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Granåsen, Gabriel
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Publications (10 of 23) Show all publications
Granberg Sandlund, M., Diamant, A., Granåsen, G. & Salzer, J. (2019). Effectiveness of care in acute dizziness presentations. European Archives of Oto-Rhino-Laryngology, 276(9), 2389-2396
Open this publication in new window or tab >>Effectiveness of care in acute dizziness presentations
2019 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 276, no 9, p. 2389-2396Article in journal (Refereed) Published
Abstract [en]

Purpose: This study aims to evaluate whether a management algorithm has improved the effectiveness of care for dizzy patients at Umea University Hospital.

Methods: This was an interventional study using medical records to collect data for acute dizziness presentations before (period 1, 2012-2014) and after (period 2, 2016-2017) the implementation of a management algorithm. Outcomes were changes in a set of pre-defined effectiveness markers and health economic effects.

Results: Total n = 2126 and n = 1487 acute dizziness presentations were identified in period 1 and 2, respectively. Baseline characteristics were similar. The proportion of patients undergoing Dix-Hallpike testing increased, 20.8% [95% confidence interval (CI) 18.8-23.0%] vs. 37.7% (95% CI 35.2-40.2%), as did BPPV diagnoses, 7.6% (95% CI 6.6-8.8%) vs. 15.3% (95% CI 13.6-17.3%). Hospitalization became less common, 61.5% (95% CI 59.4-63.6%) vs. 47.6% (95% CI 45.1-50.2%). The proportion undergoing any neuroradiological investigation decreased, 44.8% (95% CI 42.7-47.0%) vs. 36.3% (95% CI 33.8-38.7%) with a shift from CT to MRI, with unchanged sensitivity for diagnosing cerebrovascular causes. The average cost for the care of one dizzy patient decreased from $2561 during period 1 to $1808 during period 2.

Conclusions: This study shows that the implementation of a management algorithm for dizzy patients was associated with improved effectiveness of care.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Dizziness, Vertigo, Health economics, Management algorithms, Effectiveness of care
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:umu:diva-162655 (URN)10.1007/s00405-019-05470-0 (DOI)000478901700003 ()31098875 (PubMedID)
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2019-09-05Bibliographically approved
Collins, E., Strandell, A., Granåsen, G. & Idahl, A. (2019). Menopausal symptoms and surgical complications after opportunistic bilateral salpingectomy, a register-based cohort study. Paper presented at 26th European Congress of the European-Board-and-College-of-Obsterics-and-Gynecology, MAR 08-10, 2018, Paris, FRANCE. American Journal of Obstetrics and Gynecology, 220(1), Article ID 85.e1-e10.
Open this publication in new window or tab >>Menopausal symptoms and surgical complications after opportunistic bilateral salpingectomy, a register-based cohort study
2019 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 220, no 1, article id 85.e1-e10Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In recent years, the fallopian tubes have been found to play a critical role in the pathogenesis of ovarian cancer. Therefore, bilateral salpingectomy at the time of hysterectomy has been proposed as a preventive procedure, but with scarce scientific evidence to support the efficiency and safety. OBJECTIVE: Our primary objective was to evaluate the risk of surgical complications and menopausal symptoms when performing bilateral salpingectomy in addition to benign hysterectomy. Furthermore, we sought to compare time in surgery, perioperative blood loss/blood transfusion, duration of hospital stay, days to normal activities of daily living, and days out of work for hysterectomy with bilateral salpingectomy compared with hysterectomy only. A secondary objective was to study the uptake of opportunistic salpingectomy in Sweden. STUDY DESIGN: This was a retrospective observational cohort study based on data from the National Quality Register of Gynecological Surgery in Sweden. Women <55 years of age who had a hysterectomy for benign indications with or without bilateral salpingectomy in 1998 through 2016 were included. Possible confounding was adjusted for in multivariable regression models. RESULTS: During the study period, 23,369 women had a hysterectomy for benign indications. The frequency of bilateral salpingectomy at the time of hysterectomy increased mainly from 2013, which is why the period 2013 through mid-2016 was selected for further analysis (n = 6892). There was a low frequency of vaginal hysterectomy with bilateral salpingectomy performed in this period, which is why only abdominal and laparoscopic surgeries were selected for comparative analysis (n = 4906). This study indicates an increased risk of menopausal symptoms (adjusted relative risk, 1.33; 95% confidence interval, 1.04-1.69) 1 year after hysterectomy with bilateral salpingectomy compared with hysterectomy only. Hospital stay was 0.1 days longer in women having salpingectomy (P = .01), and bleeding was slightly reduced in the salpingectomy group (-20 mL, P = .04). Other outcome measures were not significantly associated with salpingectomy, albeit a tendency toward higher risk of minor complications was seen (adjusted relative risk, 1.30; 95% confidence interval, 0.93-1.83). CONCLUSION: Bilateral salpingectomy at the time of hysterectomy was associated with an increased risk of menopausal symptoms 1 year after surgery. Randomized clinical trials reducing the risk of residual and unmeasured confounding and longer follow-up are needed to correctly inform women on the risks and benefits of opportunistic salpingectomy.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
complications, hysterectomy, menopausal symptoms, opportunistic salpingectomy
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-155211 (URN)10.1016/j.ajog.2018.10.016 (DOI)000454239900016 ()30321526 (PubMedID)
Conference
26th European Congress of the European-Board-and-College-of-Obsterics-and-Gynecology, MAR 08-10, 2018, Paris, FRANCE
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-01-15Bibliographically approved
Granberg Sandlund, M., Diamant, A., Granåsen, G. & Salzer, J. (2019). Quality of care in acute dizziness presentations. Paper presented at 5th Congress of the European Academy of Neurology, Oslo, Norway, June 29 – July 2, 2019. European Journal of Neurology, 26(S1), 926-926
Open this publication in new window or tab >>Quality of care in acute dizziness presentations
2019 (English)In: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 26, no S1, p. 926-926Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background and aims: Dizziness is a common symptom at emergency departments. Studies have shown poor quality of care in acute dizziness presentations, including the overuse of computed tomography (CT) and failure to detect benign causes. This study aims to evaluate whether a management algorithm has improved the quality of care for dizzy patients at Umeå University Hospital, Sweden.

Methods: This was an interventional study using medical records to collect data for acute dizziness presentations before (period 1, 2012–2014) and after (period 2, 2016-2017) the implementation of a management algorithm (see figure). Outcomes were changes in a set of pre-defined quality markers and health economic effects.

Results: Total n=2126 and n=1487 acute dizziness presentations were identified in period 1 and 2, respectively. Baseline characteristics were similar. The proportion of patients undergoing Dix-Hallpike testing increased, 20.8% vs. 37.7%, (p<0.01), as did BPPV diagnoses, 7.6% vs. 15.3%, (p<0.01). Hospitalization became less common, 61.5% vs. 47.6% (p<0.01). The proportion undergoing any neuroradiological investigation decreased, 44.8% vs. 36.3% (p<0.01) with a shift from CT to MRI, with unchanged sensitivity for diagnosing cerebrovascular causes. The average cost for the care of one dizzy patient decreased from $2561 during period 1 to $1808 during period 2.

Conclusion: This study shows how the implementation of a management algorithm for dizzy patients can improve the quality of care and lower the expenses, without an increased number of missed stroke cases.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-161916 (URN)10.1111/ene.14019 (DOI)000474481004132 ()
Conference
5th Congress of the European Academy of Neurology, Oslo, Norway, June 29 – July 2, 2019
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically approved
Boman, J., Lindqvist, H., Forsberg, L., Janlert, U., Granåsen, G. & Nylander, E. (2018). Brief manual-based single-session Motivational Interviewing for reducing high-risk sexual behaviour in women: an evaluation. International Journal of STD and AIDS (London), 29(4), 396-403
Open this publication in new window or tab >>Brief manual-based single-session Motivational Interviewing for reducing high-risk sexual behaviour in women: an evaluation
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2018 (English)In: International Journal of STD and AIDS (London), ISSN 0956-4624, E-ISSN 1758-1052, Vol. 29, no 4, p. 396-403Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to develop and evaluate brief Motivational Interviewing (MI) to facilitate behaviour change in women at high risk of contracting sexually transmitted infections (STIs). One hundred and seventy-three women (mean age 24.7) at high risk of contracting STIs were randomized to a brief risk-reducing MI counselling intervention (n = 74) or assigned to the control group (n = 99). MI skill was assessed using the Motivational Interviewing Treatment Integrity (MITI) Coding System. Seventeen of 74 (23%) women tested for Chlamydia trachomatis (CT) in the MI intervention group and 22 of 99 (22%) in the control group had a genital CT infection 0-24 months before baseline. All additional CT testing was monitored up to 24 months for all 173 women in the study. None of the 49 CT-retested women in the MI group was CT infected, as compared to 3 of 72 (4%) women in the control group. A generalized estimating equations model with sexual high-risk behaviour measured at baseline and at six-month follow-up produced an adjusted estimated odds ratio of 0.38 (95% confidence interval = 0.158, 0.909), indicating efficacy. Brief manual-based single-session MI counselling seems to be effective in reducing high-risk sexual behaviour in women at high risk of acquiring STIs.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Chlamydia trachomatis, Europe, Motivational Interviewing, high-risk behaviour, prevention
National Category
Public Health, Global Health, Social Medicine and Epidemiology Immunology in the medical area Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-143247 (URN)10.1177/0956462417729308 (DOI)000424648100012 ()28920542 (PubMedID)
Available from: 2017-12-19 Created: 2017-12-19 Last updated: 2018-06-09Bibliographically approved
Bäckström, D., Granåsen, G., Eriksson Domellöf, M., Linder, J., Jakobson Mo, S., Riklund, K., . . . Forsgren, L. (2018). Early predictors of mortality in parkinsonism and Parkinson disease: A population-based study. Neurology, 91(22), E2045-E2056
Open this publication in new window or tab >>Early predictors of mortality in parkinsonism and Parkinson disease: A population-based study
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2018 (English)In: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 91, no 22, p. E2045-E2056Article in journal (Refereed) Published
Abstract [en]

Objective To examine mortality and associated risk factors, including possible effects of mild cognitive impairment, imaging, and CSF abnormalities, in a community-based population with incident parkinsonism and Parkinson disease. Methods One hundred eighty-two patients with new-onset, idiopathic parkinsonism were diagnosed from January 2004 through April 2009, in a catchment area of 142,000 inhabitants in Sweden. Patients were comprehensively investigated according to a multimodal research protocol and followed prospectively for up to 13.5 years. A total of 109 patients died. Mortality rates in the general Swedish population were used to calculate standardized mortality ratio and expected survival, and Cox proportional hazard models were used to investigate independent predictors of mortality. Results The standardized mortality ratio for all patients was 1.84 (95% confidence interval 1.50-2.22, p < 0.001). Patients with atypical parkinsonism (multiple system atrophy or progressive supranuclear palsy) had the highest mortality. In early Parkinson disease, a mild cognitive impairment diagnosis, freezing of gait, hyposmia, reduced dopamine transporter activity in the caudate, and elevated leukocytes in the CSF were significantly associated with shorter survival. Conclusion Although patients presenting with idiopathic parkinsonism have reduced survival, the survival is highly dependent on the type and characteristics of the parkinsonian disorder. Patients with Parkinson disease presenting with normal cognitive function seem to have a largely normal life expectancy. The finding of a subtle CSF leukocytosis in patients with Parkinson disease with short survival may have clinical implications.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-154849 (URN)10.1212/WNL.0000000000006576 (DOI)000452519500002 ()30381367 (PubMedID)
Available from: 2019-01-04 Created: 2019-01-04 Last updated: 2019-05-07Bibliographically approved
Mogren, I., Lindqvist, M., Petersson, K., Nilses, C., Small, R., Granåsen, G. & Edvardsson, K. (2018). Maternal height and risk of caesarean section in singleton births in Sweden D-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016. PLoS ONE, 13(5), Article ID e0198124.
Open this publication in new window or tab >>Maternal height and risk of caesarean section in singleton births in Sweden D-A population-based study using data from the Swedish Pregnancy Register 2011 to 2016
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 5, article id e0198124Article in journal (Refereed) Published
Abstract [en]

Caesarean section (CS) has short and long term adverse health consequences, and should therefore only be undertaken when necessary. Risk factors such as maternal age, maternal body mass index (BMI) and fetal weight have been extensively investigated in relation to CS, but the significance of maternal height has been less explored in Sweden. The aim was to investigate the significance of maternal height on risk of CS in a representative, population-based sample from Sweden, also taking into account confounders. Data on singleton births in the Swedish Pregnancy Register 2011 to 2016 were collected, including women with heights of 140 cm and above, constituting a sample of 581,844 women. Data were analysed with epidemiological and biostatistical methods. Mean height was 166.1 cm. Women born outside Sweden were significantly shorter than women born in Sweden (162.8 cm vs. 167.1 cm, p < 0.001). There was a decreasing risk of CS with increasing maternal height. This effect remained after adjustment for other risk factors for CS such as maternal age, BMI, gestational age, parity, high birth weight and country of birth. Frequency of CS was higher among women born outside Sweden compared with Swedish-born women (17.3% vs. 16.0%), however, in a multiple regression model country of birth outside Sweden diminished as a risk factor for CS. Maternal height of 178-179 cm was associated with the lowest risk of CS (OR = 0.76, CI95% 0.71-0.81), whereas height below 160 cm explained 7% of CS cases. BMI and maternal age are established factors involved in clinical assessments related to birth, and maternal height should increasingly enjoy a similar status in these considerations. Moreover, when healthcare professionals are counselling pregnant women, taller stature should be more emphasized as a positive indicator for successful vaginal birth to increase pregnant women's confidence in giving birth vaginally, with possible positive impacts for lowering CS rates.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-150693 (URN)10.1371/journal.pone.0198124 (DOI)000433521800045 ()29813118 (PubMedID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-11Bibliographically approved
Bäckström, D., Eriksson Domellöf, M., Granåsen, G., Linder, J., Mayans, S., Elgh, E., . . . Forsgren, L. (2018). Polymorphisms in dopamine-associated genes and cognitive decline in Parkinson's disease. Acta Neurologica Scandinavica, 137(1), 91-98
Open this publication in new window or tab >>Polymorphisms in dopamine-associated genes and cognitive decline in Parkinson's disease
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2018 (English)In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 137, no 1, p. 91-98Article in journal (Refereed) Published
Abstract [en]

Objectives: Cognitive decline is common in Parkinson's disease (PD), but the underlying mechanisms for this complication are incompletely understood. Genotypes affecting dopamine transmission may be of importance. This study investigates whether genotypes associated with reduced prefrontal dopaminergic tone and/or reduced dopamine D2-receptor availability (Catechol-O-methyltransferase [COMT] Val(158)Met genotype and DRD2 (CT)-T-957 genotype) affect the development of cognitive deficits in PD.

Materials and methods: One hundred and 34 patients with idiopathic PD, participating in a regional, population-based study of incident parkinsonism, underwent genotyping. After extensive baseline investigations (including imaging and biomarker analyses), the patients were followed prospectively during 6-10 years with neuropsychological evaluations, covering six cognitive domains. Cognitive decline (defined as the incidence of either Parkinson's disease mild cognitive impairment [PD-MCI] or dementia [PDD], diagnosed according to published criteria and blinded to genotype) was studied as the primary outcome.

Results: Both genotypes affected cognition, as shown by Cox proportional hazards models. While the COMT(158)Val/Val genotype conferred an increased risk of mild cognitive impairment in patients with normal cognition at baseline (hazard ratio: 2.13, P=.023), the DRD2(957)T/T genotype conferred an overall increased risk of PD dementia (hazard ratio: 3.22, P<.001). The poorer cognitive performance in DRD2(957)T/T carriers with PD occurred mainly in episodic memory and attention.

Conclusions: The results favor the hypothesis that dopamine deficiency in PD not only relate to mild cognitive deficits in frontostriatal functions, but also to a decline in memory and attention. This could indicate that dopamine deficiency impairs a wide network of brain areas.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
COMT, dementia, DRD2, mild cognitive impairment, neurodegeneration, Parkinson's disease, Parkinson's disease genetics, population-based
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-143002 (URN)10.1111/ane.12812 (DOI)000417029600014 ()
Available from: 2017-12-14 Created: 2017-12-14 Last updated: 2019-05-07Bibliographically approved
Lindkvist, M., Granåsen, G. & Grönlund, C. (2018). Precontractile optical response during excitation-contraction in human muscle revealed by non-invasive high-speed spatiotemporal NIR measurement. Scientific Reports, 8, Article ID 213.
Open this publication in new window or tab >>Precontractile optical response during excitation-contraction in human muscle revealed by non-invasive high-speed spatiotemporal NIR measurement
2018 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 213Article in journal (Refereed) Published
Abstract [en]

During muscle contraction the excitation-contraction process mediates the neural input and mechanical output. Proper muscle function and body locomotion depends on the status of the elements in the same process. However, non-invasive and in-vivo methods to study this are not available. Here we show the existence of an optical response occurring during the excitation-contraction process in human biceps brachii muscle. We developed a non-invasive instrument from a photodiode array and light emitting diodes to detect spatially propagating (similar to 5 m/s) and precontractile (similar to 6 ms onset) optical signals closely related to the action potential during electrostimulation. Although this phenomenon was observed 60 years ago on isolated frog muscle cells in the lab, it has not been shown in-vivo before now. We anticipate our results to be a starting point for a new category in-vivo studies, characterising alterations in the excitation-contraction process in patients with neuromuscular disease and to monitor effects of therapy.

Place, publisher, year, edition, pages
Nature Publishing Group, 2018
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:umu:diva-144397 (URN)10.1038/s41598-017-18455-y (DOI)000419659800048 ()29317688 (PubMedID)
Available from: 2018-02-13 Created: 2018-02-13 Last updated: 2019-05-17Bibliographically approved
Vågberg, M., Granåsen, G. & Svenningsson, A. (2017). Brain parenchymal fraction in healthy adults: a systematic review of the literature. PLoS ONE, 12(1), Article ID e0170018.
Open this publication in new window or tab >>Brain parenchymal fraction in healthy adults: a systematic review of the literature
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 1, article id e0170018Article in journal (Refereed) Published
Abstract [en]

Brain atrophy is an important feature of many neurodegenerative disorders. It can be described in terms of change in the brain parenchymal fraction (BPF). In order to interpret the BPF in disease, knowledge on the BPF in healthy individuals is required. The aim of this study was to determine data on the BPF of healthy individuals via a systematic review of the literature. The databases PubMed and Scopus were searched and 95 articles, including a total of 9269 individuals, were identified including the required data. We present values of BPF from healthy individuals stratified by age and post-processing method. The BPF correlated with age and there were significant differences in age-adjusted BPF between methods. This study contributes to increased knowledge on BPF in healthy individuals, which may assist in the interpretation of BPF in the setting of disease. We highlight the differences between post-processing methods and the need for a consensus gold standard. 

National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-128695 (URN)10.1371/journal.pone.0170018 (DOI)000392372300051 ()28095463 (PubMedID)
Available from: 2016-12-12 Created: 2016-12-12 Last updated: 2018-06-09Bibliographically approved
Leandersson, P., Granasen, G. & Borgfeldt, C. (2017). Ovarian Cancer Surgery: a Population-based Registry Study. Anticancer Research, 37(4), 1837-1845
Open this publication in new window or tab >>Ovarian Cancer Surgery: a Population-based Registry Study
2017 (English)In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 4, p. 1837-1845Article in journal (Refereed) Published
Abstract [en]

Background/Aim: To evaluate ovarian cancer surgery in tertiary centers (TC) and regional hospitals (RH). Patients and Methods: Data from the GynOp registry on patients undergoing surgery for ovarian cancer or borderline tumor from 2013 to 2015 were analyzed. Results: Four TC and 21 RH reported 1,108 cases of surgery with curative intent, 770 cases (69.5%) in TC and 338 cases (30.5%) in RH. Out of 458 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV disease 396 (86.5%) had surgery in TC. We found differences in selection for primary debulking surgery (PDS) (45% to 93%, p<0.001) and PDS achieving no residual tumor (36% to 70%, p<0.001) between the four TC. Major complications, re-admissions and re-operation rates did not differ between TC and RH. Conclusion: Tertiary centers perform more extensive surgery compared to regional hospitals without increased frequency of major complications. Tertiary centers display significant differences among patient selection for PDS, as well as achieving no residual tumor.

Place, publisher, year, edition, pages
INT INST ANTICANCER RESEARCH, 2017
Keywords
Ovarian, cancer, population, registry, surgery, complication
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-137013 (URN)10.21873/anticanres.11519 (DOI)000402167700037 ()28373449 (PubMedID)
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2018-06-09Bibliographically approved
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