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Scott, D., Johansson, J., McMillan, L. B., Ebeling, P. R., Nordström, P. & Nordström, A. (2019). Associations of Sarcopenia and Its Components with Bone Structure and Incident Falls in Swedish Older Adults. Calcified Tissue International, 105(1), 26-36
Öppna denna publikation i ny flik eller fönster >>Associations of Sarcopenia and Its Components with Bone Structure and Incident Falls in Swedish Older Adults
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2019 (Engelska)Ingår i: Calcified Tissue International, ISSN 0171-967X, E-ISSN 1432-0827, Vol. 105, nr 1, s. 26-36Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The aim of this study was to compare bone structure parameters and likelihood of falls across European Working Group on Sarcopenia in Older People (EWGSOP2) sarcopenia categories. 3334 Swedish 70-year olds had appendicular lean mass (normalized to height; ALMHt), lumbar spine and total hip areal BMD (aBMD) estimated by dual-energy X-ray absorptiometry. Volumetric BMD (vBMD) and structure at the distal and proximal tibia and radius were estimated by peripheral quantitative computed tomography. Hand grip strength and timed up-and-go were assessed, and sarcopenia was defined according to EWGSOP2 criteria. Incident falls were self-reported 6 and 12 months after baseline. Only 0.8% and 1.0% of participants had probable and confirmed sarcopenia, respectively. Almost one-third of participants with confirmed sarcopenia reported incident falls, compared with 20% for probable sarcopenia and 14% without sarcopenia (P = 0.025). Participants with confirmed sarcopenia had poorer bone parameters (all P < 0.05) except endosteal circumference at the proximal radius and tibia, while those with probable sarcopenia had lower cortical area at the proximal radius (B = - 5.9; 95% CI - 11.7, - 0.1 mm2) and periosteal and endosteal circumferences at the proximal tibia (- 3.3; - 6.4, - 0.3 and - 3.8; - 7.5, - 0.1 mm2, respectively), compared with those without sarcopenia. Compared with probable sarcopenia, confirmed sarcopenic participants had significantly lower lumbar spine and total hip aBMD, distal radius and tibia total vBMD, and proximal radius and tibia cortical vBMD, area and thickness (all P < 0.05). Swedish 70-year olds with confirmed sarcopenia demonstrate poorer BMD and bone architecture than those with probable and no sarcopenia, and have increased likelihood of incident falls.

Ort, förlag, år, upplaga, sidor
Springer, 2019
Nyckelord
Bone, Falls, Muscle, Older adults, Osteoporosis, Sarcopenia
Nationell ämneskategori
Geriatrik
Identifikatorer
urn:nbn:se:umu:diva-157881 (URN)10.1007/s00223-019-00540-1 (DOI)000469477400003 ()30899995 (PubMedID)
Forskningsfinansiär
Vetenskapsrådet, 2011-2976
Tillgänglig från: 2019-04-05 Skapad: 2019-04-05 Senast uppdaterad: 2019-06-17Bibliografiskt granskad
Bergman, J., Nordström, A., Hommel, A., Kivipelto, M. & Nordström, P. (2019). Bisphosphonates and mortality: confounding in observational studies?. Osteoporosis International
Öppna denna publikation i ny flik eller fönster >>Bisphosphonates and mortality: confounding in observational studies?
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2019 (Engelska)Ingår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965Artikel i tidskrift (Refereegranskat) Epub ahead of print
Abstract [en]

Summary: Numerous observational studies suggest that bisphosphonates reduce mortality. This study showed that bisphosphonate use is associated with lower mortality within days of treatment, although the association was not significant until the second week. Such an early association is consistent with confounding, although an early treatment effect cannot be ruled out.

Introduction: The purpose of this study was to examine whether confounding explains why numerous observational studies show that bisphosphonate use is associated with lower mortality. To this end, we examined how soon after treatment initiation a lower mortality rate can be observed. We hypothesized that, due to confounding, the association would be observed immediately.

Methods: This was a retrospective cohort study of hip fracture patients discharged from Swedish hospitals between 1 July 2006 and 31 December 2015. The data covered 260,574 hip fracture patients and were obtained from the Swedish Hip Fracture Register and national registers. Of the 260,574 patients, 49,765 met all eligibility criteria and 10,178 were pair matched (bisphosphonate users to controls) using time-dependent propensity scores. The matching variables were age, sex, diagnoses, prescription medications, type of hip fracture, type of surgical procedure, known or suspected dementia, and physical functioning status.

Results: Over a median follow-up of 2.8 years, 2922 of the 10,178 matched patients died. The mortality rate was 7.9 deaths per 100 person-years in bisphosphonate users and 9.4 deaths in controls, which corresponded to a 15% lower mortality rate in bisphosphonate users (hazard ratio 0.85, 95% confidence interval 0.79–0.91). The risk of death was lower in bisphosphonate users from day 6 of treatment, although the association was not significant until the second week.

Conclusion: Bisphosphonate use was associated with lower mortality within days of treatment initiation. This finding is consistent with confounding, although an early treatment effect cannot be ruled out.

Ort, förlag, år, upplaga, sidor
Springer London, 2019
Nyckelord
Bisphosphonates, Death, Mortality, Observational study, Osteoporosis
Nationell ämneskategori
Ortopedi
Identifikatorer
urn:nbn:se:umu:diva-162802 (URN)10.1007/s00198-019-05097-1 (DOI)31367949 (PubMedID)
Tillgänglig från: 2019-08-29 Skapad: 2019-08-29 Senast uppdaterad: 2019-09-02
Ballin, M., Lundberg, E., Sörlén, N., Nordström, P., Hult, A. & Nordström, A. (2019). Effects of Interval Training on Visceral Adipose Tissue in Centrally Obese 70-Year-Old Individuals: A Randomized Controlled Trial. Journal of The American Geriatrics Society, 67(8), 1625-1631
Öppna denna publikation i ny flik eller fönster >>Effects of Interval Training on Visceral Adipose Tissue in Centrally Obese 70-Year-Old Individuals: A Randomized Controlled Trial
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2019 (Engelska)Ingår i: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 67, nr 8, s. 1625-1631Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: To investigate the effects of 10 weeks of progressive vigorous-intensity interval training as a single intervention on body composition among 70-year-old individuals with central obesity.

DESIGN: Randomized controlled trial (ClinicalTrials.gov registration No. NCT03450655).

SETTING: Community-dwelling 70-year-old men and women living in the Umeå municipality in Sweden.

PARTICIPANTS: Seventy-seven 70-year-old men and women with central obesity (greater than 1 kg visceral adipose tissue [VAT] for women and greater than 2 kg VAT for men).

INTERVENTION: Participants allocated to the intervention group were offered a 10-week progressive concurrent exercise program performed three times per week. All participants in both groups had received tailored lifestyle recommendations focused on diet and physical activity at one occasion within 12 months prior to trial initiation.

MEASUREMENTS: The primary outcome was changes in VAT, and secondary outcomes included changes in total fat mass (FM), total lean body mass (LBM), and body mass index.

RESULTS: Comparing the groups, there were no significant differences in decrease of VAT mass (P = .10), although the intervention group significantly decreased FM by 716 g (P = .01) and gained LBM by 508 g (P = .03), compared to the control group. Furthermore, the effects of the training were significantly greater in the male subcohort (P < .05 for interaction), with positive effects also on VAT and FM, where men in the intervention group decreased VAT by 175 g (P < .05) and FM by 1364 g (P = .004), compared to the male controls.

CONCLUSIONS: The present trial demonstrates that 10 weeks of progressive vigorous interval training is sufficient to significantly decrease FM in older adults with central obesity, with positive effects also on LBM.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2019
Nyckelord
exercise, lean body mass, visceral fat
Nationell ämneskategori
Geriatrik Gerontologi, medicinsk/hälsovetenskaplig inriktning
Identifikatorer
urn:nbn:se:umu:diva-158499 (URN)10.1111/jgs.15919 (DOI)000478919000014 ()31012497 (PubMedID)
Tillgänglig från: 2019-04-29 Skapad: 2019-04-29 Senast uppdaterad: 2019-09-02Bibliografiskt granskad
Vikberg, S., Sörlén, N., Brandén, L., Johansson, J., Nordström, A., Hult, A. & Nordström, P. (2019). Effects of Resistance Training on Functional Strength and Muscle Mass in 70-Year-Old Individuals With Pre-sarcopenia: A Randomized Controlled Trial. Journal of the American Medical Directors Association, 20(1), 28-34
Öppna denna publikation i ny flik eller fönster >>Effects of Resistance Training on Functional Strength and Muscle Mass in 70-Year-Old Individuals With Pre-sarcopenia: A Randomized Controlled Trial
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2019 (Engelska)Ingår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 20, nr 1, s. 28-34Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: Sarcopenia has been defined as age-related loss of muscle mass and function. The aim of this randomized controlled trial was to examine the effects of a 10-week instructor-led resistance training program on functional strength and body composition in men and women aged 70 years with pre-sarcopenia.

DESIGN, SETTING, AND PARTICIPANTS: Participants were randomized to either 10 weeks of a physical training regimen including optional nutritional supplementation (n = 36) or to a control group (n = 34) (ClinicalTrials.gov, no. NCT03297632). The main outcome was changes in the Short Physical Performance Battery (SPPB) score. Secondary outcomes included the Timed Up and Go test, chair sit-stand time, lean body mass, and fat mass.

RESULTS: The intervention had no significant effect on SPPB in the total cohort (P = .18), when comparing changes in the intervention group with the control group. However, those given the intervention in the male subcohort increased 0.5 ± 0.4 (mean ± standard error for the difference) points in SPPB during follow-up (P = .02) compared to male controls. With respect to secondary outcomes, the intervention group decreased 0.9 ± 0.6 seconds in chair sit-stand time compared to controls (P = .01). Furthermore, the intervention resulted in significantly greater improvements for the training group than control group in all measures of body composition (P ≤ .01 for all). For example, lean body mass increased by a mean of 1147 ± 282 g (P < .001), and total fat mass decreased by a mean of 553 ± 225 g (P = .003), favoring the intervention group.

CONCLUSION/IMPLICATIONS: The main finding of this intervention study is that an easy-to-use, functional resistance training program was effective in maintaining functional strength and increasing muscle mass in older adults with pre-sarcopenia.

Ort, förlag, år, upplaga, sidor
Elsevier, 2019
Nyckelord
Resistance training, functional strength, muscle mass
Nationell ämneskategori
Sjukgymnastik Gerontologi, medicinsk/hälsovetenskaplig inriktning Geriatrik
Identifikatorer
urn:nbn:se:umu:diva-153603 (URN)10.1016/j.jamda.2018.09.011 (DOI)000454138000005 ()30414822 (PubMedID)2-s2.0-85055969854 (Scopus ID)
Anmärkning

Available online 7 November 2018.

Tillgänglig från: 2018-11-23 Skapad: 2018-11-23 Senast uppdaterad: 2019-01-15Bibliografiskt granskad
Bergman, J., Nordström, A. & Nordström, P. (2019). Epidemiology of osteonecrosis among older adults in Sweden. Osteoporosis International, 30(5), 965-973
Öppna denna publikation i ny flik eller fönster >>Epidemiology of osteonecrosis among older adults in Sweden
2019 (Engelska)Ingår i: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, nr 5, s. 965-973Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Summary: This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden.

Introduction: The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort.

Methods: In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs).

Results: The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% (n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69–8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59–8.99), dialysis (SIR, 6.65; 95% CI, 5.62–7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70–7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases.

Conclusions: Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden.

Ort, förlag, år, upplaga, sidor
Springer London, 2019
Nyckelord
Aseptic necrosis, Avascular necrosis, Bone necrosis, Register, Registry, Sweden
Nationell ämneskategori
Geriatrik
Identifikatorer
urn:nbn:se:umu:diva-155486 (URN)10.1007/s00198-018-04826-2 (DOI)000467142400005 ()30627759 (PubMedID)2-s2.0-85059865604 (Scopus ID)
Tillgänglig från: 2019-01-18 Skapad: 2019-01-18 Senast uppdaterad: 2019-06-13Bibliografiskt granskad
Sagelv, E. H., Ekelund, U., Johansson, J., Welde, B., Grimsgaard, S., Emaus, N., . . . Morseth, B. (2019). Measures Of Adiposity And Its Association To Physical Activity In Adults: The Tromso Study. Paper presented at Annual Meeting of the American-College-of-Sports-Medicine (ACSM), MAY 28-JUN 01, 2019, Orlando, FL. Medicine & Science in Sports & Exercise, 51(6), 447-447
Öppna denna publikation i ny flik eller fönster >>Measures Of Adiposity And Its Association To Physical Activity In Adults: The Tromso Study
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2019 (Engelska)Ingår i: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 51, nr 6, s. 447-447Artikel i tidskrift, Meeting abstract (Övrigt vetenskapligt) Published
Nationell ämneskategori
Idrottsvetenskap
Identifikatorer
urn:nbn:se:umu:diva-163091 (URN)10.1249/01.mss.0000561838.55831.57 (DOI)000481662801563 ()
Konferens
Annual Meeting of the American-College-of-Sports-Medicine (ACSM), MAY 28-JUN 01, 2019, Orlando, FL
Tillgänglig från: 2019-09-06 Skapad: 2019-09-06 Senast uppdaterad: 2019-09-06Bibliografiskt granskad
Scott, D., Johansson, J., McMillan, L. B., Ebeling, P. R., Nordström, A. & Nordström, P. (2019). Mid-calf skeletal muscle density and its associations with physical activity, bone health and incident 12-month falls in older adults: The Healthy Ageing Initiative. Bone, 120, 446-451
Öppna denna publikation i ny flik eller fönster >>Mid-calf skeletal muscle density and its associations with physical activity, bone health and incident 12-month falls in older adults: The Healthy Ageing Initiative
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2019 (Engelska)Ingår i: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 120, s. 446-451Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Lower skeletal muscle density, indicating greater infiltration of adipose tissue into muscles, is associated with higher fracture risk in older adults. We aimed to determine whether mid-calf muscle density is associated with falls risk and bone health in community-dwelling older adults.

METHODS: 2214 community-dwelling men and women who participated in the Healthy Ageing Initiative (Sweden) study at age 70 were included in this analysis. Mid-calf muscle density (mg/cm3) at the proximal tibia, and volumetric bone mineral density (vBMD) and architecture at the distal and proximal tibia and radius, were assessed by peripheral quantitative computed tomography. Whole-body lean and fat mass, lumbar spine and total hip areal bone mineral density (aBMD) were assessed by dual-energy X-ray absorptiometry. Participants completed seven-day accelerometer measurements of physical activity intensity, and self-reported falls data were collected 6 and 12 months later.

RESULTS: 302 (13.5%) participants reported a fall at the 6- or 12-month interview, and 29 (1.3%) reported a fall at both interviews. After adjustment for confounders, each standard deviation decrease in mid-calf muscle density was associated with a trend towards greater likelihood of experiencing a fall (OR 1.13; 95% CI 1.00, 1.29 per SD lower) and significantly greater likelihood of multiple falls (1.61; 1.16, 2.23). Higher muscle density was not associated with total hip aBMD, and was associated with lower lumbar spine aBMD (B = -0.003; 95% CI -0.005, -0.001 per mg/cm3) and higher proximal cortical vBMD (0.74; 0.20, 1.28) at the radius. At the tibia, muscle density was positively associated with distal total and trabecular vBMD, and proximal total and cortical vBMD, cortical thickness, cortical area and stress-strain index (all P < 0.05). Only moderate/vigorous (%) intensity physical activity, not sedentary time or light activity, was associated with higher mid-calf muscle density (0.086; 0.034, 0.138).

CONCLUSIONS: Lower mid-calf muscle density is independently associated with higher likelihood for multiple incident falls and appears to have localised negative effects on bone structure in older adults.

Ort, förlag, år, upplaga, sidor
Elsevier, 2019
Nyckelord
Bone density, Falls, Muscle density, Osteoporosis, Physical activity, Sarcopenia
Nationell ämneskategori
Geriatrik
Identifikatorer
urn:nbn:se:umu:diva-156222 (URN)10.1016/j.bone.2018.12.004 (DOI)000458471700052 ()30537557 (PubMedID)
Tillgänglig från: 2019-02-08 Skapad: 2019-02-08 Senast uppdaterad: 2019-04-16Bibliografiskt granskad
Hult, A., Johansson, J., Nordström, P. & Nordström, A. (2019). Objectively Measured Physical Activity in Older Adults With and Without Diabetes. Clinical Diabetes, 37(2), 142-149, Article ID cd180041.
Öppna denna publikation i ny flik eller fönster >>Objectively Measured Physical Activity in Older Adults With and Without Diabetes
2019 (Engelska)Ingår i: Clinical Diabetes, ISSN 0891-8929, E-ISSN 1945-4953, Vol. 37, nr 2, s. 142-149, artikel-id cd180041Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Increased physical activity (PA) is ordinated to increase glycemic control in subjects with diabetes. We evaluated objectively measured as well as self-reported PA in elderly individuals with and without diabetes.

Method: The study included 1872 community-dwelling individuals (49% women), all aged 70 years. Objective PA was measured by accelerometers worn for 1 week. Physical activity patterns in subjects with and without diabetes were evaluated using multivariable adjustable regression models.

Results: In the cohort 210 subjects (138 men and 72 women) were found to have diabetes. Self-reported PA showed a weak association with objective PA (r = 0.06, p = 0.01).  Individuals with known diabetes had fewer steps per day (mean 5,754) than those with detected diabetes at baseline (mean 6,359) or no diabetes (mean 7,375, all p < 0.05). A cut-off value of at least 6,000 steps per day discriminated best between individuals with and without diabetes (multi-adjusted odds ratio (OR), 0.50, 95% CI, 0.36–0.69), and overall step-count also showed the strongest correlation with objective visceral adipose tissue (VAT, β = 0.29, p < 0.001). In contrast, objectively measured PA in at least 10-minute bouts, as recommended by WHO, did not discriminate between individuals with a without diabetes (OR, 0.92, 95% CI, 0.66–1.28).

Conclusion: Despite recommendations given to subjects with diabetes, objectively measured PA was more than 20% lower in elderly individuals with diabetes. Daily step-counts was also associated with VAT, a potential mediator of the effects of PA.

Ort, förlag, år, upplaga, sidor
American Diabetes Association, 2019
Nationell ämneskategori
Klinisk medicin Endokrinologi och diabetes
Forskningsämne
folkhälsa
Identifikatorer
urn:nbn:se:umu:diva-154288 (URN)10.2337/cd18-0041 (DOI)
Tillgänglig från: 2018-12-14 Skapad: 2018-12-14 Senast uppdaterad: 2019-06-12Bibliografiskt granskad
Bergman, J., Nordström, A. & Nordström, P. (2019). Overestimation of the Limitations of Randomized Controlled Trials [Letter to the editor]. Journal of Bone and Mineral Research
Öppna denna publikation i ny flik eller fönster >>Overestimation of the Limitations of Randomized Controlled Trials
2019 (Engelska)Ingår i: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681Artikel i tidskrift, Letter (Refereegranskat) Epub ahead of print
Nationell ämneskategori
Ortopedi
Identifikatorer
urn:nbn:se:umu:diva-161820 (URN)10.1002/jbmr.3808 (DOI)000474892600001 ()31295365 (PubMedID)
Tillgänglig från: 2019-08-13 Skapad: 2019-08-13 Senast uppdaterad: 2019-08-29
Berginström, N., Nordström, P., Ekman, U., Eriksson, J., Nyberg, L. & Nordström, A. (2019). Pharmaco-fMRI in Patients With Traumatic Brain Injury: A Randomized Controlled Trial With the Monoaminergic Stabilizer (-)-OSU6162. The journal of head trauma rehabilitation, 34(3), 189-198
Öppna denna publikation i ny flik eller fönster >>Pharmaco-fMRI in Patients With Traumatic Brain Injury: A Randomized Controlled Trial With the Monoaminergic Stabilizer (-)-OSU6162
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2019 (Engelska)Ingår i: The journal of head trauma rehabilitation, ISSN 0885-9701, E-ISSN 1550-509X, Vol. 34, nr 3, s. 189-198Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: To examine the effects of monoaminergic stabilizer (-)-OSU6162 on brain activity, as measured by blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI), in patients in the chronic phase of traumatic brain injury suffering from fatigue.

SETTING: Neurorehabilitation clinic.

PARTICIPANTS: Patients with traumatic brain injury received either placebo (n = 24) or active treatment (n = 28). Healthy controls (n = 27) went through fMRI examination at one point and were used in sensitivity analysis on normalization of BOLD response.

DESIGN: Randomized, double-blinded, placebo-controlled design.

MAIN MEASURES: Effects on BOLD signal changes from before to after treatment during performance of a fatiguing attention task.

RESULTS: The fMRI results revealed treatment effects within the right occipitotemporal cortex and the right orbitofrontal cortex. In these regions, the BOLD response was normalized relative to healthy controls at the postintervention fMRI session. No effects were seen in regions in which we previously observed activity differences between patients and healthy controls while performing this fMRI task, such as the striatum.

CONCLUSION: (-)-OSU6162 treatment had influences on functional brain activity, although the normalized regional BOLD response was observed in regions that were not a priori hypothesized to be sensitive to this particular treatment, and was not accompanied by any effects on in-scanner test performance or on fatigue.

Ort, förlag, år, upplaga, sidor
Wolters Kluwer, 2019
Nyckelord
dopaminergic agents, functional magnetic resonance imaging, randomized controlled trial, traumatic brain injury
Nationell ämneskategori
Neurologi Neurovetenskaper
Identifikatorer
urn:nbn:se:umu:diva-152090 (URN)10.1097/HTR.0000000000000440 (DOI)000474249100015 ()30234850 (PubMedID)
Forskningsfinansiär
Ragnar Söderbergs stiftelseTorsten Söderbergs stiftelseKnut och Alice Wallenbergs StiftelseVästerbottens läns landsting
Tillgänglig från: 2018-09-26 Skapad: 2018-09-26 Senast uppdaterad: 2019-08-06Bibliografiskt granskad
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