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  • 151.
    Ryberg, Kristina
    et al.
    Lund University, Malmö; Uddevalla Hospital, Uddevalla.
    Bråred-Christensson, Johanna
    Department of Dermatology, Sahlgrenska Academy at University of Gothenburg, Gothenburg.
    Engfeldt, Malin
    Lund University, Malmö.
    Isaksson, Marlene
    Lund University, Malmö.
    Lindberg, Magnus
    Örebro University Hospital, Örebro.
    Matura, Mihaly
    Karolinska Institutet and Centre for Occupational and Environmental Medicin, Stockholm.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Svedman, Cecilia
    Lund University, Malmö.
    Bruze, Magnus
    Lund University, Malmö.
    Patch Testing with a Textile Dye Mix in Two Concentrations: A Multicentre Study by the Swedish Contact Dermatitis Research Group2015In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 95, no 4, p. 427-431Article in journal (Refereed)
    Abstract [en]

    Disperse dyes, which are used for colouring synthetic textile fibres, are well-known contact sensitisers. To investigate the outcome of patch-testing with a textile dye mix (TDM) at 7 dermatology clinics in Sweden, a TDM tested at 2 concentrations was included into the baseline series during one year. The mix consisted of Disperse (D) Blue 35, D Yellow 3, D Orange 1 and 3, D Red 1 and 17, all 1.0%, and D Blue 106 and D Blue 124, each 0.3% in the mix 6.6% and 1.0% each in the mix 8.0%. In 2,122 tested patients, contact allergy to the TDM at the concentration 8.0% was found in 2.8% and to the TDM at 6.6% in 2.5% of the patients. The contact allergy to the TDM could explain or contribute to the dermatitis in about 35% of the patients. Conclusion: contact allergy to the TDM is common and inclusion into the Swedish baseline series should be considered.

  • 152. Röhrl, Kari
    et al.
    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.
    Lifestyle factors and hand eczema in a Swedish adolescent population2010In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 62, no 3, p. 170-176Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hand eczema risk factors are potentially associated with lifestyle, and changes in lifestyle may influence the prevalence of this condition.

    OBJECTIVES: To report potential lifestyle risk factors and their association with hand eczema.

    PATIENTS/MATERIALS/METHODS: Cross-sectional questionnaire survey and standard patch test among Swedish upper secondary school children. The participation rate was 81% (6095/7543) for the questionnaire and 59% (4439/7543) for the test.

    RESULTS: Girls reported piercing (84% versus 18%), tattooing (6% versus 3%), smoking (24% versus 16%) and vegetarianism (21% versus 7%) significantly more often than boys. Girls had significantly more hand eczema (7% versus 4%) than boys. Besides female sex (OR 2.0), allergic rhinitis (OR 1.8), flexural eczema (OR 4.5), and positive nickel test (OR 1.7) were significant risk factors in multivariate analysis. Piercing entailed a decreased risk (OR 0.6). Other lifestyle practices had no association with hand eczema. Vegetarian diet and dental braces which potentially increase oral nickel exposure were not associated with hand eczema prevalence in nickel sensitized individuals.

    CONCLUSIONS: The studied lifestyle practices were more prevalent in girls. Smoking, tattooing, and diet were not associated with the occurrence of hand eczema.

  • 153. Sahlgren, Hanna Milerad
    et al.
    Sjöberg, Inga
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    ABC om underlivsklåda2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 9, p. 596-599Article in journal (Other academic)
  • 154.
    Sandström, Monica
    et al.
    National institute of Occupational Health, Department of Occupational Medicine.
    Hansson Mild, Kjell
    National institute of Occupational Health, Department of Occupational Medicine.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    A survey of electric and magnetic-fields among VDT operators in offices1993In: IEEE transactions on electromagnetic compatibility (Print), ISSN 0018-9375, E-ISSN 1558-187X, Vol. 35, no 3, p. 394-397Article in journal (Refereed)
    Abstract [en]

    In this study, the ambient electric and magnetic fields as well as the electromagnetic fields associated with VDT's at 150 offices are measured. The aim of the study is to find out the general level of the various electromagnetic parameters in offices and establish a technical base for a case referent study of skin symptoms among VDT workers. The median value of the 50-Hz background field in the 150 offices is 0.07 muT. Seven of the offices have background levels higher than 0.5 muT, which is high enough to cause distortion of the picture on the screen. The dominating source for electric fields in the ELF range is electric equipment in the office, not the VDT's. The median value of the electric field in the VLF range is 1.5 V/m. The equivalent surface potential is less than 0.5 kV for 63% of the measured VDT's. The computer monitor is a major source for magnetic fields in the offices. The median value of the magnetic field in the ELF range in front of the VDT is 0.21 muT, and in the VLF range 0.03 muT.

  • 155.
    Sandström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Environmental Medicine. National Institute for Occupational Health, Umeå, Sweden.
    Hansson Mild, Kjell
    National Institute of Occupational Health, Umeå, Sweden.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Wall, Stig
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Skin symptoms among VDT workers and electromagnetic-fields: a case-referent study1995In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 5, no 1, p. 29-37Article in journal (Refereed)
    Abstract [en]

    Th is case referent study is a part of the Office illness Project in Northern Sweden. From a questionnaire study among 5986 office workers, 75 VDT workers with self-reported facial skin symptoms and the same number of referents were selected for this study. The environmental electric and magnetic fields in the office as well as electromagnetic fields associated with the VDT at the workplace were measured, The aim of this part of the project was to explore the role of the measured electromagnetic parameters in relation to skin symptoms. For most of the measured parameters there was no difference between cases and referents. However, more cases than referents were found in the highest exposure group for two of the measured parameters. Fm the background electric field in the mom the relative risk in terms of crude odds ratio (OR) was 3.0 (95% CI: 1.2-7.2) for the high exposed group (greater than or equal to 31 V/m) compared with the lowest group (less than or equal to 10 V/m). The same comparison for the magnetic field in the ELF-range (greater than or equal to 0.30 mu T vs less than or equal to 0.145 mu T) in front of the VDT gave an OR of 2.7(95% CI: 1.0-6.9).

  • 156.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    How dermatologists can evaluate systemic psoriasis treatments2009In: Forum for nordic dermato-venereology, ISSN 1402-2915, Vol. 14, no 2, p. 38-40Article in journal (Refereed)
  • 157.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Physical activity and lifestyle improvement in the management of psoriasis2016In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 175, no 3, p. 452-453Article in journal (Refereed)
  • 158.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Pso-Reg: the quality register for systemic psoriasis treatment2004In: Forum for Nordic dermato-venereology, Vol. 9, no 4, p. 94-97Article in journal (Refereed)
  • 159.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    PsoReg: the Swedish registry for systemic psoriasis treatment. The registry's design and objectives.2007In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 214, no 2, p. 112-117Article in journal (Refereed)
  • 160.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Psoriasis therapy in real life: the need for registries2006In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 213, no 4, p. 327-330Article in journal (Refereed)
    Abstract [en]

    The introduction of new therapeutic options for the management of psoriasis is a challenge for the dermatology community, and new tools are needed to face this challenge. This article argues for the establishment of profession-based registries to collect solid, long-term data on the safety and effectiveness of different psoriasis treatment regimens. Managed by health care professionals, registries will be most successful if they enroll patients based on indications for treatment rather than on drugs given. This protects the evaluation process from commercial influences and allows a fair comparison of old- versus new-generation psoriasis treatments. In contrast to the patients in a registry who receive care in the natural clinical setting, subjects in randomized clinical trials (RCTs) are selected according to study criteria and may therefore not reflect the experience of patients in clinical practice. It is possible that particular risks and opportunities in the real patient population may therefore go undetected in RCTs.

    Copyright © 2006 S. Karger AG, Basel

  • 161.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Switching biologicals: switching TNFalpha antagonists in psoriasis treatment2008In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 216, no 4, p. 281-282Article in journal (Refereed)
  • 162.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    What can we learn from 'dropouts' in clinical trials?2018In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 178, no 2, p. 318-319Article in journal (Other academic)
  • 163.
    Shayesteh Afshar, Alexander
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Primary hyperhidrosis: prevalence and impacts for the individual2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Primary hyperhidrosis, excessive sweating, is a condition with unknown prevalence in many parts of the world. The disease debuts in adolescence and it affects men and women in equal proportions. A genetic background exists and the most common localisation on the body for excessive sweating is the axillary region. It is known that primary hyperhidrosis reduces quality of life and interferes with daily activities. Affected individuals often hide their sweating problems and the disease may lead to social withdrawal and isolation. Although botulinum toxin is an effective and available treatment, relatively few persons with primary hyperhidrosis seek medical healthcare and a minority of those are men.

    We investigated the prevalence of primary hyperhidrosis in Sweden and how the disease impairs quality of life, changes in daily activities, signs of depression and anxiety and alcohol consumption before and after treatment with botulinum toxin. The severity of hyperhidrosis according to the affected body sites was also investigated. Further on we explored mens experiences living with primary hyperhidrosis by interviews and content analysis.

    Our results showed that primary hyperhidrosis occurs in 5.5% of the Swedish population. The disease reduces quality of life and affects mainly the psychological health of the individuals. Persons with palmar and axillary hyperhidrosis rated their symptoms more severe and with much higher impact on their quality of life compared to persons suffering from hyperhidrosis elswhere on the body. Individuals with axillary hyperhidrosis more often reported a later debut and signs of peripheral vasoconstrictions were more common in this group compared to individuals with palmar hyperhidrosis. This made us believe that factors other than genetics seem to play a role in triggering axillary hyperhidrosis. Treatment with botulinum toxin A had a significant effect in reducing the symptoms and their interferences on daily life while increasing the overall quality of life. Signs of depression, stress and anxiety were also significantly reduced by treatment. This treatment was safe and no serious side-effects were noted. Qualitative content analysis of interviews with 15 men suffering from primary hyperhidrosis resulted in the theme: To be captured in a filthy body. The experiences of men with excessive sweating were thus interpreted as stigmatising. Stigma has a negative effect on mental health which reinforces our findings in quantitative studies when investigating quality of life. It is our assumption that the symptoms act as a vicious circle reducing quality of life, stigmatising the individual and limiting daily interactions. Addressing hyperhidrosis with information when the disease debuts in young people could reduce the stigma and enable early intervention via healthcare which may have a significant effect on the life of those affected.

  • 164.
    Shayesteh, Alexander
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Primary hyperhidrosis: Implications on symptoms, daily life, health and alcohol consumption when treated with botulinum toxin2016In: Journal of dermatology (Print), ISSN 0385-2407, E-ISSN 1346-8138, Vol. 43, no 8, p. 928-933Article in journal (Refereed)
    Abstract [en]

    Primary hyperhidrosis affects approximately 3% of the population and reduces quality of life in affected persons. Few studies have investigated the symptoms of anxiety, depression and hazardous alcohol consumption among those with hyperhidrosis and the effect of treatment with botulinum toxin. The first aim of this study was to investigate the effect of primary hyperhidrosis on mental and physical health, and alcohol consumption. Our second aim was to study whether and how treatment with botulinum toxin changed these effects. One hundred and fourteen patients answered questionnaires regarding hyperhidrosis and symptoms, including hyperhidrosis disease severity scale (HDSS), visual analog scale (VAS) 10-point scale for hyperhidrosis symptoms, hospital anxiety and depression scale (HADS), alcohol use disorder identification test (AUDIT) and short-form health survey (SF-36) before treatment with botulinum toxin and 2 weeks after. The age of onset of hyperhidrosis was on average 13.4 years and 48% described heredity for hyperhidrosis. Significant improvements were noted in patients with axillary and palmar hyperhidrosis regarding mean HDSS, VAS 10-point scale, HADS, SF-36 and sweat-related health problems 2 weeks after treatment with botulinum toxin. Changes in mean AUDIT for all participants were not significant. Primary hyperhidrosis mainly impairs mental rather than physical aspects of life and also interferes with specific daily activities of the affected individuals. Despite this, our patients did not show signs of anxiety, depression or hazardous alcohol consumption. Treatment with botulinum toxin reduced sweat-related problems and led to significant improvements in HDSS, VAS, HADS and SF-36 in our patients.

  • 165.
    Shayesteh, Alexander
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Experiences of men living with hyperhidrosis: Content analysis of interviews with 15 men suffering from primary hyperhidrosisManuscript (preprint) (Other academic)
    Abstract [en]

    Primary hyperhidrosisreduces quality of life and interferes with daily activities of those affected.Data regarding experiences of men living with this disease is scarce. The aimof this study was to explore men’s experiences of living with primaryhyperhidrosis. Interviews with 15 men were performed at the Department ofDermatology and Venereology, Umeå University Hospital. Thetranscripted data was analysed by qualitative content analysis. The analysisrevealed one theme: To be captured in a filthy body which was based on five categories and 12 sub-categories. In men with hyperhidrosis there is a daily struggle to hide or to manage the excessive sweatingand the disease was associated with being unclean or filthy. Insufficientunderstanding from others and reminders of the symptoms can be stressful,contribute to a lower self-esteem and make the individual resign fore theillness. The disease is stigmatising and has a negative effect on daily life. Menwith hyperhidrosis also experienced a lack of understanding when they discussedthe sweating problems with family members. Our results reinforce publishedquantitative studies showing that the disease has an impact on the mentalhealth of those affected. It is unknown if women are approached in a differentway by family or society in case of disclosure. Further research in women couldreveal and possibly explain the disparity that exists between the genders in seekinghealthcare. Meanwhile public education and informing children at school, at anage when the disease debuts could decrease stigmatisation and increase thewillingness to seek professional help.

  • 166.
    Shayesteh, Alexander
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Brulin, Christine
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Prevalence and Characteristics of Hyperhidrosis in Sweden: A Cross-Sectional Study in the General Population2016In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 232, no 5, p. 586-591Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Hyperhidrosis is defined as excessive sweating which can be primary or secondary. Data about the prevalence of primary hyperhidrosis are scarce for northern Europe.

    OBJECTIVE: Our aim was to investigate the prevalence of hyperhidrosis focusing on its primary form and describe the quality of life impairments for the affected individuals.

    METHODS: Five thousand random individuals aged 18-60 years in Sweden were investigated. The individuals' addresses were obtained from Statens personadressregister, SPAR, which includes all persons who are registered as resident in Sweden. A validated questionnaire regarding hyperhidrosis including the Hyperhidrosis Disease Severity Scale (HDSS) and 36-item Short Form (SF-36) health survey was sent to each individual. The participants were asked to return the coded questionnaire within 1 week.

    RESULTS: A total of 1,353 individuals (564 male, 747 female and 42 with unspecified gender) with a mean age of 43.1 ± 11.2 years responded. The prevalence of primary hyperhidrosis was 5.5%, and severe primary hyperhidrosis (HDSS 3-4 points) occurred in 1.4%. Secondary hyperhidrosis was observed in 14.8% of the participants. Our SF-36 results showed that secondary hyperhidrosis causes a significant (p < 0.001) impairment of both mental and physical abilities while primary hyperhidrosis impairs primarily the mental health (p < 0.001).

    CONCLUSION: Hyperhidrosis affects individuals in adolescence as a focal form while occurring as a generalised form with increasing age. Further, the prevalence of primary hyperhidrosis described in our study is comparable to other studies from the western hemisphere. While secondary, generalised hyperhidrosis impairs both physical and mental aspects of life, primary hyperhidrosis, with the exception of severe cases, mainly affects the mental health.

  • 167.
    Shayesteh, Alexander
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hyperhidrosis – Sweating Sites Matter: Quality of Life in Primary Hyperhidrosis according to the Sweating Sites Measured by SF-362017In: Dermatology, ISSN 1018-8665, E-ISSN 1421-9832, Vol. 233, no 6, p. 441-445Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Primary hyperhidrosis has negative impacts on quality of life. The aim of this study was to investigate whether the impacts of primary hyperhidrosis on quality of life are different depending on the localisation of the sweating.

    METHOD: We compiled background data, Hyperhidrosis Disease Severity Scale (HDSS), and Short-Form Health Survey (SF-36) post hoc results from 2 previous studies. Cases who described only 1 site as their most problematic area of sweating were included (n = 160/188) while individuals with multifocal primary sites of hyperhidrosis were excluded (n = 28/188).

    RESULTS: Individuals included were 11-62 years old with a mean age of 30.2 ± 10.4 years, and axillary hyperhidrosis (65.6%) was the most common type of hyperhidrosis. Comorbidities were more common when hyperhidrosis was reported in other than the axillary, palmar, and plantar regions. Excluding comorbidities showed the lowest SF-36 mental component summary scores for axillary (41.6 ± 11.6), palmar (40.0 ± 9.4), and plantar hyperhidrosis (41.1 ± 13.7). The HDSS showed the highest proportion of severe cases in axillary (60.6%) and palmar (51.5%) hyperhidrosis (p < 0.01) while mild cases were more often observed in plantar (60%), facial (83.3%), and other sites (85.7%) in primary hyperhidrosis (p < 0.01).

    CONCLUSION: Our results indicate that impairments in quality of life can be different depending on the manifestation of primary hyperhidrosis on the body. This can have an influence on how patients with hyperhidrosis could be prioritised in health care. Subgroup samples affected by facial hyperhidrosis and other sites of primary hyperhidrosis were however small, and more research is required to verify our findings.

  • 168.
    Shayesteh, Alexander
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nylander, Elisabet
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Botulinumtoxin hjälper mot primär fokal hyperhidros: bra effekter - få biverkningar2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 47, p. 2433-2435Article in journal (Refereed)
    Abstract [en]

    En övergripande sammanställning av större randomiserade kontrollerade studier med avseende på botulinumtoxinets effekt på hyperhidros och livskvalitet saknas. Vår genomgång av  litteraturen visar att det finns god evidens för behandling av fokal (axillär) hyperhidros med botulinumtoxin A. Livskvaliteten hos de drabbade individerna ökar efter behandlingen. Ett observandum är att samtliga studier som uppfyllde våra fastställda kriterier sponsrats av läkemedelstillverkaren och att en författare återfinns i samtliga tre granskade studier.

  • 169.
    Stecksén-Blicks, Christina
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Falk Kieri, Catharina
    Umeå University, Faculty of Medicine, Department of Odontology.
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hägg, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hair shaft structures in EDAR induced ectodermal dysplasia2015In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 16, article id 79Article in journal (Refereed)
    Abstract [en]

    Background: Mutations in the EDAR-gene cause hypohidrotic ectodermal dysplasia with defects in ectodermal appendage development including teeth, skin, exocrine glands and hair. Hair defects are sparsely described in genetically defined samples. The aim of this study was to investigate hair structures in three families with a heterozygous c.1072C > T mutation in the EDAR gene using scanning electron microscopy.

    Methods: Three Swedish families, where some members had a known c.1072C > T mutation in the EDAR gene with an autosomal dominant inheritance (AD) were included (n = 37) of which 17 carried the mutation and 20 did not. Thirty-two age and gender matched not related individuals served as a reference group. Confirmation of the c.1072C > T mutation in the EDAR gene was performed by genomic sequencing. Hairs were subjected to blinded scanning electron microscopy examination and hair defects were categorized and scored.

    Results: The minimum and maximum diameters of hairs were lower in the mutation group compared to the reference group. Subjects in the mutation group had to greater extent deep deformations in hair shafts compared to the non-mutation group and the reference group (p < 0.001).

    Conclusions: Individuals with a c.1072C > T mutation in the EDAR-gene displayed more hair shaft deformations confirming the role of EDAR for human hair follicle development and postnatal hair follicle cycling.

  • 170.
    Stefansson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Brattsand, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Ny, Annelii
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Glas, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Egelrud, Torbjörn
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Kallikrein-related peptidase 14 may be a major contributor to trypsin-like proteolytic activity in human stratum corneum.2006In: Biological chemistry (Print), ISSN 1431-6730, E-ISSN 1437-4315, Vol. 387, no 6, p. 761-768Article in journal (Refereed)
  • 171.
    Stefansson, Kristina
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Brattsand, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Roosterman, Dirk
    Kempkes, Cordula
    Bocheva, Georgeta
    Steinhoff, Martin
    Egelrud, Torbjörn
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Activation of proteinase-activated receptor-2 by human kallikrein-related peptidases2008In: Journal of Investigative Dermatology, ISSN 0022-202X, E-ISSN 1523-1747, Vol. 128, no 1, p. 18-25Article in journal (Refereed)
    Abstract [en]

    Proteinase-activated receptor-2 (PAR2) is a seven transmembrane spanning, G-protein-coupled receptor, present on the membrane of many cell types including keratinocytes. In skin, PAR2 is suggested to play a regulatory role during inflammation, epidermal barrier function, and pruritus. PAR2 is activated by trypsin-like proteases by a unique mechanism where cleavage of the receptor leads to the release of a small peptide, which activates the receptor as a tethered ligand. The endogenous activators of PAR2 on keratinocytes have not been identified as of yet. Potential candidates are kallikrein-related peptidases (KLKs) expressed by epidermal cells. Therefore, the ability of four human skin-derived KLKs was examined with regard to their capacity to activate PAR2 in vitro. PAR2 cleavage was followed by immunofluorescence analysis and functional activation by measurements of changes in intracellular calcium levels. We found that KLK5 and KLK14, but neither KLK7 nor KLK8, induced PAR2 signalling. We conclude that certain, but not all, epidermal KLKs are capable of activating PAR2. We could also show the coexpression of KLK14 and PAR2 receptor in inflammatory skin disorders. These in vitro results suggest that KLKs may take part in PAR2 activation in the epidermis and thereby in PAR2-mediated inflammatory responses, including epidermal barrier repair and pruritus. The role of KLKs in PAR2 activation in vivo remains to be elucidated.

  • 172.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. The Department of Occupational Dermatology, National Institute of Occupational Health, Solna, Sweden.
    Office illness: the worker, the work and the workplace1994Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The work started with the clinical observations in patients working in buildings with indoor air problems. Signs of seborrhoeic dermatitis, erythematous facial skin conditions and itching conditions on the trunk were noted. Another point of departure was the attribution of facial skin symptoms to VDT work by patients. A questionnaire-based prevalence study of symptoms compatible with the Sick Building Syndrome (SBS) and facial skin symptoms in 4,943 office workers formed the basis for two case referent studies, one focusing on SBS, the other on facial skin symptoms in VDT workers.

    The prevalence of SBS was three times higher in women than men. The prevalence was higher in young persons and in atopies. Facial skin symptoms showed the same pattern. Psychosocial work load, paper and VDT work were also risk indicators for SBS and for skin symptoms. The symptom excess in women was analyzed with reference to differences in biological or acquired risks and different illness and reporting behaviour. In spite of inequalities in social conditions at home and at work and differences in physical working conditions, these differences could only explain a small part of the gender difference. The odds ratio for SBS in women was lowered from 3.4 in the crude analysis to 3.0 in the multivariate analysis. Effect modification was in most cases stronger in men and the clinical validation of the questionnaire refuted the hypothesis that women over-report symptoms. The results indicate that the gender difference in symptom prevalence is part of a general pattem common to psychosomatic illnesses.

    In the case referent study of SBS, atopy, psychosocial work load, buildings built or renovated after 1977, the presence of photocopiers and a low outdoor air flow rate were risk indicators. The association between air quality and the occurrence of SBS symptoms was demonstrated by a flow-response relation between the outdoor air flow rate and SBS symptoms. In the case referent study of skin symptoms in VDT work, psychosocial work load, electric background fields, the presence of fluorescent lights with plastic shields and low cleaning frequency were risk indicators. The clinical findings in the two case groups and their referents supported the applied relevance of the studies. Compared with the referents, the SBS cases had more work- related facial erythema, seborriioeic dermatitis and general pruritus, while skin symptom cases, had more work-related facial erythema than their referents.

    The results show that SBS symptoms and facial skin symptoms have a multifactorial background with constitutional, psychosocial and physical risk indicators. As the indoor air quality is a determinant of SBS symptoms, and the building itself is but one source of indoor air pollution, it is suggested that the name Sick Building Syndrome (SBS) be replaced by Indoor Air Syndrome (IAS).

  • 173.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Sick Building Syndrome from a Medical Perspective-Symptoms and Signs2011In: Sick Building Syndrome: in Public Buildings and Workplaces / [ed] Sabah A. Abdul-Wahab, Berlin: Springer Berlin/Heidelberg, 2011, p. 453-462Chapter in book (Other academic)
    Abstract [en]

    Sick Building Syndrome (SBS) has been described and even defined as a condition that lacks clinical signs and that abates immediately in those affected after exposure ceases. There is, however, little scientific support for this standpoint. Fatigue, plus symptoms affecting the eyes, nose and skin are frequently reported by those using buildings with indoor air quality problems. Clinical studies have demonstrated a convincing association between reported symptoms and observed signs, especially those associated with the eyes, but there are also clinical signs associated with skin and nasal symptoms. The diagnostic value of laboratory investigations should be further evaluated. Contrary to assertions that SBS symptoms abate shortly after exposure ceases, there are a number of studies showing that a proportion of those exposed to unsatisfactory indoor air quality develop long-term symptoms. There is a need for both an improved definition of the syndrome and further studies of its symptoms and signs.

  • 174.
    Stenberg, Berndt
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Bruze, Magnus
    Zimerson, Erik
    Is p-tert-butylphenol-formaldehyde resin (PTBP-FR) in TRUE Test® (Mekos test) sensitizing the tested patients?2015In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 73, no 6, p. 350-357Article in journal (Refereed)
    Abstract [en]

    Background: In a population study using TRUE Test®, we noted late reactions to p-tert-butylphenol-formaldehyde resin (PTBP-FR) in 0.5% of subjects tested.

    Objectives: In order to explore possible test sensitization, differences in the contents of sensitizers within PTBP-FR in test preparations for TRUE Test® and Finn Chambers® were analysed. Subjects allergic to PTBP-FR and subjects with late reactions to PTBP-FR were retested in order to explore whether these groups reacted to different PTBP-FR sensitizers.

    Patients/materials/methods: Four individuals with late reactions and 5 subjects with established allergy to PTBP-FR were retested with defined PTBP-FR sensitizers. PTBP-FR constituents in patches from TRUE Test® were analysed with high-performance liquid chromatography. Previously analysed samples of PTBP-FR constituents served as a reference.

    Results: The pattern of reaction to PTBP-FR sensitizers was similar in both groups. Subjects with suspected sensitization had somewhat stronger reactions than controls. The concentrations of monomers, dimers and trimers were generally higher in the TRUE Test® resin than in reference substances.

    Conclusions: Retesting did not add information regarding causes of possible sensitization. Analysis showed that the resin used in TRUE Test® has a lower degree of polymerization or condensation, which may enhance its sensitizing properties. A follow-up of late reactions to PTBP-FR in TRUE Test® should be carried out.

  • 175.
    Stenberg, Berndt
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Lindberg, Magnus
    Meding, Birgitta
    Svensson, Ake
    Is the question 'Have you had childhood eczema?' useful for assessing childhood atopic eczema in adult population surveys?2006In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Contact Dermatitis, Vol. 54, no 6, p. 334-337Article in journal (Refereed)
  • 176.
    Stenberg, Berndt
    et al.
    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.
    Meding, Birgitta
    Svensson, Ake
    Dermatology in public health: a model for surveillance of common skin diseases.2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 4, p. 368-374Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim was to establish a baseline prevalence of skin conditions of public health importance in the general population and taking the validity of the questions into account. Our model is intended for future surveillance of skin conditions. METHODS: The suggested questions have for the first time been used in Swedish population surveys. A random sample was taken from the general population aged 16 to 84 years of the participating areas. RESULTS: During the past 12 months, hand eczema was reported by 9.4%, childhood eczema by 15.7% and nickel allergy by 13.7% of the population. Hand and childhood eczema questions have previously been validated. Taking the validity into account, the actual population prevalence of hand eczema (11.7%) is underestimated, and the prevalence of atopic childhood eczema (10.0%) is overestimated based on the results of the questionnaire. In addition to presenting prevalence, population survey results can be used for risk analyses. A 10-fold risk of hand eczema in individuals with childhood eczema and self-reported nickel sensitivity is shown in our study. CONCLUSIONS: Questionnaires can be used for epidemiologic surveillance so long as the questions are validated and that the validity is taken into account when estimating the occurrence of the conditions. Public health surveys such as this one lay the basis for future epidemiological surveillance of skin conditions that can be subject to interventions. We propose that these, or similar, questions should be used regularly in population surveys and supplemented by questions on skin exposure.

  • 177. Sunesson, A-L
    et al.
    Rosén, I
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Sjöström, Michael
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Multivariate evaluation of VOCs in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not.2006In: Indoor Air, ISSN 0905-6947, E-ISSN 1600-0668, Vol. 16, no 5, p. 383-391Article in journal (Refereed)
    Abstract [en]

    Volatile organic compounds (VOCs) were sampled in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not. In total, nine persons and 34 buildings were included in the study. The obtained VOC data was evaluated using multivariate methods, to investigate possible systematic differences in air quality of 'problem' and 'non-problem' buildings. All individual compounds were included as variables in a multivariate partial least squares (PLS) data analysis. 'Problem' and 'non-problem' buildings separated into two distinct groups, showing that air samples of the two groups of building were chemically different. PRACTICAL IMPLICATIONS: The study showed that there was an identifiable systematic difference in the collected VOC data between buildings causing and not causing problems for people with non-specific building-related symptoms (also called sick building syndrome, SBS). This is an important indication that even such volatile organic compounds that can be sampled by commonly used adsorbents are of importance for the presence of such symptoms. By coordination of procedures for sampling and analysis of VOCs in buildings between laboratories, to get large datasets and more general models, the method can become a useful diagnostic measure in evaluating indoor air and to identify chemical compounds and sources that contribute to SBS problems.

  • 178.
    Thid, Kristoffer
    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, Family Medicine.
    Vilka patienter vårdas var?: En retrospektiv studie av skillnader i ålder, kön, vårdtid och diagnos mellan sjukhus och sjukstuga i södra Lappland2015Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 179.
    Tillberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Berglund, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Technology/Dental Materials Science.
    Mårell, Lena
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bergdahl, Jan
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Eriksson, Nils
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Linden, Gerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    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.
    Widman, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Changes in health over time in patients with symptoms allegedly caused by dental restorative materials2005In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 33, no 6, p. 427-437Article in journal (Refereed)
    Abstract [en]

    Abstract –  Objectives:  In Sweden, many patients with symptoms allegedly caused by their dental materials have exchanged their restorations, but the effects of the exchange have been insufficiently investigated. Therefore, the aim of the study was to describe the change in health over time for these patients and the hypothesis was that the patients could be divided based on their symptoms and that the ability to recover differs between these groups. Furthermore, we also examined if other factors such as replacement of dental restorative materials and follow-up time had any impact on the perceived health status.

    Methods:  A questionnaire was sent to 614 patients who had been referred to the School of Dentistry, Umeå, Sweden, with symptoms allegedly caused by dental restorative materials. The response rate was 55%.

    Results:  The risk of having any further complaints was higher for patients with complex symptoms (P = 0.03) and these patients had exchanged their restorations to a significantly larger extent than the others (P = 0.03). The remaining complaints was more frequent among men (P = 0.02). Exchange of dental restorative materials had no significant impact on the ability to recover completely. However, the patients who had exchanged their restorations completely perceived a significantly larger alleviation of their symptoms than the others (P < 0.01), although the frequency of most of the symptoms had increased.

    Conclusions:  Patients with complex symptoms had a more unfavorable long-term prognosis concerning persistent complaints than those with localized symptoms only. Furthermore, the results indicate that the patients might experience health improvements after removal of their dental restorative materials. The reason for this improvement, however, is unclear. Further analyses regarding other possible explanations than the ‘odontological/medical’ are needed.

  • 180.
    Tillberg, Anders
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Berglund, Anders
    Umeå University, Faculty of Medicine, Department of Odontology, Dental Technology/Dental Materials Science.
    Reactions to resin-based dental materials in patients-type, time to onset, duration, and consequence of the reaction.2009In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 61, no 6, p. 313-319Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the present study was to determine the types of side-effects occurring and for how long they lasted in a group of patients with side-effects assessed to be caused by resin-based materials. METHODS: A total of 618 reports were received by the Swedish National Register of Side-Effects to Dental Materials, among which 36 were on patients with reactions assessed to be caused by resin-based restorative materials. The group examined consisted of 25 women and 11 men, with a mean age of 47.8 +/- 15.6 years. A follow-up was done through a structured telephone interview. RESULTS: The majority of symptoms were intra-oral or a combination of intra-oral and extra-oral symptoms that appeared within the first 24 hr after treatment. The most common adverse effects reported were skin problems, oral ulcers, and burning mouth. Within less than a week, the reactions had disappeared in 50% of the patients. CONCLUSION: Immediate reactions to resin-based materials were more prevalent than delayed allergic reactions, and the mechanism of the immediate reactions is probably non-allergic in most cases. There is a need for developing provocation tests to verify the association between the reaction and the material, and also to identify the offending component.

  • 181. Tishelman, Carol
    et al.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Rasmussen, Birgit H.
    Umeå University.
    Carlander, Ida
    Space and Place for End-of-Life Care: A Photo-Elicitation Study2014In: Journal of Palliative Care, ISSN 0825-8597, Vol. 30, no 3, p. 220-220Article in journal (Refereed)
  • 182.
    Tufvesson Stiller, Helena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology. Regional Cancer Center South East Sweden, Linköping, Sweden.
    Mikiver, R
    Uppugunduri, S
    Lindholm, C
    Brahme, E M
    Schmitt-Egenolf, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Health Related Quality of Life in Melanoma Patients: characterization of a Swedish cohort2019In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133Article in journal (Refereed)
    Abstract [en]

    Only few studies that have investigated the Health-Related Quality of Life (HR-QoL) in melanoma patients 1-4 , reviewed in Chernyshov et al.5 . This is to the best of our knowledge the first population-based study investigating HR-QoL in proximity to the time the patient has received melanoma diagnosis. A cross-sectional survey, approved by the ethics committee in Umeå, employing the Swedish European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ-C30v.3.0) was performed.

  • 183.
    Tärnvik, Arne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Suitability of the multiple case method when applied on dermatology and infectious diseases at the clinical stage of medical education2010In: The Internet Journal of Medical Education, ISSN 2155-6725, Vol. 1, no 1Article in journal (Refereed)
    Abstract [en]

    Background: By mimicking situations relevant to future work conditions, the multiple case method aims to trigger student interest in a subject and to induce familiarity with subject knowledge. Objectives: Our main aim was to assess the suitability of the multiple case method when applied at the clinical stage of medical education. Moreover, we wished to define the maximum group size with which students felt comfortable. Methods: Between 2001 and 2007, during 24 runs of a course in dermatology and infectious diseases, student assessments of the multiple case method were rated. Between 1993 and 2007, 1323 student evaluations were scrutinized for comments on group size. Results: On a 1-5 scale (1= value poor, 5= value high), student ratings of the multiple case method remained consistent at 4.4 to 4.7. When the number of participants in the discussion groups was 18 - 25, no comments on group size occurred. When size increased to 26 - 33 participants, 4/605 (0.7%) commented spontaneously that they would prefer discussing in a smaller group. At a size of 34 – 37, 20/396 (5.1%) expressed such a concern.

  • 184.
    Uttjek, Margaretha
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Psoriasis care consumption and consequences of having psoriasis in everyday life2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis concerns a research project about psoriasis care and conse¬quences of psoriasis in the county of Västerbotten in Northern Sweden. The overall aim of the thesis is to contribute to improvement of psoriasis care through increased knowledge of the use and accessibility of psoriasis care, and knowledge of impact of psoriasis on patients’ daily lives by describing and interpreting: (i) accessibility and use of psoriasis care, (ii) consequences of having psoriasis in everyday life, and (iii) dilemmas in psoriasis care and visions of future care among professionals, politicians and administrators.

    The theoretical framework in the psoriasis project was based on previous research, theories and concepts about priority setting, stigma, coping and qual¬ity of life. Parts of the framework were basis of the project plan and other parts were included in order to analyse the findings. Two different methodological approaches were used as complement to each other. The project started with a questionnaire to all known persons with psoriasis in Västerbotten with ques¬tions about socio-economic factors, psoriasis symptoms, psoriasis care, and quality of life. These formed the basis for two studies. The first focused on quality of life, and the other on gender differences in psoriasis care. Qualita¬tive research interviews were made with persons with psoriasis, and with ad¬ministrators, politicians and professionals. The interviews formed the basis for two studies focusing on consequences of psoriasis, and priorities and visions in psoriasis care, respectively. Findings from the studies are reported in four papers.

    Accessibility of psoriasis care influenced the use among persons with pso¬riasis. Use was also influenced by age, income, joint symptoms and quality of life. Men used psoriasis care more often than women. Both genders expected professional care and amelioration, while more women valued polite treat¬ment. Expectations were fulfilled apart from amelioration. Among decision makers, accessibility and issues on organisation and ethics involved priority dilemmas. The persons with psoriasis stated that visibility of both skin psoria¬sis and joint changes, as well as being stigmatised, was the worst with living with psoriasis. The visibility and stigmatisation were most difficult in younger ages. Some of those with both rashes and joint changes thus felt stigmatised in a twofold way. In order to deal with these difficulties, commonly used coping strategies were routinisation of both treatment and of adjustment to the stigma¬tising process, a strategy which could not be found in literature, and accep¬tance. These strategies developed with age. Those with large disease extent and joint symptoms run the highest risk of impaired health-related quality of life. Most of the interviewed participants, took power over their lives and by using coping strategies created an acceptable personal quality of life for them¬selves. Still they could not find anything positive with having psoriasis.

    In specialised care as well as local health care, special attention should be paid to gender differences and distance to treatment facilities, and handling of possible stigmatisation in patient care. This thesis suggests that the coping theories should be complemented with routinisation as a coping strategy for psoriasis patients. Also, more research on the usefulness of the letter of referral and its consequence on equality and fairness are suggested.

  • 185.
    Uttjek, Margaretha
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Dufåker, Mona
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Determinants of quality of life in a psoriasis population in northern Sweden2004In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 84, no 1, p. 37-43Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess possible determinants of quality of life in psoriasis patients in northern Sweden, and to analyse the association between these determinants and quality of life. A questionnaire was mailed to 1,707 subjects, resulting in a response rate of 74%. The study is therefore based on 1,060 subjects, since 195 denied having psoriasis. Quality of life was measured using a version of the Dermatology Life Quality Index. The extent of the disease was estimated using the patients' sketches. The association between determinants and quality of life was calculated in a risk analysis using logistic regression. Large disease extent and joint symptoms were the strongest indicators for impaired quality of life. Other indicators were withdrawal from medical treatment due to distance to treatment facilities, which strongly influenced the quality of life and choice of treatment.

  • 186.
    Uttjek, Margaretha
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Dufåker, Mona
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Psoriasis care consumption and expectations from a gender perspective in a psoriasis population in northern Sweden2005In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 85, no 6, p. 503-508Article in journal (Refereed)
    Abstract [en]

    The aim was to analyse use of psoriasis care and expectations from a gender perspective in a psoriasis population. The study is based on questionnaire data from 1060 subjects. The response rate was 74%. The relation between care consumption and studied variables was measured using regression and chi-square analysis. Care consumption was strongly influenced by age, quality of life, income and joint symptoms. Men visited a dermatologist more often, while women visited a general practitioner and treated themselves topically more frequently. Important expectations among both women and men concerned the receiving of professional care and amelioration, while more women wanted to be treated politely. Expectations were fulfilled, except those regarding amelioration, especially among men. Awareness of gender differences is important among professionals. In order to decrease such differences decision-makers should provide for a maintained specialized care as well as a local health care system of high standard.

  • 187.
    Uttjek, Margaretha
    et al.
    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.
    Dufåker, Mona
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Priority dilemmas in psoriasis care and visions of a future care in a group of administrators, politicians and professionals in northern Sweden.2008In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 87, no 2, p. 203-216Article in journal (Refereed)
    Abstract [en]

    During the 1990s priority discussions were actualized in Sweden due to increased demands on health care and limited resources. In the county of Västerbotten in northern Sweden, with large rural areas, the decision makers faced special challenges due to distances and cost. Despite discussions striving for fairness in priorities, decision makers are still dealing with limited resources and difficult priority decisions regarding different diseases and treatments.

    In this study we aimed at describing views on priorities in public psoriasis care and visions of a future care among politicians, administrators and professionals in the county of Västerbottten in northern Sweden. Qualitative research interviews were performed with 23 key-persons. The findings revealed priority dilemmas about issues on organization, accessibility and ethics. Visions of a future care appeared as ambitions of a more effective care with good accessibility, continued research, information and a holistic approach in priorities.

    We conclude that dilemmas revealed in this study were a reflection of a gap between intentions and practice. In efforts to reduce these dilemmas we suggest methods with fairness in economic planning and priority setting, with concrete, official statements about the dominating views on which the priorities are based, and public information about these statements.

  • 188.
    Uttjek, Margaretha
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Nygren, Lennart
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Dermatology and Venerology.
    Dufåker, Mona
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Marked by visibility of psoriasis in everyday life.2007In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 17, no 3, p. 364-372Article in journal (Refereed)
    Abstract [en]

    In this study, the authors aimed at a sociological approach to the individual’s everyday life with psoriasis and to this end conducted qualitative interviews with 18 persons from a county in northern Sweden. The most difficult aspects of living with psoriasis were being marked by the visibility of psoriasis, especially in the younger ages, and the visibility of joint changes. Therefore, those with both rashes and joint changes felt marked and discredited in a twofold way. Commonly used coping strategies were routinization of both the treatment and the adjustment to the marking process, and acceptance, and these strategies developed with age. Most participants experienced a good quality of life but still could find nothing positive about psoriasis. The authors suggest efforts toward increased awareness among health care professionals of the marking process and future qualitative studies about experiences of psoriasis during adolescence.

  • 189. van Schaarenburg, R. A.
    et al.
    Schejbel, L.
    Truedsson, L.
    Topaloglu, R.
    Al-Mayouf, S. M.
    Riordan, A.
    Simon, A.
    Kallel-Sellami, M.
    Arkwright, P. D.
    Ahlin, A.
    Hagelberg, S.
    Nielsen, S.
    Shayesteh, Alexander
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Morales, A.
    Tam, S.
    Genel, F.
    Berg, S.
    van den Berg, J. M.
    Kuijpers, T. W.
    Olsson, R.
    Huizinga, T. W. J.
    Lankester, A. C.
    Trouw, L. A.
    C1q deficient individuals have a wide variety of clinical presentation, quality of life and life expectancy2014In: Molecular Immunology, ISSN 0161-5890, E-ISSN 1872-9142, Vol. 61, no 2, p. 260-260Article in journal (Other academic)
  • 190. van Schaarenburg, Rosanne A.
    et al.
    Schejbel, Lone
    Truedsson, Lennart
    Topaloglu, Rezan
    Al-Mayouf, Sulaiman M.
    Riordan, Andrew
    Simon, Anna
    Kallel-Sellami, Maryam
    Arkwright, Peter D.
    Ahlin, Anders
    Hagelberg, Stefan
    Nielsen, Susan
    Shayesteh, Alexander
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Morales, Adelaida
    Tam, Schuman
    Genel, Ferah
    Berg, Stefan
    Ketel, Arnoldus G.
    van den Berg, J. Merlijn
    Kuijpers, Taco W.
    Olsson, Richard F.
    Huizinga, Tom W. J.
    Lankester, Arjan C.
    Trouw, Leendert A.
    Marked variability in clinical presentation and outcome of patients with C1q immunodeficiency2015In: Journal of Autoimmunity, ISSN 0896-8411, E-ISSN 1095-9157, Vol. 62, p. 39-44Article in journal (Refereed)
    Abstract [en]

    Objective: Globally approximately 60 cases of C1q deficiency have been described with a high prevalence of Systemic Lupus Erythematosus (SLE). So far treatment has been guided by the clinical presentation rather than the underlying C1q deficiency. Recently, it was shown that C1q production can be restored by allogeneic hematopoietic stem cell transplantation. Current literature lacks information on disease progression and quality of life of C1q deficient persons which is of major importance to guide clinicians taking care of patients with this rare disease.

    Methods: We performed an international survey, of clinicians treating C1q deficient patients. A high response rate of >70% of the contacted clinicians yielded information on 45 patients with C1q deficiency of which 25 are published.

    Results: Follow-up data of 45 patients from 31 families was obtained for a median of 11 years after diagnosis. Of these patients 36 (80%) suffer from SLE, of which 16 suffer from SLE and infections, 5 (11%) suffer from infections only and 4 (9%) have no symptoms. In total 9 (20%) of the C1q deficient individuals had died. All except for one died before the age of 20 years. Estimated survival times suggest 20% case-fatality before the age of 20, and at least 50% of patients are expected to reach their middle ages.

    Conclusion: Here we report the largest phenotypic data set on C1q deficiency to date, revealing high variance; with high mortality but also a subset of patients with an excellent prognosis. Management of C1q deficiency requires a personalized approach.

  • 191.
    Wennerstrand, Lena M
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Lind, Lisbet K
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Hofer, Per-Åke
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Lundström, Anita
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Homozygous palmoplantar keratoderma type bothnia improved by erythromycin: a case report2004In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 84, no 5, p. 405-406Article in journal (Other academic)
  • 192. Zhao, Linshu
    et al.
    Vahlquist, Anders
    Virtanen, Marie
    Wennerstrand, Lena
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Lind, Lisbet K.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Lundström, Anita
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Hellström Pigg, Maritta
    Reply to Nellen et al's Comment on the Classification of Clinical/genetic Variants of Mal de Meleda2015In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 95, no 8, p. 1034-1035Article in journal (Refereed)
  • 193. Zhao, Linshu
    et al.
    Vahlquist, Anders
    Virtanen, Marie
    Wennerstrand, Lena
    Lind, Lisbet K.
    Lundström, Anita
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Pigg, Maritta Hellström
    Palmoplantar Keratoderma of the Gamborg-Nielsen Type is Caused by Mutations in the SLURP1 Gene and Represents a Variant of Mal de Meleda2014In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 94, no 6, p. 707-710Article in journal (Refereed)
    Abstract [en]

    Palmoplantar keratoderma of the Gamborg-Nielsen type (PPK-GN) is a rare autosomal recessive skin disorder described in patients from Sweden. Mal de Meleda (MDM) is also a rare autosomal recessive inherited PPK first reported in 5 families from the island of Meleda. The 2 conditions phenotypically overlap and are characterised by palmoplantar erythematous hyperkeratotic plaques. The genetic background giving rise to PPK-GN has hitherto been unknown, whereas MDM is known to be caused by mutations in the gene encoding secreted Ly-6/uPAR-related protein 1, SLURP-1. In the present study we scrutinised individuals affected by PPK-GN for mutations in the SLURP1 gene and identified 2 different mutations. Fourteen Swedish patients were homozygous for a previously described mutation, c.43T>C, while one individual was a compound heterozygote with one copy of a novel mutation, c.280T>A, in addition to one copy of the c.43T>C mutation. Hereby we confirm that PPK-GN is an allelic variant of MDM.

1234 151 - 193 of 193
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