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  • Naumann, Marcel
    et al.
    Peikert, Kevin
    Guenther, Rene
    van der Kooi, Anneke J.
    Aronica, Eleonora
    Huebers, Annemarie
    Danel, Veronique
    Corcia, Philippe
    Pan-Montojo, Francisco
    Cirak, Sebahattin
    Haliloglu, Goeknur
    Ludolph, Albert C.
    Goswami, Anand
    Andersen, Peter M.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Prudlo, Johannes
    Wegner, Florian
    Van Damme, Philip
    Weishaupt, Jochen H.
    Hermann, Andreas
    Phenotypes and malignancy risk of different FUS mutations in genetic amyotrophic lateral sclerosis2019In: Annals of clinical and translational neurology, E-ISSN 2328-9503Article in journal (Refereed)
    Abstract [en]

    Objective Mutations in Fused in Sarcoma (FUS or TLS) are the fourth most prevalent in Western European familial amyotrophic lateral sclerosis (ALS) populations and have been associated with causing both early and very late disease onset. FUS aggregation, DNA repair deficiency, and genomic instability are contributors to the pathophysiology of FUS-ALS, but their clinical significance per se and their influence on the clinical variability have yet to be sufficiently investigated. The aim of this study was to analyze genotype-phenotype correlations and malignancy rates in a newly compiled FUS-ALS cohort. Methods We cross-sectionally reviewed FUS-ALS patient histories in a multicenter cohort with 36 novel cases and did a meta-analysis of published FUS-ALS cases reporting the largest genotype-phenotype correlation of FUS-ALS. Results The age of onset (median 39 years, range 11-80) was positively correlated with the disease duration. C-terminal domain mutations were found in 90%. Among all, P525L and truncating/ frameshift mutations most frequently caused juvenile onset, rapid disease progression, and atypical ALS often associated with negative family history while the R521 mutation site was associated with late disease onset and pure spinal phenotype. Malignancies were found in one of 40 patients. Interpretation We report the largest genotype-phenotype correlation of FUS-ALS, which enables a careful prediction of the clinical course in newly diagnosed patients. In this cohort, FUS-ALS patients did not have an increased risk for malignant diseases.

  • D'Ambruoso, Lucia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa .
    van der Merwe, Maria
    Wariri, Oghenebrume
    Byass, Peter
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa.
    Goosen, Gerhard
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Masinga, Sparara
    Mokoena, Victoria
    Spies, Barry
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Witter, Sophie
    Twine, Rhian
    Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa2019In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 34, no 6, p. 418-429Article in journal (Refereed)
    Abstract [en]

    Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating 'in the dark' in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.

  • Sondell, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Littbrand, Håkan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation Among Older People with Dementia in Nursing Homes?2019In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 23, no 10, p. 1011-1020Article in journal (Refereed)
    Abstract [en]

    Background and Objectives: Exercise can be an important way of maintaining balance function in people with dementia, but further investigation is needed to determine the optimal way of exercising. The objective was to evaluate whether exercise applicability (i.e., attendance, exercise intensity, and adverse events) and motivation were associated with the effect on functional balance of a high-intensity functional exercise program for older people with dementia in nursing homes.

    Design, Setting and Participants: Exercise intervention participants (n = 81; 60 women, 21 men) from a randomized controlled trial (UMDEX) were included. Their mean age was 84 and mean Mini-Mental State Examination score was 15.

    Intervention: Groups of 3–8 participants participated in the High-Intensity Functional Exercise (HIFE) Program, with 5 sessions per 2-week period, for 4 months (total, 40 sessions).

    Measurements: Outcome was the Berg Balance Scale (BBS), assessed at baseline and follow up, and the score difference, dichotomized to classify participants into two groups: responders (≥5-point increase) and non-responders (<5-point increase). Target variables were measures of applicability and motivation. Associations between each target variable and the outcome were analyzed using multivariable logistic regression. Baseline characteristics and new medical conditions developing during the intervention period were compared between responders and non-responders and included in the analyses when p < 0.10.

    Results: The BBS score was 28.6 ± 14.3 at baseline and 31.2 ± 15.3 at follow up, with the difference between follow-up and baseline scores ranging from −35 to 24. Twenty-nine (35.8%) participants were responders. The multivariable models showed no significant association between responders vs. non-responders and any target variable.

    Conclusion: Participation in a 4-month high-intensity functional exercise program can improve balance in many individuals with dementia in nursing homes, despite the progressiveness of dementia disorders and several co-existing medical conditions. Predicting balance exercise response based on applicability and motivation seem not to be possible, which lends no support for excluding this group from functional exercise, even when exercise intensity or motivation is not high.

  • Aasa, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Bengtsson, Victor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Berglund, Lars
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Sports Medicine.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Variability of lumbar spinal alignment among power- and weightlifters during the deadlift and barbell back squat2019In: Sports Biomechanics, ISSN 1476-3141, E-ISSN 1752-6116Article in journal (Refereed)
    Abstract [en]

    The aims of the study were to evaluate the relative and absolute variability of upper (T11-L2) and lower (L2-S2) lumbar spinal alignment in power- and weightlifters during the deadlift and back squat exercises, and to compare this alignment between the two lifting groups. Twenty-four competitive powerlifters (n = 14) and weightlifters (n = 10) performed three repetitions of the deadlift and the back squat exercises using a load equivalent to 70% of their respective one-repetition maximum. The main outcome measures were the three-dimensional lumbar spinal alignment for start position, minimum and maximum angle of their spinal alignment, and range of motion measured using inertial measurement units. Relative intra-trial reliability was calculated using the two-way random model intraclass correlation coefficient (ICC) and absolute reliability with minimal detectable change (MDC). The ICC ranged between 0.69 and 0.99 and the MDC between 1 degrees-8 degrees for the deadlift. Corresponding figures for the squat were 0.78-0.99 and 1 degrees-6 degrees. In all participants during both exercises, spinal adjustments were made in both thoracolumbar and lumbopelvic areas in all three dimensions. In conclusion, when performing three repetitions of the deadlift and the squat, lumbar spinal alignment of the lifters did not change much between repetitions and did not differ significantly between power- and weightlifters.

  • Zhu, Shaochun
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wuolikainen, Anna
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Wu, Junfang
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Öhman, Anders
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Wingsle, Gunnar
    Moritz, Thomas
    Andersen, Peter M.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Forsgren, Lars
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Trupp, Miles
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Targeted Multiple Reaction Monitoring Analysis of CSF Identifies UCHL1 and GPNMB as Candidate Biomarkers for ALS2019In: Journal of Molecular Neuroscience, ISSN 0895-8696, E-ISSN 1559-1166, Vol. 69, no 4, p. 643-657Article in journal (Refereed)
    Abstract [en]

    The neurodegenerative diseases amyotrophic lateral sclerosis (ALS) and Parkinson's disease (PD) share some common molecular deficits including disruption of protein homeostasis leading to disease-specific protein aggregation. While insoluble protein aggregates are the defining pathological confirmation of diagnosis, patient stratification based on early molecular etiologies may identify distinct subgroups within a clinical diagnosis that would respond differently in therapeutic development programs. We are developing targeted multiple reaction monitoring (MRM) mass spectrometry methods to rigorously quantify CSF proteins from known disease genes involved in lysosomal, ubiquitin-proteasomal, and autophagy pathways. Analysis of CSF from 21 PD, 21 ALS, and 25 control patients, rigorously matched for gender, age, and age of sample, revealed significant changes in peptide levels between PD, ALS, and control. In patients with PD, levels of two peptides for chromogranin B (CHGB, secretogranin 1) were significantly reduced. In CSF of patients with ALS, levels of two peptides from ubiquitin carboxy-terminal hydrolase like protein 1 (UCHL1) and one peptide each for glycoprotein non-metastatic melanoma protein B (GPNMB) and cathepsin D (CTSD) were all increased. Analysis of patients with ALS separated into two groups based on length of survival after CSF sampling revealed that the increases in GPNMB and UCHL1 were specific for short-lived ALS patients. While analysis of additional cohorts is required to validate these candidate biomarkers, this study suggests methods for stratification of ALS patients for clinical trials and identifies targets for drug efficacy measurements during therapeutic development.

  • Nydahl, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Andersson, Staffan
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Åstrand, Anders P.
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Olofsson, Thomas
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Including future climate induced cost when assessing building refurbishment performance2019In: Energy and Buildings, ISSN 0378-7788, E-ISSN 1872-6178, Vol. 203, article id UNSP 109428Article in journal (Refereed)
    Abstract [en]

    Improving energy efficiency in the existing buildings stock is essential to limit climate change and the economic assessment of measures are traditionally only based on the reduction of energy costs: However, future financial benefits of limiting climate change are rarely included in the evaluation of refurbishment investments. Although, the costs associated with global warming are expected to be extensive. This study introduces a method for the financial evaluation of energy efficiency investments that merge the reduction of life cycle energy costs with the reduction of future climate induced costs. A case study is used to exemplify the method. The case study shows that when reduced future costs due to mitigated life cycle greenhouse gas emissions are included in the analysis, the ranking between different measures can change and traditionally non-profitable measures may become financially sound investments. The introduced Economy+ indicator is shown to be an accessible performance measure to assess building refurbishment and may also be used in the design stage of new construction. (C) 2019 The Authors. Published by Elsevier B.V.

  • Zhang, Bo
    et al.
    Umeå University, Faculty of Science and Technology, Department of Plant Physiology. Umeå University, Faculty of Science and Technology, Umeå Plant Science Centre (UPSC).
    Sztojka, Bernadette
    Umeå University, Faculty of Science and Technology, Umeå Plant Science Centre (UPSC). Umeå University, Faculty of Science and Technology, Department of Plant Physiology.
    Escamez, Sacha
    Umeå University, Faculty of Science and Technology, Department of Plant Physiology. Umeå University, Faculty of Science and Technology, Umeå Plant Science Centre (UPSC).
    Vanholme, Ruben
    Hedenström, Mattias
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Wang, Yin
    Umeå University, Faculty of Science and Technology, Department of Plant Physiology. Umeå University, Faculty of Science and Technology, Umeå Plant Science Centre (UPSC).
    Gorzsás, András
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Boerjan, Wout
    Tuominen, Hannele
    Umeå University, Faculty of Science and Technology, Umeå Plant Science Centre (UPSC). Umeå University, Faculty of Science and Technology, Department of Plant Physiology.
    PIRIN2 suppresses S-type lignin accumulation in a noncell-autonomous manner in Arabidopsis xylem elements2019In: New Phytologist, ISSN 0028-646X, E-ISSN 1469-8137Article in journal (Refereed)
    Abstract [en]
    • PIRIN (PRN) genes encode cupin domain‐containing proteins that function as transcriptional co‐regulators in humans but that are poorly described in plants. A previous study in xylogenic cell cultures of Zinnia elegans suggested a role for a PRN protein in lignification. This study aimed to identify the function of Arabidopsis (Arabidopsis thaliana) PRN proteins in lignification of xylem tissues.
    • Chemical composition of the secondary cell walls was analysed in Arabidopsis stems and/or hypocotyls by pyrolysis–gas chromatography/mass spectrometry, 2D‐nuclear magnetic resonance and phenolic profiling. Secondary cell walls of individual xylem elements were chemotyped by Fourier transform infrared and Raman microspectroscopy.
    • Arabidopsis PRN2 suppressed accumulation of S‐type lignin in Arabidopsis stems and hypocotyls. PRN2 promoter activity and PRN2:GFP fusion protein were localised specifically in cells next to the vessel elements, suggesting a role for PRN2 in noncell‐autonomous lignification of xylem vessels. Accordingly, PRN2 modulated lignin chemistry in the secondary cell walls of the neighbouring vessel elements.
    • These results indicate that PRN2 suppresses S‐type lignin accumulation in the neighbourhood of xylem vessels to bestow G‐type enriched lignin composition on the secondary cell walls of the vessel elements. Gene expression analyses suggested that PRN2 function is mediated by regulation of the expression of the lignin‐biosynthetic genes.
  • Karalija, Nina
    et al.
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Wåhlin, Anders
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Ek, Jesper
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Rieckmann, Anna
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Papenberg, Goran
    Salami, Alireza
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Aging Research Center, Karolinska Institutet & Stockholm University, Tomtebodavägen 18A,S-17165, Stockholm, Sweden.
    Brandmaier, Andreas M.
    Köhncke, Ylva
    Johansson, Jarkko
    Andersson, Micael
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Axelsson, Jan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Orädd, Greger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Lövdén, Martin
    Lindenberger, Ulman
    Bäckman, Lars
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Cardiovascular factors are related to dopamine integrity and cognition in aging2019In: Annals of clinical and translational neurology, E-ISSN 2328-9503, Vol. 6, no 11, p. 2291-2303Article in journal (Refereed)
    Abstract [en]

    Objective: The aging brain undergoes several changes, including reduced vascular, structural, and dopamine (DA) system integrity. Such brain changes have been associated with age‐related cognitive deficits. However, their relative importance, interrelations, and links to risk factors remain elusive.

    Methods: The present work used magnetic resonance imaging and positron emission tomography with 11C‐raclopride to jointly examine vascular parameters (white‐matter lesions and perfusion), DA D2‐receptor availability, brain structure, and cognitive performance in healthy older adults (n = 181, age: 64–68 years) from the Cognition, Brain, and Aging (COBRA) study.

    Results: Covariance was found among several brain indicators, where top predictors of cognitive performance included caudate and hippocampal integrity (D2DR availability and volumes), and cortical blood flow and regional volumes. White‐matter lesion burden was negatively correlated with caudate DA D2‐receptor availability and white‐matter microstructure. Compared to individuals with smaller lesions, individuals with confluent lesions (exceeding 20 mm in diameter) had reductions in cortical and hippocampal perfusion, striatal and hippocampal D2‐receptor availability, white‐matter microstructure, and reduced performance on tests of episodic memory, sequence learning, and processing speed. Higher cardiovascular risk as assessed by treatment for hypertension, systolic blood pressure, overweight, and smoking was associated with lower frontal cortical perfusion, lower putaminal D2DR availability, smaller grey‐matter volumes, a larger number of white‐matter lesions, and lower episodic memory performance.

    Interpretation: Taken together, these findings suggest that reduced cardiovascular health is associated with poorer status for brain variables that are central to age‐sensitive cognitive functions, with emphasis on DA integrity.

  • Kockum, Karin
    et al.
    Virhammar, Johan
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Söderström, Lars
    Larsson, Elna-Marie
    Laurell, Katarina
    Standardized image evaluation in patients with idiopathic normal pressure hydrocephalus: consistency and reproducibility2019In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 61, no 12, p. 1397-1406Article in journal (Refereed)
    Abstract [en]

    Purpose: Assess the agreement for two investigators between computed tomography (CT) and magnetic resonance imaging (MRI) for seven imaging features included in the iNPH Radscale, a radiological screening tool.

    Methods: The study included 35 patients with idiopathic normal pressure hydrocephalus (iNPH) who were treated surgically from 2011 to 2015 at Uppsala University Hospital with preoperative CT and MRI performed with maximum 3 months between scans. Seven features were assessed: Evans’ index, temporal horn size, callosal angle, periventricular white matter changes, narrow high convexity sulci, focally enlarged sulci, and enlarged Sylvian fissures. All scans were assessed by two investigators who were blinded to each other’s results and to clinical data.

    Results: The agreement between CT and MRI was almost perfect for Evans’ index, temporal horns, narrow sulci, and Sylvian fissures (kappa and intraclass correlation, 0.84–0.91, p ≤ 0.001). There was substantial to almost perfect agreement for callosal angle and focally enlarged sulci. The concordance between modalities was fair for changes in periventricular white matter.

    Conclusion: CT and MRI are equally good for assessing radiological signs associated with iNPH except for periventricular white matter changes, as MRI has superior soft tissue contrast. The other imaging features can be evaluated consistently, and assessments are reproducible independent of modality. Therefore, the iNPH Radscale is applicable to both CT and MRI and may become an important tool for standardized evaluation in the workup in patients with suspected iNPH.

  • Boman, Antonia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Brink, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Lundquist, Anders
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Hansson, Monica
    Mathsson-Alm, Linda
    Rönnelid, Johan
    Berglin, Ewa
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Holmdahl, Rikard
    Skriner, Karl
    Serre, Guy
    Klareskog, Lars
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Antibodies against citrullinated peptides are associated with clinical and radiological outcomes in patients with early rheumatoid arthritis: a prospective longitudinal inception cohort study2019In: RMD Open, E-ISSN 2056-5933, Vol. 5, no 2, article id UNSP e000946Article in journal (Refereed)
    Abstract [en]

    Introduction: Anticitrullinated peptide antibody (ACPA) responses for 22 citrullinated peptides in patients with early rheumatoid arthritis (RA) were analysed and related to radiological and clinical outcome during the first 2 years in a prospective inception cohort.

    Methods: The ACPA reactivities were assessed in 1022 patients with early RA (symptoms <12 months) using the custom-made microarray chip (Thermo Fisher Scientific, Uppsala, Sweden) in a prospective longitudinal study of observational assessments of Disease Activity Score (DAS28 and its components) and radiology during the first 24 months, accounting for the treatment.

    Results: Frequency of ACPA reactivities varied between 13.3% and 63.1%. Of the anticyclic citrullinated peptide-2 (anti-CCP2) antibody-negative patients, ACPA reactivities were positive in 32.6%. Smoking, human leucocyte antigen-shared epitope (HLA-SE), anti-CCP2/rheumatoid factor, protein tyrosine phosphatase non-receptor type 22 (1858C/T) and DAS28 were significantly associated with number of ACPA reactivities. The ACPA reactivities modified differently the development of DAS28 over 24 months (identified using trajectories). Anti-Filaggrin307-324, anti-hnRNP (Peptide)-Z1 and anti-F4-CIT-R antibodies anticipated lower DAS28 values (p<0.01–0.05), while positivity for anti-Fibrinogen(Fib)β62-78(74), and anti-Fibα563-583 predicted higher DAS28 (p<0.01 both). Interaction between anti-Fibß36-52, anti-Pept-5 and anti-Bla-26 antibodies, respectively, and DAS28 during 24 months decreased significantly the DAS28 values (p<0.01–0.05). Corticosteroids and biologicals were related to DAS28-area under the curve and Larsen score 24 months. Anti-vimentin2-17 antibodies remained significantly associated with Larsen score at baseline and 24 months, respectively, and radiological progression, besides biologicals at 24 months adjusted for sex and age.

    Conclusions: Several ACPA reactivities modified significantly the DAS28 development during the first 24 months and were significantly associated with Larsen score at baseline, 24 months and radiological progression.

  • Manzhynski, Siarhei
    et al.
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE).
    Figge, Frank
    Coopetition for sustainability: Between organizational benefit and societal good2019In: Business Strategy and the Environment, ISSN 0964-4733, E-ISSN 1099-0836, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Sustainable development requires coopetition, that is, the cooperation of organiza-tions that compete at the same time. Research on coopetition for sustainability issparse. From a sustainability perspective, coopetition contributes to sustainabilitywhen it makes a positive contribution on the societal level. Existing research oncoopetition however focuses on organizational outcomes. In this paper, we link orga-nizational and societal outcomes of coopetition. We show that for the simple case oftwo coopting firms and an economic and an environmental dimension, there are 51different combinations that make a positive contribution to sustainability. All butone of these combinations consist of a mix of positive and negative outcomes. Weidentify four types of trade‐offs that can occur in coopetition for sustainability andthat point to different pathways of achieving sustainability.

  • Östman, Sofi
    et al.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies, Environmental Archaeology Lab.
    Eriksson, Samuel
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies, Environmental Archaeology Lab.
    Miljöarkeologisk analys av prover från Gerdalsmon, ett område med boplatslämningar och fångstgropar. Raä 109:1 (L1935:4664), Själevad socken, Örnsköldsviks kommun, Ångermanland2019Report (Other academic)
  • Östman, Sofi
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies, Environmental Archaeology Lab.
    Makrofossilanalys av stolphål och diken inom projekt Fv301 Søndersrød-Berg: Larvik kommun, Vestfold ID1446432019Report (Other academic)
  • Andrén, Kerstin
    et al.
    Wikkelso, Carsten
    Sundström, Nina
    Israelsson Larsen, Hanna
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Agerskov, Simon
    Laurell, Katarina
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience. Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Hellström, Per
    Tullberg, Mats
    Survival in treated idiopathic normal pressure hydrocephalus2019In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459Article in journal (Refereed)
    Abstract [en]

    Objective: To describe survival and causes of death in 979 treated iNPH patients from the Swedish Hydrocephalus Quality Registry (SHQR), and to examine the influence of comorbidities, symptom severity and postoperative outcome.

    Methods: All 979 patients operated for iNPH 2004–2011 and registered in the SHQR were included. A matched control group of 4890 persons from the general population was selected by Statistics Sweden. Data from the Swedish Cause of Death Registry was obtained for patients and controls.

    Results: At a median 5.9 (IQR 4.2–8.1) year follow-up, 37% of the iNPH patients and 23% of the controls had died. Mortality was increased in iNPH patients by a hazard ratio of 1.81, 95% CI 1.61–2.04, p < 0.001. More pronounced symptoms in the preoperative ordinal gait scale and the Mini-mental State Examination were the most important independent predictors of mortality along with the prevalence of heart disease. Patients who improved in both the gait scale and in the modified Rankin Scale postoperatively (n = 144) had a similar survival as the general population (p = 0.391). Deaths due to cerebrovascular disease or dementia were more common in iNPH patients, while more controls died because of neoplasms or disorders of the circulatory system.

    Conclusions: Mortality in operated iNPH patients is 1.8 times increased compared to the general population, a lower figure than previously reported. The survival of iNPH patients who improve in gait and functional independence is similar to that of the general population, indicating that shunt surgery for iNPH, besides improving symptoms and signs, can normalize survival.

  • Heijbel, Siri
    et al.
    Naili, Josefine E.
    Hedin, Axel
    W-Dahl, Annette
    Nilsson, Kjell G
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Hedström, Margareta
    The Forgotten Joint Score-12 in Swedish patients undergoing knee arthroplasty: a validation study with the Knee Injury and Osteoarthritis Outcome Score (KOOS) as comparator2019In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682Article in journal (Refereed)
    Abstract [en]

    Background and purpose — Having patients self-evaluate the outcome is an important part of the follow-up after knee arthroplasty. The Forgotten Joint Score-12 (FJS-12) introduced joint awareness as a new approach, suggested to be sensitive enough to differentiate well-functioning patients. This study evaluated the Swedish translation of the FJS-12 and investigated the validity, reliability, and interpretability in patients undergoing knee arthroplasty.

    Patients and methods — We included 109 consecutive patients 1 year after primary knee arthroplasty to assess construct validity (Pearson’s correlation coefficient, r), internal consistency (Cronbach’s alpha [CA]), floor and ceiling effects, and score distribution. The Knee injury and Osteoarthritis Outcome Score (KOOS) was the comparator instrument for the analyses. Further, 31 patients preoperatively and 22 patients postoperatively were included to assess test–retest reliability (intraclass correlation coefficient [ICC]).

    Results — Construct validity was moderate to excellent (r = 0.62–0.84). The FJS-12 showed a high degree of internal consistency (CA = 0.96). The ICC was good preoperatively (0.76) and postoperatively (0.87). Ceiling effects were 2.8% in the FJS-12 and ranging between 0.9% and 10% in the KOOS.

    Interpretation — The Swedish translation of the FJS-12 showed good validity and reliability and can be used to assess outcome after knee arthroplasty. Moreover, the FJS-12 shows promising results in its ability to differentiate well-functioning patients. Future studies on unidimensionality, scale validity, interpretability, and responsiveness are needed for a more explicit analysis of the psychometric properties.

  • Lindgren, Petter
    et al.
    Myrtennäs, Kerstin
    Forsman, Mats
    Johansson, Anders
    Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Stenberg, Per
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Department of Biological Agents, Division of CBRN Defence and Security, Swedish Defence Research Agency (FOI), SE-901 82 Umeå, Sweden.
    Nordgaard, Anders
    Ahlinder, Jon
    A likelihood ratio-based approach for improved source attribution in microbiological forensic investigations2019In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 302, article id 109869Article in journal (Refereed)
    Abstract [en]

    A common objective in microbial forensic investigations is to identify the origin of a recovered pathogenic bacterium by DNA sequencing. However, there is currently no consensus about how degrees of belief in such origin hypotheses should be quantified, interpreted, and communicated to wider audiences. To fill this gap, we have developed a concept based on calculating probabilistic evidential values for microbial forensic hypotheses. The likelihood-ratio method underpinning this concept is widely used in other forensic fields, such as human DNA matching, where results are readily interpretable and have been successfully communicated in juridical hearings. The concept was applied to two case scenarios of interest in microbial forensics: (1) identifying source cultures among series of very similar cultures generated by parallel serial passage of the Tier 1 pathogen Francisella tularensis, and (2) finding the production facilities of strains isolated in a real disease outbreak caused by the human pathogen Listeria monocytogenes. Evidence values for the studied hypotheses were computed based on signatures derived from whole genome sequencing data, including deep-sequenced low-frequency variants and structural variants such as duplications and deletions acquired during serial passages. In the F. tularensis case study, we were able to correctly assign fictive evidence samples to the correct culture batches of origin on the basis of structural variant data. By setting up relevant hypotheses and using data on cultivated batch sources to define the reference populations under each hypothesis, evidential values could be calculated. The results show that extremely similar strains can be separated on the basis of amplified mutational patterns identified by high-throughput sequencing. In the L. monocytogenes scenario, analyses of whole genome sequence data conclusively assigned the clinical samples to specific sources of origin, and conclusions were formulated to facilitate communication of the findings. Taken together, these findings demonstrate the potential of using bacterial whole genome sequencing data, including data on both low frequency SNP signatures and structural variants, to calculate evidence values that facilitate interpretation and communication of the results. The concept could be applied in diverse scenarios, including both epidemiological and forensic source tracking of bacterial infectious disease outbreaks. 

  • Meyer-Jacob, Carsten
    et al.
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Paleoecological Environmental Assessment and Research Laboratory (PEARL), Department of Biology, Queen’s University, Kingston, ON, K7L 3J9, Canada.
    Michelutti, Neal
    Paterson, Andrew M.
    Cumming, Brian F.
    Keller, Wendel (Bill)
    Smol, John P.
    The browning and re-browning of lakes: Divergent lake-water organic carbon trends linked to acid deposition and climate change2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 16676Article in journal (Refereed)
    Abstract [en]

    Dissolved organic carbon (DOC) concentrations and water colour are increasing in many inland waters across northern Europe and northeastern North America. This inland-water "browning" has profound physical, chemical and biological repercussions for aquatic ecosystems affecting water quality, biological community structures and aquatic productivity. Potential drivers of this "browning" trend are complex and include reductions in atmospheric acid deposition, changes in land use/cover, increased nitrogen deposition and climate change. However, because of the overlapping impacts of these stressors, their relative contributions to DOC dynamics remain unclear, and without appropriate long-term monitoring data, it has not been possible to determine whether the ongoing "browning" is unprecedented or simply a "re-browning" to pre-industrial DOC levels. Here, we demonstrate the long-term impacts of acid deposition and climate change on lake-water DOC concentrations in low and high acid-deposition areas using infrared spectroscopic techniques on similar to 200-year-long lake-sediment records from central Canada. We show that acid deposition suppressed naturally higher DOC concentrations during the 20th century, but that a "re-browning" of lakes is now occurring with emissions reductions in formerly high deposition areas. In contrast, in low deposition areas, climate change is forcing lakes towards new ecological states, as lake-water DOC concentrations now often exceed pre-industrial levels.

  • Odqvist, Lina
    et al.
    Jevnikar, Zala
    Riise, Rebecca
    Oberg, Lisa
    Rhedin, Magdalena
    Leonard, Dag
    Yrlid, Linda
    Jackson, Sonya
    Mattsson, Johan
    Nanda, Sambit
    Cohen, Philip
    Knebel, Axel
    Arthur, Simon
    Thorn, Kristofer
    Svenungsson, Elisabet
    Jonsen, Andreas
    Gunnarsson, Iva
    Tandre, Karolina
    Alexsson, Andrei
    Kastbom, Alf
    Rantapää-Dahlqvist, Solbritt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Eloranta, Maija-Leena
    Syvanen, Ann-Christine
    Bengtsson, Anders
    Johansson, Patrik
    Sandling, Johanna K.
    Sjowall, Christopher
    Ronnblom, Lars
    Collins, Barry
    Vaarala, Outi
    Genetic variations in A20 DUB domain provide a genetic link to citrullination and neutrophil extracellular traps in systemic lupus erythematosus2019In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, no 10, p. 1363-1370Article in journal (Refereed)
    Abstract [en]

    Objectives: Genetic variations in TNFAIP3 (A20) de-ubiquitinase (DUB) domain increase the risk of systemic lupus erythematosus (SLE) and rheumatoid arthritis. A20 is a negative regulator of NF-κB but the role of its DUB domain and related genetic variants remain unclear. We aimed to study the functional effects of A20 DUB-domain alterations in immune cells and understand its link to SLE pathogenesis.

    Methods: CRISPR/Cas9 was used to generate human U937 monocytes with A20 DUB-inactivating C103A knock-in (KI) mutation. Whole genome RNA-sequencing was used to identify differentially expressed genes between WT and C103A KI cells. Functional studies were performed in A20 C103A U937 cells and in immune cells from A20 C103A mice and genotyped healthy individuals with A20 DUB polymorphism rs2230926. Neutrophil extracellular trap (NET) formation was addressed ex vivo in neutrophils from A20 C103A mice and SLE-patients with rs2230926.

    Results: Genetic disruption of A20 DUB domain in human and murine myeloid cells did not give rise to enhanced NF-κB signalling. Instead, cells with C103A mutation or rs2230926 polymorphism presented an upregulated expression of PADI4, an enzyme regulating protein citrullination and NET formation, two key mechanisms in autoimmune pathology. A20 C103A cells exhibited enhanced protein citrullination and extracellular trap formation, which could be suppressed by selective PAD4 inhibition. Moreover, SLE-patients with rs2230926 showed increased NETs and increased frequency of autoantibodies to citrullinated epitopes.

    Conclusions: We propose that genetic alterations disrupting the A20 DUB domain mediate increased susceptibility to SLE through the upregulation of PADI4 with resultant protein citrullination and extracellular trap formation.

  • Vollmer, Tino
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin-Brandenburg School for Regenerative Therapies (BSRT) & Berlin Center for Advanced Therapies (BeCAT), Charité - Universitätsmedizin Berlin, Berlin, Germany.
    Ljungberg, Börje
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Jankowski, Vera
    Jankowski, Joachim
    Glorieux, Griet
    Stegmayr, Bernd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    An in-vitro assay using human spermatozoa to detect toxicity of biologically active substances2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 14525Article in journal (Refereed)
    Abstract [en]

    Identifying the key toxic players within an in-vivo toxic syndrome is crucial to develop targeted therapies. Here, we established a novel method that characterizes the effect of single substances by means of an ex-vivo incubation set-up. We found that primary human spermatozoa elicit a distinct motile response on a (uremic) toxic milieu. Specifically, this approach describes the influence of a bulk toxic environment (uremia) as well as single substances (uremic toxins) by real-time analyzing motile cellular behavior. We established the human spermatozoa-based toxicity testing (HSTT) for detecting single substance-induced toxicity to be used as a screening tool to identify in-vivo toxins. Further, we propose an application of the HSTT as a method of clinical use to evaluate toxin-removing interventions (hemodialysis).

  • Halvarsson, Alexandra
    et al.
    Seth, Monika
    Tegern, Matthias
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Departments of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden.
    Broman, Lisbet
    Larsson, Helena
    Remarkable increase of musculoskeletal disorders among soldiers preparing for international missions - comparison between 2002 and 20122019In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, no 1, article id 444Article in journal (Refereed)
    Abstract [en]

    Background:

    Musculoskeletal disorders (MSD) are common among soldiers and constitute the most common reason for discontinuing military service within different military populations worldwide. The aims of this study were to investigate the prevalence of musculoskeletal disorders in two cohorts, 10 years apart, in the Swedish Armed Forces, to explore differences between these cohorts and to determine associated factors with MSD.

    Method: Comparative cross-sectional study. Participants were recruited from the Swedish Armed Forces, i.e. soldiers preparing for international missions in 2002 and 2012. A total of 961 soldiers, 7% women, participated in the study.

    Data were collected using the Musculoskeletal Screening Protocol (MSP), which includes questions regarding prevalence of MSD in ten anatomical locations (neck, upper back, low back, shoulders, elbow, hand, hip, knee, lower limb and foot). An additional five questions concern perceived self-rated health, i.e. how the respondent perceives their own physical body, mental health, social environment, physical environment and work ability.

    Results: Over a ten-year period, both point prevalence and one-year prevalence of MSD in any body part increased significantly, with point prevalence increasing from 7.1 to 35.2% (p < 0.001) and one-year prevalence from 27.9 to 67.9% (p < 0.001). The knee was the most common anatomic location for MSD in both cohorts. Across each anatomical location (neck, upper back, low back, shoulders, elbow, hand, hip, knee, lower leg and foot), both point prevalence (p < 0.039) and one-year prevalence (p < 0.005) increased significantly from 2002 to 2012.

    Most soldiers reported good to excellent perceived health, i.e. self-perception of their physical body, mental health, physical and social environments, and work ability.

    The odds of reporting one-year prevalence of MSD in any body part was 5.28 times higher for soldiers in Cohort 2012, 1.91 times higher in age group 31–40 and 2.84 times higher in age group 41 and above.

    Conclusions: The prevalence of MSD increased remarkably over a ten-year period among Swedish soldiers preparing for international missions. With increasing age as one risk factor, systematic monitoring of MSD throughout the soldiers’ careers and implementation of targeted primary-to-tertiary preventive programs are thus important.

  • Vassbo, Tove K.
    et al.
    Kirkevold, Marit
    Edvardsson, David
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
    Sjögren, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lood, Qarin
    Umeå University, Faculty of Medicine, Department of Nursing. School of Nursing and Midwifery, La Trobe University, Melbourne, Australia; Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Bergland, Adel
    The meaning of working in a person-centred way in nursing homes: a phenomenological-hermeneutical study2019In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 18, no 1, article id 45Article in journal (Refereed)
    Abstract [en]

    Background: The present study aims to illuminate the meaning of working in a person-centred way as experienced by staff in nursing homes. Insights into what working in a person-centred way mean for nursing home staff may contribute to a more comprehensive understanding of what gives staff satisfaction in their work and support further development of person-centred care approach in nursing homes.

    Methods: Interviews with 29 health care personnel who had participated in a one-year intervention focusing on person-centred care and thriving in three nursing homes in Australia, Norway and Sweden were performed, and a phenomenological-hermeneutical method was used to explore staffs’ lived experiences of working in a person-centred way in nursing homes.

    Results: For nursing home staff, working in a person-centred way meant that they were able to meet individual resident’s needs and expressed preferences in close family-like relationships, understanding the residents’ rhythms and preferences as the basis of the daily work plans and being able to do ‘the little extra’ for residents. Also, working in a person-centred way meant meeting shared goals by working towards a collective practice in collaborative teams. As a whole, the staffs’ lived experiences of working in a person-centred way in nursing homes was interpreted to mean thriving at work as a psychological state in which individuals experience both a sense of vitality and learning.

    Conclusions: Working in a person-centred way means staff thriving at work in nursing homes. The results further indicate that delivering care by only focusing on routines and practical tasks and not on residents’ preferences and well-being would inhibit thriving among nursing staff, leading to the potential for dissatisfaction with work.

  • Papenberg, Goran
    et al.
    Jonasson, Lars S.
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Karalija, Nina
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Johansson, Jarkko
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Koehncke, Ylva
    Salami, Alireza
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18A, 171 65 Solna, Sweden.
    Andersson, Micael
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Axelsson, Jan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Wåhlin, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Lindenberger, Ulman
    Lovden, Martin
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Backman, Lars
    Mapping the landscape of human dopamine D2/3 receptors with [11C]raclopride2019In: Brain Structure and Function, ISSN 1863-2653, E-ISSN 1863-2661, Vol. 224, no 8, p. 2871-2882Article in journal (Refereed)
    Abstract [en]

    The dopamine D2/3 system is fundamental for sensory, motor, emotional, and cognitive aspects of behavior. Small-scale human histopathological and animal studies show high density of D2/3 dopamine receptors (D2/3DR) in striatum, but also demonstrate the existence of such receptors across cortical and limbic regions. Assessment of D2/3DR BPND in the extrastriatal regions with [C-11]raclopride has long been considered unreliable due to the relatively low density of D2/3DR outside the striatum. We describe the distribution and interregional links of D2/3DR availability measured with PET and [C-11]raclopride across the human brain in a large sample (N = 176; age range 64-68 years). Structural equation modeling revealed that D2/3DR availability can be organized according to anatomical (nigrostriatal, mesolimbic, mesocortical) and functional (limbic, associative, sensorimotor) dopamine pathways. D2/3DR availability in corticolimbic functional subdivisions showed differential associations to corresponding striatal subdivisions, extending animal and pharmacological work. Our findings provide evidence on the dimensionality and organization of [C-11]raclopride D2/3DR availability in the living human brain that conforms to known dopaminergic pathways.

  • Banda, Emmanuel
    et al.
    Svanemyr, Joar
    Sandoy, Ingvild Fossgard
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Zulu, Joseph Mumba
    Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia: a qualitative case study2019In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1685808Article in journal (Refereed)
    Abstract [en]

    Background: Cash Transfer (CT) schemes have become popular poverty reducing measures in many low and middle-income countries. Research indicates that when provided to girls in resource poor settings, cash transfers can increase education and postpone marriage and pregnancy. However, a few studies indicate that they can also have negative effects which can affect their acceptability, such as generating intra-community tensions.

    Objective: Conceptually informed by Rogers’ diffusion of innovation theory, this paper explores factors affecting the acceptability of economic support in a randomized controlled trial in rural Monze and Pemba Districts of Southern Province in Zambia.

    Methods: Qualitative data were collected through five focus group discussions and six in-depth, semi-structured interviews and analysed using thematic analysis. This study was done in the combined arm of a trial where girls received both economic support and participated in youth clubs offering sexuality and life-skills education.

    Results: In the study communities, acceptability was encouraging by the belief that economic support provided benefits beyond beneficiaries and that it improved access to education, and reduced teen pregnancies, marriages and school drop-out. However, provision of economic support only to selected girls and their parents and fear among some that the support was linked to satanic practices negatively affected acceptability. These fears were mitigated through community sensitisations.

    Conclusion: The study demonstrated that relative advantage, observability, simplicity and compatibility were key factors in influencing acceptability of the economic support. However, to enhance acceptability of cash transfer schemes aimed at addressing early marriage and pregnancy, it is important to explore socio-cultural factors that create suspicions and negative perceptions and to provide schemes that are perceived as relatively better than available similar schemes, understood, compatible and viable beyond the immediate beneficiary.

  • Jarstad, Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Eklund, Niklas
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Johansson, Patrik
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Olivius, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Saati, Abrak
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Sahovic, Dzenan
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Strandh, Veronica
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Söderström, Johanna
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Eklund Wimelius, Malin
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Åkebo, Malin
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Three approaches to peace: a framework for describing and exploring varieties of peace2019Report (Other academic)
    Abstract [en]

    For decades, peace and conflict studies have devoted more attention to conflict than to peace, and despiteits centrality, peace itself has been under-conceptualized. In this paper, we propose a theoretical frameworkand methodologies to make peace beyond the absence of war researchable. The framework is designed to capture varieties of peace between and beyond dichotomous conceptions of positive versus negative peace, or successful versus failed peace processes. To capture the complexity of peace in its empirical diversity, our framework approaches peace in three different ways: as a situation or condition in a particular locality; as a web of relationships; and as ideas or discourses about what peace is or should be. These approaches provide different avenues for researching peace, and taken together they provide a fuller picture of what peace is, how it is manifested, experienced, and understood. We argue that this framework provides a way forward in advancing conceptual understandings and empirical analyses of peace that can facilitate systematic, comparative, qualitative analyses while at the same time accounting for the complex, multifaceted nature of peace.

  • Sténs, Anna
    et al.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Roberge, Jean-Michel
    Lofmarck, Erik
    Lindahl, Karin Beland
    Felton, Adam
    Widmark, Camilla
    Rist, Lucy
    Johansson, Johanna
    Nordin, Annika
    Nilsson, Urban
    Laudon, Hjalmar
    Ranius, Thomas
    From ecological knowledge to conservation policy: a case study on green tree retention and continuous-cover forestry in Sweden2019In: Biodiversity and Conservation, ISSN 0960-3115, E-ISSN 1572-9710, Vol. 28, no 13, p. 3547-3574Article in journal (Refereed)
    Abstract [en]

    The extent to which scientific knowledge translates into practice is a pervasive question. We analysed to what extent and how ecological scientists gave input to policy for two approaches advocated for promoting forest biodiversity in production forests in Sweden: green-tree retention (GTR) and continuous-cover forestry (CCF). GTR was introduced into forest policy in the 1970s and became widely implemented in the 1990s. Ecological scientists took part in the policy process by providing expert opinions, educational activities and as lobbyists, long before research confirming the positive effects of GTR on biodiversity was produced. In contrast, CCF was essentially banned in forest legislation in 1979. In the 1990s, policy implicitly opened up for CCF implementation, but CCF still remains largely a rare silvicultural outlier. Scientific publications addressing CCF appeared earlier than GTR studies, but with less focus on the effects on biodiversity. Ecological scientists promoted CCF in certain areas, but knowledge from other disciplines and other socio-political factors appear to have been more important than ecological arguments in the case of CCF. The wide uptake of GTR was enhanced by its consistency with the silvicultural knowledge and normative values that forest managers had adopted for almost a century, whereas CCF challenged those ideas. Public pressure and institutional requirements were also key to GTR implementation but were not in place for CCF. Thus, scientific ecological knowledge may play an important role for policy uptake and development, but knowledge from other research disciplines and socio-political factors are also important.

  • Namatovu, Fredinah
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Preet, Raman
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gender-based violence among people with disabilities is a neglected public health topic2018In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 11, p. 97-100Article in journal (Refereed)
    Abstract [en]

    This paper aims to provide an analytical insight on the current state of knowledge on gender-based violence among people with disabilities, a topic where the level of data is relatively low. We briefly discuss the current research on: (a) the prevalence, risk factors and the theoretical approaches for gender-based violence among people with disabilities. (b) Service provision among people with disabilities who experience gender-based violence. (c) We also highlight areas where further research is required, the applicable theoretical approaches and provide an example on how Sweden is attempting to bridge this knowledge gap through implementing the Disability and Intimate-partner violence project (DIS-IPV) project

  • Johansson, Maria
    et al.
    Dressel, Sabrina
    Ericsson, Göran
    Sjölander-Lindqvist, Annelie
    Sandström, Camilla
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    How stakeholder representatives cope with collaboration in the Swedish moose management system2019In: Human Dimensions of Wildlife, ISSN 1087-1209, E-ISSN 1533-158X, p. 1-17Article in journal (Refereed)
    Abstract [en]

    The collaborative ecosystem-based management of moose (Alces alces) in Sweden puts a strain on the involved stakeholders. Representatives have to cope with environmental uncertainty and social stress associated with goal conflicts. This article advanced the understanding of representatives’ coping strategies in response to perceived challenges and how these coping strategies are associated with social trust, focusing upon salient value similarity. A mixed-method approach, combining a questionnaire survey (n = 624) and interviews (n = 21) among landowners and hunter representatives, was employed. Survey results showed that the presence of emotion-centered coping strategies that involve venting of negative emotions and behavioral disengagement were associated with relatively lower trust, whereas problem-solving centered coping was associated with relatively higher trust. The interviews indicated the importance of appointing group leaders who are skilled at initiating dialogue and working toward decisions and compromises, as this seemed to hinder expressions of emotion-centered coping strategies.

  • Sellgren, Fredrik
    et al.
    Koman, Anna
    Nordenström, Erik
    Hellman, Per
    Hennings, Joakim
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Muth, Andreas
    Outcomes After Surgery for Unilateral Dominant Primary Aldosteronism in Sweden2019In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323Article in journal (Refereed)
    Abstract [en]

    Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension. Surgery is the mainstay of treatment for unilateral dominant PA, but reported cure rates varies. The aim of the present study was to investigate contemporary follow-up practices and cure rates after surgery for PA in Sweden.

    Methods: Patients operated for PA and registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) 2009–2015 were identified. Patient data were extracted, and follow-up data (1–24 months) was recorded. Doses of antihypertensive medication and potassium supplementation were calculated using defined daily doses (DDD), and the Primary Aldosteronism Surgical Outcome (PASO) criteria were used to evaluate outcomes.

    Results: Of 190 registered patients, 171 (47% female, mean age 53 years, median follow-up 3.7 months) were available for analysis. In 75 patients (44%), missing data precluded evaluation of biochemical cure according to the PASO criteria. Minimal invasive approach was used in 168/171 patients (98%). Complication rate (Clavien-Dindo >3a) was 3%. No mortality was registered. Pre/postoperatively 98/66% used antihypertensives (mean DDD 3.7/1.5). 89/2% had potassium supplementation (mean DDD 2.0/0) before/after surgery. Complete/partial biochemical and clinical success according to the PASO criteria were achieved in 92/7% and 34/60%, respectively.

    Conclusion: In this study, reflecting contemporary clinical practice in Sweden complete/partial biochemical and clinical success after surgery for PA was 92/7% and 34/60%. Evaluation of biochemical cure was hampered by lack of uniform reporting of relevant outcome measures. We suggest mandatory reporting of surgical outcomes using the PASO criteria for all units performing surgery for PA.

  • Felton, Adam
    et al.
    Löfroth, Therese
    Angelstam, Per
    Gustafsson, Lena
    Hjältén, Joakim
    Felton, Annika M.
    Simonsson, Per
    Dahlberg, Anders
    Lindbladh, Matts
    Svensson, Johan
    Nilsson, Urban
    Lodin, Isak
    Hedwall, P. O.
    Sténs, Anna
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Lämås, Tomas
    Brunet, Jörg
    Kalen, Christer
    Kriström, Bengt
    Gemmel, Pelle
    Ranius, Thomas
    Keeping pace with forestry: Multi-scale conservation in a changing production forest matrix2019In: Ambio, ISSN 0044-7447, E-ISSN 1654-7209Article in journal (Refereed)
    Abstract [en]

    The multi-scale approach to conserving forest biodiversity has been used in Sweden since the 1980s, a period defined by increased reserve area and conservation actions within production forests. However, two thousand forest-associated species remain on Sweden's red-list, and Sweden's 2020 goals for sustainable forests are not being met. We argue that ongoing changes in the production forest matrix require more consideration, and that multi-scale conservation must be adapted to, and integrated with, production forest development. To make this case, we summarize trends in habitat provision by Sweden's protected and production forests, and the variety of ways silviculture can affect biodiversity. We discuss how different forestry trajectories affect the type and extent of conservation approaches needed to secure biodiversity, and suggest leverage points for aiding the adoption of diversified silviculture. Sweden's long-term experience with multi-scale conservation and intensive forestry provides insights for other countries trying to conserve species within production landscapes.

  • Krab, Eveline J
    et al.
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Monteux, Sylvain
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Weedon, James T.
    Dorrepaal, Ellen
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Plant expansion drives bacteria and collembola communities under winter climate change in frost-affected tundra2019In: Soil Biology and Biochemistry, ISSN 0038-0717, E-ISSN 1879-3428, Vol. 138, article id UNSP 107569Article in journal (Refereed)
    Abstract [en]

    At high latitudes, winter warming facilitates vegetation expansion into barren frost-affected soils. The interplay of changes in winter climate and plant presence may alter soil functioning via effects on decomposers. Responses of decomposer soil fauna and microorganisms to such changes likely differ from each other, since their life histories, dispersal mechanisms and microhabitats vary greatly.

    We investigated the relative impacts of short-term winter warming and increases in plant cover on bacteria and collembola community composition in cryoturbated, non-sorted circle tundra. By covering non-sorted circles with insulating gardening fibre cloth (fleeces) or using stone walls accumulating snow, we imposed two climate-change scenarios: snow accumulation increased autumn-to-late winter soil temperatures (−1 cm) by 1.4 °C, while fleeces warmed soils during that period by 1 °C and increased spring temperatures by 1.1 °C. Summer bacteria and collembola communities were sampled from within-circle locations differing in vegetation abundance and soil properties.

    Two years of winter warming had no effects on either decomposer community. Instead, their community compositions were strongly determined by sampling location: communities in barren circle centres were distinct from those in vegetated outer rims, while communities in sparsely vegetated patches of circle centres were intermediate. Diversity patterns indicate that collembola communities are tightly linked to plant presence while bacteria communities correlated with soil properties.

    Our results thus suggest that direct effects of short-term winter warming are likely to be minimal, but that vegetation encroachment on barren cryoturbated ground will affect decomposer community composition substantially. At decadal timescales, collembola community changes may follow relatively fast after warming-driven plant establishment into barren areas, whereas bacteria communities may take longer to respond. If shifts in decomposer community composition are indicative for changes in their activity, vegetation overgrowth will likely have much stronger effects on soil functioning in frost-affected tundra than short-term winter warming.

  • Creel, Scott
    et al.
    Spong, Göran
    Becker, Matthew
    Simukonda, Chuma
    Norman, Anita
    Schiffthaler, Bastian
    Umeå University, Faculty of Science and Technology, Umeå Plant Science Centre (UPSC). Umeå University, Faculty of Science and Technology, Department of Plant Physiology.
    Chifunte, Clive
    Carnivores, competition and genetic connectivity in the Anthropocene2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 16339Article in journal (Refereed)
    Abstract [en]

    Current extinction rates are comparable to five prior mass extinctions in the earth's history, and are strongly affected by human activities that have modified more than half of the earth's terrestrial surface. Increasing human activity restricts animal movements and isolates formerly connected populations, a particular concern for the conservation of large carnivores, but no prior research has used high throughput sequencing in a standardized manner to examine genetic connectivity for multiple species of large carnivores and multiple ecosystems. Here, we used RAD SNP genotypes to test for differences in connectivity between multiple ecosystems for African wild dogs (Lycaon pictus) and lions (Panthera leo), and to test correlations between genetic distance, geographic distance and landscape resistance due to human activity. We found weaker connectivity, a stronger correlation between genetic distance and geographic distance, and a stronger correlation between genetic distance and landscape resistance for lions than for wild dogs, and propose a new hypothesis that adaptations to interspecific competition may help to explain differences in vulnerability to isolation by humans.

  • Knoll, Lesley B.
    et al.
    Sharma, Sapna
    Denfeld, Blaize A.
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Flaim, Giovanna
    Hori, Yukari
    Magnuson, John, I
    Straile, Dietmar
    Weyhenmeyer, Gesa A.
    Consequences of lake and river ice loss on cultural ecosystem services2019In: Limnology and Oceanography Letters, ISSN 2378-2242, Vol. 4, no 5, p. 119-131Article in journal (Refereed)
    Abstract [en]

    People extensively use lakes and rivers covered by seasonal ice. Although ice cover duration has been declining over the past 150 years for Northern Hemisphere freshwaters, we know relatively little about how ice loss directly affects humans. Here, we synthesize the cultural ecosystem services (i.e., services that provide intangible or nonmaterial benefits) and associated benefits supported by inland ice. We also provide, for the first time, empirical examples that give quantitative evidence for a winter warming effect on a wide range of ice-related cultural ecosystem services and benefits. We show that in recent decades, warmer air temperatures delayed the opening date of winter ice roads and led to cancellations of spiritual ceremonies, outdoor ice skating races, and ice fishing tournaments. Additionally, our synthesis effort suggests unexploited data sets that allow for the use of integrative approaches to evaluate the interplay between inland ice loss and society.

  • Sharma, Sumit
    et al.
    Hagbom, Marie
    Carlsson, Beatrice
    Ohd, Joanna Nederby
    Insulander, Mona
    Eriksson, Ronnie
    Simonsson, Magnus
    Widerström, Micael
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden.
    Nordgren, Johan
    Secretor Status is Associated with Susceptibility to Disease in a Large GII.6 Norovirus Foodborne Outbreak2019In: Food and Environmnetal Virology, ISSN 1867-0334, E-ISSN 1867-0342Article in journal (Refereed)
    Abstract [en]

    Norovirus is commonly associated with food and waterborne outbreaks. Genetic susceptibility to norovirus is largely dependent on presence of histo-blood group antigens (HBGA), specifically ABO, secretor, and Lewis phenotypes. The aim of the study was to determine the association between HBGAs to norovirus susceptibility during a large norovirus foodborne outbreak linked to genotype GII.6 in an office-based company in Stockholm, Sweden, 2015. A two-episode outbreak with symptoms of diarrhea and vomiting occurred in 2015. An online questionnaire was sent to all 1109 employees that had worked during the first outbreak episode. Food and water samples were collected from in-house restaurant and tested for bacterial and viral pathogens. In addition, fecal samples were collected from 8 employees that had diarrhea. To investigate genetic susceptibility during the outbreak, 98 saliva samples were analyzed for ABO, secretor, and Lewis phenotypes using ELISA. A total of 542 of 1109 (49%) employees reported gastrointestinal symptoms. All 8 fecal samples tested positive for GII norovirus, which was also detected in coleslaw collected from the in-house restaurant. Eating at the in-house restaurant was significantly associated with risk of symptom development. Nucleotide sequencing was successful for 5/8 fecal samples and all belonged to the GII.6 genotype. HBGA characterization showed a strong secretor association to norovirus-related symptoms (P = 0.014). No association between norovirus disease and ABO phenotypes was observed. The result of this study shows that non-secretors were significantly less likely to report symptoms in a large foodborne outbreak linked to the emerging GII.6 norovirus strain.

  • Hallman, David M.
    et al.
    Holtermann, Andreas
    Björklund, Martin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Department of Occupational Health Sciences and Psychology, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden.
    Gupta, Nidhi
    Norregaard Rasmussen, Charlotte D.
    Sick leave due to musculoskeletal pain: determinants of distinct trajectories over 1 year2019In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 92, no 8, p. 1099-1108Article in journal (Refereed)
    Abstract [en]

    Purpose: This study aimed to identify sub-groups of workers with different trajectories of sick leave due to musculoskeletal pain over 1 year, and to investigate the extent to which the identified trajectories are associated with personal, occupational, lifestyle, and pain-related factors at baseline.

    Methods: Data on 981 blue- and white-collar workers were analyzed in the DPHACTO cohort (2012-2014). The number of days on sick leave due to pain was reported using text messages at 4-week intervals across 1 year. Latent class growth analysis was used to distinguish sub-groups with different trajectories of sick leave. A web-based questionnaire at baseline was used to assess personal, occupational (physical and psychosocial), lifestyle, and pain-related factors. Multinomial regression models were constructed to determine associations between baseline factors and trajectories of sick leave (referencing no sick leave), with adjustment for potential confounders.

    Results: Four distinct sub-groups were identified, with trajectories of sick leave due to pain ranging from no sick leave (prevalence 76%; average 0.5 days/year) to some days and increasing sick leave due to pain over 1 year (2%; 89 days/year). The increasing trajectory of sick leave was associated with higher perceived physical exertion, more time in manual work, less social community and influence at work, less leisure-time physical activity, smoking, and more severe symptoms (e.g., multisite pain, low back pain intensity, and pain interference).

    Conclusions: We identified four distinct trajectories of sick leave due to musculoskeletal pain. The sub-group with increasing sick leave due to pain was associated with several modifiable physical and psychosocial factors at work and outside work, which may have implications for prevention.

  • Kohestani, Kimia
    et al.
    Wallström, Jonas
    Dehlfors, Niclas
    Sponga, Ole Martin
    Månsson, Marianne
    Josefsson, Andreas
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Carlsson, Sigrid
    Hellstrom, Mikael
    Hugosson, Jonas
    Performance and inter-observer variability of prostate MRI (PI-RADS version 2) outside high-volume centres2019In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813Article in journal (Refereed)
    Abstract [en]

    Objective: Despite the growing trend to embrace pre-biopsy MRI in the diagnostic pathway for prostate cancer (PC), its performance and inter-observer variability outside high-volume centres remains unknown. This study aims to evaluate sensitivity of and variability between readers of prostate MRI outside specialized units with radical prostatectomy (RP) specimen as the reference standard.

    Materials and methods: Retrospective study comprising a consecutive cohort of all 97 men who underwent MRI and subsequent RP between January 2012 and December 2014 at a private hospital in Sweden. Three readers, blinded to clinical data, reviewed all images (including 11 extra prostate MRI to reduce bias). A tumour was considered detected if the overall PI-RADS v2 score was 3-5 and there was an approximate match (same or neighbouring sector) of tumour sector according to a 24 sector system used for both MRI and whole mount sections.

    Results: Detection rate for the index tumour ranged from 67 to 76%, if PI-RADS 3-5 lesions were considered positive and 54-66% if only PI-RADS score 4-5 tumours were included. Detection rate for aggressive tumours (GS >= 4 + 3) was higher; 83.1% for PI-RADS 3-5 and 79.2% for PI-RADS 4-5. The agreement between readers showed average values of 0.41 for PI-RADS score 3-5 and 0.51 for PI-RADS score 4-5.

    Conclusions: Prostate MRI evidenced a moderate detection rate for clinically significant PC with a rather large variability between readers. Clinics outside specialized units must have knowledge of their performance of prostate MRI before considering omitting biopsies in men with negative MRI.

  • Ecke, Frauke
    et al.
    Mahani, Seyed Alireza Nematollahi
    Evander, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Section of Virology.
    Hörnfeldt, Birger
    Khalil, Hussein
    Wildfire-induced short-term changes in a small mammal community increase prevalence of a zoonotic pathogen?2019In: Ecology and Evolution, ISSN 2045-7758, E-ISSN 2045-7758, Vol. 9, no 22, p. 12459-12470Article in journal (Refereed)
    Abstract [en]

    Natural disturbances like droughts and fires are important determinants of wildlife community structure and are suggested to have important implications for prevalence of wildlife-borne pathogens. After a major wildfire affecting >1,600 ha of boreal forest in Sweden in 2006, we took the rare opportunity to study the short-term response (2007-2010 and 2015) of small mammal community structure, population dynamics, and prevalence of the Puumala orthohantavirus (PUUV) hosted by bank voles (Myodes glareolus). We performed snap-trapping in permanent trapping plots in clear-cuts (n = 3), unburnt reference forests (n = 7), and the fire area (n = 7) and surveyed vegetation and habitat structure. Small mammal species richness was low in all habitats (at maximum three species per trapping session), and the bank vole was the only small mammal species encountered in the fire area after the first postfire year. In autumns of years of peak rodent densities, the trapping index of bank voles was lowest in the fire area, and in two of three peak-density years, it was highest in clear-cuts. Age structure of bank voles varied among forest types with dominance of overwintered breeders in the fire area in the first postfire spring. PUUV infection probability in bank voles was positively related to vole age. Infection probability was highest in the fire area due to low habitat complexity in burnt forests, which possibly increased encounter rate among bank voles. Our results suggest that forest fires induce cascading effects, including fast recovery/recolonization of fire areas by generalists like bank voles, impoverished species richness of small mammals, and altered prevalence of a rodent-borne zoonotic pathogen. Our pilot study suggests high human infection risk upon encountering a bank vole in the fire area, however, with even higher overall risk in unburnt forests due to their higher vole numbers.

  • Zhang, Yue
    et al.
    Santosa, Ailiana
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wang, Na
    Wang, Weibing
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Zhao, Qi
    Jiang, Yonggen
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Zhao, Genming
    Prevalence and the Association of Body Mass Index and Other Risk Factors with Prediabetes and Type 2 Diabetes Among 50,867 Adults in China and Sweden: A Cross-Sectional Study2019In: Diabetes Therapy, ISSN 1869-6953, E-ISSN 1869-6961, Vol. 10, no 6, p. 2061-2077Article in journal (Refereed)
    Abstract [en]

    Introduction: Understanding socioeconomic differences for prediabetes and type 2 diabetes (T2DM) can offer guidance for the most effective development of both prevention and intervention programmes in different settings. This study aims to determine the prevalence and risk factors for prediabetes and T2DM and to explore the effect of high body mass index (BMI) on the probability of T2DM being present among adults in China and Sweden.

    Methods: This study enrolled 25,356 adults (35–64 years old) from the Shanghai Survey in China and 25,511 adults (aged 40, 50, 60) from the Västerbotten Intervention Programme in Sweden. Data on haemoglobin A1c, capillary fasting plasma glucose, 2-h plasma glucose and self-reported diagnoses of T2DM were used in the analysis. Multinomial logistic regression was used to examine the determinants of prediabetes and T2DM. The average predicted probabilities of T2DM developing or presenting were determined for the different ages and levels of BMI in each population.

    Results: Chinese participants had a higher adjusted prevalence of T2DM (men 12.8% vs. 4.6%; women 10.6% vs. 3.1%) and prediabetes (men 12.4% vs. 12.2%; women 14.4% vs. 12.2%) than Swedish participants. Age, overweightedness/obesity, hypertension and a family history of diabetes were significant risk factors for prediabetes and T2DM. In both populations, the predicted probability of T2DM increased as the BMI increased in all age groups. At the same BMI level, Chinese participants were more likely to have T2DM compared to their Swedish counterparts. The average predicted probability of T2DM was less than 20% in nearly all age groups among Swedish women.

    Conclusions: Chinese adults had the higher prevalence of prediabetes and T2DM and a higher probability of T2DM at the same BMI level compared with Swedish adults. These results indicate the importance of addressing the ongoing obesity epidemic as a matter of urgency in order to curb what has become an apparent diabetes epidemic in both countries.

  • Ågren, Per-Olof
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Den tredje AI-vågen: essäer om AI, samhället och individen2019Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Den tredje AI-vågen är en samling essäer där Per-Olof Ågren gör ett antal nedslag i AI-landskapet från dels ett samhällsperspektiv, dels ett individperspektiv. AI-teknikens effekter och påverkan på demokratiska processer, medial utveckling och behov av förändrad utbildning är exempel på samhällsperspektiv på AI. Människans relation till AI-teknik i form av en utveckling av förmågan att uppfatta varandra och varandras intelligens samt samarbetsförmåga är exempel på individperspektiv på AI.

  • Rolandsson, Olov
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hampe, Christiane S.
    Sharp, Stephen J.
    Ardanaz, Eva
    Boeing, Heiner
    Fagherazzi, Guy
    Mancini, Francesca Romana
    Nilsson, Peter M.
    Overvad, Kim
    Chirlaque, Maria-Dolores
    Dorronsoro, Miren
    Gunter, Marc J.
    Kaaks, Rudolf
    Key, Timothy J.
    Khaw, Kay-Tee
    Krogh, Vittorio
    Kuehn, Tilman
    Palli, Domenico
    Panico, Salvatore
    Sacerdote, Carlotta
    Sanchez, Maria-Jose
    Severi, Gianluca
    Spijkerman, Annemieke M. W.
    Tumino, Rosario
    van der Schouw, Yvonne T.
    Riboli, Elio
    Forouhi, Nita G.
    Langenberg, Claudia
    Wareham, Nicholas J.
    Autoimmunity plays a role in the onset of diabetes after 40 years of age2019In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428Article in journal (Refereed)
    Abstract [en]

    Aims/hypothesis: Type 1 and type 2 diabetes differ with respect to pathophysiological factors such as beta cell function, insulin resistance and phenotypic appearance, but there may be overlap between the two forms of diabetes. However, there are relatively few prospective studies that have characterised the relationship between autoimmunity and incident diabetes. We investigated associations of antibodies against the 65 kDa isoform of GAD (GAD65) with type 1 diabetes and type 2 diabetes genetic risk scores and incident diabetes in adults in European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct, a case-cohort study nested in the EPIC cohort.

    Methods: GAD65 antibodies were analysed in EPIC participants (over 40 years of age and free of known diabetes at baseline) by radioligand binding assay in a random subcohort (n = 15,802) and in incident diabetes cases (n = 11,981). Type 1 diabetes and type 2 diabetes genetic risk scores were calculated. Associations between GAD65 antibodies and incident diabetes were estimated using Prentice-weighted Cox regression.

    Results: GAD65 antibody positivity at baseline was associated with development of diabetes during a median follow-up time of 10.9 years (HR for GAD65 antibody positive vs negative 1.78; 95% CI 1.43, 2.20) after adjustment for sex, centre, physical activity, smoking status and education. The genetic risk score for type 1 diabetes but not type 2 diabetes was associated with GAD65 antibody positivity in both the subcohort (OR per SD genetic risk 1.24; 95% CI 1.03, 1.50) and incident cases (OR 1.97; 95% CI 1.72, 2.26) after adjusting for age and sex. The risk of incident diabetes in those in the top tertile of the type 1 diabetes genetic risk score who were also GAD65 antibody positive was 3.23 (95% CI 2.10, 4.97) compared with all other individuals, suggesting that 1.8% of incident diabetes in adults was attributable to this combination of risk factors.

    Conclusions/interpretation: Our study indicates that incident diabetes in adults has an element of autoimmune aetiology. Thus, there might be a reason to re-evaluate the present subclassification of diabetes in adulthood.

  • Levitsky, Adrian
    et al.
    Pernemalm, Maria
    Bernhardson, Britt-Marie
    Forshed, Jenny
    Kölbeck, Karl
    Olin, Maria
    Henriksson, Roger
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Lehtiö, Janne
    Tishelman, Carol
    Eriksson, Lars E.
    Early symptoms and sensations as predictors of lung cancer: a machine learning multivariate model2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 16504Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to identify a combination of early predictive symptoms/sensations attributable to primary lung cancer (LC). An interactive e-questionnaire comprised of pre-diagnostic descriptors of first symptoms/sensations was administered to patients referred for suspected LC. Respondents were included in the present analysis only if they later received a primary LC diagnosis or had no cancer; and inclusion of each descriptor required >= 4 observations. Fully-completed data from 506/670 individuals later diagnosed with primary LC (n = 311) or no cancer (n = 195) were modelled with orthogonal projections to latent structures (OPLS). After analysing 145/285 descriptors, meeting inclusion criteria, through randomised seven-fold cross-validation (six-fold training set: n = 433; test set: n = 73), 63 provided best LC prediction. The most-significant LC-positive descriptors included a cough that varied over the day, back pain/aches/discomfort, early satiety, appetite loss, and having less strength. Upon combining the descriptors with the background variables current smoking, a cold/flu or pneumonia within the past two years, female sex, older age, a history of COPD (positive LC-association); antibiotics within the past two years, and a history of pneumonia (negative LC-association); the resulting 70-variable model had accurate cross-validated test set performance: area under the ROC curve = 0.767 (descriptors only: 0.736/background predictors only: 0.652), sensitivity = 84.8% (73.9/76.1%, respectively), specificity = 55.6% (66.7/51.9%, respectively). In conclusion, accurate prediction of LC was found through 63 early symptoms/sensations and seven background factors. Further research and precision in this model may lead to a tool for referral and LC diagnostic decision-making.

  • Lindgren, Joakim
    et al.
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Rönnberg, Linda
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Hult, Agneta
    Umeå University, Faculty of Social Sciences, Department of Education.
    Segerholm, Christina
    Umeå University, Faculty of Social Sciences, Department of Education.
    Evaluation machinery, qualocrats and the seemingly inevitable problem of expansion2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a Case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren and Linda Rönnberg, Dortrecht: Springer, 2019, p. 181-199Chapter in book (Refereed)
    Abstract [en]

    In this chapter we initially discuss the relation between governing, evaluation, and knowledge. Then we go back to the ideal typical notion of increasingly institutionalised evaluation machinery and locate the important work of what we label as qualocrats and what may be termed the burden of judgements within this overall frame. We finally discuss the expansion and the increasing complexity of evaluation and quality assurance work in higher education and point to some possible implications and problems.

  • Lindgren, Joakim
    et al.
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Rönnberg, Linda
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Hult, Agneta
    Umeå University, Faculty of Social Sciences, Department of Education.
    Segerholm, Christina
    Umeå University, Faculty of Social Sciences, Department of Education.
    Relaunching national evaluation and quality assurance: governing by piloting2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a Case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren and Linda Rönnberg, Dortrecht: Springer, 2019, p. 157-180Chapter in book (Refereed)
    Abstract [en]

    This chapter seeks to explore and discuss enactments in the process of piloting a part of the 2016 national evaluation and quality assurance system, namely, the pilot of institutional reviews in which higher education institutions’ internal quality assurance systems were evaluated by the Swedish Higher Education Authority. The chapter analyses the work and experiences of the different actors that took part in these processes. It shows that the pilot includes extensive work that links people, places, policies, practices, and power in particular ways and that numerous translations are made at different stages and by different actors. The results highlight the amount and forms of work done in these processes in general and in particular by actors who we have labelled “qualocrats”. Their embodied form of expertise is mobilised as they move between and across different domains to enact and promote certain knowledge in and of evaluation and quality assurance. The chapter finally suggests that the deliberate temporal design as a pilot study opened up for mutual adjustments, learning, and dialogue but also gave rise to contradictory anticipatory governing signals.

  • Lindgren, Joakim
    et al.
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Rönnberg, Linda
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Hult, Agneta
    Umeå University, Faculty of Social Sciences, Department of Education.
    Segerholm, Christina
    Umeå University, Faculty of Social Sciences, Department of Education.
    Enacting a national reform interval in times of uncertainty: evaluation gluttony among the willing2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a Case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren and Linda Rönnberg, Dortrecht: Springer, 2019, p. 119-138Chapter in book (Refereed)
    Abstract [en]

    This chapter offers an empirical illustration of the governing-evaluation-knowledge nexus by pinpointing a particular situation, a pause between two national evaluation and quality assurance (EQA) reforms, while a new national system was being planned and prepared, but its final design was not yet decided upon. This situation – unusual in the Swedish higher education policy context – adds uncertainty to the situation and opens a potential space for policymakers and higher education institutions (HEIs) to navigate. We draw on interviews and documents collected from four HEIs during this reform interval. We analyse and discuss how the four institutions navigate, coordinate, mobilise, copy, and learn in a situation without a formal national EQA system in place but in which the wider higher education policy context is deeply infused with contemporary trends and international policies and ideas on quality assurance (QA). We found that context and institutional preconditions set their mark on the work undertaken during this interval. We also discerned tendencies of homogenisation and isomorphism. Finally, we highlight the tendency of further expansion of EQA activities.

  • Segerholm, Christina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Education.
    Rönnberg, Linda
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Lindgren, Joakim
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Hult, Agneta
    Umeå University, Faculty of Social Sciences, Department of Education.
    Governing by Evaluation: Setting the scene2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a Case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren and Linda Rönnberg, Dortrecht: Springer, 2019, p. 1-23Chapter in book (Refereed)
    Abstract [en]

    This introductory chapter starts by outlining the aim of the book: to analyse and discuss the interplay between governing, evaluation and knowledge with an empirical focus on Swedish higher education. It then goes on to locate this aim and the intended contribution within the wider research context and in previous studies. The chapter also highlights some important national traits of the Swedish case and Swedish higher education policy development, before presenting the overall conceptual frame employed in the book and the project it builds on. Finally, an outline of the forthcoming chapters is provided.

  • Rönnberg, Linda
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Quality Evaluations and the Media2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren and Linda Rönnberg, Dortrecht: Springer, 2019, p. 103-118Chapter in book (Refereed)
    Abstract [en]

    The aim of this chapter is to analyse how results from the 2011 to 2014 national evaluation and quality assurance (EQA) system were communicated to and via the media. First, the analysis focuses on the attempted media framing, as manifested in press releases of national evaluations from the responsible national agencies. Second, the higher education institution-media interactions, in the context of two national quality evaluations from two subject areas (education and specialist nursing), are analysed from the perspective of how four higher education institutions’ attempted framings were (re)presented by the media. The chapter concludes with a discussion pointing to interdependence and possible reinforcement of the media-quality assurance relationship and points to some possible implications for education governing. The chapter also discusses the silences and articulations that could not be detected in the studied data, as situated within the context of reputation management and media display in the contemporary "evaluation society".

  • Lindgren, Joakim
    et al.
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Rönnberg, Linda
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Hayek and the red tape: the politics of evaluation and quality assurance reform – from shortcut governing to policy rerouting2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren and Linda Rönnberg, Dortrecht: Springer, 2019, p. 83-101Chapter in book (Refereed)
    Abstract [en]

    In this chapter, we draw attention to the important political dimension of the governing-evaluation-knowledge nexus. The aim is to describe and analyse the processes leading up to the two most recent national evaluation and quality assurance (EQA) systems in operation from 2011 to 2014 and from 2016 onwards by analysing the formation of the respective EQA systems and the actors involved in these processes. The chapter outlines political justifications and ideological beliefs and highlights central shifts and continuities in these processes. We explore how formation of EQA systems can be understood within a wider context of the work of governing by contrasting the fast, competitive "shortcut governing" from the 2011–2014 EQA system with the more dialogue- and consensus-oriented process implying a "policy rerouting" later, as manifested in the process leading up to the 2016 EQA system. We also discuss quality assurance expansion in the context of higher education policymaking.

  • Jarlbrink, Johan
    et al.
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Lundell, Patrik
    Snickars, Pelle
    Umeå University, Faculty of Arts, Department of culture and media studies. Umeå University, Faculty of Arts, Humlab.
    Mediernas historia: från big bang till big data2019Book (Refereed)
    Abstract [sv]

    Idag upplever många att medier genomsyrar allt fler delar av vardag och samhälle. Men vår samtid delar denna erfarenhet med människor som levt under tidigare perioder. För att hitta en tid då medier inte satte sin prägel på liv och samhälle måste vi gå mycket långt tillbaka i historien. Mediehistoriska perspektiv kan anläggas på de flesta historiska fenomen. Det förflutna är nämligen endast tillgängligt i medierad form – om det så gäller antikt klotter, runstenar, dammiga arkiv­ dokument, sönderfallande tidningslägg, muntliga berättelser eller förra årets Youtubeklipp. I Mediernas historia. Från big bang till big data skildras en mycket lång mediehistoria. Att mäta medievanor genom big data är idag vanligt – men även urknallen big bang är ett medialt fenomen vars kosmiska bakgrundsstrålning inte kan studeras utan att först registreras. Med en disposition i 44 avsnitt betonar boken olika mediekulturers särprägel, samtidigt som den lyfter fram hur ett myller av medier har interagerat – från beständiga lertavlor över predikstolar och tidigmodern visuell kommunikation till strömmande medier. Istället för att framhäva mediehistoriska brott och revolutioner synlig­ gör boken kontinuiteter ifråga om hur medier har etablerats, använts och förändrats fram till vår egen tid. Relationen mellan vår samtids sociala medier och traditionella mass­ medier utgör här endast ett exempel på den komplexa väv av sinsemellan hopflätade kommunikationsformer som historien består av.

  • Söderholm, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. Umeå University, Faculty of Social Sciences, Department of Psychology.
    Liljelind, Ingrid
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Edvardsson, Berit
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Development and evaluation of a questionnaire instrument for chemical intolerance, based on the International Classification of Functioning, Disability and Health2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose was to develop a questionnaire instrument to measure difficulties in activities and participation, and impact of environmental factors in chemical intolerance, based on the International Classification of Functioning, Disability and Health, and to assess its validity and reliability.

    Method: Development in three steps: (1) choosing items of relevance for chemical intolerance with an expert group, (2) conducting interviews with persons with chemical intolerance, using sampling to redundancy, (3) conducting a survey with 112 respondents at a first assessment and 91 at a second assessment for test-retest.

    Results: The final version of the instrument consists of 57 items divided in three parts, which showed good internal consistency in each part, Cronbach alpha: 0.73-0.87. It had good content validity, readability and face validity. Test-retest showed good to very good (≥0.61) Kappa agreement for 37 items, and moderate (0.41-0.60) for 17 items. Three items had poor or fair (<0.41) Kappa agreement.

    Conclusion: The instrument was found to be valid and reliable. It can be used as a clinical tool to help persons with chemical intolerance to receive the best suited help and support for each individual, identify key points in rehabilitation, measure rehabilitation outcome and establish priority for treatment. 

  • Jönsson, Maria
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Recension av Affect, emotion, and children's literature2019In: Barnboken, ISSN 0347-772X, E-ISSN 2000-4389, Vol. 42Article, book review (Other academic)
  • Lindahl, Bernt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Johansson, Helene
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lindvall, Kristina
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Näslund, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Persson, Amanda
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Vanoli, Davide
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Schulz, Peter J.
    Institute of Communication and Health, University of Lugano, Switzerland.
    Health literacy is independently and inversely associated with carotid artery plaques and cardiovascular risk2019In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881Article in journal (Refereed)
    Abstract [en]

    Aims: Health literacy, the degree to which individuals understand and act upon health information, may have a pivotal role in the prevention of cardiovascular disease (CVD), with low health literacy potentially explaining poorer adherence to prevention guidelines. We investigated the associations between health literacy, ultrasound-detected carotid atherosclerosis and cardiovascular risk factors.

    Methods: Baseline data (cross-sectional analysis) from a randomized controlled trial, integrated within the Västerbotten Intervention Program, Northern Sweden, was used. We included 3459 individuals, aged 40 or 50 years with ≥1 conventional risk factor or aged 60 years old. The participants underwent clinical examination, blood sampling, carotid ultrasound assessment of intima-media wall thickness (CIMT) and plaque formation, and answered a questionnaire on health literacy – the Brief Health Literacy Screen. The European Systematic Coronary Risk Evaluation and Framingham Risk Score were calculated.

    Results: About 20% of the participants had low health literacy. Low health literacy was independently associated with the presence of ultrasound-detected carotid artery plaques after adjustment for age and education, odds ratio (95% confidence interval) 1.54 (1.28–1.85), demonstrating a similar level of risk as for smoking. Health literacy was associated with CIMT in men. Low health literacy was associated with higher CVD risk scores. Sensitivity analyses with low health literacy set to 9% or 30% of the study sample, respectively, yielded essentially the same results.

    Conclusions: Low health literacy was independently associated with carotid artery plaques and a high level of CVD risk scores. Presenting health information in a fashion that is understood by all patients may improve preventive efforts.