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Blomstedt, Yulia
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Publications (10 of 32) Show all publications
Blomstedt, Y., Stenmark Persson, R., Awad, A., Hariz, G.-M., Philipson, J., Hariz, M., . . . Blomstedt, P. (2023). 10 years follow-up of deep brain stimulation in the caudal zona incerta/posterior subthalamic area for essential tremor. Movement Disorders Clinical Practice, 10(5), 783-793
Open this publication in new window or tab >>10 years follow-up of deep brain stimulation in the caudal zona incerta/posterior subthalamic area for essential tremor
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2023 (English)In: Movement Disorders Clinical Practice, E-ISSN 2330-1619, Vol. 10, no 5, p. 783-793Article in journal (Refereed) Published
Abstract [en]

Background: Long-term data on the effects of deep brain stimulation (DBS) for essential tremor (ET) is scarce, especially regarding DBS in the caudal Zona incerta (cZi) and the posterior subthalamic area (PSA). Objectives: The aim of this prospective study was to evaluate the effect of cZi/PSA DBS in ET at 10 years after surgery.

Methods: Thirty-four patients were included. All patients received cZi/PSA DBS (5 bilateral/29 unilateral) and were evaluated at regular intervals using the essential tremor rating scale (ETRS).

Results: One year after surgery, there was a 66.4% improvement of total ETRS and 70.7% improvement of tremor (items 1–9) compared with the preoperative baseline. Ten years after surgery, 14 patients had died and 3 were lost to follow-up. In the remaining 17 patients, a significant improvement was maintained (50.8% for total ETRS and 55.8% for tremor items). On the treated side the scores of hand function (items 11–14) had improved by 82.6% at 1 year after surgery, and by 66.1% after 10 years. Since off-stimulation scores did not differ between year 1 and 10, this 20% deterioration of on-DBS scores was interpreted as a habituation. There was no significant increase in stimulation parameters beyond the first year.

Conclusions: This 10 year follow up study, found cZi/PSA DBS for ET to be a safe procedure with a mostly retained effect on tremor, compared to 1 year after surgery, and in the absence of increase in stimulation parameters. The modest deterioration of effect of DBS on tremor was interpreted as habituation.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
DBS, essential tremor, long-term follow-up, posterior subthalamic area, zona incerta
National Category
Neurology Surgery
Identifiers
urn:nbn:se:umu:diva-206764 (URN)10.1002/mdc3.13729 (DOI)000961376000001 ()2-s2.0-85151937204 (Scopus ID)
Funder
Swedish Research Council, 2018-00618
Available from: 2023-04-28 Created: 2023-04-28 Last updated: 2023-11-13Bibliographically approved
Hariz, M., Blomstedt, Y., Blomstedt, P. & Hariz, G.-M. (2023). Anthropology of deep brain stimulation; the 30th anniversary of STN DBS in 2023. Movement Disorders Clinical Practice, 10(9), 1285-1292
Open this publication in new window or tab >>Anthropology of deep brain stimulation; the 30th anniversary of STN DBS in 2023
2023 (English)In: Movement Disorders Clinical Practice, E-ISSN 2330-1619, Vol. 10, no 9, p. 1285-1292Article, review/survey (Refereed) Published
Abstract [en]

Background: The year 2023 marks the 30th anniversary of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson’s disease (PD). This procedure prompted a universal interest in DBS for various brain disorders and resulted in a unique expansion of clinical and scientific collaboration between many disciplines, with impact on many aspects of society.

Objective: To study the anthropology of DBS, that is, its ethno-geographic origins, its evolution, its impact on clinicians and scientists, and its influence on society at large.

Material and Methods: The authors scrutinized the geo-ethnic origins of the pioneers of modern DBS, and they evaluated, based on the literature and on a long-term praxis, the development of DBS and its impact on clinicians, on healthcare, and on society.

Results: Scientists and clinicians from various geo-ethnic origins pioneered modern DBS, leading to worldwide spread of this procedure and to the establishment of large multidisciplinary teams in many centers. Neurologists became actively involved in surgery and took on new laborious tasks of programming ever more complicated DBS systems. Publications sky-rocketed and the global spread of DBS impacted positively on several aspects of society, including healthcare, awareness of neurological diseases, interdisciplinary relations, conferences, patient organizations, unemployment, industry, etc.

Conclusions: STN DBS has boosted the field of deep brain electrotherapy for many neurological and psychiatric illnesses, and DBS has generated a global benefit on many aspects of society, well beyond its clinical benefits on symptoms of diseases. With the ever-increasing indications for DBS, more positive global impact is expected.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
anthropology, deep brain stimulation, movement disorders, Parkinson's disease, subthalamic nucleus
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:umu:diva-214291 (URN)10.1002/mdc3.13858 (DOI)001065271200001 ()37772285 (PubMedID)2-s2.0-85169423554 (Scopus ID)
Available from: 2023-09-11 Created: 2023-09-11 Last updated: 2023-12-19Bibliographically approved
Hariz, M., Lees, A. J., Blomstedt, Y. & Blomstedt, P. (2022). Serendipity and Observations in Functional Neurosurgery: From James Parkinson's Stroke to Hamani's & Lozano's Flashbacks. Stereotactic and Functional Neurosurgery, 100(4), 201-209
Open this publication in new window or tab >>Serendipity and Observations in Functional Neurosurgery: From James Parkinson's Stroke to Hamani's & Lozano's Flashbacks
2022 (English)In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 100, no 4, p. 201-209Article, review/survey (Refereed) Published
Abstract [en]

Background: Serendipity and observations have a noble tradition in medicine, including neurology, and are responsible for many medical treatments (carbamazepine for tic douloureux, amantadine for Parkinson's disease, gabapentin for restless legs...). We aimed at examining the contribution of serendipity and observations to functional neurosurgery. Scholarly publications relevant to the history of functional neurosurgery for movement and psychiatric disorders were reviewed, starting from the pre-stereotactic era. The documents were scrutinized with respect to indications for surgery, surgical methods, and brain targets, in view of determining whether serendipitous discoveries and other observations contributed to various functional neurosurgical procedures. Summary: James Parkinson's observation that tremors disappeared in the arm of a person with shaking palsy after a hemiparetic stroke encouraged neurosurgeons in the first half of the 20th century to perform ablative procedures on central motor pathways. Following a lobotomy performed by Browder that extended too far medially in a psychiatric patient with coexisting Parkinson's disease (PD), it was noted that the Parkinsonian signs improved. This encouraged Russel Meyers to carry out open surgery on the caudate nucleus and basal ganglia in PD. Cooper introduced ligation of the anterior choroidal artery as a treatment for PD following a surgical accident during a pedunculotomy. Cooper later started to perform stereotactic surgery on the ventrolateral thalamus following the pathological finding that an intended pallidal lesion had in fact targeted the thalamus. Leksell discovered the ideal location of a pallidal lesion being in the posteroventral area empirically, long before the advent of the basal ganglia model of PD. Modern Deep Brain Stimulation (DBS) that started in the thalamus for tremor was the result of an observation by Benabid that intraoperative high-frequency stimulation during a thalamotomy reduced tremor. Both the discoveries of the anterior limbic subthalamic nucleus as a DBS target for OCD and the medial forebrain bundle as a DBS target for depression occurred by chance. Hamani and Lozano observed memory flashbacks in a patient who was undergoing DBS for obesity, which led to the discovery of the fornix as a potential DBS target for Alzheimer's disease. Key Messages: In the history of functional neurosurgery, serendipity and observations have resulted in discoveries of several procedures, brain targets for lesioning or DBS as well as new clinical surgical indications. In this era of neuromodulation, this technology should be exquisite in allowing potential serendipitous discoveries, provided that clinicians remain both observant and prepared.

Place, publisher, year, edition, pages
S. Karger, 2022
Keywords
Deep brain stimulation, Functional neurosurgery, History, Observation, Parkinson's disease, Serendipity
National Category
Neurology Surgery
Identifiers
urn:nbn:se:umu:diva-198734 (URN)10.1159/000525794 (DOI)000834072600001 ()35882210 (PubMedID)2-s2.0-85135737026 (Scopus ID)
Available from: 2022-08-22 Created: 2022-08-22 Last updated: 2022-08-22Bibliographically approved
Blomstedt, Y., Norberg, M., Ng, N., Nyström, L., Boman, K., Lönnberg, G., . . . Weinehall, L. (2019). Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al [Letter to the editor]. BMC Public Health, 19(1), Article ID 1095.
Open this publication in new window or tab >>Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al
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2019 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 19, no 1, article id 1095Article in journal, Letter (Refereed) Published
Abstract [en]

An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.

Keywords
Prevention, Community intervention, Evaluation, CVD
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-163072 (URN)10.1186/s12889-019-7444-3 (DOI)000480751900003 ()31409308 (PubMedID)2-s2.0-85070763966 (Scopus ID)
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2023-08-28Bibliographically approved
Blomstedt, Y., Bhutta, Z. A., Dahlstrand, J., Friberg, P., Gostin, L. O., Nilsson, M., . . . Alfvén, T. (2018). Partnerships for child health: capitalising on links between the sustainable development goals. The BMJ, 360, Article ID k125.
Open this publication in new window or tab >>Partnerships for child health: capitalising on links between the sustainable development goals
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2018 (English)In: The BMJ, E-ISSN 1756-1833, Vol. 360, article id k125Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-144954 (URN)10.1136/bmj.k125 (DOI)000423711300001 ()29363500 (PubMedID)2-s2.0-85041308504 (Scopus ID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2023-08-28Bibliographically approved
Henschke, N., Mirny, A., Haafkens, J. A., Ramroth, H., Padmawati, S., Bangha, M., . . . Kinsman, J. (2017). Strengthening capacity to research the social determinants of health in low-and middle-income countries: lessons from the INTREC programme. BMC Public Health, 17, Article ID 514.
Open this publication in new window or tab >>Strengthening capacity to research the social determinants of health in low-and middle-income countries: lessons from the INTREC programme
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2017 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 17, article id 514Article in journal (Refereed) Published
Abstract [en]

Background: The INDEPTH Training & Research Centres of Excellence (INTREC) collaboration developed a training programme to strengthen social determinants of health (SDH) research in low-and middle-income countries (LMICs). It was piloted among health-and demographic researchers from 9 countries in Africa and Asia. The programme followed a blended learning approach and was split into three consecutive teaching blocks over a 12month period: 1) an online course of 7 video lectures and assignments on the theory of SDH research; 2) a 2-week qualitative and quantitative methods workshop; and 3) a 1-week data analysis workshop. This report aims to summarise the student evaluations of the pilot and to suggest key lessons for future approaches to strengthen SDH research capacity in LMICs. Methods: Semi-structured interviews and questionnaires with 24 students from 9 countries in Africa and Asia were used to evaluate each teaching block. Information was collected about the students' motivation and interest in studying SDH, any challenges they faced during the consecutive teaching blocks, and suggestions they had for future courses on SDH. Results: Of the 24 students who began the programme, 13 (54%) completed all training activities. The students recognised the need for such a course and its potential to improve their skills as health researchers. The main challenges with the online course were time management, prior knowledge and skills required to participate in the course, and the need to get feedback from teaching staff throughout the learning process. All students found the face-to-face workshops to be of high quality and value for their work, because they offered an opportunity to clarify SDH concepts taught during the online course and to gain practical research skills. After the final teaching block, students felt they had improved their data analysis skills and were better able to develop research proposals, scientific manuscripts, and policy briefs. Conclusions: The INTREC programme has trained a promising cadre of health researchers who live and work in LMICs, which is an essential component of efforts to identify and reduce national and local level health inequities. Time management and technological issues were the greatest challenges, which can inform future attempts to strengthen research capacity on SDH.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Social determinants of health, Capacity strengthening, Education, Blended learning, Research methodology
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-137404 (URN)10.1186/s12889-017-4399-0 (DOI)000403021900005 ()28545500 (PubMedID)2-s2.0-85019906127 (Scopus ID)
Available from: 2017-07-05 Created: 2017-07-05 Last updated: 2023-08-28Bibliographically approved
Preet, R., Khan, N., Blomstedt, Y., Nilsson, M. & Stewart Williams, J. (2016). Assessing dental professionals' understanding of tobacco prevention and control: a qualitative study in Västerbotten County, Sweden. BDJ Open (2), 1-6, Article ID 16009.
Open this publication in new window or tab >>Assessing dental professionals' understanding of tobacco prevention and control: a qualitative study in Västerbotten County, Sweden
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2016 (English)In: BDJ Open, E-ISSN 2056-807X, no 2, p. 1-6, article id 16009Article in journal (Refereed) Published
Abstract [en]

Aim: To assess dental professionals’ understanding of tobacco prevention and control.

Materials and methods: In Sweden dental hygienists receive training in tobacco prevention and control. The study setting is Västerbotton County in the north of Sweden where a number of successful tobacco control initiatives have been established. A purposeful sample comprising five male and four female dental professionals and trainees was selected. Data were collected through in-depth semi-structured individual interviews and analysed using content analysis.

Results: Informants acknowledged limited adherence to tobacco prevention. They were not confident of their knowledge of tobacco and non-communicable disease prevention and had limited awareness of global oral health policies. Reasons for poor adherence included professional fragmentation, lack of training, and the absence of reimbursement for time spent on prevention activities.

Discussion: The success of efforts to reduce smoking in Västerbotton County is attributed to the network of local public health initiatives with very limited involvement by local dental professionals.

Conclusions: The findings highlight the need to more actively engage the dental workforce in tobacco control and prevention. Moreover, it is important to recognise that dental professionals can be public health advocates for tobacco control and prevention at global, national and local levels.

Keywords
Health care, Oral cancer
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-129790 (URN)10.1038/bdjopen.2016.9 (DOI)
Available from: 2017-01-09 Created: 2017-01-09 Last updated: 2023-12-11Bibliographically approved
Nyagwui, A. E., Fredinah, N., Che, L. B. & Yulia, B. (2016). Motorcycle injury among secondary school students in the Tiko municipality, Cameroon. Pan African Medical Journal, 24, Article ID 116.
Open this publication in new window or tab >>Motorcycle injury among secondary school students in the Tiko municipality, Cameroon
2016 (English)In: Pan African Medical Journal, E-ISSN 1937-8688, Vol. 24, article id 116Article in journal (Refereed) Published
Abstract [en]

Introduction: injury from motorcycle is a considerable cause of disability and death in the world and especially in low and middle-income countries; it is one of the most serious public health problems. In Cameroon, motorcycle is commonly used for transportation particularly among students. The aim of this paper is to study the risk-factors of the motorcycle-related accidents and injuries among secondary school students’ in the Tiko municipality, Cameroon.

Methods: a cross sectional study was conducted in January 2012 on 391 students age 16-24 from public and private schools in the Tiko Municipality. Logistic regression was used to estimate the association between risk factors and injuries. A closed-ended and few open-ended questionnaire was used to collect data.

Results: the study showed that over 70% of students used motorcycles always or often. Few had undergone any formal training for driving a motorcycle. The vast majority reported not wearing protective gear while driving or riding a motorcycle. Usage of protective gear was particularly low among girls. Over 16% reported using a motorbike always or occasionally under the influence of alcohol or drugs. Over 58% of respondents reported having an accident and over 35% were injured when driving or riding a motorcycle. Those who lived at the Tiko-Douala road have three times higher probability to sustain accidents and injuries than students residing elsewhere (OR 3.19 (1.20-8.46).

Conclusion: it is deeply alarming that every second respondent in the study reported having been in an accident and every third motorcycle user was somehow injured. We therefore call for an immediate attention and a deeper investigation into the highlighted situation, particularly at Tiko-Douala road.

Keywords
Awareness, practice, safety, accident, injury, students
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-132059 (URN)10.11604/pamj.2016.24.116.5069 (DOI)000391669700003 ()27642454 (PubMedID)2-s2.0-84989311466 (Scopus ID)
Available from: 2017-03-10 Created: 2017-03-10 Last updated: 2023-07-07Bibliographically approved
Blomstedt, Y., Norberg, M., Stenlund, H., Nyström, L., Lönnberg, G., Boman, K., . . . Weinehall, L. (2015). Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality: a cohort analysis based on 1 million person-years of follow-up in Västerbotten County, Sweden, during 1990-2006. BMJ Open, 5(12), Article ID e009651.
Open this publication in new window or tab >>Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality: a cohort analysis based on 1 million person-years of follow-up in Västerbotten County, Sweden, during 1990-2006
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2015 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 5, no 12, article id e009651Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To evaluate the impact of the Västerbotten Intervention Programme (VIP) by comparing all eligible individuals (target group impact) according to the intention-to-treat principle and VIP participants with the general Swedish population.

DESIGN: Dynamic cohort study.

SETTING/PARTICIPANTS: All individuals aged 40, 50 or 60 years, residing in Västerbotten County, Sweden, between 1990 and 2006 (N=101 918) were followed from their first opportunity to participate in the VIP until age 75, study end point or prior death.

INTERVENTION: The VIP is a systematic, long-term, county-wide cardiovascular disease (CVD) intervention that is performed within the primary healthcare setting and combines individual and population approaches. The core component is a health dialogue based on a physical examination and a comprehensive questionnaire at the ages of 40, 50 and 60 years.

PRIMARY OUTCOMES: All-cause and CVD mortality.

RESULTS: For the target group, there were 5646 deaths observed over 1 054 607 person-years. Compared to Sweden at large, the standardised all-cause mortality ratio was 90.6% (95% CI 88.2% to 93.0%): for women 87.9% (95% CI 84.1% to 91.7%) and for men 92.2% (95% CI 89.2% to 95.3%). For CVD, the ratio was 95.0% (95% CI 90.7% to 99.4%): for women 90.4% (95% CI 82.6% to 98.7%) and for men 96.8% (95% CI 91.7 to 102.0). For participants, subject to further impact as well as selection, when compared to Sweden at large, the standardised all-cause mortality ratio was 66.3% (95% CI 63.7% to 69.0%), whereas the CVD ratio was 68.9% (95% CI 64.2% to 73.9%). For the target group as well as for the participants, standardised mortality ratios for all-cause mortality were reduced within all educational strata.

CONCLUSIONS: The study suggests that the VIP model of CVD prevention is able to impact on all-cause and cardiovascular mortality when evaluated according to the intention-to-treat principle.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2015
Keywords
Primary care, Epidemiology, Public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-113605 (URN)10.1136/bmjopen-2015-009651 (DOI)000368839100125 ()26685034 (PubMedID)2-s2.0-84960429941 (Scopus ID)
Available from: 2015-12-21 Created: 2015-12-21 Last updated: 2023-08-28Bibliographically approved
Hedlund, C., Blomstedt, Y. & Schumann, B. (2014). Association of climatic factors with infectious diseases in the Arctic and subarctic region: a systematic review. Global Health Action, 7, 1-16
Open this publication in new window or tab >>Association of climatic factors with infectious diseases in the Arctic and subarctic region: a systematic review
2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, p. 1-16Article, review/survey (Refereed) Published
Abstract [en]

Background:

The Arctic and subarctic area are likely to be highly affected by climate change, with possible impacts on human health due to effects on food security and infectious diseases.

Objectives:

To investigate the evidence for an association between climatic factors and infectious diseases, and to identify the most climate-sensitive diseases and vulnerable populations in the Arctic and subarctic region.

Methods:

A systematic review was conducted. A search was made in PubMed, with the last update in May 2013. Inclusion criteria included human cases of infectious disease as outcome, climate or weather factor as exposure, and Arctic or subarctic areas as study origin. Narrative reviews, case reports, and projection studies were excluded. Abstracts and selected full texts were read and evaluated by two independent readers. A data collection sheet and an adjusted version of the SIGN methodology checklist were used to assess the quality grade of each article.

Results:

In total, 1953 abstracts were initially found, of which finally 29 articles were included. Almost half of the studies were carried out in Canada (n = 14), the rest from Sweden (n = 6), Finland (n = 4), Norway (n = 2), Russia (n = 2), and Alaska, US (n = 1). Articles were analyzed by disease group: food-and waterborne diseases, vector-borne diseases, airborne viral-and airborne bacterial diseases. Strong evidence was found in our review for an association between climatic factors and food-and waterborne diseases. The scientific evidence for a link between climate and specific vector-and rodent-borne diseases was weak due to that only a few diseases being addressed in more than one publication, although several articles were of very high quality. Air temperature and humidity seem to be important climatic factors to investigate further for viral-and bacterial airborne diseases, but from our results no conclusion about a causal relationship could be drawn.

Conclusions:

More studies of high quality are needed to investigate the adverse health impacts of weather and climatic factors in the Arctic and subarctic region. No studies from Greenland or Iceland were found, and only a few from Siberia and Alaska. Disease and syndromic surveillance should be part of climate change adaptation measures in the Arctic and subarctic regions, with monitoring of extreme weather events known to pose a risk for certain infectious diseases implemented at the community level.

Place, publisher, year, edition, pages
Global Health Action, 2014
Keywords
infectious diseases, climatic factors, Arctic, subarctic region, systematic reviews
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-91394 (URN)10.3402/gha.v7.24161 (DOI)000338438200001 ()24990685 (PubMedID)2-s2.0-84925223896 (Scopus ID)
Available from: 2014-08-06 Created: 2014-08-04 Last updated: 2023-03-23Bibliographically approved
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