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  • 1. Beraki, Åsa
    et al.
    Magnuson, Anders
    Samuelsson, Ulf
    Åman, Jan
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning.
    Ökad fysisk aktivitet är relaterat till lägre HbA1c -nivåer hos barn och ungdomar med typ 1-diabetes: Resultat från en studie baserad på det Svenska pediatriska kvalitets registret för barn och ungdomar med diabetes (SWEDIABKIDS)2014Ingår i: BestPractice ApS, ISSN 1902-7583, nr 12Artikel i tidskrift (Övrigt vetenskapligt)
  • 2.
    Beraki, Åsa
    et al.
    Linköping University, Linköping, Sweden.
    Magnusson, Anders
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes Research Centre, Linköping University, Linköping, Sweden.
    Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)2014Ingår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 105, nr 1, s. 119-125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To evaluate the associations between physical activity (PA) and metabolic control, measured by glycated hemoglobin (HbA1c), in a large group of children and adolescents with type 1 diabetes.

    Methods: Cross-sectional analysis of data from 4655 patients, comparing HbA1c values with levels of physical activity. The data for the children and adolescents were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7-18 years of age, had type 1 diabetes and were not in remission. Patients were grouped into five groups by frequency of PA.

    Results: Mean HbA1c level was higher in the least physically active groups (PA0: 8.8% +/- 1.5 (72 +/- 16 mmol/mol)) than in the most physically active groups (PA4: 7.7% +/- 1.0 (60 +/- 11 mmol/mol)) (p < 0.001). An inverse dose-response association was found between PA and HbA1c (beta: -0.30, 95%CI: -0.34 to -0.26, p < 0.001). This association was found in both sexes and all age groups, apart from girls aged 7-10 years. Multiple regression analysis revealed that the relationship remained significant (beta: -0.21, 95% CI: -0.25 to -0.18, p < 0.001) when adjusted for possible confounding factors.

    Conclusions: Physical activity seems to influence HbA1c levels in children and adolescents with type 1 diabetes. In clinical practice these patients should be recommended daily physical activity as a part of their treatment.

  • 3.
    Bixo Ottosson, Anna
    et al.
    Department of Internal Medicine, Västmanland County Hospital, Västerås, Sweden.
    Åkesson, Karin
    Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden; Futurum – The Academy for Health and Care, Jönköping University, Jönköping, Sweden.
    Ilvered, Rosita
    Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Forsander, Gun
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Paediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Self-care management of type 1 diabetes has improved in Swedish schools according to children and adolescents2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 12, s. 1987-1993Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Age-appropriate support for diabetes self-care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008.

    Methods: This national study was based on questionnaires answered by children and adolescents aged 6-15 years of age with type 1 diabetes attending schools or preschools in 2008 (n = 317) and 2015 (n = 570) and separate parental questionnaires. The subjects were recruited by Swedish paediatric diabetes units, with 41/44 taking part in 2008 and 41/42 in 2015.

    Results: Fewer participants said they were treated differently in school because of their diabetes in 2015 than 2008. The opportunity to perform insulin boluses and glucose monitoring in privacy increased (80% versus 88%; p < 0.05). Most (83%) adolescents aged 13-15 years were satisfied with the support they received, but levels were lower in girls (p < 0.05). More subjects had hypoglycaemia during school hours (84% versus 70%, p < 0.001), but hypoglycaemia support did not increase and was lower for adolescents than younger children (p < 0.001).

    Conclusion: Children and adolescents received more support for type 1 diabetes in Swedish schools in 2015 than 2008, but more support is needed by girls and during hypoglycaemia.

  • 4. Cerqueiro Bybrant, Mara
    et al.
    Uden, Elina
    Fredriksen, Filippa
    Gustafsson, Anna
    Arvidsson, C-G
    Edling Larsson, Helena
    Fureman, Anna-Lena
    Forsander, Gun
    Ivarsson, Sten
    Lernmark, Åke
    Ludvigsson, Johnny
    Marcus, Claude
    Pundziute-Lyckå, Auste
    Persson, Marina
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Åkesson, Karin
    Örtqvist, Eva
    Carlsson, Annelie
    High levels of anti-tissue transglutaminase antibodies predict biopsy proven celiac disease in children with type 1 diabetes2019Konferensbidrag (Refereegranskat)
  • 5.
    Ekelund, Ulf
    et al.
    Medical Research Council Epidemiology Unit, Cambridge, UK; Department of Physical Education and Health, Örebro University, Örebro, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Brage, Sören
    Medical Research Council Epidemiology Unit, Cambridge, UK.
    Ryberg, John
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Wareham, Nicholas J.
    Medical Research Council Epidemiology Unit, Cambridge, UK.
    Åman, Jan
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Does physical activity equally predict gain in fat mass among obese and nonobese young adults?2007Ingår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 31, nr 1, s. 65-71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Differences in energy metabolism and physical activity (PA) may contribute to the long-term regulation of body weight (BW).

    OBJECTIVE: To examine the associations between metabolic determinants, energy expenditure and objectively measured components of PA with change in BW and fat mass (FM). DESIGN: Prospective (4 years.), case-control study in obese (n=13) and normal weight (n=15) young adults.

    MEASUREMENTS: At baseline, we measured resting metabolic rate, substrate oxidation, movement economy (ml O(2) kg(-1) min(-1)), aerobic fitness (VO(2max)), total and PA energy expenditure by doubly labelled water, and PA by accelerometry. Fat mass was measured by DXA. At follow-up we repeated our measurements of PA and FM.

    RESULTS: Fat mass increased significantly (P<0.001) in both groups. Physical activity did not change between baseline and 'follow up'. Change in overall PA (counts per minute) was inversely associated with change in BW and (beta=-0.0124, P=0.054) and FM (beta=-0.008, P=0.04). Post hoc analyses suggested that this association was explained by changes in the normal weight group only (beta=-0.01; P=0.008; and beta=-0.0097; P=0.009, for BW and FM, respectively). Metabolic determinants, energy expenditure estimates and subcomponents of PA (i.e. time spent at different intensity levels) were not significantly associated with change in BW or FM.

    CONCLUSION: Our results suggest an independent association between PA and FM. However, this association may differ depending on obesity status. The gain in FM, without any change in PA, may suggest that dietary intake is the major contributor to the positive energy balance.

  • 6. Furuman, Anna-Lena
    et al.
    Lilja, Mikael
    Lind, Torbjörn
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Samuelsson, Ulf
    A comparison between treatment with continuous insulin infusion and multiple daily injections in children and adolescents with type 1 diabetes in Sweden-data from the Swedish national quality register SWEDIABKIDS2019Konferensbidrag (Refereegranskat)
  • 7.
    Hanås, Ragnar
    et al.
    Uddevalla Hospital, Uddevalla, Sweden.
    Eriksson, Miriam
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning. Örebro University Hospital, Örebro, Sweden.
    Diabetes - ketoacidos, hyperglukemi och hypoglukemi2010Ingår i: Akut Pediatrik / [ed] Svante Norgren, Jonas F. Ludvigsson, Mikael Norman, Stockholm: Liber, 2010, 7:e, s. 253-269Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 8.
    Karefylakis, Christos
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ariander, AnnaClara
    Rask, Peter
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rask, Eva
    Region Örebro län, Örebro.
    Effect of Vitamin D supplementation on body composition in overweight men: A randomized controlled trial2017Konferensbidrag (Refereegranskat)
  • 9.
    Karefylakis, Christos
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Petterson Pablo, Paul
    Örebro University Hospital, Örebro, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rask, Eva
    Örebro University Hospital, Örebro, Sweden.
    Eriksson, Clas-Göran
    D-vitamin C3-epimer. Metodbeskrivning och epidemiologisk studie i en mellansvensk region.2017Konferensbidrag (Refereegranskat)
  • 10.
    Karefylakis, Christos
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Endocrinology.
    Pettersson-Pablo, Paul
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics.
    Rask, Eva
    Department of Endocrinology, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Bitar, Manar
    Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden.
    Magnusson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Eriksson, Clas-Göran
    Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden.
    Vitamin D C3 epimer in a mid-Swedish region: Analytical measurement and epidemiology2018Ingår i: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 478, s. 182-187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The discovery of an epimeric form of 25(OH)D3 may complicate the interpretation of vitamin Dstatus. The aim of this study was to examine the prevalence and determinants of 25-hydroxy-3-epi-vitamin D3 (3- epi-25(OH)D3) in a mid-Swedish region and to investigate how the measurement of 3-epi-25(OH)D3 would affect the assessment of vitamin D status using current thresholds.

    Methods: We conducted a cross-sectional study of 8286 in- and outpatients in primary as well as secondary care settings. Plasma 25(OH)D, 25(OH)D2, 25(OH)D3 and 3-epi-25(OH)D3 were measured using High Pressure Liquid Chromatography – Tandem Mass Spectrometry (HPLC – MS/MS). The relative 3-epi-25(OH)D3 contribution was calculated as a percentage of the total 25(OH)D3. Blood samples were collected between March 2014 and July 2015 providing a seasonal aspect to the results.

    Results: 3-epi-25(OH)D3was detected in 635 cases (7.7% of all subjects), and the mean concentration was8.4 ± 3.5 nmol/L. 3-epi-25(OH)D3correlated significantly with 25(OH)D3(r =0.38, p < 0.001).A multivariateanalysis among the detected showed that male gender and winter season were independently associatedwith higher 3-epi-25(OH)D3/25(OH)D3percentage ratio (R2=0.044). Infants and children had a significantlyhigher detection rate compared to the reference age category (18–45 years) as well as those who were testedduring the summer season.

    Conclusions: We report findings from the first epidemiologic study of 3-epi-25(OH)D3 conducted in Sweden, based on a large population sample. 3-epi-25(OH)D3 was detected in 7.7% of the study population and the mean concentration was 8.4 nmol/L. The quantification of 3-epi-25(OH)D3 would not significantly influence the clinical interpretation of vitamin D levels. Additional studies are needed to understand the metabolic pathway and the possible physiological functions of this metabolite.

  • 11.
    Karefylakis, Christos
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ariander, Annaclara
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ehlersson, Gustaf
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rask, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Endocrinology.
    Rask, Peter
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper.
    Effect of Vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men: A randomized controlled trialManuskript (preprint) (Övrigt vetenskapligt)
  • 12.
    Karefylakis, Christos
    et al.
    Department of Endocrinology, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics.
    Ariander, Annaclara
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ehlersson, Gustaf
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Rask, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Endocrinology.
    Rask, Peter
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Physiology.
    Effect of Vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men: a randomized controlled trial2018Ingår i: Endocrine (Basingstoke), ISSN 1355-008X, E-ISSN 1559-0100, Vol. 61, nr 3, s. 388-397Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Several observational studies have shown an association between vitamin D deficiency and non-skeletal major health issues including impaired cardiorespiratory fitness and adiposity. Only a few studies have examined the impact of vitamin D supplementation on these conditions and the results are ambiguous. The aim of this study was to examine the effect of vitamin D supplementation on body composition and cardiorespiratory fitness in overweight/obese men with vitamin D deficiency.

    Methods: This study was a prospective, placebo controlled, double blinded, randomized trial with a study period of 6 months. Forty overweight/obese men (BMI > 25 kg/m2) with vitamin D deficiency (25(OH)D ≤ 55 nmol/L) were randomized to receive either 2000 IU Cholecalciferol drops or the equivalent amount of drops of placebo. At baseline and follow up body composition and cardiorespiratory fitness were measured and blood samples were obtained. Body composition was measured using bioelectrical impedance analysis (BIA) and cardiorespiratory fitness using cardiopulmonary exercise test (CPET). The primary outcomes were changes in percentage body fat and in maximum oxygen uptake (VO2max).

    Results: No statistically significant difference between the placebo and the intervention group regarding changes in percentage body fat (p = 0.54) and VO2max (p = 0.90) was observed. Moreover, there was no statistically significant difference between the groups concerning changes in BMI (p = 0.26), maximum load (p = 0.89) and oxygen uptake at anaerobic threshold (AT) (p = 0.14).

    Conclusions: We conclude that treatment with 2000 IU/d vitamin D for 6 months does not impact body composition or maximum oxygen uptake in overweight/obese men with vitamin D deficiency.

  • 13.
    Lemonaki, Myrsini
    et al.
    University Hospital of Örebro, Örebro, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Paediatric education in the Curriculum of the School of Medicine in the University of Örebro in Sweden2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: In Sweden there are seven Medical Schools. Some of them have existed in more than 50 years whereas the School of Medicine at Örebro University was established in 2011. The education is built as 5,5 year studies (330 ECTS credits) and the Curriculum is integrated according to the PBL system. The aim is to present our approach to the training in paediatrics.

    Method: The poster presents the theoretical and clinical studies, as well as the examination and the assessment system concerning the paediatric education. The medical students in Örebro study paediatrics during the study of the theme of Reproduction and Growth. This is formed in three steps during their studies, particularly in terms 2, 6, 9. As an integrated medical curriculum students have both theoretical and practical studies during all the terms. The learning methods are base studies, seminars, lectures, simulation training, and clinic practice.

    In the second term, the medical students study embryology, genetics, anatomy and have some clinical practice in the paediatric primary health center. In the sixth term, they study about the healthy newborn, child and adolescent as well as normal and retarded growth and normal development and nutrition. Students also start their training in taking medical history and doing clinical examination. In the ninth term students have focus on the sick newborn, child and adolescent. Seminars on child abuse and neglect are given with a specialized pediatrician, a specialized lawyer and social worker as teachers.

    Conclusion: The theoretical aims of the paediatric curriculum are obtained through clinical practice, team base groups, case seminaria, other seminaria, lectures, and self studies. The clinical skills are obtained through clinical skills training in paediatric units and simulation training. The examination system includes a writing exam after each term as well as an examination of clinical skills and a OSCE examination after the ninth term. The assessment ofthe students in the end of each term is very good.

    Take-home message: The training in paediatrics in the Medical school of Örebro is formed in three steps in an integrated form.

  • 14. Leprêtre, Pierre Marie
    et al.
    Ponsot, Elodie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kadi, Fawzi
    Örebro universitet, Institutionen för hälsovetenskaper.
    Cardiorespiratory responses to incremental exercise in Type 1 diabetic patients: a comparison between patients with poor and good glycaemia control2016Konferensbidrag (Refereegranskat)
  • 15. Ludvigsson, Johnny
    et al.
    Albin, Ann-Karin
    Arvidsson, Carl-Göran
    Carlsson, Annelie
    Hanås, Ragnar
    Elding-Larsson, Helena
    Rathsman, Björn
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Casas, Rosaura
    Samuelsson, Ulf
    EDCR (Etanercept Diamyd Combination Regimen), a pilot trial to preserve residual beta cell function in children with Type 1 diabetes2017Konferensbidrag (Refereegranskat)
  • 16. Petersson, Jonathan
    et al.
    Åkesson, Karin
    Sundberg, Frida
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Relation mellan tid i målområde mätt med sensorglukos och HbA1c hos barn med typ 1 diabetes2019Konferensbidrag (Refereegranskat)
  • 17.
    Petersson, Jonathan
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Åkesson, Karin
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Sundberg, Frida
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics, University Hospital Örebro, Örebro, Sweden.
    Translating Glycated Hemoglobin A1c into Time Spent in Glucose Target Range: a Multicenter Study2019Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 20, nr 3, s. 339-344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real-time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control.

    Objective: The aim of this study was to examine the relation between TIT and hemoglobin A1c (HbA1c).

    Subjects and Methods: Subjects were recruited from three diabetes care centers in Sweden. Glucose data were collected for 133 children and adolescents with type 1 diabetes through CGM using Diasend. Subjects with registration time over 80% were included in the analysis. HbA1c was collected from SWEDIABKIDS, the Swedish pediatric diabetes quality registry. TIT was defined as 3.9 to 7.8 mmol/L (70-140 mg/dL) and time in range (TIR) as 3.9 to 10 mmol/L (70-180 mg/dL).

    Results: During the period of 60 days, 105 subjects provided complete data for analysis. Mean age was 12.2 (±3.3) years, mean HbA1c was 53.9 (±8.2) mmol/mol or 7.1% (±0.7%). Mean sensor glucose value was 8.6 (±1.3) mmol/L, mean coefficient of variation was 42.2% (±7.2%), mean TIT was 40.9% (±SD 12.2%), and mean TIR was 60.8% (±13.1%). There was a significant nonlinear relation between TIT during 60 days and HbA1c, R 2 = 0.69.

    Conclusion: This study suggests a nonlinear relation between time spent in glucose target range and HbA1c. The finding implies that time spent in TIT could be a useful metric in addition to HbA1c to assess glycemic control.

  • 18.
    Philipsson, Anna
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Sandberg, Elin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Högström, Sofie
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ekstav, Lars
    Lorentzon Fagerberg, Ulrika
    Region Västmanland, Sweden.
    Mörelius, Evalotte
    Linköpings universitet, Linköping, Sweden.
    Bejerot, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Möller, Margareta
    Örebro universitet, Institutionen för hälsovetenskaper.
    Duberg, Anna
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    ”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS2019Konferensbidrag (Refereegranskat)
    Abstract [sv]

    Bakgrund och syfte

    Funktionell magsmärta drabbar många barn i skolåldern, mestadels flickor. Det kan leda till minskad livskvalitet, skolfrånvaro, sämre sömn, försämrade kamratkontakter och ökad vårdkonsumtion. Det vetenskapliga underlaget för interventioner vid långvarig smärta hos barn är begränsat. Dans kan öka rörelseglädje och förbättra kroppskännedom, vilket i sin tur påverkar självtillit och kan öka psykiskt välbefinnande. Yoga kan ge mental avslappning och reducera stressreaktioner. Syftet med studien är att utvärdera effekten av en intervention med dans och yoga på återkommande magsmärta, stress och depressiva symtom samt på funktion i vardagen hos flickor 9-13 år som har funktionell buksmärta och IBS.

    Metod

    En randomiserad kontrollerad studie genomförs med forskningspersoner som identifieras via diagnosregister samt barnmottagningarna i Västerås och Örebro, samt från primärvården. Interventionen består av dans och yoga med fokus på rörelseglädje, gemenskap och kravlöshet, och utförs som gruppaktivitet två ggr/veckan under 8 månader. Primärt utfall är förändring av magsmärta efter 8 mån. Flickorna följs upp under fem år avseende magsmärta, självskattad hälsa, stress och psykiskt välmående, fysisk aktivitet och skolfunktioner. Vidare studeras kostnad i relation till nytta.

    Resultat/(Planerade studier)

    Projektet pågår och de första resultaten beräknas publiceras hösten 2019. Projektet utvärderas både kvalitativt, genom intervjuer med flickor och vårdnadshavare, och kvantitativt, genom bland annat analys av smärtdagböcker, upplevd hälsa, stress samt med en hälsoekonomisk analys. Därutöver utvärderas salivkortisol och faeces som objektiva mått. 

    Konklusion

    Studien förväntas leda till ökad kunskap om icke-farmakologiska insatser för barn samt hur behandlingsinsatser för målgruppen kan breddas med ett kostnadseffektivt alternativ till ”standard care”.

  • 19. Pundziute Lyckå, Auste
    et al.
    Hanberger, Lena
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning. Örebro universitet, Institutionen för medicinska vetenskaper.
    Åkesson, Karin
    Samuelsson, Ulf
    BMI change during the course of type 1 diabetes is modified by the level of diabetes control: data from the Swedish national quality register SWEDIABKIDS2016Ingår i: ISPAD 2016, 2016Konferensbidrag (Refereegranskat)
  • 20.
    Rosengran, Björn
    et al.
    Lunds universitet, Lund, Sweden; Skånes universitetssjukhus, Malmö, Sweden.
    Möller, Riitta
    Karolinska institutet, Stockholm, Sweden.
    Hellman, Jarl
    Uppsala universitet, Uppsala, Sweden; Akademiska sjukhuset, Uppsala, Sweden.
    Jood, Katarina
    Sahlgrenska akademin, Göteborgs universitet, Göteborg, Sweden; Sahlgrenska universitetssjukhuset, Göteborg, Sweden.
    Ekstedt, Mattias
    Linköping universitet, Linköping, Sweden; Universitetssjukhuset i Linköping, Linköping, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Universitetssjukhuset Örebro, Örebro, Sweden.
    Alm, Stina
    Umeå universitet, Umeå, Sweden.
    Gummesson, Christina
    Lunds universitet, Lund, Sweden.
    EPA-en modell för att träna och bedöma dagligt läkarjobb2019Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, s. 1-4Artikel i tidskrift (Refereegranskat)
  • 21. Sjöström, Helena
    et al.
    Nylander, Charlotte
    Johnsson, Inger
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Intermittently scanned continuous glucose monitoring improves glycemic control in adolescents with type 1 diabetes on insulin pumps2019Konferensbidrag (Refereegranskat)
  • 22. Sundberg, Frida
    et al.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Åkesson, Karin
    Most preschool children with T!D in Sweden reach ISPAD target HbA1c2019Konferensbidrag (Refereegranskat)
  • 23.
    Särnblad, Stefan
    Örebro Regionsjukhus, Örebro, Sweden.
    Egenvård under skoldagen för barn och ungdomar med Typ 1 diabetes2016Ingår i: Diabetolog Nytt, ISSN 1401-2618, Vol. 29, nr 7-8, s. 204-206Artikel i tidskrift (Övrigt vetenskapligt)
  • 24.
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning.
    Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS).2013Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objectives: Physical activity is an important part of diabetes management. However, studies concerning the relation between physical activity and metabolic control have shown conflicting results. In this study we wanted to evaluate the effect of physical activity (PA) on metabolic control, measured by glycosylated hemoglobin (HbA1c) in a large cohort of children and adolescents with type 1 diabetes. 

    Methods: Cross-sectional analysis of data from 4,655 patients in 2010-2011, comparing HbA1c values with levels of physical activity. Data were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7–18 years of age, had type 1 diabetes and were out of remission. The patients were grouped by frequency of physical activity lasting at least 30 minutes each week as follows: PA0, none, PA1, less than once a week, PA2, 1-2 times per week, PA3, 3-5 times per week, and PA4, every day.

    Results: The frequency of physical activity was lower for older children and adolescents (p < 0.001), mean age varying from 13.5 years in PA4 to 15.9 years in PA0.

    Mean HbA1c level was higher in the least active group (PA0: 70 ± 15  mmol/mol (8.5% ± 1.4)) than in the most active group (PA4: 61 ± 13 mmol/mol (7.8% ± 1.2)) (p<0.001). Linear regression showed an inverse dose-response association between physical activity and HbA1c (β: -2.7, 95% CI: -3.0 to -2.3, p<0.001). This effect was found in both sexes and all age groups, apart from girls aged 7-10 years (p=0.252). Multiple regression analysis revealed that the association remained significant (β: -2.0, 95% CI: -2.4 to -1.7, p<0.001) when adjusted for disease duration, insulin dose, insulin methods, and hypoglycemia.

    Conclusions: This study indicates that a higher level of physical activity results in better metabolic control. More studies with objective methods in large populations are required to confirm the inverse dose-response relationship between physical activity and HbA1c.

  • 25.
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning.
    Metabola effekter av träning hos ungdomar med typ 1 diabetes2014Ingår i: Sticket, ISSN 1400-8505, nr 2, s. 4-4Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 26.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för läkarutbildning.
    Adolfsson, Sten
    Forsander, Gun
    Diabetes Mellitus in children with Down's syndrome2007Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objectives: Children with Down’s syndrome have an increased risk of type 1 diabetes. However, the reports regarding the prevalence of Down’s syndrome in children with diabetes are few. The aim oft his study was to describe the prevalence of Down’s syndrome among children with diabetes in Sweden. Another aim was to describe the insulin treatment regimens and metabolic control in children and adolescents with diabetes and Down’s syndrome.

    Methods: Data were collected by a questionnaire that was distributed to all paediatric diabetes centres in Sweden. Data on Down’s syndrome in the background population was obtained from the Swedish birth defect registry.

    Result: 41 out of 43 clinics answered the questionnaire representing 7083 subjects with diabetes. In April 2007, 15 subjects with Down’s syndrome were identified. Median age was 15.6 (range 4.5 –20.0) years, with a median duration of diabetes of 5.0 years. All children were treated with insulin, mainly with multiple insulin injections (10/15). Three children used insulin pump and two children were treated with twice daily insulin injections. One child was also treated with metformin. The median daily insulin dosage was 0.76 U/kg/d (range 0.05 – 1.7 U/kg/d) and HbA1c (Mono-S, upper reference limit 5.3% ) was 6.3 % (range 4.1 – 7.9%). Coeliac disease was reported in 5 and thyroid disease in 8 children. Simultaneous hypothyroidism, diabetes and celiac disease were noted in two children with Down’s syndrome. We identified a prevalence of Down’s syndrome in patients with diabetes of 0.21%,whereas the prevalence of Down’s syndrome in new-born children in the background population is estimated to 0.13%.

    Conclusion: The prevalence of Down’s syndrome in children with diabetes seems to be increased in Sweden. Intensive insulin therapy is possible in children and adolescence with Down’s syndrome and the metabolic control is often satisfactory. Registry validated studies are needed to confirm our findings

  • 27.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Berg, Lars
    Department of Medicine, Södra Älvsborg Hospital, Borås, Sweden.
    Detlofsson, Ingalill
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Jönsson, Åsa
    Swedish Diabetes Association, Stockholm, Sweden.
    Forsander, Gun
    Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Diabetes management in Swedish schools: a national survey of attitudes of parents, children, and diabetes teams2014Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 15, nr 8, s. 550-556Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Parents of children with type 1 diabetes often raise complaints about self-care support during school time. The aim of this study was to investigate attitudes to diabetes care in school reported by children with type 1 diabetes, their parents, and their diabetes teams.

    Method: Children who had completed preschool class or at least one grade in the nine-year compulsory school system were invited to participate. Data were collected using separate questionnaires for the children and their parents. In addition, the members of the diabetes team answered a separate questionnaire. All pediatric diabetes centers in Sweden were invited to participate in the study.

    Results: All Swedish children and adolescents with diabetes are treated at pediatric diabetes centers. Out of 44 eligible centers, 41 were able to participate. The questionnaires were completed by 317 children and adolescents and 323 parents. The mean age was 11.4 ± 2.7 years and HbA1c was 61.8 ± 12.4 mmol/mol (7.8 ± 1.1%). For 57% of the children, there was no member of staff at the school with principal responsibility to support diabetes self-care. A written action plan for hypoglycemia existed for 60% of the children. Twenty-one percent of the parents regularly gave less insulin than they calculated would be needed at breakfast because of fear of hypoglycemia during school time.

    Conclusions: Although Sweden has legislation underlining the specific need for diabetes care in school, this nationwide study demonstrates deficiencies in the support of self-care management. 

  • 28.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för läkarutbildning. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Ekelund, Ulf
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Medical Research Council Epidemiology Unit, Cambridge, U.K. .
    Åman, Jan
    Örebro universitet, Institutionen för klinisk medicin. Department of Pediatrics, University Hospital, Örebro, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Dietary fat intake predicts 1-year change in body fat in adolescent girls with type 1 diabetes2006Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 29, nr 6, s. 1227-1230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to determine whether objectively measured physical activity and dietary macronutrient intake differentially predict body fat in adolescent girls with type 1 diabetes and control girls.

    RESEARCH DESIGN AND METHODS: This study comprised 23 girls (12-19 years) with type 1 diabetes and 19 age-matched healthy control girls. At baseline, physical activity and energy intake were assessed for 7 consecutive days by accelerometry and a structured food diary, respectively. Body composition was measured by dual-energy X-ray absorptiometry at baseline and after 1 year.

    RESULTS: Fat intake was positively related to a 1-year change in percentage body fat (P = 0.006), after adjustment for total energy intake. No significant interaction was observed (case-control group x main exposure), indicating that the association between fat intake and gain in body fat was similar in both groups. Physical activity did not predict gain in body fat; however, total physical activity was positively associated with a gain in lean body mass (P < 0.01). Girls treated with six daily dosages of insulin increased their percentage of body fat significantly more than those treated with four daily injections (P < 0.05).

    CONCLUSIONS: In this prospective case-control study, we found that fat intake predicted gain in percentage of body fat in both adolescent girls with type 1 diabetes and healthy control girls. The number of daily insulin injections seems to influence the accumulation of body fat in girls with type 1 diabetes.

  • 29.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Lidskog, Marie
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Walfridsson, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hjelmqvist, Hans
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Duberg, Ann-Sofi
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Will Early Clinical Training improve the professional skills?: Experience from a New Medical Education in Sweden2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: The undergraduate medical education in Sweden is 5½ years long (11 semesters), followed by an 18 months internship before license. The university curriculum used to be 6 theoretical semesters followed by 5 “clinical” semesters. Today it is common with integrated curricula with an early introduction of clinical training.

    Method: School of Medicine at Örebro University started in January 2011 and now admits 70 students every semester. The first students graduated in June 2016. The educational approach is problem-based learning and the curriculum is integrated with six themes based on physiological processes. Biomedicine, clinical medicine and professional development are integrated throughout the entire programme.

    Results: In total, clinical placement constitutes 74 weeks of which 16 weeks are spread through the first six semesters. The remaining 58 weeks (semester 7-11) are divided into six longer periods related to the themes. The objective of clinical placement during the first 6 semesters is to practice general clinical skills like communication, history-taking and clinical examination, but also to understand the health care system and the tasks of other health care personnel. The clinical placement in semester 6 ends with a seminar for reflection around the professional development and the value of early clinical placement. The students appreciate the early clinical placements. They manage to acquire general professional skills at this early stage and have the possibility to reflect upon their choice of profession. This stimulates theoretical studies and makes them more comfortable when entering the long clinical placements related to the themes. This is beneficial also for the clinical tutors. The first Örebro students that graduated were satisfied with the preparation given “to work as doctors” and gave the University the highest rank in a national survey.

    Conclusion: Early clinical training is beneficial for the development of professional skills; it motivates and gives the student an early understanding of their future professional role. A challenge may be to find enough placements and the need for coaching adjusted for different stages of professional development.

    Take-home message: Early clinical training is beneficial for the development of professional skills.

  • 30.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Magnusson, Anders
    Ekelund, Ulf
    Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Medical Research Council Epidemiology Unit, Cambridge, UK.
    Jan, Åman
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Body fat measurement in adolescent girls with type 1 diabetes: a comparison of skinfold equations against dual energy X-ray absorptiometry2016Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, nr 10, s. 1211-1215Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold measurements compared to dual-energy X-ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age-matched controls.

    Methods: We included 49 healthy girls and 44 girls with diabetes aged 12 to 19 years old, comparing the predicted %BF based on skinfold measurements and the %BF values obtained by a Lunar DPX-L scanner. The agreement between the methods was assessed by using an Bland-Altman plot.

    Results: The skinfold measurements were significantly higher in girls with diabetes (p=0.003) despite a non-significant difference in total %BF (p=0.1). A significant association between bias and %BF was found for all tested equations in the Bland-Altman plots. Regression analysis showed that the association between skinfold measurements and %BF measured by DXA differed significantly (p=0.039) between the girls with diabetes and the healthy controls.

    Conclusion: The accuracy of skinfold thickness equations for assessment of %BF in adolescent girls with diabetes is poor in comparison with DXA measurements as criteron. Our findings highlight the need for the development of new prediction equations for girls with type 1 diabetes.

  • 31.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ponsot, Elodie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Kadi, Fawzi
    Örebro universitet, Institutionen för hälsovetenskaper.
    Acute effects on glycemia of different types of exercise in youths with type 1 diabetes2017Konferensbidrag (Refereegranskat)
  • 32.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för läkarutbildning.
    Åkesson, Karin
    Fernström, Lillemor
    Ilvered, Rosita
    Forsander, Gun
    Improved diabetes management in Swedish schools: results from two national surveys2016Konferensbidrag (Refereegranskat)
  • 33.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Åkesson, Karin
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden; Futurum-The Academy of Health and Care, Jönköping University, Jönköping, Sweden.
    Fernström, Lillemor
    Swedish Diabetes Association, Stockholm, Sweden.
    Ilvered, Rosita
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Forsander, Gun
    Institution of Clinical Sciences, Sahlgrenska Academy, Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden; The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Improved diabetes management in Swedish schools: results from two national surveys2017Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 8, nr 6, s. 463-469Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Support in diabetes self-care in school is essential to achieve optimal school performance and metabolic control. Swedish legislation regulating support to children with chronic diseases was strengthened 2009.

    Objective: To compare the results of a national survey conducted 2008 and 2015 measuring parents' and diabetes specialist teams' perceptions of support in school.

    Method: All pediatric diabetes centers in Sweden were invited to participate in the 2015 study. In each center, families with a child being treated for T1DM and attending preschool class or compulsory school were eligible. The parents' and the diabetes teams' opinions were collected in two separate questionnaires.

    Results: Forty-one out of 42 eligible diabetes centers participated and 568 parents answered the parental questionnaire in 2015. Metabolic control had improved since the 2008 survey (55.2 ± 10.6 mmol/mol, 7.2% ± 1.0%, in 2015 compared with 61.8 ± 12.4 mmol/mol, 7.8% ± 1.1% in 2008). The proportion of children with a designated staff member responsible for supporting the child's self-care increased from 43% to 59%, (P < .01). An action plan to treat hypoglycemia was present for 65% of the children in 2015 compared with 55% in 2008 (P < .01). More parents were satisfied with the support in 2015 (65% compared with 55%, P < .01).

    Conclusions: This study shows that staff support has increased and that more parents were satisfied with the support for self-care in school in 2015 compared with 2008. More efforts are needed to implement the national legislation to achieve equal support in all Swedish schools.

  • 34.
    Åkesson, Karin
    et al.
    Örebro universitet, Institutionen för läkarutbildning.
    Ilvered, Rosita
    Forsander, Gun
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning.
    A Diabetes Resource Nurse Improves the Self-Care of Children with T1D in School2013Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objectives: Although Sweden has legislation underlining the specific need for diabetes care in school, a nationwide study in 2008 demonstrated deficiencies in the support of self-care management in school-aged children with type 1 diabetes. The aim of this study was to evaluate the effect on support of self-care management in school by a diabetes resource nurse available for school personnel.

    Methods: A position as a diabetes resource nurse has been tested in Jönköping County Council for three years (2010-2013) to offer the school staff necessary knowledge about diabetes. The diabetes resource nurse visited the schools to give information in the child´s daily environment. After the first study year a questionnaire was answered by 27 parents were the diabetes resource nurse had visited their child´s school and by 58 parents where the nurse had not.

    Results: Before the visit 60 % of the children had no member of staff at the school with principal responsibility to support diabetes self-care, after the visit the number was 18 %. After the visit 85 % of the children with diabetes had an individually written action plan for hypoglycemia compared to 62 % before the visit (p=0.031). Parents were significantly less worried during their child´s school day after a visit of the diabetes resourse nurse (p=0.015). No differences were seen in HbA1c between the groups in this first analysis but this will be evaluated again after a longer follow up period.

    Conclusion: The preliminary result of the intervention shows that a diabetes resource nurse can successfully improve the support children with type 1 diabetes receive at school. A new questionnaire is currently being analyzed to evaluate the results after the three years during which the diabetes resourse nurse has performed 180 school visits. Further studies are needed to clarify which grades benefit the most from the support of a diabetes resource nurse and to inquire the school personnel´s experience of the resourse nurse´s work.

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