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  • 1.
    Holmbom, Martin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Giske, Christian G.
    Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.; Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden..
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Östholm Balkhed, Åse
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Claesson, Carina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hoffmann, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    14-Year Survey in a Swedish County Reveals a Pronounced Increase in Bloodstream Infections (BSI). Comorbidity: An Independent Risk Factor for Both BSI and Mortality2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 11Article in journal (Refereed)
    Abstract [en]

    Objectives: we assessed the incidence, risk factors and outcome of BSI over a 14-year period (2000-2013) in a Swedish county.

    Methods: retrospective cohort study on culture confirmed BSI among patients in the county of Östergötland, Sweden, with approximately 440,000 inhabitants. A BSI was defined as either community-onset BSI (CO-BSI) or hospital-acquired BSI (HA-BSI).

    Results: of a total of 11,480 BSIs, 67% were CO-BSI and 33% HA-BSI. The incidence of BSI increased by 64% from 945 to 1,546 per 100,000 hospital admissions per year during the study period. The most prominent increase, 83% was observed within the CO-BSI cohort whilst HA-BSI increased by 32%. Prescriptions of antibiotics in outpatient care decreased with 24% from 422 to 322 prescriptions dispensed/1,000 inhabitants/year, whereas antibiotics prescribed in hospital increased by 67% (from 424 to 709 DDD per 1,000 days of care). The overall 30-day mortality for HA-BSIs was 17.2%, compared to 10.6% for CO-BSIs, with an average yearly increase per 100,000 hospital admissions of 2 and 5% respectively. The proportion of patients with one or more comorbidities, increased from 20.8 to 55.3%. In multivariate analyses, risk factors for mortality within 30 days were: HA-BSI (2.22); two or more comorbidities (1.89); single comorbidity (1.56); CO-BSI (1.21); male (1.05); and high age (1.04).

    Conclusion: this survey revealed an alarming increase in the incidence of BSI over the 14-year study period. Interventions to decrease BSI in general should be considered together with robust antibiotic stewardship programmes to avoid both over- and underuse of antibiotics.

  • 2.
    Kallstrom, Ann-Christine
    et al.
    Helsingborg Hospital.
    Salme, Rebecka
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Ryden, Lisa
    Lund University.
    Nordenskjöld, Bo
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Jonsson, Per-Ebbe
    Helsingborg Hospital.
    Stål, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Oncology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    17 beta-Hydroxysteroid dehydrogenase type 1 as predictor of tamoxifen response in premenopausal breast cancer2010In: EUROPEAN JOURNAL OF CANCER, ISSN 0959-8049, Vol. 46, no 5, 892-900 p.Article in journal (Refereed)
    Abstract [en]

    17 beta-Hydroxysteroid dehydrogenases (17HSDs) are involved in the local regulation of sex steroids. 17HSD1 converts oestrone (El) to the more potent oestradiol (E2) and 17HSD2 catalyses the reverse reaction. The aim of this study was to investigate the expression of these enzymes in premenopausal breast cancers and to analyse if they have any prognostic or tamoxifen predictive value. Premenopausal patients with invasive breast cancer, stage II (UICC), were randomised to either 2 years of adjuvant tamoxifen (n = 276) or no tamoxifen (n = 288). The median follow-up was 13.9 years (range 10.5-17.5). The expression of 17HSD1 and 17HSD2 was analysed with immunohistochemistry using tissue microarrays. The enzyme expression level (-/+/++/+++) was successfully determined in 396 and 373 tumours, respectively. Women with hormone-receptor positive tumours, with low levels (-/+/++) of 17HSD1, had a 43% reduced risk of recurrence, when treated with tamoxifen (Hazard Ratio (HR) = 0.57; 95% confidence interval (CI), 0.37-0.86; p = 0.0086). On the other hand high expression (+++) of 17HSD1 was associated with no significant difference between the two treatment arms (HR = 0.91; 95% CI, 0.43-1.95; p = 0.82). The interaction between 17HSD1 and tamoxifen was significant during the first 5 years of follow-up (p = 0.023). In the cohort of systemically untreated patients no prognostic importance was observed for 17HSD1. We found no predictive or prognostic value for 17HSD2. This is the first report of 17HSD1 in a cohort of premenopausal women with breast cancer randomised to tamoxifen. Our data suggest that 17HSD1 might be a predictive factor in this group of patients.

  • 3.
    Jansson, Agneta
    et al.
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Gunnarsson, Cecilia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Cohen, Maja
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Sivik, Tove
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Stål, Olle
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Oncology. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    17β-hydroxysteroid dehydrogenase 14 affects estradiol levels in breast cancer cells and is a prognostic marker in estrogen receptor-positive breast cancer2006In: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 66, no 23, 11471-11477 p.Article in journal (Refereed)
    Abstract [en]

    Estrogens have an important role in the progression of breast cancer. The 17β-hydroxysteroid dehydrogenase (17HSD) family has been identified to be of significance in hormone-dependent tissues. 17HSD1 and 17HSD2 are the main 17HSD enzymes involved in breast cancer investigated this far, but it is possible that other hormone-regulating enzymes have a similar role. 17HSD5 and 17HSD12 are associated with sex steroid metabolism, and 17HSD14 is a newly discovered enzyme that may be involved in the estrogen balance. The mRNA expression of 17HSD5, 17HSD12, and 17HSD14 were analyzed in 131 breast cancer specimens by semiquantitative real-time PCR. The results were compared with recurrence-free survival and breast cancer-specific survival of the patients. The breast cancer cell lines MCF7, SKBR3, and ZR75-1 were transiently transfected with 17HSD14 to investigate any possible effect on estradiol levels. We found that high 17HSD5 was related to significantly higher risk of late relapse in estrogen receptor (ER)-positive patients remaining recurrence-free later than 5 years after diagnosis (P = 0.02). No relation to 17HSD12 expression was found, indicating that 17HSD12 is of minor importance in breast cancer. Patients with ER-positive tumors with high expression levels of 17HSD14 showed a significantly better prognosis about recurrence-free survival (P = 0.008) as well as breast cancer-specific survival (P = 0.01), confirmed by multivariate analysis (P = 0.04). Transfection of 17HSD14 in the human breast cancer cells MCF7 and SKBR3 significantly decreased the levels of estradiol, presenting an effect of high expression levels of the enzyme. ©2006 American Association for Cancer Research.

  • 4.
    Gunnarsson, Cecilia
    et al.
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Hellqvist, Eva
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    Stål, Olle
    Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
    17β-hydroxysteroid dehydrogenases involved in local oestrogen synthesis have prognostic significance in breast cancer2005In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 92, no 3, 547-552 p.Article in journal (Refereed)
    Abstract [en]

    The 17β-hydroxysteroid dehydrogenase (17HSD) enzymes are involved in the local regulation of sex steroids. The 17HSD type 1 enzyme catalyses the interconversion of the weak oestrone (E1) to the more potent oestradiol (E2), whereas 17HSD type 2 catalyses the oxidation of E2 to E1. The aim of this study was to correlate the expression of these enzymes in the tumour with the recurrence-free survival of tamoxifen-treated breast cancer patients. We used real-time reverse transcriptase PCR to investigate the mRNA expression of 17HSD types 1 and 2 in tumour samples from 230 postmenopausal patients. For the patients with oestrogen receptor (ER)-positive breast cancer, we found a statistically significant positive correlation between recurrence-free survival and expression of 17HSD type 2 (P = 0.026). We examined the ratio of 17HSD types 2 and 1, and ER-positive patients with low ratios showed a significantly higher rate of recurrence than those with higher ratios (P = 0.0047), ER positive patients with high expression levels of 17HSD type 1 had a significantly higher risk for late relapse (P = 0.0051). The expression of 17HSD types 1 and 2 in breast cancer differs from the expression of these enzymes in normal mammary gland, and this study indicates that the expression has prognostic significance in breast cancer.

  • 5.
    Mancia, Giuseppe
    et al.
    University of Milano Bicocca, Italy .
    Fagard, Robert
    University of Gdansk, Poland .
    Narkiewicz, Krzysztof
    University of Gdansk, Poland .
    Redon, Josep
    University of Valencia, Spain .
    Zanchetti, Alberto
    University of Milan, Italy .
    Boehm, Michael
    University of Saarlandes Kliniken, Germany .
    Christiaens, Thierry
    University of Ghent, Belgium .
    Cifkova, Renata
    Charles University of Prague, Czech Republic .
    De Backer, Guy
    University Hospital, Belgium .
    Dominiczak, Anna
    University of Glasgow, Scotland .
    Galderisi, Maurizio
    Federico II University Hospital, Italy .
    Grobbee, Diederick E.
    University of Medical Centre Utrecht, Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kirchhof, Paulus
    University of Birmingham, England .
    Kjeldsen, Sverre E.
    University of Oslo, Norway .
    Laurent, Stephane
    Hop Europeen Georges Pompidou, France .
    Manolis, Athanasios J.
    Asklepe Gen Hospital, Greece .
    Nilsson, Peter M.
    Lund University, Sweden .
    Ruilope, Luis Miguel
    Hospital 12 Octubre, Spain .
    Schmieder, Roland E.
    University Hospital, Germany .
    Sirnes, Per Anton
    Ostlandske Hjertesenter, Norway .
    Sleight, Peter
    John Radcliffe Hospital, England .
    Viigimaa, Margus
    Tallinn University of Technology, Estonia .
    Waeber, Bernard
    CHU Vaudois, Switzerland .
    Zannad, Faiez
    University of Lorraine, France .
    2013 ESH/ESC Guidelines for the management of arterial hypertension2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 28, -+ p.Article in journal (Refereed)
    Abstract [en]

    n/a

  • 6.
    Mancia, Giuseppe
    et al.
    University of Milano Bicocca, Italy .
    Fagard, Robert
    KU Leuven University, Belgium .
    Narkiewicz, Krzysztof
    Medical University of Gdansk, Poland .
    Redon, Josep
    University of Valencia, Spain .
    Zanchetti, Alberto
    University of Milan, Italy .
    Boehm, Michael
    University of Klinikum Saarlandes, Germany .
    Christiaens, Thierry
    University of Ghent, Belgium .
    Cifkova, Renata
    Charles University of Prague, Czech Republic .
    De Backer, Guy
    University Hospital, Belgium .
    Dominiczak, Anna
    University of Glasgow, Scotland .
    Galderisi, Maurizio
    Federico II University Hospital, Italy .
    Grobbee, Diederick E.
    University of Medical Centre Utrecht, Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kirchhof, Paulus
    University of Birmingham, England .
    Kjeldsen, Sverre E.
    University of Oslo, Norway .
    Laurent, Stephane
    Hop Europeen Georges Pompidou, France .
    Manolis, Athanasios J.
    Asklepeion Gen Hospital, Greece .
    Nilsson, Peter M.
    Lund University, Sweden .
    Ruilope, Luis Miguel
    Hospital 12 Octubre, Spain .
    Schmieder, Roland E.
    University Hospital, Germany .
    Sirnes, Per Anton
    Ostlandske Hjertesenter, Norway .
    Sleight, Peter
    John Radcliffe Hospital, England .
    Viigimaa, Margus
    Tallinn University of Technology, Estonia .
    Waeber, Bernard
    CHU Vaudois, Switzerland .
    Zannad, Faiez
    Centre Invest Clin 9501, France .
    2013 ESH/ESC Guidelines for themanagement of arterial hypertension The Task Force for the management ofarterial hypertension of the European Society ofHypertension (ESH) and of the European Society of Cardiology (ESC)2013In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 31, no 7, 1281-1357 p.Article in journal (Refereed)
    Abstract [en]

    n/a

  • 7.
    Mancia, Giuseppe
    et al.
    University of Milano Bicocca, Italy .
    Fagard, Robert
    KU Leuven University, Belgium .
    Narkiewicz, Krzysztof
    Medical University of Gdansk, Poland .
    Redon, Josep
    University of Valencia, Spain .
    Zanchetti, Alberto
    University of Milan, Italy .
    Boehm, Michael
    University of Saarlandes Kliniken, Germany .
    Christiaens, Thierry
    University of Ghent, Belgium .
    Cifkova, Renata
    Charles University of Prague, Czech Republic .
    De Backer, Guy
    University Hospital, Belgium .
    Dominiczak, Anna
    University of Glasgow, Scotland .
    Galderisi, Maurizio
    Federico II University Hospital, Italy .
    Grobbee, Diederick E.
    University of Medical Centre Utrecht, Netherlands .
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Kirchof, Paulus
    University of Birmingham, England .
    Kjeldsen, Sverre E.
    University of Oslo, Norway .
    Laurent, Stephane
    Hop Europeen Georges Pompidou, France .
    Manolis, Athanasios J.
    Asklepe Gen Hospital, Greece .
    Nilsson, Peter M.
    Lund University, Sweden .
    Ruilope, Luis Miguel
    Hospital 12 Octubre, Spain .
    Schmieder, Roland E.
    University Hospital, Germany .
    Sirnes, Per Anton
    Ostlandske Hjertesenter, Norway .
    Sleight, Peter
    John Radcliffe Hospital, England .
    Viigimaa, Margus
    Tallinn University of Technology, Estonia .
    Waeber, Bernard
    CHU Vaudois, Switzerland .
    Zannad, Faiez
    University of Lorraine, France .
    2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC)2013In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 31, no 10, 1925-1938 p.Article in journal (Refereed)
    Abstract [en]

    n/a

  • 8.
    Ardern, Clare
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Medical Hospital, Qatar; La Trobe University, Australia.
    Glasgow, Philip
    Sport Northern Ireland Sports Institute, North Ireland; University of Ulster, North Ireland.
    Schneiders, Anthony
    Central Queensland University, Australia.
    Witvrouw, Erik
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; University of Ghent, Belgium.
    Clarsen, Benjamin
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Cools, Ann
    University of Ghent, Belgium.
    Gojanovic, Boris
    Hop La Tour, Switzerland; Lausanne University of and Hospital, Switzerland.
    Griffin, Steffan
    University of Birmingham, England.
    Khan, Karim M.
    University of British Columbia, Canada.
    Moksnes, Havard
    Norwegian School Sports Science, Norway; Olymp Elite Sports Program Olympiatoppen, Norway.
    Mutch, Stephen A.
    SPACE Clin, Scotland; Murrayfield Stadium, Scotland.
    Phillips, Nicola
    Cardiff University, Wales.
    Reurink, Gustaaf
    Sports Phys Grp, Netherlands.
    Sadler, Robin
    Manchester City Football Club, England.
    Gravare Silbernagel, Karin
    University of Delaware, DE USA.
    Thorborg, Kristian
    University of Copenhagen, Denmark.
    Wangensteen, Arnlaug
    Aspetar Orthopaed and Sports Medical Hospital, Qatar; Norwegian School Sports Science, Norway.
    Wilk, Kevin E.
    Champ Sports Med, AL USA.
    Bizzini, Mario
    Schulthess Clin, Switzerland.
    2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern2016In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 50, no 14, 853-864 p.Article in journal (Refereed)
    Abstract [en]

    Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athletes return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.

  • 9.
    Wikström, Jonas
    Linköping University, Department of Management and Engineering, Machine Design.
    3D Model of Fuel Tank for System Simulation: A methodology for combining CAD models with simulation tools2011Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Engineering aircraft systems is a complex task. Therefore models and computer simulations are needed to test functions and behaviors of non existing systems, reduce testing time and cost, reduce the risk involved and to detect problems early which reduce the amount of implementation errors. At the section Vehicle Simulation and Thermal Analysis at Saab Aeronautics in Linköping every basic aircraft system is designed and simulated, for example the fuel system. Currently 2-dimensional rectangular blocks are used in the simulation model to represent the fuel tanks. However, this is too simplistic to allow a more detailed analysis. The model needs to be extended with a more complex description of the tank geometry in order to get a more accurate model.

    This report explains the different steps in the developed methodology for combining 3-dimensional geometry models of any fuel tank created in CATIA with dynamic simulation of the fuel system in Dymola. The new 3-dimensional representation of the tank in Dymola should be able to calculate fuel surface location during simulation of a maneuvering aircraft. 

    The first step of the methodology is to create a solid model of the fuel contents in the tank. Then the area of validity for the model has to be specified, in this step all possible orientations of the fuel acceleration vector within the area of validity is generated. All these orientations are used in the automated volume analysis in CATIA. For each orientation CATIA splits the fuel body in a specified number of volumes and records the volume, the location of the fuel surface and the location of the center of gravity. This recorded data is then approximated with the use of radial basis functions implemented in MATLAB. In MATLAB a surrogate model is created which are then implemented in Dymola. In this way any fuel surface location and center of gravity can be calculated in an efficient way based on the orientation of the fuel acceleration vector and the amount of fuel.

    The new 3-dimensional tank model is simulated in Dymola and the results are compared with measures from the model in CATIA and with the results from the simulation of the old 2-dimensional tank model. The results shows that the 3-dimensional tank gives a better approximation of reality and that there is a big improvement compared with the 2-dimensional tank model. The downside is that it takes approximately 24 hours to develop this model.

  • 10.
    Nestor, Colm
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Lentini, Antonio
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hägg Nilsson, Cathrine
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Gawel, Danuta
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Gustafsson, Mika
    Linköping University, Department of Physics, Chemistry and Biology, Bioinformatics. Linköping University, Faculty of Science & Engineering.
    Mattson, Lina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Wang, Hui
    MD Anderson Cancer Centre, TX 77030 USA.
    Rundquist, Olof
    Linköping University, Department of Physics, Chemistry and Biology, Bioinformatics. Linköping University, Faculty of Science & Engineering.
    Meehan, Richard R.
    University of Edinburgh, Scotland.
    Klocke, Bernward
    Genomatix Software GmbH, Germany.
    Seifert, Martin
    Genomatix Software GmbH, Germany.
    Hauck, Stefanie M.
    German Research Centre Environm Health GmbH, Germany.
    Laumen, Helmut
    Technical University of Munich, Germany; Technical University of Munich, Germany; Helmholtz Zentrum Munchen, Germany; Technical University of Munich, Germany; Technical University of Munich, Germany.
    Zhang, Huan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Benson, Mikael
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    5-Hydroxymethylcytosine Remodeling Precedes Lineage Specification during Differentiation of Human CD4(+) T Cells2016In: Cell reports, ISSN 2211-1247, E-ISSN 2211-1247, Vol. 16, no 2, 559-570 p.Article in journal (Refereed)
    Abstract [en]

    5-methylcytosine (5mC) is converted to 5-hydroxymethylcytosine (5hmC) by the TET family of enzymes as part of a recently discovered active DNA de-methylation pathway. 5hmC plays important roles in regulation of gene expression and differentiation and has been implicated in T cell malignancies and autoimmunity. Here, we report early and widespread 5mC/5hmC remodeling during human CD4(+) T cell differentiation ex vivo at genes and cell-specific enhancers with known T cell function. We observe similar DNA de-methylation in CD4(+) memory T cells in vivo, indicating that early remodeling events persist long term in differentiated cells. Underscoring their important function, 5hmC loci were highly enriched for genetic variants associated with T cell diseases and T-cell-specific chromosomal interactions. Extensive functional validation of 22 risk variants revealed potentially pathogenic mechanisms in diabetes and multiple sclerosis. Our results support 5hmC-mediated DNA de-methylation as a key component of CD4(+) T cell biology in humans, with important implications for gene regulation and lineage commitment.

  • 11.
    Hemdan, Tammer
    et al.
    University Hospital Uppsala, Sweden.
    Johansson, Robert
    Umeå University Hospital, Sweden.
    Jahnson, Staffan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland.
    Hellström, Pekka
    University Central Hospital, Oulu, Finland.
    Tasdemir, Ilker
    Central Hospital of Rogaland, Stavanger, Norway.
    Malmström, Per-Uno
    University Hospital Uppsala, Sweden.
    5-Year Outcome of a Randomized Prospective Study Comparing bacillus Calmette-Guerin with Epirubicin and Interferon-alpha 2b in Patients with T1 Bladder Cancer2014In: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 191, no 5, 1244-1249 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: In a multicenter, prospectively randomized study we evaluated the 5-year outcomes of bacillus Calmette-Guerin alone compared to a combination of epirubicin and interferon-alpha 2b in the treatment of patients with T1 bladder cancer. Materials and Methods: Transurethral resection was followed by a second resection and bladder mapping. Stratification was for grade and carcinoma in situ. Followup entailed regular cystoscopy and cytology during the first 5 years. The end points assessed in this analysis were recurrence-free survival, time to treatment failure and progression, cancer specific survival and prognostic factors. Results: The study recruited 250 eligible patients. The 5-year recurrence-free survival rate was 38% in the combination arm and 59% in the bacillus Calmette-Guerin arm (p = 0.001). The corresponding rates for the other end points were not significantly different, as free of progression 78% and 77%, treatment failure 75% and 75%, and cancer specific survival 90% and 92%, respectively. The type of treatment, tumor size and tumor status at second resection were independent variables associated with recurrence. Concomitant carcinoma in situ was not predictive of failure of bacillus Calmette-Guerin therapy. An independent factor for treatment failure was remaining T1 stage at second resection. Conclusions: Bacillus Calmette-Guerin was more effective than the tested combination therapy. The currently recommended management with second resection and 3-week maintenance bacillus Calmette-Guerin entails a low risk of cancer specific death. More aggressive treatment in patients with infiltrative tumors at second resection might improve these results. In particular, concomitant carcinoma in situ was not a predictive factor for poor outcome after bacillus Calmette-Guerin therapy.

  • 12.
    Lagerqvist, Bo
    et al.
    Uppsala.
    Husted, Steen
    Århus,Danmark.
    Koontny, Fredrik
    Oslo, Norge.
    Ståhle, Elisabeth
    Uppsala.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Wallentin, Lars
    Uppsala.
    5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study2006In: The Lancet, ISSN 0140-6736, Vol. 368, no 9540, 998-1004 p.Article in journal (Refereed)
    Abstract [en]

    Background: The FRISC-II invasive trial compared an early invasive with a non-invasive strategy in terms of death and myocardial infarction in non-ST-elevation acute coronary syndrome. We present 5-year follow-up results, overall and in subgroups based on recommended risk stratification criteria. Methods: In the FRISC-II trial, 2457 patients with non-ST-elevation acute coronary syndrome were randomised to early invasive strategy (coronary angiography and, if appropriate, revascularisation, within 7 days from admission) or non-invasive primarily medical strategy. Risk stratification was done on the basis of risk indicators at randomisation: age older than 65 years, male sex, diabetes mellitus, previous myocardial infarction, ST-segment depression, raised troponin concentration (>0·03 μg/L), and raised C-reactive protein or interleukin 6. Information on events after 24 months was taken from national registries. Analyses were done on an intention-to-treat basis. Findings: At 5 years the groups differed in terms of the primary composite endpoint of death, myocardial infarction, or both (invasive 217, 19·9 %, noninvasive 270, 24·5 %, risk ratio 0·81, 95% CI 0·69-0·95, p=0·009). 5-year mortality was 117 (9·7%) in the invasive group compared with 124 (10·1%) in the noninvasive group (0·95, 0·75 -1·21, p=0·693). Rates of myocardial infarction were 141 (12·9 %) in the invasive and 195 (17.7%) in the non-invasive group (0·73, 0·60-0·89, p=0·002). The benefit of the invasive strategy was confined to male patients, non-smokers, and patients with two or more risk indicators. Interpretation: The 5-year outcome of this trial indicates sustained benefit of an early invasive strategy in patients with non-ST-elevation acute coronary syndrome at moderate to high risk. © 2006 Elsevier Ltd. All rights reserved.

  • 13.
    Broström, Anders
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Nursing Science.
    Johansson, Peter
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Albers, Jan
    City Hospital Ryhov.
    Wiberg, Jan
    City Hospital Ryhov.
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology . Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Fridlund, Bengt
    Vaxjö University.
    6-month CPAP-treatment in a young male patient with severe obstructive sleep apnoea syndrome - A case study from the couples perspective2008In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, Vol. 7, no 2, 103-112 p.Article in journal (Refereed)
    Abstract [en]

    Background: Obstructive sleep apnoea syndrome (OSAS) is independently associated with an increased risk for hypertension and cardiovascular disease. Continuous positive airway pressure (CPAP) can reduce mortality and morbidity, but low compliance rates are seen. Aim: To explore and describe the experiences of CPAP-treatment in a young male patient with severe OSAS during a 6-month period from the couples perspective.

    Methods and the case: A single case study with a phenomenographic approach was employed. Diagnostic procedures of OSAS and initiation of treatment with Auto-CPAP, humidifier and a nasal mask were performed during 4 visits. Conceptions were collected at 4 different occasions during the 6-month period (before, and 2 weeks, 3 months, and 6 months after treatment initiation) by means of interviews with a 33-year old male patient and his female partner.

    Findings: Totally 17 different structural aspects were found to fluctuate during the 6-month period in relation to; influence of stressors, social reactions and adaptation to increase compliance.

    Conclusion: An increased knowledge about the influence of stressors, the social reactions, and the adaptation can help healthcare personnel to identify and better understand concerns of other patients and spouses during different time phases of the initial 6-month period of CPAP-treatment.

  • 14. de Boer, NKH
    et al.
    Reinisch, W
    Teml, A
    van Bodegraven, AA
    Schwab, M
    Lukas, M
    Ochsenkuhn, T
    Petritsch, W
    Knoflach, P
    Almer, Sven
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Gastroenterology and Hepatology . Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL.
    van der Merwe, SW
    Herrlinger, KR
    Seiderer, J
    Vogelsang, H
    Mulder, CJJ
    6-thioguanine treatment in inflammatory bowel disease: A critical appraisal by a European 6-TG working party2006In: Digestion, ISSN 0012-2823, Vol. 73, no 1, 25-31 p.Article in journal (Refereed)
    Abstract [en]

    Recently, the suggestion to use 6-thioguanine (6-TG) as an alternative thiopurine in patients with inflammatory bowel disease (IBD) has been discarded due to reports about possible (hepato) toxicity. During meetings arranged in Vienna and Prague in 2004, European experts applying 6-TG further on in IBD patients presented data on safety and efficacy of 6-TG. After thorough evaluation of its risk-benefit ratio, the group consented that 6-TG may still be considered as a rescue drug in stringently defined indications in IBD, albeit restricted to a clinical research setting. As a potential indication for administering 6-TG, we delineated the requirement for maintenance therapy as well as intolerance and/or resistance to aminosalicylates, azathioprine, 6-mercaptopurine, methotrexate and infliximab. Furthermore, indications are preferred in which surgery is thought to be inappropriate. The standard 6-TG dosage should not exceed 25 mg daily. Routine laboratory controls are mandatory in short intervals. Liver biopsies should be performed after 6-12 months, three years and then three-yearly accompanied by gastroduodenoscopy, to monitor for potential hepatotoxicity, including nodular regenerative hyperplasia (NRH) and veno-occlusive disease (VOD). Treatment with 6-TG must be discontinued in case of overt or histologically proven hepatotoxicity. Copyright (c) 2006 S. Karger AG, Basel.

  • 15.
    Kjellman, Görel
    et al.
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Öberg, Birgitta
    Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
    Hensing, Gunnel
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Alexanderson, Kristina
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    A 12-year follow-up of subjects initially sicklisted with neck/shoulder or low back diagnoses2001In: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 6, no 1, 52-63 p.Article in journal (Refereed)
    Abstract [en]

    Background and Purpose Neck/shoulder and low back pain are common in the Western world and can cause great personal and economic consequences, but so far there are few long term follow-up studies of the consequences of back pain, especially studies that separate the location of back pain. More knowledge is needed about different patterns of risk factors and prognoses for neck/shoulder and low back pain, respectively, and they should not be treated as similar conditions. The aim of the present study was to investigate possible long-term differences in neck/shoulder and low back symptoms, experienced over a 12-year period, with regard to work status, present health, discomfort and influence on daily activities.

    Method A retrospective cohort study of individuals sicklisted with neck/shoulder or low back diagnoses 12 years ago was undertaken. Included were all 213 people who, in 1985, lived in the municipality of Linköping, Sweden, were aged 25–34 years and who had taken at least one new period of sickleave lasting >28 days with a neck/shoulder or low back diagnosis. In 1996, a questionnaire was mailed to the 204 people who were still resident in Sweden (response rate 73%).

    Results Those initially absent with neck/shoulder diagnoses rated their present state of discomfort as worse than those sicklisted with low back diagnoses. Only 4% of the neck/shoulder group reported no present discomfort compared with 25% of the low back group. Notably, both groups reported the same duration of low back discomfort during the last year, which may indicate a higher risk for symptoms in more than one location for subjects with neck/shoulder problems.

    Conclusions Individuals with sickness absence of more than 28 days with neck/shoulder or low back diagnoses appear to be at high risk of developing long-standing symptoms, significantly more so for those initially having neck/shoulder diagnoses.

  • 16. Amin, AI
    et al.
    Hallböök, Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Surgery. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
    Lee, AJ
    Sexton, R
    Moran, BJ
    Heald, RJ
    A 5-cm colonic J pouch colo-anal reconstruction following anterior resection for low rectal cancer results in acceptable evacuation and continence in the long term2003In: Colorectal Disease, ISSN 1462-8910, Vol. 5, no 1, 33-37 p.Article in journal (Refereed)
    Abstract [en]

    Background. Optimal treatment for low rectal cancer is total mesorectal excision, with most patients suitable for low colo-rectal or colo-anal anastomosis. A colon pouch has early functional benefits, although long-term function, especially evacuation, might mitigate against its routine use. The aim of this study was to assess evacuation and continence in patients with a colon pouch, and to examine the impact of possible risk factors. Methods. In 1998, all 102 surviving patients with a colon pouch, whose stoma had been closed for more than one year, were sent a postal questionnaire. A composite incontinence score was calculated from questions on urgency, use of a pad, incontinence of gas, liquid or faeces, and a composite evacuation score from questions on medication taken to evacuate, straining, the need and number of times returned to evacuate. Results. The response rate was 90% (50 M, 42 F), with a median age of 68 years (IQR 60-78) and median follow-up of 2.6 years (IQR 1.7-3.9). The anastomosis was 3 cm or less from the anus in 45/92 (49%), and incontinence scores were worse in this group (P = 0.001). There were significantly higher incontinence scores in females (P = 0.014). Age, preoperative radiotherapy, part of colon used for anastomosis, post-operative leak and length of follow-up had no demonstrable effect on either score. Conclusion. Gender and anastomotic height were the only variables which influenced incontinence. Ninety percent of patients reported that their bowel function did not affect their overall wellbeing, and none would have preferred to have a stoma.

  • 17.
    Agnafors, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Västra Götalandsregionen, Södra Älvsborgs Sjukhus, Barn- och ungdomspsykiatriska kliniken.
    A Biopsychosocial and Long Term Perspective on Child Behavioral Problems: Impact of Risk and Resilience2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Vid tiden för publicering förelåg publikationen endast som manuskript

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

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

    Keyword
    Child, genotype, longitudinal, mental health, resilience
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:liu:diva-124208 (URN)
    Available from: 2016-01-22 Created: 2016-01-22 Last updated: 2016-01-22Bibliographically approved
  • 18.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Oreland, Lars
    Uppsala University, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Comasco, Erika
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 122017In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 48, no 4, 584-596 p.Article in journal (Refereed)
    Abstract [en]

    An increasing prevalence of mental health problems calls for more knowledge into factors associated with resilience. The present study used multiple statistical methodologies to examine a biopsychosocial model of risk and resilience on preadolescence behavior. Data from 889 children and mothers from a birth cohort were used. An adversity score was created by combining maternal symptoms of depression, psychosocial risk and childrens experiences of life events. The proposed resilience factors investigated were candidate genetic polymorphisms, child temperament, social functioning, and maternal sense of coherence. The l/ l genotype of the serotonin transporter linked polymorphic region was associated with lower internalizing scores, but not mainly related to the level of adversity. An easy temperament was associated with resilience for children exposed to high adversity. Social functioning was found to be promotive independent of the risk level. The results support a multiple-level model of resilience indicating effects, though small, of both biological and psychosocial factors.

  • 19.
    Agnafors, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Oreland, Lars
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Comasco, Erika
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve2016Manuscript (preprint) (Other academic)
    Abstract [en]

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

  • 20.
    Rustichini, Aldo
    et al.
    University of Minnesota.
    Dickhaut, John
    University of Minnesota.
    Ghirardato, Paolo
    Università di Torino.
    Smith, Christian Skinner
    Kansas State University.
    Pardo, José V.
    University of Minnesota.
    A Brain Imaging Study of the Choice Procedure2005In: Games and Economic Behavior, ISSN 0899-8256, E-ISSN 1090-2473, Vol. 52, no 2, 257-282 p.Article in journal (Refereed)
    Abstract [en]

    We study the behavior of subjects facing choices between certain, risky, and ambiguous lotteries. Subjects' choices are consistent with the economic theories modeling ambiguity aversion. Our results support the conjecture that subjects face choice tasks as an estimation of the value of the lotteries, and that the difficulty of the choice is an important explanatory variable (in addition to risk and ambiguity aversion).

    The brain imaging data suggest that such estimation is of an approximate nature when the choices involve ambiguous and risky lotteries, as the regions in the brain that are activated are typically located in parietal lobes. Thus such choices require mental faculties that are shared by all mammals, and in particular are independent of language. In contrast, choices involving partial ambiguous lotteries additionally produce an activation of the frontal region, which indicates a different, more sophisticated cognitive process.

  • 21.
    Strand, Joel
    et al.
    Linköping University, Department of Management and Engineering, Production Economics.
    Strandänger, Louise
    Linköping University, Department of Management and Engineering, Production Economics.
    A case study on how an e-tailer can use a multiple criteria ABC analysis to identify risk in the selection of suppliers2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Purpose – The purpose of this master thesis is to explore how an e-tailer selling bulky items can use a multiple criteria ABC analysis to make its purchasing process more effective, while balancing richness and reach, with the performance measurements of profitability, total asset turnover and inventory turnover. The purpose will be accomplished through a single case study on an e-tailer active on the Swedish furniture and home furnishing market.

    Methodology – This thesis applies a multiple criteria ABC-analysis to a single case study. The approach is semi-deductive as theory is combined with interviews on how to match and adapt theory about inventory control and purchasing with the specific requirements of an e-tailer selling bulky items.

    Findings – This thesis has resulted in a set of recommendations that aim to make the purchasing process of an e-tailer more effective. That is, capital and inventory space will be better allocated to the e-tailer’s more profitable items. Among other things, this thesis shows how dead articles can be identified and how a purchaser can prioritize more profitable articles over less profitable ones when making procurement decisions. The other recommendations are for the e-tailer to investigate the possibilities of decoupling the supply chain by keeping stock at the suppliers’ premises, to match the supplier reliability with their importance in the supply chain, and lastly to explore possibilities of drop shipment. Further, the main finding is that a comparison between the A-, B-, and C-classes and the reliability of the suppliers, highlights a gap and a possible risk. Put differently, the importance of a specific item for the business should be reflected in the choice of supplier and the multiple criteria ABC analysis is the tool to illustrate the importance.

    Keywords – E-commerce, E-tailer, richness, reach, transaction cost, ABC analysis, multiple criteria ABC, MCABC, inventory turnover ratio, supplier selection, purchasing

    Paper type – Masters thesis

  • 22.
    Nilsson, Jenny
    Linköping University, Department of Computer and Information Science.
    A Comparison Between Opaque and Transparent Displays for Vision Enhancement Systems2003Independent thesis Advanced level (degree of Magister)Student thesis
    Abstract [en]

    At night or in bad weather, the task of driving is very complex since the amount of visual information available is severely reduced. Vision Enhancement Systems may compensate for parts of the missing information by supplying the driver with a picture of the world where warm objects are made visible. This thesis investigates the impact of Vision Enhancement System display types on cognitive capture and driving performance. 16 subjects were recruited for a simulator study. It was hypothesised that when the contrast of a transparent display is high enough for the driver to separate the picture from the background and make out enough details to interpret it, the risk of cognitive capture is higher than when using an opaque display with the same objects visible. The subjects’ driving performance and opinions about the driving experience were also investigated. No significant differences in driving performance or level of cognitive capture was found. However, questionnaire answers indicate that this question needs to be investigated further to find out whether one display type is preferable because of better and safer driving performance or if individual differences between drivers require the possibility to choose the display type of their personal preference.

  • 23.
    Magnusson, Karin
    Linköping University, Department of Medical and Health Sciences.
    A comparison of persons who got Motivational Interviewing (MI) or not to promote physical activity, and prediction of factors influencing change of physical activity level after two years2010Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: Physical inactivity, related lifestyle diseases and back pain are severe problems in today’s society. One way to increase physical activity level is through Motivational Interviewing (MI).

     

    Purpose: Comparing participants who were in need of MI for physical activity due to risk of heart- and coronary disease with participants not in need of MI, and to describe whether MI for physical activity and other factors can predict change of physical activity level.

     

    Method: A cohort was followed during two years and measured on lifestyle factors, socioeconomic and psychological factors, general health, motivation to change lifestyle and back pain by questionnaires. Based on risk of heart and coronary disease, participants underwent an MI-session for increased physical activity (n=393) or no MI-session (n=380) at baseline.

     

    Results: Besides having a deteriorated lifestyle, the majority of participants who received MI were females, had lower self-estimated economy, had lower health-related quality of life, scored lower on psychological factors and had comorbidity and back pain to a larger extent. Factors related to increase of physical activity level included being physically inactive at baseline, being a female, not having MI and not having disability due to back pain.

     

    Conclusion: Participants in the MI-group had poorer health and more back pain. Having MI did not predict an increase of physical activity, but a low level of physical activity in the past and being a female did play a part in the prediction. More research is needed on MI for increase of physical activity level for an individual with risk of heart- and coronary disease and/or with back pain.

  • 24.
    Dahlström, Nicklas
    et al.
    Lund University School of Aviation, Ljungbyhed, Sweden/Swedish Defence Research Agency, Linköping, Sweden.
    Magnusson Nählinder, Staffan
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    A Comparison of Two Recorders for Obtaining In-flight Heart Rate Data2006In: Applied Psychophysiology and Biofeedback, ISSN 1090-0586, E-ISSN 1573-3270, Vol. 31, no 3, 273-279 p.Article in journal (Refereed)
    Abstract [en]

    Measurement of mental workload has been widely used for evaluation of aircraft design, mission analysis and assessment of pilot performance during flight operations. Heart rate is the psychophysiological measure that has been most frequently used for this purpose. The risk of interference with flight safety and pilot performance, as well as the generally constrained access to flights, make it difficult for researchers to collect in-flight heart rate data. Thus, this study was carried out to investigate whether small, non-intrusive sports recorders can be used for in-flight data collection for research purposes. Data was collected from real and simulated flights with student pilots using the Polar Team System sports recorder and the Vitaport II, a clinical and research recording device. Comparison of the data shows that in-flight heart rate data from the smaller and less intrusive sports recorder have a correlation of.981 with that from the clinical recorder, thus indicating that the sports recorder is reliable and cost-effective for obtaining heart rate data for many research situations.

  • 25.
    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 < 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 < 0.0001), CV mortality 1.28 (1.20-1.36; p < 0.0001), and combined CV mortality or HF hospitalization 1.24 (1.18-1.30; p < 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.

  • 26.
    Hughes, B. P.
    et al.
    Curtin University, Australia.
    Anund, Anna
    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. Swedish Rd and Transport Research Institute, S-58195 Linkoping, Sweden.
    Falkmer, Torbjörn
    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. Curtin University, Australia; La Trobe University, Australia.
    A comprehensive conceptual framework for road safety strategies2016In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 90, 13-28 p.Article in journal (Refereed)
    Abstract [en]

    Road safety strategies (generally called Strategic Highway Safety Plans in the USA) provide essential guidance for actions to improve road safety, but often lack a conceptual framework that is comprehensive, systems theory based, and underpinned by evidence from research and practice. This paper aims to incorporate all components, policy tools by which they are changed, and the general interactions between them. A framework of nine mutually interacting components that contribute to crashes and ten generic policy tools which can be applied to reduce the outcomes of these crashes was developed and used to assess 58 road safety strategies from 22 countries across 15 years. The work identifies the policy tools that are most and least widely applied to components, highlighting the potential for improvements to any individual road safety strategy, and the potential strengths and weaknesses of road safety strategies in general. The framework also provides guidance for the development of new road safety strategies, identifying potential consequences of policy tool based measures with regard to exposure and risk, useful for both mobility and safety objectives. (C) 2016 Elsevier Ltd. All rights reserved.

  • 27.
    Johannesson, M
    et al.
    Linköping University, Department of Department of Health and Society.
    Hedbrant, Johan
    Linköping University, Department of Management and Engineering, Applied Thermodynamics and Fluid Mechanics. Linköping University, Faculty of Science & Engineering.
    Jönsson, B
    Linköping University, Department of Department of Health and Society.
    A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention.1991In: Médecine et informatique, ISSN 0307-7640, Vol. 16, no 4, 355-362 p.Article in journal (Refereed)
    Abstract [en]

    In this paper a computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention is presented. Cost-effectiveness analysis makes it possible to compare the cost-effectiveness of different interventions in order to maximize the health effects for a given amount of resources. The computer simulation model was written in Turbo-Pascal to be used on an IBM-PC-compatible. The model was based on the 8-year logistic multivariate risk equations for CHD and stroke from the Framingham Heart Study, but the regression coefficients can easily be changed if local data exist. The main advantages with the model are that it is easy to use, transparent, and flexible. The model was mainly developed for scientific purposes, but should be useful also for educational purposes and clinical decision analysis. The modelling approach used should also be useful in many other medical areas.

  • 28.
    Johannesson, Magnus
    et al.
    Linköping University, Department of Thematic Studies, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Hedbrant, Johan
    Center of Technology Transfer, Institute of Technology, Linköping Universitgy, Sweden.
    Jönsson, Bengt
    Linköping University, Department of Thematic Studies, Health and Society. Linköping University, Faculty of Arts and Sciences.
    A computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention1991Report (Other academic)
    Abstract [en]

    In this paper a computer simulation model for cost-effectiveness analysis of cardiovascular disease prevention is presented. The computer simulation model was written in Turbo Pascal to be used on an IBM-PC compatible. The model was based on the 8-year logistic multivariate risk equations for coronary heart disease (CHD) and stroke from the Framingham heart study, but the regression coefficients can easily be changed if local data exists. The main advantages of the model are that it is easy to use, transparent, and flexible. The model was mainly developed for scientific purposes, but should be useful also for educational purposes and clinical decision analysis. The modelling approach should also be useful in many other medical areas.

  • 29.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Waldén, Markus
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Hägglund, Martin
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A congested football calendar and the wellbeing of players: The correlation between exposure to match play for football players in European clubs during the months prior to the World Cup 2002 and the injuries and performance of these players during the World Cup2004In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 38, 493-497 p.Article in journal (Refereed)
    Abstract [en]

    Abstract

    Objectives: To investigate the correlation between exposure to match play for football players in European clubs during the months prior to the World Cup 2002 and the injuries and performance of these players during the World Cup.

    Methods: The team doctors at eleven of the best football clubs in Europe prospectively recorded player’s exposure and injuries during the 2001-2002 season (July 2001-May 2002). Sixty-five  players  participated in the World Cup in Korea/Japan (June 2002). During the World Cup, the clubs reported injuries sustained by these players, and their performance was evaluated by three international experts.

    Results: The number of  team matches during the season varied between 40 and 76 for the different countries involved. The individual player had a mean of 36 matches during the season. Top players played more matches, especially during the final period of the season. Players that participated in the World Cup (WC players) played more matches during the season compared to players who did not participate in the World Cup (46 vs 33 matches).

    WC players did not show an increased risk for injury during the season. Twenty-nine per cent of the WC players incurred injuries during the World Cup and 32% performed below their normal standard. The players who under-performed in the World Cup played more matches during the 10 weeks prior to the World Cup compared to those who performed better than expected (12.5 vs 9, p< 0.05). Twenty-three (60%) of the 38 players who had played more than 1 match/week prior to the World Cup incurred injuries or underperformed during the World Cup.

    Conclusions: There is a considerable variation in the number of matches played per season in European professional leagues. Top-level players are obliged to play many matches especially during the final period of the season.

  • 30.
    Daneva, Maria
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Mathematics, Optimization .
    Lindberg, Per Olov
    Linköping University, The Institute of Technology. Linköping University, Department of Mathematics, Optimization .
    A Conjugate Direction Frank-Wolfe Method with Applications to the Traffic Assignment Problem2003In: Operations Research Proceedings 2002: Selected Papers of the International Conference on Operations Research (SOR 2002), Klagenfurt, September 2-5, 2002" / [ed] Leopold-Wildburger, U, Springer , 2003, -550 p.Chapter in book (Other academic)
    Abstract [en]

    This proceedings volume contains a selection of papers presented at the International Conference on Operations Research (SOR 2002).The contributions cover the broad interdisciplinary spectrum of Operations Research and present recent advances in theory, development of methods, and applications in practice. Subjects covered are Production, Logistics and Supply Chain Production, Marketing and Data Analysis, Transportation and Traffic, Scheduling and Project Management, Telecommunication and Information Technology, Energy and Environment, Public Economy, Health, Agriculture, Education, Banking, Finance, Insurance, Risk Management, Continuous Optimization, Discrete and Combinatorial Optimization, Stochastic and Dynamic Programming, Simulation, Control Theory, Systems Dynamics, Dynamic Games, Game Theory, Auctioning and Bidding, Experimental Economics, Econometrics, Statistics and Mathematical Economics, Fuzzy Logic, Multicriteria Decision Making, Decision Theory.

  • 31.
    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.

  • 32.
    Drevenhorn, E.
    et al.
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Bengtson, A
    The Sahlgrenska Academy at Göteborg University, Sweden.
    Allen, J.
    Johns Hopkins University School of Nursing, Baltimore, MD, USA.
    Säljö, R.
    Göteborg University, Sweden.
    Kjellgren, Karin
    The Sahlgrenska Academy at Göteborg University, Sweden.
    A content analysis of patient centredness in hypertension care after consultation training for nurses2007In: The Internet Journal of Advanced Nursing Practice, ISSN 1523-6064, Vol. 8, no 2Article in journal (Refereed)
    Abstract [en]

    Lifestyle changes are important when it comes to reducing the risk factors for cardiovascular complications. There is evidence that these changes are more successful if counselling is conducted in a patient-centred way. The purpose was to analyse how nurses used patient-centred counselling with hypertensive patients after video-recorded consultation training. Nineteen nurses from nurse-led clinics in hypertension care at Swedish health centres participated in residential counselling. Two audio-recordings with hypertensive patients in regular practice were made before and after the training and analysed with the emphasis on patient centredness. Weighing up the pros and cons, the identification of beliefs about treatment and negotiations about the reasons for and where to begin behavioural change increased. A slight increase in reflections and pauses was observed. Expansive and provocative questions and the identification of goals or goal-setting were used sparsely. As a result of the training, the nurses gave individually-adapted information more frequently.

  • 33.
    Spiegler, Virginia L M
    et al.
    Cardiff University, Wales .
    Naim, Mohamed M
    Cardiff University, Wales .
    Wikner, Joakim
    Linköping University, Department of Management and Engineering, Production Economics. Linköping University, The Institute of Technology.
    A control engineering approach to the assessment of supply chain resilience2012In: International Journal of Production Research, ISSN 0020-7543, E-ISSN 1366-588X, Vol. 50, no 21, 6162-6187 p.Article in journal (Refereed)
    Abstract [en]

    There is no consensus on the supply chain management definition of resilience. To aid in evaluating the dynamic behaviour of such systems we need to establish clearly elucidated performance criteria that encapsulate the attributes of resilience. A literature review establishes the latter as readiness, responsiveness and recovery. We also identify robustness as a necessary condition that would complement resilience. We find that the Integral of the Time Absolute Error (ITAE) is an appropriate control engineering measure of resilience when it is applied to inventory levels and shipment rates. We use the ITAE to evaluate an often used benchmark model of make-to-stock supply chains consisting of three decision parameters. We use both linear and nonlinear forms of the model in our evaluation. Our findings suggest that optimum solutions for resilience do not yield a system that is robust to uncertainties in lead-time. Hence supply chains will experience drastic changes in their resilience performance when lead-time changes.

  • 34.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Centre for Clinical Research in Sörmland, Uppsala University, Sweden .
    Sahlqvist, Lota
    Centre for Clinical Research in Sörmland, Uppsala University, Sweden .
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    A cross-sectional study of victimisation of bullying among schoolchildren in Sweden: Background factors and self-reported health complaints2014In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 3, 270-277 p.Article in journal (Refereed)
    Abstract [en]

    AIM:

    To examine background factors for bullying and associations between bullying victimisation and health problems.

    METHODS:

    A cross-sectional study on all pupils in grades 7 and 9 in a Swedish county was conducted in 2011 (n=5248). Data have been analysed with bi- and multivariate models.

    RESULTS:

    14% of the children reported that they had been bullied during the past 2 months. Background factors for bullying were: gender (girls more often); age (younger students more often); disability/disease; high body mass index, and having parents born abroad. There were strong associations between being bullied and poor health and self-harm. Associations with poor general health for boys and girls and mental health problems for girls showed stronger associations with higher frequency of bullying than with lower. For boys, physical bullying had stronger correlations with poor general health than written-verbal bullying.

    CONCLUSIONS:

    Bullying is a serious public health problem among young people and healthcare professionals have an important task in identifying exposed children. Children who are "different" are more exposed to bullying, which implies that school personnel, parents, and other adults in these children's social networks can play an important role in paying attention to and preventing the risk of bullying.

    .

  • 35.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medicine 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: 2011-02-03
    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, 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: 2009-08-21
  • 36.
    Karlsson, B
    et al.
    Linköping University, Department of Physics, Chemistry and Biology. Linköping University, The Institute of Technology.
    Karlsson, N
    Defence Research Establishment, Linköping.
    Wide, P
    Örebro University.
    A dynamic safety system based on sensor fusion2000In: Journal of Intelligent Manufacturing, ISSN 0956-5515, Vol. 11, no 5, 475-483 p.Article in journal (Refereed)
    Abstract [en]

    Machines in industry, including industrial robots, have in many cases dramatically reduced the man-made work and improved the work environment. New machines introduce, however, new risk factors. Traditionally machines are safeguarded by means that more or less rigidly separates the machines from the personnel. This works well in many traditional areas, i.e., where industrial robots are involved. There is however a risk that the safety system limits the valuable flexibility of the robot, which can be considered as a quality that tends to become even more valuable in the progress of programming possibilities and sensor technology. This article shows an example how a safety system can be designed to achieve increased flexibility in co-operation between human and production safety strategy. The proposed safety system is totally based on sensor information that monitors the working area, calculate the safety level and improve the system dynamically, e.g., reduce the robot capability in conjunction to the system safety level. The safety system gain information from the sensors and calculates a risk level which controls the robot speed, i.e., the speed is reduced to achieve a sufficiently low risk level. The sensor data is combined with fuzzy-based sensor fusion and fuzzy rules. The safety system is based on sensor information, hence it automatically adjusts to changes in the guarded area as long as the functionality of the sensors is maintained. Finally, we present a system implementation in an industrial robot application.

  • 37.
    Skogh, Göran
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Management and Engineering, Economics .
    A European nuclear accident pool2008In: Geneva papers on risk and insurance. Issues and practice, ISSN 1018-5895, Vol. 33, no 2, 274-287 p.Article in journal (Refereed)
    Abstract [en]

    The compensation to victims of nuclear accidents is based on a Paris (OECD) and a Vienna (UN) convention. A problem with the system is that a strictly liable, but insolvent or uninsured plant owner leaves victims without compensation. In this paper, it is argued that a system could be better organised by, for example, the European Union (EU). A State that permits a nuclear reactor on its territory should be strictly liable. Benefits are: (i) States are able to compensate large damages, (ii) theory suggests that stepwise modified risk-sharing could be made beneficial for risk-averse States, (iii) the EU can enforce sharing agreements by Member States, (iv) a State can limit its financial burden by redressing some liability to the domestic nuclear industry. The incentive created hereby, as well as regulations on location and safety may prevent accidents. A European nuclear accident pool will have a collective interest in accident prevention. © 2008 The International Association for the Study of Insurance Economics.

  • 38.
    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, 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.

  • 39.
    Grill, Tomas
    et al.
    Linköping University, Department of Mathematics.
    Östberg, Håkan
    Linköping University, Department of Mathematics.
    A Financial Optimization Approach to Quantitative Analysis of Long Term Government Debt Management in Sweden2003Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The Swedish National Debt Office (SNDO) is the Swedish Government’s financial administration. It has several tasks and the main one is to manage the central government’s debt in a way that minimizes the cost with due regard to risk. The debt management problem is to choose currency composition and maturity profile - a problem made difficult because of the many stochastic factors involved.

    The SNDO has created a simulation model to quantitatively analyze different aspects of this problem by evaluating a set of static strategies in a great number of simulated futures. This approach has a number of drawbacks, which might be handled by using a financial optimization approach based on Stochastic Programming.

    The objective of this master’s thesis is thus to apply financial optimization on the Swedish government’s strategic debt management problem, using the SNDO’s simulation model to generate scenarios, and to evaluate this approach against a set of static strategies in fictitious future macroeconomic developments.

    In this report we describe how the SNDO’s simulation model is used along with a clustering algorithm to form future scenarios, which are then used by an optimization model to find an optimal decision regarding the debt management problem.

    Results of the evaluations show that our optimization approach is expected to have a lower average annual real cost, but with somewhat higher risk, than a set of static comparison strategies in a simulated future. These evaluation results are based on a risk preference set by ourselves, since the government has not expressed its risk preference quantitatively. We also conclude that financial optimization is applicable on the government debt management problem, although some work remains before the method can be incorporated into the strategic work of the SNDO.

  • 40.
    Brüggemann, Jelmer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Swahnberg, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Linnaeus University, Sweden.
    Wijma, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    A first online intervention to increase patients perceived ability to act in situations of abuse in health care: reports of a Swedish pre-post study2015In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, no 35Article in journal (Refereed)
    Abstract [en]

    Background: Efforts to counteract abuse in health care, defined as patient-experienced abuse, have mainly focused on interventions among caregivers. This study is the first to test an online intervention focusing on how patients can counteract such abuse. The intervention aimed at increasing patients intention and perceived ability to act in future situations where they risk experiencing abuse. Methods: Participants were recruited through a nephrology clinic in Sweden. The intervention consisted of an online program that aimed to stimulate patients to think of possible actions in situations in which they risk experiencing abuse. The program comprised stories and exercises in text and comic form. The participants filled out a questionnaire immediately before and after going through the program, as well as during follow-up four to eight weeks later. Results: Forty-eight patients (39 %) participated in the study and spent, on average, 41 min responding to questions and going through the program. Both men and women, of various ages and educational backgrounds, participated. An increase in participants self-reported ability to identify opportunities to act in a given situation was seen immediately afterwards, as well as during follow up. Conclusion: The current study suggests that it is feasible and most likely useful to a variety of patients to work with the provided material that has the aim of counteracting abuse in health care. It would be of interest to further develop ways of using comics and to test similar interventions in other health care settings.

  • 41.
    Hadimeri, Henrik
    et al.
    Kärnsjukhuset, Skövde, Sweden.
    Frisenette-Fich, Carsten
    Ryhov, Jönköping, Sweden.
    Deurell, Sven-Ingemar
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Svensson, Lars
    Höglandssjukhuset, Eksjö, Sweden.
    Carlsson-Bjering, Lena
    Höglandssjukhuset, Eksjö, Sweden.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Almroth, Gabriel
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Melander, Stefan
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Haarhaus, Mathias
    Linköping University, Department of Medicine and Care, Nephrology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Andersson, Per-Olof
    Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Cassel, Agneta
    Östergötlands Läns Landsting, Heart and Medicine Center, Department of Nephrology.
    Mauritz, Nils-Johan
    Ryhov, Jönköping, Sweden.
    Ståhl-Nilsson, Agneta
    Ryhov, Jönköping, Sweden.
    Wilske, Jan
    Värnamo Sjukhus, Sweden .
    Nordström, Kataryna
    Värnamo Sjukhus, Sweden .
    Oruda, Pavel
    Värnamo Sjukhus, Sweden .
    Eriksson, Marie
    Umeå University, Sweden .
    Inghilesi Larsson, Annelie
    Umeå University, Sweden .
    Stegmayr, Bernd
    Umeå University, Sweden .
    A fixed protocol for outpatient clinic routines in the care of patients with severe renal failure2013In: Renal failure, ISSN 0886-022X, E-ISSN 1525-6049, Vol. 35, no 6, 845-854 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The primary aim of this study was to assess whether a fixed protocol, using a specially trained team, for intermediate follow-up to fulfillment of guideline targets is non-inferior to conventional follow-up in the care of uraemic patients. A secondary aim was to investigate possible impact on patient outcome.

    METHODS:

    The cohort comprised 424 patients from seven centers. Inclusion criteria were either serum creatinine exceeding 200 µmol/l or calculated clearance below 30 ml/min, representing CKD 4 or 5a. Six centers followed a standardized protocol (group 1). One center provided controls (group 2). The study design was prospective and interventional. The variables measured were blood hemoglobin, bicarbonate, calcium, phosphate, intact parathyroid hormone, albumin, renal function variables, blood pressure and RAAS blockade. The number of patients achieving the set goals was analyzed as a time trend to determine if the intervention resulted in an improvement.

    RESULTS:

    At baseline, group 1 had significantly lower GFR and higher serum creatinine, calcium, phosphate, calcium × phosphate product and bicarbonate, lower mean arterial pressure (MAP), systolic blood pressures and less use of RAAS. During the intervention, group 1 improved in the direction of guidelines for blood hemoglobin, albumin, bicarbonate and MAP. Outcome of secondary endpoints gave a risk of death of 30% in both groups, while the risk of renal replacement therapy was higher in group 1.

    CONCLUSIONS:

    However, the time to renal replacement therapy was significantly shorter in the intervention group, indicating that other variables than guideline achievements are important for the patient.

  • 42.
    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.

  • 43.
    Jansson, Jonas
    et al.
    The Swedish National Road and Transport Research Institute, Sweden.
    Gustafsson, Fredrik
    Linköping University, Department of Electrical Engineering, Automatic Control. Linköping University, The Institute of Technology.
    A Framework and Automotive Application of Collision Avoidance Decision Making2008In: Automatica, ISSN 0005-1098, Vol. 44, no 9, 2347-2351 p.Article in journal (Refereed)
    Abstract [en]

    Collision avoidance (CA) systems are applicable for most transportation systems ranging from autonomous robots and vehicles to aircraft, cars and ships. A probabilistic framework is presented for designing and analyzing existing CA algorithms proposed in literature, enabling on-line computation of the risk for faulty intervention and consequence of different actions. The approach is based on Monte Carlo techniques, where sampling-resampling methods are used to convert sensor readings with stochastic errors to a Bayesian risk. The concepts are evaluated using a real-time implementation of an automotive collision mitigation system, and results from one demonstrator vehicle are presented.

  • 44.
    Ödalen, Jörgen
    et al.
    Linköping University, Department of Management and Engineering, Political Science. Linköping University, Faculty of Arts and Sciences.
    Heyward, Clare
    University of Warwick.
    A Free Movement Passport for the Territorially Dispossessed2014Conference paper (Other academic)
    Abstract [en]

    There is a significant risk that some Small Island States will become uninhabitable due to sea level rises, driven by anthropogenic climate change. Should this happen, citizens of such states will be forced to migrate but, under the current system of international law, these migrants could become stateless. In this article we propose that migrants from threatened island states (the territorially dispossessed) should be provided with a “Passport for the Territorially Dispossessed” (PTD). A PTD also gives its holder a right to free movement and a right to choose their new nationality. The PTD proposal has an advantage over competing suggestions that states should admit a set proportion of these migrants. Quota schemes will generally fail to appropriately compensate the territorially dispossessed. The principle of free choice, by contrast, allows them to retain a measure of control over their destiny and to migrate with dignity.

  • 45.
    Kindberg, Elin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Molecular Virology. Linköping University, Faculty of Health Sciences.
    Vene, Sirkka
    Swedish Institute Infectious Disease Control.
    Mickiene, Aukse
    Kaunas University of Medicine.
    Lundkvist, Ake
    Swedish Institute Infectious Disease Control.
    Lindquist, Lars
    Karolinska University.
    Svensson, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Molecular Virology. Linköping University, Faculty of Health Sciences.
    A Functional Toll-Like Receptor 3 Gene (TLR3) May Be a Risk Factor for Tick-borne Encephalitis Virus (TBEV) Infection2011In: JOURNAL OF INFECTIOUS DISEASES, ISSN 0022-1899, Vol. 203, no 4, 523-528 p.Article in journal (Refereed)
    Abstract [en]

    Background. Tick-borne encephalitis virus (TBEV) infections may be asymptomatic or cause severe symptoms in the central nervous system. A mutation in the chemokine receptor 5 gene has been associated with increased risk of TBE but explains only a limited number of cases. Investigations of further risk factors are needed. Method. To investigate the importance of the innate immune response, we analyzed 128 TBE patients, 77 patients with aseptic meningoencephalitis (AME) and 135 healthy controls, for 3mutations: 2 in the Toll-like receptor 3 (TLR3) gene and 1 in the 2-5-oligoadenylate synthetase (OAS1) gene. Results. Although no association was found between the mutation in the OAS1 gene and TBE, the genotype distribution ofrs3775291, a mutation in TLR3, differed significantly between TBE patients and controls; 61%, 32%, and 7% of the TBE patients were carriers of the wild-type, heterozygous, and mutant genotype of rs3775291, respectively. The corresponding percentages among healthy controls (n = 126) were 52%, 29%, and 19% (P = .02), and among AME patients (n = 75) were 47%, 32%, and 21% (P = .009). Additionally, the wild-type rs3775291 allele was more common among TBE patients than among healthy controls (allele frequency, .768 vs .663; P = .01). Conclusion. A functional TLR3 is a risk factor for TBEV infection.

  • 46.
    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

  • 47.
    Edell-Gustafsson, Ulla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Nursing Science.
    Svanborg, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Clinical Neurophysiology. Östergötlands Läns Landsting, Reconstruction Centre, Department of Neurophysiology UHL.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    A gender perspective on sleeplessness behavior, effects of sleep loss, and coping resources in patients with stable coronary artery disease2006In: Heart & Lung, ISSN 0147-9563, Vol. 35, no 2, 75-89 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The primary aim of this study was to systematically compare perceived sleep quality, sleeplessness behavior, sense of mastery, self-esteem, depression, subjective health, and effects of sleep loss in men and women with stable coronary artery disease (CAD). Further aims were to determine possible predictors of poor sleep quality and sense of mastery, as well as the consequences of too little sleep. METHODS: Comparative-correlation and predictive design were used. Patients with a history of stable angina pectoris scheduled to undergo coronary angiography at Linköping University Hospital in Sweden were included. There were 47 women and 88 men (mean age 62.4 years) with CAD. Structured interviews using validated questionnaires covered sleep quality and sleep habits, effects of sleep loss, psychologic resources, and depression. RESULTS: Multiple stepwise regression analysis showed that sleeplessness behavior, depressed mood, female gender, and pharmacologic treatments with inflammation inhibitors significantly (P < .0001) accounted for the variance of poorer sleep quality. The analysis also showed that the following factors in descending order significantly accounted (P < .0001) for the outcome of sleep quality: inability to feel refreshed by sleep, difficulty in maintaining sleep, gastrointestinal problems, too little sleep, final morning awakening time, sleep onset latency, lying down because of daytime tiredness, and daytime physical tiredness. CONCLUSIONS: Compared with men, women with stable CAD may be especially at risk of experiencing poor sleep quality, even when sleeplessness behavior and pharmacologic treatments with inflammation inhibitors are controlled. It is also possible that they may be more at risk of depressed mood. Copyright © 2006 by Mosby, Inc.

  • 48.
    Bernardi, R. E.
    et al.
    Heidelberg University, Germany.
    Zohsel, K.
    Heidelberg University, Germany.
    Hirth, N.
    Heidelberg University, Germany.
    Treutlein, J.
    Heidelberg University, Germany.
    Heilig, Markus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Social and Affective Neuroscience (CSAN). Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Laucht, M.
    Heidelberg University, Germany.
    Spanagel, R.
    Heidelberg University, Germany.
    Sommer, W. H.
    Heidelberg University, Germany.
    A gene-by-sex interaction for nicotine reward: evidence from humanized mice and epidemiology2016In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 6, no e861Article in journal (Refereed)
    Abstract [en]

    It has been proposed that vulnerability to nicotine addiction is moderated by variation at the mu-opioid receptor locus (OPRM1), but results from human studies vary and prospective studies based on genotype are lacking. We have developed a humanized mouse model of the most common functional OPRM1 polymorphism rs1799971_A4G (A118G). Here we use this model system together with a cohort of German youth to examine the role of the OPRM1 A118G variation on nicotine reward. Nicotine reinforcement was examined in the humanized mouse model using i.v. self-administration. Male (n = 17) and female (n = 26) mice homozygous either for the major human A allele (AA) or the minor G allele (GG) underwent eight daily 2 h sessions of nicotine self-administration. Furthermore, male (n = 104) and female (n = 118) subjects homozygous for the A allele or carrying the G allele from the Mannheim Study of Children at Risk were evaluated for pleasurable and unpleasant experiences during their initial smoking experience. A significant sex-by-genotype effect was observed for nicotine self-administration. Male 118GG mice demonstrated higher nicotine intake than male 118AA mice, suggesting increased nicotine reinforcement. In contrast, there was no genotype effect in female mice. Human male G allele carriers reported increased pleasurable effects from their first smoking experience, as compared to male homozygous A, female G and female homozygous A allele carriers. The 118G allele appears to confer greater sensitivity to nicotine reinforcement in males, but not females.

  • 49.
    Ramchandani, V A
    et al.
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Umhau, J
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Pavon, F J
    The Scripps Research Institute, La Jolla, CA, USA.
    Ruiz-Velasco, V
    PennState College of Medicin, Hershey, PA, USA.
    Margas, W
    PennState College of Medicin, Hershey, PA, USA.
    Sun, H
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Damadzic, R
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Eskay, R
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Schoor, M
    TaconicArtemis GmbH, Köln, Germany.
    Thorsell, Annika
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Schwandt, M L
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Sommer, W H
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    George, D T
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Parsons, L H
    The Scripps Research Institute, La Jolla, CA, USA.
    Herscovitch, P
    National Institutes of Health, Bethesda, MD, USA.
    Hommer, D
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    Heilig, Marcus
    National Institute on Alcohol Abuse and Alcoholism, NIH; Bethesda, MD, USA.
    A genetic determinant of the striatal dopamine response to alcohol in men2011In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 16, no 8, 809-817 p.Article in journal (Refereed)
    Abstract [en]

    Excessive alcohol use, a major cause of morbidity and mortality, is less well understood than other addictive disorders. Dopamine release in ventral striatum is a common element of drug reward, but alcohol has an unusually complex pharmacology, and humans vary greatly in their alcohol responses. This variation is related to genetic susceptibility for alcoholism, which contributes more than half of alcoholism risk. Here, we report that a functional OPRM1 A118G polymorphism is a major determinant of striatal dopamine responses to alcohol. Social drinkers recruited based on OPRM1 genotype were challenged in separate sessions with alcohol and placebo under pharmacokinetically controlled conditions, and examined for striatal dopamine release using positron emission tomography and [(11)C]-raclopride displacement. A striatal dopamine response to alcohol was restricted to carriers of the minor 118G allele. To directly establish the causal role of OPRM1 A118G variation, we generated two humanized mouse lines, carrying the respective human sequence variant. Brain microdialysis showed a fourfold greater peak dopamine response to an alcohol challenge in h/mOPRM1-118GG than in h/mOPRM1-118AA mice. OPRM1 A118G variation is a genetic determinant of dopamine responses to alcohol, a mechanism by which it likely modulates alcohol reward.

  • 50.
    Finnström, Orvar
    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.
    A genetic reason for male excess in infant respiratory mortality?2004In: Acta Paediatrica, ISSN 0803-5253, Vol. 93, no 9, 1154-1155 p.Article in journal (Refereed)
    Abstract [en]

    Male infants have a 50% higher risk of death from respiratory diseases and a number of congenital heart diseases that can lead to cerebral hypoxia. The most important of these diseases are infant respiratory distress syndrome and sudden infant death syndrome. Conclusion: The mechanism behind the excess peri-mortality rate in male infants is not known. A genetic factor leading to reduced tolerance to hypoxia is possible.

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