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Nilsson, Kjell G
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Publications (10 of 37) Show all publications
Campbell, D., Callary, S., Field, J. & Nilsson, K. G. (2019). All-polyethylene tibial components in young patients have stable fixation; a comparison RSA study. Knee (Oxford), 26(2), 392-399
Open this publication in new window or tab >>All-polyethylene tibial components in young patients have stable fixation; a comparison RSA study
2019 (English)In: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 26, no 2, p. 392-399Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: All-polyethylene (AP) tibial components in patients aged greater than 60 years have stable tibial migration patterns and favorable survival rates when compared to identical Metal-backed (MB) designs. Tibial component migration in younger patients has not been reported. The aim of this study was to examine the migration characteristics of patients aged less than 60 years compared to a previous cohort of AP and MB tibial components of identical design in older patients.

METHODS: A prospective consecutive study examined tibial component migration in 21 patients aged less than 60 years undergoing a cemented total knee arthroplasty with an AP tibial component by radiostereometric analysis (RSA) to 24 months. Results were compared to the authors' previous series of 21 patients aged greater than 60 years that were randomized to either an AP or MB tibial component.

RESULTS: Both age groups of patients implanted with an AP component had stable migration patterns with no patient having greater than 0.2° rotation or 0.2 mm maximum total point motion. Five of 11 MB tibial components displayed continued migration between one and two years. Subsidence was similar in all groups, whilst maximum total point motion was greater for the MB cohort (0.34 mm, 0.33 mm, 0.61 mm; AP <60, AP >60, MB).

CONCLUSIONS: Young patients implanted with an AP tibial component had stable tibial migration patterns comparable to older patients with the same AP implant. Regardless of age, AP tibial components were at least as stable as MB tibial components.

LEVEL OF EVIDENCE: Level II, Prospective comparative study.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
All-polyethylene, Knee arthroplasty, Radiostereometry, Tibial migration
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-157680 (URN)10.1016/j.knee.2018.12.003 (DOI)000470052400014 ()30638681 (PubMedID)
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-06-20Bibliographically approved
Grip, H., Nilsson, K. G., Häger, C. G., Lundström, R. & Öhberg, F. (2019). Does the Femoral Head Size in Hip Arthroplasty Influence Lower Body Movements during Squats, Gait and Stair Walking?: A Clinical Pilot Study Based on Wearable Motion Sensors. Sensors, 19(14), Article ID 3240.
Open this publication in new window or tab >>Does the Femoral Head Size in Hip Arthroplasty Influence Lower Body Movements during Squats, Gait and Stair Walking?: A Clinical Pilot Study Based on Wearable Motion Sensors
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2019 (English)In: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 19, no 14, article id 3240Article in journal (Refereed) Published
Abstract [en]

A hip prosthesis design with larger femoral head size may improve functional outcomes compared to the conventional total hip arthroplasty (THA) design. Our aim was to compare the range of motion (RoM) in lower body joints during squats, gait and stair walking using a wearable movement analysis system based on inertial measurement units (IMUs) in three age-matched male groups: 6 males with a conventional THA (THAC), 9 with a large femoral head (LFH) design, and 8 hip- and knee-asymptomatic controls (CTRL). We hypothesized that the LFH design would allow a greater hip RoM, providing movement patterns more like CTRL, and a larger side difference in hip RoM in THAC when compared to LFH and controls. IMUs were attached to the pelvis, thighs and shanks during five trials of squats, gait, and stair ascending/descending performed at self-selected speed. THAC and LFH participants completed the Hip dysfunction and Osteoarthritis Outcome Score (HOOS). The results showed a larger hip RoM during squats in LFH compared to THAC. Side differences in LFH and THAC groups (operated vs. non-operated side) indicated that movement function was not fully recovered in either group, further corroborated by non-maximal mean HOOS scores (LFH: 83 +/- 13, THAC: 84 +/- 19 groups, vs. normal function 100). The IMU system may have the potential to enhance clinical movement evaluations as an adjunct to clinical scales.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
MEMS, gyroscopes, accelerometers, total hip arthroplasty, movement analysis
National Category
Orthopaedics Physiotherapy
Identifiers
urn:nbn:se:umu:diva-162882 (URN)10.3390/s19143240 (DOI)000479160300207 ()31340548 (PubMedID)
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2019-10-07Bibliographically approved
Suijkerbuijk, M. A. M., Ponzetti, M., Rahim, M., Posthumus, M., Häger, C., Stattin, E., . . . September, A. V. (2019). Functional polymorphisms within the inflammatory pathway regulate expression of extracellular matrix components in a genetic risk dependent model for anterior cruciate ligament injuries.. Journal of Science and Medicine in Sport, 22(11), 1219-1225
Open this publication in new window or tab >>Functional polymorphisms within the inflammatory pathway regulate expression of extracellular matrix components in a genetic risk dependent model for anterior cruciate ligament injuries.
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2019 (English)In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 22, no 11, p. 1219-1225Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To investigate the functional effect of genetic polymorphisms of the inflammatory pathway on structural extracellular matrix components (ECM) and the susceptibility to an anterior cruciate ligament (ACL) injury.

DESIGN: Laboratory study, case-control study.

METHODS: Eight healthy participants were genotyped for interleukin (IL)1B rs16944 C>T and IL6 rs1800795 G>C and classified into genetic risk profile groups. Differences in type I collagen (COL1A1), type V collagen (COL5A1), biglycan (BGN) and decorin (DCN) gene expression were measured in fibroblasts either unstimulated or following IL-1β, IL-6 or tumor necrosis factor (TNF)-α treatment. Moreover, a genetic association study was conducted in: (i) a Swedish cohort comprised of 116 asymptomatic controls (CON) and 79 ACL ruptures and (ii) a South African cohort of 100 CONs and 98 ACLs. Participants were genotyped for COL5A1 rs12722 C>T, IL1B rs16944 C>T, IL6 rs1800795 G>C and IL6R rs2228145 G>C.

RESULTS: IL1B high-risk fibroblasts had decreased BGN (p=0.020) and COL5A1 (p=0.012) levels after IL-1β stimulation and expressed less COL5A1 (p=0.042) following TNF-α treatment. Similarly, unstimulated IL6 high-risk fibroblasts had lower COL5A1 (p=0.012) levels than IL6 low-risk fibroblasts. In the genetic association study, the COL5A1-IL1B-IL6 T-C-G (p=0.034, Haplo-score 2.1) and the COL5A1-IL1B-IL6R T-C-A (p=0.044, Haplo-score: 2.0) combinations were associated with an increased susceptibility to ACL injury in the Swedish cohort when only male participants were evaluated.

CONCLUSIONS: This study shows that polymorphisms within genes of the inflammatory pathway modulate the expression of structural and fibril-associated ECM components in a genetic risk depended manner, contributing to an increased susceptibility to ACL injuries.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Anterior cruciate ligament injury, Extracellular matrix, Genetics, Personalized medicine, Polymorphisms
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-163874 (URN)10.1016/j.jsams.2019.07.012 (DOI)31395468 (PubMedID)2-s2.0-85072364464 (Scopus ID)
Available from: 2019-10-07 Created: 2019-10-07 Last updated: 2019-10-08Bibliographically approved
Otten, V. T., Mukka, S., Nilsson, K. G., Crnalic, S. & Kärrholm, J. (2019). Uncemented cups with and without screw holes in primary THA: a Swedish Hip Arthroplasty Register study with 22,725 hips. Acta Orthopaedica, 90(3), 258-263
Open this publication in new window or tab >>Uncemented cups with and without screw holes in primary THA: a Swedish Hip Arthroplasty Register study with 22,725 hips
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2019 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 90, no 3, p. 258-263Article in journal (Refereed) Published
Abstract [en]

Background and purpose — Uncemented cups in total hip arthroplasty (THA) are often augmented with additional screws to enhance their primary stability. We investigated whether there is a difference in the risk for revision between cups with screw holes and cups without screw holes.

Patients and methods — We analyzed the risk for cup revision of uncemented cups registered in the Swedish Hip Arthroplasty Register (SHAR) between 2000 and 2017 with respe ct to the presence of screw holes. Only patients with primary osteoarthritis (OA) were included. 22,725 cups, including 12,354 without screw holes and 10,371 with screw holes, were evaluated. Revision rates at 2 and 10 years after the primary operation were analyzed.

Results — At a median follow-up time of 3.4 years (0–18), 459 cup revisions were reported. The main reasons for cup revision during the whole observation time were infection, 52% of all cup revisions, and dislocation, 26% of all cup revisions. The survival rate with cup revision due to aseptic loosening as endpoint was 99.9% (95% CI 99.8–99.9) at 2 years for both cups with and cups without screw holes, and the survival rates at 10 years were 99.5% (CI 99.3–99.7) and 99.1% (CI 98.6–99.5), respectively. Cups without screw holes showed a decreased risk of revision due to any reason at both 2 years (adjusted hazard ratio [HR] 0.6, CI 0.5–0.8) and 10 years (HR 0.7, CI 0.5–0.9).

Interpretation — We found a very low revision rate for aseptic loosening with modern, uncemented cup designs. Cups with screw holes had an increased risk of revision due to any reason in patients with primary OA

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-158054 (URN)10.1080/17453674.2019.1599777 (DOI)000469038600013 ()30955399 (PubMedID)
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-06-17Bibliographically approved
Wojtowicz, R., Henricson, A., Nilsson, K. G. & Crnalic, S. (2019). Uncemented monoblock trabecular metal posterior stabilized high-flex total knee arthroplasty: similar pattern of migration to the cruciate-retaining design - a prospective radiostereometric analysis (RSA) and clinical evaluation of 40 patients (49 knees) 60 years or younger with 9 years' follow-up. Acta Orthopaedica
Open this publication in new window or tab >>Uncemented monoblock trabecular metal posterior stabilized high-flex total knee arthroplasty: similar pattern of migration to the cruciate-retaining design - a prospective radiostereometric analysis (RSA) and clinical evaluation of 40 patients (49 knees) 60 years or younger with 9 years' follow-up
2019 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background and purpose — Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Cemented PS implants have higher revision rate than CR implants. Can an uncemented monoblock PS TM implant be used safely in younger patients?

Patients and methods — 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Knees were evaluated with radiostereometric analysis (RSA) a mean 3 days (1–5) postoperatively, and thereafter at 6 weeks, 3 months, 1, 2, 5, and 9 years. Clinical outcome was measured with patient-related outcome measures (PROMs).

Results — The implants showed a pattern of migration with initial large migration followed by early stabilization lasting up to 9 years, a pattern known to be compatible with good long-term results. Clinical and radiological outcome was excellent with 38 of the 40 patients being satisfied or very satisfied with the procedure and bone apposition to the entire implant surface in 46 of 49 knees. Mean knee flexion was 130°. 1 knee was revised at 3 months due to medial tibial condyle collapse.

Interpretation — The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-161717 (URN)10.1080/17453674.2019.1626097 (DOI)000473539500001 ()31210081 (PubMedID)
Available from: 2019-07-26 Created: 2019-07-26 Last updated: 2019-07-26
Henricson, A., Wojtowicz, R., Nilsson, K. G. & Crnalic, S. (2019). Uncemented or cemented femoral components work equally well in total knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy, 27(4), 1251-1258
Open this publication in new window or tab >>Uncemented or cemented femoral components work equally well in total knee arthroplasty
2019 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 4, p. 1251-1258Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To study the pattern of migration and clinical results up to 10 years of uncemented versus cemented fixation of the femoral component in total knee arthroplasty.

METHODS: Randomized controlled trial was conducted of 41 patients (23 women, 18 men) under the age of 60 years using radiostereometric analysis.

RESULTS: About two-thirds of the cemented implants and half of the uncemented implants stabilized between 2 and 10 years, while the remainder displayed a small annual increase of maximum total point motion of 0.09-0.10 mm/year. At 10 years there were no statistically significant differences in migration or clinical results between the groups.

CONCLUSION: Uncemented fixation with titanium fiber mesh coating of the femoral component in total knee arthroplasty works equally as well as cemented fixation up to 10 years. An annual migration of 0.1 mm seems compatible with excellent long-term performance.

LEVEL OF EVIDENCE: I.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Femoral component TKA, RSA, Total knee arthroplasty, Uncemented TKA
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-157681 (URN)10.1007/s00167-018-5227-5 (DOI)000462637500030 ()30361757 (PubMedID)
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-04-15Bibliographically approved
Otten, V., Maguire, G. Q. J., Noz, M. E., Zeleznik, M. P., Nilsson, K. G. & Olivecrona, H. (2017). Are CT Scans a Satisfactory Substitute for the Follow-Up of RSA Migration Studies of Uncemented Cups?: A Comparison of RSA Double Examinations and CT Datasets of 46 Total Hip Arthroplasties. BioMed Research International, 2017, Article ID 3681458.
Open this publication in new window or tab >>Are CT Scans a Satisfactory Substitute for the Follow-Up of RSA Migration Studies of Uncemented Cups?: A Comparison of RSA Double Examinations and CT Datasets of 46 Total Hip Arthroplasties
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2017 (English)In: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, Vol. 2017, article id 3681458Article in journal (Refereed) Published
Abstract [en]

As part of the 14-year follow-up of a prospectively randomized radiostereometry (RSA) study on uncemented cup fixation, two pairs of stereo radiographs and a CT scan of 46 hips were compared. Tantalum beads, inserted during the primary operation, were detected in the CT volume and the stereo radiographs and used to produce datasets of 3D coordinates. The limit of agreement between the combined CT and RSA datasets was calculated in the same way as the precision of the double RSA examination. The precision of RSA corresponding to the 99% confidence interval was 1.36 degrees, 1.36 degrees, and 0.60 degrees for X-, Y-, and Z-rotation and 0.40, 0.17, and 0.37mm for X-, Y-, and Z-translation. The limit of agreement between CT and RSA was 1.51 degrees, 2.17 degrees, and 1.05 degrees for rotation and 0.59, 0.56, and 0.74mm for translation. The differences between CT and RSA are close to the described normal 99% confidence interval for precision in RSA: 0.3 degrees to 2 degrees for rotation and 0.15 to 0.6mm for translation. We conclude that measurements using CT and RSA are comparable and that CT can be used for migration studies for longitudinal evaluations of patients with RSA markers.

Place, publisher, year, edition, pages
Hindawi Publishing Corporation, 2017
National Category
Orthopaedics Surgery
Identifiers
urn:nbn:se:umu:diva-131265 (URN)10.1155/2017/3681458 (DOI)000394010400001 ()
Available from: 2017-02-10 Created: 2017-02-10 Last updated: 2019-03-20Bibliographically approved
Nilsson, K. G., Theodoulou, A., Mercer, G., Quinn, S. J. & Krishnan, J. (2017). Mid-term migration of a cementless, porous acetabular cup: A 5 year Radiostereometric analysis. Journal of Orthopaedics, 14(4), 454-460
Open this publication in new window or tab >>Mid-term migration of a cementless, porous acetabular cup: A 5 year Radiostereometric analysis
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2017 (English)In: Journal of Orthopaedics, ISSN 0972-978X, E-ISSN 0972-978X, Vol. 14, no 4, p. 454-460Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of the study was to determine the 5 year migratory and wear patterns, adverse events and clinical outcomes of a cementless, porous acetabular cup. Methods: RSA imaging of a cohort of 11 patients was retrospective analysed at 5 years post Total Hip Arthroplasty (THA). Changes in pain, function and symptoms of the hip at 5 years post-THA were compared to preoperative and 2 year postoperative assessments on the Harris Hip Score (HHS) and Hip dysfunction and Osteoarthritis Outcome Score (HOOS). Results: The majority of cup migration occurred up to 6 months and stabilised thereafter (6 months to 5 years, p = 0.091-0.866, Wilcoxon Signed Rank test). The direction of rotation around the 3 axes was evenly distributed among the cups between anterior-posterior rotation, internal-external rotation and increased-decreased inclination. The majority of the cups translated proximally, at an average migration of 0.36 mm (+/- 95% CI 0.17) at 5-years post-THA. Following initial bedding in, up to 6 months, there was no detectable polyethylene wear between 6 months and 5 years. At 5 years postoperatively, a statistically significant difference was observed across all HOOS subscales in comparison to preoperative values, with higher means reported at 5 years (p < 0.001). The total mean HHS displayed a statistically significant improvement, increasing from 'poor' preoperatively to 'good' at 5 years post-THA. Conclusion: Following initial migration between discharge and 6 months, the cementless porous acetabular cup demonstrated a tendency for stabilisation from 6 months up to 5 years post-THA, suggesting good mid-term fixation. Additionally, improvements in clinical outcome measures of pain, function and quality-of-life remained high following THA at 5 years post-surgery. 

Place, publisher, year, edition, pages
Elsevier, 2017
Keywords
Acetabular cup, Migration, Radiostereometric analysis, RSA, Total Hip Arthroplasty, THA
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-143649 (URN)10.1016/j.jor.2017.07.004 (DOI)000418482800008 ()28819343 (PubMedID)
Available from: 2018-01-08 Created: 2018-01-08 Last updated: 2018-06-09Bibliographically approved
Petursson, G., Fenstad, A. M., Gøthesen, Ø., Haugan, K., Dyrhovden, G. S., Hallan, G., . . . Furnes, O. (2017). Similar migration in computer-assisted and conventional total knee arthroplasty.. Acta Orthopaedica, 88(2), 166-172
Open this publication in new window or tab >>Similar migration in computer-assisted and conventional total knee arthroplasty.
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2017 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 2, p. 166-172Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Computer-assisted surgery (CAS) in total knee arthroplasty (TKA) has been used in recent years in the hope of improving the alignment and positioning of the implant, thereby achieving a better functional outcome and durability. However, the role of computer navigation in TKA is still under debate. We used radiostereometric analysis (RSA) in a randomized controlled trial (RCT) to determine whether there are any differences in migration of the tibial component between CAS- and conventionally (CONV-) operated TKA. Patients and methods - 54 patients (CAS, n = 26; CONV, n = 28) with a mean age of 67 (56-78) years and with osteoarthritis or arthritic disease of the knee were recruited from 4 hospitals during the period 2009-2011. To estimate the mechanical stability of the tibial component, the patients were examined with RSA up to 24 months after operation. The following parameters representing tibial component micromotion were measured: 3-D vector of the prosthetic marker that moved the most, representing the magnitude of migration (maximum total point motion, MTPM); the largest negative value for y-translation (subsidence); the largest positive y-translation (lift-off); and prosthetic rotations. The precision of the RSA measurements was evaluated and migration in the 2 groups was compared. Results - Both groups had most migration within the first 3 months, but there was no statistically significant difference in the magnitude of the migration between the CAS group and the CONV group. From 3 to 24 months, the MTPM (in mm) was 0.058 and 0.103 (p = 0.1) for the CAS and CON groups, respectively, and the subsidence (in mm) was 0.005 and 0.011 (p = 0.3). Interpretation - Mean MTPM, subsidence, lift-off, and rotational movement of tibial trays were similar in CAS- and CONV-operated knees.

National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-138113 (URN)10.1080/17453674.2016.1267835 (DOI)000399484400009 ()27996349 (PubMedID)
Available from: 2017-08-10 Created: 2017-08-10 Last updated: 2018-06-09Bibliographically approved
Gudnason, A., Adalberth, G., Nilsson, K.-G. & Hailer, N. P. (2017). Tibial component rotation around the transverse axis measured by radiostereometry predicts aseptic loosening better than maximal total point motion A follow-up of 116 total knee arthroplasties after at least 15 years. Acta Orthopaedica, 88(3), 282-287
Open this publication in new window or tab >>Tibial component rotation around the transverse axis measured by radiostereometry predicts aseptic loosening better than maximal total point motion A follow-up of 116 total knee arthroplasties after at least 15 years
2017 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 3, p. 282-287Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Maximal total point motion (MTPM) measured by radiostereometry (RSA) is widely used as a predictor of total knee arthroplasty (TKA) loosening. We compared the ability of different RSA measurements at different time points to predict loosening of tibial TKA components in the long term. Patients and methods - 116 TKAs in 116 patients were included in our analysis. 16 (14.8-17.4) years after surgery, 5 tibial components had been revised due to aseptic loosening. Receiver operating characteristic curves were calculated in order to investigate the specificity and sensitivity of different RSA parameters at different thresholds. Results - Rotation around the transverse (x-) axis measured 2 years postoperatively had the best predictive value of all parameters, with an area under the curve (AUC) of 80%. Using a threshold of 0.8 degrees, a specificity of 85% and a sensitivity of 50% were reached. The AUC for tibial component distal translation was 79% and it was 77% for proximal translation, whereas it was only 68% for MTPM. Interpretation - Rotation of the cemented tibial component around the transverse axis, proximal translation, and distal translation are slightly better at predicting aseptic loosening than MTPM, and tibial component migration measured after 2 years gives a good prediction of aseptic loosening up to 15 years.

National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-135578 (URN)10.1080/17453674.2017.1297001 (DOI)000400742500008 ()28266241 (PubMedID)
Available from: 2017-06-20 Created: 2017-06-20 Last updated: 2018-06-09Bibliographically approved
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