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  • 1.
    Eriksson, Marie
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Glader, Eva-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Norrving, Bo
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden2017Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, nr 4, artikkel-id e00654Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Ambulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy. Methods: This nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011-2012. Results: The proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12.2% to 45.7% in university hospitals (n=9), 0.5% to 38.7% in specialized nonuniversity hospitals (n=22), and 4.2% to 40.3% in community hospitals (n=41). Younger age, atrial fibrillation (AF), living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were factors associated with a higher probability of stroke alerts. Living alone, primary school education, non-European origin, previous stroke, diabetes, smoking, and dependency in activities of daily living (ADL) were associated with a lower probability of stroke alert. The proportion of patients arriving at the hospital by ambulance varied from 60.3% to 94.5%. Older age, living alone, primary school education, being born in a European country, previous stroke, AF, dependency in ADL, living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were associated with ambulance services. Hospital stroke alert frequencies correlated strongly with reperfusion rates (r=.75). Conclusion: Acute stroke alerts have a significant potential to improve stroke reperfusion rates. Prehospital stroke management varies conspicuously between hospitals and patient groups, and the elderly and patients living alone have a markedly reduced likelihood of stroke alerts.

  • 2.
    Håglin, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bäckman, Lennart
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Covariation between plasma phosphate and daytime cortisol in early Parkinson's disease2016Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 6, nr 12, artikkel-id e00556Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Disturbed phosphate homeostasis in early Parkinson′s disease (PD) may originate from a stress-related condition and nutritional status among other risk factors, age, and gender.

    Methods: Risk of malnutrition using Mini-nutritional assessment (MNA score) and plasma levels of protein markers and daytime cortisol at the time of diagnosis in PD (n = 75) were compared with a control group (n = 24). Cognition was assessed using the Mini-Mental State Examination (MMSE score) and motor function using Unified Parkinson′s Disease Rating Scale (UPDRS-part III scale).

    Results: The patients with PD had significantly lower MNA score than controls which correlated with plasma phosphate levels. The logistic regression revealed that increasing MNA protected from low plasma phosphate, final score (OR = 0.399; 95% CI = 0.196–0.816; p = .012) and total score (OR = 0.656; 95% CI = 0.422–1.018; p = .060). Phosphate correlated with albumin (r = .315; p < .006), transferrin (r = .331; p < .004) and cortisol (r = −0.355; p < .002) confirmed by logistic regressions. Increasing albumin protects from low phosphate after adjusting in logistic regression (OR = 0.806; 95% CI = 0.682–0.952; p = .011) and after including variables from Table 1 in backwards elimination, final step (OR = 0.800; 95% CI = 0.660–0.969; p = .022). MNA total score and cortisol correlated inversely, confirmed in logistic regression for MNA total score (OR = 0.786; 95% CI = 0.627–0.985; p = .037) and for MNA initial score (OR = 0.650; 95% CI = 0.453–0.930; p = .020).

    Conclusion: This study highlights the importance of phosphate for optimal nutritional status by association with MNA score and albumin in plasma. An inverse relationship between phosphate and cortisol indicate, in addition, that low phosphate levels may affect cognition and motor function in PD.

  • 3. Myrum, Craig
    et al.
    Giddaluru, Sudheer
    Jacobsen, Kaya
    Espeseth, Thomas
    Nyberg, Lars
    Lundervold, Astri J.
    Haavik, Jan
    Nilsson, Lars-Göran
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
    Reinvang, Ivar
    Steen, Vidar M.
    Johansson, Stefan
    Wibrand, Karin
    Le Hellard, Stephanie
    Bramham, Clive R.
    Common variants in the ARC gene are not associated withcognitive abilities2015Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 5, nr 10, artikkel-id e00376Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: The Activity-Regulated Cytoskeleton-associated (ARC) gene encodes a protein that is critical for the consolidation of synaptic plasticity and long-term memory formation. Given ARC's key role in synaptic plasticity, we hypothesized that genetic variations in ARC may contribute to interindividual variability in human cognitive abilities or to attention-deficit hyperactivity disorder (ADHD) susceptibility, where cognitive impairment often accompanies the disorder. Methods: We tested whether ARC variants are associated with six measures of cognitive functioning in 670 healthy subjects in the Norwegian Cognitive NeuroGenetics (NCNG) by extracting data from its Genome-Wide Association Study (GWAS). In addition, the Swedish Betula sample of 1800 healthy subjects who underwent similar cognitive testing was also tested for association with 19 tag SNPs. Results: No ARC variants show association at the study-wide level, but several markers show a trend toward association with human cognitive functions. We also tested for association between ARCSNPs and ADHD in a Norwegian sample of cases and controls, but found no significant associations. Conclusion: This study suggests that common genetic variants located in ARC do not account for variance in human cognitive abilities, though small effects cannot be ruled out.

  • 4.
    Sandström, Linda
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    Hägglund, Patricia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    Johansson, Louise
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    Blomstedt, Patric
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Neurokirurgi.
    Karlsson, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    Speech intelligibility in Parkinson's disease patients with zona incerta deep brain stimulation2015Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 5, nr 10, artikkel-id e00394Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    To investigate the effects of l-dopa (Levodopa) and cZi-DBS (deep brain stimulation in caudal zona incerta) on spontaneous speech intelligibility in patients with PD (Parkinson's disease).

    Materials and Methods

    Spontaneous utterances were extracted from anechoic recordings from 11 patients with PD preoperatively (off and on l-dopa medication) and 6 and 12 months post bilateral cZi-DBS operation (off and on stimulation, with simultaneous l-dopa medication). Background noise with an amplitude corresponding to a clinical setting was added to the recordings. Intelligibility was assessed through a transcription task performed by 41 listeners in a randomized and blinded procedure.

    Results

    A group-level worsening in spontaneous speech intelligibility was observed on cZi stimulation compared to off 6 months postoperatively (8 adverse, 1 positive, 2 no change). Twelve months postoperatively, adverse effects of cZi-DBS were not frequently observed (2 positive, 3 adverse, 6 no change). l-dopa administered preoperatively as part of the evaluation for DBS operation provided the overall best treatment outcome (1 adverse, 4 positive, 6 no change).

    Conclusions

    cZi-DBS was shown to have smaller negative effects when evaluated from spontaneous speech compared to speech effects reported previously. The previously reported reduction in word-level intelligibility 12 months postoperatively was not transferred to spontaneous speech for most patients. Reduced intelligibility due to cZi stimulation was much more prominent 6 months postoperatively than at 12 months.

  • 5.
    Sandvig, Axel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
    Arnell, Kai
    Malm, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Eklund, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Koskinen, Lars-Owe D.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Analysis of Codman microcerebrospinal fluid shunt2018Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 8, nr 10, artikkel-id e01002Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: Ventriculo-peritoneal cerebrospinal fluid (CSF) shunt is the most common method of treating pediatric hydrocephalus. The Codman microadjustable valve (CMAV) is a CSF shunt constructed for children. The objective of the study was (a) to analyze complications after insertion of a CMAV shunt in hydrocephalic children, (b)to analyze complications after replacing a CMAV by an adult-type Codman Hakim adjustable valve shunt (CHAV), and to (c) analyze the in vitro characteristics of the CMAV shunt and correlate the findings with the clinical performance of the shunt.

    Methods: A retrospective study analyzed a cohort of hydrocephalic children who had received a CMAV shunt and later replaced by a CHAV shunt. We report on the complications that resulted from replacing the CMAV with the CHAV. We tested six CMAV shunts with or without an antisiphon device (ASD) in which opening pressure, resistance, sensitivity to abdominal pressure, ASD position dependency, and function were determined. The test results were correlated with the clinical performance of the shunt in the retrospective study.

    Results: Thirty-seven children (19 boys, 18 girls) were identified. Within the first month after shunt placement, a total of 10 patients (27%) developed complications including infections, hygromas, and shunt dysfunction. Shunt survival varied from 1week to 145 months. Over the 10-year follow-up period, 13 children had their shunts replaced, six of them with a CHAV without any further complications. A bench test of the CMAV was done to test whether the opening pressure was in agreement with the manufacturer's specifications. Our results were generally in agreement with specifications stated by the manufacturer.

    Conclusion: Replacing a CMAV with a CHAV was well tolerated by the patients. Bench test results were generally in agreement with manufacturers specifications. Replacing a CMAV with a CHAV in pediatric hydrocephalus patients can be accomplished safely.

  • 6.
    Sundstedt, Stina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Holmén, Lina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    Rova, Elin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    Linder, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Nordh, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Olofsson, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Swallowing safety in Parkinson's disease after zona incerta Deep Brain Stimulation2017Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, nr 6, artikkel-id e00709Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The objective of this study was to examine swallowing function in patients with Parkinson's disease before and after caudal zona incerta deep brain (cZI DBS) surgery. The aims were to examine the effect of cZI DBS on swallowing safety regarding liquid and solid food, as well as to identify the effect of cZI DBS on body mass index (BMI) and specific items from part II of the Unified Parkinson's Disease Rating Scale (UPDRS).

    Materials and Methods: The median age of the 14 patients was 57 years (range 46–71), with a median disease duration of 6 years (range 2–13). The present sample is an extension of a previous report, into which six additional patients have been added. Fiber endoscopic examinations of swallowing function, measures of BMI, and evaluation of UPDRS part II items were made before and 12 months after surgery, with and without activated DBS.

    Results: There were no significant changes due to cZI DBS regarding penetration/aspiration, pharyngeal residue or premature spillage (> .05). Median BMI increased by +1.1 kg/m2 12 months after surgery (= .01, = .50). All reported specific symptoms from the UPDRS part II were slight or mild. A significant improvement regarding handling of utensils was seen 12 months postoperatively (= .03, = −.42).

    Conclusions: Caudal zona incerta DBS was found not to have a negative impact on swallowing safety. A significant increase in postoperative weight was observed, and speech seemed to be slightly negatively affected, whereas handling of utensils was improved with cZI DBS.

  • 7.
    Zafar, Hamayun
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi. Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
    Alghadir, Ahmad H.
    Iqbal, Zaheen Ahmed
    Iqbal, Amir
    Anwer, Shahnawaz
    Alnahdi, Ali H.
    Influence of different jaw positions on dynamic balance using Y-balance test2019Inngår i: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, artikkel-id e01507Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Jaw sensory‐motor system has been shown to affect static balance of the body. It would be interesting to know whether it can influence dynamic balance as well. The objective of this study is to examine the influence of different jaw positions on dynamic balance using the Y‐balance test.

    Methods: Eighty healthy male participants aged 20–35 years were invited to participate in this study. Dynamic balance was measured by the Y‐balance test in three directions (anterior, posteromedial, and posterolateral) for each leg separately in three jaw positions: resting jaw (control), open‐jaw, and clenched jaw.

    Results: There were no significant differences in reach distances between the different jaw positions except in the posterolateral direction. In comparison with resting jaw position, reach distance was significantly higher in open‐jaw position for the right leg and in clenched and open‐jaw positions for the left leg in the posterolateral direction.

    Conclusions: Although various studies have shown direct or indirect influence of jaw sensory‐motor system on static postural control, results of this study point to limited relation with dynamic postural control among healthy subjects. However, it supports the potential of the jaw sensory‐motor system to affect motor control during functional tasks in patients with postural instability or similar disorders.

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