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  • 151. Agmon-Levin, Nancy
    et al.
    Damoiseaux, Jan
    Kallenberg, Cees
    Sack, Ulrich
    Witte, Torsten
    Herold, Manfred
    Bossuyt, Xavier
    Musset, Lucille
    Cervera, Ricard
    Plaza-Lopez, Aresio
    Dias, Carlos
    Sousa, Maria Jose
    Radice, Antonella
    Eriksson, Catharina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Klinisk immunologi.
    Hultgren, Olof
    Viander, Markku
    Khamashta, Munther
    Regenass, Stephan
    Coelho Andrade, Luis Eduardo
    Wiik, Allan
    Tincani, Angela
    Ronnelid, Johan
    Bloch, Donald B.
    Fritzler, Marvin J.
    Chan, Edward K. L.
    Garcia-De la Torre, I.
    Konstantinov, Konstantin N.
    Lahita, Robert
    Wilson, Merlin
    Vainio, Olli
    Fabien, Nicole
    Sinico, Renato Alberto
    Meroni, Pierluigi
    Shoenfeld, Yehuda
    International recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies2014Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, nr 1, s. 17-23Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Anti-nuclear antibodies (ANA) are fundamental for the diagnosis of autoimmune diseases, and have been determined by indirect immunofluorescence assay (IIFA) for decades. As the demand for ANA testing increased, alternative techniques were developed challenging the classic IIFA. These alternative platforms differ in their antigen profiles, sensitivity and specificity, raising uncertainties regarding standardisation and interpretation of incongruent results. Therefore, an international group of experts has created recommendations for ANA testing by different methods. Two groups of experts participated in this initiative. The European autoimmunity standardization initiative representing 15 European countries and the International Union of Immunologic Societies/World Health Organization/Arthritis Foundation/Centers for Disease Control and Prevention autoantibody standardising committee. A three-step process followed by a Delphi exercise with closed voting was applied. Twenty-five recommendations for determining ANA (1-13), anti-double stranded DNA antibodies (14-18), specific antibodies (19-23) and validation of methods (24-25) were created. Significant differences between experts were observed regarding recommendations 24-25 (p<0.03). Here, we formulated recommendations for the assessment and interpretation of ANA and associated antibodies. Notably, the roles of IIFA as a reference method, and the importance of defining nuclear and cytoplasmic staining, were emphasised, while the need to incorporate alternative automated methods was acknowledged. Various approaches to overcome discrepancies between methods were suggested of which an improved bench-to-bedside communication is of the utmost importance. These recommendations are based on current knowledge and can enable harmonisation of local algorithms for testing and evaluation of ANA and related autoantibodies. Last but not least, new more appropriate terminologies have been suggested.

  • 152.
    Agnvall, Ahlbin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Chronic exertional compartment syndrome in patients with diabetes mellitus type 1 - Outcome after surgery in 78 patients2017Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 153. Agogo, George O.
    et al.
    van der Voet, Hilko
    van 't Veer, Pieter
    Ferrari, Pietro
    Muller, David C.
    Sanchez-Cantalejo, Emilio
    Bamia, Christina
    Braaten, Tonje
    Knuppel, Sven
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    van Eeuwijk, Fred A.
    Boshuizen, Hendriek C.
    A method for sensitivity analysis to assess the effects of measurement error in multiple exposure variables using external validation data2016Inngår i: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 16, artikkel-id 139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Measurement error in self-reported dietary intakes is known to bias the association between dietary intake and a health outcome of interest such as risk of a disease. The association can be distorted further by mismeasured confounders, leading to invalid results and conclusions. It is, however, difficult to adjust for the bias in the association when there is no internal validation data. Methods: We proposed a method to adjust for the bias in the diet-disease association (hereafter, association), due to measurement error in dietary intake and a mismeasured confounder, when there is no internal validation data. The method combines prior information on the validity of the self-report instrument with the observed data to adjust for the bias in the association. We compared the proposed method with the method that ignores the confounder effect, and with the method that ignores measurement errors completely. We assessed the sensitivity of the estimates to various magnitudes of measurement error, error correlations and uncertainty in the literature-reported validation data. We applied the methods to fruits and vegetables (FV) intakes, cigarette smoking (confounder) and all-cause mortality data from the European Prospective Investigation into Cancer and Nutrition study. Results: Using the proposed method resulted in about four times increase in the strength of association between FV intake and mortality. For weakly correlated errors, measurement error in the confounder minimally affected the hazard ratio estimate for FV intake. The effect was more pronounced for strong error correlations. Conclusions: The proposed method permits sensitivity analysis on measurement error structures and accounts for uncertainties in the reported validity coefficients. The method is useful in assessing the direction and quantifying the magnitude of bias in the association due to measurement errors in the confounders.

  • 154. Agogo, George O.
    et al.
    van der Voet, Hilko
    van't Veer, Pieter
    Ferrari, Pietro
    Leenders, Max
    Muller, David C.
    Sanchez-Cantalejo, Emilio
    Bamia, Christina
    Braaten, Tonje
    Knueppel, Sven
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    van Eeuwijk, Fred A.
    Boshuizen, Hendriek
    Use of Two-Part Regression Calibration Model to Correct for Measurement Error in Episodically Consumed Foods in a Single-Replicate Study Design: EPIC Case Study2014Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 11, s. e113160-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In epidemiologic studies, measurement error in dietary variables often attenuates association between dietary intake and disease occurrence. To adjust for the attenuation caused by error in dietary intake, regression calibration is commonly used. To apply regression calibration, unbiased reference measurements are required. Short-term reference measurements for foods that are not consumed daily contain excess zeroes that pose challenges in the calibration model. We adapted twopart regression calibration model, initially developed for multiple replicates of reference measurements per individual to a single-replicate setting. We showed how to handle excess zero reference measurements by two-step modeling approach, how to explore heteroscedasticity in the consumed amount with variance-mean graph, how to explore nonlinearity with the generalized additive modeling (GAM) and the empirical logit approaches, and how to select covariates in the calibration model. The performance of two-part calibration model was compared with the one-part counterpart. We used vegetable intake and mortality data from European Prospective Investigation on Cancer and Nutrition (EPIC) study. In the EPIC, reference measurements were taken with 24-hour recalls. For each of the three vegetable subgroups assessed separately, correcting for error with an appropriately specified two-part calibration model resulted in about three fold increase in the strength of association with all-cause mortality, as measured by the log hazard ratio. Further found is that the standard way of including covariates in the calibration model can lead to over fitting the two-part calibration model. Moreover, the extent of adjusting for error is influenced by the number and forms of covariates in the calibration model. For episodically consumed foods, we advise researchers to pay special attention to response distribution, nonlinearity, and covariate inclusion in specifying the calibration model.

  • 155. Agostoni, C
    et al.
    Buonocore, G
    Carnielli, VP
    De Curtis, M
    Darmaun, D
    Decsi, T
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Embleton, ND
    Fusch, C
    Genzel-Boroviczeny, O
    Goulet, O
    Kalhan, SC
    Kolacek, S
    Koletzko, B
    Lapillonne, A
    Mihatsch, W
    Moreno, L
    Neu, J
    Poindexter, B
    Puntis, J
    Putet, G
    Rigo, J
    Riskin, A
    Salle, B
    Sauer, P
    Shamir, R
    Szajewska, H
    Thureen, P
    Turck, D
    van Goudoever, JB
    Ziegler, EE
    Enteral nutrient supply for preterm infants: commentary from the European society of paediatric gastroenterology, hepatology and nutrition committee on nutrition2010Inngår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 50, nr 1, s. 85-91Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The number of surviving children born prematurely has increased substantially during the last 2 decades. The major goal of enteral nutrient supply to these infants is to achieve growth similar to foetal growth coupled with satisfactory functional development. The accumulation of knowledge since the previous guideline on nutrition of preterm infants from the Committee on Nutrition of the European Society of Paediatric Gastroenterology and Nutrition in 1987 has made a new guideline necessary. Thus, an ad hoc expert panel was convened by the Committee on Nutrition of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition in 2007 to make appropriate recommendations. The present guideline, of which the major recommendations are summarised here (for the full report, see http://links.lww.com/A1480), is consistent with, but not identical to, recent guidelines from the Life Sciences Research Office of the American Society for Nutritional Sciences published in 2002 and recommendations from the handbook Nutrition of the Preterm Infant. Scientific Basis and Practical Guidelines, 2nd ed, edited by Tsang et al, and published in 2005. The preferred food for premature infants is fortified human milk from the infant's own mother, or, alternatively, formula designed for premature infants. This guideline aims to provide proposed advisable ranges for nutrient intakes for stable-growing preterm infants up to a weight of approximately 1800 g, because most data are available for these infants. These recommendations are based on a considered review of available scientific reports on the subject, and on expert consensus for which the available scientific data are considered inadequate.

  • 156. Agrawal, Ganesh Kumar
    et al.
    Sarkar, Abhijit
    Agrawal, Raj
    Ndimba, Bongani Kaiser
    Tanou, Georgia
    Dunn, Michael J
    Kieselbach, Thomas
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Cramer, Rainer
    Wienkoop, Stefanie
    Chen, Sixue
    Rafudeen, Mohammed Suhail
    Deswal, Renu
    Barkla, Bronwyn J
    Weckwerth, Wolfram
    Heazlewood, Joshua L
    Renaut, Jenny
    Job, Dominique
    Chakraborty, Niranjan
    Rakwal, Randeep
    Boosting the Globalization of Plant Proteomics through INPPO: Current Developments and Future Prospects2012Inngår i: Proteomics, ISSN 1615-9853, E-ISSN 1615-9861, Vol. 12, nr 3, s. 359-368Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The International Plant Proteomics Organization (INPPO) is a non-profit-organization consisting of people who are involved or interested in plant proteomics. INPPO is constantly growing in volume and activity, which is mostly due to the realization among plant proteomics researchers worldwide for the need of such a global platform. Their active participation resulted in the rapid growth within the first year of INPPO's official launch in 2011 via its website (www.inppo.com) and publication of the 'Viewpoint paper' in a special issue of PROTEOMICS (May 2011). Here, we will be highlighting the progress achieved in the year 2011 and the future targets for the year 2012 and onwards. INPPO has achieved a successful administrative structure, the Core Committee (CC; composed of President, Vice-President, and General Secretaries), Executive Council (EC), and General Body (GB) to achieve INPPO objectives. Various committees and subcommittees are in the process of being functionalized via discussion amongst scientists around the globe. INPPO's primary aim to popularize the plant proteomics research in biological sciences has also been recognized by PROTEOMICS where a section dedicated to plant proteomics has been introduced starting January 2012, following the very first issue of this journal devoted to plant proteomics in May 2011. To disseminate organizational activities to the scientific community, INPPO has launched a biannual (in January and July) newsletter entitled 'INPPO Express: News & Views' with the first issue published in January 2012. INPPO is also planning to have several activities in 2012, including programs within the Education Outreach committee in different countries, and the development of research ideas and proposals with priority on crop and horticultural plants, while keeping tight interactions with proteomics programs on model plants such as Arabidopsis thaliana, rice, and Medicago truncatula. Altogether, the INPPO progress and upcoming activities are because of immense support, dedication, and hard work of all members of the INPPO community, and also due to the wide encouragement and support from the communities (scientific and non-scientific).

  • 157. Agren, Per-Henrik
    et al.
    Tullberg, Tycho
    Mukka, Sebastian
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Wretenberg, Per
    Sayed-Noor, Arkan S.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Post-traumatic in situ fusion after calcaneal fractures: A retrospective study with 7-28 years follow-up2015Inngår i: Foot and Ankle Surgery, ISSN 1268-7731, E-ISSN 1460-9584, Vol. 21, nr 1, s. 56-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In situ fusion as salvage operation after calcaneal fractures has been used. In this retrospective investigation, a group of in situ fused patients is analyzed with long-term follow-up.

    Methods: Twenty-nine patients with in situ single or multiple fusions performed between 1970 and 1990 were included. In 1998 these patients were examined with plain radiographs and computerized tomography (CT) scan of the affected foot. Also, a visual analogue score (VAS) for calcaneal fractures, short form health survey (SF-36), Olerud Molander score and American Orthopaedic Foot and Ankle society (AOFAS) hindfoot score were evaluated.

    Results: The plain radiographs and CT scan showed severe remaining deformities in these patients. The outcome parameters were generally poor and correlated to the degree of remaining deformity.

    Conclusions: Simple in situ fusion, without consideration of the deformity at hand, after a calcaneal fracture is not an adequate treatment and generally associated with poor outcome. (C) 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  • 158. Agreus, Lars
    et al.
    Hellström, Per M.
    Talley, Nicholas J.
    Wallner, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Forsberg, Anna
    Vieth, Michael
    Veits, Lothar
    Björkegren, Karin
    Engstrand, Lars
    Andreasson, Anna
    Towards a healthy stomach? Helicobacter pylori prevalence has dramatically decreased over 23 years in adults in a Swedish community2016Inngår i: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 4, nr 5, s. 686-696Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background In Western countries the prevalence of Helicobacter pylori (H. pylori) infection may be declining but there is a lack of recent longitudinal population studies. We evaluated the changing epidemiology over a 23-year period in Sweden. Materials and methods In 1989, the validated Abdominal Symptom Questionnaire (ASQ) was mailed to a random sample of inhabitants (ages 22-80 years) in a Swedish community, and 1097 (87%) responded. H. pylori serology was analysed in a representative subsample (n=145). Twenty-three years later, the ASQ was mailed again using similar selection criteria, and 388 out of 1036 responders had an upper endoscopy with assessment of H. pylori and corpus atrophy status. Results The prevalence of positive H. pylori serology decreased from 37.9% (1989) to 15.8% (2012), corresponding to a decrease in odds of 75% per decade (odds ratio (OR): 0.25; 95% confidence interval (CI): 0.11-0.59, p=0.001) independent of age, gender, body mass index (BMI) and level of education, with a pattern consistent with a birth cohort effect. The prevalence increased with increasing age (p=0.001). The prevalence of H. pylori on histology in 2012 was 11.4% (95% CI 8.6-15.0). The prevalence of corpus atrophy on serology and/or histology in 2012 was 3.2% (95% CI 1.8-5.5); all cases were 57 years old. Conclusion The stomach is healthier in 2012 compared with 1989. H. pylori prevalence in adults has decreased over the last two decades to a level where clinical management might be affected.

  • 159. Agudo, Antonio
    et al.
    Bonet, Catalina
    Sala, Núria
    Muñoz, Xavier
    Aranda, Núria
    Fonseca-Nunes, Ana
    Clavel-Chapelon, Françoise
    Boutron-Ruault, Marie Christine
    Vineis, Paolo
    Panico, Salvatore
    Palli, Domenico
    Tumino, Rosario
    Grioni, Sara
    Quirós, J Ramón
    Molina, Esther
    Navarro, Carmen
    Barricarte, Aurelio
    Chamosa, Saioa
    Allen, Naomi E
    Khaw, Kay-Tee
    Bueno-de-Mesquita, H Bas
    Siersema, Peter D
    Numans, Mattijs E
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Kaaks, Rudof
    Canzian, Federico
    Boeing, Heiner
    Meidtner, Karina
    Johansson, Mattias
    Umeå universitet, Medicinska fakulteten. WHO, IARC, Lyon, France.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Manjer, Jonas
    Overvad, Kim
    Tjonneland, Anne
    Lund, Eiliv
    Weiderpass, Elisabete
    Jenab, Mazda
    Fedirko, Veronika
    Offerhaus, G Johan A
    Riboli, Elio
    González, Carlos A
    Jakszyn, Paula
    Hemochromatosis (HFE) gene mutations and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study2013Inngår i: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 34, nr 6, s. 1244-1250Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Hereditary hemochromatosis (HH) is a strong risk factor for hepatocellular cancer, and mutations in the HFE gene associated with HH and iron overload may be related to other tumors, but no studies have been reported for gastric cancer (GC). A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC), including 365 incident gastric adenocarcinoma and 1284 controls matched by center, sex, age and date of blood collection. Genotype analysis was performed for two functional polymorphisms (C282Y/rs1800562 and H63D/rs1799945) and seven tagSNPs of the HFE genomic region. Association with all gastric adenocarcinoma, and according to anatomical localization and histological subtype, was assessed by means of the odds ratio (OR) and 95% confidence interval (CI) estimated by unconditional logistic regression adjusted for the matching variables. We observed a significant association for H63D with OR (per rare allele) of 1.32 (CI = 1.03-1.69). In subgroup analyses, the association was stronger for non-cardia anatomical subsite (OR = 1.60, CI = 1.16-2.21) and intestinal histological subtype (OR = 1.82, CI = 1.27-2.62). Among intestinal cases, two tagSNPs (rs1572982 and rs6918586) also showed a significant association that disappeared after adjustment for H63D. No association with tumors located in the cardia or with diffuse subtype was found for any of the nine SNPs analyzed. Our results suggest that H63D variant in HFE gene seems to be associated with GC risk of the non-cardia region and intestinal type, possibly due to its association with iron overload although a role for other mechanisms cannot be entirely ruled out.

  • 160. Agudo, Antonio
    et al.
    Bonet, Catalina
    Travier, Noemie
    Gonzalez, Carlos A.
    Vineis, Paolo
    Bueno-de-Mesquita, H. Bas
    Trichopoulos, Dimitrios
    Boffetta, Paolo
    Clavel-Chapelon, Francoise
    Boutron-Ruault, Marie-Christine
    Kaaks, Rudolf
    Lukanova, Annekatrin
    Schuetze, Madlen
    Boeing, Heiner
    Tjonneland, Anne
    Halkjaer, Jytte
    Overvad, Kim
    Dahm, Christina C.
    Ramon Quiros, J.
    Sanchez, Maria-Jose
    Larranaga, Nerea
    Navarro, Carmen
    Ardanaz, Eva
    Khaw, Kay-Tee
    Wareham, Nicholas J.
    Key, Timothy J.
    Allen, Naomi E.
    Trichopoulou, Antonia
    Lagiou, Pagona
    Palli, Domenico
    Sieri, Sabina
    Tumino, Rosario
    Panico, Salvatore
    Boshuizen, Hendriek
    Buchner, Frederike L.
    Peeters, Petra H. M.
    Borgquist, Signe
    Almquist, Martin
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi, Tandläkarutbildning.
    Gram, Inger T.
    Lund, Eiliv
    Weiderpass, Elisabete
    Romieu, Isabelle
    Riboli, Elio
    Impact of Cigarette Smoking on Cancer Risk in the European Prospective Investigation into Cancer and Nutrition Study2012Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 30, nr 36, s. 4550-4557Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose Our aim was to assess the impact of cigarette smoking on the risk of the tumors classified by the International Agency for Research on Cancer as causally associated with smoking, referred to as tobacco-related cancers (TRC). Methods The study population included 441,211 participants (133,018 men and 308,193 women) from the European Prospective Investigation Into Cancer and Nutrition. We investigated 14,563 participants who developed a TRC during an average follow-up of 11 years. The impact of smoking cigarettes on cancer risk was assessed by the population attributable fraction (AF(p)), calculated using the adjusted hazard ratios and 95% CI for current and former smokers, plus either the prevalence of smoking among cancer cases or estimates from surveys in representative samples of the population in each country. Results The proportion of all TRC attributable to cigarette smoking was 34.9% (95% CI, 32.5 to 37.4) using the smoking prevalence among cases and 36.2% (95% CI, 33.7 to 38.6) using the smoking prevalence from the population. The AF(p) were above 80% for cancers of the lung and larynx, between 20% and 50% for most respiratory and digestive cancers and tumors from the lower urinary tract, and below 20% for the remaining TRC. Conclusion Using data on cancer incidence for 2008 and our AF(p) estimates, about 270,000 new cancer diagnoses per year can be considered attributable to cigarette smoking in the eight European countries with available data for both men and women (Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Sweden, Denmark). 

  • 161. Agudo, Antonio
    et al.
    Cayssials, Valerie
    Bonet, Catalina
    Tjønneland, Anne
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Affret, Aurélie
    Fagherazzi, Guy
    Katzke, Verena
    Schübel, Ruth
    Trichopoulou, Antonia
    Karakatsani, Anna
    La Vecchia, Carlo
    Palli, Domenico
    Grioni, Sara
    Tumino, Rosario
    Ricceri, Fulvio
    Panico, Salvatore
    Bueno-de-Mesquita, Bas
    Peeters, Petra H.
    Weiderpass, Elisabete
    Skeie, Guri
    Nøst, Theresa H.
    Lasheras, Cristina
    Rodríguez-Barranco, Miguel
    Amiano, Pilar
    Chirlaque, María-Dolores
    Ardanaz, Eva
    Ohlsson, Bodil
    Dias, Joana A.
    Nilsson, Lena M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Myte, Robin
    Khaw, Kay-Tee
    Perez-Cornago, Aurora
    Gunter, Marc
    Huybrechts, Inge
    Cross, Amanda J.
    Tsilidis, Kostas
    Riboli, Elio
    Jakszyn, Paula
    Inflammatory potential of the diet and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study2018Inngår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 107, nr 4, s. 607-616Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Chronic inflammation plays a critical role in the pathogenesis of the 2 major types of gastric cancer. Several foods, nutrients, and nonnutrient food components seem to be involved in the regulation of chronic inflammation. We assessed the association between the inflammatory potential of the diet and the risk of gastric carcinoma, overall and for the 2 major subsites: cardia cancers and noncardia cancers. A total of 476,160 subjects (30% men, 70% women) from the European Investigation into Cancer and Nutrition (EPIC) study were followed for 14 y, during which 913 incident cases of gastric carcinoma were identified, including 236 located in the cardia, 341 in the distal part of the stomach (noncardia), and 336 with overlapping or unknown tumor site. The dietary inflammatory potential was assessed by means of an inflammatory score of the diet (ISD), calculated with the use of 28 dietary components and their corresponding inflammatory scores. The association between the ISD and gastric cancer risk was estimated by HRs and 95% CIs calculated by multivariate Cox regression models adjusted for confounders. The inflammatory potential of the diet was associated with an increased risk of gastric cancer. The HR (95% CI) for each increase in 1 SD of the ISD were 1.25 (1.12, 1.39) for all gastric cancers, 1.30 (1.06, 1.59) for cardia cancers, and 1.07 (0.89, 1.28) for noncardia cancers. The corresponding values for the highest compared with the lowest quartiles of the ISD were 1.66 (1.26, 2.20), 1.94 (1.14, 3.30), and 1.07 (0.70, 1.70), respectively. Our results suggest that low-grade chronic inflammation induced by the diet may be associated with gastric cancer risk. This pattern seems to be more consistent for gastric carcinomas located in the cardia than for those located in the distal stomach. This study is listed on the ISRCTN registry as ISRCTN12136108.

  • 162. Aguilo, Francesca
    et al.
    Avagyan, Serine
    Labar, Amy
    Sevilla, Ana
    Lee, Dung-Fang
    Kumar, Parameet
    Lemischka, Ihor R
    Zhou, Betty Y
    Snoeck, Hans-Willem
    Prdm16 is a physiologic regulator of hematopoietic stem cells.2011Inngår i: Blood, ISSN 0006-4971, E-ISSN 1528-0020, Vol. 117, nr 19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fetal liver and adult bone marrow hematopoietic stem cells (HSCs) renew or differentiate into committed progenitors to generate all blood cells. PRDM16 is involved in human leukemic translocations and is expressed highly in some karyotypically normal acute myeloblastic leukemias. As many genes involved in leukemogenic fusions play a role in normal hematopoiesis, we analyzed the role of Prdm16 in the biology of HSCs using Prdm16-deficient mice. We show here that, within the hematopoietic system, Prdm16 is expressed very selectively in the earliest stem and progenitor compartments, and, consistent with this expression pattern, is critical for the establishment and maintenance of the HSC pool during development and after transplantation. Prdm16 deletion enhances apoptosis and cycling of HSCs. Expression analysis revealed that Prdm16 regulates a remarkable number of genes that, based on knockout models, both enhance and suppress HSC function, and affect quiescence, cell cycling, renewal, differentiation, and apoptosis to various extents. These data suggest that Prdm16 may be a critical node in a network that contains negative and positive feedback loops and integrates HSC renewal, quiescence, apoptosis, and differentiation.

  • 163.
    Aguilo, Francesca
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Departments of Structural and Chemical Biology, Genetics and Genomic Sciences and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Di Cecilia, Serena
    Walsh, Martin J
    Long Non-coding RNA ANRIL and Polycomb in Human Cancers and Cardiovascular Disease2016Inngår i: Long non-coding RNAs in human disease, Springer, 2016, Vol. 394, s. 29-39Kapittel i bok, del av antologi (Fagfellevurdert)
    Abstract [en]

    The long non-coding RNA CDKN2B-AS1, commonly referred to as the Antisense Non-coding RNA in the INK4 Locus (ANRIL), is a 3.8-kb-long RNA transcribed from the short arm of human chromosome 9 on p21.3 that overlaps a critical region encompassing three major tumor suppressor loci juxtaposed to the INK4b-ARF-INK4a gene cluster and the methyl-thioadenosine phosphorylase (MTAP) gene. Genome-wide association studies have identified this region with a remarkable and growing number of disease-associated DNA alterations and single nucleotide polymorphisms, which corresponds to increased susceptibility to human disease. Recent attention has been devoted on whether these alterations in the ANRIL sequence affect its expression levels and/or its splicing transcript variation, and in consequence, global cellular homeostasis. Moreover, recent evidence postulates that ANRIL not only can regulate their immediate genomic neighbors in cis, but also has the capacity to regulate additional loci in trans. This action would further increase the complexity for mechanisms imposed through ANRIL and furthering the scope of this lncRNA in disease pathogenesis. In this chapter, we summarize the most recent findings on the investigation of ANRIL and provide a perspective on the biological and clinical significance of ANRIL as a putative biomarker, specifically, its potential role in directing cellular fates leading to cancer and cardiovascular disease.

  • 164.
    Aguilo, Francesca
    et al.
    Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Li, SiDe
    Balasubramaniyan, Natarajan
    Sancho, Ana
    Benko, Sabina
    Zhang, Fan
    Vashisht, Ajay
    Rengasamy, Madhumitha
    Andino, Blanca
    Chen, Chih-hung
    Zhou, Felix
    Qian, Chengmin
    Zhou, Ming-Ming
    Wohlschlegel, James A
    Zhang, Weijia
    Suchy, Frederick J
    Walsh, Martin J
    Deposition of 5-Methylcytosine on Enhancer RNAs Enables the Coactivator Function of PGC-1α2016Inngår i: Cell reports, ISSN 2211-1247, E-ISSN 2211-1247, Vol. 14, nr 3, s. 479-492Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Peroxisome proliferator-activated receptor-gamma coactivator 1 alpha (PGC-1α) is a transcriptional co-activator that plays a central role in adapted metabolic responses. PGC-1α is dynamically methylated and unmethylated at the residue K779 by the methyltransferase SET7/9 and the Lysine Specific Demethylase 1A (LSD1), respectively. Interactions of methylated PGC-1α[K779me] with the Spt-Ada-Gcn5-acetyltransferase (SAGA) complex, the Mediator members MED1 and MED17, and the NOP2/Sun RNA methytransferase 7 (NSUN7) reinforce transcription, and are concomitant with the m(5)C mark on enhancer RNAs (eRNAs). Consistently, loss of Set7/9 and NSun7 in liver cell model systems resulted in depletion of the PGC-1α target genes Pfkl, Sirt5, Idh3b, and Hmox2, which was accompanied by a decrease in the eRNAs levels associated with these loci. Enrichment of m(5)C within eRNA species coincides with metabolic stress of fasting in vivo. Collectively, these findings illustrate the complex epigenetic circuitry imposed by PGC-1α at the eRNA level to fine-tune energy metabolism.

  • 165.
    Aguilo, Francesca
    et al.
    Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Zakirova, Zuchra
    Nolan, Katie
    Wagner, Ryan
    Sharma, Rajal
    Hogan, Megan
    Wei, Chengguo
    Sun, Yifei
    Walsh, Martin J.
    Kelley, Kevin
    Zhang, Weijia
    Ozelius, Laurie J.
    Gonzalez-Alegre, Pedro
    Zwaka, Thomas P.
    Ehrlich, Michelle E.
    THAP1: Role in Mouse Embryonic Stem Cell Survival and Differentiation2017Inngår i: Stem Cell Reports, ISSN 2213-6711, Vol. 9, nr 1, s. 92-107Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    THAP1 (THAP [Thanatos-associated protein] domain-containing, apoptosis-associated protein 1) is a ubiquitously expressed member of a family of transcription factors with highly conserved DNA-binding and protein-interacting regions. Mutations in THAP1 cause dystonia, DYT6, a neurologic movement disorder. THAP1 downstream targets and the mechanism via which it causes dystonia are largely unknown. Here, we show that wild-type THAP1 regulates embryonic stem cell (ESC) potential, survival, and proliferation. Our findings identify THAP1 as an essential factor underlying mouse ESC survival and to some extent, differentiation, particularly neuroectodermal. Loss of THAP1 or replacement with a disease-causing mutation results in an enhanced rate of cell death, prolongs Nanog, Prdm14, and/or Rex1 expression upon differentiation, and results in failure to upregulate ectodermal genes. ChIP-Seq reveals that these activities are likely due in part to indirect regulation of gene expression.

  • 166. Aguilo, Francesca
    et al.
    Zhang, Fan
    Sancho, Ana
    Fidalgo, Miguel
    Di Cecilia, Serena
    Vashisht, Ajay
    Lee, Dung-Fang
    Chen, Chih-Hung
    Rengasamy, Madhumitha
    Andino, Blanca
    Jahouh, Farid
    Roman, Angel
    Krig, Sheryl R
    Wang, Rong
    Zhang, Weijia
    Wohlschlegel, James A
    Wang, Jianlong
    Walsh, Martin J
    Coordination of m(6)A mRNA Methylation and Gene Transcription by ZFP217 Regulates Pluripotency and Reprogramming.2015Inngår i: Cell Stem Cell, ISSN 1934-5909, E-ISSN 1875-9777, Vol. 17, nr 6, s. 689-704Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Epigenetic and epitranscriptomic networks have important functions in maintaining the pluripotency of embryonic stem cells (ESCs) and somatic cell reprogramming. However, the mechanisms integrating the actions of these distinct networks are only partially understood. Here we show that the chromatin-associated zinc finger protein 217 (ZFP217) coordinates epigenetic and epitranscriptomic regulation. ZFP217 interacts with several epigenetic regulators, activates the transcription of key pluripotency genes, and modulates N6-methyladenosine (m(6)A) deposition on their transcripts by sequestering the enzyme m(6)A methyltransferase-like 3 (METTL3). Consistently, Zfp217 depletion compromises ESC self-renewal and somatic cell reprogramming, globally increases m(6)A RNA levels, and enhances m(6)A modification of the Nanog, Sox2, Klf4, and c-Myc mRNAs, promoting their degradation. ZFP217 binds its own target gene mRNAs, which are also METTL3 associated, and is enriched at promoters of m(6)A-modified transcripts. Collectively, these findings shed light on how a transcription factor can tightly couple gene transcription to m(6)A RNA modification to ensure ESC identity.

  • 167. Aguilo, Francesca
    et al.
    Zhou, Ming-Ming
    Walsh, Martin J
    Long noncoding RNA, polycomb, and the ghosts haunting INK4b-ARF-INK4a expression.2011Inngår i: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 71, nr 16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Polycomb group proteins (PcG) function as transcriptional repressors of gene expression. The important role of PcG in mediating repression of the INK4b-ARF-INK4a locus, by directly binding to the long noncoding RNA (lncRNA) transcript antisense noncoding RNA in the INK4 locus (ANRIL), was recently shown. INK4b-ARF-INK4a encodes 3 tumor-suppressor proteins, p15(INK4b), p14(ARF), and p16(INK4a), and its transcription is a key requirement for replicative or oncogene-induced senescence and constitutes an important barrier for tumor growth. ANRIL gene is transcribed in the antisense orientation of the INK4b-ARF-INK4a gene cluster, and different single-nucleotide polymorphisms are associated with increased susceptibility to several diseases. Although lncRNA-mediated regulation of INK4b-ARF-INK4a gene is not restricted to ANRIL, both polycomb repressive complex-1 (PRC1) and -2 (PRC2) interact with ANRIL to form heterochromatin surrounding the INK4b-ARF-INK4a locus, leading to its repression. This mechanism would provide an increased advantage for bypassing senescence, sustaining the requirements for the proliferation of stem and/or progenitor cell populations or inappropriately leading to oncogenesis through the aberrant saturation of the INK4b-ARF-INK4a locus by PcG complexes. In this review, we summarize recent findings on the underlying epigenetic mechanisms that link PcG function with ANRIL, which impose gene silencing to control cellular homeostasis as well as cancer development.

  • 168. Aguiló, Francesca
    et al.
    Camarero, Nuria
    Relat, Joana
    Marrero, Pedro F
    Haro, Diego
    Transcriptional regulation of the human acetoacetyl-CoA synthetase gene by PPARgamma.2010Inngår i: Biochemical Journal, ISSN 0264-6021, E-ISSN 1470-8728, Vol. 427, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the cytosol of lipogenic tissue, ketone bodies are activated by AACS (acetoacetyl-CoA synthetase) and incorporated into cholesterol and fatty acids. AACS gene expression is particularly abundant in white adipose tissue, as it is induced during adipocyte differentiation. In order to elucidate the mechanism controlling the gene expression of human AACS and to clarify its physiological role, we isolated the human promoter, characterized the elements required to initiate transcription and analysed the expression of the gene in response to PPARgamma (peroxisome-proliferator-activated receptor gamma), an inducer of adipogenesis. We show that the human AACS promoter is a PPARgamma target gene and that this nuclear receptor is recruited to the AACS promoter by direct interaction with Sp1 (stimulating protein-1).

  • 169.
    Agvald, Liv
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Idrottsmedicin.
    Fysisk aktivitetsnivå hos barn i årskurs 3: En accelerometerstudie2018Independent thesis Advanced level (degree of Master (One Year)), 20 poäng / 30 hpOppgave
    Abstract [sv]

    Introduktion: Vikten av fysisk aktivitet är väl utredd, men kunskapsunderlaget om hur aktiva våra yngre barn är idag är fortfarande tunt. Tri-accelerometer har visat sig vara en valid metod att mäta aktivitet hos barn.

    Syfte: Syftet med studien är att undersöka och kartlägga den totala fysiska aktivitetsnivån under en veckas tid hos barn i årskurs tre på en skola i norra Sverige. Ytterligare syfte är att se hur stor andel av barnen som når upp till rekommenderad dos av daglig aktivitet, samt om det finns någon signifikant skillnad i aktivitetsnivå sett utifrån kön eller deltagande i organiserad idrott eller ej.

    Metod: Fyrtio barn deltog i studien. Deltagarnas aktivitet registrerades under en veckas tid genom en tri-accelerometer. Ett kortare frågeformulär angående deras fysiska aktivitet besvarades även.

    Resultat: Ingen signifikant skillnad avseende kön eller deltagande i organiserad idrott eller ej kunde påvisas. 39 av 40 deltagare nådde upp till rekommenderad dos av daglig aktivitet.

    Diskussion: Utifrån studien så förefaller barn i årskurs tre vara tillräckligt aktiva för att uppnå kraven på daglig aktivitetsdos, ett positivt resultat då larmrapporter om alltmer stillasittande förekommer. Större och djupare studier behövs för att se om dessa resultat stämmer i ett större sammanhang.

  • 170.
    Ahangari, Alebtekin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Chronic pelvic pain: 8 years after the 2006 WHO systematic review2013Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
  • 171.
    Ahangari, Alebtekin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Pain and Alcohol Consumption among Elderly: Evidences from WHO Study on global AGEing and adult health (Wave 1)2014Independent thesis Advanced level (degree of Master (Two Years)), 10 poäng / 15 hpOppgave
  • 172.
    Ahangari, Alebtekin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Prevalence of Chronic Pelvic Pain Among Women: An Updated Review2014Inngår i: Pain Physician, ISSN 1533-3159, E-ISSN 2150-1149, Vol. 17, nr 2, s. E141-E147Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Background: Chronic pelvic pain (CPP), defined as a noncyclical pain lasting for more than 6 months can lead to lower physical performance and quality of life in women. CPP is a worldwide problem affecting women of all ages. However, health care professionals and researchers, due to its complex nature and the lack of knowledge surrounding the condition, frequently neglect CPP. Subsequently, basic data and knowledge regarding CPP remain incomplete. Objective: To update the review of the worldwide estimation of the CPP prevalence considering the World Health Organization systematic review by Latthe et al in 2006 as point of departure. Study Design: A systematic review of CPP prevalence studies. Method: Electronic search was performed to find related articles through PubMed between 2005 and 2012 based on the PRISMA statement (2009). Results: From 140 studies, only 7 studies were about CPP prevalence. Their study design consisted of 3 cross sectional studies, one population based mailing questionnaire study, one survey study (computer assisted telephone interview), one data analysis by questionnaire, and one prospective community based study. Limitations: Paucity of population based studies in addition to probability of existence of studies at the local level with limited access to worldwide databases, lack of consensus about definition of CPP among researchers and therapists, and non-inclusion of CPP related key words in databases such as PubMed. Conclusion: Based on these articles, prevalence in general ranged between 5.7% and 26.6%. There were many countries and regions without basic data in the field of CPP. This review shows the paucity of studies, especially multidisciplinary researches with multifactorial views on CPP. Multidisciplinary studies would provide more reliable data for estimating the prevalence of CPP and its psycho-socioeconomic burden, as well as finding its etiologies and characteristics. This would be the first step towards better treatment and care for women with CPP.

  • 173.
    Ahangari, Alebtekin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå Neurosteroid Research Center, Umeå University, Umeå, Sweden.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå Neurosteroid Research Center, Umeå University, Umeå, Sweden.
    Innala, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå Neurosteroid Research Center, Umeå University, Umeå, Sweden.
    Andersson, C.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå Neurosteroid Research Center, Umeå University, Umeå, Sweden.
    Turkmen, Sahruh
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå Neurosteroid Research Center, Umeå University, Umeå, Sweden.
    Acute intermittent porphyria symptoms during the menstrual cycle2015Inngår i: Internal medicine journal (Print), ISSN 1444-0903, E-ISSN 1445-5994, Vol. 45, nr 7, s. 725-731Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Acute intermittent porphyria (AIP), a life-threatening form of the disease, is accompanied by several pain, mental and physical symptoms.

    Aims: In this study, we evaluated the cyclicity of AIP and premenstrual syndrome (PMS) symptoms in 32 women with DNA-diagnosed AIP during their menstrual cycles, in northern Sweden.

    Methods: The cyclicity of AIP symptoms and differences in them between the follicularand luteal phases, and the cyclicity of each symptom in each individual woman indifferent phases of her menstrual cycle were analysed with a prospective daily ratingquestionnaire. PMS symptoms were also evaluated in the patients on a daily rating scale.

    Results: Of the 32 women, 30 showed significant cyclicity in at least one AIP or PMS symptom (P < 0.05–0.001). Back pain (10/32) was the most frequent AIP pain symptomand sweet craving (10/15) was the most frequent PMS symptom. Pelvic pain (F = 4.823,P = 0.036), irritability (F = 7.399, P = 0.011), cheerfulness (F = 5.563, P = 0.025), sexualdesire (F = 8.298, P = 0.007), friendliness (F = 6.157, P = 0.019), breast tenderness (F =21.888, P = 0.000) and abdominal swelling (F = 16.982, P = 0.000) showed significantcyclicity. Pelvic pain and abdominal swelling (rs= 0.337, P < 0.001) showed the strongest correlation. The age of women with latent AIP was strongly correlated with abdominal swelling during the luteal phase (rs= 0.493, P < 0.01).

    Conclusion: Our results suggest that the symptoms of AIP patients change during their menstrual cycles.

  • 174.
    Ahangari, Alebtekin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Stewart Williams, Jennifer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Research Centre for Generational, Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
    Myléus, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Pain and alcohol consumption among older adults: findings from the World Health Organization Study on global AGEing and adult health, Wave 12016Inngår i: Tropical medicine & international health, ISSN 1360-2276, E-ISSN 1365-3156, Vol. 21, nr 10, s. 1282-1292Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate cross-sectional associations between self-reported recent pain and alcohol use/abstinence, and previous-day pain and previous-week alcohol consumption in adults aged 50 + in six low- and middle-income countries (LMICs). METHODS: The WHO Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010) in China, Ghana, India, Mexico, Russia and South Africa is the data source. Prevalence of alcohol use/abstinence is reported by previous-day and previous-month pain. Multinomial logistic regressions (crude and adjusted for sex and country) tested associations between recent pain and alcohol use in the pooled multicountry sample. RESULTS: Across the six SAGE countries, about one-third of respondents reported alcohol use, being highest in Russia (74%) and lowest in India (16%). Holding the effects of sex and country constant, compared with abstainers, people with previous-day pain were more likely to be previous-day or other users. With regard to the quantity and frequency of alcohol use, people with previous-day pain were more likely to be non-heavy drinkers. CONCLUSION: Overall, we found that, in this population of older adults in six LMICs, recent pain was associated with moderate use of alcohol, although there were differences between countries. The findings provide a platform for country-specific research to better understand bi-directional associations between pain and alcohol in older adults.

  • 175.
    Ahl, Caroline
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nyström, Maria
    To handle the unexpected: the meaning of caring in pre-hospital emergency care2012Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 20, nr 1, s. 33-41Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    The patient's voice has not been present to the same degree as the professional perspective in caring research in a pre-hospital context. In order to further develop and improve pre-hospital care, it is therefore important to explore patients' situations not only in life threatening but also in non-traumatic situations. This is especially important as these patients might be defined as inappropriate attendees of ambulance services. The aim of this study was to interpret and explain experiences of caring in pre-hospital care situations that are not defined as traumatic or life threatening. Twenty informants aged between 34 and 82 years were interviewed. The design of the study was exploratory, and it used an interpretative approach in order to understand the meaning of pre-hospital caring. The findings show that pre-hospital caring can be understood and explained as a matter of interplay between carer(s) and patient with potentials for positive as well as negative outcomes. Our conclusion is that the initial meeting is of vital importance in how patients experience pre-hospital care. It is suggested that general public information on the development of Swedish pre-hospital care received in turn may facilitate the first encounter between patient and carer(s). 

  • 176.
    Ahl, Caroline
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Health Sciences, University Collage of Borås, SE-501, 90 Borås, Sweden.
    Nyström, Maria
    Jansson, Lilian
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Making up one's mind: patients' experiences of calling an ambulance2006Inngår i: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 14, nr 1, s. 11-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The issue of the inappropriate use of ambulance transport and care has mainly been studied from the professionals' and caregivers' perspective, with few studies focusing on the patient and his/her experiences. To further understand whether patients use ambulance care in an inappropriate manner and, if so, why, it is important to obtain an overall picture of the patients' existential situation at the time they call an ambulance. The aim of this study was to analyse and describe patients' experiences related to the decision to call an ambulance and the wait for it to arrive. The design was explorative, and twenty informants aged between 34 and 82 years were interviewed. Qualitative content analyses were performed. The findings showed that calling for an ambulance is a major decision that is preceded by hesitation and attempts to handle the situation by oneself. Our conclusion is that the definition of inappropriate use of valuable health care resources should not be based solely on the professionals' point of view but also take account of the patients' reactions when they experience a threat to their life and health.

  • 177. Ahlberg, Alexander
    et al.
    Engström, Therese
    Nikolaidis, Polymnia
    Gunnarsson, Karin
    Johansson, Hemming
    Sharp, Lena
    Laurell, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Early self-care rehabilitation of head and neck cancer patients2011Inngår i: Acta Oto-Laryngologica, ISSN 0001-6489, E-ISSN 1651-2251, Vol. 131, nr 5, s. 552-61Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    CONCLUSIONS: No positive effects of early preventive rehabilitation could be identified. The results do not contradict the proposition that rehabilitation based on self-care can be effective but it is important to establish evidence-based training programs and identify proper instruments for selection of patients and evaluation of intervention.

    OBJECTIVES: Patients with head and neck cancer suffer from functional impairments due to intense treatment. In this study, we investigated the effectiveness of an experimental early preventive rehabilitation using hard, objective end points in a nonselective, longitudinal, prospective cohort study.

    METHODS: In all, 190 patients were included in the program and received instructions for training before the start of treatment with the aim of reducing swallowing problems and reducing mouth opening and stiffness in the neck. A control group of 184 patients was recruited.

    RESULTS: There was no difference in weight loss and 2-year survival between the two groups. No positive effects concerning functional impairments were found in patient-reported outcome measures.

  • 178. Ahlberg, Alexander
    et al.
    Nikolaidis, Polymnia
    Engström, Therese
    Gunnarsson, Karin
    Johansson, Hemming
    Sharp, Lena
    Laurell, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Öron- näs- och halssjukdomar.
    Morbidity of supraomohyoidal and modified radical neck dissection combined with radiotherapy for head and neck cancer: a prospective longitudinal study2012Inngår i: Head and Neck, ISSN 1043-3074, E-ISSN 1097-0347, Vol. 34, nr 1, s. 66-72Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The purpose of this study was to show the investigated impact of supraomohyoidal neck dissection and modified radical neck dissection, both combined with radiotherapy, on cervical range of motion (CROM), mouth opening, swallowing, lymphedema, and shoulder function.

    METHODS: One hundred eight patients who had neck dissections and 98 patients who had non-neck dissections were evaluated in a prospective, nonselective, longitudinal cohort study by a physiotherapist and a speech-language pathologist (SLP) before the start of radiotherapy and up to 12 months after treatment.

    RESULTS: The incidence of shoulder disability after neck dissection was 18%. Supraomohyoidal neck dissection had no significant effect on the evaluated parameters at any time point. Modified radical neck dissection significantly reduced CROM and mouth opening 2 months after treatment, but after 12 months only cervical rotation was still significantly reduced.

    CONCLUSION: In patients treated with external beam radiation (EBRT), modified radical neck dissection induced additional morbidity regarding CROM but not regarding mouth opening, swallowing, and lymphedema 1 year after treatment. Both modified radical neck dissection and supraomohyoidal neck dissection induced shoulder disability.

  • 179.
    Ahlberg, Camilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Johansson, Viola
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Vårdpersonalens kunskap om trycksårsprofylax: – En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    ABSTRAKT

    Bakgrund: Att förebygga sjukdom och lindra lidande är två av sjuksköterskans huvuduppgifter. Trycksår räknas som vårdskada och är ett universellt problem med relativt konstant frekvens som innebär mycket smärta och lidande för patienten. Trycksår kan förebyggas i de flesta fall vilket är en del av vårdpersonalens ansvar.

    Syfte: Denna litteraturstudie avser att beskriva vårdpersonalens kunskap om trycksårsprofylax.

    Metod: 11 kvantitativa forskningsartiklar om vårdpersonals kunskap beträffande trycksårsprofylax har granskats och sammanställts för att få en klarare syn på kunskapen.

    Resultat: Även om vårdpersonalens kunskap om trycksårsprofylax överlag är relativt god så har man ändå kunnat identifiera stora kunskapsluckor.

    Konklusion: Dessa kunskapsluckor kan vara en av orsakerna till att undvikbara trycksår fortfarande uppstår.    

    Nyckelord: Sjuksköterska, trycksår, prevention, profylax, kunskap 

  • 180.
    Ahlberg, Carolina
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Event related cortical desynchronization during motor imagery in spinal cord injury patients Can electroencephalographically-recorded mu waves command a wheelchair?2018Independent thesis Basic level (professional degree), 20 poäng / 30 hpOppgave
  • 181.
    Ahlberg, Jane
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Dannvik, Rebecka
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Omvårdnadsåtgärder: En litteraturstudie om omvårdnadsåtgärder vid Anorexia nervosa.2017Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Anorexia nervosa är en ätstörning som debuterar i allt yngre ålder och kan yttra sig på olika sätt beroende på individen. Detta leder till att det inte finns ett enkelt svar på hur sjukdomen ska behandlas. Det ställer krav på både kunskap och erfarenhet hos sjuksköterskorna för att förstå komplexiteten av anorexia nervosa, vilket är nödvändigt för att uppnå ett lyckat behandlingsresultat.

     

    Syfte: Syftet är att beskriva sjuksköterskans omvårdnadsåtgärder vid behandling av anorexia nervosa hos unga kvinnor.

     

    Metod: En litteraturstudie grundad på åtta kvalitativa artiklar. Artiklarnas resultat har granskats, analyserats och sammanställts för att besvara syftet. Databassökningen har genomförts i Cinahl, Pubmed samt PsykInfo.

     

    Resultat: Sammanfattningen av artiklarnas resultat bildade tre kategorier som beskriver de omvårdnadsåtgärder sjuksköterskorna använder: 1) Bygga och upprätthålla en god relation till patienten, 2) Säkerställa viktökning och 3) Återställa ett normalt ätbeteende.  

     

    Slutsats: Litteraturstudien beskriver hur behandlingen påverkas av hur sjuksköterskorna genomför omvårdnaden. Att skapa en god relation till patienten är en avgörande komponent för att lyckas med viktökning och en beteendeförändring hos patienten.   

     

    Nyckelord: Anorexia nervosa, behandling, kvinnor, omvårdnad, ungdomar

  • 182. Ahlborg, Liv
    et al.
    Hedman, Leif
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Murkes, Daniel
    Westman, Bo
    Kjellin, Ann
    Fellander-Tsai, Li
    Enochsson, Lars
    Visuospatial ability correlates with performance in simulated gynecological laparoscopy2011Inngår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 157, nr 1, s. 73-77Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology (OBGYN). Study design: This was a prospective cohort study carried out at two community hospitals in Sweden. Thirteen consultants in obstetrics and gynecology were included. They had previously independently performed 10-100 advanced laparoscopies. Participants were tested for visuospatial ability by the Mental Rotations Test version A (MRT-A). After a familiarization session and standardized instruction, all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies. Performance in the simulator was measured by Total Time, Score and Ovarian Diathermy Damage. Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance. The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability. Results: Visuospatial ability correlated with Total Time (r = -0.62; p = 0.03) and Score (r = 0.57; p = 0.05) in the medium level of the virtual tubal occlusion. In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time (r = -0.64; p = 0.02), Ovarian Diathermy Damage (r = -0.65; p = 0.02) and with overall Score (r = 0.64; p = 0.02). Conclusions: Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator. Testing visuospatial ability might be helpful when designing individual training programs.

  • 183. Ahlborg, Liv
    et al.
    Hedman, Leif
    Nisell, Henry
    Felländer-Tsai, Li
    Enochsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden; Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden; Division of Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Simulator training and non-technical factors improve laparoscopic performance among OBGYN trainees2013Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, nr 10, s. 1194-1201Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate how simulator training and non-technical factors affect laparoscopic performance among residents in obstetrics and gynecology. DESIGN: In this prospective study, trainees were randomized into three groups. The first group was allocated to proficiency-based training in the LapSimGyn(®) virtual reality simulator. The second group received additional structured mentorship during subsequent laparoscopies. The third group served as control group. At baseline an operation was performed and visuospatial ability, flow and self-efficacy were assessed. All groups subsequently performed three tubal occlusions. Self-efficacy and flow were assessed before and/or after each operation. SETTING: Simulator training was conducted at the Center for Advanced Medical Simulation and Training, Karolinska University Hospital. Sterilizations were performed at each trainee's home clinic. POPULATION: Twenty-eight trainees/residents from 21 hospitals in Sweden were included. METHODS/MAIN OUTCOME MEASURES: Visuospatial ability was tested by the Mental Rotation Test-A. Flow and self-efficacy were assessed by validated scales and questionnaires. Laparoscopic performance was measured as the duration of surgery. Visuospatial ability, self-efficacy and flow were correlated to the laparoscopic performance using Spearman's correlations. Differences between groups were analyzed by the Mann-Whitney U-test. RESULTS: No differences across groups were detected at baseline. Self-efficacy scores before and flow scores after the third operation were significantly higher in the trained groups. Duration of surgery was significantly shorter in the trained groups. Flow and self-efficacy correlate positively with laparoscopic performance. CONCLUSIONS: Simulator training and non-technical factors appear to improve the laparoscopic performance among trainees/residents in obstetrics and gynecology.

  • 184. Ahlborg, Liv
    et al.
    Weurlander, Maria
    Hedman, Leif
    Nisel, Henry
    Lindqvist, Pelle G
    Felländer-Tsai, Li
    Enochsson, Lars
    Individualized feedback during simulated laparoscopic training: a mixed methods study.2015Inngår i: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 6, s. 93-100Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study aimed to explore the value of individualized feedback on performance, flow and self-efficacy during simulated laparoscopy. Furthermore, we wished to explore attitudes towards feedback and simulator training among medical students.

    METHODS: Sixteen medical students were included in the study and randomized to laparoscopic simulator training with or without feedback. A teacher provided individualized feedback continuously throughout the procedures to the target group. Validated questionnaires and scales were used to evaluate self-efficacy and flow. The Mann-Whitney U test was used to evaluate differences between groups regarding laparoscopic performance (instrument path length), self-efficacy and flow. Qualitative data was collected by group interviews and interpreted using inductive thematic analyses.

    RESULTS: Sixteen students completed the simulator training and questionnaires. Instrument path length was shorter in the feedback group (median 3.9 m; IQR: 3.3-4.9) as compared to the control group (median 5.9 m; IQR: 5.0-8.1), p<0.05. Self-efficacy improved in both groups. Eleven students participated in the focus interviews. Participants in the control group expressed that they had fun, whereas participants in the feedback group were more concentrated on the task and also more anxious. Both groups had high ambitions to succeed and also expressed the importance of getting feedback. The authenticity of the training scenario was important for the learning process.

    CONCLUSIONS: This study highlights the importance of individualized feedback during simulated laparoscopy training. The next step is to further optimize feedback and to transfer standardized and individualized feedback from the simulated setting to the operating room.

  • 185.
    Ahlgren, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Folkesson, Robert
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    The association between self-paced walking speed and cognitive function among very old people.2016Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Inledning:

    I Sverige förväntas medelåldern att stiga och den äldsta åldersgruppen förutspås växa sig allt större. Nedgång i fysisk funktion och kognitiv funktion är vanligt bland människor som är äldre. Nyligen genomförda tvärsnitts- och longitudinella studier visar att det finns ett samband mellan gång och kognition. Tyvärr är forskningen begränsad då den nästintill exkluderar mycket gamla människor.Syfte:

    Utforska sambandet mellan självvald gånghastighet och kognition hos mycket gamla människor. Det specifika syftet är att analysera sambandet vid baslinjen och vid 5 års uppföljning samt sambandet i förändringen hos mycket gamla människor. Metod:

    Deltagare undersökta i Umeå 85 + / Gerontologisk regional databas-studie (GERDA), med en ålder på 85 år eller äldre, bedömdes vid baslinjen och med 5 års uppföljning. Självvald gånghastighet mättes med 2,4 meters gångtest och individernas kognitiva funktion undersöktes med hjälp av Mini-Mental State Examination.Resultat:

    Medelåldern vid baslinjen var 89,76 (SD ± 4,82). Korrelation för förändringen i självvald gånghastighet och Mini-Mental State Examination mellan baslinjen och vid uppföljningen (n = 277), r = .251, p <.001, r2 värde .063. Konklusion:

    Det finns ett samband mellan självvald gånghastighet och kognitiv funktion bland de mycket gamla, både tvärsnitt och longitudinellt. Sambandet är starkt bland de som utvecklar demens.

  • 186. Ahlgren, Camilla
    et al.
    Molin, Margareta
    Umeå universitet, Medicinsk fakultet, Odontologi, Protetik. Umeå universitet, Medicinsk fakultet, Odontologi.
    Lundh, Thomas
    Nilner, Krister
    Levels of gold in plasma after dental gold inlay insertion.2007Inngår i: Acta odontologica Scandinavica, ISSN 1502-3850, Vol. 65, nr 6, s. 331-4Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Several studies have reported increased levels of gold (Au) in the blood of patients with dental gold restorations. This study analyzed gold levels in blood plasma before dental gold inlay insertion, 0-12 months after, and 15 years after. MATERIAL AND METHODS: Plasma samples from 9 patients were taken before and 0-10 months after gold inlay insertion. Fifteen years after gold inlay insertion, further blood samples taken from 8 of these patients were analyzed for gold using inductively coupled plasma mass spectrometry. An oral examination was also carried out before and 15 years after gold inlay insertion. RESULTS: Gold levels in plasma were significantly higher 0-12 months after gold inlay insertion than before treatment (p=0.008). No significant difference in gold plasma levels was found between 0-12 months after and 15 years after insertion (p=0.109), although there was a significant correlation between the number of gold alloy surfaces and the amount of gold in plasma 15 years after insertion (p=0.028). CONCLUSIONS: This study supports a dose-related release of gold into plasma from dental gold restorations, a release that appears to be stable over time.

  • 187.
    Ahlgren, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain: a literature review2016Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 23, s. 2255-2270Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Purpose: The purpose of this study is to assess and describe the meanings given to "gender" in scientific publications that evaluate multidisciplinary, interdisciplinary or multimodal rehabilitation for patients with chronic musculoskeletal pain.

    Method: A systematic literature search for papers evaluating multimodal rehabilitation was conducted. The PubMed and EBSCO databases were searched from 1995 to 2015. Two or three researchers independently read each paper, performed a quality assessment and coded meanings of gender using qualitative content analysis.

    Results: Twenty-seven papers were included in the review. Gender was used very differently in the MMR studies investigated but primarily it referred to factual differences between men and women. Only one paper provided a definition of the concept of gender and how it had been used in that study. In the content analysis, the meaning of gender formed three categories: "Gender as a factual difference", "The man is the ideal" and "Gender as a result of social role expectations".

    Conclusions: The meaning of the concept of gender in multimodal rehabilitation is undefined and needs to be developed further. The way the concept is used should be defined in the design and evaluation of multimodal rehabilitation in future studies.

    Implications for rehabilitation

    Healthcare professionals should reflect on gender relations in encounters with patients, selection of patients into rehabilitation programs and design of programs. In rehabilitation for chronic pain the patients' social circumstances and cultural context should be given the same consideration as biological sex and pain symptoms.

  • 188.
    Ahlgren, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Gadin, Katja Gillander
    Struggle for time to teach: Teachers' experiences of their work situation2011Inngår i: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 40, nr S1, s. S111-S118Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The objective of this study was to from a gender perspective, explore elementary school teacher' experiences of their work situation, and identify conditions that could be health risks. Participants: Eighteen female teachers who work in an elementary school in Northern Sweden. Method: Thematic interviews were conducted using an interview guide. The interviews were tape-recorded and transcribed verbatim. Qualitative content analysis was used to analyse the transcribed text and interpretations were made within gender theory. Results: Four categories emerged: "Squeezed between dream and reality", "Effort to keep up with demands", "We can make it together" and "The school needs men's qualities". The categories were linked together with the theme "A struggle for time to teach". The theme describes the conflict between the teachers' ambitions to teach and create a stimulating learning environment versus the increased need for behaviour control that took time from classroom work. Beside work at the school, the teachers carried a large burden of domestic work. Conclusions: Teachers' work includes both endless demands and great joy. Their work is structured within the schools gender system in which caring duties are subordinated despite a growing demand for behaviour control. Traditional gender roles affect their domestic work load.

  • 189.
    Ahlgren, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Hammarström, Anne
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Sandberg, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Larsson, Christel
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden .
    Fjellman-Wiklund, Anncristine
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Engagement in New Dietary Habits: Obese Women's Experiences from Participating in a 2-Year Diet Intervention2016Inngår i: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, nr 1, s. 84-93Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Dietary weight loss interventions most often result in weight loss, but weight maintenance on a long-term basis is the main problem in obesity treatment. There is a need for an increased understanding of the behaviour patterns involved in adopting a new dietary behavior and to maintain the behaviour over time.

    PURPOSE: The purpose of this paper is to explore overweight and obese middle-aged women's experiences of the dietary change processes when participating in a 2-year-long diet intervention.

    METHODS: Qualitative semi-structured interviews with 12 overweight and obese women (54-71 years) were made after their participation in a diet intervention programme. The programme was designed as a RCT study comparing a diet according to the Nordic nutrition recommendations (NNR diet) and a Palaeolithic diet (PD). Interviews were analysed according to Grounded Theory principles.

    RESULTS: A core category "Engagement phases in the process of a diet intervention" concluded the analysis. Four categories included the informants' experiences during different stages of the process of dietary change: "Honeymoon phase", "Everyday life phase", "It's up to you phase" and "Crossroads phase". The early part of the intervention period was called "Honeymoon phase" and was characterised by positive experiences, including perceived weight loss and extensive support. The next phases, the "Everyday life phase" and "It's up to you phase", contained the largest obstacles to change. The home environment appeared as a crucial factor, which could be decisive for maintenance of the new dietary habits or relapse into old habits in the last phase called "Crossroads phase".

    CONCLUSION: We identified various phases of engagement in the process of a long-term dietary intervention among middle-aged women. A clear personal goal and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Gender relations within the household must be considered as a possible obstacle for women engaging in diet intervention.

  • 190.
    Ahlgren, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Malmgren Olsson, Eva-Britt
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Brulin, Christine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gender analysis of musculoskeletal disorders and emotional exhaustion: interactive effects from physical and psychosocial work exposures and engagement in domestic work2012Inngår i: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 55, nr 2, s. 212-228Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to assess the relationships between physical and psychosocial work exposures, engagement in domestic work and work-home imbalance in relation to symptoms of musculoskeletal disorders and emotional exhaustion in white- and blue-collar men and women. Three thousand employees from 21 companies were asked to answer a questionnaire on family structure, household and child care tasks, work exposure, work-home imbalance and symptoms of neck/shoulder disorders, low back disorders and emotional exhaustion. Women reported more musculoskeletal disorders and engagement in domestic work. Adverse at-work exposures were highest in blue-collar women. High engagement in domestic work was not separately associated with symptoms but paid work exposure factors were associated. High engagement in domestic work interacted with adverse work exposure and increased risk estimates for low back disorders and emotional exhaustion. Reported work-home imbalance was associated with neck/shoulder disorders in women and with emotional exhaustion in both women and men.

    Practitioner Summary. The current article adds to earlier research by showing that high engagement in domestic work is not separately associated with increased symptoms, but interacts with psychosocial work exposure variables to produce emotional exhaustion in both women and men and low back disorders in women.

  • 191.
    Ahlgren, Christina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Waling, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Kadi, Fawzi
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Djupsjöbacka, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Centre for Musculoskeletal Research, National Institute for Working Life, Umeå , Sweden.
    Thornell, Lars-Eric
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Anatomi.
    Sundelin, Gunnevi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Effects on physical performance and pain from three dynamic training programs for women with work-related trapezius myalgia2001Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 33, nr 4, s. 162-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To compare training programs for women with trapezius myalgia regarding physical performance and pain, 102 women were randomized to strength, endurance, co-ordination and non-training groups. Before and after the intervention, static strength and dynamic muscular endurance in shoulder muscles were measured on a Cybex II dynamometer. Muscle activity in shoulder muscles was monitored via surface EMG. The signal amplitude ratio between the active and passive phase of repeated contractions indicated the ability to relax. Pain at present, pain in general and pain at worst were measured on visual analogue scales. After training, within group comparisons showed that the training groups rated less pain, and in the strength training group ratings of pain at worst differed from the non-training group. Using the non-training group as a reference, static strength increased in the strength and endurance training groups and muscular endurance in all training groups. The study indicates that regular exercises with strength, endurance or co-ordination training of neck/shoulder muscles might alleviate pain for women with work-related trapezius myalgia.

  • 192.
    Ahlgren, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
    Kalciumbrist - osteoporos: parathyreoideaes roll vid adaptionen till lågt kalciumintag hos vuxna råttor1975Doktoravhandling, med artikler (Annet vitenskapelig)
  • 193.
    Ahlgren, Ulf
    Umeå universitet, Medicinska fakulteten, Umeå centrum för molekylär medicin (UCMM).
    Exploring the pancreas with optical projection tomography2012Inngår i: Imaging in Medicine, ISSN 1755-5191, Vol. 4, nr 1, s. 5-7Artikkel i tidsskrift (Fagfellevurdert)
  • 194.
    Ahlgren, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Umeå centrum för molekylär medicin (UCMM).
    Gotthardt, Martin
    Department of Nuclear Medicine, Nijmegen, Netherlands.
    Approaches for imaging islets2010Inngår i: Advances in Experimental Medicine and Biology, ISSN 0065-2598, E-ISSN 2214-8019, Vol. 654, s. 39-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The establishment of improved technologies for imaging of the pancreas is a key element in addressing several aspects of diabetes pathogenesis. In this respect, the development of a protocol that allows for non-invasive scoring of human islets, or islet beta-cells, is of particular importance. The development of such a technology would have profound impact on both clinical and experimental medicine, ranging from early diagnosis of diabetes to the evaluation of therapeutic regimes. Another important task is the development of modalities for high-resolution imaging of experimental animal models for diabetes. Rodent models for diabetes research have for decades been instrumental to the diabetes research community. The ability to image, and to accurately quantify, key players of diabetogenic processes with molecular specificity will be of great importance for elucidating mechanistic aspects of the disease. This chapter aims to overview current progress within these research areas.

  • 195. Ahlin, Cecilia
    et al.
    Fernö, Mårten
    Amini, Rose-Marie
    Tolockiene, Egle
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Blomqvist, Carl
    Bergh, Jonas
    Fjällskog, Marie-Louise
    [Ki-67 and cyclin A: prognostic factors in breast cancer. Time to introduce proliferation markers in clinical routine].2010Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, nr 10, s. 672-675Artikkel i tidsskrift (Fagfellevurdert)
  • 196.
    Ahlinder, Annie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    Labba, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Logopedi.
    SIV-Speech clarity, Intelligibility & Voice: Development of a speech assessment tool for use by healthprofessionals who work with patients treated with DeepBrain Stimulation2013Independent thesis Advanced level (professional degree), 20 poäng / 30 hpOppgave
    Abstract [en]

    Background: Patients with Parkinson’s disease (PD) and Essential tremor (ET) who havebeen treated with Deep Brain Stimulation (DBS) generally experience a positive effect,particularly regarding the motor symptoms. However, the patients’ communication skillsare often negatively affected and the assessment instrument currently used withinneurological clinical care is not sufficiently sensitive to assess these patients’ speechclarity, voice and intelligibility satisfactorily.Aim: This study’s purpose was to develop a prototype assessment tool for speech clarity,intelligibility and voice, with speech and language pathology (SLP) validity, that isadaptable to a neurological clinical care setting.Method: The assessment tool was designed using general design methodology. Aprototype was constructed and tested on speech samples of read text for reliability. ThreeSLP’s, three DBS nurses and three naive listeners (NL) were represented in the test group.Levels of agreement were calculated using Percent Close Agreement, PCA.Results: The results indicate a relatively high level of agreement between the groups, inparticular the SLP group and the DBS group (μ: 0.82, 0.79, and 0.74).Conclusion: The results demonstrate the need for an assessment tool with SLPcompetence to assess speech clarity, intelligibility and voice within neurological clinicalcare. The assessment tool was shown to be a useful and adequate prototype that can easilyevolve into a truly useful and versatile perceptual speech assessment tool. The results ofthis study should be treated cautiously, considering the test groups’ modest size.

  • 197. Ahlinder, Jon
    et al.
    Ohrman, Caroline
    Svensson, Kerstin
    Lindgren, Petter
    Johansson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Forsman, Mats
    Larsson, Pär
    Sjödin, Andreas
    Increased knowledge of Francisella genus diversity highlights the benefits of optimised DNA-based assays2012Inngår i: BMC Microbiology, ISSN 1471-2180, E-ISSN 1471-2180, Vol. 12, s. 220-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Recent advances in sequencing technologies offer promising tools for generating large numbers of genomes, larger typing databases and improved mapping of environmental bacterial diversity. However, DNA-based methods for the detection of Francisella were developed with limited knowledge about genetic diversity. This, together with the high sequence identity between several Francisella species, means there is a high risk of false identification and detection of the highly virulent pathogen Francisella tularensis. Moreover, phylogenetic reconstructions using single or limited numbers of marker sequences often result in incorrect tree topologies and inferred evolutionary distances. The recent growth in publicly accessible whole-genome sequences now allows evaluation of published genetic markers to determine optimal combinations of markers that minimise both time and laboratory costs. Results: In the present study, we evaluated 38 previously published DNA markers and the corresponding PCR primers against 42 genomes representing the currently known diversity of the genus Francisella. The results highlight that PCR assays for Francisella tularensis are often complicated by low specificity, resulting in a high probability of false positives. A method to select a set of one to seven markers for obtaining optimal phylogenetic resolution or diagnostic accuracy is presented. Conclusions: Current multiple-locus sequence-typing systems and detection assays of Francisella, could be improved by redesigning some of the primers and reselecting typing markers. The use of only a few optimally selected sequence-typing markers allows construction of phylogenetic topologies with almost the same accuracy as topologies based on whole-genome sequences.

  • 198.
    Ahlm, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Distribution of puumala virus in Sweden1997Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Puumala virus, belonging to the genus hantavirus, is the causative agent of nephropathia epidemica (NE), a relatively mild form of hemorrhagic fever with renal syndrome. Puumala virus occurs endemically in Central and Northern Europe and Western Russia. In Sweden, NE is reported from the northern and central parts but virtually not at all from the southern part of the country. The bank vole (Clethrionomys glareolus) is the main reservoir of Puumala virus and humans are infected by inhalation of aerosolized animal secreta. In northern Sweden, the density of the bank vole population varies cyclically in intervals of 3-4 years and the incidence of NE shows a covariation.

    The prevalence of serum antibodies to hantaviruses in northern Sweden was studied in a stratified and randomly selected adult population sample comprising 1538 subjects. As expected, the prevalence increased with age. There was no difference between men and women, which was unexpected based on a male:female ratio of > 2:1 in clinical reports. By use of an immunofiuorescent assay, a seroprevalence of 5.4% and by a newly developed enzyme-linked immunosorbent assay (ELISA) with recombinant Puumala virus nucleocapsid protein as antigen, a prevalence of 8.9% was recorded. This is about or more than ten times higher than what would be calculated from clinical reports.

    By use of the ELISA, an occupational risk of acquisition of Puumala virus infection was demonstrated. Serum samples from 910 farmers and 663 referent subjects living in various rural parts of Sweden were tested. Among farmers from the Puumala virus-endemic northern and central parts of the country, the seroprevalence (12.9%) was higher (p=0.01) than in referents (6.8%). In the southern part of Sweden, only 2/459 persons had antibodies. Only a limited number of children with NE had been previously reported. In a separate study, 32 children with Puumala virus infection were identified and the clinical picture of NE in children was found to be similar to that of adult cases.

    Variations in the prevalence of Puumala virus in the bank vole population within an endemic region are not well known. Here, a higher mean rodent density and a higher prevalence of Puumala virus-specific serum antibodies were recorded in the vicinity of households afflicted with NE than in rural control areas. The data indicated that the risk of exposure locally within an endemic region may vary widely and tentatively suggested that a threshold density of bank voles might be necessary to achieve before effective spread of Puumala virus within the rodent population may occur.

    There is no firm evidence of the occurrence of Puumala virus among wild living animals other than rodents. A study of Swedish moose, an animal which is ecologically well characterized, was performed. Convincing evidence of past Puumala virus infection was found in 5/260 moose originating from Puumala virus-endemic areas but in none of 167 animals from nonendemic areas. Based on the low seroprevalence recorded, moose seemed to serve as endstage hosts rather than being active parts of the enzootic circle of transmission.

    In conclusion, the present investigations confirmed that the exposure to Puumala virus is geographically well restricted in Sweden. Seroprevalence studies indicated that only a minor proportion of individuals infected with Puumala virus are clinically reported, with a bias in favour of men. NE was confirmed to occur in children, with a clinical picture similar to that of adults. An occupational risk was defined for acquisition of Puumala virus infection. Studies in rodents suggested that there may be wide local variations within a limited area in the risk of exposure to Puumala virus. The studies validated the usefulness of a newly developed ELISA based on recombinant nucleocapsid peptides of hantaviruses and finally, methodological progress was reached when Puumala virus was, for the first time, successfully isolated from a Scandinavian patient.

  • 199.
    Ahlm, Clas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Vapalahti, O.
    University of Helsinki and Helsinki University Central Hospital Laboratory, Finland.
    Evander, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Seroprevalence of Sindbis virus and associated risk factors in northern Sweden2014Inngår i: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, nr 7, s. 1559-1565Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Mosquito-borne Sindbis virus (SINV) cause disease characterized by rash, fever and arthritis which often leads to long-lasting arthralgia. To determine the seroprevalence of SINV and associated risk factors in northern Sweden, a randomly selected population aged between 25 and 74 years were invited to join the MONICA study. Serum from 1611 samples were analysed for specific IgG antibodies. Overall, 2·9% had IgG against SINV. More men (3·7%) than women (2·0%) were SINV seropositive (P = 0·047) and it was more common in subjects with a lower educational level (P = 0·013) and living in small, rural communities (P < 0·001). Seropositivity was associated with higher waist circumference (P = 0·1), elevated diastolic blood pressure (P = 0·037), and history of a previous stroke (P = 0·011). In a multiple logistic regression analysis, adjusting for known risk factors for stroke, seropositivity for SINV was an independent predictor of having had a stroke (odds ratio 4·3, 95% confidence interval 1·4–13·0,P = 0·011).

  • 200.
    Ahlm, Clas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Lindén, Christina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Linderholm, M
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Alexeyev, O A
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Billheden, J
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Virologi.
    Fagerlund, M
    Zetterlund, B
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurofysiologi.
    Settergren, B
    Central nervous system and ophthalmic involvement in nephropathia epidemica (European type of haemorrhagic fever with renal syndrome)1998Inngår i: Journal of Infection, ISSN 0163-4453, E-ISSN 1532-2742, Vol. 36, nr 2, s. 149-155Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Central nervous system (CNS) - related symptoms occur in haemorrhagic fever with renal syndrome (HFRS). To study the CNS and ophthalmic involvement in nephropathia epidemica (NE), the European type of HFRS, we included 26 patients in a prospective study. Most common CNS-related symptoms were headache (96%), insomnia (83%), vertigo (79%), nausea (79%), and vomiting (71%). Ophthalmic symptoms were reported by 82% of patients; 41% had photophobia and 50% had impaired vision. A transient loss of vision was recorded in one patient, who also had a generalized seizure. Minor white matter lesions were found in about half of the patients investigated with brain magnetic resonance imaging (MRI). Electroencephalography (EEG) showed severe alterations in only one patient, and slight and reversible patterns in another two patients. Neopterin, interleukin-6 and interferon-gamma levels in the cerebrospinal fluid (CSF) were elevated, which may indicate immune activation. However, we found no evidence of intrathecal NE virus replication. We conclude that CNS-related symptoms are common in NE, and transient ophthalmic involvement can be demonstrated in about half of the patients.

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