Svante
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Artillerigatan 12, S-58758 Linkoping, Sweden.
    Lindstedt, Daniel
    Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Artillerigatan 12, S-58758 Linkoping, Sweden.
    Thelander, Gunilla
    Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Artillerigatan 12, S-58758 Linkoping, Sweden.
    Green, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Artillerigatan 12, S-58758 Linkoping, Sweden.
    Kronstrand, Robert
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Artillerigatan 12, S-58758 Linkoping, Sweden.
    Wohlfarth, Ariane
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet and Forens Toxicol, Artillerigatan 12, S-58758 Linkoping, Sweden.
    Metabolism study for CUMYL-4CN-BINACA in human hepatocytes and authentic urine specimens: Free cyanide is formed during the main metabolic pathway2018Inngår i: Drug Testing and Analysis, ISSN 1942-7603, E-ISSN 1942-7611, Vol. 10, nr 8, s. 1270-1279Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To further elucidate the metabolism of CUMYL-4CN-BINACA, a new synthetic cannabinoid with a cyano group, and to evaluate biomarkers, we incubated the substance in human hepatocytes and analysed 9 authentic urine specimens. We also quantified CUMYL-4CN-BINACA and cyanide in blood and provide comprehensive data on the 7 autopsy cases, 5 of them determined CUMYL-4CN-BINACA intoxications. For metabolite elucidation, CUMYL-4CN-BINACA was incubated with pooled human hepatocytes for up to 5hours, urine samples were analysed with and without enzymatic hydrolysis. Data was acquired in data-dependent mode by ultra-high performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS) with an Agilent 6550 QTOF. For quantitative analysis of CUMYL-4CN-BINACA, blood samples were precipitated and analysed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Cyanide was determined by gas chromatography-headspace-nitrogen phosphorus detection (GC-headspace-NPD). CUMYL-4CN-BINACA was metabolised via CYP450-mediated hydroxylation at 4-butyl position generating a cyanohydrin (M12), which releases free cyanide to form an aldehyde intermediate and eventually generates 4-hydroxybutyl CUMYL-BINACA (M11) and CUMYL-BINACA butanoic acid (M10). Other minor metabolites were produced by hydroxylation, dihydroxylation, N-dealkylation, and dihydrodiol formation; glucuronidation was observed. One urine sample showed high intensities of M10 and a wide variety of metabolites; the other samples contained fewer metabolites in low abundance and 1 sample showed no metabolites. CUMYL-4CN-BINACA blood concentrations ranged from 0.1 to 8.3ng/g showing an overlap between fatal and non-fatal concentrations. One blood sample contained 0.36g/g cyanide. Release of free cyanide during metabolism is worrying as it might induce liver toxicity. As suggested earlier, CUMYL-BINACA butanoic acid is the most abundant biomarker in urine, but monitoring of additional metabolites or, even better, analysis for the parent in blood is recommended.

  • 12539.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Medicinska fakulteten.
    Arytmogen högerkammarkardiomyopati2016Inngår i: Idrott och hjärtat / [ed] Mats Börjesson, Mikael Dellborg, Studentlitteratur, 2016, Vol. 1, s. 141-150Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 12540.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Progression of Right Ventricular Structural Changes and Ventricular Arrhythmias in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D).J Svetlichnaya, M Astrom Aneq, S Sharma1, M Scheinman, L Klein.2015Inngår i: Heart Rythm Society Congress; Boston, May 13-15, 2015, 2015Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive right ventricular (RV) enlargement and systolic dysfunction. Implantation of an transvenous cardioverter-defibrillator (ICD) is frequently used to treat ventricular arrhythmias in ARVC but its effect on RV structural and functional changes has not been investigated.  Objective: We studied whether an ICD might affect the rate of RV structure and functional changes in patients with ARVC.  Methods: In a two-center multinational cohort of 46 pts (37±12 years, 50% men) with definite ARVC by revised 2010 Task Force Criteria, we reviewed 3.5±1.6 serial echocardiograms (range 2-11) over a mean follow-up of 6.7±3.5 years. Echocardiographic measurements included RV outflow tract (RVOT) proximal diameter in parasternal long axis (PLAX) and distal diameter in short axis (PSAX), RV-end diastolic area (RVEDA) and fractional area change (FAC). Statistical analysis was performed using t-tests for continuous and chi-squared test for categorical variables. Results: ICDs were present in 29 pts (63%). All pts enrolled at US site were encouraged to have an ICD as compared to the European site (96 vs 24%, p<0.001). In the European site, only those judged to be at high risk underwent included ICD insertion for ventricular arrhythmia (X) and/or for severe RV dysfunction (Y). Patients were evenly matched with respect to age, gender, presence of a desmosomal genetic mutation and baseline medical therapy (Table 1). The mean RVEDA and RVOT PLAX were similar in pts with and without ICDs but baseline RVOT PSAX was higher in the ICD group and FAC was substantially lower (36±10 vs 46±10%, p=0.001). When adjusted for baseline values, there was a nearly 2-fold increase in the rate of annual RVEDA increase (0.9 vs 0.5 cm2/year p=0.235) and a significant increase in rate of annual PLAX enlargement (0.07 vs 0.01 cm/year, p=0.013). All patients with ICDs had 1.2+ T.R. Conclusions: Although ICDs were implanted in pts with lower baseline RV systolic function, after adjustment for baseline values, pts with ICDs had more rapid progression of RV enlargement. We hypothesize that the RV lead with attendant tricuspid regurgitation leads to further deterioration in RV structure and function.  

  • 12541.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right Atrial Size and Function Responds to Exercise in Parallel to the Degree of Effort: The Health eHeart Study. Arjun Sinh. Meriam Astrom Aneq, Nelson B. Schiller.2015Inngår i: American Society of Echography Congress, June 12-16, 2015, 2015Konferansepaper (Annet vitenskapelig)
  • 12542.
    Åström Aneq, Meriam
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right Ventricular Longitudinal Strain based on Magnetic Resonance Feature Tracking in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy2014Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Introduction:Arrhythmogenic right ventricular cardiomyopathy (ARVC) causes fibro-fatty substitution of the myocardium in the right ventricle (RV). Cardiovascular magnetic resonance imaging (CMR) is the gold standard for visualization and volume quantification of the RV, but the assessment of wall motion, is still based on qualitative “eye-balling”. Previous studies have shown the successful application of feature tracking (CMR-FT) to the left ventricle. The aim of this study was to test the feasibility of CMR-FT to assess RV strain in patients (P) with ARVC and in healthy controls(C).Methods: Thirteen patients fulfilling Task Force Criteria for ARVC and twenty healthy subjects underwent cardiac MRI at 1,5 Tesla. Steady-state free precession cine of six long axis slices was acquired by rotating the cut planes around the long axis of the RV. The 3-, 4- and 2-chamber views of the RV were identified. Segmental longitudinal strain was measured and re-calculated in terms of regional strain for the base (B), mid (M) and apical (A) levels of the RV and for the anterior, inferior, septal and free walls. Results: RV end systolic volume was significantly higher and ejection fraction lower in patients (104-82 ml, 49- 56%).  Longitudinal strain decreased from base to apex in both groups (P:-25%, -22%, -19%, C:-31%, -24%, -20%). In a wall based analysis, the absolute strain values were significantly lower in patient lateral (P-24%, C -32%) and anterior walls (P -22%, C-28 %) but not in inferior (P-26%, C -27%) and septal walls (P -15%, C -18%). Conclusion: Feature tracking was successfully applied to the RV in this cohort of ARVC patients. Longitudinal absolute strain was lower in the basal segments, the anterior and the free walls compared to controls. This supports previous reports on the uneven regional distribution of ARVC.

  • 12543.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right Ventricular Structure and Function during Exercise in Healthy Subjects. Meriam Åström Aneq, Arjun Sinha, Julia McClellan, Melvin Scheinman, Nelson B Schiller.2015Inngår i: American Society of Echocardiography Congress; Boston, 12-16 June 2015, 2015Konferansepaper (Annet vitenskapelig)
  • 12544.
    Åström Aneq, Meriam
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    The Presence of an Implantable Cardioverter Defibrillator (ICD) May Accelerate the Progression of Right Ventricular Structural Changes in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D). Jana Svetlichnaya; Meriam Åström Aneq; Liviu Klein; Melvin Scheinman. HRS Congress, chicago, 20172017Inngår i: Heart rythm Society Congress, chicago, May 10 - 13, 2017, 2017Konferansepaper (Annet vitenskapelig)
  • 12545.
    Åström Aneq, Meriam
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Maret, Eva
    Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
    Svensson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    Right ventricular systolic function and mechanical dispersion identify patients with arrhythmogenic right ventricular cardiomyopathy.2018Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 38, nr 5, s. 779-787Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To assess right ventricular (RV) regional and global systolic function using feature tracking (FT) in patients with a definite diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) and to investigate if changes in strain amplitude and mechanical dispersion indicate a propensity for arrhythmia.

    MATERIALS AND METHODS: Twenty-seven patients fulfilling Task Force Criteria for ARVC and 24 healthy volunteers underwent MR at 1·5 Tesla. Steady-state free precession cine of long-axis slices and a short-axis stack of the RV was acquired. Segmental longitudinal systolic strain amplitude and time-to-peak (TTP) strain were measured in the four- and two-chamber views of the RV.

    RESULTS: Compared to controls, patients with ARVC had lower RV ejection fraction (RVEF), (53% vs 57%, P = 0·012) and lower longitudinal strain amplitude in the RV free wall (-20·6 vs -26·3%, P = 0·014) and in the basal part of the RV (-22·8 vs -31·7%, P<0·001). Mechanical dispersion, defined as the standard deviation (SD) of TTP of RV segments, was larger in patients with ARVC (48 ms [21-74] vs 35 ms [13-66 ms], P = 0·02). Patients with ventricular tachycardia (VT) or non-sustained VT had lower RVEF (46% vs 55%, P = 0·008), but did not have significantly lower RV strain amplitude (-19·5% vs 21·0%, P = 0·073) and no signs of mechanical dispersion (49 ms vs 48 ms, P = 0·861) compared to patients without arrhythmia.

    CONCLUSION: ARVC patients had lower longitudinal absolute strain amplitude in basal RV segments and increased mechanical dispersion compared to healthy volunteers, but the presence of mechanical dispersion was not predictive of ventricular arrhythmia.

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  • 12546.
    Åström, Eva
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Stal, Per
    Karolinska University Hospital, Sweden.
    Zenlander, Robin
    Karolinska University Hospital, Sweden.
    Edenvik, Pia
    Karolinska University Hospital, Sweden.
    Alexandersson, Catharina
    Kalmar County Hospital, Sweden.
    Haglund, Mats
    Kalmar County Hospital, Sweden.
    Ryden, Ingvar
    Kalmar County Hospital, Sweden.
    Påhlsson, Peter
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten.
    Reverse lectin ELISA for detecting fucosylated forms of alpha 1-acid glycoprotein associated with hepatocellular carcinoma2017Inngår i: PLOS ONE, E-ISSN 1932-6203, Vol. 12, nr 3, artikkel-id e0173897Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Altered fucosylation of glycoproteins is associated with development of hepatocellular carcinoma (HCC). Lectins have been commonly used to assay changes in fucosylation of plasma glycoproteins. In the present study a recombinantly engineered form of the fucose binding lectin Aleuria aurantia (AAL) consisting of a single binding site for fucose (S2), was used to construct a reverse lectin ELISA method. Microtiter plates coated with the S2 lectin were used to capture glycoproteins from plasma samples followed by antibody detection of S2-bound fucosylated alpha 1-acid glycoprotein (S2-bound AGP). The method was used to compare the level of S2-bound AGP in serum samples from a small cohort of patients with hepatitis, cirrhosis or HCC. Using the reverse S2 lectin ELISA it was shown that the levels of S2-bound AGP was significantly higher in HCC patients compared to non-cancer patients and that there was also a significant elevation of S2-bound AGP in HCC patients compared to cirrhosis patients. There was no correlation between the level of S2-bound AGP and total AGP concentration. The performance of S2-bound AGP in differentiating HCC from cirrhosis samples or hepatitis samples were compared to other markers. A combination of S2-bound AGP, alpha-fetoprotein and AGP concentration showed performances giving area under receiver operating curves of 0.87 and 0.95 respectively.

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  • 12547.
    Åström Malm, Ida
    et al.
    Jonkoping Univ, Sweden.
    Alehagen, Urban
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten.
    Blomstrand, Peter
    Jonkoping Univ, Sweden; Cty Hosp Ryhov, Sweden.
    Dahlström, Ulf
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    De Basso, Rachel
    Jonkoping Univ, Sweden.
    Higher blood pressure in elderly hypertensive females, with increased arterial stiffness and blood pressure in females with the Fibrillin-1 2/3 genotype2020Inngår i: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 20, nr 1, artikkel-id 180Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Elderly patients have a relatively high cardiovascular risk due to increased arterial stiffness, elevated blood pressure and decreased amounts of elastin in the arteries. The composition of the media layer in the arterial wall, comprising elastin, collagen, smooth muscle cells, proteoglycans, fibronectin and fibrillin-1, influences its mechanical properties. Mutations in the fibrillin-1 gene leads to increased aortic stiffness, elevated pulse pressure and aortic root dilatation. This study investigates whether there is a sex difference among hypertensive elderly patients regarding blood pressure, arterial stiffness and fibrillin-1 genotypes. Methods A total of 315 hypertensive subjects (systolic blood pressure &gt; 140 mmHg) were included in this study (155 men and 160 women aged 71-88 years). Aortic pulse wave velocity and augmentation index were determined using SphygmoCor, and brachial blood pressure was measured using an oscillometric technique. Fibrillin-1 was genotyped by polymerase chain reaction and with a capillary electrophoresis system. Results Females showed a significantly higher peripheral mean arterial pressure (females; 107.20 mmHg, males 101.6 mmHg, p = 0.008), central mean arterial pressure (females; 107.2 mmHg, males 101.6 mmHg p = 0.008), central systolic blood pressure (females; 148.1 mmHg, males 139.2 mmHg, p &lt; 0.001) and central pulse pressure (females; 68.9 mmHg, males 61.6 mmHg, p = 0.035) than males. Females with the Fibrillin-1 2/3 genotype showed a significantly higher augmentation index (FBN1 2/3; 39.9%, FBN1 2/2 35.0%, FBN1 2/4 35.8, p = 0.029) and systolic blood pressure (FBN1 2/3; 174.6 mmHg, FBN1 2/2168.9 mmHg, FBN1 2/4169.9 mmHg, p = 0.025) than females with the 2/2 and 2/4 genotypes. Conclusion The findings of this study may indicate that hypertensive elderly females, especially elderly females with Fibrillin-1 2/3, have increased systolic blood pressure and arterial stiffness.

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  • 12548.
    Åström Malm, Ida
    et al.
    Jonkoping Univ, Sweden.
    De Basso, Rachel
    Jonkoping Univ, Sweden.
    Blomstrand, Peter
    Jonkoping Univ, Sweden; Cty Hosp Ryhov, Sweden.
    Bjarnegård, Niclas
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Increased arterial stiffness in males with abdominal aortic aneurysm2021Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 41, nr 1, s. 68-75Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Abdominal aortic aneurysm (AAA), a localized dilatation of the abdominal aorta, has a prevalence of about 1.5%-3% among 65- to 70-year-old males in Europe. AAA confers an increased risk of developing major cardiovascular events in addition to the risk of aneurysm rupture. The aim of this study was to evaluate whether the arterial wall distensibility is altered in subjects with AAA. Methods Two hundred and eighty-four male subjects (182 with AAA and 102 controls) were enrolled in the study. Arterial wall distensibility was evaluated using non-invasive applanation tonometry to measure regional pulse wave velocity between the carotid and femoral arteries and the carotid and radial arteries. In addition, blood pressure was measured, and the pulse pressure waveform was analysed. Results Higher aortic augmentation index (25.1% versus 20.6%;p &lt; .001) and higher aortic pulse wave velocity (12.3 m/s versus 10.9 m/s;p &lt; .001) were demonstrated in the AAA cohort. The slightly higher arm pulse wave velocity in the AAA group (9.4 m/s versus 9.1 m/s;p &lt; .05) was abolished after adjusting for mean arterial blood pressure. Conclusions Males with AAA have decreased aortic wall distensibility and enhanced reflection waves in central aorta during systole. These results imply that increased arterial wall stiffness may be a contributing factor to the overall higher cardiovascular risk seen in patients with AAA.

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  • 12549.
    Åström Malm, Ida
    et al.
    Jonkoping Univ, Sweden.
    De Basso, Rachel
    Jonkoping Univ, Sweden.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Blomstrand, Peter
    Jonkoping Univ, Sweden; Cty Hosp Ryhov, Sweden.
    Males with abdominal aortic aneurysm have reduced left ventricular systolic and diastolic function2022Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 42, nr 1, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Abdominal aortic aneurysm (AAA) increases the risk of chronic heart failure and other major cardiovascular events. Knowledge about left ventricular function in patients with AAA is lacking. This echocardiographic study aimed to investigate whether AAA is associated with left ventricular systolic and diastolic dysfunction. Methods Echocardiography was performed in 307 males (199 AAA and 108 controls) recruited from a regional ultrasound surveillance programme of known AAA, or from an ongoing ultrasound screening programme, during 2011-2016. Results Subjects with AAA had thicker septal and posterior walls and a reduced left ventricular function compared to controls. Left ventricular ejection fraction (AAA 55 +/- 8%, controls 57 +/- 7%) and global longitudinal strain (AAA 19 +/- 3%, controls 20 +/- 3%) were lower in the group with AAA (both p &lt; 0 center dot 05). Moreover, decreased mitral annular plane systolic excursion (12 +/- 2 mm versus 13 +/- 2 mm) and higher E/e (13 +/- 5 versus 11 +/- 4) were observed in subjects with AAA (both p &lt; 0 center dot 05). The aortic sinus (38 +/- 4 mm versus 35 +/- 2 mm) and ascending aorta (36 +/- 4 mm versus 34 +/- 5 mm) were also wider in the AAA group compared to controls (both p &lt; 0 center dot 01). Conclusion AAAs are associated with reduced left ventricular systolic and diastolic function in males. The larger diameter of the aortic sinus and ascending aorta among AAA patients suggests that AAA is a general aortic disease.

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  • 12550.
    Åvall Lundqvist, Elisabeth
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
    Paradigmskifte för gynekologisk cancer2015Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, nr 50, s. 2271-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Med ökad förståelse för bakomliggande mekanismer har ett genombrott skett vad gäller behandling och förståelse av gynekologisk cancer. I år godkändes den första målriktade behandlingen vid gynekologisk cancer, och därmed blir individualiserad behandling en realitet.

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