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  • 201.
    Andersson, Chris D.
    et al.
    Linköping University Hospital.
    Meding, Birgitta
    Karolinska Institutet.
    Stenberg, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Svensson, Åke
    Malmö University Hospital.
    Working with Populations to Treat Individuals: A Report from the Swedish Dermato-Epidemiological Network (SweDEN)2012Ingår i: Forum for Nordic Dermato-Venerology, Vol. 17, nr 2, s. 44-46Artikel i tidskrift (Refereegranskat)
  • 202.
    Andersson, Christer
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Allmänmedicin.
    Svår akut intermittent porfyri kan behandlas framgångsrikt med levertansplantaoin.2004Ingår i: Läkartidningen, Vol. 101, s. 1887-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 203.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bjersing, Lars
    Lithner, Folke
    Hepatocellular carcinoma in patients from northern Sweden with acute intermittent porphyria: Morphology and mutations1996Ingår i: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 5, s. 393-397Artikel i tidskrift (Refereegranskat)
  • 204.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Blom, Helena
    Olofsson, Bengt-Olof
    Bjerle, P
    Wiklund, Urban
    Lithner, Folke
    Assessment of autonomic nerve funktion in acute intermittent porphyria; A study based on spectral analysisi of heart rate variability1996Ingår i: J Internal Medicine, Vol. 240, s. 73-79Artikel i tidskrift (Refereegranskat)
  • 205.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Bylesjö, Ingemar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lithner, Folke
    Effects of diabetes mellitus on patients with acute intermittent porphyria1999Ingår i: Journal of internal medicine, Vol. 245, nr 2, s. 193-7Artikel i tidskrift (Refereegranskat)
  • 206.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Floderus, Y
    Wikberg, Agneta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lithner, Folke
    The W198X and R173W mutations in the porphobilinogen deaminase gene in acute intermittent porphyria have higher clinical penetrance than R167: a populations-based study2000Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 60, nr 7, s. 643-648Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The biosynthesis of porphyrins is one of the most conserved parthways known, about the same sequence of reactions taking place in all species. By associating different metals, porphyrins give rise to the “pigments of life”: chlorophyll, haem and cobalamin. The unique tetrapyrrolic structure enables it to function in an array of reactions as a single electron carrier and as a catalyst for redox reactions. In this capacity, it constitutes the prosthetic group of enzymes participating in cellular respiration, in conversion reactions involving steroids and lipophilic xenobiotics, in protective mechanisms directed against oxidative stress and in pathways providing central messenger molecules. The formation of haem is accomplished by a sequence of eight dedicated enzymes encoded by different genes, some being active in ubiquitous as well as in erythroid isoforms. Large differences between the participating enzymes with regard to catalytic power, with low capacity steps positioned early in the catalytic chain, constitute a bar against substrate overloading of enzymes processing porphyrins, thus preventing accumulation in the body of these phototoxic compounds under physiological conditions. Most of the haem in the body is produced by the liver and bone marrow, but the mechanisms applied for the control of the synthesis differ between the two organs. The extremely potent hemeprotein enzymes formed in the liver are rapidly turned over in response to current metabolic needs. They have half-lives in the order of minutes or hours and are restored by fast-acting mechanisms for the de novo synthesis, when needed. Uninterrupted and instant availability of the compound is secured by acute deinhibition of the initial enzyme of the synthetic chain, ubiquitous 5-aminolevulinate synthase (ALAS-1), in response to drain of the free cellular haem pool caused by prevailing demands for hemeproteins or by increased catabolism of the compound. In contrast, in the erythroid progenitor cell the haem synthetic machinery is designed for uninterrupted production of huge amounts of haem for combination with globin chains to form hemoglobin at a steady rate. In the erythron the synthesis of the enzymes participating in the formation of haem is under control of erythropoietin, formed under hypoxic conditions. In the absence of iron, to be incorporated in the porphyrin formed in the last step of the synthesis, the mRNA of erythroid 5-aminolevulinate synthase (ALAS-2) is blocked by attachment of an iron-responsive element (IRE) binding cytosolic protein, and transcription of this key enzyme is inhibited. In humans, the genes for each of the haem synthetic enzymes may become the target of mutations that give rise to impaired cellular enzyme activity. Seven of the enzyme deficiencies are associated with accumulation of toxic intermediaries and with disease entities termed porphyrias. The acute porphyrias are characterized by attacks of neuropsychiatric symptoms, which may be due to a toxic surplus of the porphyrin presursor 5-aminolevulinic acid, or a consequence of a deficit of vital hemeproteins resulting from impaired synthesis of haem. In the cutaneous porphyrias, impairment of enzymatic steps where porphyrins are processed gives rise to solar hypersensitivity due to accumulation of phototoxic porphyrins in the skin. Early diagnosis, information to the patient regarding the nature of the illness and counselling aimed at avoidance of triggering factors are cornerstones in the handling of the porphyric diseases. Gene analysis is of incomparable diagnostic reliability in carrier detection, but biochemical methods must be applied in the important task of monitoring porphyric disease activity. In most forms of porphyria the gene carriers run the risk of development of associated diseases in liver or kidneys, a circumstance that prompts application of well-structured surveillance programs.

  • 207.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hultdin, Johan
    Schmauch, Annelie
    Dahlquist, Gisela
    Acute intermittent porphyria in childhood - a population-based study2003Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, s. 562-568Artikel i tidskrift (Refereegranskat)
  • 208.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Innala, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Acute intermittent porphyria in women: clinical expression, use and experience of exogenous sex hormones. A population-based study in northern Sweden2003Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 254, nr 2, s. 176-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the clinical expression of acute intermittent porphyria (AIP) in women, their use of exogenous sex hormones, and the effects on AIP. DESIGN: A retrospective population-based study. SUBJECTS: All women aged > or =18 years (n = 190) with DNA-diagnosed AIP in northern Sweden. RESULTS: A total of 166 women (87%) participated; 91 (55%) had manifest AIP. Severe attacks were reported by 82%; 39% reported recurrent premenstrual AIP attacks and 22% reported chronic AIP symptoms. Oral hormonal contraceptives had been used by 58% of all these women and by 50 with manifest AIP (57%). Twelve women (24%) associated oral contraceptives as precipitating AIP attacks; in nine cases their first attack. One woman experienced relief from AIP symptoms. On commencing their treatment, 72% of the women with manifest AIP had not yet suffered their first attack. Twenty-two women (25%) aged > or =45 years had used hormonal replacement therapy (HRT) at menopause to remedy climacteric symptoms (the percutaneous route was most frequently used); no AIP attack was precipitated. HRT to remedy vaginal dryness was used by 26 women (28%) aged > or =45 years without triggering an AIP attack. Miscarriages were more frequent in women with manifest AIP (50%) than in the latent group (30%, P = 0.014). CONCLUSIONS: About half of the women with AIP had used oral hormonal contraceptives. As 25% of women with manifest AIP reported attacks associated with such drugs, caution must still be recommended. Menopausal HRT only rarely affected the disorder. Miscarriage was more common amongst women with manifest AIP.

  • 209.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lithner, F.
    Umeå universitet, Medicinska fakulteten.
    Hypertension and renal impairment in patients with acute intermittent porphyria: a populaition-based study1994Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 236, nr 2, s. 169-175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To assess the association between acute intermittent porphyria (AIP), hypertension and renal disease.

    Design: A population-based matched case-control study (1:4) in 50 AIP patients (manifest/latent 25/25), a retrospective study of all individuals who died between the years 1978 and 1990 (2122 including 33 with AIP) and a group of eight patients with severe AIP.

    Results: Hypertension was found in 56% of patients with manifest AIP, 33% of their controls (P = 0.041) and 16% of patients with latent AIP (P = 0.004). Renal disease was not more common in patients with AIP than in their controls. Three of the eight patients with severe recurrent AIP had impaired renal function, caused in one by systemic lupus erythematosus (SLE) nephritis. In the other two, no cause other than AIP could be found. In the mortality study, hypertension was registered in 68% of patients with manifest AIP compared to 21% of those with latent AIP (P = 0.008) but death from myocardial infarction and stroke was not more common. Uraemia was cited as the cause of death in 9.1% of AIP patients and 1.0% of those without AIP (P = 0.006).

    Conclusions: Hypertension is more common in patients with manifest AIP than in those with latent AIP or control subjects. Renal disease may be due to hypertension, to AIP or to SLE. AIP may predispose to other renal diseases.

  • 210.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten.
    Lithner, Folke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Diagnosis of avute intermittent porphyria in northern Sweden. An evaluation of mutations analysis and biochemical methods1995Ingår i: J Internal Medicine, Vol. 237, s. 301-308Artikel i tidskrift (Refereegranskat)
  • 211.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten.
    Lithner, Folke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hypertension and renal disease in patients with acute intermitent porphyria1994Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 236, s. 169-175Artikel i tidskrift (Refereegranskat)
  • 212.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Nilsson, T.
    From the Primary Health Care Centre, Arvidsjaur, Sweden, .
    Bäckström, Torbjörn
    Atypical attack of acute intermittent porphyria: paresis but not abdominal pain2002Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 252, nr 3, s. 265-270Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We report a case of acute intermittent porphyria (AIP) in a 45-year-old woman. Her first attack occurred at the age of 38. Because of escalating cyclical premenstrual attacks, the following 2 years, depletion of the endogenous sex hormone was considered as haeme arginate treatment proved insufficient. Gonadotropin releasing hormone agonist treatment with low-dose oestradiol add back was quite successful initially but was abandoned after 18 months when progesterone add back precipitated a severe attack. Following hysterectomy and oophorectomy at age 42 and oestradiol add back, a remarkable monthly regularity of attacks ensured periodically but with milder symptoms. Two years after surgery, preceded by six attack-free months, a puzzling symptom-shift occurred, from abdominal pain, back and thigh pain during the attacks, to solely severe distal extensor paresis in the arms. Haeme arginate treatment interrupted the progress of the paresis almost immediately and motor function improved considerably up to the 9-month follow-up. Electrophysiological examination revealed only motor neuropathy, consistent with axonal degeneration. Subsequently the symptoms changed yet again, to sensory disturbances with numbness and dysesthesia as the primary expression followed by rather mild abdominal pain. However, cyclical attacks occurred, despite absence of endogenous ovarial hormone production, possibly attributable to impaired oestrogen metabolism in the liver, or adrenal oestrogen production. Treatment comprising oophorectomy, low-dose oestradiol add back and haeme arginate infusion for 2 days on the appearance of early AIP symptoms is now quite successful affording improvement in life quality.

  • 213.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Norberg, Margareta
    Eriksson, Jan W
    Rolandsson, Olof
    Stenlund, Hans
    Weinehall, Lars
    Combination of HbA1c, Fasting Glucose, and BMI is effective in Screening for Individuals at Risk of Future Type 2 Diabetes - OGTT is not needed2006Ingår i: J Internal Medicine, Vol. 260, s. 263-271Artikel i tidskrift (Refereegranskat)
  • 214.
    Andersson, Christer
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Wikberg, Agneta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lithner, Folke
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Renal symtomatology in patients with acute intermitent porphyria2000Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, s. 319-325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Can renal insufficiency in subjects with acute intermittent porphyria (AIP) be due solely to AIP?

    Design: A population-based study.

    Subjects: Subjects with AIP ≥ 18 years of age (n = 386) in the four most northerly counties of Sweden.

    Interventions: Screening with creatinine clearance at 24 h. Patients below the lower reference level underwent a repeat clearance test and, if still low, also chromEDTA clearance.

    Results: 286 (74%) subjects performed the creatinine clearance test and in 57 clearance was low; the second clearance proved normal in 23 who were then excluded. Eighteen subjects with other possible medical reasons for renal insufficiency, ethical reasons or refusing further examinations were also excluded. The 16 remaining subjects with no explanation for their renal insufficiency other than AIP were then studied in detail. All 14 women, mean age 52 years, and two uraemic men, 58 and 67 years, had manifest AIP. Twelve patients had hypertension (HT) and four were normotensive in spite of renal insufficiency. Histological findings of renal biopsies revealed diffuse glomerulosclerotic and interstitial changes with additional ischaemic lesions.

    Conclusion: Protracted vasospasm in attacks of AIP may be a cause of renal lesions. This is discussed.

  • 215.
    Andersson, Christoffer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Thoraxkirurgisk behandling av icke-småcellig lungcancer vid Norrlands Universitetssjukhus. - En registerstudie med data ur det nationella thoraxkirurgiska kvalitetsregistret ThoR och det nationella lungcancerregistret.2014Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 216. Andersson, E
    et al.
    Knutsson, A
    Hagberg, S
    Nilsson, T
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Karlsson, B
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Alfredsson, L
    Torén, K
    Incidence of asthma among workers exposed to sulphur dioxide and other irritant gases.2006Ingår i: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 27, nr 4, s. 720-725Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to investigate whether repeated peak exposure (gassings) to sulphur dioxide (SO2) and other irritant gases increases the risk of new-onset asthma. A questionnaire was sent to 4,112 sulphite workers, of whom 1,919 completed the questionnaire and 396 completed the short-form questionnaire, which was sent out as a last reminder. A sample of 130 nonrespondents completed a telephone interview using the short-form questionnaire. The incidence of adult-onset, physician-diagnosed asthma during employment duration was analysed in relation to exposure to SO2 and gassings giving rise to respiratory symptoms. Incidence rates, as well as incidence rate ratios with 95% confidence interval (CI), were calculated. Further Cox regression models were used allowing assessment of hazard ratios (HR) stratified for sex and adjusted for atopy, smoking habits and age. The incidence rate for asthma among sulphite mill workers reporting gassings of SO2 was 6.2 out of 1,000 person-yrs, compared with 1.9 out of 1,000 person-yrs among subjects unexposed to SO2 and any gassings (HR (95% CI) 4.0 (2.1-7.7)). Among males reporting gassings to SO2, the HR (95% CI) for asthma was 5.8 (2.6-13) compared with unexposed males. In conclusion, repeated peak exposure to sulphur dioxide increased the incidence of asthma during work in sulphite pulp mills, which supports the hypothesis of irritant-induced asthma.

  • 217. Andersson, Eva
    et al.
    Murgia, Nicola
    Nilsson, Tohr
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. Department of Occupational and Environmental Medicine, Sundsvall Hospital, Sundsvall, Sweden.
    Karlsson, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Torén, Kjell
    Incidence of chronic bronchitis in a cohort of pulp mill workers with repeated gassings to sulphur dioxide and other irritant gases2013Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 12, artikel-id 113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Occupational exposure to irritants is associated with chronic bronchitis. The aim of this study was to elucidate whether repeated peak exposures with respiratory symptoms, gassings, to sulphur dioxide (SO2) and other irritant gases could increase the risk of chronic bronchitis.

    METHODS: The study population comprised 3,060 Swedish pulp mill workers (84% males) from a cohort study, who completed a comprehensive questionnaire with items on chronic bronchitis symptoms, smoking habit, occupational history, and specific exposures, including gassings. 2,037 have worked in sulphite mills. Incidence rates and hazard ratios (HRs) for the observation period, 1970-2000, in relation to exposure and the frequency of repeated gassings to SO2 and other irritant gases were calculated.

    RESULTS: The incidence rate for chronic bronchitis among workers with repeated gassings was 3.5/1,000 person-years compared with 1.5/1,000 person-years among unexposed workers (HR 2.1, 95% confidence interval (CI) 1.4-3.1). The risk was even higher in the subgroup with frequent gassings (HR 3.2, 95% CI 2.0-5.2), particularly among never-smokers (HR 8.7, 95% CI 3.5-22).

    CONCLUSIONS: Repeated gassings to irritant gases increased the incidence of chronic bronchitis in our study population during and after work in pulp mills, supporting the hypothesis that occupational exposures to irritants negatively affect the airways. These results underscore the importance of preventive actions in this work environment.

  • 218.
    Andersson, Henrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Datortomografisk lungangiografi (DTLA) vid misstänkt lungemboli. Utfall vid DTLA och användande av diagnostikstöd vid Sundsvalls sjukhus.2015Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 219.
    Andersson, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Genusgörande och läkarblivande: attityder, föreställningar och förväntningar bland läkarstudenter i Sverige2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    The inclusion of a gender perspective in medicine has shown that gender is an essential factor in health and disease, in medical encounters and also in medical students’ educational environment. The aim of this study was to explore attitudes, preconceptions and norms regarding gender within medical education and processes of gender bias. First, we explored medical students gendered beliefs about patients. Second, we examined the medical students ideas about their future careers. Third, we compared awareness on gender issues among medical students in Sweden and the Netherlands.

    Method and material

    The analyses were based on data from two different sources: one experimental study based on authentic patient narratives about being diagnosed with cancer and one extensive questionaire exploring different aspects of gender issues in medical education. Both studies had a design which enabled both qualitative and quantitative research and mixed methods was used.

    Study I (Paper I and II): Eighty-one anonymous letters from patients were read by 130 students of medicine and psychology. For each letter the students were asked to state the patient’s sex and explain their choice. In paper I the students’ success rates were analysed statistically and the explanations to four letters were used to illustrate the students’ reasoning. Paper II examined the 87 medical students’ explanations closer to examine gender beliefs about patients.

    Study II (Paper III and IV): The questionaire started with an open question where medical students were asked to describe their ideal future, it also included a validated scale designed to estimate gender awareness. Paper III examined 507 swedish medical students descriptions about their ideal future and compared answers from male and female students in the beginning and at the end of medical school. Paper IV compared gender awareness among 1096 Swedish and Dutch medical students in first term.

    Findings with reflections

    Paper I showed that the patient’s sex was correctly identified in 62% of the cases. There were no difference between the results of male and female students. However, large differences between letters were observed, i.e. there were some letters were almost all students correctly identified the patient´s sex, others were almost all students were incorrect and most letters were found somewhere in the middle. Another significant finding was that the same expressions were interpreted differently depending on which initial guess the medical student had made regarding the sex of the patient.

    Paper II identified 21 categories of justifications within the students’ explanations, twelve of which were significantly associated with an assumption of either a male or female patient. Only three categories led to more correct identifications of the patients’ sex and two were more often associated with incorrect assignments. The results illustrate how beliefs about gender difference, even though they might be recognizable on a group level, are not applicable on individuals. Furthermore, the results show that medical students enter the education with beliefs about male and female patients, which could have consequenses and cause bias in their future work as doctors.

    Paper III found that almost all students, both male and female, were work-oriented. However, the female students even more so than their male counterparts. This result is particularly interesting in regards to the debate about the “feminization of medicine” in which the increasing number of female students has been adressed as a problem. When reflecting on their own lifes and their future its obvious that medical students nowadays, male and female, expect more to life than work, especially those who are on the doorstep to their professional life.

    Paper IV found that the national and cultural setting was the most crucial impact factor in relation to the medical students preconceptions and awareness about gender. The Swedish students expressed less stereotypic thinking about patients and doctors, while the Dutch students were more sensitive to gender difference. In both countries, the students’ sex mattered for gender stereotyping, with male students agreeing more to stereotypes.

    Conclusions

    A gender perspective is important in medical education. Our studies show that such initiatives needs to take cultural aspects, gender attitudes and students’ gender into account. Moreover, reflections on assumptions about men and women, patients as well as doctors, need to be included in medical curricula and the impact of implicit gender beliefs needs to be included in discussions on gender bias in health care. Also, the next generation of doctors want more to life than work. Future Swedish doctors, both female and male, intend to balance work not only with a family but also with leisure. This attitudinal change towards their future work as doctors will provide the health care system with a challenge to establish more adaptive and flexible work conditions.

  • 220.
    Andersson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Salander, Pär
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Brandstetter-Hiltunen, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Knutsson, Emma
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS).
    Is it possible to identify patient´s sex when reading blinded illness narratives? An experimental study about gender bias2008Ingår i: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 7, nr 21, s. 1-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In many diseases men and women, for no apparent medical reason, are not offered the same investigations and treatment in health care. This may be due to staff's stereotypical preconceptions about men and women, i.e., gender bias. In the clinical situation it is difficult to know whether gender differences in management reflect physicians' gender bias or male and female patients' different needs or different ways of expressing their needs. To shed some light on these possibilities this study investigated to what extent it was possible to identify patients' sex when reading their blinded illness narratives, i.e., do male and female patients express themselves differently enough to be recognised as men and women without being categorised on beforehand?

    Methods: Eighty-one authentic letters about being diseased by cancer were blinded regarding sex and read by 130 students of medicine and psychology. For each letter the participants were asked to give the author's sex and to explain their choice. The success rates were analysed statistically. To illuminate the participants' reasoning the explanations of four letters were analysed qualitatively.

    Results: The patient's sex was correctly identified in 62% of the cases, with significantly higher rates in male narratives. There were no differences between male and female participants. In the qualitative analysis the choice of a male writer was explained by: a short letter; formal language; a focus on facts and a lack of emotions. In contrast the reasons for the choice of a woman were: a long letter; vivid language; mention of emotions and interpersonal relationships. Furthermore, the same expressions were interpreted differently depending on whether the participant believed the writer to be male or female.

    Conclusion: It was possible to detect gender differences in the blinded illness narratives. The students' explanations for their choice of sex agreed with common gender stereotypes implying that such stereotypes correspond, at least on a group level, to differences in male and female patients' illness descriptions. However, it was also obvious that preconceptions about gender obstructed and biased the interpretations, a finding with implications for the understanding of gender bias in clinical practice.

  • 221.
    Andersson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Salander, Pär
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Using patients' narratives to reveal gender stereotypes among medical students2013Ingår i: Academic Medicine, ISSN 1040-2446, E-ISSN 1938-808X, Vol. 88, nr 7, s. 1015-1021Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Gender bias exists in patient treatment, and, like most people, health care providers harbor gender stereotypes. In this study, the authors examined the gender stereotypes that medical students hold about patients. Method: In 2005, in Umeå, Sweden, the authors collected 81 narratives written by patients who had undergone cancer treatment; all information that might reveal the patients’ gender was removed from the texts. Eighty-seven medical students read 40 or 41 narratives each, guessed the patient’s gender, and explained their guess. The authors analyzed the students’ explanations qualitatively and quantitatively to reveal the students’ gender stereotypes and to determine whether those stereotypes had any predictive value for correctly guessing a patient’s gender. Results: The students’ explanations contained 21 categories of justifications, 12 of which were significantly associated with the students guessing one gender or the other. Only three categories successfully predicted a correct identification of gender; two categories were more often associated with incorrect guesses. Conclusions: Medical students enter their training program with culturally shared stereotypes about male and female patients that could cause bias during their future careers as physicians. To prevent this, medical curricula must address gender stereotypes and their possible consequences. The impact of implicit stereotypes must be included in discussions about gender bias in health care.

  • 222.
    Andersson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Verdonk, Petra
    Johansson, Eva E
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lagro-Janssen, Toine
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Comparing gender awareness in Dutch and Swedish first-year medical students: results from a questionaire2012Ingår i: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 12, s. 3-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To ascertain good and appropriate healthcare for both women and men implementation of gender perspectives in medical education is needed. For a successful implementation, knowledge about students' attitudes and beliefs about men, women, and gender is crucial. The aim of this study was to compare attitudes to gender and gender stereotyping among Dutch and Swedish male and female medical students.

    Methods: In this cross-sectional study, we measured the attitudes and assumptions about gender among 1096 first year medical students (616 Dutch and 480 Swedish) with the validated Nijmegen Gender Awareness in Medicine Scale (N-GAMS). The response rate was 94% in the Netherlands and 93% in Sweden. Univariate analysis of variance (ANOVA) was used to compare the scores between Dutch and Swedish male and female students. Linear regressions were used to analyze the importance of the background variables.

    Results: There were significant differences in attitudes to gender between Dutch and Swedish students. The Swedish students expressed less stereotypical thinking about patients and doctors and the Dutch were more sensitive to gender differences. The students' sex mattered for gender stereotyping, with male students in both countries agreeing more with stereotypical statements. Students' age, father's birth country and mother's education level had some impact on the outcome.

    Conclusions: There are differences between cultures as well as between men and women in gender awareness that need to be considered when implementing gender in medical education. This study suggests that to arouse the students' interest in gender issues and make them aware of the significance of gender in medical work, the examples used in discussions need to be relevant and challenging in the context of the specific country. Due to different levels of knowledge and different attitudes within the student population it is important to create a climate for dialogue where students feel permitted to disclose their ideas and attitudes in order to become aware of what these are as well as their possible consequences on interaction and decision-making in medical work.

  • 223.
    Andersson, Jenny
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hultin, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Rolandsson, Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Att skapa läkare i glesbygd2018Ingår i: Allmänmedicin, ISSN 0281-3513, nr 3Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 224.
    Andersson, John
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Oudin, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Sundström, Anna
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nordin, Maria
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Road traffic noise, air pollution, and risk of dementia: results from the Betula project2018Ingår i: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 166, s. 334-339Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is growing evidence for a negative impact of traffic-related air pollution on risk of dementia. However, the contribution of noise exposure to this association has been rarely examined.

    Objective: We aimed to investigate the individual and combined effect of noise and air pollution on risk of dementia.

    Methods: Data on dementia incidence over a 15 year period was obtained from the Betula project, a longitudinal study on health and ageing. Estimates of annual mean levels of nitrogen oxides (NOx) at the participants’ residential address were obtained using a land-use regression model. Modelled data provided road traffic noise levels (Leq. 24 h) at the participants’ residential address at baseline. Cox proportional hazard regression was used to calculate hazard ratios (HR).

    Results: Of 1721 participants at baseline, 302 developed dementia during the follow up period. Exposure to noise levels (Leq. 24 h) > 55 dB had no significant effect on dementia risk (HR 0.95; CI: 0.57, 1.57). Residing in the two highest quartiles of NOx exposure was associated with an increased risk of dementia. The risk associated with NOx was not modified by adjusting for noise. Moreover, we found no significant interaction effects between NOx and road traffic noise on dementia risk.

    Conclusion: We found no evidence that exposure to road traffic noise, either independently or in combination with traffic air pollution, was associated with risk of dementia in our study area. Our results suggest that pollution should be considered the main component in the association between traffic related exposures and dementia.

  • 225.
    Andersson, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Adipose tissue as an active organ:  blood flow regulation and tissue-specific glucocorticoid metabolism2011Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Despite advances in the treatment of atherosclerosis, cardiovascular disease is the leading cause of death worldwide. With the population getting older and more obese, the burden of cardiovascular disease may further increase. Premenopausal women are relatively protected against cardiovascular disease compared to men, but the reasons for this sex difference are partly unknown. Redistribution of body fat from peripheral to central depots may be a contributing factor. Central fat is associated with hyperlipidemia, hyperglycemia, hypertension, and insulin resistance. Two possible mediators of these metabolic disturbances are tissue-specific production of the stress hormone cortisol and adipose tissue blood flow (ATBF). The aim of this thesis was to determine the adipose tissue production of cortisol by the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) and to investigate the regulation of ATBF.

    Materials and Methods: Cortisol release was estimated by labeled cortisol infusions and tissue-specific catheterizations of subcutaneous and visceral adipose tissue (VAT) in men. We investigated ATBF by 133Xe-washout and its relation to autonomic activity, endothelial function, adipose tissue distribution, and adipokines in different groups of women. We further investigated the effect of two diets and of weight loss on ATBF in women.

    Results: We demonstrated significant cortisol release from subcutaneous adipose tissue in humans. Splanchnic cortisol release was accounted for entirely by the liver. Cortisol release from VAT (to the portal vein) was not detected. ATBF decreased according to increasing weight and postmenopausal status, and the level of blood flow was associated with nitric oxide (NO) activity and autonomic activity. ATBF was also highly associated with leptin levels and both subcutaneous adipose tissue and VAT areas. After 6 months of diet and weight reduction, a significant difference in ATBF was observed between diet groups.

    Conclusions: Our data for the first time demonstrate the contributions of cortisol generated from subcutaneous adipose tissue, visceral tissues, and liver by 11β-HSD1. ATBF is linked to autonomic activity, NO activity, and the amount of adipose tissue (independent of fat depot). Postmenopausal overweight women exhibited a loss of ATBF flexibility, which may contribute to the metabolic dysfunction seen in this group. Weight loss in a diet program could not increase the ATBF, although there were ATBF differences between diet groups. The results will increase understanding of adipose tissue biology and contribute to the development of treatment strategies targeting obesity and obesity-related disorders.

  • 226.
    Andersson, Jonas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Inflammation and lifestyle in cardiovascular medicine2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Despite major advances in the treatment and prevention of atherosclerosis the last several decades, cardiovascular disease still accounts for the majority of deaths in Sweden. With the population getting older, more obese and with rising numbers of diabetics, the cardiovascular disease burden may increase further in the future.

    The focus in cardiovascular disease has shifted with time from calcification and narrowing of arteries to the biological processes within the atherosclerotic plaque. C-reactive protein (CRP) has emerged as one of many proteins that reflect a low grade systemic inflammation and is suitable for analysis as it is more stable and easily measured than most other inflammatory markers. Several large prospective studies have shown that CRP is not only an inflammatory marker, but even a predictive marker for cardiovascular disease. C-reactive protein is associated with several other risk factors for cardiovascular disease including obesity and the metabolic syndrome.

    Our study of twenty healthy men during a two week endurance cross country skiing tour demonstrated a decline in already low baseline CRP levels immediately after the tour and six weeks later.

    In a study of 200 obese individuals with impaired glucose tolerance randomised to a counselling session at their health care centre or a one month stay at a wellness centre, we found decreased levels of CRP in subjects admitted to the wellness centre. The effect remained at one, but not after three years of follow-up.

    In a prospective, nested, case-referent study with 308 ischemic strokes, 61 intracerebral haemorrhages and 735 matched referents, CRP was associated with ischemic stroke in both uni- and multivariate analyses. No association was found with intracerebral haemorrhages. When classifying ischemic stroke according to TOAST criteria, CRP was associated with small vessel disease. The CRP 1444 (CC/CT vs. TT) polymorphism was associated with plasma levels of CRP, but neither with ischemic stroke nor with intracerebral haemorrhage.

    A study on 129 patients with atrial fibrillation was used to evaluate whether inflammation sensitive fibrinolytic variables adjusted for CRP could predict recurrence of atrial fibrillation after electrical cardioversion. In multivariate iv models, lower PAI-1 mass was associated with sinus rhythm even after adjusting for CRP and markers of the metabolic syndrome.

    In conclusion, lifestyle intervention can be used to reduce CRP levels, but it remains a challenge to maintain this effect. CRP is a marker of ischemic stroke, but there are no significant associations between the CRP1444 polymorphism and any stroke subtype, suggesting that the CRP relationship with ischemic stroke is not causal. The fibrinolytic variable, PAI-1, is associated with the risk of recurrence of atrial fibrillation after electrical cardioversion after adjustment for CRP. Our findings suggest a pathophysiological link between atrial fibrillation and PAI-1, but the relation to inflammation remains unclear.

  • 227.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Almroth, Henrik
    Höglund, Niklas
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Jensen, Steen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Tornvall, Per
    Englund, Anders
    Rosenqvist, Mårten
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Markers of fibrinolysis as predictors for maintenance of sinus rhythm after electrical cardioversion2011Ingår i: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 127, nr 3, s. 189-192Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    No fibrinolytic component alone was found to be a predictor of recurrence of atrial fibrillation. In multivariate models lower PAI-1 mass was associated with sinus rhythm even after adjusting for CRP, markers of the metabolic syndrome and treatment with atorvastatin. Our findings suggest a patophysiological link between AF and PAI-1 mass but the relation to inflammation remains unclear.

  • 228.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Nilsson, Torbjørn K
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Effect of intensive lifestyle intervention on C-reactive protein in subjects with impaired glucose tolerance and obesity: results from a randomized controlled trial with 5-year follow-up2008Ingår i: Biomarkers: biochemical indicators of exposure, response, and susceptibility to chemicals, ISSN 1366-5804, Vol. 13, nr 7, s. 671-679Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    C-reactive protein (CRP) is a marker of metabolic and cardiovascular disease. To study the effects of lifestyle on CRP in a high-risk population we conducted a randomized controlled trial on 200 obese subjects (BMI > 27 kg m(-2)) with impaired glucose tolerance recruited from primary care settings. They were randomized to either a 1-month stay at a wellness centre focusing on diet, exercise and stress management (intervention group) or 30-60 min of oral and written information on lifestyle intervention (control group). A significant reduction of CRP was observed after 1 month and 1 year in the intervention group. They reduced their CRP levels more than the control group 1 year after intervention (p=0.004). In conclusion lifestyle intervention can decrease CRP in obese individuals with impaired glucose tolerance for up to 1 year. Further research is needed to evaluate whether the CRP level reduction translates into a decreased risk for cardiovascular morbidity.

  • 229.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Hellsten, Gideon
    Nilsson, Torbjörn K
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Effects of heavy endurance physical exercise on inflammatory markers in non-athletes2010Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 209, nr 2, s. 601-605Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Physical activity has beneficial effects on cardiovascular disease but the mechanisms are still somewhat unclear. One possible pathway may be through the anti-inflammatory effects attributed to regular physical activity. Our primary aim was to study the effects of endurance physical exercise on C-reactive protein (CRP), Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNFalpha) during the acute and recovery phases. Secondarily, we studied the impact of diet on these inflammatory markers.

    METHODS: Twenty men, aged 18-55 years, participated in a 14 days cross-country skiing tour. They traveled 12-30km per day corresponding to about 10h of heavy physical activity. The participants were randomized to a diet with either 30 or 40% of energy derived from fat. Inflammatory variables were analysed at week 0, after 1 and 2 weeks and during the recovery phase at week 6 and 8.

    RESULTS: CRP and TNFalpha increased significantly during the two weeks of exercise (1.4-5.0mg/l, p=0.00 and 6.8-8.4pg/ml, p=0.00). CRP levels were significantly lower during recovery (median 0.7mg/l) compared to baseline (median 1.4mg/l) and did not correlate to metabolic variables. There were no significant changes in IL-6 levels during the study period. For dietary groups significant CRP changes were observed only in the high fat group during recovery.

    CONCLUSIONS: CRP and TNFalpha increased significantly but reacted differently during heavy physical activity while there seemed to be no significant changes in IL-6. No significant differences regarding inflammatory variables were found between the dietary groups.

  • 230.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Johansson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ladenvall, Per
    Wiklund, Per-Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Jern, Christina
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    C-reactive protein is a determinant of first-ever stroke: prospective nested case-referent study2009Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 27, nr 6, s. 544-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: C-reactive protein (CRP) is a determinant of stroke, but there are no prospective studies on CRP and first ischemic stroke divided into etiologic subtypes. Our primary aim was to study CRP as a determinant of ischemic stroke, classified according to Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria, and intracerebral hemorrhage (ICH) in a prospective study. A secondary aim was to study the relationship between the 1444C>T polymorphism, plasma levels of CRP and stroke.

    METHODS: The study was a prospective population-based case-referent study nested within the Northern Sweden Cohorts. We defined 308 cases of ischemic stroke and 61 ICH. Two controls for each case were defined from the same cohort.

    RESULTS: The OR for the highest (>3 mg/l) versus lowest group (<1 mg/l) of CRP was 2.58 (95% CI 1.74-3.84) for ischemic stroke and 1.63 (95% CI 0.67-3.93) for ICH. In a multivariate model including traditional risk factors, CRP remained associated with ischemic stroke (OR 2.06; 95% CI 1.29-3.29). Small-vessel disease was associated with CRP in the multivariate model (OR 3.88; 95% CI 1.10-13.7). The CRP 1444 (CC/CT vs. TT) polymorphism was associated with plasma levels of CRP but neither with ischemic stroke nor with ICH.

    CONCLUSIONS: This prospective population-based study shows that CRP is significantly associated with the risk of having a first ischemic stroke, especially for small-vessel disease. No significant associations were found between the CRP 1444C>T polymorphism and any stroke subtype.

  • 231.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Karpe, Fredrik
    NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK.
    Sjöström, Lars-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Riklund, Katrine
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Association of adipose tissue blood flow with fat depot sizes and adipokines in women2012Ingår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 36, nr 6, s. 783-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore possible associations between adipose tissue (AT) blood flow (ATBF), AT depot sizes and adipocyte-derived hormones (adipokines) in women.

    Subjects: In all, 43 healthy women were divided into four groups: normal-weight (n=11) and obese (n=11) pre-menopausal women and normal-weight (n=10) and obese (n=11) post-menopausal women.

    Methods: Fasting levels of adipokines were obtained, and a single-slice computed tomography scan at the level of L4-L5 was used to estimate fat depot sizes. ATBF was assessed by xenon washout while in a fasting state and after oral glucose load. We also measured glucose, insulin and non-esterified fatty acids.

    Results: Total, subcutaneous and visceral AT areas strongly correlated with ATBF (all P<0.001). Circulating leptin levels strongly and inversely correlated with ATBF (P=0.001), but this association did not remain after adjustment for body mass index. Adiponectin was not associated with blood flow.

    Conclusion: ATBF is closely linked to subcutaneous and visceral AT size. Further analyses are needed to determine possible mediators of this association, including mechanistic studies to assess a putative role for leptin as a significant modulator of blood flow. International Journal of Obesity advance online publication, 26 July 2011; doi:10.1038/ijo.2011.152.

  • 232.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Mellberg, Caroline
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Otten, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ryberg, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rinnström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Larsson, Christel
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hauksson, Jon
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. d Department of Radiography and Biomedical Science, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
    Johansson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention2016Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 216, s. 92-96Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Accumulation of myocardial triglycerides (MTG) is associated with impaired left ventricular (LV) remodelling and function in obese and diabetic subjects. The role of MTG accumulation in development of heart failure in this group of patients is unknown. Short-term studies suggest that diets that lead to weight loss could mobilize MTG, with a favourable effect on cardiac remodelling. In a 24-month, randomized, investigator-blinded study, we assessed the effect of two different diets and subsequent weight loss on cardiac function and MTG in postmenopausal women. Methods: Sixty-eight healthy postmenopausal women with body mass index [BMI] >= 27 kg/m(2) were randomized to an ad libitum Palaeolithic diet (PD) or a Nordic Nutrition Recommendation (NNR) diet for 24 months. Morphology, cardiac function, and MTG levels were measured using magnetic resonance (MR) scanning, including proton spectroscopy at baseline and 6 and 24 months. Results: Despite mean weight losses of 4.9 (1.0) kg (NNR) and 7.8 (1.1) kg (PD), the MTG content did not change over time (p = 0.98 in the NNR and p = 0.11 in the PD group at 24 months). Reduced left ventricular mass was observed in both diet groups over 24 months. Blood pressure was reduced at 6 months, but returned to baseline levels at 24 months. End diastolic volume, stroke volume, and cardiac output decreased over time. No differences between diet groups were observed. Conclusions: Diet intervention and moderate weight loss over 24 months improved LV remodelling but did not alter MTG levels in overweight/obese postmenopausal women.

  • 233.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rosenqvist, Mårten
    Tornvall, Per
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    NT-proBNP predicts maintenance of sinus rhythm after electrical cardioversion.2015Ingår i: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 135, nr 2, s. 289-291Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia. NT-proBNP is a fragment of the prohormone brain natriuretic peptide. Previous studies indicate that increased levels of NT-proBNP are associated with higher recurrence rates of AF after electrical cardioversion. Our null hypothesis was that NT-proBNP does not predict recurrence of AF after restoration of sinus rhythm.

    METHODS: We performed a hypothesis generating study within a double-blinded, placebo-controlled, randomized, prospective multicentre study of the effects of atorvastatin on recurrence of AF after electrical cardioversion. 199 patients with persistent AF and an indication for cardioversion were included in the present substudy. NT-proBNP was assessed prior to cardioversion. Cardioversion was performed according to local standard clinical practice on an elective outpatient basis. Patients were followed-up one month after cardioversion.

    RESULTS: 181 patients had a successful cardioversion and 91 of the study group remained in sinus rhythm at day 30. Recurrence of AF was observed in 108 patients at day 30. An optimal cutpoint for NT-proBNP at 500 ng/L predicted recurrence of AF after cardioversion (OR 2.94; 95% CI 1.30-6.63). In multivariate analysis adjusting for age, sex, hypertension, and treatment group strengthened the results (OR 3,56; 95% CI 1,44-8,81). When analysing the ROC curve of NT-proBNP in baseline and atrial fibrillation at day 30 the result was 0.57.

    CONCLUSION: NT-proBNP levels are a predictor of recurrence of AF 30 days after cardioversion. ROC curves indicates that the practical value of NT-proBNP for the individual patient is limited.

  • 234.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Ryberg, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sjöström, Lars-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wiklund, Urban
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF).
    Karpe, Fredrik
    NIHR Oxford Biomedical Research Centre, Churchill Hospital, Oxford, UK..
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Long term effects of a diet intervention on adipose tissue blood flow, heart rate variability and endothelial function: a randomized controlled trialManuskript (preprint) (Övrigt vetenskapligt)
  • 235.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sjöström, Lars-Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Karlsson, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Wiklund, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Hultin, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Karpe, Fredrik
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Dysregulation of subcutaneous adipose tissue blood flow in overweight postmenopausal women2010Ingår i: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 17, nr 2, s. 365-371Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: A putative link between abdominal obesity and metabolic-vascular complications after menopause may be due to a decreased adipose tissue blood flow (ATBF). The present work aimed to analyze possible changes in ATBF with being overweight and menopausal and its putative link to endothelial dysfunction and autonomic nervous system balance.

    METHODS: Forty-three healthy women were classified into four groups according to weight and menopause status. The ATBF was measured by xenon washout while fasting and after oral glucose intake. The nitric oxide synthase inhibitor asymmetric dimethylarginine was used as a marker of endothelial function and heart rate variability-estimated autonomic nervous system activity.

    RESULTS: Fasting ATBF was decreased in both overweight groups (P = 0.044 and P = 0.048) versus normal-weight premenopausal women. Normal-weight and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight premenopausal women (P = 0.015 and P = 0.001, respectively), and overweight postmenopausal women exhibited lower maximum ATBF compared with normal-weight postmenopausal women (P = 0.003). A negative correlation was found between fasting ATBF and asymmetric dimethylarginine (P = 0.015), whereas maximum ATBF was negatively associated with sympathetic-parasympathetic nervous system balance (ratio of the power of the low frequency to the power of the high frequency; P = 0.002).

    CONCLUSIONS: Loss of ATBF flexibility in overweight postmenopausal women may contribute to the metabolic dysfunction seen in this group of women.

  • 236.
    Andersson, Jonas
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lundblad, Dan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Escher, Stefan A
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Diabetes mellitus, high BMI and low education level predict sudden cardiac death within 24 hours of incident myocardial infarction2016Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, nr 17, s. 1814-1820Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: More than half of cardiovascular mortality occurs outside the hospital, mainly due to consistently low survival rates from out-of-hospital cardiac arrest.

    METHODS: This is a prospective, nested, case-control study derived from the Västerbotten Intervention Programme and the World Health Organization's Multinational Monitoring of Trends and Determinants in Cardiovascular Disease study in northern Sweden (1986-2006). To determine predictors for sudden cardiac death risk factors for cardiovascular disease were compared between incident myocardial infarction with sudden cardiac death (n = 363) and survivors of incident myocardial infarction (n = 1998) using multivariate logistic regression analysis.

    RESULTS: Diabetes had the strongest association with sudden cardiac death out of all evaluated risk factors (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.30-2.59), followed by low education (OR 1.55, 95% CI 1.19-2.01), high body mass index (OR 1.05, 95% CI 1.02-1.08) and male sex (OR 1.42, 95% CI 1.001-2.01).

    CONCLUSIONS: The pattern of risk factors for incident myocardial infarction is different among survivors and those who die within 24 hours. The risk factors that contribute the most to death within 24 hours are diabetes mellitus, high body mass index and low education level, and can be addressed at both the public health level and by general practitioners.

  • 237. Andersson, K.
    et al.
    Pullerits, R.
    Forsblad-d'Elia, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi. Dept Rheumatology and inflammation research, Inst Medicine, Göteborg university, Göteborg.
    Erlandsson, M.
    Silfversward, T.
    Bokarewa, M.
    Oestrogen dependent regulation of micro-rna in rheumatoid arthritis2018Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 77, s. 236-237Artikel i tidskrift (Övrigt vetenskapligt)
  • 238. Andersson Kallin, Sandra
    et al.
    Lindberg, Eva
    Nilsson Sommar, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bossios, Apostolos
    Ekerljung, Linda
    Malinovschi, Andrei
    Middelveld, Roelinde
    Janson, Christer
    Excessive daytime sleepiness in asthma: what are the risk factors?2018Ingår i: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 55, nr 18, s. 844-850Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Previous studies have found that excessive daytime sleepiness (EDS) is a more common problem in asthmatic subjects than in the general population. The aim of this study was to investigate whether the prevalence of EDS is increased in asthmatic subjects and, if so, to analyse the occurrence of potential risk factors for EDS in asthmatics.

    METHODS: Cross-sectional epidemiological study. In 2008, a postal questionnaire was sent out to a random sample of 45,000 individuals aged 16-75 years in four Swedish cities.

    RESULTS: Of the 25,160 persons who participated, 7.3% were defined as having asthma. The prevalence of EDS was significantly higher in asthmatic subjects (42.1% vs 28.5%, p<0.001) compared with non-asthmatic subjects. Asthma was an independent risk factor for EDS (adjusted OR 1.29) and the risk of having EDS increased with asthma severity. Risk factors for EDS in subjects with asthma included insomnia (OR, 3.87; 95% CI, 3.10-4.84), chronic rhinosinusitis (OR, 2.00; 95% CI, 1.53-2.62), current smoking (OR, 1.60; 95% CI, 1.15-2.22) and obesity (OR, 1.53; 95% CI, 1.09-2.13).

    CONCLUSIONS: EDS is a common problem among subjects with asthma. Asthma is an independent risk factor for having EDS. Furthermore, subjects with asthma often have other risk factors for EDS, many of them potentially modifiable.

  • 239.
    Andersson, Kennet
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Suhr, Ole B.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Faes, Luca
    Wiklund, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Directed coherence analysis in patients with severe autonomic dysfunction2014Ingår i: 2014 8th conference of the European Study Group on Cardiovascular Oscillations (ESGCO), IEEE conference proceedings, 2014, s. 167-168Konferensbidrag (Refereegranskat)
    Abstract [en]

    Many different approaches have been applied to analyse the coupling between cardiovascular signals. This study evaluated the use of directed coherence, based on multivariate autoregressive modelling, for analysis of cardiovascular signals in patients with transthyretin amyloidosis, a rare disease where severe autonomic dysfunction is common.

  • 240.
    Andersson, Kristin
    et al.
    Laboratory Medicine, Lund University, Malm ö , Sweden.
    Bray, Freddie
    Cancer Registry of Norway, Oslo, Norway.
    Arbyn, Marc
    Unit of Cancer Epidemiology, Scientifi c Institute of Public Health, Brussels, Belgium.
    Storm, Hans
    Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark.
    Zanetti, Roberto
    Piedmont Cancer Registry – CPO, Torino, Italy.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Coebergh, Jan W
    Comprehensive Cancer Centre South, Eindhoven, Netherlands.
    Dillner, Joakim
    Laboratory Medicine, Lund University, Malmö, Sweden.
    The interface of population-based cancer registries and biobanks in etiological and clinical research: current and future perspectives2010Ingår i: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 49, nr 8, s. 1227-1234Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The availability of quality assured, population-based cancer registries and biobanks with high quality samples makes it possible to conduct research on large samples sets with long follow-up within a reasonable time frame. Defined quality for both cancer registries and biobanks is essential for enabling high quality biobank-based research. Recent networking projects have brought these infrastructures together to promote the combined use of cancer registries and biobanks in cancer research.

    MATERIALS AND METHODS: In this report we review the current status and future perspectives of cancer registries and biobanks and how the interface between them should be developed to optimally further cancer research.

    RESULTS AND DISCUSSION: Major conclusions for future improvements are that the research exploiting cancer registries and biobanks, and the research that is building and optimising the infrastructure, should evolve together for maximally relevant progress. Population-based and sustainable biobanks that continuously and consecutively store all samples ("Biological registries") under strict quality control are needed. There is also a need for increased education, information and visibility of the interdisciplinary sciences required for optimal exploitation of these resources.

  • 241.
    Andersson, Linus
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Claesson, Anna-Sara
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Nyberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
    Stenberg, Berndt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Brain responses to olfactory and trigeminal exposure in idiopathic environmental illness (IEI) attributed to smells: An fMRI study2014Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 77, nr 5, s. 401-408Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Idiopathic environmental intolerance (IEI) to smells is a prevalent medically unexplained illness. Sufferers attribute severe symptoms to low doses of non-toxic chemicals. Despite the label, IEI is not characterized by acute chemical senses. Theoretical models suggest that sensitized responses in the limbic system of the brain constitute an important mechanism behind the symptoms. The aim was to investigate whether and how brain reactions to low-levels of olfactory and trigeminal stimuli differ in individuals with and without IEI. METHODS: Brain responses to intranasally delivered isoamyl acetate and carbon dioxide were assessed in 25 women with IEI and 26 non-ill controls using functional magnetic resonance imaging. RESULTS: The IEI group had higher blood-oxygenated-level-dependent (BOLD) signal than controls in the thalamus and a number of, mainly, parietal areas, and lower BOLD signal in the superior frontal gyrus. The IEI group did not rate the exposures as more intense than the control group did, and there were no BOLD signal differences between groups in the piriform cortex or olfactory regions of the orbitofrontal cortex. CONCLUSIONS: The IEI reactions were not characterized by hyper-responsiveness in sensory areas. The results can be interpreted as a limbic hyperreactivity and speculatively as an inability to inhibit salient extemal stimuli.

  • 242. Andersson, Liselott
    et al.
    Eliasson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sundström Poromaa, Inger
    Increased free androgen index is associated with hypertension in premenopausal women2011Ingår i: Open Journal of Obstetrics and Gynecology, ISSN 2160-8792, E-ISSN 2160-8806, Vol. 1, s. 228-233Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Increased testosterone and decreased sex hormone-binding globulin (SHBG) are associated with a number of adverse cardiovascular risk factors in postmenopausal women. The aim of this popula-tion-based study of women aged 25 to 50 was to as-sess the relationship between free androgen index (FAI) and cardiovascular risk factors in premeno-pausal women.

    Methods: A population-based survey of 396 premenopausal women with no hormonal trea- tment was undertaken as part of the Northern Swe-den MONICA study. The study involved question-naires, anthropometry and assays of testosterone and SHBG.

    Results: Increased FAI was associated with a number of cardiovascular risk factors in premeno-pausal women but this relationship was strongly af-fected by body mass index (BMI). After adjustment for age and BMI, FAI was significantly associated with increased systolic and diastolic blood pressures.

    Conclusion: Hyperandrogenism is associated with increased blood pressure and these findings empha-size the need to assess cardiovascular risk factors in women with hyperandrogenism of all ages.

  • 243.
    Andersson, Louise
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Oudin Åström, Daniel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Pettersson-Strömbäck, Anita
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Åström, Christofer
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Med värme ihågkommen2012Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Syftet med detta projekt har varit att med hjälp av en intervjustudie och kunskapsgenomgång redovisahur utomhusmiljö, gemensamhetslokaler och bostäder kan utformas för att minska risken för att äldreoch personer med nedsatt funktionsförmåga blir medtagna eller dör i förtid under värmeböljor. Måletär att öka medvetenheten och intresset för anpassning av miljö och byggnader hos personer ansvarigaför samhällsplanering, bostadsbestånd, trygghets-, vård- och omsorgsboenden.

    Städer är normalt varmare och mindre blåsiga än det omgivande landskapet. Städernas ”varmareklimat” beror främst på den större värmelagring som kan ske i byggnader, gator, trottoarer mm,begränsat med vegetation som kan skugga och avge fukt samt aktiviteter som trafik och eldning vilketgenererar värme. Under värmeböljor ökar dödligheten mer i städer. Att leva ensam, vara sängbundenoch bo på översta våningen har visats vara riskfaktorer.

    Åtgärderna för att minska stadens värmeö och värmeböljornas effekter på människor brukar iblanddelas in i ”mjuka åtgärder” (information, varningssystem för värmeböljor, insatser för känsligagrupper), ”gröna åtgärder” (göra staden till en grönare miljö) och ”tekniska åtgärder” (skuggandekonstruktioner, modifiering av väggar, kylning/luftkonditionering inomhus etc.), vilka kompletterarvarandra. I vissa länder, bl. a. England, ska äldreboenden ha ett samlingsrum som kan hållas svaltäven under värmeböljor, men det är oklart vilken juridisk status som bestämmelserna har.

    Intervjustudien syftade till att belysa hur problemen uppfattas av personal inom äldreomsorgen iSverige. Som datainsamlingsmetod genomfördes 20 semistrukturerade intervjuer medomvårdnadspersonal i Botkyrka kommun under oktober 2011. Urvalet baserades påtillgänglighetsprincipen. Innehållsanalyser gjordes på transkriberad intervjudata och kategorier ochunderkategorier skapades utifrån återkommande teman som återfanns i texten. Slutsatserna frånstudien pekar på att de utbildnings- och informationsinsatser angående värmeböljors effekter påkänsliga grupper som riktas till personal inom äldreomsorgen borde intensifieras, samt attpersonalens kunskap om verksamheten och vårdtagarnas behov borde tas tillvara redan iplaneringsstadiet för äldreboenden.

  • 244.
    Andersson, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Asthma in school age: prevalence, incidence and remission in relation to environmental determinants. The Obstructive Lung Disease in Northern Sweden (OLIN) Studies, Thesis XI2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background In the past half-century, the prevalence of asthma among children and adolescents has risen and asthma has become an important public health challenge in Sweden as well as in many other countries, necessitating further studies on this complex disease and its risk factor pattern. The studies included in this thesis aimed to investigate the clinical expression of childhood asthma over time, to describe the determinants of new-onset and remission of asthma, and to evaluate possible environmental risk factors in northern Sweden.

    Methods As the result of a repeated questionnaire survey among primary school children aged 7-8 years in three municipalities in the north of Sweden, two pediatric cohorts were formed, one in 1996 (n=3430) and one in 2006 (n=2585). The cohort created in 1996 was followed annually until the age of 19 years. Skin prick testing was performed on children in both cohorts. Lung function and bronchial hyperreactivity testing were carried out in children with asthma in the first cohort. The study participation and retention rates were very high in both cohorts. Among children in the second cohort living in Luleå, the home addresses were assigned to coordinates in a geographical information system (GIS) to evaluate the impact on respiratory health of living near roads with much traffic, which was measured as the number of vehicles daily. We used a validated reported diagnosis of asthma and International Study of Asthma and Allergies in Childhood (ISAAC) questions were incorporated into the questionnaire. A cross-sectional study of children of the same age ten years apart, longitudinal studies on asthma incidence and remission as well as a cross-sectional study on vehicle traffic were performed.

    Results While children aged 7-8 years in 2006 more often had a physician-diagnosed asthma compared to children of the same age in 1996 (7.4% vs 5.7%, p<0.001), they had less asthma symptoms, especially severe symptoms. In parallel, a more beneficial environment and a more intense treatment with inhaled corticosteroids (ICS) were observed. The explanation for this change in clinical expression probably includes also an increased awareness and diagnosing of asthma. From age 12 years to age 19 years, the cumulative incidence of physician-diagnosed asthma was 7.2% and of current wheeze 22.0%. The risk of new-onset asthma in adolescence was increased among girls, sensitized and those with heredity for asthma. Smoking and home dampness increased the risk for incident wheeze. The risk for both incident asthma and wheeze was inversely related to number of siblings. Among children with current asthma at age 7-8 years, 21% were in remission, 38% had periodic asthma and 41% had persistent asthma at a follow-up at age 19 years. Subjects in remission and with periodic asthma had significantly less airway obstruction and showed less bronchial hyperreactivity compared to subjects with persistent asthma. The probability of asthma remission from childhood to early adulthood was significantly increased by absence of allergic sensitization, male gender and a low asthma severity scoring at age 7-8 years. Sensitization to furred animals was more important as a determinant of both incidence and remission than sensitization to pollen. Living close to roads with high traffic flows, especially with heavy vehicles, was associated with an increased risk for current wheeze. Stratified analyses showed that the effect of traffic on asthma and wheeze was restricted to non-sensitized subjects.

    Conclusion Asthma onset in adolescence was more common among girls and remission was more common among boys. Children sensitized to furred animals and children with a more severe asthma were risk groups for persistence of asthma. Environmental factors such as smoking and dampness were associated to onset of asthma symptoms during adolescence, and vehicle traffic was associated with asthma symptoms among children also in a small city with relatively low traffic flows. Preventive measures like smoking reduction programs, improvement of damp housing conditions and separation of areas where many children live from heavily trafficked roads could prove to be beneficial.

  • 245.
    Andersson, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN studies, Luleå, Sweden..
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN studies, Luleå, Sweden.
    Nordberg, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hagenbjörk, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN studies, Luleå, Sweden.
    Eriksson, Kåre
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN studies, Luleå, Sweden.
    Early life swimming pool exposure and asthma onset in children: a case-control study2018Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 17, artikel-id 34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Trichloramine exposure in indoor swimming pools has been suggested to cause asthma in children. We aimed to investigate the risk of asthma onset among children in relation to individual trichloramine exposure.

    METHODS: A longitudinal nested case-control study of 337 children with asthma (cases) and 633 controls aged 16-17 years was performed within a population-based cohort from The Obstructive Lung Disease in Northern Sweden studies (OLIN). Year of asthma onset and exposure time at different ages were obtained in telephone interviews. Trichloramine concentrations in the pool buildings were measured. Skin prick test results for inhalant allergens were available from previous examinations of the cohort. The risk for asthma was analyzed in relation to the cumulative trichloramine exposure before onset of asthma.

    RESULTS: Swimming pool exposure in early life was associated with a significantly higher risk of pre-school asthma onset. A dose-response relationship between swimming pool exposure and asthma was indicated in children with asthma onset at 1 year of age. Children who were both sensitized and exposed had a particularly high risk.

    CONCLUSIONS: Early life exposure to chlorinated swimming pool environments was associated with pre-school asthma onset.

  • 246.
    Andersson, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bjerg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    The clinical expression of asthma in schoolchildren has changed between 1996 and 20062010Ingår i: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 21, nr 5, s. 859-866Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Several studies have reported diverging trends in the prevalence of asthma and wheeze. The aim of this study was to investigate the clinical expression of childhood asthma in 1996 and 2006 by studying asthma morbidity, treatment, and environmental exposures in school children with physician-diagnosed asthma and wheeze, respectively. All children enrolled in first or second grade (7-8 yr-old) in three municipalities in northern Sweden were invited to a questionnaire study in 1996 and 2006, respectively. In 1996, 3430 (97%) participated; and in 2006, 2585 (96%) participated. The same parental completed questionnaire, including the ISAAC questions, was used in both surveys. Physician-diagnosed asthma was reported at 5.7% in 1996 and 7.4% in 2006. A significantly greater proportion of children with asthma were using inhaled corticosteroids (ICS) in 2006, 67% vs. 55% in 1996. This increase was parallel to a major decrease in severe asthma symptoms such as disturbed sleep because of wheeze (49% vs. 38%) and troublesome asthma (21% vs. 11%). The prevalence of current wheeze among the asthmatics decreased significantly; however, this was seen only among children not using ICS. Parental smoking decreased significantly as did the proportion living in damp buildings. In conclusion, although asthma remains a major public health issue in school age children, children with asthma had less respiratory symptoms and a better asthma control in 2006 compared to 1996. This parallels with an increase in treatment with ICS, more beneficial environmental conditions, and an increased diagnostic intensity resulting in a larger proportion of children with mild symptoms being diagnosed as having asthma.

  • 247.
    Andersson, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Luleå.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Luleå.
    Bjerg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. The OLIN Studies, Luleå ; Krefting Research Centre, Institute of Medicine, Göteborgs universitet.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Lundbäck, Bo
    The OLIN Studies, Luleå ; Krefting Research Centre, Institute of Medicine, Göteborgs universitet.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Luleå.
    Remission and Persistence of Asthma Followed From 7 to 19 Years of Age2013Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 132, nr 2, s. E435-E442Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: To date, a limited number of population-based studies have prospectively evaluated the remission of childhood asthma. This work was intended to study the remission and persistence of childhood asthma and related factors. METHODS: In 1996, a questionnaire was distributed to the parents of all children aged 7 to 8 years in 3 municipalities in northern Sweden, and 3430 (97%) participated. After a validation study, 248 children were identified as having asthma; these children were reassessed annually until age 19 years when 205 (83%) remained. During the follow-up period lung function, bronchial challenge testing, and skin prick tests were performed. Remission was defined as no use of asthma medication and no wheeze during the past 12 months as reported at endpoint and in the 2 annual surveys preceding endpoint (ie, for >= 3 years). RESULTS: At age 19 years, 21% were in remission, 38% had periodic asthma, and 41% persistent asthma. Remission was more common among boys. Sensitization to furred animals and a more severe asthma (asthma score >= 2) at age 7 to 8 years were both inversely associated with remission, odds ratio 0.14 (95% confidence interval 0.04-0.55) and 0.19 (0.07-0.54), respectively. Among children with these 2 characteristics, 82% had persistent asthma during adolescence. Asthma heredity, damp housing, rural living, and smoking were not associated with remission. CONCLUSIONS: The probability of remission of childhood asthma from age 7- to 8-years to age 19 years was largely determined by sensitization status, particularly sensitization to animals, asthma severity, and female gender, factors all inversely related to remission.

  • 248.
    Andersson, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnéa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Bjerg, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Lundbäck, B
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Persistence and remission of asthma followed from 7 to 19 years of ageManuskript (preprint) (Övrigt vetenskapligt)
  • 249.
    Andersson, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Norrbotten County Council, Luleå, Sweden.
    Hedman, Linnéa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Norrbotten County Council, Luleå, Sweden.
    Nordberg, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Eriksson, Kåre
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin. The OLIN Studies, Norrbotten County Council, Luleå, Sweden.
    Swimming pool attendance is related to asthma among atopic school children: a population-based study2015Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 14, nr 14, artikel-id 37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: By-products of water disinfectants have been suggested to cause asthma, especially in atopic children. However, studies on indoor swimming pool attendance and asthma in children have presented conflicting results. The present study examined the relationship between indoor swimming pool attendance and asthma among sensitized and non-sensitized children aged 11-12 years.

    Methods: An extended ISAAC questionnaire was sent to the families of all children attending fifth or sixth grade, aged 11-12 years, in two municipalities in Northern Sweden in 2010. A total of 1866 participated (96% of those invited) in the questionnaire study and 1652 (89%) also participated in skin prick testing for 10 standard airborne allergens. Asthma was defined as physician-diagnosed asthma in combination with wheeze or use of asthma medication in the last 12 months. Current swimming pool attendance was reported as >= 1/week or <1/week. Logistic regression models were used for data analysis.

    Results: The prevalence of current asthma was 8.9% (10.0% of boys; 7.9% of girls) and 14% had attended indoor pools >= 1/week. Children currently attending swimming pools >= 1/week had an increased risk of current asthma. Stratified analyses for allergic sensitization adjusted for sex, parental smoking, parental asthma, and damp housing, showed a statistically significant association for current asthma only among sensitized subjects (OR 95% CI 1.90 1.09-3.32). No association was found between current pool attendance and wheeze, sensitization, rhinitis or eczema.

    Conclusions: The present study supports the proposed link between indoor swimming pool attendance and asthma in sensitized children.

  • 250.
    Andersson, Martin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Modig, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Hedman, Linnea
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Forsberg, Bertil
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Heavy vehicle traffic is related to wheeze among schoolchildren: a population-based study in an area with low traffic flows2011Ingår i: Environmental health, ISSN 1476-069X, E-ISSN 1476-069X, Vol. 10, nr 91Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: An association between traffic air pollution and respiratory symptoms among children has been reported. However, the effects of traffic air pollution on asthma and wheeze have been very sparsely studied in areas with low traffic intensity in cold climate with poor dispersion. We evaluated the impact of vehicle traffic on childhood asthma and wheeze by objective exposure assessment.

    Methods: As a part of the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a questionnaire was sent to the families of all children attending first or second grade in Luleå (72,000 inhabitants) in Northern Sweden in 2006. The age of the children was 7-8 years and the participation rate was 98% (n = 1357). Skin prick tests were performed in 1224 (89%) children. The home addresses were given geographical coordinates and traffic counts were obtained from the local traffic authorities. A proximity model of average daily traffic and average daily heavy vehicle traffic within 200 meters from each participant's home address was used. The associations between traffic exposure and asthma and wheeze, respectively, were analysed in an adjusted multiple logistic regression model.

    Results: Exposure to high traffic flows was uncommon in the study area; only 15% of the children lived within 200 meters from a road with a traffic flow of ≥8000 vehicles per day. Living closer than 200 meters from a road with ≥500 heavy vehicles daily was associated with current wheeze, odds ratio 1.7 (confidence interval 1.0-2.7). A dose-response relation was indicated. An increased risk of asthma was also seen, however not significant, odds ratio 1.5 (confidence interval 0.8-2.9). Stratified analyses revealed that the effect of traffic exposure was restricted to the non-sensitized phenotype of asthma and wheeze. The agreement between self-reported traffic exposure and objective measurements of exposure was moderate.

    Conclusions: This study showed that already at low levels of exposure, vehicle traffic is related to an increased risk of wheeze among children. Thus, the global burden of traffic air pollution may be underestimated.

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