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  • 201. Order onlineBuy this publication >>
    Persson, Pär
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    On the Mode of Hysterectomy: with Emphasis on Recovery and Well‐Being2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Hysterectomy is the surgical removal of the uterus and it is the most common major gynaecological surgical procedure worldwide. Hysterectomy is most often indicated by benign conditions such as irregular uterine bleeding with or without uterine fibroids. Several modes of hysterectomy are available each using a different surgical approach. Psychological well‐being and recovery after hysterectomy have not been carefully investigated in randomised settings. The aims of this thesis were to evaluate different modes of hysterectomy regarding postoperative psychological well‐being in long‐term follow‐up 6 and 12 months after surgery and recovery of general well‐being in short‐term up to five weeks after surgery. Additional objectives were to study the influence of the women’s stress‐coping ability on postoperative psychological well‐being and also to analyse other factors associated with postoperative psychological well‐being and recovery of general well‐being. In a randomised trial (trial 1) of 125 women who had undergone laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH), no significant difference was found between the postoperative psychological well‐being of women in the two groups as indicated by four different psychometric measures up to 6 months after surgery. Neither did the day‐by‐day recovery of general well‐being differ between the women in the two hysterectomy groups, even when adjusted for consumption of analgesics. A high stress‐coping ability was strongly associated with a higher level of psychological well‐being preoperatively and a significantly faster recovery of general well‐being regardless of surgical method. In another randomised trial (trial 2) of 179 women who had undergone subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH), with a follow‐up time of one year, no significant difference in psychological well‐being was found between the two methods. The day‐by day recovery of general well‐being was the same in both groups. In both trial 1 and trial 2, longterm psychological well‐being improved over time during the study period regardless of the mode of hysterectomy. The occurrence of postoperative complications and a low preoperative level of psychological well‐being impair postoperative recovery significantly and prolong the duration of sick‐leave. In conclusion, the suggested benefits of the less invasive modes of hysterectomy, LH and SH, could not be proven in this study Recovery of general well‐being is associated with the woman’s stress‐coping and preoperative psychological well‐being and the studied modes of hysterectomy seem to be of less importance. This should be taken into account in preoperative counselling. Doing this will give patient and surgeon an open choice of the mode of hysterectomy to be chosen, since short‐term recovery and long‐term psychological well‐being seem to be the same in both groups in the long term.

    List of papers
    1. Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study
    Open this publication in new window or tab >>Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study
    2006 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 113, no 9, p. 1023-30Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. DESIGN: A prospective, open, randomised multicentre trial.

    SETTING: Five hospitals in the South East of Sweden.

    POPULATION: Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy.

    METHODS: Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively.

    MAIN OUTCOME MEASURES: Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time.

    RESULTS: No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group.

    CONCLUSIONS: General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.

    Keywords
    Hysterectomy, multicentre study, psychological wellbeing, psychometry, randomised
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18472 (URN)10.1111/j.1471-0528.2006.01025.x (DOI)16956334 (PubMedID)
    Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2019-06-28Bibliographically approved
    2. Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy
    Open this publication in new window or tab >>Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy
    2008 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 140, no 1, p. 108-113Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES: To determine whether the day-by-day recovery of general wellbeing was faster in women undergoing laparoscopic hysterectomy than in total abdominal hysterectomy and to analyse the association between stress coping and sick-leave and the day-by-day recovery measured as general wellbeing.

    STUDY DESIGN: A randomised multicentre trial conducted in five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study and 117 women completed the study. Fifty-five women were randomised to abdominal hysterectomy and 62 to laparoscopic hysterectomy. Day-by-day recovery of general wellbeing was measured by a visual analogue scale 1 week preoperatively, 35 days postoperatively, and during 1 week 6 months postoperatively. Stress-coping capability was measured preoperatively using a specific psychometric measurement. Sick-leave was granted with an initial period of 14 days and prolonged on patient demand with 7 days periods. Effects of operating method and stress-coping ability on the day-by-day recovery adjusted for postoperative complications and analgesics were analysed by means of analysis of variance for repeated measurements.

    RESULTS: No significant difference was found in the day-by-day recovery of the general wellbeing between the operating methods. Stress-coping ability did significantly influence the day-by-day recovery of general wellbeing. Duration of sick-leave was associated with the occurrence of postoperative complications but not with stress-coping ability.

    CONCLUSIONS: The day-by-day recovery of general wellbeing is not faster in laparoscopic hysterectomy than in abdominal hysterectomy. Women with high stress-coping abilities have a better outcome in general wellbeing than women with low stress-coping capacity. Identification of women with low stress-coping abilities and prevention of complications might be of benefit for improving postoperative wellbeing.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18473 (URN)10.1016/j.ejogrb.2008.03.006 (DOI)18456384 (PubMedID)
    Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2019-06-28Bibliographically approved
    3. A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study
    Open this publication in new window or tab >>A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study
    2010 (English)In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, no 4, p. 479-487Article in journal (Refereed) Published
    Abstract [en]

    Objective: To compare subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH) regarding influence on postoperative psychological well‐being and surgical outcome measurements.

    Design: A prospective, open, randomised multicenter trial.

    Setting: Seven hospitals and one private clinic in the south‐east of Sweden. Population: 200 women scheduled for abdominal hysterectomy for benign conditions were enrolled in the study; 179 women completed the study (94 SH and 85 TH).

    Methods: Four different psychometric tests measuring general well‐being, depression and anxiety preoperatively, six and 12 months postoperatively. Statistical analysis of variance and covariance were used. Main outcome measures: Effects of operating method on psychological well‐being postoperatively. Analysis of demographic, clinical and surgical data including peri‐ and postoperative complications and complaints at follow‐up.

    Results: No significant differences were observed between the two groups in any of the psychometric tests. Both surgical methods were associated with a significantly higher degree of psychological well‐being six and 12 months postoperatively compared with preoperatively. The operating time was significantly longer for TH than SH. No significant differences were found in the clinical measures including complications. A substantial number of women experienced persistent cyclic vaginal bleedings after SH. Neither minor or major postoperative complications nor serum concentration of sex hormones were associated with the psychological general well‐being 12 months after the operation. Conclusions: General psychological well‐being is equally improved after both SH and TH within 12 months after the operation and does not seem to be associated with occurrence of perioperative complications or serum concentration of sex hormones.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18474 (URN)10.1111/j.1471-0528.2009.02467.x (DOI)000274388200014 ()
    Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2019-06-28Bibliographically approved
    4. Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial
    Open this publication in new window or tab >>Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial
    2010 (English)In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, no 4, p. 469-478Article in journal (Refereed) Published
    Abstract [en]

    Objective: To determine whether the day‐byday postoperative recovery differs between women undergoing subtotal and total abdominal hysterectomy and to analyse factors associated with postoperative recovery and sick‐leave.

    Design: A prospective, open, randomised multicenter trial.

    Setting: Seven hospitals and one private clinic in the south‐east of Sweden.

    Population: 200 women scheduled for hysterectomy for benign conditions were enrolled in the study and 178 women completed the study. 94 women were randomised to subtotal abdominal hysterectomy and 84 to total abdominal hysterectomy.

    Methods: Day‐by day recovery of general well‐being measured by a visual analogue scale in a diary seven days preoperatively and 35 days postoperatively. Psychometric measurements included depression, anxiety and general psychological well‐being.

    Main outcome measures: Effects of operating method and preoperative well‐being on the day‐by‐day recovery and sick‐leave duration.

    Results: No significant difference was found in the day‐by‐day recovery between operating methods. Day‐by‐day recovery of general well‐being and duration of sick‐leave was strongly associated with the occurrence of minor complications but not with major complications. The level of psychological wellbeing preoperatively was strongly associated with the day‐by‐day recovery of general wellbeing and duration of sick‐leave.

    Conclusions: Day‐by‐day recovery of general well‐being is not faster in subtotal versus total abdominal hysterectomy. Independent of operation method there is an interaction between preoperative psychological wellbeing, postoperative recovery of general wellbeing and duration of sick‐leave. Postoperative complications and preoperative psychological well‐being are strong determinants for duration of sick‐leave. There is a need for intervention studies with focus on complications and preoperative well‐being.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18475 (URN)10.1111/j.1471-0528.2009.02468.x (DOI)000274388200013 ()
    Note
    This is the author's version of the work. It is posted here for personal use, not for redistribution. The definitive version was published: Persson Pär, Jan Brynhildsen and Preben Kjølhede, Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial, 2010, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, (117), 4, 469-478. http://dx.doi.org/10.1111/j.1471-0528.2009.02468.x Copyright: Blackwell Publishing Ltd. Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2019-06-28Bibliographically approved
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    On the Mode of Hysterectomy
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  • 202.
    Persson, Pär
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study2010In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, no 4, p. 479-487Article in journal (Refereed)
    Abstract [en]

    Objective: To compare subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH) regarding influence on postoperative psychological well‐being and surgical outcome measurements.

    Design: A prospective, open, randomised multicenter trial.

    Setting: Seven hospitals and one private clinic in the south‐east of Sweden. Population: 200 women scheduled for abdominal hysterectomy for benign conditions were enrolled in the study; 179 women completed the study (94 SH and 85 TH).

    Methods: Four different psychometric tests measuring general well‐being, depression and anxiety preoperatively, six and 12 months postoperatively. Statistical analysis of variance and covariance were used. Main outcome measures: Effects of operating method on psychological well‐being postoperatively. Analysis of demographic, clinical and surgical data including peri‐ and postoperative complications and complaints at follow‐up.

    Results: No significant differences were observed between the two groups in any of the psychometric tests. Both surgical methods were associated with a significantly higher degree of psychological well‐being six and 12 months postoperatively compared with preoperatively. The operating time was significantly longer for TH than SH. No significant differences were found in the clinical measures including complications. A substantial number of women experienced persistent cyclic vaginal bleedings after SH. Neither minor or major postoperative complications nor serum concentration of sex hormones were associated with the psychological general well‐being 12 months after the operation. Conclusions: General psychological well‐being is equally improved after both SH and TH within 12 months after the operation and does not seem to be associated with occurrence of perioperative complications or serum concentration of sex hormones.

  • 203.
    Persson, Pär
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Hellborg, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Attitudes to mode of hysterectomy--a survey-based study among Swedish gynecologists2009In: Acta obstetricia et gynecologica Scandinavica, ISSN 1600-0412, Vol. 88, no 3, p. 267-74Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine gynecologists' attitudes to mode of hysterectomy on benign indication. DESIGN: Cross-sectional study. SETTING: Sweden. POPULATION: Members of the Swedish Society of Obstetrics and Gynecology. METHODS: A postal questionnaire. Questions examined attitudes to mode of hysterectomy based on three clinical scenarios with different conditions of the uterus. Gynecologists were also asked to estimate how the distribution of the different modes of benign hysterectomy should be overall. The modes to choose were total abdominal, subtotal abdominal, laparoscopic or vaginal hysterectomy (VH). Analyses were performed with multiple logistic regression and multivariate analysis of covariance. MAIN OUTCOME MEASURES: Preferred mode of hysterectomy in the three scenarios and distribution of modes of hysterectomy. RESULTS: VH was the most preferred method in general as well as when the uterus was of normal size, whereas subtotal and total abdominal hysterectomy were the most favored methods when the uterus was enlarged. VH was more often preferred by male compared to female gynecologists as a personal preference. The choice and distribution of mode varied significantly between place of work, seniority and in the quantity of yearly performed hysterectomies. The minimal invasive methods, vaginal and laparoscopic hysterectomy, were recommended in more than 50% of the overall suggested distribution. CONCLUSION: Personal choice of mode of hysterectomy does not seem to strictly follow evidence-based recommendations, but varies significantly between gynecologist's gender, type of clinical setting in which the gynecologist works, seniority and by how many hysterectomies the gynecologist does annually.

  • 204.
    Persson, Pär
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy2008In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 140, no 1, p. 108-113Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To determine whether the day-by-day recovery of general wellbeing was faster in women undergoing laparoscopic hysterectomy than in total abdominal hysterectomy and to analyse the association between stress coping and sick-leave and the day-by-day recovery measured as general wellbeing.

    STUDY DESIGN: A randomised multicentre trial conducted in five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study and 117 women completed the study. Fifty-five women were randomised to abdominal hysterectomy and 62 to laparoscopic hysterectomy. Day-by-day recovery of general wellbeing was measured by a visual analogue scale 1 week preoperatively, 35 days postoperatively, and during 1 week 6 months postoperatively. Stress-coping capability was measured preoperatively using a specific psychometric measurement. Sick-leave was granted with an initial period of 14 days and prolonged on patient demand with 7 days periods. Effects of operating method and stress-coping ability on the day-by-day recovery adjusted for postoperative complications and analgesics were analysed by means of analysis of variance for repeated measurements.

    RESULTS: No significant difference was found in the day-by-day recovery of the general wellbeing between the operating methods. Stress-coping ability did significantly influence the day-by-day recovery of general wellbeing. Duration of sick-leave was associated with the occurrence of postoperative complications but not with stress-coping ability.

    CONCLUSIONS: The day-by-day recovery of general wellbeing is not faster in laparoscopic hysterectomy than in abdominal hysterectomy. Women with high stress-coping abilities have a better outcome in general wellbeing than women with low stress-coping capacity. Identification of women with low stress-coping abilities and prevention of complications might be of benefit for improving postoperative wellbeing.

  • 205.
    Persson, Pär
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study2006In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 113, no 9, p. 1023-30Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. DESIGN: A prospective, open, randomised multicentre trial.

    SETTING: Five hospitals in the South East of Sweden.

    POPULATION: Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy.

    METHODS: Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively.

    MAIN OUTCOME MEASURES: Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time.

    RESULTS: No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group.

    CONCLUSIONS: General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.

  • 206. Plevyak, M
    et al.
    Hanna, N
    Mayer, S
    Murphy, S
    Pinar, H
    Fast, L
    Ekerfelt, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine.
    Ernerudh, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Matthiesen, Leif
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sharma, S
    Deficiency of decidual IL-10 in first trimester missed abortion: A lack of correlation with the decidual immune cell profile2002In: American Journal of Reproductive Immunology and Microbiology, ISSN 8755-8920, Vol. 47, no 4, p. 242-250Article in journal (Refereed)
    Abstract [en]

    PROBLEM: To determine if first trimester missed abortion decidua is characterized by an altered immune cell profile and/or a modified interleukin (I L)-10 and interferon (IFN)-gamma production pattern compared with decidua from elective termination. METHOD OF STUDY: Flow cytometry and immunohistochemistry techniques were used to determine the decidual immune cell phenotypic profile and production pattern of IL-10 and IFN-gamma in cases of elective termination (n = 14) and missed abortion (n = 12). RESULTS: Both groups had a similar proportion of CD56(+) CD16(-),CD56(+) CD16(+), CD19(+), CD3(+), CD4(+), CD8(+), alphabeta T cells and gammadelta T cells. The majority of alphabeta and gammadelta positive T cells in both groups coexpressed the natural killer (NK) cell marker CD56, but lacked cell surface expression of CD3. Diminished decidual IL-10 staining was noted in 7/10 missed abortion cases compared with none of the elective termination cases (n = 12) (P = 0.007). A uniform decidual IFN-gamma staining pattern was observed in both groups. CONCLUSION: Decreased IL-10 production coupled with a sustained IFN-gamma presence noted in missed abortion compared with elective termination cases suggest that these cytokines may be important determinants in pregnancy outcome. In contrast, differences in the proportion of immune cells between both groups may not be a critical factor in early pregnancy loss. In normal pregnancy, decidual alphabeta and gammadelta positive T cells with reduced CD3 on their cell surface may be intrinsically restricted in T-cell receptor (TCR)-mediated activation.

  • 207.
    Pär, Persson
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial2010In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, no 4, p. 469-478Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether the day‐byday postoperative recovery differs between women undergoing subtotal and total abdominal hysterectomy and to analyse factors associated with postoperative recovery and sick‐leave.

    Design: A prospective, open, randomised multicenter trial.

    Setting: Seven hospitals and one private clinic in the south‐east of Sweden.

    Population: 200 women scheduled for hysterectomy for benign conditions were enrolled in the study and 178 women completed the study. 94 women were randomised to subtotal abdominal hysterectomy and 84 to total abdominal hysterectomy.

    Methods: Day‐by day recovery of general well‐being measured by a visual analogue scale in a diary seven days preoperatively and 35 days postoperatively. Psychometric measurements included depression, anxiety and general psychological well‐being.

    Main outcome measures: Effects of operating method and preoperative well‐being on the day‐by‐day recovery and sick‐leave duration.

    Results: No significant difference was found in the day‐by‐day recovery between operating methods. Day‐by‐day recovery of general well‐being and duration of sick‐leave was strongly associated with the occurrence of minor complications but not with major complications. The level of psychological wellbeing preoperatively was strongly associated with the day‐by‐day recovery of general wellbeing and duration of sick‐leave.

    Conclusions: Day‐by‐day recovery of general well‐being is not faster in subtotal versus total abdominal hysterectomy. Independent of operation method there is an interaction between preoperative psychological wellbeing, postoperative recovery of general wellbeing and duration of sick‐leave. Postoperative complications and preoperative psychological well‐being are strong determinants for duration of sick‐leave. There is a need for intervention studies with focus on complications and preoperative well‐being.

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  • 208.
    Risto, Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Hammar, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Hammar, Karl
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wahlström, Ola
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Elderly men with a history of distal radius fracture have significantly lower calcaneal bone density and free androgen index than age-matched controls2012In: The Aging Male, ISSN 1368-5538, E-ISSN 1473-0790, Vol. 15, no 1, p. 59-62Article in journal (Refereed)
    Abstract [en]

    Background: Age related bone loss is widely accepted as related to decreased serum levels of circulating sex hormones. Epidemiological data also show distal radius fractures in men to be a sensitive marker of bone fragility. The aim of this study was to assess if men with a history of distal radius fracture have lower bone mass density (BMD), lower free androgen index (FAI), lower total testosterone (T) and lower bio-available testosterone (Bio-T) than healthy age-matched controls. Patients and methods: A case-control study is based on consecutive cases treated for low energy distal radius fracture at our department and age-matched controls. Thirty-nine men treated between 1997-2004 and 45 age-matched controls underwent calcaneal bone density measurements (t-score) and analyses of T, Bio-T and serum hormone binding globulin (SHBG). Results: The fracture group had lower BMD (p andlt; 0.01) and lower FAI (p = 0.01). Linear regression analysis showed a correlation between Bio-T and t-scores (p = 0.03). Using analysis of covariance, a significant difference with lower Bio-T in the fracture group was shown. Conclusion: Bio-T seems to correlate with BMD in elderly men and may serve as a marker for increased fracture risk in this patient group.

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  • 209.
    Rohini Rajan, Meenu
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Fagerholm, Siri
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Jonsson, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Turkina, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Phosphorylation of IRS1 at Serine 307 in Response to Insulin in Human Adipocytes Is Not Likely to be Catalyzed by p70 Ribosomal S6 Kinase2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 4Article in journal (Refereed)
    Abstract [en]

    The insulin receptor substrate-1 (IRS1) is phosphorylated on serine 307 (human sequence, corresponding to murine serine 302) in response to insulin as part of a feedback loop that controls IRS1 phosphorylation on tyrosine residues by the insulin receptor. This in turn directly affects downstream signaling and is in human adipocytes implicated in the pathogenesis of insulin resistance and type 2 diabetes. The phosphorylation is inhibited by rapamycin, a specific inhibitor of mammalian target of rapamycin (mTOR) in complex with raptor (mTORC1). The mTORC1-downstream p70 ribosomal protein S6 kinase (S6K1), which is activated by insulin, can phosphorylate IRS1 at serine 307 in vitro and is considered the physiological protein kinase. Because the IRS1 serine 307-kinase catalyzes a critical step in the control of insulin signaling and constitutes a potential target for treatment of insulin resistance, it is important to know whether S6K1 is the physiological serine 307-kinase or not. We report that, by several criteria, S6K1 does not phosphorylate IRS1 at serine 307 in response to insulin in intact human primary adipocytes: (i) The time-courses for phosphorylation of S6K1 and its phosphorylation of S6 are not compatible with the phosphorylation of IRS1 at serine 307; (ii) A dominant-negative construct of S6K1 inhibits the phosphorylation of S6, without effect on the phosphorylation of IRS1 at serine 307; (iii) The specific inhibitor of S6K1 PF-4708671 inhibits the phosphorylation of S6, without effect on phosphorylation of IRS1 at serine 307. mTOR-immunoprecipitates from insulin-stimulated adipocytes contains an unidentified protein kinase specific for phosphorylation of IRS1 at serine 307, but it is not mTOR or S6K1.

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  • 210.
    Rubertsson, Christine
    et al.
    Uppsala University.
    Borjesson, Karin
    Karolinska University Hospital.
    Berglund, Anna
    Central Hospital Västerås.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    The Swedish validation of Edinburgh Postnatal Depression Scale (EPDS) during pregnancy2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 6, p. 414-418Article in journal (Refereed)
    Abstract [en]

    Around 10-15% of women suffer from depressive illness during pregnancy or the first year postpartum. Depression during pregnancy constitutes a risk for prenatal stress and preterm birth. No validated screening instrument for detecting depression during pregnancy was available in Swedish. Aims: We aimed to validate the Edinburgh Postnatal Depression Scale (EPDS) against DSM-IV criteria for depression during pregnancy, establish a reliable cut-off and estimate the correlation between the EPDS and HAD-S (Hospital Anxiety and Depression Scale). Methods: In a population-based community sample of 1175 pregnant women, 918 women (78%) answered questionnaires with the EPDS and HAD-S. In all, 121 were interviewed using the PRIME-MD (Primary Care Evaluation of Mental disorders) for diagnosing depression. Women were interviewed in mean gestational week 13 (range 8-21). For the EPDS, a receiver operating characteristic (ROC) curve was calculated for prediction of depression. Pearsons correlation coefficient was used to investigate the association between EPDS and HAD-S scores. Results: The optimal cut-off score on the EPDS scale for detecting depression was andgt;= 13 (standard error coefficient of 1.09 and c-statistics of 0.84) giving a sensitivity of 77% and specificity of 94%. The EPDS scores correlated strongly with the HAD-S, Pearsons correlation was 0.83 (P andlt; 0.0001). Conclusions: This study confirms that the EPDS is a valid screening instrument for detection of depressive symptoms during pregnancy. The EPDS shows persuasive measuring outcomes with an optimal cut-off at andgt;= 13. Clinical implications: Healthcare for pregnant women should consider screening procedures and follow-up routines for depressive symptoms.

  • 211.
    Rugarn, O
    et al.
    Fac Hlth Sci, Dept Obstet & Gynaecol, Linkoping, Sweden Fac Hlth Sci, Dept Neurosurg, Linkoping, Sweden.
    Theodorsson, Annette
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurosurgery UHL.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Theodorsson, Elvar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry.
    Effects of estradiol on regional concentrations of galanin in the rat brain1999In: Brain Research, ISSN 0006-8993, E-ISSN 1872-6240, Vol. 848, no 1-2, p. P323-Conference paper (Other academic)
  • 212.
    Rugarn, Olof
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Theodorsson, Annette
    Linköping University, Department of Neuroscience and Locomotion, Neurosurgery. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Stenfors, Carina
    Department of Laboratory Medicine, Karolinska Hospital, Stockholm, Sweden.
    Sex differences in neuropeptide distribution in the rat brain1999In: Peptides, ISSN 0196-9781, E-ISSN 1873-5169, Vol. 20, no 1, p. 81-86Article in journal (Refereed)
    Abstract [en]

    We have investigated possible sex differences in the regional concentrations of neuropeptides in the rat brain. Immunoreactive neurotensin (NT), neurokinin A (NKA), galanin (GAL), calcitonin gene-related peptide (CGRP), substance P (SP) and neuropeptide Y (NPY) were measured by radioimmunoassay in frontal cortex, occipital cortex, hippocampus, striatum, hypothalamus and pituitary in male and female pre- and postpubertal rats. Sex differences were found for NPY (p < 0.001), NT (p < 0.01) and GAL (p < 0.05), in particular in hippocampus, striatum, hypothalamus and pituitary, but not for CGRP, SP and NKA. Results from analysis of neuropeptides in one sex may not be entirely applicable to the other.

  • 213.
    Rugarn, Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Theodorsson, Annette
    Linköping University, Department of Neuroscience and Locomotion, Neurosurgery. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Effects of estradiol, progesterone, and norethisterone on regional concentrations of galanin in the rat brain1999In: Peptides, ISSN 0196-9781, E-ISSN 1873-5169, Vol. 20, no 6, p. 743-748Article in journal (Refereed)
    Abstract [en]

    Concentrations of immunoreactive galanin were compared in eight gross brain regions of ovariectomized female rats treated with either estradiol, estradiol + progesterone, estradiol + norethisterone, or placebo. Higher concentrations with estradiol treatment compared with placebo were found in the pituitary (357%), frontal cortex (162%), occipital cortex (174%), hippocampus (170%), and median eminence (202%). A more profound difference with addition of progesterone or norethisterone was seen in the pituitary (529% and 467%, respectively). Sex steroids, particularly estradiol, modulate galanin concentrations not only in reproductive, but also in nonreproductive, brain regions.

  • 214.
    Sandberg, Margareta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences.
    Wyon, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Nedstrand, Elisabeth
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Effects of electro-acupuncture on psychological distress in postmenopausal women2002In: Complementary Therapies in Medicine, ISSN 0965-2299, Vol. 10, no 3, p. 161-169Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate effects of electro–acupuncture (EA) on general psychological distress and relate to experience of climacteric symptoms in 30 postmenopausal women.

    Design: A randomised single-blind controlled design was used to evaluate effects of EA and extremely superficial needle insertion, with the latter serving as a near-placebo control.

    Settings: The Linköping University Hospital in Sweden. Interventions: Fourteen treatments during 12 weeks with follow-ups at 3 and 6 months.

    Outcome measures: General psychological well-being, mood and experience of climacteric symptoms. Results: Mood Scale improved only in EA group and not until 12 weeks compared to baseline, from 110 to 129 (P=0.01), and to 120 at 3-month follow-up (P=0.04). Mood was significantly better than control at 8 (P=0.05) and 12 weeks (P=0.01). Visual analogue scale estimation of climacteric symptoms was decreased at 4 weeks in both groups, and lasted throughout the study period, in EA group from 5 to 2 (P=0.04) and in control group from 5 to 3 (P=0.02) at 6-month follow-up. Well-being was ameliorated from 4 weeks in EA and from 8 weeks in control group until end of study (P=0.01, P=0.03). No significant differences on climacteric symptoms or well-being existed between the groups.

    Conclusions: This study does not show that EA is better than superficial needle insertion for the amelioration of general psychological distress and experience of climacteric symptoms in women with vasomotor symptoms after menopause. However, the more pronounced effect on mood suggests that EA might have additional effects compared with superficial needle insertion.

  • 215.
    Sandberg, Martina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Matthiesen, L
    Helsingborg Hospital.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, L J
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre . Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Systemic Th1-and Th2-associated chemokines during and after pregnancy in relation to maternal allergic disease2009In: in JOURNAL OF REPRODUCTIVE IMMUNOLOGY, vol 81, issue 2, 2009, Vol. 81, no 2, p. 164-164Conference paper (Refereed)
    Abstract [en]

    n/a

  • 216.
    Sandberg, Martina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Frykman, Anne
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Matthiesen, Leif
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Cord blood cytokines and chemokines and development of allergic disease2009In: PEDIATRIC ALLERGY AND IMMUNOLOGY, ISSN 0905-6157, Vol. 20, no 6, p. 519-527Article in journal (Refereed)
    Abstract [en]

    Exposure to ubiquitous allergens early in life, even before birth, may influence the incidence of allergic diseases later in life. During pregnancy, the fetomaternal interface is surrounded by high levels of T-helper (Th)2-like cytokines, possibly favouring the development of Th2-like immune responses in the offspring. The aim of this study was to evaluate the relation between cord blood (CB) IgE antibodies, Th1- and Th2-like cytokines and chemokines, maternal allergy and development of allergic disease during the first 2 yr of life in the offspring. The CB cytokine and chemokine levels from children of 20 allergic and 36 non-allergic women were determined by a multiplexed Luminex assay and ELISA. Total CB and maternal IgE antibody concentrations were quantified using ImmunoCAP technology. The maternal IgE levels during and after pregnancy correlated with CB IgE and Th2-associated macrophage-derived chemokine [MDC (CCL22)] levels. Development of allergic disease and sensitization was associated with increased CB IgE and MDC (CCL22) levels, as well as high ratios of MDC (CCL22) to Th1-associated interferon-gamma inducible protein 10 [IP-10 (CXCL10)] and interferon-gamma inducible T-cell alpha-chemoattractant [I-TAC (CXCL11) (n = 7 allergic vs. n = 25 non-allergic)]. The correlations between maternal IgE and CB IgE and MDC (CCL22) levels possibly indicate that the maternal immunity can affect the Th1/Th2 profile in the neonate. Development of allergic disease is associated with a more marked Th2-like deviation already at birth, shown as increased levels of CB IgE and MDC (CCL22) and higher ratios of MDC (CCL22) to IP-10 (CXCL10) and I-TAC (CXCL11).

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  • 217.
    Sandberg, Martina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Frykman, Anne
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Jonsson, Yvonne
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Persson, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Matthiesen, Leif
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Ekerfelt, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Total and allergen-specific IgE levels during and after pregnancy in relation to maternal allergy2009In: JOURNAL OF REPRODUCTIVE IMMUNOLOGY, ISSN 0165-0378, Vol. 81, no 1, p. 82-88Article in journal (Refereed)
    Abstract [en]

    Type 2 T-helper cell (Th2)-skewed immunity is associated with successful pregnancy and the ability to easily direct immune responses to a Th2-polarised profile may be an evolutionary benefit. The Th2-like immunity associated with allergic disease might generate favourable effects for the maintenance of pregnancy, but could also promote development of Th2-like immune responses and allergic disease in the offspring. The aim of this study was to explore, by using IgE as a stable proxy for Th2, the Th1/Th2 balance in allergic and non-allergic women by measuring allergen-specific and total IgE antibody levels in plasma during pregnancy and after delivery. Specific and total IgE antibody levels were determined by ImmunoCAP technology at five occasions during pregnancy (gestational weeks 10-12, 15-16, 25, 35 and 39), as well as at 2 and 12 months after delivery. Thirty-six women without and 20 women with allergic symptoms were included, of whom 13 were sensitised with allergic symptoms and 30 were non-sensitised without allergic symptoms. The levels of total IgE, but not allergen-specific IgE, were increased during early pregnancy when compared to 12 months after delivery in the sensitised women with allergic symptoms, but not in the non-sensitised women without allergic symptoms (pandlt;0.01). This increase in total IgE levels during early pregnancy only in the sensitised women with allergic symptoms indicates that allergy is associated with an enhanced Th2 deviation during pregnancy.

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  • 218.
    Sarberg, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Neurophysiology UHL.
    Restless legs syndrome during and after pregnancy and its relation to snoring2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 7, p. 850-855Article in journal (Refereed)
    Abstract [en]

    Objective. To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy-related symptoms. Design. Prospective study. Setting. Antenatal care clinics in the catchment area of Linkoping university hospital, Sweden. Population. Five hundred consecutively recruited pregnant women. Methods. Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy. Main outcome measures. Symptoms of RLS in relation to snoring in each trimester. Results. Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty-eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery. Conclusions. Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one-third of women with RLS during pregnancy may still have symptoms three years after childbirth.

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  • 219.
    Sauma, Lilian
    et al.
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Franck, Niclas
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sandström, Per
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Lindström, Torbjörn
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Nyström, Fredrik
    Linköping University, Department of Medicine and Health Sciences, Internal Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Isolated primary human visceral fat cells release more angiotensin II than subcutaneous adipocytesManuscript (preprint) (Other academic)
    Abstract [en]

    Background. Visceral obesity relates strongly to the metabolic syndrome and hence to hypertension. Although a local renin-angiotensin-system (RAS) in fat tissue is known, very few studies have dealt with RAS in isolated primary human fat cells, in particular from the visceral compartment.

    Methods. Measurement of angiotensin II (Ang II) in medium from isolated primary human fat cells from visceral and subcutaneous adipose tissues and analyses of RAS-components in human fat cells and fat tissues.

    Results. Primary human fat cells from omental adipose tissue produced more Ang II than subcutaneous cells. Treatment with insulin did not affect Ang II production and body-massindex of the fat-donors was unrelated to Ang II production. The PPAR gamma agonist rosiglitazone inhibited Ang II production in both types of isolated fat cells while addition of the Ang II receptor antagonist eprosartan inhibited the production in only subcutaneous fat cells. Addition of 50 or 200 nM of Ang II inhibited the PPAR gamma response elementactivity (PPRE-activity) in visceral, but not in the subcutaneous adipocytes.

    Conclusions. Since high PPRE-activity induced by rosiglitazone inhibited the Ang II production, it is possible that reduced PPRE-activity in the visceral human fat cells, demonstrated by us earlier, can explain the comparatively high Ang II production in these cells. This could form the basis for a local paracrine viscous circle in visceral fat where low PPRE-activity increases Ang II production that is further enhanced by Ang II-mediated inhibition of PPRE-activity which ultimately leads to high concentrations of Ang II in human adipose tissue.

  • 220.
    Sauma, Lilian
    et al.
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Stenkula, Karin G
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Kjølhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Söderström, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    PPAR-gamma response element activity in intact primary human adipocytes: effects of fatty acids2006In: Nutrition (Burbank, Los Angeles County, Calif.), ISSN 0899-9007, E-ISSN 1873-1244, Vol. 22, no 1, p. 60-68Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We studied the activity and regulation of the peroxisome proliferator-activated receptor-gamma response element (PPRE) in primary human adipocytes.

    METHODS: We transfected primary human adipocytes with a plasmid-encoding firefly luciferase cDNA under control of a PPRE from the acyl-coenzyme A oxidase gene by using our newly developed electroporation-based method. Several fatty acids were added to the fat cells to study potential activation of peroxisome proliferator-activated receptor-gamma.

    RESULTS: Cells responded maximally to 5 microM of rosiglitazone at a 5.1 +/- 1.4-fold over basal increase in luciferase activity. There was a positive correlation between body mass index and the response to 5 microM of rosiglitazone (r = 0.36, P = 0.03). Patients with type 2 diabetes had similar basal PPRE activity but responded more strongly to 5 microM of rosiglitazone than did non-diabetic subjects (10.2 +/- 5-fold and 5.4 +/- 1-fold over basal increase, respectively, P < 0.0001). Among saturated fatty acids, lauric acid was without effect, but 10 microM of palmitic or stearic acid increased PPRE activity 20% to 35% above basal levels. Monounsaturated palmitoleic acid at 1 microM induced a PPRE transcriptional activity that corresponded to half the therapeutic levels of rosiglitazone.

    CONCLUSION: Adipocytes from obese subjects and patients with type 2 diabetes responded particularly strongly to the effect of rosiglitazone on PPRE. Because fatty acids in the diet can affect the transcriptional activity of peroxisome proliferator-activated receptor-gamma over decades, the stimulation induced by stearic and palmitoleic acids can affect insulin sensitivity and, hence, cardiovascular morbidity and mortality in humans.

  • 221.
    Schmeink, Channa E.
    et al.
    Radboud University of Nijmegen.
    Bekkers, Ruud L. M.
    Radboud University of Nijmegen.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Richardus, Jan H.
    Municipal Public Health Serv Rotterdam Rijnmond.
    Berndtsson Blom, Katarina
    Ladulaas Kliniska Studier.
    David, Marie-Pierre
    GlaxoSmithKline Biol.
    Dobbelaere, Kurt
    GlaxoSmithKline Biol.
    Descamps, Dominique
    GlaxoSmithKline Biol.
    Co-administration of human papillomavirus-16/18 AS04-adjuvanted vaccine with hepatitis B vaccine: Randomized study in healthy girls2011In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 29, no 49, p. 9276-9283Article in journal (Refereed)
    Abstract [en]

    Background: To evaluate co-administration of GlaxoSmithKline Biologicals human papillomavirus-16/18 AS04-adjuvanted vaccine (HPV) and hepatitis B vaccine (HepB). Methods: This was a randomized, controlled, open, multicenter study. Healthy girls, aged 9-15 years, were randomized to receive HPV (n = 247), HepB (n = 247) or HPV co-administered with HepB (HPV+ HepB: n=247) at Months 0,1 and 6. Antibodies against hepatitis B surface antigen (HBs), HPV-16 and HPV-18 were measured, and reactogenicity and safety monitored. Co-primary objectives were to demonstrate non-inferiority of hepatitis B and HPV-16/18 immune responses at Month 7 for co-administered vaccines, compared with vaccines administered alone, in the according-to-protocol cohort. Results: The pre-defined criteria for non-inferiority were met for all co-primary immunogenicity end-points at Month 7. Anti-HBs seroprotection rates greater than= 10 mIU/mL were achieved by 97.9% and 100% of girls, respectively, following co-administration or HepB alone. Anti-HBs geometric mean titers (GMTs) (95% confidence interval) were 1280.9 (973.3-1685.7) and 3107.7 (2473.1-3905.1) milli-international units/mL, respectively. Anti-HPV-16 and -18 seroconversion rates were achieved by greater than= 99% of girls following co-administration or HPV alone. Anti-HPV-16 GMTs were 19819.8 (16856.9-23303.6) and 21712.6 (19460.2-24225.6) ELISA units (ELU)/mL, respectively. Anti-HPV-18 GMTs were 8835.1 (7636.3-10222.1) and 8838.6 (7948.5-9828.4) ELU/mL, respectively. Co-administration was generally well tolerated. Conclusions: The study results support the co-administration of HPV-16/18 AS04-adjuvanted vaccine with hepatitis B vaccine in adolescent girls aged 9-15 years. Clinical trials registration: ClinicalTrials.gov registration number NCT00652938.

  • 222.
    Sharma, Surendra
    et al.
    Brown University.
    Stabila, Joan
    Brown University.
    Pietras, Linda
    Brown University.
    Singh, Arvind R
    Brown University.
    McGonnigal, Bethany
    Brown University.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Matthiesen, Leif
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Padbury, James F
    Brown University.
    Haplotype-dependent Differential Activation of the Human IL-10 Gene Promoter in Macrophages and Trophoblasts: Implications for Placental IL-10 Deficiency and Pregnancy Complications2010In: AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, ISSN 1046-7408, Vol. 64, no 3, p. 179-187Article in journal (Refereed)
    Abstract [en]

    Problem Polymorphic changes in the IL-10 gene promoter have been identified that lead to altered IL-10 production. We hypothesized that because of these genotypic changes, the IL-10 promoter might be expressed in a cell type-specific manner and may respond differentially to inflammatory triggers. Method of study We created reporter gene promoter constructs containing GCC, ACC, and ATA haplotypes using DNA from patients harboring polymorphic changes at -1082 (G -andgt; A), -819 (C -andgt; T), and -592 (C -andgt; A) sites in the IL-10 promoter. These individual luciferase reporter constructs were transiently transfected into either primary term trophoblasts or THP1 monocytic cells. DNA-binding studies were performed to implicate the role of the Sp1 transcription factor in response to differential promoter activity. Results Our results suggest that the GCC promoter construct was activated in trophoblast cells in response to lipopolysaccharide (LPS), as demonstrated by reporter gene expression, but not in monocytic cells. The ACC construct showed weaker activation in both cell types. Importantly, while the ATA promoter was constitutively activated in both cell types, its expression was selectively repressed in response to LPS, but only in trophoblasts. DNA-nuclear protein binding assays with nuclear extracts from LPS treated or untreated cells suggested a functional relevance for Sp1 binding differences at the -592 position. Conclusions These results demonstrate cell type-specific effects of the genotypic changes in the IL-10 gene promoter. These responses may be further modulated by bacterial infections or other inflammatory conditions to suppress IL-10 production in human trophoblasts.

  • 223.
    Skoog Svanberg, A
    et al.
    Uppsala University.
    Lampic, C
    Karolinska Institute.
    Brandstrom, S
    University of Gothenburg.
    Geijervall, A L
    Sahlgrens Academy.
    Gudmundsson, J
    Uppsala University.
    Karlstrom, P O
    Karolinska Institute.
    Solensten, N G
    Umea University Hospital.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Gamete donors motivation to donate in a Swedish national sample: is there any ambivalence? in HUMAN REPRODUCTION, vol 26, issue , pp I268-I2692011In: HUMAN REPRODUCTION, Oxford University Press (OUP) , 2011, Vol. 26, p. I268-I269Conference paper (Refereed)
    Abstract [en]

    n/a

  • 224.
    Skoog Svanberg, Agneta
    et al.
    Uppsala University, Sweden .
    Lampic, Claudia
    Karolinska Institute, Sweden .
    Geijerwall, Ann-Louise
    Sahlgrens Acad, Sweden .
    Gudmundsson, Johannes
    Uppsala University, Sweden .
    Karlstrom, Per-Olof
    Karolinska Institute, Sweden .
    Solensten, Nils-Gunnar
    University of Umeå Hospital, Sweden .
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Gamete donors motivation in a Swedish national sample: is there any ambivalence? A descriptive study2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 8, p. 944-951Article in journal (Refereed)
    Abstract [en]

    Objective. To study donors motivation and ambivalence before donation of gametes. Design. Cross-sectional study. Setting. Seven Swedish university hospital clinics. Sample. Of the 220 eligible oocyte donors and 156 eligible sperm donors who were approached, 181 (82%) oocyte donors and 119 (76%) sperm donors agreed to participate. Methods. Gamete donors completed a questionnaire in the clinic prior to the donation. Main outcome measures. Motives and ambivalence towards donation. Results. In general, gamete donors donated for altruistic reasons (95%). A greater percentage of oocyte than sperm donors had a personal experience of biological children, which motivated them to donate (65 vs. 32%). A greater percentage of sperm donors compared with oocyte donors were curious about their own fertility (24 vs. 9%), and they also believed that they were contributing what they regarded as their own good genes to other couples (45 vs. 20%). Prior to donation, potential sperm donors were more ambivalent towards donating than were oocyte donors (39 and 21%, p similar toandlt;similar to 0.001). Conclusions. The motives to donate gametes are mainly altruistic. We conclude that men and women differ in their view towards donating gametes. Sperm donors had a higher degree of ambivalent feelings towards donation than oocyte donors.

  • 225.
    Spetz, Anna-Clara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    More than half of the men in a Swedish population of men aged 55, 65 and 75 believe in a male climacteric2011In: AGING MALE, ISSN 1368-5538, Vol. 14, no 1, p. 16-20Article in journal (Refereed)
    Abstract [en]

    Methods. aEuro integral A questionnaire was developed including background demographic data, symptoms possibly related to LOH and questions about mens thoughts and beliefs in a male climacteric. All men, 55-, 65- and 75-years old, living in Linkoping, Sweden ((n aEuroS== aEuroS1885)) received the questionnaire. Results. aEuro integral One thousand three hundred fifty-six ((72%%)) questionnaires were eligible for evaluation, 65.4%% of the responders had heard of a male climacteric, and 42.2%% believed it existed but only 3%% had sought medical advice for these symptoms. More than half believed that a male climacteric was related to decreased libido and less strong erections. Almost half of the men thought that decreased memory and//or dystymia and anxiousness were related to a male climacteric. Conclusions. aEuro integral The majority of men have heard of a male climacteric, but only a minority had consulted a practitioner about their symptoms. More information and knowledge are needed, for the general population to better motivate men to seek medical advice and also for the health care professionals to better deal with the symptoms of LOH.

  • 226.
    Spetz, Anna-Clara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Symptoms of testosterone deficiency in early middle aged men2012In: The Aging Male, ISSN 1368-5538, E-ISSN 1473-0790, Vol. 15, no 2, p. 78-84Article in journal (Refereed)
    Abstract [en]

    Symptoms of testosterone deficiency and concentrations of testosterone (T) and bioavailable testosterone (BT) were studied in 35-and 45-year-old men. Methods: A questionnaire, was sent to all 35-and 45-year-old men in Linkoping, Sweden (n = 1998). The questionnaire has earlier been used for 55- to 75-year-old men and included demographic data, medical history, different symptoms possibly of T deficiency and the 10 questions from the "ADAM-questionnaire". Totally 200 men randomly selected among the men who answered the questionnaire were asked to give blood samples for analysis of T-and BT-concentrations. Results: A total of 38.7% of the questionnaires were returned and analysed, and 43.5% of the 200 randomly selected men gave blood samples. The older age group reported more symptoms that may be connected to low B and BT and had lower T-and BT-concentrations. Less strong erections and higher alcohol consumption were associated with lower concentrations of BT in 45-year-old men. Conclusions: The burden of symptoms possibly related to low T concentrations were higher in 45-year-old men, and BT and T were lower. However, due to the low answer frequency and number of blood samples analyzed no general conclusions can be drawn.

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  • 227.
    Spetz, Anna-Clara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Chemistry.
    Palmefors, Lennart G
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Karlsson, Per S
    Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping. Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology.
    Joborn, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Change in testosterone concentrations over time is a better predictor than the actual concentrations for symptoms of late onset hypogonadism2011In: The Aging Male, ISSN 1368-5538, E-ISSN 1473-0790, Vol. 14, no 4, p. 249-256Article in journal (Refereed)
    Abstract [en]

    Background. Symptoms of late-onset hypogonadism (LOH) and concentrations of testosterone (T) and bioavailable testosterone (BT) were studied in relation to the data from the same men 5 years earlier. less thanbrgreater than less thanbrgreater thanMethods. In 2008, 282 men, aged 60-82 years, answered a questionnaire regarding demographic data, medical history, different symptoms of LOH and the 10 questions from the Androgen Decline in Aging Males (ADAM)-questionnaire. Blood samples were analysed for concentrations of T and calculations were made for BT. less thanbrgreater than less thanbrgreater thanResults. A total of 87.2% of the questionnaires were returned and analysed, and 75.2% of the responders gave blood samples. The oldest third of the men were most affected by LOH symptoms (p andlt; 0.05). Both T and BT concentrations decreased during the 5 years (p andlt; 0.05) but only the symptom less strong erections changed significantly (p andlt; 0.05). Men reporting one of the four specific symptoms from the ADAM-questionnaire for the first time in 2008 had a higher loss of T and BT than men who had unchanged or fewer symptoms than that reported in 2003. less thanbrgreater than less thanbrgreater thanConclusions. The magnitude of the decrease in concentrations is a better predictor of LOH than are the actual concentrations of T and BT. A combination of symptoms predicts LOH better than any single symptom.

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  • 228.
    Spetz, Anna-Clara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Fredriksson, Mats G
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Lidfeldt, Jonas
    Lund University.
    Samsioe, Goran N
    Lund University.
    Prevalence of symptoms in relation to androgen concentrations in women using estrogen plus progestogen and women using estrogen alone2009In: MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY, ISSN 1072-3714, Vol. 16, no 1, p. 149-155Article in journal (Refereed)
    Abstract [en]

    Objective: Women using estrogen plus progestogen therapy sometimes report difficult to describe symptoms, eg, changes in libido, mood, and memory, that may be related to decreased androgens. To evaluate the prevalence or such symptoms and relate these symptoms to androgen levels ill women using estrogen plus progestogen therapy, data from the Womens Health in the Lund Area Study were analyzed.

    Design: A total of 2,816 women using estrogen plus progestogen therapy were asked to complete a questionnaire consisting of questions concerning sexual well-being and different aspects of quality of life. Serum concentrations of testosterone, androstendione, sex lion-none-binding globulin, and estradiol were measured.

    Results: A total of 2,048 questionnaires were eligible for evaluation. Almost 40% of the women reported decreased libido. Approximately 70% were satisfied with their current sex life. Eight percent reported that intercourse was unpleasant because of vaginal dryness. No evident associations were found between libido and serum hormone concentrations. The most positive effects of estrogen plus progestogen therapy concerning memory and urinary tract and vaginal complaints were found in women with the highest and/or moderate testosterone levels (P &lt; 0.05).

    Conclusions: We found no strong association between symptoms related to sexual well-being or quality of life and androgen concentrations in this study. Estrogen plus progestogen therapy did not seem to affect

  • 229.
    Spetz, Anna-Clara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Frisk, Jessica
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Acupuncture as Treatment of Hot Flashes and the Possible Role of Calcitonin Gene-Related Peptide2012In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, E-ISSN 1741-4288, Vol. 2012, no 579321Article, review/survey (Refereed)
    Abstract [en]

    The mechanisms behind hot flashes in menopausal women are not fully understood. The flashes in women are probably preceded by and actually initiated by a sudden downward shift in the set point for the core body temperature in the thermoregulatory center that is affected by sex steroids, beta-endorphins, and other central neurotransmitters. Treatments that influence these factors may be expected to reduce hot flashes. Since therapy with sex steroids for hot flashes has appeared to cause a number of side effects and risks and women with hot flashes and breast cancer as well as men with prostate cancer and hot flashes are prevented from sex steroid therapy there is a great need for alternative therapies. Acupuncture affecting the opioid system has been suggested as an alternative treatment option for hot flashes in menopausal women and castrated men. The heat loss during hot flashes may be mediated by the potent vasodilator and sweat gland activator calcitonin gene-related peptide (CGRP) the concentration of which increases in plasma during flashes in menopausal women and, according to one study, in castrated men with flushes. There is also evidence for connections between the opioid system and the release of CGRP. In this paper we discuss acupuncture as a treatment alternative for hot flashes and the role of CGRP in this context.

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  • 230.
    Spetz, Anna-Clara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hot flushes in men: Prevalence and possible mechanisms2002In: Journal of the British Menopause Society, ISSN 1362-1807, Vol. 8, no 2, p. 57-62Article, review/survey (Refereed)
    Abstract [en]

    In men treated with castration because of prostatic carcinoma hot flushes are as common as in women after menopause. Flushes also occur in normal ageing men, but the prevalence is unknown. Hot flushes are probably caused by an instability in the thermo-regulatory centre, because of decreased sex hormone concentrations. Calcitonin gene-related peptide (CGRP) is involved in menopausal hot flushes in women and possibly in men with castrational therapy. Serotonin may also be implicated. Alternative treatments for hot flushes are needed, since men with prostatic carcinoma may not be treated with testosterone, and oestrogen therapy in men has many draw-backs. Therefore, development of a CGRP-antagonist may be useful. In conclusion vasomotor symptoms are common in men with castrational therapy and also exist in normal, ageing men. Since CGRP, serotonin and a decrease in sex steroids seem to be involved in hot flushes, the mechanisms behind hot flushes in men and women may be similar.

  • 231.
    Spetz, Anna-Clara
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hammar, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Varenhorst, Eberhard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Urology . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
    Hot flushes in men - Prevalence and possible mechnisms2003In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 10, no 6, p. 594-594Conference paper (Other academic)
  • 232.
    Spetz, Anna-Clara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Thorell, Lars-Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Chemistry.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hot flushes in healthy aging men differ from those in men with prostate cancer and in menopausal women2012In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 28, no 1, p. 72-75Article in journal (Refereed)
    Abstract [en]

    Calcitonin gene-related peptide (CGRP) seems to be involved in hot flushes in women and in castrated men. Therefore, we studied whether the plasma concentrations of CGRP changed during flushes in a group of healthy aging men. Twelve men (49-71 years) with no history of current or former prostate cancer or hormonal treatment reporting greater than= 20 flushes/week were investigated. Blood samples were drawn during and between flushes for analysis of CGRP and also androgen concentrations, that is, testosterone and bioavailable testosterone were analysed. Skin temperature and skin conductance were monitored. Thirty-five flushes were reported by 10 men. The plasma concentrations of CGRP did not increase during flushes. No significant change in skin temperature or conductance was found. CGRP is probably not involved in the mechanisms of flushes in healthy aging men. Therefore, flushes in aging healthy men seem to be different from flushes in men and women deprived of sex steroids where CGRP increases during flushes.

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  • 233.
    Stening, Kent
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Voster, Helene
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Amandusson, Åsa
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Blomqvist, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Influence of estrogen levels on thermal perception, pain thresholds and pain tolerance: Studies on women undergoing in vitro fertilization2012In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 13, no 5, p. 459-466Article in journal (Refereed)
    Abstract [en]

    We examined the relationship between estrogen and pain in women undergoing in vitro fertilization (IVF). Quantitative sensory tests (QST) were performed twice during the IVF-regimen: once during hormonal down-regulation and once during hormonal upregulation. A group of healthy men and a group of women using monophasic contraceptives were also examined, to control for session-to-session effects. Among the women undergoing IVF, serum 17β-estradiol levels differed strongly between treatments as expected, and increased from 65.7 (SD = 26) pmol/l during the downregulation phase, to 5188 (SD = 2524) pmol/l during the up-regulation phase. Significant outcomes in the QST were only seen for temperature perception thresholds (1.7°C vs. 2.2°C; P = 0.003) and cold pain threshold (11.5°C vs. 14.5°C; P = 0.04). A similar change in cold pain threshold was also seen in the two control groups, however, and statistical analysis suggested that this change was due to a session-to-session effect rather than being the result of hormonal modulation. Heat pain thresholds, heat tolerance, pressure pain thresholds, and the cold pressor test showed no significant differences between sessions. These data demonstrate that pain perception and pain thresholds in healthy women show little, if any, changes even with major variations in serum estradiol levels.

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  • 234.
    Stening, Kent
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Blomqvist, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Pain thresholds and pain tolerance during the ovulatory cycle in healthy women: quantitative sensory testingManuscript (preprint) (Other academic)
    Abstract [en]

    Hormonal influence on pain sensitivity at different menstrual phases is a field of contradictory results. One reason is methodological differences between studies and methodological limitations such as lack of confirmation of cycle phase by measurement of actual hormone levels. In the present study, 14 healthy women were followed during three menstrual cycles and were subjected to a battery of quantitative sensory tests 1-4 after start of menses (follicular phase) and 2-11 days before next menses (luteal phase). The material was analyzed in three different ways: cycle phase determined according to the calendar method; cycle phase determined by hormone values, with cycles showing hormone values outside reference values omitted; and cycles subdivided into three subgroups depending on hormone profile (“normal” cycle; high s-estrogen during the assumed luteal phase; and low progesterone during the assumed luteal phase). However, neither analysis showed any significant differences between the measurement done during immediate after onset of menses and those performed in the period before next menses. Consistent with the results of several previous studies, the findings indicate that pain sensitivity does not seem to vary as a function of the menstrual cycle.

  • 235.
    Stening, Kent
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Eriksson, Olle
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Henriksson, Karl-Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Lindh-Åstrand, Lotta
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Amandusson, Åsa
    Uppsala University.
    Blomqvist, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Hormonal replacement therapy does not affect self-estimated pain or experimental pain responses in post-menopausal women suffering from fibromyalgia: a double-blind, randomized, placebo-controlled trial2011In: RHEUMATOLOGY, ISSN 1462-0324, Vol. 50, no 3, p. 544-551Article in journal (Refereed)
    Abstract [en]

    Methods. Twenty-nine post-menopausal women were randomized to either 8 weeks of treatment with transdermal 17 beta-oestradiol (50 mu g/day) or placebo according to a double-blind protocol. A self-estimation of pain, a set of quantitative sensory tests measuring thresholds to temperature, thermal pain, cold pain and pressure pain, and a cold pressor test were performed on three occasions: before treatment, after 8 weeks of treatment and 20 weeks after cessation of treatment. Results. Hormonal replacement treatment significantly increased serum oestradiol levels as expected (P andlt; 0.01). However, no differences in self-estimated pain were seen between treatment and placebo groups, nor were there any differences between the two groups regarding the results of the quantitative sensory tests or the cold pressor test at any of the examined time points. Conclusion. Eight weeks of transdermal oestradiol treatment does not influence perceived pain, pain thresholds or pain tolerance as compared with placebo treatment in post-menopausal women suffering from FM.

  • 236.
    Stenkula, Karin G.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Said Suma, Lilian
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences.
    Karlsson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Cell Biology.
    Thorn, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gustavsson, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Söderström, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Strålfors, Peter
    Linköping University, Department of Clinical and Experimental Medicine, Cell Biology. Linköping University, Faculty of Health Sciences.
    Nyström, Fredrik H
    Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    Expression of a mutant IRS inhibits metabolic and mitogenic signalling of insulin in human adipocytes2004In: Molecular and Cellular Endocrinology, ISSN 0303-7207, Vol. 221, no 1-2, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Adipose tissue is a primary target of insulin, but knowledge about insulin signalling in human adipocytes is limited. We developed an electroporation technique for transfection of primary human adipocytes with a transfection efficiency of 15% ± 5 (mean ± S.D.). Human adipocytes were co-transfected with a mutant of IRS-3 (all four potential PI3-kinase binding motifs mutated: IRS-3F4) and HA-tagged protein kinase B (HA-PKB/Akt). HA-PKB/Akt was immunoprecipitated from cell lysates with anti-HA antibodies, resolved with SDS-PAGE, and immunoblotted with phospho-specific antibodies. We found that IRS-3F4 blocked insulin stimulation of HA-PKB/Akt phosphorylation and in further analyses also translocation of recombinant HA-tagged glucose transporter to the plasma membrane. IRS-3F4 also blocked insulin-induced activation of the transcription factor Elk-1. Our results demonstrate the critical importance of IRS for metabolic as well as mitogenic signalling by insulin. This method for transfection of primary human adipocytes will be useful for studying insulin signalling in human adipocytes with molecular biological techniques.

  • 237.
    Svanborg, Eva
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Harder, Lena
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Sarberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Harder, Henrik
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Broström, Anders
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    SNORING DURING PREGNANCY AND ITS RELATION TO PRE-ECLAMPSIA2009In: In Sleep, vol 32, 2009, Vol. 32, p. A219-A219Conference paper (Refereed)
  • 238.
    Svensson, J
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Immunology and Transfusion Medicine.
    CD14(+) decidual macrophages from early human pregnancy: expression of markers associated with alternatively activated macrophages and requirements for their polarization2009In: in JOURNAL OF REPRODUCTIVE IMMUNOLOGY, vol 81, issue 2, 2009, Vol. 81, no 2, p. 147-148Conference paper (Refereed)
    Abstract [en]

    n/a

  • 239.
    Svensson, J
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Mirrasekhian, E
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Freland, Sofia
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    M-CSF produced by trophoblasts induces CD163, a marker of immune regulatory decidual macrophages in JOURNAL OF REPRODUCTIVE IMMUNOLOGY, vol 94, issue 1, pp 92-922012In: JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Elsevier , 2012, Vol. 94, no 1, p. 92-92Conference paper (Refereed)
    Abstract [en]

    n/a

  • 240.
    Svensson, Judit
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Matussek, Andreas
    Department of Clinical Microbiology, County Hospital Ryhov, Jönköping.
    Geffers, Robert
    Mucosal Immunity, Helmholtz Centre for Infection Research (HCI), Braunschweig, Germany.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Gene expression and protein secretion patterns in decidual macrophages and different M1 and M2 macrophage populations with focus on M-CSF and IL-10 as polarising factors in JOURNAL OF REPRODUCTIVE IMMUNOLOGY, vol 90, issue 2, pp 151-1512011In: JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Elsevier , 2011, Vol. 90, no 2, p. 151-151Conference paper (Refereed)
    Abstract [en]

    Introduction: We have recently observed (Svensson et al., data to be published) that M-CSF and IL-10, among several factors tested, are able to induce macrophages (MΦ) with phenotypic characteristics of decidual MΦ with expression of typical M2, or immune regulatory, cell surface markers (scavenger receptor, mannose receptor, DC-SIGN). The aim of this study was to investigate in a comprehensive manner whether this finding could be shown by an extended mapping of secreted molecules and also at the gene expression level.

    Materials and methods: CD14+ blood monocytes and decidual MΦ from healthy first trimester pregnant women (n = 11) were isolated by immunomagnetic cell sorting (MACS). MΦ were also generated in vitro from MACS-sorted CD14+ blood monocytes from non-pregnant women. RNA was isolated from blood monocytes and MΦ and the expression of 100 decidual MΦ-associated genes (Gustafsson et al., PlosOne 2008) was analysed with a custom microarray. RT-PCR was used to analyse the gene expression of IRF5, which was recently associated with classically activated (M1) MΦ. A multiplex bead assay was used to quantify the levels of cytokines and chemokines in conditioned media.

    Results: To estimate the similarity of the in vitro differentiated MΦ with decidual MΦ, we performed hierarchical clustering of differentially regulated genes. M1 MΦ and MΦ treated with GM-CSF and IL-4/13 formed their own branches, indicating transcriptional profiles clearly differing from all other MΦ types analysed. MΦ differentiated with M-CSF alone or with IL-10, regardless of the growth factor used, clustered together with decidual MΦ, supporting their close relationship. Genes similarly regulated in these macrophages were not restricted to immune modulating genes. This group included the M2-associated chemokines CCL2 and CCL18, the immune modulating B7 family-related VSIG4, the angiogenic insulin-like growth factor-1 and the M2-associated folate receptor β-encoding FOLR2 and selenoprotein-encoding SEPP1. The M2 polarisation status of decidual MΦ was confirmed by low expression of the M1-associated transcription factor IRF5, and comparable levels were detected in M-CSF- and IL-10-stimulated MΦ. IRF5 expression was higher in M1 MΦ and, surprisingly, also in IL-4/13-stimulated MΦ. As to protein secretion, decidual and M-CSF/IL-10-stimulated MΦ were found to produce comparable levels of IL-10 and the pro-inflammatory cytokines IL-6 and TNF, while M1 MΦ produced significantly higher levels of TNF and did not produce IL-10. Decidual and M-CSF/IL-10-stimulated MΦ also produced high levels of the monocyte- and granulocyte-recruiting chemokines CCL2, CCL4 and CXCL1, while the Th1 cell-recruiting CXCL10 and the Th2 cell-recruiting CCL22 were only produced at low levels. CXCL10 was highest in M1 MΦ, while CCL22 levels were highest in GM-CSF and/or IL-4/13-stimulated MΦ.

    Conclusions: Our data consistently shows a central role for M-CSF and IL-10 as polarising agents for decidual MΦ, while Th2 and pro-inflammatory agents induce MΦ with clearly differing characteristics. We hypothesise that decidual MΦ have a predominant homeostatic function. This is supported by their low production of both Th1 and Th2 cell-recruiting chemokines. It is thus likely that M-CSF and IL-10 shape the polarisation of decidual MΦ contributing to the homeostatic and tolerant immune environment required for successful fetal development.

  • 241.
    Svensson, Judit
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Matussek, Andreas
    County Hospital Ryhov.
    Geffers, Robert
    Helmholtz Centre Infect Research.
    Berg, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Immunology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Macrophages at the fetal-maternal interface express markers of alternative activation and are induced by M-CSF and IL-102011In: Journal of Immunology, ISSN 0022-1767, E-ISSN 1550-6606, Vol. 187, no 7, p. 3671-3682Article in journal (Refereed)
    Abstract [en]

    During pregnancy, the maternal immune system is challenged by the presence of the fetus, which must be tolerated despite being semiallogeneic. Uterine mucosal (or decidual) macrophages (Mϕ), one of the major leukocyte populations at the fetal–maternal interface, have been implicated in fetal tolerance, but information regarding their regulation is scarce. In this study, we investigated the role of several factors potentially involved in the differentiation and polarization of decidual Mϕ with an in vitro Mϕ differentiation model. By using flow cytometry, we showed that M-CSF and IL-10 were potent inducers of M2 (immunoregulatory) Mϕ markers expressed on human decidual Mϕ (CD14, CD163, CD206, CD209). In contrast, proinflammatory stimuli, and unexpectedly also the Th2-associated IL-4 and IL-13, induced different patterns of expression, indicating that a Th2-dominated environment is not required for decidual Mϕ polarization. M-CSF/IL-10–stimulated and decidual Mϕ also showed similar cytokine secretion patterns, with production of IL-10 as well as IL-6, TNF, and CCL4. Conversely, the proinflammatory, LPS/IFN-γ–stimulated Mϕ produced significantly higher levels of TNF and no IL-10. We also used a gene array with 420 Mϕ-related genes, of which 100 were previously reported to be regulated in a global gene expression profiling of decidual Mϕ, confirming that M-CSF/IL-10–induced Mϕ are closely related to decidual Mϕ. Taken together, our results consistently point to a central role for M-CSF and in particular IL-10 in the shaping of decidual Mϕ with regulatory properties. These cytokines may therefore play an important role in supporting the homeostatic and tolerant immune milieu required for a successful pregnancy.

  • 242.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Letter: Abortion in Scandinavian countries - A reply to Dr Verkuyls letter2010In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 15, no 2, p. 151-152Article in journal (Other academic)
    Abstract [en]

    n/a

  • 243.
    Sydsjö, Adam
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Alexanderson, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science.
    Dastserri, M.
    Sydsjö, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Gender differences in sick leave related to back pain diagnoses: Influence of pregnancy2003In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 28, no 4, p. 385-389Article in journal (Refereed)
    Abstract [en]

    Study Design. A cross-sectional population-based study was conducted. Objective. To investigate the influence of pregnancy on any gender differences in sickness absence related to back pain diagnoses in the group 16 to 44 years of age. Summary of Background Data. Back pain diagnoses are a major reason for sickness absence, especially among pregnant women. There is, however, little knowledge on the extent to which back pain during pregnancy may account for any differences in sickness absence when compared with men and nonpregnant women. Methods. Data on sick leave periods certified by a physician were combined from two research databases: one including all insured persons (n = 50,167) and one including pregnant women (n = 1342) for the duration of 1 year. Results. When pregnant women were subtracted from "all women," nonpregnant women had the same cumulative incidence of sickness absence related to back pain diagnoses as men. Among "all women" sick-listed with back pain diagnoses, 37% were pregnant, a finding not evident from official statistics. Sickness absence increased with age among nonpregnant women and men, but decreased among pregnant women. Conclusions. The proportion of sickness absence related to back pain diagnoses did not differ between nonpregnant women and men ages 16 to 44 years. The importance of back pain diagnosis as a reason for sickness absence may thus be overrated among nonpregnant women.

  • 244.
    Sydsjö, Adam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Muhrbeck, Måns
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Knowledge and attitudes of Swedish politicians concerning induced abortion2012In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 17, no 6, p. 438-450Article in journal (Refereed)
    Abstract [en]

    Objective Induced abortion is more frequent in Sweden than in many other Western countries. We wanted to investigate attitudes and knowledge about induced abortion among politicians responsible for healthcare in three Swedish counties. Method A study-specific questionnaire was sent to all 375 elected politicians in three counties; 192 (51%) responded. Results The politicians stated that they were knowledgeable about the Swedish abortion law. More than half did not consider themselves, in their capacity as politicians, sufficiently informed about abortion-related matters. Most politicians (72%) considered induced abortion to be primarily a womens rights issue rather than an ethical one, and 54% considered 12 weeks gestational age an adequate upper limit for induced abortion. Only about a third of the respondents were correctly informed about the number of induced abortions annually carried out in Sweden. Conclusion Information and knowledge on induced abortion among Swedish county politicians seem not to be optimal. Changes aimed at reducing the current high abortion rates will probably not be easy to achieve as politicians seem to be reluctant to commit themselves on ethical issues and consider induced abortion mainly a womens rights issue.

  • 245.
    Sydsjö, Adam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Trends in induced abortion among Nordic women aged 40-44 years.2011In: Reproductive health, ISSN 1742-4755, Vol. 8, no 23, p. 1-5Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Women aged 40-44 years in 2005 ought to have been subjected to much more influence on attitudes and knowledge on contraceptive methods during their fertile period than women who were in the same age span in 1975 when the abortion laws were introduced.

    MATERIAL: From official statistics, the rates of induced abortion and birth rates in women aged 40-44 years were collected for Sweden, Denmark, Norway and Finland for each five-year during the period 1975-2005.

    RESULTS: With the exception of Sweden all other studied Scandinavian countries have lowered their abortion rates since 1975 (p<0.001) and reduced the proportion of induced abortions in relation to birth rate (p<0.001). In 2005 these countries also had lower rates of induced abortion than Sweden in the age group 40-44 years (p<0.001).

    CONCLUSION: There is a significant change in rates of induced abortion in women aged 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. This indicates that family planning programs works well in the Nordic countries. The differences found may be assumed to possible diverging focus on attitudes or ethical considerations.

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  • 246.
    Sydsjö, Adam
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Trends in induced abortions between 1975 and 2000 in a cohort of women born in 1960-64 in four Scandinavian countries.2009In: The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, ISSN 1473-0782, Vol. 14, no 5, p. 334-339Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study induced abortion rates, live birth rates, and proportions between the number of induced abortions and live births during a 25-year period in a cohort of Scandinavian women born 1960-1964. METHOD: The numbers of abortions and live births in a cohort of women in Denmark, Finland, Norway and Sweden who were 15-19 years old in 1975 were retrieved from official statistics for 1975, 1980, 1985, 1990, 1995 and 2000, when these women had turned 40 to 44 years of age. RESULTS: Women in each country, who were 15-19 years old in 1975, maintained their original behaviour regarding induced abortion throughout their fertile period. Women in Denmark and Sweden, who had the highest rates of induced abortion in 1975, still had higher rates than women in Norway and Finland in 2000 when aged 40-44. CONCLUSION: Behaviour and attitudes established at a young age seem to remain unchanged over time. This finding indicates that guidance and education of youths concerning reproductive matters may be decisive in shaping behaviour for most of the fertile period.

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  • 247.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Long-Term Consequences of Non-Optimal Birth Characteristics2011In: AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, ISSN 1046-7408, Vol. 66, p. 81-87Article in journal (Refereed)
    Abstract [en]

    Problem The intrauterine milieu, gestational length as well as size at birth have a profound impact on the individuals mental, physical health and development both in childhood as well as in adult life. Method of study This paper reviews the associations between preterm birth and restricted fetal growth with neuro-developmental sequelae, including increased symptoms of psychiatric disorder in childhood and early adulthood. There is also evidence that physical morbidity such as the metabolic syndrome is more common in adult life. In addition, preterm birth and restricted fetal growth have been shown to be related to respiratory disease, infectious disease, and even malignancy. Morbidity, mental and physical as well as personality/intellectual traits hugely impact on family planning and reproductive performance in adults. As restricted fetal growth may alter organ structure and functions, it is likely to also influence subsequent fertility and/or reproductive health. Results Individuals with non-optimal birth characteristics appears to have a reduction in childbearing and a deviant reproduction pattern compared to controls. Conclusion Future studies with sophisticated models for measuring the most vulnerable period of birth for children who have a low birth weight or who are at risk for being born preterm are needed to be able to explore the underlying biological mechanisms and also to plan for prevention as well as for interventions during pregnancy.

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  • 248.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Angerbjörn, Louise
    Palmquist, Sofie
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Secondary fear of childbirth prolongs the time to subsequent delivery2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 2, p. 210-214Article in journal (Refereed)
    Abstract [en]

    Objective. Most pregnant women are anxious about the delivery and up to 30% develop varying degrees of fear of childbirth (FOC). Secondary FOC occurs in parous women who have experienced a traumatic delivery. The aim of this study was to investigate the time to subsequent delivery and delivery outcome in women with secondary FOC, compared with a reference group.

    Setting. Southeast Sweden.

    Sample. 356 parous pregnant women with secondary FOC and a reference group of 634 parous women without FOC.

    Design. Descriptive, retrospective case–control study.

    Main outcome measures. Time to next pregnancy and delivery outcome.

    Results. More women with secondary FOC had a longer interval to subsequent delivery compared with parous women without FOC (p = 0.005). Women with secondary FOC had 5.2 times higher probability of having a cesarean section than the reference group. Women with secondary FOC also had on average a 40-minute longer duration of active labor than women without FOC (p < 0.001).

    Conclusions. Secondary fear of childbirth prolongs the time to subsequent delivery and the active phase of labor itself, and increases the risk for cesarean section.

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  • 249.
    Sydsjö, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ekholm, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology .
    Lampic, C
    Attitudes towards gamete donation among Swedish gynaecologists and obstetricians2008In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 23, no 4, p. 904-911Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Assisted reproductive technology (ART) legislation in Sweden has undergone a gradual transformation from being fairly restrictive when first introduced to becoming more permissive in recent years. Regarding gamete donation, Sweden became the first country to pass legislation about disclosure by establishing a child's right to find out the identity of the gamete donor once the child has reached maturity. Our aim was to investigate attitudes towards gamete donation among Swedish gynaecologists and obstetricians. METHODS: A questionnaire was mailed to all gynaecologists and obstetricians listed from a commercial register of all working in Sweden. Among 1230 eligible gynaecologists/obstetricians, 854 (69%) answered the questionnaire. RESULTS: In general, the majority of Swedish gynaecologists/obstetricians had positive attitudes towards gamete donation. Although a majority advocated openness regarding informing the child that he or she was conceived by making use of gamete donation, ∼40% opposed allowing the child to receive any information about the donor when the child has reached maturity. Even though Swedish legislation has allowed sperm donation to lesbian couples since July 2005, one-third of the gynaecologists/obstetricians opposed donation to lesbians. CONCLUSIONS: The results indicate that the gynaecologists'/obstetricians' negative attitudes towards disclosure may influence patients' ability to discuss their thoughts and feelings about donation. This may also have a negative impact on donor recruitment as well as on the extent of methods made accessible within ART. © The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.

  • 250.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Östergötlands Läns Landsting.
    Letter: Weight gain restriction for obese pregnant women2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 12, p. 1613-1613Article in journal (Other academic)
    Abstract [en]

    n/a

23456 201 - 250 of 275
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