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  • 1.
    Angelin, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Palmgren, Helena
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Illness and risk behaviour in health care students studying abroad2015In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 49, no 7, 684-691 p.Article in journal (Refereed)
    Abstract [en]

    Context: The numbers of university students studying abroad increase every year. These students are not tourists as their studies require different types of travel that expose them to different risks. Moreover, health care students (HCSs) may be exposed to even greater risks according to their travel destinations and itineraries. Clearly, research-based pre-travel advice is needed.

    Methods: This study reports on a prospective survey conducted from April 2010 to January 2014 of health care and non-health care students from Swedish universities in Umeå, Stockholm and Gothenburg studying abroad.

    Results: Of the 393 students included in the study, 85% responded. Over half (55%) were HCSs. Pre-travel health information was received by 79% and information on personal safety by 49% of HCSs. The rate of illness during travel was 52%. Health care students more often travelled to developing regions and were at increased risk for travellers' diarrhoea. One in 10 experienced theft and 3% were involved in traffic accidents. One in five met a new sexual partner during travel and 65% of these practised safe sex. Half of all participants increased their alcohol consumption while abroad; high alcohol consumption was associated with increased risk for being a victim of theft, as well as for meeting a new sexual partner during travel.

    Conclusions: University authorities are responsible for the safety and well-being of students studying abroad. This study supplies organisers and students with epidemiological data that will help improve pre-travel preparation and increase student awareness of the potential risks associated with studying abroad.

  • 2.
    Angelin, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Palmgren, Helena
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Travel and vaccination patterns: a report from a travel medicine clinic in northern Sweden2011In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 43, no 9, 714-720 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Travel Medicine Clinic in Umeå is one of Sweden's largest public providers of vaccination and counselling prior to international travel. During the study period it was the only travel medicine clinic in Umeå. This study describes the demography of the visitors to the clinic and travel destinations and durations, as well as vaccinations administered. METHODS: This was a retrospective study for the period January 2005 to April 2008 based on pre-travel consultation questionnaires and on vaccine expenditure data. A 10% sample of 16,735 first visits prior to international travel was consecutively selected according to the chronology of the visits. RESULTS: Data on 1698 travellers were included in the study. Thailand was the most common destination among visitors, accounting for one third of all destinations. Medical problems affecting pre-travel health planning were rare. Four out of 5 visitors (79%) received only 1 vaccination, mainly for hepatitis A. Travellers to Thailand more often sought travel health advice compared to travellers to Turkey, despite the fact that the 2 destinations were almost equally distributed among travellers from Umeå. We found differences between men and women in money spent on vaccines and in particular in vaccination against Japanese encephalitis. CONCLUSIONS: To assess the optimal vaccination level at a travel medicine clinic is difficult. Decisions are affected by general recommendations and the risk perception of the travel medicine practitioner, as well as the risk perception of the traveller. The sex difference found in this study might be due to gender differences in risk perception and should be further investigated.

  • 3.
    Angelin, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Palmgren, Helena
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Travel health advice: Benefits, compliance, and outcome2014In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 46, no 6, 447-453 p.Article in journal (Refereed)
    Abstract [en]

    Background: Travel health advice is an important and difficult part of a pre-travel consultation. The aim of this study was to determine whether the travel health advice given is followed by the traveller and whether it affects disease and injury experienced during travel. Methods: A prospective survey study was carried out from October 2009 to April 2012 at the Travel Medicine Clinic of the Department of Infectious Diseases, Umea University Hospital, Umea, Sweden. The Travel Medicine Clinic in Umea is the largest travel clinic in northern Sweden. Results: We included 1277 individuals in the study; 1059 (83%) responded to the post-travel questionnaire. Most visitors (88%) remembered having received travel health advice; among these, 95% found some of the health advice useful. Two-thirds (67%) claimed to have followed the advice, but fell ill during travel to the same extent as those who did not. Younger travellers (< 31 y) found our travel health advice less beneficial, were less compliant with the advice, took more risks during travel, and fell ill during travel to a greater extent than older travellers. Conclusions: Helping travellers stay healthy during travel is the main goal of travel medicine. Younger travellers are a risk group for illness during travel and there is a need to find new methods to help them avoid illness. Travellers find travel health advice useful, but it does not protect them from travel-related illness. Factors not easily influenced by the traveller play a role, but a comprehensive analysis of the benefits of travel health advice is needed.

  • 4.
    Angelin, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Forsell, Joakim
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Granlund, Margareta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Palmgren, Helena
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology. Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Risk factors for colonization with extended-spectrum beta-lactamase producing Enterobacteriaceae in healthcare students on clinical assignment abroad: A prospective study2015In: Travel Medicine and Infectious Disease, ISSN 1477-8939, E-ISSN 1873-0442, Vol. 13, no 3, 223-229 p.Article in journal (Refereed)
    Abstract [en]

    Background: The increase of antibiotic resistance in clinically important bacteria is a worldwide threat, especially in healthcare environments. International travel is a risk factor for gut colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). The risk for healthcare students of being colonized with ESBL-PE when participating in patient-related work abroad has not been previously investigated. Methods: Swedish healthcare students travelling for pre-clinical and clinical courses outside Scandinavia submitted faecal samples and survey data before and after travel. The faecal samples were screened for ESBL-PE and carbapenemase-producing Enterobacteriaceae (CPE). Screening results and survey data were analysed to identify risk factors for colonization. Results: In the 99 subjects who submitted a full set of samples, 35% were colonized with a new ESBL-PE strain during travel. No CPE was found. The most important risk factor for ESBL-PE colonization was travel destination, and the highest colonization rate was found in the South East Asia region. Antibiotic treatment during travel was an independent risk factor for ESBL-PE colonization but patient-related work was not significantly associated with an increased risk. Conclusions: Patient-related work abroad was not a risk factor for ESBL-PE suggesting that transmission from patients is uncommon. Pre-travel advice on avoiding unnecessary antibiotic treatment during travel is recommended.

  • 5.
    Birgitta, Evengård
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Fatigue. Epidemiology and Social/Industrial aspects2008In: Fatigue Science for Human Health, Springer, 2008, 17-31 p.Chapter in book (Refereed)
  • 6. Bronner, Ulf
    et al.
    Karlsson, Lillemor
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Evaluation of rapid diagnostic tests for malaria in Swedish travellers2011In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 119, no 2, 88-92 p.Article in journal (Refereed)
    Abstract [en]

    Rapid diagnostic tests (RDTs) for malaria have become valuable tools for the diagnosis of malaria in both endemic and non-endemic areas. During a 7-year period, first the MalaQuick rapid test and then the NOW Malaria test, were evaluated by well-trained laboratory technicians in a university hospital laboratory of parasitology. A total of 635 blood samples were selected from 4731 blood specimens obtained from travellers at the emergency department, at wards and at out-patient clinics. The samples were analysed by microscopy and RDT. Malaria parasites were detected in the blood films of 134 (21%) samples. The sensitivity of the RDT for Plasmodium falciparum was 97.7% (84 of 86 samples) with a negative predictive value of 99.6%. The two false-negative results were associated with low levels of parasitaemia. For non-falciparum species the sensitivity was only 58.3% (28 of 48 samples). Based on the excellent ability of the RDTs to detect P. falciparum infections, we recommend the use of the NOW Malaria test as a complement to microscopy in the laboratory.

  • 7. Bronner, Ulf
    et al.
    Karlsson, Lillemor
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    [Rapid malaria tests--good complement to microscopy. High sensitivity for Plasmodium falciparum in Swedish travellers]2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 42, 2087-2089 p.Article in journal (Refereed)
  • 8.
    Brundin, Peik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Zhao, Chunyan
    Dahlman-Wright, Karin
    Ahlm, Clas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Gene Expression of Estrogen Receptors in Pbmc From Patients With Puumala-Virus Infection2012In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 37, no 4, 355-359 p.Article in journal (Refereed)
    Abstract [en]

    The influence of estrogen signaling on infectious diseases is not fully known. Males seem to be more susceptible to infections than females. This has also been noted for the Scandinavian form of hemorrhagic fever with renal syndrome caused by Puumala hantavirus (PUUV). To investigate the differences in estrogen receptors in relation to sex and clinical severity, 20 patients (10 males, 10 females) with confirmed PUUV infection were studied. Real-time polymerase chain reaction was performed for analyzing mRNA expression of estrogen receptor-alpha (ERV), ER beta, and ER beta 2 (ER beta cx) in peripheral blood mononuclear cells from patients and healthy age-and sex-matched blood donors. Blood chemistry and peripheral blood mononuclear cells sampling were performed during the acute and convalescent phases. None or very small amounts of ER beta were detected, and ER alpha and ER beta 2 mRNA were elevated in the patient group. The samples from the males were correlated with ER beta 2; the female samples, with ER alpha. Furthermore, the female and male samples are partly separated using multivariate statistic analysis (principal component analysis), supporting findings that clinical symptoms differ depending on sex.

  • 9.
    Byrnes, Andrea
    et al.
    Dept Genetics and dept Biostatistics, University of North Carolina.
    Jacks, Andreas
    Dept Medical Epidemiology and Biostatistics, Karolinska Institutet.
    Dahlman-Wright, Karin
    Dept Biosciences and Nutrition, Karolinska Institutet.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Wright, Fred A
    Dept Biostatistics, University of North Carolina.
    Pedersen, Nancy L
    Dept Medical Epidemiology and Biostatistis, Karolinska Institutet.
    Sullivan, Patrick F
    Dept Genetics, Univ of North Carolina, Dept Medical Epid and Biostat, Karol Institutet.
    Gene expression in peripheral blood leukocytes in monozygotic twins discordant for chronic fatigue: no evidence of a biomarker2009In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 4, no 6, e5805- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic fatiguing illness remains a poorly understood syndrome of unknown pathogenesis. We attempted to identify biomarkers for chronic fatiguing illness using microarrays to query the transcriptome in peripheral blood leukocytes.

    METHODS: Cases were 44 individuals who were clinically evaluated and found to meet standard international criteria for chronic fatigue syndrome or idiopathic chronic fatigue, and controls were their monozygotic co-twins who were clinically evaluated and never had even one month of impairing fatigue. Biological sampling conditions were standardized and RNA stabilizing media were used. These methodological features provide rigorous control for bias resulting from case-control mismatched ancestry and experimental error. Individual gene expression profiles were assessed using Affymetrix Human Genome U133 Plus 2.0 arrays.

    FINDINGS: There were no significant differences in gene expression for any transcript.

    CONCLUSIONS: Contrary to our expectations, we were unable to identify a biomarker for chronic fatiguing illness in the transcriptome of peripheral blood leukocytes suggesting that positive findings in prior studies may have resulted from experimental bias.

  • 10. Bénard, A
    et al.
    Petersen, Eskild
    Salamon, R
    Chêne, G
    Gilbert, R
    Salmi, L R
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Survey of European programmes for the epidemiological surveillance of congenital toxoplasmosis.2008In: Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin, ISSN 1560-7917, Vol. 13, no 15Article in journal (Refereed)
    Abstract [en]

    The objective of this investigation was to describe systems for the epidemiological surveillance of congenital toxoplasmosis implemented in European countries. In September 2004, a questionnaire, adapted from the evaluation criteria published by the United States Centers for Disease Control and Prevention, was sent to a panel of national correspondents in 35 countries in the European geographical area with knowledge of the epidemiological surveillance systems implemented in their countries. Where necessary, we updated the information until July 2007. Responses were received from 28 countries. Some 16 countries reported routine surveillance for toxoplasmosis. In 12 countries (Bulgaria, Cyprus, Czech Republic, England and Wales, Estonia, Ireland, Latvia, Lithuania, Malta, Poland, Scotland and Slovakia), surveillance was designed to detect only symptomatic toxoplasmosis, whether congenital or not. Four countries reported surveillance of congenital toxoplasmosis, on a regional basis in Italy and on a national basis in Denmark, France and Germany. In conclusion, epidemiological surveillance of congenital toxoplasmosis needs to be improved in order to determine the true burden of disease and to assess the effectiveness of and the need for existing prevention programmes.

  • 11. Derouin, Francis
    et al.
    Pelloux, H
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Petersen, Eskild
    Peyron, F
    Mathis, A
    van Gool, T
    Chiodini, P
    Junie, M
    Kortbeek, L
    Prevention of toxoplasmosis in transplant patients.2008In: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, ISSN 1469-0691, Vol. 14, no 12, 1089-101 p.Article in journal (Refereed)
    Abstract [en]

    Toxoplasmosis is a life-threatening opportunistic infection that affects haematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. Its incidence in these patients is closely related to the prevalence of toxoplasmosis in the general population, which is high in Europe. In SOT recipients, toxoplasmosis results mainly from transmission of the parasite with the transplanted organ from a Toxoplasma-seropositive donor to a Toxoplasma-seronegative recipient. This risk is high in cases of transplantation of organs that are recognized sites of encystation of the parasite, e.g. the heart, and is markedly lower in other SOT recipients. Clinical symptoms usually occur within the first 3 months after transplantation, sometimes as early as 2 weeks post transplant, and involve febrile myocarditis, encephalitis or pneumonitis. In HSCT recipients, the major risk of toxoplasmosis results from the reactivation of a pre-transplant latent infection in seropositive recipients. The median point of disease onset is estimated at 2 months post transplant, with <10% of cases occurring before 30 days and 15-20% later than day 100. Toxoplasmosis usually manifests as encephalitis or pneumonitis, and frequently disseminates with multiple organ involvement. Diagnosis of toxoplasmosis is based on the demonstration of parasites or parasitic DNA in blood, bone marrow, cerebrospinal fluid, bronchoalveolar lavage fluid or biopsy specimens, and serological tests do not often contribute to the diagnosis. For prevention of toxoplasmosis, serological screening of donors and recipients before transplantation allows the identification of patients at higher risk of toxoplasmosis, i.e. seropositive HSCT recipients and mismatched (seropositive donor/seronegative recipients) SOT recipients. Preventing toxoplasmosis disease in those patients presently relies on prophylaxis via prescription of co-trimoxazole.

  • 12.
    Dudarev, Alexey A
    et al.
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Alloyarov, Pavel R
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Chupakhin, Valery S
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Dushkina, Eugenia V
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Sladkova, Yuliya N
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Dorofeyev, Vitaliy M
    Dubna City Hospital, Moscow oblast, Russia.
    Kolesnikova, Tatijana A
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Fridman, Kirill B
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    Food and water security issues in Russia I: Food security in the general population of the Russian Arctic, Siberia and the Far East2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, 1-10 p., 21848Article in journal (Refereed)
    Abstract [en]

    Background. Problems related to food security in Russian Arctic (dietary imbalance, predominance ofcarbohydrates, shortage of milk products, vegetables and fruits, deficit of vitamins and microelements,chemical, infectious and parasitic food contamination) have been defined in the literature. But no standardprotocol of food security assessment has been used in the majority of studies.

    Objectives. Our aim was to obtain food security indicators, identified within an Arctic collaboration,for selected regions of the Russian Arctic, Siberia and the Far East, and to compare food safety in theseterritories.

    Study design and methods. In 18 regions of the Russian Arctic, Siberia and the Far East, the followingindicators of food security were analyzed: food costs, food consumption, and chemical and biological foodcontamination for the period 2000-2011.

    Results. Food costs in the regions are high, comprising 2343% of household income. Only 4 out of 10 foodgroups (fish products, cereals, sugar, plant oil) are consumed in sufficient amounts. The consumption of milkproducts, eggs, vegetables, potatoes, fruits (and berries) is severely low in a majority of the selected regions.There are high levels of biological contamination of food in many regions. The biological and chemicalcontamination situation is alarming, especially in Chukotka. Only 7 food pollutants are under regularcontrol; among pesticides, only DDT. Evenki AO and Magadan Oblast have reached peak values in foodcontaminants compared with other regions. Mercury in local fish has not been analyzed in the majority of theregions. In 3 regions, no monitoring of DDToccurs. Aflatoxins have not been analyzed in 5 regions. Nitrateshad the highest percentage in excess of the hygienic threshold in all regions. Excesses of other pollutants indifferent regions were episodic and as a rule not high.

    Conclusion. Improvement of the food supply and food accessibility in the regions of the Russian Arctic,Siberia and the Far East is of utmost importance. Both quantitative and qualitative control of chemical andbiological contaminants in food is insufficient and demands radical enhancement aimed at improving foodsecurity.

  • 13. Dudarev, Alexey
    et al.
    Dorofeyey, Vitaliy
    Dushkina, Eugenia
    Alloyarov, Pavel
    Chupakhin, Valery
    Sladkova, Yuliya
    Kolesnikova, Tatjana
    Fridman, Kirill
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Evengård, Birgitta
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Food and water security issues in Russia III: food- and waterborne diseases in the Russian Arctic, Siberia and the Far East, 2000-20112013In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 72, 21856- p.Article in journal (Refereed)
    Abstract [en]

    Background. The food- and waterborne disease situation in Russia requires special attention. Poor quality of centralized water supplies and sewage systems, biological and chemical contamination of drinking water, as well as contamination of food products, promote widespread infectious diseases, significantly exceeding nationwide rates in the population living in the two-thirds of Russian northern territories.Objectives. The general aim was to assess the levels of food- and waterborne diseases in selected regions of Russian Arctic, Siberia and the Far East (for the period 2000ᅵ2011), and to compare disease levels among regions and with national levels in Russia.Study design and methods. This study is the first comparative assessment of the morbidity in these fields of the population of 18 selected regions of Russian Arctic, Siberia and the Far East, using official statistical sources. The incidences of infectious and parasitic food- and waterborne diseases among the general population (including indigenous peoples) have been analyzed in selected regions (per 100,000 of population, averaged for 2000ᅵ2011).Results. Among compulsory registered infectious and parasitic diseases, there were high rates and widespread incidences in selected regions of shigellosis, yersiniosis, hepatitis A, tularaemia, giardiasis, enterobiasis, ascariasis, diphyllobothriasis, opistorchiasis, echinococcosis and trichinellosis.Conclusion. Incidences of infectious and parasitic food- and waterborne diseases in the general population of selected regions of the Russian Arctic, Siberia and the Far East (2000ᅵ2011) are alarmingly high. Parallel solutions must be on the agenda, including improvement of sanitary conditions of cities and settlements in the regions, modernization of the water supply and of the sewage system. Provision and monitoring of the quality of the drinking water, a reform of the general healthcare system and the epidemiological surveillance (including gender-divided statistics), enhancement of laboratory diagnostics and the introduction of preventive actions are urgently needed.

  • 14. Dudarev, Alexey
    et al.
    Dushkina, Eugenia
    Sladkova, Yuliya
    Alloyarov, Pavel
    Chupakhin, Valeriy
    Dorofeyey, Vitaliy
    Kolesnikova, Tatijana
    Fridman, Kirill
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Food and water security issues in Russia II: Water security in general population of Russian Arctic, Siberia and Far East, 2000-20112013In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 72, 22646- p.Article in journal (Refereed)
    Abstract [en]

    Background. Poor state of water supply systems, shortage of water purification facilities and disinfection systems, low quality of drinking water generally in Russia and particularly in the regions of the Russian Arctic, Siberia and Far East have been defined in the literature. However, no standard protocol of water security assessment has been used in the majority of studies.Study design and methods. Uniform water security indicators collected from Russian official statistical sources for the period 2000ᅵ2011 were used for comparison for 18 selected regions in the Russian Arctic, Siberia and Far East. The following indicators of water security were analyzed: water consumption, chemical and biological contamination of water reservoirs of Categories I and II of water sources (centralized ᅵ underground and surface, and non-centralized) and of drinking water.Results. Water consumption in selected regions fluctuated from 125 to 340 L/person/day. Centralized water sources (both underground and surface sources) are highly contaminated by chemicals (up to 40ᅵ80%) and biological agents (up to 55% in some regions), mainly due to surface water sources. Underground water sources show relatively low levels of biological contamination, while chemical contamination is high due to additional water contamination during water treatment and transportation in pipelines. Non-centralized water sources are highly contaminated (both chemically and biologically) in 32ᅵ90% of samples analyzed. Very high levels of chemical contamination of drinking water (up to 51%) were detected in many regions, mainly in the north-western part of the Russian Arctic. Biological contamination of drinking water was generally much lower (2.5ᅵ12%) everywhere except Evenki AO (27%), and general and thermotolerant coliform bacteria predominated in drinking water samples from all regions (up to 17.5 and 12.5%, correspondingly). The presence of other agents was much lower: Coliphages ᅵ 0.2ᅵ2.7%, Clostridia spores, Giardia cysts, pathogenic bacteria, Rotavirus ᅵ up to 0.8%. Of a total of 56 chemical pollutants analyzed in water samples from centralized water supply systems, 32 pollutants were found to be in excess of hygienic limits, with the predominant pollutants being Fe (up to 55%), Cl (up to 57%), Al (up to 43%) and Mn (up to 45%).Conclusion. In 18 selected regions of the Russian Arctic, Siberia and Far East Category I and II water reservoirs, water sources (centralized ᅵ underground, surface; non-centralized) and drinking water are highly contaminated by chemical and biological agents. Full-scale reform of the Russian water industry and water security system is urgently needed, especially in selected regions.

  • 15. Edvinsson, B
    et al.
    Lappalainen, M
    Evengård, Birgitta
    Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Bacteriology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Buffalano, W
    Ferguson, D
    Guy, E
    Jenum, P
    Nowakowska, D
    Pelloux, H
    Stray-Pedersen, B
    Szénási, Z
    Real-time PCR targeting a 529-bp repeat element for diagnosis of toxoplasmosis2006In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 12, no 2, 131-136 p.Article in journal (Refereed)
    Abstract [en]

    Sensitive and rapid detection of infection with Toxoplasma gondii in transplanted immunocompromised patients is crucial for a good prognosis. Two DNA fragments are used currently for detecting T. gondii infection by PCR, i.e., the B1 gene and a 529-bp repeat element that exists in 200-300 copies/genome. This study investigated whether targeting the 529-bp repeat element gives better sensitivity and accuracy than can be obtained when targeting the B1 gene (35 copies) when concentrations of T. gondii DNA are low. The results demonstrated that detection of the 529-bp repeat element increased diagnostic sensitivity and accuracy. Addition of an internal amplification control did not affect the PCR performance and was useful in order to monitor PCR inhibition by non-specific DNA in the LightCycler instrument. The real-time PCR was used successfully in a clinical context to monitor parasitaemia in the blood of a transplant recipient suffering from toxoplasmosis.

  • 16. Edvinsson, Benjamin
    et al.
    Dardé, M-L
    Pelloux, H
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Rapid genotyping of Toxoplasma gondii by pyrosequencing.2007In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 13, no 4, 424-9 p.Article in journal (Refereed)
    Abstract [en]

    Most human infections with the protozoan parasite Toxoplasma gondii are asymptomatic, but severe symptoms can occur in immunocompromised patients, in developing foetuses, and in ocular infections in immunocompetent individuals. The majority of T. gondii strains can be divided into three main lineages, denoted types I, II and III, which are known to cause different clinical presentations. Simple molecular methods with the capacity to discriminate rapidly among strains may help to predict the course of infection and influence the choice of treatment. In the present study, real-time PCR followed by pyrosequencing was used to discriminate among types I, II and III by analysis of two single nucleotide polymorphisms in the GRA6 gene. Twenty-one isolates of T. gondii characterised previously were analysed. Three different GRA6 alleles detected by the pyrosequencing technique identified types I, II and III isolates correctly, while four atypical isolates possessed either the GRA6 allele 1 or the GRA6 allele 3. Reproducibility was 100%, and typeability, when including atypical strains, was 81%. It was also possible to discriminate a mixture of two genotypes. The method was used to identify GRA6 type II in blood and lung tissue from an allogeneic transplant recipient with toxoplasmosis.

  • 17.
    Edvinsson, Benjamin
    et al.
    Centre for Microbiological Preparedness, Swedish Institute for Infectious Diseases Control.
    Lappalainen, Maija
    Laboratory Services, Dept Virology, Helsiniki University.
    Anttila, Veli-Jukka
    Div Internal Medicine, Dept Infectious Diseases, Helsinki University.
    Paetau, Anders
    Dept Pathology, Helsinki University.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Toxoplasmosis in immunocompromized patients2009In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 41, no 5, 368-371 p.Article in journal (Refereed)
    Abstract [en]

    Infection with the cosmopolitan parasite Toxoplasma gondii is often associated with severe consequences and a high mortality rate in immunocompromized patients. Non-specific symptoms make diagnosis challenging. Monitoring of patients at risk is of value. We here present 8 cases of toxoplasmosis in immunocompromized patients with suggestions for preventive monitoring.

  • 18. Edvinsson, Benjamin
    et al.
    Lundquist, Jessica
    Ljungman, Per
    Ringdén, Olle
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    A prospective study of diagnosis of Toxoplasma gondii infection after bone marrow transplantation.2008In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 116, no 5, 345-51 p.Article in journal (Refereed)
    Abstract [en]

    Active infection with Toxoplasma gondii in immunocompromised transplant recipients can lead to toxoplasmosis, which may have a rapid disease course and in some cases be fatal. It is of paramount importance to diagnose toxoplasmosis at an early stage, and to initiate specific treatment to improve the outcome. Polymerase chain reaction (PCR) is today the primary diagnostic tool to diagnose toxoplasmosis in immunocompromised patients. Timely diagnosis may, however, be difficult if toxoplasmosis is at first asymptomatic. To investigate the magnitude of toxoplasmosis after bone marrow transplantation (BMT), we conducted a screening study by PCR where 21 autologous and 12 allogeneic BMT recipients were included. Peripheral blood samples were taken one week prior to BMT; thereafter, blood samples were drawn weekly for the first 6 months, and monthly up to one year after BMT. The samples were analyzed by conventional PCR and real-time PCR. T. gondii DNA was detected in peripheral blood from one patient 5 days post allogeneic BMT. There were no clinical signs of toxoplasmosis. Medical records were reviewed and showed a previously undiagnosed eye infection in another allogeneic BMT recipient. These two patients were seropositive for T. gondii. We concluded that monitoring for T. gondii DNA in peripheral blood samples using PCR might be a valuable method for identifying toxoplasma-seropositive stem cell transplant recipients.

  • 19.
    Evengard, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    McMichael, Anthony
    Australian Natl Univ, Canberra, ACT, Australia.
    Vulnerable populations in the Arctic2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, 11210- p.Article in journal (Refereed)
  • 20.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Vulnerable populations: health of humans and animals in a changed landscape2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, no Supplement 1, 58-60 p.Article in journal (Refereed)
  • 21.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Berner, Jim
    Brubaker, Michael
    Mulvad, Gert
    Revich, Boris
    Climate change and water security with a focus on the Arctic2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, 8449- p.Article in journal (Refereed)
    Abstract [en]

    Water is of fundamental importance for human life; access to water of good quality is of vital concern for mankind. Currently however, the situation is under severe pressure due to several stressors that have a clear impact on access to water. In the Arctic, climate change is having an impact on water availability by melting glaciers, decreasing seasonal rates of precipitation, increasing evapotranspiration, and drying lakes and rivers existing in permafrost grounds. Water quality is also being impacted as manmade pollutants stored in the environment are released, lowland areas are flooded with salty ocean water during storms, turbidity from permafrost-driven thaw and erosion is increased, and the growth or emergence of natural pollutants are increased. By 2030 it is estimated that the world will need to produce 50% more food and energy which means a continuous increase in demand for water. Decisionmakers will have to very clearly include life quality aspects of future generations in the work as impact of ongoing changes will be noticeable, in many cases, in the future. This article will focus on effects of climate-change on water security with an Arctic perspective giving some examples from different countries how arising problems are being addressed.

  • 22.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Gräns, Hanna
    Wahlund, Elisabeth
    Nord, Carl Erik
    Karolinska Institutet.
    Increased number of Candida albicans in the faecal microflora of chronic fatigue syndrome patients during the acute phase of illness.2007In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 42, no 12, 1514-5 p.Article in journal (Refereed)
  • 23.
    Evengård, Birgitta
    et al.
    Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Jacks, Andreas
    Dept Medical Epidemiology and Biostatistics, Karolinska Institutet.
    Pedersen, Nancy L
    Dept Medical Epidemiology and Biostatistis, Karolinska Institutet.
    Sullivan, Patrick F
    Dept Genetics, Univ of North Carolina, Dept Medical Epid and Biostat, Karol Institutet.
    The epidemiology of chronic fatigue in the Swedish Twin Registry2005In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 35, no 9, 1317-1326 p.Article in journal (Refereed)
    Abstract [en]

    CFS-like illness may be more common that previously acknowledged. There is a marked increase in risk by gender. Previous reports that CFS is more prevalent in individuals in certain occupational categories were not confirmed and may have been due to confounding by gender.

  • 24.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Juto, Per
    Seigneurin, Jean-Marie
    Wretlind, Bengt
    Beyond agar plates in diagnostic microbiology2012In: European Manual of Microbial Infections, Escmid , 2012Chapter in book (Refereed)
  • 25.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Marcinkute, Audrone
    Petersen, Eskild
    Northern Europe2011In: A geographic guide to infectious diseases / [ed] Petersen E, Chen LH, Schlaugenhof P, John Wiley & Sons, 2011, 1, 218-229 p.Chapter in book (Refereed)
    Abstract [en]

    The most common community-acquired infectious diseases are upper and lower respiratory tract infections, gastroenteritis, and urinary tract infections. Among vector-borne infections, Borrelia dominate but tick-borne encephalitis is found in the Baltic countries and parts of Sweden and a few cases have been reported from Denmark. The most common cause of viral meningitis is enterovirus, and herpes virus is the most common cause of encephalitis. Bacterial meningitis is rare and the most common causes are pneumococci and meningococci type B. Hepatitis A is very rare but local outbreaks are described from single imported cases. Hepatitis B is often sexually transmitted and B and C are usually related to intravenous drug abuse. Gastroenteritis due to virus is seen and food-borne outbreaks are rare but seen regularly due to virus and especially Campylobacter and Salmonella spp. (Campylobacter, the most reported in Sweden.) The prevalence of HIV is below 1% in the population and all patients are offered free antiretroviral treatment. Infections related to immunosuppressed patients like transplant recipients and patients for other reasons receiving immunosuppressive treatment are increasing primarily due to an increasingly aging population. Tuberculosis is still common in the Baltic countries where MDR is also a problem. Parasitic infections are rare, but waterborne outbreaks of Giardia have been described from Norway and Sweden. In the Baltic countries Echinococcus multilocularis seems to be spreading and Trichinella infections from consumption of infected meat has been described.

  • 26.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Destouni, Gia
    Stockholms universitet.
    Säker tillgång till mat och vatten prioriterad fråga för Arktis2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 05, CCF7- p.Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Arktis befinner sig i förändring. Dessa förändringar beror på mänskliga aktiviteter i regionen och på den globala klimatförändringen, som märks först och mest i norr till exempel där den sibiriska tundran övergår i gräsbevuxen terräng. Djur och människor som bor i den här delen av världen är redan påverkade av förändringarna och kommer att förbli så under lång tid framöver. Ursprungsbefolkningar runt om i Arktis samlar sig i protester, nu senast i Kanada. De många ursprungsbefolkningarna i Arktis lever ofta nära naturen och är därför mer sårbara än andra, men även samhällen med god infrastruktur påverkas av miljöförändringar. I Sverige märkte vi nyligen detta, när närmare 100 000 personer i Östersund och Skellefteå med omgivningar vintern 2010–2011 fick koka sitt vatten under månader på grund av att en parasit (Cryptosporidium) kom in i vattnet. Olika slags system behöver kontrolleras regelbundet, så att säkra datatolkningar kan ges till beslutsfattare, för att vidta åtgärder i tid för ökad säkerhet.

  • 27.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Nymand Larsen, JoanPaasche, Øyvind
    The new Arctic2015Collection (editor) (Refereed)
  • 28.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Paasche, Øyvind
    Nymand Larsen, Joan
    Paths to the new Arctic2015In: The new Arctic / [ed] Birgitta Evengård, Joan Nymand Larsen, Øyvind Paasche, Cham: Springer, 2015, 1-6 p.Chapter in book (Refereed)
    Abstract [en]

    In the late eighteenth century explorers and scientists started venturing into the Arctic beyond areas that were already populated by Indigenous peoples and a smaller number of new settlers, and ultimately towards the North Pole. It was about as far as anyone could get from civilization at the time, and in many respects it remains this way to this day. What the first explorers saw had not yet been seen and recorded by Western civilization. They were the first to tell the stories and document the state of the Arctic – its physical landscape and Indigenous cultures. The prosaic descriptions are many and colourful, moving and poetic, and they also soon began to provide detailed accounts of the state of Indigenous living conditions. A shared feature in these first accounts, in prints and in paintings, is the descriptions of a harsh and barren landscape frozen in time; static and unchangeable, except for the swift sways in weather. Fanciful images of indigenous communities in isolated settlements, without any contact with “western civilization” came to shape the following generations perception of the Arctic. While the Arctic gradually became a place where new maps and lines drawn became a reality to outsiders, it was also, and had been for thousands of years, the homeland for many and diverse groups of indigenous peoples, surviving in at times unforgiving conditions while developing vibrant cultures, including strong traditions for adapting to changing conditions. The storytelling is today highly valued by itself and for its importance as a complement to science. And northern art has become more vibrant than ever as shown in some chapters here integrating the changes occurring on so many grounds. It is time for new images of the region to be established. With this book we wish these new images and the new knowledge constantly being produced to reach a broad audience as the interested general public as well as policy-makers and scientific colleagues.

  • 29.
    Evengård, Birgitta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Sauerborn, Rainer
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Climate change influences infectious diseases both in the Arctic and the tropics: joining the dots2009In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed)
    Abstract [en]

    Climate change is incontestably a phenomenon of global causes and impacts. However, as much as the contribution of different regions and countries to climate change differs, as much differ the impacts. This paper examines the current and potential impact of climate change on infectious diseases in regions that could not be more different: the Arctic and the tropics (The Arctic is the area north of the Arctic Circle (66.6°N), while the tropics lie between the Tropic of Cancer (23.4°N) and the Tropic of Capricorn (23.4°S)). Despite obvious differences in environmental and socio-economic contexts, there are commonalities between these areas, both in the mechanisms through which climate change influences disease transmission and in the adaptation responses health systems can and should mount. We hope that the lessons in this comparison can be distilled both by policy makers and researchers in both regions. The purpose of this article is ‘to join the dots’ and thus stimulate discussion. Inevitably, the different dots (issues) themselves cannot be elaborated on in detail here. For this, we refer the interested reader to a wide-ranging list of references.

  • 30. Forlenza, Michael J
    et al.
    Hall, Per
    Lichtenstein, Paul
    Evengård, Birgitta
    Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Sullivan, Patrick F
    Dept Genetics, Univ of North Carolina, Dept Medical Epid and Biostat, Karol Institutet.
    Epidemiology of cancer-related fatigue in the Swedish twin registry2005In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 104, no 9, 2022-2031 p.Article in journal (Refereed)
    Abstract [en]

    A greater proportion of individuals who were listed in a national cancer registry reported experiencing fatigue compared with individuals in the general population.

  • 31.
    Forsell, Joakim
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Granlund, Margareta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Samuelsson, Linn
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Koskiniemi, Satu
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Edebro, Helen
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    High occurrence of Blastocystis sp subtypes 1-3 and Giardia intestinalis assemblage B among patients in Zanzibar, Tanzania2016In: Parasites & Vectors, ISSN 1756-3305, E-ISSN 1756-3305, Vol. 9, 370Article in journal (Refereed)
    Abstract [en]

    Background: Blastocystis is a common intestinal parasite with worldwide distribution but the distribution of Blastocystis and its subtypes in East Africa is largely unknown. In this study, we investigate the distribution of Blastocystis subtypes in Zanzibar, Tanzania and report the prevalence of intestinal parasites using both molecular methods and microscopy.

    Methods: Stool samples were collected from both diarrhoeic and non-diarrhoeic outpatients in Zanzibar. In addition to microscopy, real-time PCR for Blastocystis, Entamoeba histolytica and E. dispar, Giardia intestinalis, Cryptosporidium spp., and Dientamoeba fragilis was used. Blastocystis subtypes were determined by a conventional PCR followed by partial sequencing of the SSU-rRNA gene. Genetic assemblages of Giardia were determined by PCR with assemblage specific primers.

    Results: Intestinal parasites were detected in 85 % of the 174 participants, with two or more parasites present in 56 %. Blastocystis sp. and Giardia intestinalis were the most common parasites, identified by PCR in 61 and 53 % of the stool samples respectively, but no correlation between carriage of Blastocystis and Giardia was found. The Blastocystis subtype distribution was ST1 34.0 %, ST2 26.4 %, ST3 25.5 %, ST7 0.9 %, and 13.2 % were positive only by qPCR (non-typable). The Giardia genetic assemblages identified were A 6.5 %, B 85 %, A + B 4.3 %, and non-typable 4.3 %. The detection rate with microscopy was substantially lower than with PCR, 20 % for Blastocystis and 13.8 % for Giardia. The prevalence of Blastocystis increased significantly with age while Giardia was most prevalent in children two to five years old. No correlation between diarrhoea and the identification of Giardia, Blastocystis, or their respective genetic subtypes could be shown and, as a possible indication of parasite load, the mean cycle threshold values in the qPCR for Giardia were equal in diarrhoeic and non-diarrhoeic patients.

    Conclusions: Carriage of intestinal parasites was very common in the studied population in Zanzibar. The most commonly detected parasites, Blastocystis and Giardia, had different age distributions, possibly indicating differences in transmission routes, immunity, and/or other host factors for these two species. In the Blastocystis subtype analysis ST1-3 were common, but ST4, a subtype quite common in Europe, was completely absent, corroborating the geographical differences in subtype distributions previously reported.

  • 32.
    Forsell, Joakim
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Granlund, Margareta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Stensvold, C. R.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Clark, G. C.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Subtype analysis of Blastocystis isolates in Swedish patients2012In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 31, no 7, 1689-1696 p.Article in journal (Refereed)
    Abstract [en]

    Blastocystis is a genetically diverse and widespread intestinal parasite of animals and humans with controversial pathogenic potential. At least nine subtypes of Blastocystis have been found in humans. The genetic diversity of Blastocystis was examined in stool samples from 68 patients from the Stockholm area, Sweden. Blastocystis was identified by light microscopy, and subtyped by sequencing the 5'-end of the small subunit ribosomal RNA gene. Five Blastocystis subtypes were identified in the 63 patients whose samples were successfully subtyped: ST1 (15.9%), ST2 (14.3%), ST3 (47.6%), ST4 (20.6%), and ST7 (1.6%). ST3 was more common in males compared to females (P = 0.049). Comparative molecular analysis of Blastocystis sequences revealed intra-subtype variations within the identified subtypes with the exception of ST4. Among ST4 sequences in this study, as well as in the majority of human GenBank sequences, a limited genetic diversity was found compared to what was found among the other common subtypes (ST1, ST2 and ST3). The relative prevalence of ST4 in this study was comparable to the overall distribution of ST4 in European cohorts (16.5%). This contrasts with the sparse reports of ST4 in studies from other continents, which may indicate that the distribution of this subtype is geographically heterogeneous.

  • 33.
    Forsell, Joakim
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Koskiniemi, Satu
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Hedberg, Ida
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Edebro, Helen
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Granlund, Margareta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Bacteriology.
    Evaluation of factors affecting real-time PCR performance for diagnosis of Entamoeba histolytica and Entamoeba dispar in clinical stool samples2015In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 64, 1053-1062 p.Article in journal (Refereed)
    Abstract [en]

    Although PCR offers the potential for sensitive detection of parasites:there are several pitfalls for optimal performance, especially when DNA is extracted from a complex sample material such as stool. With the aid of a sensitive inhibitor control in a duplex real-time PCR (qPCR) for identification of Entamoeba histolytica and Entamoeba dispar we have evaluated factors that influenced the performance of the qPCR and have suggested a rationale to be used in the analysis of clinical samples. Pre-PCR processing was found to be of outmost importance for an optimal amplification since inhibitors caused false-negative results when higher amounts of sample were used. Stool sampling with a flocked swab (ESwab, Copan), yielding on average 173 mg, gave positive qPCR results in samples with cysts of E. dispar that were negative in serially diluted stool samples. The degree of inhibition found varied between samples and was not an on-off phenomenon. Even low-grade inhibition, shown as an increase of two cycles in the qPCR for the inhibitor control, could lead to false negativity in samples with low amounts of parasites. Lack of amplification in the qPCR due to inhibition could be overcome by dilution of the extracted DNA by 1/10-1/20. We also describe the use of guanidinium thiocyanate buffer for transport and storage of samples as well as a time-saving semi-automated DNA extraction method in an Arrow instrument (Nordiag) preceded by bead beating.

  • 34. Freeman, Katherine
    et al.
    Tan, Hooi Kuan
    Prusa, Andrea
    Petersen, Eskild
    Buffolano, Wilma
    Malm, Gunilla
    Cortina-Borja, Mario
    Gilbert, Ruth
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Predictors of retinochoroiditis in children with congenital toxoplasmosis: European, prospective cohort study.2008In: Pediatrics, ISSN 1098-4275, Vol. 121, no 5, e1215-22 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: By school age, 20% of children infected with congenital toxoplasmosis will have > or = 1 retinochoroidal lesion. We determined which children are most at risk and whether prenatal treatment reduces the risk of retinochoroiditis to help clinicians decide about treatment and follow-up. PATIENTS AND METHODS: We prospectively studied a cohort of children with congenital toxoplasmosis identified by prenatal or neonatal screening in 6 European countries. We determined the effects of prenatal treatment and prognostic markers soon after birth on the age at first detection of retinochoroiditis. RESULTS: Of 281 children with congenital toxoplasmosis, 50 developed ocular disease, and 17 had recurrent retinochoroiditis during a median follow-up of 4.1 years. Prenatal treatment had no significant effect on the age at first or subsequent lesions. Delayed start of postnatal treatment did not increase retinochoroiditis, but the analysis lacked power. Older gestational age at maternal seroconversion was weakly associated with a reduced risk of retinochoroiditis. The presence of nonocular clinical manifestations of congenital toxoplasmosis at birth strongly predicted retinochoroiditis. For 92% (230 of 249) of children with no retinochoroiditis detected before 4 months of age, the probability of retinochoroiditis by 4 years was low, whether clinical manifestations were present or not 8.0%. CONCLUSIONS: Prenatal treatment did not significantly reduce the risk of retinochoroiditis in this European cohort. If children have no retinochoroiditis in early infancy, the low risk of subsequent ocular disease may not justify postnatal treatment and repeated ophthalmic assessments during childhood. Controlled trials are needed to address the lack of evidence for the effectiveness of postnatal treatment.

  • 35.
    Furberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. theme Climate Change.
    FACING THE LIMIT OF RESILIENCE: PERCEPTIONS OF CLIMATE CHANGE AMONG REINDEER HERDING SAMI IN SWEDEN2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, no Supplement 1, 520-520 p.Article in journal (Other academic)
  • 36.
    Furberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Facing the limit of resilience: perceptions of climate change among reindeer herding Sami in Sweden2011In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 4, no 8417, 11- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Arctic area is a part of the globe where the increase in global temperature has had the earliest noticeable effect and indigenous peoples, including the Swedish reindeer herding Sami, are amongst the first to be affected by these changes.

    OBJECTIVE: To explore the experiences and perceptions of climate change among Swedish reindeer herding Sami.

    STUDY DESIGN: In-depth interviews with 14 Swedish reindeer herding Sami were performed, with purposive sampling. The interviews focused on the herders experiences of climate change, observed consequences and thoughts about this. The interviews were analysed using content analysis.

    RESULTS: ONE CORE THEME EMERGED FROM THE INTERVIEWS: facing the limit of resilience. Swedish reindeer-herding Sami perceive climate change as yet another stressor in their daily struggle. They have experienced severe and more rapidly shifting, unstable weather with associated changes in vegetation and alterations in the freeze-thaw cycle, all of which affect reindeer herding. The forecasts about climate change from authorities and scientists have contributed to stress and anxiety. Other societal developments have lead to decreased flexibility that obstructs adaptation. Some adaptive strategies are discordant with the traditional life of reindeer herding, and there is a fear among the Sami of being the last generation practising traditional reindeer herding.

    CONCLUSIONS: The study illustrates the vulnerable situation of the reindeer herders and that climate change impact may have serious consequences for the trade and their overall way of life. Decision makers on all levels, both in Sweden and internationally, need improved insights into these complex issues to be able to make adequate decisions about adaptive climate change strategies.

  • 37. Gilbert, Ruth E
    et al.
    Freeman, Katherine
    Lago, Eleonor G
    Bahia-Oliveira, Lilian M G
    Tan, Hooi Kuan
    Wallon, Martine
    Buffolano, Wilma
    Stanford, Miles R
    Petersen, Eskild
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Ocular sequelae of congenital toxoplasmosis in Brazil compared with Europe.2008In: PLoS neglected tropical diseases, ISSN 1935-2735, Vol. 2, no 8, e277- p.Article in journal (Refereed)
    Abstract [en]

    T. gondii causes more severe ocular disease in congenitally infected children in Brazil compared with Europe. The marked differences in the frequency, size and multiplicity of retinochoroidal lesions may be due to infection with more virulent genotypes of the parasite that predominate in Brazil but are rarely found in Europe.

  • 38. Gollub, Erica L
    et al.
    Leroy, Valériane
    Gilbert, Ruth
    Chêne, Geneviève
    Wallon, Martine
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Effectiveness of health education on Toxoplasma-related knowledge, behaviour, and risk of seroconversion in pregnancy.2008In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 136, no 2, 137-45 p.Article in journal (Refereed)
    Abstract [en]

    We conducted a bibliographic literature search using MEDLINE to review the effectiveness of health education on Toxoplasma-related knowledge, behaviour, and risk of seroconversion in pregnant women. We pre-selected studies that used comparative study designs (randomized clinical trial, quasi-experimental design or historical control), that were conducted among pregnant women, and which employed specific, Toxoplasma-related outcome measures: knowledge, behaviour, or Toxoplasma infection rate. Four studies met the inclusion criteria. All had serious methodological flaws. A Belgian study reported a significant decrease in the incidence of Toxoplasma seroconversion after the introduction of intensive counselling for pregnant women about toxoplasmosis. In Poland, a significant increase in knowledge was observed after a multi-pronged, public health educational program was launched. In Canada, an increase in knowledge and prevention behaviours was reported in the intervention group receiving counselling by trained facilitators compared with the control group. In France, no significant changes in risk behaviour were observed following a physician-delivered intervention. This review highlights the weakness of the literature in the area and the lack of studies measuring actual seroconversion. There is suggestive evidence that health education approaches may help reduce risk of congenital toxoplasmosis but this problem requires further study using more rigorous research design and methodology.

  • 39. Gras, Luuk
    et al.
    Wallon, Martine
    Pollak, Arnold
    Cortina-Borja, Mario
    Evengård, Birgitta
    Clinic of Clinical Bacteriology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Hayde, Michael
    Petersen, Eskild
    Gilbert, Ruth
    Association between prenatal treatment and clinical manifestations of congenital toxoplasmosis in infancy: a cohort study in 13 European centres2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 12, 1721-1731 p.Article in journal (Refereed)
    Abstract [en]

    Only early versus no prenatal treatment for intracranial lesions showed a statistically significant benefit. A large randomized controlled trial and/or meta-analysis of individual patient data from cohort studies is required to confirm these findings.

  • 40. Gräns, H
    et al.
    Birgitta, Evengård
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Nilsson, P
    Transcriptome analysis of PBMCs from patients with Chronic fatigue syndrome2007In: Journal of Chronic Fatigue Syndrome, ISSN 1057-3321, E-ISSN 1547-0660, Vol. 14, no 3, 7-25 p.Article in journal (Refereed)
  • 41. Gräns, Hanna
    et al.
    Nilsson, Maria
    Dahlman-Wright, Karin
    Dept Biosciences and Nutrition, Karolinska Institutet.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Reduced levels of oestrogen receptor beta mRNA in Swedish patients with chronic fatigue syndrome.2007In: Journal of Clinical Pathology, ISSN 0021-9746, E-ISSN 1472-4146, Vol. 60, no 2, 195-8 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic fatigue syndrome (CFS) is an illness with unknown aetiology and pathophysiology. The difference in incidence by sex observed for CFS indicates a role for oestrogen and oestrogen receptors in disease development. Furthermore, an immunomediated pathogenesis has been suggested for CFS, providing an additional connection to oestrogen, which displays immunomodular functions. AIMS: To investigate a possible association of oestrogen receptor (ER) mRNAs and two ERbeta single-nucleotide polymorphisms (SNPs) with CFS. METHODS: Messenger RNA levels of ERalpha, ERbeta wt and ERbeta cx were investigated in peripheral blood mononuclear cells from 30 patients with CFS and 36 healthy controls by quantitative real-time polymerase chain reaction. Two ERbeta SNPs were scored in the same material. RESULTS: The CFS group showed significantly lower mRNA expression levels of ERbeta wt compared with the healthy control group. No differences were observed for ERalpha or ERbeta cx between patients and controls. There were no significant differences in frequency for the investigated ERbeta SNPs between cases and controls. CONCLUSIONS: The reduced ERbeta wt expression level observed in this study is consistent with an immune-mediated pathogenesis of CFS. Additionally, the observation that ERbeta wt expression is decreased in CFS could provide an entry point to identify interesting, potentially disease-causing, candidate molecules for further study. A possible connection between oestrogen, oestrogen receptors and CFS should be evaluated further.

  • 42. Gräns, Hanna
    et al.
    Nilsson, P
    Evengård, Birgitta
    From the Departments of Clinical Bacteriology, Karolinska Institutet, Karolinska University Hospital, Huddinge.
    Gene expression profiling in the chronic fatigue syndrome2005In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 258, no 4, 388-390 p.Article in journal (Refereed)
  • 43.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Haukenes, Inger
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Fjellman Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lehti, Arja
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Professionell Development.
    Wiklund, Maria
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Evengard, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Low-Educated Women with Chronic Pain Were Less Often Selected to Multidisciplinary Rehabilitation Programs2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 5, e97134Article in journal (Refereed)
    Abstract [en]

    Background: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education. Methods: The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS). Results: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high-and low-educated men. Conclusion: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.

  • 44. Hannestad, Ulf
    et al.
    Theodorsson, Elvar
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    beta-Alanine and gamma-aminobutyric acid in chronic fatigue syndrome.2007In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 376, no 1-2, 23-9 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Due to the occurrence of sleep disturbances and fatigue in chronic fatigue syndrome (CFS), an investigation was performed to examine if there is an abnormal excretion of gamma-aminobutyric acid (GABA) and/or its structural analogue beta-alanine in the urine from CFS patients. Both GABA and beta-alanine are inhibitory neurotransmitters in the mammalian central nervous system. METHODS: The 24 h urine excretion of GABA and beta-alanine was determined by isotope dilution gas chromatography mass spectrometry in 33 CFS patients and 43 healthy controls. The degree of symptoms in both patients and controls was measured by grading of three typical CFS symptoms using a Visual Analogue Scale. RESULTS: Men had a significantly higher excretion of both beta-alanine and GABA than women. Comparing CFS patients with healthy controls showed no significant difference in excretion of neither beta-alanine nor GABA. No correlation was found between the excretion of beta-alanine or GABA and any of the three characteristic CFS symptoms measured. However, two female and two male CFS patients excreted considerably higher amounts of beta-alanine in their 24 h urine samples than control subjects. CONCLUSIONS: Increased excretion of beta-alanine was found in a subgroup of CFS patients, indicating that there may be a link between CFS and beta-alanine in some CFS patients.

  • 45.
    Hedlund, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bruden, Dana
    Bruce, Michael
    Hurlburt, Debby
    Rudolph, Karen
    Parkinson, Alan
    Evengård, Birgitta
    Hennessy, Thomas
    Factors affecting antimicrobial resistance among colonising Streptococcus pneumoniae in rural Alaska villages over 10 years2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, no Supplement 1, 702-703 p.Article in journal (Refereed)
  • 46. Jones, James F
    et al.
    Kohl, Katrin S
    Ahmadipour, Nooshin
    Bleijenberg, Gijs
    Buchwald, Dedra
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Jason, Leonard A
    Klimas, Nancy G
    Lloyd, Andrew
    McCleary, Kimberly
    Oleske, James M
    White, Peter D
    Fatigue: case definition and guidelines for collection, analysis, and presentation of immunization safety data.2007In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 25, no 31, 5685-96 p.Article in journal (Refereed)
  • 47.
    Kato, K
    et al.
    Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Sullivan, Patrick F
    Dept Genetics, Univ of North Carolina, Dept Medical Epid and Biostat, Karol Institutet.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Pedersen, Nancy L
    Dept Medical Epidemiology and Biostatistis, Karolinska Institutet.
    A population-based twin study of functional somatic syndromes2009In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 39, no 3, 497-505 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The mechanisms underlying the co-occurrence of the functional somatic syndromes are largely unknown. No empirical study has explicitly examined how genetic and environmental factors influence the co-morbidity of these syndromes. We aimed to examine how the co-morbidity of functional somatic syndromes is influenced by genetic and environmental factors that are in common to the syndromes. METHOD: A total of 31318 twins in the Swedish Twin Registry aged 41-64 years underwent screening interviews via a computer-assisted telephone system from 1998 to 2002. Four functional somatic syndromes (chronic widespread pain, chronic fatigue, irritable bowel syndrome, and recurrent headache) and two psychiatric disorders (major depression and generalized anxiety disorder) were assessed using structured questions based on standard criteria for each illness in a blinded manner. RESULTS: Multivariate twin analyses revealed that a common pathway model with two latent traits that were shared by the six illnesses fit best to the women's data. One of the two latent traits loaded heavily on the psychiatric disorders, whereas the other trait loaded on all four of the functional somatic syndromes, particularly chronic widespread pain, but not on the psychiatric disorders. All illnesses except the psychiatric disorders were also affected by genetic influences that were specific to each. CONCLUSIONS: The co-occurrence of functional somatic syndromes in women can be best explained by affective and sensory components in common to all these syndromes, as well as by unique influences specific to each of them. The findings clearly suggest a complex view of the multifactorial pathogenesis of these illnesses.

  • 48. Kato, Kenji
    et al.
    Sullivan, Patrick F
    Evengård, Birgitta
    Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Pedersen, Nancy L
    Chronic widespread pain and its comorbidities: a population-based study2006In: Archives of Internal Medicine, ISSN 0003-9926, E-ISSN 1538-3679, Vol. 166, no 15, 1649-1654 p.Article in journal (Refereed)
    Abstract [en]

    Associations between CWP and most comorbidities are mediated by unmeasured genetic and family environmental factors in the general population. The extent of mediation via familial factors is likely to be disorder specific.

  • 49. Kato, Kenji
    et al.
    Sullivan, Patrick F
    Evengård, Birgitta
    Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Pedersen, Nancy L
    Importance of genetic influences on chronic widespread pain2006In: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 54, no 5, 1682-1686 p.Article in journal (Refereed)
    Abstract [en]

    Individual differences in the likelihood of developing chronic widespread pain reflect modest genetic influences. There are no significant sex differences in the type or expression of the genes responsible for chronic widespread pain or in the magnitude of the relative importance of these influences on chronic widespread pain.

  • 50. Kato, Kenji
    et al.
    Sullivan, Patrick F
    Evengård, Birgitta
    Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L
    Premorbid predictors of chronic fatigue2006In: Archives of General Psychiatry, ISSN 0003-990X, E-ISSN 1538-3636, Vol. 63, no 11, 1267-1272 p.Article in journal (Refereed)
    Abstract [en]

    Elevated premorbid stress is a significant risk factor for chronic fatigue-like illness, the effect of which may be buffered by genetic influences. Emotional instability assessed 25 years earlier is associated with chronic fatigue through genetic mechanisms contributing to both personality style and expression of the disorder. These findings suggest plausible mechanisms for chronic fatiguing illness.

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