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  • 1.
    Adamic, M.
    et al.
    Dermatol Ctr Parmova, Ljubljana, Slovenia.
    Pavlovic, M. D.
    Dermatol Ctr Parmova, Ljubljana, Slovenia; Fac Med, Univ Maribor, Maribor, Slovenia.
    Rubin, A. Troilius
    Ctr Laser & Vasc Anomalies, Dept Dermatol, Skåne Univ Hosp, Malmö, Sweden.
    Palmetun-Ekback, M.
    Örebro University Hospital. Dept Dermatol, Örebro University Hospital, Örebro, Sweden.
    Boixeda, P.
    Dept Dermatol, Laser Serv, Ramon & Cajal Hosp, Univ Alcala De Henares, Madrid, Spain.
    Guidelines of care for vascular lasers and intense pulse light sources from the European Society for Laser Dermatology2015In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 29, no 9, p. 1661-1678Article in journal (Refereed)
    Abstract [en]

    AimLasers and non-coherent intense pulse light sources (IPLS) are based on the principle of selective photothermolysis and can be used for the treatment of many vascular skin lesions. A variety of lasers has been developed for the treatment of congenital and acquired vascular lesions which incorporate these concepts into their design. Although laser and light sources are very popular due to their non-invasive nature, caution should be considered by practitioners and patients to avoid permanent side-effects. The aim of these guidelines is to give evidence-based recommendations for the use of lasers and IPLS in the treatment of vascular lesions. MethodsThese guidelines were produced by a Consensus Panel made up of experts in the field of vascular laser surgery under the auspices of the European Society of Laser Dermatology. Recommendations on the use of vascular lasers and IPLS were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines. ResultsLasers and IPLS are very useful and sometimes the only available method to treat various vascular lesions. It is of a paramount importance that the type of laser or IPLS and their specific parameters are adapted to the indication but also that the treating physician is familiar with the device to be used. The crucial issue in treating vascular lesions is to recognize the immediate end-point after laser treatment. This is the single most important factor to ensure both the efficacy of the treatment and avoidance of serious side-effects.

  • 2. Berg, M.
    et al.
    Lindberg, Magnus
    Örebro University, School of Health and Medical Sciences.
    Possible gender differences in the quality of life and choice of therapy in acne2011In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 25, no 8, p. 969-972Article in journal (Refereed)
    Abstract [en]

    Background Acne is a very common skin disease that has major impact on the patients' quality of life. Although the disease has been extensively studied we still need more knowledge of factors influencing the decisions for choice of therapy. Objective To evaluate the relationships between clinical severity, patients' self-reported quality of life, treatment choice and the outcome of therapy in a structured out-patient acne clinic. Methods In total 211 consecutive patients (143 females, 68 males) at a structured acne clinic were included. At the first visit a clinical assessment was conducted, therapy was initiated and the patients answered a quality-of-life questionnaire (Dermatology Life Quality Index, DLQI). A follow up was performed after six months, when patients once again answered the DLQI questionnaire and the clinical outcome was assessed by the physician. Results The quality of life was improved after treatment at a group level. At the first visit, the quality of life showed a gender difference (females scoring worse) but did not correlate to the clinical grading nor to the choice of therapy. At six months the DLQI correlated with clinical outcome. Patients with isotretinoin therapy showed a significantly greater improvement in quality of life. There was a tendency to gender difference in the choice of therapy, as in females 32% of the patients were treated with isotretinoin although they were clinically graded as moderate. The corresponding figure for males was 23%. A correlation was found between the initial clinical grading and gender, age and the choice of therapy. Conclusion DLQI can be used to evaluate treatment effects in acne. However, the self-reported quality of life will depend on several factors including age, gender, psychosocial factors and clinical severity.

  • 3. Berne, Berit
    et al.
    Tammela, Monica
    Färm, Gunilla
    Inerot, Annica
    Lindberg, Magnus
    Örebro University, School of Health and Medical Sciences.
    Can the reporting of adverse skin reactions to cosmetics be improved?: A prospective clinical study using a structured protocol2008In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 58, no 4, p. 223-227Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of cosmetics is rising, and adverse reactions to these products are increasing. In Sweden, the Medical Products Agency (MPA) keeps a voluntary reporting system for such adverse reactions. However, the reporting is sparse, consisting almost only of cases with test-proven allergic contact dermatitis, thus under-reporting the more common irritant reactions.

    OBJECTIVE: The aim of the study was to try to improve the reporting system.

    PATIENTS AND METHODS: Dermatologists at 3 dermatology departments used a structured protocol during the clinical investigation of 151 consecutive patients reporting skin reactions to cosmetics. The protocol included symptoms, signs, affected body site, suspected products, and final diagnosis after patch testing. Based on clinical data and patch test results, a causality assessment for each product was made according to a protocol used at the MPA. Results: Allergic contact dermatitis was found in 28% of the patients, and irritant reactions were equally common at 27%.

    CONCLUSIONS: Using this structured protocol, the cases of irritant dermatitis were also reported, and it is recommended that such a protocol is used as a standard to improve the reporting of adverse reactions to skin care products.

  • 4.
    Bignell, C.
    et al.
    City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
    Unemo, Magnus
    Örebro University Hospital. WHO Collaborating Center for Gonorrhoea and Other Sexually Transmitted Infections, , Örebro University Hospital, Örebro, Sweden; Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    2012 European guideline on the diagnosis and treatment of gonorrhoea in adults [Europejskie zalecenia diagnostyczne i terapeutyczne w rzeÅŒa̧czce u dorosłych, 2012]2014In: Przegląd Dermatologiczny, ISSN 0033-2526, Vol. 101, no 2, p. 168-178Article in journal (Refereed)
  • 5.
    Bingefors, Kristina
    et al.
    Farmaci, Uppsala universitet, Uppsala, Sweden.
    Svensson, Åke
    Hudkliniken, Skånes universitetssjukhus, Malmö, Sweden.
    Isacson, Dag
    Farmaci, Uppsala universitet, Uppsala, Sweden.
    Lindberg, Magnus
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Self-reported lifetime prevalence of atopic dermatitis and co-morbidity with asthma and eczema in adulthood: a population-based cross-sectional survey2013In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 93, no 4, p. 438-441Article in journal (Refereed)
    Abstract [en]

    Atopic dermatitis and its co-morbidity with asthma and allergy is well described in younger age groups. However, population-based studies on adults with atopic dermatitis in childhood are sparse. The aims of this study were to determine: (i) the prevalence of self-reported childhood atopic dermatitis in the population; and (ii) its association with present self-reported hand eczema, eczema, allergy, urticaria and asthma. A questionnaire was sent to a cross-sectional random sample of the Swedish population (n = 7,985), age range 18–84 years (response rate 61.1%). The questionnaire included the question “Have you had childhood eczema?” and questions on 5 other medical problems (hand eczema, other eczema, asthma, urticaria and allergy). Persons reporting eczema in childhood reported increased odds ratios (OR) for hand eczema (4.01), other eczema (3.88), urticaria (2.50), allergy (2.98), and asthma (2.06) as adults. The combination of eczema, allergy and asthma had an OR of 14.10 (95% confidence interval 8.44–23.54). Adults in the age range 18–84 years reporting childhood atopic dermatitis still have high co-morbidity with eczema, asthma, urticaria and allergy.

  • 6.
    Cederlöf, M.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Karlsson, R.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, C.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Lung and Allergy Unit, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Magnusson, P. K. E.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Nordlind, K.
    Department of Medicine, Karolinska Institute, Stockholm, Sweden.
    Landén, M.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Lichtenstein, P.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Intellectual disability and cognitive ability in Darier disease: Swedish nation-wide study2015In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 173, no 1, p. 155-158Article in journal (Refereed)
    Abstract [en]

    Background: Darier disease is an autosomal dominant skin disorder caused by mutations in the ATP2A2 gene. Anecdotal reports suggest a relationship between Darier disease and intellectual disabilities, but these reports are based on small clinical samples and limited by absence of control populations.

    Objectives: To examine the risk of intellectual disability and subclinical impairments in cognitive ability in Darier disease.

    Methods: We conducted a matched cohort study based on Swedish Population-, Patient- and Conscript Registers. The risk of being diagnosed with intellectual disability was estimated in 770 individuals with Darier disease, compared with matched comparison individuals without Darier disease. Associations were examined with risk ratios from conditional logistic regressions. In addition, we analysed test-based cognitive ability data (i.e. IQ data) from the Swedish conscript examination, for a subset of patients without diagnosed intellectual disability.

    Results: Individuals with Darier disease had a sixfold increased risk of being diagnosed with intellectual disability (risk ratio 6.2, 95% confidence interval 3.1-12.4). For conscripted individuals with Darier disease but no diagnosed intellectual disability, mean cognitive ability scores were about half a standard deviation lower than for comparison subjects.

    Conclusions: Darier disease is associated with intellectual disability and subclinical impairments in cognitive ability. The Darier-causing mutations merit further attention in molecular genetic research on intellectual disability and cognitive ability.

  • 7.
    David, Fresnais
    et al.
    Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ingberg, Edvin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infection.
    Elvar, Theodorsson
    Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Ström, Jakob O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Neurology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Lack of association in acne and salivary testosterone2018In: Journal of controversies in biomedical research, ISSN 2205-5975, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    The pathogenesis of acne vulgaris has only been partially elucidated. Various hormones, especially androgens, are likely to play a role, but results of studies are still inconclusive. The objective of the current study was to investigate whether day to day variation in salivary testosterone correlates with acne in males. Saliva samples were collected for 120 consecutive days from each of the 40 males. Salivary testosterone concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Facial acne lesions were assessed on a daily basis by photography by the participating males. Potential confounders’ (sexual intercourse, masturbation, physical exercise and disease) were also registered every day by the participants. A significant but weak association between salivary testosterone and acne was found (n = 4602, r = 0.031, P = 0.034). Elevated testosterone concentrations were associated with an increase in acne, but when testosterone concentrations were above twice the individual average, acne lesions paradoxically decreased. The current results indicate that daily fluctuations in salivary testosterone levels in males are associated with acne patterns, but the weak correlation suggests that the effect is too small to be of clinical significance. The analysis in the current study was complicated by a large number of days on which the participants had no acne, as well as the seemingly non-monotonic relation between testosterone and acne. This may indicate that the actual relation is stronger than concluded here.

  • 8.
    De Meyer, Dorien
    et al.
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
    Kottner, Jan
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Clinical Research Center for Hair and Skin Science, Department of Dermatology and Allergy, Charité-Universitätsmedizin, Berlin, Germany.
    Beele, Hilde
    Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
    Schmitt, Jochen
    Center for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus TU Dresden, Dresden, Germany.
    Lange, Toni
    Center for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus TU Dresden, Dresden, Germany.
    Van Hecke, Ann
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Nursing Department, Ghent University Hospital, Ghent, Belgium.
    Verhaeghe, Sofie
    Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department Health Care, VIVES University College, Roeselare, Belgium.
    Beeckman, Dimitri
    Örebro University, School of Health Sciences. Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
    Delphi Procedure In Core Outcome Set Development: Rating Scale And Consensus Criteria Determined Outcome Selection2019In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 111, p. 23-31Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare two different rating scales within one Delphi study for defining consensus in core outcome set development and to explore the influence of consensus criteria on the outcome selection.

    STUDY DESIGN: Randomized controlled parallel group trial with 1:1 allocation within the first Delphi round of the Core Outcome Set in the Incontinence-Associated Dermatitis (CONSIDER) project. Outcomes were rated on a three-point or nine-point Likert scale. Decisions about which outcomes to retain were determined by commonly used consensus criteria (i.e., (combinations of) proportions with restricted ranges, central tendency within a specific range and decrease in variance).

    RESULTS: Fifty-seven participants (group 1=28, group 2=29) rated 58 outcomes. The use of the nine-point scale resulted in almost twice as many outcomes being rated as 'critical' compared to the three-point scale (24 versus 13). Stricter criteria and combining criteria led to less outcomes being identified as 'critical'.

    CONCLUSION: The format of rating scales in Delphi studies for core outcome set development and the definition of the consensus criteria influence outcome selection. The use of the nine-point scale might be recommended to inform the consensus process for a subsequent rating or face-to-face meeting. The three-point scale might be preferred when determining final consensus.

  • 9. Domeika, M.
    et al.
    Litvinenko, I.
    Smirnova, T.
    Gaivaronskaya, O.
    Savicheva, A.
    Sokolovskiy, E.
    Ballard, R. C.
    Unemo, Magnus
    Örebro University, School of Health and Medical Sciences.
    Laboratory diagnostics for non-viral sexually transmitted infections in St. Petersburg, Russia: current situation and hallmarks for improvements2008In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 22, no 9, p. 1094-1100Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The numbers and performance characteristics of laboratories providing sexually transmitted infection (STI) diagnostic services, as well as the rates of morbidity due to STIs in St. Petersburg, Russia, remain largely unknown.

    OBJECTIVE: The aim of the present study was to evaluate the range, quality and availability of diagnostic services for several non-viral STIs (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and Trichomonas vaginalis) in St. Petersburg during the period September 2005 to June 2006.

    METHODS: Survey data focusing on organization and performance characteristics of STI diagnostic services were assessed using questionnaires, telephone interviews and site visits.

    RESULTS: A total of 118 laboratories providing STI diagnostic services were identified. Of the surveyed laboratories, 54% (64 of 118) diagnosed syphilis, 81% (96 of 118) gonorrhoea, 80% (94 of 118) trichomoniasis and 49% (58 of 118) chlamydial infections. Although most of the laboratories could provide a presumptive diagnosis for syphilis, most of the N. gonorrhoeae and T. vaginalis testing of women did not adhere to international recommendations. Of the laboratories with the capacity to diagnose C. trachomatis infection, 69% still used serological testing (enzyme-linked immunosorbent assay) to detect antibodies to C. trachomatis.

    CONCLUSIONS: Overall, the diagnostic methods used to establish a laboratory diagnosis, the system of case reporting, the training of laboratory personnel and the level of interlaboratory communication clearly require improvement. This study represents the first step in a process of evaluation of the laboratory support for STI services and the establishment of an interlaboratory network in St. Petersburg.

  • 10.
    Ekbäck, Maria Palmetun
    et al.
    Örebro University Hospital. Dept Dermatol, Örebro University Hospital, Örebro, Sweden; Drug & Therapeut Committee, Örebro University Hospital, Örebro, Sweden.
    Troilius, Agneta
    Laser & Vascular Anomalies, Dermatol Dept, Skåne Univ Hosp, Malmö, Sweden.
    Laser therapy for refractory discoid lupus erythematosus when everything else has failed2013In: Journal of Cosmetic & Laser Therapy, ISSN 1476-4172, E-ISSN 1476-4180, Vol. 15, no 5, p. 260-265Article in journal (Refereed)
    Abstract [en]

    Background: Discoid lupus erythematosus (DLE) is restricted to the skin, mostly the face, often chronic and disfiguring. Standard medical therapies include topical corticosteroids and antimalarials. This is a retrospective long-term follow-up of refractory DLE treated with different lasers and intense pulsed light (IPL). Methods and materials : Sixteen patients with histologically confirmed DLE participated in this study. Two men and fourteen women, aged 28-69 years, mean age 54 years, were treated at the laser units of the Departments of Dermatology at the University Hospital of Orebro from 2001 and at Skane University Hospital in Malmo, Sweden from 1999. Several therapies, including first- and secondline treatments and even cryotherapy, had been used without response. Many patients had marked scarring. Pulsed dye laser (PDL) and IPL were used with low fluencies. Results: Of 16 patients, 14 were improved regarding itching, erythema, scaling, scarring and pain. There was no scarring as a side effect of laser therapy or IPL. Two patients were not satisfied: one because of long healing time, and the other because of post inflammatory hyper pigmentation. Conclusion: IPL and PDL is a safe adjunctive therapy to conventional treatment of DLE. In the effort to prevent severe scarring and disfigurement it should be used as early as possible.

  • 11.
    Ekbäck, Maria [Palmetun]
    et al.
    Örebro University, School of Health and Medical Sciences.
    Wijma, Klaas
    Benzein, Eva
    "It is always on my mind": women's experiences of their bodies when living with hirsutism2009In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 30, no 5, p. 358-372Article in journal (Refereed)
    Abstract [en]

    Many women suffer from excessive hair growth, often in combination with polycystic ovarian syndrome (PCOS). It is unclear how hirsutism influences such women's experiences of their bodies. Our aim is to describe and interpret women's experiences of their bodies when living with hirsutism. Interviews were conducted with 10 women with hirsutism. We used a qualitative latent content analysis. Four closely intertwined themes were disclosed: the body was experienced as a yoke, a freak, a disgrace, and as a prison. Hirsutism deeply affects women's experiences of their bodies in a negative way.

  • 12.
    Evenhamre, Karolina
    et al.
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Ekbäck, Maria Palmetun
    Örebro University Hospital. Department of Dermatology, Örebro University Hospital, Örebro, Sweden; Department of Medical Sciences, Faculty of Medicine, Örebro University, Örebro, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Correlations Between Disease-specific DLQI and Generic WHOQOL-BREF Quality of Life Instruments in a Clinical Population with Mixed Dermatological Diagnoses: A Pilot Study2017In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 97, no 2, p. 270-272Article in journal (Refereed)
  • 13.
    Fall, Sofia
    et al.
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden .
    Bruze, Magnus
    Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden .
    Isaksson, Marlene
    Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden .
    Lidén, Carola
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden .
    Matura, Mihaly
    Unit of Occupational and Environmental Dermatology, Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden .
    Stenberg, Berndt
    Dermatology and Venereology, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Contact allergy trends in Sweden: a retrospective comparison of patch test data from 1992, 2000, and 20092015In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 72, no 5, p. 297-304Article in journal (Refereed)
    Abstract [en]

    Background: Contact allergy prevalence rates change over time as a result of variations in allergen exposure. Data from patch test clinics are often used as markers for allergy trends.

    Objectives: The aim of the present retrospective study was to describe trends in rates of sensitization to allergens in the Swedish baseline series.

    Patients/materials/methods: Prevalence rates are described by comparing consecutive patch test data from 1992, 2000 and 2009 in Swedish patch test clinics. In total, 3680 patients were included in 1992, 3825 in 2000, and 3112 in 2009.

    Results: Among test substances with a sensitization rate above 2% in 2009, significant decreases were noted for nickel sulfate, cobalt chloride, colophonium, and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI), and a significant increase for p-phenylenediamine, as compared with 1992. Potassium dichromate reactions had increased among younger women, whereas reactions to nickel and cobalt had decreased in this group. Sensitization to chromium, cobalt and fragrance mix I had decreased among older men, and sensitization to nickel had decreased among younger men.

    Conclusions: It is probable that these changes in 1992-2009 reflect both changes in regulations for nickel, lower levels of chromium in cement and of MCI/MI in cosmetics, and increasing use of hair dyes.

  • 14.
    Guy, Rebecca J.
    et al.
    The Kirby Institute, University of New South Wales, Sydney, Australia.
    Causer, Louise M.
    The Kirby Institute, University of New South Wales, Sydney, Australia.
    Klausner, Jeffrey D.
    Department of Global Health, University of California, San Francisco, USA.
    Unemo, Magnus
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Toskin, Igor
    Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
    Azzini, Anna M.
    Verona University, Verona, Veneto, Italy.
    Peeling, Rosanna W.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Performance and operational characteristics of point-of-care tests for the diagnosis of urogenital gonococcal infections2017In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 93, no Suppl. 4, p. S16-S21Article, review/survey (Refereed)
    Abstract [en]

    Background: In 2012, there was an estimated 78 million new cases of gonorrhoea globally. Untreated infection may lead to reproductive and neonatal morbidity and facilitate HIV transmission. Diagnosis and treatment are a priority for control and prevention, yet use of point-of-care tests (POCTs) for Neisseria gonorrhoeae (NG) is limited.

    Objectives: To review the performance and operational characteristics of NG POCTs for diagnosis of urogenital gonorrhoea.

    Methods: We compiled and synthesised findings from two separate systematic reviews which included evaluations published until August 2015.

    Results: Six tests were included: five were immunochromatographic tests (ICTs) or optical immunoassay (OIAs) based on antigen detection; with 5-7 steps and results in 25-40 min, and one (GeneXpert CT/NG) was a 'near-patient test' based on nucleic acid amplification technique (NAAT); with three steps, electricity required, and results in 90 min. When compared with laboratory-based NAATs as the reference tests, sensitivities of ICT and OIA-based POCTs ranged from 12.5% to 70% when cervical/vaginal swabs were tested. Specificities ranged from 89% to 99.8%. The near-patient NAAT had sensitivities of >95% and specificities of >99.8% consistently across all specimen types (urine, cervical and vaginal swabs).

    Conclusions: Based on a limited number of evaluations, antigen detection POCTs for NG lacked sufficient sensitivity to be used for screening. A near-patient NAAT has acceptable performance, only involved a few steps, but needs electricity, a temperature-controlled environment and has a 90 min run time. To achieve wider scale up of NG POCTs, we need strong evidence of cost-effectiveness, which should inform guidelines and ultimately increase test development, demand and reduce costs.

  • 15. Hadad, Ronza
    et al.
    Fredlund, Hans
    Örebro University, School of Health and Medical Sciences.
    Unemo, Magnus
    Örebro University, School of Health and Medical Sciences.
    Evaluation of the new COBAS TaqMan CT test v2.0 and impact on the proportion of new variant Chlamydia trachomatis by the introduction of diagnostics detecting new variant C trachomatis in Örebro county, Sweden2008In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 85, p. 190-193Article in journal (Refereed)
    Abstract [en]

    Background: The new variant of Chlamydia trachomatis (nvCT), discovered in Sweden in 2006, contains a 377-bp cryptic plasmid deletion, which includes the targets for the COBAS Amplicor/TaqMan C trachomatis/Neisseria gonorrhoea and Abbott m2000rt C trachomatis/N gonorrhoea tests.

    Objectives: To evaluate the new real-time COBAS TaqMan CT test v2.0 (CTM CT v2.0) for C trachomatis diagnostics and to investigate whether the proportion of nvCT was affected by the introduction of genetic diagnostics detecting nvCT (LightMix 480HT) in Örebro county, Sweden.

    Methods: CTM CT v2.0 compared with LightMix 480 HT PCR for the diagnosis of C trachomatis was evaluated. Discrepant samples were analysed using BD ProbeTec ET and Abbott m2000rt RealTime CT II. All previously LightMix and cell culture-positive samples were analysed using an nvCT-specific PCR.

    Results: The sensitivity, specificity, negative predictive value and positive predictive value of CTM CT v2.0 for examined samples (n  =  1058) was 100%, 99.8%, 100% and 98.2%, respectively. Of 11 577 consecutive PCR samples, 9.4% (n  =  1084) were positive and 34.3% (n  =  372) of these were nvCT. Of 2306 consecutive culture samples, 5.0% (n  =  116) were C trachomatis positive and 38.8% (n  =  45) of these were nvCT.

    Conclusions: CTM CT v2.0 is a sensitive and specific method for C trachomatis detection. Studies including larger numbers of symptomatic and asymptomatic patients as well as genital and extragenital samples, and in comparison with other internationally validated and, ideally, US Food and Drug Administration-approved C trachomatis nucleic acid amplification tests are imperative. The proportion of nvCT remains high in Örebro county, Sweden, despite the introduction of genetic diagnostics to detect the mutant. 

  • 16. Hadad, Ronza
    et al.
    Fredlund, Hans
    Örebro University, School of Health and Medical Sciences.
    Unemo, Magnus
    Örebro University, School of Health and Medical Sciences.
    Impact on the proportion of the new variant of Chlamydia trachomatis (nvCT) by introduction of diagnostics detecting nvCT and evaluation of Cobas TaqMan48 CT Test v2.0 for C. trachomatis diagnostics in Örebro county, Sweden2008Conference paper (Other academic)
  • 17.
    Hagvall, Lina
    et al.
    Department of Dermatology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Bruze, Magnus
    Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.
    Engfeldt, Malin
    Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.
    Isaksson, Marléne
    Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences. Department of Dermatology, University Hospital, Örebro, Sweden.
    Ryberg, Kristina
    Department of Dermatology, Uddevalla Hospital, Uddevalla, Sweden.
    Stenberg, Berndt
    Department of Public Health and Clinical Medicine, Dermatology & Venereology, Umeå University, Umeå, Sweden.
    Svedman, Cecilia
    Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.
    Karlberg, Ann-Therese
    Dermatochemistry, Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden.
    Bråred Christensson, Johanna
    Department of Dermatology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Dermatochemistry, Department of Chemistry and Molecular Biology, University of Gothenburg, Gothenburg, Sweden.
    Contact allergy to oxidized geraniol among Swedish dermatitis patients: A multicentre study by the Swedish Contact Dermatitis Research Group2018In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 79, no 4, p. 232-238Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Geraniol is a widely used fragrance terpene, and is included in fragrance mix I. Geraniol is prone to autoxidation, forming the skin sensitizers geranial, neral, and geraniol-7-hydroperoxide. Oxidized geraniol has previously been patch tested in 1 clinic, giving 1% to 4.6% positive reactions in consecutive patients when tested at 2% to 11%.

    AIM: To compare test reactions to pure and oxidized geraniol, to compare 2 different test concentrations of oxidized geraniol and to investigate the pattern of concomitant reactions to fragrance markers of the baseline series in a multicentre setting.

    METHODS: One thousand four hundred and seventy-six consecutive patients referred for patch testing were patch tested with geraniol 6% pet. and oxidized geraniol 6% and 11% pet.

    RESULTS: Pure geraniol 6% pet., oxidized geraniol 6% pet. and oxidized geraniol 11% pet. gave 1%, 3% and 8% positive patch test reactions and 0.7%, 3% and 5% doubtful reactions, respectively. Approximately 50% of the patients with doubtful reactions to oxidized geraniol 6% pet. had positive reactions to oxidized geraniol 11% pet.

    CONCLUSIONS: Oxidized geraniol 11% pet. provides better detection than oxidized geraniol 6% pet. As most patients reacted only to oxidized geraniol, it is important to explore further whether oxidized geraniol should be included in a baseline patch test series.

  • 18.
    Hedberg, Yolanda S.
    et al.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Surface and Corrosion Science, Department of Chemistry, KTH Royal Institute of Technology, Stockholm, Sweden.
    Lidén, Carola
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences. Department of Dermatology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Chromium Dermatitis in a Metal Worker Due to Leather Gloves and Alkaline Coolant2016In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 96, no 1, p. 104-105Article in journal (Refereed)
  • 19.
    Hjelmevoll, Stig Ove
    et al.
    Departments of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
    Olsen, Merethe Elise
    Departments of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
    Sollid, Johanna U. Ericson
    Department of Microbiology and Virology, Institute of Medical Biology, University Hospital of North Norway, Tromsø, Norway.
    Haaheim, Hakon
    Departments of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
    Melby, Kjetil K.
    Department of Microbiology, Oslo University Hospital Ullevål, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
    Moi, Harald
    Olafiaklinikken, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
    Unemo, Magnus
    Örebro University Hospital. WHO Collaborating Centre for Gonorrhoea and other STIs, National Reference Laboratory for Pathogenic Neisseria, Örebro University Hospital, Örebro, Sverige; Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Skogen, Vegard
    Departments of Infectious Diseases, Medical Clinic, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
    Appropriate Time for Test-of-Cure when Diagnosing Gonorrhoea with a Nucleic Acid Amplification Test2012In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 92, no 3, p. 316-319Article in journal (Refereed)
    Abstract [en]

    Culture is commonly regarded as the gold standard for diagnosis of Neisseria gonorrhoeae. However, nucleic acid amplification tests (NAATs) have rapidly replaced culture for diagnostics in many settings. The aim of the present study was to investigate the appropriate time for test-of-cure (TOC) when NAATs are used for diagnosis of gonorrhoea. In total, 30 patients (28 men and 2 women) provided urethral, cervical, rectal or pharyngeal specimens for TOC. All included patients, except one who did not return for second TOC before day 19, tested negative within 2 weeks after treatment with cefixime 400 mg x 1. Antimicrobial susceptibility testing showed that 68% of the culture-positive strains were resistant to ciprofloxacin. Thus, the recommended empirical treatment with ciprofloxacin in Norway should be changed immediately. TOC can be performed 2 weeks after treatment when NAATs are used for diagnosis of gonorrhoea.

  • 20.
    Horner, P.
    et al.
    Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, United Kingdom.
    Donders, G.
    Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium.
    Cusini, M.
    Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy.
    Gomberg, M.
    Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia.
    Jensen, J. S.
    Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark.
    Unemo, Magnus
    Örebro University, School of Medical Sciences. Örebro University Hospital. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology.
    Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and U. urealyticum in men and women?: a Position Statement from the European STI Guidelines Editorial Board2018In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 32, no 11, p. 1845-1851Article in journal (Refereed)
    Abstract [en]

    At present, we have no evidence that we are doing more good than harm detecting and subsequently treating Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum colonisations/infections. Consequently, routine testing and treatment of asymptomatic or symptomatic men and women for M. hominis, U. urealyticum, and U. parvum is not recommended. Asymptomatic carriage of these bacteria is common and the majority of individuals do not develop disease. Although U. urealyticum has been associated with urethritis in men, it is probably not causal unless a high load is present (likely carriage in 40-80% of detected cases). The extensive testing, detection and subsequent antimicrobial treatment of these bacteria performed in some settings may result in selection of antimicrobial resistance, in these bacteria, "true" STI agents, as well as in the general microbiota, and substantial economic cost for society and individuals, particularly women. The commercialisation of many particularly multiplex PCR assays detecting traditional non-viral STIs together with M. hominis, U. parvum and/or U. urealyticum have worsened this situation. Thus, routine screening of asymptomatic men and women or routine testing of symptomatic individuals for M. hominis, U. urealyticum, and U. parvum is not recommended. If testing of men with symptomatic urethritis is undertaken, traditional STI urethritis agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, M. genitalium and, in settings where relevant, Trichomonas vaginalis should be excluded prior to U. urealyticum testing and quantitative species-specific molecular diagnostic tests should be used. Only men with high U. urealyticum load should be considered for treatment, however, appropriate evidence for effective treatment regimens is lacking. In symptomatic women, bacterial vaginosis (BV) should always be tested for and treated if detected.

  • 21.
    Isaksson, Marlene
    et al.
    Dept Occupat & Environm Dermatol, Dept Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Brared-Christensson, Johanna
    Dept Dermatol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Engfeldt, Malin
    Dept Occupat & Environm Dermatol, Dept Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Lindberg, Magnus
    Örebro University Hospital. Dept Dermatol, Örebro University Hospital, Örebro, Sweden.
    Matura, Mihaly
    Inst Environm Med, Dept Dermatol, Unit Occupat & Environm Dermatol, Karolinska Inst, Stockholm, Sweden; Dept Dermatol, Ctr Occupat & Environm Medicine, Stockholm, Sweden.
    Möller, Halvor
    Dept Occupat & Environm Dermatol, Dept Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Ryberg, Kristina
    Dept Dermatol, Uddevalla Cent Hosp, Uddevalla, Sweden.
    Stenberg, Berndt
    Dept Publ Hlth & Clin Med, Dept Dermatol, Umeå Univ, Umeå, Sweden.
    Svedman, Cecilia
    Dept Occupat & Environm Dermatol, Dept Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Bruze, Magnus
    Dept Occupat & Environm Dermatol, Dept Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Patch Testing with Formaldehyde 2.0% in Parallel with 1.0% by the Swedish Contact Dermatitis Research Group2014In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 94, no 4, p. 408-410Article in journal (Refereed)
    Abstract [en]

    In a multicentre study consecutively patch-tested dermatitis patients were tested simultaneously with 1.0% and 2.0% (w/v) formaldehyde in aqua applied with a micro-pipette (15 mu l) to the filter paper disc in Finn Chambers (0.30 mg/cm(2) and 0.60 mg/cm(2), respectively). A total of 2,122 dermatitis patients were patch-tested. In all, 77 (3.6%) patients reacted positively to formaldehyde; 37 reacted only to 2.0%, 35 reacted to both concentrations and 5 patients reacted only to 1.0%. Significantly more patients were thus diagnosed with contact allergy to formaldehyde with 2.0% compared to 1.0% (p<0.001) without causing more irritant reactions. The detected number of isolated allergic reactions to the 2 formaldehyde-releasers in the Swedish baseline series and not to formaldehyde itself raises the question whether quaternium-15 1.0% and diazolidinyl urea 2.0% should be present in the Swedish baseline series.

  • 22.
    Isaksson, Marlene
    et al.
    Dept Occupat & Environm Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Inerot, Annica
    Dept Dermatol, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Liden, Carola
    Inst Environm Med, Karolinska Inst, Stockholm, Sweden; Ctr Occupat & Environm Med, Unit Occupat & Environm Dermatol, Stockholm Cty Council,Stockholm, Sweden.
    Lindberg, Magnus
    Örebro University Hospital. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Matura, Mihaly
    Inst Environm Med, Karolinska Inst, Stockholm, Sweden; Ctr Occupat & Environm Med, Unit Occupat & Environm Dermatol, Stockholm Cty Council, Stockholm, Sweden.
    Möller, Halvor
    Dept Occupat & Environm Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Stenberg, Berndt
    Dept Publ Hlth & Clin Med, Umeå Univ, Umeå, Sweden.
    Bruze, Magnus
    Dept Occupat & Environm Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Multicentre patch testing with fragrance mix II and hydroxyisohexyl 3-cyclohexene carboxaldehyde by the Swedish Contact Dermatitis Research Group2014In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 70, no 3, p. 187-189Article in journal (Refereed)
  • 23.
    Jamil, Wasim N.
    et al.
    Örebro University, School of Medical Sciences. Department of Dermatology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences. Department of Dermatology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Effects of time and recall of patch test results on quality of life (QoL) after testing: Cross-sectional study analyzing QoL in hand eczema patients 1, 5 and 10 years after patch testing2017In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 77, no 2, p. 88-94Article in journal (Refereed)
    Abstract [en]

    Background: Patch testing can improve health-related quality of life (HRQoL).

    Objectives: To study the impact on HRQoL of elapsed time after patch testing (1-10 years), and how the outcome of testing and patients' recall affects HRQoL.

    Patients/materials/methods: The Dermatology Life Quality Index (DLQI) questionnaire was sent to all patients (aged 18-65 years) who were patch tested for suspected contact allergy in 2009, 2005 and 2000 at the Department of Dermatology in Örebro.

    Results: The response rate was 51% (n = 256). The DLQI score was significantly lower at 10 years after patch testing (mean DLQI = 5.5) than at 1 year (mean DLQI = 7.7). Work was the most impaired aspect. A binary logistic model showed that only time (10 years after testing) was associated with no effect, a light effect or a moderate effect (DLQI < 10) on HRQoL. No such association was seen for patients with negative or positive test results concerning full recall, partial recall or no recall of diagnosed allergens.

    Conclusions: Although there was an improvement in HRQoL over time, the work aspect remained a major problem. The improvement was not affected by the outcome of testing and patients' recall of test results.

  • 24.
    Jamil, Wassim N.
    et al.
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Erikssohn, Ingalill
    Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Lindberg, Magnus
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    How well is the outcome of patch testing remembered by the patients?: A 10-year follow-up of testing with the Swedish baseline series at the Department of Dermatology in Örebro, Sweden2012In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 66, no 4, p. 215-220Article in journal (Refereed)
    Abstract [en]

    Background: Patch testing is beneficial for patients with contact dermatitis. However, it is not known how well the outcome of patch testing is remembered after a prolonged period.

    Objectives: To study how well patients remember the outcome of their tests after 1-10 years. Patients/materials/methods. In 2010, a questionnaire was sent to all patients tested with the Swedish baseline series in 2009, 2005, and 2000.

    Results: The response rate was 53.3% (252/473), and 96% (241/252) of patients reported that they had been submitted for allergy testing. Among those with positive patch test results, 79% (111/141) remembered a positive result and 29% (41/141) reported the correct name of the allergen. We found a wide variation (0-80%) in how well the patients remembered positive test results for different allergens. The ability to recall allergens had no relationship with the localization or extension of eczema lesions, but was negatively correlated with the number of diagnosed allergies, the number of years after patch testing, and being male.

    Conclusions: Our results indicate that improved information for patients following patch testing is required, in order to improve the prognosis of contact dermatitis.

  • 25.
    Johansen, Jeanne D.
    et al.
    Dept Dermatoallergol, Natl Allergy Res Ctr, Gentofte Hosp, Univ Copenhagen, Hellerup, Denmark.
    Aalto-Korte, Kristiina
    Occupat Med, Finnish Inst Occupat Hlth, Helsinki, Finland.
    Agner, Tove
    Dept Dermatol, Bispebjerg Hosp, Univ Copenhagen, Copenhagen, Denmark.
    Andersen, Klaus E.
    Odense Univ Hosp, Univ Southern Denmark, Dept Dermatol, Odense, Denmark; Allergy Ctr, Odense Univ Hosp, Univ Southern Denmark, Odense, Denmark.
    Bircher, Andreas
    Dept Dermatol, Allergy Unit, Univ Basel Hosp, Basel, Switzerland; Univ Basel, Basel, Switzerland.
    Bruze, Magnus
    Dept Occupat & Environm Dermatol, Skåne Univ Hosp, Lund Univ, Malmö, Sweden.
    Cannavo, Alicia
    Hosp Municipal Vicente Lopez Prof Bernard Houssay, Buenos Aires DF, Argentina.
    Gimenez-Arnau, Ana
    Dept Dermatol, Hosp Mar, Univ Autonoma Barcelona, Barcelona, Spain.
    Goncalo, Margarida
    Dept Dermatol, Univ Hosp, Coimbra, Portugal; Fac Med, Univ Coimbra, Coimbra, Portugal.
    Goossens, An
    Dept Dermatol, Contact Allergy Unit, Univ Hosp KU Leuven, Leuven, Belgium.
    John, Swen M.
    Dept Dermatol, Environm Med, Hlth Theory,Univ Osnabruck, Osnabruck, Germany.
    Liden, Carola
    Inst Environm Med, Karolinska Inst, Stockholm, Sweden.
    Lindberg, Magnus
    Dept Dermatol, Örebro University Hospital, Örebro, Sweden.
    Mahler, Vera
    Dept Dermatol, Allergy Unit, Univ Hosp Erlangen, Erlangen, Germany.
    Matura, Mihly
    Ctr Occupat & Environm Med, Unit Occupat & Environm Dermatol, Stockholms Läns Sjukvårdsområde (SLSO), Stockholm, Sweden.
    Rustemeyer, Thomas
    Dept Dermatol, Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands.
    Serup, Jorgen
    Dept Dermatol, Bispebjerg Hosp, Univ Copenhagen, Copenhagen, Denmark.
    Spiewak, Radoslaw
    Dept Expt Dermatol & Cosmetol, Coll Med, Jagiellonian Univ, Krakow, Poland.
    Thyssen, Jacob P.
    Dept Dermatoallergol, Natl Allergy Res Ctr, Gentofte Hosp, Univ Copenhagen, Hellerup, Denmark.
    Vigan, Martine
    Dept Dermatol, Centre Hospitalier Régional Universitaire (CHRU) Besancon, Besancon, France.
    White, Ian R.
    St Johns Inst Dermatol, Dept Cutaneous Allergy, St Thomas Hosp, London, England.
    Wilkinson, Mark
    Spire Hosp, Leeds, England.
    Uter, Wolfgang
    Dept Med Informat Biometry & Epidemiol, Univ Erlangen Nurnberg, Erlangen, Germany.
    European Society of Contact Dermatitis guideline for diagnostic patch testing: recommendations on best practice2015In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 73, no 4, p. 195-221Article, review/survey (Refereed)
    Abstract [en]

    The present guideline summarizes all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by a highlighted short practical recommendation. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing, and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.

  • 26.
    Josefson, Anna
    Örebro University, School of Health and Medical Sciences.
    Nickel allergy and hand eczema: epidemiological aspects2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Nickel allergy is the most prevalent contact allergy and has been discussed as a possible riskfactor for hand eczema. However, hand eczema is one of the most frequently occurring skindiseases and has multifactorial origin. The aim of this thesis was to study the association between nickel allergy and hand eczema in the general population. There are only a fewpopulation-based studies previously published, that include patch testing. In addition, this thesis aimed to evaluate methods to follow the prevalence of nickel allergy.The study cohort consisted of 908 women who had been patch tested for the occurrence of nickel allergy as schoolgirls. Twenty years later, they were invited to participate in a follow-up questionnaire study. The response rate was 81%. In total, 17.6% of respondents reported handeczema after the age of 15 years and there was no statistically significant difference in the occurrence of hand eczema between those who were nickel-positive and those who were nickel negativeas schoolgirls. To further investigate possible links, another study was performed,which included a second questionnaire, a clinical investigation and patch testing. All schoolgirls from the baseline study who were still living in the area as adults were invited to participate and the participation rate was 77%. Patch test showed 30.1% nickel-positive individuals.When all participants were included in the analysis, there was no statistically significant difference between nickel-positive and nickel-negative women regarding occurrence of hand eczema. The most important risk factor for hand eczema was childhood eczema. Adjusted prevalence proportion ratio (PPR) for hand eczema after age 15 in relation to nickel patch testresults was 1.03 (95% CI 0.71--1.50) and in relation to childhood eczema 3.68 (95% CI 2.45--5.54). When women with and without history of childhood eczema were analyzed separately, the hand eczema risk was doubled in nickel-positive women without history of childhood eczema. In conclusion, the risk of hand eczema in nickel-positive women may previously havebeen overestimated. Next, the validity of self-reported nickel allergy was investigated. In the established cohort; two questions regarding nickel allergy were compared with patch test results. The validity of self-reported nickel allergy was low, and the questions regarding nickel allergy overestimated the true prevalence of nickel allergy. The positive predictive values were 59% and 60%. Another method for estimating the prevalence of nickel allergy, namely self-patch testing, was validated in the last study. In total, 191 patients from three different dermatology departments participated. The validity of self-testing for nickel allergy was adequate, with sensitivity 72%and proportion of agreement 86%.

    List of papers
    1. Nickel allergy and hand eczema: a 20-year follow up
    Open this publication in new window or tab >>Nickel allergy and hand eczema: a 20-year follow up
    2006 (English)In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 55, no 5, p. 286-290Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to investigate the occurrence of hand eczema after 20 years in women patch tested to nickel during childhood. In 1982-1983, 960 schoolgirls were patch tested for nickel allergy; its prevalence was found to be 9%. 20 years later, the same individuals received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. 735 of 908 women (80.9%) answered the questionnaire. In total, 17.6% of respondents reported hand eczema after the age of 15 years, and the 1-year prevalence was 12.8%. There was no statistically significant difference in the occurrence of hand eczema between the groups who had previously tested positive and negative for nickel allergy. 38.3% of the respondents considered themselves to be nickel sensitive at the time they answered the questionnaire; in this group, the reported prevalence of hand eczema after age 15 was 22.5%. 31.4% of those with a history of atopic dermatitis reported hand eczema after age 15, compared with 10.6% of those without (P < 0.001). In conclusion, contact allergy to nickel in childhood did not seem to increase the prevalence of hand eczema later in life.

    Place, publisher, year, edition, pages
    Oxford: Wiley, 2006
    Keywords
    nickel allergy, hand eczema, childhood eczema, population-based, childhood eczema, epidemiology, interaction, missing value analysis, patch test, wet work
    National Category
    Medical and Health Sciences Dermatology and Venereal Diseases
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-12500 (URN)10.1111/j.1600-0536.2006.00958.x (DOI)
    Available from: 2010-11-19 Created: 2010-11-18 Last updated: 2017-12-12Bibliographically approved
    2. Nickel allergy as risk factor for hand eczema: a population-based study
    Open this publication in new window or tab >>Nickel allergy as risk factor for hand eczema: a population-based study
    2009 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 160, no 4, p. 828-834Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: In population-based studies using self-reported nickel allergy, a hand eczema prevalence of 30-43% has been reported in individuals with nickel allergy. In a previous Swedish study, 958 schoolgirls were patch tested for nickel. In a questionnaire follow up 20 years later no association was found between nickel allergy and hand eczema. OBJECTIVES: To investigate further the relation between nickel allergy and hand eczema. METHODS: Three hundred and sixty-nine women, still living in the same geographical area, now aged 30-40 years, were patch tested and clinically investigated regarding hand eczema. RESULTS: Patch testing showed 30.1% nickel-positive individuals. The adjusted prevalence proportion ratio (PPR) for hand eczema after age 15 years in relation to nickel patch test results was 1.03 (95% confidence interval, CI 0.71-1.50). A history of childhood eczema was reported by 35.9%, and the PPR for hand eczema in relation to childhood eczema was 3.68 (95% CI 2.45-5.54). When analysing the relation separately in women with and without a history of childhood eczema a statistical interaction was found. The hand eczema risk was doubled in nickel-positive women without a history of childhood eczema, with a PPR of 2.23 (95% CI 1.10-4.49) for hand eczema after age 15 years. CONCLUSIONS: A doubled risk for hand eczema was found in nickel-positive women without a history of childhood eczema. When analysing all participants, there was no statistically significant difference between nickel-positive and nickel-negative women regarding occurrence of hand eczema. The most important risk factor for hand eczema was childhood eczema. The risk for hand eczema in nickel-positive women may previously have been overestimated.

    National Category
    Medical and Health Sciences Dermatology and Venereal Diseases
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-11994 (URN)10.1111/j.1365-2133.2008.09006.x (DOI)19183170 (PubMedID)
    Available from: 2010-10-04 Created: 2010-10-04 Last updated: 2017-12-12Bibliographically approved
    3. Validity of self-reported nickel allergy
    Open this publication in new window or tab >>Validity of self-reported nickel allergy
    2010 (English)In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 62, no 5, p. 289-293Article in journal (Refereed) Published
    Abstract [en]

    Background: To estimate the prevalence of nickel allergy, self-reports are sometimes used in epidemiological studies. Self-reports are practical and may facilitate estimation of prevalence provided that the questions are validated.Objectives: To investigate the validity of self-reported nickel allergy.Methods: Three hundred and sixty-nine women, aged 30–40 years, from the general population participated in the study. The participants answered a questionnaire before a clinical examination and patch testing. The two questions being validated were ‘Are you sensitive/hypersensitive/allergic to nickel?’ and ‘Do you get a rash from metal buttons, jewellery or other metal items that come in direct contact with your skin?’Results: Patch test showed nickel-positive reaction in 30% of the subjects. Self-reported prevalence of nickel allergy as indicated by the two respective questions was 40% and 35%. Positive predictive values for the two questions were 59% (95% CI 50–67) and 60% (95% CI 51–69). History of childhood eczema was over-represented among women with ‘false-positive’ self-reported nickel allergy (P = 0.008). Self-reported hand eczema or ‘high wet exposure’ did not influence the validity.Conclusions: The validity of self-reported nickel allergy is low. The questions regarding nickel allergy overestimate the true prevalence of nickel allergy.

    Place, publisher, year, edition, pages
    Oxford: Wiley, 2010
    Keywords
    epidemiology, patch test, predictive value, questionnaire, sensitivity, specificity
    National Category
    Medical and Health Sciences Dermatology and Venereal Diseases
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-12502 (URN)10.1111/j.1600-0536.2010.01702.x (DOI)000277000100004 ()
    Available from: 2010-11-19 Created: 2010-11-18 Last updated: 2018-04-19Bibliographically approved
    4. Validation of self-testing as a method to estimate the prevalence of nickel allergy
    Open this publication in new window or tab >>Validation of self-testing as a method to estimate the prevalence of nickel allergy
    Show others...
    2011 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 91, no 5, p. 526-530Article in journal (Refereed) Published
    Abstract [en]

    Background: Valid epidemiological tools are required for surveillance of the prevalence of contact allergy. Population based studies including patch testing is the most reliable method, but implies heavy expenses and logistical problems. Clinical data are not representative for the general population and questionnaires concerning contact allergy have a low validity. Self-testing might be a useful method but it has to be validated and evaluated.

    Objectives: To investigate the validity of self-patch testing for nickel allergy. Methods: Patients from three dermatology clinics were included consecutively when referred to patch testing. In total, 191 patients participated and they were provided with a self-test package including written instructions. The self-test was applied on the arm by the patient, on the same day as the patch test was applied on the back, in the clinic. The patient evaluated the self-test before the patch test reading at the clinic.

    Results: Patch test at dermatology clinic (‘gold standard’) gave 46/191 (24%) nickel-positive individuals. The sensitivity of the self-test was 72% (95% CI 57–84), the specificity was 91% (95% CI 85–95) and the proportion of agreement was 86% (95% CI 81–91).Conclusions: The validity of self-testing for nickel allergy was adequate in the studied population. To determine whether self-testing is a useful tool for measuring the prevalence of nickel allergy in the general population further studies will be needed.

    Place, publisher, year, edition, pages
    Society for Publication of Acta Dermato-Venereologica, 2011
    Keywords
    contact allergy, epidemiology, patch test, self-test, sensitivity, specificity
    National Category
    Medical and Health Sciences Dermatology and Venereal Diseases
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-12503 (URN)10.2340/00015555-1120 (DOI)000294887800006 ()21874219 (PubMedID)2-s2.0-80051991751 (Scopus ID)
    Available from: 2010-11-19 Created: 2010-11-18 Last updated: 2018-05-02Bibliographically approved
  • 27.
    Josefson, Anna
    et al.
    Örebro University Hospital. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Berg, Mats
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Gånemo, Agneta
    Department of Dermatology, Institute of Clinical Research in Malmö, Lund University, Malmö, Sweden.
    Hallander, Anna
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Hindsén-Stenström, Monica
    Department of Dermatology, Institute of Clinical Research in Malmö, Lund University, Malmö, Sweden.
    Meding, Birgitta
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Svensson, Åke L.
    Department of Dermatology, Institute of Clinical Research in Malmö, Lund University, Malmö, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Methodological aspects of assessing hand eczema: Comparison of two tools and three different categories of evaluators2017In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 176, no 5, p. 1373-1375Article in journal (Refereed)
  • 28.
    Josefson, Anna
    et al.
    Örebro University, School of Health and Medical Sciences.
    Färm, Gunilla
    Magnuson, A.
    Meding, Birgitta
    Nickel allergy as risk factor for hand eczema: a population-based study2009In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 160, no 4, p. 828-834Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In population-based studies using self-reported nickel allergy, a hand eczema prevalence of 30-43% has been reported in individuals with nickel allergy. In a previous Swedish study, 958 schoolgirls were patch tested for nickel. In a questionnaire follow up 20 years later no association was found between nickel allergy and hand eczema. OBJECTIVES: To investigate further the relation between nickel allergy and hand eczema. METHODS: Three hundred and sixty-nine women, still living in the same geographical area, now aged 30-40 years, were patch tested and clinically investigated regarding hand eczema. RESULTS: Patch testing showed 30.1% nickel-positive individuals. The adjusted prevalence proportion ratio (PPR) for hand eczema after age 15 years in relation to nickel patch test results was 1.03 (95% confidence interval, CI 0.71-1.50). A history of childhood eczema was reported by 35.9%, and the PPR for hand eczema in relation to childhood eczema was 3.68 (95% CI 2.45-5.54). When analysing the relation separately in women with and without a history of childhood eczema a statistical interaction was found. The hand eczema risk was doubled in nickel-positive women without a history of childhood eczema, with a PPR of 2.23 (95% CI 1.10-4.49) for hand eczema after age 15 years. CONCLUSIONS: A doubled risk for hand eczema was found in nickel-positive women without a history of childhood eczema. When analysing all participants, there was no statistically significant difference between nickel-positive and nickel-negative women regarding occurrence of hand eczema. The most important risk factor for hand eczema was childhood eczema. The risk for hand eczema in nickel-positive women may previously have been overestimated.

  • 29.
    Josefson, Anna
    et al.
    Örebro University, School of Health and Medical Sciences.
    Färm, Gunilla
    Dept Dermatol, Karolinska Univ Hosp, Stockholm, Sweden .
    Meding, Birgitta
    Inst Environm Med, Karolinska Inst, Stockholm, Sweden.
    Validity of self-reported nickel allergy2010In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 62, no 5, p. 289-293Article in journal (Refereed)
    Abstract [en]

    Background: To estimate the prevalence of nickel allergy, self-reports are sometimes used in epidemiological studies. Self-reports are practical and may facilitate estimation of prevalence provided that the questions are validated.Objectives: To investigate the validity of self-reported nickel allergy.Methods: Three hundred and sixty-nine women, aged 30–40 years, from the general population participated in the study. The participants answered a questionnaire before a clinical examination and patch testing. The two questions being validated were ‘Are you sensitive/hypersensitive/allergic to nickel?’ and ‘Do you get a rash from metal buttons, jewellery or other metal items that come in direct contact with your skin?’Results: Patch test showed nickel-positive reaction in 30% of the subjects. Self-reported prevalence of nickel allergy as indicated by the two respective questions was 40% and 35%. Positive predictive values for the two questions were 59% (95% CI 50–67) and 60% (95% CI 51–69). History of childhood eczema was over-represented among women with ‘false-positive’ self-reported nickel allergy (P = 0.008). Self-reported hand eczema or ‘high wet exposure’ did not influence the validity.Conclusions: The validity of self-reported nickel allergy is low. The questions regarding nickel allergy overestimate the true prevalence of nickel allergy.

  • 30.
    Josefson, Anna
    et al.
    Örebro University, School of Health and Medical Sciences.
    Färm, Gunillla
    Natl Inst Working Life, S-11391 Stockholm, Sweden.
    Stymne, Birgitta
    Karolinska Inst, Dept Med, S-17177 Stockholm, Sweden.
    Meding, Birgitta
    Karolinska Inst, Dept Med, S-17177 Stockholm, Sweden.
    Nickel allergy and hand eczema: a 20-year follow up2006In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 55, no 5, p. 286-290Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate the occurrence of hand eczema after 20 years in women patch tested to nickel during childhood. In 1982-1983, 960 schoolgirls were patch tested for nickel allergy; its prevalence was found to be 9%. 20 years later, the same individuals received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. 735 of 908 women (80.9%) answered the questionnaire. In total, 17.6% of respondents reported hand eczema after the age of 15 years, and the 1-year prevalence was 12.8%. There was no statistically significant difference in the occurrence of hand eczema between the groups who had previously tested positive and negative for nickel allergy. 38.3% of the respondents considered themselves to be nickel sensitive at the time they answered the questionnaire; in this group, the reported prevalence of hand eczema after age 15 was 22.5%. 31.4% of those with a history of atopic dermatitis reported hand eczema after age 15, compared with 10.6% of those without (P < 0.001). In conclusion, contact allergy to nickel in childhood did not seem to increase the prevalence of hand eczema later in life.

  • 31.
    Josefson, Anna
    et al.
    Örebro University, School of Health and Medical Sciences.
    Svensson, Åke
    Department of Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Färm, Gunilla
    Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden.
    Engfeldt, Malin
    Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Meding, Birgitta
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Validation of self-testing as a method to estimate the prevalence of nickel allergy2011In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 91, no 5, p. 526-530Article in journal (Refereed)
    Abstract [en]

    Background: Valid epidemiological tools are required for surveillance of the prevalence of contact allergy. Population based studies including patch testing is the most reliable method, but implies heavy expenses and logistical problems. Clinical data are not representative for the general population and questionnaires concerning contact allergy have a low validity. Self-testing might be a useful method but it has to be validated and evaluated.

    Objectives: To investigate the validity of self-patch testing for nickel allergy. Methods: Patients from three dermatology clinics were included consecutively when referred to patch testing. In total, 191 patients participated and they were provided with a self-test package including written instructions. The self-test was applied on the arm by the patient, on the same day as the patch test was applied on the back, in the clinic. The patient evaluated the self-test before the patch test reading at the clinic.

    Results: Patch test at dermatology clinic (‘gold standard’) gave 46/191 (24%) nickel-positive individuals. The sensitivity of the self-test was 72% (95% CI 57–84), the specificity was 91% (95% CI 85–95) and the proportion of agreement was 86% (95% CI 81–91).Conclusions: The validity of self-testing for nickel allergy was adequate in the studied population. To determine whether self-testing is a useful tool for measuring the prevalence of nickel allergy in the general population further studies will be needed.

  • 32. Jurstrand, Margareta
    et al.
    Herrmann, B.
    Morin, T.
    Ödmark, S.
    Christersson, L.
    Fredlund, Hans
    Örebro University, School of Health and Medical Sciences.
    Unemo, Magnus
    Örebro University, School of Health and Medical Sciences.
    Characterization of Chlamydia trachomatis genotype E by multi locus sequence typing after the finding of the new variant (nvCt) in a Swedish county 20062008Conference paper (Other academic)
  • 33.
    Jönsson, Agnez
    et al.
    WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Jacobsson, Susanne
    Örebro University, School of Medical Sciences. Örebro University Hospital. WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology.
    Foerster, Sunniva
    WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cole, Michelle J.
    Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK.
    Unemo, Magnus
    Örebro University, School of Medical Sciences. Örebro University Hospital. WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology.
    Performance characteristics of newer MIC gradient strip tests compared with the Etest for antimicrobial susceptibility testing of Neisseria gonorrhoeae2018In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 126, no 10, p. 822-827Article in journal (Refereed)
    Abstract [en]

    For Neisseria gonorrhoeae susceptibility testing, Etest, comparable to agar dilution, is frequently used. In recent years, newer MIC gradient strip tests have been commercialized. However, these tests have not been appropriately evaluated for gonococci. We evaluated the sensitivity, specificity, accuracy, quality, availability of antimicrobials and cost of the MIC Test Strip (Liofilchem), M.I.C.Evaluator (Oxoid) and Ezy MIC Strip (HiMedia), compared to the reference Etest (bioMérieux), for gonococcal susceptibility testing. The MICs of eight antimicrobials in 103 gonococcal international reference strains (n = 29) and clinical isolates (n = 74) were examined. Coefficient of determination (R2), complete agreement, essential agreement, SIR categorical agreement, sensitivity, specificity and accuracy were calculated. R2 of the MICs for the antimicrobials ranged between 0.674–0.996, 0.617–0.993, and 0.643–0.994 for the MIC Test Strip, M.I.C.Evaluator strips and Ezy MIC Strips respectively. The essential agreement (SIR categorical agreement) was 99.6% (88.6%), 100% (87.1%) and 93.0% (83.1%) respectively. M.I.C.Evaluator strips for gonococcal key antimicrobials were lacking and the Ezy MIC Strips showed an inconsistent accuracy, quality and some strips were contaminated. The Liofilchem MIC Test Strips had limitations, but might be relatively accurate alternatives to Etest for gonococci. Strict quality assurance (at manufacturing and testing laboratory), including quality controls, are required.

  • 34.
    Kelly, Helen
    et al.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Coltart, Cordelia E. M.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Pai, Nitika Pant
    Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Canada.
    Klausner, Jeffrey D.
    Department of Global Health, University of California, Los Angeles, USA.
    Unemo, Magnus
    WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden.
    Toskin, Igor
    Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
    Peeling, Rosanna W.
    Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
    Systematic reviews of point-of-care tests for the diagnosis of urogenital Chlamydia trachomatis infections2017In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 93, no Suppl. 4, p. S22-S30Article, review/survey (Refereed)
    Abstract [en]

    Background: WHO estimates that 131 million new cases of urogenital Chlamydia trachomatis (CT) infections occur globally every year. Most infections are asymptomatic. Untreated infection in women can lead to severe complications. Screening and treatment of at-risk populations is a priority for prevention and control.

    Objectives: To summarise systematic reviews of the performance characteristics of commercially available point-of-care tests (POCT) for screening and diagnosis of urogenital CT infection.

    Methods: Two separate systematic reviews covering the periods 2004-2013 and 2010-2015 were conducted on rapid CT POCTs. Studies were included if tests were evaluated against a valid reference standard.

    Results: In the first review, 635 articles were identified, of which 11 were included. Nine studies evaluated the performance of eight antigen detection rapid POCTs on 10 280 patients and two studies evaluated a near-patient nucleic acid amplification test (NAAT) on 3518 patients. Pooled sensitivity of antigen detection tests was 53%, 37% and 63% for cervical swabs, vaginal swabs and male urine, and specificity was 99%, 97% and 98%, respectively. The pooled sensitivity and specificity of the near-patient NAAT for all specimen types were >98% and 99.4%, respectively. The second review identified two additional studies on four antigen detection POCTs with sensitivities and specificities of 22.7%-37.7% and 99.4%-100%, respectively. A new two-step 15 min rapid POCT using fluorescent nanoparticles showed performance comparable to that of near-patient NAATs.

    Conclusions: The systematic reviews showed that antigen detection POCTs for CT, although easy to use, lacked sufficient sensitivity to be recommended as a screening test. A near-patient NAAT shows acceptable performance as a screening or diagnostic test but requires electricity, takes 90 min and is costly. More affordable POCTs are in development.

  • 35.
    Klasson, Maria
    et al.
    Örebro University, School of Medical Sciences. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences. Department of Dermatology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Arvidsson, Helena
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Pettersson, Carin
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Husby, Bente
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Westberg, Håkan
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Biological monitoring of dermal and air exposure to cobalt at a Swedish hard metal production plant: does dermal exposure contribute to uptake?2017In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 77, no 4, p. 201-207Article in journal (Refereed)
    Abstract [en]

    Background: Occupational exposure to cobalt is well established in hard metal manufacture. Cobalt is known to cause contact allergy, asthma, hard metal lung disease, and lung cancer. The relationship between skin exposure and uptake determined in blood has not been extensively investigated.

    Objective: To examine whether skin and inhalable air exposure to cobalt contributes to uptake, determined as cobalt in blood, in a hard metal manufacturing factory.

    Methods: The amount of cobalt on the skin found with an acid wash technique, the air concentrations of inhalable cobalt and cobalt blood concentrations were determined and correlated in exposed workers.

    Results: We found a significant rank correlation for cobalt concentrations on the skin, in inhalable air, and in blood (0.376-0.498). Multiple linear regression showed significant regression coefficients for cobalt skin exposure and blood (B = 0.01, p < 0.05) and for inhalable cobalt in air and blood (B = 49.1, p < 0.001). According to our model based on data from the regression analyses, a twofold increase in skin exposure levels at different air concentrations caused a 3 - 14% increase in blood levels.

    Conclusions: Our data suggest that skin exposure to cobalt in the hard metal industry could affect the total uptake at the same order of magnitude as air exposure.

  • 36. Kubanova, A.
    et al.
    Frigo, N.
    Kubanov, A.
    Sidorenko, S.
    Priputnevich, T.
    Vachnina, T.
    Al-Khafaji, N.
    Polevshikova, S.
    Solomka, V.
    Domeika, M.
    Unemo, Magnus
    Örebro University, School of Health and Medical Sciences.
    National surveillance of antimicrobial susceptibility in Neisseria gonorrhoeae in 2005-2006 and recommendations of first-line antimicrobial drugs for gonorrhoea treatment in Russia2008In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 84, no 4, p. 285-289Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate comprehensively the antimicrobial susceptibility and resistance of Neisseria gonorrhoeae during 2005-2006 in a national survey and to recommend effective antimicrobial drugs for the treatment of gonorrhoea in Russia.

    METHODS: The susceptibility of N gonorrhoeae isolates, cultured mainly from consecutive gonorrhoea patients (n = 1030) during the period January 2005 to December 2006 in Russia, to penicillin G, ceftriaxone, ciprofloxacin, tetracycline and spectinomycin was analysed using the agar dilution method. Nitrocefin discs were used for beta-lactamase detection.

    RESULTS: All isolates were susceptible to ceftriaxone. During 2005 and 2006, however, 5%, 50%, 70% and 77% displayed intermediate susceptibility or resistance to spectinomycin, ciprofloxacin, tetracycline and penicillin G, respectively. Furthermore, 4% of the isolates were beta-lactamase producing during these years. The different federal districts of Russia displayed substantial heterogeneities with regard to the prevalence of gonorrhoea and antimicrobial resistance among N gonorrhoeae isolates.

    CONCLUSIONS: In Russia, penicillins, ciprofloxacin, or tetracycline should definitively not be used in the empirical treatment of gonorrhoea. The recommended first-line antimicrobial drug should be ceftriaxone. If ceftriaxone is not available, spectinomycin ought to be used. Increasing levels of intermediate susceptibility and resistance to spectinomycin have, however, been observed during recent years and, accordingly, great care and monitoring should be undertaken when using this agent. Continuous local, national and international surveillance of N gonorrhoeae antimicrobial susceptibility, in order to reveal the emergence of new resistance, to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis, is crucial.

  • 37. Kucinskiene, Vesta
    et al.
    Juseviciute, Violeta
    Valiukeviciene, Skaidra
    Milasauskiene, Zemyna
    Unemo, Magnus
    Örebro University, School of Health and Medical Sciences.
    Domeika, Marius
    Home sampling and pooling of vaginal samples are effective tools for genetic screening of Chlamydia trachomatis among high school female students in Lithuania2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 2, p. 88-93Article in journal (Refereed)
    Abstract [en]

    The aims were 1) to estimate the prevalence of C. trachomatis infection among sexually active female students in Kaunas, Lithuania; 2) to investigate the usefulness of personal invitation, self-sampling, and pooling of samples for screening; and 3) to evaluate the costs of the approaches used. A cross-sectional study inviting 795 female students (18–31 y of age) from 7 high schools and 1 college in Kaunas was performed. The response rate was 67% (533/795). Self-obtained vaginal samples were analysed, individually and pooled (n=3), using Digene Hybrid Capture II CT/NG Test. The overall prevalence of C. trachomatis infection was 5.6%. Among the sexually active female students 20–24 y of age (n=424), the prevalence was 7.1%; however, the prevalence varied from 0% to 14.2% at the different schools. For estimation of the population prevalence based solely on identification of C. trachomatis positive pools, the pooling strategy reduced the costs by 85%. For estimation of population prevalence and for diagnosis of each individual sample, pooling reduced the costs by 70%. Targeted screening, using pooling to reduce the expenses, mainly of 3rd and 4th y Lithuanian female students could be recommended. By extended personal contact and internet-based communication, increased participation rates may be attained.

  • 38. Lan, P. T.
    et al.
    Srålsby Lundborg, C.
    Phuc, H. D.
    Sihavong, A.
    Unemo, Magnus
    Örebro University, School of Health and Medical Sciences.
    Chuc, N. T. K.
    Khang, T. H.
    Mogren, I.
    Reproductive tract infections including sexually transmitted infections: a population-based study of women of reproductive age in a rural district of Vietnam.2008In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 84, no 2, p. 126-132Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the prevalences of reproductive tract infections (RTI)/sexually transmitted infections (STI) among married women in a rural district of Vietnam, and analyse the influence of socioeconomic, sociodemographic, and other determinants possibly related to RTI/STI. Methods: A community-based cross-sectional study. Married women aged 18–49 years (n  =  1012) were interviewed and underwent a gynaecological examination. Specimens were collected for laboratory diagnosis of chlamydia, gonorrhoea, trichomonas, bacterial vaginosis (BV), candidiasis, hepatitis B, HIV, and syphilis. Results: In total, 37% of the women were clinically diagnosed with an RTI/STI. Aetiologically confirmed RTI/STI was identified in 39% of the women (including 6% with STI). Endogenous infections were most prevalent (candidiasis 26%, BV 11%) followed by hepatitis B 8.3%, Chlamydia trachomatis 4.3%, Trichomonas vaginalis 1%, Neisseria gonorrhoeae 0.7%, genital warts 0.2%, and HIV and syphilis 0%. Fifty per cent of the STI cases were asymptomatic. Younger age and intrauterine devices were significantly associated with an increased risk of BV. Determinants of candidiasis were vaginal douching, high education level and low economic status, whereas a determinant of chlamydia was high economic status. Outmigration of the husband was associated with an increased risk of hepatitis B surface antigen seroposivity among women. Conclusions: RTI/STI were prevalent among married women in a rural population of Vietnam. Syndromic algorithms should be consistently supplemented by risk assessment in order to reduce under and overtreatment. Microscopic diagnosis could be applied in primary care settings to achieve more accurate diagnoses. The promotion of health education aimed at reducing RTI/STI prevalences is an important tool in STI/HIV control programmes. Vaccination to prevent hepatitis B for migrants should be considered.

  • 39.
    Latif, Ahmed S.
    et al.
    Public Health Consultant, Brisbane, Australia.
    Gwanzura, Lovemore
    Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
    Machiha, Anna
    STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe.
    Ndowa, Francis
    STI, HIV/AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe.
    Tarupiwa, Andrew
    National Microbiology Reference Laboratory, Harare, Zimbabwe.
    Gudza-Mugabe, Muchaneta
    National Microbiology Reference Laboratory, Harare, Zimbabwe.
    Shukusho, Fungai D.
    National Microbiology Reference Laboratory, Harare, Zimbabwe.
    Chakanyuka Musanhu, Christine
    Country Office, World Health Organization, Harare, Zimbabwe.
    Wi, Teodora
    Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
    Unemo, Magnus
    WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Antimicrobial susceptibility in Neisseria gonorrhoeae isolates from five sentinel surveillance sites in Zimbabwe, 2015-20162018In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 94, no 1, p. 62-66Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major public health concerns worldwide. Enhanced AMR surveillance for gonococci is essential globally. In Zimbabwe, very limited gonococcal AMR data were reported. Our aims were to (i) implement quality-assured gonococcal AMR surveillance in Zimbabwe and (ii) investigate gonococcal AMR at five health centres in 2015-2016.

    METHODS: Gonococcal isolates from 104 men with urethral discharge were tested for susceptibility to kanamycin, ceftriaxone, cefixime, ciprofloxacin and azithromycin using Etest.

    RESULTS: All isolates (102 possible to test) were susceptible to ceftriaxone and cefixime. The level of resistance (intermediate resistance) to kanamycin and ciprofloxacin was 2.0% (2.0%) and 18.6% (27.5%), respectively. The two kanamycin-resistant isolates (R≥128 mg/L) had a kanamycin minimum inhibitory concentration (MIC) of >256 mg/L. The ciprofloxacin resistance ranged from 9.5% to 30.8% in the five sentinel sites. Only 10 (9.6%) of the isolates were tested for susceptibility to azithromycin and 1 (10.0%) was resistant (MIC=4 mg/L).

    CONCLUSIONS: The emergence of multidrug-resistant gonorrhoea internationally is a major public health concern and gonococcal AMR surveillance is crucial globally. In Zimbabwe, gonococcal AMR surveillance has now been implemented and quality assured according to WHO standards. The results of this first surveillance will be used to directly inform revisions of the national treatment guidelines. It is imperative to further strengthen the surveillance of gonococcal AMR, and ideally also treatment failures, in Zimbabwe and most countries in the WHO African region, which requires continuous national and international support, including technical support, and political and financial commitment.

  • 40.
    Lebwohl, Benjamin
    et al.
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA; Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Hanna
    Department of Oncology-Pathology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
    Hansson, Johan
    Department of Oncology-Pathology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
    Green, Peter H. R.
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Risk of cutaneous malignant melanoma in patients with celiac disease: A population-based study2014In: The Journal of American Academy of Dermatology, ISSN 0190-9622, E-ISSN 1097-6787, Vol. 71, no 2, p. 245-248Article in journal (Refereed)
    Abstract [en]

    Background: Celiac disease (CD) carries an increased risk of several malignancies, including cancers of the gastrointestinal tract and hematologic malignancies. The disease course of cutaneous malignant melanoma (CMM) is affected by the immune status of the host, and therefore may be associated with CD.

    Objective: We sought to test for an association between CD and CMM in a population-based setting.

    Methods: We queried all (n = 28) pathology departments in Sweden and identified patients with intestinal histology consistent with CD. Each patient was matched to up to 5 control subjects by age, gender, calendar period, and region. Using Cox proportional hazards, we tested for an association between CD and the subsequent diagnosis of CMM.

    Results: Among patients with CD (n = 29,028), 78 subsequently developed CMM (0.3%). Compared with control subjects there was no significant association between CD and CMM (hazard ratio 0.94, 95% confidence interval 0.73-1.20). This null association was similar for men (hazard ratio 0.99, 95% confidence interval 0.68-1.44) and women (hazard ratio 0.89, 95% confidence interval 0.64-1.24), and in all age strata.

    Limitations: Lack of data regarding undiagnosed CD is a limitation.

    Conclusion: In this population-based study we found no association between CD and the subsequent diagnosis of CMM. Prior studies showing a positive association between these 2 entities may have been a result of referral bias.

  • 41.
    Lebwohl, Benjamin
    et al.
    Coll Phys & Surg, Dept Med, Celiac Dis Ctr, Columbia Univ, New York NY, USA;Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Sundstrom, Anders
    Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Jabri, Bana
    Celiac Dis Ctr, Univ Chicago, Chicago IL, USA.
    Kupfer, Sonia S.
    Celiac Dis Ctr, Univ Chicago, Chicago IL, USA.
    Green, Peter H. R.
    Coll Phys & Surg, Dept Med, Celiac Dis Ctr, Columbia Univ, New York NY, USA.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Isotretinoin Use and Celiac Disease: A Population-Based Cross-Sectional Study2014In: American Journal of Clinical Dermatology, ISSN 1175-0561, E-ISSN 1179-1888, Vol. 15, no 6, p. 537-542Article in journal (Refereed)
    Abstract [en]

    Background and aim: Isotretinoin, a vitamin A analogue, can promote a pro-inflammatory milieu in the small intestine in response to dietary antigens. We hypothesized that oral isotretinoin exposure would increase the risk of celiac disease (CD).

    Methods: We contacted all 28 pathology departments in Sweden, and through biopsy reports identified 26,739 individuals with CD. We then compared the prevalence of ever using oral isotretinoin to the prevalence in 134,277 matched controls through conditional logistic regression. Data on isotretinoin exposure were obtained from the national Swedish Prescribed Drug Registry. As the only indication for isotretinoin use in Sweden is acne, we also examined its relationship to CD. Data on acne were obtained from the Swedish Patient Registry.

    Results: Ninety-three individuals with CD (0.35 %) and 378 matched controls (0.28 %) had a prescription of isotretinoin. This corresponded to an odds ratio (OR) of 1.22 [95 % confidence interval (CI) 0.97-1.54]. Risk estimates were similar in men and women, and when we restricted our data to individuals diagnosed after the start of the Prescribed Drug Registry. Restricting our analyses to individuals diagnosed aged 12-45 years did not influence the risk estimates (OR 1.38, 95 % CI 0.97-1.97). Meanwhile, having a diagnosis of acne was positively associated with CD (OR 1.34, 95 % CI 1.20-1.51).

    Conclusions: This study found no association between isotretinoin use and CD, but a small excess risk of CD in patients with a diagnosis of acne.

  • 42.
    Lillsunde Larsson, Gabriella
    et al.
    Örebro University, School of Health Sciences. Department of Laboratory Medicine.
    Kaliff, Malin
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    Sorbe, Bengt
    Örebro University, School of Health Sciences. Department of Oncology.
    Helenius, Gisela
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    Karlsson, Mats G.
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    HPV16 viral characteristics in primary, recurrent and metastatic vulvar carcinoma2018In: Papillomavirus research, ISSN 2405-8521, Vol. 6, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Vulvar carcinoma is the fourth most common gynecological malignancy. Two separate carcinogenic pathways are suggested, where one is associated with the human papillomavirus (HPV) and HPV16 the most common genotype.

    The aim of this study was to evaluate HPV-markers in a set of primary tumors, metastases and recurrent lesions of vulvar squamous cell carcinomas (VSCC). Ten HPV16-positive VSCC with metastatic regional lymph nodes, distant lymphoid/hematogenous metastases or local recurrent lesions were investigated for HPV genotype, HPV16 variant, HPV16 viral load, HPV16 integration and HPV16 E2BS3 and 4 methylation.

    In all 10 analyzed case series, the same HPV genotype (HPV16), HPV16 variant and level of viral load were detected in all lesions within a patient case. Primary tumors with a high E2/E6 ratio were found to have fewer vulvar recurrences and/or metastases after diagnosis and treatment. Also, a significantly lower viral load was evident in regional lymph nodes compared to primary tumors.

    The data presented strengthens the evidence for a clonal HPV-induced pathway for vulvar carcinoma.

  • 43.
    Lindberg, Magnus
    Örebro University, School of Medical Sciences.
    A New Perspective on the Formation of Stratum Corneum Intercellular Space2016In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 96, no 3, p. 291-291Article in journal (Refereed)
    Abstract [en]

    is missing (In this Issue...).

  • 44.
    Lindberg, Magnus
    Örebro University Hospital. Dept Dermatol, Örebro University Hospital, Örebro, Sweden.
    The hand eczema proteome: imbalance of epidermal barrier proteins2015In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 172, no 4, p. 852-853Article in journal (Refereed)
  • 45.
    Lindberg, Magnus
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Dermatology, University Hospital Örebro, Örebro County Council, Örebro, Sweden; IMM, Karolinska Institutet, Stockholm, Sweden.
    Berg, Mats
    Department of Dermatology Sörmland, Mälar Hospital, Eskilstuna, FoU Centre Sörmland, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Some observations on reporting quality of life in treatment of psoriasis in outpatient clinics2012In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 93, no 2, p. 210-11Article in journal (Refereed)
  • 46.
    Lindberg, Magnus
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Dermatology, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Bingefors, Kerstin
    Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden.
    Meding, Birgitta
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Berg, Mats
    Centre for Clinical Research Sörmland, Eskilstuna, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Hand eczema and health-related quality of life: a comparison of EQ-5D and the Dermatology Life Quality Index (DLQI) in relation to the hand eczema extent score (HEES)2013In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 69, no 3, p. 138-143Article in journal (Refereed)
    Abstract [en]

    Background: Health-related quality of life (HRQoL) is associated with the extent and severity of hand eczema. We still lack a consensus about which HRQoL instrument to use as the standard, and how to measure the extent and severity of hand eczema.

    Objectives: To compare the Dermatology Life Quality Index (DLQI) with EQ-5D (a standardized instrument for use as a measure of health outcome), and to evaluate how the Hand Eczema Extent Score (HEES) relates to these instruments.

    Methods: Ninety-three patients (61 females) were included. The HEES was recorded by a dermatologist, and the DLQI and EQ-5D by the patients. The results were analysed with factor analysis and non-parametric statistics.

    Results: The DLQI and EQ-5D showed decreased HRQoL. Using factor analysis, we could not establish an association between the DLQI and EQ-5D. There were, however, correlations between the DLQI and the HEES (0.31), the EQ(index) and the HEES (-0.32), the DLQI and the EQ(VAS) (-0.62), and the DLQI and the EQ(index) (-0.67) (the EQ(VAS) and the EQ(index) are calculated from EQ-5D).

    Conclusions: We could not link factors in the DLQI to EQ-5D, which has previously been done for SF-36 (Short Form 36). On the basis of this, we cannot recommend EQ-5D over SF-36 for hand eczema studies. The DLQI correlates with the EQ(VAS) and the EQ(index), and can probably be used as an approximation for EQ-5D. Our findings with the HEES are interesting, as it can be used by patients.

  • 47.
    Lindberg, Magnus
    et al.
    Örebro University Hospital. Department of Dermatology, Örebro University Hospital, Örebro, Sweden.
    Isacson, Dag
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Bingefors, Kerstin
    Department of Pharmacy, Uppsala University, Uppsala, Sweden.
    Self-reported Skin Diseases, Quality of Life and Medication Use: A Nationwide Pharmaco-epidemiological Survey in Sweden2014In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 94, no 2, p. 188-191Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine self-reported consumption of dermatological pharmaceuticals and quality of life (QoL), measured with Short Form 36, in relation to eczema, acne, psoriasis and other inflammatory skin conditions in the Swedish population. A questionnaire containing questions on the occurrence of skin diseases, health-related QoL and the use of pharmaceuticals was sent to a cross-sectional sample of the Swedish population, age range 18-84 years (n =8,000). The response rate was 61%. The 1-year prevalence of skin diseases was 30-35%, with females reporting a higher prevalence. The prevalence was 11.5% for eczema other than hand eczema, 10.2% for acne, 7.5% for hand eczema, 3.9% for psoriasis and 3.1% for urticaria. QoL was significantly affected and 25% of females and 19% of males had used a dermatological drug. Compared with hand eczema, persons with psoriasis and other eczema reported significantly more use of topical steroids on prescription and more use of dermatological pharmaceuticals in total. Skin conditions are common; they affect QoL and lead to a high consumption of dermatological drugs; which deserves increased awareness in the society.

  • 48.
    Lindberg, Magnus
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Atopic dermatitis and gut microbiota2017In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 176, no 2, p. 297-298Article in journal (Refereed)
  • 49. Lundbäck, David
    et al.
    Fredlund, Hans
    Örebro University, Department of Clinical Medicine.
    Berglund, Torsten
    Wretlind, Bengt
    Unemo, Magnus
    Örebro University, Department of Clinical Medicine.
    Molecular epidemiology of Neisseria gonorrhoeae- identification of the first presumed Swedish transmission chain of an azithromycin-resistant strain2006In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 114, no 1, p. 67-71Article in journal (Refereed)
    Abstract [en]

    In the present study, 10 azithromycin-resistant Neisseria gonorrhoeae isolates from 6 Swedish male patients in 2004, 3 sporadic Swedish azithromycin-resistant N. gonorrhoeae isolates from recent years and one Swedish N. gonorrhoeae isolate from 2003 that was susceptible to azithromycin but assigned the same serological variant (serovar), i.e. IB-37, as the isolates from 2004 were included. The isolates were characterized phenotypically using antibiograms and serovar determination and genetically with pulsed-field gel electrophoresis (PFGE), entire porB gene sequencing and N. gonorrhoeae multiantigen sequence typing (NG-MAST). The epidemiological information and the results of the thorough phenotypic characterisation and genetic characterisation identified the first presumed domestic transmission of one azithromycin-resistant N. gonorrhoeae strain in Sweden in 2004. This stresses the need for continuous surveillance of the antibiotic susceptibility of N. gonorrhoeae in order to identify emergence of new resistance, monitor the changing patterns of the susceptibility, and be able to update treatment recommendations on a regular basis.

  • 50.
    Löwa, Anna
    et al.
    Institute for Pharmacy, Pharmacology & Toxicology, Freie Universität Berlin, Berlin, Germany.
    Jevtic, Marijana
    Institute for Pharmacy, Pharmacology & Toxicology, Freie Universität Berlin, Berlin, Germany.
    Gorreja, Frida
    Örebro University, School of Medical Sciences.
    Hedtrich, Sarah
    Institute for Pharmacy, Pharmacology & Toxicology, Freie Universität Berlin, Berlin, Germany.
    Alternatives to animal testing in basic and preclinical research of atopic dermatitis2018In: Experimental dermatology, ISSN 0906-6705, E-ISSN 1600-0625, Vol. 27, no 5, p. 476-483Article, review/survey (Refereed)
    Abstract [en]

    Atopic dermatitis (AD) is a chronic inflammatory skin disease of increasing prevalence, especially in industrialized countries. Roughly 25% of the children and 1%-3% of adults are affected. Although significant progress has been made in the understanding of the pathogenesis of AD, many aspects remain poorly understood. Moreover, there is a pressing need for improved therapeutic options. Studies to elucidate the pathophysiological pathways of AD and to identify novel therapeutic targets over the last few decades have been conducted almost exclusively in animal models. However, in vitro approaches such as 3D skin disease models have recently emerged due to an increasing awareness of distinct interspecies-related differences that hamper the effective translation of results from animal models to humans. In addition, there is growing political and social pressure to develop alternatives to animal models according to the 3Rs principle (reduction, refinement and replacement of animal models).

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