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  • 1.
    Browaldh, Nanna
    et al.
    Karolinska University Hospital.
    Friberg, Danielle
    Karolinska University Hospital.
    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.
    Nerfeldt, Pia
    Karolinska University Hospital.
    15-year efficacy of uvulopalatopharyngoplasty based on objective and subjective data2011In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 131, no 12, 1303-1310 p.Article in journal (Refereed)
    Abstract [en]

    Conclusions: This follow-up showed a stable and significant decrease in median oxygen desaturation index 4% (ODI(4)) values over the years. Approximately two-thirds of the patients fulfilled the success criteria (ODI4 reduction of 50% and andlt;20) after 15 years. A majority had improved/cured excessive daytime sleepiness (EDS) and were satisfied. No increased mortality rate was seen. Objectives: To evaluate sleep apnoea recordings and symptoms in patients with obstructive sleep apnoea syndrome 15 years after uvulopalatopharyngoplasty (UPPP) compared to baseline and previous follow-ups. Methods: This was a non-randomized, prospective intervention study on 50 patients who underwent UPPP during 1985-88. Their initial median age was 49 years (range 38-71) and ODI4 was 26.5 (4-82). Results: In all, 13 patients had died; 26 patients underwent sleep apnoea recordings. Median ODI4 had decreased from 26.5 (range 4-82) to 8.5 (0-60), p andlt; 0.01, a mean reduction of 52%; 65% of patients achieved the success criteria. One-third was objectively categorized as non-snorers. Median body mass index was unchanged. The questionnaires were answered by 32 of 37 patients; 88% reported improved or cured EDS and 78% were satisfied. Pharyngeal disturbances ratings were low. The standardized mortality rate did not differ from the general Swedish population.

  • 2.
    Tondel, Martin
    et al.
    University of Gothenburg.
    Murgia, Nicola
    University of Perugia.
    Persson, Bodil
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Occupational and Environmental Medicine Centre.
    Lindh, Jonas
    Ryhov County Hospital.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Neurology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    2,5-Hexanedione in the General Population: Environmental Exposure or Endogenous Production? in EPIDEMIOLOGY, vol 22, issue 1, pp S34-S352011In: EPIDEMIOLOGY, Williams and Wilkins , 2011, Vol. 22, no 1, S34-S35 p.Conference paper (Refereed)
    Abstract [en]

    n/a

  • 3.
    Johansson, Ann-Katrin
    et al.
    University of Bergen.
    Johansson, Anders
    University of Bergen.
    Unell, Lennart
    Örebro Cty Council.
    Ekback, Gunnar
    Örebro Cty Council.
    Ordell, Sven
    Carlsson , Gunnar E
    University of Gothenburg.
    A 15-yr longitudinal study of xerostomia in a Swedish population of 50-yr-old subjects2009In: EUROPEAN JOURNAL OF ORAL SCIENCES, ISSN 0909-8836 , Vol. 117, no 1, 13-19 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine the changes in prevalence of xerostomia in subjects from 50 to 65 yr of age. Questionnaires were sent to all subjects who were born in 1942 and were living in two Swedish counties in 1992, 1997, 2002, and 2007. The analyses focused on those who answered the questionnaires both in 1992 and in 2007. The response rate was 71.4% (n = 6,346) in 1992 and 73.1% (n = 6,078) in 2007. Of those who answered the questionnaire in 1992, 74.3% (n = 4,714) also responded in 2007. There was an almost linear increase in the prevalence of xerostomia at the four study time-points (i.e. when the subjects were 50, 55, 60, and 65 yr of age). Xerostomia was more prevalent at night than during the day. The pooled prevalence of night-time and daytime xerostomia was 6% at 50 yr of age and 15% at 65 yr of age, and it was higher in women than in men on both occasions. Logistic regression analyses showed that impaired health and smoking were significantly associated with daytime xerostomia but not with night-time xerostomia. Despite the increase in prevalence of xerostomia from 50 to 65 yr of age, there was considerable variation during the observation period. The incidence rate was 13% (507/4,015) and the disappearance rate was 42% (104/250) (dichotomized answers).

  • 4.
    Olsson, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, EMK-endokrin.
    Eriksson, M
    Johnson, O
    Kjellström, T
    Lanke, J
    Lytken Larsen, M
    Pedersen, T
    Tikkanen, MJ
    Wiklund, O
    A 52-week, multicenter, randomized, parallel-group, double-blind, double-dummy study to assess the efficacy of atorvastatin and simvastatin in reaching low-density lipoprotein cholesterol and triglyceride targets: The Treat-to-Target (3T) Study2003In: Clinical Therapeutics, ISSN 0149-2918, E-ISSN 1879-114X, Vol. 25, no 1, 119-138 p.Article in journal (Refereed)
    Abstract [en]

    Background: Guidelines for the prevention of coronary heart disease call for low-density lipoprotein cholesterol (LDL-C) reduction as the primary target of treatment and reduction of triglycerides (TG) as an additional target. Objective: The purpose of this study was to investigate the ability of atorvastatin and simvastatin to reduce LDL-C and TG concentrations and to meet 3 target lipid levels: LDL-C =2.6 mmol/L, TG =1.5 mmol/L, and both LDL-C =2.6 mmol/L and TG =1.5 mmol/L. Methods: The Treat-to-Target (3T) Study was a 52-week, multicenter, randomized, parallel-group study. Using the double-blind, double-dummy technique, adult patients aged 35 to 75 years with cardiovascular disease and dyslipidemia, defined as LDL-C concentration =4.0 mmol/L (=155 mg/dL), were randomized in a 1:1 ratio to receive once-daily oral treatment with 20 mg atorvastatin or 20 mg simvastatin. Fasting (12-hour) blood samples for the estimation of lipid levels and clinical laboratory values were collected after 4, 8, 12, 26, and 52 weeks. The dose was doubled after 12 weeks if the target National Cholesterol Education Program level of LDL-C (=2.6 mmol/L [100 mg/dL]) was not reached at 8 weeks. Results: The intent-to-treat analysis included 552 patients (418 men, 134 women) randomized to receive atorvastatin and 535 (404 men, 131 women) randomized to receive simvastatin. The number of patients enrolled in the study allowed the evaluation of the drugs' effects on YG. Patient demographic characteristics were similar for the 2 treatment groups, and there were no differences in baseline lipid values. Compared with simvastatin, atorvastatin produced significantly greater reductions in LDL-C (8 weeks: -46% vs -40%, P < 0.001, 52 weeks: -49% vs -44%, P < 0.001) and in YG (8 weeks: -23% vs -14%, P < 0.001, 52 weeks: -24% vs -16%, P < 0.001). Compared with simvastatin-treated patients, a significantly greater number of atorvastatin-treated patients reached the LDL-C target after 8 weeks (45% vs 24%, P < 0.001). Fewer atorvastatin patients needed to have their dose doubled, nevertheless more atorvastatin patients reached the LDL-C target after 52 weeks (61% vs 41%, P < 0.001). Both statins were well tolerated. Muscular symptoms occurred in 12 patients (2.2%) in the atorvastatin group and in 13 patients (2.4%) in the simvastatin group. Conclusions: Atorvastatin 20 or 40 mg/d for up to 1 year of treatment was significantly more effective than simvastatin 20 or 40 mg/d m reducing LDL-C and YG levels and at achieving recommended lipid targets in this selected patient population with cardiovascular disease and dyslipidemia. Both statins were well tolerated.

  • 5.
    La Fleur, Linnea
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Johansson, Ann-Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Roberg, Karin
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of ENT - Head and Neck Surgery UHL.
    A CD44(high)/EGFR(low) Subpopulation within Head and Neck Cancer Cell Lines Shows an Epithelial-Mesenchymal Transition Phenotype and Resistance to Treatment2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 9Article in journal (Refereed)
    Abstract [en]

    Mortality in head and neck squamous cell carcinoma (HNSCC) is high due to emergence of therapy resistance which results in local and regional recurrences that may have their origin in resistant cancer stem cells (CSCs) or cells with an epithelial-mesenchymal transition (EMT) phenotype. In the present study, we investigate the possibility of using the cell surface expression of CD44 and epidermal growth factor receptor (EGFR), both of which have been used as stem cell markers, to identify subpopulations within HNSCC cell lines that differ with respect to phenotype and treatment sensitivity. Three subpopulations, consisting of CD44(high)/EGFR(low), CD44(high)/EGFR(high) and CD44(low) cells, respectively, were collected by fluorescence-activated cell sorting. The CD44(high)/EGFR(low) population showed a spindle-shaped EMT-like morphology, while the CD44(low) population was dominated by cobblestone-shaped cells. The CD44(high)/EGFR(low) population was enriched with cells in G0/G1 and showed a relatively low proliferation rate and a high plating efficiency. Using a real time PCR array, 27 genes, of which 14 were related to an EMT phenotype and two with stemness, were found to be differentially expressed in CD44(high)/EGFR(low) cells in comparison to CD44(low) cells. Moreover, CD44(high)/EGFR(low) cells showed a low sensitivity to radiation, cisplatin, cetuximab and gefitinib, and a high sensitivity to dasatinib relative to its CD44(high)/EGFR(high) and CD44(low) counterparts. In conclusion, our results show that the combination of CD44 (high) and EGFR (low) cell surface expression can be used to identify a treatment resistant subpopulation with an EMT phenotype in HNSCC cell lines.

  • 6.
    Palm, Jenny
    et al.
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Ellegård, Kajsa
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences. Not Found:Linkoping Univ, Dept Themat Studies Technol and Social Change, Linkoping, Sweden.
    Hellgren, Mattias
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    A cluster analysis of energy-consuming activities in everyday life2018In: Building Research & Information, ISSN 0961-3218, E-ISSN 1466-4321, Vol. 46, no 1, 99-113 p.Article in journal (Refereed)
    Abstract [en]

    Flexible consumption in the household sector concerns individuals daily choices and the routines that develop in their households. Targeting household-level energy consumption therefore requires an understanding of energy consumption in relation to individual household members activity patterns. Individual time-diaries reveal when, for how long and where energy-related activities occur, permitting discussions of the temporal flexibility of these activities. Using multiple time-diaries (n=6477) from a population reveals differences in activity patterns in larger groups and permits recorded activities to be clustered. Few explorative studies perform cluster analyses of energy-consuming activities in order to examine when and for how long these activities occur. When clustering is done, it is usually based on socio-economic factors, and not on the activities performed in sequence. This paper reports a time-geographically inspired cluster analysis based on when and for how long some activities requiring electricity are performed in the home by individuals in a population. The presented cluster analysis based on activities gives a new perspective to the discussion of flexible users and provides a basis for deeper analyses, for example, of whether activities are moveable in time for individuals, complementing cluster analysis based on other variables.

  • 7.
    Zarenoe, Reza
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    A cohort study of patients with tinnitus and sensorineural hearing loss in a Swedish population2013In: Auris, nasus, larynx, ISSN 0385-8146, E-ISSN 1879-1476, Vol. 40, no 1, 41-45 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We aimed to describe a large cohort of patients with tinnitus and sensorineural hearing loss (SNHL) in Sweden, and also to explore the possibility of finding potential possible differences between various diagnoses within SNHL. It is also of great interest to see how a multidisciplinary team was used in the different subgroups and the frequency of hearing aids use in patients with tinnitus.

    METHODS: Medical records of all patients who had received the diagnosis SNHL in Östergötland County, Sweden between 2004 and 2007 were reviewed. Patients between 20 and 80 years with tinnitus and a pure tone average (PTA) lower than 70dB HL were included in the study. Patients were excluded from the analyses if they had a cochlear implantation, middle ear disorders or had a hearing loss since birth or childhood. The investigators completed a form for each included patient, covering background facts, and audiograms taken at the yearly check up.

    RESULTS: Of a total 1672 patients' medical record review, 714 patients were included. The majority of patients (79%) were in the age group over 50 years. In male patients with bilateral tinnitus, the PTA for the left ear was significantly higher than for the right ear. The results regarding the configuration of hearing loss revealed that 555 patients (78%) had symmetric and 159 (22%) asymmetric hearing loss. Retrocochlear examinations were done in 372 patients and MRI was the most common examination. In all patients, 400 had no hearing aids and out of those 220 had unilateral tinnitus and 180 patients had bilateral tinnitus. 219 patients had a PTA>20dB HL and did not have any hearing aid. Results demonstrated that the Stepped Care model was not used widely in the daily practice. In our study, patients with bilateral-, unilateral hearing loss or Mb Ménière were the most common patients included in the Stepped Care model.

    CONCLUSION: In a large cohort of patients with SNHL and tinnitus, despite their hearing loss only 39% had hearing aids. It was observed that the medical record review often showed a lack of information about many background factors, such as; patients' general health condition, which could be a quality factor that needs improvement. Our results show that the Stepped Care model could be an effective option for providing a better access for tinnitus-focused treatment, although the number of patients in this study who were included in the Stepped Care model was low.

  • 8.
    Schmidt, Susann
    et al.
    Linköping University, Department of Physics, Chemistry and Biology, Thin Film Physics. Linköping University, Faculty of Science & Engineering.
    Czigany, Zsolt
    Hungarian Academic Science, Hungary.
    Wissting, Jonas
    Linköping University, Department of Physics, Chemistry and Biology, Thin Film Physics. Linköping University, Faculty of Science & Engineering.
    Greczynski, Grzegorz
    Linköping University, Department of Physics, Chemistry and Biology, Thin Film Physics. Linköping University, Faculty of Science & Engineering.
    Janzén, Erik
    Linköping University, Department of Physics, Chemistry and Biology, Semiconductor Materials. Linköping University, Faculty of Science & Engineering.
    Jensen, Jens
    Linköping University, Department of Physics, Chemistry and Biology, Thin Film Physics. Linköping University, Faculty of Science & Engineering.
    Ivanov, Ivan Gueorguiev
    Linköping University, Department of Physics, Chemistry and Biology, Semiconductor Materials. Linköping University, Faculty of Science & Engineering.
    Hultman, Lars
    Linköping University, Department of Physics, Chemistry and Biology, Thin Film Physics. Linköping University, Faculty of Science & Engineering.
    A comparative study of direct current magnetron sputtering and high power impulse magnetron sputtering processes for CNX thin film growth with different inert gases2016In: Diamond and related materials, ISSN 0925-9635, E-ISSN 1879-0062, Vol. 64, 13-26 p.Article in journal (Refereed)
    Abstract [en]

    Reactive direct current magnetron sputtering (DCMS) and high power impulse magnetron sputtering (HiPIMS) discharges of carbon in different inert gas mixtures (N-2/Ne, N-2/Ar, and N-2/Kr) were investigated for the growth of carbon-nitride (CNX) thin films. Ion mass spectrometry showed that energies of abundant plasma cations are governed by the inert gas and the N-2-to-inert gas flow ratios. The population of ion species depends on the sputter mode; HiPIMS yields approximately ten times higher flux ratios of ions originating from the target to process gas ions than DCMS. Exceptional are discharges in Ne with N-2-to-Ne flow ratios &lt;20%. Here, cation energies and the amount of target ions are highest without influence on the sputter mode. CNX thin films were deposited in 14% N-2/inert gas mixtures at substrate temperatures of 110 degrees C and 430 degrees C. The film properties show a correlation to the substrate temperature, the applied inert gas and sputter mode. The mechanical performance of the films is mainly governed by their morphology and composition, but not by their microstructure. Amorphous and fullerene-like CN0.14 films exhibiting a hardness of similar to 15 GPa and an elastic recovery of similar to 90% were deposited at 110 degrees C in reactive Kr atmosphere by DCMS and HiPIMS.

  • 9.
    Sundquist, Marie
    et al.
    Department of Surgery, County Hospital, Kalmar, Sweden.
    Thorstenson, Sten
    Department of Cytology and Pathology, County Hospital, Kalmar, Sweden.
    Brudin, Lars
    Department of Physiology, County Hospital, Kalmar, Sweden.
    Stål, Olle
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Nordenskjöld, Bo
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    A comparison between flow cytometric assessment of S-phase fraction and Nottingham histologic grade as prognostic instruments in breast cancer2000In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 63, no 1, 11-15 p.Article in journal (Refereed)
    Abstract [en]

    Flow cytometric DNA analysis with assessment of S-phase fraction and DNA ploidy was compared to Nottingham histologic grade. The study population consisted of 654 patients who presented between 1987 and 1996 with primary operable breast cancer and whose tumours had been analysed for S-phase fraction and DNA ploidy at the time of surgery. Grade, tumour size, node status, steroid receptor status, age, S-phase fraction and DNA ploidy were analysed univariately and multi-variately in a Cox proportional hazard analysis. In the univariate analyses all parameters were statistically significantly associated with breast cancer mortality during the follow-up period of 2–11 years. The most powerful predictor of death from breast cancer in the multiple regression analysis was grade. Patients with grade 1 tumours have excellent prognosis. We conclude that tumour grade is a strong prognostic indicator applicable to all breast cancer patients, regardless of size and nodal status, and advocate its general use.

  • 10.
    Lesen, Eva
    et al.
    Nordic School for Public Health.
    Sandstrom, Tatiana Z
    Nordic School for Public Health.
    Carlsten, Anders
    Medical Prod Agency.
    Jönsson, Anna K
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Diagnostics, Department of Clinical Pharmacology.
    Mardby, Ann-Charlotte
    University of Gothenburg.
    Andersson Sundell, Karolina
    Nordic School for Public Health.
    A comparison of two methods for estimating refill adherence to statins in Sweden: the RARE project2011In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 20, no 10, 1073-1079 p.Article in journal (Refereed)
    Abstract [en]

    Purpose To analyse and compare refill adherence to statins estimated with two different methods with a focus on sensitivity to definitions. less thanbrgreater than less thanbrgreater thanMethods Individuals aged 18-85 years who filled a statin prescription for the first time in 1.5 years during 1 January-30 June 2007 were followed until emigration or death or until 2 years after their first statin purchase. The data were collected via linkage between the Swedish Prescribed Drug Register, the National Patient Register and the Total Population Register. Days supply was estimated based on amount dispensed and prescribed dosage. Refill adherence was estimated with the continuous measure of medication acquisition (CMA) and the maximum gap method (cut-off 45days). The impact of altering definitions, for example, regarding hospitalisations, length of observation period and management of overlapping supply, was analysed. less thanbrgreater than less thanbrgreater thanResults The study included 36661 individuals (mean age 64 years, 47% women). The median proportion of days with statins was 95%, and 76% were classified as adherent with a cut-off at andgt;= 80% with CMA. With the maximum gap method, 65% were adherent. Disregarding hospitalisations did not alter the results. Emigration or death at least one year after statin initiation was associated with a lower adherence with both methods, and a shorter observation period and adding overlapping supply to the subsequent prescription increased the adherence estimates. less thanbrgreater than less thanbrgreater thanConclusions The choice of method and definitions, particularly regarding the management of overlapping supplies and the length of observation period, has a substantial impact on estimates of refill adherence to statins.

  • 11.
    Jonsson, Åsa
    et al.
    County Hospital Ryhov, Sweden.
    Hallberg, Ann-Charlotte
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, Faculty of Arts and Sciences.
    Edner, Magnus
    Karolinska University Hospital, Sweden.
    Lund, Lars H.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    A comprehensive assessment of the association between anemia, clinical covariates and outcomes in a population-wide heart failure registry2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 211, 124-131 p.Article in journal (Refereed)
    Abstract [en]

    Background: The aim was to investigate the prevalence of, predictors of, and association with mortality and morbidity of anemia in a large unselected cohort of patients with heart failure (HF) and reduced ejection fraction (HFrEF) and to explore if there were specific subgroups of high risk. Methods: In patients with HFrEF in the Swedish Heart Failure Registry, we assessed hemoglobin levels and associations between baseline characteristics and anemia with logistic regression. Using propensity scores for anemia, we assessed the association between anemia and outcomes with Cox regression, and performed interaction and sub-group analyses. Results: There were 24 511 patients with HFrEF (8303 with anemia). Most important independent predictors of anemia were higher age, male gender and renal dysfunction. One-year survival was 75% with anemia vs. 81% without (p &lt; 0.001). In the matched cohort after propensity score the hazard ratio associated with anemia was for all-cause death 1.34 (1.28-1.40; p &lt; 0.0001), CV mortality 1.28 (1.20-1.36; p &lt; 0.0001), and combined CV mortality or HF hospitalization 1.24 (1.18-1.30; p &lt; 0.0001). In interaction analyses, anemia was associated with greater risk with lower age, male gender, EF 30-39%, and NYHA-class I-II. Conclusion: In HFrEF, anemia is associated with higher age, male gender and renal dysfunction and increased risk of mortality and morbidity. The influence of anemia on mortality was significantly greater in younger patients, in men, and in those with more stable HF. The clinical implication of these findings might be in the future to perform targeted treatment studies. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 12.
    Koh, Angela S.
    et al.
    National Heart Centre Singapore, Singapore; Duke NUS Medical Sch, Singapore.
    Ting Tay, Wan
    National Heart Centre Singapore, Singapore.
    Hwa Katherine Teng, Tiew
    National Heart Centre Singapore, Singapore; University of Western Australia, Australia.
    Vedin, Ola
    Uppsala University, Sweden; Uppsala Clin Research Centre UCR, Sweden.
    Benson, Lina
    Regional Cancer Centre Stockholm Gotland, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Savarese, Gianluigi
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Lam, Carolyn S. P.
    National Heart Centre Singapore, Singapore; Duke NUS Medical Sch, Singapore; National University of Health Syst, Singapore.
    Lund, Lars H.
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    A comprehensive population-based characterization of heart failure with mid-range ejection fraction2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no 12, 1624-1634 p.Article in journal (Refereed)
    Abstract [en]

    Aims Clinical features and outcomes in the novel phenotype heart failure with mid-range ejection fraction [HFmrEF, ejection fraction (EF) 40-49%] were compared with heart failure with reduced EF (HFrEF, EF amp;lt; 40%) and preserved EF (HFpEF, EF amp;gt;= 50%). Methods and results In the Swedish Heart Failure Registry, we assessed the association between baseline characteristics and EF group using multivariable logistic regressions, and the association between EF group and all-cause mortality using multivariable Cox regressions. Of 42 061 patients, 56% had HFrEF, 21% had HFmrEF, and 23% had HFpEF. Characteristics were continuous for age (72 +/- 12 vs. 74 +/- 12 vs. 77 +/- 11 years), proportion of women (29% vs. 39% vs. 55%), and 13 other characteristics. Coronary artery disease (CAD) was distinctly more common in HFrEF (54%) and HFmrEF (53%) vs. HFpEF (42%); adjusted odds ratio for CAD in HFmrEF vs. HFpEF was 1.52 [95% confidence interval (CI) 1.41-1.63]. For six additional characteristics HFmrEF resembled HFrEF, for seven characteristics HFmrEF resembled HFpEF, and for 10 characteristics there was no pattern. The adjusted hazard ratio (HR) for mortality in HFrEF vs. HFpEF was 1.35 (95% CI 1.14-1.60) at 30 days, 1.26 (95% CI 1.17-1.35) at 1 year, and 1.20 (95% CI 1.14-1.26) at 3 years. In contrast, HFmrEF and HFpEF had a similar prognosis (HR 1.06, 95% CI 0.86-1.30 at 30 days; HR 1.08, 95% CI 1.00-1.18 at 1 year; and HR 1.06, 95% CI 1.00-1.12 at 3 years). Three-year mortality was higher in HFmrEF than in HFpEF in the presence of CAD (HR 1.11, 95% CI 1.02-1.21), but not in the absence of CAD (HR 1.02, 95% CI 0.94-1.12; P for interaction amp;lt; 0.001). Conclusions HFmrEF was an intermediate phenotype, except that CAD was more common in HFmrEF and HFrEF vs. HFpEF, crude all-cause mortality was lower in HFmrEF and HFrEF, adjusted all-cause mortality was lower in HFmrEF and HFpEF, and CAD portended a higher adjusted risk of death in HFmrEF and HFrEF.

  • 13.
    Bohlin, Gustav
    et al.
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, Faculty of Science & Engineering.
    Göransson, Andreas C.
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, Faculty of Science & Engineering.
    Höst, Gunnar
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, Faculty of Science & Engineering.
    Tibell, Lena
    Linköping University, Department of Science and Technology, Media and Information Technology. Linköping University, Faculty of Science & Engineering.
    A conceptual characterization of online videos explaining natural selection2017In: Science & Education, ISSN 0926-7220, E-ISSN 1573-1901, Vol. 26, no 7-9, 975-999 p.Article in journal (Refereed)
    Abstract [en]

    Educational videos on the Internet comprise a vast and highly diverse source of information. Online search engines facilitate access to numerous videos claiming to explain natural selection, but little is known about the degree to which the video content match key evolutionary content identified as important in evolution education research. In this study, we therefore analyzed the content of 60 videos accessed through the Internet, using a criteria catalog with 38 operationalized variables derived from research literature. The variables were sorted into four categories: (a) key concepts (e.g. limited resources and inherited variation), (b) threshold concepts (abstract concepts with a transforming and integrative function), (c) misconceptions (e.g. that evolution is driven by need), and (d) organismal context (e.g. animal or plant). The results indicate that some concepts are frequently communicated, and certain taxa are commonly used to illustrate concepts, while others are seldom included. In addition, evolutionary phenomena at small temporal and spatial scales, such as subcellular processes, are rarely covered. Rather, the focus is on population-level events over time scales spanning years or longer. This is consistent with an observed lack of explanations regarding how randomly occurring mutations provide the basis for variation (and thus natural selection). The findings imply, among other things, that some components of natural selection warrant far more attention in biology teaching and science education research.

  • 14.
    Dionne, Clermont E
    et al.
    Laval University, Québec, Canada and Keele University, Staffordshire, UK.
    Dunn, Kate M
    Keele University, Staffordshire, UK.
    Croft, Peter R
    Keele University, Staffordshire, UK.
    Nachemson, Alf L
    Buchbinder, Rachelle
    Walker, Bruce F
    Wyatt, Mary
    Cassidy, J David
    Rossignol, Michel
    Leboeuf-Yde, Charlotte
    Hartvigsen, Jan
    Leino-Arjas, Päivi
    Latza, Ute
    Reis, Shmuel
    Gil Del Real, Maria Teresa
    Kovacs, Francisco M
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Cedraschi, Christine
    Bouter, Lex M
    Koes, Bart W
    Picavet, H Susan J
    van Tulder, Maurits W
    Burton, Kim
    Foster, Nadine E
    Macfarlane, Gary J
    Thomas, Elaine
    Underwood, Martin
    Waddell, Gordon
    Shekelle, Paul
    Volinn, Ernest
    Von Korff, Michael
    A consensus approach toward the standardization of back pain definitions for use in prevalence studies2008In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 33, no 1, 95-103 p.Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN: A modified Delphi study conducted with 28 experts in back pain research from 12 countries.

    OBJECTIVE: To identify standardized definitions of low back pain that could be consistently used by investigators in prevalence studies to provide comparable data.

    SUMMARY OF BACKGROUND DATA: Differences in the definition of back pain prevalence in population studies lead to heterogeneity in study findings, and limitations or impossibilities in comparing or summarizing prevalence figures from different studies.

    METHODS: Back pain definitions were identified from 51 articles reporting population-based prevalence studies, and dissected into 77 items documenting 7 elements. These items were submitted to a panel of experts for rating and reduction, in 3 rounds (participation: 76%). Preliminary results were presented and discussed during the Amsterdam Forum VIII for Primary Care Research on Low Back Pain, compared with scientific evidence and confirmed and fine-tuned by the panel in a fourth round and the preparation of the current article.

    RESULTS: Two definitions were agreed on a minimal definition (with 1 question covering site of low back pain, symptoms observed, and time frame of the measure, and a second question on severity of low back pain) and an optimal definition that is made from the minimal definition and add-ons (covering frequency and duration of symptoms, an additional measure of severity, sciatica, and exclusions) that can be adapted to different needs.

    CONCLUSION: These definitions provide standards that may improve future comparisons of low back pain prevalence figures by person, place and time characteristics, and offer opportunities for statistical summaries.

  • 15.
    Petersson, Ulla
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Nilsson, Peter
    Department of Clinical Sciences, Lund University, University Hospital, Malmö , Sweden.
    A consultation-based method is equal to SCORE and an extensive laboratory-based method in predicting risk of future cardiovascular disease2009In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, no 5, 536-540 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As cardiovascular disease (CVD) is one of the most common causes of mortality worldwide, much interest has been focused on reliable methods to predict cardiovascular risk.

    DESIGN: A cross-sectional, population-based screening study with 17-year follow-up in Southern Sweden.

    METHODS: We compared a non-laboratory, consultation-based risk assessment method comprising age, sex, present smoking, prevalent diabetes or hypertension at baseline, blood pressure (systolic >/=140 or diastolic >/=90), waist/height ratio and family history of CVD to Systemic COronary Risk Evaluation (SCORE) and a third model including several laboratory analyses, respectively, in predicting CVD risk. The study included clinical baseline data on 689 participants aged 40-59 years without CVD. Blood samples were analyzed for blood glucose, serum lipids, insulin, insulin-like growth factor-I, insulin-like growth factor binding protein-1, C-reactive protein, asymmetric dimethyl arginine and symmetric dimethyl arginine. During 17 years, the incidence of total CVD (first event) and death was registered.

    RESULTS: A non-laboratory-based risk assessment model, including variables easily obtained during one consultation visit to a general practitioner, predicted cardiovascular events as accurately [hazard ratio (HR): 2.72; 95% confidence interval (CI): 2.18-3.39, P<0.001] as the established SCORE algorithm (HR: 2.73; 95% CI: 2.10-3.55, P<0.001), which requires laboratory testing. Furthermore, adding a combination of sophisticated laboratory measurements covering lipids, inflammation and endothelial dysfunction, did not confer any additional value to the prediction of CVD risk (HR: 2.72; 95% CI: 2.19-3.37, P<0.001). The c-statistics for the consultation model (0.794; 95% CI: 0.762-0.823) was not significantly different from SCORE (0.767; 95% CI: 0.733-0.798, P=0.12) or the extended model (0.806; 95% CI: 0.774-0.835, P=0.55).

    CONCLUSION: A risk algorithm based on non-laboratory data from a single primary care consultation predicted long-term cardiovascular risk as accurately as either SCORE or an elaborate laboratory-based method in a defined middle-aged population.

  • 16.
    Andersson, Gerhard
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, Clinical and Social Psychology.
    Asmundson, Gordon J
    Denev, Johanna
    Nilsson, Johanna
    Hans-Christian, Larsen
    A controlled trial of cognitive-behavior therapy combined with vestibular rehabilitation in the treatment of dizziness2006In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 44, no 9, 1265-1273 p.Article in journal (Refereed)
    Abstract [en]

    Dizziness is a common and often untreated symptom in the general population. The aim of this study was to investigate the effects of a combined cognitive-behavioral/vestibular rehabilitation (VR) program, using a randomized control design. A total of 29 participants were randomized to treatment consisting of psychoeducation, vestibular exercises, relaxation and cognitive interventions, or to serve as waiting list controls. Measures of dizziness-related handicap, dizziness-provoking movements, and daily diary registrations of dizziness symptoms at pre- and post-treatment showed statistically significant improvements in many domains, which translated to moderate effect sizes. These findings provide preliminary support for the combination of Cognitive-behavioral therapy (CBT) and VR methods in the treatment of dizziness. © 2005 Elsevier Ltd. All rights reserved.

  • 17.
    Lindqvist, Kent
    et al.
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Lindholm, L.
    Department of Public Health and Clinical Medicine, Umeå University, Sweden.
    A cost-benefit analysis of the community-based injury prevention programme in Motala, Sweden—a WHO Safe Community2001In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 115, no 5, 317-322 p.Article in journal (Refereed)
    Abstract [en]

    The objective in this study was to calculate costs and benefits caused by a safe community injury prevention programme in Motala, Sweden. The study design was a quasi-experimental evaluation involving an intervention population and a non-random control population. All injuries were recorded before and after an intervention programme. The presented calculations show that costs of injuries in a societal perspective decreased from 116 million Swedish Crowns (SEK) to 96 million SEK, while the cost for the intervention was estimated at approximately 10 million SEK. Thus, the safe community injury prevention programme in Motala should be judged as cost-effective. 

  • 18.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    A cross-sectional study of factors associated with the number of anatomical pain sites in an actual elderly general population: results from the PainS65+cohort2017In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, 2009-2019 p.Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have illustrated that multisite pain is more frequent than single pain site, and it is associated with an array of negative consequences. However, there is limited knowledge available about the potential factors associated with multisite pain in the elderly general population. Objective: This cross-sectional study examines whether the number of anatomical pain sites (APSs) is related to sociodemographic and health-related factors in older adults including oldestold ages using a new method (APSs) to assess the location of pain on the body. Materials and methods: The sample came from the PainS65+ cohort, which included 6,611 older individuals (mean age = 76.0 years; standard deviation [SD] = 7.4) residing in southeastern Sweden. All the participants completed and returned a postal survey that measured sociodemographic data, total annual income, pain intensity and frequency, general well-being, and quality of life. The number of pain sites (NPS) was marked on a body manikin of 45 sections, and a total of 23 APSs were then calculated. Univariable and multivariable models of regression analysis were performed. Results: Approximately 39% of the respondents had at least two painful sites. The results of the regression analysis showed an independent association between the APSs and the age group of 75-79 years, women, married, high pain intensity and frequency, and low well-being and quality of life, after adjustments for consumption of analgesics and comorbidities. The strongest association was observed for the higher frequency of pain. Conclusion: Our results suggest that APSs are highly prevalent with strong relationships with various sociodemographic and health-related factors and concur well with the notion that multisite pain is a potential indicator of increased pain severity and impaired quality of life in the elderly. Our comprehensive method of calculating the number of sites could be an essential part of the clinical presentation, assessment, and treatment of multisite pain.

  • 19.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences.
    A Data-Rich World: Population‐based registers in healthcare research2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Advances and integration of information and communication technologies into healthcare systems offer new opportunities to improve public health worldwide. In Sweden, there are already unique possibilities for epidemiological research from registers because of a long tradition of centralized data collection into population-based registers and their allowance for linkage. The growing efficiency of automated digital storage provides growing volumes of archived data that increases the potential of analyses further.

    The purpose of this thesis can be divided into two parallel themes: illustrations and discussions of the use and usefulness of population-based registers on the one hand, and specific research questions in epidemiology and healthcare research on the other. The research questions are addressed in separate papers.

    From the Swedish Cancer Registry, 25 years of incidence data on testicular cancer was extracted for a large cohort. Record linkage to survey data on serum cholesterol showed a highly significant positive association, suggesting that elevated serum cholesterol concentration is a risk factor for testicular cancer. Since the finding is the first of its kind and because of wide confidence intervals further studies are needed to confirm the association.

    Östergötland County council’s administra-tive database (the Care Data Warehouse in Östergötland (CDWÖ)) provided data for preva-lence estimations of four common chronic diseases.

    The prevalence rate agreed very well with previous estimates for diabetes and fairly well with those for asthma. For hypertension and chronic obstructive pulmonary disease, the observed rates were lower than previous prevalence estimates. Data on several consecutive years covering all healthcare levels are needed to achieve valid prevalence estimates.

    CDWÖ data was also used to analyse the impact of diabetes on the prevalence of ischemic heart disease. Women had higher diabetes/non-diabetes prevalence rate ratios across all ages. The relative gender difference remained up to the age of 65 years and thereafter decreased considerably.

    The age-specific direct healthcare cost of diabetes was explored using data from the CDWÖ, the county council’s Cost Per Patient database and the Swedish Prescribed Drug Register. The cost per patient and the relative magnitude of different cost components varied considerably by age, which is important to consider in the future planning of diabetes management.

    The Cancer Registry was established mainly as a basis for epidemiological surveillance and research, exemplified in this thesis by a study on testicular cancer. In contrast, the newly established and planned healthcare databases in different Swedish counties are mainly for managerial purposes. As is shown in this thesis, these new databases may also be used to address problems in epidemiology and healthcare research.

    List of papers
    1. Serum cholesterol and testicular cancer incidence in 45 000 men followed for 25 years
    Open this publication in new window or tab >>Serum cholesterol and testicular cancer incidence in 45 000 men followed for 25 years
    2005 (English)In: British Journal of Cancer, ISSN 0007-0920, Vol. 92, no 9, 1785-1786 p.Article in journal (Refereed) Published
    Abstract [en]

    In a 25-year follow-up study of 44 864 men with measured serum cholesterol levels, the testicular cancer hazard ratios for the serum cholesterol categories 5.7–6.9 and ≥7.0 mmol l-1 vs the reference category (<5.7 mmol l-1) were 1.3 and 4.5, respectively; P-value for trend=0.005. This highly significant association suggests that high-serum cholesterol is a risk factor for testicular cancer.

    Keyword
    epidemiology, testicular neoplasm, cholesterol
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12757 (URN)10.1038/sj.bjc.6602539 (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2011-02-03
    2. Estimating disease prevalence using a population-based administrative healthcare database
    Open this publication in new window or tab >>Estimating disease prevalence using a population-based administrative healthcare database
    2007 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, Vol. 35, no 4, 424-431 p.Article in journal (Refereed) Published
    Abstract [en]

    Aims: In Östergötland County, Sweden, all data on hospital care and primary healthcare (PHC) have been entered in a diagnosis-related administrative database since 1999. This database was used to estimate the prevalence of four chronic diseases and to examine the capture of data in PHC, outpatient hospital care, and inpatient hospital care, considered in different time frames.

    Methods: A case-finding algorithm identified patients with at least one healthcare contact involving a diagnosis of diabetes, hypertension, asthma, or chronic obstructive pulmonary disease (COPD) in 1999—2003. Prevalence rates were calculated as the ratio of the number of identified patients alive to the total number of inhabitants on 31 December 2003 (n~415,000).

    Results: Prevalence rates were 4.4% for diabetes, 10.3% for hypertension, 4.5% for asthma, and 1.2% for COPD. For all four diagnoses, the proportions of patients identified on only one healthcare level were greatest for PHC, reaching rates of 23%, 68%, 53%, and 48%, respectively. The cases identified solely in PHC comprised larger proportions of women and patients over the age of 65 years. Considering the proportion of patients identified in 2003 in relation to the total five-year period gave values of 71%, 50%, 38%, and 58%, respectively, for the four diagnoses.

    Conclusions: The administrative healthcare databases in Sweden today can be important tools in epidemiological research. However, data on several consecutive years and both PHC and hospital data are needed to achieve valid prevalence estimates.

    Keyword
    Asthma, COPD, diabetes mellitus, epidemiology, healthcare, hypertension, inpatients, prevalence, primary outpatients, registries
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12758 (URN)10.1080/14034940701195230 (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2009-05-19
    3. Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study
    Open this publication in new window or tab >>Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study
    2008 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 79, no 3, 497-502 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: To explore age and gender differences in the impact of diabetes on the prevalence of ischemic heart disease (IHD) in a defined population.

    Methods: Data were obtained from an administrative health care register covering a population of about 415 000. The study included all patients aged 45-74 years diagnosed between 1999-2003 with IHD (n=11 311) and diabetes (n=10 364) by physicians at all primary health care centres (PHCs) and out- and inpatient clinics at all hospitals in the county of Östergötland, Sweden.

    Results: In the 45-54 year-old age group, diabetes was associated with an increase in IHD prevalence equivalent to ageing about 20 years in women and 10 years in men. The diabetes/nondiabetes IHD prevalence rate ratio (IPR) decreased with age in both men and women (trend p-values < 0.001). The IPR was higher among women than men in each age group, though the female relative excess decreased from 75% higher in the 45-54 year-old age group to 33% higher in the 65-74 year-old age group (trend p-value = 0.018).

    Conclusions: The relative gender difference in the impact of diabetes on IHD in younger middle-aged patients remained up to the age of 65 years, decreasing considerably thereafter.

    Place, publisher, year, edition, pages
    Institutionen för medicin och hälsa, 2008
    Keyword
    aging, coronary disease, diabetes mellitus, prevalence, sex differences
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-11241 (URN)10.1016/j.diabres.2007.10.009 (DOI)
    Note
    Original publication: Ann-Britt E. Wiréhn, Carl Johan Östgren and John M. Carstensen, Age and Gender Differences in the Impact of Diabetes on the Prevalence of Ischemic Heart Disease: a Population-Based Register Study, 2008, Diabetes Research and Clinical Practice, (79), 3, 497-502. http://dx.doi.org/10.1016/j.diabres.2007.10.009. Copyright: Elsevier B.V., http://www.elsevier.com/Available from: 2008-03-12 Created: 2008-03-12 Last updated: 2017-12-13
    4. Age-specific direct health care costs attributable to diabetesin a Swedish population: a register-based analysis
    Open this publication in new window or tab >>Age-specific direct health care costs attributable to diabetesin a Swedish population: a register-based analysis
    2008 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 6, 732-737 p.Article in journal (Refereed) Published
    Abstract [en]

    Aims: The aim of this population-based study was to explore the age-specific additional direct healthcare cost for patients with diabetes compared with the non-diabetic population.

    Methods: In 1999-2005, patients with diabetes in the Swedish county of Östergötland (n = 20 876) were identified from an administrative database. Cost data on the healthcare expenditure in primary healthcare, out-patient hospital care and in-patient care for the entire county population (n = ∼415 000) in 2005 were extracted from a cost per patient (CPP) database, which includes information on all utilized healthcare resources in the county. Data on drug sales were obtained from the Swedish Prescribed Drug Register.

    Results: The cost per person was 1.8 times higher in patients with diabetes than in the non-diabetic population, 7.7 times higher in children and 1.3 times higher in subjects aged > 75 years. The additional cost per person for diabetes was €1971; €3930 and €1367, respectively, for children and subjects aged > 75 years. The proportion of total additional diabetes costs attributable to in-patient care increased with age from 25 to 50%; in-patient care was the most expensive component at all ages except in children, for whom visiting a specialist was most expensive. The diabetes-related segment of the total healthcare cost was 6.6%, increasing from 2.0% in children to 10.3% in the age group 65-74 years, declining to 6.2% in the oldest age group.

    Conclusions: The direct medical cost of diabetes varies considerably by age. Knowledge about the influence of age on healthcare costs to society will be important in future planning of diabetes management.

    Keyword
    Diabetes, Economics, Healthcare delivery, Prevalence, Registers
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-12760 (URN)10.1111/j.1464-5491.2008.02444.x (DOI)
    Available from: 2007-11-06 Created: 2007-11-06 Last updated: 2017-12-14
  • 20.
    Palm, Elin
    Linköping University, Department of Culture and Communication, Centre for Applied Ethics. Linköping University, Faculty of Arts and Sciences.
    A Declaration of Healthy Dependence: The case of home care2014In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 22, no 4, 385-404 p.Article in journal (Refereed)
    Abstract [en]

    Aging populations have become a major concern in the developed world and are expected to require novel care strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualized care to meet the increased demand for care services in response to demographic change. Increasingly, care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-based home care is typically portrayed as the key to a cost-effective future care that better can accommodate the needs of an aging population and promote care recipients’ independence. In light of the emerging technology-based home care, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novel care form. Notions of independence as used by care planners, care providers and technology developers are examined in relation to ICT-based home care and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated.

  • 21.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Wang, Chen
    Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    A fifteen-year follow-up of neurological conditions in VLBW children without overt disability: Relation to gender, neonatal risk factors, and end stage MRI findings2008In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 84, no 5, 343-349 p.Article in journal (Refereed)
    Abstract [en]

    Background: Very low birthweight (VLBW; birth weight ≤ 1500 g) children run a greater risk than controls of developing neurosensory disabilities, but also minor neurological disturbances.

    Aims: To assess neurological status from the neonatal period up to fifteen years of age in VLBW children without overt neurological disability in relation to gender, neonatal risk factors, and Magnetic Resonance Imaging (MRI) findings of the brain.

    Study design: A population based follow-up study of VLBW children and their controls.

    Subjects: Eighty VLBW children without overt disability, in a cohort of 86 surviving VLBW children, were enrolled in a follow-up study at 40 weeks gestational age and at 4, 9, and 15 years of age. 56 VLBW children were examined with cerebral MRI at 15 years of age.

    Outcome measures: Neurological test scores. MRI findings, principally white matter damage (WMD).

    Results: VLBW children were inferior in neurological assessments in comparison with controls at 40 weeks gestational age and 4 and 15 years of age. VLBW girls did not differ from their controls at 9 and 15 years. Fourteen of 56 (25%) VLBW children had abnormal MRI findings and 13 were evaluated as mild WMD. Children with WMD did not differ in neurological outcome from those without WMD at any examination. Mechanical ventilation and/or intraventricular haemorrhage (IVH) during the neonatal period were significantly related to less a favourable outcome at follow-up examinations.

    Conclusion: A cohort of VLBW children without overt neurological disability had a poorer neurological condition up to adolescence in comparison with controls. A quarter of the VLBW children had mild WMD but without relation to the neurological functions. Mechanical ventilation and IVH were related to poorer neurological outcome.

  • 22.
    Ramström, A Sofia
    et al.
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Fagerberg, I.
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    Lindahl, Tomas
    Linköping University, Department of Biomedicine and Surgery, Clinical Chemistry. Linköping University, Faculty of Health Sciences.
    A flow cytometric assay for the study of dense granule storage and release in human platelets1999In: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 10, no 2-3, 153-158 p.Article in journal (Refereed)
    Abstract [en]

    The clinical manifestations of platelet dense (δ) granule defects are easy bruising, as well as epistaxis and bleeding after delivery, tooth extractions and surgical procedures. The observed symptoms may be explained either by a decreased number of granules or by a defect in the uptake/release of granule contents. We have developed a method to study platelet dense granule storage and release. The uptake of the fluorescent marker, mepacrine, into the platelet dense granule was measured using flow cytometry. The platelet population was identified by the size and binding of a phycoerythrin-conjugated antibody against GPIb. Cells within the discrimination frame were analysed for green (mepacrine) fluorescence. Both resting platelets and platelets previously stimulated with collagen and the thrombin receptor agonist peptide SFLLRN was analysed for mepacrine uptake. By subtracting the value for mepacrine uptake after stimulation from the value for uptake without stimulation for each individual, the platelet dense granule release capacity could be estimated. Whole blood samples from 22 healthy individuals were analysed. Mepacrine incubation without previous stimulation gave mean fluorescence intensity (MFI) values of 83±6 (mean ± 1 SD, range 69–91). The difference in MFI between resting and stimulated platelets was 28±7 (range 17–40). Six members of a family, of whom one had a known δ-storage pool disease, were analysed. The two members (mother and son) who had prolonged bleeding times also had MFI values disparate from the normal population in this analysis. The values of one daughter with mild bleeding problems but a normal bleeding time were in the lower part of the reference interval.

  • 23.
    Josefsson, Ann
    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.
    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.
    A follow-up study of postnatal depressed women: Recurrent maternal depressive symptoms and child behaviour after four years2007In: Archives of Women's Mental Health, ISSN 1434-1816, Vol. 10, no 4, 141-145 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the prevalence of depressive symptoms and self reported health of women who have shown previous postpartum depressive symptoms. To examine the behavior of four-year-old children born to mothers affected by postpartum depression.

    Methods: Longitudinal study. The index group (n = 251) constituted of all women with postpartum depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS), in a population-based study made in the late 1990s. The control group (n = 502) consisted of women without postpartum depressive symptoms on the EPDS at the same occasion. Approximately four years after delivery these women were asked to answer a short questionnaire on general health, the EPDS, and also to assess their child’s behavior with the Richman Pre-School Behaviour Checklist. Results: Women with a history of postpartum depressive symptoms were approximately 6 times more likely to have recurrent depressive symptoms (OR = 5.82, 95% CI: 3.79–8.93), compared to those without postpartum depressive symptoms, and they were also more likely to experience physical and mental illness. Although postpartum depressive symptoms in the mothers were involved in explaining the likelihood of behavioral problems in their four-year-old children, mothers with current depressive symptoms were the most likely to have a child with behavioral problems (OR = 4.71, 95% CI: 1.88–11.78). Conclusion: Postpartum depressive illness constitutes a risk for future illness as well as maternal perceived behavioral problems in offspring. In order to diminish long-term adverse consequences for the mother and the child there is a great need to recognize and treat women with postpartum depressive symptoms as early as possible.

  • 24.
    Häll, Carl Henrik
    Linköping University, Department of Science and Technology. Linköping University, The Institute of Technology.
    A Framework for Evaluation and Design of an Integrated Public Transport System2006Licentiate thesis, monograph (Other academic)
    Abstract [en]

    Operators of public transport always try to make their service as attractive as possible, to as many persons as possible and in a so cost effective way as possible. One way to make the service more attractive, especially to elderly and disabled, is to offer door-to-door transportation. The cost for the local authorities to provide this service is very high and increases every year.

    To better serve the needs of the population and to reduce the cost for transportation of elderly and disabled, public transportation systems are evolving towards more flexible solutions. One such flexible solution is a demand responsive service integrated with a fixed route service, together giving a form of flexible public transport system. The demand responsive service can in such a system be used to carry passengers from their origin to a transfer location to the fixed route network, and/or from the fixed route network to their destination.

    This thesis concerns the development of a framework for evaluation and design of such an integrated public transport service. The framework includes a geographic information system, optimization tools and simulation tools. This framework describes how these tools can be used in combination to aid the operators in the planning process of an integrated service. The thesis also presents simulations made in order to find guidelines of how an integrated service should be designed. The guidelines are intended to help operators of public transport to implement integrated services and are found by evaluating the effects on availability, travel time, cost and other service indicators for variations in the design and structure of the service.

    In a planning system for an integrated public transport service, individual journeys must in some way be scheduled. For this reason the thesis also presents an exact optimization model of how journeys should be scheduled in this kind of service.

  • 25.
    Östberg, AL
    et al.
    Public Dental Services and Skaraborg Institute, Skövde.
    Halling, Arne
    Östergötlands Läns Landsting, Public Dental Service.
    Lindblad, U
    Public Dental Services and Skaraborg Institute, Skövde.
    A gender perspective of self-perceived oral health in adolescents: associations with attitudes and behaviours2001In: Community Dental Health, ISSN 0265-539X, Vol. 18, no 2, 110-116 p.Article in journal (Refereed)
    Abstract [en]

    Objective To investigate the associations between dental attitudes and behaviours, and self-perceived oral health from a gender perspective in an adolescent population. Design A census survey. Self-reported questionnaires were answered anonymously in a standardised manner in classrooms. Attitudes studied included the importance of sound teeth and feelings towards visits to the dentist. Behaviours were represented by floss usage and sweets consumption. Setting All senior and upper secondary level schools in Skaraborg County, Sweden. Subjects 17,280 students, aged 13-18 years, Outcome measures Self-perceived oral health. represented by a single-item rating: satisfaction with the appearance of the teeth: self-assessed gum bleeding and a perceived oral health (POH) index. Results Recognising sound teeth as important was a predominating attitude among the respondents (boys 94%, girls 97%) and was significantly associated with a good perceived oral health overall. Individuals who experienced visits to dentist as unpleasant (boys 36%, girls 43%) were less likely to perceive good oral health as single-item rated (OR for boys 0.55[0.49, 0.63], girls 0.40[0.34, 0.47]). Regular use of floss had a small protective effect on bleeding gums. Daily sweets consumption showed a significant and inverse association with self-perceived oral health as single-item rated (OR for boys 0.53[0.44, 0.66], girls 0.49[0.40, 0.60]). Girls, more often than boys, perceived their oral health to be good, except in the perception of the appearance of their teeth. Conclusions It is concluded that the strong associations between attitudes and self-perceived oral health should be recognised in strategies for oral health promotion and that gender differences must be considered.

  • 26.
    Sederholm Lawesson, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    A gender perspective on short- and long term mortality in ST-elevation myocardial infarction: a report from the SWEDEHEART register2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 18, no 2, 1041-1047 p.Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies of patients admitted for ST-elevation myocardial infarction [STEMI] have indicated that women have a higher risk of early mortality than do men. These studies have presented limited information on gender related differences in the short term and almost no information on the long term. Methods and results: We analysed a prospective, consecutively included STEMI population consisting of 54,146 patients (35% women). This population consists of almost all patients hospitalised in Sweden between January 1, 1995 and December 31, 2006 as recorded in the SWEDEHEART register (formerly RIKS-HIA). Follow-up time ranged from one to 13 years (mean 4.6). Women had a lower probability of being given reperfusion therapy, odds ratio [OR] 0.83 (95% confidence interval [CI] 0.79-0.88). During the time these STEMI patients were in the hospital, 13% of the women and 7% of men died, multivariable adjusted OR 1.21 (95% CI 1.11-1.32). During the follow up period, 46% of the women died as compared with 32% of the men. There was, however, no gender difference in age-adjusted risk of long term mortality (hazard ratio [HR] 0.98, 95% CI 0.95-1.01) whereas the multivariable adjusted risk was lower in women (HR 0.92, 95% CI 0.89-0.96). The long term risk of re-infarction was the same in men and women (HR 0.98, 95% CI 0.93-1.03) whereas men in the youngest group had a higher risk than women in that age group (HR 0.82, 95% CI 0.72-0.94). Conclusion: In STEMI, women had a higher risk of in-hospital mortality but the long-term risk of death was higher in men. More studies are needed in the primary percutaneous coronary intervention (pPCI) era that are designed to determine why women fare worse than men after STEMI during the first phase when they are in hospital

  • 27.
    Kling, Daniel
    et al.
    Norwegian Institute Public Heatlh, Norway; Norwegian University of Life Science, Norway.
    Tillmar, Andreas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. National Board Forens Med, Department Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Egeland, Thore
    Norwegian University of Life Science, Norway; Norwegian Institute Public Heatlh, Norway.
    Mostad, Petter
    Norwegian University of Life Science, Norway; University of Gothenburg, Sweden.
    A general model for likelihood computations of genetic marker data accounting for linkage, linkage disequilibrium, and mutations2015In: International journal of legal medicine (Print), ISSN 0937-9827, E-ISSN 1437-1596, Vol. 129, no 5, 943-954 p.Article in journal (Refereed)
    Abstract [en]

    Several applications necessitate an unbiased determination of relatedness, be it in linkage or association studies or in a forensic setting. An appropriate model to compute the joint probability of some genetic data for a set of persons given some hypothesis about the pedigree structure is then required. The increasing number of markers available through high-density SNP microarray typing and NGS technologies intensifies the demand, where using a large number of markers may lead to biased results due to strong dependencies between closely located loci, both within pedigrees (linkage) and in the population (allelic association or linkage disequilibrium (LD)). We present a new general model, based on a Markov chain for inheritance patterns and another Markov chain for founder allele patterns, the latter allowing us to account for LD. We also demonstrate a specific implementation for X chromosomal markers that allows for computation of likelihoods based on hypotheses of alleged relationships and genetic marker data. The algorithm can simultaneously account for linkage, LD, and mutations. We demonstrate its feasibility using simulated examples. The algorithm is implemented in the software FamLinkX, providing a user-friendly GUI for Windows systems (FamLinkX, as well as further usage instructions, is freely available at www.famlink.se). Our software provides the necessary means to solve cases where no previous implementation exists. In addition, the software has the possibility to perform simulations in order to further study the impact of linkage and LD on computed likelihoods for an arbitrary set of markers.

  • 28.
    Mészáros, Gábor
    et al.
    University of Natural Resources and Life Sciences, Vienna, Austria.
    Eaglen, Sophie
    University of Natural Resources and Life Sciences, Vienna, Austria.
    Waldmann, Patrik
    Linköping University, Department of Computer and Information Science, Statistics. Linköping University, The Institute of Technology.
    Sölkner, Johann
    University of Natural Resources and Life Sciences, Vienna, Austria.
    A genome wide association study for longevity in cattle2014In: Open Journal of Genetics, ISSN 2162-4453, E-ISSN 2162-4461, Vol. 4, no 1, 46-55 p.Article in journal (Refereed)
    Abstract [en]

    Longevity is regarded as the most important functional trait in cattle breeding with high economic value yet low heritability. In order to identify genomic regions associated with longevity, a genome wise association study was performed using data from 4887 Fleckvieh bulls and 33,556 SNPs after quality control. Single SNP regression was used for identification of important SNPs including eigenvectors as a means of correction for population structure. SNPs selected with a false discovery rate threshold of 0.05 and with local false discovery rate identified genomic regions associated with longevity which were subsequently cross checked with the National Center for Biotechnology Information (NCBI) database. This, to identify interesting genes in cattle and their homologue forms in other species. The most notable genes were SYT10 located on chromosome 5, ADAMTS3 on chromosome 6, NTRK2 on chromosome 8 and SNTG1 on chromosome 14 of the cattle genome. Several of the genes found have previously been associated with cattle fertility. Poor fertility is an important culling reason and thereby affects longevity in cattle. Several signals were located in regions sparse with described genes, which suggest that there might be several other non-identified genetic pathways for this important trait.

  • 29.
    Huyghe, Jeroen R
    et al.
    University of Antwerp.
    Fransen, Erik
    University of Antwerp.
    Hannula, Samuli
    University of Oulu.
    Van Laer, Lut
    University of Antwerp.
    Van Eyken, Els
    University of Antwerp.
    Mäki-Torkko, Elina
    Linköping University, Department of Clinical and Experimental Medicine, Technical Audiology. Linköping University, Faculty of Health Sciences.
    Aikio, Pekka
    University of Oulu.
    Sorri, Martti
    University of Oulu.
    Huentelman, Matthew J
    Translat Genom Research Institute, Phoenix.
    Van Camp, Guy
    University of Antwerp.
    A genome-wide analysis of population structure in the Finnish Saami with implications for genetic association studies2011In: EUROPEAN JOURNAL OF HUMAN GENETICS, ISSN 1018-4813, Vol. 19, no 3, 347-352 p.Article in journal (Refereed)
    Abstract [en]

    The understanding of patterns of genetic variation within and among human populations is a prerequisite for successful genetic association mapping studies of complex diseases and traits. Some populations are more favorable for association mapping studies than others. The Saami from northern Scandinavia and the Kola Peninsula represent a population isolate that, among European populations, has been less extensively sampled, despite some early interest for association mapping studies. In this paper, we report the results of a first genome-wide SNP-based study of genetic population structure in the Finnish Saami. Using data from the HapMap and the human genome diversity project (HGDP-CEPH) and recently developed statistical methods, we studied individual genetic ancestry. We quantified genetic differentiation between the Saami population and the HGDP-CEPH populations by calculating pair-wise F-ST statistics and by characterizing identity-by-state sharing for pair-wise population comparisons. This study affirms an east Asian contribution to the predominantly European-derived Saami gene pool. Using model-based individual ancestry analysis, the median estimated percentage of the genome with east Asian ancestry was 6% (first and third quartiles: 5 and 8%, respectively). We found that genetic similarity between population pairs roughly correlated with geographic distance. Among the European HGDP-CEPH populations, F-ST was smallest for the comparison with the Russians (F-ST=0.0098), and estimates for the other population comparisons ranged from 0.0129 to 0.0263. Our analysis also revealed fine-scale substructure within the Finnish Saami and warns against the confounding effects of both hidden population structure and undocumented relatedness in genetic association studies of isolated populations.

  • 30.
    Van Laer, Lut
    et al.
    University of Antwerp, Belgium.
    Huyghe, Jeroen
    University of Antwerp, Belgium.
    Hannula, Samuli
    University of Oulu, Finland.
    Van Eyken, Els
    University of Antwerp, Belgium.
    Stephan, Dietrich
    Translational Genomics Research Institute, Phoenix, AZ, USA.
    Mäki-Torkko, Elina
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL. University of Oulu, Finland.
    Aikio, Pekka
    University of Oulu, Finland.
    Fransen, Erik
    University of Antwerp, Belgium.
    Lysholm-Bernacchi, Alana
    The Translational Genomics Research Institute, Phoenix, AZ, USA.
    Sorri, Martti
    University of Oulu, Finland.
    Huentelman, Matthew
    Translational Genomics Research Institute, Phoenix, AZ, USA.
    Van Camp, Guy
    University of Antwerp, Belgium.
    A genome-wide association study for age-related hearing impairment in the Saami2010In: European Journal of Human Genetics, ISSN 1018-4813, E-ISSN 1476-5438, Vol. 18, no 6, 685-693 p.Article in journal (Refereed)
    Abstract [en]

    This study aimed at contributing to the elucidation of the genetic basis of age-related hearing impairment (ARHI), a common multifactorial disease with an important genetic contribution as demonstrated by heritability studies. We conducted a genome-wide association study (GWAS) in the Finnish Saami, a small, ancient, genetically isolated population without evidence of demographic expansion. The choice of this study population was motivated by its anticipated higher extent of LD, potentially offering a substantial power advantage for association mapping. DNA samples and audiometric measurements were collected from 352 Finnish Saami individuals, aged between 50 and 75 years. To reduce the burden of multiple testing, we applied principal component (PC) analysis to the multivariate audiometric phenotype. The first three PCs captured 80% of the variation in hearing thresholds, while maintaining biologically important audiometric features. All subjects were genotyped with the Affymetrix 100 K chip. To account for multiple levels of relatedness among subjects, as well as for population stratification, association testing was performed using a mixed model. We summarised the top-ranking association signals for the three traits under study. The top-ranked SNP, rs457717 (P-value 3.55 x 10(-7)), was associated with PC3 and was localised in an intron of the IQ motif-containing GTPase-activating-like protein (IQGAP2). Intriguingly, the SNP rs161927 (P-value 0.000149), seventh-ranked for PC1, was positioned immediately downstream from the metabotropic glutamate receptor-7 gene (GRM7). As a previous GWAS of a European and Finnish sample set already suggested a role for GRM7 in ARHI, this study provides further evidence for the involvement of this gene.

  • 31.
    Neely, G Gregory
    et al.
    Austrian Academy of Science.
    Hess, Andreas
    University of Erlangen Nurnberg.
    Costigan, Michael
    Harvard University.
    Keene, Alex C
    NYU.
    Goulas, Spyros
    Austrian Academy of Science.
    Langeslag, Michiel
    Innsbruck Medical University.
    Griffin, Robert S
    Massachusetts General Hospital.
    Belfer, Inna
    University of Pittsburgh.
    Dai, Feng
    University of Pittsburgh.
    Smith, Shad B
    University N Carolina.
    Diatchenko, Luda
    University N Carolina.
    Gupta, Vaijayanti
    Strand Life Science Pvt Ltd.
    Xia, Cui-Ping
    Austrian Academy Science.
    Amann, Sabina
    Austrian Academy of Science.
    Kreitz, Silke
    University of Erlangen Nurnberg.
    Heindl-Erdmann, Cornelia
    University of Erlangen Nurnberg.
    Wolz, Susanne
    University of Erlangen Nurnberg.
    Ly, Cindy V
    Strand Life Science Pvt Ltd.
    Sarangi, Rinku
    Strand Life Science Pvt Ltd.
    Dan, Debasis
    Strand Life Science Pvt Ltd.
    Novatchkova, Maria
    Austrian Academy of Science.
    Rosenzweig, Mark
    Brandeis University.
    Gibson, Dustin G
    University N Carolina.
    Truong, Darwin
    Austrian Academy of Science.
    Schramek, Daniel
    Austrian Academy of Science.
    Zoranovic, Tamara
    Austrian Academy of Science.
    Cronin, Shane J F
    Austrian Academy of Science.
    Angjeli, Belinda
    Austrian Academy of Science.
    Brune, Kay
    University of Erlangen Nurnberg.
    Dietzl, Georg
    Stanford University.
    Maixner, William
    University N Carolina.
    Meixner, Arabella
    Austrian Academy of Science.
    Thomas, Winston
    Deltagen Inc.
    Pospisilik, J Andrew
    Max Planck Institute.
    Alenius, Mattias
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Developmental Biology, IKE.
    Kress, Michaela
    Innsbruck Medical University.
    Subramaniam, Sai
    Strand Life Science Pvt Ltd.
    Garrity, Paul A
    Brandeis University.
    Bellen, Hugo J
    Baylor College of Medicine.
    Woolf, Clifford J
    Harvard University.
    Penninger, Josef M
    Austrian Academy of Science.
    A Genome-wide Drosophila Screen for Heat Nociception Identifies alpha 2 delta 3 as an Evolutionarily Conserved Pain Gene2010In: CELL, ISSN 0092-8674, Vol. 143, no 4, 628-638 p.Article in journal (Refereed)
    Abstract [en]

    Worldwide, acute, and chronic pain affects 20% of the adult population and represents an enormous financial and emotional burden. Using genome-wide neuronal-specific RNAi knockdown in Drosophila, we report a global screen for an innate behavior and identify hundreds of genes implicated in heat nociception, including the alpha 2 delta family calcium channel subunit straightjacket (stj). Mice mutant for the stj ortholog CACNA2D3 (alpha 2 delta 3) also exhibit impaired behavioral heat pain sensitivity. In addition, in humans, alpha 2 delta 3 SNP variants associate with reduced sensitivity to acute noxious heat and chronic back pain. Functional imaging in alpha 2 delta 3 mutant mice revealed impaired transmission of thermal pain-evoked signals from the thalamus to higher-order pain centers. Intriguingly, in alpha 2 delta 3 mutant mice, thermal pain and tactile stimulation triggered strong cross-activation, or synesthesia, of brain regions involved in vision, olfaction, and hearing.

  • 32. Enström, Camilla
    et al.
    Osman, Abdimajid
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Lindahl, Tomas
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    A genotyping method for VKORC1 1173C>T by Pyrosequencing® technology2008In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 68, no 5, 427-430 p.Article in journal (Refereed)
    Abstract [en]

    Vitamin K epoxide reductase complex subunit 1 (VKORC1) is the site of inhibition by warfarin and other anti-vitamin K drugs during oral anticoagulant therapy. The SNP rs9934438 in intron 1 of VKORC1 (c.173+1000C>T or 1173C>T) discriminating the VKORC1*2 haplotype is associated with low warfarin dose requirement and unstable prothrombin time - international normalized ratio. To genotype this SNP, we have developed a rapid method using Pyrosequencing® technology. The proposed method takes a post-PCR sample preparation of less than 1 h and a DNA sequencing time of less than 15 min to genotype 96 samples. The current method was compared with a dHPLC method that we reported previously. Genotype frequencies at VKORC1 1173C>T for our Swedish population were 38 % wild-type, 40 % heterozygote and 22 % homozygote. The frequency of the T-allele was 0.42, which exactly matches the frequency previously reported for Germans. The current method can be used to determine whether patients initiating warfarin therapy are carriers of SNP 1173 C>T that is strongly associated with low warfarin dose requirement. © 2008 Informa UK Ltd (Informa Healthcare, Taylor & Francis AS).

  • 33.
    Jonsson, E
    et al.
    Quantify Research, Stockholm, Sweden.
    Hansson-Hedblom, A
    Quantify Research, Stockholm, Sweden.
    Ljunggren, Ö
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Åkesson, K
    Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden.
    Spångeus, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Kanis, J A
    University of Sheffield, Sheffield, UK, Catholic University of Australia, Melbourne, Australia.
    Borgström, F
    Quantify Research, Stockholm, Karolinska Institutet, Stockholm, Sweden.
    A health economic simulation model for the clinical management of osteoporosis.2017In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965Article in journal (Refereed)
    Abstract [en]

    The objective was to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice. Results showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings.

    INTRODUCTION: The purpose of this study is to estimate the burden of osteoporosis in Sweden based on current clinical practice and the cost-effectiveness of improvements in the management of osteoporosis over the clinical management compared to current clinical practice.

    METHODS: The analysis was carried out using a model that simulates the individual patients considered for pharmacological treatment during 1 year and their projected osteoporosis treatment pathway, quality-adjusted life years (QALYs) and costs over their remaining lifetime. All patients regardless of treatment or no treatment were simulated. Information on current management of osteoporosis in terms of patient characteristics and treatment patterns were derived from a Swedish osteoporosis research database based on national registers and patient records. Current (standard) clinical management was compared with alternative scenarios mirroring Swedish treatment guidelines.

    RESULTS: The national burden in terms of lost QALYs was estimated at 14,993 QALYs and the total economic cost at €776M. Scenario analyses showed that 382-3864 QALYs could be gained at a cost/QALY ranging from cost-saving to €31368, depending on the scenario. The margin of investment, i.e. the maximum amount that could be invested in the healthcare system to achieve these improvements up to the limit of the willingness to pay/QALY, was estimated at €199M on a population level (€3,634/patient).

    CONCLUSIONS: The analysis showed that better compliance to treatment guidelines is associated with better projected outcomes and cost-savings. From a cost-effectiveness perspective, there is also considerable room for investment to achieve these improvements in the management of osteoporosis.

  • 34.
    Samuelsson, Ulf
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Steineck, Isabelle
    Herning Hospital, Denmark .
    Gubbjornsdottir, Soffia
    University of Gothenburg, Sweden .
    A high mean-HbA1c value 3-15 months after diagnosis of type 1 diabetes in childhood is related to metabolic control, macroalbuminuria, and retinopathy in early adulthood - a pilot study using two nation-wide population based quality registries2014In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 15, no 3, 229-235 p.Article in journal (Refereed)
    Abstract [en]

    BackgroundIntensive treatment of patients with type 1 diabetes delays the onset of long-term complications. ObjectivesOn the basis of the information from two nation-wide quality registers, we investigated to which extent HbA1c values 3-15months after diagnosis in childhood are related to metabolic control, albuminuria, and retinopathy in early adulthood. MethodsIn Sweden, physicians register all children and adolescents with type 1 diabetes mellitus in the Swedish Pediatric Quality Registry. After 18yr of age, people with diabetes are followed by the Swedish National Diabetes Register. We identified 1543 children and adolescents with a mean age of 13.9yr at diagnosis and a mean duration of type 1 diabetes mellitus of 7.1yr. ResultsChildren and adolescents with poor metabolic control (mean HbA1c 70mmol/mol (8.6 %)) adjacent to diagnosis had a significantly higher mean HbA1c value years later as adults than did patients with a good metabolic control [less than50mmol/mol (6.7%) (pless than0.001)]. The patients in the high group were also less physically active and smoked more as adults. The proportion of females was higher in the poor metabolic group. Patients with a high mean HbA1c 3-15months after diagnosis had significantly more often macroalbuminuria and retinopathy in early adulthood. ConclusionsMetabolic control adjacent to the diagnosis of type 1 diabetes in childhood or adolescence can predict metabolic control in early adulthood. It is therefore very important that pediatric diabetes teams identify key factors for successful early metabolic control. Actively using quality registries may be one such factor.

  • 35.
    Timpka, Toomas
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Hermansson, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Bolme, P
    Häger, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Valter, L
    A high-precision protocol for identification of preschool children at risk for persisting obesity2007In: PLoS ONE, ISSN 1932-6203, Vol. 2, no 6Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies suggest that adolescent adiposity is established already in preadolescence. Earlier studies have confirmed a strong tracking of obesity from adolescence to adulthood. Our aim was to examine the diagnostic accuracy of a population-derived protocol for identification of preschool children at risk for obesity in preadolescence. Methodology/Principal Findings: We analysed data obtained for child health surveillance up to age 5 from 5778 children born in a swedish county in 1991. The basic data set included age, sex, and weight and height measurements from the regular checkups between ages 1.5 and 5. Data not routinely collected in the child health centre setting were disregarded. The children were at age 10 randomly assigned to protocol derivation and validation cohorts and assessed for obesity according to IOTF criteria. The accuracy of predicting obesity in the validation cohort was measured using decision precision, specificity, and sensitivity. The decision protocol selected 1.4% of preschool children as being at obesity risk. The precision of the protocol at age 10 was 82% for girls and 80% for boys, and the specificity was 100% for both boys and girls, The sensitivity was higher for girls (41 %) than for boys (21%). The relative risk for obesity at age 10 estimated by the odds ratio for individuals selected by the protocol compared to non-selected peers was 212.6 (95% confidence interval 56.6 to 798.4) for girls and 120.3 (95% Cl 24.5 to 589.91for boys. Conclusion/Significance: A simple and inexpensive decision protocol based on BMI values proved to have high precision and specificity for identification of preschool children at risk for obesity persisting into adolescence, while the sersitivity was low especially for boys. Implementation and further evaluations of the protocol in chlid health centre settings are warranted. © 2007 Timpka et al.

  • 36.
    von Wachenfeldt, Anna
    et al.
    Karolinska Inst, Karolinska Univ Hosp, Dept Oncol, S-11883 Stockholm, Sweden .
    Lindblom, Annika
    Karolinska Univ Hosp, Dept Mol Med & Surg, CMM, Stockholm, Sweden .
    Gronberg, Henrik
    Umea Univ Hosp, Ctr Oncol, S-90185 Umea, Sweden .
    Einbeigi, Zakaria
    Univ Gothenburg, Sahlgrenska Acad, Dept Oncol, Gothenburg, Sweden .
    Rosenquist, Richard
    Uppsala Univ, Dept Genet & Pathol, Uppsala, Sweden .
    Gårdman, Camilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine.
    Iselius, Lennart
    Karolinska Univ Hosp, Dept Surg, Stockholm, Sweden.
    A hypothesis-generating search for new genetic breast cancer syndromes - a national study in 803 Swedish families2007In: HEREDITY CANCER IN CLINICAL PRACTICE, ISSN 1731-2302, Vol. 5, no 1, 17-24 p.Article in journal (Refereed)
    Abstract [en]

    Among Swedish families with an inherited predisposition for breast cancer, less than one third segregate mutations in genes known to be associated with an increased risk of breast cancer in combination with other types of tumours. In a search for new putative familial breast cancer syndromes we studied Swedish families undergoing genetic counselling during 1992-2000. Four thousand families from counselling clinics in Sweden were eligible for study. Families with breast cancer only were excluded, as were families with mutations in genes already known to be associated with malignant diseases. We identified 803 families with two or more cases of breast cancer and at least one other type of cancer. The observed proportion of different types of non-breast cancer was compared with the percentage distribution of non-breast cancer tumours in Sweden in 1958 and 1999. We found tumours in the colon, ovary, endometrium, pancreas and liver, as well as leukaemia in a significantly larger proportion of the study population than in the general population in both years. These tumours were also seen among families where several members had one additional tumour, suggesting that malignancies at these sites, in combination with breast tumours, could constitute genetic syndromes. Endometrial carcinoma has not previously been described in the context of breast cancer syndromes and the excess of malignancies at this site could not be explained by secondary tumours. Thus, we suggest that endometrial carcinoma and breast cancer constitute a new breast cancer syndrome. Further investigation is warranted to categorize phenotypes of both breast and endometrial tumours in this subgroup.

  • 37.
    Motel-Klingebiel, Andreas
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    A life course scholar’s view: Life courses crystallise in demographic structure2015In: Population ageing from a life-course perspective / [ed] Kathrin Komp, Stina Johansson, Bristol: Policy Press, 2015, 39-42 p.Chapter in book (Refereed)
  • 38.
    Håkansson, Jennie
    et al.
    Linköping University, Department of Physics, Chemistry and Biology, Zoology . Linköping University, The Institute of Technology.
    Jensen, Per
    Linköping University, Department of Physics, Chemistry and Biology, Zoology . Linköping University, The Institute of Technology.
    A longitudinal study of antipredator behaviour in four successive generations of two populations of captive red junglefowl2008In: Applied Animal Behaviour Science, ISSN 0168-1591, E-ISSN 1872-9045, Vol. 114, no 3-4, 409-418 p.Article in journal (Refereed)
    Abstract [en]

    Conservation breeding and reintroduction into the wild can only be an effective management tool if behaviours essential for a life in the wild are maintained in captivity. The aim of this study was to investigate how a protected captive environment influences antipredator behaviour over generations. The red junglefowl (Gallus gallus) was used as a case study. Birds from two different captive populations were followed over four generations. In the last three generations, all birds were hatched and reared in the same indoor settings. Antipredator behaviour was measured in each generation in a standardised test where the birds were exposed to a simulated predator attack. The test was divided into three parts: pre-exposure period, exposure and post-exposure periods. There was an interaction effect between Population and generation (F-3.129 = 4.84, P < 0.01) on behaviour during the pre-exposure period, suggesting that the birds "baseline" agitation level may have been altered differently in the two populations. Population differences were also found during the post-exposure period but the populations tended to become more similar over successive generations in their behaviour after the exposure. Furthermore, there were significant effects of generation (H (d.f. = 1, N = 137) = 10.94, P < 0.05) as well as population (H (d.f. = 1, N = 137) = 5.17, P < 0.05) on the immediate reaction to the simulated predator attack. In conclusion, over four successive generations, the two populations altered their antipredator behaviour and tended to become more similar. This study shows that antipredator behaviour may change over generations in a captive environment. This is likely to be one of the most crucial factors for successful reintroduction into the wild and hence, it is a very important aspect to consider for conservation breeding.

  • 39.
    Holmqvist, Britt-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Löfman, Owe
    Institute of Mathematical Science and Technology, The Norwegian University of Life Sciences, Aas, Norway.
    Samuelsson, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    A low incidence of Type 1 diabetes between 1977 and 2001 in south-eastern Sweden in areas with high population density and which are more deprived2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 3, 255-260 p.Article in journal (Refereed)
    Abstract [en]

    Aims  To explore how socioeconomic factors and population density may contribute to the geographical variation of incidence of Type 1 diabetes in children in south-eastern Sweden.

    Method  All children diagnosed with Type 1 diabetes in south-eastern Sweden during 1977–2001 were defined geographically to their place of residence and were allocated x and y coordinates in the national grid. The population at risk and socioeconomic data were aggregated in 82 000 200-m squares and geocoded likewise. A socioeconomic index was calculated using a signed χ2 method. Rural–urban gradients were defined by overlay analysis in a geographic information system.

    Results  The incidence during the past 25 years has been rising steadily, particularly in the last 6 years. The incidence was highest in areas with a high proportion of small families, of families with a high family income and better education, and this was found both at the time of diagnosis and at the time of birth. In the rural–urban analysis, the lowest incidence was found in the urban area with > 20 000 inhabitants, where there was also a higher frequency of deprivation.

    Conclusions  Our findings indicate that geographical variations in incidence rates of Type 1 diabetes in children are associated with socioeconomic factors and population density, although other contributing factors remain to be explained.

  • 40.
    Pienaar, Elsje
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Lerm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    A mathematical model of the initial interaction between Mycobacterium tuberculosis and macrophages2014In: Journal of Theoretical Biology, ISSN 0022-5193, E-ISSN 1095-8541, Vol. 342, 23-32 p.Article in journal (Refereed)
    Abstract [en]

    There is a large body of literature describing molecular level interactions between Mycobacterium tuberculosis (Mtb) and macrophages. Macrophages initiate a range of anti-bacterial mechanisms in response to infection, and Mtb is capable of surviving and circumventing many of these responses. We apply a computational approach to ask: what are the effects on the cellular level of these opposing interactions? The model considers the interplay between bacterial killing and the pathogen's interference with macrophage function. The results reveal an oscillating balance between host and pathogen, but the balance is transient and varies in length, indicating that stochasticity in the bacterial population or host response could contribute to the diverse incubation periods observed in exposed individuals. The model captures host and strain variation and gives new insight into host-pathogen compatibility and co-evolution.

  • 41. Liljedahl, U
    et al.
    Karlsson, J
    Melhus, H
    Kurland, L
    Lindersson, M
    Kahan, T
    Nyström, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MC - Medicincentrum, EMT-endo.
    Lind, L
    Syvanen, AC
    A microarray minisequencing system for pharmacogenetic profiling of antihypertensive drug response2003In: Pharmacogenetics, ISSN 0960-314X, E-ISSN 1473-561X, Vol. 13, no 1Article in journal (Refereed)
    Abstract [en]

    We aimed to develop a microarray genotyping system for multiplex analysis of a panel of single nucleotide polymorphisms (SNPs) in genes encoding proteins involved in blood pressure regulation, and to apply this system in a pilot study demonstrating its feasibility in the pharmacogenetics of hypertension. A panel of 74 SNPs in 25 genes involved in blood pressure regulation was selected from the SNP databases, and genotyped in DNA samples of 97 hypertensive patients. The patients had been randomized to double-blind treatment with either the angiotensin II type 1 receptor blocker irbesartan or the ▀1-adrenergic receptor blocker atenolol. Genotyping was performed using a microarray based DNA polymerase assisted 'minisequencing' single nucleotrde primer extension assay with fluorescence detection. The observed genotypes were related to the blood pressure reduction using stepwise multiple regression analysis. The allele frequencies of the selected SNPs were determined in the Swedish population. The established microarray-based genotyping system was validated and allowed unequivocal multiplex genotyping of the panel of 74 SNPs in every patient. Almost 7200 SNP genotypes were generated in thestudy. Profiles of four or five SNP-genotypes that may be useful as predictors of blood pressure reduction after antihypertensive treatment were identified. Our results highlight the potential of microarray-based technology for SNP genotyping in pharmacogenetics. Pharrnacogenetics 13:7-17 ⌐ 2003 Lippincott Williams & Wilkins.

  • 42.
    Petersson, Fredrik
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Borch, Kurt
    Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Rehfeld, J.F.
    Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Denmark.
    Franzén, Lennart E.
    Department of Pathology, University Hospital, Örebro, Sweden.
    A morphometric study of antral G-cell density in a sample of adult general population: comparison of three different methods and correlation with patient demography, helicobacter pylori infection, histomorphology and circulating gastrin levels2009In: International Journal of Clinical and Experimental Pathology, ISSN 1936-2625, E-ISSN 1936-2625, Vol. 2, no 3, 239-248 p.Article in journal (Refereed)
    Abstract [en]

    Helicobacter pylori infection has been linked to hypergastrinemia and either decreased or normal G-cell content in the antral mucosa. To clarify this controversial issue, we quantitatively determined antral G-cell content on the same biopsy specimens with three different methods and examined whether these methods are intercorrelated and the relation of these methods to plasma gastrin concentrations, demography, the occurrence of H. pylori infection and chronic gastritis. Gastric antral mucosal biopsy sections from 273 adults (188 with and 85 without H pylori infection) from a general population sample were examined immunohistochemically for G-cells using cell counting, stereology (point counting) and computerized image analysis. Gastritis was scored according to the updated Sydney system. Basal plasma gastrin concentrations were measured by radioimmunoassay. The three methods for G-cell quantification were poorly correlated and the results showed no correlation with basal plasma gastrin concentrations. The antral G-cell density and scores for H. pylori colonization were positively related to age. Neither the scores for chronic inflammation, nor the scores for inflammatory activity, atrophy or intestinal metaplasia were consistently related to the antral G-cell content. In conclusion, the results of three techniques for G-cell quantification in the gastric antral mucosa were poorly intercorrelated and none of the methods correlated with plasma gastrin concentrations. Age and scores for H pylori colonization seem to be determinants of the G-cell density. That common morphometric techniques correlate poorly is of utmost importance to bear in mind when quantitative morphological studies are planned, compared or interpreted.

  • 43.
    Lorefält, Birgitta
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wilhelmsson, Susan
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    A multifaceted intervention model can give a lasting improvement of older peoples nutritional status2012In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, no 4, 378-382 p.Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was with a multifaceted intervention model improve the nutritional status of elderly people living in residential homes to increase their energy intake and to maintain improvements over time. less thanbrgreater than less thanbrgreater thanThree different municipal residential homes in the south-east of Sweden. less thanbrgreater than less thanbrgreater thanThe study population consisted of 67 elderly people. A within-subjects design was used which means that the participants were their own controls. less thanbrgreater than less thanbrgreater thanA multifaceted intervention model was chosen, which included education on both theoretical and practical issues, training and support for staff, and individualized snacks to the residents. less thanbrgreater than less thanbrgreater thanNutritional status was measured by Mini Nutritional Assessment (MNA), the consumption of food was recorded by the staff using a food record method for 3 consecutive days. The length of night-time fasting has been calculated from the food records. less thanbrgreater than less thanbrgreater thanNutritional status improved after 3 months of intervention and was maintained after 9 months. Weight increased during the whole study period. Night-time fasting decreased but not to the recommended level. less thanbrgreater than less thanbrgreater thanThis study shows that it is possible by a multifaceted intervention model to increase energy intake including expanding snacks and thereby improve and maintain nutritional status over a longer period in the elderly living in residential homes. This result was possible to achieve because staff received education and training in nutritional issues and by provision of support during a period when new routines were introduced.

  • 44.
    Dahlin, Lars-Göran
    et al.
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Granfeldt, Hans
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hultkvist, Henrik
    Linköping University, Department of Medicine and Care, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    A multimodal approach for reducing wound infections after sternotomy2004In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 3, no 1, 206-210 p.Article in journal (Refereed)
    Abstract [en]

    As previous efforts failed to reduce infection rates after cardiac surgery at our institution, we developed a concept based on adjustment of surgical technique. This concept was then evaluated in clinical practice. We modified our surgical technique towards: minimizing contamination, avoidance of devitalizing tissue, and securing a rigid fixation of the caudal part of sternum. After a pilot series sequential series was compared before and after introduction of the modified technique in a case-series design. All surgical site infections were recorded at discharge, after 6 weeks and by the attending cardiologist at 2 and 6 months. In the pilot series 9/136 patients developed sternal wound infections (SWI) compared with 15/89 patients in the control group (P=0.015). In the larger study population we found a significant drop in the total number of SWIs (72/772 vs 124/772, P≪0.0001). Although not statistically significant a 32% reduction in deep SWIs was observed. No reduction in infections at harvest sites for graft material was seen. The preliminary results from the pilot study appear reproducible and we were able to reduce the incidence of SWIs significantly, using this simple modified surgical technique.

  • 45.
    Nyholm, Tufve
    et al.
    Umeå University, Sweden; Uppsala University, Sweden.
    Olsson, Caroline
    Gothenburg University, Sweden; Western Sweden Healthcare Reg, Sweden.
    Agrup, Måns
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Bjork, Peter
    Mälar Hospital, Sweden.
    Bjork-Eriksson, Thomas
    Sahlgrenska University Hospital, Sweden.
    Gagliardi, Giovanna
    Karolinska University Hospital, Sweden.
    Grinaker, Hanne
    Swedish Radiation Safety Authority, Sweden.
    Gunnlaugsson, Adalsteinn
    Lund University, Sweden.
    Gustafsson, Anders
    Cureos AB, Sweden.
    Gustafsson, Magnus
    Sahlgrenska University Hospital, Sweden.
    Johansson, Bengt
    Örebro University Hospital, Sweden; University of Örebro, Sweden.
    Johnsson, Stefan
    Kalmar County Hospital, Sweden.
    Karlsson, Magnus
    Umeå University, Sweden.
    Kristensen, Ingrid
    Lund University, Sweden.
    Nilsson, Per
    Lund University, Sweden.
    Nystrom, Leif
    Umeå University, Sweden.
    Onjukka, Eva
    Karolinska University Hospital, Sweden.
    Reizenstein, Johan
    University of Örebro, Sweden.
    Skonevik, Johan
    Umeå University, Sweden; Örebro University Hospital, Sweden.
    Soderstrom, Karin
    Umeå University, Sweden.
    Valdman, Alexander
    Karolinska University Hospital, Sweden.
    Zackrisson, Bjorn
    Umeå University, Sweden.
    Montelius, Anders
    Uppsala University, Sweden.
    A national approach for automated collection of standardized and population-based radiation therapy data in Sweden2016In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 119, no 2, 344-350 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: To develop an infrastructure for structured and automated collection of interoperable radiation therapy (RT) data into a national clinical quality registry. Materials and methods: The present study was initiated in 2012 with the participation of seven of the 15 hospital departments delivering RT in Sweden. A national RT nomenclature and a database for structured unified storage of RT data at each site (Medical Information Quality Archive, MIQA) have been developed. Aggregated data from the MIQA databases are sent to a national RT registry located on the same IT platform (INCA) as the national clinical cancer registries. Results: The suggested naming convention has to date been integrated into the clinical workflow at 12 of 15 sites, and MIQA is installed at six of these. Involvement of the remaining 3/15 RT departments is ongoing, and they are expected to be part of the infrastructure by 2016. RT data collection from ARIA (R), Mosaiq (R), Eclipse (TM), and Oncentra (R) is supported. Manual curation of RT-structure information is needed for approximately 10% of target volumes, but rarely for normal tissue structures, demonstrating a good compliance to the RT nomenclature. Aggregated dose/volume descriptors are calculated based on the information in MIQA and sent to INCA using a dedicated service (MIQA2INCA). Correct linkage of data for each patient to the clinical cancer registries on the INCA platform is assured by the unique Swedish personal identity number. Conclusions: An infrastructure for structured and automated prospective collection of syntactically inter operable RT data into a national clinical quality registry for RT data is under implementation. Future developments include adapting MIQA to other treatment modalities (e.g. proton therapy and brachytherapy) and finding strategies to harmonize structure delineations. How the RT registry should comply with domain-specific ontologies such as the Radiation Oncology Ontology (ROO) is under discussion. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 46.
    Vande Walle, Johan GJ
    et al.
    Dept Pediatric Nephrology, University of Gent, .
    Mattsson, Sven
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Schurmans, Thierry
    Dept of Pediatric Nephrology, Brussels, Belgium.
    Hoebeke, Piet
    Dept of Pediatrics Urology, University of Gent .
    Deboe, Veerle
    Dept of Urology van de Vrije Universiteit, Brussels.
    Norgaard, Jens Peter
    Ferring Pharmaceuticals A/S Copenhagen, Denmark. .
    A new fast-melting oral formulation of desmopressin: A pharmacodynamic study in children with primary nocturnal enuresis2006In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 97, no 3, 603-609 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine the pharmacodynamic properties of a new oral lyophilisate formulation of desmopressin (in single doses of 30, 60, 120, 240, 360 or 480 μg) in children with known primary nocturnal enuresis (PNE) and thus identify those dosages that could provide a duration of action corresponding to a typical length of night-time sleep in children with PNE, additional objectives were to determine the safety and tolerability of desmopressin in this population. PATIENTS AND METHODS: Children with PNE (mean three or more wet nights/week), aged 6-12 years, were randomized into a double-blind, placebo-controlled study. An overhydration technique was used before dosing to suppress endogenous vasopressin production and thereby ensure that any antidiuresis could be attributed to treatment. Dosing with desmopressin or placebo occurred when urinary production was >0.13 mL/min/kg. Urinary volume, osmolality and duration of urinary-concentrating action (above three threshold levels: 125, 200 and 400 mOsm/kg) were determined as endpoints. RESULTS: All 72 participants receiving desmopressin had a pharmacodynamic response to the drug, while there was no change in urinary output in the 12 placebo-treated patients. There was a clear relationship between desmopressin dose and duration of action and osmolality during action, although the three highest-dose groups had similar results. The mean duration of action of desmopressin at the lowest osmolality threshold level was 3.6-10.6 h, according to dose, for the highest threshold, the values were 1.3-8.6 h. CONCLUSION: Desmopressin, as the oral lyophilisate, causes a marked decrease in urinary output in hydrated children with PNE. A small dose range (120-240 μg) is likely to control diuresis for a period corresponding to a night's sleep (7-11 h) in most children with PNE. However, some patients might require a higher dose to obtain antidiuresis for the complete night. © 2006 BJU International.

  • 47.
    Kytovuori, Laura
    et al.
    Oulu University Hospital, Finland; University of Oulu, Finland; University of Oulu, Finland; Oulu University Hospital, Finland.
    Hannula, Samuli
    Oulu University Hospital, Finland; University of Oulu, Finland; Oulu University Hospital, Finland; University of Oulu, Finland.
    Mäki-Torkko, Elina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences. Oulu University Hospital, Finland.
    Sorri, Martti
    Oulu University Hospital, Finland; University of Oulu, Finland; Oulu University Hospital, Finland; University of Oulu, Finland.
    Majamaa, Kari
    Oulu University Hospital, Finland; University of Oulu, Finland; University of Oulu, Finland; Oulu University Hospital, Finland.
    A nonsynonymous mutation in the WFS1 gene in a Finnish family with age-related hearing impairment2017In: Hearing Research, ISSN 0378-5955, E-ISSN 1878-5891, Vol. 355, 97-101 p.Article in journal (Refereed)
    Abstract [en]

    Wolfram syndrome (WS) is caused by recessive mutations in the Wolfram syndrome 1 (WFS1) gene. Sensorineural hearing impairment (HI) is a frequent feature in WS and, furthermore, certain mutations in WFS1 cause nonsyndromic dominantly inherited low-frequency sensorineural HI. These two phenotypes are clinically distinct indicating that WFS1 is a reasonable candidate for genetic studies in patients with other phenotypes of HI. Here we have investigated, whether the variation in WFS1 has a pathogenic role in age-related hearing impairment (ARHI). WFS1 gene was investigated in a population sample of 518 Finnish adults born in 1938-1949 and representing variable hearing phenotypes. Identified variants were evaluated with respect to pathogenic potential. A rare mutation predicted to be pathogenic was found in a family with many members with impaired hearing. Twenty members were recruited to a segregation study and a detailed clinical examination. Heterozygous p.Tyr528His variant segregated completely with late-onset HI in which hearing deteriorated first at high frequencies and progressed to mid and low frequencies later in life. We report the first mutation in the WFS1 gene causing late-onset HI with audiogram configurations typical for ARHI. Monogenic forms of ARHI are rare and our results add WFS1 to the short list of such genes. (C) 2017 Elsevier B.V. All rights reserved.

  • 48.
    Farnebo, Lovisa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Laurell, Göran
    Uppsala University, Sweden.
    Makitie, Antti
    University of Helsinki, Finland; Helsinki University Hospital, Finland; Karolinska Institute, Sweden.
    A Nordic survey on the management of head and neck CUP2016In: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 136, no 11, 1159-1163 p.Article in journal (Refereed)
    Abstract [en]

    Conclusion: The management of Head and Neck Cancer of Unknown Primary (HNCUP) patients varies both between centres within and also between the Nordic countries. This study contributes to a continuing discussion of how to improve the accuracy of diagnosis and quality of treatment of HNCUP patients.Objectives: The initiative for this study was based on the lack of common guidelines for diagnostic procedures and for treatment of HNCUP patients in the Nordic countries constituting a region having a rather homogeneous population.Method: A structured questionnaire was sent to all university hospitals in the five Nordic countries.Results: Four of the five Nordic countries use either national guidelines or specific protocols when handling HNCUP. The main diagnostic tools are PET-CT, fine needle aspiration, endoscopic evaluation with biopsies, and most often bilateral tonsillectomy. At 21 of 22 university hospitals the treatment decision is made at a multidisciplinary conference. Three of seven Swedish centres use only radiotherapy or chemoradiotherapy to treat N+ HNCUP patients. Robotic surgery for biopsy of the tongue base is beginning to become an alternative to targeted biopsies in Sweden and Finland. Narrow Band Imaging is used only in Finland.

  • 49.
    Pizzari, T.
    et al.
    Section of Ethology, Dept. of Anim. Environ. and Health, Swed. Univ. of Agricultural Sciences, PO Box 234, Skara SE 532 31, Sweden, Evolution and Ecology Group, School of Biology, University of Leeds, Leeds LS2 9JT, United Kingdom.
    Jensen, Per
    Linköping University, Department of Physics, Chemistry and Biology, Zoology .
    Cornwallis, C.K.
    Dept. of Animal and Plant Sciences, University of Sheffield, Sheffield S10 2TN, United Kingdom.
    A novel test of the phenotype-linked fertility hypothesis reveals independent components of fertility2004In: Philosophical Transactions of the Royal Society of London. Biological Sciences, ISSN 0962-8436, E-ISSN 1471-2970, Vol. 271, no 1534, 51-58 p.Article in journal (Refereed)
    Abstract [en]

    The phenotype-linked fertility hypothesis predicts that male sexual ornaments signal fertilizing efficiency and that the coevolution of male ornaments and female preference for such ornaments is driven by female pursuit of fertility benefits. In addition, directional testicular asymmetry frequently observed in birds has been suggested to reflect fertilizing efficiency and to covary with ornament expression. However, the idea of a phenotypic relationship between male ornaments and fertilizing efficiency is often tested in populations where environmental effects mask the underlying genetic associations between ornaments and fertilizing efficiency implied by this idea. Here, we adopt a novel design, which increases genetic diversity through the crossing of two divergent populations while controlling for environmental effects, to test: (i) the phenotypic relationship between male ornaments and both, gonadal (testicular mass) and gametic (sperm quality) components of fertilizing efficiency, and (ii) the extent to which these components are phenotypically integrated in the fowl, Gallus gallus. We show that consistent with theory, the testosterone-dependent expression of a male ornament, the comb, predicted testicular mass. However, despite their functional inter-dependence, testicular mass and sperm quality were not phenotypically integrated. Consistent with this result, males of one parental population invested more in testicular and comb mass, whereas males of the other parental population had higher sperm quality. We found no evidence that directional testicular asymmetry covaried with ornament expression. These results shed new light on the evolutionary relationship between male fertilizing efficiency and ornaments. Although testosterone-dependent ornaments may covary with testicular mass and thus reflect sperm production rate, the lack of phenotypic integration between gonadal and gametic traits reveals that the expression of an ornament is unlikely to reflect the overall fertilizing efficiency of a male.

  • 50.
    Vaziri-Sani, Fariba
    et al.
    Lund University.
    Delli, Ahmed J
    Lund University,.
    Elding-Larsson, Helena
    Lund University.
    Lindblad, Bengt
    Queen Silvia Childrens Hospital.
    Carlsson, Annelie
    Lund University.
    Forsander, Gun
    Queen Silvia Childrens Hospital.
    Ivarsson, Sten A
    Lund University.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Marcus, Claude
    Karolinska Institute.
    Lernmark, Ake
    Lund University.
    A novel triple mix radiobinding assay for the three ZnT8 (ZnT8-RWQ) autoantibody variants in children with newly diagnosed diabetes2011In: JIM - Journal of Immunological Methods, ISSN 0022-1759, E-ISSN 1872-7905, Vol. 371, no 1-2, 25-37 p.Article in journal (Refereed)
    Abstract [en]

    Background and aims: Autoantibodies against the zinc transporter 8 (ZnT8A) are common in type 1 diabetes (T1D). ZnT8A analyses are complicated by the fact that there are three variants of the autoantigen at amino acid position 325 representing ZnT8-R (Arginine), ZnT8-W (Tryptophan) and ZnT8-Q (Glutamin). The aims of the study were: 1) to develop an autoantigen triple mix Radio-Binding Assay (RBA) for ZnT8A: 2) to identify the individual ZnT8-R,-W,-QA reactivity and 3) to validate the triple mix ZnT8A RBA in children with newly diagnosed T1D. less thanbrgreater than less thanbrgreater thanMethods: Serum samples were obtained from 2664 (56% males, n = 1436) patients in the Swedish nationwide Better Diabetes Diagnosis (BDD) study representing patients with T1D (97%, n = 2582), T2D (1.7%, n = 46), MODY (1.0%, n = 28) and secondary diabetes (0.3%, n = 8). cDNA coding for the C-terminal end of each variant was prepared by site-directed mutagenesis and subcloned into a high efficiency in vitro transcription translation vector. The ZnT8 variants were labeled with 35S-methionine and used in a standard RBA separating free from autoantibody-bound autoantigen with Protein A-Sepharose. less thanbrgreater than less thanbrgreater thanResults: ZnT8-TripleA was detected in 1678 (65%) patients with T1D, 4 (9%) T2D, 3 (11%) MODY and in none (0%) of the patients with secondary diabetes. Among the T1D patients ZnT8-RA was detected in 1351 (52%) patients, ZnT8-WA in 1209(47%) and ZnT8-QA in 790(31%) demonstrating that 1661 (64%) had one or several ZnT8A. The ZnT8-TripleA assay showed a false positive rate of 1.9% (n = 49). Only 1.2% (n = 32) of the T1D patients were false negative for ZnT8-TripleA compared to 0/46(0%) of the T2D patients. The precision (intra assay CV) and reproducibility (inter assay CV) of the ZnT8-TripleA assay did not differ from the RBA of the individual ZnT8 variants. less thanbrgreater than less thanbrgreater thanConclusion: We conclude that the ZnT8-TripleA assay had low false positive and false negative rates. The ZnT8-TripleA assay would therefore be highly suitable not only to analyze patient with newly diagnosed diabetes but also for screening the general population since this assay demonstrated high sensitivity and very high specificity.

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