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  • 1.
    Adlitzer, Helena
    et al.
    Regionalt cancercentrum Stockholm Gotland.
    Andershed, Birgitta
    Ersta Sköndal Högskola.
    Axelsson, Bertil
    Östersunds sjukhus; Umeå universitet.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    Fridegren, Inger
    Nacka Närsjukhus.
    Friedrichsen, Maria
    Palliativt kompetenscentrum Östergötland, Vrinnevisjukhuset; Linköpings Universitet .
    Fürst, Carl-Johan
    Palliativt utvecklingscentrum, Lunds universitet och Region Skåne.
    Heedman, Per-Anders
    Palliativt kompetenscentrum i Östergötland.
    Henoch, Ingela
    Sahlgrenska akademin; Göteborgs universitet.
    Kenne Sarenmalm, Elisabeth
    FoU Centrum, Skaraborgs sjukhus, Skövde.
    Löfdahl, Elisabet
    Palliativa sektionen SU/Sahlgrenska universitetssjukhuset.
    Melin-Johansson, Christina
    Mittuniversitetet.
    Molander, Ulla
    Sahlgrenska Universitetssjukhuset, Göteborg.
    Persson, Hans
    Danderyds sjukhus.
    Pessah-Rasmussen, Hélène
    Skånes Universitetssjukhus (SUS).
    Rasmussen, Birgit H
    Lunds universitet och Region Skåne.
    Schaufelberger, Maria
    Sahlgrenska universitetssjukhuset.
    Seiger Cronfalk, Berit
    Ersta Sköndal Högskola; Karolinska Institutet.
    Silk, Gerd
    Kvalitets- och utvecklingsenheten Region Gotland.
    Strang, Peter
    Karolinska Institutet och Stockholms Sjukhem, Stockholm.
    Strömberg, Anna
    Linköpings universitetssjukhus.
    Tavemark, Sofia
    Örebro kommun.
    Ternestedt, Britt-Marie
    Ersta Sköndal Högskola, Stockholm.
    Wennman-Larsen, Agneta
    Sophiahemmet Högskola; Karolinska Institutet.
    Wikström, Gerhard
    Uppsala Universitet.
    Österlind, Jane
    Ersta Sköndal högskola.
    Palliativ vård i livets slutskede: Nationellt vårdprogram2016Report (Other academic)
  • 2.
    Agnew, Louise
    et al.
    Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
    Johnston, Venerina
    Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
    Ludvigsson, Maria Landen
    Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Rehab Väst, County Council of Östergötland, Motala, Sweden.
    Peterson, Gunnel
    Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Uppsala, Sweden.
    Overmeer, Thomas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Johansson, Gun
    Institute of Environmental Medicine, Occupational and Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Peolsson, Anneli
    Division of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia; Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Factors associated with work ability in patients with chronic whiplash-associated disorder grade II-III: a cross-sectional analysis2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 6, 546-551 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the factors related to self-perceived work ability in patients with chronic whiplash-associated disorder grades II-III.

    Design: Cross-sectional analysis.

    Patients: A total of 166 working age patients with chronic whiplash-associated disorder.

    Methods: A comprehensive survey collected data on work ability (using the Work Ability Index); demographic, psychosocial, personal, work- and condition-related factors. Forward, stepwise regression modelling was used to assess the factors related to work ability.

    Results: The proportion of patients in each work ability category were as follows: poor (12.7%); moderate (39.8%); good (38.5%); excellent (9%). Seven factors explained 65% (adjusted R-2 = 0.65, p < 0.01) of the variance in work ability. In descending order of strength of association, these factors are: greater neck disability due to pain; reduced self-rated health status and health-related quality of life; increased frequency of concentration problems; poor workplace satisfaction; lower self-efficacy for performing daily tasks; and greater work-related stress.

    Conclusion: Condition-specific and psychosocial factors are associated with self-perceived work ability of individuals with chronic whiplash-associated disorder.

  • 3.
    Ahl, Rebecka
    et al.
    Örebro University, School of Medical Sciences. Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Riddez, Louis
    Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Mohseni, Shahin
    Department of Surgery, Division of Trauma and Acute Care Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Surgery, Division of Trauma and Acute Care Surgery, Örebro University Hospital, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Digital rectal examination for initial assessment of the multi-injured patient: Can we depend on it?2016In: Annals of Medicine and Surgery, ISSN 2049-0801, Vol. 9, 77-81 p.Article in journal (Refereed)
    Abstract [en]

    Background: Digital rectal examination (DRE) is part of the assessment of trauma patients as recommended by ATLS (R). The theory behind is to aid early diagnosis of potential lower intestinal, urethral and spinal cord injuries. Previous studies suggest that test characteristics of DRE are far from reliable. This study examines the correlation between DRE findings and diagnosis and whether DRE findings affect subsequent management.

    Materials and methods: Patients with ICD-10 codes for spinal cord, urethral and lower intestinal injuries were identified from the trauma registry at an urban university hospital between 2007 and 2011. A retrospective review of electronic medical records was carried out to analyse DRE findings and subsequent management.

    Results: 253 patients met the inclusion criteria with a mean age of 44 +/- 20 years and mean ISS of 26 +/- 16. 160 patients had detailed DRE documentation with abnormal findings in 48%. Sensitivity rate was 0.47. Correlational analysis between examination findings and diagnosis gave a kappa of 0.12. Subsequent management was not altered in any case due to DRE findings.

    Conclusion: DRE in trauma settings has low sensitivity and does not change subsequent management. Excluding or postponing this examination should therefore be considered. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 4.
    Ahmadi, Zainab
    et al.
    Lund University, Lund, Sweden.
    Sundh, Josefin
    Örebro University, School of Medical Sciences.
    Hermansson, Anna B.
    Uppsala University Hospital, Uppsala, Sweden.
    Ekström, Magnus
    Lund University, Lund, Sweden.
    Does Long-Term Oxygen Therapy 24 H/day Improve Survival Compared To 15 H/day In Hypoxemic Chronic Obstructive Pulmonary Disease?2016In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 193Article in journal (Refereed)
  • 5.
    Allvin, Renée
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Skills Centre.
    Berndtzon, Magnus
    Metodikum – Skill Centre of Medical Simulation Region County Jönköping, Jönköping, sweden.
    Carlzon, Liisa
    Simulation Centre West, Department of Research, Education and Development, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Edelbring, Samuel
    Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Institute of Medicine and Health, Medical Faculty, Linköping University, Linköping, Sweden.
    Hultin, Magnus
    Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care, Medical Faculty, Umeå University, Umeå, Sweden.
    Karlgren, Klas
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Research, Education and Development and Innovation, Södersjukhuset Hospital, Stockholm, Sweden.
    Masiello, Italo
    Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset Hospital, Stockholm, Sweden.
    Kallestedt, Marie-Louise Södersved
    Clinical Skills Centre, Centre for Clinical Research, Uppsala University, Västerås, Sweden.
    Tamás, Éva
    Department of Cardiovascular Diseases, Institute of Medicine and Health, Medical Faculty, University of Linköping, Linköping, Sweden.
    Confident but not theoretically grounded - experienced simulation educators' perceptions of their own professional development2017In: Advances in Medical Education and Practice, ISSN 1179-7258, E-ISSN 1179-7258, Vol. 8, 99-108 p.Article in journal (Refereed)
    Abstract [en]

    Background: Medical simulation enables the design of learning activities for competency areas (eg, communication and leadership) identified as crucial for future health care professionals. Simulation educators and medical teachers follow different career paths, and their education backgrounds and teaching contexts may be very different in a simulation setting. Although they have a key role in facilitating learning, information on the continuing professional development (pedagogical development) of simulation educators is not available in the literature.

    Objectives: To explore changes in experienced simulation educators' perceptions of their own teaching skills, practices, and understanding of teaching over time.

    Methods: A qualitative exploratory study. Fourteen experienced simulation educators participated in individual open-ended interviews focusing on their development as simulation educators. Data were analyzed using an inductive thematic analysis.

    Results: Marked educator development was discerned over time, expressed mainly in an altered way of thinking and acting. Five themes were identified: shifting focus, from following to utilizing a structure, setting goals, application of technology, and alignment with profession. Being confident in the role as an instructor seemed to constitute a foundation for the instructor's pedagogical development.

    Conclusion: Experienced simulation educators' pedagogical development was based on self-confidence in the educator role, and not on a deeper theoretical understanding of teaching and learning. This is the first clue to gain increased understanding regarding educational level and possible education needs among simulation educators, and it might generate several lines of research for further studies.

  • 6.
    Amcoff, Karin
    Örebro University, School of Medical Sciences.
    Serological and faecal biomarkers in inflammatory bowel disease2018Doctoral thesis, comprehensive summary (Other academic)
  • 7.
    Appelros, Peter
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Neurology.
    Terent, Andreas
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Thrombolysis in acute stroke2015In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, no 9976, 1394-1394 p.Article in journal (Refereed)
  • 8.
    Bankole, Landry-Cyrille
    et al.
    Örebro University, School of Health Sciences. Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, Université de Lyon, Saint-Etienne, France; Unité de Myologie, Centre Hospitalier, Universitaire de Saint-Etienne, Saint-Etienne, France; Centre Référent Maladies Neuromusculaires Rares Rhône-Alpes, Saint-Etienne, France.
    Millet, Guillaume Y.
    Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, Université de Lyon, Saint-Etienne, France; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; U1042, INSERM, Grenoble, France.
    Temesi, John
    Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, Université de Lyon, Saint-Etienne, France; Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
    Bachasson, Damien
    U1042, INSERM, Grenoble, France; Laboratoire HP2, Grenoble Alpes University, Grenoble, France.
    Ravelojaona, Marion
    Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, Université de Lyon, Saint-Etienne, France; Unité de Myologie, Centre Hospitalier, Universitaire de Saint-Etienne, Saint-Etienne, France; Centre Référent Maladies Neuromusculaires Rares Rhône-Alpes, Saint-Etienne, France.
    Wuyam, Bernard
    U1042, INSERM, Grenoble, France; Laboratoire HP2, Grenoble Alpes University, Grenoble, France; Centre Référent Maladies Neuromusculaires Rares Rhône-Alpes, Saint-Etienne, France.
    Verges, Samuel
    U1042, INSERM, Grenoble, France; Laboratoire HP2, Grenoble Alpes University, Grenoble, France.
    Ponsot, Elodie
    Örebro University, School of Health Sciences.
    Antoine, Jean-Christophe
    Centre Référent Maladies Neuromusculaires Rares Rhône-Alpes, Saint-Etienne, France.
    Kadi, Fawzi
    Örebro University, School of Health Sciences.
    Feasson, Leonard
    Laboratoire Interuniversitaire de Biologie de la Motricité, UJM-Saint-Etienne, Université de Lyon, Saint-Etienne, France; Unité de Myologie, Centre Hospitalier, Universitaire de Saint-Etienne, Saint-Etienne, France; Centre Référent Maladies Neuromusculaires Rares Rhône-Alpes, Saint-Etienne, France.
    Safety and efficacy of a 6-month home-based exercise program in patients with facioscapulohumeral muscular dystrophy A randomized controlled trial2016In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 95, no 31, e4497Article in journal (Refereed)
    Abstract [en]

    Background: Previous randomized controlled trials investigating exercise training programs in facioscapulohumeral muscular dystrophy (FSHD) patients are scarce and of short duration only. This study assessed the safety and efficacy of a 6-month home-ased exercise training program on fitness, muscle, and motor function in FSHD patients.

    Methods: Sixteen FSHD patients were randomly assigned to training (TG) and control (CG) groups (both n=8) in a home-based exercise intervention. Training consisted of cycling 3 times weekly for 35minutes (combination of strength, high-intensity interval, and low-intensity aerobic) at home for 24 weeks. Patients in CG also performed an identical training program (CTG) after 24 weeks. The primary outcome was change in peak oxygen uptake (VO2 peak) measured every 6 weeks. The principal secondary outcomes were maximal quadriceps strength (MVC) and local quadriceps endurance every 12 weeks. Other outcome measures included maximal aerobic power (MAP) and experienced fatigue every 6 weeks, 6-minute walking distance every 12 weeks, and muscle characteristics from vastus lateralis biopsies taken pre- and postintervention.

    Results: The compliance rate was 91% in TG. Significant improvements with training were observed in the VO2 peak (+19%, P= 0.002) and MAP by week 6 and further to week 24. Muscle endurance, MVC, and 6-minute walking distance increased and experienced fatigue decreased. Muscle fiber cross-sectional area and citrate synthase activity increased by 34% (P=0.008) and 46% (P=0.003), respectively. Dystrophic pathophysiologic patterns were not exacerbated. Similar improvements were experienced by TG and CTG.

    Conclusions: A combined strength and interval cycling exercise-training program compatible with patients' daily professional and social activities leads to significant functional benefits without compromising muscle tissue.

  • 9.
    Baumgart, Juliane
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Nilsson, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Evers, Anneli Stavreus
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Kallak, Theodora Kunovac
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Poromaa, Inger Sundström
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer2013In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 20, no 2, 162-168 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The goal of this study was to investigate sexual function in postmenopausal breast cancer patients treated with aromatase inhibitors.

    Methods: A population-based, cross-sectional study was conducted among postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched controls with and without estrogen treatment. Sexual function was assessed with a standardized questionnaire.

    Results: In all, 42.4% of aromatase inhibitor-treated breast cancer patients were dissatisfied with their sex life in general, and 50.0% reported low sexual interest; this was significantly more common than in tamoxifen-treated patients and controls (P < 0.05). Aromatase inhibitorYtreated patients reported insufficient lubrication in 73.9% and dyspareunia in 56.5% of cases, which were significantly more common than in controls, irrespective of hormonal use (P < 0.05). Tamoxifen-treated patients reported significantly more dyspareunia (31.3%; P < 0.05) but resembled controls in all other concerns.

    Conclusions: Our findings suggest that sexual dysfunction in aromatase inhibitorYtreated women is a greatly underestimated problem.

  • 10.
    Belayneh, Dereje K.
    et al.
    Int Cardiovasc Hosp, Addis Ababa, Ethiopia..
    Kellerth, Thomas
    Orebro Univ Hosp, Dept Cardiol, Orebro, Sweden..
    Thyrotoxic hypokalemic periodic paralysis in an African male: a case report2015In: Clinical Case Reports, E-ISSN 2050-0904, Vol. 3, no 2, 102-105 p.Article in journal (Refereed)
    Abstract [en]

    Thyrotoxic hypokalemic periodic paralysis is a rare manifestation of thyrotoxicosis and is rarely reported in non-Asian populations. A 26-year-old Ethiopian male who presented with recurrent flaccid tetraparesis, hypokalemia, and hyperthyroidism is reported here. Thyroid function should be routinely checked in patients with acute or recurrent hypokalemic paralysis.

  • 11.
    Bengtsson, Torbjörn
    et al.
    Department of Medical and Health Sciences, Cardiovascular Inflammation Research Centre, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, H
    Department of Clinical and Experimental Medicine, Cardiovascular Inflammation Research Centre, Linköping University, Linköping, Sweden.
    Gunnarsson, P
    Department of Medical and Health Sciences, Cardiovascular Inflammation Research Centre, Linköping University, Linköping, Sweden.
    Skoglund, C
    Department of Medical and Health Sciences, Cardiovascular Inflammation Research Centre, Linköping University, Linköping, Sweden.
    Elison, C
    Department of Clinical and Experimental Medicine, Cardiovascular Inflammation Research Centre, Linköping University, Linköping, Sweden.
    Leanderson, P
    Department of Clinical and Experimental Medicine, Cardiovascular Inflammation Research Centre, Linköping University, Linköping, Sweden.
    Lindahl, M
    Department of Clinical and Experimental Medicine, Cardiovascular Inflammation Research Centre, Linköping University, Linköping, Sweden.
    The periodontal pathogen Porphyromonas gingivalis cleaves apoB-100 and increases the expression of apoM in LDL in whole blood leading to cell proliferation2008In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 263, no 5, 558-571 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Several studies support an association between periodontal disease and atherosclerosis with a crucial role for the pathogen Porphyromonas gingivalis. This study aims at investigating the proteolytic and oxidative activity of P. gingivalis on LDL in a whole blood system using a proteomic approach and analysing the effects of P. gingivalis-modified LDL on cell proliferation.

    METHODS: The cellular effects of P. gingivalis in human whole blood were assessed using lumi-aggregometry analysing reactive oxygen species production and aggregation. Blood was incubated for 30 min with P. gingivalis, whereafter LDL was isolated and a proteomic approach was applied to examine protein expression. LDL-oxidation was determined by analysing the formation of protein carbonyls. The effects of P. gingivalis-modified LDL on fibroblast proliferation were studied using the MTS assay.

    RESULTS: Incubation of whole blood with P. gingivalis caused an extensive aggregation and ROS production, indicating platelet and leucocyte activation. LDL prepared from bacteria-exposed blood showed an increased protein oxidation, elevated levels of apoM and formation of two apoB-100 N-terminal fragments. Porphyromonas gingivalis-modified LDL markedly increased the growth of fibroblasts. Inhibition of gingipain R suppressed the modification of LDL by P. gingivalis.

    CONCLUSIONS: The ability of P. gingivalis to change the protein expression and proliferative capacity of LDL may represent a crucial event in periodontitis-associated atherosclerosis.

  • 12.
    Bergh, Cecilia
    Örebro University, School of Medical Sciences.
    Life-course influences on occurrence and outcome for stroke and coronary heart disease2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.

    List of papers
    1. Stress resilience in male adolescents and subsequent stroke risk: cohort study
    Open this publication in new window or tab >>Stress resilience in male adolescents and subsequent stroke risk: cohort study
    Show others...
    2014 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, no 12, 1331-1336 p.Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    BMJ Publishing Group Ltd, 2014
    Keyword
    stroke
    National Category
    Neurology Psychiatry Surgery
    Identifiers
    urn:nbn:se:oru:diva-35058 (URN)10.1136/jnnp-2013-307485 (DOI)000345276400010 ()2-s2.0-84896691316 (Scopus ID)
    Note

    Funding Agency:

    UK Economic and Social Research Council (ESRC) RES-596-28-0001 ES/J019119/1

    Stiftelsen Olle Engqvist Byggmästare 

    Örebro University 

    Available from: 2014-05-15 Created: 2014-05-15 Last updated: 2017-12-05Bibliographically approved
    2. Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age
    Open this publication in new window or tab >>Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age
    Show others...
    2015 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 101, no 8, 623-629 p.Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: Psychosocial stress is a suggested risk for coronary heart disease (CHD). The relationship of stress resilience in adolescence with subsequent CHD risk is underinvestigated, so our objective was to assess this and investigate the possible mediating role of physical fitness.

    METHODS: In this register-based study, 237 980 men born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semistructured interview with a psychologist. Some 10 581 diagnoses of CHD were identified. Cox regression estimated the association of stress resilience with CHD, with adjustment for established cardiovascular risk factors.

    RESULTS: Low-stress resilience was associated with increased CHD risk. The association remained after adjustment for physical fitness and other potential confounding and mediating factors, with adjusted HRs (and 95% CIs) of 1.17 (1.10 to 1.25), with some evidence of mediation by physical fitness. CHD incidence rates per 1000 person-years (and 95% CIs) for low-stress, medium-stress and high-stress resilience were 2.61 (2.52 to 2.70), 1.97 (1.92 to 2.03) and 1.59 (1.53 to 1.67) respectively. Higher physical fitness was inversely associated with CHD risk; however, this was attenuated by low-stress resilience, shown by interaction testing (p<0.001).

    CONCLUSIONS: Low-stress resilience in adolescence was associated with increased risk of CHD in middle age and may diminish the benefit of physical fitness. This represents new evidence of the role of stress resilience in determining risk of CHD and its interrelationship with physical fitness.

    Place, publisher, year, edition, pages
    BMJ Publishing Group Ltd, 2015
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Epidemiology; Cardiology
    Identifiers
    urn:nbn:se:oru:diva-43425 (URN)10.1136/heartjnl-2014-306703 (DOI)000351755300009 ()25740818 (PubMedID)2-s2.0-84927665875 (Scopus ID)
    Note

    Funding Agencies:

    UK Economic and Social Research Council (ESRC) RES-596-28-0001  ES/JO19119/1

    Stiftelsen Olle Engqvist Byggmästare, Folksam

    Örebro University

    Available from: 2015-03-06 Created: 2015-03-06 Last updated: 2017-12-04Bibliographically approved
    3. Determinants in adolescence of stroke-related hospital stay duration in men: a national cohort study
    Open this publication in new window or tab >>Determinants in adolescence of stroke-related hospital stay duration in men: a national cohort study
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    2016 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 47, no 9, 2416-2418 p.Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Lippincott Williams & Wilkins, 2016
    Keyword
    Adolescent, blood pressure, length of stay, psychological stress, risk factors
    National Category
    Cardiac and Cardiovascular Systems Neurology
    Identifiers
    urn:nbn:se:oru:diva-51591 (URN)10.1161/STROKEAHA.116.014265 (DOI)000383559300052 ()27491740 (PubMedID)2-s2.0-84982813061 (Scopus ID)
    Note

    Funding Agencies:

    UK Economic and Social Research Council RES-596-28-0001  ES/JO19119/1

    Stiftelsen Olle Engqvist Byggmästare

    Folksam

    Örebro University

    Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2017-11-28Bibliographically approved
    4. Severe infections and subsequent delayed cardiovascular disease: national cohort study
    Open this publication in new window or tab >>Severe infections and subsequent delayed cardiovascular disease: national cohort study
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Family Medicine
    Identifiers
    urn:nbn:se:oru:diva-55808 (URN)
    Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2017-10-18Bibliographically approved
  • 13.
    Bergh, Cecilia
    et al.
    Örebro University, School of Medical Sciences.
    Fall, Katja
    Örebro University, School of Medical Sciences.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Sjöqvist, Hugo
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, UK .
    Severe infections and subsequent delayed cardiovascular disease: national cohort studyManuscript (preprint) (Other academic)
  • 14.
    Bergström, Ida
    et al.
    Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Immunology and Transfusion Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Lundberg, Anna K.
    Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Jönsson, Simon
    Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Särndahl, Eva
    Örebro University, School of Medical Sciences. IRiSC - Inflammatory Response and Infection Susceptibility Centre.
    Ernerudh, Jan
    Department of Clinical Immunology and Transfusion Medicine, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Jonasson, Lena
    Department of Medical and Health Sciences, Division of Cardiovascular Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Annexin A1 in blood mononuclear cells from patients with coronary artery disease: Its association with inflammatory status and glucocorticoid sensitivity2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 3, e0174177Article in journal (Refereed)
    Abstract [en]

    Annexin A1 (AnxA1) is a key player in resolution of inflammation and a mediator of glucocorticoid actions. In atherosclerotic tissue, increased expression of AnxA1 has been associated with protective plaque-stabilizing effects. Here, we investigated the expression of AnxA1 in peripheral blood mononuclear cells (PBMCs) from patients with coronary artery disease (CAD). Blood was collected from 57 patients with stable CAD (SCAD) and 41 healthy controls. We also included a minor group (n = 10) with acute coronary syndrome (ACS). AnxA1 mRNA was measured in PBMCs. Expression of AnxA1 protein (total and surface-bound) and glucocorticoid receptors (GR) were detected in PBMC subsets by flow cytometry. Also, salivary cortisol, interleukin(IL)-6 and IL-10 in plasma, and LPS-induced cytokine secretion from PBMCs, with or without dexamethasone, were assessed. AnxA1 mRNA was found to be slightly increased in PBMCs from SCAD patients compared with controls. However, protein expression of AnxA1 or GRs in PBMC subsets did not differ between SCAD patients and controls, despite SCAD patients showing a more proinflammatory cytokine profile ex vivo. Only surface expression of AnxA1 on monocytes correlated with dexamethasone-mediated suppression of cytokines. In ACS patients, a marked activation of AnxA1 was seen involving both gene expression and translocation of protein to cell surface probably reflecting a rapid glucocorticoid action modulating the acute inflammatory response in ACS. To conclude, surface expression of AnxA1 on monocytes may reflect the degree of glucocorticoid sensitivity. Speculatively, "normal" surface expression of AnxA1 indicates that anti-inflammatory capacity is impaired in SCAD patients.

  • 15.
    Bill-Axelson, Anna
    et al.
    Univ Uppsala Hosp, Dept Surg Sci, Uppsala, Sweden.
    Holmberg, Lars
    Univ Uppsala Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden; Kings Coll London, Sch Med, Div Canc Studies, London WC2R 2LS, England.
    Garmo, Hans
    Univ Uppsala Hosp, Reg Canc Ctr Uppsala Orebro, Uppsala, Sweden; Kings Coll London, Sch Med, Div Canc Studies, London WC2R 2LS, England.
    Rider, Jennifer R.
    Brigham & Womens Hosp, Dept Med, Channing Lab, Boston, MA USA; Harvard Univ, Sch Med, Boston, MA USA; Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA.
    Taari, Kimmo
    Univ Helsinki, Cent Hosp, Dept Urol, Helsinki, Finland.
    Busch, Christer
    Univ Uppsala Hosp, Dept Immunol Genet & Pathol, Uppsala, Sweden.
    Nordling, Stig
    Univ Helsinki, Dept Pathol, Helsinki, Finland.
    Häggman, Michael
    Univ Uppsala Hosp, Dept Surg Sci, Uppsala, Sweden.
    Andersson, Swen-Olof
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Urol.
    Spångberg, Anders
    Linköping Univ Hosp, Dept Urol, Linköping, Sweden.
    Andrén, Ove
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Urol.
    Palmgren, Juni
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Steineck, Gunnar
    Karolinska Inst, Dept Pathol & Oncol, Div Clin Canc Epidemiol, Stockholm, Sweden; Sahlgrens Acad, Div Clin Canc Epidemiol, Gothenburg, Sweden.
    Adami, Hans-Olov
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden; Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA.
    Johansson, Jan-Erik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept Urol.
    Radical Prostatectomy or Watchful Waiting in Early Prostate Cancer2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 370, no 10, 932-942 p.Article in journal (Refereed)
    Abstract [en]

    Background: Radical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain.

    Methods: Between 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy.

    Results: During 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P=0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical prostatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P=0.04).

    Conclusions: Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.)

    The randomized Swedish trial of prostatectomy versus watchful waiting in disease detected mainly clinically (not by PSA screening) continues to show a benefit for early prostatectomy. The number of men younger than 65 needed to treat to prevent one death is now four. The Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4), a randomized trial of radical prostatectomy versus watchful waiting in men with localized prostate cancer diagnosed before the era of prostate-specific antigen (PSA) testing, showed a survival benefit of radical prostatectomy as compared with observation at 15 years of follow-up.(1) By contrast, the Prostate Cancer Intervention versus Observation Trial (PIVOT), initiated in the early era of PSA testing, showed that radical prostatectomy did not significantly reduce prostate cancer-specific or overall mortality after 12 years.(2) PSA screening profoundly changes the clinical domain of study. Among other considerations, the substantial additional lead time ...

  • 16.
    Boman, Tomas
    et al.
    Department of Social Work and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden; Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.
    Kjellberg, Anders
    Department of Building, Energy and Environmental Engineering, Faculty of Engineering and Sustainable Development, University of Gävle, Gävle, Sweden.
    Danermark, Berth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.
    Boman, Eva
    Department of Social Work and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Employment opportunities for persons with different types of disability2015In: Alter;European Journal of Disability Research ;Journal Europeen de Recherche Sur le Handicap, ISSN 1875-0672, E-ISSN 1875-0680, Vol. 9, no 2, 116-129 p.Article in journal (Refereed)
    Abstract [en]

    The employment status of groups with different disabilities was analysed as were potentially important moderating factors (work ability, structural and individual factors). A secondary analysis was performed on 4359 respondents with disabilities from Statistics Sweden's Labour Market Investigation. The respondents were divided into six disability groups (communicative-hearing, communicative-speech-reading, communicative-vision, psychological disability, medical disability, physical disability). Logistic regression analyses showed that the probability of being employed was highest among respondents with hearing disabilities and respondents with psychological disabilities were least likely to be employed. Being a woman (very young or old) with only primary education and with partially or very impaired work ability, reduced employment opportunities. Higher education did not increase employment opportunities for respondents with impaired workability. In summary, the type of disability is essential for employment opportunities, and differences between disability groups cannot be explained by differences in other variables. The moderating factors studied were found to be of equal importance in all groups.

  • 17.
    Cajander, Sara
    Örebro University, School of Medical Sciences.
    Dynamics of Human Leukocyte Antigen-D Related expression in bacteremic sepsis2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Monocytic human leukocyte antigen-D related (mHLA-DR) expression determined by flow cytometry has been suggested as a biomarker of sepsisinduced immunosuppression.

    In order to facilitate use of HLA-DR in clinical practice, a quantitative real-time PCR technique measuring HLA-DR at the transcription level was developed and evalutated. Levels of HLA-DR mRNA correlated to mHLADR expression and were robustly measured, with high reproducibility, during the course of infection. Dynamics of mHLA-DR expression was studied during the first weeks of bloodstream infection (BSI) and was found to be dependent on the bacterial etiology of BSI. Moreover, mHLA-DR was shown to be inversely related to markers of inflammation. In patients with unfavourable outcome, sustained high C-reactive protein level and high neutrophil count were demonstrated along with low mHLA-DR expression and low lymphocyte count. This supports the theory of sustained inflammation in sepsis-induced immunosuppression. The association between mHLA-DR and bacterial etiology may be linked to the clinical trajectory via differences in ability to cause intractable infection. Staphylococcus aureus was the dominating etiology among cases with unfavourable outcome. With focus on patients with S. aureus BSI, those with complicated S. aureus BSI were found to have lower HLA-DR mRNA expression during the first week than those with uncomplicated S. aureus BSI. If these results can be confirmed in a larger cohort, HLA-DR measurement could possibly become an additional tool for early identification of patients who require further investigation to clear infectious foci and achieve source control.

    In conclusion, PCR-based measurement of HLA-DR is a promising method for measurements of the immune state in BSI, but needs further evaluation in the intensive care unit setting to define the predictive and prognostic value for deleterious immunosuppression. The etiology of infection should be taken into consideration in future studies of translational immunology in sepsis.

    List of papers
    1. Preliminary results in quantitation of HLA-DRA by real-time PCR: a promising approach to identify immunosuppression in sepsis
    Open this publication in new window or tab >>Preliminary results in quantitation of HLA-DRA by real-time PCR: a promising approach to identify immunosuppression in sepsis
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    2013 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, R223Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Reduced monocyte human leukocyte antigen (mHLA)-DR surface expression in the late phase of sepsis is postulated as a general biomarker of sepsis-induced immunosuppression and an independent predictor of nosocomial infections. However, traditional monitoring of mHLA-DR by flow cytometry has disadvantages due to specific laboratory requirements. An mRNA-based HLA-DR monitoring by polymerase chain reaction (PCR) would improve the clinical usage and facilitate conduction of large multicenter studies. In this study, we evaluated an mRNA-based HLA-DR monitoring by quantitative real-time PCR (qRT-PCR) as an alternative method to traditional flow cytometry.

    Methods: Fifty-nine patients with sepsis and blood culture growing pathogenic bacteria were studied. Blood samples were collected at day 1 or 2 after admission, for measurement of mHLA-DR by flow cytometry and mRNA expression of HLA-DRA and class II transactivator (CIITA) by qRT-PCR. Blood samples from blood donors were used as controls (n = 30).

    Results: A significant reduced expression of mHLA-DR, HLA-DRA, and CIITA was seen in septic patients compared with controls. HLA-DRA mRNA level in whole blood was highly correlated with surface expression of mHLA-DR.

    Conclusions: Patients with sepsis display a diminished expression of HLA-DR at the monocyte surface as well as in the gene expression at the mRNA level. The mRNA expression level of HLA-DRA monitored by qRT-PCR correlates highly with surface expression of HLA-DR and appears to be a possible future biomarker for evaluation of immunosuppression in sepsis.

    Place, publisher, year, edition, pages
    London, United Kingdom: BioMed Central, 2013
    National Category
    Medical and Health Sciences Clinical Laboratory Medicine
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-34293 (URN)10.1186/cc13046 (DOI)000331540900039 ()24093602 (PubMedID)2-s2.0-84884967732 (Scopus ID)
    Note

    Funding Agencies:

    Nyckelfonden (Örebro, Sweden)

    Research committee of Örebro County Council

    Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-12-05Bibliographically approved
    2. Quantitative Real-Time Polymerase Chain Reaction Measurement of HLA-DRA Gene Expression in Whole Blood Is Highly Reproducible and Shows Changes That Reflect Dynamic Shifts in Monocyte Surface HLA-DR Expression during the Course of Sepsis
    Open this publication in new window or tab >>Quantitative Real-Time Polymerase Chain Reaction Measurement of HLA-DRA Gene Expression in Whole Blood Is Highly Reproducible and Shows Changes That Reflect Dynamic Shifts in Monocyte Surface HLA-DR Expression during the Course of Sepsis
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    2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, e0154690Article in journal (Refereed) Published
    Abstract [en]

    Introduction: A decrease in the expression of monocyte surface protein HLA-DR (mHLA-DR), measured by flow cytometry (FCM), has been suggested as a marker of immunosuppression and negative outcome in severe sepsis. However, FCM is not always available due to sample preparation that limits its use to laboratory operational hours. In this prospective study we evaluated dynamic changes in mHLA-DR expression during sepsis in relation to changes in HLA-DRA gene expression and Class II transactivator (CIITA), measured by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR).

    Aims: The aims of this study were: 1. to validate the robustness of qRT-PCR measurement of HLA-DRA- and CIITA-mRNA expression, in terms of reproducibility; and 2. to see if changes in expression of these genes reflect changes in mHLA-DR expression during the course of severe and non-severe bacteraemic sepsis.

    Methods and Findings: Blood samples were collected from 60 patients with bacteraemic sepsis on up to five occasions during Days 1-28 after hospital admission. We found the reproducibility of the qRT-PCR method to be high by demonstrating low threshold variations (<0.11 standard deviation (SD)) of the qRT-PCR system, low intra-assay variation of Ct-values within triplicates (≤0.15 SD) and low inter-assay variations (12%) of the calculated target gene ratios. Our results also revealed dynamic HLA-DRA expression patterns during the course of sepsis that reflected those of mHLA-DR measured by FCM. Furthermore, HLA-DRA and mHLA-DR recovery slopes in patients with non-severe sepsis differed from those in patients with severe sepsis, shown by mixed model for repeated measurements (p<0.05). However, during the first seven days of sepsis, PCR-measurements showed a higher magnitude of difference between the two sepsis groups. Mean differences (95% CI) between severe sepsis (n = 20) and non-severe sepsis (n = 40) were; on day 1-2, HLA-DRA 0.40 (0.28-0.59) p<0.001, CIITA 0.48 (0.32-0.72) p = 0.005, mHLA-DR 0.63 (0.45-1.00) p = 0.04, day 7 HLA-DRA 0.59 (0.46-0.77) p<0.001, CIITA 0.56 (0.41-0.76) p<0.001, mHLA-DR 0.81 (0.66-1.00) p = 0.28.

    Conclusion: We conclude that qRT-PCR measurement of HLA-DRA expression is robust, and that this method appears to be preferable to FCM in identifying patients with severe sepsis that may benefit from immunostimulation.

    Place, publisher, year, edition, pages
    San Francisco, USA: Public Library of Science, 2016
    National Category
    Infectious Medicine
    Identifiers
    urn:nbn:se:oru:diva-50323 (URN)10.1371/journal.pone.0154690 (DOI)000375676400061 ()27144640 (PubMedID)
    Note

    Funding Agencies:

    Nyckelfonden (Örebro, Sweden)

    Research committee of Örebro County Council

    Available from: 2016-05-27 Created: 2016-05-16 Last updated: 2017-11-30Bibliographically approved
    3. Monocytic HLA-DR expression differs between bacterial etiologies and is inversely related to C-reactive protein and neutrophil count during the course of bloodstream infection
    Open this publication in new window or tab >>Monocytic HLA-DR expression differs between bacterial etiologies and is inversely related to C-reactive protein and neutrophil count during the course of bloodstream infection
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Family Medicine
    Identifiers
    urn:nbn:se:oru:diva-57488 (URN)
    Available from: 2017-04-25 Created: 2017-04-25 Last updated: 2017-10-18Bibliographically approved
    4. Expression of HLA-DRA and CD74 mRNA in whole blood during the course of complicated and uncomplicated Staphylococcus aureus bacteraemia
    Open this publication in new window or tab >>Expression of HLA-DRA and CD74 mRNA in whole blood during the course of complicated and uncomplicated Staphylococcus aureus bacteraemia
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Family Medicine
    Identifiers
    urn:nbn:se:oru:diva-56198 (URN)
    Available from: 2017-03-08 Created: 2017-03-08 Last updated: 2017-10-18Bibliographically approved
  • 18.
    Cajander, Sara
    et al.
    Örebro University, School of Medical Sciences.
    Rasmussen, Gunlög
    Örebro University, School of Medical Sciences.
    Tina, Elisabet
    Örebro University, School of Medical Sciences.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medical Sciences.
    Källman, Jan
    Örebro University, School of Medical Sciences.
    Strålin, Kristoffer
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden .
    Monocytic HLA-DR expression differs between bacterial etiologies and is inversely related to C-reactive protein and neutrophil count during the course of bloodstream infectionManuscript (preprint) (Other academic)
  • 19.
    Chang, Zheng
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fazel, Seena
    Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England.
    Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release2016In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 316, no 17, 1798-1807 p.Article in journal (Refereed)
    Abstract [en]

    Importance: Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.

    Objective: To investigate the associations between major classes of psychotropic medications and violent reoffending.

    Design, Setting, and Participants: This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.

    Exposures: Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.

    Main Outcomes and Measures: Violent crime after release from prison.

    Results: The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.

    Conclusions and Relevance: Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.

  • 20.
    Chen, Qi
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Sjölander, Arvid
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Runeson, Bo
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study2014In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 348, g3769Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between drug treatment for attention-deficit/hyperactivity disorder (ADHD) and risk of concomitant suicidal behaviour among patients with ADHD.

    Design: Register based longitudinal study using within patient design.

    Setting: Linkage of multiple national registers in Sweden.

    Participants: 37,936 patients with ADHD born between 1960 and 1996 and followed from 2006 to 2009 for treatment status by ADHD drug treatment and suicide related events (suicide attempt and completed suicide).

    Main outcome measure: Incidence rate of suicide related events during ADHD drug treatment periods compared with that during non-treatment periods.

    Results: Among 37,936 patients with ADHD, 7019 suicide related events occurred during 150,721 person years of follow-up. At the population level, drug treatment of ADHD was associated with an increased rate of suicide related events (hazard ratio 1.31, 95% confidence interval 1.19 to 1.44). However, the within patient comparison showed a reverse association between ADHD drug treatment and rate of suicide related events (0.89, 0.79 to 1.00). Among stimulant users, a reduced within patient rate of suicide related events was seen during treatment periods (0.81, 0.70 to 0.94). Among non-stimulant/mixed users, no significantly increased within patient rate of suicide related events during non-stimulant treatment periods was seen (0.96, 0.72 to 1.30).

    Conclusions: This study found no evidence for a positive association between the use of drug treatments for ADHD and the risk of concomitant suicidal behaviour among patients with ADHD. If anything, the results pointed to a potential protective effect of drugs for ADHD on suicidal behaviour, particularly for stimulant drugs. The study highlights the importance of using within patient designs to control for confounding in future pharmacoepidemiological studies.

  • 21.
    Chillón, Palma
    et al.
    Department of Physical Education and Sport, School of Sport Sciences, University of Granada, Granada, Spain.
    Ortega, Francisco B
    Department of Physical Education and Sport, School of Sport Sciences, University of Granada, Granada, Spain; Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Sweden; Department of Physiology, School of Medicine, University of Granada, Granada, Spain.
    Ruiz, Jonatan R
    Department of Physical Education and Sport, School of Sport Sciences, University of Granada, Granada, Spain; Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Sweden.
    Evenson, Kelly R
    Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at, Chapel Hill, NC, United States; Center for Health Promotion and Disease Prevention, University of North Carolina at, Chapel Hill, NC, United States.
    Labayen, Idoia
    Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Sweden; Department of Nutrition and Food Sciences, University of the Basque Country, UPV/EHU Vitoria, Spain.
    Martínez-Vizcaino, Vicente
    Social and Health Care Research Center, University of Castilla-La Mancha, Cuenca, Spain.
    Hurtig-Wennlöf, Anita
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Veidebaum, Toomas
    National Institute for Heath Development, Centre of Behavioral and Health Sciences, Tallinn, Estonia.
    Sjöström, Michael
    Department of Biosciences and Nutrition, Unit for Preventive Nutrition, Karolinska Institutet, Sweden.
    Bicycling to school is associated with improvements in physical fitness over a 6-year follow-up period in Swedish children2012In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 55, no 2, 108-112 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine whether modes of commuting to school at baseline and changes in commuting were related to 6-year changes in cardiorespiratory fitness in youth.

    METHODS: A total of 262 (142 girls) Swedish children (9 years at entry) were measured at baseline (1998/9) and follow-up (2004/5). Mode of commuting to school was assessed by questionnaire and fitness by a maximal bicycle test.

    RESULTS: At baseline, 34% of children used passive modes of commuting (e.g., car, motorcycle, bus, train), 54% walked, and 12% bicycled to school. Six years later the percentage of bicyclists increased 19% and the percentage of walkers decreased 19%. On average, children who bicycled to school increased their fitness 13% (p=0.03) more than those who used passive modes and 20% (p=0.002) more than those who walked. Children who used passive modes or walked at baseline and bicycled to school at 6 years later increased their fitness 14% (p=0.001) more than those who remained using passive modes or walking at follow-up.

    CONCLUSIONS: Implementing initiatives that encourage bicycling to school may be a useful strategy to increase cardiorespiratory fitness of children.

  • 22.
    Danielsson-Tham, Marie-Louise
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Lura rötmånaden!1995In: SLU just nu! – Personaltidning för Sveriges lantbruksuniversitet, ISSN 1102-0954, no 5, 20-20 p.Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Tiden mellan den 22 juli och 23 augusti benämns i folkmun rötmånaden. Denna månad är känd för allehanda ruskigheter. Då föds kalvar med två huvuden, såren vill inte läka och mjölken surnar.

  • 23.
    Danielsson-Tham, Marie-Louise
    et al.
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Bannerman, Elisabeth
    Institut Pasteur, Paris, France.
    Bille, Jacques
    Lausanne, Switzerland.
    Ericsson, Henrik
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Jacquet, Christine
    Institut Pasteur, Paris, France.
    Loncarevic, Semir
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Rocourt, Jocelyne
    Institut Pasteur, Paris, France.
    Tham, Wilhelm
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Ursing, Jan
    Malmö Allmänna Sjukhus, Malmö, Sweden.
    The characterization of Swedish human Listeria monocygtogenes strains isolated 1958–19941995In: Proceedings of the XII International Symposium on Problems of Listeriosis, Canning Bridge: Promaco Conventions , 1995, 469-469 p.Conference paper (Refereed)
  • 24.
    De Bruyne, Bernard
    et al.
    Onze Lieve Vrouw Hosp, Cardiovasc Ctr Aalst, Aalst, Belgium..
    Fearon, William F.
    Stanford Univ, Med Ctr, Stanford, CA 94305 USA.;Palo Alto Vet Affairs Hlth Care Syst, Stanford, CA USA..
    Pijls, Nico H. J.
    Catharina Hosp, Dept Cardiol, Eindhoven, Netherlands.;Eindhoven Univ Technol, Dept Biomed Engn, NL-5600 MB Eindhoven, Netherlands..
    Barbato, Emanuele
    Onze Lieve Vrouw Hosp, Cardiovasc Ctr Aalst, Aalst, Belgium..
    Tonino, Pim
    Catharina Hosp, Dept Cardiol, Eindhoven, Netherlands.;Eindhoven Univ Technol, Dept Biomed Engn, NL-5600 MB Eindhoven, Netherlands..
    Piroth, Zsolt
    Hungarian Inst Cardiol, Budapest, Hungary..
    Jagic, Nikola
    Clin Ctr Kragujevac, Kragujeva, Serbia..
    Mobius-Winckler, Sven
    Heart Ctr Leipzig, Leipzig, Germany..
    Rioufol, Gilles
    Cardiovasc Hosp, Lyon, France..
    Witt, Nils
    Karolinska Inst Sodersjukhuset, Stockholm, Sweden..
    Kala, Petr
    Univ Hosp, Brno, Czech Republic..
    MacCarthy, Philip
    Kings Coll Hosp London, London SE5 8RX, England..
    Engstroem, Thomas
    Univ Copenhagen Hosp, Rigshosp, DK-2100 Copenhagen, Denmark..
    Oldroyd, Keith
    Golden Jubilee Natl Hosp, Glasgow, Lanark, Scotland..
    Mavromatis, Kreton
    Atlanta Vet Affairs Med Ctr, Decatur, GA USA..
    Manoharan, Ganesh
    Royal Victoria Hosp, Belfast BT12 6BA, Antrim, North Ireland..
    Verlee, Peter
    Eastern Maine Med Ctr, Bangor, Gwynedd, Wales..
    Fröbert, Ole
    Örebro University Hospital.
    Curzen, Nick
    Southampton Univ Hosp NHS Trust, Southampton, Hants, England..
    Johnson, Jane B.
    St Jude Med, St Paul, MN USA..
    Limacher, Andreas
    Univ Bern, Inst Social & Prevent Med, Bern, Switzerland.;Univ Bern, Dept Clin Res, Clin Trials Unit Bern, Bern, Switzerland..
    Nueesch, Eveline
    Univ Bern, Inst Social & Prevent Med, Bern, Switzerland.;Univ Bern, Dept Clin Res, Clin Trials Unit Bern, Bern, Switzerland..
    Jueni, Peter
    Univ Bern, Inst Social & Prevent Med, Bern, Switzerland.;Univ Bern, Dept Clin Res, Clin Trials Unit Bern, Bern, Switzerland..
    Fractional Flow Reserve-Guided PCI for Stable Coronary Artery Disease2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, no 13, 1208-1217 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy.

    METHODS: In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years.

    RESULTS: The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P<0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P<0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P = 0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P = 0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years.

    CONCLUSIONS: In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone.

  • 25.
    De Bruyne, Bernard
    et al.
    Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium .
    Fröbert, Ole
    Örebro University Hospital.
    Fearon, William F.
    Stanford University Medical Center, Stanford CA, USA.
    Fractional Flow Reserve-Guided PCI versus Medical Therapy in Stable Coronary Disease2012In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 367, no 11, 991-1001 p.Article in journal (Refereed)
    Abstract [en]

    Background: The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone.

    Methods: In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization.

    Results: Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary endpoint event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P<0.001). The difference was driven by a lower rate of urgent revascularization in the PCI group than in the medical-therapy group (1.6% vs. 11.1%; hazard ratio, 0.13; 95% CI, 0.06 to 0.30; P<0.001); in particular, in the PCI group, fewer urgent revascularizations were triggered by a myocardial infarction or evidence of ischemia on electrocardiography (hazard ratio, 0.13; 95% CI, 0.04 to 0.43; P<0.001). Among patients in the registry, 3.0% had a primary end-point event.

    Conclusions: In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01132495.)

  • 26.
    Elwin, Marie
    Örebro University, School of Medical Sciences.
    Description and measurement of sensory symptoms in autism spectrum2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Unusual responses to sensory stimuli have been reported in nearly all children with autism spectrum conditions (ASC). A few studies on adults indicate that the sensory and perceptual problems persist into adulthood. Sensory symptoms have not been included in the diagnostic criteria for ASC but in the new diagnostic manual (DSM-5, 2013) hyper- or hyporeactivity or unusual sensory interests were included in the diagnostic criteria for ASC. Sensory phenomena are mostly investigated in studies involving children and the scales used to measure sensory reactivity have been constructed on the basis of the scientific literature and parents’ reports. The experiences of adults with ASC are not well understood and have not been systematically used to develop measures.

    The overall aim of the thesis was to capture the first-hand experiences of and perspectives on sensory reactivity and translate them into a self-rating scale. To fulfil this overarching aim the personal sensory experiences of adults with ASC were investigated and the variations and range of atypical sensory phenomena explored and described in two qualitative studies (study I and II). The analyses of the firstperson descriptions enabled the development of items for a scale. These were reduced in steps and the final scale which was named the Sensory Reactivity in Autism Spectrum scale (SR-AS) comprised 32 items in four subscales: high awareness/ hyperreactivity, low awareness/hyporeactivity, strong sensory interests and sensory/motor. The SR-AS was validated using content and factor analyses. Its discriminative validity was then investigated as well as its reliability in the form of internal consistency (study III). In the final step the scale was used to identify clusters of atypical sensory functioning in adults with ASC by hierarchical cluster analysis (study IV). Three different sensory clusters were found.

    The main contribution of this thesis is its presentation of individual experience and perspectives and the creation of an clinical tool to measure atypical sensory reactivity frequently experienced by people with ASC. The ways in which the SR-AS can be used comprise assessment of individual sensory patterns for self-knowledge and awareness, to enable the development of coping strategies and to provide information on environmental adjustments required. In diagnostic processes where other criteria for ASC are fulfilled the SR-AS can be used for assessing sensory symptoms according to the DSM-5.

    List of papers
    1. Autobiographical Accounts of Sensing in Asperger Syndrome and High-Functioning Autism
    Open this publication in new window or tab >>Autobiographical Accounts of Sensing in Asperger Syndrome and High-Functioning Autism
    2012 (English)In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 26, no 5, 420-429 p.Article in journal (Refereed) Published
    Abstract [en]

    Sensory experiences in Asperger syndrome (AS) or high-functioning autism (HFA) were explored by qualitative content analysis of autobiographical texts by persons with AS/HFA. Predetermined categories of hyper- and hyposensitivity were applied to texts. Hypersensitivity consists of strong reactions and heightened apprehension in reaction to external stimuli, sometimes together with overfocused or unselective attention. It was common in vision, hearing, and touch. In contrast, hyposensitivity was frequent in reaction to internal and body stimuli such as interoception, proprioception, and pain. It consists of less registration, discrimination, and recognition of stimuli as well as cravings for specific stimuli. Awareness of the strong impact of sensitivity is essential for creating good environments and encounters in the context of psychiatric and other health care.

    Place, publisher, year, edition, pages
    Philadelphia, USA: Elsevier, 2012
    National Category
    Family Medicine
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-49474 (URN)10.1016/j.apnu.2011.10.003 (DOI)000309437700011 ()22999038 (PubMedID)2-s2.0-84866446577 (Scopus ID)
    Available from: 2016-03-29 Created: 2016-03-24 Last updated: 2017-11-30Bibliographically approved
    2. Too much or too little: hyper- and hypo-reactivity in high-functioning autism spectrum conditions
    Open this publication in new window or tab >>Too much or too little: hyper- and hypo-reactivity in high-functioning autism spectrum conditions
    2013 (English)In: Journal of Intellectual & Developmental Disability, ISSN 1366-8250, E-ISSN 1469-9532, Vol. 38, no 3, 232-241 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Sensory reactivity in people with autism spectrum conditions (ASC) has been found to differ in comparison to reactivity in people without ASC. In this study sensory experiences of high-functioning individuals with ASC were explored and described.

    Method: Interview data from 15 participants with a diagnosis of ASC were analysed by content analysis.

    Results: Seven aspects of sensory experiences were identified: Being hyper- and hypo-reactive, reacting to general overload, having strong stimuli preferences, managing attentiveness to stimuli, managing sensory/motor stimuli, and dealing with consequences of sensory reactions in daily life.

    Conclusions: The categorisation of sensory reactivity in this study can guide clinicians on how to pose questions about sensory issues to individuals with ASC. The assessment of spectrum-specific sensory experiences in high-functioning ASC and their association with other social and nonsocial features of ASC are goals for further research.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2013
    Keyword
    Autism spectrum disorder, sensory reactivity, qualitative research
    National Category
    Nursing
    Research subject
    Occupational therapy; Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-30899 (URN)10.3109/13668250.2013.815694 (DOI)000323729700005 ()23984882 (PubMedID)2-s2.0-84883442689 (Scopus ID)
    Available from: 2013-09-26 Created: 2013-09-20 Last updated: 2017-12-06Bibliographically approved
    3. Development and pilot validation of a sensory reactivity scale for adults with high functioning autism spectrum conditions: Sensory Reactivity in Autism Spectrum (SR-AS)
    Open this publication in new window or tab >>Development and pilot validation of a sensory reactivity scale for adults with high functioning autism spectrum conditions: Sensory Reactivity in Autism Spectrum (SR-AS)
    2016 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 2, 103-110 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Unusual reactions to sensory stimuli are experienced by 90-95% of people with an autism spectrum condition (ASC). Self-reported sensory reactivity in ASC has mainly been measured with generic questionnaires developed and validated on data from the general population. Interest in sensory reactivity in ASC increased after the inclusion of hyper- and hypo-reactivity together with unusual sensory interest as diagnostic markers of ASC in the DSM-5.

    Aims: To develop and pilot validate a self-report questionnaire designed from first-hand descriptions of the target group of adults diagnosed with high functioning ASC. Psychometric properties of the questionnaire were evaluated on a sample of participants with ASC diagnoses (N = 71) and a random sample from the general population (N = 162).

    Results: The Sensory Reactivity in Autism Spectrum (SR-AS is intended to be used as a screening tool in diagnostic processes with adults and for support in adapting compensating strategies and environmental adjustments. The internal consistency was high for both the SR-AS and its subscales. The total scale Cronbach's alpha was 0.96 and the subscales alphas were 0.80. Confirmatory factor analysis (CFA) showed best fit for a four-factor model of inter-correlated factors: hyper and hypo-reactivity, strong sensory interest and a sensory/motor factor. The questionnaire discriminated well between ASC-diagnosed participants and participants from the general population.

    Conclusions: The SR-AS displayed good internal consistency and discriminatory power and promising factorial validity.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2016
    Keyword
    Autism spectrum, Psychometric validation, Scale development, Sensory reactivity
    National Category
    Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-47286 (URN)10.3109/08039488.2015.1053984 (DOI)000366184300004 ()26158770 (PubMedID)2-s2.0-84949437448 (Scopus ID)
    Note

    Funding Agencies:

    Research Committee of Örebro County Council

    Uppsala-Örebro Regional Research Council

    Available from: 2016-01-07 Created: 2016-01-04 Last updated: 2017-12-01Bibliographically approved
    4. Sensory clusters of adults with and without autism spectrum conditions
    Open this publication in new window or tab >>Sensory clusters of adults with and without autism spectrum conditions
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Family Medicine
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-49580 (URN)
    Available from: 2016-03-29 Created: 2016-03-29 Last updated: 2017-10-17Bibliographically approved
  • 27.
    Elwin, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research centre, Örebro, Sweden.
    Ek, Lena
    Department of Psychology, Stockholm University, Sweden.
    Schröder, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research centre, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research centre, Örebro, Sweden.
    Autobiographical Accounts of Sensing in Asperger Syndrome and High-Functioning Autism2012In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 26, no 5, 420-429 p.Article in journal (Refereed)
    Abstract [en]

    Sensory experiences in Asperger syndrome (AS) or high-functioning autism (HFA) were explored by qualitative content analysis of autobiographical texts by persons with AS/HFA. Predetermined categories of hyper- and hyposensitivity were applied to texts. Hypersensitivity consists of strong reactions and heightened apprehension in reaction to external stimuli, sometimes together with overfocused or unselective attention. It was common in vision, hearing, and touch. In contrast, hyposensitivity was frequent in reaction to internal and body stimuli such as interoception, proprioception, and pain. It consists of less registration, discrimination, and recognition of stimuli as well as cravings for specific stimuli. Awareness of the strong impact of sensitivity is essential for creating good environments and encounters in the context of psychiatric and other health care.

  • 28.
    Elwin, Marie
    et al.
    Örebro University, School of Health Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences.
    Ek, Lena
    Department of Psychology, Lund University, Lund, Sweden.
    Wallsten, Tuula
    Centre for Clinical Research, Uppsala University, the County Hospital, Västerås, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences.
    Sensory clusters of adults with and without autism spectrum conditionsManuscript (preprint) (Other academic)
  • 29.
    Emilsson, Louise
    et al.
    Örebro University, School of Medicine, Örebro University, Sweden. Vårdcentralen Värmlands Nysäter, Primary Care Res Unit, Värmlands Nysäter, Värmland County, Sweden.
    James, Stefan
    Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Ludvigsson, Jonas F.
    Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics.
    Ischaemic heart disease in first-degree relatives to coeliac patients2014In: European Journal of Clinical Investigation, ISSN 0014-2972, E-ISSN 1365-2362, Vol. 44, no 4, 359-364 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Coeliac disease (CD) has been linked to an increased risk of ischaemic heart disease (IHD). We examined the risk of IHD in first-degree relatives and spouses to coeliac patients to ascertain the genetic contribution to IHD excess risk.

    Study design and setting: Coeliac disease was defined as having a biopsy-verified villous atrophy (Marsh grade 3) in 1969-2008 (n=29096). Coeliac patients were matched to 144522 controls. Through Swedish registers, we identified all first-degree relatives and spouses to coeliac patients and their controls, in total 87622 unique coeliac relatives and 432655 unique control relatives. Our main outcome measure was IHD defined according to relevant international classification of disease codes in the Swedish Inpatient Registry or in the Cause of Death Registry. Hazard ratios (HR) and confidence intervals (CI) were estimated through Cox regression adjusted for sex, age-group and calendar year at study entry of the relative.

    Result: During a median follow-up of 108 years, 2880 coeliac relatives and 13817 control relatives experienced IHD. First-degree relatives of coeliac patients were at increased risk of IHD (HR=105; 95% CI=100-109, P-value=004), while spouses were at no increased risk (HR=099; 95% CI=087-112). The excess risk of IHD in coeliac first-degree relatives aged 40-59years was 70/100000 person-years.

    Conclusion: First-degree relatives to coeliac patients seem to be at an increased risk of IHD but the excess risk is so small that it has little clinical relevance.

  • 30.
    Ericsson, Henrik
    et al.
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Danielsson-Tham, Marie-Louise
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Tham, Wilhelm
    Department of Food Hygiene, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.
    Listeria monocytogenes serovar 4b strains divided into two groups using polymerase chain reaction (PCR) and restriction enzyme analysis (REA)1995In: Proceedings of the XII Interenational Symposium on Problems of Listeriosis, Canning Bridge: Promaco Conventions , 1995, 421-421 p.Conference paper (Refereed)
  • 31.
    Fang, Fang
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Valdimarsdottir, Unnur
    Center of Public Health Sciences, University of Iceland, Reykjavík, Iceland.
    Suicide and Cardiovascular Death after a Cancer Diagnosis REPLY2012In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 367, no 3, 277-277 p.Article in journal (Refereed)
  • 32.
    Fang, Xin
    et al.
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Li, Runkui
    College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China; State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
    Kan, Haidong
    Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP 3 ), Fudan University, Shanghai, China.
    Bottai, Matteo
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology and Biostatistics.
    Bayesian model averaging method for evaluating associations between air pollution and respiratory mortality: a time-series study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 8, e011487Article in journal (Refereed)
    Abstract [en]

    Objective: To demonstrate an application of Bayesian model averaging (BMA) with generalised additive mixed models (GAMM) and provide a novel modelling technique to assess the association between inhalable coarse particles (PM10) and respiratory mortality in time-series studies.

    Design: A time-series study using regional death registry between 2009 and 2010.

    Setting: 8 districts in a large metropolitan area in Northern China.

    Participants: 9559 permanent residents of the 8 districts who died of respiratory diseases between 2009 and 2010.

    Main outcome measures: Per cent increase in daily respiratory mortality rate (MR) per interquartile range (IQR) increase of PM10 concentration and corresponding 95% confidence interval (CI) in single-pollutant and multipollutant (including NOx, CO) models.

    Results: The Bayesian model averaged GAMM (GAMM+ BMA) and the optimal GAMM of PM10, multipollutants and principal components (PCs) of multipollutants showed comparable results for the effect of PM10 on daily respiratory MR, that is, one IQR increase in PM10 concentration corresponded to 1.38% vs 1.39%, 1.81% vs 1.83% and 0.87% vs 0.88% increase, respectively, in daily respiratory MR. However, GAMM+ BMA gave slightly but noticeable wider CIs for the single-pollutant model (-1.09 to 4.28 vs -1.08 to 3.93) and the PCs-based model (-2.23 to 4.07 vs -2.03 vs 3.88). The CIs of the multiple-pollutant model from two methods are similar, that is, -1.12 to 4.85 versus -1.11 versus 4.83.

    Conclusions: The BMA method may represent a useful tool for modelling uncertainty in time-series studies when evaluating the effect of air pollution on fatal health outcomes.

  • 33.
    Fazel, Seena
    et al.
    Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
    Zetterqvist, Johan
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Antipsychotics, mood stabilisers, and risk of violent crime2014In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 384, no 9949, 1206-1214 p.Article in journal (Refereed)
    Abstract [en]

    Background: Antipsychotics and mood stabilisers are prescribed widely to patients with psychiatric disorders worldwide. Despite clear evidence for their efficacy in relapse prevention and symptom relief, their effect on some adverse outcomes, including the perpetration of violent crime, is unclear. We aimed to establish the effect of antipsychotics and mood stabilisers on the rate of violent crime committed by patients with psychiatric disorders in Sweden.

    Methods: We used linked Swedish national registers to study 82,647 patients who were prescribed antipsychotics or mood stabilisers, their psychiatric diagnoses, and subsequent criminal convictions in 2006-09. We did within-individual analyses to compare the rate of violent criminality during the time that patients were prescribed these medications versus the rate for the same patients while they were not receiving the drugs to adjust for all confounders that remained constant within each participant during follow-up. The primary outcome was the occurrence of violent crime, according to Sweden's national crime register.

    Findings: In 2006-09, 40,937 men in Sweden were prescribed antipsychotics or mood stabilisers, of whom 2657 (6·5%) were convicted of a violent crime during the study period. In the same period, 41,710 women were prescribed these drugs, of whom 604 (1·4 %) had convictions for violent crime. Compared with periods when participants were not on medication, violent crime fell by 45% in patients receiving antipsychotics (hazard ratio [HR] 0·55, 95% CI 0·47-0·64) and by 24% in patients prescribed mood stabilisers (0·76, 0·62-0·93). However, we identified potentially important differences by diagnosis-mood stabilisers were associated with a reduced rate of violent crime only in patients with bipolar disorder. The rate of violence reduction for antipsychotics remained between 22% and 29% in sensitivity analyses that used different outcomes (any crime, drug-related crime, less severe crime, and violent arrest), and was stronger in patients who were prescribed higher drug doses than in those prescribed low doses. Notable reductions in violent crime were also recorded for depot medication (HR adjusted for concomitant oral medications 0·60, 95% CI 0·39-0·92).

    Interpretation: In addition to relapse prevention and psychiatric symptom relief, the benefits of antipsychotics and mood stabilisers might also include reductions in the rates of violent crime. The potential effects of these drugs on violence and crime should be taken into account when treatment options for patients with psychiatric disorders are being considered.

    Funding: The Wellcome Trust, the Swedish Prison and Probation Service, the Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare.

  • 34.
    Fengsrud, Espen
    Örebro University, School of Medical Sciences.
    Atrial fibrillation: endoscopic ablation and postoperative studies2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke, heart failure and cardiovascular death. Initial treatment focuses on rhythm or rate control and anticoagulation after risk assessment. Catheter abla-tion (CA) is an option in highly symptomatic patients but is less effective in long-standing persistent AF(LSPAF). Total endoscopic ablation is an alternative, but its clinical role needs further evaluation. In patients undergoing aortocoronary bypass graft (CABG) surgery, up to 9 % present with preoperative AF. One-third experience postoperative AF, which is associated with increased hospital stay, risk of stroke and decreased long-term survival. The long-term effects on heart rhythm have not been studied.

    Methods and Results: 571 patients undergoing CABG from 1999 to 2000 were followed for six years. Postoperative AF was the strongest independent risk factor for late AF and an age-independent risk factor for late mortality. 615 pa-tients from the same cohort, including patients with preoperative AF, were fol-lowed up at 15 years. Death due to cerebral ischaemia, heart failure and sudden death were most common in the pre- and postoperative AF groups. The presence of pre- or postoperative AF was an independent risk factor for late mortality.

    In our first ten patients, total endoscopic ablation of AF using a right-sided unilateral approach was feasible and safe with acceptable results. 36 patients with symptomatic LSPAF were then randomized to total endoscopic ablation or rate control. Loop recorders were implanted in all patients. In the control group, all patients were in permanent AF for 12 months. In the ablation group, 12/15 patients (80%) were in SR without antiarrhythmic drugs at 12 months. Median freedom of AF at 3–12 months was 95%, and 8/15 (53%) had an AF burden of < 5%. Myocardial function, physical working capacity(PWC) and subjective physical and mental health improved.

    Conclusions: Postoperative AF patients have an eightfold increased risk of future AF and a doubled long-term cardiovascular mortality. Both pre- or post-operative AF in CABG patients is a major risk factor for late cardiovascular morbidity and mortality. Total endoscopic ablation of AF is feasible and safe. In patients with LSPAF, it significantly reduced AF burden at 12 months compared with controls. Myocardial function, PWC and subjective physical and mental health improved.

    List of papers
    1. Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality
    Open this publication in new window or tab >>Postoperative atrial fibrillation in patients undergoing aortocoronary bypass surgery carries an eightfold risk of future atrial fibrillation and a doubled cardiovascular mortality
    2010 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 37, no 6, 1353-1359 p.Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: This article presents a study of postoperative atrial fibrillation (AF) and its long-term effects on mortality and heart rhythm.

    METHODS: The study cohort consisted of 571 patients with no history of AF who underwent primary aortocoronary bypass surgery from 1999 to 2000. Postoperative AF occurred in 165/571 patients (28.9%). After a median follow-up of 6 years, questionnaires were obtained from 91.6% of surviving patients and an electrocardiogram (ECG) from 88.6% of all patients. Data from hospitalisations due to arrhythmia or stroke during follow-up were analysed. The causes of death were obtained for deceased patients.

    RESULTS: In postoperative AF patients, 25.4% had atrial fibrillation at follow-up compared with 3.6% of patients with no AF at surgery (p<0.001). An episode of postoperative AF was the strongest independent risk factor for development of late AF, with an adjusted risk ratio of 8.31 (95% confidence interval (CI) 4.20-16.43). Mortality was 29.7% (49 deaths/165 patients) in the AF group and 14.8% (60 deaths/406 patients) in the non-AF group (p<0.001). Death due to cerebral ischaemia was more common in the postoperative AF group (4.2% vs 0.2%, p<0.001), as was death due to myocardial infarction (6.7% vs 3.0%, p=0.041). Postoperative AF was an age-independent risk factor for late mortality, with an adjusted hazard ratio of 1.57 (95% CI 1.05-2.34).

    CONCLUSIONS: Postoperative AF patients have an eightfold increased risk of developing AF in the future, and a doubled long-term cardiovascular mortality.

    Keyword
    Atrial fibrillation; Bypass; Surgery; Follow-up studies; Survival
    National Category
    Cardiac and Cardiovascular Systems
    Research subject
    Cardiology
    Identifiers
    urn:nbn:se:oru:diva-35559 (URN)10.1016/j.ejcts.2009.12.033 (DOI)000279086500020 ()20138531 (PubMedID)2-s2.0-77952584268 (Scopus ID)
    Available from: 2014-06-27 Created: 2014-06-27 Last updated: 2017-12-12Bibliographically approved
    2. Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact
    Open this publication in new window or tab >>Pre- and postoperative atrial fibrillation in CABG patients have similar prognostic impact
    2017 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 51, no 1, 21-27 p.Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To study pre- and postoperative atrial fibrillation and its long-term effects in a cohort of aortocoronary bypass surgery patients.

    Design: Altogether 615 patients undergoing aortocoronary bypass graft surgery in 1999-2000 were studied. Forty-four (7%) had preoperative atrial fibrillation. Postoperative atrial fibrillation occurred in 165/615 patients (27%) while 406/615 patients (66%) had no atrial fibrillation. After a median follow-up of 15 years, symptoms and medication in survivors were recorded, and cause of death in the deceased was obtained.

    Results: Death due to cerebral ischaemia was most common in the pre- and postoperative atrial fibrillation groups (7% and 5%, respectively, v. 2% among those without atrial fibrillation, p = 0.038), as were death due to heart failure (18% and 14%, v. 7%, p = 0.007) and sudden death (9% and 5%, v. 2%, p = 0.029). The presence of pre- or postoperative atrial fibrillation was an independent risk factor for late mortality (hazard ratios 1.47 (1.02-2.12) and 1.28 (1.01-1.63), respectively).

    Conclusions: Patients with pre- or postoperative atrial fibrillation undergoing aortocoronary bypass surgery have increased long-term mortality and risk of cerebral ischemic and cardiovascular death compared with patients in sinus rhythm.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2017
    Keyword
    Atrial fibrillation, bypass surgery, cerebral ischaemia, anticoagulation, survival
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:oru:diva-52180 (URN)10.1080/14017431.2016.1234065 (DOI)000392468400004 ()27615545 (PubMedID)2-s2.0-84988640946 (Scopus ID)
    Note

    Funding Agency:

    Research Committee, Orebro University Hospital  136/04

    Available from: 2016-09-21 Created: 2016-09-14 Last updated: 2017-12-12Bibliographically approved
    3. Total endoscopic ablation of atrial fibrillation
    Open this publication in new window or tab >>Total endoscopic ablation of atrial fibrillation
    2015 (English)In: Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery, ISSN 1813-9175Article in journal (Refereed) Published
    Abstract [en]

    Total endoscopic ablation of atrial fibrillation is a treatment option in symptomatic patients after unsuccessful catheter ablation or when catheter ablation is considered inappropriate. We describe a technique of endoscopic ablation of the left atrium using temperature-controlled unipolar or bipolar radiofrequency. A left atrial box lesion encircling the pulmonary veins is created using three ports in the right hemithorax. The technical aspects and preliminary results of the procedure are discussed.

    Place, publisher, year, edition, pages
    Oxford University Press, 2015
    Keyword
    Ablation; Atrial fibrillation; Endoscopy; Radiofrequency energy
    National Category
    Surgery
    Research subject
    Surgery esp. Thoracic and Cardivascular Surgery
    Identifiers
    urn:nbn:se:oru:diva-50201 (URN)10.1093/mmcts/mmv010 (DOI)26079408 (PubMedID)2-s2.0-84944929578 (Scopus ID)
    Available from: 2016-07-04 Created: 2016-05-04 Last updated: 2017-12-12Bibliographically approved
    4. Total endoscopic ablation of patients with long-standing persistent atrial fibrillation: a randomized controlled study
    Open this publication in new window or tab >>Total endoscopic ablation of patients with long-standing persistent atrial fibrillation: a randomized controlled study
    Show others...
    2016 (English)In: Interactive Cardiovascular and Thoracic Surgery, ISSN 1569-9293, E-ISSN 1569-9285, Vol. 23, no 2, 292-298 p.Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Total endoscopic ablation of atrial fibrillation is an alternative to catheter ablation, but its clinical role needs further evaluation. The aim of this study was to compare total endoscopic ablation with rate control in patients with long-standing persistent atrial fibrillation and to examine the effect of endoscopic ablation on heart rhythm, symptoms, physical working capacity and myocardial function during 1 year of follow-up.

    Methods: In a prospective controlled study, 36 patients aged >50 years with symptomatic long-standing persistent atrial fibrillation were randomized to either total endoscopic ablation (n = 17, after two drop-outs before ablation n = 15) or rate control therapy (n = 19). In the ablation group, a box lesion encircling the pulmonary veins was performed, using temperature-controlled radiofrequency energy. Loop recorders were implanted in all patients. Echocardiography and quality-of-life assessment were performed at 6 and 12 months, and physical working capacity assessment at 6 months.

    Results: There was no mortality or thromboembolic event. In the control group, all patients were in permanent atrial fibrillation during 12 months of follow-up. In the ablation group, the proportion of patients in sinus rhythm without antiarrhythmic drugs was 12/15 (80%) at 12 months. The median freedom of atrial fibrillation at 3-12 months was 95% in the ablation group and the proportion of patients with an atrial fibrillation burden of <5% at 3-12 months was 8/15 (53%). The left ventricular ejection fraction increased during follow-up in the ablation group compared with the control group (from 53.7 ± 8.6 to 58.8 ± 6.5%, P = 0.003), combined with a reduction in the left atrial area (from 29.2 ± 5.5 to 27.2 ± 6.3 cm(2), P = 0.002). The physical working capacity increased in the ablation group compared with the control group (from 94 ± 21.4 to 102.9 ± 14.4%, P = 0.011). The subjective physical and mental capacity scale also improved during follow-up in the ablation group, but not in the control group (P =0.003 and 0.018, respectively).

    Conclusions: Total endoscopic ablation in patients with long-standing persistent atrial fibrillation significantly reduced atrial fibrillation burden 12 months after intervention compared with controls. The left ventricular function, physical working capacity and subjective physical and mental health were improved. These results need to be confirmed in larger randomized trials.

    Place, publisher, year, edition, pages
    Oxford, United Kingdom: Oxford University Press, 2016
    Keyword
    Atrial fibrillation, ablation, endoscopy, randomized trial, implantable loop recorder
    National Category
    Surgery Cardiac and Cardiovascular Systems
    Research subject
    Surgery esp. Thoracic and Cardivascular Surgery; Cardiology
    Identifiers
    urn:nbn:se:oru:diva-50200 (URN)10.1093/icvts/ivw088 (DOI)000383248800021 ()27068249 (PubMedID)2-s2.0-84981165123 (Scopus ID)
    Note

    Funding Agency:

    Research Committee of Örebro University Hospital

    Available from: 2016-07-04 Created: 2016-05-04 Last updated: 2017-12-12Bibliographically approved
  • 35.
    Fröbert, Ole
    et al.
    Örebro University Hospital.
    James, Stefan K.
    Uppsala Univ, Uppsala, Sweden.
    Thrombus Aspiration during Myocardial Infarction REPLY2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 370, no 7, 675-676 p.Article in journal (Refereed)
  • 36.
    Geijer, Håkan
    et al.
    Örebro University, School of Health Sciences. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Sweden; Department of Radiology.
    Udumyan, Ruzan
    Örebro University, School of Health Sciences. Department of Clinical Epidemiology and Biostatistics.
    Lohse, Georg
    Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Sweden; Örebro Rehab Center, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Sweden; Department of Medicine.
    Temperature measurements with a temporal scanner: systematic review and meta-analysis2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 3, e009509Article in journal (Refereed)
    Abstract [en]

    Objectives: Systematic review and meta-analysis on the diagnostic accuracy of temporal artery thermometers (TAT).

    Design: Systematic review and meta-analysis. The index test consisted of temperature measurement with TAT. The reference test consisted of an estimation of core temperature.

    Participants: Clinical patients as well as healthy participants, with or without fever.

    Interventions: Literature search in PubMed, Embase, Cinahl and Web of Science. Three reviewers selected articles for full-text reading after which a further selection was made. Risk of bias was assessed with QUADAS-2. Pooled difference and limits of agreement (LoA) were estimated with an inverse variance weighted approach. Subgroup and sensitivity analyses were performed. Sensitivity and specificity were estimated using hierarchical models. Quality of evidence was assessed according to the GRADE system.

    Primary and secondary outcome measures: The primary outcome was measurement accuracy expressed as mean difference ±95% LoA. A secondary outcome was sensitivity and specificity to detect fever. If tympanic thermometers were assessed in the same population as TAT, these results were recorded as well.

    Results: 37 articles comprising 5026 participants were selected. Pooled difference was -0.19°C (95% LoA -1.16 to 0.77°C), with moderate quality of evidence. Pooled sensitivity was 0.72 (95% CI 0.61 to 0.81) with a specificity of 0.94 (95% CI 0.87 to 0.97). The subgroup analysis revealed a trend towards underestimation of the temperature for febrile patients. There was a large heterogeneity among included studies with wide LoA which reduced the quality of evidence.

    Conclusions: TAT is not sufficiently accurate to replace one of the reference methods such as rectal, bladder or more invasive temperature measurement methods. The results are, however, similar to those with tympanic thermometers, both in our meta-analysis and when compared with others. Thus, it seems that TAT could replace tympanic thermometers with the caveat that both methods are inaccurate.

    Trial registration number: CRD42014008832.

  • 37.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Theander, Kersti
    Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden.
    Adherence to guidelines in patients with chronic heart failure in primary health care2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, 336-343 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care.

    DESIGN: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire.

    SETTING: Three primary health care centres in Sweden.

    SUBJECTS: Patients with a CHF diagnosis registered in their medical record.

    MAIN OUTCOME MEASURES: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9).

    RESULTS: The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour.

    CONCLUSION: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.

  • 38.
    Golparian, Daniel
    et al.
    Orebro Univ Hosp, WHO Collaborating Ctr Gonorrhoea & Other Sexually, Natl Reference Lab Pathogen Neisseria, Dept Lab Med,Clin Microbiol, Orebro, Sweden..
    Unemo, Magnus
    Örebro University Hospital. WHO Collaborating Ctr Gonorrhoea & Other Sexually, Natl Reference Lab Pathogen Neisseria, Dept Lab Med,Clin Microbiol.
    Will Genome Analysis Elucidate Evolution, Global Transmission and Virulence of Neisseria Meningitidis Lineages?2015In: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 2, no 3, 186-187 p.Article in journal (Refereed)
  • 39.
    Götberg, Matthias
    et al.
    Lund University, Lund, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences.
    Instantaneous Wave-free Ratio versus Fractional Flow Reserve: Reply2017In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 377, no 16, 1596-1597 p.Article in journal (Refereed)
  • 40.
    Hammar, Per
    et al.
    Västmanland County Hospital Västerås, Department of Radiology, Västerås, Sweden; Uppsala University, Department of Radiology, Oncology & Radiation Science, Uppsala, Sweden.
    Nordenskjöld, Anna M.
    Örebro University Hospital. Department of Cardiology.
    Lindahl, Bertil
    Uppsala Clinical Research Centre, Uppsala, Sweden; Uppsala University, Departmentof Medical Sciences, Cardiology, Uppsala, Sweden.
    Duvernoy, Olov
    Uppsala University, Department of Radiology, Oncology & Radiation Science, Uppsala, Sweden.
    Ahlstrom, Håkan
    Uppsala University, Department of Radiology, Oncology & Radiation Science, Uppsala, Sweden.
    Johansson, Lars
    Astra Zeneca, Mölndal, Sweden..
    Hadziosmanovic, Nermin
    Uppsala Clinical Research Centre, Uppsala, Sweden.
    Bjerner, Tomas
    Uppsala University, Department of Radiology, Oncology & Radiation Science, Uppsala, Sweden.
    Unrecognized myocardial infarctions assessed by cardiovascular magnetic resonance are associated with the severity of the stenosis in the supplying coronary artery2015In: Journal of Cardiovascular Magnetic Resonance, ISSN 1097-6647, E-ISSN 1532-429X, Vol. 17, 98Article in journal (Refereed)
    Abstract [en]

    Background: A previous study has shown an increased prevalence of late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) detected unrecognized myocardial infarction (UMI) with increasing extent and severity of coronary artery disease. However, the coronary artery disease was evaluated on a patient level assuming normal coronary anatomy. Therefore, the aims of the present study were to investigate the prevalence of UMI identified by LGE CMR imaging in patients with stable angina pectoris and no known previous myocardial infarction; and to investigate whether presence of UMI is associated with stenotic lesions in the coronary artery supplying the segment of the myocardium in which the UMI is located, using coronary angiography to determine the individual coronary anatomy in each patient.

    Methods: In this prospective multicenter study, we included patients with stable angina pectoris and without prior myocardial infarction, scheduled for coronary angiography. A LGE CMR examination was performed prior to the coronary angiography. The study cohort consisted of 235 patients (80 women, 155 men) with a mean age of 64.8 years.

    Results: UMIs were found in 25 % of patients. There was a strong association between stenotic lesions (>= 70 % stenosis) in a coronary artery and the presence of an UMI in the myocardial segments supplied by the stenotic artery; it was significantly more likely to have an UMI downstream a stenosis >= 70 % as compared to <70 % (OR 5.1, CI 3.1-8.3, p < 0.0001). 56 % of the UMIs were located in the inferior and infero-lateral myocardial segments, despite predominance for stenotic lesions in the left anterior descending artery.

    Conclusion: UMI is common in patients with stable angina and the results indicate that the majority of the UMIs are of ischemic origin due to severe coronary atherosclerosis. In contrast to what is seen in recognized myocardial infarctions, UMIs are predominately located in the inferior and infero-lateral myocardial segments.

  • 41.
    Hasselgren, Mikael
    et al.
    Centre for Public Health Research, University of Karlstad, Sweden.
    Arne, M
    Centre for Public Health Research, University of Karlstad, Sweden.
    Lindahl, A
    Centre for Public Health Research, University of Karlstad, Sweden.
    Janson, S
    Centre for Public Health Research, University of Karlstad, Sweden.
    Lundbäck, B
    Respiratory Epidemiology Unit, Department of Occupational Medicine, National Institute for Working Life, Umeå and Solna, Sweden.
    Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 1, 54-57 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the prevalence of respiratory symptoms, asthma and chronic obstructive pulmonary disease (COPD), and to relate it to an estimated detection rate in primary health care.

    DESIGN: A two-staged study with a cross-sectional survey and a clinical validation.

    SETTING: The adult population of Värmland, a county in Sweden.

    SUBJECTS: 4814 persons completed the survey and 206 the confirmative validation study.

    MAIN OUTCOME MEASURES: Prevalence of respiratory symptoms, of asthma and COPD.

    RESULTS: More than 40% reported respiratory symptoms. Wheeze was reported by 8.0%, shortness of breath by 11.4% and sputum production by 14.1%. Smoking was more common among women than among men. The prevalence of asthma was 8.2% and COPD 2.1%. Of persons with asthma, 33% were estimated to be undiagnosed, 67% used medication and nearly 60% attended primary health care services.

    CONCLUSION: Respiratory symptoms as well as asthma were common in this study and equivalent to earlier findings. The difference between the epidemiologically estimated prevalence of asthma and the lower detection rate in primary health care can be explained by at least three factors: persons who did not seek any care, were underdiagnosed or attended other health care providers.

  • 42.
    Hay, Simon I.
    et al.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle WA, USA; Oxford Big Data Inst, Li Ka Shing Ctr Hlth Informat & Discovery, Oxford University, Oxford, England.
    Dalal, Koustuv
    Örebro University, School of Health Sciences.
    Murray, Christopher J. L.
    Univ Washington, Inst Hlth Metr & Evaluat, Seattle WA, USA.
    GBD 2016 DALYs, Group author
    HALE Collaborators, Group author
    Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 20162017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 390, no 10100, 1260-1344 p.Article in journal (Refereed)
    Abstract [en]

    Background: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI).

    Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate.

    Findings: The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally.

    Interpretation: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support.

  • 43.
    Humble, Mats B.
    Örebro University, School of Medical Sciences.
    Obsessive-compulsive disorder, serotonin and oxytocin: treatment response and side effects2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved.

    Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD.

    In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses.

    Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system.

    In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.

    List of papers
    1. The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders
    Open this publication in new window or tab >>The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders
    Show others...
    2014 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, 549-559 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive-compulsive symptoms and diagnosis of obsessive-compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date.

    Aim: The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population.

    Method: The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category "Obsessive-compulsive related disorders", accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive-compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS.

    Results: Principal component factor analysis produced five subscales titled "Symmetry", "Forbidden thoughts", "Contamination", "Magical thoughts" and "Dysmorphic thoughts". The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62-70% Cronbach's alpha = 0.81; Severity Scale: sensitivity = 72%, specificities = 75-84%, Cronbach's alpha = 0.94).

    Conclusions: The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive-compulsive symptoms in clinical psychiatry.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2014
    Keyword
    Attention deficit hyperactivity disorder, Autism, Assessment, Compulsive behaviour, Obsessions
    National Category
    Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-39459 (URN)10.3109/08039488.2014.884631 (DOI)000343980600005 ()24568661 (PubMedID)
    Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2017-12-05Bibliographically approved
    2. Reactivity of serotonin in whole blood: relationship with drug response in obsessive-compulsive disorder
    Open this publication in new window or tab >>Reactivity of serotonin in whole blood: relationship with drug response in obsessive-compulsive disorder
    2001 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 49, no 4, 360-368 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Obsessive-compulsive disorder responds almost only to potent serotonin reuptake inhibitors. Previous studies have suggested a relation between serotonergic function and clinical outcome in serotonin reuptake inhibitor treatment of obsessive-compulsive disorder.

    Methods: In a randomized, double-blind trial, comparing clomipramine, paroxetine, and a placebo in obsessive-compulsive disorder, serotonin levels in whole blood (WB-5-HT) were measured at baseline, after 1 week, and after 4 weeks of treatment and related to clinical outcome in 36 patients.

    Results: In patients treated with serotonin reuptake inhibitors there was a pronounced decrease of WB-5-HT, variable after 1 week and uniformly maximal after 4 weeks. The decrease of WB-5-HT after 1 week of serotonin reuptake inhibitor treatment correlated negatively with clinical outcome after 12 weeks (r = -.61, p =.0006); hence, patients with slower WB-5-HT reactivity eventually responded better to treatment. Baseline WB-5-HT, but not WB-5-HT reactivity, was related to season. Depression, autistic traits, and previous serotonin reuptake inhibitor treatment predicted nonresponse.

    Conclusions: A fast decrease of WB-5-HT was associated with poor clinical outcome. This may be related to faster serotonin efflux from platelets, which has previously been linked to autism. Further studies are necessary to identify the underlying mechanism and discern whether serotonin reuptake inhibitor-induced WB-5-HT decrease is clinically useful.

    Place, publisher, year, edition, pages
    New York, USA: Elsevier, 2001
    Keyword
    Obsessive-compulsive disorder, serotonin, kinetics, serotonin reuptake inhibitors, autism, prediction of response, randomized controlled trial
    National Category
    Medical and Health Sciences Psychiatry Neurology
    Identifiers
    urn:nbn:se:oru:diva-50184 (URN)10.1016/S0006-3223(00)00956-2 (DOI)000167183100007 ()11239907 (PubMedID)2-s2.0-0035865647 (Scopus ID)
    Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2017-11-30Bibliographically approved
    3. Reactivity of serotonin in whole blood: response to Mulder et al.
    Open this publication in new window or tab >>Reactivity of serotonin in whole blood: response to Mulder et al.
    2002 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 51, no 3, 267-268 p.Article in journal, Letter (Other academic) Published
    Place, publisher, year, edition, pages
    Elsevier, 2002
    National Category
    Psychiatry Neurosciences
    Identifiers
    urn:nbn:se:oru:diva-51955 (URN)10.1016/S0006-3223(01)01316-6 (DOI)000173811000011 ()
    Available from: 2016-09-05 Created: 2016-09-05 Last updated: 2017-11-21Bibliographically approved
    4. Plasma oxytocin changes and anti-obsessive response during serotonin reuptake inhibitor treatment: a placebo controlled study
    Open this publication in new window or tab >>Plasma oxytocin changes and anti-obsessive response during serotonin reuptake inhibitor treatment: a placebo controlled study
    2013 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 13, 344- p.Article in journal (Refereed) Published
    Abstract [en]

    Background: The drug treatments of choice for obsessive-compulsive disorder (OCD) are serotonin reuptake inhibitors (SRIs). However, a correlation between the neuropeptide oxytocin in cerebrospinal fluid and the severity of OCD has previously been shown, and oxytocin and serotonin are interconnected within the brain. Few studies have investigated whether SRIs have any effect on oxytocin; thus, our aim was to explore the possibility that oxytocinergic mechanisms contribute to the anti-obsessive effect of SRIs.

    Method: In a randomized, double-blind trial, comparing SRIs (clomipramine and paroxetine) with placebo in 36 adults with OCD (characterized for subtypes), plasma oxytocin was measured with radioimmunoassay after plasma extraction, at baseline, after 1 week, and after 4 weeks of treatment, and related to baseline severity and clinical response after 12 weeks, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

    Results: Baseline oxytocin levels correlated positively with baseline Y-BOCS ratings, but only among the future SRI responders. Patients with early onset of OCD had higher baseline oxytocin. During treatment, plasma oxytocin did not differ between SRI and placebo treatment. In SRI responders, plasma oxytocin first decreased and then increased; in non-responders (to SRI as well as to placebo), the reverse was the case. After 4 weeks, treatment responders had attained higher oxytocin levels compared to non-responders. The intra-individual range (i.e. the variability) of plasma oxytocin between measurements was the measure that best differentiated responders from non-responders. This range was higher in responders than non-responders, and lower in patients with autistic traits.

    Conclusions: SRIs have highly variable effects on plasma oxytocin between individuals. The associations between baseline oxytocin and OCD severity and between oxytocin changes and treatment response support the notions that oxytocin is involved in OCD pathophysiology, and that the anti-obsessive effects of SRIs are partly exerted through oxytocinergic mechanisms.

    Keyword
    Obsessive-compulsive disorder, Oxytocin/plasma, Serotonin, Serotonin uptake inhibitors, Treatment response, Randomized controlled trial, Autism spectrum disorder, Placebo response
    National Category
    Medical and Health Sciences Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-33285 (URN)10.1186/1471-244X-13-344 (DOI)000329160000001 ()24359174 (PubMedID)2-s2.0-84890670310 (Scopus ID)
    Funder
    Swedish Research Council, 2011-3646
    Note

    Funding Agency: Örebro County Council; Örebro University (se även Forskningsfinansiär)

    Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2017-12-06Bibliographically approved
    5. Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial
    Open this publication in new window or tab >>Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial
    2016 (English)In: Sexual medicine, ISSN 2050-1161, Vol. 4, no 3, e145-e155 p.Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Serotonin reuptake inhibitors (SRIs) are widely used for the treatment of psychiatric disorders, including obsessive-compulsive disorder (OCD). SRIs commonly cause delayed orgasm, the mechanism of which is poorly understood. Oxytocin is involved in sexual function and is interconnected with serotonin within the brain. SRIs are reported to affect the oxytocin system, but possible relations between SRI-induced changes of sexual function and oxytocin are unexplored in humans. In a randomized, double-blinded, placebo-controlled trial of OCD, the anti-obsessive efficacy and adverse events of SRIs and oxytocin measurements were studied.

    Aims: To identify possible correlates between oxytocin levels and sexual function; find out whether sexual side effects correlate with levels of oxytocin and/or paroxetine and clomipramine; and test whether changes in sexual functioning are related to an anti-obsessive response.

    Methods Reported sexual function and oxytocin plasma levels at rest were studied in 31 adults (15 men and 16 women) with OCD who participated in a randomized, double-blinded trial comparing the SRIs clomipramine and paroxetine with placebo. Sexual adverse effects were quantified by a clinician-administered semistructured interview. Anti-obsessive response was based on the Yale-Brown Obsessive-Compulsive Scale.

    Main outcome measures: Ratings on the Sexual Symptom Checklist, plasma oxytocin, serum paroxetine and clomipramine levels, and Yale-Brown Obsessive-Compulsive Scale scores.

    RESULTS: Baseline oxytocin levels were positively correlated with baseline OCD severity, but not with sexual functioning. Impaired orgasm at week 6 was reported by 73% of SRI-treated and 20% of placebo-treated patients (P = .03). Impaired orgasm was related to higher oxytocin levels after 4 weeks of SRI treatment (P < .01) but not to SRI concentrations. In men, an association between impaired orgasm and anti-obsessive treatment response was found (P = .028).

    CONCLUSION: This pilot study suggests that some collateral effects of SRIs, particularly delayed orgasm, might be influenced by changes within the oxytocinergic system and are related to anti-obsessive mechanisms. Early-onset delayed orgasm in SRI-treated patients could serve as a predictor for OCD treatment response.

    Place, publisher, year, edition, pages
    Oxford, United Kingdom: Elsevier, 2016
    Keyword
    Obsessive-Compulsive Disorder; Oxytocin/Plasma; Serotonin; Clomipramine; Paroxetine; Serotonin Uptake Inhibitors; Response Prediction; Adverse Effects; Randomized Controlled Trial; Sexual Physiology
    National Category
    Psychiatry Family Medicine
    Identifiers
    urn:nbn:se:oru:diva-50976 (URN)10.1016/j.esxm.2016.04.002 (DOI)000389259700003 ()27320409 (PubMedID)2-s2.0-85006216627 (Scopus ID)
    Available from: 2016-06-21 Created: 2016-06-21 Last updated: 2017-10-18Bibliographically approved
  • 44.
    Humble, Mats B.
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Örebro, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences. University Health Care Research Center, Örebro, Sweden.
    Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial2016In: Sexual medicine, ISSN 2050-1161, Vol. 4, no 3, e145-e155 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: Serotonin reuptake inhibitors (SRIs) are widely used for the treatment of psychiatric disorders, including obsessive-compulsive disorder (OCD). SRIs commonly cause delayed orgasm, the mechanism of which is poorly understood. Oxytocin is involved in sexual function and is interconnected with serotonin within the brain. SRIs are reported to affect the oxytocin system, but possible relations between SRI-induced changes of sexual function and oxytocin are unexplored in humans. In a randomized, double-blinded, placebo-controlled trial of OCD, the anti-obsessive efficacy and adverse events of SRIs and oxytocin measurements were studied.

    Aims: To identify possible correlates between oxytocin levels and sexual function; find out whether sexual side effects correlate with levels of oxytocin and/or paroxetine and clomipramine; and test whether changes in sexual functioning are related to an anti-obsessive response.

    Methods Reported sexual function and oxytocin plasma levels at rest were studied in 31 adults (15 men and 16 women) with OCD who participated in a randomized, double-blinded trial comparing the SRIs clomipramine and paroxetine with placebo. Sexual adverse effects were quantified by a clinician-administered semistructured interview. Anti-obsessive response was based on the Yale-Brown Obsessive-Compulsive Scale.

    Main outcome measures: Ratings on the Sexual Symptom Checklist, plasma oxytocin, serum paroxetine and clomipramine levels, and Yale-Brown Obsessive-Compulsive Scale scores.

    RESULTS: Baseline oxytocin levels were positively correlated with baseline OCD severity, but not with sexual functioning. Impaired orgasm at week 6 was reported by 73% of SRI-treated and 20% of placebo-treated patients (P = .03). Impaired orgasm was related to higher oxytocin levels after 4 weeks of SRI treatment (P < .01) but not to SRI concentrations. In men, an association between impaired orgasm and anti-obsessive treatment response was found (P = .028).

    CONCLUSION: This pilot study suggests that some collateral effects of SRIs, particularly delayed orgasm, might be influenced by changes within the oxytocinergic system and are related to anti-obsessive mechanisms. Early-onset delayed orgasm in SRI-treated patients could serve as a predictor for OCD treatment response.

  • 45.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Impact of changing positively worded items to negatively worded items in the Swedish web‐version of the Quality of Recovery (SwQoR) questionnaire2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 3, 502-507 p.Article in journal (Refereed)
    Abstract [en]

    Rationale, aims, and objectives: The Swedish web-version of the Quality of Recovery questionnaire is used to evaluate a person's postoperative recovery after anesthesia and surgery. An earlier study found an increased risk of answering incorrectly when the questionnaire included both positive and negative items. Therefore, this study investigated the effect of changing positively worded items to negatively worded items.

    Methods: This was a cross-sectional study including 90 second-year nursing students. Seven pairs of positively and negatively worded items were evaluated for differences in response as well as agreement between the items.

    Results: Two pairs of items showed higher mean values if the item was negatively worded. Between-item agreement for positively worded item scores and their corresponding reverse-coded negatively worded item scores was poor-to-moderate (intraclass correlation coefficient: 0.35-0.76). A moderate agreement was found when testing all positively worded items against the recoded negatively worded items (intraclass correlation coefficient: 0.65). Internal consistency was 0.86 for the positively worded items and 0.76 for the negatively worded items.

    Conclusions: Changing from positive to negative wording produced some differences in Swedish web-version of the Quality of Recovery item scores. Internal consistency was acceptable, but 2 items (not having a general feeling of well-being and not speaking normally) need further refinement.

  • 46.
    Jarl, Gustav
    et al.
    Örebro University, School of Medical Sciences. Department of Prosthetics and Orthotics; University Health Care Research Center.
    Lundqvist, Lars-Olov
    Örebro University, School of Law, Psychology and Social Work. University Health Care Research Center.
    Adherence to wearing therapeutic shoes among people with diabetes: a systematic review and reflections2016In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 10, 1521-1528 p.Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Therapeutic shoes are prescribed to prevent diabetic foot ulcers, but adherence to wearing the shoes is often poor.

    Aim: The aim of this study was to review the literature on factors that are associated with adherence to wearing therapeutic shoes and construct a model of adherence to aid future research and development in the field.

    Methods: We conducted a systematic search in PubMed, CINAHL, and PsycINFO for quantitative studies on factors associated with adherence to wearing therapeutic shoes among people with diabetes.

    Results: Six studies were included in the review. The studies focused mainly on patient-, therapy-, and condition-related adherence factors. There is some evidence (three to five studies) that sex, diabetes duration, and ulcer history are not associated with adherence. The evidence for or against the other factors was weak (only one or two studies) or conflicting.

    Conclusion: There is no conclusive evidence for using any factor to predict adherence to wearing therapeutic shoes, but there is some evidence against using certain factors for predicting adherence. Future studies should include a broader range of factors, including health system and social/economic factors, and they should investigate perceived costs and benefits of wearing therapeutic shoes in comparison with other shoes or no shoes. A seesaw model is presented illustrating the complex phenomenon of adherence. Further research is needed to identify factors associated with adherence to wearing therapeutic shoes, to enable the development of interventions to improve adherence and thereby reduce ulceration rates among people with diabetic foot complications.

  • 47.
    Johansson, Kari
    et al.
    Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
    Cnattingius, Sven
    Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
    Näslund, Ingmar
    Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, Sweden .
    Roos, Nathalie
    Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
    Lagerros, Ylva Trolle
    Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
    Granath, Fredrik
    Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
    Stephansson, Olof
    Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Sweden .
    Neovius, Martin
    Clinical Epidemiology Unit (T2), Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden .
    Outcomes of pregnancy after bariatric surgery2015In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 372, no 9, 814-824 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

    METHODS: We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother's presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

    RESULTS: Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P< 0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P< 0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P< 0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference -4.5 days; 95% CI, -2.9 to -6.0; P< 0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P = 0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P = 0.06). There was no significant between-group difference in the frequency of congenital malformations.

    CONCLUSIONS: Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality.

  • 48. Järhult, Bengt
    et al.
    Bejerot, Susanne
    Evidensbasera kvalitetsrgistren! [Evidence-base the quality registries!]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 30-31, 1912-1913 p.Article in journal (Refereed)
  • 49.
    Kalla, Rahul
    et al.
    Univ Edinburgh, Inst Genet & Mol Med, Edinburgh EH8 9YL, Midlothian, Scotland..
    Adams, Alex
    Univ Edinburgh, Inst Genet & Mol Med, Edinburgh EH8 9YL, Midlothian, Scotland..
    Nimmo, Elaine
    Univ Edinburgh, Inst Genet & Mol Med, Edinburgh EH8 9YL, Midlothian, Scotland..
    Kennedy, Nicholas
    Univ Edinburgh, Inst Genet & Mol Med, Edinburgh EH8 9YL, Midlothian, Scotland..
    Ventham, Nicholas
    Univ Edinburgh, Inst Genet & Mol Med, Edinburgh EH8 9YL, Midlothian, Scotland..
    Vatn, Morten
    Univ Oslo, Inst Clin Med, EpiGen, Campus Ahus, Oslo, Norway..
    Jahnsen, Jorgen
    Akershus Univ Hosp, Lorenskog, Norway..
    Ricanek, Petr
    Akershus Univ Hosp, Lorenskog, Norway..
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Gastroenterology.
    Pierik, Marieke
    Maastricht Univ, Med Ctr, Maastricht, Netherlands..
    Gomollon, Fernando
    Univ Lozano Blesa, Hosp Clin, IIS Aragon, Zaragoza, Spain..
    Gut, Ivo
    Barcelona Inst Sci & Technol, Ctr Genom Regulat, CNAG CRG, Barcelona, Spain..
    D'Amato, Mauro
    BioCruces Hlth Res Inst, Bilbao, Spain..
    Satsangi, Jack
    Univ Edinburgh, Inst Genet & Mol Med, Edinburgh EH8 9YL, Midlothian, Scotland..
    Epigenetic alterations in inflammatory bowel disease: the complex interplay between genome-wide methylation alterations, germline variation, and gene expression2017In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 389, no Suppl. 1, 52-52 p.Article in journal (Refereed)
  • 50.
    Kennedy, Beatrice
    Örebro University, School of Medical Sciences.
    Childhood bereavement, stress resilience, and cancer risk: an integrated life-cource approach2018Doctoral thesis, comprehensive summary (Other academic)
123 1 - 50 of 136
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