To Örebro University

oru.seÖrebro University Publications
Change search
Refine search result
1234567 1 - 50 of 635
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Aam, Stina
    et al.
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Gynnild, Mari Nordbø
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Munthe-Kaas, Ragnhild
    Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Saltvedt, Ingvild
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Lydersen, Stian
    Department of Mental Health, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.
    Knapskog, Anne-Brita
    Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
    Ihle-Hansen, Hege
    Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
    Ellekjær, Hanne
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Stroke Unit, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Eldholm, Rannveig Sakshaug
    Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatric Medicine, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Fure, Brynjar
    Örebro University, School of Medical Sciences. Department of Internal Medicine, Central Hospital, Karlstad, Sweden.
    The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study2021In: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 12, article id 678794Article in journal (Refereed)
    Abstract [en]

    Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.

    Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI.

    Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR =12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively).

    Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

  • 2.
    af Edholm, Karolina
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lidman, Christer
    Karolinska University Hospital, Solna, Sweden.
    Andersson, Sören
    Örebro University, School of Medical Sciences.
    Solders, Göran
    Karolinska Institutet, Stockholm, Sweden.
    Paucar, Martin
    Karolinska University Hospital, Solna, Sweden.
    Clinical Reasoning: Leg weakness and stiffness at the emergency room2019In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 92, no 6, p. E622-E625Article in journal (Other academic)
    Abstract [en]

    A 48-year-old woman from the Maghreb came to the emergency department with insidious gait difficulties, urgency, and constipation starting 6 months prior to the visit. The patient's complaints consisted of weakness, stiffness, and pain in her legs. Her medical history consisted of Hashimoto thyroiditis and breast cancer, with the latter having motivated surgery 4 months prior to admission. Histopathologic examination had demonstrated ductal cancer sensitive to estrogen and mapping with sentinel node biopsy ruled out metastasis. For that reason, the patient was treated with local radiation given weekly over 1 month and treatment with tamoxifen was started. Physical examination upon admission demonstrated weakness and spasticity in both legs. Reflexes were brisk; bilateral nonsustained foot clonus and Babinski sign were also present. Bilateral dorsal flexion was reduced, but vibration and sensation to touch and pinprick were normal. Sphincter tonus was reduced; systemic manifestations such as myalgias, fever, skin rashes, uveitis, sicca, and arthritic joints were absent.

  • 3.
    Aghajani, Moji
    et al.
    Department of Child and Adolescent Psychiatry, Curium, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
    Colins, Olivier F.
    Department of Child and Adolescent Psychiatry, Curium, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands; School of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden.
    Klapwijk, Eduard T.
    Department of Child and Adolescent Psychiatry, Curium, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands.
    Veer, Ilya M.
    Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany.
    Andershed, Henrik
    Örebro University, School of Law, Psychology and Social Work.
    Popma, Arne
    Department of Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam, the Netherlands; Faculty of Law, Leiden University, Institute of Criminal Law and Criminology, Leiden, the Netherlands.
    van der Wee, Nic J.
    Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands.
    Vermeiren, Robert R. J. M.
    Department of Child and Adolescent Psychiatry, Curium, Leiden University Medical Center, Leiden, the Netherlands; Leiden Institute for Brain and Cognition (LIBC), Leiden, the Netherlands.
    Dissociable relations between amygdala subregional networks and psychopathy trait dimensions in conduct-disordered juvenile offenders2016In: Human Brain Mapping, ISSN 1065-9471, E-ISSN 1097-0193, Vol. 37, no 11, p. 4017-4033Article in journal (Refereed)
    Abstract [en]

    Psychopathy is a serious psychiatric phenomenon characterized by a pathological constellation of affective (e.g., callous, unemotional), interpersonal (e.g., manipulative, egocentric), and behavioral (e.g., impulsive, irresponsible) personality traits. Though amygdala subregional defects are suggested in psychopathy, the functionality and connectivity of different amygdala subnuclei is typically disregarded in neurocircuit-level analyses of psychopathic personality. Hence, little is known of how amygdala subregional networks may contribute to psychopathy and its underlying trait assemblies in severely antisocial people. We addressed this important issue by uniquely examining the intrinsic functional connectivity of basolateral (BLA) and centromedial (CMA) amygdala networks in relation to affective, interpersonal, and behavioral traits of psychopathy, in conduct-disordered juveniles with a history of serious delinquency (N = 50, mean age = 16.83 ± 1.32). As predicted, amygdalar connectivity profiles exhibited dissociable relations with different traits of psychopathy. Interpersonal psychopathic traits not only related to increased connectivity of BLA and CMA with a corticostriatal network formation accommodating reward processing, but also predicted stronger CMA connectivity with a network of cortical midline structures supporting sociocognitive processes. In contrast, affective psychopathic traits related to diminished CMA connectivity with a frontolimbic network serving salience processing and affective responding. Finally, behavioral psychopathic traits related to heightened BLA connectivity with a frontoparietal cluster implicated in regulatory executive functioning. We suggest that these trait-specific shifts in amygdalar connectivity could be particularly relevant to the psychopathic phenotype, as they may fuel a self-centered, emotionally cold, and behaviorally disinhibited profile.

  • 4.
    Aghanavesi, Somayeh
    et al.
    Department of Computer Engineering, Dalarna University, Borlänge, Sweden.
    Bergquist, Filip
    Department of Pharmacology, Institute of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden.
    Nyholm, Dag
    Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.
    Senek, Marina
    Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden.
    Memedi, Mevludin
    Örebro University, Örebro University School of Business.
    Motion sensor-based assessment of Parkinson's disease motor symptoms during leg agility tests: results from levodopa challenge2020In: IEEE journal of biomedical and health informatics, ISSN 2168-2194, E-ISSN 2168-2208, Vol. 24, no 1, p. 111-118Article in journal (Refereed)
    Abstract [en]

    Parkinson's disease (PD) is a degenerative, progressive disorder of the central nervous system that mainly affects motor control. The aim of this study was to develop data-driven methods and test their clinimetric properties to detect and quantify PD motor states using motion sensor data from leg agility tests. Nineteen PD patients were recruited in a levodopa single dose challenge study. PD patients performed leg agility tasks while wearing motion sensors on their lower extremities. Clinical evaluation of video recordings was performed by three movement disorder specialists who used four items from the motor section of the Unified PD Rating Scale (UPDRS), the treatment response scale (TRS) and a dyskinesia score. Using the sensor data, spatiotemporal features were calculated and relevant features were selected by feature selection. Machine learning methods like support vector machines (SVM), decision trees and linear regression, using 10-fold cross validation were trained to predict motor states of the patients. SVM showed the best convergence validity with correlation coefficients of 0.81 to TRS, 0.83 to UPDRS #31 (body bradykinesia and hypokinesia), 0.78 to SUMUPDRS (the sum of the UPDRS items: #26-leg agility, #27-arising from chair and #29-gait), and 0.67 to dyskinesia. Additionally, the SVM-based scores had similar test-retest reliability in relation to clinical ratings. The SVM-based scores were less responsive to treatment effects than the clinical scores, particularly with regards to dyskinesia. In conclusion, the results from this study indicate that using motion sensors during leg agility tests may lead to valid and reliable objective measures of PD motor symptoms.

  • 5.
    Aghanavesi, Somayeh
    et al.
    Computer Engineering, School of Technology and Business Studies, Dalarna University, Borlänge, Sweden.
    Memedi, Mevludin
    Örebro University, Örebro University School of Business.
    Westin, Jerker
    Computer Engineering, School of Technology and Business Studies, Dalarna University, Borlänge, Sweden.
    Measuring temporal irregularity in spiral drawings of patients with Parkinson’s disease2017In: Abstracts of the 21st International Congress of Parkinson's Disease and Movement Disorders, John Wiley & Sons, 2017, Vol. 32, p. s252-s252, article id 654Conference paper (Other (popular science, discussion, etc.))
    Abstract [en]

    Objective: The aim of this work is to evaluate clinimetric properties of a method for measuring Parkinson’s disease (PD) upper limb temporal irregularities during spiral drawing tasks.

    Background: Basal ganglia fluctuations of PD patients are associated with motor symptoms and relating them to objective sensor-based measures may facilitate the assessment of temporal irregularities, which could be difficult to be assessed visually. The present study investigated the upper limb temporal irregularity of patients at different stages of PD and medication time points.

    Methods: Nineteen PD patients and 22 healthy controls performed repeated spiral drawing tasks on a smartphone. Patients performed the tests before a single levodopa dose and at specific time intervals after the dose was given. Three movement disorder specialists rated the videos of patients' performance according to six items of UPDRS-III, dyskinesia (Dys), and Treatment Response Scale (TRS). A temporal irregularity score (TIS) was developed using approximate entropy (ApEn) method. Differences in mean TIS between two groups of patients and healthy subjects, and also across four subject groups: early, intermediate, advanced patients and, healthy subjects were assessed. The relative ability of TIS to detect changes from baseline (no medication) to later time points when patients were on medication was assessed. Correlations between TIS and clinical rating scales were assessed by Pearson correlation coefficients and test-retest reliability of TIS was measured by intra-class correlation coefficients (ICC).

    Results: The mean TIS was significantly different between healthy subjects and patients (P<0.0001). When assessing the changes in relation to treatment, clinical-based scores (TRS and Dys) had better responsiveness than TIS. However, the TIS was able to capture changes from Off to On, and the wearing off effects. Correlations between TIS and clinical scales were low indicating poor validity. Test-retest reliability correlation coefficient of the mean TIS was good (ICC=0.67).

    Conclusions: Our study found that TIS was able to differentiate spiral drawings drawn by patients from those drawn by healthy subjects. In addition, TIS could capture changes throughout the levodopa cycle.TIS was weakly correlated to clinical ratings indicating that TIS measures high frequency upper limb temporal irregularities that could be difficult to be detected during clinical observations.

  • 6.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden ; .
    Thelin, Eric Peter
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Sjölin, Gabriel
    Örebro University, School of Medical Sciences. Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Bellander, Bo Michael
    Department of Clinical Neuroscience, Karolinska Institutet Solna, Stockholm, Sweden.
    Riddez, Louis
    Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Talving, Peep
    Department of Surgery, Tartu University Hospital, Tartu, Estonia.
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
    β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study2017In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 43, no 6, p. 783-789Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Severe traumatic brain injury (TBI) is the predominant cause of death and disability following trauma. Several studies have observed improved survival in TBI patients exposed to β-blockers, however, the effect on functional outcome is poorly documented.

    METHODS: Adult patients with severe TBI (head AIS ≥ 3) were identified from a prospectively collected TBI database over a 5-year period. Patients with neurosurgical ICU length of stay <48 h and those dying within 48 h of admission were excluded. Patients exposed to β-blockers ≤ 48 h after admission and who continued with treatment until discharge constituted β-blocked cases and were matched to non β-blocked controls using propensity score matching. The outcome of interest was Glasgow Outcome Scores (GOS), as a measure of functional outcome up to 12 months after injury. GOS ≤ 3 was considered a poor outcome. Bivariate analysis was deployed to determine differences between groups. Odds ratio and 95% CI were used to assess the effect of β-blockers on GOS.

    RESULTS: 362 patients met the inclusion criteria with 21% receiving β-blockers during admission. After propensity matching, 76 matched pairs were available for analysis. There were no statistical differences in any variables included in the analysis. Mean hospital length of stay was shorter in the β-blocked cases (18.0 vs. 26.8 days, p < 0.01). The risk of poor long-term functional outcome was more than doubled in non-β-blocked controls (OR 2.44, 95% CI 1.01-6.03, p = 0.03).

    CONCLUSION: Exposure to β-blockers in patients with severe TBI appears to improve functional outcome. Further prospective randomized trials are warranted.

  • 7. Ahlström, Gerd
    et al.
    Lindvall, B.
    Wenneberg, Stig
    Örebro University, Department of Nursing and Caring Sciences.
    Gunnarsson, Lars-Gunnar
    Örebro University, Department of Clinical Medicine.
    A comprehensive rehabilitation programme tailored to the needs of adults with muscular dystrophy2006In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 20, no 2, p. 132-141Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess if activities of daily living (ADL), coping and quality of life could be improved in adults with muscular dystrophy through a comprehensive rehabilitation programme. DESIGN: Quasi-experimental, controlled clinical study comparing patients with similar age and disease aspects. SETTING: Two different counties in Sweden, being either study or control setting. SUBJECTS: The study group comprised 37 adults (21 women, 16 men; mean age 50 years), while the control group comprised 39 people (25 women, 14 men; mean age 46 years). INTERVENTIONS: Four rehabilitation sessions tailored to different medical, physical and psychosocial needs of the patients, comprising a total of 10 days over a period of 18 months. MAIN MEASURES: ADL, the Mental Adjustment to Cancer Scale measuring coping strategies, the Sickness Impact Profile measuring health-related quality of life, the Hospital Anxiety and Depression Scale, and the Psychosocial Well-being Questionnaire. RESULTS: No significant differences were found between groups with regard to the outcome measures. There was increased dependence on others in ADL after 18 months in both groups, but it was more pronounced in the control group. Furthermore, a clear trend was observed in the data with regard to coping patterns, the control group using more coping strategies such as 'Helplessness/hopelessness' (P= 0.057), 'Anxious preoccupation' (P = 0.085) and 'Fatalistic' (P= 0.073) when being compared to the study group. CONCLUSIONS: No apparent effects on ADL were found from the rehabilitation programme, although there was a tendency of reduction of maladaptive coping patterns in the study group. This initial study may provide the rationale and basis for a randomized controlled trial.

  • 8.
    Ahola-Erkkilä, Sofia
    et al.
    Research Program of Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki, Finland.
    Carroll, Christopher J.
    Research Program of Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki, Finland.
    Peltola-Mjösund, Katja
    Research Program of Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki, Finland.
    Tulkki, Valtteri
    Research Program of Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki, Finland.
    Mattila, Ismo
    VTT Technical Research Centre of Finland, Espoo, Finland.
    Seppänen-Laakso, Tuulikki
    VTT Technical Research Centre of Finland, Espoo, Finland.
    Oresic, Matej
    Örebro University, School of Medical Sciences. VTT Technical Research Centre of Finland, Espoo, Finland.
    Tyynismaa, Henna
    Research Program of Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki, Finland.
    Suomalainen, Anu
    Research Program of Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Helsinki, Finland; Department of Neurology, Helsinki, University Central Hospital, Helsinki, Finland.
    Ketogenic diet slows down mitochondrial myopathy progression in mice2010In: Human Molecular Genetics, ISSN 0964-6906, E-ISSN 1460-2083, Vol. 19, no 10, p. 1974-1984Article in journal (Refereed)
    Abstract [en]

    Mitochondrial dysfunction is a major cause of neurodegenerative and neuromuscular diseases of adult age and of multisystem disorders of childhood. However, no effective treatment exists for these progressive disorders. Cell culture studies suggested that ketogenic diet (KD), with low glucose and high fat content, could select against cells or mitochondria with mutant mitochondrial DNA (mtDNA), but proper patient trials are still lacking. We studied here the transgenic Deletor mouse, a disease model for progressive late-onset mitochondrial myopathy, accumulating mtDNA deletions during aging and manifesting subtle progressive respiratory chain (RC) deficiency. We found that these mice have widespread lipidomic and metabolite changes, including abnormal plasma phospholipid and free amino acid levels and ketone body production. We treated these mice with pre-symptomatic long-term and post-symptomatic shorter term KD. The effects of the diet for disease progression were followed by morphological, metabolomic and lipidomic tools. We show here that the diet decreased the amount of cytochrome c oxidase negative muscle fibers, a key feature in mitochondrial RC deficiencies, and prevented completely the formation of the mitochondrial ultrastructural abnormalities in the muscle. Furthermore, most of the metabolic and lipidomic changes were cured by the diet to wild-type levels. The diet did not, however, significantly affect the mtDNA quality or quantity, but rather induced mitochondrial biogenesis and restored liver lipid levels. Our results show that mitochondrial myopathy induces widespread metabolic changes, and that KD can slow down progression of the disease in mice. These results suggest that KD may be useful for mitochondrial late-onset myopathies.

  • 9. Akhter, Shaheen
    et al.
    Mannan, Muzharul
    Biswas, Animesh
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Determinants of epilepsy in infancy in Bangladesh: a case-control study2013In: Neurology Asia, ISSN 1823-6138, Vol. 18, no 1, p. 17-22Article in journal (Refereed)
    Abstract [en]

    Background: Very little research has been done on childhood epilepsy in Bangladesh. Greater knowledge on risk factors of epilepsy in the early years of life could help to improve understanding of epilepsy, can tell us about its prognosis and allow early intervention.

    Objective: This study was designed to explore the determinants of epilepsy in infancy, in Bangladesh.

    Method: A case-control study involving 63 patients with epilepsy was performed in two specialized hospitals in Bangladesh. Children with epilepsy were the study population.

    Result: Birth asphyxia, neonatal seizure and history of consanguinity were significantly associated with epilepsy in infancy (OR 7.4, 95% CI 2.37-6.57, OR 4.13, 95% CI 1.67-4.65 and OR 10.85, CI 2.11-41.08 respectively). Complication during antenatal period of pregnancy was found to be higher in children who develop epilepsy in infancy but it was not signifi cant (OR 2.76; 95% CI 1.08-4.89). Coexisting impairments were highly signifi cant in children having seizure onset in infancy (OR 5.9; p=.000); these were -developmental delay, speech and language delay, mental retardation and cerebral palsy.

    Conclusion: Birth asphyxia, neonatal seizure and parental consanguinity, were significantly associated with epilepsy in infancy in Bangladesh. Antenatal complications were higher in infancy though not signifi cant. Epilepsy starting at this age was significantly associated with neurodevelopmental impairments.

  • 10.
    Alaie, Iman
    et al.
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Frick, Andreas
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Marteinsdottir, Ina
    Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Hartvig, Per
    Dept Drug Design & Pharmacol, Univ Copenhagen, Copenhagen, Denmark.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Eriksson, Elias
    Dept Pharmacol, Univ Gothenburg, Gothenburg, Sweden.
    Fredrikson, Mats
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Furmark, Tomas
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Serotonin Synthesis Rate and the Tryptophan Hydroxylase-2 G-703T Polymorphism in Social Anxiety Disorder2014In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 75, no 9, p. 357S-357SArticle in journal (Other academic)
  • 11.
    Alping, P.
    et al.
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Karolinska Institutet, Clinical Epidemiology Division, Department of Medicine Solna, Stockholm, Sweden.
    Burman, J.
    Uppsala University, Department of Neuroscience, Uppsala, Sweden.
    Fink, K.
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Stockholm Health Services, Academic Specialist Centre, Stockholm, Sweden.
    Fogdell-Hahn, A.
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
    Gunnarsson, Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Neurology.
    Hillert, J.
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Karolinska University Hospital, Department of Neurology, Stockholm, Sweden.
    Langer-Gould, A.
    Kaiser Permanente, Clinical and Translational Neuroscience, Southern California Permanente Medical Group, Pasadena, United States.
    Lycke, J.
    University of Gothenburg, Department of Clinical Neuroscience, Gothenburg, Sweden.
    Nilsson, P.
    Lund University, Department of Clinical Sciences/Neurology, Lund, Sweden.
    Olsson, T.
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden; Stockholm Health Services, Academic Specialist Centre, Stockholm, Sweden.
    Salzer, J.
    Department of Clinical ScienUmeå University, Department of Pharmacology and Clinical Neuroscience, Umeå, Sweden.
    Svenningsson, A.
    Karolinska Institutet, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden.
    Vrethem, M.
    Linköping University, Department of Clinical and Experimental Medicine, Linköping, Sweden.
    Frisell, T.
    Linköping University, Department of Clinical and Experimental Medicine, Linköping, Sweden.
    Piehl, F.
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
    Effectiveness of initial MS treatments in the COMBAT-MS trial: injectables, dimethyl fumarate, natalizumab and rituximab2021In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 27, no Suppl. 2, p. 21-22Article in journal (Other academic)
    Abstract [en]

    Introduction: Direct comparisons across multiple disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) are valuable in clinical decision making. COMBAT-MS (NCT03193866) is an observational drug trial capturing data on clinical relapses, lesions on magnetic resonance imaging (MRI), Expanded Disability Status Scale (EDSS), and drug survival, at all Swedish university clinics.

    Objective: Compare the effectiveness of the most common initial MS therapies in Sweden.

    Methods: All first-ever MS treatments with injectables (INJ, interferon-β/glatiramer acetate), dimethyl fumarate (DMF), natalizumab (NTZ), and rituximab (RTX), started 2011-01-01 to 2020-12-14, were identified with prospectively recorded outcome data in the Swedish MS Register. Follow-up continued even if the therapy ended. Missing data were imputed using multiple imputation and potential confounding was adjusted for using stabilized inverse probability of treatment weighting with baseline variables: age, sex, MS duration, geographical region, EDSS, and relapses. All comparisons are made against RTX.

    Results: We included 1936 first-ever therapy episodes: 856 INJ, 341 DMF, 270 NTZ, and 469 RTX. Baseline characteristics differed by DMT, with natalizumab having the youngest patients, shortest MS duration, and the most previous relapses.After adjustment, the hazard ratio (HR) for first relapse vs RTX was for INJ 5.9 (95% confidence interval 3.7; 9.5), DMF 2.8 (1.7; 4.8), and NTZ 1.8 (1.0; 3.3). Similarly, the relative three-year lesion rate was for INJ 6.06 (3.75; 9.80), DMF 3.52 (2.01; 6.17), and NTZ 2.03 (1.14; 3.64). EDSS differences at three years were only marginally different: INJ 0.25 (0.06; 0.44), DMF 0.05 (-0.16; 0.26), and NTZ 0.00 (-0.23; 0.24). In contrast, HR for treatment discontinuation was marked: INJ 32.5 (19.0; 55.7), DMF 20.2 (11.5; 35.4), and NTZ 16.2 (8.9; 29.5).

    Conclusions: In treatment-naïve patients, RTX was associated with the lowest risk of relapses and MRI lesions, and by far the lowest probability of switching to a second therapy. In contrast, EDSS at 3 years was similar for RTX, DMF, and NTZ, and only slightly higher for INJ. The apparent difference in effectiveness between NTZ and RTX could possibly be explained by the vulnerable period after switching from NTZ, mainly due to JC virus positivity. These findings underscore the importance of tracking long-term outcomes from first DMT start, while considering subsequent therapy switches.

  • 12.
    Alping, Peter
    et al.
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Askling, Johan
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Burman, Joachim
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Fink, Katharina
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Fogdell-Hahn, Anna
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Gunnarsson, Martin
    Örebro University, School of Medical Sciences. Department of Neurology.
    Hillert, Jan
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
    Langer-Gould, Annette
    Clinical and Translational Neuroscience, Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA, USA.
    Lycke, Jan
    Department of Clinical Neuroscience and Rehabilitation, University of Gothenburg, Gothenburg, Sweden.
    Nilsson, Petra
    Department of Clinical Sciences/Neurology, Lund University, Lund, Sweden.
    Salzer, Jonatan
    Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
    Svenningsson, Anders
    Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
    Vrethem, Magnus
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Olsson, Tomas
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Piehl, Fredrik
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Frisell, Thomas
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
    Cancer Risk for Fingolimod, Natalizumab, and Rituximab in Multiple Sclerosis Patients2020In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 87, no 5, p. 688-699Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Novel, highly effective disease-modifying therapies have revolutionized multiple sclerosis (MS) care. However, evidence from large comparative studies on important safety outcomes, such as cancer, is still lacking.

    METHODS: In this nationwide register-based cohort study, we linked data from the Swedish MS register to the Swedish Cancer Register and other national health care and census registers. We included 4,187 first-ever initiations of rituximab, 1,620 of fingolimod, and 1,670 of natalizumab in 6,136 MS patients matched for age, sex, and location to 37,801 non-MS general population subjects. Primary outcome was time to first invasive cancer.

    RESULTS: We identified 78 invasive cancers among treated patients: rituximab 33 (incidence rate [IR] per 10,000 person-years = 34.4, 95% confidence interval [CI] = 23.7-48.3), fingolimod 28 (IR = 44.0, 95% CI = 29.2-63.5), and natalizumab 17 (IR = 26.0, 95% CI = 15.1-41.6). The general population IR was 31.0 (95% CI = 27.8-34.4). Adjusting for baseline characteristics, we found no difference in risk of invasive cancer between rituximab, natalizumab, and the general population but a possibly higher risk with fingolimod compared to the general population (hazard ratio [HR] = 1.53, 95% CI = 0.98-2.38) and rituximab (HR = 1.68, 95% CI = 1.00-2.84).

    INTERPRETATION: In this first large comparative study of 3 highly effective MS disease-modifying therapies, no increased risk of invasive cancer was seen with rituximab and natalizumab, compared to the general population. However, there was a borderline-significant increased risk with fingolimod, compared to both the general population and rituximab. It was not possible to attribute this increased risk to any specific type of cancer, and further studies are warranted to validate these findings.

  • 13.
    Amer, Ahmed
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Eliasson, Ann-Christin
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Peny-Dahlstrand, Marie
    Regional Rehabilitation Centre, Queen Silvia Children's Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Prosthetics and Orthotics, Örebro University Hospital, Örebro, Sweden.
    Validity and test-retest reliability of Children's Hand-use Experience Questionnaire in children with unilateral cerebral palsy2016In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, no 7, p. 743-749Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the validity of the internet-based version of the Children's Hand-use Experience Questionnaire (CHEQ) by testing the new four-category rating scale, internal structure, and test-retest reliability.

    Method: Data were collected for 242 children with unilateral cerebral palsy (CP) (137 males and 105 females; mean age 9y 10mo, SD 3y 5mo, range 6-18y). Twenty children from the study sample (mean age 11y 8mo, SD 3y 10mo) participated in a retest within 7 to 14 days. Validity was tested by Rasch analysis based on a rating scale model and test-retest reliability by Kappa analysis and intraclass correlation coefficient (ICC).

    Results: The four-category rating scale was within recommended criteria for rating scale structure. One item was removed because of misfit. CHEQ showed good scale structure according to the criteria. The effective operational range was >90% for two of the CHEQ scales. Test-retest reliability for the three CHEQ scales was: grasp efficacy, ICC=0.91; time taken, ICC=0.88; and feeling bothered, ICC=0.91.

    Interpretation: The internet-based CHEQ with a four-category rating scale is valid and reliable for use in children with unilateral CP. Further studies are needed to investigate the validity of the internet-based version of CHEQ for children with upper limb reduction deficiency or obstetric brachial plexus palsy and the validity of the recommended improvements to the current version.

  • 14.
    Andelic, Nada
    et al.
    Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway.
    Røe, Cecilie
    Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Brunborg, Cathrine
    Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
    Zeldovich, Marina
    Institute of Medical Psychology and Medical Sociology, University Medical Center, Göttingen, Germany.
    Løvstad, Marianne
    Research Department, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
    Løke, Daniel
    Research Department, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
    Borgen, Ida M
    Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
    Voormolen, Daphne C
    Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
    Howe, Emilie I
    Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Forslund, Marit V
    Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
    Dahl, Hilde M
    Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Child Neurology, Oslo University Hospital, Oslo, Norway.
    von Steinbuechel, Nicole
    Institute of Medical Psychology and Medical Sociology, University Medical Center, Göttingen, Germany.
    Frequency of fatigue and its changes in the first 6 months after traumatic brain injury: results from the CENTER-TBI study2021In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 268, no 1, p. 61-73Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fatigue is one of the most commonly reported subjective symptoms following traumatic brain injury (TBI). The aims were to assess frequency of fatigue over the first 6 months after TBI, and examine whether fatigue changes could be predicted by demographic characteristics, injury severity and comorbidities.

    METHODS: Patients with acute TBI admitted to 65 trauma centers were enrolled in the study Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI). Subjective fatigue was measured by single item on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), administered at baseline, three and 6 months postinjury. Patients were categorized by clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU). Injury severity, preinjury somatic- and psychiatric conditions, depressive and sleep problems were registered at baseline. For prediction of fatigue changes, descriptive statistics and mixed effect logistic regression analysis are reported.

    RESULTS: Fatigue was experienced by 47% of patients at baseline, 48% at 3 months and 46% at 6 months. Patients admitted to ICU had a higher probability of experiencing fatigue than those in ER and ADM strata. Females and individuals with lower age, higher education, more severe intracranial injury, preinjury somatic and psychiatric conditions, sleep disturbance and feeling depressed postinjury had a higher probability of fatigue.

    CONCLUSION: A high and stable frequency of fatigue was found during the first 6 months after TBI. Specific socio-demographic factors, comorbidities and injury severity characteristics were predictors of fatigue in this study.

  • 15.
    Andersson, Åsa
    et al.
    Karolinska institutet, Stockholm, Sweden; Örebro University Hospital, Örebro, Sweden.
    Seiger, Åke
    Karolinska institutet, Stockholm, Sweden.
    Appelros, Peter
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Karolinska institutet, Stockholm, Sweden; Örebro University Hospital, Örebro, Sweden.
    Hip fractures in persons with stroke2013In: Stroke Research and Treatment, ISSN 2090-8105, E-ISSN 2042-0056, Vol. 2013, article id 954279Article in journal (Refereed)
    Abstract [en]

    Background. Our aim was to determine the incidence of hip fractures within two years after stroke, to identify associated factors, to evaluate which test instruments that best could identify people at risk, and to describe the circumstances that prevailed when they sustained their hip fractures. Method. A total of 377 persons with first-ever stroke were followed up for a 24-month period. Stroke severity, cognition, and associated medical conditions were registered. The following test instruments were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Berg Balance Scale, Timed Up & Go, and Stops Walking When Talking. Result. Sixteen of the persons fractured their hip within the study period, which corresponds to an incidence of 32 hip fractures per 1000 person-years. Persons with fractures more often had impaired vision and cognitive impairment and more had had previous fractures. Of the investigated test instruments, Timed Up & Go was the best test to predict fractures. Conclusion. The incidence of hip fractures in persons with stroke was high in this study. Persons with previous fractures, and visual and cognitive defects are at the greatest risk. Certain test instruments could be used in order to find people at risk, which should be targeted for fall preventive measures.

  • 16.
    Andin, Josefine
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.
    Elwer, Åsa
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Mäki-Torkko, Elina
    Örebro University, School of Medical Sciences. Swedish Institute for Disability Research.
    Arithmetic in the adult deaf signing brain2020In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547, Vol. 98, no 4, p. 643-654Article in journal (Refereed)
    Abstract [en]

    We have previously shown that deaf signers recruit partially different brain regions during simple arithmetic compared to a group of hearing non-signers, despite similar performance. Specifically, hearing individuals show more widespread activation in brain areas that have been related to the verbal system of numerical processing, i.e., the left angular and inferior frontal gyrus, whereas deaf individuals engaged brain areas that have been related to the quantity system of numerical processing, i.e., the right horizontal intraparietal sulcus. This indicates that compared to hearing non-signers, deaf signers can successfully make use of processes located in partially different brain areas during simple arithmetic. In this study, which is a conceptual replication and extension of the above-presented study, the main aim is to understand similarities and differences in neural correlates supporting arithmetic in deaf compared to hearing individuals. The primary objective is to investigate the role of the right horizontal intraparietal gyrus, the left inferior frontal gyrus, the hippocampus, and the left angular gyrus during simple and difficult arithmetic and how these regions are connected to each other. A second objective is to explore what other brain regions support arithmetic in deaf signers. Up to 34 adult deaf signers and the same amount of hearing non-signers will be enrolled in an functional magnetic resonance imaging study that will include simple and difficult subtraction and multiplication. Brain imaging data will be analyzed using whole-brain analysis, region of interest analysis and connectivity analysis. This is the first study to investigate neural underpinnings of arithmetic of different difficulties in deaf individuals.

  • 17.
    Andrews, Carin
    et al.
    Karolinska Institute, Stockholm, Sweden.
    Kakooza-Mwesige, Angelina
    Karolinska Institute, Stockholm, Sweden; Makerere University, Kampala, Uganda.
    Almeida, Rita
    Karolinska Institute, Stockholm, Sweden.
    Swartling Peterson, Stefan
    Karolinska Institute, Stockholm, Sweden; Uppsala University, Uppsala, Sweden; UNICEF, New York, NY, USA.
    Wabwire-Mangen, Fred
    Makerere University College of Health Sciences, Kampala, Uganda.
    Eliasson, Ann-Christin
    Karolinska Institute, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Forssberg, Hans
    Karolinska Institute, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Impairments, functional limitations, and access to services and education for children with cerebral palsy in Uganda: a population-based study2020In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 62, no 4, p. 454-462Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the functional limitations and associated impairments of children with cerebral palsy (CP) in rural Uganda, and care-seeking behaviour and access to assistive devices and education.

    METHOD: Ninety-seven children with CP (42 females, 55 males; age range 2-17y) were identified in a three-stage population-based screening with subsequent medical examinations and functional assessments. Information on school and access to care was collected using questionnaires. The data were compared with Swedish and Australian cohorts of children with CP. We used the χ2 test and linear regression models to analyse differences between groups.

    RESULTS: Younger children were more severely impaired than older children. Two-fifths of the children had severe impairments in communication, about half had intellectual disability, and one third had seizures. Of 37 non-walking children, three had wheelchairs and none had walkers. No children had assistive devices for hearing, seeing, or communication. Care-seeking was low relating to lack of knowledge, insufficient finances, and 'lost hope'. One-third of the children attended school. Ugandan children exhibited lower developmental trajectories of mobility and self-care than a Swedish cohort.

    INTERPRETATION: The needs for children with CP in rural Uganda are not met, illustrated by low care-seeking, low access to assistive devices, and low school attendance. A lack of rehabilitation and stimulation probably contribute to the poor development of mobility and self-care skills. There is a need to develop and enhance locally available and affordable interventions for children with CP in Uganda.

    WHAT THIS PAPER ADDS: Development of mobility and self-care skills is lower in Ugandan than Swedish children with cerebral palsy (CP). Older children in Uganda with CP are less impaired than younger children. Untreated seizures and impairments of communication and intellect are common. Access to health services, assistive devices, and education is low. Caregivers lack knowledge and finances to seek care and often lose hope of their child improving.

  • 18.
    Andrews, Carin
    et al.
    Karolinska Institute, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Kakooza-Mwesige, Angelina
    Makerere University, Kampala, Uganda.
    Eliasson, Ann-Christin
    Karolinska Institute, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Forssberg, Hans
    Karolinska Institute, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    Important report on cerebral palsy in Bangladesh: but different findings compared with other countries need further exploration2019In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 61, no 5, p. 511-512Article in journal (Refereed)
  • 19.
    Andsberg, Gunnar
    et al.
    Department of Rehabilitation Medicine and Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
    Esbjörnsson, Magnus
    Department of Medicine, Hässleholm, Sweden.
    Olofsson, Arne
    Region Skåne Prehospital Unit, Lund, Sweden.
    Lindgren, Arne
    Department of Rehabilitation Medicine and Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
    Norrving, Bo
    Department of Rehabilitation Medicine and Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
    von Euler, Mia
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.
    PreHospital Ambulance Stroke Test: pilot study of a novel stroke test2017In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 25, no 1, article id 37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS).

    METHODS: The PreHospital Ambulance Stroke Test (PreHAST), an eight item test based on NIHSS, which scores stroke severity from 0-19 points, was designed and adapted for the ambulance services. In the pilot study the ambulance nurses used PreHAST to assess patients with suspected stroke in the prehospital setting. Regardless of the results after PreHAST testing the patients were triaged with a provisional stroke diagnosis. The PreHAST scores were compared with the final diagnosis and the ability to differentiate stroke and transient ischemic attacks (TIA) with ongoing symptoms at evaluation from non-stroke patients was analysed.

    RESULTS: 69 patients were included in the study, 26 had stroke/TIA and 43 other diagnoses. All stroke/TIA patients were identified by PreHAST (sensitivity 100% (95% CI; 87-100%)). The specificity increased with higher PreHAST scores and the discriminative capacity for PreHAST for different cut off values showed an area under the curve of 0.77 (95%CI; 0.66-0.88) in the receiver operating characteristic (ROC) analysis.

    DISCUSSION: PreHAST is designed for high sensitivity, screening for a broad range of stroke symptoms including most key components of NIHSS. The promising sensitivity between 87 and 100% in our study has to be confirmed in a larger study also including multiple centres. Higher PreHAST scores implied more typical patterns of stroke and accordingly the proportion of stroke mimics decrease with higher scores. However, also stroke mimics with epilepsy/seizure and patients with deficit after prior stroke could show higher PreHAST scores. Other prehospital stroke tests that evaluate stroke severity have been designed with the main purpose to screen for large vessel occlusion. The advantage of PreHAST is the dual purpose not only to evaluate stroke severity but also to screen for stroke in general.

    CONCLUSIONS: PreHAST is a new screening test of stroke adapted for ambulance services that in addition to high sensitivity for stroke, provides a grading system with increasing specificity with higher scores.

  • 20.
    Appelros, Peter
    Örebro University Hospital. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Cognitive impairment in lacunar strokes2014In: European Neurological Review, ISSN 1758-3837, Vol. 9, no 1, p. 64-67Article in journal (Refereed)
    Abstract [en]

    Vascular cognitive impairment is closely related to stroke. Each condition is a risk factor for the other. Cognitive impairment is a symptom that makes it difficult for a stroke patient to live at home. In this review paper, different types of vascular cognitive impairment are discussed, with emphasis on cognitive impairment related to lacunar strokes (LACS). Symptoms, diagnostics, epidemiology, treatment, and prognosis are surveyed. LACS are often associated with leukoaraiosis, which is related to subcortical ischemic vascular dementia. Even if LACS often are mild, they may therefore be associated with cognitive impairment on longer term.

  • 21.
    Appelros, Peter
    Örebro University, Department of Clinical Medicine.
    Heart failure and stroke2006In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 37, no 7, p. 1637-1637Article in journal (Refereed)
  • 22.
    Appelros, Peter
    Örebro University, Department of Clinical Medicine.
    Prevalence and predictors of pain and fatigue after stroke: a population-based study2006In: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 29, no 4, p. 329-333Article in journal (Refereed)
    Abstract [en]

    Pain and fatigue are two often overlooked symptoms after stroke. Their prevalence and determinants are not well understood. In this study patients with first-ever stroke (n=377) were examined at baseline and after 1 year. General characteristics of the patients, as well as stroke type, stroke severity and risk factors were registered at baseline. After 1 year survivors (n=253) were examined with respect to residual impairment, disability, cognition and depression. They were asked whether they had experienced pain and/or fatigue which had started after the stroke, and which the patient felt to be stroke related. Twenty-eight patients (11%) had stroke-associated pain and 135 (53%) had stroke-associated fatigue. Pain was associated with depression and different manifestations of stroke severity, especially degree of paresis at baseline. Fatigue was more associated with physical disability. In univariate analysis, fatigue was also associated with sleep disturbances. In conclusion, it is important to be aware of the occurrence of pain and fatigue after stroke, because these symptoms are common, they impair quality of life and they are potentially treatable. Post-stroke depression may coexist with pain and fatigue. The detection of one symptom should lead to consideration of the others. Follow-up and individual assessment of stroke patients is crucial.

  • 23.
    Appelros, Peter
    et al.
    Örebro University Hospital, Örebro, Sweden; Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    Andersson, Åsa
    Örebro University Hospital, Örebro, Sweden; Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    Changes in mini mental state examination score after stroke: lacunar infarction predicts cognitive decline2006In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 13, no 5, p. 491-495Article in journal (Refereed)
    Abstract [en]

    Stroke and cognitive impairment are inter-related. The purpose of this study was to show the natural evolution of cognitive performance during the first year after a stroke, and to show which factors that predict cognitive decline. Subjects were patients with a first-ever stroke who were treated in a stroke unit. A total of 160 patients were included. At baseline patients were evaluated with regard to stroke type, stroke severity, pre-stroke dementia and other risk factors. Mini Mental State Examinations (MMSE) were performed after 1 week and after 1 year. Patients had a median increase of 1 point (range -8 to +9) on the MMSE. Thirty-two pre cent of the patients deteriorated, 13% were unchanged, and 55% improved. Lacunar infarction (LI) and left-sided stroke were associated with a failure to exhibit improvement. Patients with LI had an average decline of 1.7 points, whilst patients with other stroke types had an average increase of 1.8 points. Most stroke survivors improve cognitively during the first year after the event. The outcome for LI patients is worse, which suggests that LI may serve as a marker for concomitant processes that cause cognitive decline.

  • 24.
    Appelros, Peter
    et al.
    Örebro University Hospital. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Háls Berglund, Maria
    Riksstroke, Medicincentrum, University Hospital of Norrland, Umeå, Sweden.
    Ström, Jakob O.
    Örebro University, School of Medical Sciences. Department of Clinical Chemistry, Linköping University, Linköping, Sweden.
    Long-Term Risk of Stroke after Transient Ischemic Attack2017In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 43, no 1-2, p. 25-30Article in journal (Refereed)
    Abstract [en]

    Background: In the absence of active management, the stroke risk after a transient ischemic attack (TIA) may be high. Almost 10 years ago, the results of the EXPRESS and SOS-TIA studies called for a more rapid management of TIA patients. The purpose of this study was to investigate the other stroke risks in the longer term, after the implementation of a more active approach to TIA. We also wanted to assess the predictive value of the ABCD2 score in this context.

    Methods: Riksstroke is the national stroke registry in Sweden. Data from Riksstroke's TIA module, and the national cause-of-death register, for the years 2011 and 2012 were used in this study. Stroke occurrence was monitored via Riksstroke. Cox's regression was used for risk evaluation. The predictive value of the ABCD2 score was assessed by calculating the area under the receiver operating characteristics curve.

    Results: A total of 15,068 TIA episodes occurred in 14,102 patients. The follow-up time varied between 0 and 819 days, with an average of 417 days. The mortality for all TIA patients during the follow-up time was 7.1%. Of the unique patients, 545 had one or more strokes (3.9%), corresponding to 34 events per 1,000 person years. Significant risk factors for stroke were: age, previous TIA, atrial fibrillation (AF), oral anticoagulant (OAC) treatment, hypertension treatment, and the ABCD2 items speech impairment, unilateral weakness, and diabetes mellitus. The ABCD2 score correlated with a subsequent stroke, but its predictive value was low.

    Conclusion: The risk of stroke is low after the acute phase of a TIA, probably lower than in previous studies. This may be due to better secondary prevention in recent years. Several risk factors predict stroke, notably hypertensive treatment, which may be inadequate; and AF, where OACs may be under-used. It is difficult to identify the role of the ABCD2 score in clinical practice.

  • 25.
    Appelros, Peter
    et al.
    Örebro University Hospital. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Jonsson, Fredrik
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Signild
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Asplund, Kjell
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Glader, Eva-Lotta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Kerstin Hulter
    Department of Medicine, Enköping Hospital, Enköping, Sweden.
    Norrving, Bo
    Department of Neurology, Lund University Hospital, Lund, Sweden.
    Stegmayr, Birgitta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Terént, Andreas
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Trends in stroke treatment and outcome between 1995 and 2010: observations from Riks-Stroke, the Swedish stroke register2014In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, no 1, p. 22-29Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care.

    METHODS: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered.

    RESULTS: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes.

    CONCLUSIONS: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital.

  • 26. Appelros, Peter
    et al.
    Matérne, Marie
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Jarl, Gustav
    Örebro University Hospital. Örebro University, School of Health Sciences.
    Arvidsson Lindvall, Mialinn
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center .
    Comorbidity in Stroke Survivors in a Medium-Sized Swedish Municipality2023Conference paper (Other academic)
  • 27.
    Appelros, Peter
    et al.
    University Health Care Research Center,Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Matérne, Marie
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Jarl, Gustav
    Örebro University Hospital. Örebro University, School of Health Sciences. University Health Care Research Center; Department of Prosthetics and Orthotics.
    Arvidsson Lindvall, Mialinn
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Comorbidity in stroke survivors in a medium-sized Swedish municipality2023In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 37, no Suppl. 1, p. 135-136Article in journal (Other academic)
    Abstract [en]

    Objectives: The purpose of this study was to evaluate the prevalence and impact of stroke-related comorbidity in a community-based sample of stroke survivors. With respect to the patients’ functional outcomes and general health, we wanted to find out which types of comorbidity were most important.

    Materials and Methods: All stroke survivors (n = 330) living in a medium-sized Swedish municipality were included. To determine the presence of comorbidities patient records were reviewed. A selection of patient reported outcomes were used to assess subjective symptoms, functional outcomes, and general health. All patients were asked to answer a questionnaire, the Swedish Stroke Register (Riksstroke). Three questions from the questionnaire were used as additional measures of comorbidity. “Do you feel tired?,” “Do you have pain?” and “Do you feel depressed?” As outcome measures the patient reported measures from the Riksstroke questionnaire were used: * Do you still have problems after your stroke? * Have you been able to return to the life and activities you had before the stroke? * How is your mobility now? * Do you get help from someone when visiting the toilet? * Do you get help with dressing and undressing? * How do you assess your general health? Logistic regression models were used to investigate the association between comorbidities, residual symptoms, and subjective symptoms on the one hand, and functional outcomes and general health on the other hand.

    Results: Hypertension (80%) was the most common cardiovascular risk factor. Ischemic heart disease was found in 18% and congestive heart failure in 10%. Of non-cardiovascular disorders, orthopedic diseases were commonest (30%). Psychiatric disorders and cognitive impairment were present in 11% and 12% respectively. Logistic regression analyses found that hemiparesis was associated with both poorer functional outcomes and lower general health. Additionally, orthopedic disorders, vertigo, cognitive impairment, nicotine use, chronic pulmonary disorders, and older age, were also associated with poorer functional outcomes. Psychiatric, orthopedic and neurological disorders were associated with poorer general health. The patient-reported outcome measure “feeling of tiredness” was a predictor of both outcomes, while “feeling depressed” and “having pain” were associated with poorer general health.

    Conclusions: Many medical conditions, several of which have received little attention so far, are associated with poorer functional outcome and lower general health among stroke survivors. Future research into comorbidities relevant to function and general health in stroke patients could further focus on these disorders that hitherto have received little attention.

  • 28.
    Appelros, Peter
    et al.
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Matérne, Marie
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Jarl, Gustav
    Örebro University Hospital. Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Arvidsson Lindvall, Mialinn
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Comorbidity in Stroke-Survivors: Prevalence and Associations with Functional Outcomes and Health2021In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 30, no 10, article id 106000Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The purpose of this study was to evaluate the prevalence and impact of stroke-related comorbidity in a community-based sample of stroke survivors. We sought to find out which types of comorbidity that were most important with respect to the patients' functional outcomes and general health.

    MATERIALS AND METHODS: All stroke survivors (n = 330) living in a medium-sized Swedish municipality were included. Patient records were reviewed to determine the presence of comorbidities. A selection of patient reported outcomes were used to assess subjective symptoms, functional outcomes, and general health. Logistic regression models were used to investigate the association between comorbidities, residual symptoms, and subjective symptoms on the one hand, and functional outcomes and general health on the other hand.

    RESULTS: Hypertension (80%) was the most common cardiovascular risk factor. Ischemic heart disease was found in 18% and congestive heart failure in 10%. Of non-cardiovascular disorders, orthopaedic diseases were commonest (30%). Psychiatric disorders and cognitive impairment were present in 11% and 12% respectively. Hemiparesis is associated with both functional outcomes and general health. Additionally, orthopedic disorders, vertigo, cognitive impairment, nicotine use, chronic pulmonary disorders, and age, are associated with different functional outcomes. Psychiatric, orthopedic and neurological disorders are related to general health. The patient-reported outcome measure "feeling of tiredness" is important for many of the outcomes, while "feeling depressed" and "having pain" are associated with general health.

    CONCLUSIONS: Many medical conditions, several of which have received little attention so far, are associated with functional outcome and general health in stroke survivors. If the intention is to describe comorbidity relevant to function and general health in stroke patients, disorders that hitherto have received little attention, must be considered.

  • 29.
    Appelros, Peter
    et al.
    Örebro University, Department of Clinical Medicine.
    Nydevik, Ingegerd
    Terént, Andreas
    Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 1, p. 43-49Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS: One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS: Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS: In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.

  • 30.
    Appelros, Peter
    et al.
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Svensson, Elisabeth
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Heidenreich, Kaja
    Örebro University, School of Medical Sciences. Health Care Research Center.
    Svantesson, Mia
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Ethical issues in stroke thrombolysis revisited2021In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 144, no 6, p. 611-615Article in journal (Refereed)
  • 31.
    Arora, Teresa
    et al.
    Zayed University, Abu Dhabi, United Arab Emirates.
    Grey, Ian
    Department of Cognitive Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates.
    Östlundh, Linda
    The National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates.
    Alamoodi, Asma
    Zayed University, Abu Dhabi, United Arab Emirates.
    Omar, Omar M.
    Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, England, United Kingdom.
    Lam, Kin-Bong Hubert
    Nuffield Department of Population Health, University of Oxford, Oxford, England, United Kingdom.
    Grandner, Michael
    University of Arizona, Tucson AZ, USA.
    A systematic review and meta-analysis to assess the relationship between sleep duration/quality, mental toughness and resilience amongst healthy individuals2022In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 62, article id 101593Article, review/survey (Refereed)
    Abstract [en]

    The majority of sleep research has focused on deleterious health outcomes, with little attention to positive sequels. A systematic review of the literature regarding sleep duration and/or sleep quality in relation to mental toughness and resilience amongst non-clinical, healthy populations was completed. Eight databases and selected sources for grey literature were searched from their inception to April 2021. A total of 1925 unique records (1898 from the database search and 27 from grey sources) were identified and screened against the pre-set inclusion and exclusion criteria. Of these, 68 studies were eligible and 63 were included in the meta-analysis. Pooled results indicated a weak, positive correlation between sleep duration and resilience (r = 0.11, p < 0.001), and sleep quality (r = 0.27, p < 0.001). The pooled correlation was slightly attenuated for prospective studies pertaining to sleep quality and resilience (r = 0.18, p < 0.001). We found evidence of high publication bias for studies that explored the relationship between sleep quality and resilience. Sleep and resilience are positively correlated but additional research is needed to verify the direct relationship through carefully designed, prospective studies that capture both subjective and objective sleep estimates. For a more comprehensive understanding, complementary reviews that explore the sleep-resilience association are needed for clinical populations, and those who have suffered extreme hardship.

  • 32.
    Arvidsson Lindvall, Mialinn
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Appelros, Peter
    Örebro University, Faculty of Medicine and Health, Örebro, Sweden.
    Forsberg, Anette
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Anderzen-Carlsson, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Experiences of living with balance limitations after first-ever stroke2023Conference paper (Refereed)
    Abstract [en]

    Background:  

    Stroke is the leading cause of serious, long-term disability among adults. Balance control after stroke may be affected due to motor impairment such as muscle weakness, spasticity and impaired sensory function and also cognitive deficits may affect balance control. The balance limitations affect walking and independence in activities of daily living. Having good balance has been described as an important factor in outdoor walking and for participation in exercises. Studies in which persons with stroke describe their experience of balance in everyday life are scarce.

    Purpose:  

    The aim of the present presentation is to describe experiences of living with balance limitations in everyday life after first-ever stroke.

    Methods:  

    Twenty persons initially agreed to participate; however, one person later declined further participation, thus giving a sample size of 19 participants (10 females and 9 men), aged between 42-92 years. The inclusion criteria were: having had a first-ever stroke and having self-reported impaired balance, unaffected speech, independence in toileting and dressing, and walking ability indoors and outdoors with or without a walking aid. A qualitative data collection through individual interviews was conducted. Data was analysed by means of an inductive content analysis covering both the manifest and the latent content of the transcribed interviews.

    Results:  

    The participants' experiences of balance and its influence in everyday life, are presented in two themes. The first theme “Feeling dizzy and unstable is a continuous challenge”, revolves around participants' descriptions of balance as a constant feeling of dizziness and unsteadiness. The second theme “Feeling trust and confidence despite dizziness and unsteadiness” is about perceived abilities and feelings of confidence about still being able to do things oneself, despite the dizziness and unsteadiness.

    Conclusion(s):  

    All participants experienced the balance limitations as a continuous challenge in everyday life, yet they also felt trust and confidence and experienced that they still managed their everyday life. In future research it would be of interest to establish which strategies can make persons with stroke feel in balance in relation to fear of falling.

    Implications:

    In physical therapy practice, the experiences of balance limitations after stroke from the person with stroke add valuable information to various assessments. By asking the person about their abilities and challenges in daily living, rehabilitation interventions can be more individualized and based on the person's actual condition and their wishes and needs.

  • 33.
    Autti-Rämö, Ilona
    et al.
    The Social Insurance Institute, Helsinki, Finland.
    Eliasson, Ann-Christin
    Karolinska Institute, Stockholm, Sweden.
    Forssberg, Hans
    Karolinska Institute, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Stockholm, Sweden.
    How to bridge the gap between systematic reviews and clinical guidelines2014In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 56, no 4, p. 398-400Article in journal (Refereed)
  • 34.
    Axén, Iben
    et al.
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Gunnar
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institutet, Stockholm, Sweden.
    Using few and scattered time points for analysis of a variable course of pain can be misleading: an example using weekly text message data2014In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 14, no 8, p. 1454-1459Article in journal (Refereed)
    Abstract [en]

    Background context: Because low back pain (LBP) is a fluctuating condition, the diversity in the prediction literature may be due to when the outcome is measured.

    Purpose: The objective of this study was to investigate the prediction of LBP using an outcome measured at several time points.

    Study design/setting: A multicenter clinical observational study in Sweden.

    Patient sample: Data were collected on 244 subjects with nonspecific LBP. The mean age of the subjects was 44 years, the mean pain score at inclusion was 4.4/10, and 51% of the sample had experienced LBP for more than 30 days the previous year.

    Outcome measures: The outcome used in this study was the “number of days with bothersome pain” collected with weekly text messages for 6 months.

    Methods: In subjects with nonspecific LBP, weekly data were available for secondary analyses. A few baseline variables were chosen to investigate prediction at different time points: pain intensity, the presence of leg pain, duration of LBP the previous year, and self-rated health at baseline. Age and gender acted as additional covariates.

    Results: In the multilevel models, the predictive variables interacted with time. Thus, the risk of experiencing a day with bothersome LBP varied over time. In the logistic regression analyses, the predictive variable's previous duration showed a consistent predictive ability for all the time points. However, the variables pain intensity, leg pain, and self-rated health showed inconsistent predictive patterns.

    Conclusions: An outcome based on frequently measured data described the variability in the prediction of future LBP over time. Prediction depended on when the outcome was measured. These results may explain the diversity of the results of the predictor studies in the literature.

  • 35. Bahmanyar, S.
    et al.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Hillert, J.
    Ekbom, A.
    Olsson, T.
    Cancer risk among patients with multiple sclerosis and their parents2009In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 72, no 13, p. 1170-1177Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We investigated cancer risk among patients with multiple sclerosis (MS) and whether variation by age at MS diagnosis helps to elucidate mechanisms underlying the previously reported reduced cancer risk. We also studied cancer risk among parents to ascertain if MS susceptibility genes may confer protection against cancer in relatives. METHODS: Cox proportional hazards regression, adjusted for age, sex, area, and socioeconomic index, estimated cancer risk among 20,276 patients with MS and 203,951 individuals without MS, using Swedish general population register data. Similar analyses were conducted among 11,284 fathers and 12,006 mothers of patients with MS, compared with 123,158 fathers and 129,409 mothers of controls. RESULTS: With an average of 35 years of follow-up, there was a decreased overall cancer risk among patients with MS (hazard ratio = 0.91, 0.87-0.95). Increased risks were observed for brain tumors (1.44, 1.21-1.72) and urinary organ cancer (1.27, 1.05-1.53). Parents of patients with MS did not have a notably increased or decreased overall cancer risk. CONCLUSIONS: The reduction in cancer risk in patients with multiple sclerosis (MS) may result from behavioral change, treatment, or we speculate that some immunologic characteristics of MS disease activity improve antitumor surveillance. The lack of association among parents indicates that a simple inherited characteristic is unlikely to explain the reduced cancer risk among patients with MS. MS is associated with increased risk for some cancers, such as of urinary organs and brain tumors (although surveillance bias may be responsible).

  • 36.
    Baktiar, Chawan
    et al.
    Örebro University, School of Health Sciences.
    Rignert, Ellen
    Örebro University, School of Health Sciences.
    Datortomografi perfusions roll vid utredning och behandling av akut ischemisk stroke utifrån ett diagnostiskt och radiografiskt perspektiv: En litteraturstudie2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Stroke is the most common cause of acquired neurological disability in adults and the third most common cause of death in Sweden. Symptoms and severity vary depends on the area limitation of the injury. Risk-prone brain tissue can recover with early treatment and can minimize permanent damage to the brain. Initially, a CT (Computed Tomography) scan of the brain is performed, but to enable thrombectomy treatment, it is recommended that in addition to CT angiography, diagnostics of salvageable brain tissue be done with CT-perfusion (CTP).  

    The aim of this literature review based on 20 quality reviewed studies is to elucidate, from a radiographic perspective, the role of CTP of the brain in the diagnosis and treatment of acute ischemic stroke (AIS) in occlusion of major cerebral arteries.  

    The results show that selection for thrombectomy based on advanced image processing doubles the probability of good functional results compared to the standard CT. Selection based on the CT method may include patients who would have been excluded by CTP due to large variation in CTP core volume. 

    Conclusion: Our study shows that CTP provides increased diagnostic safety in AIS and may affect subsequent treatment. 

    Download full text (pdf)
    fulltext
  • 37.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Bayram Özdemir, Sevgi
    Örebro University, School of Law, Psychology and Social Work.
    Özdemir, Metin
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Adolescents' sleep trajectories over time: school stress as a potential risk factor for the development of chronic sleep problems2019In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 64, no Suppl. 1, p. S27-S27Article in journal (Other academic)
    Abstract [en]

    Introduction: Sleep is a complex behavior affected by biological, psychosocial and contextual factors typically present during adolescent development (Becker, Langberg, & Byars, 2015), including increasing autonomy from parents, increasing school demands, and socializing more with peers. However, these normative changes do not explain temporary vs chronic sleep disturbances. Who are the adolescents at risk for developing chronic sleep problems? Some risk factors have been identified as crucial, such as poor sleep hygiene and family stressors, others are not as clear, such as technology use (Bartel et al., 2015). The impact of another important stressor for youths other than family, the school context, has received less attention (Meldrum, 2018). The aim of this study was twofold; first, we explored sleep trajectories from early to mid-adolescence to be able to identify a risk group showing persistent sleep problems (including insomnia and short sleep duration); then, we investigated the role of school stressors (i.e., conflicts with teachers, performance, school-leisure conflict, attendance), controlling for well-established risk factors, in the development of chronic sleep problems in a large cohort of adolescents.

    Materials and methods: We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1457; Mage = 13.2 [range: 12- 15 years], SD = .43; 52.7% boys). We collected the data from all schools in three communities in central Sweden, during school hours. Using established measures, the students reported on their sleep duration (calculated from reported bedtime, wake-time, and sleep onset latency; SSHS [Wolfson & Carskadon, 1998]), insomnia symptoms (ISI; Morin, 1993), sleep hygiene (ASHS; LeBourgeois, Giannotti, Cortesi, Wolfson, & Harsh, 2005), technology use, and perceived stress (including school, home and peer related stress) (ASQ; Byrne, Davenport, & Mazanov, 2007).

    First we used latent class analysis (LCA) to identify adolescents' sleep trajectories, then we used regression analyses to predict the risk-group trajectory of chronic insomnia and short sleep duration, controlling for gender.

    Results: We found four trajectories for adolescents' insomnia; 1) low-stable (69%), 2) low-increasing (18%), 3) high-decreasing (8%), 4) high-increasing (5%; 'risk-group'). For sleep duration, we found two trajectories; 1) ∼8 h slightly decreasing (79%), 2) ∼7 h decreasing (21%; 'risk-group').

    School stressors including stress of fitting in with peers, stress of schoolwork leaving too little leisure time, a stressful home environment, poor sleep hygiene, and being female were risk factors for chronic insomnia symptoms. Conflicts with teachers, poor sleep hygiene, and being female were risk-factors for chronic insufficient sleep.

    Conclusions: Over and above well-known risk-factors for poor sleep, such as poor sleep hygiene, (Bartel et al., 2015), school-related stress was a significant predictor of persistent sleep problems in adolescents. Therefore, helping adolescents to handle school stress might be a promising strategy to improve sleep health in this population.

  • 38.
    Bejerot, Susanne
    et al.
    Norra Stockholms psykiatri, Stockholm, Sweden.
    Bruno, Kai
    BUP Brommaplan, Stockholm, Sweden.
    Gerland, Gunilla
    Lindquist, Lars
    Infektionskliniken, Karolinska universitetssjukhuset, Huddinge, Sweden.
    Nordin, Viviann
    Sachsska barn- och ungdomssjukhuset, Södersjukhuset, Stockholm, Sweden.
    Pelling, Henrik
    BUP-kliniken, Akademiska sjukhuset, Uppsala, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Misstänk PANDAS hos barn med akuta neuropsykiatriska symptom. Infektion bakom sjukdomen [Suspect PANDAS in children with acute neuropsychiatric symptoms. Infection behind the disease]: långvarig antibiotikabehandling bör övervägas  [long-term antibiotic therapy should be considered]2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 41, p. 1803-1803, article id CDCDArticle in journal (Refereed)
  • 39.
    Bejerot, Susanne
    et al.
    Örebro University, School of Medical Sciences.
    Edman, Gunnar
    Department of Clinical Sciences, Danderyds Sjukhus, Karolinska Institutet, Solna, Sweden..
    Frisén, Louise
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
    Humble, Mats B.
    Örebro University, School of Medical Sciences.
    Evidence-Based Brief Obsessive-Compulsive Scale2017In: Journal of Central Nervous System Disease, E-ISSN 1179-5735, Vol. 9, article id UNSP 1179573517702867Article in journal (Other academic)
  • 40.
    Bejerot, Susanne
    et al.
    Norra Stockholms psykiatri, Stockholm, Sweden.
    Gardner, Ann
    Järvapsykiatrin, institutionen för klinisk neurovetenskap, Karolinska institutet, Stockholm, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Diagnostik och terapi utmanar än, trots snabb tillväxt av kunskap [Diagnosis and therapy are still challenging, despite the rapid growth of knowledge]2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 39, p. 1638-1641, article id CYRHArticle, review/survey (Refereed)
    Abstract [sv]

    Psychiatric diagnoses are not reflections of the aetiology of the disorder, but rather lists of symptoms with considerable overlaps, which hamper research and may cause confusion. The diagnoses of autism spectrum disorder, attention deficit hyperactivity disorder and tic disorder are often comorbid along with a number of other symptomatic syndromes. Individual immune responsivity is possibly involved in pathophysiological mechanisms. Multiple environmental factors may contribute to the clinical phenotypes. Recent research supports to some extent the involvement of dietary and nutritional factors in ADHD. In spite of impressive progress in the molecular biological understanding of the pathophysiology of these disorders, treatment options are still limited and more research is warranted.

  • 41.
    Bejerot, Susanne
    et al.
    Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nordin, Viviann
    Karolinska Institutet, Stockholm, Sweden.
    Autismspektrumsyndrom ersätter Aspergers syndrome och autism: [Autism spectrum syndrome replaces Asperger syndrome and autism]2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 39, p. 1660-1663, article id CUH6Article in journal (Refereed)
    Abstract [sv]

    Autism spectrum disorder describes a behaviourally defined impairment in social interaction and communication, along with the presence of restricted interests and repetitive behaviours. Although the etiology is mostly unknown, it is evident that biological factors affect the brain and result in the autistic clinical presentation. Assessment for diagnosing autism spectrum disorder should be comprehensive in order to cover all sorts of problems related to the disorder. Knowledge and experience from working with neurological and psychiatric disorders are a prerequisite for quality in the examination. Up to now, there is no cure for autism spectrum disorder, but support and adaptations in education are nevertheless important for obtaining sufficient life quality for the patients and the family.

  • 42.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Stockholm, Sweden .
    Rydén, Eleonore M.
    Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Stockholm, Sweden .
    Arlinde, Christina M
    Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Stockholm, Sweden .
    Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder: a prospective study2010In: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 71, no 12, p. 1590-1597Article in journal (Refereed)
    Abstract [en]

    Background: Given that adults with ADHD continue to use stimulants for extended periods of time, studies on the long-term effectiveness and adverse events are warranted. The aims of this study were to investigate factors associated with persistence in treatment in an exploratory manner and to document side effects and reasons for discontinuation.

    Method: The current study describes the systematic follow-up of 133 psychiatric patients with DSM-IV-diagnosed ADHD treated with central stimulants at a specialized outpatient unit between January 1, 2001, and August 31, 2006. A standardized questionnaire, derived from the Targeted Attention-deficit Disorder Symptoms Rating Scale, was used in order to measure improvement of the following target symptoms: hyperactivity, impulsivity, irritability, distractibility, structure/organization problems, inattention, and restlessness.

    Results: Eighty percent of the patients were successfully treated with stimulants at the 6- to 9-month follow-up. Fifty percent remained in treatment after 2 years or more. Forty-five percent were treated for comorbid anxiety and/or depression during the study period. Only 15% dropped out because of lack of efficacy. The amount of clinical response over the first 6 to 9 months (but not at 6 weeks) predicted adherence to treatment at 2 years. The patients' heart rate increased from a least squares mean ± SE of 70 ± 2.2 to 80 ± 2.1 bpm (P = .00003) while blood pressure remained unchanged at the ≥ 2-year follow-up. Severe side effects or drug abuse were not detected in this cohort.

    Conclusions: The long-term treatment outcome shows that stimulants are effective in adult ADHD and side effects tend to be mild.

  • 43.
    Benoit, Daniel L
    et al.
    nstitution for Surgical Sciences, Section of Sports Medicine, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden; Department of Mechanical Engineering, University of Delaware, 106 Spencer Lab, Newark, DE 19711, United States.
    Ramsey, Dan K
    Department of Physical Therapy, University of Delaware, Newark, DE, United States.
    Lamontagne, Mario
    School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada.
    Xu, Lanyi
    School of Human Kinetics, University of Ottawa, Ottawa, Canada.
    Wretenberg, Per
    Örebro University Hospital. Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden; Institution for Surgical Sciences, Section of Orthopaedics, Karolinska Institute, Stockholm, Sweden.
    Renström, Per
    Institution for Surgical Sciences, Section of Sports Medicine, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden.
    Effect of skin movement artifact on knee kinematics during gait and cutting motions measured in vivo2006In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 24, no 2, p. 152-164Article in journal (Refereed)
    Abstract [en]

    Eight healthy male subjects had intra-cortical bone-pins inserted into the proximal tibia and distal femur. Three reflective markers were attached to each bone-pin and four reflective markers were mounted on the skin of the tibia and thigh, respectively. Roentgen-stereophotogrammetric analysis (RSA) was used to determine the anatomical reference frame of the tibia and femur. Knee joint motion was recorded during walking and cutting using infrared cameras sampling at 120Hz. The kinematics derived from the bone-pin markers were compared with that of the skin-markers. Average rotational errors of up to 4.4 degrees and 13.1 degrees and translational errors of up to 13.0 and 16.1mm were noted for the walk and cut, respectively. Although skin-marker derived kinematics could provide repeatable results this was not representative of the motion of the underlying bones. A standard error of measurement is proposed for the reporting of 3D knee joint kinematics.

  • 44.
    Bergh, Cecilia
    et al.
    Örebro University, School of Medical Sciences.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Appelros, Peter
    Department of Neurology, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Determinants in adolescence of stroke-related hospital stay duration in men: a national cohort study2016In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 47, no 9, p. 2416-2418Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke.

    Methods: Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first.

    Results: Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45).

    Conclusions: Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors.

  • 45.
    Bergh, Cecilia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Appelros, Peter
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Departnment of Epidemiology and Public Health, University College London, London, UK; Cinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stress resilience in male adolescents and subsequent stroke risk: cohort study2014In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, no 12, p. 1331-1336Article in journal (Refereed)
    Abstract [en]

    Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.

    Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.

    Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.

    Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.

  • 46.
    Berglund, Annika
    et al.
    Karolinska Institutet Stroke Research Network at Södersjukhuset, Södersjukhuset, Stockholm, Sweden.
    Svensson, Leif
    Karolinska Institutet Stroke Research Network at Södersjukhuset, Södersjukhuset, Stockholm, Sweden.
    Wahlgren, Nils
    Karolinska Institutet Stroke Research Network at Södersjukhuset, Södersjukhuset, Stockholm, Sweden.
    von Euler, Mia
    Karolinska Institutet Stroke Research Network at Södersjukhuset, Södersjukhuset, Stockholm, Sweden.
    Face Arm Speech Time Test use in the prehospital setting, better in the ambulance than in the emergency medical communication center2014In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, no 3, p. 212-216Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Prehospital identification of acute stroke increases the possibility of early treatment and good outcome. To increase identification of stroke, the Face Arm Speech Time (FAST) test was introduced in the Emergency Medical Communication Center (EMCC). This substudy aims to evaluate the implementation of the FAST test in the EMCC and the ambulance service.

    METHODS: The study was conducted in the region of Stockholm, Sweden during 6 months. The study population consisted of all calls to the EMCC concerning patients presenting at least one FAST symptom or a history/finding making the EMCC or ambulance personnel to suspect stroke within 6 h. Positive FAST was compared to diagnosis at discharge. Positive predictive values (PPV) for a stroke diagnosis at discharge were calculated.

    RESULTS: In all, 900 patients with a median age of 71 years were enrolled, 667 (74%) by the EMCC and 233 (26%) by the ambulances. At discharge, 472 patients (52%) were diagnosed with stroke/transient ischemic attack (TIA), 337 identified by the EMCC (71%) and 135 (29%) by the ambulances. The PPV for a discharge diagnosis of stroke/TIA was 51% (CI 47-54%) in EMCC-enrolled and 58% (CI 52-64%) in ambulance-enrolled patients. With a positive FAST the PPV of a correct stroke/TIA diagnosis increased to 56% (CI 52-61%) and 73% (CI 66-80%) in EMCC- and ambulance-enrolled patients, respectively. Positive FAST from EMCC was also found in 44% of patients with a nonstroke diagnosis at discharge. A stroke/TIA diagnosis at discharge but negative FAST was found in 58 and 27 patients enrolled by the EMCC and ambulances, respectively.

    CONCLUSIONS: The PPV of FAST is higher when used on the scene by ambulance than by EMCC. FAST may be a useful prehospital tool to identify stroke/TIA but has limitations as the test can be negative in true strokes, can be positive in nonstrokes, and FAST symptoms may be present but not identified in the emergency call. For the prehospital care situation better identification tools are needed.

  • 47.
    Bergström, Gunnar
    et al.
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Bergström, Cecilia
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Jan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Jensen, Irene
    Division of Intervention and Implementation Research, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients: Is sick leave outcome dependent on psychologically derived patient groups?2010In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 4, p. 426-433Article in journal (Refereed)
    Abstract [en]

    A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.

  • 48.
    Biström, M.
    et al.
    Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
    Andersen, O.
    Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Alonso-Magdalena, L.
    Department of Neurology, Skåne University Hospital, Malmö, Sweden.
    Gunnarsson, Martin
    Örebro University, School of Medical Sciences. Department of Neurology.
    Vrethem, M.
    Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Hultdin, J.
    Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden.
    Sundström, P.
    Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
    High serum concentrations of vitamin D may protect against multiple sclerosis2018In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 24, no Suppl. 2, p. 1001-1002Article in journal (Other academic)
  • 49.
    Biström, M.
    et al.
    Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
    Hultdin, J.
    Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden.
    Andersen, O.
    Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Alonso-Magdalena, L.
    Department of Neurology, Skåne University Hospital, Malmö, sweden.
    Jons, D.
    Department of Clinical Neuroscience, Institution of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg.
    Gunnarsson, Martin
    Örebro University, School of Medical Sciences. Department of Neurology.
    Vrethem, M.
    Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Sundström, P.
    Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
    Leptin levels are associated with multiple sclerosis risk2019In: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 25, no Suppl. 2, p. 904-904Article in journal (Other academic)
    Abstract [en]

    Introduction: One environmental factor that in the last decade repeatedly has been linked to increased risk of developing multiple sclerosis (MS) is overweight, including obesity, early in life. The incidence of both MS and overweight are increasing, making elucidation of this connection important. The adipokine leptin is strongly correlated to both body mass index and total fat mass and the peptide hormone insulin is associated with obesity and type 2 diabetes, making leptin and insulin suitable biomarkers to investigate the connection between overweight and MS.

    Objectives: To determine if leptin or insulin are risk factors for developing relapsing MS.

    Aims: To further the understanding of how overweight influence MS risk.

    Methods: In this case-control study, we compared concentrations of leptin and insulin in 649 individuals that later developed relapsing-remitting MS with 649 matched controls. Cases were matched for biobank, sex, date of sampling and age with decreasing priority. Only prospectively collected samples from individuals below the age of 40 were included in the study. Conditional logistic regression was performed on log10 transformed and z-scored values for the entire group, separately for men and women and divided into age groups.

    Results: A 1-unit leptin z-score increase was associated with increased risk of MS in individuals below 20 years of age (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.1–1.9) and for all men (OR 1.4, 95% CI 1.0–2.0). In contrast, for women aged 30-39 years there was a lower risk of MS with increased leptin levels (OR 0.74, 95% CI 0.54–1.0) when adjusting for insulin levels. No statistically significant association was found between insulin levels and MS risk.

    Conclusions: We show that the pro-inflammatory adipokine leptin is a risk factor for MS among young individuals. The age dependent relationship between leptin and MS risk in women - for whom leptin levels are several-fold higher than in men - suggests a possible role for leptin as being the link between MS risk and being overweight early in life.

  • 50. Bjerkenstedt, Lars
    et al.
    Farde, Lars
    Terenius, Lars
    Edman, Gunnar
    Venizelos, Nikolaos
    Örebro University, Department of Clinical Medicine.
    Wiesel, Frits-Axel
    Support for limited brain availability of tyrosine in patients with schizophrenia2006In: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 9, no 2, p. 247-255Article in journal (Refereed)
    Abstract [en]

    Several mechanisms have been suggested to account for altered dopaminergic neurotransmission in schizophrenia. The brain is the only organ for which amino-acid transport is limited and competition for transport over the blood-brain barrier (BBB) occurs at physiological plasma concentrations. One line of research suggests that patients with schizophrenia have altered brain levels of the essential amino acid tyrosine, the precursor for the synthesis of dopamine. The most common hypothesis is that less tyrosine is available because of competition with elevated levels of other amino acids. By consequence, the synthesis of dopamine in the brain will decrease. In contrast, another line of evidence suggests a change in the affinity for one of the transport proteins. A limitation of this research has been that the systems for amino-acid transport across the BBB have not been fully characterized at a molecular or functional level. The L system is the major system for transport of tyrosine across cell membranes including the BBB. The A system is also involved in this transport. Earlier in-vitro studies using fibroblasts have demonstrated a normal L system in schizophrenia but nevertheless reduced tyrosine transport. The combination of molecular research, fibroblast techniques, and brain imaging provides a new basis for clinical research on the role of amino-acid membrane transport in schizophrenia.

1234567 1 - 50 of 635
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf