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  • 251.
    Anderson, Carl A.
    et al.
    Wellcome Trust Genome Campus Hinxton, Wellcome Trust Sanger Institute, Cambridge, United Kingdom.
    Halfvarson, Jonas
    Örebro universitet, Hälsoakademin.
    Rioux, John D.
    Inflammatory Bowel Diseases, Queensland Institute of Medical Research, Brisbane, Australia.
    Meta-analysis identifies 29 additional ulcerative colitis risk loci, increasing the number of confirmed associations to 472011Ingår i: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 43, nr 3, s. 246-252Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Genome-wide association studies and candidate gene studies in ulcerative colitis have identified 18 susceptibility loci. We conducted a meta-analysis of six ulcerative colitis genome-wide association study datasets, comprising 6,687 cases and 19,718 controls, and followed up the top association signals in 9,628 cases and 12,917 controls. We identified 29 additional risk loci (P < 5 × 10(-8)), increasing the number of ulcerative colitis-associated loci to 47. After annotating associated regions using GRAIL, expression quantitative trait loci data and correlations with non-synonymous SNPs, we identified many candidate genes that provide potentially important insights into disease pathogenesis, including IL1R2, IL8RA-IL8RB, IL7R, IL12B, DAP, PRDM1, JAK2, IRF5, GNA12 and LSP1. The total number of confirmed inflammatory bowel disease risk loci is now 99, including a minimum of 28 shared association signals between Crohn's disease and ulcerative colitis.

  • 252.
    Andersson, Anneli
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Tuvblad, Catherine
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Department of Psychology, University of Southern California, Los Angeles, CA, USA.
    Chen, Qi
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.
    Du Rietz, Ebba
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.
    Cortese, Samuele
    Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life sciences & Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; New York University Child Study Center, New York, NY, USA.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden.
    Research Review: The strength of the genetic overlap between ADHD and other psychiatric symptoms - a systematic review and meta-analysis2020Ingår i: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) frequently co-occurs with other psychiatric disorders. Twin studies have established that these co-occurrences are in part due to shared genetic risks. However, the strength of these genetic overlaps and the potential heterogeneity accounted for by type of psychiatric symptoms, age, and methods of assessment remain unclear. We conducted a systematic review to fill this gap.

    METHODS: ) were used as effect size measures.

    RESULTS:  = .50 (0.33-0.65).

    CONCLUSIONS: These findings indicate that the co-occurrence of externalizing, internalizing, and neurodevelopmental disorder symptoms in individuals with ADHD symptoms in part is due to a shared genetic risk.

  • 253. Andersson, Christin
    et al.
    Blennow, Kaj
    Johansson, Sven-Erik
    Almkvist, Ove
    Engfeldt, Peter
    Örebro universitet, Hälsoakademin.
    Lindau, Maria
    Eriksdotter-Jönhagen, Maria
    Differential CSF biomarker levels in APOE-epsilon4-positive and -negative patients with memory impairment2007Ingår i: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 23, nr 2, s. 87-95Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To investigate the relationships between episodic memory, APOE genotype, CSF markers (total tau, T-tau; phospho-tau, P-tau; beta-amyloid, Abeta42) and longitudinal cognitive decline. METHODS: 124 memory clinic patients were retrospectively divided into 6 groups based on (i) episodic memory function (Rey Auditory Verbal Learning Test, RAVLT): severe, moderate or no impairment (SIM, MIM or NIM), and (ii) APOE genotype (epsilon4+ or epsilon4-). CSF marker levels and cognitive decline were compared across groups. RESULTS: Episodic memory function, according to RAVLT scores, was significantly correlated with CSF marker levels only among epsilon4+ subjects and not among epsilon4- subjects. When comparing the 6 subgroups, SIM epsilon4+ and MIM epsilon4+ groups showed significantly lower Abeta42 levels than the other groups. T-tau and P-tau levels were significantly increased in SIM epsilon4+ when compared to all the other groups, including the SIM epsilon4- group. However, both SIM epsilon4+ and SIM epsilon4- declined cognitively during the follow-up. CONCLUSION: It remains to be determined whether APOE genotype affects the expression of biomarkers in CSF, or whether the different biomarker patterns reflect different types of disease processes in patients with progressive cognitive dysfunction.

  • 254. Andersson, Christin
    et al.
    Lindau, Maria
    Almkvist, Ove
    Engfeldt, Peter
    Örebro universitet, Institutionen för klinisk medicin.
    Johansson, Sven-Erik
    Eriksdotter Jonhagen, Maria
    Identifying patients at high and low risk of cognitive decline using Rey Auditory Verbal Learning Test among middle-aged memory clinic outpatients2006Ingår i: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 21, nr 4, s. 251-259Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To investigate whether application of cutoff levels in an episodic memory test (Rey Auditory Verbal Learning Test, RAVLT) is a useful method for identifying patients at high and low risk of cognitive decline and subsequent dementia. METHODS: 224 patients with memory complaints (mean age = 60.7 years, mean MMSE = 28.2) followed-up at a memory clinic over approximately 3 years were assigned retrospectively to one of three memory groups from their baseline results in RAVLT [severe (SIM), moderate (MIM) or no impairment (NIM)]. These groups were investigated regarding cognitive decline. RESULTS: Patients assigned to SIM showed significant cognitive decline and progressed to dementia at a high rate, while a normal performance in RAVLT at baseline (NIM) predicted normal cognition after 3 years. Patients with MIM constituted a heterogeneous group; some patients deteriorated cognitively, while the majority remained stable or improved. CONCLUSIONS: The application of cutoff levels in RAVLT at baseline showed that patients with severely impaired RAVLT performance were at a high risk of cognitive decline and progression to dementia, while patients with normal RAVLT results did not show cognitive decline during 3 years. Furthermore, the initial degree of memory impairment was decisive in the cognitive prognosis 3 years later.

  • 255.
    Andersson, Erik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kruse, Robert
    Örebro universitet, Institutionen för medicinska vetenskaper.
    D'Amato, M.
    Department of Medicine, Karolinska Institutet Solna, Stockholm, Sweden.
    Repsilber, Dirk
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Inflammatory biomarkers in serum discriminate Crohn's disease and ulcerative colitis from healthy controls2016Ingår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 10, nr Suppl. 1, s. S86-S87Artikel i tidskrift (Övrigt vetenskapligt)
  • 256.
    Andersson, Erik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kruse, Robert
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Neumann, Gunter
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    D'Amato, Mauro
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; BioDonostia Health Research Institute, San Sebastian, Spain; IKERBASQUE Basque Foundation for Science, Bilbao, Spain.
    Repsilber, Dirk
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Subphenotypes of inflammatory bowel disease are characterized by specific serum protein profiles2017Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 10, artikel-id e0186142Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Genetic and immunological data indicate that inflammatory bowel disease (IBD) are characterized by specific inflammatory protein profiles. However, the serum proteome of IBD is still to be defined. We aimed to characterize the inflammatory serum protein profiles of Crohn's disease (CD) and ulcerative colitis (UC), using the novel proximity extension assay.

    Methods: A panel of 91 inflammatory proteins were quantified in a discovery cohort of CD (n = 54), UC patients (n = 54), and healthy controls (HCs; n = 54). We performed univariate analyses by t-test, with false discovery rate correction. A sparse partial least-squares (sPLS) approach was used to identify additional discriminative proteins. The results were validated in a replication cohort.

    Results: By univariate analysis, 17 proteins were identified with significantly different abundances in CD and HCs, and 12 when comparing UC and HCs. Additionally, 64 and 45 discriminant candidate proteins, respectively, were identified with the multivariate approach. Correspondingly, significant cross-validation error rates of 0.12 and 0.19 were observed in the discovery cohort. Only FGF-19 was identified from univariate comparisons of CD and UC, but 37 additional discriminant candidates were identified using the multivariate approach. The observed cross-validation error rate for CD vs. UC remained significant when restricting the analyses to patients in clinical remission. Using univariate comparisons, 16 of 17 CD-associated proteins and 8 of 12 UC-associated proteins were validated in the replication cohort. The area under the curve for CD and UC was 0.96 and 0.92, respectively, when the sPLS model from the discovery cohort was applied to the replication cohort.

    Conclusions: By using the novel PEA method and a panel of inflammatory proteins, we identified proteins with significantly different quantities in CD patients and UC patients compared to HCs. Our data highlight the potential of the serum IBD proteome as a source for identification of future diagnostic biomarkers.

  • 257. Andersson, Gerhard
    et al.
    Bergström, Jan
    Buhrman, Monica
    Carlbring, Per
    Holländare, Fredrik
    Örebro universitet, Hälsoakademin.
    Kaldo, Viktor
    Nilsson-Ihrfelt, Elisabeth
    Paxling, Björn
    Ström, Lars
    Waara, Johan
    Development of a new approach to guided self-help via the Internet: The Swedish experience2008Ingår i: Journal of technology in human services, ISSN 1522-8835, E-ISSN 1522-8991, Vol. 26, nr 2-4, s. 161-181Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations

  • 258.
    Andersson, Gunnel
    Örebro universitet, Hälsoakademin.
    Urinary incontinence: prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews.

    Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI.

    Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems.

    In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.

    Delarbeten
    1. Urinary incontinence prevalence, impact on daily living and desire for treatmentt: a population-based study
    Öppna denna publikation i ny flik eller fönster >>Urinary incontinence prevalence, impact on daily living and desire for treatmentt: a population-based study
    2004 (Engelska)Ingår i: Scandinavian journal of urology and nephrology, ISSN 0036-5599, Vol. 38, nr 2, s. 125-130Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE:

    To investigate the prevalence of urinary incontinence in a representative population in Sweden, and to assess to what extent the condition affects daily life and to what degree those afflicted desire treatment.

    MATERIAL AND METHODS:

    In a population-based study, a postal questionnaire comprising 12 questions on urinary incontinence was sent to a representative sample of 15 360 randomly selected residents (aged 18-79 years) of Orebro County, Sweden. This was a supplement to a comprehensive survey of public health and general living conditions.

    RESULTS:

    The response rate was 64.5%. The prevalence of urinary incontinence was 19% when defined as "any leakage" and 7% when defined as "at least once a week". Women were more afflicted than men, and the proportion of people with urinary incontinence increased markedly with increasing age. Most considered their problems to be minor, having little impact on daily life, which was reflected by the fact that only 18% of those with urinary incontinence desired treatment. About 17% of those with urinary incontinence reported severe problems that interfered with daily life. Of respondents with severe problems, 42% did not want treatment.

    CONCLUSION:

    According to this population-based study, urinary incontinence is not a major problem for most people in the community. Although a considerable proportion of the population report urinary incontinence, the majority experience minor problems and only 18% desire treatment. For a limited group of people, urinary incontinence is a severe problem. It is important that healthcare resources are optimized to identify and meet the needs of those who are most afflicted.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis, 2004
    Nyckelord
    impact on daily life, population‐based study, prevalence, urinary incontinence Read More: http://informahealthcare.com/doi/abs/10.1080/00365590310022608
    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3043 (URN)10.1080/00365590310022608 (DOI)000221058000005 ()15204395 (PubMedID)2-s2.0-1942422250 (Scopus ID)
    Tillgänglig från: 2009-01-12 Skapad: 2009-01-12 Senast uppdaterad: 2018-11-16Bibliografiskt granskad
    2. Urinary incontinence - why refraining from treatment?: a population based study
    Öppna denna publikation i ny flik eller fönster >>Urinary incontinence - why refraining from treatment?: a population based study
    Visa övriga...
    2005 (Engelska)Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, nr 4, s. 301-307Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To investigate why persons with urinary incontinence (UI) refrain from seeking care and treatment.

    MATERIAL AND METHODS: A population-based study was undertaken in which a public health survey and a specific UI questionnaire were sent to 15 360 randomly selected residents (age 18-79 years) of Orebro County, Sweden. For all persons reporting UI, the expressed wish for treatment or no treatment was analyzed in relation to relevant variables from both inquiry forms using binary logistic regression analysis.

    RESULTS: The response rate was 64.5%. UI was reported by 2194 persons, 1724 of whom comprised the study population. A statistically significant association was found between the degree of UI and a desire for treatment. Persons who did not experience daily leakage and those who did not perceive the leakage as troublesome or having an affect on their daily life mostly stated that they did not desire treatment. Socioeconomic or other health-related factors were not associated with desiring or not desiring treatment for UI.

    CONCLUSIONS: Our results show that it is the perceived severity of UI that determines whether afflicted persons desire treatment or not. Other factors, relating to seeking healthcare in general, were not found to be of importance. Interventions to identify those in need of treatment for UI should primarily be directed towards those with severe symptoms.

    Ort, förlag, år, upplaga, sidor
    London: Taylor & Francis, 2005
    Nyckelord
    : Healthcare-seeking behavior, population-based study, urinary incontinence
    Nationell ämneskategori
    Medicin och hälsovetenskap Urologi och njurmedicin Omvårdnad
    Forskningsämne
    Medicin; Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-4540 (URN)10.1080/00365590510031129 (DOI)000231453100007 ()16118105 (PubMedID)2-s2.0-27144476977 (Scopus ID)
    Anmärkning

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2713

    Tillgänglig från: 2008-04-14 Skapad: 2008-04-14 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    3. Accepting and adjusting: Older women's experiences of living with urinary incontinence
    Öppna denna publikation i ny flik eller fönster >>Accepting and adjusting: Older women's experiences of living with urinary incontinence
    2008 (Engelska)Ingår i: Urologic Nursing, ISSN 1053-816X, Vol. 28, nr 2, s. 115-121Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    In-depth interviews were performed with 11 Swedish women who contacted a district nurse to obtain sanitary protection. Three key constituents (themes) emerged: "learning to live with it despite difficulties," "other illnesses are more important," and "reluctance to seek care." The essence of the phenomenon of living with urinary incontinence (Ul) was expressed as "a situation to accept and adjust to."

    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-3045 (URN)- ()18488587 (PubMedID)2-s2.0-45849087670 (Scopus ID)
    Anmärkning

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2713

    Funding agency:Orebro CountyCouncil's Research Fund

    Tillgänglig från: 2009-01-12 Skapad: 2009-01-12 Senast uppdaterad: 2019-05-22Bibliografiskt granskad
    4. Perceptions of urinary incontinence among syrian Christian women living in Sweden
    Öppna denna publikation i ny flik eller fönster >>Perceptions of urinary incontinence among syrian Christian women living in Sweden
    2009 (Engelska)Ingår i: Journal of Transcultural Nursing, ISSN 1043-6596, E-ISSN 1552-7832, Vol. 20, nr 3, s. 296-303Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The purpose of this study was to describe the perception of urinary incontinence (UI) among Syrian women living in Sweden. DESIGN: A qualitative, descriptive design with focus group discussions (FGDs) was used and analyzed with content analysis. Fourteen Syrian women were interviewed in three FGDs. FINDINGS: Three categories emerged, "Thoughts on UI," "Managing UI," and "Communication With the Health Care System." Among the interviewees, UI was a common, and expected, problem, which could be managed. However, some expressed shame and embarrassment. Some talked about communication problems with health care. DISCUSSION: and Implications for Practice: The health care system should be adjusted to the women's needs, with awareness of the communication difficulties, which could result in misunderstanding and neglected treatments.

    Nyckelord
    urinary incontinence, ethnic group, interpreter, focus group discussion, psychosocial factors
    Nationell ämneskategori
    Omvårdnad
    Forskningsämne
    Vårdvetenskap
    Identifikatorer
    urn:nbn:se:oru:diva-7355 (URN)10.1177/1043659609334850 (DOI)000267504000005 ()19372538 (PubMedID)2-s2.0-67650503250 (Scopus ID)
    Tillgänglig från: 2009-06-22 Skapad: 2009-06-22 Senast uppdaterad: 2017-10-18Bibliografiskt granskad
    Ladda ner (pdf)
    COVER01
  • 259.
    Andersson, Gunnel
    et al.
    Örebro universitet, Institutionen för klinisk medicin. Department of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Evidence Based Medicine and Assessment of Medical Technology, Örebro, Sweden.
    Johansson, Jan-Erik
    Örebro universitet, Institutionen för klinisk medicin. Department of Urology, Örebro University Hospital, Örebro, Sweden; Centre for Evidence Based Medicine and Assessment of Medical Technology, Örebro, Sweden.
    Sahlberg-Blom, Eva
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Pettersson, Nicklas
    Department of Public Health, O¨ rebro County Council, O¨ rebro, Sweden.
    Nilsson, Kerstin
    Örebro universitet, Institutionen för klinisk medicin. Centre for Evidence Based Medicine and Assessment of Medical Technology, O¨ rebro, Sweden; Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Urinary incontinence - why refraining from treatment?: a population based study2005Ingår i: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, nr 4, s. 301-307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate why persons with urinary incontinence (UI) refrain from seeking care and treatment.

    MATERIAL AND METHODS: A population-based study was undertaken in which a public health survey and a specific UI questionnaire were sent to 15 360 randomly selected residents (age 18-79 years) of Orebro County, Sweden. For all persons reporting UI, the expressed wish for treatment or no treatment was analyzed in relation to relevant variables from both inquiry forms using binary logistic regression analysis.

    RESULTS: The response rate was 64.5%. UI was reported by 2194 persons, 1724 of whom comprised the study population. A statistically significant association was found between the degree of UI and a desire for treatment. Persons who did not experience daily leakage and those who did not perceive the leakage as troublesome or having an affect on their daily life mostly stated that they did not desire treatment. Socioeconomic or other health-related factors were not associated with desiring or not desiring treatment for UI.

    CONCLUSIONS: Our results show that it is the perceived severity of UI that determines whether afflicted persons desire treatment or not. Other factors, relating to seeking healthcare in general, were not found to be of importance. Interventions to identify those in need of treatment for UI should primarily be directed towards those with severe symptoms.

  • 260. Andersson, H.
    et al.
    Hartmanová, B.
    Bäck, Erik
    Örebro universitet, Institutionen för klinisk medicin.
    Eliasson, H.
    Örebro universitet, Institutionen för klinisk medicin.
    Landfors, M.
    Näslund, L.
    Rydén, P.
    Sjöstedt, A.
    Transcriptional profiling of the peripheral blood response during tularemia2006Ingår i: Genes and Immunity, ISSN 1466-4879, E-ISSN 1476-5470, Vol. 7, nr 6, s. 503-513Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Tularemia is a febrile disease caused by the highly contagious bacterium Francisella tularensis. We undertook an analysis of the transcriptional response in peripheral blood during the course of ulceroglandular tularemia by use of Affymetrix microarrays comprising 14,500 genes. Samples were obtained from seven individuals at five occasions during 2 weeks after the first hospital visit and convalescent samples 3 months later. In total, 265 genes were differentially expressed, 95 of which at more than one time point. The differential expression was verified with real-time quantitative polymerase chain reaction for 36 genes (R(2)=0.590). The most prominent changes were noted in samples drawn on days 2-3 and a considerable proportion of the upregulated genes appeared to represent an interferon-gamma-induced response and also a proapoptotic response. Genes involved in the generation of innate and acquired immune responses were found to be downregulated, presumably a pathogen-induced event. A logistic regression analysis revealed that seven genes were good predictors of the early phase of tularemia. This is the first description of the transcriptional host response to ulceroglandular tularemia and the study has identified gene subsets relevant to the pathogenesis of the disease and subsets that may serve as early diagnostic biomarkers.

  • 261.
    Andersson, Ida-Maria
    et al.
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Nilsson, Sandra
    School of Life Sciences, University of Skövde, Skövde, Sweden.
    Adolfsson, Annsofie
    School of Life Sciences, University of Skövde, Skövde, Sweden; Department of Obstetrics and Gynecology, Skaraborg Hospital, Skövde, Sweden.
    How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again: a qualitative interview study2012Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, nr 2, s. 262-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to investigate how women who have experienced one or more miscarriages manage their feelings when they become pregnant again.

    Method: Individual qualitative interviews were conducted with 16 women who were pregnant again after experiencing one or more miscarriages. The interviews were analysed using qualitative content analysis with an inductive approach.

    Results: The analysis of the material ended up in five categories: distancing herself from her pregnancy, focusing on her pregnancy symptoms, searching for confirming information, asking for ultrasound examination and asking for professional and social support. Because of their past experience with miscarriage, it could be painful to have another pregnancy terminate in disappointment. Therefore, the women manage their feelings by distancing themselves from their pregnancies. Simultaneously, they are managing their emotions by seeking affirmation that their current pregnancy is normal.

    Conclusion: Generally speaking, women manage their emotions by themselves. They feel isolated with their worries and concerns, and they are in need of the support provided from their intimate circle of friends and family as well as from the staff of the maternity health care ward. Unfortunately, the women do not feel that they get the support they need from the staff, instead they have to rely on their friends, family and partners to help them manage their emotions.

  • 262.
    Andersson, Jessika
    et al.
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Sundström, Johan
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Kurland, Lisa
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    Gustavsson, Thomas
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden.
    Hulthe, Johannes
    Wallenberg Laboratory, Sahlgrenska University Hospital, Gothenburg, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Elmgren, Anders
    AstraZeneca R&D, Mölndal, Sweden.
    Zilmer, Kersti
    Department of Biochemistry, University of Tartu, Tartu, Estonia.
    Zilmer, Mihkel
    Department of Biochemistry, University of Tartu, Tartu, Estonia.
    Lind, Lars
    Department of Medicine, Uppsala University Hospital, Uppsala, Sweden.
    The carotid artery plaque size and echogenicity are related to different cardiovascular risk factors in the elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study2009Ingår i: Lipids, ISSN 0024-4201, E-ISSN 1558-9307, Vol. 44, nr 5, s. 397-403Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Carotid plaques can be characterised by ultrasound by size and echogenicity. Both size and echogenicity are predictors of cardiovascular events. The aim of this study was to examine whether traditional risk factors and markers of inflammation and oxidation were associated with plaque size and echogenicity. Computerised analysis of carotid plaque size and echogenicity (grey scale median, GSM) were performed by ultrasound in a population-based health survey in 1,016 subjects aged 70 years (PIVUS study). Information on cardiovascular risk factors was collected, together with markers of inflammation and oxidation. Increased Framingham risk score, systolic blood pressure, higher BMI and decreased HDL, lower glutathione levels were related to echolucent plaques. Previous or present smoking was common with significantly more pack-years related to the echorich plaques. Plaque size was associated with increased Framingham risk score, systolic blood pressure, blood glucose levels, smoking, ApoB/A1 ratio, OxLDL, TNF alpha, HOMA insulin resistance, leucocyte count, decreased BCD-LDL and low levels of l-selectin. Low HDL, increased BMI and decreased glutathione levels were associated with the echolucency of carotid plaques, implying metabolic factors to play a role for plaque composition. Markers of inflammation were related to plaque size alone, implying inflammation to be predominantly associated with the amount of atherosclerosis. These results suggest that plaque size and echogenicity are influenced by different risk factors.

  • 263.
    Andersson, Karin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Metal artifacts in computed tomography: impact of reduction methods on image quality and radiotherapy treatment planning2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Degradation of image quality by metal artifacts is a common problem in computed tomography (CT) imaging, which can limit the diagnostic value of a CT examination and also introduce inaccuracies in radiotherapy (RT) treatment planning. In recent years, commercial metal artifact reduction (MAR) methods have been launched by several CT vendors. The overall aim of this thesis was to evaluate MAR methods in diagnostic imaging and RT treatment planning.

    Evaluations of hip prosthesis phantom CT images showed that MAR algorithms in general improved image quality, based on both visual grading analysis and quantitative measures, while the application of virtual monoenergetic reconstructions insufficiently reduced metal artifacts. In some cases additional artifacts were introduced by the MAR algorithms. MAR algorithms were also evaluated in hip prosthesis phantom CT imaging used for proton therapy treatment planning, where improvements in dose calculation accuracy were observed.

    Studies of Head & Neck (H&N) implant CT images in RT treatment planning were also performed. By visual grading of anatomy visualization with respect to target delineation in dental implant patient images, MAR algorithms were shown to significantly improve image quality. However, only minor effects of H&N implant artifacts on proton dose distributions were seen. The impact might be greater for more severe artifacts than those studied here, and thus further investigations of such cases are needed.

    In conclusion, MAR algorithms have been shown to enhance image quality for diagnostic applications and to improve anatomy visualization in RT treatment planning. The MAR algorithms led to increased proton dose calculation accuracy in some cases, while in other situations only minor changes were seen.

    Delarbeten
    1. Evaluation of a metal artifact reduction algorithm in CT studies used for proton radiotherapy treatment planning
    Öppna denna publikation i ny flik eller fönster >>Evaluation of a metal artifact reduction algorithm in CT studies used for proton radiotherapy treatment planning
    2014 (Engelska)Ingår i: Journal of Applied Clinical Medical Physics, ISSN 1526-9914, E-ISSN 1526-9914, Vol. 15, nr 5, s. 112-119Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Metal objects in the body such as hip prostheses cause artifacts in CT images. When CT images degraded by artifacts are used for treatment planning of radiotherapy, the artifacts can yield inaccurate dose calculations and, for particle beams, erroneous penetration depths. A metal artifact reduction software (O-MAR) installed on a Philips Brilliance Big Bore CT has been tested for applications in treatment planning of proton radiotherapy. Hip prostheses mounted in a water phantom were used as test objects. Images without metal objects were acquired and used as reference data for the analysis of artifact-affected regions outside of the metal objects in both the O-MAR corrected and the uncorrected images. Water equivalent thicknesses (WET) based on proton stopping power data were calculated to quantify differences in the calculated proton beam penetration for the different image sets. The WET to a selected point of interest between the hip prostheses was calculated for several beam directions of clinical relevance. The results show that the calculated differences in WET relative to the reference case were decreased when the O-MAR algorithm was applied. WET differences up to 2.0 cm were seen in the uncorrected case while, for the O-MAR corrected case, the maximum difference was decreased to 0.4 cm. The O-MAR algorithm can significantly improve the accuracy in proton range calculations. However, there are some residual effects, and the use of proton beam directions along artifact streaks should only be used with caution and appropriate margins.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2014
    Nyckelord
    metal artifact reduction, radiation therapy, water equivalent thickness, proton range
    Nationell ämneskategori
    Radiologi och bildbehandling
    Identifikatorer
    urn:nbn:se:oru:diva-65011 (URN)10.1120/jacmp.v15i5.4857 (DOI)000345121900010 ()28297224 (PubMedID)2-s2.0-84929502869 (Scopus ID)
    Tillgänglig från: 2018-02-15 Skapad: 2018-02-15 Senast uppdaterad: 2018-02-15Bibliografiskt granskad
    2. Metal artefact reduction in CT imaging of hip prostheses-an evaluation of commercial techniques provided by four vendors
    Öppna denna publikation i ny flik eller fönster >>Metal artefact reduction in CT imaging of hip prostheses-an evaluation of commercial techniques provided by four vendors
    Visa övriga...
    2015 (Engelska)Ingår i: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 88, nr 1052, artikel-id 20140473Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: The aim of this study was to evaluate commercial metal artefact reduction (MAR) techniques in X-ray CT imaging of hip prostheses.

    Methods: Monoenergetic reconstructions of dual-energy CT (DECT) data and several different MAR algorithms, combined with single-energy CT or DECT, were evaluated by imaging a bilateral hip prosthesis phantom. The MAR images were compared with uncorrected images based on CT number accuracy and noise in different regions of interest.

    Results: The three MAR algorithms studied implied a general noise reduction (up to 67%, 74% and 77%) and an improvement in CT number accuracy, both in regions close to the prostheses and between the two prostheses. The application of monoenergetic reconstruction, without any MAR algorithm, did not decrease the noise in the regions close to the prostheses to the same extent as did the MAR algorithms and even increased the noise in the region between the prostheses.

    Conclusion: The MAR algorithms evaluated generally improved CT number accuracy and substantially reduced the noise in the hip prostheses phantom images, both close to the prostheses and between the two prostheses. The study showed that the monoenergetic reconstructions evaluated did not sufficiently reduce the severe metal artefact caused by large orthopaedic implants.

    Advances in knowledge: This study evaluates several commercially available MAR techniques in CT imaging of large orthopaedic implants.

    Ort, förlag, år, upplaga, sidor
    British Institute of Radiology, 2015
    Nationell ämneskategori
    Radiologi och bildbehandling
    Forskningsämne
    Radiologi
    Identifikatorer
    urn:nbn:se:oru:diva-46510 (URN)10.1259/bjr.20140473 (DOI)000363313000002 ()26110201 (PubMedID)2-s2.0-84938837932 (Scopus ID)
    Tillgänglig från: 2015-11-17 Skapad: 2015-11-16 Senast uppdaterad: 2018-09-04Bibliografiskt granskad
    3. Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography
    Öppna denna publikation i ny flik eller fönster >>Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography
    Visa övriga...
    2016 (Engelska)Ingår i: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 89, nr 1063, artikel-id 20150993Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objectives: To evaluate metal artefact reduction (MAR) techniques from four computed tomography (CT) vendors in hip prosthesis imaging.

    Methods: Bilateral hip prosthesis phantom images, obtained by using MAR algorithms for single energy CT data or dual energy CT (DECT) data and by monoenergetic reconstructions of DECT data, were visually graded by five radiologists using ten image quality criteria. Comparisons between the MAR images and a reference image were performed for each scanner separately. Ordinal probit regression analysis was used.

    Results: The MAR algorithms in general improved the image quality based on the majority of the criteria (up to between 8/10 and 10/10) with a statistically improvement in overall image quality (P<0.001). However, degradation of image quality, such as new artefacts, was seen in some cases. A few monoenergetic reconstruction series improved the image quality (P<0.004) for one of the DECT scanners, but it was only improved for some of the criteria (up to 5/10). Monoenergetic reconstructions resulted in worse image quality for the majority of the criteria (up to 7/10) for the other DECT scanner.

    Conclusions: The MAR algorithms improved the image quality of the hip prosthesis CT images. However, since additional artefacts and degradation of image quality were seen in some cases, all algorithms should be carefully evaluated for every clinical situation. Monoenergetic reconstructions were in general concluded to be insufficient for reducing metal artifacts. Advances in knowledge: Qualitative evaluation of the usefulness of several MAR techniques from different vendors in CT imaging of hip prosthesis.

    Ort, förlag, år, upplaga, sidor
    London, United Kingdom: British Institute of Radiology, 2016
    Nationell ämneskategori
    Radiologi och bildbehandling
    Forskningsämne
    Radiologi
    Identifikatorer
    urn:nbn:se:oru:diva-50103 (URN)10.1259/bjr.20150993 (DOI)000378096400009 ()27123700 (PubMedID)
    Tillgänglig från: 2016-05-03 Skapad: 2016-05-03 Senast uppdaterad: 2019-04-12Bibliografiskt granskad
    4. CT image metal artifacts in proton radiotherapy treatment planning: evaluation of two commercial correction algorithms
    Öppna denna publikation i ny flik eller fönster >>CT image metal artifacts in proton radiotherapy treatment planning: evaluation of two commercial correction algorithms
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Radiologi och bildbehandling
    Identifikatorer
    urn:nbn:se:oru:diva-65012 (URN)
    Tillgänglig från: 2018-02-15 Skapad: 2018-02-15 Senast uppdaterad: 2018-09-18Bibliografiskt granskad
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    Spikblad
  • 264.
    Andersson, Karin M.
    et al.
    Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Ahnesjo, Anders
    Uppsala University, Uppsala, Sweden.
    Vallhagen Dahlgren, Christina
    Skandionkliniken, Uppsala, Sweden..
    Evaluation of a metal artifact reduction algorithm in CT studies used for proton radiotherapy treatment planning2014Ingår i: Journal of Applied Clinical Medical Physics, ISSN 1526-9914, E-ISSN 1526-9914, Vol. 15, nr 5, s. 112-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Metal objects in the body such as hip prostheses cause artifacts in CT images. When CT images degraded by artifacts are used for treatment planning of radiotherapy, the artifacts can yield inaccurate dose calculations and, for particle beams, erroneous penetration depths. A metal artifact reduction software (O-MAR) installed on a Philips Brilliance Big Bore CT has been tested for applications in treatment planning of proton radiotherapy. Hip prostheses mounted in a water phantom were used as test objects. Images without metal objects were acquired and used as reference data for the analysis of artifact-affected regions outside of the metal objects in both the O-MAR corrected and the uncorrected images. Water equivalent thicknesses (WET) based on proton stopping power data were calculated to quantify differences in the calculated proton beam penetration for the different image sets. The WET to a selected point of interest between the hip prostheses was calculated for several beam directions of clinical relevance. The results show that the calculated differences in WET relative to the reference case were decreased when the O-MAR algorithm was applied. WET differences up to 2.0 cm were seen in the uncorrected case while, for the O-MAR corrected case, the maximum difference was decreased to 0.4 cm. The O-MAR algorithm can significantly improve the accuracy in proton range calculations. However, there are some residual effects, and the use of proton beam directions along artifact streaks should only be used with caution and appropriate margins.

  • 265.
    Andersson, Karin M.
    et al.
    Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Norrman, Eva
    Department of Medical Physics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Krauss, Wolfgang
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Cao, Yang
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Jendeberg, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Geijer, Mats
    Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden .
    Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography2016Ingår i: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 89, nr 1063, artikel-id 20150993Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To evaluate metal artefact reduction (MAR) techniques from four computed tomography (CT) vendors in hip prosthesis imaging.

    Methods: Bilateral hip prosthesis phantom images, obtained by using MAR algorithms for single energy CT data or dual energy CT (DECT) data and by monoenergetic reconstructions of DECT data, were visually graded by five radiologists using ten image quality criteria. Comparisons between the MAR images and a reference image were performed for each scanner separately. Ordinal probit regression analysis was used.

    Results: The MAR algorithms in general improved the image quality based on the majority of the criteria (up to between 8/10 and 10/10) with a statistically improvement in overall image quality (P<0.001). However, degradation of image quality, such as new artefacts, was seen in some cases. A few monoenergetic reconstruction series improved the image quality (P<0.004) for one of the DECT scanners, but it was only improved for some of the criteria (up to 5/10). Monoenergetic reconstructions resulted in worse image quality for the majority of the criteria (up to 7/10) for the other DECT scanner.

    Conclusions: The MAR algorithms improved the image quality of the hip prosthesis CT images. However, since additional artefacts and degradation of image quality were seen in some cases, all algorithms should be carefully evaluated for every clinical situation. Monoenergetic reconstructions were in general concluded to be insufficient for reducing metal artifacts. Advances in knowledge: Qualitative evaluation of the usefulness of several MAR techniques from different vendors in CT imaging of hip prosthesis.

    Ladda ner fulltext (pdf)
    Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography
  • 266.
    Andersson, Karin M.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Norrman, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Metal Artifacts in CT Imaging of Hip Prostheses: Evaluation of Metal Artifact Reduction Techniques Provided by Four Vendors2015Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    PURPOSE: The aim of this study was to evaluate metal artifact reduction (MAR) techniques, provided by four vendors, in CT imaging of hip prostheses.

    METHOD AND MATERIALS: A water phantom containing hip prostheses mounted in calf bones was scanned with four CT scanners; Philips Ingenuity; Toshiba Aquilion ONE Vision edition; GE Discovery 750 HD and Siemens SOMATOM Definition Flash. An uncorrected (reference) image was obtained for every CT and compared with images acquired with the scanner specific MAR technique; either monoenergetic reconstruction of Dual Energy CT (DECT) data (GE and Siemens) or the use of a MAR algorithm software (Philips and Toshiba), or a combination of the two (GE). The MAR techniques were applied for varying tube voltage, kernel and reconstruction technique. The reference images were quantitatively compared to the MAR images by analyzing the noise and the CT number accuracy in region of interests (ROIs). Visual grading was performed by five radiologists based on ten image quality (IQ) criteria.

    RESULTS: The MAR algorithms implied a general noise reduction (by up to 77%) and improved IQ based on the majority of the visual grading criteria. The use of monoenergetic reconstructions of DECT data, without any MAR algorithm, did not decrease the noise in the ROIs to the same extent as the MAR algorithms (up to 41%) and did even increase the noise in one ROI. The visual grading evaluation showed that monoenergetic reconstructions in general degraded the IQ for one of the DECT scanners and improved the IQ for only a few of the criteria for the other DECT scanner.

    CONCLUSION: The quantitative analysis and the visual grading evaluation showed that the IQ was generally improved when the MAR algorithms were used. However, additional artifacts and degradation of the IQ were noted in some MAR image regions. The use of monoenergetic reconstruction was concluded to not reduce metal artifacts to the same extent as the MAR algorithms and to even degrade the IQ in several image regions.

    CLINICAL RELEVANCE/APPLICATION: This study points out advantages and potential risks of using MAR techniques in CT imaging of hip prostheses and will be useful for clinics when optimizing CT scan protocols and purchasing new CT systems.

  • 267.
    Andersson, Karin M.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Nowik, P.
    Department of Medical Physics, Karolinska University Hospital, Stockholm, Sweden.
    Persliden, Jan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medical Physics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Thunberg, Per
    Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
    Norrman, Eva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medical Physics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Metal artefact reduction in CT imaging of hip prostheses-an evaluation of commercial techniques provided by four vendors2015Ingår i: British Journal of Radiology, ISSN 0007-1285, E-ISSN 1748-880X, Vol. 88, nr 1052, artikel-id 20140473Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this study was to evaluate commercial metal artefact reduction (MAR) techniques in X-ray CT imaging of hip prostheses.

    Methods: Monoenergetic reconstructions of dual-energy CT (DECT) data and several different MAR algorithms, combined with single-energy CT or DECT, were evaluated by imaging a bilateral hip prosthesis phantom. The MAR images were compared with uncorrected images based on CT number accuracy and noise in different regions of interest.

    Results: The three MAR algorithms studied implied a general noise reduction (up to 67%, 74% and 77%) and an improvement in CT number accuracy, both in regions close to the prostheses and between the two prostheses. The application of monoenergetic reconstruction, without any MAR algorithm, did not decrease the noise in the regions close to the prostheses to the same extent as did the MAR algorithms and even increased the noise in the region between the prostheses.

    Conclusion: The MAR algorithms evaluated generally improved CT number accuracy and substantially reduced the noise in the hip prostheses phantom images, both close to the prostheses and between the two prostheses. The study showed that the monoenergetic reconstructions evaluated did not sufficiently reduce the severe metal artefact caused by large orthopaedic implants.

    Advances in knowledge: This study evaluates several commercially available MAR techniques in CT imaging of large orthopaedic implants.

  • 268.
    Andersson, Karin M.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Physics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Vallhagen Dahlgren, C.
    The Skandion clinic, Uppsala, Sweden.
    Reizenstein, J.
    Department of Oncology, Örebro University Hospital, Örebro, Sweden; , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ahnesjö, A.
    Medical Radiation Sciences, Department of Immunology-Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Physics , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Impact of Metal Artifacts on Proton Therapy Treatment Planning Accuracy2017Ingår i: 56th Annual Meeting of the Particle Therapy Cooperative Group (PTCOG) 8-13 May 2017: Proceedings, The Particle Therapy Cooperative Group , 2017, Vol. 4, s. 68-68, artikel-id 1Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Purpose: To evaluate for proton therapy treatment planning the feasibility of two commercial metal artifact reduction (MAR) algorithms in CT-imaging.

    Materials and Methods: A head phantom with removable dental fillings and a body phantom with a removable hip prosthesis were scanned to evaluate O-MAR (Philips) and iMAR (Siemens). Reference images (scans without metal) were acquired and subtracted from the uncorrected (no MAR) and MAR-images. CT number-differences were mapped to differences in stopping power ratios to water. In addition, proton treatment plans for a parotid, tonsil and prostate-target were optimized based on uncorrected and MAR images and recalculated on reference images. Beams were arranged to not traverse metal, enabling evaluation of metal artifact impact on target coverage.

    Results: MAR algorithms reduced the most extreme dental filling artifacts, but residual artifacts still remained. iMAR reduced hip prosthesis artifacts to large extent, while considerable artifacts still were present with O-MAR. For parotid and tonsil-plans, D98%to PTV was nearly intact in the reference recalculations for both uncorrected and MAR-based plans, with maximum-difference,0.3%. For uncorrected prostate plans, D98%decreased more than 4% in the reference recalculation. For the iMAR prostate plan, D98%was almost identical in the reference recalculation (97.5% versus 97.4%). A slight D98%-decrease was seen in the reference for the O-MAR based plan (96.8% versus 97.5%).

    Conclusion: Hip prosthesis artifacts reduced target coverage accuracy, but it was substantially improved with MAR algorithms. Dental filling artifacts were moderately reduced with MAR, but did not substantially affect target coverage

  • 269.
    Andersson, Karin M.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Vallhagen Dahlgren, Christina
    The Skandion Clinic, Uppsala, Sweden.
    Reizenstein, Johan
    Department of Oncology, Faculty of Medicine and Health, Örebro University, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ahnesjö, Anders
    Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper.
    CT image metal artifacts in proton radiotherapy treatment planning: evaluation of two commercial correction algorithmsManuskript (preprint) (Övrigt vetenskapligt)
  • 270.
    Andersson, Karin M.
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. The Skandion Clinic, Uppsala, Sweden.
    Vallhagen Dahlgren, Christina
    The Skandion Clinic, Uppsala, Sweden.
    Reizenstein, Johan
    Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ahnesjö, Anders
    Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Thunberg, Per
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Physics.
    Evaluation of two commercial CT metal artifact reduction algorithms for use in proton radiotherapy treatment planning in the head and neck area2018Ingår i: Medical physics (Lancaster), ISSN 0094-2405, Vol. 45, nr 10, s. 4329-4344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To evaluate two commercial CT metal artifact reduction (MAR) algorithms for use in proton treatment planning in the head and neck (H&N) area.

    METHODS: An anthropomorphic head phantom with removable metallic implants (dental fillings or neck implant) was CT-scanned to evaluate the O-MAR (Philips) and the iMAR (Siemens) algorithms. Reference images were acquired without any metallic implants in place. Water equivalent thickness (WET) was calculated for different path directions and compared between image sets. Images were also evaluated for use in proton treatment planning for parotid, tonsil, tongue base, and neck node targets. The beams were arranged so as to not traverse any metal prior to the target, enabling evaluation of the impact on dose calculation accuracy from artifacts surrounding the metal volume. Plans were compared based on γ analysis (1 mm distance-to-agreement/1% difference in local dose) and dose volume histogram metrics for targets and organs at risk (OARs). Visual grading evaluation of 30 dental implant patient MAR images was performed by three radiation oncologists.

    RESULTS: In the dental fillings images, ΔWET along a low-density streak was reduced from -17.0 to -4.3 mm with O-MAR and from -16.1 mm to -2.3 mm with iMAR, while for other directions the deviations were increased or approximately unchanged when the MAR algorithms were used. For the neck implant images, ΔWET was generally reduced with MAR but residual deviations remained (of up to -2.3 mm with O-MAR and of up to -1.5 mm with iMAR). The γ analysis comparing proton dose distributions for uncorrected/MAR plans and corresponding reference plans showed passing rates >98% of the voxels for all phantom plans. However, substantial dose differences were seen in areas of most severe artifacts (γ passing rates of down to 89% for some cases). MAR reduced the deviations in some cases, but not for all plans. For a single patient case dosimetrically evaluated, minor dose differences were seen between the uncorrected and MAR plans (γ passing rate approximately 97%). The visual grading of patient images showed that MAR significantly improved image quality (P < 0.001).

    CONCLUSIONS: O-MAR and iMAR significantly improved image quality in terms of anatomical visualization for target and OAR delineation in dental implant patient images. WET calculations along several directions, all outside the metallic regions, showed that both uncorrected and MAR images contained metal artifacts which could potentially lead to unacceptable errors in proton treatment planning. ΔWET was reduced by MAR in some areas, while increased or unchanged deviations were seen for other path directions. The proton treatment plans created for the phantom images showed overall acceptable dose distributions differences when compared to the reference cases, both for the uncorrected and MAR images. However, substantial dose distribution differences in the areas of most severe artifacts were seen for some plans, which were reduced by MAR in some cases but not all. In conclusion, MAR could be beneficial to use for proton treatment planning; however, case-by-case evaluations of the metal artifact-degraded images are always recommended.

  • 271.
    Andersson, Madelen
    et al.
    Dept Infect Dis, Blekinge Hosp, Karlskrona, Sweden.
    Resman, Fredrik
    Dept Translat Med Med Microbiol, Lund Univ, Malmö, Sweden.
    Eitrem, Rickard
    Dept Communicable Dis Control, County Blekinge, Karlskrona, Sweden.
    Drobni, Peter
    Dept Clin Microbiol, County Kronoberg, Växjö, Sweden; Dept Clin Microbiol, County Kronoberg, Karlskrona, Sweden.
    Riesbeck, Kristian
    Dept Translat Med Med Microbiol, Lund Univ, Malmö, Sweden.
    Kahlmeter, Gunnar
    Dept Clin Microbiol, County Kronoberg, Växjö, Sweden; Dept Clin Microbiol, County Kronoberg, Karlskrona, Sweden; Dept Med Sci, Div Clin Bacteriol, Uppsala Univ, Uppsala, Sweden.
    Sundqvist, Martin
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro universitet, Institutionen för medicinska vetenskaper. Dept Clin Microbiol, County Kronoberg, Växjö, Sweden; Dept Clin Microbiol, County Kronoberg, Karlskrona, Sweden; Dept Lab Med Clin Microbiol, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Outbreak of a beta-lactam resistant non-typeable Haemophilus influenzae sequence type 14 associated with severe clinical outcomes2015Ingår i: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 15, artikel-id 581Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: During October 2011 several residents and staff members at a long-term care facility (LTCF) for elderly fell ill with respiratory symptoms. Several of the residents required hospitalization and one died. Non-typeable Haemophilus influenzae (NTHi) was identified as the causative pathogen. Methods: A descriptive analysis of the outbreak and countermeasures was performed. For each identified bacterial isolate implied in the outbreak, standard laboratory resistance testing was performed, as well as molecular typing and phylogenetic analysis. Results: The identified H. influenzae was beta-lactamase negative but had strikingly high MIC-values of ampicillin, cefuroxime and cefotaxime. All isolates displayed the same mutation in the ftsI gene encoding penicillin-binding protein (PBP) 3, and all but one were identified as sequence type 14 by Multilocus Sequence Typing (MLST). In total 15 individuals in connection to the LTCF; 8 residents, 6 staff members and one partner to a staff member were colonized with the strain. Conclusion: This report illustrates the existence of non-typeable H. influenzae with high virulence, and furthermore emphasizes the importance of continuous surveillance of possible outbreaks in health care facilities and prompt measures when outbreaks occur.

  • 272.
    Andersson, Maria
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Fredriksson, Valeria
    Svenska audionomers inställning gentemot kompetensutvecklingsprogram2013Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Sammanfattning:

    Audionomyrket har utvecklats från ett assisterande till ett självständigt yrke. Framsteg inom forskning berörande audiologi ställer höga krav på audionomens kompetensutveckling. Internationellt har det undersökts hur kompetensutveckling kan förbättras, genom bildandet av frivilliga eller obligatoriska kompetensutvecklingsprogram, för att ge en säker patientvård och en tillfredsställande yrkesutveckling. I Sverige ansvarar varje audionom enskilt för sin kompetensutveckling. Det finns i dagsläget inga studier som undersöker svenska audionomers inställning till att införa liknande kompetensutvecklingsprogram som finns internationellt, vilket är motivet bakom studien. Syftet är att undersöka svenska audionomers inställning kring frivilliga samt obligatoriska kompetensutvecklingsprogram med tillhörande gransknings-process för att vidareutveckla audionomprofessionen och hålla samtliga yrkesverksamma ajour med ny vetenskap. En kvantitativ metod i form av en webbenkät tillämpades för att nå ut till ett stort omfång yrkesverksamma audionomer över hela Sverige. Studiens resultat visar att ett stort antal yrkesverksamma audionomer är positivt inställda till det frivilliga samt obligatoriska kompetensutvecklingsprogrammet med tillhörande granskningsprocess. En förändrad form av kompetensutvecklingssystem än den nuvarande är därmed eftersträvad av majoriteten. Studiens resultat har tagit fasta på att kompetensutvecklingsprogram bör inriktas mot både de tvärvetenskapliga områden som professionen bygger på och audionomens specialiseringsområden. Audionomerna anser att tiden motsvarande en till åtta timmar per månad är tillräcklig för kompetensutvecklande aktiviteter. Audionomerna har en stor medvetenhet om vikten av att utveckla den professionella kompetensen. Hindrande faktorer som ekonomi, hög patientgenomströmning, tidsbrist, etc. minskar audionomernas möjlighet till deltagande av kompetensutvecklande aktiviteter. De yttre omständigheterna bidrar till att yrkesverksamma audionomer i hög grad önskar en förändrad form av kompetensutvecklings-system än den nuvarande.

    Ladda ner fulltext (pdf)
    Svenska audionomers inställning gentemot kompetensutvecklingsprogram
  • 273.
    Andersson, Maria
    et al.
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden; Faculty of Public Health Studies, Inland Norway University of Applied Sciences, Elverum, Norway.
    Carlsson, Eva
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Health Care Research Center.
    Persenius, Mona
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden.
    Older people's perceptions of the quality of oral care in short-term care units: A cross-sectional study2018Ingår i: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 13, nr 2, artikel-id e12185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a lack of knowledge about oral care among older people living in short-term care (STC) units and how the quality of oral care provided by nursing staff is perceived by the older people.

    Aim: To (i) describe person-related conditions among older people in STC, (ii) describe and compare perceptions of the quality of oral care (including perceptions of care received and the subjective importance of such care), within and between older people who have the ability to perform oral self-care and those who are dependent on help with oral care and (iii) examine the relationship between person-related conditions and the quality of oral care.

    Methods: A cross-sectional study was conducted with 391 older people in STC units in Sweden based on self-reported questionnaire and clinical assessments.

    Results: The older people were assessed as having normal oral health (2%), moderate oral health problems (78%) or severe oral health problems (20%). When comparing older people's perceptions of quality of oral care in terms of perceived reality and subjective importance, significant differences appeared within and between groups. Psychological well-being had a significant relationship with perception of the quality of oral care (both perceived reality and subjective importance), and gender and oral health status had a significant relationship with subjective importance.

    Conclusions: Older people's perceptions of areas for improvement regarding quality of oral care is a new and important knowledge for nursing staff in STC units. Older people want personalised information regarding oral health and oral care. Registered Nurses who take the responsibility in nursing care for older people's oral health may avoid unnecessary suffering by older people caused by oral health problems.

    Implications for practice: Older people's perspective is an important component for quality work and might lead to improvements in the quality of oral care in STC.

  • 274.
    Andersson, Patiyan
    et al.
    Division of Cell Biology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Kolaric, Aleksandra
    Department of Pathology, Örebro University Hospital, Örebro, Sweden.
    Windahl, Torgny
    Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Kirrander, Peter
    Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Söderkvist, Peter
    Division of Cell Biology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Karlsson, Mats G
    Department of Pathology, Örebro University Hospital, Örebro, Sweden.
    PIK3CA, HRAS and KRAS gene mutations in human penile cancer2008Ingår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 179, nr 5, s. 2030-2034Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The knowledge of somatic mutations that arise in penile cancer is limited. We examined the dysregulation of components in the phosphatidylinositol 3-kinase and Ras pathways.

    Materials and Methods: Using single stranded conformational analysis and direct sequencing we performed mutational analysis of the PIK3CA, PTEN, HRAS, KRAS, NRAS and BRAF genes in 28 penile tumors.

    Results: We identified somatic missense mutations in 11 of the 28 penile cancer samples (39%). In the PIK3CA gene 8 mutations (29%) were identified that were E542K or E545K. In the HRAS gene a G12S and a Q61L mutation were found (7%). The KRAS gene contained 1 mutation (3%), that is a G12S change. PIK3CA mutations were found in all grades and stages, whereas HRAS and KRAS mutations were found in larger and more advanced tumors. The mutations were mutually exclusive, suggesting that dysregulation of either pathway is sufficient for the development and progression of penile carcinoma.

    Conclusions: The high frequency of mutations in the PIK3CA, HRAS and KRAS genes leads us to believe that dysregulation of the phosphatidylinositol 3-kinase or Ras pathway is significant for the development and progression of penile carcinoma.

  • 275.
    Andersson, Pernilla
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Barn och datortomografi: konsekvensen av att utsätta barn för joniserande strålning2013Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Ladda ner fulltext (pdf)
    Barn och datortomografi: konsekvensen av att utsätta barn för joniserande strålning
  • 276.
    Andersson, Pia
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Augustsson, Lena
    Preoperativa metoder som anestesisjuksköterskan kan använda sig utav för att minska den postoperativa smärtan2011Självständigt arbete på avancerad nivå (yrkesexamen), 5 poäng / 7,5 hpStudentuppsats (Examensarbete)
  • 277.
    Andersson, Siv Folkhammar
    et al.
    Unit of Rehabilitation, Kalmar County Council, Oskarshamn, Sweden.
    Bergman, Stefan
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; Primary Health Care Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Henriksson, Elisabet Welin
    Divison of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Division of Nursing Science, Department of Medical and Health Science, Linköping University, Linköping, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; School of Business, Engineering and Science, Halmstad University, Halmstad, Sweden.
    Arthritis management in primary care: A study of physiotherapists' current practice, educational needs and adherence to national guidelines2017Ingår i: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 15, nr 4, s. 333-340Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis-related practice in physiotherapy and to study adherence to evidence-based care.

    METHODS: Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire.

    RESULTS: Sixty-four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA (p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA (p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA (p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment (p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA.

    CONCLUSIONS: PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care.

  • 278.
    Andersson, Sonia
    et al.
    Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden.
    Belkić, Karen
    Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; Claremont Graduate University, Claremont, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, USA.
    Mints, Miriam
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden.
    Östensson, Ellinor
    Department of Women's and Children's Health, Karolinska University Hospital and Institute, Stockholm, Sweden.
    Acceptance of Self-Sampling Among Long-Term Cervical Screening Non-Attenders with HPV-Positive Results: Promising Opportunity for Specific Cancer Education2019Ingår i: Journal of Cancer Education, ISSN 0885-8195, E-ISSN 1543-0154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aims to investigate acceptance of vaginal self-sampling for high-risk human papilloma virus (HPV) among long-term screening non-attenders at increased cervical cancer risk and to identify leverage points to promote screening adherence among these women. Forty-three long-term screening non-attenders performed home vaginal self-sampling for HPV, had positive HPV results, and subsequently attended gynecologic examination. Sixteen (37.2%) had high-grade cervical intraepithelial neoplasia (CIN2 or 3), and two had invasive cervical cancer. Forty-one of these women completed a questionnaire concerning Specific Knowledge about HPV, CIN, and cervical cancer, potential barriers to screening and views about self-sampling. Results were compared with 479 women treated for CIN2+ who attended gynecologic follow-up and also performed self-sampling. Significant multivariate predictors of long-term non-attender status compared with referents were low Specific Knowledge, high confidence in self-sampling, and potential barriers-refraining from activity to attend gynecologic examination, needing another's help to attend, and long travel time. Non-attenders citing fear/refraining from gynecologic examination as why they preferred self-sampling significantly more often had lowest Specific Knowledge compared with other non-attenders. All non-attenders could envision themselves doing self-sampling again while only 74% of referents endorsed this statement (p = 0.0003). We conclude that HPV self-sampling is an acceptable option for women at increased cervical cancer risk who have been long-term screening non-attenders. Educational outreach to enhance Specific Knowledge about HPV, CIN and cervical cancer is critical. Those non-attenders who explicitly avoid gynecologic examinations need special attention. Trial Registry: Clinicaltrials.gov NCT02750124.

  • 279.
    Andersson, Susanne
    et al.
    Örebro universitet, Hälsoakademin.
    Eriksson, Angelica
    Ljudmiljön på två särboenden för äldre: En pilotstudie2011Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Ladda ner fulltext (pdf)
    Ljudmiljön på två särboenden för äldre: En pilotstudie
  • 280.
    Andersson, T.
    et al.
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Bryngelsson, I. L.
    Department of Occupational and Environmental Medicine, Örebro University, Örebro, Sweden.
    Magnuson, A.
    Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden.
    Fröbert, Ole
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Henriksson, K.
    Department of Medical Science, Uppsala University, Uppsala, Sweden.
    Edvardsson, N.
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Poci, Dritan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    What do patients with incident atrial fibrillation and no comorbidities at the time of diagnosis die of?2017Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction: Little is known about the long-term mortality risk and the causes of death in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).

    Purposes: To identify the causes of death in patients with AF and without comorbidities at the time of AF diagnosis.

    Methods: We identified 9 519 patients with first diagnosed AF and no co-morbidities at the time of AF diagnosis in a nation-wide registry of patients hospitalized between 1995 and 2008. They represented 3.5% of the original cohort of 271186 patients hospitalized with incident AF. Patients with any diagnosis from ICD9 and ICD10 at the time of AF diagnosis wereexcluded. They were matched for age, sex and calendar year of AF diagnosis with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.

    Results: During follow-up, 11.1% and 8.3% of patients with AF and controls died, HR 1.3, 95% CI 1.2–1.4. Most of the difference was explained by deaths of cardiovascular causes, 8.3% versus 3.9%, (HR 2.0, 95% CI 1.8–2.3). The cause of death pattern was the same in controls although at much lower rates. The age adjusted relative risk was higher in women than in men, HR 2.3, 95% CI 1.9–2.8 versus HR 1.7, 95% CI 1.4–2.0. Myocardial infarction was the most common cardiovascular cause of death but was less common among patients with AF than in controls, 20.5% versus 32.0%. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8–4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6–1.5). The time from AF diagnosis to death was 6.0±3.1 years, as compared to the time from inclusion to death, 5.8±3.1 years, in controls.

    Conclusions: Only cardiovascular diseases were more often causes of death than in controls. Women carried a significantly higher relative risk than men. The duration between AF diagnosis and death suggests that there is often time enough for early intervention with antithrombotic therapy, rhythm and/or rate control and treatment of risk factors as they appear. Interestingly, controls had the same cause of death pattern although at much lower rates.

  • 281.
    Andersson, Tommy
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Atrial fibrillation and cause of death, sex differences in mortality, and anticoagulation treatment in low-risk patients2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Atrial fibrillation (AF) is the most common arrhythmia but information on cause of death in patients with AF is sparse, and whether individuals at low risk of cerebral infarction (CVL) should receive antico-agulant medication is controversial. Studies of sex differences with respect to mortality risk have shown conflicting results.

    Methods: Data were obtained from Swedish National Registers. In Study I, there were 272 186 AF patients and matched controls and in Studies II and III, 9519 AF patients and no other diagnosis and matched controls. Study IV compared treatment with warfarin to no treatment in 48 433 patients with AF. Hazard ratio (HR) was calculated with 95% confidence intervals and outcome rates as number per 1000 person-years.

    Results: Ischemic heart disease (IHD) was the most common underlying cause of death and was present in 40.2% of AF patients at a HR of 1.7 (1.4-2.1). CVL/stroke was a cause of death in 13.1%, HR 2.7 (1.8-4.0). Among underlying and contributing causes of death, the most common diagnoses were IHD in 43.5%, HR 1.7 (1.4-2.0) and heart failure in 33.1%, HR 2.9 (2.2-3.7). The HRs for mortality in females with AF in age categories ≤65, 65-74, and 75-85 were 2.15, 1.72, and 1.44, and for males 1.76, 1.36, and 1.24. The rates of mortality in females with AF in age categories 55-64, 65-74, and 75-85 were 6.2, 20.7, and 57.3, and for males 8.5, 27.3, and 64.5. In patients 65-74 years, females with a CHA2DS2-VASc score of 2, and males with a score of 1 receiving warfarin treatment showed a significantly reduced risk of cerebral infarc-tion/stroke, HR 0.46 (0.25-0.83) for females and for males, HR 0.39 (0.21-0.73).

    Conclusions: Most common causes of death in AF patients were CVL/stroke, heart failure, and IHD. HR of mortality in patients with AF was higher in females than in males but absolute risk was higher in males with AF compared to females with AF. Anticoagulant therapy was benefi-cial in patients ≥65 years, regardless of the CHA2DS2-VASc score.

    Delarbeten
    1. All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study
    Öppna denna publikation i ny flik eller fönster >>All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study
    Visa övriga...
    2013 (Engelska)Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr 14, s. 1061-1067Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) <= 85 years at the time of hospitalization with incidental AF 1995-2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories <= 65, 65-74, and 75-85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.

    Nyckelord
    Atrial fibrillation, Mortality, Gender, Age, Long term
    Nationell ämneskategori
    Kardiologi
    Forskningsämne
    Kardiologi
    Identifikatorer
    urn:nbn:se:oru:diva-38709 (URN)10.1093/eurheartj/ehs469 (DOI)000317424300014 ()23321349 (PubMedID)2-s2.0-84876218799 (Scopus ID)
    Anmärkning

    Funding agencies ar:

    AstraZeneca R&D, Mölndal, Sweden

    Örebro Heart Foundation Research and

    Committee of Örebro University Hospital

    Tillgänglig från: 2014-11-18 Skapad: 2014-11-18 Senast uppdaterad: 2018-07-23Bibliografiskt granskad
    2. Gender-related differences in risk of cardiovascular morbidity and all-cause mortality in patients hospitalized with incident atrial fibrillation without concomitant diseases: A nationwide cohort study of 9519 patients
    Öppna denna publikation i ny flik eller fönster >>Gender-related differences in risk of cardiovascular morbidity and all-cause mortality in patients hospitalized with incident atrial fibrillation without concomitant diseases: A nationwide cohort study of 9519 patients
    Visa övriga...
    2014 (Engelska)Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 177, nr 1, s. 91-99Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Background: Previous studies of patients with "lone" and "idiopathic" atrial fibrillation (AF) have provided conflicting evidence concerning the development, management and prognosis of this condition.

    Methods: In this nation-wide, retrospective, cohort study, we studied patients diagnosed with incidental AF recorded in national Swedish registries between 1995 and 2008. Controls were matched for age, sex and calendar year of the diagnosis of AF in patients. All subjects were free of any in-hospital diagnosis from 1987 and until patients were diagnosed with AF and also free of any diagnosis within one year from the time of inclusion. Follow-up continued until 2009. We identified 9519 patients (31% women) and 12,468 matched controls.

    Results: Relative risks (RR) versus controls for stroke or transient ischemic attack (TIA) in women were 19.6, 4.4, 3.4 and 2.5 in the age categories <55, 55-64, 65-74 and 75-85, years respectively. Corresponding figures for men were 3.4, 2.5, 1.7 and 1.9. RR for heart failure were 6.6, 6.6, 6.3 and 3.8 in women and 7.8, 4.6, 4.9 and 2.9 in men. All RR were statistically significant with p < 0.01. RR for myocardial infarction and all-cause mortality were statistically significantly increased only in the two oldest age categories in women and 65-74 years in men.

    Conclusions: Patients with AF and no co-morbidities at inclusion had at least a doubled risk of stroke or TIA and a tripled risk of heart failure, through all age categories, as compared to controls. Women were at higher RR of stroke or TIA than men. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).

    Ort, förlag, år, upplaga, sidor
    Elsevier, 2014
    Nyckelord
    Atrial fibrillation, Cardiovascular morbidity, Mortality, Cohort, Nationwide
    Nationell ämneskategori
    Kardiologi
    Identifikatorer
    urn:nbn:se:oru:diva-56310 (URN)10.1016/j.ijcard.2014.09.092 (DOI)000343895000046 ()25499348 (PubMedID)
    Anmärkning

    Funding Agencies:

    AstraZeneca RD Mölndal

    Örebro Heart Foundation

    Research Committee of Örebro University Hospital OLL 2012-265231

    Tillgänglig från: 2017-03-14 Skapad: 2017-03-14 Senast uppdaterad: 2018-06-19Bibliografiskt granskad
    3. Patients without comorbidities at the time of diagnosis of atrial fibrillation: causes of death during long-term follow-up compared to matched controls
    Öppna denna publikation i ny flik eller fönster >>Patients without comorbidities at the time of diagnosis of atrial fibrillation: causes of death during long-term follow-up compared to matched controls
    Visa övriga...
    2017 (Engelska)Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 40, nr 11, s. 1076-1082Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Little is known about the long-term, cause-specific mortality risk in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).

    METHODS: From a nation-wide registry of patients hospitalized with incident AF between 1995 and 2008 we identified 9 519 patients with a first diagnosed AF and no comorbidities at the time of AF diagnosis. They were matched with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.

    RESULTS: During follow-up, 11.1% of patients with AF and 8.3% of controls died. Cardiovascular diseases were the most common causes of death and the only diagnoses which showed significantly higher relative risk in patients with AF than controls (HR 2.0, 95% CI 1.8-2.3), and the relative risk was significantly higher in women than in men. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8-4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6-1.5). The time from AF diagnosis to death was 6.0 ± 3.1 years.

    CONCLUSIONS: In patients with incident AF and no known comorbidities at the time of AF diagnosis, only cardiovascular diseases were more often causes of death as compared to controls. Women carried a significantly higher relative risk than men.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2017
    Nyckelord
    atrial fibrillation, cause of death, idiopathic, morbidity, mortality
    Nationell ämneskategori
    Kardiologi
    Identifikatorer
    urn:nbn:se:oru:diva-61704 (URN)10.1002/clc.22776 (DOI)000417744800020 ()28841233 (PubMedID)2-s2.0-85028540727 (Scopus ID)
    Forskningsfinansiär
    AstraZeneca
    Anmärkning

    Funding Agency:

    Örebro Heart Foundation 

    Research Committee of Örebro University Hospital, Sweden 

    Tillgänglig från: 2017-11-13 Skapad: 2017-11-13 Senast uppdaterad: 2018-09-18Bibliografiskt granskad
    4. Patients with atrial fibrillation and outcomes of cerebral infarction in those with treatment of warfarin versus no warfarin with references to CHA(2)DS(2)-VASc score, age and sex: A Swedish nationwide observational study with 48 433 patients
    Öppna denna publikation i ny flik eller fönster >>Patients with atrial fibrillation and outcomes of cerebral infarction in those with treatment of warfarin versus no warfarin with references to CHA(2)DS(2)-VASc score, age and sex: A Swedish nationwide observational study with 48 433 patients
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    2017 (Engelska)Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 5, artikel-id e0176846Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aims: There is controversy in the guidelines as to whether patients with atrial fibrillation and a low risk of stroke should be treated with anticoagulation, especially those with a CHA(2)DS(2)-VASc score of 1 point.

    Methods: In a retrospective, nationwide cohort study, we used the Swedish National Patient Registry, the National Prescribed Drugs Registry, the Swedish Registry of Education and the Population and Housing Census Registry. 48 433 patients were identified between 1 January 2006 and 31 December 2008 with incident atrial fibrillation who were divided in age categories, sex and a CHA(2)DS(2)-VASc score of 0, 1, 2 and >= 3 and they were included in a time-varying analysis of warfarin treatment versus no treatment. The primary end-point was cerebral infarction and stroke, and patients were followed until 31 December 2009.

    Results: Patients with 1 point from the CHA(2)DS(2)-VASc score showed the following adjusted hazard ratios (HR) with a 95% confidence interval: men 65-74 years 0.46 (0.25-0.83), men < 65 years 1.11 (0.56-2.23) and women < 65 years 2.13 (0.94-4.82), where HR < 1 indicates protection with warfarin. In patients < 65 years and 2 points, HR in men was 0.35 (0.18-0.69) and in women 1.84 (0.86-3.94) while, in women with at least 3 points, HR was 0.31 (0.16-0.59). In patients 65-74 years and 2 points, HR in men was 0.37 (0.23-0.59) and in women 0.39 ( 0.21-0.73). Categories including age >= 65 years or >= 3 points showed a statistically significant protection from warfarin.

    Conclusions: Our results support that treatment with anticoagulation may be considered in all patients with an incident atrial fibrillation diagnosis and an age of 65 years and older, i.e. also when the CHA(2)DS(2)-VASc score is 1.

    Ort, förlag, år, upplaga, sidor
    Public Library of Science, 2017
    Nationell ämneskategori
    Kardiologi
    Forskningsämne
    Kardiologi
    Identifikatorer
    urn:nbn:se:oru:diva-57914 (URN)10.1371/journal.pone.0176846 (DOI)000400648500084 ()28472091 (PubMedID)2-s2.0-85019090489 (Scopus ID)
    Anmärkning

    Funding Agencies:

    Research Committee of Örebro University  0LL 2012-265231 

    AstraZeneca RD Mölndal  

    Örebro Heart Foundation 

    Tillgänglig från: 2017-06-08 Skapad: 2017-06-08 Senast uppdaterad: 2018-07-31Bibliografiskt granskad
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    Atrial fibrillation and cause of death, sex differences in mortality, and anticoagulation treatment in low-risk patients
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  • 282.
    Andersson, Tommy
    et al.
    Dept Cardiology, Örebro Univ Hospital, Örebro, Sweden.
    Magnuson, Anders
    Bryngelsson, Ing-Liss
    Dept. Occupational & Environmental Medicine, Örebro Univ Hospital, Örebro, Sweden.
    Fröbert, Ole
    Örebro University Hospital, Örebro, Sweden.
    Henriksson, Karin M.
    Dept. Laboratory Medicine, Lund Univ, Lund, Sweden; The Sahlgrenska Academy, Sahlgrenska Univ. Hospital, Gothenburg, Sweden.
    Edvardsson, Nils
    The Sahlgrenska Academy, Sahlgrenska Univ. Hospital, Gothenburg, Sweden.
    Poci, Dritan
    Region Örebro län.
    All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995-2008: a Swedish nationwide long-term case-control study2013Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, nr 14, s. 1061-1067Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims To evaluate long-term all-cause risk of mortality in women and men hospitalized for the first time with atrial fibrillation (AF) compared with matched controls. Methods and results A total of 272 186 patients (44% women) <= 85 years at the time of hospitalization with incidental AF 1995-2008 and 544 344 matched controls free of in-hospital diagnosis of AF were identified. Patients were followed via record linkage of the Swedish National Patient Registry and the Cause of Death Registry. Using Cox regression models, the long-term relative all-cause mortality risk, adjusted for concomitant diseases, in women vs. controls was 2.15, 1.72, and 1.44 (P < 0.001) in the age categories <= 65, 65-74, and 75-85 years, respectively. The corresponding figures for men were 1.76, 1.36, and 1.24 (P < 0.001). Among concomitant diseases, neoplasm, chronic renal failure, and chronic obstructive pulmonary disease contributed most to the increased all-cause mortality vs. controls. In patients with AF as the primary diagnosis, the relative risk of mortality was 1.63, 1.46, and 1.28 (P < 0.001) in women and 1.45, 1.17, and 1.10 (P < 0.001) in men. Conclusion Atrial fibrillation was an independent risk factor of all-cause mortality in patients with incident AF. The concomitant diseases that contributed most were found outside the thromboembolic risk scores. The highest relative risk of mortality was seen in women and in the youngest patients compared with controls, and the differences between genders in each age category were statistically significant.

  • 283.
    Andersson, Tommy
    et al.
    Dept Cardiol, Örebro Univ Hosp, Örebro, Sweden.
    Magnuson, Anders
    Clin Epidemiol & Biostat Unit, Örebro University Hospital, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Dept Occupat & Environm Med, Örebro University Hospital, Örebro, Sweden.
    Fröbert, Ole
    Region Örebro län. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Karin M.
    Dept Med Sci, Uppsala Univ, Uppsala, Sweden; AstraZeneca R&D, Mölndal, Sweden.
    Edvardsson, Nils
    Sahlgrenska Univ Hosp, Sahlgrenska Acad, Gothenburg, Sweden.
    Poci, Dritan
    Region Örebro län. Dept Cardiol, Örebro University Hospital, Örebro, Sweden.
    Gender-related differences in risk of cardiovascular morbidity and all-cause mortality in patients hospitalized with incident atrial fibrillation without concomitant diseases: A nationwide cohort study of 9519 patients2014Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 177, nr 1, s. 91-99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous studies of patients with "lone" and "idiopathic" atrial fibrillation (AF) have provided conflicting evidence concerning the development, management and prognosis of this condition.

    Methods: In this nation-wide, retrospective, cohort study, we studied patients diagnosed with incidental AF recorded in national Swedish registries between 1995 and 2008. Controls were matched for age, sex and calendar year of the diagnosis of AF in patients. All subjects were free of any in-hospital diagnosis from 1987 and until patients were diagnosed with AF and also free of any diagnosis within one year from the time of inclusion. Follow-up continued until 2009. We identified 9519 patients (31% women) and 12,468 matched controls.

    Results: Relative risks (RR) versus controls for stroke or transient ischemic attack (TIA) in women were 19.6, 4.4, 3.4 and 2.5 in the age categories <55, 55-64, 65-74 and 75-85, years respectively. Corresponding figures for men were 3.4, 2.5, 1.7 and 1.9. RR for heart failure were 6.6, 6.6, 6.3 and 3.8 in women and 7.8, 4.6, 4.9 and 2.9 in men. All RR were statistically significant with p < 0.01. RR for myocardial infarction and all-cause mortality were statistically significantly increased only in the two oldest age categories in women and 65-74 years in men.

    Conclusions: Patients with AF and no co-morbidities at inclusion had at least a doubled risk of stroke or TIA and a tripled risk of heart failure, through all age categories, as compared to controls. Women were at higher RR of stroke or TIA than men. (C) 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).

  • 284.
    Andersson, Tommy
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders
    Region Örebro län.
    Bryngelsson, Ing-Liss
    Region Örebro län. Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Henriksson, Karin M.
    Department of Medical Science, Uppsala University, Uppsala, Sweden.
    Edvardsson, Nils
    Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden.
    Poci, Dritan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Patients with atrial fibrillation and outcomes of cerebral infarction in those with treatment of warfarin versus no warfarin with references to CHA(2)DS(2)-VASc score, age and sex: A Swedish nationwide observational study with 48 433 patients2017Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 5, artikel-id e0176846Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: There is controversy in the guidelines as to whether patients with atrial fibrillation and a low risk of stroke should be treated with anticoagulation, especially those with a CHA(2)DS(2)-VASc score of 1 point.

    Methods: In a retrospective, nationwide cohort study, we used the Swedish National Patient Registry, the National Prescribed Drugs Registry, the Swedish Registry of Education and the Population and Housing Census Registry. 48 433 patients were identified between 1 January 2006 and 31 December 2008 with incident atrial fibrillation who were divided in age categories, sex and a CHA(2)DS(2)-VASc score of 0, 1, 2 and >= 3 and they were included in a time-varying analysis of warfarin treatment versus no treatment. The primary end-point was cerebral infarction and stroke, and patients were followed until 31 December 2009.

    Results: Patients with 1 point from the CHA(2)DS(2)-VASc score showed the following adjusted hazard ratios (HR) with a 95% confidence interval: men 65-74 years 0.46 (0.25-0.83), men < 65 years 1.11 (0.56-2.23) and women < 65 years 2.13 (0.94-4.82), where HR < 1 indicates protection with warfarin. In patients < 65 years and 2 points, HR in men was 0.35 (0.18-0.69) and in women 1.84 (0.86-3.94) while, in women with at least 3 points, HR was 0.31 (0.16-0.59). In patients 65-74 years and 2 points, HR in men was 0.37 (0.23-0.59) and in women 0.39 ( 0.21-0.73). Categories including age >= 65 years or >= 3 points showed a statistically significant protection from warfarin.

    Conclusions: Our results support that treatment with anticoagulation may be considered in all patients with an incident atrial fibrillation diagnosis and an age of 65 years and older, i.e. also when the CHA(2)DS(2)-VASc score is 1.

  • 285.
    Andersson, Tommy
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Frøbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Henriksson, Karin M.
    Department of Medical Science, Uppsala University, Uppsala and AstraZeneca R&D, Mölndal, Sweden.
    Edvardsson, Nils
    Sahlgrenska Academy at Sahlgrenska University Hospital, Göteborg, Sweden.
    Poçi, Dritan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Patients without comorbidities at the time of diagnosis of atrial fibrillation: causes of death during long-term follow-up compared to matched controls2017Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 40, nr 11, s. 1076-1082Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Little is known about the long-term, cause-specific mortality risk in patients without comorbidities at the time of diagnosis of atrial fibrillation (AF).

    METHODS: From a nation-wide registry of patients hospitalized with incident AF between 1995 and 2008 we identified 9 519 patients with a first diagnosed AF and no comorbidities at the time of AF diagnosis. They were matched with 12 468 controls. The follow-up continued until December 2008. Causes of death were classified according to the ICD-10 codes.

    RESULTS: During follow-up, 11.1% of patients with AF and 8.3% of controls died. Cardiovascular diseases were the most common causes of death and the only diagnoses which showed significantly higher relative risk in patients with AF than controls (HR 2.0, 95% CI 1.8-2.3), and the relative risk was significantly higher in women than in men. Stroke was a more common cause among patients with AF, 13.1% versus 9.7% (HR 2.7, 95% CI 1.8-4.0), while cerebral hemorrhage was more common among controls, 4.7% versus 10.2% (HR 0.9, 95% CI 0.6-1.5). The time from AF diagnosis to death was 6.0 ± 3.1 years.

    CONCLUSIONS: In patients with incident AF and no known comorbidities at the time of AF diagnosis, only cardiovascular diseases were more often causes of death as compared to controls. Women carried a significantly higher relative risk than men.

  • 286.
    Andersson, Torbjörn
    Örebro universitet, Hälsoakademin.
    Den digitala röntgenavdelningen2008Ingår i: Radiologi / [ed] Peter Aspelin, Holger Pettersson, Lund: Studentlitteratur , 2008, s. 125-134Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 287. Andersson, Åsa G.
    et al.
    Kamwendo, Kitty
    Örebro universitet, Institutionen för vårdvetenskap och omsorg.
    Seiger, Åke
    Appelros, Peter
    Örebro universitet, Institutionen för klinisk medicin.
    How to identify potential fallers in a stroke unit: validity indexes of 4 test methods2006Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, nr 3, s. 186-191Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The aim of this study was to describe general characteristics of patients with stroke who have a tendency to fall and to determine whether certain test instruments can identify fallers. METHODS: Patients treated in a stroke unit during a 12-month period were included. At inclusion assessments were made with Berg Balance Scale Berg Balance Scale, Stops Walking When Talking, Timed Up & Go (TUG) and diffTUG. At follow-up 6 or 12 months later, patients who had fallen were identified. RESULTS: During the time from discharge to follow-up on 159 patients, 68 patients fell and 91 did not. Fallers fell more often during their initial hospital stay, used sedatives more often and were more visually impaired, compared with non-fallers. The Berg Balance Scale, Stops Walking When Talking and TUG results differed between fallers and non-fallers. The combined results of Berg Balance Scale and Stops Walking When Talking increased the possibility of identifying fallers. CONCLUSION: Berg Balance Scale, Stops Walking When Talking and TUG can be used to evaluate which patients have a tendency to fall in order to carry out preventive measures. Berg Balance Scale can be used in all patients. Stops Walking When Talking can give additional information if the patient is able to walk. TUG is a possible choice, but fewer patients can perform it.

  • 288.
    Andersson, Åsa G.
    et al.
    Karolinska institutet, Stockholm, Sweden; Örebro University Hospital, Örebro, Sweden.
    Seiger, Åke
    Karolinska institutet, Stockholm, Sweden.
    Appelros, Peter
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Karolinska institutet, Stockholm, Sweden; Örebro University Hospital, Örebro, Sweden.
    Hip fractures in persons with stroke2013Ingår i: Stroke Research and Treatment, ISSN 2090-8105, E-ISSN 2042-0056, Vol. 2013, artikel-id 954279Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 289.
    Anderzen Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Leibring, Ingela
    Fear and coping during treatment for acute lymphatic leukemia: from the perspective of children 5-9 years old2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: The concept of fear can be defined as ”an unpleasant often strong emotion caused by expectation of danger”. It is reasonable to believe that fear and coping of fear, can vary during the course of treatment for ALL. The aim of the present study was to describe a longitudinal perspective on fear related to having ALL, based on children’s perspective, as well as to describe the strategies these children use when experiencing fear.

    Design: The study has a longitudinal descriptive qualitative design. Three girls and 10 boys, initially aged 5-9 were interviewed once to three times during their treatment period (approximately two months after the diagnosis, after one year and at the end of the 2.5-year long treatment). In total, 35 interviews were conducted. Data were analyzed using a matrix-based qualitative analysis method.

    Results: The children described fear of being subjected to needles and related to having a feeding tube, to remove adhesive tape and taking tablets, as well as fear related to the bodily changes caused by the ALL. Existential fears were most frequently mentioned at end of treatment. The children wanted to participate in their care. They used cognitive strategies, such as ”thinking the right way” and emotional strategies, such as crying out loud and kicking. The fears changed over time, but the fear of being subjected to needles remained for half of the children, but was less intense at the end of treatment. The strategies developed, and became more sophisticated over the treatment period.

    Conclusion: The fear changed throughout the course of treatment, and so did the strategies used. It is reasonable to believe that the need for support also vary, which is a topic for future research.

  • 290.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Audiological Research Centre.
    Health care consumption in infants with CHARGE syndrome: a case-study2017Konferensbidrag (Refereegranskat)
  • 291.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Leibring, I.
    Karlstad University, Faculty of Health- Science and Technology- Department of Health Sciences- Nursing, Karlstad, Sweden.
    Fear and Coping During Treatment for Acute Lymphatic Leukemia - from the Perspective of Children 5-9 Years Old2018Ingår i: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 65, nr Suppl.2, s. S598-S598Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background/Objectives: The concept of fear can be defined as ”an unpleasant often strong emotion caused by expectation of danger”. It is reasonable to believe that fear and coping of fear, can vary during the course of treatment for ALL. The aim of the present study was to describe a longitudinal perspective on fear related to having ALL, based on children's perspective, as well as to describe the strategies these children use when experiencing fear.

    Design/Methods: The study has a longitudinal descriptive qualitative design. Three girls and 10 boys, initially aged 5-9 were interviewed once to three times during their treatment period (approximately two months after the diagnosis, after one year and at the end of the 2.5-year long treatment). In total, 35 interviews were conducted. Data were analyzed using a matrix-based qualitative analysis method.

    Results: The children described fear of being subjected to needles and related to having a feeding tube, removing adhesive tape and taking tablets, as well as fear related to the bodily changes caused by the ALL. Existential fears were most frequently mentioned at the end of treatment. The children wanted to participate i n their care. They used cognitive strategies, such as ”thinking the right way” and emotional strategies, such as crying out loud and kicking. The fears changed over time, but the fear of being subjected to needles remained for half of the children, but was less intense at the end of treatment. The strategies developed, and became more sophisticated over the treatment period.

    Conclusions: The fear changed throughout the course of treatment, and so did the strategies used. It is reasonable to believe that the need for support also vary, which i s a topic for future research.

  • 292.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Hälsoakademin.
    Aktuell forskare om barn med cancer, deras rädsla och sättet den hanteras på2008Ingår i: Barnbladet, ISSN 0349-1994, Vol. 33, nr 2, s. 45-46Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 293.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Hälsoakademin.
    Att hantera rädsla hos barn med cancer2008Ingår i: Onkologi i Sverige, ISSN 1653-1582, Vol. 4, nr 6, s. 14-20Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 294.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Hälsovetenskapliga institutionen.
    Existentiella rädslor hos barn med cancer: föräldrars och vårdpersonals berättelser2007Ingår i: Omsorg: Nordisk tidsskrift for Palliativ Medisin, ISSN 0800-7489, Vol. 24, nr 4, s. 33-39Artikel i tidskrift (Övrigt vetenskapligt)
  • 295.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro universitet, Hälsoakademin.
    Kihlgren, Annica
    Örebro universitet, Hälsoakademin.
    Sörlie, Venke
    Högskolan i Bodö.
    Embodied suffering: experiences of fear in adolescent girls with cancer2008Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 12, nr 2, s. 129-143Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Previously, fear in adolescents with cancer has been sparsely described from an emic perspective. The aim of this study was to illuminate fear in adolescents with personal experience of cancer. The participants were six adolescent girls between the age of 14 and 16 years who were no longer under active treatment for cancer but still went for regular check-ups. Open interviews were conducted. Data were analysed according to the phenomenological hermeneutic method. In the result one main theme was identified: `an embodied fear — a threat to the personal self'. This theme was built up by three separate but intertwined themes: `experiencing fear related to the physical body', `experiencing existential fear' and `experiencing fear related to the social self'. In the comprehensive understanding the fear was interpreted from youth cultural aspects as well as a holistic perspective. The importance of professionals taking the whole person and their situation into account when meeting the fear is underlined.

  • 296.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Kihlgren, Mona
    Skeppner, Gunnar
    Sörlie, Venke
    How physicians and nurses handle fear in children with cancer2007Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 22, nr 1, s. 71-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Previous research on fear in children with cancer has often focused on interventions to alleviate fear related to medical procedures and less on how to meet the challenges related to existential fear. This study aimed to describe how experienced nurses and physicians handle fear in children with cancer. Ten nurses and physicians with more than 10 years of experience in child oncology from a university hospital in Sweden were interviewed, and a qualitative content analysis was performed on the data. Nurses' and physicians' handling of fear encompasses commitment and closeness and yet also a distancing from fear and its expressions

  • 297.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Kihlgren, Mona
    Svantesson, Mia
    Örebro universitet, Institutionen för klinisk medicin.
    Sörlie, Venke
    Children's fear as experienced by the parents of children with cancer2007Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 22, nr 3, s. 233-244Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is known that children with cancer experience and express fear, but little is found in the literature about how the parents experience their child's fear. This study aimed to highlight the parents' lived experience and understanding of their child's fear. Focus group interviews with 15 parents were performed. Data were analyzed through a phenomenological hermeneutic method. Fear in children with cancer is described by the parents as a multidimensional phenomenon, which is somehow difficult to identify. It appears in contrast to the absence of fear. The comprehensive understanding of the results reveals that the parents experience their children's fear as both a suffering and an ethical demand for the parents to answer.

  • 298.
    Andin, Josefine
    et al.
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.
    Elwer, Åsa
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Mäki-Torkko, Elina
    Örebro universitet, Institutionen för medicinska vetenskaper. Swedish Institute for Disability Research.
    Arithmetic in the adult deaf signing brain2020Ingår i: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547, Vol. 98, nr 4, s. 643-654Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 299.
    Andjelkov, Nenad
    et al.
    Department of Orthopedics, Västmanlands Regional Hospital, Västerås, Sweden; Centre for Clinical Research, Uppsala University, Västmanlands Regional Hospital, Västerås, Sweden; Department of Orthopedics, University Hospital Örebro, Örebro, Sweden.
    Riyadh, Hasan
    Department of Orthopedics, Västmanlands Regional Hospital, Västerås, Sweden.
    Wretenberg, Per
    Department of Orthopedics, University Hospital Örebro, Örebro, Sweden.
    Neuralgic and Nociceptive Pain in the Knee as a Cause of the Treatment Failure after Cartilage Repair Surgery: Two Case Reports2018Ingår i: Journal of Pain & Relief, ISSN 2167-0846, Vol. 7, nr 4, artikel-id 325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Cartilage injuries are one of the most frequent causes of knee pain. Other causes such as meniscus tears, synovial plica, synovitis, partial and total ligament ruptures are rather easy to identify by standard diagnostic methods and diagnostic arthroscopy. In this study we are describing two other clinical states, which could be the cause of the knee pain and should be addressed before a decision for operative treatment of cartilage injury has been made by a surgeon.

    Materials and Methods: Two patients with isolated focal defects due to previous trauma to the knee were diagnosed both using magnetic resonance imaging preoperatively and intraoperatively during arthroscopy. These were operated arthroscopically with standard procedure for micro fracture. Both patients had treatment failure without a sign of significant improvement after six and twelve months.

    Results: Second look arthroscopy was performed in both cases due to the treatment failure and close to normal cartilage was found in the patella in first case and both in trochlea and medial femoral condyle in other case. No other cause of pain could be identified both with second look arthroscopy and magnetic resonance imaging done 6-12 months postoperatively. The patients were diagnosed with neuralgic pain in one case, and nociceptive pain in other case.

    Conclusion: These states are rare, but have to be addressed by the surgeon before making the decision about the operative treatment. By doing so, one could avoid eventual treatment failure and exposition of the patient to an unnecessary risk of complications during the surgery.

  • 300.
    Andrade, Anenisia C.
    et al.
    Karolinska Inst, Stockholm, Sweden; Karolinska Univ Hosp, Stockholm, Sweden.
    Gkourogianni, Alexandra
    Karolinska Inst, Stockholm, Sweden; Karolinska Univ Hosp, Stockholm, Sweden.
    Segerlund, Emma
    Sunderby Hosp, Sunderby, Sweden.
    Werner-Sperker, Antje
    Sunderby Hosp, Sunderby, Sweden.
    Horemuzova, Eva
    Karolinska Inst, Stockholm, Sweden; Karolinska Univ Hosp, Stockholm, Sweden.
    Dahlgren, Jovanna
    Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Nilsson, Ola
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Inst, Stockholm, Sweden; Karolinska Univ Hosp, Stockholm, Sweden.
    Short Stature Due To Two Novel Heterozygous Igf1r Mutations and Response To Gh Treatment2017Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 88, nr Suppl. 1, s. 130-131, artikel-id P1-842Artikel i tidskrift (Övrigt vetenskapligt)
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