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  • 101.
    Adamo, Marianna
    et al.
    Univ Brescia, Italy.
    Chioncel, Ovidiu
    Univ Med & Pharm Carol Davila, Romania.
    Pagnesi, Matteo
    Univ Brescia, Italy.
    Bayes-Genis, Antoni
    Univ Hosp Germans Trias i Pujol, Spain; Univ Hosp Germans Trias i Pujol, Spain; Univ Autonoma Barcelona, Spain; Inst Salud Carlos III, Spain.
    Abdelhamid, Magdy
    Cairo Univ, Egypt.
    Anker, Stefan D.
    German Ctr Cardiovasc Res DZHK, Germany; Charite Univ Med Berlin, Germany.
    Antohi, Elena-Laura
    Univ Med & Pharm Carol Davila, Romania.
    Badano, Luigi
    Ist Auxol Italiano, Italy; Univ Milano Bicocca, Italy.
    Ben Gal, Tuvia
    Tel Aviv Univ, Israel.
    Boehm, Michael
    Saarland Univ Hosp, Germany.
    Delgado, Victoria
    Univ Hosp Germans Trias i Pujol, Spain; Univ Hosp Germans Trias i Pujol, Spain; Univ Autonoma Barcelona, Spain; Inst Salud Carlos III, Spain.
    Dreyfus, Julien
    Ctr Cardiol Nord, France.
    Faletra, Francesco F.
    ISMETT Ist Mediterraneo Trapianti & Terapie Alta S, Italy; Fdn Cardioctr Ticino, Switzerland.
    Farmakis, Dimitrios
    Athens Univ Hosp Attikon, Greece.
    Filippatos, Gerasimos
    Athens Univ Hosp Attikon, Greece.
    Grapsa, Julia
    Kings Coll London, England.
    Gustafsson, Finn
    Copenhagen Univ Hosp, Denmark.
    Hausleiter, Joerg
    Div Cardiol, Germany.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Karam, Nicole
    Univ Paris Cite, France.
    Lund, Lars
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Lurz, Philipp
    Univ Med Ctr Mainz, Germany.
    Maisano, Francesco
    Univ Vita Salute, Italy.
    Moura, Brenda
    Univ Porto, Portugal; Porto Armed Forces Hosp, Portugal.
    Mullens, Wilfred
    Hosp Oost Limburg, Belgium.
    Praz, Fabien
    Univ Bern, Switzerland.
    Sannino, Anna
    Univ Naples Federico II, Italy.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Tocchetti, Carlo Gabriele
    Univ Naples Federico II, Italy.
    van Empel, Vanessa P. M.
    Maastricht Univ Med Ctr MUMC, Netherlands.
    von Bardeleben, Ralph Stephan
    Univ Med Ctr Mainz, Germany.
    Yilmaz, Mehmet Birhan
    Dokuz Eylul Univ, Turkiye.
    Zamorano, Jose Luis
    Hosp Univ Ramon y Cajal, Spain.
    Ponikowski, Piotr
    Wroclaw Med Univ, Poland.
    Barbato, Emanuele
    Sapienza Univ Rome, Italy.
    Rosano, Giuseppe M. C.
    Dept Med Sci, Italy.
    Metra, Marco
    Univ Brescia, Italy; Univ Brescia, Italy.
    Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC2024Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.

  • 102.
    Adamopoulos, Stamatis
    et al.
    Onassis Cardiac Surg Ctr, Greece.
    Corra, Ugo
    Ctr Med Riabilitaz Veruno, Italy.
    Laoutaris, Ioannis D.
    Onassis Cardiac Surg Ctr, Greece.
    Pistono, Massimo
    Ctr Med Riabilitaz Veruno, Italy.
    Agostoni, Pier Giuseppe
    IRCCS, Italy; Univ Milan, Italy.
    Coats, Andrew J. S.
    IRCCS San Raffaele Pisana, Italy.
    Leiro, Maria G. Crespo
    UDC, Spain.
    Cornelis, Justien
    Univ Antwerp, Belgium.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Filippatos, Gerasimos
    Attikon Univ Hosp, Greece.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Ruschitzka, Frank
    Univ Heart Ctr, Switzerland.
    Seferovic, Petar M.
    Univ Belgrade, Serbia.
    Schmid, Jean-Paul
    Klin Barmelweid AG, Switzerland.
    Volterrani, Maurizio
    IRCCS San Raffaele Pisana, Italy.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Hosp, Italy.
    Exercise training in patients with ventricular assist devices: a review of the evidence and practical advice. A position paper from the Committee on Exercise Physiology and Training and the Committee of Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology2019Ingår i: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 21, nr 1Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patients functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patients needs. Finally, gaps in our knowledge are discussed.

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  • 103.
    Adams, Yvonne
    et al.
    Univ Copenhagen, Denmark.
    Clausen, Anne Skovsbo
    Copenhagen Univ Hosp, Denmark; Copenhagen Univ Hosp, Denmark.
    Jensen, Peter Ostrup
    Lager, Malin
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Natl Reference Lab Borrel, Div Clin Microbiol, Other Tick Borne Bacter, Lab Med, Reg Jonkoping Cty, Jonkoping, Sweden.
    Wilhelmsson, Peter
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Natl Reference Lab Borrel, Div Clin Microbiol, Other Tick Borne Bacter, Lab Med, Reg Jonkoping Cty, Jonkoping, Sweden.
    Henningsson, Anna J.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Natl Reference Lab Borrel, Div Clin Microbiol, Other Tick Borne Bacter, Lab Med, Reg Jonkoping Cty, Jonkoping, Sweden.
    Lindgren, Per-Eric
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Natl Reference Lab Borrel, Div Clin Microbiol, Other Tick Borne Bacter, Lab Med, Reg Jonkoping Cty, Jonkoping, Sweden.
    Faurholt-Jepsen, Daniel
    Copenhagen Univ Hosp, Denmark.
    Mens, Helene
    Copenhagen Univ Hosp, Denmark.
    Kraiczy, Peter
    Goethe Univ Frankfurt, Germany.
    Kragh, Kasper Norskov
    Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark.
    Bjarnsholt, Thomas
    Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark.
    Kjaer, Andreas
    Copenhagen Univ Hosp, Denmark; Copenhagen Univ Hosp, Denmark.
    Lebech, Anne-Mette
    Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark.
    Jensen, Anja R.
    Univ Copenhagen, Denmark.
    3D blood-brain barrier-organoids as a model for Lyme neuroborreliosis highlighting genospecies dependent organotropism2023Ingår i: ISCIENCE, ISSN 2589-0042, Vol. 26, nr 1, artikel-id 105838Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Lyme neuroborreliosis (LNB), a tick-borne infection caused by spirochetes within the Borrelia burgdorferi sensu lato (s.L.) complex, is among the most prevalent bacterial central nervous system (CNS) infections in Europe and the US. Here we have screened a panel of low- passage B. burgdorferi s.l. isolates using a novel, human-derived 3D blood-brain barrier (BBB)-organoid model. We show that human-derived BBB-organoids support the entry of Borrelia spirochetes, leading to swelling of the organoids and a loss of their structural integrity. The use of the BBB-organoid model highlights the organotropism between B. burgdorferi s.l. genospecies and their ability to cross the BBB contributing to CNS infection.

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  • 104.
    Adil, Mohammed Yasin
    et al.
    Univ Oslo, Norway; Norwegian Dry Eye Clin, Norway.
    Xiao, Jiaxin
    Univ Oslo, Norway; Norwegian Dry Eye Clin, Norway.
    Olafsson, Jonatan
    Univ Oslo, Norway.
    Chen, Xiangjun
    Univ Oslo, Norway; Norwegian Dry Eye Clin, Norway; Arendal Hosp, Norway; Vestre Viken Hosp Trust, Norway; Univ Coll Southeast Norway, Norway.
    Lagali, Neil
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Ögonkliniken US/LiM.
    Raeder, Sten
    Norwegian Dry Eye Clin, Norway.
    Utheim, Oygunn A.
    Oslo Univ Hosp, Norway.
    Dartt, Darlene A.
    Harvard Med Sch, MA 02115 USA.
    Utheim, Tor P.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Univ Oslo, Norway; Vestre Viken Hosp Trust, Norway; Univ Coll Southeast Norway, Norway; Oslo Univ Hosp, Norway; Oslo Univ Hosp, Norway; Oslo Univ Hosp, Norway.
    Meibomian Gland Morphology Is a Sensitive Early Indicator of Meibomian Gland Dysfunction2019Ingår i: American Journal of Ophthalmology, ISSN 0002-9394, E-ISSN 1879-1891, Vol. 200, s. 16-25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To investigate the relationship between meibomian gland (MG) morphology and clinical dry eye tests in patients with meibomian gland dysfunction (MGD). DESIGN: Cross-sectional study. SUBJECTS: Total 538 MGD patients and 21 healthy controls. METHODS: MG loss on meibography images of upper (UL) and lower lids (LL) was graded on a scale of 0 (lowest degree of MG loss) to 3. MG length, thickness, and interglandular space in the UL were measured. Clinical tests included meibum expression and quality, tear film break-up time, ocular staining, osmolarity, Schirmer I, blink interval timing, and Ocular Surface Disease Index (OSDI) questionnaire. RESULTS: Mean UL and LL meibogrades were significantly higher in MGD patients compared to controls (P amp;lt; .001 for UL and LL). The sensitivity and specificity of the meibograde as a diagnostic parameter for MGD was 96.7% and 85%, respectively. Schirmer I was significantly increased in MGD patients with meibograde 1 compared to patients with meibograde 0, 2, and 3 in the UL (P amp;lt; .05 ). MG thickness increased with higher meibograde (P amp;lt; .001). MG morphology correlated significantly but weakly with several clinical parameters (P amp;lt; .05). OSDI did not correlate with any MG morphologic parameter. CONCLUSIONS: Grading of MG loss using meibograde effectively diagnoses MGD. Compensatory mechanisms such as increased aqueous tear production and dilation of MGs make early detection of MGD difficult by standard clinical measures of dry eye, whereas morphologic analysis of MGs reveals an early stage of MGD, and therefore represents a complementary clinical parameter with diagnostic potential. (C) 2018 Elsevier Inc. All rights reserved.

  • 105.
    Adini, B.
    et al.
    Tel Aviv University, Israel.
    Bodas, M.
    Tel Aviv University, Israel.
    Nilsson, Heléne
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Katastrofmedicinskt centrum.
    Peleg, K.
    Tel Aviv University, Israel; Gertner Institute Health Policy and Epidemiol, Israel.
    Policies for managing emergency medical services in mass casualty incidents2017Ingår i: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 48, nr 9, s. 1878-1883Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Diverse decision-making is needed in managing mass casualty incidents (MCIs), by emergency medical services (EMS). The aim of the study was to review consensus among international experts concerning policies of EMS management during MCIs. Methods: Applicability of 21 EMS policies was tested through a 2-cycle modified e-Delphi process, in which 38 multi-disciplinary experts from 10 countries participated. Threshold for approving proposed solutions was defined as consensus of amp;gt;80%. Policies that did not achieve the targeted consensus were reviewed to detect variability according to respondents origin country. Results: 16 policies were endorsed in the first cycle including collaboration between ambulance service providers; implementing a unified mode of operation; preparing criteria for ground versus aerial evacuation; and, developing support systems for caregivers exposed to violence. An additional policy which proposed that senior EMS officers should not necessarily act as on-site MCI commanders was endorsed in the second cycle. Demographic breakdown of views concerning non-consensual policies revealed differences according to countries of origin. Assigning ambulances to off-duty team members was highly endorsed by experts from Israel and South Africa and strongly rejected by European respondents. Avoiding entry to risk areas until declared safe was endorsed by European, Asian and Oceanic experts, but rejected by Israeli, South African and North American experts. Conclusions: Despite uniqueness of countries and EMS agencies, solutions to most dilemmas were applicable to all organizations, regardless of location or affiliation. Cultural diversity was found concerning readiness to implement military-civilian collaboration in MCIs and a rigid separation between work-leisure responsibilities. (C) 2017 Elsevier Ltd. All rights reserved.

  • 106.
    Adlam, David
    et al.
    Univ Leicester, England; Glenfield Hosp, England.
    Alfonso, Fernando
    Hosp Univ La Princess, Spain.
    Maas, Angela
    Radboud Univ Nijmegen, Netherlands.
    Vrints, Christiaan
    Univ Antwerp, Belgium.
    Writing commitee, (Medarbetare/bidragsgivare)
    European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection ESC-ACCA Position Paper on spontaneous coronary artery dissection2018Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr 36, s. 3353-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    n/a

  • 107.
    Adnan, Ali
    et al.
    Univ Gothenburg, Sweden.
    Hogmo, Anders
    Karolinska Hosp, Sweden.
    Sjodin, Helena
    Karolinska Hosp, Sweden.
    Gebre-Medhin, Maria
    Lund Univ, Sweden.
    Laurell, Goran
    Uppsala Univ, Sweden.
    Reizenstein, Johan
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden.
    Farnebo, Lovisa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för sinnesorgan och kommunikation. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Öron- näsa- och halskliniken.
    Norberg, Lena S.
    Umea Univ, Sweden.
    Notstam, Isak
    Umea Univ, Sweden.
    Holmberg, Erik
    Sahlgrens Univ Hosp, Sweden.
    Cange, Hedda H.
    Univ Gothenburg, Sweden.
    Hammerlid, Eva
    Univ Gothenburg, Sweden.
    Health-related quality of life among tonsillar carcinoma patients in Sweden in relation to treatment and comparison with quality of life among the population2020Ingår i: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 42, nr 5, s. 860-872Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The health-related quality of life (HRQOL) of tonsillar carcinoma survivors was explored to investigate any HRQOL differences associated with tumor stage and treatment. The survivors HRQOL was also compared to reference scores from the population. Methods In this exploratory cross-sectional study patients were invited 15 months after their diagnosis and asked to answer two quality of life questionnaires (EORTC QLQ- C30, EORTC QLQ- HN35), 405 participated. Results HRQOL was associated with gender, with males scoring better than females on a few scales. Patients HRQOL was more associated with treatment than tumor stage. Patients HRQOL was worse than that in an age- and sex-matched reference group from the normal population, the largest differences were found for problems with dry mouth followed by problems with sticky saliva, senses, swallowing and appetite loss. Conclusions The tonsillar carcinoma patients had a worse HRQOL compared to the general population one year after treatment.

  • 108.
    Adoberg, Annika
    et al.
    North Estonia Med Ctr, Estonia.
    Paats, Joosep
    Tallinn Univ Technol, Estonia.
    Arund, Jurgen
    Tallinn Univ Technol, Estonia.
    Dhondt, Annemieke
    Ghent Univ Hosp, Belgium.
    Fridolin, Ivo
    Tallinn Univ Technol, Estonia.
    Glorieux, Griet
    Ghent Univ Hosp, Belgium.
    Holmar, Jana
    Tallinn Univ Technol, Estonia.
    Lauri, Kai
    Synlab Eesti OU, Estonia.
    Leis, Liisi
    North Estonia Med Ctr, Estonia.
    Luman, Merike
    North Estonia Med Ctr, Estonia; Tallinn Univ Technol, Estonia.
    Pilt, Kristjan
    Tallinn Univ Technol, Estonia.
    Uhlin, Fredrik
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Njurmedicinska kliniken US. Tallinn Univ Technol, Estonia.
    Tanner, Risto
    Tallinn Univ Technol, Estonia.
    Treatment with Paracetamol Can Interfere with the Intradialytic Optical Estimation in Spent Dialysate of Uric Acid but Not of Indoxyl Sulfate2022Ingår i: Toxins, ISSN 2072-6651, E-ISSN 2072-6651, Vol. 14, nr 9, artikel-id 610Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Optical online methods are used to monitor the haemodialysis treatment efficiency of end stage kidney disease (ESKD) patients. The aim of this study was to analyse the effect of the administration of UV-absorbing drugs, such as paracetamol (Par), on the accuracy of optical monitoring the removal of uremic toxins uric acid (UA) and indoxyl sulfate (IS) during standard haemodialysis (HD) and haemodiafiltration (HDF) treatments. Nine patients received Par in daily dosages 1-4 g for 30 sessions. For 137 sessions, in 36 patients the total daily dosage of UV-absorbing drugs was less than 500 mg, and for 6 sessions 3 patients received additional UV-absorbing drugs. Par administration slightly affected the accuracy of optically assessed removal of UA expressed as bias between optically and laboratory-assessed reduction ratios (RR) during HD but not HDF employing UV absorbance of spent dialysate (p < 0.05) at 295 nm wavelength with the strongest correlation between the concentration of UA and absorbance. Corresponding removal of IS based on fluorescence at Ex280/Em400 nm during HD and HDF was not affected. Administration of UV-absorbing drugs may in some settings influence the accuracy of optical assessments in spent dialysate of the removal of uremic solutes during haemodialysis treatment of ESKD patients.

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  • 109.
    Adolfsson, Emelie
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Wesolowska, Paulina
    IAEA, Austria.
    Izewska, Joanna
    IAEA, Austria.
    Lund, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten.
    Carlsson Tedgren, Åsa
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Karolinska Univ Hosp, Sweden.
    END-TO-END AUDIT: COMPARISON OF TLD AND LITHIUM FORMATE EPR DOSIMETRY2019Ingår i: Radiation Protection Dosimetry, ISSN 0144-8420, E-ISSN 1742-3406, Vol. 186, nr 1, s. 119-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to test two different solid state dosimetry systems for the purpose of end-to-end audits of radiotherapy volumetric modulated arc therapy (VMAT) technique; a lithium formate electron paramagnetic resonance system and a lithium fluoride thermoluminescent dosimetry system. As a complement to the solid state systems, ion chamber measurements were performed. A polystyrene phantom with a planning target volume (PTV) and an organ at risk (OAR) structure was scanned using CT. A VMAT dose plan was optimized to deliver 2 Gy to the target volume and to minimize the dose to the OAR. The different detectors were inserted into the phantom and the planned dose distribution was delivered. The measured doses were compared to the treatment planning system (TPS) calculated doses. Good agreement was found between the TPS calculated and the measured doses, well accepted for the dose determinations in remote dosimetry audits of VMAT treatment technique.

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  • 110.
    Adolfsson, Emma
    et al.
    Orebro Univ, Sweden.
    Kling, Daniel
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.
    Gunnarsson, Cecilia
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk genetik. Region Östergötland, Regionledningskontoret, Övr Regionledningskontoret.
    Jonasson, Jon
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk genetik.
    Green, Henrik
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.
    Green, Anna
    Orebro Univ, Sweden.
    Whole exome sequencing of FFPE samples - expanding the horizon of forensic molecular autopsies2023Ingår i: International journal of legal medicine, ISSN 0937-9827, E-ISSN 1437-1596, Vol. 137, s. 1215-1234Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Forensic molecular autopsies have emerged as a tool for medical examiners to establish the cause of death. It is particularly useful in sudden unexplained deaths where the cause of death cannot be determined with a regular medical autopsy. We provide the first study of exome data from formalin-fixed paraffin-embedded samples (FFPE) paired with data from high-quality blood samples in forensic applications. The approach allows exploration of the potential to use FFPE samples for molecular autopsies and identify variants in extensive exome data. We leverage the high uniformity of the hybridization capture approach provided by Twist Bioscience to target the complete exome and sequence the libraries on a NextSeq 550. Our findings suggest that exome sequencing is feasible for 24 out of a total of 35 included FFPE samples. When successful, the coverage across the exome is comparatively high (> 90% covered to 20X) and uniform (fold80 below 1.5). Detailed variant comparisons for matched FFPE and blood samples show high concordance with few false variants (positive predictive value of 0.98 and a sensitivity of 0.97) with no distinct FFPE artefacts. Ultimately, we apply carefully constructed forensic gene panels in a stepwise manner to find genetic variants associated with the clinical phenotype and with relevance to the sudden unexplained death.

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  • 111.
    Adolfsson, Emma
    et al.
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden.
    Qvick, Alvida
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden.
    Green, Henrik
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.
    Kling, Daniel
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.
    Gunnarsson, Cecilia
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk genetik. Region Östergötland, Regionledningskontoret, Övr Regionledningskontoret.
    Jonasson, Jon
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för cellbiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk genetik. Orebro Univ Hosp, Sweden.
    Green, Anna
    Orebro Univ Hosp, Sweden; Orebro Univ, Sweden.
    Technical in-depth comparison of two massive parallel DNA-sequencing methods for formalin-fixed paraffin-embedded tissue from victims of sudden cardiac death2021Ingår i: Forensic Science International: Genetics, ISSN 1872-4973, E-ISSN 1878-0326, Vol. 53, artikel-id 102522Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sudden cardiac death (SCD) is a tragic and traumatic event. SCD is often associated with hereditary genetic disease and in such cases, sequencing of stored formalin fixed paraffin embedded (FFPE) tissue is often crucial in trying to find a causal genetic variant. This study was designed to compare two massive parallel sequencing assays for differences in sensitivity and precision regarding variants related to SCD in FFPE material. From eight cases of SCD where DNA from blood had been sequenced using HaloPlex, corresponding FFPE samples were collected six years later. DNA from FFPE samples were amplified using HaloPlex HS, sequenced on MiSeq, representing the first method, as well as amplified using modified Twist and sequenced on NextSeq, representing the second method. Molecular barcodes were included to distinguish artefacts from true variants. In both approaches, read coverage, uniformity and variant detection were compared using genomic DNA isolated from blood and corresponding FFPE tissue, respectively. In terms of coverage uniformity, Twist performed better than HaloPlex HS for FFPE samples. Despite higher overall coverage, amplicon-based HaloPlex technologies, both for blood and FFPE tissue, suffered from design and/or performance issues resulting in genes lacking complete coverage. Although Twist had considerably lower overall mean coverage, high uniformity resulted in equal or higher fraction of genes covered at >= 20X. By comparing variants found in the matched samples in a pre-defined cardiodiagnostic gene panel, HaloPlex HS for FFPE material resulted in high sensitivity, 98.0% (range 96.6-100%), and high precision, 99.9% (range 99.5-100%) for moderately fragmented samples, but suffered from reduced sensitivity (range 74.2-91.1%) in more severely fragmented samples due to lack of coverage. Twist had high sensitivity, 97.8% (range 96.8-98.7%) and high precision, 99.9% (range 99.3-100%) in all analyzed samples, including the severely fragmented samples.

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  • 112.
    Adolfsson, Karin
    et al.
    Univ Gothenburg, Sweden; Ryhov Cty Hosp, Sweden.
    Kreicbergs, Ulrika
    Marie Cederschiold Univ Coll, Sweden; Karolinska Inst, Sweden.
    Bratthall, Charlotte
    Kalmar Cty Hosp, Sweden.
    Holmberg, Erik
    Univ Gothenburg, Sweden; Western Sweden Healthcare Reg, Sweden.
    Bjork-Eriksson, Thomas
    Univ Gothenburg, Sweden; Western Sweden Healthcare Reg, Sweden.
    Stenmarker, Margaretha
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Univ Gothenburg, Sweden; Futurum Acad Hlth & Care, Sweden.
    Referral of patients with cancer to palliative care: Attitudes, practices and work-related experiences among Swedish physicians2022Ingår i: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 31, nr 6, artikel-id e13680Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective This study aimed to explore the attitudes, practices and work-related experiences among Swedish physicians regarding the referral process, integration and transition between oncology care and palliative care (PC). Methods A cross-sectional online survey was performed with a study-specific questionnaire in 2016-2017 in south-eastern Sweden. Physicians working with cancer patients within surgical specialties, medical specialties and paediatric oncology participated. Results The vast majority of the 130 participating physicians (99.2%) stated that PC was beneficial for the patient and were positive about early integration of PC (65.5%). Still, only 27.6% of the participants introduced PC at an early stage of non-curable disease. However, paediatric oncologists had a very early introduction of PC in comparison with medical specialties (p = 0.004). Almost 90% of the study population said they wanted to know that the patient had been taken care of by another care facility. Conclusions Despite the physicians positive attitude towards early integration and referral to PC, they often acted late in the disease trajectory. This late approach can reduce the patients opportunity of improving quality of life during severe circumstances. There is a need for in-depth knowledge of the physicians challenges in order to bridge the gap between intentions and actions.

  • 113.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Editorial Material: Is surgery for the subacromial pain syndrome ever indicated? in ACTA ORTHOPAEDICA, vol 86, issue 6, pp 639-6402015Ingår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 86, nr 6, s. 639-640Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    n/a

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  • 114.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Post-traumatic stiff elbow2018Ingår i: EFORT open reviews, ISSN 2058-5241, Vol. 3, nr 5, s. 210-216Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Post-traumatic and post-operative stiffness of the elbow joint is relatively common and may in pronounced cases markedly interfere with normal upper extremity function.Soft-tissue contractures and heterotopic bone formation are two major causes of limited movement.Extensive recent research has elucidated many of the pathways contributing to these conditions, but the exact mechanisms are still unknown.In the early phase of soft-tissue contractures conservative treatment may be valuable, but in longstanding cases operative treatment is often necessary.Several different options are available depending on the severity of the condition and the underlying offending structures. Surgical treatment may allow significant gains in movement but rarely complete restoration, and complications are not uncommon.The following presentation reviews the recent literature on pathomechanisms and treatment alternatives. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170062.

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  • 115.
    Adolfsson, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping. Örebro University, Sweden.
    What keeps a shoulder stable - Is there an ideal method for anterior stabilisation?2024Ingår i: SHOULDER & ELBOW, ISSN 1758-5732, Vol. 16, nr 1Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The gleno-humeral joint is by far the most mobile in the human body but also afflicted by dislocations, predominantly anterior. Surgical stabilisation is often successful but failures not uncommon. The following review describes potential causes of failure and highlights the need of adapting surgical methods to pathomorphology.

  • 116.
    Adolfsson, Lars
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Nestorson, Jens
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Ortopedkliniken i Linköping.
    Scheer, Johan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten.
    Extensive soft tissue lesions in redislocated after simple elbow dislocations2017Ingår i: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 26, nr 7, s. 1294-1297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The majority of simple elbow dislocations (no associated fractures) can be treated nonoperatively with a short period of immobilization followed by guided aftercare. This case series describes the soft tissue injuries in a rare subset of patients in whom the elbow redislocated despite adequate immobilization. Methods: During a 6-year period, 8 patients were identified. They were all treated with reduction and casting in 90 degrees of flexion or more. At 1 week of follow-up, redislocation had occurred in all patients and open soft tissue repair was performed. The injuries were documented and the patients were followed up clinically and with radiographs. Results: Extensive soft tissue injuries, including both collateral ligament injuries and muscle origin avulsions from either or both sides, were found in all patients. The functional result at follow-up was satisfactory in all patients. Conclusion: Vast soft tissue injuries including both collateral ligaments and muscle origins should be expected in the event of early severe instability of a dislocated elbow joint. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

  • 117.
    Adori, Csaba
    et al.
    Karolinska Inst, Sweden.
    Daraio, Teresa
    Karolinska Inst, Sweden.
    Kuiper, Raoul
    Karolinska Inst, Sweden.
    Barde, Swapnali
    Karolinska Inst, Sweden.
    Horvathova, Lubica
    Slovak Acad Sci, Slovakia.
    Yoshitake, Takashi
    Karolinska Inst, Sweden.
    Ihnatko, Robert
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi. Linköpings universitet, Medicinska fakulteten. Georg August Univ Gottingen, Germany.
    Valladolid-Acebes, Ismael
    Karolinska Inst, Sweden.
    Vercruysse, Pauline
    Karolinska Inst, Sweden.
    Wellendorf, Ashley M.
    Cincinnati Childrens Hosp Med Ctr, OH 45229 USA.
    Gramignoli, Roberto
    Karolinska Inst, Sweden.
    Bozoky, Bela
    Karolinska Univ Hosp, Sweden.
    Kehr, Jan
    Karolinska Inst, Sweden.
    Theodorsson, Elvar
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi.
    Cancelas, Jose A.
    Cincinnati Childrens Hosp Med Ctr, OH 45229 USA; Univ Cincinnati, OH 45267 USA.
    Mravec, Boris
    Slovak Acad Sci, Slovakia; Comenius Univ, Slovakia.
    Jorns, Carl
    Karolinska Univ Hosp Huddinge, Sweden.
    Ellis, Ewa
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Mulder, Jan
    Karolinska Inst, Sweden.
    Uhlen, Mathias
    Karolinska Inst, Sweden; Royal Inst Technol, Sweden.
    Bark, Christina
    Karolinska Inst, Sweden.
    Hökfelt, Tomas
    Karolinska Inst, Sweden.
    Disorganization and degeneration of liver sympathetic innervations in nonalcoholic fatty liver disease revealed by 3D imaging2021Ingår i: Science Advances, E-ISSN 2375-2548, Vol. 7, nr 30, artikel-id eabg5733Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Hepatic nerves have a complex role in synchronizing liver metabolism. Here, we used three-dimensional (3D) immunoimaging to explore the integrity of the hepatic nervous system in experimental and human nonalcoholic fatty liver disease (NAFLD). We demonstrate parallel signs of mild degeneration and axonal sprouting of sympathetic innervations in early stages of experimental NAFLD and a collapse of sympathetic arborization in steatohepatitis. Human fatty livers display a similar pattern of sympathetic nerve degeneration, correlating with the severity of NAFLD pathology. We show that chronic sympathetic hyperexcitation is a key factor in the axonal degeneration, here genetically phenocopied in mice deficient of the Rac-1 activator Vav3. In experimental steatohepatitis, 3D imaging reveals a severe portal vein contraction, spatially correlated with the extension of the remaining nerves around the portal vein, enlightening a potential intrahepatic neuronal mechanism of portal hypertension. These fundamental alterations in liver innervation and vasculature uncover previously unidentified neuronal components in NAFLD pathomechanisms.

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  • 118.
    Adua, Eric
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten.
    Oteng Danso, Frank
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten.
    Mensah Boa-Amponsem, Oswald
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten.
    Adusei-Mensah, Frank
    University of Cape Coast, Ghana.
    Effect of Neutrophils on Nitric Oxide Production from Stimulated Macrophages2015Ingår i: Iranian Journal of Immunology, ISSN 1735-1383, E-ISSN 1735-367X, Vol. 12, nr 2, s. 94-103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: During the initial phase of an infection, there is an upregulation of inducible nitric oxide synthase in the macrophages for the production of nitric oxide. This is followed by the recruitment of polymorphonuclear leukocytes (neutrophils) which release arginase. Arginase competes with inducible nitric oxide synthase for a common substrate L-arginine. Objective: To investigate whether the entry of neutrophils and release of arginase can interfere with nitric oxide production from stimulated mouse macrophages. Methods: Neutrophils were isolated from human blood and stimulated with cytodex-3 beads. Cultured macrophages were stimulated with lipopolysaccharide and interferon gamma with or without N (G)-nitro-L-arginine methyl ester or N (omega)-hydroxy-nor-L-arginine. Measurement of NO2-/NO3- and urea were done using the spectrophotometer. Results: A significantly higher level of nitric oxide production from stimulated macrophages was observed compared to control. There was a decrease in nitric oxide production when stimulated macrophages were treated with the supernatant from activated neutrophils (pless than0.05). Conclusion: Arginase from neutrophils can modulate nitric oxide production from activated macrophages which may affect the course of infection by intracellular bacteria.

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  • 119.
    Aengerud, Karin Hellstroem
    et al.
    Umea Univ, Sweden.
    Ericsson, Maria
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Brannstrom, Margareta
    Umea Univ, Sweden.
    Sederholm Lawesson, Sofia
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Strömberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Thylén, Ingela
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Symptoms of Acute Myocardial Infarction as Described in Calls to Tele-Nurses and in Questionnaires A Mixed-Methods Study2023Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 38, nr 2, s. 150-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundPatient-reported symptoms of acute myocardial infarction (MI) may be affected by recall bias depending on when and where symptoms are assessed.AimThe aim of this study was to gain an understanding of patients symptom description in more detail before and within 24 hours after a confirmed MI diagnosis.MethodsA convergent parallel mixed-methods design was used to examine symptoms described in calls between the tele-nurse and the patient compared with symptoms selected by the patient from a questionnaire less than 24 hours after hospital admission. Quantitative and qualitative data were analyzed separately and then merged into a final interpretation.ResultsThirty patients (median age, 67.5 years; 20 men) were included. Chest pain was the most commonly reported symptom in questionnaires (24/30). Likewise, in 19 of 30 calls, chest pain was the first complaint mentioned, usually described together with the symptom onset. Expressions used to describe symptom quality were pain, pressure, discomfort, ache, cramp, tension, and soreness. Associated symptoms commonly described were pain or numbness in the arms, cold sweat, dyspnea, weakness, and nausea. Bodily sensations, such as feeling unwell or weak, were also described. Fear and tiredness were described in calls significantly less often than reported in questionnaires (P = .01 and P = .02), whereas "other" symptoms were more often mentioned in calls compared with answers given in the questionnaire (P = .02). Some symptoms expressed in the calls were not listed in the questionnaire, which expands the understanding of acute MI symptoms. The results showed no major inconsistencies between datasets.ConclusionPatients MI symptom descriptions in tele-calls and those reported in questionnaires after diagnosis are comparable and convergent.

  • 120.
    Aerts, Marc
    et al.
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Minalu, Girma
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Bösner, Stefan
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Buntinx, Frank
    Department of Public Health and Primary Care, KU Leuven, Belgium; Department of General Practice, Maastricht University, The Netherlands..
    Burnand, Bernard
    Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland..
    Haasenritter, Jörg
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Herzig, Lilli
    Institute of Family Medicine, University of Lausanne, Switzerland..
    Knottnerus, J André
    Department of General Practice, Maastricht University, The Netherlands..
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Vikbolandet.
    Renier, Walter
    Department of Public Health and Primary Care, KU Leuven, Belgium.
    Sox, Carol
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, USA..
    Sox, Harold
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH , USA; Patient-Centered Outcomes Research Institute, Washington, USA..
    Donner-Banzhoff, Norbert
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.2017Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 81, s. 120-128Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care.

    STUDY DESIGN AND SETTING: Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies.

    RESULTS: The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%).

    CONCLUSIONS: Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action.

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  • 121.
    af Geijerstam, Peder
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Pre-PhD vid The George Institute for Global Health2023Ingår i: Vaskulär Medicin, ISSN 2000-3188, Vol. 39, nr 4, s. 6-7Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 122.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ekholmen.
    Nyström, Fredrik
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Home Blood Pressure Compared With Office Blood Pressure in Relation to Dysglycemia2022Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 35, nr 9, s. 810-819Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Masked hypertension is more common in individuals with type 2 diabetes than in individuals with normoglycemia. We aimed to explore if there is a discrepancy between office blood pressure (office BP) and home blood pressure monitoring (HBPM) in relation to HbA1c as well as glycemic status in 5,029 middle-aged individuals.

    Methods: HBPM was measured in a subsample of 5,029 participants in The Swedish CardioPulmonary BioImage Study (SCAPIS), a population-based cohort of 50–64 years old participants. Both office BP and HBPM were obtained after 5 minutes’ rest using the semiautomatic Omron M10-IT oscillometric device. White coat effect was calculated by subtracting systolic HBPM from systolic office BP. Participants were classified according to glycemic status: Normoglycemia, prediabetes, or diabetes based on fasting glucose, HbA1c value, and self-reported diabetes diagnosis.

    Results: Of the included 5,025 participants, 947 (18.8%) had sustained hypertension, 907 (18.0%) reported taking antihypertensive treatment, and 370 (7.4%) had diabetes mellitus. Both systolic office BP and HBPM increased according to worsened glycemic status (P for trend 0.002 and 0.002, respectively). Masked hypertension was more prevalent in participants with dysglycemia compared with normoglycemia (P = 0.036). The systolic white coat effect was reversely associated with HbA1c (P = 0.012).

    Conclusions: The systolic white coat effect was reversely associated with HbA1c, and the prevalence of masked hypertension increased with dysglycemia.

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  • 123.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ekholmen.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna.
    Nyström, Fredrik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease2023Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, nr 7, s. 1084-1091Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Masked hypertension is associated with cardiovascular disease (CVD). However, previous large studies have not used the same device to measure office and home blood pressure (BP) and adhered to current home BP measurement recommendations of the European Society of Hypertension. We aimed to characterize masked hypertension and explore its relation to manifestations of CVD.

    Methods: A randomly selected cohort of 5057 participants aged 50–64 years from the Swedish CardioPulmonary BioImage Study (SCAPIS) was evaluated with office and home BP using the semi-automatic Omron M10-IT oscillometric device. Additional analyses included pulse wave velocity (PWV) and coronary artery calcium score (CACS).

    Results: Of participants, 4122 did not have current antihypertensive treatment, and were thus included in our analyses. Of these, 2634 (63.9%) had sustained normotension, and 172 (4.2%) had masked hypertension. Participants with masked hypertension vs. sustained normotension were more often men (66.9 vs. 46.2%, P < 0.001). Those with masked hypertension had higher mean PWV [9.3 (95% confidence interval, 95% CI 9.1–9.5) vs. 8.3 (95% CI 8.2–8.4) m/s, P < 0.001] and odds ratio for CACS at least 100 [1.65 (95% CI 1.02–2.68), P = 0.040]. These associations were similar in a posthoc analysis of masked hypertension and sustained normotension, matched for age, sex and systolic office BP.

    Conclusion: Masked hypertension was associated with markers of CVD. This suggests that home BP is a better predictor of risk, even when the recordings are performed with the same measurement device, in a population-based setting with randomized recruitment.

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  • 124.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Harris, Katie
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Johansson, Maria M.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Rörelse och Hälsa. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Chalmers, John
    The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Nägga, Katarina
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Region Östergötland, Närsjukvården i centrala Östergötland, Medicinska och geriatriska akutkliniken.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Orthostatic Hypotension and Cognitive Function in Individuals 85 Years of Age: A Longitudinal Cohort Study in Sweden2024Ingår i: Aging and Disease, ISSN 2152-5250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Orthostatic hypotension (OH) is more common in the elderly, and associated with increased mortality. However, its implications in 85-year-olds are not known.

    Methods: In the prospective observational cohort study Elderly in Linköping Screening Assessment (ELSA 85), 496 individuals in Linköping, Sweden, were followed from age 85 years with cognitive assessments. Blood pressure (BP) was measured supine and after 1, 3, 5, and 10 minutes of standing. Participants with a BP fall of ≥20 mmHg systolic or ≥10 mmHg diastolic after 1 or 3 minutes were classified as classical continuous or classical transient OH depending on whether the BP fall was sustained or not, at subsequent measurements. Those with a BP fall of the same magnitude, but only after 5 or 10 minutes were classified as delayed OH.

    Results: Of participants, 329 took part in BP measurements and were included. Of these, 156 (47.4%) had classical OH (113 [34.3%] continuous classical, 38 [11.6%] transient classical), and 15 (4.6%) had delayed OH. Cognitive assessments were not markedly different between groups. After 8.6 years, 195 (59.3%) of the participants had died, and delayed vs no OH was associated with twice the risk of all-cause mortality, HR 2.15 (95% CI 1.12-4.12). Transient classical OH was associated with reduced mortality, HR 0.58 (95% CI 0.33-0.99), but not after multiple adjustments, and continuous classical OH was not associated with mortality.

    Conclusion: OH may have different implications for morbidity and mortality in 85-year-olds compared with younger populations.

  • 125.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Janryd, Fredrik
    Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Nyström, Fredrik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Smoking and cardiovascular disease in patients with type 2 diabetes: a prospective observational study2023Ingår i: Journal of Cardiovascular Disease, ISSN 2330-4596, E-ISSN 2330-460X, Vol. 24, nr 11, s. 802-807Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Cigarette smoking is a major risk factor for cardiovascular disease. In type 2 diabetes mellitus (T2D), medications such as antihypertensives and statins can reduce the increased cardiovascular risk. The aim of this study was to evaluate the impact of cigarette smoking on major adverse cardiovascular event (MACE) and all-cause mortality in patients with T2D in a relatively well treated Swedish cohort.

    Methods

    Seven hundred and sixty-one patients with T2D aged 55–66 years were followed in the prospective observational CArdiovascular Risk factors in patients with DIabetes – a Prospective study in Primary care (CARDIPP) study. Baseline data included blood samples of markers of dysglycemia and inflammation, blood pressure as well as questionnaire responses regarding cigarette smoking. Participants were followed for incidence of MACE and all-cause mortality.

    Results

    Of the included 663 participants, the mean age was 60.6 (SD 3.1) years and 423 (63.8%) were men. Levels of C-reactive protein and vitamin D, as well as the proportion of participants treated with antihypertensives, acetylic salicylic acid, statins, and diabetes medications, were similar between smokers and nonsmokers. Median follow-up time was 11.9 (Q1–Q3 10.8–12.7) years. Cigarette smoking was associated with all-cause mortality [hazard ratio 2.24 (95% confidence interval, 95% CI 1.40–3.56), P < 0.001], but not MACE [hazard ratio 1.30 (95% CI 0.77–2.18), P = 0.328].

    Conclusion

    In patients with T2D, cigarette smoking was not associated with an increased risk of MACE. This raises the question of whether cardioprotective drugs in individuals with T2D to some degree mitigate the cardiovascular harm of smoking, even though they do not affect other dire consequences of smoking.

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  • 126.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Joelsson, Annelie
    Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Nyström, Fredrik H
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    A low dose of daily licorice intake affects renin, aldosterone, and home blood pressure in a randomized crossover trial2024Ingår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 119, nr 3, s. 682-691Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Licorice, through the effects of glycyrrhizic acid (GA), raises blood pressure (BP). The World Health Organization has suggested that 100 mg GA/d would be unlikely to cause adverse effects, but of 13 previously published studies none have been randomized and controlled and independently quantified the GA content.

    Objective

    Our aim was to analyze the effects on home BP of a daily licorice intake containing 100 mg GA.

    Methods

    Healthy volunteers were randomly assigned to start with either licorice or a control product in a nonblinded, 2 × 2 crossover study. Home BP was measured daily, and blood samples were collected at the end of each 2-wk period.

    Results

    There were 28 participants and no dropouts. The median age was 24.0 y (interquartile range 22.8–27.0 y). During the licorice compared with control intake period, the systolic home BP increased [mean difference: 3.1 mm Hg (95% confidence interval [CI]: 0.8, 5.4 mm Hg) compared with −0.3 mm Hg (95% CI: −1.8, 1.3 mm Hg); P = 0.018] and renin and aldosterone were suppressed [mean change: −30.0% (95% CI: −56.7%, −3.3%) compared with 15.8% (95% CI: −12.8%, 44.4%); P = 0.003; and −45.1% (95% CI: −61.5%, −28.7%) compared with 8.2% (95% CI: −14.7%, 31.1%); P <0.001, respectively]. In the quartile of participants with the most pronounced suppression of renin and aldosterone, N-terminal prohormone of brain natriuretic peptide concentration increased during the licorice compared with control period [mean change: 204.1% (95% CI: −11.6%, 419.7%) compared with 72.4% (95% CI: −52.2%, 197.1%); P = 0.016].

    Conclusions

    We found licorice to be more potent than previously known, with significant increases in BP, after a daily intake of only 100 mg GA. Thus, the safe limit of intake of this substance might need to be reconsidered.

  • 127.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna. The George Institute for Global Health, University of New South Wales, Sydney, Australia.
    Jonasson, Lena
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Lindahl, Tomas
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk kemi. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi.
    Engvall, Jan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Nyström, Fredrik H.
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Alfredsson, Joakim
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    P-selectin and C-reactive protein in relation to home blood pressure and coronary calcification: a SCAPIS substudy2024Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Soluble P-selectin (sP-selectin) and high-sensitivity C-reactive protein (hsCRP) have previously been associated with hypertension, but the relation with out-of-office blood pressure (BP) and coronary artery calcification score is unknown. We aimed to examine the relationship between sP-selectin, hsCRP and home BP, as well as coronary artery calcification score and carotid artery plaques.

    Methods: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), 5057 randomly selected participants were evaluated with office and home BP using the semi-automatic Omron M10-IT device. For this cross-sectional study, participants with sP-selectin <4 standard deviations above mean and hsCRP <5 mg/l, representing low-grade inflammation, were included. Using generalized linear models, these inflammatory markers were evaluated in relation to BP classifications, as well as coronary artery calcification score and carotid artery plaques.

    Results: Of participants, 4548 were included in the analyses. The median age was 57.2 (53.4–61.2) years, and 775 (17.0%) reported taking medication for hypertension. Participants in the highest quartile of sP-selectin [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.40–1.98, P < 0.001] and hsCRP [OR 2.25, (95% CI 1.89–2.60), P < 0.001] were more likely to have sustained hypertension. Participants in the highest quartile of hsCRP were also more likely to have masked hypertension, OR (95% CI) 2.31 (1.72–3.10), P < 0.001 and carotid artery plaques, OR (95% CI) 1.21 (1.05–1.38), P = 0.007.

    Conclusion: Increased sP-selectin and hsCRP were independently associated with sustained hypertension. These findings indicate an association between hypertension and platelet activity, as expressed by sP-selectin.

    Publikationen är tillgänglig i fulltext från 2025-03-19 00:00
  • 128.
    af Geijerstam, Peder
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Rådholm, Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Kärna.
    Nyström, Fredrik
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin.
    Liten mängd lakrits ökar hemblodtrycket2024Ingår i: Vaskulär Medicin, ISSN 2000-3188, Vol. 40, nr 1, s. -24Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 129.
    Af Sandeberg, Margareta
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    Wenemark, Marika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för verksamhetsstöd och utveckling, Verksamhetsutveckling vård och hälsa.
    Bartholdson, Cecilia
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    Lützén, Kim
    Department of Women's and Children's Health, Karolinska Institutet.
    Pergert, Pernilla
    Department of Women's and Children's Health, Karolinska Institutet, Children's and Women's Health, Karolinska University Hospital.
    To change or not to change - translating and culturally adapting the paediatric version of the Moral Distress Scale-Revised (MDS-R)2017Ingår i: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 18, nr 14, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised (MDS-R) is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of this study were to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction.

    METHODS: The procedure included linguistic translation and cultural adaptation of MDS-R's paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care.

    RESULTS: To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens.

    CONCLUSIONS: Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients.

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    To change or not to change - translating and culturally adapting the paediatric version of the Moral Distress Scale-Revised (MDS-R)
  • 130.
    af Ugglas, Bjorn
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Skyttberg, Niclas
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Wladis, Andreas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Katastrofmedicinskt centrum.
    Djarv, Therese
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Holzmann, Martin J.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Emergency department crowding and hospital transformation during COVID-19, a retrospective, descriptive study of a university hospital in Stockholm, Sweden2020Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 28, nr 1, artikel-id 107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives COVID-19 presents challenges to the emergency care system that could lead to emergency department (ED) crowding. The Huddinge site at the Karolinska university hospital (KH) responded through a rapid transformation of inpatient care capacity together with changing working methods in the ED. The aim is to describe the KH response to the COVID-19 crisis, and how ED crowding, and important input, throughput and output factors for ED crowding developed at KH during a 30-day baseline period followed by the first 60 days of the COVID-19 outbreak in Stockholm Region. Methods Different phases in the development of the crisis were described and identified retrospectively based on major events that changed the conditions for the ED. Results were presented for each phase separately. The outcome ED length of stay (ED LOS) was calculated with mean and 95% confidence intervals. Input, throughput, output and demographic factors were described using distributions, proportions and means. Pearson correlation between ED LOS and emergency ward occupancy by phase was estimated with 95% confidence interval. Results As new working methods were introduced between phase 2 and 3, ED LOS declined from mean (95% CI) 386 (373-399) minutes to 307 (297-317). Imaging proportion was reduced from 29 to 18% and admission rate increased from 34 to 43%. Correlation (95% CI) between emergency ward occupancy and ED LOS by phase was 0.94 (0.55-0.99). Conclusions It is possible to avoid ED crowding, even during extreme and quickly changing conditions by leveraging previously known input, throughput and output factors. One key factor was the change in working methods in the ED with higher competence, less diagnostics and increased focus on rapid clinical admission decisions. Another important factor was the reduction in bed occupancy in emergency wards that enabled a timely admission to inpatient care. A key limitation was the retrospective study design.

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  • 131.
    Afzelius, Maria
    et al.
    Malmö University, Sweden.
    Ostman, Margareta
    Malmö University, Sweden.
    Råstam, Maria
    Lund University, Sweden; University of Gothenburg, Sweden.
    Priebe, Gisela
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barnafrid. Linköpings universitet, Medicinska fakulteten. Lund University, Sweden.
    Parents in adult psychiatric care and their children: a call for more interagency collaboration with social services and child and adolescent psychiatry2018Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, nr 1, s. 31-38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A parental mental illness affects all family members and should warrant a need for support.Aim: To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration.Methods: Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients main diagnoses, comorbidity, children below the age of 18, and child-focused interventions.Results: Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care.Conclusions: Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.

  • 132.
    Ageberg, Eva
    et al.
    Lund Univ, Sweden.
    Bunke, Sofia
    Lund Univ, Sweden.
    Lucander, Karolina
    Lund Univ, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Donaldson, Alex
    La Trobe Univ, Australia; Federat Univ Australia, Australia.
    Facilitators to support the implementation of injury prevention training in youth handball: A concept mapping approach2019Ingår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, nr 2, s. 275-285Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is a need for research to identify effective implementation strategies for injury prevention training within real-world community sports. The aim of this ecological participatory study was to identify facilitators, among stakeholders at multiple levels, that could help injury prevention training become part of regular training routines in youth team handball. Concept mapping, a mixed-method approach for qualitative data collection and quantitative data analysis, was used. Stakeholders (n = 196) of two community team handball clubs (29% players, 13% coaches, 38% caregivers, 11% club, district and national handball administrators, 9% unknown) participated in a brainstorming process. After the research team synthesized the 235 generated statements, 50 stakeholders (34% players, 22% coaches, 24% caregivers, 20% administrators) sorted 89 unique facilitator statements into clusters and rated them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis yielded five clusters (stress value 0.231): "Understanding and applying knowledge," "Education, knowledge, and consistency," "Set-up and exercises," "Inspiration, motivation, and routines," and "Club policy and expert collaboration." The cluster "Understanding and applying knowledge" had the highest mean importance (3.17 out of 4) and feasibility (2.93) ratings. The 32 statements rated as both highly important and feasible (Go-zone) indicate action is required at the individual (end-users) and organizational (policymakers) levels to implement injury prevention training. Results suggest that developing evidence-based context-specific injury prevention training, incorporating physiological, biomechanical and psychological components, and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to facilitate the implementation of injury prevention training in youth team handball.

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  • 133.
    Ageberg, Eva
    et al.
    Lund Univ, Sweden.
    Bunke, Sofia
    Lund Univ, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Donaldson, Alex
    La Trobe Univ, Australia.
    Planning injury prevention training for youth handball players: application of the generalisable six-step intervention development process2020Ingår i: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 26, nr 2, s. 164-169Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Youth handball players are vulnerable to injuries. Because there is no available injury prevention training specifically developed for youth handball players targeting both upper and lower limbs or incorporating psychological aspects of injury, we undertook the Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT) project. We used an ecological participatory design incorporating the perspectives of multiple stakeholders (health beneficiaries, programme deliverers and policy makers). The aim of this paper was to describe the process of developing the I-PROTECT model, featuring injury prevention training and an accompanying implementation strategy. Design We used the generalisable six-step intervention development process, outlined to guide researchers when developing implementable, evidence-based sports injury prevention interventions, to develop the I-PROTECT model. The six-step process involves establishing a research-stakeholder collaborative partnership to (1) identify and synthesise research evidence and clinical experience; (2) consult with relevant experts; (3) engage end users to ensure their needs, capacity and values are considered; (4) test the feasibility and acceptability of the intervention; (5) evaluate the intervention against theory; and (6) obtain feedback from early implementers. Two community handball clubs in southern Sweden, offering organised training for youth male and female players, and the district handball federation, participate in the intervention development. Drafts of the I-PROTECT model will be developed and revised with key stakeholder advice and input throughout all six steps. Conclusion The I-PROTECT model described will be an end user-driven intervention, including evidence-based, theory-informed and context-specific injury prevention training for youth handball, and an associated implementation strategy.

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  • 134.
    Agebratt, Christian
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Ström, Edvin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Romu, Thobias
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Dahlqvist Leinhard, Olof
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Radiofysikavdelningen US.
    Borga, Magnus
    Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska fakulteten.
    Leandersson, Per
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Arbets- och miljömedicin.
    Nyström, Fredrik H.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Endokrinmedicinska kliniken.
    A Randomized Study of the Effects of Additional Fruit and Nuts Consumption on Hepatic Fat Content, Cardiovascular Risk Factors and Basal Metabolic Rate2016Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 11, nr 1, s. e0147149-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Fruit has since long been advocated as a healthy source of many nutrients, however, the high content of sugars in fruit might be a concern.

    Objectives

    To study effects of an increased fruit intake compared with similar amount of extra calories from nuts in humans.

    Methods

    Thirty healthy non-obese participants were randomized to either supplement the diet with fruits or nuts, each at +7 kcal/kg bodyweight/day for two months. Major endpoints were change of hepatic fat content (HFC, by magnetic resonance imaging, MRI), basal metabolic rate (BMR, with indirect calorimetry) and cardiovascular risk markers.

    Results

    Weight gain was numerically similar in both groups although only statistically significant in the group randomized to nuts (fruit: from 22.15±1.61 kg/m2 to 22.30±1.7 kg/m2, p = 0.24 nuts: from 22.54±2.26 kg/m2 to 22.73±2.28 kg/m2, p = 0.045). On the other hand BMR increased in the nut group only (p = 0.028). Only the nut group reported a net increase of calories (from 2519±721 kcal/day to 2763±595 kcal/day, p = 0.035) according to 3-day food registrations. Despite an almost three-fold reported increased fructose-intake in the fruit group (from 9.1±6.0 gram/day to 25.6±9.6 gram/day, p<0.0001, nuts: from 12.4±5.7 gram/day to 6.5±5.3 gram/day, p = 0.007) there was no change of HFC. The numerical increase in fasting insulin was statistical significant only in the fruit group (from 7.73±3.1 pmol/l to 8.81±2.9 pmol/l, p = 0.018, nuts: from 7.29±2.9 pmol/l to 8.62±3.0 pmol/l, p = 0.14). Levels of vitamin C increased in both groups while α-tocopherol/cholesterol-ratio increased only in the fruit group.

    Conclusions

    Although BMR increased in the nut-group only this was not linked with differences in weight gain between groups which potentially could be explained by the lack of reported net caloric increase in the fruit group. In healthy non-obese individuals an increased fruit intake seems safe from cardiovascular risk perspective, including measurement of HFC by MRI.

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  • 135.
    Agelii, M. Leu
    et al.
    Gothenburg Univ, Sweden.
    Andersson, M. L. E.
    Lund Univ, Sweden; Spenshult Res & Dev Ctr, Sweden.
    Jones, B. L.
    Univ Pittsburgh, PA USA.
    Sjöwall, Christopher
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Reumatologiska kliniken i Östergötland.
    Kastbom, Alf
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Reumatologiska kliniken i Östergötland.
    Hafstrom, I
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Forslind, K.
    Lund Univ, Sweden; Helsingborgs Hosp, Sweden.
    Gjertsson, I
    Gothenburg Univ, Sweden.
    Disease activity trajectories in rheumatoid arthritis: a tool for prediction of outcome2021Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 50, nr 1, s. 1-10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Predicting treatment response and disease progression in rheumatoid arthritis (RA) remains an elusive endeavour. Identifying subgroups of patients with similar progression is essential for understanding what hinders improvement. However, this cannot be achieved with response criteria based on current versus previous Disease Activity Scores, as they lack the time component. We propose a longitudinal approach that identifies subgroups of patients while capturing their evolution across several clinical outcomes simultaneously (multi-trajectories). Method For exploration, the RA cohort BARFOT (n = 2829) was used to identify 24 month post-diagnosis simultaneous trajectories of 28-joint Disease Activity Score and its components. Measurements were available at inclusion (0), 3, 6, 12, 24, and 60 months. Multi-trajectories were found with latent class growth modelling. For validation, the TIRA-2 cohort (n = 504) was used. Radiographic changes, assessed by the modified Sharp van der Heijde score, were correlated with trajectory membership. Results Three multi-trajectories were identified, with 39.6% of the patients in the lowest and 18.9% in the highest (worst) trajectory. Patients in the worst trajectory had on average eight tender and six swollen joints after 24 months. Radiographic changes at 24 and 60 months were significantly increased from the lowest to the highest trajectory. Conclusion Multi-trajectories constitute a powerful tool for identifying subgroups of RA patients and could be used in future studies searching for predictive biomarkers for disease progression. The evolution and shape of the trajectories in TIRA-2 were very similar to those in BARFOT, even though TIRA-2 is a newer cohort.

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  • 136.
    Ageno, Walter
    et al.
    University of Insubria, Italy.
    Buller, Harry R.
    Academic Medical Centre, Netherlands.
    Falanga, Anna
    Hospital Papa Giovanni XXIII, Italy; Hospital Papa Giovanni XXIII, Italy.
    Hacke, Werner
    Heidelberg University, Germany.
    Hendriks, Jeroen
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. University of Adelaide, Australia.
    Lobban, Trudie
    Arrhythmia Alliance and AF Assoc, England.
    Merino, Jose
    University of La Paz, Spain.
    Milojevic, Ivan S.
    Gen Hospital Cuprija, Serbia.
    Moya, Francisco
    Vithas Xanit Int Hospital, Spain.
    Bart van der Worp, H.
    University of Medical Centre Utrecht, Netherlands.
    Randall, Gary
    SAFE, England.
    Tsioufis, Konstantinos
    University of Athens, Greece.
    Verhamme, Peter
    University of Leuven, Belgium.
    John Camm, A.
    St Georges University of London, England; Imperial Coll, England.
    Managing reversal of direct oral anticoagulants in emergency situations Anticoagulation Education Task Force White Paper2016Ingår i: Thrombosis and Haemostasis, ISSN 0340-6245, E-ISSN 2567-689X, Vol. 116, nr 6, s. 1003-1010Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there is a definite need for a reversal agent (e.g. in cases of life-threatening bleeding, bleeding into a closed space or organ, persistent bleeding despite local haemostatic measures, and need for urgent interventions and/or interventions that carry a high risk for bleeding), when reversal agents may be helpful, and when a reversal agent is generally not needed. Key stakeholders who require 24-7/around-the-clock access to these agents vary among hospitals; however, from a practical perspective the emergency department is recommended as an appropriate location for these agents. Clearly, the advent of new agents requires standardised protocols for treating bleeding on an institutional level.

  • 137.
    Agerstrom, Jens
    et al.
    Linnaeus Univ, Sweden.
    Andrell, Cecilia
    Lund Univ, Sweden.
    Bremer, Anders
    Linnaeus Univ, Sweden.
    Strömberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Reg Kalmar Cty, Sweden.
    Israelsson, Johan
    Linnaeus Univ, Sweden; Kalmar Cty Hosp, Sweden.
    All else equal: Examining treatment bias and stereotypes based on patient ethnicity and socioeconomic status using in-hospital cardiac arrest clinical vignettes2024Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 63, s. 86-91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Research on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination - whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed. Objective: The primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals (HCP) stereotypical beliefs about these groups. Methods: HCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patients ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes). Results: No significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients. Conclusions: Swedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

  • 138. Beställ onlineKöp publikationen >>
    Agnafors, Sara
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Västra Götalandsregionen, Södra Älvsborgs Sjukhus, Barn- och ungdomspsykiatriska kliniken.
    A Biopsychosocial and Long Term Perspective on Child Behavioral Problems: Impact of Risk and Resilience2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

    Delarbeten
    1. Symptoms of Depression Postpartum and 12 years Later-Associations to Child Mental Health at 12 years of Age
    Öppna denna publikation i ny flik eller fönster >>Symptoms of Depression Postpartum and 12 years Later-Associations to Child Mental Health at 12 years of Age
    2013 (Engelska)Ingår i: Maternal and Child Health Journal, ISSN 1092-7875, E-ISSN 1573-6628, Vol. 17, nr 3, s. 405-414Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Springer Verlag (Germany), 2013
    Nyckelord
    CBCL, Children, Mental health, Postpartum depression, SESBiC-study
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-90750 (URN)10.1007/s10995-012-0985-z (DOI)000316021200003 ()
    Tillgänglig från: 2013-04-05 Skapad: 2013-04-05 Senast uppdaterad: 2021-05-18
    2. Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems - a longitudinal study.
    Öppna denna publikation i ny flik eller fönster >>Effect of gene, environment and maternal depressive symptoms on pre-adolescence behavior problems - a longitudinal study.
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    2013 (Engelska)Ingår i: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 7, nr 1, s. 10-Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2013
    Nationell ämneskategori
    Psykiatri
    Identifikatorer
    urn:nbn:se:liu:diva-104869 (URN)10.1186/1753-2000-7-10 (DOI)23518193 (PubMedID)
    Tillgänglig från: 2014-02-28 Skapad: 2014-02-28 Senast uppdaterad: 2024-01-17Bibliografiskt granskad
    3. Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects
    Öppna denna publikation i ny flik eller fönster >>Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects
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    2016 (Engelska)Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16Artikel i tidskrift (Refereegranskat) 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

    Nationell ämneskategori
    Psykiatri
    Identifikatorer
    urn:nbn:se:liu:diva-124207 (URN)10.1186/s12887-016-0614-x (DOI)000377535800002 ()
    Anmärkning

    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

    Tillgänglig från: 2016-01-22 Skapad: 2016-01-22 Senast uppdaterad: 2024-01-10Bibliografiskt granskad
    4. A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve
    Öppna denna publikation i ny flik eller fönster >>A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve
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    2016 (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    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.

    Nyckelord
    Child, genotype, longitudinal, mental health, resilience
    Nationell ämneskategori
    Psykiatri
    Identifikatorer
    urn:nbn:se:liu:diva-124208 (URN)
    Tillgänglig från: 2016-01-22 Skapad: 2016-01-22 Senast uppdaterad: 2024-01-10Bibliografiskt granskad
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  • 139.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Barmark, Mimmi
    Lund Univ, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Correction: Mental health and academic performance: a study on selection and causation effects from childhood to early adulthood (vol 56, pg 857, 2021)2024Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 24, s. 199-199Artikel i tidskrift (Övrigt vetenskapligt)
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  • 140.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Barmark, Mimmi
    Lund Univ, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Mental health and academic performance: a study on selection and causation effects from childhood to early adulthood2021Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 56, nr 5, s. 857-866Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose

    An inverse relationship between mental health problems and academic achievement is a well-known phenomenon in the scientific literature. However, how and when this association develops is not fully understood and there is a lack of longitudinal, population-based studies on young children. Early intervention is important if associations are to be found already during childhood. The aim of the present study was to investigate the development of the association between mental health and academic performance during different developmental periods of childhood and adolescence.

    Methods

    Data from a longitudinal birth cohort study of 1700 children were used. Child mental health was assessed through mother’s reports at age 3, and self-reports at age 12 and 20. Academic performance was assessed through teacher reports on educational results at age 12 and final grades from compulsory school (age 15–16) and upper secondary school (age 18–19). The association between mental health and academic performance was assessed through regression models.

    Results

    The results indicate that social selection mechanisms are present in all three periods studied. Behavioral and emotional problems at age 3 were associated with performing below grade at age 12. Similarly, mental health problems at age 12 were associated with lack of complete final grades from compulsory school and non-eligibility to higher education. Academic performance at ages 15 and 19 did not increase the risk for mental health problems at age 20.

    Conclusion

    Mental health problems in early childhood and adolescence increase the risk for poor academic performance, indicating the need for awareness and treatment to provide fair opportunities to education.

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  • 141.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Bladh, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Ekselius, Lisa
    Uppsala Univ, Sweden.
    Svedin, Carl Goran
    Ersta Skondal Bracke Univ Coll, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Maternal temperament and character: associations to child behavior at the age of 3 years2021Ingår i: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 15, nr 1, artikel-id 23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The influence of maternal temperament on child behavior, and whether maternal temperament impact boys and girls differently is not thoroughly studied. The aim was to investigate the impact of maternal temperament and character on child externalizing and internalizing problems at age 3. Methods A birth-cohort of 1723 mothers and their children were followed from birth to age 3. At the childs age of 3 months, the mothers filled out standardized instruments on their temperament and character using the Temperament and Character Inventory (TCI) and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). At the childs age of 3 years, the mothers reported on child behavior using the Child Behaviour Checklist (CBCL). Results Maternal temperamental trait novelty seeking was positively associated with externalizing problems in the total population and in girls. Harm avoidance was positively associated with externalizing problems in the total population and in boys, and with internalizing problems in the total population and boys and girls respectively. Maternal character traits of self-directedness and cooperativeness were negatively associated with both externalizing and internalizing problems in the total population and in boys and girls respectively. Conclusions Maternal character traits were more influential on child behavior than were temperamental traits, and thus the opportunities for intervention targeted at parental support are good. Maternal mental health and socioeconomic aspects also increased the risk for child behavior problems, indicating the need for recognition and support in clinical settings.

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  • 142.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barnafrid. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Mental health in young mothers, single mothers and their children2019Ingår i: BMC Psychiatry, E-ISSN 1471-244X, Vol. 19, artikel-id 112Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Parenthood is a life transition that can be especially demanding for vulnerable individuals. Young maternal age and maternal single status have been reported to increase the risk for adverse outcomes for both mother and child. The aim of this study was to investigate the effect of young maternal age and maternal single status on maternal and child mental health and child development at age 3. Methods: A birth-cohort of 1723 mothers and their children were followed from birth to age 3. Sixty-one mothers (3.5%) were age 20 or younger, and 65 (4.0%) reported single status at childbirth. The mothers filled out standardized instruments and medical information was retrieved from the standardized clinical assessment of the children at Child Welfare Centers, (CWC). Results: Young maternal age was associated with symptoms of postpartum depression whereas single status was not. Young mothers were more prone to report internalizing and externalizing problems in their children, while there was no association between single status and child behavioral problems. No differences were seen on child development (CWC scores). School drop-out was, however, a more influential factor on depressive symptoms postpartum than maternal age. Conclusion: Young mothers are at increased risk for symptoms of postpartum depression which indicates the need for attention in pre- and postnatal health care programs. Single mothers and their children were not found to be at increased risk for adverse outcomes. The importance of schooling was demonstrated, indicating the need for societal support to encourage adolescents to remain in school.

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  • 143.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Sodra Alvsborgs Hosp, Sweden.
    Kjellstrom, Anna Norman
    Reg Vastra Gotaland, Sweden.
    Bjork, Marcus Praetorius
    Reg Vastra Gotaland, Sweden; Univ Gothenburg, Sweden.
    Rusner, Marie
    Sodra Alvsborgs Hosp, Sweden; Univ Gothenburg, Sweden.
    Torgerson, Jarl
    Sahlgrens Univ Hosp, Sweden.
    Health care utilization in children and adolescents with psychiatric disorders2023Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 148, nr 4, s. 327-337Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Mental illness is increasing among young people and likewise the request for health care services. At the same time, somatic comorbidity is common in children and adolescents with psychiatric disorders. There is a lack of studies on health care use in children and adolescents, and the hypothesis was that children and adolescents with psychiatric disorders use more primary-, and specialized somatic health care compared to children without psychiatric disorders. Methods: In this retrospective population-based register study, all individuals aged 3-17 years living in Vastra Gotaland region in Sweden in 2017 were included (n = 298,877). Linear and Poisson regression were used to compare health care use during 2016-2018 between children with and without psychiatric diagnoses, controlling for age and gender. The results were reported as unstandardised beta coefficient (beta) and adjusted prevalence ratio (aPR) respectively. Results: Having a psychiatric diagnosis was associated with more primary care visits (beta 2.35, 95% CI 2.30-2.40). This applied to most diagnoses investigated. Girls had more primary care visits than boys. Likewise, individuals with psychiatric diagnoses had more specialized somatic outpatient care (beta 1.70, 95% CI 1.67-1.73), both planned and unplanned (beta 1.23, 95% CI 1.21-1.25; beta 0.18, 95% CI 0.17-0.19). Somatic inpatient care was more common in those having a psychiatric diagnosis (aPR 1.65, 95% CI 1.58-1.72), with the diagnoses of psychosis and substance use exerting the greatest risk. Conclusions: Psychiatric diagnoses were associated with increased primary-, somatic outpatient- as well as somatic inpatient care. Increased awareness of comorbidity and easy access to relevant health care could be beneficial for patients and caregivers. The results call for a review of current health care systems with distinct division between medical disciplines and levels of health care.

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  • 144.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Sodra Alvsborgs Hosp, Sweden.
    Norman Kjellstrom, Anna
    Reg Vastra Gotaland, Sweden.
    Torgerson, Jarl
    Sahlgrens Univ Hosp, Sweden.
    Rusner, Marie
    Sodra Alvsborgs Hosp, Sweden; Univ Gothenburg, Sweden.
    Somatic comorbidity in children and adolescents with psychiatric disorders2019Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, nr 11, s. 1517-1525Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the adult population, psychiatric disorders are associated with somatic illness. Explanatory life style factors have been found, but also a failure to recognize somatic illness in this group. Another factor is side effects from long-term use of antipsychotic drugs. Given the psychiatric-somatic comorbidity in the adult population, it is of interest to investigate whether an association exists already during childhood. The aim of the present study was to investigate the frequency of somatic illness in children and adolescents with a psychiatric diagnose. Data were obtained from the regional health care database Vega, Sweden. Psychiatric and somatic diagnoses obtained during 2011-2013 for individuals aged 3-18 years were extracted. Descriptive statistics were used to examine difference in somatic morbidity between children with and without psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric and somatic diagnoses. Anxiety and behavioral disorders were associated with all somatic conditions investigated at nearly all ages. The same applied to substance use, investigated at age 9-18 years. Affective disorders were associated with all somatic conditions at age 12-18 years. Psychotic conditions were associated with asthma, bowel disorders and myalgia in adolescents. Children with psychiatric disorders are at remarkably high risk for concurrent somatic illness. The associations span across many types of conditions and across all ages. The results support the need for awareness of somatic morbidity in child and adolescent psychiatric clinical settings, and the need for coordinated health care for children with comorbid states.

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  • 145.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Barnafrid. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Oreland, Lars
    Uppsala University, Sweden.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Comasco, Erika
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    A Biopsychosocial Approach to Risk and Resilience on Behavior in Children Followed from Birth to Age 122017Ingår i: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327, Vol. 48, nr 4, s. 584-596Artikel i tidskrift (Refereegranskat)
    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.

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  • 146.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Oreland, Lars
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Comasco, Erika
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    A biopsychosocial approach to risk and resilience on behavior in children followed from birth to age twelve2016Manuskript (preprint) (Övrigt vetenskapligt)
    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.

  • 147.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Comasco, Erika
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bladh, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
    Oreland, Lars
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Svedin, Carl Göran
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Barn- och ungdomspsykiatriska kliniken.
    Early predictors of behavioural problems in pre-schoolers: a longitudinal study of constitutional and environmental main and interaction effects2016Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16Artikel i tidskrift (Refereegranskat)
    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

  • 148.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Sodra Alvsborgs Hosp, Sweden.
    Sydsjö, Gunilla
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Svedin, Carl Goran
    Marie Cederschiold Univ, Sweden.
    Bladh, Marie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, Kvinnokliniken US.
    Symptoms of depression and internalizing problems in early adulthood - associated factors from birth to adolescence2023Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 77, nr 8, s. 799-810Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PurposeEven though the mechanisms behind the development of depression and internalizing problems remains unknown, many different factors have been shown to increase the risk. Longitudinal studies enable the investigation of exposure during different developmental periods during childhood. This study aims to examine factors associated with depressive and internalizing problems at age 20 in terms of sociodemographic factors, previous mental health problems and stressful life events during childhood, adolescence, and early adulthood.MethodsA birth cohort of 1723 children were followed to age 20. At the 20-year follow-up, n = 731 (44%) participated. Standardized instruments were filled out at baseline and the 3-,12- and 20-year follow-ups.ResultsDepressive problems at age 20 were associated with female gender, experience of interpersonal life events reported at age 20, bullying victimization and reports on paternal mental health problems. Participants with depressive problems were also less likely to have experienced adolescence as happy and to report that their father had been a good father. Internalizing problems at age 20 were, in addition, associated with internalizing problems at age 12 and reports on maternal mental health problems. Internalizing problems were associated with a lower likelihood of experiencing adolescence as happy in the final model.ConclusionRecent events (i.e. interpersonal life events and bullying) seemed to be the most influential factors on the development of internalizing and depressive problems. Internalizing problems during childhood increased the risk for internalizing problems in early adulthood, emphasizing the importance of early intervention. Fewer factors were found to increase the risk for depressive problems compared to internalizing problems.

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  • 149.
    Agnafors, Sara
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Sodra Alvsborgs Hosp, Sweden.
    Torgerson, Jarl
    Sahlgrens Univ Hosp, Sweden.
    Rusner, Marie
    Sodra Alvsborgs Hosp, Sweden; Univ Gothenburg, Sweden.
    Kjellstrom, Anna Norman
    Head Off, Sweden.
    Injuries in children and adolescents with psychiatric disorders2020Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 20, nr 1, artikel-id 1273Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Unintentional injuries are a leading cause of morbidity and mortality in children of all ages. Prevention strategies require knowledge of risk factors, and behavior and psychiatric disorders have been suggested to influence the risk of injury during childhood. While externalizing disorders have been found to increase the risk for injuries, results are mixed regarding internalizing disorders, such as affective and anxiety conditions, and Autism Spectrum Disorders (ASD). There is a need for large scale studies relying on robust data sources. The aim of the present study was to examine the association between psychiatric disorders and injuries requiring medical attention, in a large population-based cohort of 350,000 children and adolescents in Sweden. Methods Data were obtained from the regional health care database Vega. Psychiatric diagnoses and injury diagnoses obtained during 2014-2018 for individuals aged 0-17 years in 2016 were extracted. Descriptive statistics were used to examine differences in 5-year injury prevalence between children with and without different psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric diagnoses and injuries requiring medical attention. Results The results show an increased risk for concurrent injuries in general, but the patterns vary by age and psychiatric disorder. Externalizing disorders and anxiety conditions were associated with concurrent injuries, while individuals with ASD had a lower risk for most injuries included. Affective disorders were associated with an increased risk for wounds, concussion, complications and poisoning, while the risk for fractures was decreased. Self-inflicted injury was more common in all psychiatric conditions investigated during adolescence, except for ASD. Children and adolescents with many types of psychiatric disorders were also at increased risk for a concurrent maltreatment diagnosis. Conclusions A general pattern of increased risk for concurrent injuries in children and adolescents with most psychiatric diagnoses was found, but the associations vary by age and type of psychiatric disorder. The results add to the literature on risk factors for injuries in children and adolescents, supporting diagnosis specific patterns. Several psychiatric diagnoses were associated with a marked increase in injury risk, indicating a high burden of disease for affected individuals.

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  • 150.
    Agnew, Louise
    et al.
    University of Queensland, Australia.
    Johnston, Venerina
    University of Queensland, Australia.
    Landén Ludvigsson, Maria
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Peterson, Gunnel
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Overmeer, Thomas
    Malardalen University, Sweden; University of Örebro, Sweden.
    Johansson, Gun
    Karolinska Institute, Sweden.
    Peolsson, Anneli
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. University of Queensland, Australia.
    FACTORS ASSOCIATED WITH WORK ABILITY IN PATIENTS WITH CHRONIC WHIPLASH-ASSOCIATED DISORDER GRADE II-III: A CROSS-SECTIONAL ANALYSIS2015Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 6, s. 546-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III. Design: Cross-sectional analysis. Patients: A total of 166 working age patients with chronic whiplash-associated disorder. Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability. Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p less than 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress. Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

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