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  • 301.
    Fang, Xin
    et al.
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Li, Runkui
    College of Resources and Environment, University of Chinese Academy of Sciences, Beijing, China; State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
    Kan, Haidong
    Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China; Key Laboratory of Health Technology Assessment of the Ministry of Health, School of Public Health, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP), Fudan University, Shanghai, China.
    Bottai, Matteo
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cao, Yang
    Örebro universitet, Institutionen för medicinska vetenskaper. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bayesian model averaging method for evaluating associations between air pollution and respiratory mortality: a time-series study2016Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 6, nr 8, artikkel-id e011487Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

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

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

  • 302.
    Faresjö, Å
    et al.
    Linköping University, Linköping, Sweden.
    Grodzinsky, E
    County Council of Östergötland, Linköping, Sweden.
    Johansson, S
    University of Gothenburg, Gothenburg, Sweden .
    Wallander, MA
    Uppsala University, Uppsala, Sweden.
    Timpka, T
    Linköping University, Linköping, Sweden.
    Åkerlind, Ingemar
    Linköping University, Sweden.
    A population based case control study of work and psychosocial problems in patients with irritable bowel syndrome - women are more seriously affected than men.2007Inngår i: American Journal of Gastroenterology, ISSN 0002-9270, Vol. 102, nr 2, s. 371-379Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Everyday psychosocial functioning and quality of life are known to be reduced for patients with irritable bowel syndrome (IBS), but few previous studies have analyzed associations with functioning in working life. Accordingly, we examined perceptions of working conditions, functioning in the workplace, quality of life, and psychological complaints among IBS patients compared with age- and sex-matched controls. METHODS: A case-control study design was used based on 347 IBS patients from Swedish general practice who were compared with age- and sex-matched controls (N = 1,041) randomly selected from the general population. A survey was performed including validated questions concerning job strain, quality of life (SF-36 [Short Form 36]), absence because of illness, depression, anxiety, and sleeping habits. RESULTS: The IBS patients reported considerably more often that their daily performance in working life was affected by their gastrointestinal problems (OR [odds ratio] 7.14, 95% CI 5.45-9.36). Male IBS cases only reported less authority regarding decisions on their working pace (OR 5.44, 95% CI 1.28-23.18), while female IBS patients reported less decision authority regarding planning their work (OR 2.29, 95% CI 1.13-4.64), fewer learning opportunities at work (OR 2.12, 95% CI 1.26-3.57), and more long-term sick leave than their controls (OR 3.70, 95% CI 1.94-7.07). The female IBS cases also reported lower quality of life in all dimensions than their controls. CONCLUSION: In particular, female IBS patients reported lower authority over decisions at work and problems in their daily functioning in the workplace. These associations persisted after adjustments for possible confounders such as mood, sleeping problems, and perceived health.

  • 303.
    Faria, Vanda
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Center for Pain and the Brain, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
    Gingnell, Malin
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    M. Hoppe, Johanna
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hjorth, Olof
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Alaie, Iman
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Frick, Andreas
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Hultberg, Sara
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Wahlstedt, Kurt
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Engman, Jonas
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Månsson, Kristoffer N.T.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.; Department of Psychology, Stockholm University, Stockholm, Sweden.
    Carlbring, Per
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Reis, Margareta
    Department of Medical and Health Sciences, Division of Drug Research, Linköping University, Linköping, Sweden.
    Larsson, Elna-Marie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi.
    Fredrikson, Mats
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Furmark, Tomas
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder: A Randomized Trial2017Inngår i: EBioMedicine, E-ISSN 2352-3964, nr 24, s. 179-188, artikkel-id S2352-3964(17)30385-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD).

    METHODS: We did a randomized clinical trial, within an academic medical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram (20mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSAS-SR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face-matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory - State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605.

    FINDINGS: Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n=24) as compared to covert (n=22) SSRI administration yielded significantly better outcome on the LSAS-SR (adjusted difference 21.17, 95% CI 10.69-31.65, p<0.0001) with more than three times higher response rate (50% vs. 14%; χ(2)(1)=6.91, p=0.009) and twice the effect size (d=2.24 vs. d=1.13) from pre-to posttreatment. There was no significant between-group difference on anticipatory speech anxiety (STAI-S), both groups improving with treatment. No serious adverse reactions were recorded. On fMRI outcomes, there was suggestive evidence for a differential neural response to treatment between groups in the posterior cingulate, superior temporal and inferior frontal gyri (all z thresholds exceeding 3.68, p≤0.001). Reduced social anxiety with treatment correlated significantly with enhanced posterior cingulate (z threshold 3.24, p=0.0006) and attenuated amygdala (z threshold 2.70, p=0.003) activity.

    INTERPRETATION: The clinical and neural effects of escitalopram were markedly influenced by verbal suggestions. This points to a pronounced placebo component in SSRI-treatment of SAD and favors a biopsychosocial over a biomedical explanatory model for SSRI efficacy.

    FUNDING RESOURCES: The Swedish Research Council for Working Life and Social Research (grant 2011-1368), the Swedish Research Council (grant 421-2013-1366), Riksbankens Jubileumsfond - the Swedish Foundation for Humanities and Social Sciences (grant P13-1270:1).

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  • 304.
    Fart, Frida
    Örebro universitet, Institutionen för medicinska vetenskaper.
    The Ageing Gut, in Health and Disease2022Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    There is a global ageing phenomenon, which stress the importance for an improved health for the increased population of older adults. One important factor for a good health is a well-functioning gut. Hence, this thesisinvestigates several aspects of gut health for older adults, spanning from overall gut health in community-dwelling older adults, to investigating a gut disease model: inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis. 

    When investigating community-dwelling older adults, gastrointestinal symptoms were found to be common and correlated to a lower experience of well-being. In addition, more than half of the population did not reach the recommended intake of several macronutrients, including protein and fibre. Compared to a group of active older adults, still practising orienteering, i.e., senior orienteers, community-dwelling older adult’s further showed signs of a less healthier gut microbiota, including lower levels of Faecalibacterium prausnitzii.

    By investigating the disease model of inflammatory bowel disease, later onset of Crohn’s disease seemed to have less hyperresponsive adaptive immune response toward the own gut microbiota, which seems to be due to a less genetic predisposition among later onset individuals. Interestingly, an environmental pollutant, per- and polyfluoroalkyl substances (PFAS), was increased in the serum of late-onset ulcerative colitis patients compared to healthy controls. A higher level of PFAS further correlated to a disturbed bile acid pool. In addition, PFAS induced an increased intestinal permeability across ileal and colonic murine tissue. 

    In conclusion, the work included in this thesis further emphasises the importance of a maintained gut health. In addition, the work highlights diet, an active life-style, gut microbiota and environmental factors, for example PFAS, as targets of future interventions studies with the aim to improve gut health and overall health among older adults. 

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  • 305.
    Fart, Frida
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Amcoff, Karin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Andersson, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kalla, Rahul
    The IBD Character Consortium.
    Satsangi, Jack
    Lindqvist, Carl Mårten
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Schoultz, Ida
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Loss of tolerance to microbial antigens in preclinical Crohn’s disease differs with age at diagnosis: A twin studyManuskript (preprint) (Annet vitenskapelig)
  • 306.
    Fart, Frida
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Tingö, Lina
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Engelheart, Stina
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Lindqvist, Carl M.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Brummer, Robert Jan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kihlgren, Annica
    Örebro universitet, Institutionen för hälsovetenskaper.
    Schoultz, Ida
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Gut Health and its Associations to Well-being and Nutrient intake in Community-Dwelling Older AdultsManuskript (preprint) (Annet vitenskapelig)
  • 307.
    Fazel, Seena
    et al.
    Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
    Zetterqvist, Johan
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Antipsychotics, mood stabilisers, and risk of violent crime2014Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 384, nr 9949, s. 1206-1214Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

  • 308.
    Fears, R.
    et al.
    German Natl Acad Sci Leopoldina, European Acad Sci Advisory Council, Halle, Saale, Germany.
    Griffin, G. E.
    St Georges Univ London, Inst Infect & Immun, London, England.
    Larhammar, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Larhammar: Farmakologi.
    ter Meulen, V.
    German Natl Acad Sci Leopoldina, European Acad Sci Advisory Council, Halle, Saale, Germany.
    van der Meer, J. W. M.
    Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands.
    Globalization of Traditional Chinese Medicine: what are the issues for ensuring evidence-based diagnosis and therapy?2020Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 287, nr 2, s. 210-213Artikkel i tidsskrift (Annet vitenskapelig)
  • 309.
    Fengsrud, Espen
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Atrial fibrillation: endoscopic ablation and postoperative studies2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

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

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

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

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

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  • 310.
    Ferrando, Carlos
    et al.
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Soro, Marina
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Unzueta, Carmen
    Hosp Santa Creu & Sant Pau, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Canet, Jaume
    Hosp Germans Tries & Pujol, Dept Anesthesiol & Crit Care, Badalona, Spain..
    Tusman, Gerardo
    Hosp Privado Comunidad Mar Del Plata, Dept Anesthesiol, Mar Del Plata, Buenos Aires, Argentina..
    Suarez-Sipmann, Fernando
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet. Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.
    Librero, Julian
    Navarrabiomed Fdn Miguel Servet, Red Invest Serv Salud Enfermedades Cron REDISSEC, Pamplona, Spain..
    Peiro, Salvador
    Ctr Super Invest Salud Publ CSISP FISABIO, Red Invest Serv Salud Enfermedades Cron REDISSEC, Valencia, Spain..
    Pozo, Natividad
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Delgado, Carlos
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Ibanez, Maite
    Hosp Villajoyosa, Dept Anesthesiol, Villajoyosa, Spain..
    Aldecoa, Cesar
    Hosp Villajoyosa, Dept Anesthesiol & Crit Care, Villajoyosa, Spain..
    Garutti, Ignacio
    Hosp Gen Gregorio Maranon, Dept Anesthesiol & Crit Care, Madrid, Spain..
    Pestana, David
    Hosp Ramon & Cajal, Anesthesiol & Crit Care, Madrid, Spain..
    Rodriguez, Aurelio
    Hosp Dr Negrin, Anesthesiol & Crit Care, Gran Canaria, Spain..
    Garcia del Valle, Santiago
    Hosp Fdn Alcorcon, Anesthesiol & Crit Care, Alcorcon, Spain..
    Diaz-Cambronero, Oscar
    Hosp La Fe, Anesthesiol & Crit Care, Valencia, Spain..
    Balust, Jaume
    Hosp Clin Barcelona, Anesthesiol & Crit Care, Barcelona, Spain..
    Javier Redondo, Francisco
    Hosp Gen, Anesthesiol & Crit Care, Ciudad Real, Spain..
    De La Matta, Manuel
    Hosp Virgen del Rocio, Anesthesiol & Crit Care, Seville, Spain..
    Gallego, Lucia
    Hosp Miguel Servet, Anesthesiol & Crit Care, Zaragoza, Spain..
    Granell, Manuel
    Hosp Gen Valencia, Anesthesiol & Crit Care, Valencia, Spain..
    Martinez, Pascual
    Hosp Albacete, Anesthesiol & Crit Care, Albacete, Spain..
    Perez, Ana
    Hosp Elche, Anesthesiol & Crit Care, Elche, Spain..
    Leal, Sonsoles
    Hosp Povisa, Anesthesiol & Crit Care, Vigo, Spain..
    Alday, Kike
    Hosp La Princesa, Anesthesiol & Crit Care, Madrid, Spain..
    Garcia, Pablo
    Hosp 12 Octubre, Anesthesiol & Crit Care, Madrid, Spain..
    Monedero, Pablo
    Clin Univ Navarra, Anesthesiol & Crit Care, Pamplona, Spain..
    Gonzalez, Rafael
    Hosp Univ Leon, Anesthesiol & Crit Care, Leon, Spain..
    Mazzinari, Guido
    Hosp Manises, Anesthesiol & Crit Care, Manises, Spain..
    Aguilar, Gerardo
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Villar, Jesus
    Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain.;Hosp Univ Dr Negrin, Res Unit, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Gran Canaria, Spain.;St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr Biomed Sci, Toronto, ON, Canada..
    Javier Belda, Francisco
    Hosp Clin Univ, Dept Anesthesiol & Crit Care, Valencia, Spain..
    Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection: study protocol for a randomised controlled trial2017Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 7, nr 7, artikkel-id e016765Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction Surgical site infection (SSI) is a serious postoperative complication that increases morbidity and healthcare costs. SSIs tend to increase as the partial pressure of tissue oxygen decreases: previous trials have focused on trying to reduce them by comparing high versus conventional inspiratory oxygen fractions (FIO 2) in the perioperative period but did not use a protocolised ventilatory strategy. The open-lung ventilatory approach restores functional lung volume and improves gas exchange, and therefore it may increase the partial pressure of tissue oxygen for a given FIO 2. The trial presented here aims to compare the efficacy of high versus conventional FIO 2 in reducing the overall incidence of SSIs in patients by implementing a protocolised and individualised global approach to perioperative open-lung ventilation. Methods and analysis This is a comparative, prospective, multicentre, randomised and controlled two-arm trial that will include 756 patients scheduled for abdominal surgery. The patients will be randomised into two groups: (1) a high FIO 2 group (80% oxygen; FIO 2 of 0.80) and (2) a conventional FIO 2 group (30% oxygen; FIO 2 of 0.30). Each group will be assessed intra-and postoperatively. The primary outcome is the appearance of postoperative SSI complications. Secondary outcomes are the appearance of systemic and pulmonary complications. Ethics and dissemination The iPROVE-O2 trial has been approved by the Ethics Review Board at the reference centre (the Hospital Clinico Universitario in Valencia). Informed consent will be obtained from all patients before their participation. If the approach using high FIO 2 during individualised open-lung ventilation decreases SSIs, use of this method will become standard practice for patients scheduled for future abdominal surgery. Publication of the results is anticipated in early 2019.

    Fulltekst (pdf)
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  • 311.
    Fhärm, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Rolandsson, Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    ‘Aiming for the stars’—GPs’ dilemmas in the prevention of cardiovascular disease in type 2 diabetes patients: focus group interviews2009Inngår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, nr 26, s. 109-114Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Studies have revealed low adherence to guidelines for treatment of diabetes and cardiovascular risk factors.

    Objective

    To explore general practitioners’ experiences regarding treatment practice in type 2 diabetes with specific focus on the prevention of cardiovascular disease.

    Methods

    Fourteen experienced general practitioners from nine health care centres with group practices were interviewed in focus groups. The interviews were digitally recorded, transcribed verbatim and analysed by qualitative content analysis.

    Results

    The overall theme was “dilemmas” in GPs´ treatment practice for type 2 diabetes patients. Five main dilemma categories were identified. First, the GPs were hesitant about labelling someone who feels healthy as ill. Secondly, regarding communicating a diabetes diagnosis and its consequences; should the patient be frightened or comforted? Thirdly, the GPs experienced uncertainty in their role; were they to take responsibility for the care or not? Fourthly, the GPs expressed a conflict between lifestyle changes and drug treatment. Fifthly, the GPs described difficulties in integrating science into reality.

    Conclusions

    The five dilemmas in the general practitioners’ approach to diabetes patients and the treatment of their cardiovascular risk were related to the GPs´ professional role and communication with the patient. To consider these dilemmas in educational efforts is probably essential to achieve improved diabetes care and guideline adherence. 

  • 312.
    Fogelkvist, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Body image in patients with residual eating disorder symptoms: treatment effects of acceptance and commitment therapy and participants' reflections2021Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall aim of this thesis was to evaluate an acceptance and commitment (ACT) group intervention targeting body image in patients with residual eating disorder (ED) symptoms, including treatment effects and participants’ reflections on body image and the intervention. Studies I, II and III are based on a randomized controlled trial including 99 patients that were randomized to the ACT intervention or to continue treatment as usual (TAU). Different self-assessment questionnaires were administered before and after the intervention and at follow up by one and two years. Study IV is based on interviews with patients that had completed the intervention, and did not participate in the trial. 

    From written evaluations in study I body image was shown to mean different things for different individuals. This was also shown by different expectations on treatment. Study II showed that the ACT intervention was superior to TAU in reducing ED symptoms and body dissatisfaction, while care consumption was lower. In addition, ratings of dropout was low. In study III, it was shown that symptom improvement from the ACT intervention rather than TAU was more pronounced in participants with restrictive ED psychopathology. Participants who displayed binge eating and/or purging ED psychopathology, showed improvement on ED symptoms regardless of intervention. Participants younger than 25, and with lower ratings at baseline, showed no improvement on ED symptoms if continuing with TAU. From interviews with participants in study IV, the intervention was described as demanding, and participants described the importance of their own efforts. Specific processes of the intervention were helpful and the context of the group and context outside of treatment could facilitate or hinder progress. Perceived changes in body image differed between participants in study I, showing the potential breadth of the intervention.

    Conclusions from this thesis was that an intervention based on ACT targeting body image was suitable and helpful for patients with residual EDsymptoms. Though the intervention was demanding, dropout was low, and specific processes were described as helpful.

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  • 313.
    Fogelkvist, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center.
    Gustafsson, Sanna Aila
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Parling, Thomas
    Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorderManuskript (preprint) (Annet vitenskapelig)
  • 314.
    Fogelkvist, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center.
    Parling, Thomas
    Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council.
    Kjellin, Lars
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Live with your body – participants reflections on an Acceptance and commitment therapy group intervention for patients with residual eating disorder symptomsManuskript (preprint) (Annet vitenskapelig)
  • 315. Forouzanfar, Mohammad H.
    et al.
    Kivipelto, Miia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Murray, Christopher J. L.
    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 20152016Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, nr 10053, s. 1659-1724Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.

    Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).

    Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.

    Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.

  • 316.
    Fors, Uno
    et al.
    Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden.
    Forsberg, Elenita
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Gunning, William
    Department of Pathology, University of Toledo, Toledo, Ohio, USA.
    Can virtual patients be used to assess clinical reasoning? The effect of different grading metrics2012Inngår i: 15th Ottawa Conference, Abstracts, Ottawa: AMEE , 2012, s. 166-166Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Background

    Virtual patients (VPs) can be used to assess clinical reasoning. Grading metrics applied to VP exams may include scoring for appropriate differential diagnoses, proposed therapy, and the learner’s approach to the case. The learner’s inquiry of medical history, physical exam, and lab/ancillary tests utilized during the exam can all be graded.  However, the best grading metric used to assess clinical reasoning for VP examination is unresolved. 

    Summary of Work

    Results from two groups of students assessed by VP-based examination (n>300) were used as a basis to evaluate different grading metrics. These grading models were also compared with results of other traditional student examination performance. 

    Summary of Results

    Each method of grading had both pronounced advantages and disadvantages with none considered ideal. However one grading metric was perceived to perform slightly better. None of the scoring methods had a direct correlation with four traditional exam formats to which they were compared. 

    Conclusions

    Each grading metric used in this study had advantages and disadvantages. Medical school exams employing VP-based exams need to define what should be assessed for reliable utilization.

    Take-home Messages

    Objectives of VP-based examination are essential to measure learner competency in an appropriate context. Traditional exams do not necessarily measure the same aptitude that VP-based exams measure.

  • 317.
    Forsander, G.
    et al.
    Univ Gothenburg, Sweden.
    Stallknecht, S.
    Incentive, Denmark.
    Samuelsson, Ulf
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för barns och kvinnors hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Barn- och kvinnocentrum, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus.
    Marcus, C.
    Karolinska Inst, Sweden.
    Bogelund, M.
    Incentive, Denmark.
    Preferences for treatment among adolescents with Type 1 diabetes: a national study using a discrete choice experiment model2018Inngår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 35, nr 5, s. 621-629Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AimTo test the possibility of using a discrete choice experiment model, on a national level in adolescents with Type 1 diabetes, in order to obtain a better understanding of drivers of and barriers to diabetes self-care. MethodsA survey instrument was constructed and tested on a small group of the target population: adolescents aged 15 to amp;lt;18 years with Type 1 diabetes. All individuals in Sweden belonging to this target group (N=2112) were then identified via the Swedish paediatric diabetes quality registry SWEDIABKIDS, and were sent an invitation to answer an online questionnaire. A valid response for the discrete choice experiment analyses was achieved from 431 individuals. ResultsThe included respondents were not statistically different from non-participants in terms of age and duration of diabetes, but more young women entered the study and the participants had (on average) a significantly lower HbA(1c) value than the non-participants. Participants regarded as undesirable both non-severe hypoglycaemic events (day and night) and hyperglycaemic events. Avoiding weight gain and even achieving weight loss were the most important aspects among female respondents, who were willing to trade off a substantial level of glycaemic control [13 mmol/mol (1.2%)] to avoid a weight gain of 3 kg. Hypothetical equipment improvements were desired. ConclusionsThe responses may provide useful indications of the aspects that the respondents would prioritize given a real-life dilemma. For treatment effects, stratification along gender lines was important, whereas the treatment administration aspects were stratified according to treatment type because these aspects are closely related.

  • 318.
    Forsell, Karl
    Department of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Health hazards and cancer in relation to occupational exposures among Swedish seafarers2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    This thesis explores health hazards for seafarers in the Swedish merchant fleet, and occupational risks for lung cancer, mesothelioma and hematologic malignancy (HM). A special focus has been exposure to benzene and biomarker levels for work on product or chemical tankers during the mid-1990’ies.

    In a case report, we describe two cases of mesothelioma and two cases of lung cancer having worked in the engine room. Cumulative exposure to asbestos were up to 5 fibreyears. Other exposures were carcinogenic PAHs and nitroarenes. A web-based survey to active seafarers in the Swedish merchant fleet revealed noise, the risk of accidents, whole-body vibrations and ergonomic strain as main work environment problems. General health, work ability and safety climate were all rated high. Associations were found between lower airway symptoms and soot (PR 2.4, 95% CI 1.1-5.1) and between hearing impairment and noise exposure (PR 1.5; 95% CI 1.3–1.7). Iso-strain was especially common in the service department. Twenty-two percent of men and 45% of women had been subjected to harassments. The tanker study showed a geometric mean for benzene exposure of 0.45 mg/m3 (4hTWA) during a work shift, with a wide range (0.02-143 mg/m3). Correlations were found between exposure and benzene in alveolar air (p<0.0001), unmetabolised benzene in urine (p<0.0001) and ttMA in urine (p=0.0011). All biomarkers increased significantly during work (p<0.002). In a case-referent study with the observation period 1985 to 2014, the OR for HM was 1.32 (95% CI 0.86-2.02) if work on tankers had started before 1985 and with a cumulated tanker service of at least five years. If work on tankers had started after 1985, the OR was 0.85 (95% CI 0.51-1.43).

    In conclusion, health hazards in today’s seafaring relate to physical, chemical and psychosocial factors. Work on tankers with mixed open and closed cargo systems might have led to important benzene up-take. Possibly, the risk for HM for seafarers on tankers has decreased during the last decades.

  • 319.
    Forsstrom, David
    et al.
    Stockholm University, Sweden.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Carlbring, Per
    Stockholm University, Sweden.
    Usage of a Responsible Gambling Tool: A Descriptive Analysis and Latent Class Analysis of User Behavior2016Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, nr 3, s. 889-904Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Gambling is a common pastime around the world. Most gamblers can engage in gambling activities without negative consequences, but some run the risk of developing an excessive gambling pattern. Excessive gambling has severe negative economic and psychological consequences, which makes the development of responsible gambling strategies vital to protecting individuals from these risks. One such strategy is responsible gambling (RG) tools. These tools track an individuals gambling history and supplies personalized feedback and might be one way to decrease excessive gambling behavior. However, research is lacking in this area and little is known about the usage of these tools. The aim of this article is to describe user behavior and to investigate if there are different subclasses of users by conducting a latent class analysis. The user behaviour of 9528 online gamblers who voluntarily used a RG tool was analysed. Number of visits to the site, self-tests made, and advice used were the observed variables included in the latent class analysis. Descriptive statistics show that overall the functions of the tool had a high initial usage and a low repeated usage. Latent class analysis yielded five distinct classes of users: self-testers, multi-function users, advice users, site visitors, and non-users. Multinomial regression revealed that classes were associated with different risk levels of excessive gambling. The self-testers and multi-function users used the tool to a higher extent and were found to have a greater risk of excessive gambling than the other classes.

  • 320.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Apropå mammografiscreening. Informerat samtycke: även i Sverige?2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 1-2, s. 9-Artikkel i tidsskrift (Annet vitenskapelig)
  • 321.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Kan begreppet positionerade kunskaper användas för att granska och utveckla (allmän)medicinsk kunskap?2004Inngår i: Medicinsk genusforskning: teori och begreppsutveckling, Stockholm: Vetenskapsrådet , 2004, s. 138-145Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 322.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Klimakteriet och vetenskapen: en historia att lära av?2010Konferansepaper (Annet vitenskapelig)
  • 323.
    Forssén, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Livslopp och barnafödande: viktiga aspekter i patient-läkarmötet2004Inngår i: Kropp och genus i medicinen / [ed] Birgitta Hovelius, Eva E Johansson, Lund: Studentlitteratur, 2004, s. 127-135Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 324.
    Forssén, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Carlstedt, Gunilla
    Feminism som vetenskapligt perspektiv - ett exempel2008Inngår i: Tillämpad kvalitativ forskning inom hälso- och sjukvård / [ed] Granskär & Höglund-Nielsen, Lund: Studentlitteratur , 2008, 1, s. 57-72Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 325.
    Forssén, Annika
    et al.
    Department of Human Work Sciences, Luleå University of Technology, Luleå, Sweden.
    Carlstedt, Gunilla
    Department of Human Work Sciences, Luleå University of Technology, Luleå, Sweden.
    Kvinnors ansvarstagande kan leda till ohälsa2001Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, nr 16, s. 1930-1933Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Women often feel compelled to assume responsibility for the needs and wishes of others. This is of consequence to their own health. The concept »compulsive sensitivity» is used in this article to describe a work injury that can result when this demand is excessive and the trained sensitivity to the needs of others has come to dictate woman’s way of being and acting. This kind of ill health is seen as a result of the gender division of labor that persists in our society. The article is based on qualitative research on women’s work, health and ill health.

  • 326.
    Forssén, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Carlstedt, Gunilla
    “You really do something useful with kids”: mothering and experienced health and illness in a group of elderly Swedish women2008Inngår i: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 29, nr 10, s. 1019-1039Artikkel i tidsskrift (Fagfellevurdert)
  • 327.
    Forssén, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hetlevik, A
    Meland, E
    Vetenskap och kunskapssyn2009Inngår i: Skapar vården ohälsa?: allmänmedicinska reflektioner / [ed] John Brodersen, Birgitta Hovelius, Lotte Hvas, Lund: Studentlitteratur , 2009, 1, s. 39-49Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 328.
    Forssén, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hetlevik, I
    Meland, E
    Kan sundhesvaesenet skabe usundhed?: Refleksjoer fra almen praksis2009Inngår i: Månedsskrift for praktisk laegegerningArtikkel i tidsskrift (Annet vitenskapelig)
  • 329.
    Forssén, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Meland, Eivind
    Universitetet i Bergen, Norge.
    Rethinking scientific responsibility (Workshop)2012Konferansepaper (Annet vitenskapelig)
  • 330.
    Forsum, Elisabet
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Flinke Carlsson, Eva
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Henriksson, Hanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Henriksson, Pontus
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet.
    Löf, Marie
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för kliniska vetenskaper. Linköpings universitet, Hälsouniversitetet. Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden.
    Total body fat content versus BMI in 4-year-old healthy Swedish children.2013Inngår i: Journal of Obesity, ISSN 2090-0708, E-ISSN 2090-0716, Vol. 2013, artikkel-id 206715Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Childhood overweight and obesity, a worldwide problem, is generally identified using BMI (body mass index). However, this application of BMI has been little investigated in children below 5 years of age due to a lack of appropriate methods to assess body composition. Therefore, we used air displacement plethysmography (ADP) to study 4.4-year old boys and girls since this method is accurate in young children if they accept the requirements of the measurement. The purpose was to analyze the relationship between BMI and body fat in these children. Body composition was assessed in 76 (43 boys, 33 girls) of the 84 children brought to the measurement session. Boys and girls contained 25.2 ± 4.7 and 26.8 ± 4.0% body fat, respectively. BMI-based cut-offs for overweight could not effectively identify children with a high body fat content. There was a significant (P < 0.001) but weak (r = 0.39) correlation between BMI and body fat (%). In conclusion, requirements associated with a successful assessment of body composition by means of ADP were accepted by most 4-year-olds. Furthermore, BMI-based cut-offs for overweight did not effectively identify children with a high body fatness and BMI explained only a small proportion of the variation in body fat (%) in this age group.

    Fulltekst (pdf)
    fulltext
  • 331.
    Franks, Paul W
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Childhood obesity, other cardiovascular risk factors, and premature death2010Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 362, nr 13, s. 1840-1842Artikkel, omtale (Annet vitenskapelig)
  • 332.
    Franks, Paul W
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Poveda, Alaitz
    Gene-lifestyle and gene-pharmacotherpy interactions in obesity and its cardiovascular consequences2011Inngår i: Current vascular pharmacology, ISSN 1875-6212, Vol. 9, nr 4, s. 401-456Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Obesity is a highly prevalent complex trait that raises the risk of other chronic diseases such as type 2 diabetes, certain cancers, sleep apnea, and cardiovascular disease, and shortens lifespan. Clinical intervention studies focused on weight loss and epidemiological studies of obesity indicate that genetic variation may modify the relationship between lifestyle behaviors and weight loss or weight gain. Similar observations have also emerged from pharmacogenetic studies. The literature includes several reports from these studies, but few examples of interactions have been adequately replicated. In this review we introduce the topics of population genetics research and gene x environment interaction. We also provide a systematic review of the published literature on gene x lifestyle (physical activity and dietary factors) and gene x drug interactions in relation to obesity. Finally, we overview the scope and findings from these studies and discuss some of their strengths and limitations.

  • 333.
    Freedman, Ben
    et al.
    University of Sydney, Australia; University of Sydney, Australia.
    Camm, John
    St George Hospital, England.
    Calkins, Hugh
    Johns Hopkins University, MD USA.
    Healey, Jeffrey S.
    McMaster University, Canada.
    Rosenqvist, Marten
    Karolinska Institute, Sweden.
    Wang, Jiguang
    Jiaotong University, Peoples R China.
    Albert, Christine M.
    Harvard Medical Sch, MA USA.
    Anderson, Craig S.
    George Institute Global Heatlh, Australia.
    Antoniou, Sotiris
    Barts Health NHS Trust, England.
    Benjamin, Emelia J.
    NHLBI, MA USA; Boston University, MA 02215 USA.
    Boriani, Giuseppe
    University of Modena and Reggio Emilia, Italy.
    Brachmann, Johannes
    Klinikum Coburg, Germany.
    Brandes, Axel
    Odense University Hospital, Denmark.
    Chao, Tze-Fan
    National Yang Ming University, Taiwan.
    Conen, David
    McMaster University, Canada; University Hospital, Switzerland.
    Engdahl, Johan
    Karolinska Institute, Sweden.
    Fauchier, Laurent
    Karolinska Institute, Sweden; University of Tours, France.
    Fitzmaurice, David A.
    University of Birmingham, England.
    Friberg, Leif
    Karolinska Institute, Sweden.
    Gersh, Bernard J.
    Mayo Clin, MN USA.
    Gladstone, David J.
    University of Toronto, Canada.
    Glotzer, Taya V.
    Hackensack University, NJ USA.
    Gwynne, Kylie
    University of Sydney, Australia.
    Hankey, Graeme J.
    University of Western Australia, Australia.
    Harbison, Joseph
    Trinity Coll Dublin, Ireland.
    Hillis, Graham S.
    University of Western Australia, Australia.
    Hills, Mellanie T.
    StopAfib Org, TX USA.
    Kamel, Hooman
    Weill Cornell Medical Coll, NY USA.
    Kirchhof, Paulus
    University of Birmingham, England; SWBH and UHB NHS trusts, England; AFNET, Germany.
    Kowey, Peter R.
    Lankenau Institute Medical Research, OK USA.
    Krieger, Derk
    University Hospital Zurich, Switzerland.
    Lee, Vivian W. Y.
    Chinese University of Hong Kong, Peoples R China.
    Levin, Lars-Åke
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Lip, Gregory Y. H.
    University of Birmingham, England; Aalborg University, Denmark.
    Lobban, Trudie
    Arrhythmia Alliance, England.
    Lowres, Nicole
    University of Sydney, Australia.
    Mairesse, Georges H.
    Clin Sud Luxembourg, Belgium.
    Martinez, Carlos
    Institute Epidemiol Stat and Informat, Germany.
    Neubeck, Lis
    Edinburgh Napier University, Scotland.
    Orchard, Jessica
    University of Sydney, Australia.
    Piccini, Jonathan P.
    Duke University, NC USA.
    Poppe, Katrina
    University of Auckland, New Zealand.
    Potpara, Tatjana S.
    University of Belgrade, Serbia.
    Puererfellner, Helmut
    Ordensklinikum Linz, Austria.
    Rienstra, Michiel
    University of Groningen, Netherlands.
    Sandhu, Roopinder K.
    University of Alberta, Canada.
    Schnabel, Renate B.
    University of Heart Centre, Germany.
    Siu, Chung-Wah
    University of Hong Kong, Peoples R China.
    Steinhubl, Steven
    Scripps Translat Science Institute, CA USA.
    Svendsen, Jesper H.
    University of Copenhagen, Denmark.
    Svennberg, Emma
    Karolinska Institute, Sweden.
    Themistoclakis, Sakis
    Osped Angelo Venice Mestre, Italy.
    Tieleman, Robert G.
    Martini Hospital, Netherlands.
    Turakhia, Mintu P.
    Stanford University, CA 94305 USA; VA Palo Alto Health Care Syst, CA USA.
    Tveit, Arnljot
    Baerum Hospital, Norway.
    Uittenbogaart, Steven B.
    Academic Medical Centre, Netherlands.
    Van Gelder, Isabelle C.
    University of Groningen, Netherlands.
    Verma, Atul
    University of Toronto, Canada.
    Wachter, Rolf
    University of Gottingen, Germany.
    Yan, Bryan P.
    Chinese University of Hong Kong, Peoples R China.
    Screening for Atrial Fibrillation A Report of the AF-SCREEN International Collaboration2017Inngår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 135, nr 19, s. 1851-+Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Approximately 10% of ischemic strokes are associated with atrial fibrillation (AF) first diagnosed at the time of stroke. Detecting asymptomatic AF would provide an opportunity to prevent these strokes by instituting appropriate anticoagulation. The AF-SCREEN international collaboration was formed in September 2015 to promote discussion and research about AF screening as a strategy to reduce stroke and death and to provide advocacy for implementation of country-specific AF screening programs. During 2016, 60 expert members of AF-SCREEN, including physicians, nurses, allied health professionals, health economists, and patient advocates, were invited to prepare sections of a draft document. In August 2016, 51 members met in Rome to discuss the draft document and consider the key points arising from it using a Delphi process. These key points emphasize that screen-detected AF found at a single timepoint or by intermittent ECG recordings over 2 weeks is not a benign condition and, with additional stroke factors, carries sufficient risk of stroke to justify consideration of anticoagulation. With regard to the methods of mass screening, handheld ECG devices have the advantage of providing a verifiable ECG trace that guidelines require for AF diagnosis and would therefore be preferred as screening tools. Certain patient groups, such as those with recent embolic stroke of uncertain source (ESUS), require more intensive monitoring for AF. Settings for screening include various venues in both the community and the clinic, but they must be linked to a pathway for appropriate diagnosis and management for screening to be effective. It is recognized that health resources vary widely between countries and health systems, so the setting for AF screening should be both country-and health system-specific. Based on current knowledge, this white paper provides a strong case for AF screening now while recognizing that large randomized outcomes studies would be helpful to strengthen the evidence base.

  • 334.
    Friman, Göran
    et al.
    Karlstads universitet, Fakulteten för hälsa, natur- och teknikvetenskap (from 2013), Institutionen för hälsovetenskaper (from 2013).
    Wårdh, Inger
    Karolinska Institutet.
    Nilsson, Gunnar
    Karolinska Institutet.
    Hultin, Margareta
    Karolinska Institutet.
    Identifying patients in dental settings at risk of cardiovascular disease and diabetes2013Inngår i: Cardiovascular system, ISSN 2052-4358, Vol. 1, nr 5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The purpose of our study was to identify patients in a dental setting at risk of already having or developing high blood pressure or high plasma glucose, investigate possible associations between these conditions and periodontal status and explore the correlation between screening results and follow-up assessments concerning the need for medical treatment and/or lifestyle changes performed by medical staff.

    Methods: A total of 170 dental patients were consecutively included at their regular yearly check-up visit. Data on age, weight, height, amount and use of tobacco and medication for cardiovascular disease and diabetes mellitus were collected, as well as data about systolic and diastolic blood pressure, in addition to pulse and plasma glucose. Clinical and radiographic examinations revealed data about periodontal status by probing periodontal pockets and measuring marginal alveolar bone loss by means of x-rays. Patients who exceeded normal diastolic blood pressure and plasma glucose values were referred for diagnosis and care.

    Results: Thirty-nine patients exhibiting high values were provided referrals and 24 or 14.1% of the 170 participants required additional care. The correlation between oral and medical health care concerning blood pressure recorded was 64.5% (p<0.001), while the correlation was 40.0% (p<0.001) concerning plasma glucose. Among middle aged men and elderly subjects, the data revealed/showed a significant correlation between marginal alveolar bone loss and high systolic blood pressure (p=0.001).

    Conclusions: The correlation between oral health care and medical health care registrations based on blood pressure and plasma glucose indicates that it may be appropriate for dental professionals to perform opportunistic medical screening and refer risk patients to the medical care system before complications occur. In order to identify medical risk patients in dental settings on the basis of high blood pressure, a suggestion may be to examine middle-aged men and elderly patients of both sexes who exhibit radiographic markers for marginal alveolar bone loss.

  • 335. Fröberg, Frida
    et al.
    Rosendahl, Ingvar K
    Abbott, Max
    Romild, Ulla
    Tengström, Anders
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The Incidence of Problem Gambling in a Representative Cohort of Swedish Female and Male 16-24 Year-Olds by Socio-demographic Characteristics, in Comparison with 25-44 Year-Olds2015Inngår i: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 31, nr 3, s. 621-641Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We aimed to estimate the incidence of a first episode of problem gambling among Swedish 16-24 year-olds by demographic and socio-economic characteristics, and to compare the incidence between 16-24 and 25-44 year-olds, and between young women and men. Other aims were to estimate the proportions of recovery and incidence in recurrent problem gambling, and prevalence of problem gambling among 16-44 year-olds in Sweden. We selected 4,358 participants aged 16-44 from the nationally representative Swedish Longitudinal Gambling Study in 2008/2009 and 2009/2010. The primary outcome measure was a first episode of problem gambling during 12 months before the follow-up as measured by the Problem Gambling Severity Index among participants without a history of problem gambling at baseline. The incidence proportion of a first episode of problem gambling among 16-24 year-olds was 2.26 % (95 % confidence interval 1.52-3.36); three times lower among females (1.14; 0.42-3.07 %) than males (3.32; 2.19-5.01 %). Young age and household financial problems were associated with first episode problem gambling among young women. Among 25-44 year-olds, the incidence proportion of a first episode of problem gambling was 0.81 % (0.41-1.56). Recovery from problem gambling was high, in particular among females. Individual transitions from problem gambling to recovery and to recurrent problem gambling, between baseline and follow-up, were common regardless of age. This study adds further evidence to research suggesting that there is a high mobility in and out of problem gambling over time on an individual level. The high incidence of first episode problem gambling among youth in Sweden stresses the importance of prevention of problem gambling at an early age.

  • 336.
    Fröbert, Ole
    et al.
    Region Örebro län.
    James, Stefan K.
    Uppsala Univ, Uppsala, Sweden.
    Thrombus Aspiration during Myocardial Infarction REPLY2014Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 370, nr 7, s. 675-676Artikkel i tidsskrift (Fagfellevurdert)
  • 337.
    Försti, Asta
    et al.
    Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany / Center for Primary Health Care Research, Clinical Research Center, Lund University, Malmö, Sweden.
    Li, Xuchen
    Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany.
    Wagner, Kerstin
    Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany.
    Tavelin, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Enquist, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Altieri, Andrea
    Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Hemminki, Kari
    Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany / Center for Primary Health Care Research, Clinical Research Center, Lund University, Malmö, Sweden.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Polymorphisms in the transforming growth factor beta 1 pathway in relation to colorectal cancer progression2010Inngår i: Genes, Chromosomes and Cancer, ISSN 1045-2257, E-ISSN 1098-2264, Vol. 49, nr 3, s. 270-281Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Transforming growth factor beta1 (TGFB1) acts as a growth inhibitor of normal colonic epithelial cells, however, as a tumor promoter of colorectal cancer (CRC) cells. To explore the association between genetic polymorphisms in the TGFB1 pathway and CRC susceptibility and clinical outcome, we carried out a case-control study on a Swedish population of 308 CRC cases and 585 age- and gender-matched controls. The cases were sampled prospectively and had up to 16 years follow-up, making the study material particularly suitable for survival analysis. On the basis of their reported or predicted functional effect, nine single-nucleotide polymorphisms (TGFB1: Leu10Pro; TGFBR1: 9A/6A and IVS7G+24A; FURIN: C-229T; THBS1: T+42C; LTBP1L: C-256G; LTBP4: T-893G and Thr750Ala; BAMBI: T-779A) were selected for genotyping. We evaluated the associations between genotypes and CRC and Dukes' stage. Survival probabilities were compared between different subgroups. The observed statistically significant associations included a decreased CRC risk for TGFBR1 IVS7G+24A minor allele carriers (odds ratio (OR): 0.72, 95% confidence interval (CI): 0.53-0.97), less aggressive tumors with Dukes' stage A+B for carriers of LTBP4 Thr750Ala and BAMBI T-779A minor alleles (OR: 0.58, 95%CI: 0.36-0.93 and OR: 0.51, 95%CI: 0.29-0.89, respectively) and worse survival for FURIN C-229T heterozygotes (hazard ratio: 1.63, 95%CI: 1.08-2.46). As this is the first study about the influence of the polymorphisms in the TGFB1 pathway on CRC progression, further studies in large independent cohorts are warranted.

  • 338.
    Gandhi, Wiebke
    et al.
    McGill University, Canada; University of Reading, England.
    Morrison, India
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Centrum för social och affektiv neurovetenskap. Linköpings universitet, Medicinska fakulteten.
    Schweinhardt, Petra
    McGill University, Canada; McGill University, Canada; Balgrist University Hospital, Switzerland.
    How Accurate Appraisal of Behavioral Costs and Benefits Guides Adaptive Pain Coping2017Inngår i: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 8, artikkel-id 103Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Coping with pain is a complex phenomenon encompassing a variety of behavioral responses and a large network of underlying neural circuits. Whether pain coping is adaptive or maladaptive depends on the type of pain (e.g., escapable or inescapable), personal factors (e.g., individual experiences with coping strategies in the past), and situational circumstances. Keeping these factors in mind, costs and benefits of different strategies have to be appraised and will guide behavioral decisions in the face of pain. In this review we present pain coping as an unconscious decision-making process during which accurately evaluated costs and benefits lead to adaptive pain coping behavior. We emphasize the importance of passive coping as an adaptive strategy when dealing with ongoing pain and thus go beyond the common view of passivity as a default state of helplessness. In combination with passive pain coping, we highlight the role of the reward system in reestablishing affective homeostasis and discuss existing evidence on a behavioral and neural level. We further present neural circuits involved in the decision-making process of pain coping when circumstances are ambiguous and, therefore, costs and benefits are difficult to anticipate. Finally, we address the wider implications of this topic by discussing its relevance for chronic pain patients.

    Fulltekst (pdf)
    fulltext
  • 339. Gao, Tao
    et al.
    McKenna, Brian
    Li, Changhong
    Reichert, Maximilian
    Nguyen, James
    Singh, Tarjinder
    Yang, Chenghua
    Pannikar, Archana
    Doliba, Nicolai
    Zhang, Tingting
    Stoffers, Doris A.
    Edlund, Helena
    Umeå universitet, Medicinska fakulteten, Umeå centrum för molekylär medicin (UCMM).
    Matschinsky, Franz
    Stein, Roland
    Stanger, Ben Z.
    Pdx1 Maintains beta Cell Identity and Function by Repressing an alpha Cell Program2014Inngår i: Cell Metabolism, ISSN 1550-4131, E-ISSN 1932-7420, Vol. 19, nr 2, s. 259-271Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Pdx1 is a homeobox-containing transcription factor that plays a key role in pancreatic development and adult beta cell function. In this study, we traced the fate of adult beta cells after Pdx1 deletion. As expected, beta-cell-specific removal of Pdx1 resulted in severe hyperglycemia within days. Surprisingly, a large fraction of Pdx1-deleted cells rapidly acquired ultrastructural and physiological features of a cells, indicating that a robust cellular reprogramming had occurred. Reprogrammed cells exhibited a global transcriptional shift that included derepression of the alpha cell transcription factor MafB, resulting in a transcriptional profile that closely resembled that of alpha cells. These findings indicate that Pdx1 acts as a master regulator of beta cell fate by simultaneously activating genes essential for beta cell identity and repressing those associated with alpha cell identity. We discuss the significance of these findings in the context of the emerging notion that loss of beta cell identity contributes to the pathogenesis of type 2 diabetes.

  • 340.
    Gartlehner, Gerald
    et al.
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Hansen, Richard A
    Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University, 207 Dunstan Hall, Auburn, AL 36849.
    Morgan, Laura C
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Thaler, Kylie
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Lux, Linda
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Van Noord, Megan
    Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599.
    Mager, Ursula
    Ludwig Boltzmann Institute for Health Promotion Research, Vienna, Austria. .
    Thieda, Patricia
    226 Barclay Road, Chapel Hill, NC 27516.
    Gaynes, Bradley N
    Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC.
    Wilkins, Tania
    Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Chapel Hill, NC 27599.
    Strobelberger, Michaela
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Lloyd, Stacey
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Reichenpfader, Ursula
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Lohr, Kathleen N
    RTI International, Research Triangle Park, 3040 Cornwallis Road, PO Box 12194, NC 27709.
    Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: an updated meta-analysis.2011Inngår i: Annals of Internal Medicine, ISSN 0003-4819, E-ISSN 1539-3704, Vol. 155, nr 11, s. 772-785Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Second-generation antidepressants dominate the management of major depressive disorder (MDD), but evidence on the comparative benefits and harms of these agents is contradictory.

    PURPOSE: To compare the benefits and harms of second-generation antidepressants for treating MDD in adults.

    DATA SOURCES: English-language studies from PubMed, Embase, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to August 2011 and reference lists of pertinent review articles and gray literature.

    STUDY SELECTION: 2 independent reviewers identified randomized trials of at least 6 weeks' duration to evaluate efficacy and observational studies with at least 1000 participants to assess harm.

    DATA EXTRACTION: Reviewers abstracted data about study design and conduct, participants, and interventions and outcomes and rated study quality. A senior reviewer checked and confirmed extracted data and quality ratings.

    DATA SYNTHESIS: Meta-analyses and mixed-treatment comparisons of response to treatment and weighted mean differences were conducted on specific scales to rate depression. On the basis of 234 studies, no clinically relevant differences in efficacy or effectiveness were detected for the treatment of acute, continuation, and maintenance phases of MDD. No differences in efficacy were seen in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbid conditions. Individual drugs differed in onset of action, adverse events, and some measures of health-related quality of life.

    LIMITATIONS: Most trials were conducted in highly selected populations. Publication bias might affect the estimates of some comparisons. Mixed-treatment comparisons cannot conclusively exclude differences in efficacy. Evidence within subgroups was limited.

    CONCLUSION: Current evidence does not warrant recommending a particular second-generation antidepressant on the basis of differences in efficacy. Differences in onset of action and adverse events may be considered when choosing a medication.

    PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

  • 341. Gaziano, Liam
    et al.
    Sun, Luanluan
    Arnold, Matthew
    Bell, Steven
    Cho, Kelly
    Kaptoge, Stephen K
    Song, Rebecca J
    Burgess, Stephen
    Posner, Daniel C
    Mosconi, Katja
    Robinson-Cohen, Cassianne
    Mason, Amy M
    Bolton, Thomas R
    Tao, Ran
    Allara, Elias
    Schubert, Petra
    Chen, Lingyan
    Staley, James R
    Staplin, Natalie
    Altay, Servet
    Amiano, Pilar
    Arndt, Volker
    Ärnlöv, Johan
    Barr, Elizabeth L M
    Björkelund, Cecilia
    Boer, Jolanda M A
    Brenner, Hermann
    Casiglia, Edoardo
    Chiodini, Paolo
    Cooper, Jackie A
    Coresh, Josef
    Cushman, Mary
    Dankner, Rachel
    Davidson, Karina W
    de Jongh, Renate T
    Donfrancesco, Chiara
    Engström, Gunnar
    Freisling, Heinz
    de la Cámara, Agustín Gómez
    Gudnason, Vilmundur
    Hankey, Graeme J
    Hansson, Per-Olof
    Heath, Alicia K
    Hoorn, Ewout J
    Imano, Hironori
    Jassal, Simerjot K
    Kaaks, Rudolf
    Katzke, Verena
    Kauhanen, Jussi
    Kiechl, Stefan
    Koenig, Wolfgang
    Kronmal, Richard A
    Kyrø, Cecilie
    Lawlor, Deborah A
    Ljungberg, Börje
    MacDonald, Conor
    Masala, Giovanna
    Meisinger, Christa
    Melander, Olle
    Moreno Iribas, Conchi
    Ninomiya, Toshiharu
    Nitsch, Dorothea
    Nordestgaard, Børge G
    Onland-Moret, Charlotte
    Palmieri, Luigi
    Petrova, Dafina
    Garcia, Jose Ramón Quirós
    Rosengren, Annika
    Sacerdote, Carlotta
    Sakurai, Masaru
    Santiuste, Carmen
    Schulze, Matthias B
    Sieri, Sabina
    Sundström, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk epidemiologi.
    Tikhonoff, Valérie
    Tjønneland, Anne
    Tong, Tammy
    Tumino, Rosario
    Tzoulaki, Ioanna
    van der Schouw, Yvonne T
    Monique Verschuren, W M
    Völzke, Henry
    Wallace, Robert B
    Wannamethee, S Goya
    Weiderpass, Elisabete
    Willeit, Peter
    Woodward, Mark
    Yamagishi, Kazumasa
    Zamora-Ros, Raul
    Akwo, Elvis A
    Pyarajan, Saiju
    Gagnon, David R
    Tsao, Philip S
    Muralidhar, Sumitra
    Edwards, Todd L
    Damrauer, Scott M
    Joseph, Jacob
    Pennells, Lisa
    Wilson, Peter W F
    Harrison, Seamus
    Gaziano, Thomas A
    Inouye, Michael
    Baigent, Colin
    Casas, Juan P
    Langenberg, Claudia
    Wareham, Nick
    Riboli, Elio
    Gaziano, J Michael
    Danesh, John
    Hung, Adriana M
    Butterworth, Adam S
    Wood, Angela M
    Di Angelantonio, Emanuele
    Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses2022Inngår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 146, nr 20, s. 1507-1517Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke.

    METHODS: Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank.

    RESULTS: There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values <60 or >105 mL·min-1·1.73 m-2, compared with those with eGFR between 60 and 105 mL·min-1·1.73 m-2. Mendelian randomization analyses for CHD showed an association among participants with eGFR <60 mL·min-1·1.73 m-2, with a 14% (95% CI, 3%-27%) higher CHD risk per 5 mL·min-1·1.73 m-2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min-1·1.73 m-2. Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD.

    CONCLUSIONS: In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.

    Fulltekst (pdf)
    fulltext
  • 342.
    Gefen, Amit
    et al.
    Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Department of Mathematics and Statistics, Faculty of Sciences, Hasselt University, Hasselt, Belgium.
    Alves, Paulo
    Wounds Research Lab, Centre for Interdisciplinary Research in Health, Faculty of Nursing and Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.
    Beeckman, Dimitri
    Örebro universitet, Institutionen för hälsovetenskaper. Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Cullen, Breda
    RedC Consultancy, Bradford, UK.
    Lázaro-Martínez, José Luis
    Diabetic Foot Unit, Universidad Complutense de Madrid, Madrid, Spain.
    Lev-Tov, Hadar
    Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Hospital Miller School of Medicine, Miami, Florida, USA.
    Santamaria, Nick
    School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
    Swanson, Terry
    Nurse Practitioner, Warrnambool, Victoria, Australia.
    Woo, Kevin
    School of Nursing, Queen's University, Kingston, Ontario, Canada.
    Söderström, Bengt
    Wound Care Research and Development, Mölnlycke Health Care AB, Gothenburg, Sweden.
    Svensby, Anna
    Wound Care Research and Development, Mölnlycke Health Care AB, Gothenburg, Sweden.
    Malone, Matthew
    Research and Development, Bioactives and Wound Biology, Mölnlycke Health Care AB, Gothenburg, Sweden; and Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
    Nygren, Erik
    Wound Care Research and Development, Mölnlycke Health Care AB, Gothenburg, Sweden.
    Fluid handling by foam wound dressings: From engineering theory to advanced laboratory performance evaluations2024Inngår i: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 21, nr 2, artikkel-id e14674Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    This article describes the contemporary bioengineering theory and practice of evaluating the fluid handling performance of foam-based dressings, with focus on the important and clinically relevant engineering structure-function relationships and on advanced laboratory testing methods for pre-clinical quantitative assessments of this common type of wound dressings. The effects of key wound dressing material-related and treatment-related physical factors on the absorbency and overall fluid handling of foam-based dressings are thoroughly and quantitively analysed. Discussions include exudate viscosity and temperature, action of mechanical forces and the dressing microstructure and associated interactions. Based on this comprehensive review, we propose a newly developed testing method, experimental metrics and clinical benchmarks that are clinically relevant and can set the standard for robust fluid handling performance evaluations. The purpose of this evaluative framework is to translate the physical characteristics and performance determinants of a foam dressing into achievable best clinical outcomes. These guiding principles are key to distinguishing desirable properties of a dressing that contribute to optimal performance in clinical settings.

  • 343.
    Geijer, Håkan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper. Örebro University Hospital, Örebro, Sweden.
    Lohse, Georg
    Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Örebro Rehab Center, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskaper. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Temperature measurements with a temporal scanner: systematic review and meta-analysis2016Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 6, nr 3, artikkel-id e009509Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

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

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

    Trial registration number: CRD42014008832.

  • 344.
    Gerdle, Bjorn
    et al.
    Linkoping Univ, Pain & Rehabil Ctr, Dept Med & Hlth Sci, SE-58185 Linkoping, Sweden.
    Akerblom, Sophia
    Skane Univ Hosp, Dept Pain Rehabil, Lund, Sweden;Lund Univ, Dept Psychol, Lund, Sweden.
    Stalnacke, Britt-Marie
    Umea Univ, Rehabil Med, Dept Community Med & Rehabil, Umea, Sweden.
    Jansen, Gunilla Brodda
    Danderyd Hosp, Dept Clin Sci, Div Rehabil Med, Stockholm, Sweden.
    Enthoven, Paul
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Ernberg, Malin
    Karolinska Inst, Dept Dent Med, Stockholm, Sweden;SCON, Huddinge, Sweden.
    Dong, Huan-Ji
    Linkoping Univ, Pain & Rehabil Ctr, Dept Med & Hlth Sci, SE-58185 Linkoping, Sweden.
    Äng, Björn O.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, S-23100 Huddinge, Sweden;Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Boersma, Katja
    Orebro Univ, Sch Law Psychol & Social Work, Orebro, Sweden.
    The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation: a SQRP study of more than 20,000 chronic pain patients2019Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, nr 4, s. 693-711Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims:

    Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up.

    Methods:

    Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods.

    Results:

    The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements.

    Conclusions:

    Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP.

    Implications:

    This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.

  • 345.
    Gerdle, Björn
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Boersma, Katja
    Orebro Univ, Sweden.
    Asenlof, Pernilla
    Uppsala Univ, Sweden.
    Stalnacke, Britt-Marie
    Umea Univ, Sweden.
    Larsson, Britt
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Ringqvist, Asa
    Skane Univ Hosp, Sweden.
    Influences of Sex, Education, and Country of Birth on Clinical Presentations and Overall Outcomes of Interdisciplinary Pain Rehabilitation in Chronic Pain Patients: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)2020Inngår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 9, nr 8, artikkel-id 2374Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study investigates the effects of sex, education, and country of birth on clinical presentations and outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRPs). A multivariate improvement score (MIS) and two retrospective estimations of changes in pain and ability to handle life situations were used as the three overall outcomes of IMMRPs. The study population consisted of chronic pain patients within specialist care in the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2008 and 2016 at baseline (n = 39,916), and for the subset participating in IMMRPs (n = 14,666). A cluster analysis based on sex, education, and country of origin revealed significant differences in the following aspects: best baseline clinical situation was for European women with university educations and the worst baseline clinical situation was for all patients born outside Europe of both sexes and different educations (i.e., moderate-large effect sizes). In addition, European women with university educations also had the most favorable overall outcomes in response to IMMRPs (small effect sizes). These results raise important questions concerning fairness and equality and need to be considered when optimizing assessments and content and delivery of IMMRPs for patients with chronic pain.

    Fulltekst (pdf)
    fulltext
  • 346.
    Gerdle, Björn
    et al.
    Linkoping Univ, Pain & Rehabil Ctr, SE-58183 Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Ghafouri, Bijar
    Linkoping Univ, Pain & Rehabil Ctr, SE-58183 Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Ghafouri, Nazdar
    Linkoping Univ, Pain & Rehabil Ctr, SE-58183 Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Backryd, Emmanuel
    Linkoping Univ, Pain & Rehabil Ctr, SE-58183 Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Signs of ongoing inflammation in female patients with chronic widespread pain A multivariate, explorative, cross-sectional study of blood samples2017Inngår i: Medicine, ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, nr 9, artikkel-id e6130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This cross-sectional study investigates the plasma inflammatory profile of chronic widespread pain CWP) patients compared to healthy controls CON). Rather than analyzing a relatively few substances at a time, we used a new multiplex proximity extension assay PEA) panel that enabled the simultaneous analysis of 92 inflammation-related proteins, mainly cytokines and chemokines. Seventeen women with CWP and 21 female CON participated and a venous blood sample was drawn from all subjects. Pain intensity and pain thresholds for pressure, heat, and cold were registered. A PEA panel 92 proteins) was used to analyze the blood samples. Multivariate data analysis by projection was used in the statistical analyses. Eleven proteins significantly differentiated the CON and CWP subjects R-2=0.58, Q(2)=0.37, analysis of variance of cross-validated predictive residuals P=0.006). It was not possible to significantly regress pain thresholds within each group CON or CWP). Positive significant correlations existed between several proteins and pain intensities in CWP, but the model reliability of the regression was poor. CWP was associated with systemic low-grade inflammation. Larger studies are needed to confirm the results and to investigate which alterations are condition-specific and which are common across chronic pain conditions. The presence of inflammation could promote the spreading of pain, a hallmark sign of CWP. As it has been suggested that prevalent comorbidities to pain (e.g., depression and anxiety, poor sleep, and tiredness) also are associated with inflammation, it will be important to determine whether inflammation may be a common mediator.

    Fulltekst (pdf)
    fulltext
  • 347.
    Gerdle, Björn
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Larsson, Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Muscle2018Inngår i: Fibromyalgia syndrome and widespread pain: from Construction to relevant Recognition / [ed] Winifried Häuser & Serge Perrot, Wolters Kluwer, 2018, s. 215-231Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 348.
    Gerdle, Björn
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Molander, Peter
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Stenberg, Gunilla
    Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Stålnacke, Britt-Marie
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten.
    Enthoven, Paul
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för fysioterapi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain-a practice based evidence study from two SQRP centres.2016Inngår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 17, nr 1, artikkel-id 490Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: For patients with chronic pain, the heterogeneity of clinical presentations makes it difficult to identify patients who would benefit from multimodal rehabilitation programs (MMRP). Yet, there is limited knowledge regarding the predictors of MMRP's outcomes. This study identifies predictors of outcome of MMRPs at a 12-month follow-up (FU-12) based on data from the Swedish Quality Registry for Pain Rehabilitation (SQRP).

    METHODS: Patients with chronic pain from two clinical departments in Sweden completed the SQRP questionnaires-background, pain characteristics, psychological symptoms, function, activity/participation, health and quality of life-on three occasions: 1) during their first visit; 2) immediately after the completion of their MMRP; and 3) 12 months after completing the MMRP (n = 227). During the FU-12, the patients also retrospectively reported their global impressions of any changes in their perception of pain and their ability to handle their life situation in general.

    RESULTS: Significant improvements were found for pain, psychological symptoms, activity/participation, health, and quality of life aspects with low/medium strong effects. A general pattern was observed from the analyses of the changes from baseline to FU-12; the largest improvements in outcomes were significantly associated with poor situations according to their respective baseline scores. Although significant regressors of the investigated outcomes were found, the significant predictors were weak and explained a minor part of the variation in outcomes (15-25%). At the FU-12, 53.6% of the patients reported that their pain had decreased and 80.1% reported that their life situation in general had improved. These improvements were associated with high education, low pain intensity, high health level, and work importance (only pain perception). The explained variations were low (9-11%).

    CONCLUSIONS: Representing patients in real-world clinical settings, this study confirmed systematic reviews that outcomes of MMRP are associated with broad positive effects. A mix of background and baseline variables influenced the outcomes investigated, but the explained variations in outcomes were low. There is still a need to develop standardized and relatively simple outcomes that can be used to evaluate MMRP in trials, in clinical evaluations at group level, and for individual patients.

    Fulltekst (pdf)
    fulltext
  • 349. Gerdle, Björn
    et al.
    Åkerblom, Sophia
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Jansen, Gunilla Brodda
    Enthoven, Paul
    Ernberg, Malin
    Dong, Huan-Ji
    Äng, Björn O.
    Boersma, Katja
    The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation: a SQRP study of more than 20,000 chronic pain patients2019Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, nr 4, s. 693-711Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims: Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up.

    Methods: Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods.

    Results: The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements.

    Conclusions: Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP.

    Implications: This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.

  • 350.
    Ghafouri, Bijar
    et al.
    Linköping Univ, Pain & Rehabil Ctr, Linköping, Sweden.;Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Ernberg, Malin
    Karolinska Inst, Dept Dent Med, Stockholm, Sweden.;Karolinska Inst, Scandinavian Ctr Orofacial Neurosci SCON, Stockholm, Sweden..
    Andrell, Paulin
    Sahlgrens Acad, Sahlgrenska Univ Hosp, Pain Ctr, Dept Anaesthesiol & Intens Care Med,Reg Vastra Go, Gothenburg, Sweden.;Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Anaesthesiol & Intens Care Med, Gothenburg, Sweden..
    Backryd, Emmanuel
    Linköping Univ, Pain & Rehabil Ctr, Linköping, Sweden.;Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Fisher, Marcelo Rivano
    Lund Univ, Skane Univ Hosp, Dept Neurosurg & Pain Rehabil, Lund, Sweden.;Lund Univ, Fac Med, Dept Clin Sci Malmö, Lund, Sweden.;Lund Univ, Dept Hlth Sci, Rehabil Med Res Grp, Lund, Sweden..
    Freund-Levi, Yvonne
    Örebro Univ, Sch Med Sci, Örebro, Sweden.;Univ Hosp Örebro, Dept Geriatr, Örebro, Sweden.;Södertälje Hosp, Dept Geriatr, Södertälje, Sweden.;Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, Stockholm, Sweden..
    Grelz, Henrik
    Lund Univ, Skane Univ Hosp, Dept Neurosurg & Pain Rehabil, Lund, Sweden.;Lund Univ, Fac Med, Dept Clin Sci Malmö, Lund, Sweden..
    Grabel, Olaf
    Sahlgrens Acad, Sahlgrenska Univ Hosp, Pain Ctr, Dept Anaesthesiol & Intens Care Med,Reg Vastra Go, Gothenburg, Sweden..
    Karlsten, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kosek, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Klinisk smärtforskning. Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Lofgren, Monika
    Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Rehabil Med, Stockholm, Sweden..
    Ringqvist, Asa
    Lund Univ, Skane Univ Hosp, Dept Neurosurg & Pain Rehabil, Lund, Sweden.;Lund Univ, Fac Med, Dept Clin Sci Malmö, Lund, Sweden..
    Rudling, Karin
    Univ Hosp Örebro, Dept Rehabil Med, Örebro, Sweden..
    Stalnacke, Britt-Marie
    Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Rehabil Med, Stockholm, Sweden.;Umeå Univ, Dept Community Med & Rehabil, Rehabil Med, Umeå, Sweden..
    Sorlen, Niklas
    Umeå Univ, Dept Clin Sci, Neurosci, Umeå, Sweden..
    Uhlin, Karin
    Karolinska Inst, Dept Clin Sci, Stockholm, Sweden.;Danderyd Hosp, Dept Rehabil Med, Stockholm, Sweden..
    Westergren, Hans
    Lund Univ, Skane Univ Hosp, Dept Neurosurg & Pain Rehabil, Lund, Sweden.;Lund Univ, Fac Med, Dept Clin Sci Malmö, Lund, Sweden.;Lund Univ, Dept Hlth Sci, Rehabil Med Res Grp, Lund, Sweden..
    Gerdle, Bjorn
    Linköping Univ, Pain & Rehabil Ctr, Linköping, Sweden.;Linköping Univ, Dept Hlth Med & Caring Sci, Linköping, Sweden..
    Swedish Chronic Pain Biobank: protocol for a multicentre registry and biomarker project2022Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 11, artikkel-id e066834Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for individual patients based on biomarkers and other patient-related factors, has received increasing attention in different diseases but used less in chronic pain. This cooperative project from all Swedish University Hospitals will investigate whether there are changes in inflammation and metabolism patterns in saliva and blood in chronic pain patients and whether the changes correlate with clinical characteristics and rehabilitation outcomes.

    Methods and analysis: Patients at multidisciplinary pain centres at University Hospitals in Sweden who have chosen to participate in the Swedish Quality Registry for Pain Rehabilitation and healthy sex-matched and age-matched individuals will be included in the study. Saliva and blood samples will be collected in addition to questionnaire data obtained from the register. From the samples, proteins, lipids, metabolites and micro-RNA will be analysed in relation to, for example, diagnosis, pain characteristics, psychological distress, body weight, pharmacological treatment and clinical rehabilitation results using advanced multivariate data analysis and bioinformatics.

    Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Dnr 2021-04929) and will be conducted in accordance with the declaration of Helsinki.The results will be published in open access scientific journals and in popular scientific relevant journals such as those from patient organisations. Data will be also presented in scientific meetings, meeting with healthcare organisations and disseminated in different lecturers at the clinics and universities.

    Fulltekst (pdf)
    fulltext
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