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  • 301. Appelros, Peter
    et al.
    Jonsson, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asberg, Signild
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Glader, Eva-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asberg, Kerstin Hulter
    Norrving, Bo
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Terent, Andreas
    Trends in Stroke Treatment and Outcome between 1995 and 2010: Observations from Riks-Stroke, the Swedish Stroke Register2014Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, nr 1, s. 22-29Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care.

    Methods: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered. Results: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes.

    Conclusions: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital. (C) 2013 S. Karger AG, Basel

  • 302. Appelros, Peter
    et al.
    Jonsson, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asplund, Kjell
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Eriksson, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Glader, Eva-Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asberg, Kerstin Hulter
    Norrving, Bo
    Stegmayr, Birgitta
    Epidemiologic Center, National Board of Health and Welfare, Stockholm.
    Terént, Andreas
    Trends in baseline patient characteristics during the years 1995-2008: observations from Riks-Stroke, the Swedish Stroke Register2010Ingår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 30, nr 2, s. 114-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Many baseline parameters in Riks-Stroke have changed over the years. This has consequences for the interpretation of outcome data. Some changes may be due to inclusion bias, others due to alterations in general health, evolution of vascular risk factors or demographics.

  • 303. Appelros, Peter
    et al.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Terént, Andreas
    Riks-Stroke och hur fallgropar vid tolkning av resultaten undviks2008Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 8, s. 529-533Artikel i tidskrift (Övrigt vetenskapligt)
  • 304. Appelros, Peter
    et al.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Terént, Andreas
    Sex differences in stroke epidemiology: a systematic review2009Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 40, nr 4, s. 1082-1090Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: Epidemiological studies, mainly based on Western European surveys, have shown that stroke is more common in men than in women. In recent years, sex-specific data on stroke incidence, prevalence, subtypes, severity and case-fatality have become available from other parts of the world. The purpose of this article is to give a worldwide review on sex differences in stroke epidemiology. METHODS: We searched PubMed, tables-of-contents, review articles, and reference lists for community-based studies including information on sex differences. In some areas, such as secular trends, ischemic subtypes and stroke severity, noncommunity-based studies were also reviewed. Male/female ratios were calculated. RESULTS: We found 98 articles that contained relevant sex-specific information, including 59 incidence studies from 19 countries and 5 continents. The mean age at first-ever stroke was 68.6 years among men, and 72.9 years among women. Male stroke incidence rate was 33% higher and stroke prevalence was 41% higher than the female, with large variations between age bands and between populations. The incidence rates of brain infarction and intracerebral hemorrhage were higher among men, whereas the rate of subarachnoidal hemorrhage was higher among women, although this difference was not statistically significant. Stroke tended to be more severe in women, with a 1-month case fatality of 24.7% compared with 19.7% for men. CONCLUSIONS: Worldwide, stroke is more common among men, but women are more severely ill. The mismatch between the sexes is larger than previously described.

  • 305.
    Arabi, Thyba
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Biomedicinsk laboratorievetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Cajal cellernas roll i mag-tarm komplikationer hos patienter med transtyretin amyloidos2017Självständigt arbete på grundnivå (yrkesexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 306. Araghi, Marzieh
    et al.
    Galanti, Maria Rosaria
    Lundberg, Michael
    Lager, Anton
    Engström, Gunnar
    Alfredsson, Lars
    Knutsson, Anders
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Sund, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Trolle Lagerros, Ylva
    Bellocco, Rino
    Pedersen, Nancy L.
    Östergren, Per-Olof
    Magnusson, Cecilia
    Use of moist oral snuff (snus) and pancreatic cancer: pooled analysis of nine prospective observational studies2017Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 141, nr 4, s. 687-693Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83–1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.

  • 307. Araghi, Marzieh
    et al.
    Galanti, Maria Rosaria
    Lundberg, Michael
    Liu, Zhiwei
    Ye, Weimin
    Lager, Anton
    Engström, Gunnar
    Manjer, Jonas
    Alfredsson, Lars
    Knutsson, Anders
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Palmqvist, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gylling, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lagerros, Ylva Trolle
    Bellocco, Rino
    Pedersen, Nancy L
    Östergren, Per-Olof
    Magnusson, Cecilia
    Smokeless tobacco (snus) use and colorectal cancer incidence and survival: Results from nine pooled cohorts2017Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 45, nr 8, s. 741-748Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.

    METHODS: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

    RESULTS: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.

    CONCLUSIONS: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.

  • 308. Araujo, Pedro
    et al.
    Tilahun, Ephrem
    Zeng, Yingxu
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    A novel strategy for discriminating marine oils by using the positional distribution (sn-1, sn-2, sn-3) of omega-3 polyunsaturated fatty acids in triacylglycerols2018Ingår i: Talanta: The International Journal of Pure and Applied Analytical Chemistry, ISSN 0039-9140, E-ISSN 1873-3573, Vol. 182, s. 32-37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A novel strategy for discriminating genuine and adulterated marine oils is proposed. The strategy consists of i) determining the stereospecific distribution (sn-1, sn-2 and sn-3) of omega 3 polyunsaturated fatty acids (omega-3 PUFA) on the backbone of triacylglycerols by using liquid chromatography tandem mass spectrometry; ii) transforming the qualitative stereospecific information into quantitative data by means of a novel strategy; iii) analyzing the transformed data by principal component analysis. The proposed strategy was tested on pure oils (seal, salmon, cod liver, sandeel, blue whiting, herring), a mixture of blue whiting, herring, sandeel and Norway pout and some intentionally adulterated oils. In addition, some published krill oil data were analyzed to confirm the reliability of the new approach.

  • 309.
    Arinaitwe, Moses
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Initiative and Innovation: A Narrative Account of Rural Hospital Workers in Eastern Uganda2012Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
  • 310.
    Arista, Nora Nindi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Does Health Insurance Protect Indonesians from Catastrophic Health Expenditure and Impoverishment?: The Analysis of if Health Insurance is protective against Catastrophic Health Expenditure and Impoverishment In Indonesia2017Självständigt arbete på avancerad nivå (magisterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: The World Health Organization has called for implementing universal health coverage to protect households from catastrophic health expenditure and impoverishment. However, few studies in Indonesia has focused on the benefits of health insurance in protecting against catastrophic health expenditure and impoverishment. This study aims to examine whether health insurance protects the household from catastrophic health expenditure and impoverishment and if so what characteristics are to some extent associated with catastrophic health expenditure and impoverishment.

    Methods: Cross-sectional data at household level from Indonesia Family Life Survey (IFLS) in wave 5 (2014-2015) have been used. 14.080 households are included in the analysis. The distribution of health payments and catastrophic expenditure methodology was used to measure catastrophic health expenditure and impoverishment. Multiple logistic regressions were done for examining the association between catastrophic health spending, impoverishment and health insurance, after adjusting for other socio-demographic factors (household size, area, health care utilization, chronic disease, etc.). Sensitivity analysis was used to check the sensitivity of the main result.

    Results: Household with up to one-third and more than two third of the family member have health insurance have a lower risk of catastrophic health spending. In contrast, we found a non-significant association of health insurance and impoverishment after adjustment (p>0.05). The household characteristics that are associated with catastrophic health expenditure and impoverished were a family lives in rural area, have more than two third of its member have chronic diseases, have higher inpatient visit, have at least one member<5 years old or >55 years old, and lower level of education for a household leader.

    Conclusion: This study found that health insurance has the possibility to protect the households from catastrophic health expenditure, but not from impoverishment. The study presents important implications for health policymakers, which increasing the coverage of health insurance especially for vulnerable group or households in Indonesia setting is important to protect and reduce the burden of out-of-pocket health expenditures.

  • 311.
    Arista, Nora Nindi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Socioeconomic Inequalities in Smoking Behaviour among Adults in Indonesia: A Decomposition Analysis2018Självständigt arbete på avancerad nivå (masterexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Background: Tobacco consumption is one of the most significant causes of premature death globally. One out of four men in the world is an active smoker with a total estimate of 933 million current smokers in 2015. Indonesia has one of the highest smoking rates in the world along with Russia and Bangladesh. Smoking was concentrated among the worst-off population in many low-middle income countries. Studies on the determinants of socioeconomic disparities in smoking in Indonesia are currently lacking. This study fills this gap of knowledge by investigating the socioeconomic inequality in smoking and socioeconomic factors explaining the disparities in smoking behaviour among adults aged 15 years old and above in Indonesia.

    Methods: This cross-sectional study utilized data from the Indonesia Family Life Survey (IFLS) Wave 5 conducted in 2014-2015. The study included 29,844 individuals aged above 15 years old. The outcome was smoking status (defined as current smokers and never smokers). Socioeconomic status was defined based on wealth index created using Principal Component Analysis on housing characteristics and ownership of assets. Socioeconomic inequalities in smoking were measured using Concentration Index (CI) and graphed as Concentration Curve (CC). The determinants of socioeconomic inequalities in smoking (including socioeconomic, material and psychosocial factors) were assessed using Wagstaff decomposition analysis. All the analyses were conducted separately for men and women.

    Result: About 70.3% of men and 2.4% of women was current smokers in Indonesia (p<0.001). The concentration index showed an existing socioeconomic inequalities in smoking behaviour was concentrated among the poorest, and the inequality was more prominent among men (CI: -0.23; 95%CI: -0.26; -0.20) compared with women (CI: -0.05; 95% CI: -0.06; -0.04)). The decomposition analysis indicated that wealth index was the major contributor to socioeconomic inequalities in both gender (men: 26.6%, women: 49.2%).

    Conclusion: Smoking is concentrated among the most impoverished population in both genders, and is more prominent among men. The major contributor to the socioeconomic inequalities in smoking is material factors, particularly the wealth index. This study confirms the multi-dimension determinants of smoking inequalities such as the sociodemographic, material, psychosocial, and health factors. Therefore, a comprehensive approach and government commitment to smoking prevention and control are needed to reduce the prevalence of smoking in Indonesia, especially among the most vulnerable group.

  • 312.
    Arnadottir, Solveig A
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik. School of Health Sciences, University of Akureyri, Iceland .
    Gunnarsdottir, Elin D
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Determinants of self-rated health in old age: a population-based, cross-sectional study using the international classification of functioning2011Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, s. 670-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Self-rated health (SRH) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older populations concerning future health, functional decline, disability, and mortality. The aim of this study was to use the theoretical framework of the International Classification of Functioning, Disability and Health (ICF) to create a better understanding of factors associated with SRH among community-dwelling older people in urban and rural areas.

    Methods: The study design was population-based and cross-sectional. Participants were 185 Icelanders, randomly selected from a national registry, community-dwelling, 65-88 years old, 63% urban residents, and 52% men. Participants were asked: "In general, would you say your health is excellent, very good, good, fair, or poor?" Associations with SRH were analyzed with ordinal logistic regression. Explanatory variables represented aspects of body functions, activities, participation, environmental factors and personal factors components of the ICF.

    Results: Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables. Multivariate analysis, however, demonstrated that SRH had an independent association with five variables representing ICF body functions, activities, and personal factors components: The likelihood of a better SRH increased with advanced lower extremity capacity (adjusted odds ratio [adjOR] = 1.05, < 0.001), upper extremity capacity (adjOR = 1.13, = 0.040), household physical activity (adjOR = 1.01, = 0.016), and older age (adjOR = 1.09, = 0.006); but decreased with more depressive symptoms (adjOR = 0.79, < 0.001).

    Conclusions: The results highlight a collection of ICF body functions, activities and personal factors associated with higher SRH among community-dwelling older people. Some of these, such as physical capacity, depressive symptoms, and habitual physical activity are of particular interest due to their potential for change through public health interventions. The use of ICF conceptual framework and widely accepted standardized assessments should make these results comparable and relevant in an international context.

  • 313.
    Arnadottir, Solveig A
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Gunnarsdottir, Elin D
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Participation frequency and perceived participation restrictions at older age: applying the International Classification of Functioning, Disability and Health (ICF) framework2011Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 33, nr 23-24, s. 2208-2216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To identify variables from different components of International Classification of Functioning, Disability and Health (ICF) associated with older people's participation frequency and perceived participation restrictions. Method: Participants (N = 186) were community-living, 65-88 years old and 52% men. The dependent variables, participation frequency (linear regression) and perceived participation restrictions (logistic regression), were measured using The Late-Life Function and Disability Instrument. Independent variables were selected from various ICF components. Results: Higher participation frequency was associated with living in urban rather than rural community (beta = 2.8, p < 0.001), physically active lifestyle (beta = 4.6, p < 0.001) and higher cognitive function (beta = 0.3, p = 0.009). Lower participation frequency was associated with being older (beta = -0.2, p = 0.002) and depressive symptoms (beta = -0.2, p = 0.029). Older adults living in urban areas, having more advanced lower extremities capacity, or that were employed had higher odds of less perceived participation restrictions (adjusted odds ratio [OR] = 5.5, p = 0.001; OR = 1.09, p < 0.001; OR = 3.7, p = 0.011; respectively). In contrast, the odds of less perceived participation restriction decreased as depressive symptoms increased (OR = 0.8, p = 0.011). Conclusions: Our results highlight the importance of capturing and understanding both frequency and restriction aspects of older persons' participation. ICF may be a helpful reference to map factors associated with participation and to study further potentially modifiable influencing factors such as depressive symptoms and advanced lower extremity capacity.

  • 314.
    Arnadottir, Solveig
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Gunnarsdottir, E
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Self-rated health: a valid outcome in geriatric physical therapy?Artikel i tidskrift (Refereegranskat)
  • 315.
    Arnetz, Bengt B.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Department of Family Medicine, College of Human Medicine, Michigan State University, Michigan, USA; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Lewalski, Philip
    Arnetz, Judy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Department of Family Medicine, College of Human Medicine, Michigan State University, Michigan, USA; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Breejen, Karen
    Przyklenk, Karin
    Examining self-reported and biological stress and near misses among Emergency Medicine residents: a single-centre cross-sectional assessment in the USA2017Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 8, artikel-id e016479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To examine the relationship between perceived and biological stress and near misses among Emergency Medicine residents.

    Design: Self-rated stress and stress biomarkers were assessed in residents in Emergency Medicine before and after a day shift. The supervising physicians and residents reported numbers of near misses.

    Setting: The study took place in the Emergency Department of a large trauma 1 centre, located in Detroit, USA. Participants Residents in Emergency Medicine volunteered to participate. The sample consisted of 32 residents, with complete data on 28 subjects. Residents' supervising physicians assessed the clinical performance of each resident.

    Primary and secondary outcome measures: Participants' preshift and postshift stress, biological stress (salivary cortisol, plasma interleukin-6, tumour necrosis factor-alpha (TNF-alpha) and high-sensitivity C-reactive protein), residents' and supervisors' reports of near misses, number of critically ill and patients with trauma seen during the shift.

    Results: Residents' self-reported stress increased from an average preshift level of 2.79 of 10 (SD 1.81) to a postshift level of 5.82 (2.13) (p<0.001). Residents cared for an average of 2.32 (1.52) critically ill patients and 0.68 (1.06) patients with trauma. Residents reported a total of 7 near misses, compared with 11 reported by the supervising physicians. After controlling for baseline work-related exhaustion, residents that cared for more patients with trauma and had higher levels of TNF-a reported a higher frequency of near misses (R-2=0.72; p=0.001). Residents' preshift ratings of how stressful they expected the shift to be were related to the supervising physicians' ratings of residents' near misses during the shift.

    Conclusion: Residents' own ratings of near misses were associated with residents' TNF-alpha, a biomarker of systemic inflammation and the number of patients with trauma seen during the shift. In contrast, supervisor reports on residents' near misses were related only to the residents' preshift expectations of how stressful the shift would be.

  • 316.
    A'Roch, Roman
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Gustafsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Johansson, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Poelaert, Jan
    Anesthesiology, University of Brussels, Belgium.
    Haney, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Left ventricular strain and peak systolic velocity: responses to controlled changes in load and contractility, explored in a porcine model2012Ingår i: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 10, nr 22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Tissue velocity echocardiography is increasingly used to evaluate global and regional cardiac function. Previous studies have suggested that the quantitative measurements obtained during ejection are reliable indices of contractility, though their load-sensitivity has been studied in different settings, but still remains a matter of controversy. We sought to characterize the effects of acute load change (both preload and afterload) and change in inotropic state on peak systolic velocity and strain as a measure of LV contractility.

    METHODS: Thirteen anesthetized juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and transthoracic echocardiography. Transient inflation of a vena cava balloon catheter produced controlled load alterations. At least eight consecutive beats in the sequence were analyzed with tissue velocity echocardiography during the load alteration and analyzed for change in peak systolic velocities and strain during same contractile status with a controlled load alteration. Two pharmacological inotropic interventions were also included to generate several myocardial contractile conditions in each animal.

    RESULTS: Peak systolic velocities reflected the drug-induced changes in contractility in both radial and longitudinal axis. During the acute load change, the peak systolic velocities remain stable when derived from signal in the longitudinal axis and from the radial axis. The peak systolic velocity parameter demonstrated no strong relation to either load or inotropic intervention, that is, it remained unchanged when load was systematically and progressively varied (peak systolic velocity, longitudinal axis, control group beat 1- 5.72 +/- 1.36 with beat 8- 6.49 +/- 1.28 cm/sec, 95% confidence interval), with the single exception of the negative inotropic intervention group where peak systolic velocity decreased a small amount during load reduction (beat 1- 3.98 +/- 0.92 with beat 8- 2.72 +/- 0.89 cm/sec). Systolic strain, however, showed a clear degree of load-dependence.

    CONCLUSIONS: Peak systolic velocity appears to be load-independent as tested by beat-to-beat load reduction, while peak systolic strain appears to be load-dependent in this model. Peak systolic velocity, in a controlled experimental model where successive beats during load alteration are assessed, has a strong relation to contractility. Peak systolic velocity, but not peak strain rate, is largely independent of load, in this model. More study is needed to confirm this finding in the clinical setting.

  • 317.
    A'roch, Roman
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Gustafsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Johansson, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Poelaert, Jan
    Dept of Anesthesiology and Perioperative Medicine, University hospital of Brussels. Belgium.
    Haney, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Strain and peak systolic velocities: relation to load in a porcine modelManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background:  Tissue velocity echocardiography is increasingly used to evaluate global and regional cardiac function.  Previous studies have suggested that the quantitative measurements obtained during ejection are reliable indices of contractility.  Their load-sensitivity has been studied in different settings, but still remains a matter of controversy.  We sought to characterize the effects of acute load change and change in inotropic state on peak systolic velocity and strain as a measure of LV contractility, and particularly to determine if these parameters were load-dependent.

    Methods: Thirteen anesthetised juvenile pigs were studied, using direct measurement of left ventricular (LV) pressure and volume and transthoracic echocardiography. Transient inflation of a vena cava balloon catheter produced controlled preload alterations.  At least eight consecutive beats in the preload alteration sequence were analysed with tissue velocity echocardiography (TVE) during the preload alteration and analysed for change in peak systolic velocities (PSV) and strain (e) during same contractile status with a controlled preload alteration.  Two pharmacological inotropic interventions were also included to generate several myocardial contractile conditions in each animal.

    Results: PSV reflected the drug-induced changes in contractility in both radial and longitudinal axis.  During the acute load change, the PSV remain stable when derived from signal in the longitudinal axis and from the radial axis.  The peak systolic velocity parameter demonstrated no strong relation to either load or inotropic intervention, that is, it remained unchanged when load was systematically and progressively varied.  Peak systolic strain, however, showed a clear degree of load-dependence.

    Conclusion:  Peak systolic velocity appears to be load-independent as tested by beat to beat load reduction, while peak systolic strain appears to be load-dependent in this model.  Peak systolic velocity has a strong relation to contractility, independent of load, in serial measures, in this model.  More study is needed to confirm this in the clinical setting.

  • 318.
    A'roch, Roman
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Gustafsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Poelaert, Jan
    Dept of Anesthesiology and Perioperative Medicine, University hospital of Brussels. Belgium.
    Johansson, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Haney, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Left ventricular twist is load-dependentManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Background: Left ventricular rotation and twist can be assessed noninvasively by speckle tracking echocardiography. We sought to characterize the effects of acute load change and change in inotropic state on rotation parameters as a measure of LV contractility.

    Methods: Seven anesthetised juvenile pigs were studied, using direct measurement of left ventricular (LV) pressure and volume and simultaneous transthoracic echocardiography. Transient inflation of an inferior vena cava balloon catheter (IVCBO) produced controlled load reduction.  First and last beats in the sequence of eight were analysed with speckle tracking (STE) during the load alteration and analysed for change in rotation/twist during controlled load alteration at same contractile status.  Two pharmacological inotropic interventions were also included to examine the same hypothesis in additionally conditions of increased and decreased myocardial contractility in each animal.

    Results: The IVCBO load change compared for first to last beat resulted in LV twist increase (11.67° ±2.65° vs. 16.17° ±3.56° respectively, p < 0.004) during the load alteration and under adrenaline stimulation LV twist increase 12.56° ±5.1° vs. 16.57° ±4.6° (p < 0.013), and though increased, didn’t reach significance in nega­tive inotropic condition.  Untwisting rate increased significantly at baseline from    -41.7°/sec ±41.6°/sec vs. -122.6°/sec ±55.8°/sec (P < 0.039) and under adrenaline stimulation untwisting rate increased  (-55.3°/sec ±3.8°/sec vs.  -111.4°/sec ±24.0°/sec (p<0.05), but did not systematically changed in negative inotropic condition.

    Conclusions: Peak systolic LV twist and peak early diastolic untwisting rate are load dependent.  Changes in LV load should be considered when interpreting  LV rotation/ twist.

  • 319.
    A'Roch, Roman
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Gustafsson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Poelaert, Jan
    Anesthesiology, University of Brussels, Belgium.
    Johansson, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Haney, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Left ventricular twist is load-dependent as shown in a large animal model with controlled cardiac load2012Ingår i: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 10, nr 26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Left ventricular rotation and twist can be assessed noninvasively by speckle tracking echocardiography. We sought to characterize the effects of acute load change and change in inotropic state on rotation parameters as a measure of left ventricular (LV) contractility.

    METHODS: Seven anesthetised juvenile pigs were studied, using direct measurement of left ventricular pressure and volume and simultaneous transthoracic echocardiography. Transient inflation of an inferior vena cava balloon (IVCB) catheter produced controlled load reduction. First and last beats in the sequence of eight were analysed with speckle tracking (STE) during the load alteration and analysed for change in rotation/twist during controlled load alteration at same contractile status. Two pharmacological inotropic interventions were also included to examine the same hypothesis in additionally conditions of increased and decreased myocardial contractility in each animal. Paired comparisons were made for different load states using the Wilcoxon's Signed Rank test.

    RESULTS: The inferior vena cava balloon occlusion (IVCBO) load change compared for first to last beat resulted in LV twist increase (11.67degrees +/-2.65degrees vs. 16.17degrees +/-3.56degrees respectively, p < 0.004) during the load alteration and under adrenaline stimulation LV twist increase 12.56degrees +/-5.1degrees vs. 16.57degrees +/-4.6degrees (p < 0.013), and though increased, didn't reach significance in negative inotropic condition. Untwisting rate increased significantly at baseline from 41.7degrees/s +/-41.6degrees/s vs.122.6degrees/s +/-55.8degrees/s (P < 0.039) and under adrenaline stimulation untwisting rate increased (55.3degrees/s +/-3.8degrees/s vs.111.4degrees/s +/-24.0degrees/s (p < 0.05), but did not systematically changed in negative inotropic condition.

    CONCLUSIONS: Peak systolic LV twist and peak early diastolic untwisting rate are load dependent. Differences in LV load should be included in the interpretation when serial measures of twist are compared.

  • 320. Arokiasamy, Perianayagam
    et al.
    Uttamacharya, .
    Kowal, Paul
    Capistrant, Benjamin D.
    Gildner, Theresa E.
    Thiele, Elizabeth
    Biritwum, Richard B.
    Yawson, Alfred E.
    Mensah, George
    Maximova, Tamara
    Wu, Fan
    Guo, Yanfei
    Zheng, Yang
    Kalula, Sebastiana Zimba
    Rodriguez, Aaron Salinas
    Espinoza, Betty Manrique
    Liebert, Melissa A.
    Eick, Geeta
    Sterner, Kirstin N.
    Barrett, Tyler M.
    Duedu, Kwabena
    Gonzales, Ernest
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Negin, Joel
    Jiang, Yong
    Byles, Julie
    Madurai, Savathree Lorna
    Minicuci, Nadia
    Snodgrass, J. Josh
    Naidoo, Nirmala
    Chatterji, Somnath
    Chronic Noncommunicable Diseases in 6 Low-and Middle-Income Countries: Findings From Wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (SAGE)2017Ingår i: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 185, nr 6, s. 414-428Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged >= 50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low-and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

  • 321. Aronsson, Gunnar
    et al.
    Theorell, Tores
    Grape, Tom
    Hammarström, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hogstedt, Christer
    Marteinsdottir, Ina
    Skoog, Ingmar
    Traskman-Bendz, Lil
    Hall, Charlotte
    A systematic review including meta-analysis of work environment and burnout symptoms2017Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 17, artikel-id 264Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies – original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms.

    Methods: A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990–2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1–5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used.

    Results: Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout.

    Conclusion: While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

  • 322. Aronsson, Mattias
    et al.
    Persson, Josefine
    Blomstrand, Christian
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
    Levin, Lars-Ake
    Cost-effectiveness of endovascular thrombectomy in patients with acute ischemic stroke2016Ingår i: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 86, nr 11, s. 1053-1059Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.Methods:The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND-IA), Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT), and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) along with data from published studies and registries were used in this analysis. We used a health care payer perspective and a lifelong time horizon to estimate costs and effects.Results:The model showed that adding thrombectomy with stent retrievers to guideline-based care (including IV thrombolysis) resulted in a gain of 0.40 life-years and 0.99 quality-adjusted life-years along with a cost savings of approximately $221 per patient. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.Conclusions:Adding endovascular treatment to standard care resulted in substantial clinical benefits at low costs. The results were consistent throughout irrespective of whether data from ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, or SWIFT PRIME were used in this model.

  • 323.
    Arslan, Alan A
    et al.
    Department of Environmental Medicine, New York University School of Medicine.
    Clendenen, Tess V
    Department of Environmental Medicine, New York University School of Medicine.
    Koenig, Karen L
    Department of Environmental Medicine, New York University School of Medicine.
    Hultdin, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Enquist, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Ågren, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Lukanova, Annekatrin
    Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
    Sjodin, Hubert
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
    Zeleniuch-Jacquotte, Anne
    Department of Environmental Medicine, New York University School of Medicine.
    Shore, Roy E
    Radiation Effects Research Foundation, Hiroshima, Japan.
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Toniolo, Paolo
    Department of Environmental Medicine, New York University School of Medicine.
    Lundin, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Circulating vitamin d and risk of epithelial ovarian cancer2009Ingår i: Journal of oncology, ISSN 1687-8450, Vol. 2009, s. 672492-672500Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We conducted a nested case-control study within two prospective cohorts, the New York University Women's Health Study and the Northern Sweden Health and Disease Study, to examine the association between prediagnostic circulating levels of 25-hydroxy vitamin D (25(OH)D) and the risk of subsequent invasive epithelial ovarian cancer (EOC). The 25(OH)D levels were measured in serum or plasma from 170 incident cases of EOC and 373 matched controls. Overall, circulating 25(OH)D levels were not associated with the risk of EOC in combined cohort analysis: adjusted OR for the top tertile versus the reference tertile, 1.09 (95% CI, 0.59-2.01). In addition, there was no evidence of an interaction effect between VDR SNP genotype or haplotype and circulating 25(OH)D levels in relation to ovarian cancer risk, although more complex gene-environment interactions may exist.

  • 324. Arslan, Alan A.
    et al.
    Koenig, Karen L.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Afanasyeva, Yelena
    Shore, Roy E.
    Chen, Yu
    Lundin, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
    Toniolo, Paolo
    Hallmans, Göran
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Zeleniuch-Jacquotte, Anne
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning.
    Circulating Estrogen Metabolites and Risk of Breast Cancer in Postmenopausal Women2014Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 23, nr 7, s. 1290-1297Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It has been hypothesized that predominance of the 2-hydroxylation estrogen metabolism pathway over the 16 alpha-hydroxylation pathway may be inversely associated with breast cancer risk. Methods: We examined the associations of invasive breast cancer risk with circulating 2-hydroxyestrone (2-OHE1), 16 alpha-hydroxyestrone (16 alpha-OHE1), and the 2-OHE1: 16 alpha-OHE1 ratio in a case-control study of postmenopausal women nested within two prospective cohorts: the New York University Women's Health Study (NYUWHS) and the Northern Sweden Mammary Screening Cohort (NSMSC), with adjustment for circulating levels of estrone, and additional analyses by tumor estrogen receptor (ER) status. Levels of 2-OHE1 and 16 alpha-OHE1 were measured using ESTRAMET 2/16 assay in stored serum or plasma samples from 499 incident breast cancer cases and 499 controls, who were matched on cohort, age, and date of blood donation. Results: Overall, no significant associations were observed between breast cancer risk and circulating levels of 2-OHE1, 16 alpha-OHE1, or their ratio in either cohort and in combined analyses. For 2-OHE1, there was evidence of heterogeneity by ER status in models adjusting for estrone (P <= 0.03). We observed a protective association of 2-OHE1 with ER + breast cancer [multivariate-adjusted OR for a doubling of 2-OHE1, 0.67 (95% confidence interval [CI], 0.48-0.94; P = 0.02)]. Conclusions: In this study, higher levels of 2-OHE1 were associated with reduced risk of ER + breast cancer in postmenopausal women after adjustment for circulating estrone. Impact: These results suggest that taking into account the levels of parent estrogens and ER status is important in studies of estrogen metabolites and breast cancer.

  • 325. Arsov, S.
    et al.
    Trajceska, L.
    van Oeveren, W.
    Smit, A. J.
    Dzekova, P.
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sikole, A.
    Rakhorst, G.
    Graaff, R.
    The influence of body mass index on the accumulation of advanced glycation end products in hemodialysis patients2015Ingår i: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 69, nr 3, s. 309-313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND/OBJECTIVES: The level of skin autofluorescence (AF) at a given moment is an independent predictor of mortality in hemodialysis (HD) patients. Skin AF is a measure of the accumulation of advanced glycation end products (AGEs). The aim of the study was to estimate the influence of nutrition on the 1-year increase of skin AF (Delta AF) in HD patients.

    SUBJECTS/METHODS: A total of 156 HD patients were enrolled in this study. Skin AF, body mass index (BMI), superoxide dismutase, myeloperoxidase, C-reactive protein, inter-cellular adhesion molecule-1, von Willebrand factor and heart-type fatty acid-binding protein were measured four times at intervals of approximately half a year. Data from the monthly routine blood analysis were also used. Daily calorie, protein and AGE intakes were assessed from food recordings over a period of 1 week.

    RESULTS: A J-shaped relation was found between baseline BMI and Delta AF (P = 0.01). The lowest point of the J-shaped curve is found for BMI = 24.3 kg/m(2). In the univariate analysis of the contributors to the 1-year Delta AF, we found that beside BMI = 24.3 kg/m(2), AGE and calorie intakes, as well as myeloperoxidase and HD vintage, had a P < 0.10. The sole independent predictor of the 1-year Delta AF was BMI = 24.3 kg/m(2) (P = 0.01).

    CONCLUSIONS: It appears that calorie, protein and AGE intakes hardly influence the 1-year Delta AF in HD patients. BMI of HD patients of around 24 kg/m(2) resulted in a lower 1-year Delta AF.

  • 326. Arsov, S.
    et al.
    Trajceska, L.
    van Oeveren, W.
    Smit, A. J.
    Vidimliski, P. Dzekova
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sikole, A.
    Rakhorst, G.
    Graaff, R.
    The use of a skin age reader to evaluate risk of cvd and mortality in dialysis patients2011Ingår i: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 34, nr 8, s. 606-606Artikel i tidskrift (Övrigt vetenskapligt)
  • 327. Arsov, S.
    et al.
    Vidimliski, P. Dzekova
    Trajceska, L.
    Graaff, R.
    van Oeveren, W.
    Smit, A. J.
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Schalkwijk, C.
    Sikole, A.
    Rakhorst, G.
    Accumulation rate of ages in the skin biopsy tissue of dialysis patients2011Ingår i: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 34, nr 8, s. 650-650Artikel i tidskrift (Övrigt vetenskapligt)
  • 328. Arsov, Stefan
    et al.
    Graaff, Reindert
    Morariu, Aurora M
    van Oeveren, Wim
    Smit, Andries J
    Busletic, Irena
    Trajcevska, Lada
    Selim, Gjulsen
    Dzekova, Pavlina
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sikole, Aleksandar
    Rakhorst, Gerhard
    Does hepatitis C increase the accumulation of advanced glycation end products in haemodialysis patients?2010Ingår i: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 25, nr 3, s. 885-891Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Hepatitis C may cause increased levels of oxidative stress that contribute to accumulation of advanced glycation end products (AGEs), which increase the risk of cardiovascular disease (CVD). The aim of this study was to determine the influence of hepatitis C on AGE accumulation in haemodialysis patients. METHODS: AGE accumulation was measured by means of skin autofluorescence (AF) in 92 haemodialysis (HD) patients and 93 age-matched healthy controls. In the HD patients, CVD-related biochemical variables were also measured. The HD patients were tested for hepatitis C virus (HCV) antibodies and allocated to a HCV+ or HCV- group. RESULTS: Skin AF of the healthy subjects was lower than skin AF in the HD patients (3.13 +/- 0.95 vs 2.2 +/- 0.47; P < 0.001). We calculated the average increase of skin AF in the healthy subjects to be 0.017 arbitrary units per year, being 14 times lower than in HD patients with CVD only and 20 times lower than in HD patients suffering from combined CVD and diabetes mellitus (DM). Multivariate regression analysis showed that AGE accumulation in HD patients can be described by the independent effects of age, DM, CVD and HD vintage. Although inter-cellular adhesion molecule 1 and liver enzymes were elevated in HCV+ HD patients, levels of oxidative stress markers and skin AF were not significantly different between HCV+ and HCV- HD patients. CONCLUSIONS: AGE accumulation was higher in the HD patients than in the healthy controls. AGE accumulation did not differ in HCV+ and HCV- HD patients. This might be due to the fact that hepatitis C did not cause oxidative stress in our HD population. Independent markers of AGE accumulation were age, HD vintage, DM and CVD, but not hepatitis C.

  • 329. Arsov, Stefan
    et al.
    Trajceska, Lada
    van Oeveren, Wim
    Smit, Andries J
    Dzekova, Pavlina
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Sikole, Aleksandar
    Rakhorst, Gerhard
    Graaff, Reindert
    Increase in skin autofluorescence and release of heart-type fatty acid binding protein in plasma predicts mortality of hemodialysis patients2013Ingår i: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 37, nr 7, s. E114-E122Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Advanced glycation end-products (AGEs) are uremic toxins that accumulate progressively in hemodialysis (HD) patients. The aim of this study was to assess the 1-year increase in skin autofluorescence (DAF), a measure of AGEs accumulation and plasma markers, as predictors of mortality in HD patients. One hundred sixty-nine HD patients were enrolled in this study. Skin autofluorescence was measured twice, 1 year apart using an AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). Besides routine blood chemistry, additional plasma markers including superoxide dismutase, myeloperoxydase, intercellular adhesion molecule 1 (ICAM-1), C-reactive protein (hs-CRP), heart-type fatty acid binding protein (H-FABP), and von Willebrand factor were measured at baseline. The mortality of HD patients was followed for 36 months. Skin autofluorescence values of the HD patients at the two time points were significantly higher (P < 0.001) than those of healthy subjects of the same age. Mean 1-year DAF of HD patients was 0.16 +/- 0.06, which was around seven-to ninefold higher than 1-year DAF in healthy subjects. Multivariate Cox regression showed that age, hypertension, 1-year DAF, hs-CRP, ICAM-1, and H-FABP were independent predictors of overall mortality. Hypertension, 1-year DAF, hs-CRP, and H-FABP were also independent predictors of cardiovascular mortality. One-year DAF and plasma H-FABP, used separately and in combination, are strong predictors of overall and cardiovascular mortality in HD patients.

  • 330. Arthur, Samuelina S.
    et al.
    Nyide, Bongiwe
    Soura, Abdramane Bassiahi
    Kahn, Kathleen
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weston, Mark
    Sankoh, Osman
    Tackling malnutrition: a systematic review of 15-year research evidence from INDEPTH health and demographic surveillance systems2015Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, s. 1-13, artikel-id 28298Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Nutrition is the intake of food in relation to the body's dietary needs. Malnutrition results from the intake of inadequate or excess food. This can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity. Objective: To perform a systematic review to assess research conducted by the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) of health and demographic surveillance systems (HDSSs) over a 15-year period on malnutrition, its determinants, the effects of under and over nutrition, and intervention research on malnutrition in low- and middle-income countries (LMICs). Methods: Relevant publication titles were uploaded onto the Zotero research tool from different databases (60% from PubMed). Using the keywords 'nutrition', 'malnutrition', 'over and under nutrition', we selected publications that were based only on data generated through the longitudinal HDSS platform. All titles and abstracts were screened to determine inclusion eligibility and full articles were independently assessed according to inclusion/exclusion criteria. For inclusion in this study, papers had to cover research on at least one of the following topics: the problem of malnutrition, its determinants, its effects, and intervention research on malnutrition. One hundred and forty eight paperswere identified and reviewed, and 67 were selected for this study. Results: The INDEPTH research identified rising levels of overweight and obesity, sometimes in the same settings as under-nutrition. Urbanisation appears to be protective against under-nutrition, but it heightens the risk of obesity. Appropriately timed breastfeeding interventions were protective against malnutrition. Conclusions: Although INDEPTH has expanded the global knowledge base on nutrition, many questions remain unresolved. There is a need for more investment in nutrition research in LMICs in order to generate evidence to inform policies in these settings.

  • 331.
    Arvidsson, Sandra
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Cardiac function in hereditary transthyretin amyloidosis: an echocardiographic study2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Hereditary transthyretin amyloidosis (ATTR) is a lethal disease in which misfolded transthyretin (TTR) proteins accumulate as insoluble aggregates in tissues throughout the body. A common mutation is the exchange of valine to methionine at place 30 (TTR V30M), a form endemically found in the northern parts of Sweden. The main treatment option for ATTR amyloidosis is liver transplantation as the procedure halts production of mutated transthyretin. The disease is associated with marked phenotypic diversity ranging from predominant cardiac complications to pure neuropathy. Two different types of fibril composition – one in which both fragmented and full-length TTR are present (type A) and one consisting of only full-length TTR (type B) have been suggested to account for some phenotypic differences. Cardiac amyloidosis is associated with increased myocardial thickness and the disease could easily be mistaken for other entities characterised by myocardial thickening, such as sarcomeric hypertrophic cardiomyopathy (HCM). The aims in this thesis were to investigate echocardiographic characteristics in Swedish ATTR amyloidosis patients, and to identify markers aiding in differentiating ATTR heart disease from HCM. Another objective was to examine the impact of fibril composition and sex on the phenotypic variation in amyloid heart disease.

    Methods: A total of 122 ATTR amyloidosis patients that had undergone thorough echocardiographic examinations were included in the studies. Analyses of ventricular geometry as well as assessment of systolic and diastolic function were performed, using both conventional echocardiographic methods and speckle tracking technique. ECG analysis was conducted in study I, allowing measurement of QRS voltage. In study I and study II ATTR patients were compared to patients with HCM. In addition, 30 healthy controls were added to study II.

    Results: When parameters from ECG and echocardiography were investigated, the results revealed that the combination of QRS voltage <30 mm (<3 mV) and an interventricular/posterior wall thickness quotient <1.6 could differentiate cardiac ATTR amyloidosis from HCM. Differences in degree of right ventricular involvement were also demonstrated between HCM and ATTR amyloidosis, where ATTR patients displayed a right ventricular apical sparing pattern whereas the inverse pattern was found in HCM. Analysis of fibril composition revealed increased LV wall thickness in type A patients compared to type B, but in addition type A women displayed both lower myocardial thickness and more preserved systolic function as compared to type A males. When cardiac geometry and function were evaluated pre and post liver transplantation in type A and B patients, significant deterioration was detected in type A but not in type B patients after liver transplantation.

    Conclusions: Increasing awareness of typical cardiac amyloidotic signs by echocardiography is important to reduce the risk of delayed diagnosis. Our classification model based on ECG and echocardiography could aid in differentiating ATTR amyloidosis from HCM. Furthermore, the apical sparing pattern found in the right ventricle may pose another clue for amyloid heart disease, although it requires to be studied further. Furthermore, we disclosed that type A fibrils, male sex and increasing age were important determinants of increased myocardial thickness. As type A fibril patients displayed rapid cardiac deterioration after liver transplantation other treatment options should probably be sought for this group of patients.

  • 332.
    Arvidsson, Sandra
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Wikström, Gerhard
    Suhr, Ole B.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lindqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Right ventricular involvement in transthyretin amyloidosis2018Ingår i: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 25, nr 3, s. 160-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The extent of right ventricular (RV) involvement in transthyretin amyloidosis (ATTR) is unknown.

    Objectives: This study sought to establish the degree of RV involvement in ATTR amyloidosis, and compare findings with RV involvement in hypertrophic cardiomyopathy (HCM).

    Methods: Forty-two patients with ATTR amyloidosis and echocardiographic evidence of cardiac amyloidosis (cardiac ATTR), 19 ATTR patients with normal left ventricular (LV) wall thickness (non-cardiac ATTR), 25 patients with diagnosed HCM and 30 healthy controls were included in this study. Echocardiographic measurements for conventional parameters, as well as RV global and segmental strain, were recorded.

    Results: When comparing RV structure and function between cardiac ATTR amyloidosis and HCM patients, only segmental strain differed between the two groups. In cardiac ATTR amyloidosis, we found an RV apex-to-base strain gradient with highest deformation in the apex. This pattern was reversed in patients with HCM.

    Conclusions: RV involvement is common in cardiac ATTR patients. The present study also detected an RV apical sparing pattern in patients with ATTR cardiomyopathy, similar to what has previously been described for the left ventricle in these patients. This pattern was not seen in HCM patients. Further studies are needed to assess the clinical importance of these findings.

  • 333.
    Arvidsson, Sandra
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Pilebro, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Westermark, Per
    Lindqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Klinisk fysiologi.
    Suhr, Ole B
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Amyloid Cardiomyopathy in Hereditary Transthyretin V30M Amyloidosis - Impact of Sex and Amyloid Fibril Composition2015Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 11, artikel-id e0143456Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Transthyretin V30M (ATTR V30M) amyloidosis is a phenotypically diverse disease with symptoms ranging from predominant neuropathy to exclusive cardiac manifestations. The aims of this study were to determine the dispersion of the two types of fibrils found in Swedish ATTR V30M patients -Type A consisting of a mixture of truncated and full length ATTR fibrils and type B fibrils consisting of full length fibrils, and to estimate the severity of cardiac dysfunction in relation to fibril composition and sex.

    MATERIAL AND METHODS: Echocardiographic data were analysed in 107 Swedish ATTR V30M patients with their fibril composition determined as either type A or type B. Measurements of left ventricular (LV) dimensions and evaluation of systolic and diastolic function including speckle tracking derived strain were performed. Patients were grouped according to fibril type and sex. Multivariate linear regression was utilised to determine factors of significant impact on LV thickness.

    RESULTS: There was no significant difference in proportions of the two types of fibrils between men and women. In patients with type A fibrils, women had significantly lower median septal (p = 0.007) and posterior wall thicknesses (p = 0.010), lower median LV mass indexed to height (p = 0.008), and higher septal strain (p = 0.037), as compared to males. These differences were not apparent in patients with type B fibrils. Multiple linear regression analysis revealed that fibril type, sex and age all had significant impact on LV septal thickness.

    CONCLUSION: This study demonstrates a clear difference between sexes in the severity of amyloid heart disease in ATTR V30M amyloidosis patients. Even though type A fibrils were associated with more advanced amyloid heart disease compared to type B, women with type A fibrils generally developed less cardiac infiltration than men. The differences may explain the better outcome for liver transplanted late-onset female patients compared to males.

  • 334. Ascher, H
    et al.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Ivarsson, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Kristiansson, B
    Lindberg, T
    Stenhammar, L
    [Infant food and celiac disease. Risk of increase when changing the diet]1994Ingår i: Lakartidningen, ISSN 0023-7205, Vol. 91, nr 49, s. 4641-3Artikel i tidskrift (Övrigt vetenskapligt)
  • 335.
    Asgedom, Girmay
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Clinical and immunological outcome of antiretroviral treatment in Saint Mary Axum Hospital2013Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 336. Ashar, Foram N.
    et al.
    Mitchell, Rebecca N.
    Albert, Christine M.
    Newton-Cheh, Christopher
    Brody, Jennifer A.
    Mueller-Nurasyid, Martina
    Moes, Anna
    Meitinger, Thomas
    Mak, Angel
    Huikuri, Heikki
    Junttila, M. Juhani
    Goyette, Philippe
    Pulit, Sara L.
    Pazoki, Raha
    Tanck, MichaelW.
    Blom, Marieke T.
    Zhao, XiaoQing
    Havulinna, Aki S.
    Jabbari, Reza
    Glinge, Charlotte
    Tragante, Vinicius
    Escher, Stefan A.
    Chakravarti, Aravinda
    Ehret, Georg
    Coresh, Josef
    Li, Man
    Prineas, Ronald J.
    Franco, Oscar H.
    Kwok, Pui-Yan
    Lumley, Thomas
    Dumas, Florence
    McKnight, Barbara
    Rotter, Jerome I.
    Lemaitre, Rozenn N.
    Heckbert, Susan R.
    O'Donnell, Christopher J.
    Hwang, Shih-Jen
    Tardif, Jean-Claude
    VanDenburgh, Martin
    Uitterlinden, Andre G.
    Hofman, Albert
    Stricker, Bruno H. C.
    de Bakker, Paul I. W.
    Franks, Paul W.
    Jansson, Jan-Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Asselbergs, Folkert W.
    Halushka, Marc K.
    Maleszewski, Joseph J.
    Tfelt-Hansen, Jacob
    Engstrom, Thomas
    Salomaa, Veikko
    Virmani, Renu
    Kolodgie, Frank
    Wilde, Arthur A. M.
    Tan, Hanno L.
    Bezzina, Connie R.
    Eijgelsheim, Mark
    Rioux, John D.
    Jouven, Xavier
    Kääb, Stefan
    Psaty, Bruce M.
    Siscovick, David S.
    Arking, Dan E.
    Sotoodehnia, Nona
    A comprehensive evaluation of the genetic architecture of sudden cardiac arrest2018Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr 44, s. 3961-+Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Sudden cardiac arrest (SCA) accounts for 10% of adult mortality in Western populations. We aim to identify potential loci associated with SCA and to identify risk factors causally associated with SCA.

    Methods and results: We carried out a large genome-wide association study (GWAS) for SCA (n = 3939 cases, 25 989 non-cases) to examine common variation genome-wide and in candidate arrhythmia genes. We also exploited Mendelian randomization (MR) methods using cross-trait multi-variant genetic risk score associations (GRSA) to assess causal relationships of 18 risk factors with SCA. No variants were associated with SCA at genome-wide significance, nor were common variants in candidate arrhythmia genes associated with SCA at nominal significance. Using cross-trait GRSA, we established genetic correlation between SCA and (i) coronary artery disease (CAD) and traditional CAD risk factors (blood pressure, lipids, and diabetes), (ii) height and BMI, and (iii) electrical instability traits (QT and atrial fibrillation), suggesting aetiologic roles for these traits in SCA risk.

    Conclusions: Our findings show that a comprehensive approach to the genetic architecture of SCA can shed light on the determinants of a complex life-threatening condition with multiple influencing factors in the general population. The results of this genetic analysis, both positive and negative findings, have implications for evaluating the genetic architecture of patients with a family history of SCA, and for efforts to prevent SCA in high-risk populations and the general community.

  • 337.
    Askeljung, Johannes
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Patients and co-followers’ attitudes towards the concept Virtual Health Room2018Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 338.
    Askling, J
    et al.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Baecklund, E
    Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden.
    Granath, F
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Geborek, P
    Department of Rheumatology, Lund University Hospital, Lund, Sweden.
    Fored, M
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Backlin, C
    Department of Genetics and Pathology, Uppsala University, Uppsala, Sweden, Uppsala, Sweden.
    Bertilsson, L
    Department of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Cöster, L
    Department of Rheumatology, Linköping University Hospital, Linköping, Sweden.
    Jacobsson, LT
    Department of Rheumatology, Malmö University Hospital, Malmö, Sweden.
    Lindblad, S
    Rheumatology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Lysholm, J
    Department of Rheumatology, Falu County Hospital, Falun, Sweden.
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Saxne, T
    Department of Rheumatology, Lund University Hospital, Lund, Sweden.
    van Vollenhoven, R
    Rheumatology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Klareskog, L
    Rheumatology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
    Feltelius, N
    Medical Products Agency, Uppsala, Sweden.
    Anti-tumour necrosis factor therapy in rheumatoid arthritis and risk of malignant lymphomas: relative risks and time trends in the Swedish Biologics Register2009Ingår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 68, nr 5, s. 648-653Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Tumour necrosis factor (TNF) antagonists have proved effective as treatment against rheumatoid arthritis ( RA), but the unresolved issue of whether the use of anti-TNF therapy increases the already elevated risk of lymphoma in RA remains a concern. Methods: Using the Swedish Biologics Register (ARTIS), the Swedish Cancer Register, pre-existing RA cohorts and cross-linkage with other national health and census registers, a national RA cohort (n = 67 743) was assembled and patients who started anti-TNF therapy between 1998 and July 2006 ( n = 6604) were identified. A general population comparator ( n = 471 024) was also assembled and the incidence of lymphomas from 1999 to 31 December 2006 was assessed and compared in these individuals. Results: Among the 6604 anti-TNF-treated RA patients, 26 malignant lymphomas were observed during 26 981 person-years of follow-up, which corresponded to a relative risk (RR) of 1.35 (95% CI 0.82 to 2.11) versus anti-TNF-naive RA patients ( 336 lymphomas during 365 026 person-years) and 2.72 ( 95% CI 1.82 to 4.08) versus the general population comparator ( 1568 lymphomas during 3 355 849 person-years). RA patients starting anti-TNF therapy in 1998-2001 accounted for the entire increase in lymphoma risk versus the two comparators. By contrast, RR did not vary significantly by time since start of first treatment or with the accumulated duration of treatment, nor with the type of anti-TNF agent. Conclusion: Overall and as used in routine care against RA, TNF antagonists are not associated with any major further increase in the already elevated lymphoma occurrence in RA. Changes in the selection of patients for treatment may influence the observed risk.

  • 339. Askling, J
    et al.
    Fored, C M
    Baecklund, E
    Brandt, L
    Backlin, C
    Ekbom, A
    Sundström, C
    Bertilsson, L
    Coster, L
    Geborek, P
    Jacobsson, L T
    Lindblad, S
    Lysholm, J
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Saxne, T
    Klareskog, L
    Feltelius, N
    Haematopoietic malignancies in rheumatoid arthritis: lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists.2005Ingår i: Annals of the rheumatic diseases, ISSN 0003-4967, Vol. 64, nr 10, s. 1414-20Artikel i tidskrift (Refereegranskat)
  • 340. Askling, J
    et al.
    Fored, C M
    Brandt, L
    Baecklund, E
    Bertilsson, L
    Feltelius, N
    Coster, L
    Geborek, P
    Jacobsson, L T
    Lindblad, S
    Lysholm, J
    Rantapää-Dahlqvist, S
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Reumatologi.
    Saxne, T
    Klareskog, L
    Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumour necrosis factor antagonists.2005Ingår i: Ann Rheum Dis, ISSN 0003-4967, Vol. 64, nr 10, s. 1421-6Artikel i tidskrift (Refereegranskat)
  • 341. Askling, Johan
    et al.
    Baecklund, Eva
    Granath, Fredrik
    Geborek, Pierre
    Fored, Michael
    Backlin, Carin
    Bertilsson, Lennart
    Cöster, Lars
    Jacobsson, Lennart
    Lindblad, Staffan
    Lysholm, Jörgen
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Reumatologi.
    Saxne, Tore
    van Vollenhoven, Ronald
    Klareskog, Lars
    Feltelius, Nils
    Anti-TNF therapy in RA and risk of malignant lymphomas Relative risks and time-trends in the Swedish Biologics Register.2008Ingår i: Ann Rheum Dis, ISSN 1468-2060Artikel i tidskrift (Refereegranskat)
  • 342. Askling, Johan
    et al.
    Fored, C Michael
    Brandt, Lena
    Baecklund, Eva
    Bertilsson, Lennart
    Coster, Lars
    Geborek, Pierre
    Jacobsson, Lennart T
    Lindblad, Staffan
    Lysholm, Jörgen
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Reumatologi.
    Saxne, Tore
    Romanus, Victoria
    Klareskog, Lars
    Feltelius, Nils
    Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden.2005Ingår i: Arthritis Rheum, ISSN 0004-3591, Vol. 52, nr 7, s. 1986-92Artikel i tidskrift (Refereegranskat)
  • 343. Askling, Johan
    et al.
    Fored, C Michael
    Brandt, Lena
    Baecklund, Eva
    Bertilsson, Lennart
    Feltelius, Nils
    Cöster, Lars
    Geborek, Pierre
    Jacobsson, Lennart T
    Lindblad, Staffan
    Lysholm, Jörgen
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinsk fakultet, Folkhälsa och klinisk medicin, Reumatologi.
    Saxne, Tore
    van Vollenhoven, Ronald F
    Klareskog, Lars
    Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists.2007Ingår i: Ann Rheum Dis, ISSN 0003-4967, Vol. 66, nr 10, s. 1339-44Artikel i tidskrift (Refereegranskat)
  • 344. Askling, Johan
    et al.
    Holmqvist, Marie
    Ljung, Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Is Rheumatoid Arthritis a Mortal Disease?2017Ingår i: Arthritis & Rheumatology, ISSN 2326-5191, E-ISSN 2326-5205, Vol. 69, nr 8, s. 1509-1511Artikel i tidskrift (Övrigt vetenskapligt)
  • 345.
    Askling, Johan
    et al.
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    van Vollenhoven, Ronald F
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    Granath, Fredrik
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    Raaschou, Pauline
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    Fored, C Michael
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    Baecklund, Eva
    Uppsala University Hospital, Uppsala, Sweden.
    Dackhammar, Christina
    Sahlgrenska University Hospital, Gothenburg, Sweden.
    Feltelius, Nils
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    Cöster, Lars
    Linköping University Hospital, Linköping, Sweden.
    Geborek, Pierre
    Lund University Hospital, Lund, Sweden.
    Jacobsson, Lennart T
    Malmö University Hospital, Malmö, Sweden.
    Lindblad, Staffan
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    Rantapää-Dahlqvist, Solbritt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Saxne, Tore
    Lund University Hospital, Lund, Sweden.
    Klareskog, Lars
    Karolinska University Hospital at Solna and Karolinska Institutet, Stockholm, Sweden.
    Cancer risk in patients with rheumatoid arthritis treated with anti-tumor necrosis factor α therapies: does the risk change with the time since start of treatment?2009Ingår i: Arthritis and Rheumatism, ISSN 0004-3591, E-ISSN 1529-0131, Vol. 60, nr 11, s. 3180-3189Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To determine the short-term and medium-term risks of cancer in patients receiving anti-tumor necrosis factor alpha (anti-TNFalpha) therapies that have proven effective in the treatment of chronic inflammatory conditions. METHODS: By linking together data from the Swedish Biologics Register, Swedish registers of RA, and the Swedish Cancer Register, we identified and analyzed for cancer occurrence a national cohort of 6,366 patients with RA who first started anti-TNF therapy between January 1999 and July 2006. As comparators, we used a national biologics-naive RA cohort (n = 61,160), a cohort of RA patients newly starting methotrexate (n = 5,989), a cohort of RA patients newly starting disease-modifying antirheumatic drug combination therapy (n = 1,838), and the general population of Sweden. Relative risks (RRs) were estimated using Cox regression analyses, examining overall RR as well as RR by time since the first start of anti-TNF therapy, by the duration of active anti-TNF therapy, and by the anti-TNF agent received. RESULTS: During 25,693 person-years of followup in 6,366 patients newly starting anti-TNF, 240 first cancers occurred, yielding an RR of 1.00 (95% confidence interval 0.86-1.15) versus the biologics-naive RA cohort, and similar RRs versus the other 2 RA comparators. RRs did not increase with increasing time since the start of anti-TNF therapy, nor with the cumulative duration of active anti-TNF therapy. During the first year following the first treatment start, but not thereafter, dissimilar cancer risks for adalimumab, etanercept, and infliximab were observed. CONCLUSION: During the first 6 years after the start of anti-TNF therapy in routine care, no overall elevation of cancer risk and no increase with followup time were observed.

  • 346.
    Asklund, Ina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Nyström, E.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Sjöström, M.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Umefjord, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Samuelsson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Treatment of stress urinary incontinence via a smartphone application: a randomised controlled trial2015Ingår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 34, nr Supplement 3 Meeting Abstract 16, s. S40-S42Artikel i tidskrift (Övrigt vetenskapligt)
  • 347.
    Asklund, Ina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Nyström, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Sjöström, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Umefjord, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Samuelsson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Mobile app for treatment of stress urinary incontinence: a randomized controlled trial2017Ingår i: Neurourology and Urodynamics, ISSN 0733-2467, E-ISSN 1520-6777, Vol. 36, nr 5, s. 1369-1376Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women.

    METHODS: Randomized controlled trial, conducted 2013-2014 in Sweden. Community-dwelling adult women with ≥1 SUI episode/week recruited through our website and randomized to app treatment (n = 62) or control group (postponed treatment, n = 61). One participant from each group was lost to follow-up. Intervention was the mobile app Tät(®) with a treatment program focused on pelvic floor muscle training (PFMT), and information about SUI and lifestyle factors. Primary outcomes, 3 months after randomization: symptom severity (International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form [ICIQ-UI SF]); and condition-specific quality of life (ICIQ Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]).

    RESULTS: One hundred and twenty-three women were included (mean age 44.7), with moderate/severe SUI (97.5%, 120/123), mean ICIQ-UI SF score 11.1 (SD 2.8) and mean ICIQ-LUTSqol score 34.4 (SD 6.1) at baseline. At follow-up, the app group reported improvements in symptom severity (mean ICIQ-UI SF score reduction: 3.9, 95% confidence interval 3.0-4.7) and condition-specific quality of life (mean ICIQ-LUTSqol score reduction: 4.8, 3.4-6.2) and the groups were significantly different (mean ICIQ-UI SF score difference: -3.2, -4.3to -2.1; mean ICIQ-LUTSqol score difference: -4.6, -7.8 to -1.4). In the app group, 98.4% (60/61) performed PFMT at follow-up, and 41.0% (25/61) performed it daily.

    CONCLUSIONS: The mobile app treatment was effective for women with SUI and yielded clinically relevant improvements. This app may increase access to first-line treatment and adherence to PFMT.

  • 348.
    Asklund, Ina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Samuelsson, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hamberg, Katarina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Umefjord, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Sjöström, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    User Experience of an App-Based Treatment for Stress Urinary Incontinence: Qualitative Interview Study2019Ingår i: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, nr 3, artikel-id e11296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Stress urinary incontinence (SUI) affects 10%-39% of women. Its first-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed supervised or unsupervised. Health apps are increasing in number and can be used to improve adherence to treatments. We developed the Tät app, which provides a 3-month treatment program with a focus on PFMT for women with SUI. The app treatment was evaluated in a randomized controlled trial, which demonstrated efficacy for improving incontinence symptoms and quality of life. In this qualitative interview study, we investigated participant experiences of the app-based treatment.

    Objective: This study aimed to explore women’s experiences of using an app-based treatment program for SUI.

    Methods: This qualitative study is based on telephone interviews with 15 selected women, with a mean age of 47 years, who had used the app in the previous randomized controlled trial. A semistructured interview guide with open-ended questions was used, and the interviews were transcribed verbatim. Data were analyzed according to the grounded theory.

    Results: The results were grouped into three categories: “Something new!” “Keeping motivation up!” and “Good enough?” A core category, “Enabling my independence,” was identified. The participants appreciated having a new and modern way to access a treatment program for SUI. The use of new technology seemed to make incontinence treatment feel more prioritized and less embarrassing for the subjects. The closeness to their mobile phone and app features like reminders and visual graphs helped support and motivate the women to carry through the PFMT. The participants felt confident that they could perform the treatment program on their own, even though they expressed some uncertainty about whether they were doing the pelvic floor muscle contractions correctly. They felt that the app-based treatment increased their self-confidence and enabled them to take responsibility for their treatment.

    Conclusions: Use of the app-based treatment program for SUI empowered the women in this study and helped them self-manage their incontinence treatment. They appreciated the app as a new tool for supporting their motivation to carry through a slightly challenging PFMT program.

    Trial Registration: ClinicalTrials.gov NCT01848938; https://clinicaltrials.gov/ct2/show/NCT01848938 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01848938)

  • 349. Asli, Lene A.
    et al.
    Braaten, Tonje
    Olsen, Anja
    Tjonneland, Anne
    Overvad, Kim
    Nilsson, Lena Maria
    Umeå universitet, Arktiskt centrum vid Umeå universitet (Arcum). Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    Renstrom, Frida
    Umeå universitet, Medicinska fakulteten, Enheten för biobanksforskning. Department of Clinical Sciences, Lund University, Sweden.
    Lund, Eiliv
    Skeie, Guri
    Potato consumption and risk of pancreatic cancer in the HELGA cohort2018Ingår i: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 119, nr 12, s. 1408-1415Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Potatoes have been a staple food in many countries throughout the years. Potatoes have a high glycaemic index (GI) score, and high GI has been associated with several chronic diseases and cancers. Still, the research on potatoes and health is scarce and contradictive, and we identified no prospective studies that had investigated the association between potatoes as a single food and the risk of pancreatic cancer. The aim of this study was to prospectively investigate the association between potato consumption and pancreatic cancer among 114 240 men and women in the prospective HELGA cohort, using Cox proportional hazard models. Information on diet (validated FFQ's), lifestyle and health was collected by means of a questionnaire, and 221 pancreatic cancer cases were identified through cancer registries. The mean follow-up time was 11.4 (95 % CI 0.3, 169) years. High consumption of potatoes showed a non-significantly higher risk of pancreatic cancer in the adjusted model (hazard ratio (HR) 1.44; 95 % CI 0.93, 2.22, P-for trend 0.030) when comparing the highest v. the lowest quartile of potato consumption. In the sex-specific analyses, significant associations were found for females (HR 2.00; 95 % CI 1.07, 3.72, P-for trend 0.020), but not for males (HR 1.01; 95 % CI 0.56, 1.84, P-for trend 0.34). In addition, we explored the associations by spline regression, and the absence of dose-response effects was confirmed. In this study, high potato consumption was not consistently associated with a higher risk of pancreatic cancer. Further studies with larger populations are needed to explore the possible sex difference.

  • 350.
    Asplund, K.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Managing risk factors2011Ingår i: Special Issue: Abstracts of the 15th Congress of the EFNS, Budapest, Hungary, 2011, Oxford: Rapid Communications , 2011, Vol. 18, s. 621-621Konferensbidrag (Refereegranskat)
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