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  • 301.
    Becker, Julia
    et al.
    Institute for Disaster and Emergency Management, Berlin, Germany.
    Kurland, Lisa
    Örebro universitet, Institutionen för medicinska vetenskaper. Örebro University Hospital, Örebro, Sweden.
    Höglund, Erik
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Ambulance Department, Örebro Country Council, Örebro, Sweden.
    Hugelius, Karin
    Örebro universitet, Institutionen för hälsovetenskaper. Ambulance Department, Örebro Country Council, Örebro, Sweden.
    Dynamic ambulance relocation: a scoping review2023Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 12, artikel-id e073394Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objectives Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation.

    Design A scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included.

    Results Most papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances.

    Conclusions Current knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.

  • 302.
    Beckman, Linda
    et al.
    Department of Public Health Science, Karlstad University, Karlstad, Sweden; Department of Health Service Research, Management& Policy, University of Florida FL, USA.
    Hagquist, Curt
    Department of Education and Special Education, University of Gothenburg, Gothenburg.
    Svensson, Åke
    Department of Dermatology and Venereology, Malmö University Hospital, Malmö, Sweden.
    Langan, Sinéad M.
    Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine; Health Data Research UK, London, UK.
    von Kobyletzki, Laura B.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Lund; Centre for Clinical Research Örebro University, Örebro, Sweden.
    Relationship between Eczema and Self-reported Difficulties Keeping up with School Education: A Cross-sectional Study2023Ingår i: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 103, artikel-id adv5268Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Eczema is a common chronic disease that affects both children and adults, and may have an adverse impact on school performance, as it is characteristically pruritic, and hence may lead to poor concentration and inadequate sleep. The aim of this study was to elucidate the relationship between eczema and self-reported difficulties keeping up with school education. The study was based on cross-sectional questionnaire data collected in schools among all 9th graders (15-16 years old) within a Swedish county. Logistic regression analyses were used to assess the association between having eczema and self-reported difficulties keeping up with school education. A total of 2,620 pupils participated (50.1% female). An increased odds ratio (OR) of selfreported difficulties keeping up with school education was found in adolescents with eczema compared with those without eczema after adjustment for sex and family residence (OR 2.13, 95% confidence interval (95% CI) 1.32-3.44), and with additional adjustment for sleeping problems, attention-deficit hyperactivity disorder, allergy, rhinitis, asthma, and alcohol consumption (adjusted OR 1.78, CI 1.05-3.00). Eczema may be a relevant risk factor for difficulty keeping up with school education in adolescents. However, studies that can assess temporality, based in different settings with objective reports of both eczema and self-reported difficulties at school, are needed to confirm these findings.

  • 303.
    Bednarska, Olga
    et al.
    Department of Gastroenterology, Linköping University Hospital, Linköping, Sweden.
    Nyhlin, Nils
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Schmidt, Peter Thelin
    Department of Medicine, Ersta Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Solna, Sweden.
    Johansson, Gabriele Wurm
    Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Toth, Ervin
    Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden.
    Lindfors, Perjohan
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Solna, Sweden; Aleris Gastromottagningen City, Stockholm, Sweden.
    The Effectiveness and Tolerability of a Very Low-Volume Bowel Preparation for Colonoscopy Compared to Low and High-Volume Polyethylene Glycol-Solutions in the Real-Life Setting2022Ingår i: Diagnostics, ISSN 2075-4418, Vol. 12, nr 5, artikel-id 1155Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Adequate bowel cleansing is essential for high-quality colonoscopy. Recently, a new very low-volume 1 litre (1L) polyethylene glycol (PEG) plus ascorbate solution (ASC) has been introduced. Our aims were to assess the effectiveness and tolerability of this product compared to low-volume 2L PEG-ASC and high-volume 4L PEG solutions, in a real-life setting. In six endoscopy units in Sweden, outpatients undergoing colonoscopy were either prescribed solutions according to local routines, or the very low-volume solution in split dose regimen. Bowel cleansing effectiveness and patient experience was assessed using the Boston Bowel preparation scale (BBPS) and a patient questionnaire. A total of 1098 patients (mean age 58 years, 52% women) were included. All subsegment and the total BBPS scores were significantly greater for 1L PEG-ASC in comparison to other solutions (p < 0.05 for 1L PEG-ASC and 4L PEG for transverse and left colon, otherwise p < 0.001). Nausea was more frequent with 1L PEG-ASC compared to 2L PEG-ASC (p < 0.001) and vomiting were more often reported compared to both other solutions (p < 0.01 and p < 0.05 for 2L PEG-ASC and 4L PEG, respectively). Smell, taste, and total experience was better for 1L PEG-ASC compared to 4L PEG (p < 0.001), and similar compared to the 2L PEG-ASC. In conclusion, 1L PEG-ASC leads to better bowel cleansing compared to 2L PEG-ASC or 4L PEG products, with similar or greater patient satisfaction.

  • 304.
    Bejerot, Susanne
    et al.
    Region Örebro län. Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    Edman, Gunnar
    Dept Psychiat, TioHundra AB, Norrtälje, Sweden.
    Anckarsäter, Henrik
    Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Berglund, Gunilla
    Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Gillberg, Christopher
    Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Hofvander, Björn
    Dept Clin Sci, Lund Univ, Malmö, Sweden.
    Humble, Mats B.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Mörtberg, Ewa
    Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Råstam, Maria
    Dept Clin Sci, Lund Univ, Malmö, Sweden.
    Ståhlberg, Ola
    Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Frisen, Louise
    Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders2014Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, nr 8, s. 549-559Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive-compulsive symptoms and diagnosis of obsessive-compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date.

    Aim: The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population.

    Method: The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category "Obsessive-compulsive related disorders", accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive-compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS.

    Results: Principal component factor analysis produced five subscales titled "Symmetry", "Forbidden thoughts", "Contamination", "Magical thoughts" and "Dysmorphic thoughts". The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62-70% Cronbach's alpha = 0.81; Severity Scale: sensitivity = 72%, specificities = 75-84%, Cronbach's alpha = 0.94).

    Conclusions: The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive-compulsive symptoms in clinical psychiatry.

    Ladda ner fulltext (pdf)
    The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders
  • 305.
    Bejerot, Susanne
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center.
    Lindgren, Ann
    Central Health Services in pre-schools, schools and upper secundary schools, Municipality of Norrtälje, Stockholm, Sweden.
    Rosén, Jörgen
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Bejerot, Eva
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Elwin, Marie
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Teaching psychiatry to large groups in society2019Ingår i: BMC Medical Education, E-ISSN 1472-6920, Vol. 19, nr 1, artikel-id 148Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is a need to educate a range of professionals in caring for individuals with long-term mental disability who reside within our communities. Empathy alone is insufficient. The Kognus 4-Step Education Program was developed to achieve this goal.

    METHOD: The program consisted of independent courses, including an 18-session basic course on psychiatric disability (on-site or online), advanced courses, and highly specialized training programs (Nidotherapy/Peer Consultation). Experts lectured together with clients with psychiatric disabilities. We first report Swedish reforms in which institutionalized patients were relocated to semi-independent individual households. We then describe the design and implementation of the education program. Approximately 50% of participants who were younger than 36 years old lacked any healthcare education. The participants' backgrounds, perceptions, participation in the education program, and costs are presented.

    RESULTS: Between 2009 and 2014, 8959 participants attended the Kognus psychiatry courses online or on-site in Stockholm (basic on-site course, n = 2111; online course, n = 4480; advanced courses, n = 2322; highly specialized programs, n = 46). A total of 73% of the participants satisfactorily attended the basic sessions on-site compared with 11% of the online participants. The developers conducted the education program for the first 3 years. Thereafter, another course provider continued the program with other types of participants. The program was perceived to be equally interesting and meaningful to participants with low and high levels of education, demonstrating the generalizability of the program. The quality of the basic and advanced courses was rated as 4.4 and 4.3, respectively, on a 5-point Likert scale.

    CONCLUSIONS: Personnel without appropriate education who work with people with psychiatric/intellectual disabilities can be educated in large numbers. The Kognus program represents a novel and successful way of training people who have no formal education about some essentials of good mental healthcare. Moreover, the model can be easily implemented elsewhere.

    Ladda ner fulltext (pdf)
    Teaching psychiatry to large groups in society
  • 306.
    Bejerot, Susanne
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Sweden; Inflammatory Response and Infection Susceptibility Centre, (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Sigra, Sofia
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Sweden.
    Welin, Elisabet
    Örebro universitet, Institutionen för hälsovetenskaper.
    Eklund, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. Inflammatory Response and Infection Susceptibility Centre, (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hylén, Ulrika
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Sweden; Inflammatory Response and Infection Susceptibility Centre, (iRiSC), Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Humble, Mats B.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rituximab as an adjunctive treatment for schizophrenia spectrum disorder or obsessive-compulsive disorder: Two open-label pilot studies on treatment-resistant patients2023Ingår i: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 158, s. 319-329Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this explorative study, we investigated if an adjunctive treatment with one single dose of the monoclonal antibody rituximab would improve symptoms and function in treatment-resistant patients with schizophrenia spectrum disorder (SSD, n = 9) or obsessive-compulsive disorder (OCD, n = 10), based on the inflammatory hypothesis for mental disorders. Patients were followed for one year. Disability was measured with the Personal and Social Performance score (PSP). At baseline, the mean PANSS score in the SSD group was 99 ± 32 and the mean Y-BOCS score in the OCD group was 27.5 ± 7. Mean PSP scores were 32 ± 10.2 and 42.5 ± 9.9 in the SSD and OCD groups, respectively. Seven had Paediatric Acute-Onset Neuropsychiatric Syndrome (PANS) in retrospect, and 3 SSD patients had schizo-obsessive subtype. 4/8 SSD patients showed a ≥40% reduction in PANSS at endpoint I week 20, however, 7/9 were similarly improved already at week 12. Among the OCD patients, 2/10 showed a ≥35% reduction in Y-BOCS at week 20. Disability was significantly improved only in the SSD group. The percentual decrease of PANSS scores in SSD patients was associated with the increase in immunoglobulin levels week 20 (n = 8: IgG r = 0.85, p = .007; IgA r = 0.79, p = .019; IgM r = 0.73, p = .038). Rituximab was generally well tolerated in these patients. Self-rated improvements since baseline were reported for psychic (p = .021), neurological (p = .059), and autonomic (p < .001) side effects (UKU-SERS-Pat side-effect scale). Anxiety was commonly reported by OCD patients, while an initial increase in psychotic symptoms was seen in a few SSD patients. An RCT is underway to evaluate rituximab in SSD.

  • 307.
    Bejerot, Susanne
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Center.
    Wallén, Johan
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Manouilenko, Irina
    Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Allimak Soul Care AB, Stockholm, Sweden.
    Hesselmark, Eva
    Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
    Elwin, Marie
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Schizotypal traits in Swedish speaking psychiatric patients and non-psychiatric controls2020Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 74, nr 5, s. 327-331Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Recently, schizotypal personality traits were measured in a multinational sample recruited from 14 countries, however no Scandinavian cohort was included. The aim of this study was, therefore, to measure schizotypal personality traits in Swedish-speaking populations, with and without psychiatric disorders, and to investigate the psychometric properties of the Swedish version of the Schizotypal Personality Questionnaire-Brief (SPQ-B).

    Methods: The SPQ-B results from 50 psychiatric patients were compared to controls (n = 202). An additional sample of 25 controls completed the full SPQ twice and we calculated test-retest reliability for SPQ and SPQ-B. We estimated the internal consistency for SPQ-B and SPQ-B factors with omega. We compared the results of SPQ-B (M and SD) in patient and control groups to corresponding results worldwide.

    Results: We found similarity between our SPQ-B scores and those from other published samples. SPQ-B showed good internal consistency and acceptable test-retest correlations. The results indicate that the Swedish version of the instrument is valid and can differentiate psychiatric cohorts from non-psychiatric controls.

    Conclusion: The Swedish version of the SPQ-B exhibit good psychometric properties and is useful for assessing schizotypal traits in clinical and non-clinical populations.

  • 308.
    Belayneh, Dereje K.
    et al.
    St. Gabriel General Hospital, Addis Ababa, Ethiopia.
    Calais, Fredrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiology.
    Asymptomatic giant right coronary artery aneurysm in Kawasaki disease: A case report2020Ingår i: Clinical Case Reports, E-ISSN 2050-0904, Vol. 8, nr 12, s. 2732-2738Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Incidentally diagnosed giant coronary artery aneurysms (gCAA) exceeding 50 mm in diameter are extremely rare and carry increased risks of cardiovascular morbidity and mortality. Currently, surgery is the preferred treatment for such gCAA.

  • 309.
    Belkić, Karen
    et al.
    Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; School of Community/Global Health, Claremont Graduate University, Claremont, CA, USA; Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
    Andersson, Sonia
    Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, Stockholm, Stockholm, Sweden.
    Alder, Susanna
    Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, Stockholm, Stockholm, Sweden.
    Mints, Miriam
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, Stockholm, Stockholm, Sweden; Department of Gynecology and Obstetrics, School of Medical Sciences, Faculty of Medicine-Health, Örebro University, Örebro, Sweden.
    Megyessi, David
    Department of Women's and Children's Health, Obstetrics-Gynecology Division, Karolinska Institute, Stockholm, Stockholm, Sweden.
    Predictors of treatment failure for adenocarcinoma in situ of the uterine cervix: Up to 14 years of recorded follow-up2022Ingår i: Oncology Letters, ISSN 1792-1074, E-ISSN 1792-1082, Vol. 24, nr 4, artikel-id 357Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The incidence of adenocarcinoma-in-situ (AIS) of the uterine cervix is rising, with invasive adenocarcinoma becoming increasingly common relative to squamous cell carcinoma. The present study reviewed a cohort of 84 patients first-time treated by conization for histologically-confirmed AIS from January 2001 to January 2017, to identify risk factors associated with recurrent/persistent AIS as well as progression to invasive cervical cancer. Nearly 80% of the patients were age 40 or younger at conization. Endocervical and ectocervical margins were deemed clear in 42 of the patients. All but two patients had ≥1 follow-up, with post-conization high-risk human papilloma virus (HPV) results documented in 52 patients. Altogether, 12 histopathologically-confirmed recurrences (14.3%) were detected; two of these patients had microinvasive or invasive carcinoma. In three other patients cytology showed AIS, but without recorded histopathology. Eight patients underwent hysterectomy for incomplete resection very soon after primary conization; they were not included in bivariate or multivariate analyses. Having ≥1 post-follow-up positive HPV finding yielded the highest sensitivity for histologically-confirmed recurrence: 87.5 [95% confidence interval (CI) 47.4-99.7]. Current or historical smoking status provided highest specificity: 94.4 (95% CI 72.7-99.9) and overall accuracy: 88.0 (95% CI 68.8-97.5) for histologically-confirmed recurrence. With multiple logistic regression (MLR), adjusting for age at conization and abnormal follow-up cytology, positive HPV18 was the strongest predictor of histologically-confirmed recurrence (P<0.005). Having ≥2 positive HPV results also predicted recurrence (P<0.02). Any unclear margin yielded an odds ratio 7.21 (95% CI 1.34-38.7) for histologically-confirmed recurrence adjusting for age, but became non-significant when including abnormal cytology in the MLR model. The strong predictive value of HPV, particularly HPV18 and persistent HPV positivity vis-à-vis detected recurrence indicated that regular HPV testing for patients treated for AIS is imperative. In conclusion, furthering a participatory approach, including attention to smoking with encouragement to attend needed long-term follow-up, can better protect these patients at high risk for cervical cancer.

  • 310.
    Bengtsdotter, Hanna
    et al.
    Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden.
    Lundin, Cecilia
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Gemzell Danielsson, Kristina
    Department of Women’s and Children’s Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
    Bixo, Marie
    Department of Clinical Science, Umeå University, Umeå, Sweden.
    Baumgart, Juliane
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynaecology.
    Marions, Lena
    Department of Clinical Science and Education, Karolinska Institutet Södersjukhuset, Stockholm, Sweden.
    Brynhildsen, Jan
    Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Malmborg, Agota
    Department of Obstetrics and Gynaecology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Lindh, Ingela
    Department of Obstetrics and Gynaecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sundström Poromaa, Inger
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use2018Ingår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, nr 1, s. 45-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Previous studies have emphasised that women with pre-existing mood disorders are more inclined to discontinue hormonal contraceptive use. However, few studies have examined the effects of combined oral contraceptives (COC) on mood in women with previous or ongoing mental disorders.

    Materials and methods: This is a supplementary analysis of an investigator-initiated, double-blinded, randomised clinical trial during which 202 women were treated with either a COC (1.5mg estradiol and 2.5mg nomegestrolacetate) or placebo during three treatment cycles. The Mini International Neuropsychiatric Interview was used to collect information on previous or ongoing mental disorders. The primary outcome measure was the total change score in five mood symptoms on the Daily Record of Severity of Problems (DRSP) scale in the intermenstrual phase of the treatment cycle.

    Results: Women with ongoing or previous mood, anxiety or eating disorders allocated to COC had higher total DRSP -scores during the intermenstrual phase of the treatment cycle in comparison with corresponding women randomised to placebo, mean difference 1.3 (95% CI 0.3-2.3). In contrast, among women without mental health problems, no difference in total DRSP -scores between COC- and placebo users was noted. Women with a risk use of alcohol who were randomised to the COC had higher total DRSP -scores than women randomised to placebo, mean difference 2.1 (CI 95% 1.0-3.2).

    Conclusions: Women with ongoing or previous mental disorders or risk use of alcohol have greater risk of COC-induced mood symptoms. This may be worth noting during family planning and contraceptive counselling.

  • 311.
    Bengtsson, Bonnie
    et al.
    Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Unit of Gastroenterology andnRheumatology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Askling, Johan
    Rheumatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Hagström, Hannes
    Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden; Unit of Gastroenterology andnRheumatology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Validity of administrative codes associated with cirrhosis in Sweden2020Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 55, nr 10, s. 1205-1210Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Although cirrhosisis a major cause of liver-related mortality globally, validation studies of the administrative coding for diagnoses associated with cirrhosis are scarce. We aimed to determine the validity of the International Classification of Diseases, 10th revision (ICD-10) codes corresponding to cirrhosis and its complications in the Swedish National Patient Register (NPR).

    Methods: We randomly selected 750 patients with ICD codes for either alcohol-related cirrhosis (K70.3), unspecified cirrhosis (K74.6) oesophageal varices (I85.0/I85.9), hepatocellular carcinoma (HCC, C22.0) or ascites (R18.9) registered in the NPR from 72 healthcare centres in 2000-2016. Hospitalisation events and outpatient visits in specialised care were included. Positive predictive values (PPVs) were calculated using the information in the patient charts as the gold standard.

    Results: Complete data were obtained for 630 (of 750) patients (84%). For alcohol-related cirrhosis, 126/136 cases were correctly coded, corresponding to a PPV of 93% (95% confidence interval, 95%CI: 87-96). The PPV for cirrhosis with unspecified aetiology was 91% (121/133, 95%CI: 85-95) and 96% for oesophageal varices (118/123, 95%CI: 91-99). The PPV was lower for HCC, 84% (91/109, 95%CI: 75-90). The PPV for liver-related ascites was low, 43% (56/129, 95%CI: 35-52), as this category often consisted of non-hepatic ascites. When combining the ascites code with a code for chronic liver disease, the PPV for liver-related ascites increased to 93% (50/54, 95%CI: 82-98).

    Conclusions: The validity of ICD-10 codes for cirrhosis, oesophageal varices and HCC is high. However, coding for ascites should be combined with a code of chronic liver disease to have an acceptable validity.

  • 312.
    Benoit, Daniel L
    et al.
    nstitution for Surgical Sciences, Section of Sports Medicine, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden; Department of Mechanical Engineering, University of Delaware, 106 Spencer Lab, Newark, DE 19711, United States.
    Ramsey, Dan K
    Department of Physical Therapy, University of Delaware, Newark, DE, United States.
    Lamontagne, Mario
    School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada.
    Xu, Lanyi
    School of Human Kinetics, University of Ottawa, Ottawa, Canada.
    Wretenberg, Per
    Region Örebro län. Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden; Institution for Surgical Sciences, Section of Orthopaedics, Karolinska Institute, Stockholm, Sweden.
    Renström, Per
    Institution for Surgical Sciences, Section of Sports Medicine, Karolinska Institute, Stockholm, Sweden; Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden.
    Effect of skin movement artifact on knee kinematics during gait and cutting motions measured in vivo2006Ingår i: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 24, nr 2, s. 152-164Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Eight healthy male subjects had intra-cortical bone-pins inserted into the proximal tibia and distal femur. Three reflective markers were attached to each bone-pin and four reflective markers were mounted on the skin of the tibia and thigh, respectively. Roentgen-stereophotogrammetric analysis (RSA) was used to determine the anatomical reference frame of the tibia and femur. Knee joint motion was recorded during walking and cutting using infrared cameras sampling at 120Hz. The kinematics derived from the bone-pin markers were compared with that of the skin-markers. Average rotational errors of up to 4.4 degrees and 13.1 degrees and translational errors of up to 13.0 and 16.1mm were noted for the walk and cut, respectively. Although skin-marker derived kinematics could provide repeatable results this was not representative of the motion of the underlying bones. A standard error of measurement is proposed for the reporting of 3D knee joint kinematics.

  • 313.
    Benoit, Daniel L
    et al.
    School of Rehabilitation Sciences, University of Ottawa, Canada; School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.; Canada.
    Ramsey, Dan K
    Department of Physical Therapy, University of Delaware, Newark, DE, United States.
    Lamontagne, Mario
    School of Human Kinetics, University of Ottawa, Ottawa, Ont., Canada.
    Xu, Lanyi
    School of Human Kinetics, University of Ottawa, Ottawa, Ont., Canada.
    Wretenberg, Per
    Region Örebro län. Institution for Surgical Sciences, Section of Orthopaedics, Karolinska Institute, Stockholm, Sweden; Section of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    Renström, Per
    Institution for Surgical Sciences, Section of Orthopaedics, Karolinska Institute, Stockholm, Sweden; Section of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
    In vivo knee kinematics during gait reveals new rotation profiles and smaller translations2007Ingår i: Clinical Orthopaedics and Related Research, ISSN 0009-921X, E-ISSN 1528-1132, Vol. 454, s. 81-88Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In order to identify abnormal or pathological motions associated with clinically relevant questions such as injury mechanisms or factors leading to joint degeneration, it is essential to determine the range of normal tibiofemoral motion of the healthy knee. In this study we measured in vivo 3D tibiofemoral motion of the knee during gait and characterized the nonsagittal plane rotations and translations in a group of six healthy young adults. The subjects were instrumented with markers placed on intracortical pins inserted into the tibia and femur as well as marker clusters placed on the skin of the thigh and shank. The secondary rotations and translation excursions of the knee were much smaller than those derived from skin markers and previously described in the literature. Also, for a given knee flexion angle, multiple combinations of transverse and frontal plane knee translation or rotation positions were found. This represents normal knee joint motions and ensemble averaging of gait data may mask this important subject-specific information.

  • 314.
    Bento, Celeste
    et al.
    Department of Hematology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal .
    Percy, Melanie J.
    Department of Haematology, Belfast City Hospital, Belfast, United Kingdom .
    Gardie, Betty
    Unité Mixte de Recherche (UMR) 892 Inserm - 6299 CNRS, Université de Nantes, Nantes, France; Laboratoire de Génétique Oncologique de l'Ecole Pratique des Hautes Etudes (EPHE), INSERM U753, Institut de cancérologie Gustave Roussy, Villejuif, France .
    Maia, Tabita Magalhaes
    Department of Hematology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal .
    van Wijk, Richard
    Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, Netherlands .
    Perrotta, Silverio
    Dipartimento della Donna, Del Bambino e di Chirurgia Generale e Specialistica, Second University of Naples, Naples, Italy .
    Della Ragione, Fulvio
    Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy .
    Almeida, Helena
    Department of Hematology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal .
    Rossi, Cedric
    Laboratoire d'Hématologie, Centre Hospitalier Universitaire Dijon, Dijon, France .
    Girodon, Francois
    Laboratoire d'Hématologie, Centre Hospitalier Universitaire Dijon, Dijon, France .
    Åström, Maria
    Region Örebro län. Departments of Medicine and Laboratory Medicine.
    Neumann, Drorit
    Department of Cell and Developmental Biology, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel .
    Schnittger, Susanne
    Munich Leukemia Laboratory (MLL), Munich, Germany .
    Landin, Britta
    Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden .
    Minkov, Milen
    Department of Hematology/Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria .
    Randi, Maria Luigia
    Department of Medicine DIMED, University of Padua, Padua, Italy .
    Richard, Stephane
    Laboratoire de Génétique Oncologique de l'Ecole Pratique des Hautes Etudes (EPHE), INSERM U753, Institut de cancérologie Gustave Roussy, Villejuif, France .
    Casadevall, Nicole
    Hôpital Saint Antoine, Paris, France; Assistance Publique-Hôpitaux de Paris, Paris, France; Pierre et Marie Curie University, Paris, France; UMR1009 Institut Gustave Roussy Villejuif, Paris, France .
    Vainchenker, William
    UMR 1009 and GRex, INSERM, Université Paris-Sud, Institut Gustave Roussy, Villejuif, France .
    Rives, Susana
    Department of Pediatric Hematology, Hospital Sant Joan de Déu de Barcelona, University of Barcelona, Barcelona, Spain .
    Hermouet, Sylvie
    Unité Mixte de Recherche (UMR) 892 Inserm - 6299 CNRS, Université de Nantes, Nantes, France .
    Ribeiro, M. Leticia
    Department of Hematology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal .
    McMullin, Mary Frances
    Department of Haematology, CCRCB, Queen's University, Belfast, Northern Ireland, United Kingdom .
    Cario, Holger
    Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany .
    Genetic Basis of Congenital Erythrocytosis: Mutation Update and Online Databases2014Ingår i: Human Mutation, ISSN 1059-7794, E-ISSN 1098-1004, Vol. 35, nr 1, s. 15-26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Congenital erythrocytosis (CE), or congenital polycythemia, represents a rare and heterogeneous clinical entity. It is caused by deregulated red blood cell production where erythrocyte overproduction results in elevated hemoglobin and hematocrit levels. Primary congenital familial erythrocytosis is associated with low erythropoietin (Epo) levels and results from mutations in the Epo receptor gene (EPOR). Secondary CE arises from conditions causing tissue hypoxia and results in increased Epo production. These include hemoglobin variants with increased affinity for oxygen (HBB, HBA mutations), decreased production of 2,3-bisphosphoglycerate due to BPGM mutations, or mutations in the genes involved in the hypoxia sensing pathway (VHL, EPAS1, and EGLN1). Depending on the affected gene, CE can be inherited either in an autosomal dominant or recessive mode, with sporadic cases arising de novo. Despite recent important discoveries in the molecular pathogenesis of CE, the molecular causes remain to be identified in about 70% of the patients. With the objective of collecting all the published and unpublished cases of CE the COST action MPN&MPNr-Euronet developed a comprehensive Internet-based database focusing on the registration of clinical history, hematological, biochemical, and molecular data (http://www.erythrocytosis.org/). In addition, unreported mutations are also curated in the corresponding Leiden Open Variation Database.

  • 315.
    Beraki, Åsa
    et al.
    Linköping University, Linköping, Sweden.
    Magnusson, Anders
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Samuelsson, Ulf
    Department of Clinical and Experimental Medicine, Division of Pediatrics and Diabetes Research Centre, Linköping University, Linköping, Sweden.
    Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)2014Ingår i: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 105, nr 1, s. 119-125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 316.
    Berg von Linde, Maria
    et al.
    Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden.
    Johansson, Karin
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Research Laboratory.
    Kruse, Robert
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Örebro University, Örebro, Sweden.
    Helenius, Gisela
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine.
    Samano, Ninos
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiothoracic and Vascular Surgery.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Frøbert, Anne Mette
    Department of Chemistry and Bioscience, Faculty of Engineering and Science, Aalborg University, Aalborg, Denmar.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Expression of Paracrine Effectors in Human Adipose-Derived Mesenchymal Stem Cells Treated With Plasma From Brown Bears (Ursus arctos)2021Ingår i: Clinical and Translational Science, ISSN 1752-8054, E-ISSN 1752-8062, Vol. 14, nr 1, s. 317-325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Adipose-derived mesenchymal stem cells (ADSCs) are promising candidates for novel cell therapeutic applications. Hibernating brown bears sustain tissue integrity and function via unknown mechanisms, which might be plasma borne. We hypothesized that plasma from hibernating bears may increase the expression of favorable factors from human ADSCs. In an experimental study, ADSCs from patients with ischemic heart disease were treated with interventional media containing plasma from hibernating and active bears, respectively, and with control medium. Extracted RNA from the ADSCs was sequenced using next generation sequencing. Statistical analyses of differentially expressed genes were performed using fold change analysis, pathway analysis, and gene ontology. As a result, we found that genes associated with inflammation, such as IGF1, PGF, IL11, and TGFA, were downregulated by > 10-fold in ADSCs treated with winter plasma compared with control. Genes important for cardiovascular development, ADM, ANGPTL4, and APOL3, were upregulated in ADSCs when treated with winter plasma compared with summer plasma. ADSCs treated with bear plasma, regardless if it was from hibernating or active bears, showed downregulation of IGF1, PGF, IL11, INHBA, IER3, and HMOX1 compared with control, suggesting reduced cell growth and differentiation. This can be summarized in the conclusion that plasma from hibernating bears suppresses inflammatory genes and activates genes associated with cardiovascular development in human ADSCs. Identifying the involved regulator(s) holds therapeutic potential.

  • 317.
    Berge, M.
    et al.
    Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Bertilsson, L.
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Hultgren, Olof
    Örebro universitet, Institutionen för medicinska vetenskaper. Department Clinical Immunology and Transfusion Medicine.
    Hugosson, Svante
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department Clinical Immunology and Transfusion Medicine.
    Saber, Amanj
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department Clinical Immunology and Transfusion Medicine.
    Qualitative and quantitative comparison of allergen component-specific to birch and grass analyzed by ImmunoCAP assay and Euroline immunoblot test2023Ingår i: European annals of allergy and clinical immunology, E-ISSN 1764-1489, Vol. 55, nr 2, s. 68-77Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In the diagnostic work up of allergy, determining allergen component-specific immunoglobulin E (IgE) is important for diagnosis, prognosis and choice of treatment.

    Objective: The purpose of this study was to evaluate the performance of the immunoblotting assay (Euroline) in detection of IgE antibodies against timothy grass and birch pollen allergen components compared to fluorescent enzyme assay (ImmunoCAP, Phadia 250).

    Methods: A total of 128 serum samples from patients allergic to timothy grass and birch pollen were analysed. The levels of IgE antibodies to timothy grass and birch pollen were measured using Euroline DPA-Dx pollen 1 and ImmunoCAP assay. The two methods were then compared on binary (positive vs negative), semi-quantitative (IgE classes) and quantitative (concentration) levels. The two methods were also compared to results from skin prick testing.

    Results: The Euroline method showed a positive percentage agreement of 93% and negative percentage agreement of 94% with an overall accuracy of 94% when compared to ImmunoCAP. Kappa analysis showed moderate strength of agreement between the methods in determining IgE classes for 7/11 components tested. All components showed a positive correlation when analysed using Spearman's rank correlation.

    Conclusions: Overall, we found that there is good correlation between the Euroline and ImmunoCAP methods in measuring IgE sensitization.

  • 318.
    Berge, Martin
    et al.
    Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Bertilsson, Lena
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Hultgren, Olof
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden; Department Clinical Immunology and Transfusion Medicine, Faculty of Medicine and Health Örebro University, Örebro, Sweden.
    Hugosson, Svante
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Saber, Amanj
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Otolaryngology, Örebro University Hospital, Örebro, Sweden.
    Pre-treatment allergen-specific IgE analysis and outcomes of allergen immunotherapy2022Ingår i: European annals of allergy and clinical Immunology, ISSN 1764-1489, Vol. 54, nr 5, s. 218-228Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:  Patients show varied results to allergen immunotherapy (AIT. The reason for this variability is unclear.

    Objective: To describe the relationship between AIT efficacy and demographic characteristics, as well as pre-treatment plasma levels of specific IgE-antibodies to grass and birch pollen.

    Methods: A retrospective study was performed based on medical records of 128 patients who received AIT. The patients completed a questionnaire and pre-AIT plasma levels of allergen-specific IgE to grass and birch pollen were measured using EUROLINE DPA-Dx pollen 1 method. Results. Seventy percent of patients classified their allergic symptoms as less severe after AIT. Twenty-seven percent had received AIT targeting only grass pollen, 19% targeting only birch pollen, and 55% targeting both grass and birch. A total of 35 different IgE profiles were found across our study population. On comparison of the demographic characteristics and concentration of allergen-specific IgE-antibodies, no statistically significant differences could be found.

    Conclusions: The majority of patients rated their allergic symptoms as less severe after AIT. No clear relationship could be demonstrated between pre-treatment allergen-specific IgE concentration, or demographic characteristics, and effect of AIT. There may be other factors underlying the different responses to AIT.

  • 319.
    Bergemalm, Daniel
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Andersson, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterolog.
    Hultdin, Johan
    Department of Medical Biosciences, Division of Clinical Chemistry, Umeå University, Umeå, Sweden.
    Eriksson, Carl
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Rush, Stephen T.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kalla, Rahul
    MRC Centre for Inflammation Research, Queens Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.
    Adams, Alex T.
    Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.
    Keita, Åsa V.
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    D'Amato, Mauro
    CIC bioGUNE Basque Research and Technology Alliance, BRTA and IKERBASQUE, Basque Science Foundation, Bilbao, Spain; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Gomollon, Fernando
    HCU "Lozano Blesa," IIS Aragón, Zaragoza, Spain.
    Jahnsen, Jorgen
    Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Ricanek, Petr
    Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.
    Satsangi, Jack
    Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom.
    Repsilber, Dirk
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Karling, Pontus
    Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Systemic Inflammation in Preclinical Ulcerative Colitis2021Ingår i: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 161, nr 5, s. 1526-1539.e9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND & AIMS: Pre-clinical ulcerative colitis is poorly defined. We aimed to characterize the pre-clinical systemic inflammation in ulcerative colitis, using a comprehensive set of proteins.

    METHODS: We obtained plasma samples, biobanked from individuals who later in life developed ulcerative colitis (n=72), and matched healthy controls (n=140), within a population-based screening cohort. We measured 92 proteins related to inflammation using a proximity extension assay. The biological relevance of these findings were validated in an inception cohort of ulcerative colitis patients (n=101), and healthy controls (n=50). To examine the influence of genetic and environmental factors on these markers, a cohort of healthy twin siblings of ulcerative colitis patients (n=41) and matched healthy controls (n=37) were explored.

    RESULTS: Six proteins (MMP10, CXCL9, CCL11, SLAMF1, CXCL11 and MCP1) were upregulated (p<0.05) in pre-clinical ulcerative colitis compared to controls based on both univariate and mulativariable models. Ingenuity Pathway Analyses identified several potential key regulators, including IL-1b, TNF, IFN-gamma, OSM, NFĸB, IL-6 and IL-4. For validation, we built a multivariable model to predict disease in the inception cohort. The model discriminated treatment-naïve ulcerative colitis patients from controls with leave-one-out cross-validation (AUC=0.92). Consistently, MMP10, CXCL9, CXCL11, and MCP-1, but not CCL11 and SLAMF1, were significantly upregulated among the healthy twin siblings, even though their relative abundances seemed higher in incident ulcerative colitis.

    CONCLUSIONS: A set of inflammatory proteins are upregulated several years before a diagnosis of ulcerative colitis. These proteins were highly predictive of an ulcerative colitis diagnosis, and some seemed to be upregulated already at exposure to genetic and environmental risk factors.

  • 320.
    Bergemalm, Daniel
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Andersson, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Karling, Pontus
    Department of Public Health and Clinical Medicine, Division of Medicine, Umea University, Umeå, Sweden.
    Eriksson, Carl
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Repsilber, Dirk
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hultdin, Johan
    Medical Biosciences, Clinical Chemistry, Umea University, Umeå, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper.
    IBD Character Consortium,
    Markers of systemic inflammation in preclinical ulcerative colitis2019Ingår i: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 7, nr 8_suppl, s. 111-111Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Data on the preclinical stage of ulcerative colitis (UC) are sparse. At diagnosis, UC often shows a modest increase in systemic inflammatory markers like C-reactive protein (CRP). However, a subclinical inflammation with elevated levels of CRP and interleukin-6 (IL6) in serum have been observed several years before diagnosis [1]. First-degree relatives, including healthy twin siblings, also display elevated levels of some inflammatory markers as a consequence of shared genetic and environmental risk factors [2]. It is reasonable to believe that the preclinical inflammation, reflecting early pathogenic mechanisms, ultimately leads to a diagnosis of UC.

    Aim and Method: We aimed to deeper examine the systemic preclinical inflammation in UC using a comprehensive set of protein markers. Cases with UC were identified at clinical follow-up of a prospectively collected population-based cohort of healthy individuals from northern Sweden. Plasma samples from cases and controls were subjected to proximity extension assay for relative quantification of 92 protein markers of inflammation. Results were validated in an inception cohort of treatment naïve, newly diagnosed patients with UC (n=101) vs. healthy controls (n=50). In addition, to examine the impact of shared genetic and environmental factors, a cohort of healthy mono- and dizygotic twin siblings of twins with UC (n=41) and matched healthy controls (n=37) were explored.

    Results: Pre-diagnostic plasma samples from 72 cases who later in life developed UC and 140 controls, matched for gender, age, year of health survey and area of residence, were identified (table 1). Six proteins were significantly upregulated (p<0.05) in pre-diagnostic UC compared to matched healthy controls. A receiver-operating curve based prediction model using the six protein markers combined with sex, age, smoking status and time to diagnose was set up for validation. The model discriminated newly diagnosed, treatment naïve UC cases from healthy controls (AUC=0.96; CI 0.93-0.98). An AUC of 0.73 (CI 0.62-0.84) was observed when the model was applied to healthy twin siblings vs. healthy controls and four out of six proteins were upregulated similarly as in the pre-diagnostic samples. The relative levels of the six proteins showed an intermediate upregulation in pre-diagnostic samples and samples from healthy twin siblings compared to samples at diagnosis of UC. Only one protein showed a significant correlation with time to diagnosis in the pre-diagnostic samples. Using pathway analysis, the six protein upregulations pointed towards subclinical inflammation in UC being caused by dysregulation of four immune pathways.

    Conclusions: This is the first comprehensive characterisation of preclinical systemic inflammation in UC. Inflammatory proteins were upregulated several years prior to diagnosis of UC and to some extent these alterations were also seen in healthy twin siblings of UC patients. Characterisation of the preclinical stage of UC could pave the way for identification of predictive biomarkers and preventive strategies.

  • 321.
    Bergemalm, Daniel
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Kruse, Robert
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Sapnara, Maria
    Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Hultgren Hörnquist, Elisabeth
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Elevated fecal peptidase D at onset of colitis in Galphai2(-/-) mice, a mouse model of IBD2017Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 12, nr 3, artikel-id e0174275Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The identification of novel fecal biomarkers in inflammatory bowel disease (IBD) is hampered by the complexity of the human fecal proteome. On the other hand, in experimental mouse models there is probably less variation. We investigated the fecal protein content in mice to identify possible biomarkers and pathogenic mechanisms.

    Methods: Fecal samples were collected at onset of inflammation in Galphai2(-/-) mice, a well-described spontaneous model of chronic colitis, and from healthy littermates. The fecal proteome was analyzed by two-dimensional electrophoresis and quantitative mass spectrometry and results were then validated in a new cohort of mice.

    Results: As a potential top marker of disease, peptidase D was found at a higher ratio in Galphai24mouse feces relative to controls (fold change 27; p = 0.019). Other proteins found to be enriched in Gai2(-/-) mice were mainly pancreatic proteases, and proteins from plasma and blood cells. A tendency of increased calprotectin, subunit S100-A8, was also observed (fold change 21; p = 0.058). Proteases are potential activators of inflammation in the gastrointestinal tract through their interaction with the proteinase-activated receptor 2 (PAR2). Accordingly, the level of PAR2 was found to be elevated in both the colon and the pancreas of Galphai24- mice at different stages of disease.

    Conclusions: These findings identify peptidase D, an ubiquitously expressed intracellular peptidase, as a potential novel marker of colitis. The elevated levels of fecal proteases may be involved in the pathogenesis of colitis and contribute to the clinical phenotype, possibly by activation of intestinal PAR2.

  • 322.
    Bergemalm, Daniel
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medicine.
    Ramström, Sofia
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Kardeby, Caroline
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hultenby, Kjell
    Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm.
    Göthlin Eremo, Anna
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Research Laboratory.
    Sihlbom, Carina
    Proteomics Core Facility, University of Gothenburg, Gothenburg.
    Bergström, Jörgen
    Proteomics Core Facility, University of Gothenburg, Gothenburg.
    Palmblad, Jan
    Åström, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medicine.
    Platelet proteome and function in X-linked thrombocytopenia with thalassemia and in silico comparisons with gray platelet syndrome2021Ingår i: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 106, nr 11, s. 2947-2959Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In X-linked thrombocytopenia with thalassemia (XLTT; OMIM 314050), caused by the mutation p.R216Q in exon 4 of the GATA1 gene, male hemizygous patients display macrothrombocytopenia, bleeding diathesis and a β-thalassemia trait. Herein, we describe findings in two unrelated Swedish XLTT families with a bleeding tendency exceeding what is expected from the thrombocytopenia. Blood tests revealed low P-PAI-1 and P-factor 5, and elevated S-thrombopoietin levels. Transmission electron microscopy showed diminished numbers of platelet α- and dense granules. The proteomes of isolated blood platelets from 5 male XLTT patients, compared to 5 gender- and age matched controls, were explored. Quantitative mass spectrometry showed alterations of 83 proteins (fold change ≥±1.2, q< .05). Of 46 downregulated proteins, 39 were previously reported to be associated with platelet granules. Reduced protein levels of PTGS1 and SLC35D3 were validated in megakaryocytes of XLTT bone marrow biopsies by immunohistochemistry. Platelet function testing by flow cytometry revealed low dense- and α-granule release and fibrinogen binding in response to ligation of receptors for ADP, the thrombin receptor PAR4 and the collagen receptor GPVI. Significant reductions of a number of α-granule proteins overlapped with a previous platelet proteomics investigation in the inherited macrothrombocytopenia gray platelet syndrome (GPS). In contrast, Ca2+ transporter proteins that facilitate dense granule release were downregulated in XLTT but upregulated in GPS. Ingenuity Pathway Analysis showed altered Coagulation System and Protein Ubiquitination pathways in the XLTT platelets. Collectively, the results revealed protein and functional alterations affecting platelet α- and dense granules in XLTT, probably contributing to bleeding.

  • 323.
    Bergemalm, P-O
    Region Örebro län.
    Interrupted speech and MRI findings after traumatic head injury: A long-term follow-up2013Ingår i: Hearing, Balance and Communication, ISSN 2169-5725, Vol. 11, nr 2, s. 80-86Artikel i tidskrift (Refereegranskat)
  • 324.
    Bergengren, Lovisa
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Full genotyping and FAM19A4/miR124-2 methylation analysis in high-risk humanpapillomavirus-positive samples from women over 30 years participating in cervical cancerscreening in Örebro, Sweden2023Ingår i: Shaped Challenges of HPV Driven Cancers: From Research to Practice, 2023Konferensbidrag (Övrigt vetenskapligt)
  • 325.
    Bergengren, Lovisa
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Obstetrics and Gynaecology.
    Ryen, Linda
    University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Flodström, Clelia
    Department of Women´s health, Örebro University Hospital, Örebro, Sweden.
    Fadl, Helena
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynaecology.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Karlsson, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine.
    Helenius, Gisela
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine.
    Effectiveness and costs of implemented primary HPV cervical screening: a populationbased cohort studyManuskript (preprint) (Övrigt vetenskapligt)
  • 326.
    Bergengren, Lovisa
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynaecology.
    Ryen, Linda
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Centre.
    Flodström, Clelia
    Department of Women's Health, Örebro University Hospital, Örebro, Sweden.
    Fadl, Helena
    Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Udumyen, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Clinical Epidemiology and Biostatistics.
    Karlsson, Mats G.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Helenius, Gisela
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine.
    Effectiveness and costs of an implemented primary HPV cervical screening programme in Sweden: A population based cohort study2022Ingår i: Preventive Medicine Reports, E-ISSN 2211-3355, Vol. 25, artikel-id 101675Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Swedish guidelines recommend cervical screening with primary HPV for women ≥ 30 years of age. The aim of this study was to compare an implemented HPV cervical screening programme in the Region of Örebro County from September 1, 2016, with the former cytology-based screening programme.

    The clinical effectiveness by means of number of high-grade squamous intraepithelial lesions (HSILs) and cervical cancer cases detected in histology within 12 months after the screening test, together with cost implications were the main outcomes. Data were retrieved from the Swedish National Cervical Screening Registry between the years 2014-2015 (cytology based screening) and 2017-2018(HPV based screening), including screening information such as invitations and cytology and histology diagnoses.

    The detection rate of HSIL + among women ≥ 30 years of age was 1.2 times higher with HPV screening, but data revealed an increase in direct colposcopy referral rate by 54% and a higher percentage of irrelevant findings (≤LSIL). Screening based on HPV for women ≥ 30 has increased yearly cost from 1 to 1.3 million EUR, while increasing the number of HSIL + identified. Two thirds of the total costs are from visits for screening samples in the programme.

    HPV screening detected more cases of HSIL + compared to cytology screening among women ≥ 30 although high colposcopy rate, high rate of clinical irrelevant findings and higher costs were shown in the HPV-based screening programme, which implies that alterations in the screening programme in the future are important to consider.

  • 327.
    Bergengren, Oskar
    et al.
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Belozerov, Alexej
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Bill-Axelson, Anna
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Garmo, Hans
    Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
    Hagberg, Oskar
    Institution of Translational Medicine, Lund University, Malmö, Sweden.
    Aljabery, Firas
    Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Jahnson, Staffan
    Division of Urology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Jerlström, Tomas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Urology.
    Malmström, Per-Uno
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Sherif, Amir
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Ströck, Viveka
    Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Söderkvist, Karin
    Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
    Ullén, Anders
    Genitourinary Oncology and Urology Unit, Department of Oncology-Pathology, Karolinska Institutet, And Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
    Holmberg, Lars
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
    Häggström, Christel
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Public Health and Clinical Medicine, Northern Registry Centre, Umeå University, Sweden.
    Liedberg, Fredrik
    Institution of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Short term outcomes after robot assisted and open cystectomy: A nation-wide population-based study2023Ingår i: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, nr 4, s. 868-874Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: We aimed to compare short term outcomes after robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC) for urinary bladder cancer in a large population.

    MATERIALS AND METHODS: We included all patients without distant metastases who underwent either RARC or ORC with ileal conduit between 2011 and 2019 registered in the Bladder cancer data Base Sweden (BladderBaSe) 2.0. Primary outcome was unplanned readmissions within 90 days, and secondary outcomes within 90 days of surgery were reoperations, Clavien 3-5 complications, total days alive and out of hospital, and mortality. The analysis was carried out using multivariate regression models.

    RESULTS: Out of 2905 patients, 832 were operated with RARC and 2073 with ORC. Robotic procedures were to a larger extent performed during later years, at high volume centers (47% vs 17%), more often for organ-confined disease (82% vs. 72%) and more frequently in patients with high socioeconomic status (26% vs. 21%). Patients operated with RARC were more commonly readmitted (29% vs. 25%). In multivariable analysis RARC was associated with decreased risk of Clavien 3-5 complications (OR 0.58, 95% CI 0.47-0.72), reoperations (OR 0.53, 95% CI 0.39-0.71) and had more days alive and out of hospital (mean difference 3.7 days, 95% CI 2.4-5.0).

    CONCLUSION: This study illustrates the "real-world" effects of a gradual and nation-wide introduction of RARC. Patients operated with RARC had fewer major complications and reoperations but were more frequently readmitted compared to ORC. The observed differences were largely due to more wound related complications among patients treated with ORC.

  • 328.
    Bergh, Anne-Louise
    et al.
    School of Health Sciences, University of Borås, Borås, Sweden.
    Johansson, Inger
    Department of Nursing, University College Gjøvik, Gjøvik, Norway; Department of Nursing, University of Karlstad, Karlstad, Sweden.
    Persson, Eva
    School of Health Sciences, University of Borås, Borås, Sweden; Department of Health Sciences, Lund University, Lund, Sweden.
    Karlsson, Jan
    Region Örebro län. Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Friberg, Febe
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Health Studies, University of Stavanger, Stavanger, Norway.
    Nurses' Patient Education Questionnaire - development and validation process2015Ingår i: Journal of Research in Nursing, ISSN 1744-9871, E-ISSN 1744-988X, Vol. 20, nr 3, s. 181-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Conditions for nurses' daily patient education work are unclear and require clarification. The aim was to develop and validate the Nurses' Patient Education Questionnaire, a questionnaire that assesses nurses' perceptions of appropriate conditions for patient education work: what nurses say they actually do and what they think about what they do. The questionnaire was developed from a literature review, resulting in the development of five domains. This was followed by 'cognitive interviewing' with 14 nurses and dialogue with 5 pedagogical experts. The five domains were identified as significant for assessing nurses' beliefs and knowledge; education environment; health care organisation; interdisciplinary cooperation and collegial teamwork; and patient education activities. A content validity index was used for agreement of relevance and consensus of items by nurses (n = 10). The total number of items in the final questionnaire is 60, consisting of demographic items, what nurses report they do and perceptions about patient education in daily work. The questionnaire can be used by managers and nurses to identify possibilities and barriers to patient education in different care contexts.

  • 329.
    Bergh, Anne-Louise
    et al.
    Sch Hlth Sci, Univ Borås, Borås, Sweden.
    Persson, Eva
    Sch Hlth Sci, Univ Borås, Borås, Sweden; Dept Hlth Sci, Fac Med, Lund Univ, Lund, Sweden.
    Karlsson, Jan
    Region Örebro län. Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Friberg, Febe
    Dept Hlth Studies, Fac Social Sci, Univ Stavanger, Stavanger, Norway.
    Registered nurses' perceptions of conditions for patient education - focusing on aspects of competence2014Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, nr 3, s. 523-536Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. Aim: The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. Methods: The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. Results: Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. Conclusions: Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

  • 330.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sjöqvist, Hugo
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Severe infections and subsequent delayed cardiovascular disease2017Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 18, s. 1958-1966Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Severe infections in adulthood are associated with subsequent short-term cardiovascular disease. Whether hospital admission for sepsis or pneumonia is associated with persistent increased risk (over a year after infection) is less well established.

    Design: The design of this study was as a register-based cohort study.

    Methods: Some 236,739 men born between 1952-1956 were followed from conscription assessments in adolescence to 2010. All-cause cardiovascular disease ( n = 46,754), including coronary heart disease ( n = 10,279) and stroke ( n = 3438), was identified through national registers 1970-2010 (at ages 18-58 years).

    Results: Sepsis or pneumonia in adulthood (resulting in hospital admission) are associated with increased risk of cardiovascular disease in the years following infection. The risk is highest during the first year after the infection, with an adjusted hazard ratio (and 95% confidence intervals) of 6.33 (5.65-7.09) and a notably increased risk persisted with hazard ratios of 2.47 (2.04-3.00) for the second and 2.12 (1.71-2.62) for the third year after infection. The risk attenuated with time, but remained raised for at least five years after infection; 1.87 (1.47-2.38). The results are adjusted for characteristics in childhood, cardiovascular risk factors and medical history in adolescence. Similar statistically significant associations were found for coronary heart disease and stroke.

    Conclusions: Raised risks of cardiovascular disease following hospital admission for sepsis or pneumonia were increased for more than five years after the infection, but with the highest magnitude during the first three years following infection, suggesting a period of vulnerability when health professionals and patients should be aware of the heightened risk for cardiovascular disease.

  • 331.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Landberg, Rikard
    Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Andersson, Kristina
    Department of Experimental Medical Science, Lund University, Lund, Sweden; Glucanova AB, Lund, Sweden.
    Heyman-Lindén, Lovisa
    Molecular Nutrition, Department of Experimental Medical Science, Lund University, Lund, Sweden; Berry Lab AB, Lund, Sweden.
    Rascón, Ana
    Glucanova AB, Lund, Sweden; Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Khalili, Payam
    Department of Cardiology and Acute Internal Medicine, Central Hospital, Karlstad, Sweden.
    Kåregren, Amra
    Department of Medicine, Hospital Region Västmanland, Västerås, Sweden.
    Nilsson, Johan
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Pirazzi, Carlo
    Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Erlinge, David
    Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology.
    Effects of Bilberry and Oat intake on lipids, inflammation and exercise capacity after Acute Myocardial Infarction (BIOAMI): study protocol for a randomized, double-blind, placebo-controlled trial2021Ingår i: Trials, E-ISSN 1745-6215, Vol. 22, nr 1, artikel-id 338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Bilberries from Sweden, rich in polyphenols, have shown cholesterol-lowering effects in small studies, and the cholesterol-lowering properties of oats, with abundant beta-glucans and potentially bioactive phytochemicals, are well established. Both may provide cardiometabolic benefits following acute myocardial infarction (AMI), but large studies of adequate statistical power and appropriate duration are needed to confirm clinically relevant treatment effects. No previous study has evaluated the potential additive or synergistic effects of bilberry combined with oats on cardiometabolic risk factors. Our primary objective is to assess cardioprotective effects of diet supplementation with dried bilberry or with bioprocessed oat bran, with a secondary explorative objective of assessing their combination, compared with a neutral isocaloric reference supplement, initiated within 5 days following percutaneous coronary intervention (PCI) for AMI.

    METHODS: The effects of Bilberry and Oat intake on lipids, inflammation and exercise capacity after Acute Myocardial Infarction (BIOAMI) trial is a double-blind, randomized, placebo-controlled clinical trial. A total of 900 patients will be randomized post-PCI to one of four dietary intervention arms. After randomization, subjects will receive beverages with bilberry powder (active), beverages with high-fiber bioprocessed oat bran (active), beverages with bilberry and oats combined (active), or reference beverages containing no active bilberry or active oats, for consumption twice daily during a 3-month intervention. The primary endpoint is the difference in LDL cholesterol change between the intervention groups after 3 months. The major secondary endpoint is exercise capacity at 3 months. Other secondary endpoints include plasma concentrations of biochemical markers of inflammation, metabolomics, and gut microbiota composition after 3 months.

    DISCUSSION: Controlling hyperlipidemia and inflammation is critical to preventing new cardiovascular events, but novel pharmacological treatments for these conditions are expensive and associated with negative side effects. If bilberry and/or oat, in addition to standard medical therapy, can lower LDL cholesterol and inflammation more than standard therapy alone, this could be a cost-effective and safe dietary strategy for secondary prevention after AMI.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT03620266 . Registered on August 8, 2018.

  • 332.
    Bergh, Cecilia
    et al.
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Pre-stroke characteristics and stroke severity after first stroke in middle-aged men2015Ingår i: Nordic Stroke 2015: 18th Nordic Congress of Cerebrovascular Diseases, 2015Konferensbidrag (Refereegranskat)
  • 333.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Fall, Katja
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Appelros, Peter
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Departnment of Epidemiology and Public Health, University College London, London, UK; Cinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stress resilience in male adolescents and subsequent stroke risk: cohort study2014Ingår i: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, nr 12, s. 1331-1336Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.

    Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.

    Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.

    Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.

  • 334.
    Berghammer, Malin
    et al.
    Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Karlsson, Jan
    Region Örebro län. Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Ekman, Inger
    Inst Hlth & Care Sci, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Ctr Person Ctr Care, Univ Gothenburg, Gothenburg, Sweden.
    Eriksson, Peter
    Inst Med, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Dellborg, Mikael
    Inst Med, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Self-reported health status (EQ-5D) in adults with congenital heart disease2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 165, nr 3, s. 537-543Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Today, more patients with congenital heart disease (CHD) reach adulthood. There are conflicting findings concerning the relationship between quality of life (QoL) or health state for adults with CHD and the complexity of their CHD. The aim of the study was, firstly, to compare the reported health status and health perception of adult patients with CHD and, secondly, to investigate what variables influenced the patients' health status and health perception. Methods: Data from 1435 patients completing the EQ-5D questionnaire, which includes reported health status and health perception, were analyzed. Results: Valid EQ-5D data were reported by 1274 patients, showing overall results indicating a good health status. Problems were most frequently reported in the dimension "pain/discomfort" (31.9%) and "anxiety/depression" (29.8%). Higher occurrence of problems were reported by patients with complex disease i.e. single ventricle (p<0.001) and by female patients (p<0.0001). Symptomatic patients reported a lower health status (p<0.0001) and a lower perceived health on EQ-VAS (p<0.0001). Of the asymptomatic patients, 20.5% nevertheless reported problems in "pain/discomfort" and 22.2% in the "anxiety/depression" dimension. Conclusion: The health status of adults with CHD is influenced by symptoms, NYHA-classification, age and gender. Adults with CHD report a lower occurrence of problems in comparison to previously published results from a general population, but the importance of actively asking about the patient's experience is demonstrated by the high degree of asymptomatic patients reporting problems on EQ-5D. (c) 2011 Elsevier Ireland Ltd. All rights reserved.

  • 335.
    Bergkvist, Anna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Orthopedics, Örebro University School of Medical Sciences, Örebro, Sweden; Örebro University Hospital, Örebro, Sweden.
    Lundqvist, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Orthopedics.
    Pantzar-Castilla, Evelina
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Orthopedics.
    Distal radius fractures in children aged 5-12 years: a Swedish nationwide register-based study of 25 777 patients2023Ingår i: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 24, nr 1, artikel-id 560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Distal radius fracture (DRF) is the most common type of fracture in children. There is no clear consensus on primary treatment for complete DRFs. Kirschner wire (K-wire) fixation has been recommended, to avoid the risk of redislocation. However, recent studies have indicated that casting can be sufficient, at least for children with two or more years left to grow. There is no recent study regarding pediatric DRFs and the extent of K-wire fixations in the Swedish population. The purpose of this study was to investigate epidemiology and treatment of pediatric DRFs registered in the Swedish Fracture Register (SFR).

    METHODS: In this retrospective study, based on data from SFR for children aged 5-12 years with DRF between January 2015 and October 2022, we investigated epidemiology and choice of treatment. Sex, age, type of DRF, treatment, cause and mechanism of injury, were analyzed.

    RESULTS: In total, 25,777 patients were included, 7,173 (27%) with complete fractures. Number and peak age of girls vs. boys with fractures were 11,742 (46%), 10 years, and 14,035 (54%), 12 years, respectively. Odds ratio (OR) for a K-wire fixation in girls vs. boys was 0.81 (95% confidence interval (CI) 0.74-0.89, p < .001). With age 5 -7 years as reference, OR for age group 8-10 years was 0.88 (95% CI 0.80-0.98 p = .019) and OR for age group 11-12 years was 0.81 (95% CI 0.73-0.91 p =  < .001.

    CONCLUSION: Casting only was the preferred treatment for all fractures (76%). Boys acquired DRFs more often than girls, with a peak age of 12 years. Younger children and boys with a complete fracture were more likely than older children and girls to receive a K-wire. Further research regarding indications for K-wiring of DRFs in the pediatric population is needed.

  • 336.
    Berglund, Ida C.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Radiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Wikström, Maria B.
    Örebro universitet, Institutionen för medicinska vetenskaper. Emergency Department, Arvika Hospital, Arvika, Sweden.
    Lidén, Mats
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Radiology.
    Hörer, Tal M.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsson, Kristofer F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery.
    External anatomical landmarks to guide placement of resuscitative endovascular balloon occlusion of the inferior vena cava (REBOVC): a radiological study in trauma patientsManuskript (preprint) (Övrigt vetenskapligt)
  • 337.
    Bergman, David
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Brommaplans Primary Health Care Center, Stockholm, Sweden.
    Clemente, Mark S.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Khalili, Flamed
    Division of Gastroenterology, Massachusetts General Hospital, Boston Massachusetts, USA; Harvard Medical School, Boston Massachusetts, USA.
    Agréus, Lars
    Division for Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.
    Hultcrantz, Rolf
    Unit of Hepatology, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    A nationwide cohort study of the incidence of microscopic colitis in Sweden2019Ingår i: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 49, nr 11, s. 1395-1400Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Epidemiological studies of microscopic colitis have shown varying but increasing incidence rates. Aim To assess the incidence of microscopic colitis in Sweden.

    Methods: Nationwide cohort study performed in 1995-2015 based on biopsy reports. Age-specific and age-standardised incidence rates were calculated.

    Results: We identified 13 844 patients with an incident diagnosis of microscopic colitis. Lymphocytic colitis (n = 9238) constituted 67% and collagenous colitis (n = 4606) 33% of microscopic colitis. The mean age at time of diagnosis of microscopic colitis was 60.2 years (58.6 for lymphocytic colitis, 63.3 for collagenous colitis). The lifetime risk of developing microscopic colitis was 0.87% in women (95% confidence interval, CI: 0.85-0.88) and 0.35% in men (95% CI: 0.34-0.36). From 2006, the overall incidence of microscopic colitis was approximately 10.5 cases per 100 000 person-years (95% CI: 9.8-11.3) with higher rates in women (72% of cases, incidence rate ratio = 2.4 (95% CI: 2.3-2.5) and the elderly with increasing rates up to 75-79 years. From 2006-2015, there was a significant increase of 1% per year (P = 0.02) in the overall microscopic colitis incidence rate in women; the estimated annual percent change was similar, although not statistically significant, in men (P = 0.15).

    Conclusions: In Sweden, the incidence of microscopic colitis is still increasing in women, although the rate appears to be stabilising. The incidence is particularly high in women and the elderly up to age 75-79 years. Finally, across a lifetime, 1 in 115 females and 1 in 286 males are expected to be diagnosed with microscopic colitis and thus posing a considerable disease burden.

  • 338.
    Bergman, David
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hagström, Hannes
    Division of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Capusan, Andrea Johansson
    Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Mårild, Karl
    Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden; Department of Pediatric Gastroenterology, Queen Silvia Children’s Hospital, Gothenburg, Sweden.
    Nyberg, Fredrik
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sundquist, Kristina
    Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA .
    Incidence of ICD-Based Diagnoses of Alcohol-Related Disorders and Diseases from Swedish Nationwide Registers and Suggestions for Coding2020Ingår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 12, s. 1433-1442Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To improve consistency between register studies in Sweden and ensure valid comparisons of possible changes in alcohol-related disorders and diseases (ARDDs) over time, we propose a definition of ARDDs. Based on this definition, we examined Sweden's incidence rates of ARDDs from 1970 to 2018 in non-primary healthcare settings (inpatient and outpatient).

    Methods: Swedish Society of Epidemiology members were invited to give feedback on the International Classification of Disease (ICD) codes with a potential link to alcohol use. We then calculated age-standardised and age-specific incidence of ARDDs over time according to the National Patient Register, and the lifetime prevalence of ARDDs diagnosed in adults alive in Sweden on Dec 31, 2018.

    Results: Sweden's estimated incidence of ARDDs increased substantially after introducing the new ICD-9 codes in 1987. In the past 10 years (2009-2018), the incidence of ARDDs has been stable (males: 110/100,000 person-years, females: 49/100,000 person-years). Requiring at least two ICD records for diagnosed ARDDs led to a somewhat lower incidence of ARDDs (males: 71 per 100,000 person-years, females: 29 per 100,000 person-years). In Sweden, the lifetime prevalence of diagnosed ARDDs in adults on Dec 31, 2018, was 1.9% (95% CI=1.9-1.9). Conclusion: In this nationwide study, we found an incidence of ARDDs of 50-100/100,000 person-years. In 2018, 1 in 52 adults in Sweden had been diagnosed with ARDDs in the National Patient Register.

  • 339.
    Bergman, David
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Khalili, Hamed
    Massachusetts General Hospital, Crohn’s and Colitis Center and Harvard Medical School, Boston MA, USA; Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Roelstraete, Bjorn
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Microscopic Colitis and Risk Of Cancer-AA Population-Based Cohort Study2021Ingår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 15, nr 2, s. 212-221Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Aims: The association between microscopic colitis [MC] and cancer risk is unclear. Large, population-based studies are lacking.

    Methods: We conducted a nationwide cohort study of 11 758 patients with incident MC [diagnosed 1990-2016 in Sweden], 50 828 matched reference individuals, and 11 614 siblings to MC patients. Data were obtained through Sweden's pathology departments and from the Swedish Cancer Register. Adjusted hazard ratios [aHRs] were calculated using Cox proportional hazards models.

    Results: At the end of follow-up [mean: 6.7 years], 1239 [10.5%] of MC patients had received a cancer diagnosis, compared with 4815 [9.5%] of reference individuals (aHR 1.08 [95% confidence interval1.02-1.16]). The risk of cancer was highest during the first year of follow up. The absolute excess risks for cancer at 5, 10, and 20 years after MC diagnosis were + 1.0% (95% confidence interval [C1]0.4%-1.6%), +1.5% [0.4%-2.6%], and + 3.7% [-2.3-9.6%], respectively, equivalent to one extra cancer event in every 55 individuals with MC followed for 10 years. MC was associated with an increased risk of lymphoma (aHR 1.43 [1.06-1.92]) and lung cancer (aHR 1.32 [1.04-1.68]) but with decreased risks of colorectal (aHR 0.52 [0.40-0.66]) and gastrointestinal cancers (aHR 0.72 [0.60-0.85]). We found no association with breast or bladder cancer. Using siblings as reference group to minimise the impact of shared genetic and early environmental factors, patients with MC were still at an increased risk of cancer (HR 1.20 [1.06-1.36]).

    Conclusions: This nationwide cohort study demonstrated an 8% increased risk of cancer in MC patients. The risk was highest during the first year of follow-up.

  • 340.
    Bergman, David
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Brommaplans Primary Health Care Center, Stockholm County, Stockholm, Sweden.
    King, James
    Centre for health informatics, University of Calgary Cumming School of Medicine, Calgary Alberta, Canada.
    Lebwohl, Benjamin
    Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Clements, Mark S.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Roelstraete, Bjorn
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Kaplan, Gilaad G.
    Department of Medicine, University of Calgary, Calgary Alberta, Canada.
    Green, Peter Hr
    Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Murray, Joseph A.
    Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester Minnesota, USA.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Two waves of coeliac disease incidence in Sweden: a nationwide population-based cohort study from 1990 to 20152022Ingår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 71, nr 6, s. 1088-1094Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess the incidence of biopsy-verified coeliac disease (CD) in Sweden and examine the incidence of duodenal/jejunal biopsies with normal mucosa over time as a proxy for CD awareness and investigation.

    Design: Nationwide population-based cohort study 1990-2015 based on biopsy reports indicating villous atrophy (VA) or normal mucosa in the duodenum/jejunum.

    Results: We identified 44 771 individuals (63% females) with a biopsy report specifying VA and 412 279 (62% females) with a biopsy report indicating normal mucosa (without a prior biopsy indicating VA). The median age at diagnosis of CD was 28 years. The mean age-standardised incidence rate during the study period was 19.0 per 100 000 person-years (95% CI 17.3 to 20.8). The incidence reached a peak in 1994 for both sexes and a second higher peak in 2002-2003 for females and in 2006 for males. The lifetime risk of developing CD was 1.8% (2.3% in females and 1.4% in males). Prior to 2015, there was a parallel rise in rates for biopsies showing normal duodenal/jejunal mucosa.

    Conclusions: In Sweden, the incidence of CD increased until 2002-2003 in females and until 2006 in males. Since then, the incidence of CD has declined despite increasing duodenal/jejunal biopsies, suggesting that increased awareness and investigation are unlikely to elevate the incidence of the disease in Sweden. Across a lifetime, 1 in 44 females and 1 in 72 males are expected to be diagnosed with CD in Sweden, indicating a relatively high societal burden of disease.

  • 341.
    Bergman, Marie
    et al.
    Department of Oncology, Hospital of Karlstad, Karlstad, Sweden.
    Fountoukidis, Georgios
    Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Smith, Daniel
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ahlgren, Johan
    Regional Cancer Centre, Mid-Sweden Health Care Region, Uppsala, Sweden.
    Lambe, Mats
    Regional Cancer Centre, Mid-Sweden Health Care Region, Uppsala, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Valachis, Antonios
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Oncology.
    Effect of Smoking on Treatment Efficacy and Toxicity in Patients with Cancer: A Systematic Review and Meta-Analysis2022Ingår i: Cancers, ISSN 2072-6694, Vol. 14, nr 17, artikel-id 4117Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    AIM: The aim of the present systematic review and meta-analysis was to summarize the current evidence on the potential impact of smoking during cancer treatment on treatment efficacy and toxicity irrespective of cancer type.

    METHODS: A systematic literature search was performed using two electronic databases for potentially eligible studies. Only studies based on multivariable analysis for the association between smoking, compared to non-smokers (never or former), and treatment efficacy or toxicity were included. Pooled Hazard Ratios (HRs) or Odds Ratios (ORs) and corresponding 95% Confidence Intervals (CIs) were estimated through random-effects meta-analyses.

    RESULTS: In total, 97 eligible studies were identified, of which 79 were eligible for the pooled analyses. Smoking during radiation therapy, with or without chemotherapy, was associated with an increased risk of locoregional recurrence (pooled HR: 1.56; 95% CI: 1.28-1.91 for radiation therapy; pooled HR: 4.28; 95% CI: 2.06-8.90 for chemoradiotherapy) and worse disease-free survival (pooled HR: 1.88; 95% CI: 1.21-2.90 for radiation therapy; pooled HR: 1.92; 95% CI: 1.41-2.62 for chemoradiotherapy) as well as a higher risk for radiation-induced toxicity (pooled OR: 1.84; 95% CI: 1.32-2.56 for radiation therapy; pooled OR: 2.43; 95% CI: 1.43-4.07 for chemoradiotherapy) with low-to-moderate certainty of evidence. Smoking during treatment with EGFR tyrosine kinase inhibitors (EGFR-TKIs) in patients with lung cancer was associated with worse progression-free survival compared to non-smokers (pooled HR: 1.43; 95% CI: 1.14-1.80; moderate certainty of evidence), whereas smoking was associated with improved progression-free survival in patients treated with checkpoint inhibitors (HR: 0.70; 95% CI: 0.58-0.84; moderate certainty of evidence). No statistically significant associations were observed between smoking and treatment efficacy or toxicity to chemotherapy.

    CONCLUSION: The present meta-analysis confirms earlier evidence of the negative impact of smoking during radiation therapy, with or without chemotherapy, on treatment efficacy and radiation-induced toxicity as well as a negative impact of smoking on the efficacy of EGFR-TKIs and a positive impact on the efficacy of checkpoint inhibitors. The evidence is too weak to draw firm conclusions on the potential association between smoking and chemotherapy, whereas there is no evidence for pooled analyses regarding other types of systemic oncological therapy.

  • 342.
    Bergquist, Annika M.
    et al.
    Karolinska University Hospital, Department of Medicine Huddinge, Unit of Gastroenterology and Rheumatology, Huddinge, Sweden.
    Nyhlin, Nils
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Lenzen, Henrike
    Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany; University Hospital Essen, University of Duisburg-Essen, Department of Gastroenterology and Hepatology, Essen, Germany.
    Hepatobiliary malignancy surveillance strategies in primary sclerosing cholangitis associate with reduced mortality2021Ingår i: Journal of Hepatology, ISSN 0168-8278, E-ISSN 1600-0641, Vol. 75, nr Suppl. 2, s. S227-S228Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background and aims: Patients with primary sclerosing cholangitis (PSC) are at increased risk for hepatobiliary malignancies, especially cholangiocarcinoma. Although many recommend surveillance for malignancy in PSC, different strategies are used by various centers and countries. We aimed to evaluate different surveillance strategies and their effectiveness in PSC with the hypothesis that surveillance imaging improves survival.

    Method: We queried centers about surveillance practices and retrospectively collected imaging surveillance data for hepatobiliary cancer in 2, 975 patients with PSC from 28 centers within the International PSC Study Group (IPSCSG). Surveillance strategies were grouped in (i) non-surveillance (no imaging in asymptomatic patients), (ii) magnetic resonance imaging (MRI) and/or ultrasound (US) surveillance (regular imaging regardless of symptoms/labs) and (iii) surveillance including endoscopic retrograde cholangiopancreatography (ERCP)-based (imaging and/or ERCP regardless of symptoms/labs). The primary end point was all-cause mortality. Cox-proportional hazard regression models were used to estimate hazard ratios (HRs).

    Results: 65.6% (1953/2975) of patients were male, mean age (SD) at diagnosis of PSC was 35.6 (14.2) years, with concomitant IBD in 71.5% (2127/2973). Hepatobiliary malignancy was found in 175 (5.9%) patients at 7.9 years of follow-up (Figure). Surveillance strategies differed significantly between centers. Of patients undergoing surveillance, 83% were subjected to MRI/MRCP, 49% to US and 28% to ERCP. Deaths were more frequent in the non-surveillance group 23.4% (82/350) than in the surveillance group 8.3% (218/2625). Mortality rate (95% CI) per 1000 person-years was 23.1 (18.1–28.1) inthe non-surveillance group (n = 350), 12.5 (10.6–14.5) in imaging surveillance with MRI and/or US (n = 1897) and 8.4 (6.3–10.5) in surveillance that included ERCP (n = 728). The risk of dying wasr educed in patients undergoing any type of surveillance (HR 0.53; 95% CI: 0.41–0.68) and the reduced risk remained after adjusting for sex, age and start year of follow-up (HR 0.61; 95% CI: 0.47–0.80).

    Conclusion: A broad variety of surveillance strategies across centers are used. Regular sur veillance for hepatobiliary malignancy in patients with PSC is associated with improved survival.

  • 343.
    Bergquist, Annika
    et al.
    Department of Medicine Huddinge, Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; European Reference Network for Hepatological Diseases, Stockholm, Sweden.
    Weismüller, Tobias J.
    Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Bonn, Germany.
    Levy, Cynthia
    Division of Digestive Health and Liver Diseases, University of Miami, Miami, FL, USA; Schiff Center for Liver Diseases, University of Miami, Miami, FL, USA.
    Rupp, Christian
    Department of Gastroenterology, Infectious Diseases, Intoxication, Heidelberg University Hospital, Heidelberg, Germany.
    Joshi, Deepak
    Institute of Liver Studies, King's College Hospital London, United Kingdom.
    Nayagam, Jeremy Shanika
    Institute of Liver Studies, King's College Hospital London, United Kingdom.
    Montano-Loza, Aldo J.
    Division of Gastroenterology and Liver Unit, Department of Medicine, University of Alberta, Edmonton, Canada.
    Lytvyak, Ellina
    Division of Gastroenterology and Liver Unit, Department of Medicine, University of Alberta, Edmonton, Canada.
    Wunsch, Ewa
    Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland.
    Milkiewicz, Piotr
    Translational Medicine Group, Pomeranian Medical University in Szczecin, Szczecin, Poland; Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland .
    Zenouzi, Roman
    Department of Medicine and Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Schramm, Christoph
    Department of Medicine and Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Cazzagon, Nora
    Department of Surgery, Oncology and Gastroenterology, University of Padova, , Padova, Italy and European Reference Network on Hepatological Disease, European Reference Network for Hepatological Diseases, Azienda Ospedaliera-Università di Padova, Padova, Italy.
    Floreani, Annarosa
    Studiosa Senior University of Padova, Italy and Scientific Consultant IRCCS Negrar, Verona, Italy.
    Friis Liby, Ingalill
    Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Wiestler, Miriam
    Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; European Reference Network for Hepatological Diseases, Hannover, Germany.
    Wedemeyer, Heiner
    Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; European Reference Network for Hepatological Diseases, Hannover, Germany.
    Zhou, Taotao
    Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Bonn, Germany.
    Strassburg, Christian P.
    Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Bonn, Germany.
    Rigopoulou, Eirini
    Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.
    Dalekos, George
    Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.
    Narasimman, Manasa
    Schiff Center for Liver Diseases, University of Miami, Miami, FL, USA.
    Verhelst, Xavier
    Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium, Ghent Liver Research Center, Ghent University, Belgium; European Reference Network for Hepatological Diseases, Ghent, Belgium.
    Degroote, Helena
    Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium, Ghent Liver Research Center, Ghent University, Belgium; European Reference Network for Hepatological Diseases, Ghent, Belgium.
    Vesterhus, Mette
    Norwegian PSC Research Centre, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.
    Kremer, Andreas E
    Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany; Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
    Bündgens, Bennet
    Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
    Rorsman, Fredrik
    Department of Gastroenterology and Hepatology, University Hospital, Uppsala, Sweden.
    Nilsson, Emma
    Department of Clinical Sciences, Lund University, Lund, Sweden; Gastroenterology Clinic, Skåne University Hospital, Sweden.
    Jørgensen, Kristin Kaasen
    Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.
    von Seth, Erik
    Department of Medicine Huddinge, Unit of Gastroenterology and Rheumatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; European Reference Network for Hepatological Diseases, Stockholm, Sweden.
    Cornillet, Martin
    Department of Medicine Huddinge, Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Nyhlin, Nils
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Martin, Harry
    Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, UK.
    Kechagias, Stergios
    Department of Health, Medicine and Caring Sciences, Unit of Internal Medicine, Linköping University, Linköping, Sweden.
    Wiencke, Kristine
    Norwegian PSC Research Centre, Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.
    Werner, Mårten
    Department of Public Health and clinical medicine, Umeå University, Umeå, Sweden.
    Terziroli Beretta-Piccoli, Benedetta
    Epatocentro Ticino, Università della Svizzera Italiana, Lugano, Switzerland.
    Marzioni, Marco
    Clinic of Gastroenterology and Hepatology, Università Politecnica delle Marche, Ospedali Riuniti - University Hospital, Ancona, Italy.
    Isoniemi, Helena
    Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.
    Arola, Johanna
    Department of Pathology and Huslab, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Wefer, Agnes
    Division of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Söderling, Jonas
    Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Färkkilä, Martti
    University of Helsinki and Helsinki University Hospital, Clinic of Gastroenterology, Abdominal Center, Helsinki, Finland.
    Lenzen, Henrike
    Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; European Reference Network for Hepatological Diseases, Hannover, Germany; Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany .
    Impact on follow-up strategies in patients with primary sclerosing cholangitis2023Ingår i: Liver international (Print), ISSN 1478-3223, E-ISSN 1478-3231, Vol. 43, nr 1, s. 127-138Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND & AIMS: Evidence for the benefit of scheduled imaging for early detection of hepatobiliary malignancies in primary sclerosing cholangitis (PSC) is limited. We aimed to compare different follow-up strategies in PSC with the hypothesis that regular imaging improves survival.

    METHODS: We collected retrospective data from 2,975 PSC patients from 27 centers. Patients were followed from the start of scheduled imaging or in case of clinical follow-up from January 1, 2000, until death or last clinical follow-up alive. The primary endpoint was all-cause mortality.

    RESULTS: A broad variety of different follow-up strategies were reported. All except one center used regular imaging, ultrasound (US) and/or magnetic resonance imaging (MRI). Two centers used scheduled ERCP in addition to imaging for surveillance purposes. The overall HR (CI95%) for death, adjusted for sex, age and start year of follow-up, were 0.61 (0.47-0.80) for scheduled imaging with and without ERCP; 0.64 (0.48-0.86) for US/MRI and 0.53 (0.37-0.75) for follow-up strategies including scheduled ERCP. The lower risk of death remained for scheduled imaging with and without ERCP after adjustment for cholangiocarcinoma (CCA) or high-grade dysplasia as a time-dependent covariate, HR 0.57 (0.44-0.75). Hepatobiliary malignancy was diagnosed in 175 (5.9%) of the patients at 7.9 years follow-up. Asymptomatic patients (25%) with CCA had better survival if scheduled imaging had been performed.

    CONCLUSIONS: Follow-up strategies vary considerably across centers. Scheduled imaging was associated with improved survival. Multiple factors may contribute to this result including early tumor detection and increased endoscopic treatment of asymptomatic benign biliary strictures.

  • 344.
    Bergqvist, Erik
    et al.
    Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden; Psychiatric In-Patient Clinic, Hallands Sjukhus Varberg, Region Halland, Varberg, Sweden.
    Probert-Lindström, Sara
    Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden.
    Fröding, Elin
    School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden; Region Jönköpings Län, Jönköping, Sweden.
    Palmqvist-Öberg, Nina
    Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden.
    Ehnvall, Anna
    Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Psychiatric Out-Patient Clinic, Region Halland, Varberg, Sweden.
    Sunnqvist, Charlotta
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.
    Sellin, Tabita
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. University Health Care Research Center.
    Vaez, Marjan
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Waern, Margda
    Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; Psychosis Clinic, Sahlgrenska University Hospital, Region Västra Götaland, Mölndal, Sweden.
    Westrin, Åsa
    Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden; Office of Psychiatry and Habilitation, Region Skåne, Lund, Sweden.
    Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records2022Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, nr 1, artikel-id 664Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences.

    METHODS: Design: A retrospective explorative study with a medical record review covering the two years preceding suicide.

    SETTING: All health care units located in 20 of Sweden's 21 regions.

    PARTICIPANTS: All individuals residing in participating regions who died by suicide during 2015 (n = 949).

    RESULTS: Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (≥ 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide.

    CONCLUSION: Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.

  • 345.
    Bergström, Hannah
    et al.
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Larsson, Lars-Göran
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Audio-video recording during laparoscopic surgery reduces irrelevant conversation between surgeons: a cohort study2018Ingår i: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 18, nr 1, artikel-id 92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The prevalence of perioperative surgical complications is a worldwide issue: In many cases, these events are preventable. Audio-video recording during laparoscopic surgery provides useful information for the purposes of education and event analyses, and may have an impact on the focus of the surgeons operating. The aim of the present study was to investigate how audio-video recording in the operating room during laparoscopic surgery affects the focus of the surgeon and his/her assistant.

    METHODS: A group of laparoscopic procedures where video recording only was performed was compared to a group where both audio and video recordings were made. All laparoscopic procedures were performed at Lindesberg Hospital, Sweden, during the period August to September 2017. The primary outcome was conversation not relevant to the ongoing procedure. Secondary outcomes were intra- and postoperative adverse events or complications, operation time and number of times the assistant was corrected by the surgeon.

    RESULTS: The study included 41 procedures, 20 in the video only group and 21 in the audio-video group. The material comprised laparoscopic cholecystectomies, totally extraperitoneal inguinal hernia repairs and bariatric surgical procedures. Irrelevant conversation time fell from 4.2% of surgical time to 1.4% when both audio and video recordings were made (p = 0.002). No differences in perioperative adverse event or complication rates were seen.

    CONCLUSION: Audio-video recording during laparoscopic abdominal surgery reduces irrelevant conversation time and may improve intraoperative safety and surgical outcome.

    TRIAL REGISTRATION: Available at FOU Sweden (ID: 232771) and retrospectively at Clinical trials.gov (ID: NCT03425175 ; date of registration 7/2 2018).

  • 346.
    Berçot, Béatrice
    et al.
    Université Paris Cité, INSERM, IAME, Paris, France; APHP, Infectious Agents Department, Saint Louis Hospital, Paris, France; French National Reference Centre for bacterial STIs, Associated Laboratory for Gonococci, Paris, France.
    Caméléna, François
    Université Paris Cité, INSERM, IAME, Paris, France; APHP, Infectious Agents Department, Saint Louis Hospital, Paris, France; French National Reference Centre for bacterial STIs, Associated Laboratory for Gonococci, Paris, France.
    Mérimèche, Manel
    Université Paris Cité, INSERM, IAME, Paris, France; APHP, Infectious Agents Department, Saint Louis Hospital, Paris, France; French National Reference Centre for bacterial STIs, Associated Laboratory for Gonococci, Paris, France.
    Jacobsson, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Ӧrebro University, Ӧrebro, Sweden.
    Sbaa, Ghalia
    APHP, Infectious Agents Department, Saint Louis Hospital, Paris, France; French National Reference Centre for bacterial STIs, Associated Laboratory for Gonococci, Paris, France.
    Mainardis, Mary
    APHP, Infectious Agents Department, Saint Louis Hospital, Paris, France; French National Reference Centre for bacterial STIs, Associated Laboratory for Gonococci, Paris, France.
    Valin, Cyrille
    Laboratoire Anse, Biogroup, Lyon, France.
    Molina, Jean-Michel
    AP-HP, Hôpital Saint-Louis, Lariboisière, Département de Maladies Infectieuses et Tropicales, Paris, France; Université Paris Cité, UMR S976, INSERM, Paris, France.
    Bébéar, Cécile
    University of Bordeaux, USC EA 3671, Mycoplasmal and Chlamydial Infections in Humans, Bordeaux University Hospital, French National Reference Centre for Bacterial STIs, Bordeaux, France.
    Chazelle, Emilie
    Santé Publique France, French National Public Health Agency, Saint-Maurice, France.
    Lot, Florence
    Santé Publique France, French National Public Health Agency, Saint-Maurice, France.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Ӧrebro University, Ӧrebro, Sweden.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Ӧrebro University, Ӧrebro, Sweden; Institute for Global Health, University College London, London, United Kingdom .
    Ceftriaxone-resistant, multidrug-resistant Neisseria gonorrhoeae with a novel mosaic penA-237.001 gene, France, June 20222022Ingår i: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 27, nr 50, s. 17-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We report a ceftriaxone-resistant, multidrug-resistant urogenital gonorrhoea case in a heterosexual woman in France, June 2022. The woman was successfully treated with azithromycin 2 g. She had unprotected sex with her regular partner, who developed urethritis following travel to Vietnam and Switzerland. Whole genome sequencing of the gonococcal isolate (F92) identified MLST ST1901, NG-STAR CC- 199, and the novel mosaic penA-237.001, which caused ceftriaxone resistance. penA-237.001 is 98.7% identical to penA-60.001, reported in various ceftriaxone-resistant strains, including the internationally spreading FC428 clone.

  • 347.
    Bettoni, Serena
    et al.
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Maziarz, Karolina
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Stone, M. Rhia L.
    Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane QLD, Australia.
    Blaskovich, Mark A. T.
    Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane QLD, Australia.
    Potempa, Jan
    Faculty of Biochemistry, Biophysics and Biotechnology, Jagiel- lonian University, Krakow, Poland. Department of Oral Immunity and Infectious Diseases, University of Louisville School of Dentistry, Louisville KY, United States.
    Bazzo, Maria Luiza
    Molecular Biology, Microbiology and Serology Laboratory, Federal University of Santa Catarina, Florianopolis, Brazil.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization (WHO) Collaborating Centre for Gonorrhoea and other STIs.
    Ram, Sanjay
    Department of Medicine, Division of Infectious Diseases, Univer- sity of Massachusetts Medical School, Worcester MA, United States.
    Blom, Anna M.
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Serum complement activation by C4BP-IgM fusion protein can restore susceptibility to antibiotics in Neisseria gonorrhoeae2022Ingår i: Molecular Immunology, ISSN 0161-5890, E-ISSN 1872-9142, Vol. 141, s. 215-215Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background: The sexually transmitted infection gonorrhea is a common health problem worldwide causing critical reproductive sequelae such as infertility. An effective vaccine remains elusive and antibiotics used in clinics are becoming ineffective because of the rapid spread of resistance among Neisseria gonorrhoeae, the causative organism of gonorrhea. We previously created a human fusion protein called C4BP-IgM to mark and eliminate bacteria by activating host complement. C4BP-IgM links the two N-terminal domains of C4BP, which bind to gonococci, with the Fc domain of IgM to increase complement activation on and kill bacteria. We documented that C4BP-IgM enhances bactericidal activity of serum against clinical C4BP-binding gonococcal isolates from patients, and markedly attenuated the duration and burden of gonococcal infection in a mouse vaginal colonizationmodel 1. Here, we explore the activity of C4BP-IgM as an adjuvant to several antibiotics (spectinomycin, azithromycin, cefixime, ceftriaxone and ciprofloxacin) currently or previously used to treat gonorrhea.

    Materials and methods: Cooperative bactericidal activity between C4BP-IgM, complement and antibiotics was evaluated by monitoring survival and membrane alterations of a laboratory isolate and two clinical azithromycin-resistant gonococcal strains, which also resisted killing by normal human serum. Effect of complement and C4BP-IgM on uptake and intracellular activity of selected antibiotics was also assessed.

    Results: We found that human serum, as source of complement components, reduced MIC values of antibiotics against N. gonorrhoeae. Addition of C4BP-IgM at concentrations which only partially reduced survival, induced complete killing of bacteria when both serum and antibiotics were present. Bactericidal cooperation between complement and antimicrobials was revealed to be triggered by membrane damage induced by C4BP-IgM complement activation. Formation of membrane attack complex pores on bacteria facilitated uptake of antimicrobials, which in turn enhanced their intracellular concentration and activity. Remarkably, C4BP-IgM restored susceptibility to azithromycin of two azithromycin-resistant clinical gonococcal strains that overexpressed the MtrC-MtrD-MtrE efflux pump.

    Conclusion: We provide proof-of-principle for the use of C4BP-IgM fusion protein as an adjuvant to antibiotics, which could be re-purposed for clinical use pending the development of effective new treatments.

  • 348.
    Bettoni, Serena
    et al.
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Maziarz, Karolina
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Stone, M. Rhia L.
    Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
    Blaskovich, Mark A. T.
    Centre for Superbug Solutions, Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia.
    Potempa, Jan
    Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland; Department of Oral Immunity and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States.
    Bazzo, Maria Luiza
    Molecular Biology, Microbiology and Serology Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization (WHO) Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine.
    Ram, Sanjay
    Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, MA, United States.
    Blom, Anna M.
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Serum Complement Activation by C4BP-IgM Fusion Protein Can Restore Susceptibility to Antibiotics in Neisseria gonorrhoeae2021Ingår i: Frontiers in Immunology, E-ISSN 1664-3224, Vol. 12, artikel-id 726801Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Neisseria gonorrhoeae is the etiological agent of gonorrhea, the second most common bacterial sexually transmitted infection worldwide. Reproductive sequelae of gonorrhea include infertility, ectopic pregnancy and chronic pelvic pain. Most antibiotics currently in clinical use have been rendered ineffective due to the rapid spread of antimicrobial resistance among gonococci. The developmental pipeline of new antibiotics is sparse and novel therapeutic approaches are urgently needed. Previously, we utilized the ability of N. gonorrhoeae to bind the complement inhibitor C4b-binding protein (C4BP) to evade killing by human complement to design a chimeric protein that linked the two N-terminal gonococcal binding domains of C4BP with the Fc domain of IgM. The resulting molecule, C4BP-IgM, enhanced complement-mediated killing of gonococci. Here we show that C4BP-IgM induced membrane perturbation through complement deposition and membrane attack complex pore insertion facilitates the access of antibiotics to their intracellular targets. Consequently, bacteria become more susceptible to killing by antibiotics. Remarkably, C4BP-IgM restored susceptibility to azithromycin of two azithromycin-resistant clinical gonococcal strains because of overexpression of the MtrC-MtrD-MtrE efflux pump. Our data show that complement activation can potentiate activity of antibiotics and suggest a role for C4BP-IgM as an adjuvant for antibiotic treatment of drug-resistant gonorrhea.

  • 349.
    Bettoni, Serena
    et al.
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Shaughnessy, Jutamas
    Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
    Maziarz, Karolina
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Ermert, David
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Gulati, Sunita
    Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
    Zheng, Bo
    Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
    Mörgelin, Matthias
    Colzyx, Lund, Sweden.
    Jacobsson, Susanne
    World Health Organization (WHO) Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Örebro University, Örebro, Sweden.
    Riesbeck, Kristian
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization (WHO) Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine.
    Ram, Sanjay
    Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
    Blom, Anna M.
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    C4BP-IgM protein as a therapeutic approach to treat Neisseria gonorrhoeae infections2019Ingår i: JCI Insight, ISSN 2379-3708, Vol. 4, nr 23, artikel-id 131886Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Gonorrhea is a sexually transmitted infection with 87 million new cases per year globally. Increasing antibiotic resistance has severely limited treatment options. A mechanism that Neisseria gonorrhoeae uses to evade complement attack is binding of the complement inhibitor C4b-binding protein (C4BP). We screened 107 porin B1a (PorB1a) and 83 PorB1b clinical isolates randomly selected from a Swedish strain collection over the last 10 years and noted that 96/107 (89.7%) PorB1a and 16/83 (19.3%) PorB1b bound C4BP; C4BP binding substantially correlated with the ability to evade complement-dependent killing (r = 0.78). We designed 2 chimeric proteins that fused C4BP domains to the backbone of IgG or IgM (C4BP-IgG; C4BP-IgM) with the aim of enhancing complement activation and killing of gonococci. Both proteins bound gonococci (KD C4BP-IgM = 2.4 nM; KD C4BP-IgG 980.7 nM), but only hexameric C4BP-IgM efficiently outcompeted heptameric C4BP from the bacterial surface, resulting in enhanced complement deposition and bacterial killing. Furthermore, C4BP-IgM substantially attenuated the duration and burden of colonization of 2 C4BP-binding gonococcal isolates but not a non-C4BP-binding strain in a mouse vaginal colonization model using human factor H/C4BP-transgenic mice. Our preclinical data present C4BP-IgM as an adjunct to conventional antimicrobials for the treatment of gonorrhea.

  • 350.
    Bettoni, Serena
    et al.
    Lund University - Department of Translational Medicine, Malmö, Sweden.
    Shaughnessy, Jutamas
    Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, USA.
    Maziarz, Karolina
    Lund University - Department of Translational Medicine, Malmö, Sweden.
    Ermert, David
    Lund University - Department of Translational Medicine, Malmö, Sweden.
    Jacobsson, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine.
    Riesbeck, Kristian
    Lund University - Department of Translational Medicine, Malmö, Sweden.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. WHO Collaborating Centre for Gonorrhoea and Other STIs, National Reference Laboratory for STIs, Department of Laboratory Medicine.
    Blom, Anna
    Lund University - Department of Translational Medicine, Malmö, Sweden.
    Ram, Sanjay
    Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, USA.
    C4BP-IGM FUSION PROTEIN AS A NOVEL THERAPEUTIC APPROACH TO TREAT NEISSERIA GONORRHOEAE INFECTIONS2019Ingår i: Molecular Immunology, ISSN 0161-5890, E-ISSN 1872-9142, Vol. 114, s. 470-470Artikel i tidskrift (Övrigt vetenskapligt)
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