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  • 101.
    Hjalte, Frida
    et al.
    Swedish Institute for Health Economics, Lund.
    Steen Carlsson, Katarina
    Swedish Institute for Health Economics, Lund; Department of Clinical Sciences, Lund University, Malmö.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Real-world outcome analysis of continuously and intermittently treated patients with moderate to severe psoriasis after switching to a biologic agent2015In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 230, no 4, p. 347-353Article in journal (Refereed)
    Abstract [en]

    Background: Clinical studies of continuous versus intermittent biologic therapy for moderate to severe psoriasis demonstrate improved efficacy with continuous treatment. Objective: To analyse Swedish real-world data of continuously and intermittently treated biologic-naive patients after switching to a biologic agent. Methods: This is an observational study based on PsoReg, the Swedish registry for systemic psoriasis treatment. Outcome effects in biologic-naive patients who switched to a biologic agent (n = 351) were analysed in groups of continuous, intermittent and terminated treatment. Results: Intermittently treated patients (n = 50) reported higher Psoriasis Area and Severity Index and Dermatology Life Quality Index values after switching than patients with continuous (n = 260) or terminated treatment (n = 41). Study Limitations:The reason for intermittent treatment was not recorded. The intermittently treated patients may be a heterogeneous group and a limitation is that it cannot be determined whether less than continuous use was offered to handle negative aspects. Conclusion: Patients with continuous biologic treatment tend to achieve better outcomes compared to intermittently treated patients.

  • 102.
    Hägg, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Psoriasis in Sweden: observational studies from an epidemiological perspective2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Psoriasis is a heterogeneous disease with several clinical manifestations; the symptoms are characterized by redness, scaliness and thickness of the skin. There are several treatment options available for psoriasis and patients with moderate to severe psoriasis generally need systemic agents. In 2004 biologics were introduced for patients with moderate to severe psoriasis in Sweden.

    Methods: The Swedish Health Care Registers and the Swedish registry for systemic treatment of psoriasis PsoReg, were used to; estimate the incidence of psoriasis cases in the Swedish specialist care, to examine the treatment allocation and important factors related to the initiation of especially biologic treatment.

    Results: On average 9000 new psoriasis patients entered specialist care in Sweden each year under study, corresponding to an incidence of 98 patients per 100,000 person-years. In the treatment allocation analysis of the incident psoriasis cases in the Swedish specialist care Patients living in a Metropolitan Area and with a University degree were more likely to initiate a biologic treatment. By analysing biologic-naïve patients enrolled in PsoReg, PASI (the physician’s assessment of the psoriasis severity) and Psoriasis Arthropathy were shown to be two important factors associated with the initiation of biologic treatment while sex was not. Furthermore, it was also shown that the decision to initiate biological treatment was more strongly associated with PASI than with DLQI (the patients’ assessment of the disease impact Quality of Life).

    Conclusion: These studies indicate that there are inequalities in the assignments of systemic psoriasis treatments (especially in biologic treatment). Since the allocation of treatments should not depend on sex, education or residency in a Metropolitan Area but rather the need of care, it is important that future studies continue analysing possible factors that could influence the initiation of treatment in clinical practice.

  • 103.
    Hägg, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Sundström, Anders
    Psoriasis Patients New to Specialist Care in Sweden 2007-2009: A Two-Year Follow-Up of Treatment Allocation2016In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 25, p. 4-5Article in journal (Other academic)
  • 104. Hägg, David
    et al.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Sundström, Anders
    Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
    Specialist treatment of psoriasis in Sweden between 2007 and 2009: Incidence and treatment allocation during a two-year follow-upManuscript (preprint) (Other academic)
  • 105.
    Hägg, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Sundström, Anders
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    The higher proportion of men with psoriasis treated with biologics may be explained by more severe disease in men2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 5, p. e63619-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Moderate to severe psoriasis, once regarded as merely a skin disease, is today seen as an inflammatory systemic disease. The sex ratio of the prevalence of psoriasis is balanced. In recent years several reports have documented that men receive more systemic or UV treatment than women, and different hypotheses were made. In PsoReg, the national registry for systemic treatment of psoriasis in Sweden, we have, like other European registries, observed a predominance of men (59%), especially of men treated with biologics (63%). Biologics are a relatively new group of very effective but high-priced drugs. The objective of this study was to analyse if women are discriminated by not having the same access to the high-priced biologics.

    DESIGN: Population based cohort study using data from a nationwide quality register of psoriasis patients.

    POPULATION: 2294 patients with moderate to severe psoriasis receiving systemic treatment from a specialist in dermatology.

    MAIN OUTCOME MEASURES: Time to initiation of biologic treatment. A multiple Cox proportional hazard's regression was performed, with time to initiating a biologic treatment as the outcome in order to assess the independent role of the patient's sex in initiating such therapy. The psoriasis severity was defined as a time-varying variable.

    RESULTS: Men had more severe psoriasis than women according to the Psoriasis Area and Severity Index (PASI), regardless of age at enrolment, and throughout the study period. The analysis in the multiple Cox regression show that age, psoriasis severity and psoriasis arthropathy were relevant factors for initiating biologic therapy, whereas sex is not.

    CONCLUSIONS: Although as many women as men are believed to suffer from psoriasis, men seem to be more severely affected by psoriasis. The asymmetry in allocation of biologic therapy thereby probably reflects the differing disease activity between the sexes, and is not a discrimination against women per se.

  • 106.
    Hägg, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Sundström, A
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Decision for biological treatment in real life is more strongly associated with the Psoriasis Area and Severity Index (PASI) than with the Dermatology Life Quality Index (DLQI)2015In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 29, no 3, p. 452-456Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Following the establishment of the National Quality Registry for systemic psoriasis treatment (PsoReg), the two psoriasis outcome measurements, Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), are now integrated in clinical practice in Sweden. According to current guidelines, the initiation of a biological treatment should depend on a combination of the physician's (PASI) and the patients' assessment of the disease impact on a health-related quality of life measure (DLQI).

    OBJECTIVE: To evaluate if either of the two measures, PASI or DLQI, is more strongly associated with initiation of biological therapy.

    METHODS: The study is based on 2216 patients suffering from moderate to severe psoriasis who were biological naïve at enrolment to PsoReg. The relationship between the two measures PASI and DLQI and initiation of biological treatment (as outcome) were estimated by a logistic regression and a Cox proportional hazard's model with combinations of PASI and DLQI as independent variables.

    RESULTS: The adjusted regression models showed that patients with high PASI score and low DLQI score had a higher chance to receive biological treatment compared to patients with low PASI score and high DLQI score.

    CONCLUSION: The decision to initiate biological treatment is more strongly associated with PASI than with DLQI. However, since the DLQI reflects both socio-economic costs and patient suffering better than PASI, the relevance of the DLQI may be underestimated in clinical practice.

  • 107.
    Hägg, David
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, T2, 171 76 Stockholm, Sweden.
    Sundström, Anders
    Centre for Pharmacoepidemiology (CPE), Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Severity of psoriasis differs between men and women: a registry based study of the clinical outcome measure Psoriasis Area and Severity Index (PASI) in 5438 patients2017In: American Journal of Clinical Dermatology, ISSN 1175-0561, E-ISSN 1179-1888, Vol. 18, p. 583-590Article in journal (Refereed)
    Abstract [en]

    Background: Psoriasis is a common skin disease and moderate to severe psoriasis is associated with a dose-dependent risk for metabolic and cardiovascular morbidity. It has previously been speculated that women have less severe psoriasis, as men are overrepresented in psoriasis registers and consume more care.

    Objective: The objective of this study was to investigate, for the first time, the sex differences in the severity of psoriasis using the gold standard of severity measurement, the Psoriasis Area and Severity Index (PASI), and the distinct elements of the PASI score.

    Design, Setting and Participants: This was a cross-sectional study based on the national registry for systemic treatment of psoriasis in Sweden (PsoReg), with 5438 patients experiencing moderate to severe psoriasis. Differences in the PASI score and its elements at enrolment were tested by multivariable ordinal logistic regressions.

    Main Outcome Measures: The different components of the PASI score were used to analyze the assessment of disease severity. For each body area (head, arms, trunk, and legs), the score of the plaque characteristics and degree of skin involvement were used as outcomes.

    Results: Women had statistically significantly lower median PASI scores (5.4) than men (7.3) [p < 0.001], which was consistent across all ages. The difference remained statistically significant in a multivariable linear regression. The itemized PASI analyses from the Mann–Whitney–Wilcoxon tests and the adjusted ordinal logistic regressions confirmed that women had significantly lower scores than men in all areas of the body, except for the head. No differences in the use of medications prior to enrolment could be found that may cause this difference between the sexes.

    Conclusions: As the PsoReg contains the detailed disease measurement PASI, which was traditionally used for selected participants in clinical studies only, a nationwide unselected population could be investigated. The fact that women have less severe psoriasis can explain the dominance of males in the systemic treatment of psoriasis. These findings motivate a gender perspective in the management of psoriasis and in the prevention and management of its comorbidities.

  • 108. Isaksson, Marléne
    et al.
    Bråred-Christensson, Johanna
    Engfeldt, Malin
    Lindberg, Magnus
    Matura, Mihaly
    Möller, Halvor
    Ryberg, Kristina
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Svedman, Cecilia
    Bruze, Magnus
    Patch testing with formaldehyde 2.0% in parallel with 1.0% by the Swedish Contact Dermatitis Research Group2014In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 94, no 4, p. 408-410Article in journal (Refereed)
    Abstract [en]

    In a multicentre study consecutively patch-tested dermatitis patients were tested simultaneously with 1.0% and 2.0% (w/v) formaldehyde in aqua applied with a micropipette (15 µl) to the filter paper disc in Finn Chambers (0.30 mg/cm2 and 0.60 mg/cm2, respectively). A total of 2,122 dermatitis patients were patch-tested. In all, 77 (3.6%) patients reacted positively to formaldehyde; 37 reacted only to 2.0%, 35 reacted to both concentrations and 5 patients reacted only to 1.0%. Significantly more patients were thus diagnosed with contact allergy to formaldehyde with 2.0% compared to 1.0% (p < 0.001) without causing more irritant reactions. The detected number of isolated allergic reactions to the 2 formaldehyde-releasers in the Swedish baseline series and not to formaldehyde itself raises the question whether quaternium-15 1.0% and diazolidinyl urea 2.0% should be present in the Swedish baseline series.

  • 109. Isaksson, Marléne
    et al.
    Hansson, Christer
    Inerot, Annica
    Lidén, Carola
    Matura, Mihaly
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Möller, Halvor
    Bruze, Magnus
    Multicentre patch testing with compositae mix by the Swedish contact dermatitis research group2011In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 91, no 3, p. 295-298Article in journal (Refereed)
    Abstract [en]

    Sesquiterpene lactone mix detects contact allergy to these compounds present in the plant family Asteraceae. This marker is present in many baseline series. An additional marker is Compositae mix, which is not present in many baseline series. To investigate whether this allergen should be inserted into the Swedish baseline series, sex dermatology centres representing the Swedish Contact Dermatitis Research Group included Compositae mix into their baseline series for 1.5 years. Of 2818 patients tested, 31 (1.1%) reacted to Compositae mix and 26 (0.9%) to Sesquiterpene lactone mix. Active sensitization to Compositae mix was noted in two cases. Only 0.4% of Asteraceae contact allergy cases would have been missed if Compositae mix had not been tested, a frequency too low to merit its inclusion in the baseline series. Due to obvious geographical differences in frequency in frequency of simultaneous allergic reactions to Compositae mix and Sesquiterpene lactone mix, the question as to whether specific baseline series (including Compositae mix or not as a "tail" substance) should be used in the different centres must be addressed. Another option could be to remove Sesquiterpene lactone mix from the baseline series and substitute it with Compositae mix.

  • 110. Isaksson, Marléne
    et al.
    Inerot, Annica
    Lidén, Carola
    Lindberg, Magnus
    Matura, Mihaly
    Möller, Halvor
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Bruze, Magnus
    Multicentre patch testing with fragrance mix II and hydroxyisohexyl 3-cyclohexene carboxaldehyde by the Swedish Contact Dermatitis Research Group2014In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 70, no 3, p. 187-189Article in journal (Refereed)
  • 111. Isaksson, Marléne
    et al.
    Inerot, Annica
    Lidén, Carola
    Matura, Mihaly
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Möller, Halvor
    Bruze, Magnus
    Multicentre patch testing with a resol resin based on phenol and formaldehyde2011In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 65, no 1, p. 34-37Article in journal (Refereed)
    Abstract [en]

    Background. Contact allergy to phenol-formaldehyde resins (PFRs) based on phenol and formaldehyde is not detected by a p-tertiary-butylphenol-formaldehyde resin (PTBP-FR) included in most baseline patch test series.

    Objectives. To investigate the rate of contact allergy to PFR-2 (a mixture of monomers and dimers from a resol resin based on phenol and formaldehyde) in a Swedish population, and to investigate associated simultaneous allergic reactions.

    Methods. Five centres representing the Swedish Contact Dermatitis Research Group included PFR-2 in their patch test baseline series for a period of 1.5 years.

    Results. Of 2504 patients tested, 27 (1.1%) reacted to PFR-2. Of those 27 individuals, 2 had a positive reaction to formaldehyde and 2 to PTBP-FR. Simultaneous allergic reactions were noted to colophonium in 6, to Myroxylon pereirae in 14, and to fragrance mix I in 15.

    Conclusions. The contact allergy frequency in the tested population (1.1%) merits its inclusion in the Swedish baseline series and possibly also in other baseline series. Simultaneous allergic reactions were noted to colophonium, M. pereirae, and fragrance mix I.

  • 112.
    Jahns, Anika C.
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Lundskog, Bertil
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Nosek, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Killasli, H.
    Emtestam, L.
    Alexeyev, Oleg A.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Microbiology of folliculitis decalvans: a histological study of 37 patients2015In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 29, no 5, p. 1025-1026Article in journal (Other academic)
  • 113.
    Jahns, Anika
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Killasli, Hassan
    Nosek, Daniel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lundskog, Bertil
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Lenngren, Anna
    Muratova, Zhanna
    Emtestam, Lennart
    Alexeyev, Oleg
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Microbiology of hidradenitis suppurativa (acne inversa): a histological study of 27 patients2014In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 122, no 9, p. 804-809Article in journal (Refereed)
    Abstract [en]

    Hidradenitis suppurativa (acne inverse) (HS) is a chronic skin disease primarily affecting hair follicles. The aetiology of HS is unknown, but infection is believed to play some role. This retrospective study investigated the microbial colonization directly in skin appendices in HS skin samples. Archival samples from 27 patients with HS were screened by immunofluorescence labelling with monoclonal and polyclonal antibodies against Gram-positive bacteria, Propionibacterium acnes and Propionibacterium granulosum. Fluorescence in situ hybridization was used for further species identification of Staphylococcus spp. Overall, 17 patients (63%) were found positive for bacterial colonization. Of these, 15 showed colonization in hair follicles and/or sinus tracts. The most commonly identified bacteria were DAPI labelled coccoids that were seen in 71% of the positive patients in the form of biofilms and microcolonies. P. acnes was found as biofilms in hair follicles of two patients. Staphylococcus aureus and coagulase-negative staphylococci were not detected in any sample. The results of this study indicate a common bacterial presence in HS skin lesions. Bacterial biofilms are not uncommon and their pathogenic role needs further evaluation.

  • 114.
    Johansson, Amanda
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Forsgren, Sture
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Wilén, Jonna
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Kalezic, Nebojsa
    Sandström, Monica
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    No effect of mobile phone-like RF exposure on patients with atopic dermatitis.2008In: Bioelectromagnetics, ISSN 1521-186X, Vol. 29, no 5, p. 353-362Article in journal (Refereed)
    Abstract [en]

    This study investigates the effect of exposure to a mobile phone-like radiofrequency (RF) electromagnetic field on people with atopic dermatitis (AD). Fifteen subjects with AD were recruited and matched with 15 controls without AD. The subjects were exposed for 30 min to an RF field at 1 W/kg via an indoor base station antenna attached to a 900 MHz GSM mobile phone. Blood samples for ELISA analysis of the concentration of substance P (SP), tumor necrosis factor receptor 1 (TNF R1), and brain derived neurotrophic factor (BDNF) in serum were drawn before and after the provocation (exposure/sham). Baseline heart rate and heart rate variability, local blood flow, and electrodermal activity were also recorded. No significant differences between the subject groups were found for baseline neurophysiological data. The cases displayed a serum concentration of TNF R1 significantly higher than the control subjects and a significantly lower serum concentration of BDNF in the baseline condition. For SP there was no difference between groups. However, no effects related to RF exposure condition were encountered for any of the measured substances. As to symptoms, a possible correlation with exposure could not be evaluated, due to too few symptom reports. The result of the study does not support the hypothesis of an effect of mobile phone-like RF exposure on serum levels of SP, TNF R1, and BDNF in persons with AD.

  • 115. Kapferer-Seebacher, Ines
    et al.
    Pepin, Melanie
    Werner, Roland
    Aitman, Timothy J
    Nordgren, Ann
    Stoiber, Heribert
    Thielens, Nicole
    Gaboriaud, Christine
    Amberger, Albert
    Schossig, Anna
    Gruber, Robert
    Giunta, Cecilia
    Bamshad, Michael
    Björck, Erik
    Chen, Christina
    Chitayat, David
    Dorschner, Michael
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hale, Christopher J
    Hanna, David
    Hennies, Hans Christian
    Heiss-Kisielewsky, Irene
    Lindstrand, Anna
    Lundberg, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology.
    Mitchell, Anna L
    Nickerson, Deborah A
    Reinstein, Eyal
    Rohrbach, Marianne
    Romani, Nikolaus
    Schmuth, Matthias
    Silver, Rachel
    Taylan, Fulya
    Vandersteen, Anthony
    Vandrovcova, Jana
    Weerakkody, Ruwan
    Yang, Margaret
    Pope, F Michael
    Byers, Peter H
    Zschocke, Johannes
    Periodontal Ehlers-Danlos Syndrome Is Caused by Mutations in C1R and C1S, which Encode Subcomponents C1r and C1s of Complement2016In: American Journal of Human Genetics, ISSN 0002-9297, E-ISSN 1537-6605, Vol. 99, no 5, p. 1005-1014Article in journal (Refereed)
    Abstract [en]

    Periodontal Ehlers-Danlos syndrome (pEDS) is an autosomal-dominant disorder characterized by early-onset periodontitis leading to premature loss of teeth, joint hypermobility, and mild skin findings. A locus was mapped to an approximately 5.8 Mb region at 12p13.1 but no candidate gene was identified. In an international consortium we recruited 19 independent families comprising 107 individuals with pEDS to identify the locus, characterize the clinical details in those with defined genetic causes, and try to understand the physiological basis of the condition. In 17 of these families, we identified heterozygous missense or in-frame insertion/deletion mutations in C1R (15 families) or C1S (2 families), contiguous genes in the mapped locus that encode subunits C1r and C1s of the first component of the classical complement pathway. These two proteins form a heterotetramer that then combines with six C1q subunits. Pathogenic variants involve the subunit interfaces or inter-domain hinges of C1r and C1s and are associated with intracellular retention and mild endoplasmic reticulum enlargement. Clinical features of affected individuals in these families include rapidly progressing periodontitis with onset in the teens or childhood, a previously unrecognized lack of attached gingiva, pretibial hyperpigmentation, skin and vascular fragility, easy bruising, and variable musculoskeletal symptoms. Our findings open a connection between the inflammatory classical complement pathway and connective tissue homeostasis.

  • 116.
    Khatami, Alireza
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
    Emmelin, Maria
    Talaee, Rezvan
    Mohammadi, Akram Miramin
    Aghazadeh, Nessa
    Firooz, Alireza
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Lived experiences of patients suffering from acute Old World cutaneous leishmaniasis: A qualitative content analysis study from Iran2018In: Iranian Journal of Arthropod-Borne Diseases, ISSN 1735-7179, E-ISSN 2008-2517, Vol. 12, no 2, p. 180-195Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore the experiences of patients who suffer from acute cutaneous leishmaniasis in Iran, focusing on quality of life.

    Methods: The study was conducted at two different sites in Iran in 2010–2011. Individual in-depth interviews were conducted with six men and six women parasitologically confirmed acute cutaneous leishmaniasis. Interviews were recorded, transcribed verbatim, and translated into English. Qualitative content analysis was used for data analysis.

    Results: The participants, aged 23 to 63yr, had mild to severe disease. Based on the analysis four main themes were developed. "Fearing an agonizing disease" reflects patients' experiences of disease development resulting in sadness and depression, "struggling to cope" and "taking on the blame" both illustrate how patients experience living with the disease, which included both felt and enacted stigma as major social concerns. "Longing for being seen and heard" refers to patients' experiences with healthcare as well as their expectations and demands from communities and healthcare to be involved in closing the knowledge and awareness gap.

    Conclusion: Mental and social dimensions of cutaneous leishmaniasis were complex and adversely affected patients' lives by causing psychological burden and limiting their social interactions. Health authorities have to plan programs to increase the disease awareness to prevent the existing stigma to improve patients' social condition and medical care.

  • 117.
    Khatami, Alireza
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Talaee, Rezvan
    Mohammadi, Akram Miramin
    Aghazadeh, Nessa
    Emmelin, Maria
    Firooz, Alireza
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Development of CL-QoL: A disease-specific instrument for measuring quality of life in adult patients with acute Old World cutaneous leishmaniasisIn: Article in journal (Refereed)
  • 118.
    K:son Blomquist, Hans
    et al.
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    Frängsmyr, Agneta
    Hernell, Olle
    Umeå University, Faculty of Medicine, Clinical Sciences, Paediatrics.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Bäck, Ove
    Dietary intake of vitamin D during the second half of infancy in Swedish infants2004In: Scandinavian Journal of Food & Nutrition, ISSN 1748-2976, Vol. 48, no 4, p. 173-177Article in journal (Refereed)
  • 119. Lazarevic, Vladimir
    et al.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Markuszewska, Alicja
    Häggroth, Jonas
    [Schnitzler syndrome--unknown, rare but treatable]2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 46, p. 3348-51Article in journal (Refereed)
  • 120.
    Lind, Lisbet K
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Stecksén-Blicks, Christina
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Lejon, Kristina
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    EDAR mutation in autosomal dominant hypohidrotic ectodermal dysplasia in two Swedish families2006In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 7, p. 80-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hypohidrotic ectodermal dysplasia (HED) is a genetic disorder characterized by defective development of teeth, hair, nails and eccrine sweat glands. Both autosomal dominant and autosomal recessive forms of HED have previously been linked to mutations in the ectodysplasin 1 anhidrotic receptor (EDAR) protein that plays an important role during embryogenesis.

    METHODS: The coding DNA sequence of the EDAR gene was analyzed in two large Swedish three-generational families with autosomal dominant HED.

    RESULTS: A non-sense C to T mutation in exon 12 was identified in both families. This disease-specific mutation changes an arginine amino acid in position 358 of the EDAR protein into a stop codon (p.Arg358X), thereby truncating the protein. In addition to the causative mutation two polymorphisms, not associated with the HED disorder, were also found in the EDAR gene.

    CONCLUSION: The finding of the p.Arg358X mutation in the Swedish families is the first corroboration of a previously described observation in an American family. Thus, our study strengthens the role of this particular mutation in the aetiology of autosomal dominant HED and confirms the importance of EDAR for the development of HED.

  • 121.
    Lundwall, Åke
    et al.
    Malmö Allmänna sjukhus, Klinisk kemi.
    Brattsand, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Kalikrein-related peptidases2008In: Cellular and Molecular Life Sciences (CMLS), ISSN 1420-682X, E-ISSN 1420-9071, Vol. 65, no 13, p. 2019-2038Article, review/survey (Refereed)
  • 122. Maksymowych, WP
    et al.
    Wessler, A
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Suarez-Almazor, M
    Ritzel, G
    Von Borstel, RC
    Pazderka, F
    Russell, AS
    Polymorphism in an HLA linked proteasome gene influences phenotypic expression of disease in HLA-B27 positive individuals1994In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 21, no 4, p. 665-669Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the potential influence of the HLA-linked LMP (low molecular weight polypeptide) genes on disease susceptibility in HLA-B27 individuals with ankylosing spondylitis (AS).

    METHODS: A polymorphic CfoI restriction enzyme site in the coding region of one proteasome gene was evaluated in 125 genomic DNA samples from B27 individuals with well documented AS, 55 of whom had had acute iritis, and 42 samples from normal, ethnically matched B27 blood donors where AS was excluded.

    RESULTS: Analysis of individuals with B27 AS with iritis revealed significant differences in allelic distribution of this biallelic locus compared to patients with B27 AS without iritis. Furthermore, homozygosity for the disease associated allele was significantly more prevalent in patients with AS with iritis (72.7%) than in patients without iritis (38.6%) (p(uncorrected) = 0.0003) or B27 controls (45.2%) (p(uncorrected) = 0.01).

    CONCLUSION: Our findings support the involvement of additional HLA linked genes in the phenotypic expression of disease in B27 individuals and suggest a role for the non-B27 HLA haplotype in susceptibility to iritis.

  • 123.
    Meding, Birgitta
    et al.
    Karolinska Institutet, institutet flr miljömedicin.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Svensson, Åke
    Skånes universitetssjukhus Malmö.
    Lindberg, Magnus
    Universitetssjukhuset Örebro.
    Handeksem - en folksjukdom som påverkar livskvalitet och arbetsförmåga: önskvärt med tidigare behandling och bättre uppföljning2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 4, p. 145-148Article in journal (Other academic)
    Abstract [sv]

    Årsprevalensen av handeksem är 10 procent hos vuxna, och handeksem är vanligare hos kvinnor.

    Handeksem påverkar livskvaliteten funktionellt och mentalt.

    Handeksem medför konsekvenser i både privatlivet och arbetslivet.

    Handeksem får socioekonomiska konsekvenser i form av arbetsbyten, sjukvårdskonsumtion, sjukskrivning och produktionsbortfall.

    Prognosen för handeksem är i dag dålig.

    Behandlingen av handeksem omfattar lokalbehandling, sy­stemisk behandling och fysikalisk ljusbehandling.

    Behov finns av flera kontrollerade, randomiserade och jämförande behandlingsstudier.

    Behov finns av ökad kunskap om och förståelse av tidiga insatser och bättre uppfölj­­ning och information till patienterna.

  • 124.
    Mellenius, Harriet
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Virology.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Jensen, Jørgen Skov
    [Mycoplasma genitalium should be suspected in unspecific urethritis and cervicitis. A study from Vasterbotten confirms the high prevalence of the bacteria]2005In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, no 47, p. 3538-3541Article in journal (Refereed)
    Abstract [sv]

    The microbe Mycoplasma genitalium has in several studies been proposed as an individual cause of non-gonococcal urethritis (NGU) in men, and has been associated with pelvic inflammatory disease (PID) and salpingitis. The prevalence of M genitalium has generally been 50-90% of the prevalence of C trachomatis, and this seems to be the case in Sweden as well. This is the first study of the pathogenesis and prevalence of M genitalium in northern Sweden. In total 823 samples, 340 from women and 483 from men, were screened for M genitalium by using a PCR method. Thirtythree (4.0%) patients, 13 (3.8%) women and 20 (4.1%) men, were infected by M genitalium. In the same group 60 (7.3%) patients, 16 (4.7%) women and 44 (9.1%) men, were infected by Chlamydia trachomatis. None of the 22 patients that were tested after treatment with azitromycin was still infected.

  • 125. Metsävainio, Ann-Sofie
    et al.
    Utter, Annika
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Lidén, Carola
    Meding, Birgitta
    Svensson, Ake
    [Skin allergy and hypersensitivity surveyed in a Swedish study]2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Lakartidningen, Vol. 103, no 41, p. 3075-3078Article in journal (Refereed)
  • 126. Moberg, C
    et al.
    Meding, B
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Svensson, A
    Lindberg, M
    Remembering childhood atopic dermatitis as an adult: factors that influence recollection.2006In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 155, no 3, p. 557-60Article in journal (Refereed)
  • 127.
    Niklasson, O.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    The prevalence and characteristics of pruritus in patients with heart failure2015In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 172, no 6, p. 1541-1546Article in journal (Refereed)
    Abstract [en]

    Background Pruritus (itching) can be a distressing symptom, and previous research suggests that it is common in patients with chronic heart failure (CHF).

    Objectives The primary aim was to examine the prevalence of itching in patients with CHF and to compare this first to that among patients with coronary artery disease (CAD) and second to that of a normal Swedish population. The study also explored characteristics and possible causes of pruritus in patients with CHF.

    Methods In this cross-sectional prevalence study, a questionnaire was sent to 130 patients with CHF and to 130 with CAD. A total of 85 patients with CHF (65.4%) and 82 with CAD (63.1%) participated. Data were also compared with those of a previous study examining symptoms in a normal Swedish population.

    Results The prevalence of itching at some point during the last 3 months was 40.0% in patients with CHF and 23.2% in patients with CAD (P = 0.019). This difference was not significant after adjusting for sex, age and medication. Patients with CHF described their pruritus as more disturbing than patients with CAD. In addition, 13.6% of patients with CHF and 3.8% of persons in the normal population experienced itching every week without any rash (P = 0.001).

    Conclusions Pruritus is common and sometimes disturbing in patients with CHF and warrants clinical attention. Medication should be considered as a cause of itching and may explain differences in the prevalence between patients with CHF and those with CAD. However, other causes of itching in patients with CHF should be explored in prospective studies.

  • 128.
    Nilsson, Eskil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Department of Dermatology, Sundsvall Hospital, Sundsvall Sweden.
    Individual and environmental risk factors for hand eczema in hospital workers1986Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Individual and environmental risk factors in hand eczema have been investigated in a prospective cohort study of 2452 newly employed hospital workers with a follow-up time of 20 months. Current hand eczema was analyzed in 142 wet hospital workers from this cohort with respect to the etiologic importance of irritants, allergens and contact urticants. The density of the microflora and the effect on the microflora of topical treatment with a potent corticosteroid were studied in 20 patients with hand eczema.

    ’Wet’ hospital work was found to increase the odds of developing hand eczema only twice compared to 'dry' office work. Nursing children under four years old and the lack of a dish-washing machine significantly increased the risk of contracting hand eczema. Unfavourable combinations of these domestic factors increased the risk as much as wet work. A history of atopic dermatitis approximately tripled the odds both in wet as well as in dry work.

    Histories of earlier hand eczema (HHE), metal dermatitis (HMD) and of atopy were analyzed as risk factors for hand eczema in 1857 women in wet work. HHE increased the odds by a factor of 12.9 and created a subdivision of the population into high risk individuals and normal risk individuals. HHE was found in half of the subjects with atopic dermatitis, in one quarter of the subjects with atopic mucosal symptoms and in one fifth of the non-atopics. A HMD increased the odds by a factor of 1.8. This increase was seen as a high risk level in subjects with HHE and as a normal risk level in subjects with no HHE. A history of atopic disease as a complement to information about HHE and HMD increased the odds by another 1.3 times. The predicted probability of developing hand eczema ranged from 91 % in subjects with a combination of HHE, HMD and atopy to 24% in subjects with none of these risk factors.

    Subjects with AD were found to suffer a more severe form of hand eczema with significantly higher figures for medical consultation, sick- leave, termination due to hand eczema, early debut, permanent symtoms and vesicular lesions.

    Amongst the patients investigated for current hand eczema high risk individuals were overrepresented. It was claimed in 92.3% of the cases that trivial irritant factors had elicited the current episodes of hand eczema. In 35% of the cases the exposure to the irritant took place largely at home. Although contact sensitivity and contact urticaria were fairly common, they mostly seemed to be of minor importance in the etiology of the current hand eczema.

    Staphylococcus aureus colonized eczematous lesions of the hands in 18/20 patients. The density exceeded 105 colony forming units/cm2 in 15/20 patients. Only three of these patients showed signs of clinical infection. Successful topical treatment with a potent corticosteroid significantly reduced the colonization of S. aureus.

  • 129.
    Nordin, Steven
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Palmquist, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Claeson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    The environmental hypersensitivity symptom inventory: metric properties and normative data from a population-based study2013In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 71, no 18, p. 1-10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: High concomitant intolerance attributed to odorous/pungent chemicals, certain buildings, electromagnetic fields (EMF), and everyday sounds calls for a questionnaire instrument that can assess symptom prevalence in various environmental intolerances. The Environmental Hypersensitivity Symptom Inventory (EHSI) was therefore developed and metrically evaluated, and normative data were established. The EHSI consists of 34 symptom items, requires limited time to respond to, and provides a detailed and broad description of the individual's symptomology.

    METHODS: Data from 3406 individuals who took part in the Vasterbotten Environmental Health Study were used. The participants constitute a random sample of inhabitants in the county of Vasterbotten in Sweden, aged 18 to 79 years, stratified for age and gender.

    RESULTS: Exploratory factor analysis identified five significant factors: airway symptoms (9 items; Kuder-Richardson Formula 20 coefficient, KR-20, of internal consistency = 0.74), skin and eye symptoms (6 items; KR-20 = 0.60), cardiac, dizziness and nausea symptoms (4 items; KR-20 = 0.55), head-related and gastrointestinal symptoms (5 items; KR-20 = 0.55), and cognitive and affective symptoms (10 items; KR-20 = 0.80). The KR-20 was 0.85 for the entire 34-item EHSI. Symptom prevalence rates in percentage for having the specific symptoms every week over the preceding three months constitute normative data.

    CONCLUSIONS: The EHSI can be recommended for assessment of symptom prevalence in various types of environmental hypersensitivity, and with the advantage of comparing prevalence rates with normality.

  • 130. Norlin, J. M.
    et al.
    Calara, P. S.
    Persson, U.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Real-world outcomes in 2,646 psoriasis patients: one in five has PASI ≥ 10 and/or DLQI ≥ 10 under ongoing systemic therapy2017In: Journal of dermatological treatment (Print), ISSN 0954-6634, E-ISSN 1471-1753, Vol. 28, no 6, p. 500-504Article in journal (Refereed)
    Abstract [en]

    Background Although biologics introduced a new era in psoriasis care when available a decade ago, it is unclear to what extent the available systemic treatments treat patients adequately. Objective To analyse the clinical severity and quality of life of the psoriasis population in Sweden treated with systemics. Methods Data included 2,646 patients from the Swedish Registry for Systemic Treatment of Psoriasis. Average Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and EQ-5D were reported. A subgroup of persisting moderate-to-severe psoriasis as defined by PASI≥10 and/or DLQI≥10 after >12 weeks treatment was analysed. Results Mean (SD) PASI, DLQI, and EQ-5D were 4.12 (4.57), 4.11 (5.24) and 0.79 (0.22). Eighteen percent had persisting moderate-to-severe psoriasis (n = 472). These patients were younger, had higher BMI, had psoriasis arthritis and were smoking to a larger extent (p < 0.01) compared to lower-severity patients (n = 2174). Mean (SD) EQ-5D was also considerably lower 0.63 (0.29) vs. 0.82 (0.19) (p < 0.01). Conclusion Almost one in every five patients had persisting moderate-to-severe psoriasis, despite ongoing systemic treatment. Both comorbidities and life style factors were associated with persisting moderate-to-severe psoriasis. The considerably lower generic quality of life in these patients demonstrates an unmet need. Subsequently, improved access to biologics and continuous drug development is needed in psoriasis.

  • 131. Norlin, J. M.
    et al.
    Nilsson, K.
    Persson, U.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Complete Skin Clearance and PASI response rates in clinical practice- Predictors, Health Related Quality of Life improvements and implications for treatment goals2019In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: PASI90 is suggested to be the new standard endpoint RCTs of biologics for psoriasis, whereas treatment guidelines often still refer to PASI75.

    OBJECTIVES: To analyse in a real-world setting: Firstly, what factors are associated with higher levels of treatment response to biologics. Secondly, the Health-Related Quality of Life gains associated with different response levels in clinical practice.

    METHODS: Biologically-naïve patients with PASI, DLQI and EQ-5D outcomes before (maximum 6 months) and after (3-12 months) switch to biologics during registration in the Swedish Register for systemic treatment of psoriasis, PsoReg, were included (n=515). Patient characteristics associated with higher treatment response were analysed by regression analyses. Improvements in absolute PASI, DLQI and EQ-5D were assessed in different PASI percent response levels.

    RESULTS: High PASI percentage response was associated with higher PASI before switch and lower BMI. DLQI and EQ-5D improved within all responder groups (p<0·001). The magnitude of improvements in DLQI (p=0·02) differed between responder groups. The mean (SD) DLQI improvement for PASI75-<90, PASI90-<100 responders and patients achieving Complete Skin Clearance (PASI100) were 9·9 (7·4), 11·5 (7·0) and 8·0 (6·1), respectively.

    CONCLUSION: PASI percentage change is largely dependent on absolute PASI before switch. Patients in clinical practice lack "baseline" PASI values as they may switch directly from one treatment to another or stay successfully treated for a longer time period. Treatment goals such as PASI90 are thus not suitable for treatment guidelines or for follow-up in clinical practice.

  • 132.
    Norlin, Jenny
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Effectiveness and costs of new medical technologies: register-based research in psoriasis2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Psoriasis is a chronic, immunological and systemic disease with an estimated prevalence of about 2-3 percent. Psoriasis is associated with the joint disease psoriasis arthropathy. There are several treatments options available for psoriasis and patients with moderate to severe psoriasis generally need systemic agents. In 2004 biologics were introduced for patients with moderate to severe psoriasis in Sweden.

    The overall objective of this thesis was to assess the relationship between Health Related Quality of Life (HRQOL) and clinical outcome measures in psoriasis patients, to analyse the effectiveness of biologics in psoriasis in everyday clinical practice and to explore how costs of the psoriasis population changed after the introduction of biologics in Sweden.

    Methods: Research was based on national administrative registers and PsoReg, the Swedish registry for systemic treatment of psoriasis. In a cross-sectional study (paper I) the three outcome measures: the generic HRQOL measure EQ-5D, the dermatology specific HRQOL measure the Dermatology Life Quality Index (DLQI) and the clinical measure of skin involvement, Psoriasis Area and Severity Index (PASI), were analysed by demographic characteristics. The generic EQ-5D among psoriasis patients was compared to previously published values for the general population in Sweden. Relationships between measures were examined with correlation tests and regression analysis. A longitudinal study included patients registered in PsoReg who switched to a biologic agent for the first time during registration (paper II). The three outcomes EQ-5D, DLQI, and PASI were analysed before and after switch in the overall patient group and in subgroups. The relative effectiveness of continuing with the standard care of conventional treatment compared to switching from standard care to biologics was analysed in patients with moderate to severe psoriasis (paper III). Patients in PsoReg were matched with propensity scores and average treatment effects were estimated. The estimated outcomes were the change of EQ-5D, DLQI, and PASI. Patients were identified in national registers at the National Board of Health and Welfare when analysing costs; either by a registration of a psoriasis diagnosis in the national patients register and/or by a registration in the prescribed drugs register of a topical treatment with calcipotriol, a substance which has the indication psoriasis only (paper IV). Direct costs included patients’ visits in specialist health care and prescribed drugs used for psoriasis treatment, retrieved from the national patients register and the prescribed drugs register, respectively. Indirect costs included productivity loss in terms of sick leave and disability pension, which estimated as excess costs compared to controls. Controls were selected from the normal population and matched on sex, age and municipality. Productivity loss was estimated based on data from the Longitudinal integration database for health insurance and labour market studies at Statistics Sweden.

    Results: Patients with moderate to severe psoriasis had significantly lower HRQOL in EQ-5D than the general population (paper I). Women rated their HRQOL lower than men, even though men had more severe clinical skin involvement than women. (paper I). The generic measure EQ-5D and the dermatology-specific DLQI had moderate correlations whereas EQ-5D had low correlation with the clinical measure PASI (paper I). Patients who switched to a biologic agent during registration in PsoReg had significant improvements in all outcomes (paper II). Patients who fulfilled the criteria for moderate to severe psoriasis had the highest benefits of the biologic agents (paper II). The matched conventionally and biologically treated patients with moderate to severe psoriasis were essentially equal in important observable variables (paper III). The subgroup of patients not responding to conventional treatment had high potential benefits of biologic agents (paper III). Individuals with psoriasis had sick leave and disability pension to a larger extent than their matched controls (paper IV). Direct costs increased, whereas the indirect costs of productivity loss decreased between 2006 and 2009 (paper IV).

    Conclusion: Psoriasis is associated both with direct costs and indirect costs, and it has a negative impact on patients’ HRQOL. When evaluating psoriasis treatments and making decisions about treatment guidelines, both generic, dermatology-specific HRQOL measures, and clinical measures are necessary; as they answer to different needs. Although dependent on data quality, generalisability, and current pricing, results suggest that conventional treatments are suitable as first line and biologic agents as second line treatment. Results indicate that the different types of systemic treatments are not allocated optimally among patients with psoriasis in Swedish clinical practice.

  • 133.
    Norlin, Jenny M
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Steen Carlsson, K
    Persson, U
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Analysis of three outcome measures in moderate to severe psoriasis: a registry-based study of 2450 patients2012In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 166, no 4, p. 797-802Article in journal (Refereed)
    Abstract [en]

    Background: As moderate to severe psoriasis is a systemic disease with large effects on health related quality of life (HRQOL) generic measures that include overall health, not only skin involvement, are necessary. The knowledge about the relationship between the generic preference-based EQ-5D and dermatology-specific measures in psoriasis is limited.

    Objective: The objective was to analyse EQ-5D, the Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI) in patients with moderate to severe psoriasis in Swedish clinical practice by demographic characteristics, to compare EQ-5D among patients to Swedish population values, and to analyse the relationships between EQ-5D, DLQI and PASI.

    Methods: This observational cohort study was based on PsoReg, the Swedish National Registry for Systemic Treatment of Psoriasis. EQ-5D among psoriasis patients was compared to a defined general population in Sweden, retrieved from a previous study. Relationships between measures were examined with correlation tests and regression analysis.

    Results: 2450 patients (men n=1479, women n=971) were included. Median EQ-5D, DLQI and PASI was 0.769, 4 and 4.7, respectively. Psoriasis patients had a significantly lower EQ-5D compared to the defined general population. EQ-5D correlated moderately with DLQI (-0.55) and weakly with PASI (-0.25) (p<0.001).

    Conclusions: When assessing psoriasis treatments and making decisions about treatment guidelines and resource allocation, EQ-5D, DLQI and PASI provide a useful set of complementary tools, answering to different needs. If EQ-5D is not included in the original trial the second best option in cost-effectiveness studies is to use mapping between DLQI and EQ-5D.

  • 134.
    Norlin, Jenny M.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. The Swedish Institute for Health Economics (IHE), Lund, Sweden.
    Steen Carlsson, Katarina
    Department of Clinical Sciences, Skåne University Hospital, Clinical Research, Lund University, Malmö, Sweden.
    Persson, Ulf
    Institute for Economic Research, School of Economics, Lund University, Lund, Sweden.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Register-Based Evaluation of Relative Effectiveness of New Therapies: Biologics Versus Conventional Agents in Treatment of Psoriasis in Sweden2015In: BioDrugs, ISSN 1173-8804, E-ISSN 1179-190X, Vol. 29, no 6, p. 389-398Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) was established in 2006. This article analyzes the implementation phase of biologics in the treatment of moderate to severe psoriasis in Sweden in the period 2006-2012. Clinical studies have shown efficacy of biologic agents in psoriasis, but their relative effectiveness in real-world clinical practice has rarely been studied.

    OBJECTIVE: To estimate the incremental changes in clinical health-related quality-of-life measures in patients receiving biologics versus conventional systemic agents.

    METHODS: Patients fulfilling the clinical criteria for moderate to severe psoriasis were included. Average treatment effects were estimated from longitudinal data as incremental changes in: (1) the Psoriasis Area and Severity Index (PASI) score, (2) the Dermatology Life Quality Index (DLQI) score, and (3) the EQ-5D score, by matching patients switching to biologics with patients remaining on conventional systemic agents.

    RESULTS: The study included 239 biologic-treated patients and 378 conventionally treated patients. The matched patient groups were essentially equivalent in terms of important patient characteristics. The average treatment effects of biologics versus conventional systemic agents were 2.2 for PASI, 3.5 for DLQI, and 0.11 for EQ-5D. The estimated incremental benefits of biologics for the subgroup of patients not responding to their conventional systemic agent were even greater.

    CONCLUSION: Register-based research complements knowledge from randomized controlled trials regarding relative effectiveness in clinical practice. This information can be used to support health care decision making. This research suggests that there is both under- and overtreatment with biologics in Swedish clinical practice. Reallocation of biologics to more severe cases of psoriasis could improve overall health in the total patient population.

  • 135.
    Norlin, Jenny M.
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. The Swedish Institute for Health Economics, Lund.
    Steen Carlsson, Katarina
    Department of Clinical Sciences, Skåne University Hospital, Clinical Research, Lund University, Malmö, Sweden.
    Persson, Ulf
    Institute for Economic Research, School of Economics, Lund University, Lund, Sweden.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Resource use in patients with psoriasis after the introduction of biologics in Sweden2015In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 95, no 2, p. 156-161Article in journal (Refereed)
    Abstract [en]

    The introduction of biologics has changed treatment patterns as well as costs in patients with psoriasis. To estimate direct and indirect costs of the psoriasis population in Sweden, and to analyse changes in costs between 2006 and 2009. The study population was identified in national registers. Direct costs included health care visits with primary psoriasis diagnoses in specialist care and drugs relevant for treating psoriasis. Productivity loss, including long-term sick leave and disability pension, was estimated as the difference compared to matched controls from the general population. Total direct cost (in SEK 2009 price level) increased from SEK 348 million in 2006 to SEK 459 million in 2009, whereas the total productivity loss decreased from SEK 1,646 to 1,618 million between 2006 and 2009. Although direct costs, especially for biologic agents, have increased for patients with psoriasis over time, this study indicates that costs related to productivity loss are still more substantial.

  • 136.
    Norlin, Jenny M
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Steen Carlsson, Katarina
    Department of Clinical Sciences, Skåne University Hospital, Clinical Research, Lund University, Malmö, Sweden.
    Persson, Ulf
    Institute for Economic Research, School of Economics, Lund University, Lund, Sweden.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Switch to biological agent in psoriasis significantly improved clinical and patient-reported outcomes in real-world practice2012In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 225, no 4, p. 326-332Article in journal (Refereed)
    Abstract [en]

    Background: Although clinical studies have shown efficacy of biological agents in moderate to severe psoriasis, observational studies of real-world effectiveness are rare.

    Objective: To analyse the psoriasis area and severity index (PASI) and quality of life by the EQ-5D questionnaire and dermatology quality of life index (DLQI) in psoriasis patients who switched from conventional systemic treatment to biological agents in clinical practice. Furthermore, to analyse patient groups with the highest benefit of biological agents.

    Methods: Longitudinal, observational study based on the Swedish National Registry for Systemic Treatment of Pso-riasis, PsoReg. Outcomes of biological-naïve patients who switched to a biological agent (n = 267) were analysed before switch and at the first follow-up.

    Results: Patients significantly improved in EQ-5D, DLQI and PASI (p < 0.001). Patients with DLQI ≥10 and/or PASI ≥10 had the greatest benefits from biological agents in terms of EQ-5D.

    Conclusions: Patients with moderate to severe psoriasis benefit from biological agents in clinical practice; the patients with the highest benefits were those with high pretreatment PASI and DLQI scores.

  • 137.
    Norlin, Jenny
    et al.
    Umeå University. Leo Pharma AS Köpenhamn, Institutet för hälso och sjukvårdsekonomi (IHE).
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Steen Carlsson, Katarina
    Persson, Ulf
    Registerstudier mäter effektivitet av läkemedel i klinisk praxis: Exemplet PsoReg – omfördelning av systemisk terapi kan ge ökad effektivitet2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 24, p. 1061-3Article in journal (Refereed)
    Abstract [en]

    Pharmaceuticals and medical technologies may have different outcomes in randomized controlled trials and observational studies. Register-based research can provide complementary information about the effectiveness of new medical technologies in clinical practice. Studies based on PsoReg, the Swedish register for systemic treatment of psoriasis, indicate that there is both an over- and under-treatment with biologics in patients with psoriasis in clinical practice. By optimizing the allocation of biologic systemic treatments for psoriasis the overall health level would increase without increas­ing the budget.

  • 138.
    Ny, Annelii
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Egelrud, Torbjörn
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Epidermal hyperproliferation and decreased skin barrier function in mice overexpressing stratum corneum chymotryptic enzyme.2004In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 84, no 1, p. 18-22Article in journal (Refereed)
  • 139.
    Nylander, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Ebrahimi, Majid
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Diagnostics. Umeå University, Faculty of Medicine, Department of Odontology, Endodontics.
    Wahlin, Ylva-Britt
    Umeå University, Faculty of Medicine, Department of Odontology, Oral Diagnostics. Umeå University, Faculty of Medicine, Department of Odontology, Endodontics.
    Boldrup, Linda
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Nylander, Karin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Changes in miRNA expression in sera and correlation to duration of disease in patients with multifocal mucosal lichen planus.2012In: Journal of Oral Pathology & Medicine, ISSN 0904-2512, E-ISSN 1600-0714, Vol. 41, no 1, p. 86-89Article in journal (Refereed)
    Abstract [en]

    Background: Mucosal lichen planus is a severe variant of lichen planus, Lichen planus (LP), which in many ways affect patients' lives. The aetiology is not fully understood, and there is no treatment clearing the disease once and for all. Oral LP has by the WHO been classified as a precancerous lesion. Micro-RNAs, miRNAs, are non-coding, small single-stranded RNAs involved in biological processes like apoptosis, proliferation, differentiation, metastasis, angiogenesis and immune response.

    Methods and Results: In sera from 30 patients with multifocal mucosal LP, 15 miRNAs were identified as significantly differentially expressed compared with controls. The three most up-regulated miRNAs are all connected to oral squamous cell carcinoma or epithelial carcinoma in general.

    Discussion: Even if no specific LP-associated miRNA profile was found, data clearly indicate that miRNAs could play a role in the earlier phases of lichen planus.

  • 140.
    Nylander, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Tunback, Petra
    Commentary on "Phimosis with Preputial Fissures as a Predictor of Undiagnosed Type 2 Diabetes in Adults"2017In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 97, no 1, p. 145-145Article in journal (Refereed)
  • 141.
    Nylander, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Wahlin, Ylva-Britt
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Lundskog, B
    Umeå University, Faculty of Medicine, Medical Biosciences, Pathology.
    Wahlin, Anders
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Genital graft-versus-host disease in a male following allogeneic stem cell transplantation2007In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 87, no 4, p. 367-368Article in journal (Refereed)
  • 142.
    Nylander Lundqvist, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Bergdahl, Jan
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Vestibulodynia (former vulvar vestibulitis): Personality in affected women2005In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 26, no 4, p. 251-256Article in journal (Refereed)
  • 143.
    Nylander Lundqvist, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Wahlin, Ylva-Britt
    Umeå University, Faculty of Medicine, Odontology, Oral and Maxillofacial Radiology.
    Bergdahl, M
    Umeå University, Faculty of Medicine, Odontology.
    Bergdahl, Jan
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Psychological health in patients with genital and oral erosive lichen planus2006In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 20, no 6, p. 661-666Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported. OBJECTIVES: As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed. RESULTS: Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group. DISCUSSION AND CONCLUSIONS: Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.

  • 144. Nyrén, Miruna
    et al.
    Lindberg, Magnus
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Svensson, Margareta
    Svensson, Ake
    Meding, Birgitta
    Influence of childhood atopic dermatitis on future worklife.2005In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 31, no 6, p. 474-478Article in journal (Refereed)
  • 145. Ormerod, AD
    et al.
    Augustin, M
    Baker, C
    Chosidow, O
    Cohen, AD
    Dam, TN
    Garcia-Doval, I
    Lecluse, LL
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Spuls, PI
    Watson, KD
    Naldi, L
    Challenges for synthesising data in a network of registries for systemic Psoriasis therapies2012In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 224, no 3, p. 236-243Article in journal (Refereed)
    Abstract [en]

    Background: Large disease registries are the preferred method to assess long-term treatment safety. If psoriasis registries collaborate in a network, their power to assess safety is increased.

    Objective: To identify heterogeneity in psoriasis registries and methodological challenges for synthesising the data they provide.

    Methods: We surveyed the registries in PSONET and identified and addressed the challenges to collaborative analysis for the network in several round table meetings.

    Results: Eight out of 10 registries had a prospective comparator cohort with similar disease characteristics but not on biologics. Registries differed in the coding and validation or follow-up of adverse events and in the way they sampled their population. Fifteen challenges to registries collaborating were identified in the areas of operational governance, structural conduct, bias and analysis.

    Conclusions: Participation in PSONET, a network of psoriasis registries, helps identify and solve common issues, enhancing the individual registries, and provides larger sets of more powerful safety data in a diverse population. Challenges to interpreting data collectively include heterogeneity in sampling, variable penetration of biologics and compatibility of different datasets.

    Copyright (c) 2012 S. Karger AG, Basel

  • 146.
    Palmquist, Eva
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Claeson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Neely, Gregory
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Overlap in prevalence between various types of environmental intolerance2014In: International journal of hygiene and environmental health (Print), ISSN 1438-4639, E-ISSN 1618-131X, Vol. 217, no 4-5, p. 427-434Article in journal (Refereed)
    Abstract [en]

    Environmental intolerance (EI) is characterized by attribution of several, multisystem symptoms to specific environmental exposures, such as exposure to odorous/pungent chemicals, certain buildings, electromagnetic fields (EMFs) and everyday sounds. The symptoms are medically unexplained, non-specific and the symptoms overlap between different types of EI. To approach the issue of underlying mechanisms the matter of overlap in prevalence between intolerances can provide valuable information. The aim of the study was to examine if the overlap between intolerance to odorous/pungent chemicals, certain buildings, EMFs and sounds is larger than the expected overlap if no association would exist between them. The study was using cross-sectional data from the Västerbotten Environmental Health Study in Sweden; a large questionnaire-based survey. 8520 adults (18-79 years) were randomly selected after stratification for age and sex, of whom 3406 (40%) participated. Individuals with the four types of intolerance were identified either through self-report, or by having been physician-diagnosed with a specific EI. The overlaps between the four EIs were greater than predictions based on coincidence for both self-reported and diagnosed cases (except for the overlap between diagnosed intolerance to sounds and EMFs). The results raise the question whether different types of EI share similar underlying mechanisms, or at least that the sufferers of EI share some predisposition to acquire the conditions.

  • 147.
    Palmquist, Eva
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Neely, Gregory
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Who recovers from environmental intolerance?Manuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: Environmental intolerance (EI) is a condition characterized by the attribution of symptoms to, and experience of negative hedonics of certain aspects in the environment (such as odorous/pungent chemicals, everyday sounds, and electromagnetic fields – EMFs). To date few studies have reported the prognosis of EI (i.e. recovery or generalization of a certain EI to an additional EI, thus general EI). Therefore, the purpose of the present study was to assess the chances of recovery from a specific EI as well as the chances of a specific EI to spread into general EI during a six-year period. The study also aimed to investigate whether levels of stress, burnout, anxiety, depression and emotional/behavioral disturbance of environmental sources could predict recovery from a specific EI.

    Methods: Longitudinal data were used (three data-collection waves - T1: 2010, T2: 2013, T3: 2016) from the Västerbotten Environmental Health Study in Sweden. At T1, 539 participants reported a specific EI, constituting the sample. Two different probability calculations were used to estimate the chances of recovering from a specific EI or to develop general EI. The first calculation considered only those individuals who responded to the questionnaire at all three data-collection waves. The second calculation was based on the Chapman-Kolmogorov equation to calculate the 2-step transition probabilities, including all participants from T1. Multinomial logistic regression was used to test whether burnout (Shirom Melamed Burnout Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), perceived stress (Perceived Stress Scale-10) and emotional and behavioral disturbance by environmental sources (Chemical Sensitivity Scale for Sensory Hyperreactivity, Electromagnetic Field Sensitivity Scale-11, and Noise Sensitivity Scale-11) were predictors of recovering from EI or spreading into general EI.

    Results: The probability of recovering from EI was 44.3% according to the probability calculation based on the participants that remained in the study at T3. The probability of specific EI spreading into general EI was 12.8%. Based on the Chapman-Kolmogorov equation, 34.6% recovered and 10.0% reported general EI. The only significant predictor of recovery found in this study was CSS-SHR, in which one step increase of the scale reduced the odds of recovering by 0.94 times.

    Conclusion: The results indicate that the prognosis for EI is fairly good and that low emotional and behavioral disruption by environmental exposure increases the odds of recovering.

  • 148.
    Palmquist, Eva
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Neely, Gregory
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Coping and social support in environmental intoleranceManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: Environmental intolerance (EI) is a broad term encompassing several conditions characterized by unspecific symptom patterns attributed to certain environmental exposure, such as odorous/pungent chemicals, electromagnetic fields (EMFs) and sounds. Limited documentation of the role of coping strategies and social support in these EIs motivated the present study of (i) combinations of coping strategies and social support in high and low intolerance severity at baseline, and (ii) combinations of coping strategies and social support at baseline that are associated with recovery from EI at follow-up, three years later.

    Methods: The study used cross-sectional and longitudinal data from the Västerbotten Environmental Health Study in Sweden, which is a large questionnaire-based survey. Individuals with EI attributed to chemicals, EMFs or sounds were identified through self-report (n=301 at baseline, n=213 at follow-up). The extent of use of four problem- and four emotion-focused strategies were assessed as well as perceived emotional, instrumental and informative support from seven sources.

    Results: The low and high intolerance severity groups differed as a function of relatively high problem-focused coping and instrumental support compared to lower reported levels of informational support, emotion-focused coping and emotional support. The groups not recovering and recovering from EI differed as a function of relatively high instrumental support and problem-focused coping compared to lower reported levels of informational support, emotional support and emotion-focused coping.

    Conclusions: The combination of coping strategies and perceived social support seem to be important in recovering from EI, for which emotion-focused coping, emotional and informational support seem to enhance recovery.

  • 149.
    Palmquist, Eva
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Neely, Gregory
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Environmental intolerance and mental ill-health: which comes first?Manuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: Environmental intolerance (EI) is a broad term encompassing several conditions characterized by unspecific symptom patterns attributed to certain environmental exposure. EI has previously been associated with mental ill-health, but prospective studies (enabling the direction of causality) within the field are sparse. This motivated the present study of testing whether (i) burnout, anxiety, depression and perceived stress are predictors of EI attributed to chemicals, certain buildings or sounds, and (ii) EI attributed to chemicals, certain buildings or sounds are predictors of burnout, anxiety or depression.

    Methods: The study used longitudinal data from the Västerbotten Environmental Health Study in Sweden, which is a large questionnaire-based survey. Individuals with EI attributed to chemicals, certain buildings or sounds were identified through self-report. Logistic regression was used to test whether burnout (Shirom Melamed Burnout Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and perceived stress (Perceived Stress Scale-10) were predictors of EI, and, vice versa, whether EI attributed to chemicals, certain buildings or sounds were predictors of burnout, anxiety and depression. 

    Results: Burnout, anxiety, depression and perceived stress predicted EI attributed to chemicals and sounds, but not EI attributed to certain buildings (after controlling for age, sex, other EIs and asthma). EI attributed to chemicals, certain buildings or sounds were not predictors of burnout, anxiety or depression, except for EI attributed to certain buildings which was a significant predictor of burnout.

    Conclusion: The results provide important information about the cause-effect relations between EIs and mental ill-health, of value for both treatment and preventive healthcare for EI. 

  • 150.
    Pommer, Linda
    et al.
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Fick, Jerker
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Sundell, J
    Nilsson, C
    Sjöström, Michael
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Andersson, Barbro
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Class separation of buildings with high and low prevalence of SBS by principal component analysis2004In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 14, no 1, p. 16-23Article in journal (Refereed)
    Abstract [en]

    In this study, we were able to separate buildings with high and low prevalence of sick building syndrome (SBS) using principal component analysis. The prevalence of SBS was defined by the presence of at least one typical skin, mucosal and general (headache and fatigue) symptom. Data from the Swedish Office Illness Study describing the presence and level of chemical compounds in outdoor, supply, and room air, respectively, were evaluated together with information about the buildings in six models. When all data were included the most complex model was able to separate 71% of the high prevalence buildings from the low prevalence buildings. The most important variable that separates the high prevalence buildings from the low prevalence buildings was a more frequent occurrence or a higher concentration of compounds with shorter retention time in the high prevalence buildings. Elevated relative humidity in supply and room air and higher levels of total volatile organic compounds in outdoor and supply air were more common in high prevalence buildings. Ten building variables also contributed to the separation of the two classes of low and high prevalence buildings.

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