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  • 301. Andrén, Ove
    et al.
    Garmo, H.
    Mucci, L.
    Andersson, Swen-Olof
    Johansson, Jan-Erik
    Örebro universitet, Hälsoakademin.
    Fall, Katja
    Incidence and mortality of incidental prostate cancer: a Swedish register-based study2009Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 100, nr 1, s. 170-173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In a national register-based study of incidence trends and mortality of incidental prostate cancer in Sweden, we found that a significant proportion (26.6%) of affected men diagnosed died of their disease, which challenges earlier descriptions of incidental prostate cancer as a non-lethal disease.

  • 302.
    Andrén, Ove
    et al.
    Örebro universitet, Hälsoakademin.
    Garmo, Hans
    Mucci, Lorelei
    Andersson, Swen-Olof
    Johansson, Jan-Erik
    Fall, Katja
    Time trends and survival among men diagnosed with incidental prostate cancer in Sweden: a register-based study between 1970 and 2003Manuskript (preprint) (Övrigt vetenskapligt)
  • 303.
    Andrén, Ove
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Widmark, A.
    Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
    Fält, A.
    Ulvskog, E.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Oncology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Davidsson, Sabina
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Karlsson, C. Thellenberg
    Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
    Hjälm-Eriksson, M.
    Department of Oncology, Karolinska Institute, Stockholm, Sweden.
    Cabazitaxel followed by androgen deprivation therapy (ADT) significantly improves time to progression in patients with newly diagnosed metastatic hormone sensitive prostate cancer (mHSPC): A randomized, open label, phase III, multicenter trial2017Ingår i: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 28, nr Suppl. 5, artikel-id 811PArtikel i tidskrift (Övrigt vetenskapligt)
  • 304.
    Andsberg, Gunnar
    et al.
    Department of Rehabilitation Medicine and Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
    Esbjörnsson, Magnus
    Department of Medicine, Hässleholm, Sweden.
    Olofsson, Arne
    Region Skåne Prehospital Unit, Lund, Sweden.
    Lindgren, Arne
    Department of Rehabilitation Medicine and Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
    Norrving, Bo
    Department of Rehabilitation Medicine and Neurology, Lund University, Skåne University Hospital, Lund, Sweden.
    von Euler, Mia
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden.
    PreHospital Ambulance Stroke Test: pilot study of a novel stroke test2017Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 25, nr 1, artikel-id 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

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

  • 305.
    Angelhoff, Charlotte
    et al.
    Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden; Department of Clinical and Experimental Medicine, Department of Paediatrics, Linköping University, Linköping, Sweden.
    Blomqvist, Ylva Thernström
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Helmer, Charlotte Sahlén
    Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden; Department of Clinical and Experimental Medicine, Department of Paediatrics, Linköping University, Linköping, Sweden.
    Olsson, Emma
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Pediatrics.
    Shorey, Shefaly
    Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
    Frostell, Anneli
    Division of Psychology, Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
    Morelius, Evalotte
    Department of Social and Welfare Studies, Division of Nursing Science, Linköping University, Norrköping, Sweden.
    Effect of skin-to-skin contact on parents' sleep quality, mood, parent-infant interaction and cortisol concentrations in neonatal care units: study protocol of a randomised controlled trial2018Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, nr 7, artikel-id e021606Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Separation after preterm birth is a major stressor for infants and parents. Skin-to-skin contact (SSC) is a method of care suitable to use in the neonatal intensive care unit (NICU) to minimise separation between parents and infants. Less separation leads to increased possibilities for parent-infant interaction, provided that the parents' sleep quality is satisfactory. We aimed to evaluate the effect of continuous SSC on sleep quality and mood in parents of preterm infants born <33 weeks of gestation as well as the quality of parent-infant interaction and salivary cortisol concentrations at the time of discharge.

    Methods and analysis: A randomised intervention study with two arms-intervention versus standard care. Data will be collected from 50 families. Eligible families will be randomly allocated to intervention or standard care when transferred from the intensive care room to the family-room in the NICU. The intervention consists of continuous SSC for four consecutive days and nights in the family-room. Data will be collected every day during the intervention and again at the time of discharge from the hospital. Outcome measures comprise activity tracker (Actigraph); validated self-rated questionnaires concerning sleep, mood and bonding; observed scorings of parental sensitivity and emotional availability and salivary cortisol. Data will be analysed with pairwise, repeated measures, Mann Whitney U-test will be used to compare groups and analysis of variance will be used to adjust for different hospitals and parents' gender.

    Ethics and dissemination: The study is approved by the Regional Research Ethics Board at an appropriate university (2016/89-31). The results will be published in scientific journals. We will also use conferences and social media to disseminate our findings.

  • 306.
    Angelison, L.
    et al.
    Helsingborg, Sweden.
    Almer, S.
    Stockholm, Sweden.
    Eriksson, A.
    Gothenburg, Sweden.
    Karling, P.
    Umeå, Sweden.
    Fagerberg, U.
    Västeras, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Thörn, M.
    Uppsala, Sweden.
    Björk, J.
    Stockholm, Sweden.
    Hindorf, U.
    Lund, Sweden.
    Löfberg, R.
    Stockholm, Sweden.
    Bajor, A.
    Gothenburg, Sweden.
    Hjortswang, H.
    Linköping, Sweden.
    Hammarlund, P.
    Ängelholm, Sweden.
    Grip, O.
    Malmö, Sweden.
    Torp, J.
    Kristianstad, Sweden.
    Marsal, J.
    Lund, Sweden.
    Hertervig, E.
    Lund, Sweden.
    Long-term outcome of infliximab treatment in chronic active ulcerative colitis: a Swedish multicentre study of 250 patients2017Ingår i: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 45, nr 4, s. 519-532Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Real-life long-term data on infliximab treatment in ulcerative colitis are limited.

    Aim: To study the long-term efficacy and safety of infliximab in chronic active ulcerative colitis and possible predictors of colectomy and response were also examined.

    Methods: A retrospective multi-centre study of infliximab treatment in 250 patients with chronic active ulcerative colitis with inclusion criteria: age ≥18 years, ambulatory treated, steroid-dependent or intolerant and/or immunomodulator refractory or intolerant.

    Results: Steroid-free clinical remission was achieved by 123/250 patients (49.2%) at 12 months and in 126/250 patients at a median follow-up of 2.9 years (50.4%). Primary response at 3 months was achieved by 190/250 (76.0%) patients and associated with a high probability of response 168/190 (88.4%) at 12 months and 143/190 (75.3%) at follow-up. Long-term rate of colectomy in primary responders was 6/190 (3.2%) at 12 months and 27/190 (14.2%) at last follow-up. Failure to achieve response at 3 months was associated with a high risk of subsequent colectomy, 29/60 (48.3%) at 12 months and 41/60 (68.3%) at follow-up. Response at 12 months was associated with a low risk of subsequent colectomy, 14/181 (7.7%) compared with non-response 19/34 (55.9%) (P < 0.0001). Non-response at 3 months was an independent predictor of subsequent colectomy (HR = 9.40, 95% CI = 5.10-17.35, P < 0.001). Concomitant azathioprine therapy did not influence outcome in terms of colectomy.

    Conclusions: Long-term efficacy of infliximab treatment in chronic active ulcerative colitis is excellent especially in patients who respond to induction treatment. Conversely, non-response at 3 months predicts a poor outcome, with a high risk of subsequent colectomy.

  • 307.
    Angenete, Eva
    et al.
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Thornell, Anders
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp östra, Univ Gothenburg, Gothenburg, Sweden.
    Burcharth, Jakob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Pommergaard, Hans-Christian
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Skullman, Stefan
    Dept Surg, Skaraborgs Hosp, Skövde, Sweden.
    Bisgaard, Thue
    Div Surg, GastroUnit, Hvidovre Hosp, Univ Copenhagen, Hvidovre, Denmark.
    Jess, Per
    Dept Surg, Roskilde Hosp, Roskilde, Denmark.
    Lackberg, Zoltan
    NAL Hosp Grp, Trollhättan, Sweden.
    Matthiessen, Peter
    Region Örebro län. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Heath, Jane
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Rosenberg, Jacob
    Dept Surg, Herlev Hosp, Univ Copenhagen, Herlev, Denmark.
    Haglind, Eva
    Scandinavian Surg Outcomes Res Grp, Dept Surg,Inst Clin Sci, Sahlgrenska Univ Hosp Östra, Univ Gothenburg, Gothenburg, Sweden.
    Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis The First Results From the Randomized Controlled Trial DILALA2016Ingår i: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 263, nr 1, s. 117-122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.

    Background:Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and stoma (Hartmann procedure) with considerable postoperative morbidity and mortality. Laparoscopic lavage has been suggested as a less invasive surgical treatment.

    Methods:Laparoscopic lavage was compared with colon resection and stoma in a randomized controlled multicenter trial, DILALA (ISRCTN82208287). Initial diagnostic laparoscopy showing Hinchey III was followed by randomization. Clinical data was collected up to 12 weeks postoperatively.

    Results: Eighty-three patients were randomized, out of whom 39 patients in laparoscopic lavage and 36 patients in the Hartmann procedure groups were available for analysis. Morbidity and mortality after laparoscopic lavage did not differ when compared with the Hartmann procedure. Laparoscopic lavage resulted in shorter operating time, shorter time in the recovery unit, and shorter hospital stay.

    Conclusions:In this trial, laparoscopic lavage as treatment for patients with perforated diverticulitis Hinchey III was feasible and safe in the short-term.

  • 308.
    Angerås, Oskar
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Haraldsson, Inger
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Redfors, Björn
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Petursson, Petur
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Albertsson, Per
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ioanes, Dan
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Odenstedt, Jacob
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Olsson, Hans
    Department of Cardiology, Karlstad Hospital, Karlstad, Sweden.
    Witt, Nils
    Department of Cardiology, South Hospital Stockholm, Stockholm, Sweden.
    Rück, Andreas
    Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Millgård, Jonas
    Department of Cardiology, Sunderby Hospital, Sunderbyn, Sweden.
    Nilsson, Johan
    Department of Cardiology, Heart Centre, Umeå University Hospital, Umeå, Sweden.
    Persson, Jonas
    Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
    Söderbom, Måns
    Department of Economics, University of Gothenburg, Gothenburg, Sweden.
    Wedel, Hans
    Health Metrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Erlinge, David
    Department of Cardiology, Lund University, Lund, Sweden.
    James, Stefan
    Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Ramunddal, Truls
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Omerovic, Elmir
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Impact of Thrombus Aspiration on Mortality, Stent Thrombosis, and Stroke in Patients With ST-Segment-Elevation Myocardial Infarction: A Report From the Swedish Coronary Angiography and Angioplasty Registry2018Ingår i: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, nr 1, artikel-id e007680Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Thrombus aspiration is still being used in a substantial number of patients despite 2 large randomized clinical trials showing no favorable effect of routine thrombus aspiration during primary percutaneous coronary intervention in patients with STsegment- elevation myocardial infarction. The aim of this observational study was to evaluate the impact of thrombus aspiration on mortality, stent thrombosis, and stroke using all available data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).

    Methods and Results: We identified 42 829 consecutive patients registered in SCAAR between January 2005 and September 2014 who underwent percutaneous coronary intervention for ST-segment-elevation myocardial infarction. Thrombus aspiration was used in 25% of the procedures. We used instrumental variable analysis with administrative healthcare region as the treatmentpreference instrumental variable to evaluate the effect of thrombus aspiration on mortality, stent thrombosis, and stroke. Thrombus aspiration was not associated with mortality at 30 days (risk reduction: -1.2; 95% confidence interval [CI], -5.4 to 3.0; P=0.57) and 1 year (risk reduction: -2.4; 95% CI, -7.6 to 3.0; P=0.37). Thrombus aspiration was associated with a lower risk of stent thrombosis both at 30 days (risk reduction: -2.7; 95% CI, -4.1 to -1.4; P<0.001) and 1 year (risk reduction: -3.5; 95% CI, -5.3 to -1.7; P<0.001). In-hospital stroke and neurologic complications did not differ between groups (risk reduction: 0.1; 95% CI, -0.8 to 1.1; P=0.76).

    Conclusions: Mortality was not different between the groups. Thrombus aspiration was associated with decreased risk of stent thrombosis. Our study provides important evidence for the external validity of previous randomized studies regarding mortality.

  • 309.
    Annika, Lindh
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Theander, K.
    Arne, M.
    Lisspers, K.
    Lundh, L.
    Sandelowsky, H.
    Ställberg, B.
    Thors Adolfsson, E.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Zakrisson, Ann-Britt
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    A descriptive study of incorrect inhalation technique in patients with COPD in primary care2018Konferensbidrag (Refereegranskat)
  • 310.
    Annika, Lindh
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Centre for clinical research, County Council of Värmland, Karlstad, Sweden.
    Theander, Kersti
    Centre for clinical research, County Council of Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for clinical research, County Council of Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Karlstad, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lundh, Lena
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Stockholm, Sweden.
    Sandelowsky, Hanna
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Adolfsson, Eva Thors
    Primary health care, Region Västmanland, Västerås, Sweden.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Zakrisson, Ann-Britt
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Healthcare Research Center.
    Description of inhalation technique in patients with COPD in primary care2018Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52, nr Suppl. 62, artikel-id PA2070Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: A recent systematic review showed that only about one third of the patients had a correct inhalation technique and the number had not improved the last 40 years¹.

    Aim: The aim was to describe errors, separated into errors related to devices and errors related to inhalation technique, that occur when patients with COPD inhale medications.

    Method: In this descriptive study, patients with a COPD diagnosis were recruited from a randomized controlled trial performed 2015-2016 in primary care in four county councils in Sweden. A COPD nurse assessed the inhalation technique using a checklist with errors related to devices and to inhalation technique with possibility to write additional comments.

    Results: In total, 167 patients using 287 inhalers were assessed, 52% (n = 86) were female, mean age 71 years. A total of 163 errors were noted in the checklist, of which 87 were related to inhalation technique and 76 were related to devices. Except from this the COPD nurse had written comments regarding 53 errors that were not included in the checklist. At least one error (range: 1-7 errors) was made by 46% (n = 76) of the patients.

    Conclusion: The results show that many patients do not use the device correctly. Both errors related to inhalation technique and related to devices were present. This implies that there is a need to focus on both aspects when teaching patients how to inhale their medication. The checklist used in this study needs to be further improved.

  • 311.
    Annika, Lindh
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Theander, Kersti
    Arne, Mats
    Lisspers, Karin
    Lundh, Lena
    Sandelowsky, Hanna
    Ställberg, Björn
    Thors Adolfsson, Eva
    Zakrisson, Ann-Britt
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Incorrect inhalation technique is common in patients with COPD in primary care2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    The results show that many patients don’t use the inhaler correctly. Errors related to inhalation technique were twice as common as those related to devices. When teaching patients to use the inhalers it seems like there is a need to focus more on the inhalation technique itself. The checklist used in this study needs to be further improved.

  • 312.
    Anniko, Malin
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Tillfors, M
    Faculty of Arts and Social Sciences, Department of Social and Psychological Studies: Psychology, Karlstad University, Karlstad, Sweden.
    Sources of stress and worry in the development of stress-related mental health problems: A longitudinal investigation from early- to mid-adolescence2019Ingår i: Anxiety, Stress, and Coping, ISSN 1061-5806, E-ISSN 1477-2205, Vol. 32, nr 2, s. 155-167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Stress and stress-related mental health complaints are common and increasing among adolescents, especially girls. Identifying typical sources of stress as well as central intervention targets is an important effort in the development of effective prevention and treatment protocols. This study investigated worry as potential mediator in the development of mental health problems in response to common stressors in adolescence. We also examined to what sources adolescents ascribe their stress over the years from the 7th through the 9th grade.

    DESIGN: Prospective cohort study.

    METHODS: Self-reported subjective stressor load, worry, anxiety and depressive symptoms were assessed in a sample of Swedish 7th graders (N = 1137; 46% girls, mean age 13.2) with follow-up assessments one and two years later.

    RESULTS: School was the most common source of stress across all time-points, with girls reporting considerable more stress than boys. Worry mediated the relationship between overall stressor load and depressive symptoms and anxiety over time and was not moderated by gender.

    CONCLUSIONS: Worry may be an important target in stress prevention and efforts to prevent stress-related problems would benefit from focusing on early adolescence as especially school stress is already relatively common in grade 7.

  • 313.
    Anniko, Malin
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Boersma, Katja
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    van Wijk, Nikil Ph. L.
    Aquarius Analyses & Training (AA&T), Curaçao.
    Byrne, Don
    The Medical School, College of Medicine Biology and Environment, The Australian National University, Canberra, Australia.
    Tillfors, Maria
    Department of Social and Psychological Studies, Psychology, Karlstad University, Karlstad, Sweden.
    Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents2018Ingår i: Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, E-ISSN 2245-8875, Vol. 6, nr 1, s. 4-15Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Stressor experience is an important topic of research concerning adolescent health and ill-health. For this, valid and reliable measures of adolescent stress are needed. The Adolescent Stress Questionnaire 2 was developed to tap into stressor domains specific for adolescence. Psychometric evaluations in Australian and European samples have indicated adequate psychometric properties. However, the ASQ-2 is quite extensive, which may render its use in large cohort studies, where several aspects of adolescent health are investigated, inconvenient and problematic.

    Objective: To evaluate the psychometric properties of a short version of the ASQ-2 (ASQ-S) in terms of construct validity and factorial invariance across gender.

    Method: The ASQ-2 was translated into Swedish and items were retained from nine of the ten scales based on factor loadings. One scale (stress of emerging adult responsibilities) was removed entirely due to low internal consistency and variance explained. The remaining 27 items were piloted and then included in an ongoing 5-year longitudinal study involving the participation of all students in the 7th and 8th grade in public schools from three Swedish municipalities (N = 2768, 47.5 % girls, mean age 13.64 years). For this study data from the first and second wave was used.

    Results: A nine factor Confirmatory Factor Analysis (CFA) showed a good fit to the data and invariance across sexes was supported. The nine scales correlated positively with depressive symptoms, anxiety and worry and negatively with self-esteem. Girls reported higher stress levels than boys in eight of the nine scales. Stressors related to peer pressure predicted reported levels of anxiety and worry one year later, whereas stressors related to romantic relationships predicted depressive symptoms.

    Conclusions: Overall this study suggests that the ASQ-S could be a valid measure of adolescent stressor experience and psychometrically equivalent to the full ASQ-2.

  • 314.
    Ansari, Malik
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Azar, Jonny
    Barn och föräldrars behov av information och förberedelser inför ett kirurgiskt ingrepp2011Självständigt arbete på avancerad nivå (yrkesexamen), 5 poäng / 7,5 hpStudentuppsats (Examensarbete)
  • 315.
    Appelros, Peter
    Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Cognitive impairment in lacunar strokes2014Ingår i: European Neurological Review, ISSN 1758-3837, Vol. 9, nr 1, s. 64-67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 316.
    Appelros, Peter
    Örebro universitet, Institutionen för klinisk medicin.
    Heart failure and stroke2006Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 37, nr 7, s. 1637-1637Artikel i tidskrift (Refereegranskat)
  • 317.
    Appelros, Peter
    Örebro universitet, Institutionen för klinisk medicin.
    Prevalence and predictors of pain and fatigue after stroke: a population-based study2006Ingår i: International Journal of Rehabilitation Research, ISSN 0342-5282, E-ISSN 1473-5660, Vol. 29, nr 4, s. 329-333Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 318.
    Appelros, Peter
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Andersson, A. G.
    Changes in mini mental state examination score after stroke: lacunar infarction predicts cognitive decline2006Ingår i: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 13, nr 5, s. 491-495Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 319.
    Appelros, Peter
    et al.
    Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Farahmand, Bahman
    Epi-consultants (Formerly Karolinska Institute), Alzheimer Disease Research Center, Stockholm, Sweden.
    Terént, Andreas
    Department of Medical Sciences,Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
    Åsberg, Signild
    Department of Medical Sciences, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
    To Treat or Not to Treat: Anticoagulants as Secondary Preventives to the Oldest Old With Atrial Fibrillation.2017Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, nr 6, s. 1617-1623Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: Anticoagulant treatment is effective for preventing recurrent ischemic strokes in patients who have atrial fibrillation. This benefit is paid by a small increase of hemorrhages. Anticoagulant-related hemorrhages seem to increase with age, but there are few studies showing whether the benefits of treatment persist in old age.

    METHODS: For this observational study, 4 different registers were used, among them Riksstroke, the Swedish Stroke Register. Patients who have had a recent ischemic stroke, were 80 to 100 years of age, and had atrial fibrillation, were included from 2006 through 2013. The patients were stratified into 3 age groups: 80 to 84, 85 to 89, and ≥90 years of age. Information on stroke severity, risk factors, drugs, and comorbidities was gathered from the registers. The patients were followed with respect to ischemic or hemorrhagic stroke, other hemorrhages, or death.

    RESULTS: Of all 23 356 patients with atrial fibrillation, 6361 (27%) used anticoagulants after an ischemic stroke. Anticoagulant treatment was associated with less recurrent ischemic stroke in all age groups. Hemorrhages increased most in the ≥90-year age group, but this did not offset the overall beneficial effect of the anticoagulant. Apart from age, no other cardiovascular risk factor or comorbidity was identified that influenced the risk of anticoagulant-associated hemorrhage. Drugs other than anticoagulants did not influence the incidence of major hemorrhage.

    CONCLUSIONS: Given the patient characteristics in this study, there is room for more patients to be treated with anticoagulants, without hemorrhages to prevail. In nonagenarians, hemorrhages increased somewhat more, but this did not affect the overall outcome in this age stratum.

  • 320.
    Appelros, Peter
    et al.
    Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Háls Berglund, Maria
    Riksstroke, Medicincentrum, University Hospital of Norrland, Umeå, Sweden.
    Ström, Jakob O.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Chemistry, Linköping University, Linköping, Sweden.
    Long-Term Risk of Stroke after Transient Ischemic Attack2017Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 43, nr 1-2, s. 25-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 321.
    Appelros, Peter
    et al.
    Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Jonsson, Fredrik
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Signild
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Asplund, Kjell
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Glader, Eva-Lotta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Åsberg, Kerstin Hulter
    Department of Medicine, Enköping Hospital, Enköping, Sweden.
    Norrving, Bo
    Department of Neurology, Lund University Hospital, Lund, Sweden.
    Stegmayr, Birgitta
    Riks-Stroke, Department of Medicine, Umeå University Hospital, Umeå, Sweden.
    Terént, Andreas
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Trends in stroke treatment and outcome between 1995 and 2010: observations from Riks-Stroke, the Swedish stroke register2014Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, nr 1, s. 22-29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 322.
    Appelros, Peter
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Nydevik, Ingegerd
    Terént, Andreas
    Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences2006Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, nr 1, s. 43-49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 323.
    Appelros, Peter
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Terent, Andreas
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Thrombolysis in acute stroke2015Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, nr 9976, s. 1394-1394Artikel i tidskrift (Refereegranskat)
  • 324.
    Arancibia, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Eriksson, Emma
    ”Det klickar i mitt öra…” Objektiv tinnitus orsakad av palatal myoklonus: En forskningsöversikt2013Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    Bakgrund: Tinnitus är idag vanligt förekommande och kan klassificeras som antingen subjektiv eller objektiv. Subjektiv tinnitus hörs endast av den drabbade individen, medan objektiv tinnitus kommer från verkliga ljud som kan mätas eller höras av andra. Palatal myoklonus innebär muskelryckningar i palatala muskler och räknas bland muskulära orsaker till objektiv tinnitus.

    Syfte: Syftet med denna studie är att belysa objektiv tinnitus orsakad av essentiell palatal myoklonus med avseende på symptombild, diagnostik samt behandling och utfall.

    Metod: En forskningsöversikt har genomförts för att besvara studiens syfte.

    Resultat: Resultatet visar att symptombilden vid essentiell palatal myoklonus främst är objektiv klickande tinnitus, vilken i vissa fall varit mycket svår för individen att hantera och i majoriteten av fallen haft en negativ inverkan på de drabbade individernas livskvalitet. De diagnostiska metoder som används är i många fall mätningar som görs i syfte att utesluta påverkan från andra organ, i synnerhet någon form av neurologisk patologi. Nasal endoskopi, audiologiska utredningar och magnetkameraröntgen är några av de mätmetoder som använts för att ställa korrekt diagnos. Bland behandlingsmetoder nämns främst injektion av botulinumtoxin A i muskler kring mjuka gommen samt farmakologiska behandlingsmetoder, men även ett par mer sällsynta behandlingsmetoder beskrivs såsom radiofrekvensablation av palatala muskler och kirurgisk blockering av örontrumpeten.

    Slutsats: En tidig, korrekt diagnos för den drabbade individen är angelägen då denna objektiva tinnitus kan vara enormt påfrestande. Det föreligger ett behov av kontrollerade studier på ett större antal individer för att fastställa reproducerbarheten i de behandlingsmetoder som idag finns att tillgå.

  • 325.
    Arenhall, Eva
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Nilsson, Ulrica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Steinke, Elaine
    School of Nursing, Wichita State University, Wichita, USA.
    Fridlund, Bengt
    School of Health and Welfare, Jönköping University, Jönköping, Sweden.
    Decreased sexual function in partners after patients’ first-time myocardial infarction2018Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, nr 6, s. 521-526Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: A myocardial infarction event affects not only patients but also partners, although how it affects the partners’ sexual function is not studied.

    Aim: The purpose of this study was to describe and compare how partners experienced their sexual function one year before with one year after first-time myocardial infarction of their partner.

    Methods: A longitudinal and comparative design was used. Self-reported data on Watts Sexual Function Questionnaire was collected retrospectively at two occasions from 123 partners (87 women and 36 men), measuring the year prior to the first-time myocardial infarction and the year after. Data were analysed using descriptive and inferential statistics.

    Results: The total score for Watts Sexual Function Questionnaire showed a significant decrease over time. In all four subscales a decrease was found, which were statistically significant in three out of the four subscales (sexual desire, 19.39 vs 18.61; p<0.001, orgasm, 14.11 vs 13.64; p=0.027 and satisfaction, 12.61 vs 12.31; p=0.042). Twenty-six partners reported that their intercourse frequencies decreased over time, while six partners reported an increased intercourse frequency.

    Conclusions: Partners’ sexual function decreased after patients’ first-time myocardial infarction. It is important for health personnel to offer information and discussion about sexual function and concerns with both patients and partners after a first-time myocardial infarction.

  • 326.
    Arenhall, Eva
    et al.
    Örebro universitet, Hälsoakademin. Department of Cardiology, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Kristofferzon, Marja-Leena
    Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden; Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Uppsala, Sweden.
    Fridlund, Bengt
    School of Health and Caring Sciences, Linnéaus University, Växjö, Sweden; School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Malm, Dan
    School of Health Sciences, Jönköping University, Jönköping, Sweden; Department of Internal Medicine, Division of Cardiology, County Hospital Ryhov, Jönkoping, Sweden.
    Nilsson, Ulrica
    Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    The male partners' experiences of the intimate relationships after a first myocardial infarction2011Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, nr 2, s. 108-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Stress in the intimate relationship is found to worsen the prognosis in women suffering from myocardial infarction (MI). Little is known about how male spouses experience the intimate relationship.

    Aim: This study aimed to explore and describe the experience of men's intimate relationships in connection to and after their female partner's first MI.

    Methods: An explorative and qualitative design was used. Interviews were conducted with 16 men having a partner who the year before had suffered a first MI. The data were analysed with qualitative content analysis.

    Results: Three themes emerged: masculine image challenged; life takes another direction; and life remains unchanged. The men were forced to deal with an altered image of themselves as men, and as sexual beings. They were hesitant to approach their spouse in the same way as before the MI because they viewed her to be more fragile. The event also caused them to consider their own lifestyle, changing towards healthier dietary and exercise habits.

    Conclusions: After their spouse's MI, men experienced a challenge to their masculine image. They viewed their spouse as being more fragile, which led the men to be gentler in sexual intimacy and more hesitant to invite sexual activity. This knowledge about how male spouses experience the intimate relationship could be helpful for health personnel in hospitals and primary care when they interact with couples where the woman suffers from cardiac disease or other chronic disorders. (C) 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 327.
    Arinell, Karin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Immobilization as a risk factor for arterial and venous thrombosis2018Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aim: Immobilization and a sedentary lifestyle are correlated with an elevated risk of both arterial and venous thrombosis. The goal of this research was to investigate whether markers associated with cardiovascular disease risk are altered during long term immobilization in a human model and in the brown bear, which survives annual cycles of long-term immobilization.

    Methods: In study populations assigned to 20-60 days of strict head-down-tilt bed rest 24h a day, we analysed blood levels of the emerging cardiovascular disease marker cystatin C, soluble markers of in vivo platelet activation P-selectin and PDGF-BB, and platelet aggregation. Blood samples were taken from free-ranging brown bears in summer and again during hibernation for analysis of lipid profile and platelet aggregation. Histological examination was performed on the left anterior descending coronary artery and aortic arches of bears harvested during the hunting season.

    Results: During prolonged bed rest in humans, levels of cystatin C and platelet aggregation remained unchanged, but we observed a significant decrease in platelet activation markers. Brown bear plasma lipids were elevated during hibernation compared with the active state and cholesterol levels were generally considerably higher than normal human values. The arterial specimens showed no signs of atherosclerosis. Platelet aggregation was halved during hibernation compared to the active state.

    Conclusions: Long-term immobilization has effects on several cardiovascular risk factors in both humans and bears. Increased knowledge and understanding of the protective mechanisms that allows the brown bear to survive repeated periods of immobilization could contribute to new strategies for prevention and treatment of cardiovascular disease in humans.

    Delarbeten
    1. Effect of prolonged standardized bed rest on cystatin C and other markers of cardiovascular risk
    Öppna denna publikation i ny flik eller fönster >>Effect of prolonged standardized bed rest on cystatin C and other markers of cardiovascular risk
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    2011 (Engelska)Ingår i: BMC Physiology, ISSN 1472-6793, E-ISSN 1472-6793, Vol. 11, artikel-id 17Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND: Sedentary lifestyle is associated with coronary artery disease but even shorter periods of physical inactivity may increase cardiovascular risk. Cystatin C is independently associated with cardiovascular disease and our objective was to investigate the relation between this novel biomarker and standardized bed rest. Research of immobilization physiology in humans is challenging because good biological models are in short supply. From the Women International Space simulation for Exploration study (WISE) we studied markers of atherosclerosis and kidney function, including cystatin C, in a standardized bed rest study on healthy volunteers. Fifteen healthy female volunteers participated in a 20-day ambulatory control period followed by 60 days of bed rest in head-down tilt position (-6°) 24 h a day, finalized by 20 days of recovery. The subjects were randomized into two groups during bed rest: a control group (n = 8) that remained physically inactive and an exercise group (n = 7) that participated in both supine resistance and aerobic exercise training.

    RESULTS: Compared to baseline values there was a statistically significant increase in cystatin C in both groups after bed rest (P < 0.001). Glomerular filtration rate (GFR), calculated by both cystatin C and Cockcroft-Gault equation, decreased after bed rest while there were no differences in creatinine or creatine kinase levels. CRP did not change during bed rest in the exercise group, but there was an increase of CRP in the control group during recovery compared to both the baseline and the bed rest periods. The apo-B/apo-Ai ratio increased during bed rest and decreased again in the recovery period. Subjects experienced a small but statistically significant reduction in weight during bed rest and compared to baseline weights remained lower at day 8 of recovery.

    CONCLUSION: During and following prolonged standardized bed rest the concentrations of several clinically relevant cardiovascular risk markers change.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2011
    Nationell ämneskategori
    Kardiologi
    Identifikatorer
    urn:nbn:se:oru:diva-66787 (URN)10.1186/1472-6793-11-17 (DOI)22152087 (PubMedID)2-s2.0-83055192077 (Scopus ID)
    Tillgänglig från: 2018-04-26 Skapad: 2018-04-26 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
    2. Brown Bears (Ursus arctos) Seem Resistant to Atherosclerosis Despite Highly Elevated Plasma Lipids during Hibernation and Active State
    Öppna denna publikation i ny flik eller fönster >>Brown Bears (Ursus arctos) Seem Resistant to Atherosclerosis Despite Highly Elevated Plasma Lipids during Hibernation and Active State
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    2012 (Engelska)Ingår i: Clinical and Translational Science, ISSN 1752-8054, E-ISSN 1752-8062, Vol. 5, nr 3, s. 269-272Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Hibernation is an extreme physiological challenge for the brown bear (Ursus arctos) in which metabolism is based mainly on lipids. The study objective was to compare plasma lipids in hibernating and active free-ranging brown bears and relate them to arterial histopathology. Blood was drawn from seven immobilized free-ranging brown bears (three females, 23 years old) during hibernation in February and from the same bears while active in June and analyzed by enzymatic and automated hematology methods within 48 hours of sampling. Left anterior descending coronary arteries and aortic arches from 12 bears (six females, 1.512 years old) killed in hunting were examined by histopathology. Total plasma cholesterol decreased from hibernation to the active period (11.08 +/- 1.04 mmol/L vs. 7.89 +/- 1.96 mmol/L, P= 0.0028) as did triglyceride (3.16 +/- 0.62 mmol/L vs. 1.44 +/- 0.27 mmol/L, P= 0.00012) and LDL cholesterol (4.30 +/- 0.71 mmol/L vs. 2.02 +/- 1.03 mmol/L, P= 0.0075), whereas HDL cholesterol was unchanged. No atherosclerosis, fatty streaks, foam cell infiltration, or inflammation were seen in any arterial samples. Brown bears tolerate elevated cholesterol levels, obesity, physical inactivity, and circulatory slow flow during hibernation without signs of -atherosclerosis. This species might serve as a reverse translational model for atherosclerosis resistance.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell, 2012
    Nyckelord
    apolipoproteins, cholesterol, hibernation physiology, triglycerides
    Nationell ämneskategori
    Annan biologi
    Identifikatorer
    urn:nbn:se:oru:diva-58327 (URN)10.1111/j.1752-8062.2011.00370.x (DOI)000305077100014 ()22686205 (PubMedID)2-s2.0-84862224614 (Scopus ID)
    Anmärkning

    Funding Agencies:

    NordForsk (an organization under the Nordic Council of Ministers)  44042

    Tillgänglig från: 2017-06-27 Skapad: 2017-06-27 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
    3. Downregulation of platelet activation markers during long-term immobilization
    Öppna denna publikation i ny flik eller fönster >>Downregulation of platelet activation markers during long-term immobilization
    Visa övriga...
    2013 (Engelska)Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 24, nr 5, s. 369-374Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Immobilization and sedentary lifestyle are risk factors for venous thromboembolism and cardiovascular disease, yet little is known about platelet function during long-term physical inactivity. Our aim was to investigate platelet activation markers and their coupling to standardized immobilization: platelet-derived growth factor (PDGF-BB) and P-selectin. We studied 15 healthy females participating in the Women International Space simulation for Exploration study. Following a 20-day ambulatory control period, the subjects underwent 60 days of bed rest in head-down tilt position (-6 degrees) 24 hours a day, finalized by 20 days of recovery. The subjects were randomized into two groups during bed rest: a control group (n = 8) that remained physically inactive and an exercise group (n = 7) that participated in both supine resistance and aerobic exercise training. Blood samples for the analysis of platelet activation markers were collected at baseline (5 days before bed rest), after 44 days of bed rest and 8 days into the recovery period. Compared to baseline, the levels of P-selectin and PDGF-BB decreased after bed rest (by 55%, p = 0.01 and 73%, p < 0.03, respectively) and remained decreased in the recovery period (by 76%, p < 0.001 and 78%, p < 0.02, respectively, compared to baseline). Platelet count (baseline value for the exercise group 260 000/mu l +/- 34 000 and baseline value for the control group 210 000/mu l +/- 30 000) did not change during the bed rest study (two-way repeated measurements ANOVA, p = ns). There were no statistical differences between the physically inactive and the exercise group. During long-term immobilization, a known risk factor for thrombosis, the levels of P-selectin and PDGF-BB decreased. Our findings indicate downregulation of platelet activation during immobilization.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis, 2013
    Nyckelord
    Platelets, P-selectin, PDGF, immobilization, thrombosis
    Nationell ämneskategori
    Hematologi Kardiologi
    Identifikatorer
    urn:nbn:se:oru:diva-56417 (URN)10.3109/09537104.2012.715215 (DOI)000321065000005 ()22931233 (PubMedID)2-s2.0-84879764932 (Scopus ID)
    Tillgänglig från: 2017-03-16 Skapad: 2017-03-16 Senast uppdaterad: 2018-05-27Bibliografiskt granskad
    4. Biochemical Foundations of Health and Energy Conservation in Hibernating Free-Ranging Subadult Brown Bear Ursus arctos
    Öppna denna publikation i ny flik eller fönster >>Biochemical Foundations of Health and Energy Conservation in Hibernating Free-Ranging Subadult Brown Bear Ursus arctos
    Visa övriga...
    2016 (Engelska)Ingår i: Journal of Biological Chemistry, ISSN 0021-9258, E-ISSN 1083-351X, Vol. 291, nr 43, s. 22509-22523Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Brown bears (Ursus arctos) hibernate for 5-7 months without eating, drinking, urinating and defecating at a metabolic rate of only 25% of the summer activity rate. Nonetheless, they emerge healthy and alert in spring. We quantified the biochemical adaptations for hibernation by comparing the proteome, metabolome, and hematologic features of blood from hibernating and active free-ranging subadult brown bears with a focus on conservation of health and energy. We found that total plasma protein concentration increased during hibernation, even though the concentrations of most individual plasma proteins decreased, as did the white blood cell types. Strikingly, antimicrobial defense proteins increased in concentration. Central functions in hibernation involving the coagulation response and protease inhibition, as well as lipid transport and metabolism, were upheld by increased levels of very few key or broad-specificity proteins. The changes in coagulation factor levels matched the changes in activity measurements. A dramatic 45-fold increase in sex-hormone-binding-globulin SHBG levels during hibernation draws, for the first time, attention to its significant but unknown role in maintaining hibernation physiology. We propose that energy for the costly protein synthesis is reduced by three mechanisms, (i) dehydration, which increases protein concentration without de novo synthesis; (ii) reduced protein degradation rates due to a 6 °C reduction in body temperature, and decreased protease activity; and (iii) a marked redistribution of energy resources only increasing de novo synthesis of few key proteins. This comprehensive global data identified novel biochemical strategies for bear adaptations to the extreme condition of hibernation, and have implications for our understanding of physiology in general.

    Ort, förlag, år, upplaga, sidor
    Rockville, USA: American Society for Biochemistry and Molecular Biology, 2016
    Nyckelord
    Antimicrobial proteins, blood constituents, coagulation factor, complement system, hibernation physiology, metabolomics, protein turnover, proteomics, sex hormone-binding globulin (SHBG)
    Nationell ämneskategori
    Biokemi och molekylärbiologi
    Forskningsämne
    Biokemi
    Identifikatorer
    urn:nbn:se:oru:diva-52176 (URN)10.1074/jbc.M116.742916 (DOI)000386760600013 ()27609515 (PubMedID)2-s2.0-84992343533 (Scopus ID)
    Anmärkning

    Funding Agency:

    Lundbech Foundation R126-2012-12408

    Aalborg University

    Tillgänglig från: 2016-09-21 Skapad: 2016-09-14 Senast uppdaterad: 2018-07-16Bibliografiskt granskad
    5. Physical inactivity and platelet function in humans and brown bears: A comparative study
    Öppna denna publikation i ny flik eller fönster >>Physical inactivity and platelet function in humans and brown bears: A comparative study
    Visa övriga...
    2018 (Engelska)Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 29, nr 1, s. 87-90Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Physical inactivity increases the risk of thromboembolism. However, good standardized human models on inactivity are in short supply and experimental models are few.

    Our objective was to investigate how standardized bed rest affects platelet aggregation in humans and to investigate if aggregation is altered in a translational model system - the hibernating brown bear (Ursus arctos). We collected blood from (1) healthy male volunteers participating in a 21-day bed rest study in head-down tilt position (-6°) 24 h a day; (2) free-ranging brown bears captured during winter hibernation and again during active state in summer. We analyzed platelet function using multiple electrode platelet aggregometry. In total, 9 healthy male volunteers (age 31.0 ± 6.4 years) and 13 brown bears (7 females and 6 males, age 2.8 ± 0.6 years) were included. In hibernating bears adenosine diphosphate, arachidonic acid, thrombin receptor activating peptide, and collagen impedance aggregometry tests were all halved compared to summer active state. In human volunteers no statistically significant changes were found between baseline and the end of bed rest. In human male volunteers 3 weeks of bed rest did not affect platelet function. In hibernating brown bears platelet aggregation was halved compared to summer and we hypothesize that this is a protective measure to avoid formation of thrombi under periods of low blood flow.

    Ort, förlag, år, upplaga, sidor
    Taylor & Francis, 2018
    Nyckelord
    Thrombosis; Platelets; Platelet aggregation; Immobilization
    Nationell ämneskategori
    Fysiologi Medicinsk bioteknologi (med inriktning mot cellbiologi (inklusive stamcellsbiologi), molekylärbiologi, mikrobiologi, biokemi eller biofarmaci) Hematologi
    Identifikatorer
    urn:nbn:se:oru:diva-61740 (URN)10.1080/09537104.2017.1336530 (DOI)000423584700015 ()28758823 (PubMedID)2-s2.0-85026519068 (Scopus ID)
    Tillgänglig från: 2017-11-01 Skapad: 2017-11-01 Senast uppdaterad: 2018-08-16Bibliografiskt granskad
  • 328.
    Arinell, Karin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Acute Internal Medicine, Centralsjukhuset, Karlstad, Sweden.
    Blanc, Stéphane
    CNRS UMR 7178, Institut Pluridisciplinaire Hubert Curien, Université de Strasbourg, Strasbourg, France.
    Welinder, Karen Gjesing
    Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark.
    Støen, Ole Gunnar
    Norwegian Institute for Nature Research, Trondheim, Norway.
    Evans, Alina L.
    Department of Forestry and Wildlife Management, Inland Norway University of Applied Sciences, Koppang, Norway.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Physical inactivity and platelet function in humans and brown bears: A comparative study2018Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 29, nr 1, s. 87-90Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Physical inactivity increases the risk of thromboembolism. However, good standardized human models on inactivity are in short supply and experimental models are few.

    Our objective was to investigate how standardized bed rest affects platelet aggregation in humans and to investigate if aggregation is altered in a translational model system - the hibernating brown bear (Ursus arctos). We collected blood from (1) healthy male volunteers participating in a 21-day bed rest study in head-down tilt position (-6°) 24 h a day; (2) free-ranging brown bears captured during winter hibernation and again during active state in summer. We analyzed platelet function using multiple electrode platelet aggregometry. In total, 9 healthy male volunteers (age 31.0 ± 6.4 years) and 13 brown bears (7 females and 6 males, age 2.8 ± 0.6 years) were included. In hibernating bears adenosine diphosphate, arachidonic acid, thrombin receptor activating peptide, and collagen impedance aggregometry tests were all halved compared to summer active state. In human volunteers no statistically significant changes were found between baseline and the end of bed rest. In human male volunteers 3 weeks of bed rest did not affect platelet function. In hibernating brown bears platelet aggregation was halved compared to summer and we hypothesize that this is a protective measure to avoid formation of thrombi under periods of low blood flow.

  • 329.
    Arinell, Karin
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Christensen, Kjeld
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Blanc, Stéphane
    Institut Pluridisciplinaire Hubert Curien-De'partement d'Ecologie, Physiologie, Ethologie Unite' Mixte de Recherche 7178. Centre National de la Recherche Scientifique, Universite' de Strasbourg, Strasbourg, France.
    Larsson, Anders
    Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
    Fröbert, Ole
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Effect of prolonged standardized bed rest on cystatin C and other markers of cardiovascular risk2011Ingår i: BMC Physiology, ISSN 1472-6793, E-ISSN 1472-6793, Vol. 11, artikel-id 17Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Sedentary lifestyle is associated with coronary artery disease but even shorter periods of physical inactivity may increase cardiovascular risk. Cystatin C is independently associated with cardiovascular disease and our objective was to investigate the relation between this novel biomarker and standardized bed rest. Research of immobilization physiology in humans is challenging because good biological models are in short supply. From the Women International Space simulation for Exploration study (WISE) we studied markers of atherosclerosis and kidney function, including cystatin C, in a standardized bed rest study on healthy volunteers. Fifteen healthy female volunteers participated in a 20-day ambulatory control period followed by 60 days of bed rest in head-down tilt position (-6°) 24 h a day, finalized by 20 days of recovery. The subjects were randomized into two groups during bed rest: a control group (n = 8) that remained physically inactive and an exercise group (n = 7) that participated in both supine resistance and aerobic exercise training.

    RESULTS: Compared to baseline values there was a statistically significant increase in cystatin C in both groups after bed rest (P < 0.001). Glomerular filtration rate (GFR), calculated by both cystatin C and Cockcroft-Gault equation, decreased after bed rest while there were no differences in creatinine or creatine kinase levels. CRP did not change during bed rest in the exercise group, but there was an increase of CRP in the control group during recovery compared to both the baseline and the bed rest periods. The apo-B/apo-Ai ratio increased during bed rest and decreased again in the recovery period. Subjects experienced a small but statistically significant reduction in weight during bed rest and compared to baseline weights remained lower at day 8 of recovery.

    CONCLUSION: During and following prolonged standardized bed rest the concentrations of several clinically relevant cardiovascular risk markers change.

  • 330.
    Arinell, Karin
    et al.
    Dept Cardiol, Örebro Univ Hosp, Örebro, Sweden.
    Fröbert, Ole
    Region Örebro län. Dept Cardiol.
    Blanc, Stephane
    Dept Ecol Physiol & Ethol, Dept Ecol, Inst Pluridisciplinaire Hubert Curien, Strasbourg, France.
    Larsson, Anders
    Dept Clin Chem, Uppsala Univ, Uppsala, Sweden.
    Christensen, Kjeld
    Region Örebro län. Dept Cardiol.
    Downregulation of platelet activation markers during long-term immobilization2013Ingår i: Platelets, ISSN 0953-7104, E-ISSN 1369-1635, Vol. 24, nr 5, s. 369-374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Immobilization and sedentary lifestyle are risk factors for venous thromboembolism and cardiovascular disease, yet little is known about platelet function during long-term physical inactivity. Our aim was to investigate platelet activation markers and their coupling to standardized immobilization: platelet-derived growth factor (PDGF-BB) and P-selectin. We studied 15 healthy females participating in the Women International Space simulation for Exploration study. Following a 20-day ambulatory control period, the subjects underwent 60 days of bed rest in head-down tilt position (-6 degrees) 24 hours a day, finalized by 20 days of recovery. The subjects were randomized into two groups during bed rest: a control group (n = 8) that remained physically inactive and an exercise group (n = 7) that participated in both supine resistance and aerobic exercise training. Blood samples for the analysis of platelet activation markers were collected at baseline (5 days before bed rest), after 44 days of bed rest and 8 days into the recovery period. Compared to baseline, the levels of P-selectin and PDGF-BB decreased after bed rest (by 55%, p = 0.01 and 73%, p < 0.03, respectively) and remained decreased in the recovery period (by 76%, p < 0.001 and 78%, p < 0.02, respectively, compared to baseline). Platelet count (baseline value for the exercise group 260 000/mu l +/- 34 000 and baseline value for the control group 210 000/mu l +/- 30 000) did not change during the bed rest study (two-way repeated measurements ANOVA, p = ns). There were no statistical differences between the physically inactive and the exercise group. During long-term immobilization, a known risk factor for thrombosis, the levels of P-selectin and PDGF-BB decreased. Our findings indicate downregulation of platelet activation during immobilization.

  • 331.
    Arkema, Elizabeth V.
    et al.
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Solna, Sweden.
    Svenungsson, Elisabet
    Department of Medicine Solna, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden.
    von Euler, Mia
    Department of Clinical Science and Education, Karolinska Institutet, Solna, Sweden; Stroke Research Network at Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Sjöwall, Christopher
    Clinical and Experimental Medicine, Rheumatology/Division of Neuro and Inflammation Sciences, Linköping University, Linköping, Sweden.
    Simard, Julia F.
    Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Solna, Sweden; Department of Health Research and Policy, Division of Epidemiology, Stanford School of Medicine, Stanford, California, USA; Department of Medicine, Division of Immunology and Rheumatology, Stanford School of Medicine, Stanford, California, USA.
    Stroke in systemic lupus erythematosus: a Swedish population-based cohort study2017Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 76, nr 9, s. 1544-1549Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the occurrence of ischaemic and haemorrhagic stroke in systemic lupus erythematosus (SLE) compared with the general population by age, sex and time since SLE diagnosis METHODS: Adults with incident SLE were identified from the Swedish National Patient Register (NPR, n=3390) and general population comparators from the Total Population Register were matched on age, sex and county (n=16730). Individuals were followed prospectively until first of death, December 2013, emigration or incident stroke (identified from the NPR, Cause of Death Register and the Stroke Register). Incidence rates, rate differences and HR were estimated comparing SLE with non-SLE. Estimates were stratified by sex, age and time since diagnosis.

    RESULTS: We observed 126 strokes in SLE and 304 in the general population. Individuals with SLE had a twofold increased rate of ischaemic stroke compared with the general population (HR 2.2; 95% CI 1.7 to 2.8). The HR for intracerebral haemorrhage was 1.4 (95% CI 0.7 to 2.8). There was effect modification by sex and age, with the highest HRs for females and individuals <50 years old. The HR for ischaemic stroke was highest in the first year of follow-up (3.7; 95% CI 2.1 to 6.5).

    CONCLUSIONS: The relative risk of ischaemic stroke in SLE was more than doubled compared with the general population, and importantly, the highest relative risks were observed within the first year after SLE diagnosis. Thus, the first encounter with patients presents an opportunity for rheumatologists to screen for risk factors and intervene.

  • 332.
    Arnell, Susann
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center (UFC) Region Örebro County, Örebro, Sweden.
    Jerlinder, K.
    Faculty of Health and Occupational Studies, University of Gävle, Gävle , Sweden.
    Lundqvist, Lars-Olov
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. University Health Care Research Center (UFC) Region Örebro County, Örebro, Sweden.
    Participation in physical activities: a multilevel challenge for adolescents with autism spectrum disorders2017Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Physical inactivity is one of the biggest current public health problems. Few adolescents with autism spectrum disorder (ASD) achieve the recommendation of daily physical activity (PA). The reasons for not being physically active depend on several complex factors, yet not comprehensively described from the adolescents’point of view. The absence of their perspective means that intervention strategies for health enhancing physical activity may not encompass the experiences of the adolescents themselves. Therefore the purpose of this study was to develop an understanding of the perceptions, experiences and reflections of adolescents with ASDs’participation in PA.

    Participants and methods: Twenty-four adolescents, diagnosed with ASD without a co-occurring intellectual disability, aged 12-16 years, participated in the study.Data was collected using qualitative interviews and inductively analyzed using qualitative content analysis.

    Results: Adolescents with ASD were a heterogeneous group in regard to their current PA habits and preferences. Their willingness to participate in PA was conditioned regarding; what, where, when and with whom. They described challenges in the activity and the social context during PA, especially during the mandatory physical education. Perceived demands, freedom of choice, physical ability and sense of control affected their PA participation.

    Conclusion: Findings indicate that the adolescents’willingness to participate was associated with interacting and individual-related conditions, which can be misinterpreted as unwillingness to participate in PA. Thus aspects of autonomy and knowledge about individual conditions and needs have to be recognized when intervention strategies for health enhancing physical activities are planned for this population.

  • 333.
    Arntyr Hellgren, P.
    et al.
    Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Simmons, D.
    School of Medicine, Western Sydney University, Campbelltown NSW, Australia.
    Hanson, U.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Magnuson, A.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Birth trauma in babies born to women with and without type 1 diabetes in Sweden 1998-2012: relationship with maternal and baby weight2017Ingår i: 49th Annual Meeting of the Diabetic Pregnancy Study Group: Abstract book, 2017, s. 66-67Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    We compared birth trauma rates in pregnancies among women with and without type 1 diabetes (DM1) and tested the relationship with maternal body mass index (BMI) and large for gestational age (LGA) as a risk factor. This is a population-based cohort study 1998-2012 using the Swedish Medical Birth Registry (MBR) which includes 99% of Swedish pregnancies. All pregnancies up until gestational week 41 were included. We excluded mothers with other types of diabetes, duplex pregnancies and all pregnancies ending with a caesarean section (51.1% and 16.5% in women with and without DM1 respectively). The incidence of birth trauma was adjusted for BMI, maternal age, parity, Nordic or non-Nordic origin, smoking, chronic hypertensive disease, LGA and the baby ́s sex using logistic regression. This left 2,758 and 783,412 births with complete data among DM1 and control mothers respectively. The mean BMI, maternal age and gestational age at birth in full weeks was 25.6 (SD 4.5), 30.0 (SD 5.1) and 37.9 (SD 1.9) respectively among women with DM1 and 24.2 (SD 4.3), 29.7 (SD 5.1) and 38.9 (SD 1.5) respectively among controls. Preliminary results show that birth trauma rates did not vary significantly with increasing BMI compared with the reference BMI (18.50-24.9 kg/m2) among women with DM1 (odds ratios (OR) with increasing BMI (<18.49, 25.0-29.9, 30.0-34.9, >35.0 kg/m2) were 1.9 (95%CI 0.2-15.7), 1.0 (95%CI 0.7-1.5), 0.5 (95%CI 0.2-1.0), 1.1 (95%CI 0.5-2.4) respectively). Conversely, among controls, the OR for birth trauma increasedwith increasing BMI: 0.7 (95%CI 0.6-0.9), 1.4 (95%CI 1.3-1.5), 1.8 (95%CI 1.6-2.0), and 2.2 (95%CI 1.9-2.4) respectively. However, birth trauma was 3.9 (95%CI 2.7-5.7) and 7.0 (95%CI 6.5-7.5) fold more common after adjustment with LGA among women with andwithout DM1 respectively. We conclude that birth trauma rates are associated with LGA with comparatively greater impact among women without, than with, DM1. LGA is clearly an important outcome in its own right and a predictor of birth trauma. We hypothesise that the reduced risk of birth trauma from LGA among women with DM1 is due to increased monitoring with multiple ultrasounds to determine the fetal growth rate, along with earlier planned delivery (including earlier induction with vaginal delivery ata lower birthweight or caesarean section). While more research is needed to find better ways to reduce LGA in DM1, many of the obese control women would have undiagnosed/untreated GDM due to the Swedish criteria at the time (2 hours >=9.0mmol/l). Besidestreating lower levels of hyperglycaemia during pregnancy, the frequency of growth monitoring in obese mothers to reduce their babies’ risk of birth trauma due to LGA, needs to be evaluated. Life course cost effectiveness analyses would be useful.

  • 334.
    Aronsson, Johnas
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    DESATURATION I SAMBAND MED GENERELL ANESTESI: En litteraturgenomgång2009Självständigt arbete på avancerad nivå (yrkesexamen), 5 poäng / 7,5 hpStudentuppsats (Examensarbete)
  • 335.
    Arora, Manish
    et al.
    Environmental and Occupational Medicine and Epidemiology Program, Harvard School of Public Health, Boston, USA; Cellular and Molecular Pathology Research Unit, Department of Oral Pathology and Oral Medicine, University of Sydney, Sydney, Australia; Population Oral Health, University of Sydney, Sydney, Australia.
    Weuve, Jennifer
    Environmental and Occupational Medicine and Epidemiology Program, Harvard School of Public Health, Boston, USA; Department of Epidemiology, Harvard School of Public Health, Boston, USA.
    Fall, Katja
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology, Harvard School of Public Health, Boston, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Mucci, Lorelei A.
    Department of Epidemiology, Harvard School of Public Health, Boston, USA; Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
    An exploration of shared genetic risk factors between periodontal disease and cancers: a prospective co-twin study2010Ingår i: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 171, nr 2, s. 253-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Biologic mechanisms underlying associations of periodontal disease with cancers remain unknown. The authors propose that both conditions share common genetic risk factors. They analyzed associations between baseline periodontal disease, measured by questionnaire-recorded tooth mobility, and incident cancers, identified by linkage with national registries, between 1963 and 2004 in 15,333 Swedish twins. The authors used co-twin analyses to control for familial factors and undertook analyses restricted to monozygotic twins to further control for confounding by genetic factors. They observed 4,361 cancer cases over 548,913 person-years. After adjustment for covariates, baseline periodontal disease was associated with increased risk of several cancers ranging from 15% for total cancer (proportional hazard ratio (HR) = 1.15, 95% confidence interval (CI): 1.01, 1.32) to 120% for corpus uterine cancer (HR = 2.20, 95% CI: 1.16, 4.18). Periodontal disease was also associated with increased risk of colorectal (HR = 1.62, 95% CI: 1.13, 2.33), pancreatic (HR = 2.06, 95% CI: 1.14, 3.75), and prostate (HR = 1.47, 95% CI: 1.04, 2.07) cancers. In co-twin analyses, dizygotic twins with baseline periodontal disease showed a 50% increase in total cancer risk (HR = 1.50, 95% CI: 1.04, 2.17), but in monozygotic twins this association was markedly attenuated (HR = 1.07, 95% CI: 0.63, 1.81). Similar patterns emerged for digestive tract cancers, suggesting that shared genetic risk factors may partially explain associations between periodontal disease and cancers.

  • 336.
    Arora, Tulika
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Velagapudi, Vidya
    VTT Technical Research Centre of Finland, Espoo, Finland; Metabolomics Unit, Institute for Molecular Medicine Finland FIMM, Helsinki, Finland.
    Pournaras, Dimitri J.
    Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom.
    Welbourn, Richard
    Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom.
    le Roux, Carel W.
    Diabetes Complications Research Centre, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland; Gastrosurgical Laboratory, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Oresic, Matej
    Örebro universitet, Institutionen för medicinska vetenskaper. VTT Technical Research Centre of Finland, Espoo, Finland; Steno Diabetes Center A/S, Gentofte, Denmark.
    Bäckhed, Fredrik
    Department of Molecular and Clinical Medicine, Institute of Medicie, University of Gothenburg, Gothenburg, Sweden; Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Receptology and Enteroendocrinology, University of Copenhagen, Copenhagen, Denmark.
    Roux-en-Y Gastric Bypass Surgery Induces Early Plasma Metabolomic and Lipidomic Alterations in Humans Associated with Diabetes Remission2015Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 5, artikel-id e0126401Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Roux-en-Y gastric bypass (RYGB) is an effective method to attain sustained weight loss and diabetes remission. We aimed to elucidate early changes in the plasma metabolome and lipidome after RYGB. Plasma samples from 16 insulin-resistant morbidly obese subjects, of whom 14 had diabetes, were subjected to global metabolomics and lipidomics analysis at pre-surgery and 4 and 42 days after RYGB. Metabolites and lipid species were compared between time points and between subjects who were in remission and not in remission from diabetes 2 years after surgery. We found that the variables that were most discriminatory between time points were decanoic acid and octanoic acid, which were elevated 42 days after surgery, and sphingomyelins (18:1/21:0 and 18:1/23:3), which were at their lowest level 42 days after surgery. Insulin levels were lower at 4 and 42 days after surgery compared with pre-surgery levels. At 4 days after surgery, insulin levels correlated positively with metabolites of branched chain and aromatic amino acid metabolism and negatively with triglycerides with long-chain fatty acids. Of the 14 subjects with diabetes prior to surgery, 7 were in remission 2 years after surgery. The subjects in remission displayed higher pre-surgery levels of tricarboxylic acid cycle intermediates and triglycerides with long-chain fatty acids compared with subjects not in remission. Thus, metabolic alterations are induced soon after surgery and subjects with diabetes remission differ in the metabolic profiles at pre- and early post-surgery time points compared to patients not in remission.

  • 337.
    Arvidsson, Bo
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Bodin, Lennart
    Institute of Environmental Medicine, Unit of Intervention and Implementation Research, Karolinska Institute, Stockholm, Sweden.
    Rask, Eva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
    Schwarcz, Erik
    Region Örebro län. Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden.
    Möller, Margareta
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Reference data for bone mineral density in Swedish women using digital X-ray radiometry2013Ingår i: Journal of clinical densitometry, ISSN 1094-6950, E-ISSN 1559-0747, Vol. 16, nr 2, s. 183-188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    During the last decade, digital X-ray radiometry (DXR) has been used to measure bone mineral density (BMD) in the metacarpal bones. The aim of this study was to establish Swedish reference material for bone mass in women, measured in the metacarpal bones with DXR, and compare these data with the data from the manufacturer. A sample of 1440 women aged 20-79yr living in Örebro County was randomly assigned from the population register. Microdose mammography was used (Sectra MDM L30; Sectra Imtec AB, Linköping, Sweden) to measure BMD. Cole's LMS method was used to calculate DXR. Six hundred sixty-nine (48.3%) women participated. Peak bone mass occurred at the age of 43.4yr with a BMD of 0.597g/cm(2) (standard deviation: 0.050). Our Swedish data correlated well with the manufacturer's material. Only among women aged 50-59yr did BMD differ, where the Swedish sample had lower values. The LMS method can be used to describe the DXR data and provide a more detailed picture of bone density distribution. DXR-BMD in Swedish women aged 20-79yr is equivalent to findings from other studies, showing the same distribution of BMD in most age groups except for ages 50-59yr.

  • 338.
    Arvidsson, Caroline
    Örebro universitet, Institutionen för hälsovetenskaper.
    Barns munhälsorelaterade livskvalitet mätt med CPQ: skalans tillförlitlighet och överenstämmelse mellan barn- och föräldraskattning2017Självständigt arbete på avancerad nivå (yrkesexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    SAMMANFATTNING

    Bakgrund: Child Perceptions Questionnaire (CPQ) är ett mätinstrument för mätning av munhälsorelaterad livskvalitet (Oral health-related quality of life; OHRQoL) hos barn. Tidigare studier där instrumentet använts är utförda utanför Norden och då livskvalitet kan upplevas olika beroende på var man bor eller vem man är, är det av stor vikt att värdera hur instrumentet fungerar i en barnpopulation i Sverige.

    Syfte: 1. Värdera mätinstrumentets tillförlitlighet i termer av intern konsistens och test-retest stabilitet. 2. Beskriva överenstämmelsen mellan barns självskattning och föräldrars skattning av barnens munhälsorelaterade livskvalitet mätt med CPQ11-14-ISF:16 och P-CPQ- ISF:16. 3. Analysera om överenstämmelsen varierar med grad av eventuella bettavvikelser.

    Material och metod: Tvåhundrafyrtionio barn med medelålder 11,5 år (SD 0,8) och respektive förälder har deltagit i en tvärsnittsstudie där de har besvarat CPQ11-14-ISF:16 i samband med en klinisk undersökning på ortodontiavdelningen. Förekomst av bettavvikelser registrerades och ortodontiskt behandlingsbehov bedömdes enligt Index of Orthodontic Treatment Need (IOTN).

    Resultat: Mätinstrumentet sågs ha hög reliabilitet för totalskalan. Både barn och föräldraskattningen visade på en god munhälsorelaterad livskvalitet med låga värden på CPQ. Barnens självskattning låg dock högre (CPQ total score) 9,27 än föräldrarnas skattning (P-CPQ total score) 5,15. Överensstämmelsen mellan barn och föräldraskattningen var låg (ICC = 0,22) och påverkades inte av barnets ortodontiska behandlingsbehov.

    Konklusion: Mätinstrumentet ska betraktas som endimensionellt och ger uttryck för tillförlitlighet på totalskalan. Bristen på samstämmighet indikerar att såväl barnens som föräldrarnas skattningar bör beaktas.

  • 339.
    Asfaw Idosa, Berhane
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Clinical Medicine.
    Sahdo, Berolla
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Clinical Medicine.
    Balcha, Ermias
    Department of Clinical Medicine, School of Health and Medical Sciences, Örebro University, Örebro, Swedenital, Örebro, Sweden.
    Kelly, Anne
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Clinical Medicine.
    Söderquist, Bo
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Särndahl, Eva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Clinical Medicine.
    C10X polymorphism in the CARD8 gene is associated with bacteraemia2014Ingår i: Immunity, inflammation and disease, E-ISSN 2050-4527, Vol. 2, nr 1, s. 13-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The NLRP3 inflammasome is an intracellular multi-protein complex that triggers caspase-1 mediated maturation of interleukin-1β (IL-1β); one of the most potent mediators of inflammation and a major cytokine produced during severe infections, like sepsis. However, the excessive cytokine levels seem to stage for tissue injury and organ failure, and high levels of IL-1β correlates with severity and mortality of sepsis. Instead, recent data suggest caspase-1 to function as a guardian against severe infections. CARD8 has been implied to regulate the synthesis of IL-1β via interaction to caspase-1. In recent years, polymorphism of CARD8 (C10X) per se or in combination with NLRP3 (Q705K) has been implicated with increased risk of inflammation. The aim was to investigate the correlation of these polymorphisms with severe blood stream infection. Human DNA was extracted from blood culture bottles that were found to be positive for microbial growth (i.e. patients with bacteraemia). Polymorphisms Q705K in the NLRP3 gene and C10X in the CARD8 gene were genotyped using TaqMan genotyping assay. The results were compared to healthy controls and to samples from patients with negative cultures. The polymorphism C10X was significantly over-represented among patients with bacteraemia as compared to healthy controls, whereas patients with negative blood culture were not associated with a higher prevalence. No association was observed with polymorphism Q705K of NLRP3 in either group of patients. Patients carrying polymorphism C10X in the CARD8 gene are at increased risk of developing bacteraemia and severe inflammation.

  • 340.
    Asghar, Naveed
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Gunaltay, Sezin
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Tran, Pham Tue Hung
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Melik, Wessam
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Höglund, Urban
    Adlego Biomedical AB, Uppsala, Sweden.
    Johansson, Christer
    Academy of Quality Pharm Science and BiQ Pharma AB, Södertälje, Sweden.
    Frelin, Lars
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sällberg, Matti
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper.
    DNA launched suicidal flaviviruses as therapeutic vaccine candidates2018Konferensbidrag (Refereegranskat)
    Abstract [en]

    Chronic liver disease, resulting from Hepatitis B virus (HBV), Hepatitis D virus (HDV), or Hepatitis C virus (HCV) infections, contributes to a major health burden worldwide. The relativelyhigh cost of the HCV treatment brings concerns about the accessibility, especially in the developing countries. Hence, there exists a need for cost effect interventions with high efficiency. We aim to develop therapeutic vaccine candidates against HBV, HCV and HDV using DNA based subgenomic flavivirus replicons as a delivery system. Tick-borne encephalitis virus (TBEV), Langat virus (LGTV), West-Nile virus (WNV), or Kunjinvirus (KUNV) replicon with firefly luciferase geneas a reporter were expressed and characterized in cell culture studies. WNV and KUNV replicons showed significantly higher replication compared to their respective negative controls with unfunctional viral RNA dependent RNA polymerase. KUNV and WNV replicons were chosen for cloning the HCV or HB/DV vaccine candidate gene by replacing luciferasegene. Owing to the self-replicating trait of the flavivirus subgenomic replicons, Western blotting demonstrated that the antigen expression by KUNV and WNV replicons was several folds higher than the positive control. These results suggest that DNA based KUNV and WNV replicons may function as carriers for the hepatitis vaccine candidate genes, and these replicons are currently used for in vivostudies in animal models.

  • 341.
    Asghar, Naveed
    et al.
    School of Natural Science, Technology & Environmental Studies, Södertörn University, Huddinge, Sweden.
    Lindblom, Pontus
    Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Melik, Wessam
    School of Natural Science, Technology & Environmental Studies, Södertörn University, Huddinge, Sweden.
    Lindqvist, Richard
    Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden.
    Haglund, Mats
    Department of Infectious Diseases, County Hospital, Kalmar, Sweden.
    Forsberg, Pia
    Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Clinic of Infectious Diseases, Linköping University Hospital, Linköping, Sweden.
    Överby, Anna K.
    Department of Clinical Microbiology, Virology, Umeå University, Umeå, Sweden.
    Andreassen, Åshild
    Division of Infectious Disease Control, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway.
    Lindgren, Per-Eric
    Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Division of Medical Services, Department of Microbiology, County Hospital Ryhov, Jönköping, Sweden.
    Johansson, Magnus
    Örebro universitet, Institutionen för läkarutbildning. School of Natural Science, Technology & Environmental Studies, Södertörn University, Huddinge, Sweden; RiSC - Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Tick-Borne Encephalitis Virus Sequenced Directly from Questing and Blood-Feeding Ticks Reveals Quasispecies Variance2014Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 7, artikel-id e103264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The increased distribution of the tick-borne encephalitis virus (TBEV) in Scandinavia highlights the importance of characterizing novel sequences within the natural foci. In this study, two TBEV strains: the Norwegian Mandal 2009 (questing nymphs pool) and the Swedish Saringe 2009 (blood-fed nymph) were sequenced and phylogenetically characterized. Interestingly, the sequence of Mandal 2009 revealed the shorter form of the TBEV genome, similar to the highly virulent Hypr strain, within the 3' non-coding region (3'NCR). A different genomic structure was found in the 3'NCR of Saringe 2009, as in-depth analysis demonstrated TBEV variants with different lengths within the poly(A) tract. This shows that TBEV quasispecies exists in nature and indicates a putative shift in the quasispecies pool when the virus switches between invertebrate and vertebrate environments. This prompted us to further sequence and analyze the 3'NCRs of additional Scandinavian TBEV strains and control strains, Hypr and Neudoerfl. Toro 2003 and Habo 2011 contained mainly a short (A) 3C(A)6 poly(A) tract. A similar pattern was observed for the human TBEV isolates 1993/783 and 1991/4944; however, one clone of 1991/4944 contained an (A) 3C(A)11 poly(A) sequence, demonstrating that quasispecies with longer poly(A) could be present in human isolates. Neudoerfl has previously been reported to contain a poly(A) region, but to our surprise the resequenced genome contained two major quasispecies variants, both lacking the poly(A) tract. We speculate that the observed differences are important factors for the understanding of virulence, spread, and control of the TBEV.

  • 342.
    Asghar, Naveed
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Maravelia, Panagiota
    aboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Caro-Perez, Noelia
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Tarn, Hung
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Melik, Wessam
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Pasetto, Anna
    aboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ahlen, Gustaf
    aboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Frelin, Lars
    aboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Höglund, Urban
    Johansson, Christer
    Sällberg, Matti
    aboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Immunogenicity of DNA launched suicidal flavivirus replicons for protective vaccination against hepatitis viruses2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Chronic liver disease, resulting from Hepatitis B virus (HBV), Hepatitis D virus (HDV), or Hepatitis C virus (HCV) infections, contributes to a major health burden worldwide. Chronic infections with the hepatitis C virus (HCV) can be effectively cured by antivirals. However, as cured patients can be re-infected they lack protective immune responses. In addition, the relativelyhigh cost of the HCV treatment brings concerns about the accessibility, especially in the developing countries. Hence, there exists a need for cost effect vaccines with high efficiency to control and possibly eradicate Hepatitis viruses globally. The vaccine should induce either, or both, neutralizing antibodies and protective T cell responses. We therefore have developed DNA based flavivirus replicons as a potent delivery system that effectively prime HCV-specific T cell responses. We generated suicidal subgenomic DNA replicons of Tick-borne encephalitis virus (TBEV), Langat virus (LGTV), West-Nile virus (WNV), and Kunjinvirus (KUNV) expressing either a fusion protein between the HCV NS3/4A and a stork hepatitis B virus core or a vaccine candidate gene of HB/DV. Transfection experiments showed that the antigen expression by KUNV and WNV replicons was several folds higher than the antigen expression by standard DNA plasmid with CMV promoter. The immunogenicity of three suicidal flaviviral DNA replicons expressing HCV NS3/4A was tested in mice and compared to HCV NS3/4A expression by the standard DNA plasmid. The KUNV-HCV replicon was the best replicon-based immunogen with respect to priming of HCV NS3/4A-specific T cells as determined by ELISpot, dextramer staining, and polyfunctionality. Importantly, a mutant KUNV-HCV immunogen lacking replication failed to induce immune responses. Thus, the newly developed KUNV-based suicidal DNA launched replicon vaccine for HCV is a highly attractive candidate as a prophylactic vaccine against chronic hepatitis C. In addition, we are currently testing the immunogenicity of KUNV-HB/DV replicon in mice.

  • 343.
    Asghar, Naveed
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Maravelia, Panagiota
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Caro-Perez, Noelia
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Tran, Pham Tue Hung
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Melik, Wessam
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Pasetto, Anna
    aboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ahlen, Gustaf
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Frelin, Lars
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Höglund, Urban
    Adlego Biomedical AB, Uppsala, Sweden.
    Johansson, Christer
    Academy of Quality Pharm Science and BiQ Pharma AB, Södertälje, Sweden.
    Sällberg, Matti
    Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Immunogenicity of DNA launched suicidal flavivirus replicons for protective vaccination against hepatitis viruses2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Chronic liver disease, resulting from Hepatitis B virus (HBV), Hepatitis D virus (HDV), or Hepatitis C virus (HCV) infections, contributes to a major health burden worldwide. Chronic infections with the hepatitis C virus (HCV) can be effectively cured by antivirals. However, as cured patients can be re-infected they lack protective immune responses. In addition, the relativelyhigh cost of the HCV treatment brings concerns about the accessibility, especially in the developing countries. Hence, there exists a need for cost effect vaccines with high efficiency to control and possibly eradicate Hepatitis viruses globally. The vaccine should induce either, or both, neutralizing antibodies and protective T cell responses. We therefore have developed DNA based flavivirus replicons as a potent delivery system that effectively prime HCV-specific T cell responses. We generated suicidal subgenomic DNA replicons of Tick-borne encephalitis virus (TBEV), Langat virus (LGTV), West-Nile virus (WNV), and Kunjinvirus (KUNV) expressing either a fusion protein between the HCV NS3/4A and a stork hepatitis B virus core or a vaccine candidate gene of HB/DV. Transfection experiments showed that the antigen expression by KUNV and WNV replicons was several folds higher than the antigen expression by standard DNA plasmid with CMV promoter. The immunogenicity of three suicidal flaviviral DNA replicons expressing HCV NS3/4A was tested in mice and compared to HCV NS3/4A expression by the standard DNA plasmid. The KUNV-HCV replicon was the best replicon-based immunogen with respect to priming of HCV NS3/4A-specific T cells as determined by ELISpot, dextramer staining, and polyfunctionality. Importantly, a mutant KUNV-HCV immunogen lacking replication failed to induce immune responses. Thus, the newly developed KUNV-based suicidal DNA launched replicon vaccine for HCV is a highly attractive candidate as a prophylactic vaccine against chronic hepatitis C. In addition, we are currently testing the immunogenicity of KUNV-HB/DV replicon in mice.

  • 344.
    Asghar, Naveed
    et al.
    School of Natural Sciences,Technology and Environmental Studies, Södertörn University, Huddinge, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden; Inflammatory Response and Infection Susceptibility Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Petersson, Mona
    School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge, Sweden.
    Johansson, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge, Sweden.
    Dinnetz, Patrik
    School of Natural Sciences, Technology and Environmental Studies, Södertörn University, Huddinge, Sweden.
    Local landscape effects on population dynamics of Ixodes ricinus2016Ingår i: Geospatial health, ISSN 1827-1987, Vol. 11, nr 3, s. 283-289, artikel-id 487Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Ixodes ricinus, a common tick in Europe, transmits severe tickborne pathogens (TBPs). In Sweden, both prevalence and incidence of tick-borne infections have increased during the last few decades, and a majority of the cases is reported from the area around Stockholm. Among ticks, transmission of TBPs involves co-feeding of susceptible larvae or nymphs with infected ticks on the same host. Seasonal synchrony of immature stages and total tick abundance are important factors for the probability of horizontal transmission of TBPs. We have studied the association between local landscape characteristics and population dynamics and the probability of co-occurrence of different life cycle stages of I. ricinus at different locations south of Stockholm, Sweden. We found significant spatiotemporal variation in tick activity patterns. Mean tick abundance varied with a tenfold difference among study sites. The probability of co-occurrence of larvae, nymphs and female adults was highest in June and decreased significantly with vegetation height. In addition, the amount of forest habitat and open water in the surrounding landscape of the study sites expressed significant negative effects on tick abundance and co-occurrence, indicating that environmental heterogeneity may increase the likelihood of good rodent habitats, which in turn, are suitable hosts for immature ticks.

  • 345.
    Asp, Filip
    et al.
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Cochlear Implants M43, Karolinska University Hospital, Stockholm, Sweden.
    Mäki-Torkko, Elina
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden; Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Karltorp, Eva
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Cochlear Implants M43, Karolinska University Hospital, Stockholm, Sweden.
    Harder, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden.
    Hergils, Leif
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of ENT-Head Neck Surgery, County Council of Östergötland, Linköping, Sweden.
    Eskilsson, Gunnar
    Department of Cochlear Implants, M43, Karolinska University Hospital, Stockholm, Sweden.
    Stenfelt, Stefan
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Swedish Institute for Disability Research, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    A longitudinal study of the bilateral benefit in children with bilateral cochlear implants2015Ingår i: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 54, nr 2, s. 77-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the development of the bilateral benefit in children using bilateral cochlear implants by measurements of speech recognition and sound localization.

    DESIGN: Bilateral and unilateral speech recognition in quiet, in multi-source noise, and horizontal sound localization was measured at three occasions during a two-year period, without controlling for age or implant experience. Longitudinal and cross-sectional analyses were performed. Results were compared to cross-sectional data from children with normal hearing.

    STUDY SAMPLE: Seventy-eight children aged 5.1-11.9 years, with a mean bilateral cochlear implant experience of 3.3 years and a mean age of 7.8 years, at inclusion in the study. Thirty children with normal hearing aged 4.8-9.0 years provided normative data.

    RESULTS: For children with cochlear implants, bilateral and unilateral speech recognition in quiet was comparable whereas a bilateral benefit for speech recognition in noise and sound localization was found at all three test occasions. Absolute performance was lower than in children with normal hearing. Early bilateral implantation facilitated sound localization.

    CONCLUSIONS: A bilateral benefit for speech recognition in noise and sound localization continues to exist over time for children with bilateral cochlear implants, but no relative improvement is found after three years of bilateral cochlear implant experience.

  • 346.
    Aspelund, Amalia Liljequist
    et al.
    Department of Research and Education, Karolinska Institutet, Stockholm, Sweden.
    Patel, Mohamed Quraish
    Department of Surgery, Khayelitsha Hospital, Cape Town, South Africa.
    Kurland, Lisa
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Research and Education, Karolinska Institutet, Stockholm, Sweden.
    McCaul, Michael
    Biostatistics Unit, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa.
    van Hoving, Daniël Jacobus
    Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa.
    Evaluating trauma scoring systems for patients presenting with gunshot injuries to a district-level urban public hospital in Cape Town, South Africa2019Ingår i: African journal of emergency medicine, ISSN 2211-419X, Vol. 9, nr 4, s. 193-196Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Trauma scoring systems are widely used in emergency settings to guide clinical decisions and to predict mortality. It remains unclear which system is most suitable to use for patients with gunshot injuries at district-level hospitals. This study compares the Triage Early Warning Score (TEWS), Injury Severity Score (ISS), Trauma and Injury Severity Score (TRISS), Kampala Trauma Score (KTS) and Revised Trauma Score (RTS) as predictors of mortality among patients with gunshot injuries at a district-level urban public hospital in Cape Town, South Africa.

    Methods: Gunshot-related patients admitted to the resuscitation area of Khayelitsha Hospital between 1 January 2016 and 31 December 2017 were retrospectively analysed. Receiver Operating Characteristic (ROC) analysis were used to determine the accuracy of each score to predict all-cause in-hospital mortality. The odds ratio (with 95% confidence intervals) was used as a measure of association.

    Results: In total, 331 patients were included in analysing the different scores (abstracted from database n = 431, excluded: missing files n = 16, non gunshot injury n = 10, <14 years n = 1, information incomplete to calculate scores n = 73). The mortality rate was 6% (n = 20). The TRISS and KTS had the highest area under the ROC curve (AUC), 0.90 (95% CI 0.83-0.96) and 0.86 (95% CI 0.79-0.94), respectively. The KTS had the highest sensitivity (90%, 95% CI 68-99%), while the TEWS and RTS had the highest specificity (91%, 95% CI 87-94% each).

    Conclusions: None of the different scoring systems performed better in predicting mortality in this high-trauma burden area. The results are limited by the low number of recorded deaths and further studies are needed.

  • 347.
    Asplund, R.
    et al.
    Family Medicine Stockholm, Karolinska Institute, Huddinge, Sweden; Research and Development Unit, Jämtland County Council, Östersund, Sweden.
    Lindblad, Birgitta Ejdervik
    Department of Ophthalmology, Sundsvall Hospital, Sundsvall, Sweden.
    Sleep and sleepiness 1 and 9 months after cataract surgery2004Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 38, nr 1, s. 69-75Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study was undertaken to analyze sleep development in a group of patients during the first 9 months after cataract extraction. Men and women (n=407) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during two periods in 2000-2002 were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 and 9 months after the operation. The response rate was 90.8%. The mean ages of the participating men and women were 74.5 and 75.6 years, respectively. One week after cataract extraction the visual acuity in the treated eye was 0.67 (+/-0.31) in men and 0.69 (+/-0.28) in women (NS), and showed an inverse relationship to age in both men (P<0.01) and women (P<0.0001). One month after cataract extraction 28.3% of the men and 37.5% of the women experienced poor sleep, and after 9 months the figures were 15.8 and 31.4%, respectively. Frequent awakenings and difficulty in falling asleep after nocturnal awakenings improved correspondingly. Being well rested in the morning increased and daytime sleepiness decreased. The results indicate that in elderly persons with cataract sleep is improved 1 month after cataract extraction and further improvement during the first 9 months may be experienced.

  • 348.
    Asplund, R.
    et al.
    Family Medicine Stockholm, Karolinska Institute, Huddinge, Sweden; Research and Development Unit (Forsknings- och utvecklingsenheten), Jämtland County Council, Östersund, Sweden.
    Lindblad, Birgitta Ejdervik
    Department of Ophthalmology, Sundsvall Hospital, Sundsvall, Sweden.
    The development of sleep in persons undergoing cataract surgery2002Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 35, nr 2, s. 179-187Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study was undertaken in order to analyse sleep in a group of patients who were operated on for cataract. All patients (n=328) undergoing cataract surgery at the Department of Ophthalmology, Sundsvall Hospital during a 4-month period were asked to complete a questionnaire on the state and change of sleep and sleepiness 1 month after the operation. Twelve persons were unable or declined to participate. The response rate was 97.2%. The mean ages of the participating men and women were 74.5 and 76.3 years, respectively. Pre-operative visual acuity in the operated eye was 0.16 in men and 0.18 in women. After cataract extraction sleep was improved in 12.0% of the men and in 26.3% of the women. Nevertheless poor sleep 1 month post-operatively was reported by 29.3% of the men and 42.6% of the women (P<0.05). There was no age-related increase in sleep complaints. The results indicate that in elderly persons with cataract sleep is impaired, and that 1 month after cataract extraction improved sleep may be experienced.

  • 349.
    Assadi, Ghazaleh
    et al.
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden .
    Vesterlund, Liselotte
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Bonfiglio, Ferdinando
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Mazzurana, Luca
    Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Cordeddu, Lina
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Schepis, Danika
    Rheumatology unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden .
    Mjösberg, Jenny
    Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden .
    Ruhrmann, Sabrina
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Fabbri, Alessia
    Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy .
    Vukojevic, Vladana
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Percipalle, Piergiorgio
    Biology Program, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates; Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, Stockholm, Sweden.
    Salomons, Florian A.
    Department of Cell and Molecular Biology, Karolinska Institutet, Stockholm, Sweden.
    Laurencikiene, Jurga
    Lipid laboratory, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Törkvist, Leif
    Gastrocentrum, Karolinska University Hospital, Stockholm, Sweden .
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    D'Amato, Mauro
    Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden; BioDonostia Health Research Institute, San Sebastian and IKERBASQUE, Basque Foundation for Science, Bilbao, Spain .
    Functional Analyses of the Crohn's Disease Risk Gene LACC12016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 12, artikel-id e0168276Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Genetic variation in the Laccase (multicopper oxidoreductase) domain-containing 1 (LACC1) gene has been shown to affect the risk of Crohn's disease, leprosy and, more recently, ulcerative colitis and juvenile idiopathic arthritis. LACC1 function appears to promote fatty-acid oxidation, with concomitant inflammasome activation, reactive oxygen species production, and anti-bacterial responses in macrophages. We sought to contribute to elucidating LACC1 biological function by extensive characterization of its expression in human tissues and cells, and through preliminary analyses of the regulatory mechanisms driving such expression.

    Methods: We implemented Western blot, quantitative real-time PCR, immunofluorescence microscopy, and flow cytometry analyses to investigate fatty acid metabolism-immune nexus (FAMIN; the LACC1 encoded protein) expression in subcellular compartments, cell lines and relevant human tissues. Gene-set enrichment analyses were performed to initially investigate modulatory mechanisms of LACC1 expression. A small-interference RNA knockdown in vitro model system was used to study the effect of FAMIN depletion on peroxisome function.

    Results: FAMIN expression was detected in macrophage-differentiated THP-1 cells and several human tissues, being highest in neutrophils, monocytes/macrophages, myeloid and plasmacytoid dendritic cells among peripheral blood cells. Subcellular co-localization was exclusively confined to peroxisomes, with some additional positivity for organelle endomembrane structures. LACC1 co-expression signatures were enriched for genes involved in peroxisome proliferator-activated receptors (PPAR) signaling pathways, and PPAR ligands downregulated FAMIN expression in in vitro model systems.

    Conclusion: FAMIN is a peroxisome-associated protein with primary role(s) in macrophages and other immune cells, where its metabolic functions may be modulated by PPAR signaling events. However, the precise molecular mechanisms through which FAMIN exerts its biological effects in immune cells remain to be elucidated.

  • 350.
    Astrøm, Anne N.
    et al.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Ekbäck, Gunnar
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Region Örebro County, Örebro, Sweden.
    Ordell, Sven
    Dental Commissioning Unit, Östergötland County Council, Linköping University, Linköping, Sweden.
    Lie, Stein A.
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Gulcan, Ferda
    Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Dental hygienist attendance and its covariates in an ageing Swedish cohort2017Ingår i: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 125, nr 6, s. 487-494Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Delegation of tasks between professional groups is important to make health-care services accessible and effective for ageing people. Focussing on a Swedish 1942 birth cohort and guided by Andersen's Behavioral Model, this study assessed dental hygienist attendance from age 50 to age 70 and identified covariates at the population-averaged and person-specific levels. In 1992, a census of 50-yr-old subjects was invited to participate in a questionnaire survey. Of the 6,346 respondents, 3,585 completed follow-ups in 1997, 2002, 2007, and 2012. Multiple logistic regression analysis was conducted using a marginal model and a random intercept model. Cochran's Q test revealed that significantly more respondents confirmed dental hygienist attendance in 2012 than in 1992 (57.2% in 2012 vs. 26.0% in 1992). Population-averaged ORs for dental hygienist attendance across time were 3.5 at age 70 yr compared with age 50 yr (baseline); 2.0 if being a regular rather than an irregular dental attendee; and 0.7 if being of non-native origin compared with native origin. The corresponding person-specific ORs were 8.9, 3.2, and 0.5. Consistent with Andersen's Behavioral Model, predisposing, enabling, and need-related factors were associated with dental hygienist attendance at population-averaged and person-specific levels. This has implications for promoting dental hygienist attendance among ageing people.

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