liu.seSök publikationer i DiVA
Ändra sökning
Avgränsa sökresultatet
1234567 151 - 200 av 12626
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Träffar per sida
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
  • Standard (Relevans)
  • Författare A-Ö
  • Författare Ö-A
  • Titel A-Ö
  • Titel Ö-A
  • Publikationstyp A-Ö
  • Publikationstyp Ö-A
  • Äldst först
  • Nyast först
  • Skapad (Äldst först)
  • Skapad (Nyast först)
  • Senast uppdaterad (Äldst först)
  • Senast uppdaterad (Nyast först)
  • Disputationsdatum (tidigaste först)
  • Disputationsdatum (senaste först)
Markera
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 151.
    Agren, Martin
    et al.
    Prosthodont Specialist Clin, Sweden.
    Sahin, Christofer
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Hudkliniken i Östergötland.
    Pettersson, Mattias
    Umea Univ, Sweden.
    The effect of botulinum toxin injections on bruxism: A systematic review2020Ingår i: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 47, nr 3, s. 395-402Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective To systematize evidence on the efficacy of botulinum toxin type A (BTA) in the treatment of bruxism measured through bite force or electromyography (EMG) at the masseter muscle. Method Identification of relevant articles through databases PubMed, Web of Science, SCOPUS, Ovid and EBSCO and manual search were performed for sources from review articles. Studies scoring less than 3 on the Jadad Scale were excluded. Results Four articles were included after an exclusion of 333 articles. 3 articles measured EMG and 1 bite force. 1 article did not record a significant drop of activity, 1 article recorded reduction midway and at final endpoint. 2 articles recorded initial reduction, but a non significant difference at later follow up. Conclusion The available research is inconclusive and does not show enough evidence that bruxism can be treated with BTA injections. However, promising results have been shown in individual studies and further research in this area is needed.

  • 152.
    Agreus, Lars
    et al.
    Institutionen för neurobiologi, vårdvetenskap och samhälle, Karolinska institutet, Stockholm, Sverige; Öregrunds vårdcentral, Sverige.
    Borgquist, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Tsoposidis, Alexandros
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Wallenius, Ville
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Kostic, Srdjan
    Avdelningen för kirurgi, institutionen för kliniska vetenskaper, Göteborgs universitet, Sverige; Sahlgrenska universitetssjukhuset/Östra, Göteborg, Sverige.
    Lundell, Lars
    Avdelningen för kirurgi, CLINTEC, Karolinska institutet, Stockholm, Sverige.
    Lindberg, Greger
    Institutionen för medicin Huddinge, Karolinska institutet, Sverige; PF mag- och tarmsjukdomar, Karolinska universitetssjukhuset, Stockholm, Sverige.
    Stor överförskrivning och ökat bruk av protonpumpshämmare: Utbildning och information är en nyckel till att vägleda läkare och allmänhet till rätt användning [Significant over- and misuse of PPIs]2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Protonpumpshämmare är den bästa behandlingen försyrarelaterade störningar.

    De viktigaste indikationerna för protonpumpshämmare är gastroesofageal refluxsjukdom (GERD), eradikationav H pylori-infektion i kombination med antibiotika, H pylori-negativa magsår och läkning av och profylax mot NSAID-/coxib-inducerade magsår, hypersekretoriska sjukdomstillstånd som Zollinger–Ellisons syndrom.

    Marknaden för protonpumpshämmare fortsätter attväxa i de flesta länder.

    Ett stort antal internationella publikationer dokumenterar att överförskrivning av protonpumpshämmarefortsätter att vara mycket utbredd, både inom och utanför sjukhus, och utan tendens att minska.

    De främsta orsakerna till överförskrivning av protonpumpshämmare är väl kända och tydligt definierade.

    De två viktigaste konsekvenserna av överförskrivning är skenande läkemedelskostnader och risk för biverkningar.

    Utbildning och information är nyckeln till att vägledasjukhusläkare, primärvårdsläkare och allmänhet till rättanvändning av protonpumpshämmare.

  • 153.
    Aguila, Monica
    et al.
    UCL Inst Ophthalmol, England.
    Bellingham, James
    UCL Inst Ophthalmol, England.
    Athanasiou, Dimitra
    UCL Inst Ophthalmol, England.
    Bevilacqua, Dalila
    UCL Inst Ophthalmol, England.
    Duran, Yanai
    UCL Inst Ophthalmol, England.
    Maswood, Ryea
    UCL Inst Ophthalmol, England.
    Parfitt, David A.
    UCL Inst Ophthalmol, England.
    Iwawaki, Takao
    Kanazawa Med Univ, Japan.
    Spyrou, Ioannis
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi. Linköpings universitet, Medicinska fakulteten.
    Smith, Alexander J.
    UCL Inst Ophthalmol, England.
    Ali, Robin R.
    UCL Inst Ophthalmol, England.
    Cheetham, Michael E.
    UCL Inst Ophthalmol, England.
    AAV-mediated ERdj5 overexpression protects against P23H rhodopsin toxicity2020Ingår i: Human Molecular Genetics, ISSN 0964-6906, E-ISSN 1460-2083, Vol. 29, nr 8, s. 1310-1318Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rhodopsin misfolding caused by the P23H mutation is a major cause of autosomal dominant retinitis pigmentosa (adRP). To date, there are no effective treatments for adRP. The BiP co-chaperone and reductase ERdj5 (DNAJC10) is part of the endoplasmic reticulum (ER) quality control machinery, and previous studies have shown that overexpression of ERdj5 in vitro enhanced the degradation of P23H rhodopsin, whereas knockdown of ERdj5 increased P23H rhodopsin ER retention and aggregation. Here, we investigated the role of ERdj5 in photoreceptor homeostasis in vivo by using an Erdj5 knockout mouse crossed with the P23H knock-in mouse and by adeno-associated viral (AAV) vector-mediated gene augmentation of ERdj5 in P23H-3 rats. Electroretinogram (ERG) and optical coherence tomography of Erdj5(-/-) and P23H(+/-):Erdj5(-/-) mice showed no effect of ERdj5 ablation on retinal function or photoreceptor survival. Rhodopsin levels and localization were similar to those of control animals at a range of time points. By contrast, when AAV2/8-ERdj5-HA was subretinally injected into P23H-3 rats, analysis of the full-field ERG suggested that overexpression of ERdj5 reduced visual function loss 10 weeks post-injection (PI). This correlated with a significant preservation of photoreceptor cells at 4 and 10 weeks PI. Assessment of the outer nuclear layer (ONL) morphology showed preserved ONL thickness and reduced rhodopsin retention in the ONL in the injected superior retina. Overall, these data suggest that manipulation of the ER quality control and ER-associated degradation factors to promote mutant protein degradation could be beneficial for the treatment of adRP caused by mutant rhodopsin.

    Ladda ner fulltext (pdf)
    fulltext
  • 154.
    Aguilera, Katherina
    et al.
    Karolinska Inst, Sweden.
    Bladh, Oscar
    Karolinska Inst, Sweden.
    Marking, Ulrika
    Karolinska Inst, Sweden; Publ Hlth Agcy Sweden, Sweden.
    Norin, Nina Greilert
    Karolinska Inst, Sweden.
    Rihani, Ali
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Ujvari, Dorina
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Ning, Frank Chenfei
    Karolinska Inst, Sweden.
    Klingström, Jonas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för molekylär medicin och virologi. Linköpings universitet, Medicinska fakulteten. Publ Hlth Agcy Sweden, Sweden.
    Havervall, Sebastian
    Karolinska Inst, Sweden.
    Aberg, Mikael
    Uppsala Univ, Sweden.
    Blom, Kim
    Karolinska Inst, Sweden; Publ Hlth Agcy Sweden, Sweden.
    Alm, Jessica J.
    Karolinska Inst, Sweden.
    Thalin, Charlotte
    Karolinska Inst, Sweden.
    Prevalence of SARS-CoV-2 infections among Swedish healthcare workers on duty in December 20232024Ingår i: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 38, artikel-id 100872Artikel i tidskrift (Övrigt vetenskapligt)
  • 155.
    Ahl, Magnus
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Inst Postgrad Dent Educ, Sweden.
    Marcusson, Agneta
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Käkkliniken US.
    Ulander, Martin
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för neurobiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurofysiologiska kliniken US.
    Magnusson, Anders
    Inst Postgrad Dent Educ, Sweden; Jonkoping Univ, Sweden.
    Cardemil, Carina
    Karolinska Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Larsson, Pernilla
    Malmo Univ, Sweden; Folktandvarden Ostergotland, Sweden.
    Translation and validation of the English-language instrument Orthognathic Quality of Life Questionair into Swedish2021Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, nr 1, s. 19-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: In orthognathic surgery, understanding the patients motives for treatment is a key factor for postoperative patient satisfaction and treatment success. In countries/systems where orthognathic surgery is funded by public means, patients are referred mainly due to functional problems, although studies of quality of life related changes after treatment indicate that psychosocial and aesthetic reasons might be equal or more important for the patient. There is no available validated condition specific instruments in the Swedish language for quality of life evaluation of patients with dentofacial deformities. Aims/objectives: Cross cultural translation and adaptation of the English-language instrument Orthognathic Quality of Life Questionnaire (OQLQ) into Swedish. Methods: OQLQ was translated into Swedish. A total of 121 patients in four groups were recruited and the Swedish version of the OQLQ (OQLQ-S) was tested by psychometric methods. Reliability was assessed by internal consistency and test-retest reliability. Validity was evaluated by face, convergent and discriminant validity. Results/findings and conclusions: OQLQ-S is reliable and showed good construct validity and internal consistency and can be used in a Swedish speaking population as a complement to clinical variables to evaluate patients with dentofacial deformity.

  • 156.
    Ahlander, B. M.
    et al.
    Ryhov County Hospital, Jönköping, Sweden.
    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.
    Ericsson, E.
    Faculty of Medicine and Health, School of Health Science, Örebro University, Örebro, Sweden.
    Anxiety during magnetic resonance imaging of the spine in relation to scanner design and size2020Ingår i: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 26, nr 2, s. 110-116Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Magnetic resonance imaging in closed-bore scanners sometimes provokes anxiety but closed-bore designs have gradually become wider and shorter. Open scanners may be easier to tolerate. The aim was to compare patient anxiety during MRI between bore diameters of 60 cm and 70 cm, and to determine the current level of patient anxiety and experience in open scanners in a clinical setrting. Methods: Consecutive patients referred for examination of the spine in 60 cm and 70 cm bores and one open scanner participated. Four established/validated questionnaires, answered before, directly after (N = 155) and one week after (N = 109) the MRI-examination were used, measuring anxiety, fear and depression. Results: No difference was found in the patient scores of anxiety between the 60 cm and the 70 cm scanners on the examination day. At follow-up, patients in the 70 cm bore rated their examination experience better (p < 0.025), compared to patients in the 60 cm bore. Patients in the open scanner rated higher levels of anxiety (p < 0.001) before, directly after and one week after the examination, compared to the closed bore scanners. Conclusion: Scanners with a 70 cm diameter bore seem more tolerable than those with a 60 cm bore. Patients referred to the open scanner had on average a higher tendency to express anxiety. Still, patient anxiety in MRI is challenging and further research required. Implications for practice: Patients prefer to be examined in 70 cm bore scanners compared with 60 cm. If open scanners arent available extended support may be necessary for the most anxious patients. (c) 2019 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

    Ladda ner fulltext (pdf)
    fulltext
  • 157. Beställ onlineKöp publikationen >>
    Ahlander, Britt-Marie
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Magnetic Resonance Imaging of the Heart: Image quality, measurement accuracy and patient experience2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Non-invasive diagnostic imaging of atherosclerotic coronary artery disease (CAD) is frequently carried out with cardiovascular magnetic resonance imaging (CMR) or myocardial perfusion single photon emission computed tomography (MPS). CMR is the gold standard for the evaluation of scar after myocardial infarction and MPS the clinical gold standard for ischemia. Magnetic Resonance Imaging (MRI) is at times difficult for patients and may induce anxiety while patient experience of MPS is largely unknown.

    Aims: To evaluate image quality in CMR with respect to the sequences employed, the influence of atrial fibrillation, myocardial perfusion and the impact of patient information. Further, to study patient experience in relation to MRI with the goal of improving the care of these patients.

    Method: Four study designs have been used. In paper I, experimental cross-over, paper (II) experimental controlled clinical trial, paper (III) psychometric crosssectional study and paper (IV) prospective intervention study. A total of 475 patients ≥ 18 years with primarily cardiac problems (I-IV) except for those referred for MRI of the spine (III) were included in the four studies.

    Result: In patients (n=20) with atrial fibrillation, a single shot steady state free precession (SS-SSFP) sequence showed significantly better image quality than the standard segmented inversion recovery fast gradient echo (IR-FGRE) sequence (I). In first-pass perfusion imaging the gradient echo-echo planar imaging sequence (GREEPI) (n=30) had lower signal-to-noise and contrast–to-noise ratios than the steady state free precession sequence (SSFP) (n=30) but displayed a higher correlation with the MPS results, evaluated both qualitatively and quantitatively (II). The MRIAnxiety Questionnaire (MRI-AQ) was validated on patients, referred for MRI of either the spine (n=193) or the heart (n=54). The final instrument had 15 items divided in two factors regarding Anxiety and Relaxation. The instrument was found to have satisfactory psychometric properties (III). Patients who prior CMR viewed an information video scored significantly (lower) better in the factor Relaxation, than those who received standard information. Patients who underwent MPS scored lower on both factors, Anxiety and Relaxation. The extra video information had no effect on CMR image quality (IV).

    Conclusion: Single shot imaging in atrial fibrillation produced images with less artefact than a segmented sequence. In first-pass perfusion imaging, the sequence GRE-EPI was superior to SSFP. A questionnaire depicting anxiety during MRI showed that video information prior to imaging helped patients relax but did not result in an improvement in image quality.

    Delarbeten
    1. Image quality and myocardial scar size determined with magnetic resonance imaging in patients with permanent atrial fibrillation: a comparison of two imaging protocols
    Öppna denna publikation i ny flik eller fönster >>Image quality and myocardial scar size determined with magnetic resonance imaging in patients with permanent atrial fibrillation: a comparison of two imaging protocols
    Visa övriga...
    2010 (Engelska)Ingår i: CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, ISSN 1475-0961, Vol. 30, nr 2, s. 122-129Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Pandgt;Background: Magnetic resonance imaging (MRI) of the heart generally requires breath holding and a regular rhythm. Single shot 2D steady-state free precession (SS_SSFP) is a fast sequence insensitive to arrhythmia as well as breath holding. Our purpose was to determine image quality, signal-to-noise (SNR) and contrast-to-noise (CNR) ratios and infarct size with a fast single shot and a standard segmented MRI sequence in patients with permanent atrial fibrillation and chronic myocardial infarction. Methods: Twenty patients with chronic myocardial infarction and ongoing atrial fibrillation were examined with inversion recovery SS_SSFP and segmented inversion recovery 2D fast gradient echo (IR_FGRE). Image quality was assessed in four categories: delineation of infarcted and non-infarcted myocardium, occurrence of artefacts and overall image quality. SNR and CNR were calculated. Myocardial volume (ml) and infarct size, expressed as volume (ml) and extent (%), were calculated, and the methodological error was assessed. Results: SS_SSFP had significantly better quality scores in all categories (P = 0 center dot 037, P = 0 center dot 014, P = 0 center dot 021, P = 0 center dot 03). SNRinfarct and SNRblood were significantly better for IR_FGRE than for SS_SSFP (P = 0 center dot 048, P = 0 center dot 018). No significant difference was found in SNRmyocardium and CNR. The myocardial volume was significantly larger with SS_SSFP (170 center dot 7 versus 159 center dot 2 ml, P andlt; 0 center dot 001), but no significant difference was found in infarct volume and infarct extent. Conclusion: SS_SSFP displayed significantly better image quality than IR_FGRE. The infarct size and the error in its determination were equal for both sequences, and the examination time was shorter with SS_SSFP.

    Nyckelord
    atrial fibrillation, magnetic resonance imaging, myocardial infarction, segmented inversion recovery 2D fast gradient echo, single shot inversion recovery 2D steady-state free precession
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-54159 (URN)10.1111/j.1475-097X.2009.00914.x (DOI)000274438800006 ()
    Tillgänglig från: 2010-02-26 Skapad: 2010-02-26 Senast uppdaterad: 2021-12-28
    2. An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion
    Öppna denna publikation i ny flik eller fönster >>An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion
    Visa övriga...
    2017 (Engelska)Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, nr 1, s. 52-61Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo–echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference. Methods Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study. Results Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI). Conclusion GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2017
    Nyckelord
    cardiac imaging techniques, coronary heart disease, Magnetic Resonance Imaging, nuclear medicine, perfusion
    Nationell ämneskategori
    Radiologi och bildbehandling Medicinsk laboratorie- och mätteknik Medicinsk bildbehandling Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-130795 (URN)10.1111/cpf.12267 (DOI)000390688200008 ()26147785 (PubMedID)
    Anmärkning

    Funding agencies: Medical Research Council of Southeast Sweden [12437]; Futurum, the County council of Jonkoping [12440, 81851, 217261]; Linkoping University; County Council of Ostergotland [281281]; Swedish Heart-Lung Foundation [20120449]

    Tillgänglig från: 2016-08-24 Skapad: 2016-08-24 Senast uppdaterad: 2021-12-28Bibliografiskt granskad
    3. Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ)
    Öppna denna publikation i ny flik eller fönster >>Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ)
    Visa övriga...
    2016 (Engelska)Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 6, s. 1368-1380Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim. To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging-Anxiety Questionnaire. Background. Questionnaires measuring patients anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. Design. Psychometric cross-sectional study with test-retest design. Methods. A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbachs alpha. Criterion-related validity, known-group validity and test-retest was calculated. Results. Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbachs alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. Conclusion. Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

    Ort, förlag, år, upplaga, sidor
    WILEY-BLACKWELL, 2016
    Nyckelord
    anxiety; instrument development; magnetic resonance imaging; nurse; nursing; reliability; validity
    Nationell ämneskategori
    Övrig annan medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-129145 (URN)10.1111/jan.12917 (DOI)000376007400014 ()26893007 (PubMedID)
    Anmärkning

    Funding Agencies|Swedish Heart and Lung Foundation; Futurum County Council of Jonkoping

    Tillgänglig från: 2016-06-13 Skapad: 2016-06-13 Senast uppdaterad: 2021-12-28
    Ladda ner fulltext (pdf)
    Magnetic Resonance Imaging of the Heart: Image quality, measurement accuracy and patient experience
    Ladda ner (pdf)
    omslag
    Ladda ner (jpg)
    presentationsbild
  • 158.
    Ahlander, Britt-Marie
    et al.
    Department of Radiology, Ryhov County Hospital, SE-55185, Jönköping, Sweden..
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Maret, Eva
    Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, SE-14186, Stockholm, Sweden..
    Ericsson, Elisabeth
    Faculty of Medicine and Health, School of Health Science, Örebro University, SE-701 82, Örebro, Sweden..
    Positive effect on patient experience of video-information given prior to cardiovascular magnetic resonance imaging, a clinical trial2018Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, nr 5-6, s. 1250-1261Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on patient anxiety and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy. To evaluate if additional information has an impact on motion artefacts. Background: Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases. Although cardiovascular magnetic resonance imaging is considered to be painless, patients may experience anxiety due to the closed environment. Design: A prospective randomized intervention study, not registered. Methods: The sample (n=148) consisted of 97 patients referred for cardiovascular magnetic resonance imaging, randomized to receive either video information in addition to standard text-information (CMR-video/n=49) or standard text-information alone (CMR-standard/n=48). A third group undergoing myocardial perfusion scintigraphy (n=51) was compared with the cardiovascular magnetic resonance imaging-standard group. Anxiety was evaluated before, immediately after the procedure and one week later. Five questionnaires were used: Cardiac Anxiety Questionnaire, State-Trait-Anxiety Inventory, Hospital-Anxiety and Depression-scale, MRI-Fear-Survey-Schedule and the MRI-Anxiety-Questionnaire. Motion artefacts were evaluated by three observers, blinded to the information given. Data were collected between April 2015 and April 2016. The study followed the CONSORT guidelines RESULT: The CMR-video group scored lower (better) than the cardiovascular magnetic resonance imaging-standard group in the factor Relaxation (p=0.039) but not in the factor Anxiety. Anxiety levels were lower during scintigraphic examinations compared to the CMR-standard group (p<0.001). No difference was found regarding motion artefacts between CMR-video and CMR-standard. Conclusion: Patient ability to relax during cardiovascular magnetic resonance imaging increased by adding video information prior the exam, which is important in relation to perceived quality in nursing. No effect was seen on motion artefacts. Relevance To Clinical Practice: Video information prior to examinations can be an easy and time effective method to help patients cooperate in imaging procedures.

    Ladda ner fulltext (pdf)
    fulltext
  • 159.
    Ahlander, Britt-Marie
    et al.
    Department of Radiology, Ryhov County Hospital, Jönköping.
    Maret, Eva
    Department of Radiology, Ryhov County Hospital, Jönköping / Department of Clinical Physiology, Karolinska University Hospital, Stockholm.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar County Hospital, Kalmar.
    Starck, Sven-Åke
    Department of Natural Science and Biomedicine, School of Health Sciences, Jönköping University / Department of Oncology, Hospital Physics, Ryhov County Hospital, Jönköping.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US.
    An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion2017Ingår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, nr 1, s. 52-61Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo–echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference. Methods Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study. Results Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI). Conclusion GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.

  • 160.
    Ahlander, Britt-Marie
    et al.
    Ryhov County Hospital, Sweden.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Linnaeus University, Sweden.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Maret, Eva
    Karolinska University Hospital, Sweden; Karolinska Institute, Sweden.
    Ericsson, Elisabeth
    University of Örebro, Sweden.
    Development and validation of a questionnaire evaluating patient anxiety during Magnetic Resonance Imaging: the Magnetic Resonance Imaging-Anxiety Questionnaire (MRI-AQ)2016Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 6, s. 1368-1380Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. To develop and validate a new instrument measuring patient anxiety during Magnetic Resonance Imaging examinations, Magnetic Resonance Imaging-Anxiety Questionnaire. Background. Questionnaires measuring patients anxiety during Magnetic Resonance Imaging examinations have been the same as used in a wide range of conditions. To learn about patients experience during examination and to evaluate interventions, a specific questionnaire measuring patient anxiety during Magnetic Resonance Imaging is needed. Design. Psychometric cross-sectional study with test-retest design. Methods. A new questionnaire, Magnetic Resonance Imaging-Anxiety Questionnaire, was designed from patient expressions of anxiety in Magnetic Resonance Imaging-scanners. The sample was recruited between October 2012-October 2014. Factor structure was evaluated with exploratory factor analysis and internal consistency with Cronbachs alpha. Criterion-related validity, known-group validity and test-retest was calculated. Results. Patients referred for Magnetic Resonance Imaging of either the spine or the heart, were invited to participate. The development and validation of Magnetic Resonance Imaging-Anxiety Questionnaire resulted in 15 items consisting of two factors. Cronbachs alpha was found to be high. Magnetic Resonance Imaging-Anxiety Questionnaire correlated higher with instruments measuring anxiety than with depression scales. Known-group validity demonstrated a higher level of anxiety for patients undergoing Magnetic Resonance Imaging scan of the heart than for those examining the spine. Test-retest reliability demonstrated acceptable level for the scale. Conclusion. Magnetic Resonance Imaging-Anxiety Questionnaire bridges a gap among existing questionnaires, making it a simple and useful tool for measuring patient anxiety during Magnetic Resonance Imaging examinations.

    Ladda ner fulltext (pdf)
    fulltext
  • 161.
    Ahlbeck, Lars
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Allergicentrum US.
    Astma lathund: Astma hos vuxna2018Övrigt (Övrigt vetenskapligt)
    Abstract [sv]

    Åtta till tio procent av den vuxna befolkningen har astma. Av dessa har 65 procent lindrig, 25 procent medelsvår och 10 procent svår astma. Astma är en heterogen sjukdom, där en kronisk luftvägsinflammation oftast föreligger.

    Sjukdomen kännetecknas av återkommande luftvägssymtom såsom pip i bröstet, andnöd, trånghetskänsla i bröstet och hosta som varierar över tiden tillsammans med en variabel luftvägsobstruktion.

    Ladda ner fulltext (pdf)
    Astma lathund: Astma hos vuxna
  • 162. Beställ onlineKöp publikationen >>
    Ahlbeck, Lars
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Allergicentrum US.
    Intralymphatic Immunotherapy: A Novel Route to Ameliorate Allergic Rhinitis Due to Pollen2024Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Allergy to pollen and animal dander is a major public health problem. Close to 30% of the population have symptoms from the upper and/or lower respiratory tract when they meet fur animals or pollen. Whereas symptom-relieving medications have a good to sufficient effect on about 80% of those affected, a large group of 10–20% have severe symptoms, despite medication, with an impact on well-being and ability to work. In Sweden, the annual cost of allergy was calculated at €1.3 billion in 2014.

    Immunotherapy is effective in treating and preventing pollen allergy and allergic asthma, but is expensive, complicated, requiring 40 injections, and takes more than three years to complete if subcutaneous injections are used. Tablets placed under the tongue are another method, with one tablet taken every day for three years. Only 1.5‰ receive such treatment, yet just over 3% would need it.

    With intralymphatic immunotherapy, a small dose of allergen is given in a lymph node in the groin on 3 occasions, one month apart. As this method takes only eight weeks, it is a much faster and less costly treatment. However, although several studies have shown that the treatment is safe, its efficacy remains the subject of doubt.

    Our pilot study in 2012, with a 3-year follow-up to 2015, showed encouraging results, and was followed by a double-blind randomised study with 72 participants from 2014 to 2018. The research subjects then received treatment with birch and grass pollen extract or one extract and a placebo. Regardless of treatment, symptoms, quality of life and medication consumption improved during the birch and grass pollen seasons in the 3 years after treatment. Increased frequencies of T-regulatory lymphocytes may explain the non-specific effects.

    In 2017 to 2018, we conducted a double-blind study with 38 participants, half of whom received placebo and half, active treatment. In this study, we saw no difference between the treatment groups in the first year after treatment. However, after discontinuation and unblinding in 2019, i.e., two years after treatment, the actively treated group improved in terms of symptoms, and quality of life was improved compared with the placebo group despite less need for medication. T-regulatory lymphocytes increased one year after treatment only in the actively treated group.

    A long-term follow-up of the research subjects from our two larger studies in 2022, i.e., five to eight years after treatment, showed in the double-blind study without a pure placebo that the scores for symptoms, medication use, and quality of life remained as low as after the first three years. In the placebo-controlled study, a statistically significant improvement in symptoms remained during the grass pollen season. Analysing the two studies together, symptom improvement was significant even during the birch pollen season. Thus, although the effect does not seem to diminish, those who did not receive birch, but only grass, needed to use more medication during the birch pollen season in 2022, seven to eight years after treatment. Moreover, those who did not receive grass but only birch needed more medication during the grass pollen season. This may suggest that the non-specific effect begins to wane after seven to eight years.

    Allergy to pollen is a major problem for individuals and society, where symptom-relieving treatment with drugs is not enough for many. They can be helped with immunotherapy, which takes at least three years, is expensive and fraught with side effects. In contrast, intralymphatic immunotherapy involves three injections over eight weeks. Our three studies show that the treatment is safe and indicate that it has a clinical effect up to eight years after treatment. T-regulatory cells appear to be important to the immunological mechanism, leading to tolerance to pollen.

    Delarbeten
    1. Intralymphatic allergen immunotherapy against pollen allergy. A 3-year open follow-up study of 10 patients
    Öppna denna publikation i ny flik eller fönster >>Intralymphatic allergen immunotherapy against pollen allergy. A 3-year open follow-up study of 10 patients
    Visa övriga...
    2018 (Engelska)Ingår i: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 121, nr 5, s. 626-627Artikel i tidskrift, Letter (Refereegranskat) Published
    Abstract [en]

    To date, allergen immunotherapy (AIT) is the only treatment that affects the long-term development of allergic rhinoconjunctivitis and induces clinical tolerance primarily by stimulating regulatory T (Treg) cells, attenuating T helper 2 (Th2) responses and synthesis of blocking antibodies1. Conventional AIT with subcutaneous injections, sublingual tablets or drops is effective, but consumes time and resources 2.

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2018
    Nyckelord
    Immunotherapy, Intralymphatic, Allergy, Rhinoconjunctivitis, T-cells
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-150594 (URN)10.1016/j.anai.2018.07.010 (DOI)000448665400022 ()30021119 (PubMedID)
    Anmärkning

    Funding agencies: Region Ostergotland; Allergy Center in Linkoping; Medical Research Council of Southeast Sweden (FORSS); Bergh Foundation; Asthma and Allergy Association of Sweden

    Tillgänglig från: 2018-08-28 Skapad: 2018-08-28 Senast uppdaterad: 2024-01-02Bibliografiskt granskad
    2. Intralymphatic immunotherapy with one or two allergens renders similar clinical response in patients with allergic rhinitis due to birch and grass pollen
    Öppna denna publikation i ny flik eller fönster >>Intralymphatic immunotherapy with one or two allergens renders similar clinical response in patients with allergic rhinitis due to birch and grass pollen
    Visa övriga...
    2022 (Engelska)Ingår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 52, nr 6, s. 747-759Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Introduction

    There is a need for a fast, efficient and safe way to induce tolerance in patients with severe allergic rhinitis. Intralymphatic immune therapy has been shown to be effective.

    Methods

    Patients with severe birch and timothy allergy were randomized and received three doses of 0.1 ml of birch and 5-grass allergen extracts (10,000 SQ units/ml, ALK-Abello), or birch and placebo or 5-grass and placebo by ultrasound-guided injections into inguinal lymph nodes at monthly intervals. Rhinoconjunctivitis total symptom score, medication score and rhinoconjunctivitis quality of life questionnaire were evaluated before treatment and after each birch and grass pollen season during three subsequent years. Circulating proportions of T helper subsets and allergen-induced cytokine and chemokine production were analysed by flow cytometry and Luminex.

    Results

    The three groups reported fewer symptoms, lower use of medication and improved quality of life during the birch and grass pollen seasons each year after treatment at an almost similar rate independently of treatment with one or two allergens. Mild local pain was the most common adverse event. IgE levels to birch decreased, whereas birch-induced IL-10 secretion increased in all three groups. IgG4 levels to birch and timothy and skin prick test reactivity remained mainly unchanged. Conjunctival challenge tests with timothy extract showed a higher threshold for allergen. In all three groups, regulatory T cell frequencies were increased 3 years after treatment.

    Conclusions

    Intralymphatic immunotherapy with one or two allergens in patients with grass and birch pollen allergy was safe, effective and may be associated with bystander immune modulatory responses.

    Ort, förlag, år, upplaga, sidor
    Chichester, United Kingdom: Wiley-Blackwell Publishing Inc., 2022
    Nyckelord
    allergy; intralymphatic immunotherapy; hypersensitivity; rhinoconjunctivitis immunotherapy; intralymphatic; allergy
    Nationell ämneskategori
    Lungmedicin och allergi
    Identifikatorer
    urn:nbn:se:liu:diva-184407 (URN)10.1111/cea.14138 (DOI)000776517300001 ()35332591 (PubMedID)2-s2.0-85127382771 (Scopus ID)
    Anmärkning

    Funding Agencies: Region Östergotland; Medical Research Council of Southeast Sweden (FORSS); Th Bergh Foundation; Asthma and Allergy Association

    Tillgänglig från: 2022-04-21 Skapad: 2022-04-21 Senast uppdaterad: 2023-11-27Bibliografiskt granskad
    3. Intralymphatic immunotherapy with birch and grass pollen extracts. A randomized double-blind placebo-controlled clinical trial
    Öppna denna publikation i ny flik eller fönster >>Intralymphatic immunotherapy with birch and grass pollen extracts. A randomized double-blind placebo-controlled clinical trial
    Visa övriga...
    2023 (Engelska)Ingår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 53, nr 8, s. 809-820Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    IntroductionThere is a need to evaluate the safety and efficacy of intralymphatic immunotherapy (ILIT) for inducing tolerance in patients with allergic rhinitis. MethodsThirty-seven patients with seasonal allergic symptoms to birch and grass pollen and skin prick test &gt;3 mm and/or IgE to birch and timothy &gt;0.35 kU/L were randomized to either ILIT, with three doses of 0.1 mL of birch pollen and 5-grass pollen allergen extracts on aluminium hydroxide (10,000 SQ-U/ml; ALK-Abello) or placebo using ultrasound-guided intralymphatic injections at monthly intervals. Daily combined symptom medical score and rhinoconjunctivitis total symptom score were recorded during the peak pollen seasons the year before and after treatment. Rhinoconjunctivitis total symptom score, medication score and rhinoconjunctivitis quality of life questionnaire were recorded annually starting 2 years after treatment. Circulating proportions of T helper cell subsets and allergen-induced cytokine and chemokine production were analysed using flow cytometry and ELISA. ResultsThere were no differences between the groups related to daily combined symptom medical score the year before and after treatment. Two years after ILIT (after unblinding), the actively treated group reported significantly fewer symptoms, lower medication use and improved quality of life than did the placebo group. After the pollen seasons the year after ILIT, T regulatory cell frequencies and grass-induced IFN-gamma levels increased only in the actively treated group. ConclusionIn this randomized controlled trial, ILIT with birch and grass pollen extract was safe and accompanied by immunological changes. Further studies are required to confirm or refute the efficacy of the treatment.

    Ort, förlag, år, upplaga, sidor
    WILEY, 2023
    Nyckelord
    allergy; hypersensitivity; intralymphatic immunotherapy; rhinoconjunctivitis
    Nationell ämneskategori
    Lungmedicin och allergi
    Identifikatorer
    urn:nbn:se:liu:diva-193405 (URN)10.1111/cea.14307 (DOI)000962776700001 ()37013723 (PubMedID)
    Anmärkning

    Funding Agencies|Astma- och Allergifoerbundet; Region OEstergoetland; Medical Research Council of Southeast Sweden (FORSS); Bergh Foundation

    Tillgänglig från: 2023-05-03 Skapad: 2023-05-03 Senast uppdaterad: 2023-11-27
    Ladda ner fulltext (pdf)
    fulltext
    Ladda ner (png)
    presentationsbild
  • 163.
    Ahlbeck, Lars
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Allergicentrum US.
    Ahlberg, Emelie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Björkander, Janne
    Acad Hlth & Care, Sweden.
    Aldén, Caroline
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Papapavlou, Georgia
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Palmberg, Laura
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Nyström Kronander, Ulla
    Region Östergötland, Medicincentrum, Allergicentrum US.
    Retsas, Pavlos
    Region Östergötland, Medicincentrum, Allergicentrum US.
    Nordenfelt, Patrik
    Cty Hosp Ryhov, Sweden.
    Togö, Totte
    Region Östergötland, Medicincentrum, Allergicentrum US.
    Johansen, Pål
    Univ Zurich, Switzerland.
    Rolander, Bo
    Acad Hlth & Care, Sweden.
    Duchén, Karel
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Allergicentrum US. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Intralymphatic immunotherapy with one or two allergens renders similar clinical response in patients with allergic rhinitis due to birch and grass pollen2022Ingår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 52, nr 6, s. 747-759Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

    There is a need for a fast, efficient and safe way to induce tolerance in patients with severe allergic rhinitis. Intralymphatic immune therapy has been shown to be effective.

    Methods

    Patients with severe birch and timothy allergy were randomized and received three doses of 0.1 ml of birch and 5-grass allergen extracts (10,000 SQ units/ml, ALK-Abello), or birch and placebo or 5-grass and placebo by ultrasound-guided injections into inguinal lymph nodes at monthly intervals. Rhinoconjunctivitis total symptom score, medication score and rhinoconjunctivitis quality of life questionnaire were evaluated before treatment and after each birch and grass pollen season during three subsequent years. Circulating proportions of T helper subsets and allergen-induced cytokine and chemokine production were analysed by flow cytometry and Luminex.

    Results

    The three groups reported fewer symptoms, lower use of medication and improved quality of life during the birch and grass pollen seasons each year after treatment at an almost similar rate independently of treatment with one or two allergens. Mild local pain was the most common adverse event. IgE levels to birch decreased, whereas birch-induced IL-10 secretion increased in all three groups. IgG4 levels to birch and timothy and skin prick test reactivity remained mainly unchanged. Conjunctival challenge tests with timothy extract showed a higher threshold for allergen. In all three groups, regulatory T cell frequencies were increased 3 years after treatment.

    Conclusions

    Intralymphatic immunotherapy with one or two allergens in patients with grass and birch pollen allergy was safe, effective and may be associated with bystander immune modulatory responses.

    Ladda ner fulltext (pdf)
    fulltext
  • 164.
    Ahlbeck, Lars
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Allergicentrum US.
    Ahlberg, Emelie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Nyström Kronander, Ulla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Allergicentrum US.
    Björkander, Janne
    Futurum, Academy of Health and Care, Jönköping, Sweden.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten.
    Intralymphatic allergen immunotherapy against pollen allergy. A 3-year open follow-up study of 10 patients2018Ingår i: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, E-ISSN 1534-4436, Vol. 121, nr 5, s. 626-627Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To date, allergen immunotherapy (AIT) is the only treatment that affects the long-term development of allergic rhinoconjunctivitis and induces clinical tolerance primarily by stimulating regulatory T (Treg) cells, attenuating T helper 2 (Th2) responses and synthesis of blocking antibodies1. Conventional AIT with subcutaneous injections, sublingual tablets or drops is effective, but consumes time and resources 2.

    Ladda ner fulltext (pdf)
    fulltext
  • 165.
    Ahlbeck, Lars
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Allergicentrum US.
    Ahlberg, Emelie
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Stuivers, Linn
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Bjorkander, Janne
    Futurum, Sweden.
    Nyström Kronander, Ulla
    Region Östergötland, Medicincentrum, Allergicentrum US.
    Retsas, Pavlos
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Govindaraj, Dhanapal
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Duchén, Karel
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Allergicentrum US.
    Intralymphatic immunotherapy with birch and grass pollen extracts. A randomized double-blind placebo-controlled clinical trial2023Ingår i: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 53, nr 8, s. 809-820Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IntroductionThere is a need to evaluate the safety and efficacy of intralymphatic immunotherapy (ILIT) for inducing tolerance in patients with allergic rhinitis. MethodsThirty-seven patients with seasonal allergic symptoms to birch and grass pollen and skin prick test &gt;3 mm and/or IgE to birch and timothy &gt;0.35 kU/L were randomized to either ILIT, with three doses of 0.1 mL of birch pollen and 5-grass pollen allergen extracts on aluminium hydroxide (10,000 SQ-U/ml; ALK-Abello) or placebo using ultrasound-guided intralymphatic injections at monthly intervals. Daily combined symptom medical score and rhinoconjunctivitis total symptom score were recorded during the peak pollen seasons the year before and after treatment. Rhinoconjunctivitis total symptom score, medication score and rhinoconjunctivitis quality of life questionnaire were recorded annually starting 2 years after treatment. Circulating proportions of T helper cell subsets and allergen-induced cytokine and chemokine production were analysed using flow cytometry and ELISA. ResultsThere were no differences between the groups related to daily combined symptom medical score the year before and after treatment. Two years after ILIT (after unblinding), the actively treated group reported significantly fewer symptoms, lower medication use and improved quality of life than did the placebo group. After the pollen seasons the year after ILIT, T regulatory cell frequencies and grass-induced IFN-gamma levels increased only in the actively treated group. ConclusionIn this randomized controlled trial, ILIT with birch and grass pollen extract was safe and accompanied by immunological changes. Further studies are required to confirm or refute the efficacy of the treatment.

    Ladda ner fulltext (pdf)
    fulltext
  • 166.
    Ahlbeck, Lars
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Allergicentrum US.
    Berggren Rygaard, Helena
    Region Östergötland, Primärvårdscentrum, Vårdcentralen Ekholmen, Linköping.
    Astma lathund: Astma hos barn2019Övrigt (Övrigt vetenskapligt)
    Abstract [sv]

    Eftersom få läkemedelsstudier utförs på barn är många av dagens läkemedel som ges till barn ofullständigt dokumenterade vad gäller dosering, effekt och säkerhet. Barn får många läkemedel utanför godkänd produktresumé (off-label), som licensläkemedel eller som apoteksberett läkemedel. I brist på vetenskaplig dokumentation har barnläkarna tvingats att utveckla egna behandlingsrekommendationer som vilar på beprövad erfarenhet. Det gör att det kan föreligga skillnader mellan riktlinjer både på lokal och på nationell nivå. Vidare är diagnostiken svårare eftersom lungfunktionstester inte är möjligt på små- och förskolebarn. Våra rekommendationer vilar på referenserna sist i denna lathund.

    Ladda ner fulltext (pdf)
    Astma lathund: Astma hos barn
  • 167.
    Ahlberg, Emelie
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Al-Kaabawi, Ahmed
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Thune, Rebecka
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten.
    Simpson, Melanie Rae
    Norwegian Univ Sci & Technol NTNU, Norway.
    Pedersen, Sindre Andre
    Norwegian Univ Sci & Technol NTNU, Norway.
    Cione, Erika
    Univ Calabria, Italy.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Tingö, Lina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Orebro Univ, Sweden; Orebro Univ, Sweden.
    Breast milk microRNAs: Potential players in oral tolerance development2023Ingår i: Frontiers in Immunology, E-ISSN 1664-3224, Vol. 14, artikel-id 1154211Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Breast milk is an essential source of nutrition and hydration for the infant. In addition, this highly complex biological fluid contains numerous immunologically active factors such as microorganisms, immunoglobulins, cytokines and microRNAs (miRNAs). Here, we set out to predict the function of the top 10 expressed miRNAs in human breast milk, focusing on their relevance in oral tolerance development and allergy prevention in the infant. The top expressed miRNAs in human breast milk were identified on basis of previous peer-reviewed studies gathered from a recent systematic review and an updated literature search. The miRNAs with the highest expression levels in each study were used to identify the 10 most common miRNAs or miRNA families across studies and these were selected for subsequent target prediction. The predictions were performed using TargetScan in combination with the Database for Annotation, Visualization and Integrated Discovery. The ten top expressed miRNAs were: let-7-5p family, miR-148a-3p, miR-30-5p family, miR-200a-3p + miR-141-3p, miR-22-3p, miR-181-5p family, miR-146b-5p, miR-378a-3p, miR-29-3p family, miR-200b/c-3p and miR-429-3p. The target prediction identified 3,588 potential target genes and 127 Kyoto Encyclopedia of Genes and Genomes pathways; several connected to the immune system, including TGF-b and T cell receptor signaling and T-helper cell differentiation. This review highlights the role of breast milk miRNAs and their potential contribution to infant immune maturation. Indeed, breast milk miRNAs seem to be involved in several pathways that influence oral tolerance development.

    Ladda ner fulltext (pdf)
    fulltext
  • 168.
    Ahlberg, Emelie
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Tingö, Lina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Orebro Univ, Sweden.
    Evaluation of five column-based isolation kits and their ability to extract miRNA from human milk2021Ingår i: Journal of Cellular and Molecular Medicine (Print), ISSN 1582-1838, E-ISSN 1582-4934, Vol. 25, nr 16, s. 7973-7979Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    MicroRNA can be found in various body fluids, including breast milk. MicroRNA may be transferred from mother to infant via breast milk and potentially regulate the development of the infants immune system on a post-transcriptional level. This study aimed to determine the microRNA extraction efficiency of five RNA extraction kits from human skim milk samples. Their efficiency was determined by comparing microRNA concentrations, total RNA yield and purity. Furthermore, hsa-miR-148a-3p expression and the recovery of an exogenous control, cel-miR-39-3p, were quantified using qPCR. Each kit extracted different amounts of microRNA and total RNA, with one kit tending to isolate the highest amount of both RNA species. Based on these results, the extraction kit ReliaPrep (TM) miRNA Cell and Tissue Miniprep System from Promega was found to be the most appropriate kit for microRNA extraction from human skim milk. Moreover, further research is needed to establish a standardized protocol for microRNA extraction from breast milk.

    Ladda ner fulltext (pdf)
    fulltext
  • 169.
    Ahlberg, Emelie
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Martí Generó, Magalí Martí
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten.
    Govindaraj, Dhanapal
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Severin, Elisabet
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Allergicentrum US.
    Duchén, Karel
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Allergicentrum US.
    Jenmalm, Maria
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten.
    Tingö, Lina
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Orebro Univ, Sweden.
    Immune-related microRNAs in breast milk and their relation to regulatory T cells in breastfed children2023Ingår i: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 34, nr 4, artikel-id e13952Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundThe immunomodulatory capacity of breast milk may partially be mediated by microRNAs (miRNA), small RNA molecules that regulate gene expression on a post-transcriptional level and are hypothesized to be involved in modulation of immunological pathways. Here, we evaluate the expression of immune-related miRNAs in breast milk after pre- and postnatal supplementation with Limosilactobacillus reuteri and omega-3 (omega-3) polyunsaturated fatty acids (PUFAs), and the association to infant regulatory T cell (Treg) frequencies. MethodsOne-hundred and twenty women included in a double-blind, randomized, placebo-controlled allergy intervention trial received L. reuteri and/or omega-3 PUFAs daily from gestational week 20. Using Taqman qPCR, 24 miRNAs were analyzed from breast milk obtained at birth (colostrum) and after 3 months (mature milk) of lactation. The proportion of activated and resting Treg cells were analyzed in infant blood using flow cytometry at 6, 12, and 24 months. ResultsRelative expression changed significantly over the lactation period for most of the miRNAs; however, the expression was not significantly influenced by any of the supplements. Colostrum miR-181a-3p correlated with resting Treg cell frequencies at 6 months. Colostrum miR-148a-3p and let-7d-3p correlated with the frequencies of activated Treg cells at 24 months, as did mature milk miR-181a-3p and miR-181c-3p. ConclusionMaternal supplementation with L. reuteri and omega-3 PUFAs did not significantly affect the relative miRNA expression in breast milk. Interestingly, some of the miRNAs correlate with Treg subpopulations in the breastfed children, supporting the hypothesis that breast milk miRNAs could be important in infant immune regulation. Trial registrationClinicalTrials.gov-ID: NCT01542970.

    Ladda ner fulltext (pdf)
    fulltext
  • 170.
    Ahlberg, Eva-Lena
    et al.
    Region Östergötland, Hälso- och sjukvårdens stab.
    Elfström, Johan
    Region Östergötland, Hälso- och sjukvårdens stab.
    Borgstedt Risberg, Madeleine
    Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Öhrn, Annica
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Övr Regionledningskontoret.
    Andersson, Christer
    Region Östergötland, Hälso- och sjukvårdens stab.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hälso- och sjukvårdens stab.
    Nilsen, Per
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Learning From Incident Reporting?: Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care2020Ingår i: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425, Vol. 16, nr 4, s. 264-268Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives Incident reporting (IR) systems have the potential to improve patient safety if they enable learningfrom the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council.

    Methods The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence.

    Results Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline.

    Conclusions The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.

  • 171. Ahlberg, M
    et al.
    Bäckman, C
    Jones, C
    Walther, S
    Hollman Frisman, Gunilla
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Group communication confirms feelings among partners of former intensive care patients2014Konferensbidrag (Refereegranskat)
  • 172.
    Ahlberg, M
    et al.
    Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Bäckman, C
    Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Jones, C
    Musculoskeletal Biologu, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK.
    Walther, S
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Hollman Frisman, Gunilla
    Region Östergötland, Sinnescentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Moving forward in life after being an on-looker in intensive care partner's experience of group-communication2016Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Partners have a burdensome time during and after their partners’ intensive care period. They may appear to be coping well

    outwardly but inside feel vulnerable and lost. Evaluated interventions for partners on this aspect are limited.

    Aim: The aim of this study was to describe the experience of participating in group communication with other partners of former intensive

    care patients.

    Design: The study has a descriptive intervention-based design where group communication for partners of former, surviving intensive care

    unit (ICU) patients was evaluated.

    Methods: A strategic selection was made of adult partners to former adult intensive care patients (n=15), 5 men and 10 women, aged

    37–89 years. Two group communication sessions lasting 2 h were held at monthly intervals with three to five partners. The partners later wrote,

    in a notebook, about their feelings of participating in group communications. To deepen the understanding of the impact of the sessions, six of

    the partners were interviewed. Content analysis was used to analyse the notebooks and the interviews.

    Findings: Three categories were identified: (1) Emotional impact, the partners felt togetherness and experienced worries and gratitude, (2)

    Confirmation, consciousness through insight and reflection and (3) The meeting design, group constellation and recommendation to participate

    in group communication.

    Conclusion: Partners of an intensive care patient are on a journey, constantly trying to adapt to the new situation and find new strategies

    to ever-changing circumstances. Group communications contributed to togetherness and confirmation. To share experiences with others is one

    way for partners to be able to move forward in life.

    Relevance to clinical practice: Group communication with other patients’ partners eases the process of going through the burden of

    being a partner to an intensive care patient. Group communications needs to be further developed and evaluated to obtain consensus and

    evidence for the best practice.

    Key words: Communication • Content analysis • Intensive care • Nursing • Partners

  • 173. Beställ onlineKöp publikationen >>
    Ahlberg, Mona
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Being cared for in an Intensive Care Unit – family functioning and support2022Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    När COVID - 19 kom in som en objuden gäst i vår vardag, har omvårdnad inom intensivvården påverkats, och gjort att studierna innehåller data både före och under COVID-19 pandemin.   

    Före pandemin erbjöd de flesta intensivvårdsavdelningar, som tar hand om patienter med kritisk sjukdom i en teknisk miljö, familjemedlemmar att besöka patienten dygnet runt. Detta är en stressig och skrämmande miljö för både patienten och dennes familj. De kan påverkas mentalt och fysiskt med bland annat symtom som sömnsvårigheter, stress och depression. Intensivvårdspatienten kommer ofta inte ihåg något från tiden de vårdats på intensiven och familjen behöver förklara och återberätta den förlorade tiden. Under pandemin förändrades detta, med restriktioner och begränsad möjlighet att besöka sjukhuset och patienten på grund av virusutbrott. Familjemedlemmar fick information om patientens sjukdomstillstånd, per telefon av en läkare.   

    Det övergripande syftet med denna avhandling var att undersöka familjefunktionen hos familjer med en familjemedlem som vårdats på intensivvårdsavdelning. Det fanns också en avsikt att beskriva och utvärdera hur en intervention påverkar familjen och enskilda familjemedlemmar i familjer där en familjemedlem fick intensivvård.  

    I dessa studier användes kvalitativa, kvantitativa och mixad metod. Deltagarna var vuxna intensivvårdspatienter från sju intensivvårdskliniker och deras familjer. Resultaten som undersöks mellan familjer baseras på patient- och familjekarakteristika.  

    Resultatet i studie I, visar att familjer som erfarit COVID - 19 sjukdom och vårdats på intensivvårdsavdelning, har existentiella funderingar.   

    Studie II visar ingen större påverkan på familjefunktion mellan familjerna, men svaren skiljer sig inom familjen som erfarit intensivvård.

    I studie III där familjer som upplever intensivvård och deltagit i hälsostödjande familjesamtal visar en medvetenhet om familjefunktion. Samtalen för familjen närmare varandra, genom förbättrad förståelse av varandra.   

    I studie IV jämfördes familjefunktion, hopp om framtiden och känsla av sammanhang bland deltagarna i två interventionsgrupper: Hälsostödjande familjesamtal och stödgruppssamtal. Familjefunktion och hopp om fram-tiden var högre i gruppen som deltog i hälsostödjande familjesamtalen och begriplighet, meningsfullhet och vitalitet var högre bland deltagarna i stödgruppssamtalet.  

    Genom att utforska hur familjens funktion påverkar, den enskilde familjemedlemmen och familjen som enhet, av kritisk sjukdom och intensivvård kan nya arbetssätt stärkas i omvårdnaden av patienter och deras anhöriga.  

    Delarbeten
    1. Family Health Conversations create awareness of family functioning.
    Öppna denna publikation i ny flik eller fönster >>Family Health Conversations create awareness of family functioning.
    2020 (Engelska)Ingår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, nr 2, s. 102-108Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: The whole family is affected if one family member is critically ill. The Family Health Conversation Intervention may give the family tools that support healthier family functioning.

    AIMS AND OBJECTIVES: The aim of this study was to identify which components of family function are affected when families participate in Family Health Conversations.

    DESIGN: A secondary analysis was performed of existing qualitative interviews. The Family Health Conversation is an intervention where nurses ask the family reflective questions, and reflection is made possible in three conversation sessions.

    METHODS: This study included transcribed data from 13 follow-up interviews from seven families attending Family Health Conversations after three and 12 months. Data were analysed with narrative analysis, focusing on family function.

    RESULTS: Three themes were identified. The families' family functioning had been supported with: improved understanding of each other-there was an understanding of being in the same situation but still having totally different experiences; more concern for each other-they talked about their different experiences and felt they had become closer to each other; and a process of working through-they had experienced working through various experiences, standing by and supporting, and then being able to move on.

    CONCLUSIONS: The Family Health Conversation Intervention is provided to families, accompanied by nurses. The families in this study gained an awareness of their family function that brought the family closer because of improved understanding of each other and the situation. The families experienced openness, and the family members spoke more freely with each other, which facilitated the progress of working through the experience of critical illness and helped to maintain healthy family functioning.

    RELEVANCE TO CLINICAL PRACTICE: It is important to have an overall perspective and to recognize the patient and the family as equally important within the family for awareness of family function.

    Nyckelord
    family members, family nursing, intensive care, narrativism, secondary analysis
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-157714 (URN)10.1111/nicc.12454 (DOI)000516973500006 ()31197904 (PubMedID)
    Anmärkning

    Funding agencies: Health Research Council in the South-East of Sweden [FORSS 466311]; Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences, Linkoping University, Norrkoping, Sweden

    Tillgänglig från: 2019-06-19 Skapad: 2019-06-19 Senast uppdaterad: 2022-11-10
    2. Family Health Conversations Versus Support Group Conversations When a Family Member Has Been Critically Ill: A Mixed Methods Study
    Öppna denna publikation i ny flik eller fönster >>Family Health Conversations Versus Support Group Conversations When a Family Member Has Been Critically Ill: A Mixed Methods Study
    2021 (Engelska)Ingår i: Families, Systems & Health, ISSN 1091-7527, E-ISSN 1939-0602, Vol. 39, nr 2, s. 293-305Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Introduction: When a family member has been critically ill and cared for at an intensive care unit the individual family member as well as the family system are affected and in need of support. The aim of this study was to compare and contrast the responses from 2 different types of follow-up interventions for families of critically ill persons, focusing on individual hopes, health-related quality of life, family functioning and ability to cope with challenges. Method: Adult family members from 3 hospitals attended 1 of 2 interventions 2 months after intensive care. The family health conversation included the family. The support group conversation included just family members and not the patient who had experienced intensive care. Data were collected via self-reported questionnaires and follow-up interviews with family members. Quantitative and qualitative data were first analyzed separately, and the results were then integrated through mixed methods analysis. Results: A total of 38 family members took part in the interventions. Family members in the 2 intervention groups talked about how they had more hope for the future, and about how talking within the family and the group had helped them justify their feelings, which empowered them in the transition toward a healthier quality of life. Comparisons of the interventions show a higher significance of family function and hope in the family health conversation. Discussion: The article illustrates a disparity between how family members function and the needs they have for follow-up. We discuss what kind of follow-up these persons need.

    Ort, förlag, år, upplaga, sidor
    EDUCATIONAL PUBLISHING FOUNDATION-AMERICAN PSYCHOLOGICAL ASSOC, 2021
    Nyckelord
    family members; family nursing; family relations; intensive care; mixed methods
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-178966 (URN)10.1037/fsh0000607 (DOI)000687054400012 ()34410772 (PubMedID)
    Anmärkning

    Funding Agencies|Health Research Council in the Southeast of Sweden [FORSS 466311]; Department of Anesthesiology and Intensive Care, Norrkoping, Sweden; Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden

    Tillgänglig från: 2021-09-07 Skapad: 2021-09-07 Senast uppdaterad: 2022-11-10
    Ladda ner fulltext (pdf)
    fulltext
    Ladda ner (png)
    presentationsbild
  • 174.
    Ahlberg, Mona
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Berterö, Carina
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa.
    Hollman Frisman, Gunilla
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa.
    Ågren, Susanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Family Health Conversations create awareness of family functioning2018Konferensbidrag (Övrigt vetenskapligt)
  • 175.
    Ahlberg, Mona
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Berterö, Carina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Ågren, Susanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Family functioning of families experiencing intensive care and the specific impact of the COVID-19 pandemic: A grounded theory study2023Ingår i: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 76, artikel-id 103397Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: In order to provide a deeper understanding of family functioning, the aim of this study was to identify, describe and conceptualise the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit, with the impact of a pandemic.Research methodology/design: The study has a grounded theory design including interviews with eight families.Setting: Former adult intensive care patients cared for Covid-19 infection and their family. Eight patients and twelve family members from three different intensive care units.Main outcome measures: The results presented are grounded in data and identified in the core category "Existential issues" and the categories "Value considerateness; Anxiety and insecurity in life; Insight into the unpredictability of life." Findings: The core category could be found in all data and its relationship and impact on the categories and each other. The core is a theoretical construction, whereas the family functioning of families where a formerly critically ill family member had stayed at the intensive care unit was identified, described, and conceptualised. Being able to talk repeatedly about existential issues and the anxiety and insecurity in life, with people that have similar experiences helps the patient and their family to consider and gain insight into the unpredictability of life, and thereby better cope with changes in life.Conclusion: There is awareness about the love that exists within the family. A willing to supporting each other in the family even if the critical illness made the family anxious and afraid. Implications for clinical practice: Even if the pandemic Covid-19 led to restrictions inhibiting family focused nursing, it is important to confirm the family as a part of the caring of the ICU patient. The patients are not alone, their family are fighting together for the future.

    Ladda ner fulltext (pdf)
    fulltext
  • 176.
    Ahlberg, Mona
    et al.
    Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Bäckman, Carl
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Jones, Christina
    Musculoskeletal Biology, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK.
    Walther, Sten
    Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Hollman Frisman, Gunilla
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum.
    Moving on in life after intensive care - partners' experience of group communication2015Ingår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 20, nr 5, s. 256-263Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:Partners have a burdensome time during and after their partners’ intensive care period. They may appear to be coping welloutwardly but inside feel vulnerable and lost. Evaluated interventions for partners on this aspect are limited.

    Aim:The aim of this study was to describe the experience of participating in group communication with other partners of former intensivecare patients.

    Design:The study has a descriptive intervention-based design where group communication for partners of former, surviving intensive careunit (ICU) patients was evaluated.

    Methods:A strategic selection was made of adult partners to former adult intensive care patients (n=15), 5 men and 10 women, aged37–89 years. Two group communication sessions lasting 2 h were held at monthly intervals with three to five partners. The partners later wrote,in a notebook, about their feelings of participating in group communications. To deepen the understanding of the impact of the sessions, six ofthe partners were interviewed. Content analysis was used to analyse the notebooks and the interviews.

    Findings:Three categories were identified: (1) Emotional impact, the partners felt togetherness and experienced worries and gratitude, (2)Confirmation, consciousness through insight and reflection and (3) The meeting design, group constellation and recommendation to participatein group communication.

    Conclusion:Partners of an intensive care patient are on a journey, constantly trying to adapt to the new situation and find new strategiesto ever-changing circumstances. Group communications contributed to togetherness and confirmation. To share experiences with others is oneway for partners to be able to move forward in life.

    Relevance to clinical practice:Group communication with other patients’ partners eases the process of going through the burden ofbeing a partner to an intensive care patient. Group communications needs to be further developed and evaluated to obtain consensus andevidence for the best practice.

    Ladda ner fulltext (pdf)
    fulltext
  • 177.
    Ahlberg, Mona
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Hollman Frisman, Gunilla
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Berterö, Carina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Ågren, Susanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Family Health Conversations create awareness of family functioning.2020Ingår i: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, nr 2, s. 102-108Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The whole family is affected if one family member is critically ill. The Family Health Conversation Intervention may give the family tools that support healthier family functioning.

    AIMS AND OBJECTIVES: The aim of this study was to identify which components of family function are affected when families participate in Family Health Conversations.

    DESIGN: A secondary analysis was performed of existing qualitative interviews. The Family Health Conversation is an intervention where nurses ask the family reflective questions, and reflection is made possible in three conversation sessions.

    METHODS: This study included transcribed data from 13 follow-up interviews from seven families attending Family Health Conversations after three and 12 months. Data were analysed with narrative analysis, focusing on family function.

    RESULTS: Three themes were identified. The families' family functioning had been supported with: improved understanding of each other-there was an understanding of being in the same situation but still having totally different experiences; more concern for each other-they talked about their different experiences and felt they had become closer to each other; and a process of working through-they had experienced working through various experiences, standing by and supporting, and then being able to move on.

    CONCLUSIONS: The Family Health Conversation Intervention is provided to families, accompanied by nurses. The families in this study gained an awareness of their family function that brought the family closer because of improved understanding of each other and the situation. The families experienced openness, and the family members spoke more freely with each other, which facilitated the progress of working through the experience of critical illness and helped to maintain healthy family functioning.

    RELEVANCE TO CLINICAL PRACTICE: It is important to have an overall perspective and to recognize the patient and the family as equally important within the family for awareness of family function.

    Ladda ner fulltext (pdf)
    fulltext
  • 178.
    Ahlberg, Mona
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Persson, Carina
    Linnaeus Univ, Sweden.
    Berterö, Carina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Ågren, Susanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Exploring family functioning and - hardiness in families experiencing adult intensive care - A cross-sectional study2023Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 18, nr 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Being cared for in an intensive care unit affects both the patient being cared for and the family in various ways. The family is of great importance for the recovery of the former intensive-care patient. The aim is to explore family functioning and family hardiness in families of former intensive care patients. A cross-sectional study using two self-reported questionnaires. Former adult intensive care patients and their family were recruited to participate between December 2017 and June 2019. The data were coded and entered the Statistical Package for the Social Sciences version 25, for analysis. To explore questionnaire data, descriptive and inferential statistical analyses were performed. Scale values were calculated on, both family wise and between the patients and the family members. STROBE checklist was used. Data was collected from 60 families (60 former intensive cared patients and 85 family members) and showed that 50 families scored healthy family functioning and 52 high strengths in hardiness. The data showed small variations between and within families for family functioning and family hardiness, there were only two families scoring low for both family functioning and hardiness. The variation was higher within the families, but there was no significance level.The conclusions were that family functioning and hardiness was, to a large extent, assessed as good by the families. Nevertheless, it is important to help the family obtain information and support. So, the family need to continue to communicate, finding coping abilities and strengths in adopting new strategies to protect the family unit. The family are very important for members mental and physical recovery as the health of one family member affects the family as a unit.

    Ladda ner fulltext (pdf)
    fulltext
  • 179.
    Ahlberg, Mona
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Anestesi- och intensivvårdskliniken VIN.
    Persson, Carina
    Linnaeus Univ, Sweden.
    Berterö, Carina
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Ågren, Susanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Thorax-kärlkliniken i Östergötland.
    Family Health Conversations Versus Support Group Conversations When a Family Member Has Been Critically Ill: A Mixed Methods Study2021Ingår i: Families, Systems & Health, ISSN 1091-7527, E-ISSN 1939-0602, Vol. 39, nr 2, s. 293-305Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: When a family member has been critically ill and cared for at an intensive care unit the individual family member as well as the family system are affected and in need of support. The aim of this study was to compare and contrast the responses from 2 different types of follow-up interventions for families of critically ill persons, focusing on individual hopes, health-related quality of life, family functioning and ability to cope with challenges. Method: Adult family members from 3 hospitals attended 1 of 2 interventions 2 months after intensive care. The family health conversation included the family. The support group conversation included just family members and not the patient who had experienced intensive care. Data were collected via self-reported questionnaires and follow-up interviews with family members. Quantitative and qualitative data were first analyzed separately, and the results were then integrated through mixed methods analysis. Results: A total of 38 family members took part in the interventions. Family members in the 2 intervention groups talked about how they had more hope for the future, and about how talking within the family and the group had helped them justify their feelings, which empowered them in the transition toward a healthier quality of life. Comparisons of the interventions show a higher significance of family function and hope in the family health conversation. Discussion: The article illustrates a disparity between how family members function and the needs they have for follow-up. We discuss what kind of follow-up these persons need.

    Ladda ner fulltext (pdf)
    fulltext
  • 180. Beställ onlineKöp publikationen >>
    Ahle, Margareta
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Necrotising Enterocolitis: epidemiology and imaging2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Necrotising enterocolitis (NEC) is a potentially devastating intestinal inflammation of multifactorial aetiology in premature or otherwise vulnerable neonates. Because of the broad spectrum of presentations, diagnosis and timing of surgical intervention may be challenging, and imaging needs to be an integrated part of management.

    The first four studies included in this thesis used routinely collected, nationwide register data to describe the incidence of NEC in Sweden 1987‒2009, its variation with time, seasonality, space-time clustering, and associations with maternal, gestational, and perinatal factors, and the risk of intestinal failure in the aftermath of the disease.

    Early infant survival increased dramatically during the study period. The incidence rate of NEC was 0.34 per 1,000 live births, rising from 0.26 per 1,000 live births in the first six years of the study period to 0.57 in the last five. The incidence rates in the lowest birth weights were 100‒160 times those of the entire birth cohort. Seasonal variation was found, as well as space-time clustering in association with delivery hospitals but not with maternal residential municipalities.

    Comparing NEC cases with matched controls, some factors, positively associated with NEC, were isoimmunisation, fetal distress, caesarean section, persistent ductus arteriosus, cardiac and gastrointestinal malformations, and chromosomal abnormalities. Negative associations included maternal pre-eclampsia, maternal urinary infection, and premature rupture of the membranes. Intestinal failure occurred in 6% of NEC cases and 0.4% of controls, with the highest incidence towards the end of the study period.

    The last study investigated current practices and perceptions of imaging in the management of NEC, as reported by involved specialists. There was great consensus on most issues. Areas in need of further study seem mainly related to imaging routines, the use of ultrasound, and indications for surgery.

    Developing alongside the progress of neonatal care, NEC is a complex, multifactorial disease, with shifting patterns of predisposing and precipitating causes, and potentially serious long-term complications. The findings of seasonal variation, spacetime clustering, and negative associations with antenatal exposure to infectious agents, fit into the growing understanding of the central role of bacteria and immunological processes in normal maturation of the intestinal canal as well as in the pathogenesis of NEC. Imaging in the management of NEC may be developed through future studies combining multiple diagnostic parameters in relation to clinical outcome.

    Delarbeten
    1. Epidemiology and Trends of Necrotizing Enterocolitis in Sweden: 1987-2009
    Öppna denna publikation i ny flik eller fönster >>Epidemiology and Trends of Necrotizing Enterocolitis in Sweden: 1987-2009
    2013 (Engelska)Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 132, nr 2, s. E443-E451Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To investigate temporal, seasonal, and geographic variations in the incidence of necrotizing enterocolitis (NEC) and its relation to early infant survival in the Swedish population and in subgroups based on gestational age, birth weight, and gender. less thanbrgreater than less thanbrgreater thanMETHODS: In the Swedish birth cohort of 1987 through 2009 all children with a diagnosis of NEC were identified in the National Patient Register, the Swedish Medical Birth Register, and the National Cause of Death Register. NEC incidence, early mortality, and seasonality were analyzed with descriptive statistics, Poisson regression, and auto regression. less thanbrgreater than less thanbrgreater thanRESULTS: The overall incidence of NEC was 3.4 in 10 000 live births, higher in boys than in girls (incidence rate ratio 1.22, 95% confidence interval 1.06-1.40, P = .005), with a peak in November and a trough in May, and increased with an average of similar to 5% a year during the study period. In most subgroups, except the most immature, an initial decrease was followed by a steady increase. Seven-day mortality decreased strongly in all subgroups over the entire study period (annual incidence rate ratio 0.96, 95% confidence interval 0.95-0.96, P andlt; .001). This was especially marked in the most premature and low birth weight infants. less thanbrgreater than less thanbrgreater thanCONCLUSIONS: After an initial decrease, the incidence of NEC has increased in Sweden during the last decades. An association with the concurrent dramatically improved early survival seems likely.

    Ort, förlag, år, upplaga, sidor
    American Academy of Pediatrics, 2013
    Nyckelord
    necrotizing enterocolitis, premature infants, perinatal mortality, perinatal care, epidemiology, trends, seasonal variation
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:liu:diva-98148 (URN)10.1542/peds.2012-3847 (DOI)000322957300017 ()
    Anmärkning

    Funding Agencies|County Council of Ostergotland||Futurum||Academy of Health Care||Jonkoping County Council, Jonkoping, Sweden||Medical Research Council of Southeast Sweden||

    Tillgänglig från: 2013-09-30 Skapad: 2013-09-30 Senast uppdaterad: 2018-03-27
    2. Population-based study showed that necrotising enterocolitis occurred in space-time clusters with a decreasing secular trend in Sweden
    Öppna denna publikation i ny flik eller fönster >>Population-based study showed that necrotising enterocolitis occurred in space-time clusters with a decreasing secular trend in Sweden
    Visa övriga...
    2017 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 7, s. 1097-1102Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim: This study investigated space-time clustering of neonatal necrotising enterocolitis over three decades. Methods: Space-time clustering analyses objects that are grouped by a specific place and time. The Knox test and Kulldorffs scan statistic were used to analyse space-time clusters in 808 children diagnosed with necrotising enterocolitis in a national cohort of 2 389 681 children born between 1987 and 2009 in Sweden. The municipality the mother lived in and the delivery hospital defined closeness in space and the time between when the cases were born - seven, 14 and 21 days - defined closeness in time. Results: The Knox test showed no indication of space-time clustering at the residential level, but clear indications at the hospital level in all the time windows: seven days (p = 0.026), 14 days (p = 0.010) and 21 days (p = 0.004). Significant clustering at the hospital level was found during 1987-1997, but not during 1998-2009. Kulldorffs scan statistic found seven significant clusters at the hospital level. Conclusion: Space-time clustering was found at the hospital but not residential level, suggesting a contagious environmental effect after delivery, but not in the prenatal period. The decrease in clustering over time may reflect improved routines to minimise the risk of contagion between patients receiving neonatal care.

    Ort, förlag, år, upplaga, sidor
    WILEY, 2017
    Nyckelord
    Cluster analysis; Necrotising enterocolitis; Neonatal care; Precipitating contagion; Preterm infant
    Nationell ämneskategori
    Pediatrik
    Identifikatorer
    urn:nbn:se:liu:diva-139608 (URN)10.1111/apa.13851 (DOI)000405216700022 ()28349558 (PubMedID)
    Anmärkning

    Funding Agencies|Swedish government; county councils

    Tillgänglig från: 2017-08-16 Skapad: 2017-08-16 Senast uppdaterad: 2022-10-04
    3. Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden: A national case-control study
    Öppna denna publikation i ny flik eller fönster >>Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden: A national case-control study
    2018 (Engelska)Ingår i: PLOS ONE, E-ISSN 1932-6203, PLoS ONE, ISSN 1932-6203, Vol. 13, nr 3, artikel-id e0194352Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective

    To analyze associations of maternal, fetal, gestational, and perinatal factors with necrotizing enterocolitis in a matched case-control study based on routinely collected, nationwide register data.

    Study design

    All infants born in 1987 through 2009 with a diagnosis of necrotizing enterocolitis in any of the Swedish national health care registers were identified. For each case up to 6 controls, matched for birth year and gestational age, were selected. The resulting study population consisted of 720 cases and 3,567 controls. Information on socioeconomic data about the mother, maternal morbidity, pregnancy related diagnoses, perinatal diagnoses of the infant, and procedures in the perinatal period, was obtained for all cases and controls and analyzed with univariable and multivariable logistic regressions for the whole study population as well as for subgroups according to gestational age.

    Results

    In the study population as a whole, we found independent positive associations with necrotizing enterocolitis for isoimmunization, fetal distress, cesarean section, neonatal bacterial infection including sepsis, erythrocyte transfusion, persistent ductus arteriosus, cardiac malformation, gastrointestinal malformation, and chromosomal abnormality. Negative associations were found for maternal weight, preeclampsia, maternal urinary infection, premature rupture of the membranes, and birthweight. Different patterns of associations were seen in the subgroups of different gestational age.

    Conclusion

    With some interesting exceptions, especially in negative associations, the results of this large, population based study, are in keeping with earlier studies. Although restrained by the limitations of register data, the findings mirror conceivable pathophysiological processes and underline that NEC is a multifactorial disease.

    Ort, förlag, år, upplaga, sidor
    San Francisco, United States: Public Library of Science, 2018
    Nationell ämneskategori
    Pediatrik
    Identifikatorer
    urn:nbn:se:liu:diva-146093 (URN)10.1371/journal.pone.0194352 (DOI)000428168400016 ()29570713 (PubMedID)2-s2.0-85044427061 (Scopus ID)
    Anmärkning

    Funding agencies: Region Ostergotland, Sweden [LiO-107641]; Medical Research Council of Southeast Sweden [FORSS-77481]; Futurum - the Academy of Health Care, Jonkoping County Council, Jonkoping, Sweden; Region Ostergotland [LIO-130291, LIO-204581, LIO-280451, LIO-361481, L

    Tillgänglig från: 2018-03-27 Skapad: 2018-03-27 Senast uppdaterad: 2021-06-14Bibliografiskt granskad
    4. The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature
    Öppna denna publikation i ny flik eller fönster >>The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature
    2018 (Engelska)Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 28, nr 9, s. 3621-3631Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives

    To investigate current practices and perceptions of imaging in necrotising enterocolitis (NEC) according to involved specialists, put them in the context of current literature, and identify needs for further investigation.

    Methods

    Two hundred two neonatologists, paediatric surgeons, and radiologists answered a web-based questionnaire about imaging in NEC at their hospitals. The results were descriptively analysed, using proportion estimates with 95% confidence intervals.

    Results

    There was over 90% agreement on the value of imaging for confirmation of the diagnosis, surveillance, and guidance in decisions on surgery as well as on abdominal radiography as the first-choice modality and the most important radiographic signs. More variation was observed regarding some indications for surgery and the use of some ultrasonographic signs. Fifty-eight per cent stated that ultrasound was used for NEC at their hospital. Examination frequency, often once daily or more but with considerable variations, and projections used in AR were usually decided individually rather than according to fixed schedules. Predicting the need of surgery was regarded more important than formal staging.

    Conclusion

    Despite great agreement on the purposes of imaging in NEC and the most important radiographic signs of the disease, there was considerable diversity in routines, especially regarding examination frequency and the use of ultrasound. Apart from continuing validation of ultrasound, important objectives for future studies include definition of the supplementary roles of both imaging modalities in relation to other diagnostic parameters and evaluation of various imaging routines in relation to timing of surgery, complications, and mortality rate.

    Ort, förlag, år, upplaga, sidor
    Springer, 2018
    Nyckelord
    Enterocolitis, necrotising, Abdominal radiography, Ultrasonography, Surveys and questionnaires, Professional practice
    Nationell ämneskategori
    Pediatrik
    Identifikatorer
    urn:nbn:se:liu:diva-146094 (URN)10.1007/s00330-018-5362-x (DOI)000440984300006 ()
    Tillgänglig från: 2018-03-27 Skapad: 2018-03-27 Senast uppdaterad: 2018-08-24
    Ladda ner fulltext (pdf)
    Necrotising Enterocolitis: epidemiology and imaging
    Ladda ner (pdf)
    omslag
    Ladda ner (jpg)
    presentationsbild
  • 181.
    Ahle, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Drott, Peder
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Elfvin, Anders
    Department of Pediatrics, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Andersson, Roland E.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för Kirurgi, Ortopedi och Onkologi. Linköpings universitet, Medicinska fakulteten. Department of Surgery, Ryhov County Hospital, Jönköping, Sweden .
    Maternal, fetal and perinatal factors associated with necrotizing enterocolitis in Sweden: A national case-control study2018Ingår i: PLOS ONE, E-ISSN 1932-6203, PLoS ONE, ISSN 1932-6203, Vol. 13, nr 3, artikel-id e0194352Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective

    To analyze associations of maternal, fetal, gestational, and perinatal factors with necrotizing enterocolitis in a matched case-control study based on routinely collected, nationwide register data.

    Study design

    All infants born in 1987 through 2009 with a diagnosis of necrotizing enterocolitis in any of the Swedish national health care registers were identified. For each case up to 6 controls, matched for birth year and gestational age, were selected. The resulting study population consisted of 720 cases and 3,567 controls. Information on socioeconomic data about the mother, maternal morbidity, pregnancy related diagnoses, perinatal diagnoses of the infant, and procedures in the perinatal period, was obtained for all cases and controls and analyzed with univariable and multivariable logistic regressions for the whole study population as well as for subgroups according to gestational age.

    Results

    In the study population as a whole, we found independent positive associations with necrotizing enterocolitis for isoimmunization, fetal distress, cesarean section, neonatal bacterial infection including sepsis, erythrocyte transfusion, persistent ductus arteriosus, cardiac malformation, gastrointestinal malformation, and chromosomal abnormality. Negative associations were found for maternal weight, preeclampsia, maternal urinary infection, premature rupture of the membranes, and birthweight. Different patterns of associations were seen in the subgroups of different gestational age.

    Conclusion

    With some interesting exceptions, especially in negative associations, the results of this large, population based study, are in keeping with earlier studies. Although restrained by the limitations of register data, the findings mirror conceivable pathophysiological processes and underline that NEC is a multifactorial disease.

    Ladda ner fulltext (pdf)
    fulltext
  • 182.
    Ahle, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Magnusson, Amanda
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
    Elfvin, Anders
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden.
    Andersson, Roland
    Department of Surgery, County Hospital Ryhov, Jönköping, Sweden.
    Space-time clustering of necrotizing enterocolitis supports the existence of transmissible causes.2017Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Problem Statement: Despite great efforts to prevent necrotizing enterocolitis (NEC) the incidence may in fact be increasing, and changes in the patient population over time seem to lead to changes in clinical presentation and risk factor spectrum as well. The presence of bacteria is an important prerequisite in the pathogenesis, but, rather than being caused by specific pathogens, inflammation and bacterial invasion are thought to be mediated through erroneous interaction between microbiota and innate immunity during colonization of the gut. There are, however, reports of episodic outbreaks of NEC, seasonal variation in incident rates, and clustering, suggesting a role for transmissible infectious agents or other environmental factors around the pregnant mother or newborn infant. In order to investigate evidence for such factors we have analyzed the occurrence of space-time clusters in Sweden over 23 years. Methods: A national register-based cohort of all children born between 1987 and 2009 in Sweden, diagnosed with NEC, was identified. The Knox test and Kulldorff’s scan method were used to analyze signs of space-time clusters at two geographical levels; the mother’s residential address and the delivery hospital. Time windows of seven, 14 and 21 days were used for closeness in time. Results: The Knox test showed clustering on hospital level in all studied temporal windows; seven days (p=0.022) 14 days (p=0.011) and 21 days (p=0.006), and Kulldorff’s scan method found seven significant clusters. On residential level, there was no indication of space-time interaction. When comparing two time periods, significant clustering on hospital level was found during 1987-1997, but not during 1998-2009. Conclusion: Space-time clustering was found on hospital level, but not on community level, suggesting a contagious environmental effect at and after delivery but not in the materno-fetal environment outside the hospital before birth. The decrease in clustering over time suggests that improved routines in neonatal care have minimized the risk of NEC precipitating contagions spreading between patients in the neonatal intensive care unit. The importance of such routines should not be forgotten while our efforts to bring down NEC incidence are directed towards other challenges.

  • 183.
    Ahle, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Ringertz, Hans G.
    Department of Radiology, Stanford University Medical Center, Stanford, USA; Division of Diagnostic Radiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Rubesova, Erika
    Department of Radiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Stanford, USA.
    The role of imaging in the management of necrotising enterocolitis: a multispecialist survey and a review of the literature2018Ingår i: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 28, nr 9, s. 3621-3631Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    To investigate current practices and perceptions of imaging in necrotising enterocolitis (NEC) according to involved specialists, put them in the context of current literature, and identify needs for further investigation.

    Methods

    Two hundred two neonatologists, paediatric surgeons, and radiologists answered a web-based questionnaire about imaging in NEC at their hospitals. The results were descriptively analysed, using proportion estimates with 95% confidence intervals.

    Results

    There was over 90% agreement on the value of imaging for confirmation of the diagnosis, surveillance, and guidance in decisions on surgery as well as on abdominal radiography as the first-choice modality and the most important radiographic signs. More variation was observed regarding some indications for surgery and the use of some ultrasonographic signs. Fifty-eight per cent stated that ultrasound was used for NEC at their hospital. Examination frequency, often once daily or more but with considerable variations, and projections used in AR were usually decided individually rather than according to fixed schedules. Predicting the need of surgery was regarded more important than formal staging.

    Conclusion

    Despite great agreement on the purposes of imaging in NEC and the most important radiographic signs of the disease, there was considerable diversity in routines, especially regarding examination frequency and the use of ultrasound. Apart from continuing validation of ultrasound, important objectives for future studies include definition of the supplementary roles of both imaging modalities in relation to other diagnostic parameters and evaluation of various imaging routines in relation to timing of surgery, complications, and mortality rate.

    Ladda ner fulltext (pdf)
    fulltext
  • 184.
    Ahle, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Rubesova, Erika
    Stanford university, US.
    Ringertz, Hans
    Stanford university, US.
    The significance of radiographic and ultrasonographic findings in the management of necrotising enterocolitis - results from a survey2017Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Necrotising Enterocolitis (NEC) remains a potentially devastating emergency in neonates, predominantly the premature. Ever since it was first described in the 60's, imaging has played a great role in definition, staging, and monitoring of the disease. The radiographic image can change before the clinical condition, but typical signs are often transient and may be missing even in severe NEC [1-4]. These circumstances have led to the recommendation of frequent imaging and to the insight that the clinical decisions cannot rely solely on radiological signs [5-7]. Ultrasound (US) as a possibility to enhance sensitivity and diagnostic accuracy was first described in the mid 80's [8, 9] and was included in a diagnostic algorithm suggested by in 1994 [6], but despite great effort to develop and validate the method, its role in the management of NEC has not yet been established [7, 10, 11].

    Meanwhile, in order to improve interobserver agreement and diagnostic accuracy of AR, the radiographic signs of NEC have also been systematized into the DAAS scale [12]. Imaging, as an adjunct to clinical assessment [11], is crucial in the diagnosis and management of NEC. The purpose of this survey was to investigate current views and routines, as described by involved specialists, and identify areas in need of further study and discussion.

    Ladda ner fulltext (pdf)
    The significance of radiographic and ultrasonographic findings in the management of necrotising enterocolitis - results from a survey
  • 185.
    Ahle, Margareta
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för radiologiska vetenskaper. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Röntgenkliniken i Linköping.
    Rubesova, Erika
    Stanford university, US.
    Ringertz, Hans
    Stanford university, US.
    The use of imaging in necrotising enterocolitis - results from a survey2017Konferensbidrag (Övrigt vetenskapligt)
    Ladda ner fulltext (pdf)
    E-poster C-2872
  • 186.
    Ahlin, Fredrik
    et al.
    Linköpings universitet, Medicinska fakulteten. Wilhelminen Hospital, Austria.
    Arfvidsson, John
    Linköpings universitet, Medicinska fakulteten. Wilhelminen Hospital, Austria.
    Vargas, Kris G.
    Wilhelminen Hospital, Austria.
    Stojkovic, Stefan
    Medical University of Vienna, Austria; Ludwig Boltzmann Cluster Cardiovasc Research, Austria.
    Huber, Kurt
    Wilhelminen Hospital, Austria; Ludwig Boltzmann Cluster Cardiovasc Research, Austria; Sigmund Freud University, Austria.
    Wojta, Johann
    Medical University of Vienna, Austria; Ludwig Boltzmann Cluster Cardiovasc Research, Austria; Medical University of Vienna, Austria.
    MicroRNAs as circulating biomarkers in acute coronary syndromes: A review2016Ingår i: Vascular pharmacology, ISSN 1537-1891, E-ISSN 1879-3649, Vol. 81, s. 15-21Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Coronary artery disease (CAD) and its complications remain the most common cause of death worldwide. Cardiac troponins (cTn) are standard biomarkers used today for diagnosis and risk stratification of myocardial infarction (MI). Increasing efforts are made to develop additional, new biomarkers for more effective and safe rule-in and rule-out of MI patients at the emergency department. During the past decade, microRNAs (miRNAs) have emerged as new, potential diagnostic biomarkers in several diseases, including MI. In this review, we aimed to summarize some of the prominent studies in the field, and discuss the potential value of miRNAs in the diagnosis of MI. (C) 2016 Elsevier Inc. All rights reserved.

  • 187.
    Ahlner, Johan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Swedish National Board Forens Med, Department Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Holmgren, Anita
    Swedish National Board Forens Med, Department Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Jones, A Wayne
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Swedish National Board Forens Med, Department Forens Genet and Forens Toxicol, Linkoping, Sweden.
    Demographics and post-mortem toxicology findings in deaths among people arrested multiple times for use of illicit drugs and/or impaired driving2016Ingår i: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 265, s. 138-143Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem. Methods: This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma. Results: Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p amp;lt; 0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p amp;lt; 0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p amp;lt; 0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p amp;lt; 0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids. Conclusions: This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 188.
    Ahlstrand, I.
    et al.
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. School of Health Sciences, Jönköping University, Jönköping, Sweden; School of Occupational Therapy and Social Work, CHIRI, Curtin University, Perth, WA, Australia.
    Dahlström, Örjan
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Björk, Mathilda
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Rehabenheten. School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project2015Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, nr 4, s. 259-264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier. Method: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years. Results: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2. Conclusions: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

  • 189.
    Ahlstrand, Inger
    et al.
    Jonköping University, Sweden.
    Björk, Mathilda
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Rehabenheten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Jonköping University, Sweden.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Jonköping University, Sweden; Curtin University, Australia.
    Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis2015Ingår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, nr 8, s. 1353-1362Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (greater than 40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

  • 190.
    Ahlstrand, Inger
    et al.
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Vaz, Sharmila
    School of Occupational Therapy & Social Work, CHIRI, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Thyberg, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Björk, Mathilda
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för arbetsterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    Self-efficacy and pain acceptance as mediators of the relationship between pain and performance of valued life activities in women and men with rheumatoid arthritis2017Ingår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 6, s. 824-834Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

    METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

    RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

    CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

  • 191.
    Ahlstrom, Christer
    et al.
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Fors, Carina
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Akerstedt, Torbjorn
    Stockholm Univ, Sweden; Karolinska Inst, Sweden.
    The effect of daylight versus darkness on driver sleepiness: a driving simulator study2018Ingår i: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 27, nr 3, artikel-id e12642Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Driver sleepiness studies are often carried out with alert drivers during daytime and sleep-deprived drivers during night-time. This design results in a mixture of different factors (e.g. circadian effects, homeostatic effects, light conditions) that may confound the results. The aim of this study was to investigate the effect of light conditions on driver sleepiness. Thirty young male drivers (23.6 +/- 1.7years old) participated in a driving simulator experiment where they drove on a rural road. A 2x2 design was used with the conditions daylight versus darkness, and daytime (full sleep) versus night-time (sleep deprived). The results show that light condition had an independent effect on the sleepiness variables. The subjective sleepiness measured by Karolinska Sleepiness Scale was higher, lateral position more left-oriented, speed lower, electroencephalogram alpha and theta higher, and blink durations were longer during darkness. The number of line crossings did not change significantly with light condition. The day/night condition had profound effects on most sleepiness indicators while controlling for light condition. The number of line crossings was higher during night driving, Karolinska Sleepiness Scale was higher, blink durations were longer and speed was lower. There were no significant interactions, indicating that light conditions have an additive effect on sleepiness. In conclusion, Karolinska Sleepiness Scale and blink durations increase primarily with sleep deprivation, but also as an effect of darkness. Line crossings are mainly driven by the need for sleep and the reduced alertness at the circadian nadir. Lane position is, however, more determined by light conditions than by sleepiness.

  • 192.
    Ahlstrom, Christer
    et al.
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Lovgren, Maria Gink
    Volvo Bus Corp, Denmark.
    Nilsson, Mats
    Volvo Bus Corp, Denmark.
    Willstrand, Tania Dukic
    Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    Anund, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Rehabiliteringsmedicinska kliniken. Swedish Natl Rd and Transport Res Inst VTI, Linkoping, Sweden.
    The effect of an active steering system on city bus drivers muscle activity2019Ingår i: International Journal of Occupational Safety and Ergonomics, ISSN 1080-3548, E-ISSN 2376-9130, Vol. 25, nr 3, s. 377-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    City bus drivers spend hours driving under time pressure, in congested traffic and in a monotonous sitting position. This leads to unhealthy working conditions, especially in terms of physical and psychological stress. The aim of this study is to investigate whether an active steering system can alleviate the musculoskeletal stress involved in manoeuvring a bus. Twenty bus drivers drove a city bus equipped with the Volvo dynamic steering (VDS) support system in real traffic. Steering effort was evaluated with electromyography and with a questionnaire. Compared to baseline, VDS significantly reduced the required muscle activity by on average 15-25% while turning, and up to 68% in the part of the manoeuvre requiring maximum effort. The bus drivers believed that VDS will help reduce neck and shoulder problems, and they expressed a desire to have VDS installed in their own bus.

  • 193.
    Ahlstrom, Christina A. A.
    et al.
    US Geol Survey, AK 99508 USA.
    Woksepp, Hanna
    Kalmar Cty Reg, Sweden; Linnaeus Univ, Sweden.
    Sandegren, Linus
    Uppsala Univ, Sweden.
    Ramey, Andrew M. M.
    US Geol Survey, AK 99508 USA.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Kalmar Cty Reg, Sweden.
    Exchange of Carbapenem-Resistant Escherichia coli Sequence Type 38 Intercontinentally and among Wild Bird, Human, and Environmental Niches2023Ingår i: Applied and Environmental Microbiology, ISSN 0099-2240, E-ISSN 1098-5336, Vol. 89, nr 6, artikel-id e0031923Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Carbapenem-resistant bacteria are a threat to public health globally and have been found in the environment as well as the clinic. Some bacterial clones are associated with carbapenem resistance genes, such as Escherichia coli sequence type 38 (ST38) and the carbapenemase gene bla(OXA-48). Carbapenem-resistant Enterobacteriaceae (CRE) are a global threat to human health and are increasingly being isolated from nonclinical settings. OXA-48-producing Escherichia coli sequence type 38 (ST38) is the most frequently reported CRE type in wild birds and has been detected in gulls or storks in North America, Europe, Asia, and Africa. The epidemiology and evolution of CRE in wildlife and human niches, however, remains unclear. We compared wild bird origin E. coli ST38 genome sequences generated by our research group and publicly available genomic data derived from other hosts and environments to (i) understand the frequency of intercontinental dispersal of E. coli ST38 clones isolated from wild birds, (ii) more thoroughly measure the genomic relatedness of carbapenem-resistant isolates from gulls sampled in Turkey and Alaska, USA, using long-read whole-genome sequencing and assess the spatial dissemination of this clone among different hosts, and (iii) determine whether ST38 isolates from humans, environmental water, and wild birds have different core or accessory genomes (e.g., antimicrobial resistance genes, virulence genes, plasmids) which might elucidate bacterial or gene exchange among niches. Our results suggest that E. coli ST38 strains, including those resistant to carbapenems, are exchanged between humans and wild birds, rather than separately maintained populations within each niche. Furthermore, despite close genetic similarity among OXA-48-producing E. coli ST38 clones from gulls in Alaska and Turkey, intercontinental dispersal of ST38 clones among wild birds is uncommon. Interventions to mitigate the dissemination of antimicrobial resistance throughout the environment (e.g., as exemplified by the acquisition of carbapenem resistance by birds) may be warranted.IMPORTANCE Carbapenem-resistant bacteria are a threat to public health globally and have been found in the environment as well as the clinic. Some bacterial clones are associated with carbapenem resistance genes, such as Escherichia coli sequence type 38 (ST38) and the carbapenemase gene bla(OXA-48). This is the most frequently reported carbapenem-resistant clone in wild birds, though it was unclear if it circulated within wild bird populations or was exchanged among other niches. The results from this study suggest that E. coli ST38 strains, including those resistant to carbapenems, are frequently exchanged among wild birds, humans, and the environment. Carbapenem-resistant E. coli ST38 clones in wild birds are likely acquired from the local environment and do not constitute an independent dissemination pathway within wild bird populations. Management actions aimed at preventing the environmental dissemination and acquisition of antimicrobial resistance by wild birds may be warranted.

  • 194.
    Ahlstrom, Christina A.
    et al.
    US Geol Survey, AK 99508 USA.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi och molekylär medicin. Linköpings universitet, Medicinska fakulteten. Kalmar Cty Hosp, Sweden.
    Woksepp, Hanna
    Kalmar Cty Hosp, Sweden.
    Hernandez, Jorge
    Uppsala Univ, Sweden.
    Olsen, Bjorn
    Uppsala Univ, Sweden.
    Ramey, Andrew M.
    US Geol Survey, AK 99508 USA.
    Acquisition and dissemination of cephalosporin-resistant E.coli in migratory birds sampled at an Alaska landfill as inferred through genomic analysis2018Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 8, artikel-id 7361Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Antimicrobial resistance (AMR) in bacterial pathogens threatens global health, though the spread of AMR bacteria and AMR genes between humans, animals, and the environment is still largely unknown. Here, we investigated the role of wild birds in the epidemiology of AMR Escherichia coli. Using next-generation sequencing, we characterized cephalosporin-resistant E. coli cultured from sympatric gulls and bald eagles inhabiting a landfill habitat in Alaska to identify genetic determinants conferring AMR, explore potential transmission pathways of AMR bacteria and genes at this site, and investigate how their genetic diversity compares to isolates reported in other taxa. We found genetically diverse E. coli isolates with sequence types previously associated with human infections and resistance genes of clinical importance, including blaCTX-M and blaCMY. Identical resistance profiles were observed in genetically unrelated E. coli isolates from both gulls and bald eagles. Conversely, isolates with indistinguishable core-genomes were found to have different resistance profiles. Our findings support complex epidemiological interactions including bacterial strain sharing between gulls and bald eagles and horizontal gene transfer among E. coli harboured by birds. Results suggest that landfills may serve as a source for AMR acquisition and/or maintenance, including bacterial sequence types and AMR genes relevant to human health.

    Ladda ner fulltext (pdf)
    fulltext
  • 195.
    Ahlstrom, Christina A.
    et al.
    US Geol Survey, AK 99508 USA.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi, infektion och inflammation. Linköpings universitet, Medicinska fakulteten. Kalmar Cty Council, Sweden.
    Woksepp, Hanna
    Kalmar Cty Hosp, Sweden.
    Hernandez, Jorge
    Kalmar Cty Hosp, Sweden.
    Reed, John A.
    US Geol Survey, AK 99508 USA.
    Tibbitts, Lee
    US Geol Survey, AK 99508 USA.
    Olsen, Bjoern
    Uppsala Univ, Sweden.
    Douglas, David C.
    US Geol Survey, AK USA.
    Ramey, Andrew M.
    US Geol Survey, AK 99508 USA.
    Satellite tracking of gulls and genomic characterization of faecal bacteria reveals environmentally mediated acquisition and dispersal of antimicrobial-resistant Escherichia coli on the Kenai Peninsula, Alaska2019Ingår i: Molecular Ecology, ISSN 0962-1083, E-ISSN 1365-294X, Vol. 28, nr 10, s. 2531-2545Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Gulls (Larus spp.) have frequently been reported to carry Escherichia coli exhibiting antimicrobial resistance (AMR E. coli); however, the pathways governing the acquisition and dispersal of such bacteria are not well described. We equipped 17 landfill-foraging gulls with satellite transmitters and collected gull faecal samples longitudinally from four locations on the Kenai Peninsula, Alaska to assess: (a) gull attendance and transitions between sites, (b) spatiotemporal prevalence of faecally shed AMR E. coli, and (c) genomic relatedness of AMR E. coli isolates among sites. We also sampled Pacific salmon (Oncorhynchus spp.) harvested as part of personal-use dipnet fisheries at two sites to assess potential contamination with AMR E. coli. Among our study sites, marked gulls most commonly occupied the lower Kenai River (61% of site locations) followed by the Soldotna landfill (11%), lower Kasilof River (5%) and upper Kenai River (amp;lt;1%). Gulls primarily moved between the Soldotna landfill and the lower Kenai River (94% of transitions among sites), which were also the two locations with the highest prevalence of AMR E. coli. There was relatively high spatial and temporal variability in AMR E. coli prevalence in gull faeces and there was no evidence of contamination on salmon harvested in personal-use fisheries. We identified E. coli sequence types and AMR genes of clinical importance, with some isolates possessing genes associated with resistance to as many as eight antibiotic classes. Our findings suggest that gulls acquire AMR E. coli at habitats with anthropogenic inputs and subsequent movements may represent pathways through which AMR is dispersed.

  • 196.
    Ahlstrom, Christina A.
    et al.
    US Geol Survey, AK 99508 USA.
    Frick, Anna
    State Alaska Dept Hlth & Social Serv, AK USA.
    Pongratz, Catherine
    State Alaska Dept Hlth & Social Serv, AK USA.
    Spink, Kimberly
    State Alaska Dept Hlth & Social Serv, AK USA.
    Xavier, Catherine
    State Alaska Dept Hlth & Social Serv, AK USA.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Kalmar Cty Council, Sweden.
    Ramey, Andrew M.
    US Geol Survey, AK 99508 USA.
    Genomic comparison of carbapenem-resistant Enterobacteriaceae from humans and gulls in Alaska2021Ingår i: Journal of Global Antimicrobial Resistance, ISSN 2213-7165, E-ISSN 2213-7173, Vol. 25, s. 23-25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Wildlife may harbour clinically important antimicrobial-resistant bacteria, but the role of wildlife in the epidemiology of antimicrobial-resistant bacterial infections in humans is largely unknown. In this study, we aimed to assess dissemination of the bla(KPC) carbapenemase gene among humans and gulls in Alaska. Methods: We performed whole-genome sequencing to determine the genetic context of bla(KPC) in bacterial isolates from all four human carbapenemase-producing Enterobacteriaceae (CPE) infections reported in Alaska between 2013-2018 and to compare the sequences with seven previously reported CPE isolates from gull faeces within the same region and time period. Results: Genomic analysis of CPE isolates suggested independent acquisition events among humans with no evidence for direct transmission of bla(KPC) between people and gulls. However, some isolates shared conserved genetic elements surrounding bla(KPC), suggesting possible exchange between species. Conclusion: Our results highlight the genomic plasticity associated with bla(KPC) and demonstrate that sampling of wildlife may be useful for identifying clinically relevant antimicrobial resistance not observed through local passive surveillance in humans. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.

    Ladda ner fulltext (pdf)
    fulltext
  • 197.
    Ahlstrom, Christina A.
    et al.
    US Geol Survey, AK 99508 USA.
    Ramey, Andrew M.
    US Geol Survey, AK 99508 USA.
    Woksepp, Hanna
    Kalmar Council, Sweden.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi, infektion och inflammation. Linköpings universitet, Medicinska fakulteten. Kalmar Council, Sweden.
    Early emergence of mcr-1-positive Enterobacteriaceae in gulls from Spain and Portugal2019Ingår i: Environmental Microbiology Reports, ISSN 1758-2229, E-ISSN 1758-2229, Vol. 11, nr 5, s. 669-671Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We tested extended-spectrum beta-lactamase producing bacteria from wild gulls (Larus spp.) sampled in 2009 for the presence of mcr-1. We report the detection of mcr-1 and describe genome characteristics of four Escherichia coli and one Klebsiella pneumoniae isolate from Spain and Portugal that also exhibited colistin resistance. Results represent the earliest evidence for colistin-resistant bacteria in European wildlife.

  • 198.
    Ahlstrom, Christina A.
    et al.
    US Geol Survey, AK 99508 USA.
    Ramey, Andrew M.
    US Geol Survey, AK 99508 USA.
    Woksepp, Hanna
    Dept Dev and Publ and Hlth, Sweden.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för mikrobiologi, infektion och inflammation. Linköpings universitet, Medicinska fakulteten. Dept Infect Dis, Sweden.
    Repeated Detection of Carbapenemase-Producing Escherichia coil in Gulls Inhabiting Alaska2019Ingår i: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 63, nr 8, artikel-id e00758-19Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Here, we report the first detection of carbapenemase-producing Escherichia coli in Alaska and in wildlife in the United States. Wild bird (gull) feces sampled at three locations in Southcentral Alaska yielded isolates that harbored plasmidencoded bla(kpc-2), or chromosomally encoded bla(OXA-48) and genes associated with antimicrobial resistance to up to eight antibiotic classes.

  • 199.
    Ahlstrom, Christina A.
    et al.
    US Geol Survey, AK USA; US Geol Survey, AK 99508 USA.
    Scott, Laura C.
    US Geol Survey, AK USA.
    Woksepp, Hanna
    Reg Kalmar Cty, Sweden; Linnaeus Univ, Sweden.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Reg Kalmar Cty, Sweden.
    Ramey, Andrew M.
    US Geol Survey, AK USA.
    Environmental antimicrobial resistance gene detection from wild bird habitats using two methods: A commercially available culture-independent qPCR assay and culture of indicator bacteria followed by whole-genome sequencing2023Ingår i: Journal of Global Antimicrobial Resistance, ISSN 2213-7165, E-ISSN 2213-7173, Vol. 33, s. 186-193Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: A variety of methods have been developed to detect antimicrobial resistance (AMR) in differ-ent environments to better understand the evolution and dissemination of this public health threat. Com-parisons of results generated using different AMR detection methods, such as quantitative PCR (qPCR) and whole-genome sequencing (WGS), are often imperfect, and few studies have analysed samples in parallel to evaluate differences. In this study, we compared bacterial culture and WGS to a culture-independent commercially available qPCR assay to evaluate the concordance between methods and the utility of each in answering research questions regarding the presence and epidemiology of AMR in wild bird habitats.Methods: We first assessed AMR gene detection using qPCR in 45 bacterial isolates from which we had existing WGS data. We then analysed 52 wild bird faecal samples and 9 spatiotemporally collected water samples using culture-independent qPCR and WGS of phenotypically resistant indicator bacterial isolates.Results: Overall concordance was strong between qPCR and WGS of bacterial isolates, although concor-dance differed among antibiotic classes. Analysis of wild bird faecal and water samples revealed that more samples were determined to be positive for AMR via qPCR than via culture and WGS of bacterial isolates, although qPCR did not detect AMR genes in two samples from which phenotypically resistant isolates were found.Conclusions: Both qPCR and culture followed by sequencing may be effective approaches for characteris-ing AMR genes harboured by wild birds, although data streams produced using these different tools may have advantages and disadvantages that should be considered given the application and sample matrix.Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

    Ladda ner fulltext (pdf)
    fulltext
  • 200.
    Ahlstrom, Christina A.
    et al.
    US Geol Survey, AK 99508 USA.
    van Toor, Marielle L.
    Linnaeus Univ, Sweden.
    Woksepp, Hanna
    Kalmar Cty Hosp, Sweden.
    Chandler, Jeffrey C.
    USDA APHIS WS, CO 80521 USA.
    Reed, John A.
    US Geol Survey, AK 99508 USA.
    Reeves, Andrew B.
    US Geol Survey, AK 99508 USA.
    Waldenstrom, Jonas
    Linnaeus Univ, Sweden.
    Franklin, Alan B.
    USDA APHIS WS, CO 80521 USA.
    Douglas, David C.
    US Geol Survey, AK 99801 USA.
    Bonnedahl, Jonas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för inflammation och infektion. Linköpings universitet, Medicinska fakulteten. Dept Infect Dis, Sweden.
    Ramey, Andrew M.
    US Geol Survey, AK 99508 USA.
    Evidence for continental-scale dispersal of antimicrobial resistant bacteria by landfill-foraging gulls2021Ingår i: Science of the Total Environment, ISSN 0048-9697, E-ISSN 1879-1026, Vol. 764, artikel-id 144551Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Anthropogenic inputs into the environment may serve as sources of antimicrobial resistant bacteria and alter the ecology and population dynamics of synanthropic wild animals by providing supplemental forage. In this study, we used a combination of phenotypic and genomic approaches to characterize antimicrobial resistant indicator bacteria, animal telemetry to describe host movement patterns, and a novel modeling approach to combine information from these diverse data streams to investigate the acquisition and long-distance dispersal of antimicrobial resistant bacteria by landfill-foraging gulls. Our results provide evidence that gulls acquire antimicrobial resistant bacteria from anthropogenic sources, which they may subsequently disperse across and between continents via migratory movements. Furthermore, we introduce a flexible modeling framework to estimate the relative dispersal risk of antimicrobial resistant bacteria in western North America and adjacent areas within East Asia, which may be adapted to provide information on the risk of dissemination of other organisms and pathogens maintained by wildlife through space and time. Published by Elsevier B.V.

1234567 151 - 200 av 12626
RefereraExporteraLänk till träfflistan
Permanent länk
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Annat format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annat språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf