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  • 151.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Audiological Research Centre, Örebro University, Örebro, Sweden.
    A qualitative evaluation of the National Expert Team regarding the assessment and diagnosis of deafblindness in Sweden2017Ingår i: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 19, nr 4, s. 362-374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Deafblindness is a rare condition with multiple causes. Given its rarity, professionals generally have limited knowledge of this condition and insufficient experience managing it. Accordingly, in Sweden, a National Expert Team was established to assess and diagnose deafblindness. The aim of this study was to identify the conceptions of persons with deafblindness, parents of children with deafblindness and professionals involved in their care, rehabilitation and education regarding their participation in the assessment and diagnostic procedures performed by this national team. A phenomenographic design was employed. The main findings were illustrated by five descriptive categories: An opportunity for improvement in daily living, ability to interact with the cream of the crop, personal effort, effects of genetics beyond drawing blood and limited professional interaction.

  • 152.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Audiological Research Centre.
    Health care consumption in infants with CHARGE syndrome: a case-study2017Konferensbidrag (Refereegranskat)
  • 153.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Knowledge, skills and information needs on older residents’ hearing loss and hearing aids: Translation and adaptation of a Norwegian instrument2020Konferensbidrag (Refereegranskat)
  • 154.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Almqvist, Kjerstin
    Källström, Åsa
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Appell, Petra
    Gillå, Cristina
    Lind, Maria
    Lindgren Fändriks, Anna
    Child Health Care: A Place for Asking about Domestic Violence2018Konferensbidrag (Övrigt vetenskapligt)
  • 155.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Bergström, Mattias
    Mäkki-Torkko, Elina
    Carlsson, Per-Inge
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bjuresäter, Kaisa
    Knowledge, skills and information needs on older residents’ hearing loss and hearing aids: Translation and adaptation of a Norwegian instrument2022Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objective: The objective with the project is to find a valid and culturally appropriate instrument for measuring the professionals' knowledge, skills and information needs on older residents’ hearing loss and hearing aids. Such an instrument could optimally be used in clinical praxis, as well as in research, for cross-sectional studies and for measuring change related to educational interventions.

    Materials: The Norwegian instrument Knowledge, skills and information needs on residents’ hearing loss and hearing aids was identified in the literature. Its content was, by the research group regarded as relevant in a Swedish setting, although some cultural adaptations seemed to be necessary.

    Methods: The translation and cultural adaptations were performed in line with the International Society For Pharmacoeconomics and Outcomes Research (ISPOR) Task Force For Translation and Cultural Adapation, as outlined below:

    1. We first asked one of the original authors for permission to translate the instrument.

    2. Two of the authors (KB and MB) individually translated the content of the instrument. Their first language is Swedish, but both are familiar with the Norwegian language.

    3. The other authors individually and together checked the translations and judged whether the statements were comprehensible in Swedish, and made necessary cultural adaptations. For example, the nursing home settings, and job types within this sector are not identical in the two countries.

    4. An independent person, with knowledge of both Swedish and Norwegian (Norwegian being the first language), but with no previous knowledge of the instrument made a back-translation. This person had good knowledge of the setting, being a professor in geriatrics.

    5. The authors compared the original version of the instrument with the back-translated version and discussed some inconsistences with the first author of the original instrument, before we all agreed on a first preliminary Swedish version.

    6. 12 professionals having audiological competence, experience of nursing older people or teaching in nursing piloted the first preliminary Swedish version. They suggested some reformulations of questions and responses, which were discussed and decided on within the research group.

    7. The next step is to test the preliminary Swedish version of the instrument, which will take place during the winter of 2019-2020. A sample of professionals working in different nursing homes in two Swedish counties will be invited to participate. The plan is to include 400 professionals. The sample size is based on an optimal sample for performing a factor analysis as part of the assessment of the psychometric properties of the preliminary Swedish version. It also allows cross-sectional sub-analyses, based on different groups of professionals and level of nursing home.

    8. The project will be presented in a scientific journal, and used in a future intervention study. The instrument can also be used in clinical improvement work.

    Conclusion: The results are promising. To the best of our knowledge, there is no Swedish instrument available for measuring professionals' knowledge, skills and information needs on older residents’ hearing loss and hearing aids. It seems necessary to have such an instrument, as the number of older people increases in Sweden, as well as worldwide. Impaired hearing, as well as assistive needs increase with age, and thus it is of great importance to ensure that professionals working with older people have sufficient knowledge to assist them.

  • 156.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Bäccman, Charlotte
    Faculty of Arts and Social Sciences, Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden; Faculty of Arts and Social Sciences, Center for Service Research, Karlstad University, Karlstad, Sweden.
    Almqvist, Kjerstin
    Faculty of Arts and Social Sciences, Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
    The professional relationship forms the base: Swedish child health care nurses' experiences of encountering mothers exposed to intimate partner violence2021Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 16, nr 1, artikel-id 1988043Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: This study aimed to explore child health care nurses' clinical experiences from encounters with mothers exposed to intimate partner violence (IPV), as little research has explored this topic.

    METHOD: Nine child health care nurses from two Swedish regions were interviewed. The interviews were analysed using thematic analysis.

    RESULTS: The narratives depicted the nurses' strong commitment to, and professional relationship with, the exposed mothers. The experience of working as a nurse and having encountered IPV in clinical practice made the nurses more confident, which impacted their performance and attitude towards this topic. The ability to uphold the professional relationship was threatened by lack of support and interprofessional collaborations.

    CONCLUSIONS: The professional relationship was central to the encounters, yet could impose an emotional burden on the nurses. While the nurses wanted to improve their knowledge of the process around the mother and child, they were happy to pass the primary responsibility over to other professionals. The findings highlight the challenge in establishing sustainable support for nurses, and building a transparent collaboration process between the health care sector and the social services, serving the well-being and safety of the mother and child.

  • 157.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Huus, Karina
    Wahlqvist, Moa
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Björk, Maria
    Health related quality of life, family climate and sense of coherence in family members in families where a parent has deafblindness2020Konferensbidrag (Refereegranskat)
  • 158.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Huus, Karina
    Wahlqvist, Moa
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Björk, Maria
    The experience of family life when one parent has deafblindness: the partner’s perspective2020Konferensbidrag (Refereegranskat)
  • 159.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Leibring, I.
    Karlstad University, Faculty of Health- Science and Technology- Department of Health Sciences- Nursing, Karlstad, Sweden.
    Fear and Coping During Treatment for Acute Lymphatic Leukemia - from the Perspective of Children 5-9 Years Old2018Ingår i: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 65, nr Suppl.2, s. S598-S598Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

  • 160.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Leibring, Ingela
    Karlstad University, Faculty of Health, Science and Technology, Institution for Health, Karlstad, Sweden.
    CHILDREN'S NARRATIVES OF SUPPORT FROM PARENTS WHEN EXPERIENCING FEAR RELATED TO ACUTE LYMPHOBLASTIC LEUKEMIA2022Ingår i: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 69, nr Suppl. 5, s. S528-S528, artikel-id P067Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background and Aims: Children diagnosed with Acute Lymphoblastic Leukemia (ALL) typically undergo intense treatment with frequent hospitalizations. Medical, as well as existential fears have been identified. It has also been found that children's coping strategies develop during their illness trajectory. The literature on what children with ALL find to be valuable support from parents when experiencing fear is sparse. Thus, the aim of this presentation is to describe what young children find to be important support from their parents when experiencing fear related to ALL.

    Methods: The study had a longitudinal descriptive qualitative design. Thirteen children (3 girls and 10 boys), initially 5-9 years old were interviewed once to three times during their treatment period (approximately 2 months after the diagnosis, after 1 year, and at end of treatment). Data were analyzed using a matrix-based qualitative analysis method.

    Results: The parents’ physical and emotional closeness was the most frequently reported support. It eased the children's medical and existential fears. The children also found it supportive when the parents facilitated for them to participate in their care and when the parents acted as their advocate. Other supportive measures were offering distraction, talking to the child about their fears, assisting the professionals in alleviating pain and fear, being playful and encouraging. Five children also appreciated when their parents restricted them, during medical procedures. The experiences of support varied between children and between different time points during treatment.

    Conclusions: Although being quite young, the children were able to describe what they found to be supportive when experiencing fear, or for preventing fear. The parental support had an impact on the child's emotional, social and physical wellbeing. Professionals should encourage parents to stay with their child, and offer support to the parents, so that they in turn can support their child.

  • 161.
    Anderzen-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Leibring, Ingela
    Qualitative matrix based analysis: a useful alternative for analyzing longitudinal data of children’s experiences2020Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Previously, researchers have pointed out the importance of giving voice to children’s experiences of health care, as well to follow these experiences over time.

    Objective: To describe experiences of fear in 5-9 year-old children, related to having Acute Lymphoblastic Leukemia (ALL).

    Method: 3 girls and 10 boys participated in one to three interviews during their treatment period. The interviews were performed approximately two months after diagnosis, after one year and at the end of treatment (after 2.5 years). The data comprised 35 interviews in total, with an average length of 35 minutes. To capture the longitudinal perspective, a qualitative matrix methodology was adopted. First, individual matrices for each child was developed, where all narratives about their fears during the entire treatment period were inserted. Next, a cross-case matrix was developed, where all text from all the individual case-matrices were compiled for each time point. The general idea of the matrices was to visualize data, thus enabling the researchers to easier identify common patterns, between cases and over time. In this step, common fears experienced by the children were identified, and finally, summary cross-case matrices were created. These were used to summarize how many children who had experienced various fears at the three time points, during treatment.

    Results: Fear of needles was the most commonly reported fear. This fear was most prominent and most often reported at the start of treatment. For >50% of the children this fear remained at the end of treatment. Fear related to the physical changes caused by the ALL or treatment, on the other hand increased during the treatment period.

    Conclusion: The qualitative matrix based methodology was found to be useful when analyzing qualitative longitudinal interview-data from children with ALL. The analysis was quite manifest, which suited the data derived from young children.

  • 162.
    Anderzén Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Leibring, Ingela
    Karlstad University, Faculty Of Health, Science And Technology, Institution For Health, Karlstad, Sweden.
    Children’s Narratives of Support From Professionals when Experiencing Fear Related to Acute Lymphoblastic Leukemia2020Ingår i: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 67, nr S4, s. 120-120, artikel-id 0255Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Children diagnosed with Acute Lymphoblastic Leukemia (ALL) typically face 2.5 years treatment, which initially is intense and includes frequent hospitalizations. Previous research has identified various fears during treatment: fear of getting needles, removal of adhesive tapes, having a feeding tube, taking tablets and the physical changes related to ALL itself, as well as to treatments. The children’s coping strategies develop during the course of illness. The literature on what children with ALL find to be supportive when experiencing fear is sparse. The aim of this presentation is thus to describe what children 5-9 years old find to be important support from professionals when experiencing fear related to ALL.

  • 163.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Audiological Research Centre, Region Örebro County, Örebro University Hospital, Örebro, Sweden; The Swedish Institute for Disability Research (SIDR), Örebro, Sweden.
    CHARGE syndrome: a five case study of the syndrome characteristics and health care consumption during the first year in life2015Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 30, nr 1, s. 6-16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    CHARGE syndrome is characterized by impaired vision and hearing, as well as physical malformations. The aim of this study is to describe the characteristics of the malformations and the health care consumption during the first year, in a Swedish sample having CHARGE syndrome. Three of the five individuals fulfilled all the traditional criteria for a clinical diagnosis of CHARGE syndrome. All infants were hospitalized from 26 to 230. days, subjected to 10-34 different diagnostic procedures and prescribed 10-28 different medications during their first year. Coordinated and individually adapted care is urged, as these infants and their families are in of need multiple health care contacts.

  • 164.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Carvalho Lamy, Zeni
    Departamento de Saúde Pública, Universidade Federal do Maranhâo, Hospital Universitário, Sao Luis, Brazil.
    Tingvall, Maria
    Department of Obstetrics and Gynaecology, Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Parental experiences of providing skin-to-skin care to their newborn infant: Part 2: A qualitative meta-synthesis2014Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, artikel-id 24907Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aim: To synthesize and interpret qualitative research findings focusing on parental experiences of skin-to-skin care (SSC) for newborn infants.

    Background: SSC induces many benefits for newborn infants and their parents. Three meta-analyses have been conducted on physiological outcomes, but no previous qualitative meta-synthesis on parental experiences of SSC has been identified.

    Design: The present meta-synthesis was guided by the methodology described by Paterson and co-workers.

    Data sources: Four databases were searched, without year or language limitations, up until December 2013. Manual searches were also performed. The searches and subsequent quality appraisal resulted in the inclusion of 29 original qualitative papers from 9 countries, reporting experiences from 401 mothers and 94 fathers.

    Review methods: The meta-synthesis entails a meta-data analysis, analysis of meta-method, and meta-theory in the included primary studies. Based on the three analyses, the meta-synthesis represents a new interpretation of a phenomenon. The results of the meta-data analysis have been presented as a qualitative systematic review in a separate paper.

    Results: When synthesizing and interpreting the findings from the included analyses, a theoretical model of Becoming a parent under unfamiliar circumstances emerged. Providing SSC seems to be a restorative as well as an energy-draining experience. A supportive environment has been described as facilitating the restorative experience, whereas obstacles in the environment seem to make the provision of SSC energy-draining for parents. When the process is experienced as positive, it facilitates the growth of parental self-esteem and makes the parents ready to assume full responsibility for their child.

    Conclusion: The results show that SSC can be interpreted not only as a family-including and important health care intervention but also in terms of actually becoming a parent. The process of becoming a parent in this specific situation is influenced by external factors in three different levels; family and friends, community, and society at large. The descriptions of providing SSC are similar to what has previously been described as the natural process of becoming a mother or a father.

  • 165.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Carvalho Lamy, Zeny
    Departamento de Saúde Pública, Universidade Federal do Maranhâo, Hospital Universitário, Sao Luis MA, Brazil.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Parental experiences of providing skin-to-skin care to their newborn infant: Part 1: A qualitative systematic review2014Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, artikel-id 24906Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Aim: To describe parental experiences of providing skin-to-skin care (SSC) to their newborn infants.

    Background: SSC care for newborn infants has been reported to have positive physiological and psychological benefits to the infants and their parents. No systematic review regarding parental experiences has been identified.

    Design: In this first part of a meta-study, the findings of a systematic literature review on parental experience of SSC care are presented.

    Data sources: Four databases were searched, without year or language limitations, up until December 2013. Manual searches were performed in reference lists and in a bibliography of the topic.

    Review methods: After a quality-appraisal process, data from the original articles were extracted and analysed using qualitative content analysis.

    Results: The systematic and manual searches led to the inclusion of 29 original qualitative papers from nine countries, reporting experiences from 401 mothers and 94 fathers. Two themes that characterized the provision of SSC emerged: a restoring experience and an energy-draining experience.

    Conclusion: This review has added scientific and systematic knowledge about parental experiences of providing SSC. Further research about fathers’ experiences is recommended.

  • 166.
    Anderzén-Carlsson, Agneta
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Lundholm, Ulla Persson
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Kohn, Monica
    Nora Health Care Centre, Örebro County Council, Nora, Sweden.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University, Örebro, Sweden.
    Medical yoga: another way of being in the world-A phenomenological study from the perspective of persons suffering from stress-related symptoms2014Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, artikel-id 23033Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The prevalence of stress-related illness has grown in recent years. Many of these patients seek help in primary health care. Yoga can reduce stress and thus complements pharmacological therapy in medical practice. To our knowledge, no studies have investigated patients' experiences of yoga treatment in a primary health care setting or, specifically, the experiences of yoga when suffering from stress-related illness. Thus, the aim of the present study was to explore the meaning of participating in medical yoga as a complementary treatment for stress-related symptoms and diagnosis in a primary health care setting. This study has a descriptive phenomenological design and took place at a primary health care centre in Sweden during 2011. Five women and one man (43-51 years) participated. They were recruited from the intervention group (n = 18) in a randomized control trial, in which they had participated in a medical yoga group in addition to standard care for 12 weeks. Data were collected by means of qualitative interviews, and a phenomenological data analysis was conducted. The essential meaning of the medical yoga experience was that the medical yoga was not an endpoint of recovery but the start of a process towards an increased sense of wholeness. It was described as a way of alleviating suffering, and it provided the participants with a tool for dealing with their stress and current situation on a practical level. It led to greater self-awareness and self-esteem, which in turn had an implicit impact on their lifeworld. In phenomenological terms, this can be summarized as Another way of being in the world, encompassing a perception of deepened identity. From a philosophical perspective, due to using the body in a new way (yoga), the participants had learnt to see things differently, which enriched and recast their perception of themselves and their lives.

  • 167.
    Andreasson, A.
    et al.
    Sahlgrenska university hospital, Dept. of Urology, Göteborg, Sweden.
    Hällgren, A.
    Linköping university, Dept. of Biomedical and Clinical Sciences, Linköping, Sweden.
    Georgeoulas, P.
    Örebro University Hospital, Dept. of Urology, Örebro, Sweden.
    Forsberg, J.
    Linköping university, Dept. of Biomedical and Clinical Sciences, Linköping, Sweden.
    Fridriksson, J.
    Umeå University, Dept. of Surgical and Perioperative Sciences, Umeå, Sweden.
    Granåsen, G.
    Umeå University, Dept. of Public Health and Clinical Medicine, Umeå, Sweden.
    Lundström, K-J
    Umeå University, Dept. of Surgical and Perioperative Sciences, Umeå, Sweden.
    Resare, S.
    Norrland University Hospital, Dept. of Urology, Umeå, Sweden.
    Lönn, Backman B.
    Umeå University, Dept. of Nursing, Umeå, Sweden.
    Grabe, M.
    Lund university, Dept. of Translational Medicine, Lund, Sweden.
    Stattin, P.
    Uppsala university, Dept. of surgical sciences, Uppsala, Sweden.
    Stranne, J.
    Göteborg University, The Institute of Clinical Sciences, Göteborg, Sweden.
    Sundqvist, M.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Styrke, J.
    Umeå University, Dept. of Surgical and Perioperative Sciences, Umeå, Sweden.
    Fosfomycin versus Ciprofloxacin as transrectal prostatebiopsy antibiotic prophylaxis an open randomized controlled multicenter drug trial2023Ingår i: European Urology, ISSN 0302-2838, E-ISSN 1873-7560, Vol. 83, nr Suppl. 1, s. S180-S180, artikel-id A0131Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction & Objectives: Antibiotic prophylaxis are administered as a routine to decrease the risk for septic complications following transrectal prostate biopsy. Fosfomycin administered 1 h or more prior to biopsy has equal or better infectious complication rates as compared to Ciprofloxacin in both prospective and retrospective studies from countries with high rates of antibiotic resistance. The aim of this study was to investigate if Fosfomycin administered immediately prior to prostate biopsy was as effective as Ciprofloxacin in Sweden, a country with low rates of antibiotic resistance.

    Materials & Methods: A randomized, controlled, open, multicenter, non-inferiority-study including men of all ages undergoing transrectal prostate biopsy was performed in the urology departments of three Swedish hospitals. The total number of patients were planned for 3448, divided into low and high infection risk groups. The low-risk group was randomized to either one dose of Fosfomycin 3g or Ciprofloxacin 750mg before biopsy. The high-risk group was randomized to either two doses of Fosfomycin 3g prior to biopsy and one more 24 h after biopsy or Ciprofloxacin 500mg once prior to biopsy and then twice daily for three days. The drugs were administered orally. All patients had a rectal swab for culture before and after biopsy. The endpoint was hospitalisation due to urinary tract infection within 14 days from biopsy, follow-up was performed with a phone interview.

    Results: The safety board prematurely interrupted the study after 42 included patients due to an unusual high number of hospitalisations. Four out of 20 patients (20%), three in the low-risk group and one in the high-risk group, had been hospitalised due to urosepsis in the Fosfomycin group. One further patient described fever symptoms but did not seek health care. No patient in the Ciprofloxacin group (n=21) described symptoms of infection from the urinary tract. One patient was lost to follow-up. A one-sided binomial test showed a p-value of <0.001. Two of the four hospitalised patients had a positive blood culture for Pseudomonas Aeruginosa and one had a positive rectal swab culture for Pseudomonas species both before and after biopsy.

    Conclusions: The study does not support the use of Fosfomycin administered immediately prior to prostate biopsy. The results may have been affected by the unexpected high number of Pseudomonas infections, a bacteria where Fosfomycin often lack effect. If Fosfomycin is to be used it should be with caution if Pseudomonas has been seen in earlier cultures

  • 168.
    Andreoli, L.
    et al.
    University of Brescia | ASST Spedali Civili, Dept Clinical and Experimental Sciences | Unit of Rheumatology and Clinical Immunology, Brescia, Italy.
    Lini, D.
    University of Brescia | ASST Spedali Civili, Dept Clinical and Experimental Sciences | Unit of Rheumatology and Clinical Immunology, Brescia, Italy.
    Schreiber, K.
    Danish Hospital for Rheumatic Diseases, Rheumatology, Sønderborg, Denmark; University of Southern Denmark, Department of Regional Health Research (IRS), Odense, Denmark; Guys and St Thomas’ NHS Foundation Trust, Thrombosis and Hemostasis, London, United Kingdom.
    Sen, P.
    Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, India.
    Ravichandran, N.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India.
    Parodis, Ioannis
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karolinska Institutet and Karolinska University Hospital, Stockholm, Division of Rheumatology, Department of Medicine Solna, Stockholm, Sweden; Faculty of Medicine and Health, Örebro University, Department of Rheumatology, Örebro, Sweden.
    Toro Gutierrez, C. E.
    Pontifica Universidad Javeriana, Reference Center for Osteoporosis, Rheumatology and Dermatology, Cali, Colombia.
    Katchamart, W.
    Mahidol University, Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
    Goo, P. A.
    Queen Savang Vadhana Memorial Hospital, Department of Medicine, Chonburi, Thailand.
    Shumnalieva, R.
    University Hospital “St. Ivan Rilski”, Department of Rheumatology, Sofia, Bulgaria.
    Chibuzo, O. C.
    University of Nigeria Teaching Hospital, Ituku-Ozalla/University of Nigeria, Enugu Campus, Department of Medicine, Enugu, Nigeria.
    Velikova, T.
    Sofia University St. Kliment Ohridski, Medical Faculty, Sofia, Bulgaria.
    Day, J.
    Institute of Medical Research, Walter and Eliza Hall, Parkville, Australia; University of Melbourne, Department of Medical Biology, Parkville, Australia; Royal Melbourne Hospital, Department of Rheumatology, Parkville, Australia.
    Joshi, M.
    Byramjee Jeejeebhoy Government Medical College, Sassoon General Hospitals, Pune, India.
    Katsuyuki Shinjo, S.
    Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Division of Rheumatology, São Paulo, Brazil.
    Gracia-Ramos, A. E.
    National Medical Center “La Raza”, Instituto Mexicano del Seguro Social, Department of Internal Medicine, General Hospital, Mexico City, Mexico.
    Cavagna, L.
    University of Pavia, Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Pavia, Italy.
    Kuwana, M.
    Nippon Medical School Graduate School of Medicine, Department of Allergy and Rheumatology, Tokyo, Japan.
    Knitza, J.
    Friedrich-Alexander-Universität Erlangen-Nürnberg, Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Germany.
    Makol, A.
    Mayo Clinic, Division of Rheumatology, Rochester, United States of America.
    Chen, Y. M.
    Taichung Veterans General Hospital, Division of Allergy, Immunology and Rheumatology, Department of Medical Research, Taichung, Taiwan, Republic of China.
    Chinoy, H.
    School of Biological Sciences, The University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, Manchester, United Kingdom; Manchester University NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; Manchester Academic Health Science Centre, Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
    Agarwal, V.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India.
    Aggarwal, R.
    University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, United States of America.
    Gupta, L.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India; New Cross Hospital, Royal Wolverhampton Trust, Department of Rheumatology, Wolverhampton, United Kingdom.
    COVID-19 VACCINE SAFETY DURING PREGNANCY AND BREASTFEEDING IN WOMEN WITH AUTOIMMUNE DISEASES: RESULTS FROM THE COVAD STUDY2023Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 82, nr Suppl. 1, s. 56-57, artikel-id OP0082Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: COVID-19 vaccine hesitancy among pregnant and breastfeeding women with autoimmune diseases (AID) is often attributed to the fear of adverse events (AE) and disease flares (DF). No data are available regarding COVID-19 vaccine safety in this population.

    Objectives: We aimed at describing delayed-onset (>7 days) vaccine-related AE (minor and major), DF, and related AID treatment modifications from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study.

    Methods: Among complete responses from 9201 participants as of June 21, 2022, 6787 (73.8%) were women. Six subgroups were identified upon diagnosis of AID vs healthy controls (HC) and their pregnancy/breastfeeding status at the time of any dose of vaccine (Figure 1).

    Results: Forty pregnant and 52 breastfeeding AID patients were identified and their vaccination rates (at least one dose) was 100% and 96.2%, respectively (Table 1). Overall AE, minor AE, and major AE were reported significantly more frequently by pregnant than non-pregnant patients (45% vs. 26%, p=0.01; 40% vs. 25.9%, p=0.03; 17.5% vs. 4.6%, p<0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC. Post-vaccination DF were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients (n=2315). All DF in pregnant/breastfeeding patients were managed with glucocorticoids and a fifth of them required initiation or change in immunosuppressive treatment.

    Conclusion: This study provides the first insights into the safety of COVID-19 vaccination during the antenatal period in women with AID. While AEs were more commonly reported by pregnant patients with AID, these were no higher than among pregnant healthy controls without AID. These observations are reassuring, likely to strengthen physician-patient communication and overcome hesitancy as the benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of AE and DF.

    Reference: [1]Fazal ZZ, et al; COVAD Study Group. COVAD survey 2 long-term outcomes: unmet need and protocol. Rheumatol Int 2022; 42:2151-2158.

  • 169.
    Anens, Elisabeth
    et al.
    Department of Neuroscience, Section for Physiotherapy, Uppsala, Sweden.
    Ahlström, Isabell
    Department of Neuroscience, Section for Physiotherapy, Uppsala, Sweden.
    Emtner, Margareta
    Department of Neuroscience, Section for Physiotherapy, Uppsala, Sweden.
    Zetterberg, Lena
    Department of Neuroscience, Section for Physiotherapy, Uppsala, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Region Örebro County, University Research Health Care Centre, Örebro, Sweden.
    Hellström, Karin
    Department of Neuroscience, Section for Physiotherapy, Uppsala, Sweden.
    Validity and reliability of physical activity measures in multiple sclerosis2023Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 39, nr 1, s. 137-153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The purpose was to evaluate the psychometric properties of physical activity measures in persons with multiple sclerosis (PwMS).

    METHODS: Adults with multiple sclerosis were recruited, n = 30 (validation) and n = 57 (test-retest). Steps measured with PiezoRX, Yamax SW200 and ActiGraph GT9X Link (AGlink) and time in different positions measured with AGlink were validated against data from video analysis. Psychometric properties of the Physical Activity and Disability Survey - Revised Swedish version (PADS-R(Sw)) was evaluated.

    RESULTS: The most valid measures were AGlink using the low-frequency extension filter, and PiezoRX with median absolute percentage errors (MeAPEs) of 0.9-3.1% and 1.3-3.3%. The MeAPEs were higher for Yamax SW200 (2.9-21.0%), AGlink display (3.6-44.8%) and AGlink normal filter (8.9-48.9%), indicating low validity. AGlink was not valid in measurements of sitting (MeAPE 12.0-12.5%) or lying (MeAPE 31.0-41.7%). The correlation between PADS-R(Sw) and AGlink steps was r = 0.492 (p = .009). The relative reliability of PADS-R(Sw) was ICC2,1 0.85 (CI 0.76-0.91), and absolute reliability was SEM 0.54.

    CONCLUSION: AGlink and PiezoRX were valid measures of steps in PwMS. The questionnaire PADS-R(Sw) was valid, with high relative reliability, but its absolute reliability was unsatisfactory.

  • 170.
    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, 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.

  • 171.
    Angelin, Martin
    et al.
    Department of Clinical Microbiology, Infectious Diseases, Umeå University, Sweden.
    Sjölin, Jan
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden.
    Kahn, Fredrik
    Department of Clinical Sciences, Division of Infection Medicine, Lund University, Sweden.
    Ljunghill Hedberg, Anna
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden.
    Rosdahl, Anja
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Infectious Diseases.
    Skorup, Paul
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Sweden.
    Werner, Simon
    Department of Infectious Diseases, Skåne University Hospital, Malmö, Region Skåne, Sweden.
    Woxenius, Susanne
    Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Askling, Helena H.
    Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Sweden; Academic Specialist Centre, Stockholm County Health Care Services, Region Stockholm, Sweden.
    Qdenga® - A promising dengue fever vaccine; can it be recommended to non-immune travelers?2023Ingår i: Travel Medicine and Infectious Disease, ISSN 1477-8939, E-ISSN 1873-0442, Vol. 54, artikel-id 102598Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Qdenga® has been approved by the European Medicines Agency (EMA) for individuals > 4 years of age and for use according to national recommendations. The vaccine shows high efficacy against virologically confirmed dengue and severe dengue in clinical studies on 4-16-year old's living in endemic areas. For individuals 16-60 years old only serological data exists and there is no data for individuals > 60 years. Its use as a travel vaccine is still unclear. We present the studies behind the approval and the recommendations for travelers as issued by the Swedish Society for Infectious Diseases Physicians.

  • 172.
    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.

  • 173.
    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.

  • 174.
    Aniskevich, Aliaksandra
    et al.
    Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus.
    Shimanskaya, Iryna
    Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus.
    Boiko, Iryna
    Department of Functional and Laboratory Diagnostics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine; World Health Organization Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections (STIs), National Reference Laboratory for STIs, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Golubovskaya, Tatyana
    Mogilev Regional Skin and Venereal Diseases Dispensary, Mogilev, Belarus.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. World Health Organization Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections (STIs), National Reference Laboratory for STIs, Department of Laboratory Medicine, Clinical Microbiology.
    Stanislavova, Iryna
    Mogilev Regional Skin and Venereal Diseases Dispensary, Mogilev, Belarus.
    Jacobsson, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections (STIs), National Reference Laboratory for STIs, Department of Laboratory Medicine, Clinical Microbiology.
    Adaskevich, Aliaksandr
    Mogilev Regional Skin and Venereal Diseases Dispensary, Mogilev, Belarus.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other Sexually Transmitted Infections (STIs), National Reference Laboratory for STIs, Department of Laboratory Medicine, Clinical Microbiology.
    Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-20192021Ingår i: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 21, nr 1, artikel-id 520Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea.

    METHODS: N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009-2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified β-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher's exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance.

    RESULTS: In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced β-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018-2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment.

    CONCLUSIONS: The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

  • 175.
    Anna Karin, Hedström
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of surgery.
    Tim, Spelman
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Lars, Forsberg
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Erik, Näslund
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Jan, Hillert
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The impact of bariatric surgery on disease activity and progression of multiple sclerosis: A nationwide matched cohort study2022Ingår i: Multiple Sclerosis Journal, ISSN 1352-4585, E-ISSN 1477-0970, Vol. 28, nr 13, s. 2099-2105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Surgical outcomes in patients with multiple sclerosis (MS) following metabolic surgery appear to be similar compared to those of the general bariatric population.

    OBJECTIVE: To study the impact of metabolic surgery on the clinical course of MS.

    METHODS: Using data from the Scandinavian Obesity Surgery Registry and the Swedish Multiple Sclerosis register, we compared disease outcomes in 122 cases of MS who had undergone metabolic surgery with those of 122 cases of MS without surgery, matched by a two-staged Propensity score match, including age at disease onset, sex, MS phenotype, body mass index, and preoperative severity of MS as measured by the Expanded Disability Status Scale.

    RESULTS: The time to 6-month confirmed disability progression during the first five years postbaseline was shorter among the surgical patients (hazard ratio (HR) = 2.31, 95% confidence interval (CI) = 1.09-4.90; p = 0.03). No differences were observed regarding postoperative annual relapse rate (p = 0.24) or time to first postoperative relapse (p = 0.52).

    CONCLUSION: Although metabolic surgery appears to be a safe and efficient treatment of obesity in patients with MS, the clinical course of the disease might be negatively affected. Long-term nutritional follow-up after surgery and supplementation maintenance are crucial, particularly among those with preoperative deficits.

  • 176.
    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)
  • 177.
    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.

  • 178.
    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.

  • 179.
    Annika, Lindh
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Theander, Kersti
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala, 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; Division of Family Medicine and Primary Care, Karolinska Institutet, NVS, Stockholm, Sweden.
    Sandelowsky, Hanna
    Academic Primary Health Care Centre, Stockholm, Sweden; Division of Family Medicine and Primary Care, Karolinska Institutet, NVS, Stockholm, Sweden.
    Ställberg, Björn
    dDepartment of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Centre.
    Zakrisson, Ann-Britt
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Centre.
    Errors in inhaler use related to devices and to inhalation technique among patients with chronic obstructive pulmonary disease in primary health care2019Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 6, nr 4, s. 1519-1527Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to describe inhaler use in primary health care patients with chronic obstructive pulmonary disease (COPD) and to categorize these patients into those making errors related to devices, those making errors related to inhalation technique and those making errors related to both.

    Design: Observational study. Methods COPD nurses used a checklist to assess the use of inhalers by patients with spirometry-verified COPD (N = 183) from primary healthcare centres. The STROBE checklist has been used.

    Results: The mean age of the patients was 71 (SD 9) years. Almost half of them (45%) made at least one error; of these, 50% made errors related to devices, 31% made errors related to inhalation technique and 19% made errors related both to devices and to inhalation technique.

  • 180.
    Annika, Lindh
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Centre for Clinical Research and Education, Region Värmland, Sweden.
    Theander, Kersti
    Centre for Clinical Research and Education, Region Värmland, Sweden.
    Arne, Mats
    Centre for Clinical Research and Education, Region Värmland, Sweden; Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Sweden.
    Lundh, Lena
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Sweden.
    Sandelowsky, Hanna
    Academic Primary Health Care Centre, Stockholm, Sweden; Karolinska Institute, NVS, Division of Family Medicine and Primary Care, Stockholm, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Sweden.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Zakrisson, Ann-Britt
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    One additional educational session in inhaler use to patients with COPD in primary health care: A controlled clinical trial2022Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 105, nr 9, s. 2969-2975Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate whether one additional educational session about inhaler use, delivered to patients with COPD in primary healthcare, could affect the patients' skills in inhaler use. Specifically, to study the effects on errors related to handling the device, to inhalation technique, and to both.

    METHODS: This nonrandomized controlled clinical trial included 64 patients who used devices and made errors. COPD nurses assessed inhaler use using a checklist and educated patients. Intervention group received one additional educational session after two weeks.

    RESULTS: At baseline, patients in the IG had more devices (n = 2,1) compared to patients in the CG (n = 1,6) (p = 0.003). No other statistically significant differences were seen at baseline. At follow-up, intervention group showed a lower proportion of patients who made errors related to handling the device (p = 0.006). No differences were seen in the other categories.

    CONCLUSION: One additional educational session in inhaler use for patients with COPD was effective in reducing the proportion of patients making errors related to handling of their devices.

    PRACTICE IMPLICATIONS: Categorization of errors might help healthcare professionals to assess the suitability of patients' devices, tailor patient education, and thus improve patient health.

  • 181.
    Aoude, M.
    et al.
    Saint Joseph University of Beirut, Rheumatology Department, Beirut, Lebanon.
    Gupta, L.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India; The Royal Wolverhampton NHS Trust, Dept. of Rheumatology, Wolverhampton, United Kingdom.
    Hmamouchi, I.
    Temara Hospital, Rheumatology Unit, Temara, Morocco; Faculty of Medicine and Pharmacy, Mohammed V University, Laboratory of Biostatistics, Clinical Research and Epidemiology (LBRCE), Rabat, Morocco.
    Grignaschi, S.
    Fondazione I.R.C.C.S. Policlinico San Matteo, Rheumatology, Pavia, Italy; The University of Pavia, Department of Internal Medicine and Medical Therapeutics, Pavia, Italy.
    Cavagna, L.
    Fondazione I.R.C.C.S. Policlinico San Matteo, Rheumatology, Pavia, Italy; The University of Pavia, Department of Internal Medicine and Medical Therapeutics, Pavia, Italy.
    Kim, M.
    University of Illinois College of Medicine at Peoria, Department of Internal Medicine, Peoria, United States of America.
    R, N.
    Sanjay Gandhi Postgraduate Institute of Medical Sciences, Department of Clinical Immunology and Rheumatology, Lucknow, India.
    Lilleker, J. B.
    School of Biological Sciences University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Rochester, United Kingdom; Manchester Centre for Clinical Neurosciences, Clinical Neurosciences, Salford, United Kingdom.
    Sen, P.
    Maulana Azad Medical College(MAMC), Rheumatology, New Delhi, India.
    Agarwal, V.
    Mahatma Gandhi Mission Medical College, Navi Mumbai, India.
    Kardes, S.
    Istanbul University Faculty of Medicine, Department of Medical Ecology and Hydroclimatology, Istanbul, Turkey.
    Day, J.
    Royal Melbourne Hospital Neuroscience Foundation, Department of Rheumatology, Parkville, Australia; WEHI - Walter and Eliza Hall Institute of Medical Research, Parkville, Australia; University of Melbourne, Department of Medical Biology, Parkville, Australia.
    Makol, A.
    Mayo Clinic, Division of Rheumatology, Rochester, United States of America.
    Milchert, M.
    Pomeranian Medical University, Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Szczecin, Poland.
    Gheita, T. A.
    Faculty Of Medicine Kasr Al-Ainy Cairo University, Rheumatology Department, Cairo, Egypt.
    Salim, B.
    Fauji Foundation Hospital Road, Rheumatology Department, Rawalpindi, Pakistan.
    Velikova, T.
    Lozenetz University Hospital, Department of Clinical Immunology, Sofia, Bulgaria.
    Gracia-Ramos, A. E.
    MSS, Department of Internal Medicine, Ciudad de México, Mexico.
    Parodis, Ioannis
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karolinska University Hospital, Division of Rheumatology, Stockholm, Sweden; Örebro University, Department of Rheumatology, Örebro, Sweden.
    Selva-O'callaghan, A.
    La Vall d’Hebron, Systemic Autoimmune Diseases Unit, Internal Medicine Department, Barcelona, Spain.
    Nikiphorou, E.
    King’s College London, Centre for Rheumatic Diseases, London, United Kingdom; King’s College Hospital, Dept of Rheumatology, London, United Kingdom.
    Chatterjee, T.
    University of Illinois College of Medicine at Peoria, Department of Internal Medicine, Peoria, United States of America.
    Tan, A. L.
    Leeds General Infirmary, NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom; University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom.
    Saavedra, M. A.
    Centro Medico Nacional La Raza, Departamento de Reumatología, Ciudad de México, Mexico.
    Shinjo, S. Katsuyuki
    Centro Medico Nacional La Raza, Departamento de Reumatología, Ciudad de México, Mexico.
    Knitza, J.
    University of Erlangen-Nuremberg, Medizinische Klinik 3 - Rheumatologie und Immunologie, Erlangen, Germany.
    Kuwana, M.
    Nippon Medical School, Department of Allergy and Rheumatology, Bunkyo City, Japan.
    Nune, A.
    Southport & Ormskirk Hospital NHS Trust, Southport, United Kingdom.
    Distler, O.
    University Hospital of Zürich, Rheumatology, Zürich, Switzerland.
    Chinoy, H.
    School of Biological Sciences University of Manchester, Division of Musculoskeletal and Dermatological Sciences, Manchester, United Kingdom; NIHR Manchester Biomedical Research Unit, Manchester, United Kingdom; Salford Royal NHS Foundation Trust, Rheumatology, Manchester, United Kingdom.
    Aggarwal, R.
    University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, United States of America.
    Ziade, N.
    Saint Joseph University of Beirut, Rheumatology Department, Beirut, Lebanon; Hôtel-Dieu de France, Rheumatology Department, Beirut, Lebanon.
    TREATMENT PATTERNS OF IDIOPATHIC INFLAMMATORY MYOPATHIES: RESULTS FROM AN INTERNATIONAL COHORT OF OVER 1,400 PATIENTS2022Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 81, nr Suppl. 1, s. 105-106Artikel i tidskrift (Övrigt vetenskapligt)
  • 182.
    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.

  • 183.
    Appelros, Peter
    et al.
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Arvidsson Lindvall, Mialinn
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Matérne, Marie
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Stroke prevalence in a medium-sized Swedish municipality2021Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 143, nr 2, s. 210-216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Many patients who have had stroke survive with functional disability for years. Stroke prevalence is a fundamental measure of the impact of stroke in society. Stroke prevalence has never been evaluated in Sweden.

    MATERIALS & METHODS: 2019 with respect to stroke survivors (ICD-10 I60-I69) living in Kumla (population 21,738), a municipality well representative of Sweden.

    RESULTS: 330 individuals with stroke were found, of which 42% were women. The mean age was 74.1 years in men and 75.1 years in women. 11.5% of the patients had more than one stroke. The mean duration since the first stroke was 8.3 years. The crude prevalence per 100,000 was 1754 in men, 1281 in women and 1518 in both sexes. Adjusted to the European population, the ratio was 1570 per 100,000, and to the World population 936 per 100,000.

    CONCLUSIONS: In spite of a declining stroke incidence in Sweden, the stroke prevalence in Kumla, Sweden, is relatively high. Comparisons with other studies indicate that a decline in prevalence may have occurred since the early 2000s. Modern registers can support data collection, but the index stroke may have occurred almost forty years back in time.

  • 184.
    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.

  • 185.
    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.

  • 186.
    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.

  • 187. Appelros, Peter
    et al.
    Matérne, Marie
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Jarl, Gustav
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskaper.
    Arvidsson Lindvall, Mialinn
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center .
    Comorbidity in Stroke Survivors in a Medium-Sized Swedish Municipality2023Konferensbidrag (Övrigt vetenskapligt)
  • 188.
    Appelros, Peter
    et al.
    University Health Care Research Center,Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Matérne, Marie
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center.
    Jarl, Gustav
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center; Department of Prosthetics and Orthotics.
    Arvidsson Lindvall, Mialinn
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Comorbidity in stroke survivors in a medium-sized Swedish municipality2023Ingår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 37, nr Suppl. 1, s. 135-136Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

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

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

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

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

  • 189.
    Appelros, Peter
    et al.
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Matérne, Marie
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Jarl, Gustav
    Region Örebro län. Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Arvidsson Lindvall, Mialinn
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Comorbidity in Stroke-Survivors: Prevalence and Associations with Functional Outcomes and Health2021Ingår i: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 30, nr 10, artikel-id 106000Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 190.
    Appelros, Peter
    et al.
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Svensson, Elisabeth
    Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Heidenreich, Kaja
    Örebro universitet, Institutionen för medicinska vetenskaper. Health Care Research Center.
    Svantesson, Mia
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Ethical issues in stroke thrombolysis revisited2021Ingår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 144, nr 6, s. 611-615Artikel i tidskrift (Refereegranskat)
  • 191.
    Arbeus, Mikael
    et al.
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    de Souza, Domingos Ramos
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery.
    Geijer, Håkan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology.
    Lidén, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology.
    Pinheiro, Bruno
    Department of Cardiovascular Surgery, Hospital do Coracao Anis Rassi, Goiania, Brazil.
    Bodin, Lennart
    Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Samano, Ninos
    Department of Cardiothoracic Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Anaesthesiology and Intensive Care, Thoracic Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
    Five-year patency for the no-touch saphenous vein and the left internal thoracic artery in on- and off-pump coronary artery bypass grafting2021Ingår i: Journal of cardiac surgery, ISSN 0886-0440, E-ISSN 1540-8191, Vol. 36, nr 10, s. 3702-3708Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Randomized trials show high long-term patency for no-touch saphenous vein grafts in coronary artery bypass grafting. The patency rate in off-pump coronary bypass surgery for these grafts has not been investigated. Our center participated in the CORONARY randomized trial, NCT00463294. This is a study aimed to assess the patency of no-touch saphenous veins in on- versus off-pump coronary bypass surgery at five-year follow-up.

    METHODS: Fifty-six patients were included. Forty of 49 patients, alive at 5 years, participated in this follow-up. There were 21 and 19 patients in the on- and off-pump groups respectively. No-touch saphenous veins were used to bypass all targets and in some cases the left anterior descending artery. Graft patency according to distal anastomosis was evaluated with computed tomography angiography.

    RESULTS: The five-year patency rate was 123/139 (88.5%). The patency for the no-touch vein grafts was 57/64 (89.1%) in the on-pump versus 37/45 (82.2%) in the off-pump group. All left internal thoracic arteries except for one, 29/30 (96.6%), were patent. All vein grafts used to bypass the left anterior descending and the diagonal arteries were patent 32/32. The lowest patency rate for the saphenous veins was to the right coronary territory, particularly in off-pump surgery (80.0% vs. 62.5% for the on- respective off-pump groups).

    CONCLUSIONS: Comparable 5-year patency for the no-touch saphenous veins and the left internal thoracic arteries to the left anterior descending territory in both on- and off-pump coronary artery bypass grafting. Graft patency in off-pump CABG is lower to the right coronary artery.

  • 192.
    Arborelius, U P
    et al.
    Kinesiology Research Group, Department of Anatomy, Karolinska Institute, Stockholm, Sweden.
    Wretenberg, Per
    Region Örebro län. Kinesiology Research Group, Department of Anatomy, Karolinska Institute, Stockholm, Sweden.
    Lindberg, F
    Kinesiology Research Group, Department of Anatomy, Karolinska Institute, Stockholm, Sweden.
    The effects of armrests and high seat heights on lower-limb joint load and muscular activity during sitting and rising1992Ingår i: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 35, nr 11, s. 1377-1391Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The loading moment of force on the hip, knee, and ankle joints of nine healthy men rising from four different types of stools were compared, together with the levels of myoelectrical activity (EMG) in four leg muscles. Two types of stool (stand stools) had higher seats than a normal chair. The other two were of ordinary seat height, but one also had armrests. The bodyweight carried by the different stools when sitting was also measured, and the subject estimated the effort required for each trial. The mean maximum knee moment was over 60% lower when rising from the high stool than from 'ordinary' seat height. The difference between the high and low stand stool was also significant (p less than 0.001). Using the high stool or help of the arms reduced the mean maximum hip moment by about 50%. The mean maximum ankle moment was only marginally influenced by the different stools. Knee moment was influenced more by seat height than was hip moment. Vastus lateralis activity was significantly higher when subjects rose from 'ordinary' height than when rising from either stand stool (p less than 0.001). The rectus femoris muscle was little activated and the semitendinosus muscle was activated earlier when rising from higher seat heights. All subjects estimated the effort of rising from the higher stand stool to be lower than from the lower stand stool or from 'ordinary' height without arm rests. It was concluded that stand stools are good alternatives for workers who change frequently between sitting and standing work.

  • 193.
    Areskoug Sandberg, E.
    et al.
    Department of Clinical Sciences Malmö, Clinical Research Center, Center for Primary Health Care Research, Lund University, Lund, Sweden.
    Stenman, E.
    Department of Clinical Sciences Malmö, Clinical Research Center, Center for Primary Health Care Research, Lund University, Lund, Sweden.
    Palmer, K.
    Department of Clinical Sciences Malmö, Clinical Research Center, Center for Primary Health Care Research, Lund University, Lund, Sweden.
    Duberg, Anna
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Sundquist, J.
    Department of Clinical Sciences Malmö, Clinical Research Center, Center for Primary Health Care Research, Lund University, Lund, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School Medicine at Mount Sinai, New York, USA; Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan.
    Sundquist, K.
    Department of Clinical Sciences Malmö, Clinical Research Center, Center for Primary Health Care Research, Lund University, Lund, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School Medicine at Mount Sinai, New York, USA; Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan.
    A 10-Week School-Based Mindfulness Intervention and Symptoms of Depression and Anxiety Among School Children and Adolescents: A Controlled Study2024Ingår i: School Mental Health, ISSN 1866-2625, E-ISSN 1866-2633Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Mental health problems are increasing among children and adolescents. School-based mindfulness interventions are gaining popularity worldwide and may be a way to decrease depression and anxiety symptoms in students. However, before introducing large-scale mindfulness interventions in school settings, more research is needed on feasible, easily applicable practices that are possible to fit in the school schedule. In this controlled intervention study, a total of 1399 students aged 9-16 were included. The 10-week classroom-based mindfulness intervention comprised daily, brief mindfulness sessions led by schoolteachers or via audio files. Symptoms of depression and anxiety were evaluated with Beck scales prior to and after the intervention. In addition to whole group analyses, subgroup analyses on age, sex as well as mode of delivery were performed. ClinicalTrials.gov ID: NCT03327714. No significant differences between the intervention and control group in change of depression or anxiety symptoms after the intervention were detected. However, the subgroup of students who received teacher-led mindfulness sessions (16%) had a significant decrease of depression and anxiety symptoms after 10 weeks compared to those who received the sessions via audio files. Brief mindfulness sessions on daily basis did not have any detectable overall effect on depression and anxiety symptoms among schoolchildren. Our findings do not support an introduction of large-scale mindfulness interventions in schools although the potential influence of mode of delivery needs to be further examined.

    Clinical trial registration: The study was registered at ClinicalTrials.gov (identifier: NCT03327714).

  • 194.
    Areskoug Sandberg, Elin
    et al.
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Duberg, Anna
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center.
    Lorenzon Fagerberg, Ulrika
    Centre for Clinical Research, Department of Paediatrics, Västmanland Hospital, Region Västmanland, Uppsala University, Västerås, Sweden; Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Mörelius, Evalotte
    School of Nursing and Midwifery, Edith Cowan University, Joondalup WA, Australia; Perth Children’s Hospital, Nedlands WA, Australia.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Saliva Cortisol in Girls With Functional Abdominal Pain Disorders: A Randomized Controlled Dance and Yoga Intervention2022Ingår i: Frontiers in Pediatrics , E-ISSN 2296-2360, Vol. 10, artikel-id 836406Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Functional abdominal pain disorders (FAPDs) are common among girls and has been associated with stress. Cortisol is one of the major stress hormones. Dance and yoga have been shown to reduce abdominal pain among girls with FAPDs.

    Aim: To investigate the effect of an 8-month intervention with dance and yoga on cortisol levels in saliva among girls with FAPDs.

    Methods: A total of 121 girls aged 9-13 years with irritable bowel syndrome (IBS) or functional abdominal pain were included in the study. Participants were randomized into an intervention group and a control group. The intervention group attended a combined dance and yoga session twice a week for 8 months. Saliva samples were collected during 1 day, in the morning and evening, at baseline, and at 4 and 8 months. Subjective pain and stress were assessed as well.

    Results: No significant effects on saliva cortisol levels between groups were observed after completion of the intervention at 8 months. However, evening cortisol and evening/morning quotient were significantly reduced at 4 months in the intervention group compared to the control group (p = 0.01, p = 0.004). There was no association between cortisol quota and pain or stress.

    Conclusion: Improvements in cortisol levels were seen in the intervention group at 4 months but did not persist until the end of the study. This indicates that dance and yoga could have a stress-reducing effect during the ongoing intervention.

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    Saliva Cortisol in Girls With Functional Abdominal Pain Disorders: A Randomized Controlled Dance and Yoga Intervention
  • 195.
    Arevström, Lilith
    et al.
    Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Bergh, Cecilia
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Landberg, Rikard
    Department of Food Science, Swedish University of Agricultural Sciences, Uppsala, Sweden; Department of Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Göteborg, Sweden.
    Wu, Huaxing
    Department of Food Science, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Rodriguez-Mateos, Ana
    Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
    Waldenborg, Micael
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Cardiology.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Swede.
    Blanc, Stephane
    Department of Ecology, Physiology and Ethology, Hubert Curien Pluridisciplinary Institute, University of Strasbourg, Strasbourg, France.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Freeze-dried bilberry (Vaccinium myrtillus) dietary supplement improves walking distance and lipids after myocardial infarction: an open-label randomized clinical trial2019Ingår i: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 62, s. 13-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Bilberries, Vaccinium myrtillus, have a high content of phenolic compounds including anthocyanins, which could provide cardiometabolic health benefits following acute myocardial infarction (AMI). We hypothesized that standard medical therapy supplemented with freeze-dried bilberry after AMI would have a more beneficial effect on cardiovascular risk markers and exercise capacity than medical therapy alone. Patients were allocated in a 1:1 ratio within 24 hours of percutaneous coronary intervention in an 8-week trial either to V myrtillus powder (40 g/d, equivalent to 480 g fresh bilberries) and standard medical therapy or to a control group receiving standard medical therapy alone. High-sensitivity C-reactive protein and exercise capacity measured with the 6-minute walk test were the primary biochemical and clinical end points, respectively. Fifty subjects completed the study. No statistically significant difference in high-sensitivity C-reactive protein was detected between groups. The mean 6-minute walk test distance increased significantly more in the bilberry group compared to the control group: mean difference 38 m at follow-up (95% confidence interval 14-62, P = .003). Ex vivo oxidized low-density lipoprotein was significantly lowered in the bilberry group compared to control, geometric mean ratio 0.80 (95% confidence interval 0.66-0.96, P = .017), whereas total cholesterol and low-density lipoprotein cholesterol did not differ significantly between groups. Anthocyanin-derived metabolites in blood increased significantly in the bilberry group during the intervention and were different after 8 weeks between the bilberry group and control. Findings in the present study suggest that bilberries may have clinically relevant beneficial effects following AMI; a larger, double-blind clinical trial is warranted to confirm this.

  • 196.
    Ariel Gianecini, Ricardo
    et al.
    Instituto Nacional de Enfermedades Infecciosas—Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
    Poklepovich, Tomas
    Instituto Nacional de Enfermedades Infecciosas—Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs.
    Cuenca, Noelia
    Instituto Nacional de Enfermedades Infecciosas—Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
    Tuduri, Ezequiel
    Instituto Nacional de Enfermedades Infecciosas—Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs.
    Campos, Josefina
    Instituto Nacional de Enfermedades Infecciosas—Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
    Galarza, Patricia
    Instituto Nacional de Enfermedades Infecciosas—Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Buenos Aires, Argentina.
    Genomic Epidemiology of Azithromycin-Nonsusceptible Neisseria gonorrhoeae, Argentina, 2005-20192021Ingår i: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 27, nr 9, s. 2369-2378Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Azithromycin-nonsusceptible Neisseria gonorrhoeae strains are an emerging global public health threat. During 2015-2018, the prevalence of azithromycin-nonsusceptible gonococcal infection increased significantly in Argentina. To investigate the genomic epidemiology and resistance mechanisms of these strains, we sequenced 96 nonsusceptible isolates collected in Argentina during 2005-2019. Phylogenomic analysis revealed 2 main clades, which were characterized by a limited geographic distribution, circulating during January 2015-November 2019. These clades included the internationally spreading multilocus sequence types (STs) 1580 and 9363. The ST1580 isolates, which had MICs of 2-4 mu g/mL, had mutations in the 23S rRNA. The ST9363 isolates, which had MICs of 2-4 or >256 mu g/mL, had mutations in the 23S rRNA, a mosaic mtr locus, or both. Identifying the geographic dissemination and characteristics of these predominant clones will guide public health policies to control the spread of azithromycin-nonsusceptible N. gonorrhoeae in Argentina.

  • 197.
    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, 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.

  • 198.
    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.

  • 199.
    Arinell, Karin
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Sahdo, Berolla
    Department of Clinical Medicine, Örebro University, Örebro, Sweden.
    Evans, Alina L.
    Faculty of Forestry and Wildlife Management, Hedmark University College, Evenstad, Norway; Section of Arctic Veterinary Medicine, Norwegian School of Veterinary Science, Tromsø, Norway.
    Arnemo, Jon M.
    Faculty of Forestry and Wildlife Management, Hedmark University College, Evenstad, Norway; Department of Wildlife Fish and Environmental Studies, Faculty of Forest Sciences, Swedish University of Agricultural Sciences, Umeå, Sweden.
    Baandrup, Ulrik
    Department of Pathology, Vendsyssel Hospital, Hjørring, Denmark; Faculty of Medical Sciences, Aalborg, Denmark.
    Fröbert, Ole
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Brown Bears (Ursus arctos) Seem Resistant to Atherosclerosis Despite Highly Elevated Plasma Lipids during Hibernation and Active State2012Ingår i: Clinical and Translational Science, ISSN 1752-8054, E-ISSN 1752-8062, Vol. 5, nr 3, s. 269-272Artikel i tidskrift (Refereegranskat)
    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.

  • 200.
    Arnison, Tor
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Clinical Epidemiology and Biostatistics.
    Prevention is better than cure: why early interventions for insomnia and chronic pain during adolescence should be a priority2023Ingår i: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14, artikel-id 1206977Artikel i tidskrift (Refereegranskat)
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