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  • 1.
    Almevall, Ariel
    et al.
    Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden.
    Dahlin Almevall, Albin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Öhlin, Jerry
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Zingmark, Karin
    Department of Health, Education and Technology, Division of Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden.
    Niklasson, Johan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort2024In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 122, article id 105392Article in journal (Refereed)
    Abstract [en]

    Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.

    Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.

    Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.

    Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).

    Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.

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  • 2.
    Amin, Bawan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Yttre vändningsförsök: Är det säkert?2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 3.
    Aronsson, Ingela
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Neely, Anna Stigsdotter
    Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden; Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Faculty of Medical and Health Sciences, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen (ISMC) and Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
    Eskilsson, Therese
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Gavelin, Hanna M.
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    "Recovery activities are needed every step of the way": exploring the process of long-term recovery in people previously diagnosed with exhaustion disorder2024In: BMC Psychology, E-ISSN 2050-7283, Vol. 12, no 1, article id 248Article in journal (Refereed)
    Abstract [en]

    Background: Sick-leave rates are high due to stress-related illnesses, but little is still known about the process of recovery from these conditions. The aim of this study was to explore the experiences of the recovery process, 6 to 10 years after treatment in people previously diagnosed with exhaustion disorder (ED), focusing on facilitators and barriers for the process of recovery from ED, and recovery activities experienced as helpful during the recovery process.

    Method: Thirty-eight participants (average age: 52 years, 32 females) previously diagnosed with ED were interviewed with semi-structured interviews 6–10 years after undergoing treatment. The interviews were analyzed with thematic analysis.

    Results: Three themes resulted from the analysis. The first theme, “A long and rocky road”, summarizes the fluctuating path to feeling better and emphasizes barriers and facilitators that affected the process of recovery, with a focus on external life events and the participants’ own behaviors. Facilitators were changing workplace, receiving support, a reduction in stressors, and changed behaviors. Barriers were a poor work environment, caregiver responsibilities, negative life events and lack of support. The second theme “Recovery activities are needed every step of the way” describes how both the need for recovery activities and the types of activities experienced as helpful changed during the recovery process, from low-effort recovery activities for long periods of time to shorter and more active recovery activities. Recovery activities were described as important for self-care but hard to prioritize in everyday life. The last theme, “Reorienting to a new place”, captures the struggle to cope with the remaining impact of ED, and how internal facilitators in terms of understanding and acceptance were important to reorient and adjust to a new way of functioning.

    Conclusions: Recovering from ED is a long and ongoing process where recovery activities are needed every step of the way. Our results highlight the importance of supporting personal recovery and long-term behavioral change, addressing individual stressors that may perpetuate the condition, and adjusting recovery activities according to where the person is in the recovery process.

    Trial registration: ClinicalTrials.gov: NCT0073772. Registered on March 8, 2017. This study was pre-registered on Open Science Framework (osf.io).

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  • 4.
    Birnefeld, Johan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Cerebral hemodynamics in stroke, cerebral small vessel disease and pharmacological interventions: a 4D flow MRI study2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aim: Current cerebrovascular imaging techniques provide important information on arterial anatomy and structural pathologies, such as stenoses and occlusions, but physicians are left to infer how the blood flow is affected. In addition, the relationship between blood pressure and cerebral blood flow is complex and poorly understood. Increased transmission of cardiac pulsatility to the cerebral microvasculature has been suggested as a causative factor of cerebral small vessel disease (CSVD) but previous research have yielded conflicting results regarding this relationship. 4D flow magnetic resonance imaging (MRI) is a novel and promising technique enabling time-resolved blood flow quantification with whole-brain coverage and relatively short scan times. However, despite its obvious potential, there is not yet an evidence-based application for the use of 4D flow MRI within stroke or CSVD. This dissertation aimed to apply 4D flow MRI to describe blood flow patterns in posterior circulation stroke and cerebral blood flow responses to common pharmacological agents used to alter arterial blood pressure as well as to examine the relationship between cerebral arterial pulsatility and CSVD.

    Methods and Results: This doctoral dissertation consisted of four papers, referred to by roman numerals. 4D flow MRI and computed tomography angiography (CTA) were applied in 25 patients with acute ischemic stroke in the posterior circulation and a reference population of 15 healthy elderly (paper I). Individual flow profiles were created for each stroke patient and hemodynamic disturbances as well as collateral compensation were described. We show that hemodynamic findings were related to structural findings from CTA.

    The cross-sectional relationship between cerebral arterial pulsatility (quantified using 4D flow MRI as pulsatility index [PI] and flow volume pulsatility [FVP]) and features of CSVD were examined using regression analysis in 89 patients with acute ischemic stroke (paper II) and a population-based sample of 862 elderly (paper III). Internal carotid artery FVP was associated with increasing white matter hyperintensity (WMH) volume in patients with stroke and TIA (paper II). In addition, increasing middle cerebral artery FVP and PI were associated with worse cognitive function. In the population sample, high FVP and PI were associated with increasing WMH volume, lower brain volume and the presence of lacunes, but not the composite MRI-CSVD (paper III). Among subjects with MRI-CSVD, displaying symptoms consistent with cerebral small vessel disease was associated with higher WMH volume, lower brain volume and active smoking, but not any measure of pulsatility.

    Eighteen healthy volunteers were administered noradrenaline to increase mean arterial pressure by 20% above baseline, and labetalol to decrease mean arterial pressure to 15% below baseline (paper IV). Cerebral blood flow was measured using phase-contrast MRI at each blood pressure level and compared to baseline. Despite a marked increase in blood pressure, noradrenaline administration caused a reduction in cerebral blood flow and cardiac output. Meanwhile, labetalol administration caused no change in cerebral blood flow but an increased cardiac output.

    Conclusions: 4D flow MRI can detect hemodynamic disturbances and discriminate between hemodynamic disturbances and normal flow in patients with structural vascular pathologies. This additional information compared to structural imaging alone could potentially be used for prognosis and selection for procedures in clinical care. Cerebral arterial pulsatility is modestly associated with several MRI and clinical features of CSVD but not all. Cerebral arterial pulsatility as the main risk factor of CSVD seems unlikely but its involvement in the pathophysiology cannot be ruled out. Raising the blood pressure with noradrenaline decreases cerebral blood flow and cardiac output without any redistribution from peripheral to cerebral flow. This highlights the pitfalls of using blood pressure as a surrogate for cerebral blood flow and questions the validity of our understanding of cerebral autoregulation. Lowering the blood pressure with labetalol does not affect cerebral blood flow, reassuring its use in clinical routine. 4D flow MRI can be integrated into an in-patient work-up in selected cases of acute ischemic stroke and into the workflow of large epidemiological studies.

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  • 5.
    Björk, Emma
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry. Division of Obstetrics and Gynecology/Örnsköldsvik Hospital, Örnsköldsvik, Sweden.
    Israelsson, Pernilla
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Nagaev, Ivan
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Nagaeva, Olga
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Lundin, Eva
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Ottander, Ulrika
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Endometriotic tissue-derived exosomes downregulate NKG2D-mediated cytotoxicity and promote apoptosis: mechanisms for survival of endometriotic tissue at ectopic sites2024Manuscript (preprint) (Other academic)
    Abstract [en]

    Endometriosis, affecting 10% of women, is defined as implantation, survival, and growth of endometriumlike/endometriotic tissue outside the uterine cavity, causing inflammation, infertility, pain andsusceptibility to ovarian cancer. Despite extensive studies, its etiology and pathogenesis are poorlyunderstood and largely unknown. The prevailing view is that the immune system of endometriosispatients fails to clear ectopically disseminated endometrium from retrograde menstruation. Exosomes aresmall extracellular vesicles that exhibit immunomodulatory properties. We studied the role ofendometriotic tissue-secreted exosomes in the pathophysiology of endometriosis. Two exosome-mediatedmechanisms known to impair the immune response were investigated: 1) downregulation of NKG2Dmediatedcytotoxicity and 2) FasL- and TRAIL-induced apoptosis of activated immune cells. We showedthat secreted endometriotic exosomes isolated from supernatants of short-term explant cultures carry theNKG2D ligands MICA/B and ULBP1-3; and the proapoptotic molecules FasL and TRAIL on theirsurface, i.e. signature molecules of exosome-mediated immune suppression. Acting as decoys, theseexosomes downregulate the NKG2D receptor, impair NKG2D-mediated cytotoxicity and induce apoptosisof activated PBMC and Jurkat cells through the FasL- and TRAIL pathway. The secreted endometrioticexosomes create an immunosuppressive gradient at the ectopic site, forming a “protective shield” aroundthe endometriotic lesions. This gradient guards the endometriotic lesions against clearance by a cytotoxicattack and creates immunologic privilege by induction of apoptosis in activated immune cells. Takentogether, our results provide a plausible, exosome-based mechanistic explanation for the immunedysfunction and the compromised immune surveillance in endometriosis and contribute with novelinsights into the pathogenesis of this enigmatic disease.

  • 6.
    Björk, Emma
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry. Division of Obstetrics and Gynecology/Örnsköldsvik Hospital, Örnsköldsvik, Sweden.
    Israelsson, Pernilla
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Nagaeva, Olga
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Mincheva-Nilsson, Lucia
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology.
    Ottander, Ulrika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Enhanced CD56 expression and increased numbers of CD56+bright cells in the peripheral blood of untreated endometriosis patientsManuscript (preprint) (Other academic)
    Abstract [en]

    Problem: Endometriosis is characterized by ectopic implantation of endometrial-like tissue and impaired immuneresponses such as the cytotoxic function of NK cells. NK cells can be divided into two subpopulations where theCD56+bright cells produce more cytokines and have low natural cytotoxicity compared to CD56+dim cells. Themajority (>90%) of circulating NK cells are CD56+dim whereas very few (0-10 %) are CD56+bright.

    Method of Study: Using flow cytometry, NK cell subpopulations were analyzed in peripheral blood from 21individuals with endometriosis and 12 healthy controls. Furthermore, the NKG2D receptor expression on PBMCswas analyzed in untreated and treated endometriosis patients and controls.

    Results: We found an increased level of CD56+bright cells in 8 of 21 endometriosis patients. After surgery andhormonal treatment, the levels were normalized to that of controls. In a new cohort, the NKG2D receptorexpression on PBMCs was analyzed, with a lower expression in untreated patients compared to controls andpatients treated by surgery and hormones.

    Conclusions: Our findings of a dominant CD56+bright NK cell subpopulation in peripheral blood, anddownregulated levels of the NKG2D receptor on PBMCs, may explain the impaired cytotoxic immune functioncausing the persistence of ectopic endometrium in untreated endometriosis patients.

  • 7.
    Björnfot, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Larsson, Jenny
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Hansson, William
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Birnefeld, Johan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Garpebring, Anders
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Qvarlander, Sara
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Koskinen, Lars-Owe D.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Wåhlin, Anders
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Cerebral arterial stiffness is linked to white matter hyperintensities and perivascular spaces in older adults: a 4D flow MRI study2024In: Journal of Cerebral Blood Flow and Metabolism, ISSN 0271-678X, E-ISSN 1559-7016Article in journal (Refereed)
    Abstract [en]

    White matter hyperintensities (WMH), perivascular spaces (PVS) and lacunes are common MRI features of small vessel disease (SVD). However, no shared underlying pathological mechanism has been identified. We investigated whether SVD burden, in terms of WMH, PVS and lacune status, was related to changes in the cerebral arterial wall by applying global cerebral pulse wave velocity (gcPWV) measurements, a newly described marker of cerebral vascular stiffness. In a population-based cohort of 190 individuals, 66–85 years old, SVD features were estimated from T1-weighted and FLAIR images while gcPWV was estimated from 4D flow MRI data. Additionally, the gcPWV’s stability to variations in field-of-view was analyzed. The gcPWV was 10.82 (3.94) m/s and displayed a significant correlation to WMH and white matter PVS volume (r = 0.29, p < 0.001; r = 0.21, p = 0.004 respectively from nonparametric tests) that persisted after adjusting for age, blood pressure variables, body mass index, ApoB/A1 ratio, smoking as well as cerebral pulsatility index, a previously suggested early marker of SVD. The gcPWV displayed satisfactory stability to field-of-view variations. Our results suggest that SVD is accompanied by changes in the cerebral arterial wall that can be captured by considering the velocity of the pulse wave transmission through the cerebral arterial network.

  • 8.
    Bromfalk, Åsa
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
    Intervention for prevention: easing children’s preoperative anxiety2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Preoperative anxiety in children is associated with several adverse outcomes and consequences that can have a negative impact on the perioperative outcome and delay recovery. Anxiety can cause stress-induced cardiorespiratory instability, increased postoperative pain, nausea, emergence delirium, and long-term behavior changes. The ideal premedication for children is still debated. Only a few studies have examined the use of premedication in relation to total intravenous anesthesia (TIVA), and there is also a lack of studies exploring staff’s experiences of premedication. The aim of this thesis was to compare midazolam (a benzodiazepine), clonidine, and dexmedetomidine (a2-agonists) given as premedication to preschool children, regarding anxiety, cardiorespiratory response to sedation, time to postoperative recovery, posthospital negative behavior changes (NBCs), and staff’s experiences of the interventions.

    Methods: In a randomized clinical trial, 90 children aged 2–6 years, scheduled for TIVA and ear, nose, and throat surgery, were randomized to one of three groups, receiving midazolam 0.5 mg/kg, clonidine 4 mg/kg, or dexmedetomidine 2 mg/kg. The children were included at a 200-bed county hospital in northern Sweden and observed with validated tools from the day of surgery until two weeks postoperatively (Studies I–IV). To explore the clinical aspects, we conducted focus group interviews to elicit perioperative staff’s experiences of the studied interventions and analyzed the data with qualitative content analysis (Study V). 

    Results: Midazolam reduced preoperative anxiety and provided perioperative cardiorespiratory stability. Clonidine and dexmedetomidine provided deeper sedation along with a minor decrease in heart rate. Some children, mainly from the clonidine group, awoke during the preoperative preparation, triggering anxiety, while the midazolam group remained conscious, calm, and cooperative. Postoperatively, the midazolam group emerged earlier from anesthesia compared to the two a2-agonist groups. However, the midazolam group had more episodes of postoperative anxiety, delirium, and pain compared to both groups receiving a2-agonists, and the overall recovery and discharge time from the post-anesthesia care unit was thus the same for all groups. The posthospital study showed at least one NBC in half of the children during the first two weeks after surgery. The staff’s experiences of premedication could be summarized in three themes: a matter of time, covering the efforts of building trust along with timing the administration and onset; don’t wake the sleeping bear, covering the challenge of maintaining sleep in the sleeping child in order to avoid a backlash if woken; and on responsive tiptoes, covering safety precautions and ethical perspectives on the interventions.

    Conclusion: The different premedications varied in their ability to reduce anxiety and to induce sleep, and this manifested itself throughout the perioperative process. Short-acting midazolam reduced preoperative anxiety but did not provide adequate sleep, and early postoperative emergence occasionally caused a rise in adverse symptom intensification. The long-lasting and sleep-inducing a2-agonists showed an unsatisfactory anxiolytic effect in comparison to midazolam. The sleep was superficial, and an awakening risked triggering anxiety. The staff strove to keep the sedated child asleep, and the recovery time was better and more peaceful when the children slept for a long time postoperatively. However, despite a calm perioperative process, one in two children presented with posthospital NBC. At the doses used in this study, all these premedications seem to be safe in cardiorespiratory terms, and the decision of which one to use should be tailored by individual and time.

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  • 9.
    Buchwald, Pamela
    et al.
    Department of Surgery, Skåne University Hospital, Malmö, Sweden; Lund University, Lund, Sweden.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Department of Surgery, Helsinki University, Helsinki, Finland.
    Does it really matter if the surgeon is female or male?2024In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 113, no 2, p. 182-183Article in journal (Other academic)
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  • 10.
    Carlund, Olivia
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Thörn, Elina
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Osterman, Pia
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Fors, Maja
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Dernstedt, Andy
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Forsell, Mattias N. E.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry.
    Erlanson, Martin
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Landfors, Mattias
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Degerman, Sofie
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Immunology/Immunchemistry. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Hultdin, Magnus
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Semimethylation is a feature of diffuse large B-cell lymphoma, and subgroups with poor prognosis are characterized by global hypomethylation and short telomere length2024In: Clinical Epigenetics, E-ISSN 1868-7083, Vol. 16, no 1, article id 68Article in journal (Refereed)
    Abstract [en]

    Background: Large B-cell lymphoma (LBCL) is the most common lymphoma and is known to be a biologically heterogeneous disease regarding genetic, phenotypic, and clinical features. Although the prognosis is good, one-third has a primary refractory or relapsing disease which underscores the importance of developing predictive biological markers capable of identifying high- and low-risk patients. DNA methylation (DNAm) and telomere maintenance alterations are hallmarks of cancer and aging. Both these alterations may contribute to the heterogeneity of the disease, and potentially influence the prognosis of LBCL.

    Results: We studied the DNAm profiles (Infinium MethylationEPIC BeadChip) and relative telomere lengths (RTL) with qPCR of 93 LBCL cases: Diffuse large B-cell lymphoma not otherwise specified (DLBCL, n = 66), High-grade B-cell lymphoma (n = 7), Primary CNS lymphoma (n = 8), and transformation of indolent B-cell lymphoma (n = 12). There was a substantial methylation heterogeneity in DLBCL and other LBCL entities compared to normal cells and other B-cell neoplasms. LBCL cases had a particularly aberrant semimethylated pattern (0.15 ≤ β ≤ 0.8) with large intertumor variation and overall low hypermethylation (β > 0.8). DNAm patterns could not be used to distinguish between germinal center B-cell-like (GC) and non-GC DLBCL cases. In cases treated with R-CHOP-like regimens, a high percentage of global hypomethylation (β < 0.15) was in multivariable analysis associated with worse disease-specific survival (DSS) (HR 6.920, 95% CI 1.499–31.943) and progression-free survival (PFS) (HR 4.923, 95% CI 1.286–18.849) in DLBCL and with worse DSS (HR 5.147, 95% CI 1.239–21.388) in LBCL. These cases with a high percentage of global hypomethylation also had a higher degree of CpG island methylation, including islands in promoter-associated regions, than the cases with less hypomethylation. Additionally, telomere length was heterogenous in LBCL, with a subset of the DLBCL-GC cases accounting for the longest RTL. Short RTL was independently associated with worse DSS (HR 6.011, 95% CI 1.319–27.397) and PFS (HR 4.689, 95% CI 1.102–19.963) in LBCL treated with R-CHOP-like regimens.

    Conclusion: We hypothesize that subclones with high global hypomethylation and hypermethylated CpG islands could have advantages in tumor progression, e.g. by inactivating tumor suppressor genes or promoting treatment resistance. Our findings suggest that cases with high global hypomethylation and thus poor prognosis could be candidates for alternative treatment regimens including hypomethylating drugs.

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  • 11.
    Coser, Omar
    et al.
    Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Rome, Italy; Unit of Advanced Robotics and Human-Centered Technologies, Università Campus Bio-Medico di Roma, Rome, Italy.
    Tamantini, Christian
    Unit of Advanced Robotics and Human-Centered Technologies, Università Campus Bio-Medico di Roma, Rome, Italy.
    Soda, Paolo
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Unit of Computer Systems and Bioinformatics, Università Campus Bio-Medico di Roma, Rome, Italy.
    Zollo, Loredana
    Unit of Advanced Robotics and Human-Centered Technologies, Università Campus Bio-Medico di Roma, Rome, Italy.
    AI-based methodologies for exoskeleton-assisted rehabilitation of the lower limb: a review2024In: Frontiers in Robotics and AI, E-ISSN 2296-9144, Vol. 11, article id 1341580Article, review/survey (Refereed)
    Abstract [en]

    Over the past few years, there has been a noticeable surge in efforts to design novel tools and approaches that incorporate Artificial Intelligence (AI) into rehabilitation of persons with lower-limb impairments, using robotic exoskeletons. The potential benefits include the ability to implement personalized rehabilitation therapies by leveraging AI for robot control and data analysis, facilitating personalized feedback and guidance. Despite this, there is a current lack of literature review specifically focusing on AI applications in lower-limb rehabilitative robotics. To address this gap, our work aims at performing a review of 37 peer-reviewed papers. This review categorizes selected papers based on robotic application scenarios or AI methodologies. Additionally, it uniquely contributes by providing a detailed summary of input features, AI model performance, enrolled populations, exoskeletal systems used in the validation process, and specific tasks for each paper. The innovative aspect lies in offering a clear understanding of the suitability of different algorithms for specific tasks, intending to guide future developments and support informed decision-making in the realm of lower-limb exoskeleton and AI applications.

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  • 12.
    Eltorky, Hagar
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Department of Biochemistry, Faculty of Science, Zagazig University, Zagazig, Egypt.
    AbdelMageed, Manar
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Department of Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
    Ismail, Hager
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Department of Clinical Pathology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
    Zahran, Faten
    Department of Biochemistry, Faculty of Science, Zagazig University, Zagazig, Egypt.
    Guirgis, Adel
    Department of Molecular Biology, Genetic Engineering, Biotechnology Research Institute, University of Sadat City, Menoufia, Sadat, Egypt.
    Ohlsson, Lina
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Lindmark, Gudrun
    Institution of Clinical Sciences, Lund University, Lund, Sweden.
    Hammarström, Marie-Louise
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Hammarström, Sten
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Sitohy, Basel
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    LGR6 is a prognostic biomarker for less differentiated tumors in lymph nodes of colon cancer patients2024In: Frontiers in Oncology, E-ISSN 2234-943X, Vol. 14, article id 1393075Article in journal (Refereed)
    Abstract [en]

    Introduction: The aim was to investigate whether the stem cell marker LGR6 has prognostic value in colon cancer, alone or in combination with the prognostic biomarkers CEA and CXCL16.

    Methods: LGR6 mRNA levels were determined in 370 half lymph nodes of 121 colon cancer patients. Ability to predict relapse after curative surgery was estimated by Kaplan-Meier survival model and Cox regression analyses.

    Results: Patients with high LGR6 levels [LGR6(+)] had a decreased mean survival time of 11 months at 5-year follow-up and 47 months at 12-year follow-up, respectively, with hazard ratios of 3.2 and 2.8. LGR6 mRNA analysis added prognostic value to CEA and CXCL16 mRNA analysis. In the poor prognosis groups CEA(+) and CXCL16(+), further division was achieved by LGR6 analysis. LGR6(+) patients had a very poor prognosis. LGR6 also identified a small number of CEA(-), TNM stage I patients who relapsed suggesting stem cell origin of these tumors. LGR6 and LGR5 levels correlated strongly in lymph nodes of stage I and IV patients but not in stage II patients, suggesting that these stem cell markers are differentially regulated.

    Conclusion: This study highlights LGR6 as a useful prognostic biomarker independently and in combination with CEA, CXCL16 or LGR5 identifying different risk groups.

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  • 13.
    Enlund, Mats
    et al.
    Uppsala University, Center for Clinical Research, Västerås, Sweden; Dept of Anesthesia & Intensive Care, Västmanland Hospital, Västerås, Sweden; ESAIC Onco Anaesthesiology Research Group, EuroPeriscope.
    Hållberg, Hampus
    Epistat AB, Uppsala, Sweden.
    Berglund, Anders
    Epistat AB, Uppsala, Sweden.
    Sherif, Amir
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University Hospital, Umeå, Sweden.
    Enlund, Anna
    Uppsala University, Center for Clinical Research, Västerås, Sweden; Dept of Anesthesia & Intensive Care, Västmanland Hospital, Västerås, Sweden.
    Bergkvist, Leif
    Uppsala University, Center for Clinical Research, Västerås, Sweden.
    Long-term survival after volatile or propofol general anesthesia for bladder cancer surgery: a retrospective national registry cohort study2024In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 140, no 6, p. 1126-1133Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Prospective interventional trials and retrospective observational analyses provide conflicting evidence regarding the relationship between propofol versus inhaled volatile general anesthesia and long-term survival after cancer surgery. In specific, bladder cancer surgery lacks prospective clinical trial evidence.

    METHODS: Data on bladder cancer surgery performed under general anesthesia between 2014 and 2021 from The National Quality Registry for Urinary Tract and Bladder Cancer and the Swedish Perioperative Registry were record-linked. Overall survival was compared between patients receiving propofol or inhaled volatile for anesthesia maintenance. The minimum clinically important difference was defined as a five-percentage point difference in five-year survival.

    RESULTS: Of 7,571 subjects, 4,519 (59.7%) received an inhaled volatile anesthetic and 3,052 (40.3%) received propofol for general anesthesia maintenance. The two groups were quite similar in most respects but differed in ASA physical status and tumor stage. Propensity score matching was used to address treatment bias. Survival did not differ during follow-up (median 45 months [interquartile range, 33 to 62]) in neither the full unmatched cohort, nor following 1:1 propensity score matching (3,052 matched pairs). The Kaplan-Meier adjusted five-year survival rates in the matched cohort were 898/3,052, 67.5% (65.7-69.3) for propofol and 852/3,052, 68.5% (66.7-70.4) for inhaled volatile general anesthesia, respectively (hazard ratio 1.05 [95% CI: 0.96 to 1.15], P = 0.332). A sensitivity analysis restricted to 1,766 propensity score matched pairs of patients who received only one general anesthetic during the study period did not demonstrate a difference in survival; Kaplan-Meier adjusted five-year-survival rates were 521/1,766, 67.1% (64.7-69.7) and 482/1,766, 68.9% (66.5-71.4) for propofol and inhaled volatile general anesthesia, respectively (hazard ratio 1.09 [95% CI: 0.97 to 1.23], P = 0.139).

    CONCLUSIONS: Among patients undergoing bladder cancer surgery under general anesthesia, there was no statistically significant difference in long-term overall survival associated with the choice of propofol or an inhaled volatile maintenance.

  • 14.
    Ericson, Anna
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Tromboemboliska händelser och njurfunktionsnedsättning hos patienter som genomgår neoadjuvant kemoterapi (NAC) och radikal cystektomi (RC) för muskelinvasiv urinblåsecancer (MIBC): Är det nytta för alla patienter med rutinmässig trombosprofylax?2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 15.
    Frykholm, Erik
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Simonsson, Emma
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Levik Sandström, Sofi
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Hedlund, Mattias
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Holmberg, Henrik
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Lindelöf, Nina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Boraxbekk, Carl-Johan
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen (ISMC) and Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
    Rosendahl, Erik
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Applicability of a supramaximal high-intensity interval training program for older adults previously not engaged in regular exercise: analyses of secondary outcomes from the Umeå HIT Study2024In: Psychology of Sport And Exercise, ISSN 1469-0292, E-ISSN 1878-5476, Vol. 73, article id 102647Article in journal (Refereed)
    Abstract [en]

    This analysis of secondary outcomes investigated the applicability of supramaximal high-intensity interval training (HIT) with individually prescribed external intensity performed on stationary bicycles. Sixty-eight participants with a median (min; max) age of 69 (66; 79), at the time not engaged in regular exercise were randomized to 25 twice-weekly sessions of supramaximal HIT (20-min session with 10 × 6-s intervals) or moderate-intensity training (MIT, 40-min session with 3 × 8-min intervals). The primary aim was outcomes on applicability regarding; adherence to prescribed external interval intensity, participant reported positive and negative events, ratings of perceived exertion (RPE 6–20), and affective state (Feeling Scale, FS -5–5). A secondary aim was to investigate change in exercise-related self-efficacy (Exercise Self-Efficacy Scale) and motivation (Behavioural Regulations in Exercise Questionnaire-2). Total adherence to the prescribed external interval intensity was [median (min; max)] 89 % (56; 100 %) in supramaximal HIT, and 100 % (95; 100 %) in MIT. The supramaximal HIT group reported 60 % of the positive (112 of 186) and 36 % of the negative (52 of 146) events. At the end of the training period, the median (min; max) session RPE was 15 (12; 17) for supramaximal HIT and 14 (9; 15) for MIT. As for FS, the median last within-session rating was 3 (−1; 5) for supramaximal HIT and 3 (1; 5) for MIT. Exercise-related motivation increased (mean difference in Relative Autonomy Index score = 1.54, 95 % CI [0.69; 2.40]), while self-efficacy did not change (mean difference = 0.55, 95 % CI [-0.75; 1.82]), regardless of group. This study provide support for supramaximal HIT in supervised group settings for older adults.

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  • 16.
    Genlund, Klara
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Kemikalieexponering under fosterstadiet och påverkan på födelsevikt.2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 17.
    Glans, Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Wilén, Jonna
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Hansson, B.
    Department of Clinical Sciences Lund, Diagnostic Radiology, Lund University, Lund, Sweden.
    Audulv, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindgren, Lenita
    Umeå University, Faculty of Medicine, Department of Nursing.
    Managing acoustic noise within MRI: a qualitative interview study among Swedish radiographers2024In: Radiography, ISSN 1078-8174, E-ISSN 1532-2831, Vol. 30, no 3, p. 889-895Article in journal (Refereed)
    Abstract [en]

    Introduction: Acoustic noise from magnetic resonance imaging (MRI) can cause hearing loss and needs to be mitigated to ensure the safety of patients and personnel. Capturing MR personnel's insights is crucial for guiding the development and future applications of noise-reduction technology. This study aimed to explore how MR radiographers manage acoustic noise in clinical MR settings.

    Methods: Using a qualitative design, we conducted semi-structured individual interviews with fifteen MR radiographers from fifteen hospitals around Sweden. We focused on the clinical implications of participants’ noise management, using an interpretive description approach. We also identified sociotechnical interactions between People, Environment, Tools, and Tasks (PETT) by adopting a Human Factors/Ergonomics framework. Interview data were analyzed inductively with thematic analysis (Braun and Clarke).

    Results: The analysis generated three main themes regarding MR radiographers’ noise management: (I) Navigating Occupational Noise: Risk Management and Adaptation; (II) Protecting the Patient and Serving the Exam, and (III) Establishing a Safe Healthcare Environment with Organizational Support.

    Conclusion: This study offers insights into radiographers’ experiences of managing acoustic noise within MRI, and the associated challenges. Radiographers have adopted multiple strategies to protect patients and themselves from adverse noise-related effects. However, they require tools and support to manage this effectively, suggesting a need for organizations to adopt more proactive, holistic approaches to safety initiatives.

    Implications for practice: The radiographers stressed the importance of a soundproofed work environment to minimize occupational adverse health effects and preserve work performance. They acknowledge noise as a common contributor to patient distress and discomfort. Providing options like earplugs, headphones, mold putty, software-optimized “quiet” sequences, and patient information were important tools. Fostering a safety culture requires proactive safety efforts and support from colleagues and management.

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  • 18.
    Govik, Fanny
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Medelhavskost och framtida risk för subtyper av kolorektalcancer.2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 19.
    Grahn, Oskar
    et al.
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Holmgren, Klas
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Jonsson, Pär
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Borgmästars, Emmy
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lundin, Christina
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    Rutegård, Martin
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Peritoneal infection after colorectal cancer surgery induces substantial alterations in postoperative protein levels: an exploratory studyManuscript (preprint) (Other academic)
    Abstract [en]

    Purpose: Peritoneal infection, due to anastomotic leakage, after resection for colorectal cancer have been shown to associate with increased cancer recurrence and mortality, as well as cardiovascsular morbidity. Alterations in circulating protein levels could help shed light on the underlying mechanisms, prompting this exploratory study of 64 patients operated for colorectal cancer with anastomosis.

    Methods: Thirty-two cases who suffered a postoperative peritoneal infection were matched with 32 controls who had a complication-free postoperative stay. Proteins in serum samples at their first postoperative visit and at one year after surgery were analysed using proximity extension assays and enzyme-linked immunosorbent assays. Multivariate projection methods, adjusted for multiple testing, were used to compare levels between groups, and enrichment and network analyses were performed.

    Results: Seventy-seven proteins, out of 270 tested, were differentially expressed at a median sampling time of 41 days after surgery. Many of the differentially expressed top hub proteins have known involvement in cancer progression, survival, invasiveness and metastasis. Over-represented pathways were related to cardiomyopathy, cell-adhesion, extracellular matrix, phosphatidylinositol-3-kinase/Akt (PI3K/Akt) and transforming growth factor beta (TGF-β) signaling.

    Conclusion: These affected proteins and pathways could provide clues as to why these patients might suffer increased cancer recurrence, mortality and cardiovascular morbidity.

  • 20.
    Granlöf, Fanny
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Effekten av olika djup hjärnstimulerings inställningar på rörelsefunktion och balans hos patienter med essentiell tremor – en pilotstudie2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 21.
    Haidar, Ali
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    HelvävnadsinfärgningUtveckling och Applikation för 3D-mikroskopi (Muskel)2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 22.
    Holgersson, Emma
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Utvärdering efter plattfixation av femurfrakturer; öppen jämfört med miniinvasiv teknik2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 23.
    Jakobsén, Sara
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Radiologiska begränsningar vid preoperativ stadiebestämning av kolorektalcancer2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 24.
    Jansson Udekwu, Kristina
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    En utvärdering av det nationella uppföljningsprogrammet för muskel invasiv blåscancer (MIBC) - Är uppföljningen av relevans för complete och partial responders trots låg klinisk observerad risk för recidiv?2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 25.
    Johansson, Birgitta
    et al.
    Department of Immunology, Genetics, and Pathology, Uppsala University, Rudbecklaboratoriet, Uppsala, Sweden.
    Cajander, Åsa
    Division of Visual Information and Interaction, Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Ahmad, Awais
    Division of Visual Information and Interaction, Department of Information Technology, Uppsala University, Uppsala, Sweden.
    Ohlsson-Nevo, Emma
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Fransson, Per
    Umeå University, Faculty of Medicine, Department of Nursing.
    Granström, Brith
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    von Essen, Louise
    Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden.
    Langegård, Ulrica
    Department of Immunology, Genetics, and Pathology, Uppsala University, Rudbecklaboratoriet, Uppsala, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Pettersson, Mona
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Henriksson, Anna
    Physiotherapy and behavioral medicine, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; The School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Ehrsson, Ylva Tiblom
    Department of Surgical Sciences, Section of Otorhinolaryngology and Head & amp; Neck Surgery, Uppsala University, Akademiska sjukhuset, ingång 70, bv, Rudbecklaboratoriet, Uppsala, Sweden.
    The effect of internet-administered support (carer eSupport) on preparedness for caregiving in informal caregivers of patients with head and neck cancer compared with support as usual: a study protocol for a randomized controlled trial2024In: BMC Cancer, E-ISSN 1471-2407, Vol. 24, no 1, article id 494Article in journal (Refereed)
    Abstract [en]

    Background: Informal caregivers (ICs) of patients with cancer provide essential and mainly uncompensated care. A self-perceived preparedness to care for the patient is associated with a lower caregiver burden, described as the extent to which caregiving is perceived as having adverse effects on IC functioning and well-being. ICs’ well-being is associated with patient-perceived quality of care, suggesting that interventions to optimize ICs’ health are essential in order to improve patient care. Head and neck cancer (HNC) is the seventh most common malignant disease in the world. The disease and its treatment have a significant negative impact on the patient’s health and quality of life. Symptoms usually interfere with swallowing, food and fluid intake, breathing, speaking, and communication. ICs frequently manage patients’ symptoms and side effects, especially problems related to nutrition and oral pain, without being properly prepared. Carer eSupport is an Internet-administered intervention, based on focus group discussions with ICs, developed in collaboration with ICs and healthcare professionals, tested for feasibility, and deemed feasible. This study protocol outlines the methods of investigating the effects of Carer eSupport plus support as usual (SAU) on self-reported preparedness for caregiving, caregiver burden, and well-being in the ICs of patients with HNC, compared with ICs receiving SAU only.

    Methods and analysis: In this randomized controlled trial, 110 ICs of patients with HNC, undergoing radiotherapy combined with surgery and/or medical oncological treatment, will be randomized (1:1) to Carer eSupport plus SAU or SAU only. Data will be collected at baseline (before randomization), post-intervention (after 18 weeks), and 3 months after post-intervention. The primary outcome is self-reported preparedness for caregiving. Secondary outcomes are self-reported caregiver burden, anxiety, depression, and health-related quality of life. The effect of Carer eSupport plus SAU on preparedness for caregiving and secondary outcomes, compared with SAU only, will be evaluated by intention to treat analyses using linear regression models, mixed-model regression, or analysis of covariance.

    Discussion: If proven effective, Carer eSupport has the potential to significantly improve ICs’ preparedness for caregiving and their wellbeing, thereby improving patient-perceived quality of care and patient wellbeing.

    Trial registration: ClinicalTrials.gov; NCT06307418, registered 12.03.2024 (https://clinicaltrials.gov/search? term=NCT06307418).

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  • 26.
    Karalija, Nina
    et al.
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Papenberg, Goran
    Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Johansson, Jarkko
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Wåhlin, Anders
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Salami, Alireza
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Medical and Translational Biology. Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Andersson, Micael
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Axelsson, Jan
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Kuznetsov, Dmitry
    Faculty of Sociology, University of Bielefeld, Bielefeld, Germany.
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Lövdén, Martin
    Department of Psychology, University of Gothenburg, Göteborg, Sweden.
    Lindenberger, Ulman
    Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, United Kingdom.
    Bäckman, Lars
    Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Longitudinal support for the correlative triad among aging, dopamine D2-like receptor loss, and memory decline2024In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 136, p. 125-132Article in journal (Refereed)
    Abstract [en]

    Dopamine decline is suggested to underlie aging-related cognitive decline, but longitudinal examinations of this link are currently missing. We analyzed 5-year longitudinal data for a sample of healthy, older adults (baseline: n = 181, age: 64–68 years; 5-year follow-up: n = 129) who underwent positron emission tomography with 11C-raclopride to assess dopamine D2-like receptor (DRD2) availability, magnetic resonance imaging to evaluate structural brain measures, and cognitive tests. Health, lifestyle, and genetic data were also collected. A data-driven approach (k-means cluster analysis) identified groups that differed maximally in DRD2 decline rates in age-sensitive brain regions. One group (n = 47) had DRD2 decline exclusively in the caudate and no cognitive decline. A second group (n = 72) had more wide-ranged DRD2 decline in putamen and nucleus accumbens and also in extrastriatal regions. The latter group showed significant 5-year working memory decline that correlated with putamen DRD2 decline, along with higher dementia and cardiovascular risk and a faster biological pace of aging. Taken together, for individuals with more extensive DRD2 decline, dopamine decline is associated with memory decline in aging.

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  • 27.
    Lauvrud, Anne Therese
    Umeå University, Faculty of Medicine, Department of Medical and Translational Biology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Optimizing stem cells for reconstructive surgery2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Fat grafting has become an established method in plastic surgery for treating soft tissue defects. The results for survival of the fat being transplanted is unpredictable and supplementation of the graft with the Stromal Vascular Fraction (SVF) or cultures Adipose tissue-derived stem cells (ASCs) can enhance graft viability. The ASCs are a heterogenous group of cells with various cell membrane markers, and differing growth promoting and differentiation characteristics of the stem cells derived from the fat. It is of high importance when expanding cells prior to the transplantation of the cells into patients, that the culture conditions are well defined and ideally are xenofree, avoiding use of animal-derived products. Furthermore, the procedures must be safe and not increase risk for recurrence of cancer after reconstructive surgeries. This thesis explores the phenotypic properties of a selected population of ASCs, with a view to determining their suitability for transplantation into fat grafts. ASCs were isolated from SVF of human abdominal fat and CD146+ cells were selected using immunomagnetic beads. The proliferation, angiogenic and adipogenic properties were significantly higher in the CD146+ cells. Stem cells were also isolated from lipoaspirate obtained using two different liposuction methods. Waterjet lipoaspirates yielded the greatest number of CD146+ cells with high adipogenic potential and angiogenic activity. The cells could also be successfully isolated using a closed processing system. Cells were expanded in either foetal bovine serum, platelet lysate or a chemically defined xenofree (XV) medium. Cultures in XV medium proliferated the fastest, expressed the highest number of CD146+ cells, and showed the best adipogenic and angiogenic properties. To test possible ASCs interactions with cancer cells, co-cultures with MCF-7 breast cancer cells were established. Conditioned medium from co-cultures significantly increased the migration of the cancer cells but not their proliferation, and there was increased expression of Tenascin-C in these cultures. The research in this thesis work has shown more optimal ways to isolate and expand ASCs, potentially offering new therapeutic reconstructive treatment options for a variety of medical conditions.

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  • 28.
    Lauvrud, Anne Therese
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery. Umeå University, Faculty of Medicine, Department of Medical and Translational Biology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Giraudo, Maria
    Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Wiberg, Rebecca
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Wiberg, Mikael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery. Umeå University, Faculty of Medicine, Department of Medical and Translational Biology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Kingham, Paul J.
    Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Brohlin, Maria
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Anatomy. Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    The influence of xeno-free culture conditions on the angiogenic and adipogenic differentiation profile of adipose tissue-derived stem cellsManuscript (preprint) (Other academic)
  • 29.
    Leffler, Klara
    et al.
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Tommaso Luppino, Luigi
    Department Physics and Technology, UiT The Arctic University of Norway, Tromsø, Norway.
    Kuttner, Samuel
    University Hospital of North Norway, Tromsø, Norway; Physics and Technology, UiT The Arctic University of Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway..
    Axelsson, Jan
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Deep learning-based filling of incomplete sinograms from low-cost, long axial field-of-view PET scanners with inter-detector gaps2023In: The international networking symposiumon artificial intelligence and informatics in nuclear medicine: Program book, University Medical Center Groningen , 2023, p. 59-59Conference paper (Refereed)
  • 30.
    Leffler, Klara
    et al.
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Tommaso Luppino, Luigi
    Department Physics and Technology, UiT The Arctic University of Norway, Tromsø, Norway.
    Kuttner, Samuel
    University Hospital of North Norway, Tromsø, Norway; Physics and Technology, UiT The Arctic University of Norway, Tromsø, Norway; Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
    Söderkvist, Karin
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Axelsson, Jan
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Filling of incomplete sinograms from sparse PET detector configurations using a residual U-NetManuscript (preprint) (Other academic)
  • 31.
    Lu, Sai San Moon
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Antibiotics use in relation to colorectal cancer risk, survival and postoperative complications2024Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Growing evidence suggests that antibiotic-induced dysbiosis of gut microbiota potentially contributes to colorectal cancer development and oncological outcomes. However, the role of antibiotics in colorectal cancer incidence, survival and postoperative outcomes at a population level remains incompletely understood.

    Aims: The overall aim of the thesis is to investigate prescription antibiotics use in relation to colorectal cancer risk, survival and postoperative complications, particularly surgical site infections including anastomotic leakage.

    Methods: The thesis work includes matched case-control and cohort studies, leveraging complete population-based data from Swedish national registers. Paper I is a matched case-control study that consists of 40 545 colorectal cancer cases and 202 720 matched controls, aiming to investigate antibiotics use and risk of incident colorectal cancer. Multivariable conditional logistic regression was used. Paper II is a cohort study, including 47 303 colorectal cancer cases, investigating antibiotics use in relation to cancer-specific survival. Stratified Cox proportional-hazards regression was used. Paper III includes 38 839 colorectal cancer cases who had undergone abdominal tumour-resection surgery and assesses antibiotics use in relation to surgical site infections, including anastomotic leakage, within 30 days after surgery. Logistic regression with multi-level mixed-effects models was used.

    Results: In paper I, a dose-response association between antibiotics use and a higher risk of proximal colon cancer was found, whereas a slight inverse association with rectal cancer was observed, mainly in women. A null association was found between methenamine hippurate, assessed as a negative control due to no known effect on gut microbiome, and the risk of colorectal cancer. In paper II, the findings did not support any substantial negative effect of antibiotics on cancer-specific survival, except for very high cumulative exposure (>180 days) in stage I-III diseases. In stage IV colorectal cancer, modest inverse relationships between antibiotics use and survival were noted. In paper III, prescription antibiotics use up to 4.5 years before surgery was associated with a higher risk of surgical site infections, including anastomotic leakage, after colon cancer surgery but not rectal cancer surgery. A null association was observed between methanamine hippurate and the risk of surgical site infections. For cardiovascular and/or neurological complications, also considered as a negative control due to expected negligible or null effects of gut microbiome on these outcomes after surgery, associations were null in both colon and rectal cancer.

    Conclusion: These studies provided further support for antibiotics use as a modifiable risk factor for proximal colon cancer and identified antibiotics taken long before surgery as a novel risk factor for surgical site infections, including anastomotic leakage, after colon cancer surgery. In contrast, we did not find any substantial negative impact of antibiotics on cancer-specific survival. Taken together, the findings described in this thesis provide etiological insights and may contribute to strategies to prevent colon cancer and improve postoperative outcomes through prudent use of antibiotics, thereby aiding in the reduction of colorectal cancer incidence and mortality.

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  • 32.
    Lu, Sai San Moon
    et al.
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Rutegård, Martin
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Häggström, Christel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Gylfe, Åsa
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Harlid, Sophia
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Antibiotics use up to 4.5 years before colorectal cancer surgery is associated with an elevated risk of surgical site infections, including anastomotic leakage, particularly in colon cancer: a Swedish nationwide studyManuscript (preprint) (Other academic)
  • 33.
    Lundström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Eliasson, Håkan
    Karolinska Institutet, Institutionen för kvinnors och barns hälsa.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Holter study of heart rate variability in children and adolescents with long QT syndromeManuscript (preprint) (Other academic)
  • 34.
    Lundström, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Assessment of arrhythmias and heart rate response in healthy adolescents performing face immersion and body submersion in ice-cold waterManuscript (preprint) (Other academic)
  • 35.
    Melhus, Jonatan
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Stabilitet i ryggraden är associerat med höggradig ryggmärgskompression2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 36.
    Mert Karaoglu, Helin
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Morfologiska, funktionella och elektriska förändringar över tid vid transtyretin hjärtamyloidos.2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 37.
    Mäntylä, Matti
    et al.
    Helsinki University Hospital, Comprehensive Cancer Centre, Finland.
    Elomaa, Inkeri
    Helsinki University Hospital, Comprehensive Cancer Centre, Finland.
    Mattson, Johanna
    Helsinki University Hospital, Comprehensive Cancer Centre, Finland.
    Lindroos, Pia
    Helsinki, Finland.
    Killander, Dick
    Lund University, Sweden.
    Littbrand, Bo
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Overgaard, Jens
    Aarhus University, Denmark.
    Tenhunen, Mikko
    Helsinki University Hospital, Comprehensive Cancer Centre, Finland.
    Lars R Holsti (1926-2023), Big name in Finnish and Nordic oncology2024In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 63, p. 229-Article in journal (Refereed)
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  • 38.
    Nyberg, Anette
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Department of Nursing Umeå University Umeå Sweden;Department of Diagnostics and Intervention, Anaesthesiology and Intensive Care Medicine Umeå University Umeå Sweden.
    Jirwe, Maria
    Department of Health Sciences Swedish Red Cross University Huddinge Sweden;Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet Solna Sweden.
    Fagerdahl, Ami
    Department of Clinical Research and Education, Södersjukhuset Karolinska Institutet Solna Sweden.
    Otten, Volker T C
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Haney, Michael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Olofsson, Birgitta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Perioperative patient safety indicators: a Delphi study2024In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed)
    Abstract [en]

    Aim: To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context.

    Design: A modified Delphi method.

    Methods: A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study.

    Results: The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment.

    Conclusion: Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety.

    Implications for the profession and patient care:This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement.

    Impact: The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care.

    Reporting Method: The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'.

    Patient or Public Contribution: No patient or public contribution.

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  • 39.
    Nääs, Charlotta
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    von Salomé, Jenny
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Rosén, Anna
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Patients’ perceptions and practices of informing relatives: a qualitative study within a randomised trial on healthcare-assisted risk disclosure2024In: European Journal of Human Genetics, ISSN 1018-4813, E-ISSN 1476-5438Article in journal (Refereed)
    Abstract [en]

    In a multicentre randomised controlled trial (DIRECT), we evaluate whether an intervention of providing direct letters from healthcare professionals to at-risk relatives (ARRs) affects the proportion of ARRs contacting a cancer genetics clinic, compared with patient-mediated disclosure alone (control). With the aim to explore how the patients included in the trial perceived and performed risk communication with their ARRs we analysed 17 semi-structured interviews with reflexive thematic analysis. All patients described that they disclosed risk information to all close relatives themselves. No integrity-related issues were reported by patients offered the intervention, and all of them accepted direct letters to all their ARRs. Patients’ approaches to informing distant relatives were unpredictable and varied from contacting all distant ARRs, sharing the burden with the family, utilising the offer of sending direct letters, vaguely relying on others to inform, or postponing disclosure. Most patients limited their responsibility to the disclosure, although others wanted relatives to get genetic counselling or felt a need to provide additional information to the ARRs before ending their mission. We also identified confusion about the implication of test results, who needed risk information, and who was responsible for informing ARRs. These misunderstandings possibly also affected risk disclosure. This study revealed that despite accepting the direct letters to be sent to all relatives, the patients also contributed to risk disclosure in other ways. It was only in some situations to distant relatives that the healthcare-assisted letter was the only means of communication to the ARRs.

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  • 40.
    Oskarsson, Elvira
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Komorbiditetsförändringar mellan tidpunkten för diagnos och vid tidpunkten för radikal cystektomi hos patienter med muskelinvasiv urinblåsecancer som genomgår neoadjuvant kemoterapi2023Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 41.
    Pajus, Evelina
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Införande av indocyaningrönt ljus (ICG) vid laparoskopisk galloperation i Sundsvall2023Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 42.
    Papenberg, Goran
    et al.
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Karalija, Nina
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Johansson, Jarkko
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Andersson, Micael
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Axelsson, Jan
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Riklund, Katrine
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Lindenberger, Ulman
    Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Medical and Translational Biology.
    Bäckman, Lars
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    The influence of hippocampal dopamine D2 receptor losses on episodic-memory decline across 5 years is moderated by BDNF and KIBRA polymorphisms2024In: Cortex, ISSN 0010-9452, E-ISSN 1973-8102, Vol. 176, p. 53-61Article in journal (Refereed)
    Abstract [en]

    Losses in dopamine (DA) functioning may contribute to aging-related decline in cognition. Hippocampal DA is necessary for successful episodic memory formation. Previously, we reported that higher DA D2 receptor (D2DR) availability in hippocampus is beneficial for episodic memory only in older carriers of more advantageous genotypes of well-established plasticity-related genetic variations, the brain-derived neurotrophic factor (BDNF, rs6265) and the kidney and brain expressed protein (KIBRA, rs17070145) polymorphisms. Extending our observations to the longitudinal level, the current data show that individuals with one or no beneficial BDNF and KIBRA genotype (n = 80) decline more in episodic memory across five years, without any contribution of losses in hippocampal D2DR availability to memory decline. Although carriers of two beneficial genotypes (n = 39) did not decline overall in episodic memory, losses of hippocampal D2DR availability were predictive of episodic-memory decline among these individuals. Our findings have implications for interventions targeting DA modulation to enhance episodic memory in aging, which may not benefit all older individuals.

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  • 43.
    Rajwa, Pawel
    et al.
    Department of Urology, Medical University of Silesia, Zabrze, Poland; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
    Borkowetz, Angelika
    Department of Urology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
    Abbott, Thomas
    European Association of Urology, Nijmegen, Netherlands.
    Alberti, Andrea
    Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
    Bjartell, Anders
    Department of Translational Medicine, Lund University, Lund, Sweden.
    Brash, James T.
    IQVIA, Real World Solutions, Brighton, United Kingdom.
    Campi, Riccardo
    Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
    Chilelli, Andrew
    Astellas Pharma Europe Ltd, Surrey, United Kingdom.
    Conover, Mitchell
    Janssen Research & Development, NJ, Titusville, United States.
    Constantinovici, Niculae
    Bayer AG, Berlin, Germany.
    Davies, Eleanor
    IQVIA, Real World Solutions, Brighton, United Kingdom.
    De Meulder, Bertrand
    Association EISBM, Vourles, France.
    Eid, Sherrine
    SAS Institute, NC, Cary, United States.
    Gacci, Mauro
    Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
    Golozar, Asieh
    Odysseus Data Services, NY, New York, United States; OHDSI Center, Northeastern University, MA, Boston, United States.
    Hafeez, Haroon
    Shaukat Khanum Memorial Cancer Hospital & Research Centre, Peshawar, Pakistan.
    Haque, Samiul
    SAS Institute, NC, Cary, United States.
    Hijazy, Ayman
    Association EISBM, Vourles, France.
    Hulsen, Tim
    Department of Hospital Services & Informatics, Philips Research, Eindhoven, Netherlands.
    Josefsson, Andreas
    Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Khalid, Sara
    University of Oxford, Oxford, United Kingdom.
    Kolde, Raivo
    Institute of Computer Science, University of Tartu, Estonia, Tartu, Estonia.
    Kotik, Daniel
    Center for Advanced Systems Understanding, Görlitz, Germany; Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
    Kurki, Samu
    Bayer OY, Turku, Finland.
    Lambrecht, Mark
    SAS Institute, NC, Cary, United States.
    Leung, Chi-Ho
    S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
    Moreno, Julia
    SAS Institute, NC, Cary, United States.
    Nicoletti, Rossella
    Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
    Nieboer, Daan
    Erasmus MC University Medical Center, Rotterdam, Netherlands.
    Oja, Marek
    Institute of Computer Science, University of Tartu, Estonia, Tartu, Estonia.
    Palanisamy, Soundarya
    SAS Institute, NC, Cary, United States.
    Prinsen, Peter
    Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands.
    Reich, Christian
    Odysseus Data Services, NY, New York, United States; OHDSI Center, Northeastern University, MA, Boston, United States.
    Raffaele Resta, Giulio
    Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
    Ribal, Maria J.
    Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
    Gómez Rivas, Juan
    Department of Urology, Hospital Clinico San Carlos, Madrid, Spain.
    Smith, Emma
    Guidelines Office, European Association of Urology, Arnhem, Netherlands.
    Snijder, Robert
    Janssen Research & Development, NJ, Titusville, United States.
    Steinbeisser, Carl
    Collaborate Project Management, Munich, Germany.
    Vandenberghe, Frederik
    SAS Institute, NC, Cary, United States.
    Cornford, Philip
    Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom.
    Evans-Axelsson, Susan
    Bayer AG, Berlin, Germany.
    N'Dow, James
    Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom.
    Willemse, Peter-Paul M.
    Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands.
    Research protocol for an observational health data analysis on the adverse events of systemic treatment in patients with metastatic hormone-sensitive prostate cancer: big data analytics using the PIONEER platform2024In: European Urology Open Science, ISSN 2666-1691, E-ISSN 2666-1683, Vol. 63, p. 81-88Article in journal (Refereed)
    Abstract [en]

    Combination therapies in metastatic hormone-sensitive prostate cancer (mHSPC), which include the addition of an androgen receptor signaling inhibitor and/or docetaxel to androgen deprivation therapy, have been a game changer in the management of this disease stage. However, these therapies come with their fair share of toxicities and side effects. The goal of this observational study is to report drug-related adverse events (AEs), which are correlated with systemic combination therapies for mHSPC. Determining the optimal treatment option requires large cohorts to estimate the tolerability and AEs of these combination therapies in “real-life” patients with mHSPC, as provided in this study. We use a network of databases that includes population-based registries, electronic health records, and insurance claims, containing the overall target population and subgroups of patients defined by unique certain characteristics, demographics, and comorbidities, to compute the incidence of common AEs associated with systemic therapies in the setting of mHSPC. These data sources are standardised using the Observational Medical Outcomes Partnership Common Data Model. We perform the descriptive statistics as well as calculate the AE incidence rate separately for each treatment group, stratified by age groups and index year. The time until the first event is estimated using the Kaplan-Meier method within each age group. In the case of episodic events, the anticipated mean cumulative counts of events are calculated. Our study will allow clinicians to tailor optimal therapies for mHSPC patients, and they will serve as a basis for comparative method studies.

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  • 44.
    Rinnström, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Johansson, Bengt
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    New findings on ascending aortic dilation in coarctation of the aorta: expanding perspectives2024In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 83, no 12, p. 1147-1148Article in journal (Other academic)
  • 45.
    Rosenbaum, William
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Bovinder Ylitalo, Erik
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Castel, Guillaume
    CBGP, INRAE, CIRAD, Institut Agro, IRD, Univ Montpellier, Montpellier, France.
    Sjödin, Andreas
    CBRN Security and Defence, Swedish Defence Research Agency - FOI, Umeå, Sweden.
    Larsson, Pär
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Medical and Clinical Genetics.
    Wigren Byström, Julia
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Forsell, Mattias N. E.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Ahlm, Clas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Pettersson, Lisa
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Tuiskunen-Bäck, Anne
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Hybrid capture-based next-generation sequencing of new and old world Orthohantavirus strains and wild-type Puumala isolates from humans and bank voles2024In: Journal of Clinical Virology, ISSN 1386-6532, E-ISSN 1873-5967, Vol. 172, article id 105672Article in journal (Refereed)
    Abstract [en]

    Orthohantaviruses, transmitted primarily by rodents, cause hemorrhagic fever with renal syndrome (HFRS) in Eurasia and hantavirus pulmonary syndrome in the Americas. These viruses, with documented human-to-human transmission, exhibit a wide case-fatality rate, 0.5–40 %, depending on the virus species, and no vaccine or effective treatment for severe Orthohantavirus infections exists. In Europe, the Puumala virus (PUUV), carried by the bank vole Myodes glareolus, causes a milder form of HFRS. Despite the reliance on serology and PCR for diagnosis, the three genomic segments of Swedish wild-type PUUV have yet to be completely sequenced.

    We have developed a targeted hybrid-capture method aimed at comprehensive genomic sequencing of wild-type PUUV isolates and the identification of other Orthohantaviruses. Our custom-designed panel includes >11,200 probes covering the entire Orthohantavirus genus. Using this panel, we sequenced complete viral genomes from bank vole lung tissue, human plasma samples, and cell-cultured reference strains. Analysis revealed that Swedish PUUV isolates belong to the Northern Scandinavian lineage, with nucleotide diversity ranging from 2.8 % to 3.7 % among them. Notably, no significant genotypic differences were observed between the viral sequences from reservoirs and human cases except in the nonstructural protein.

    Despite the high endemicity of PUUV in Northern Sweden, these are the first complete Swedish wild-type PUUV genomes and substantially increase our understanding of PUUV evolution and epidemiology. The panel's sensitivity enables genomic sequencing of human samples with viral RNA levels reflecting the natural progression of infection and underscores our panel's diagnostic value, and could help to uncover novel Orthohantavirus transmission routes.

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  • 46.
    Sandström, Niclas
    et al.
    Department of Oncology, Vaasa Central Hospital, Vaasa, Finland.
    Leppälä, Emilia
    Vaasa Central Hospital, Vaasa, Finland.
    Jekunen, Antti
    Department of Oncology, Vaasa Central Hospital, Vaasa, Finland; Oncology, University of Turku Faculty of Medicine, Turku, Finland.
    Johansson, Mikael
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Andersén, Heidi
    Vaasa Central Hospital, Vaasa, Finland; Oncology, University of Turku Faculty of Medicine, Turku, Finland; Respiratory Medicine, Tampere University, Tampere, Finland.
    Role of patient characteristics in adherence to first-line treatment guidelines in breast, lung and prostate cancer: insights from the Nordic healthcare system2024In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 4, article id e084689Article in journal (Refereed)
    Abstract [en]

    Objectives: This study investigates the influence of socioeconomic status, health literacy, and numeracy on treatment decisions and the occurrence of adverse events in patients with breast, lung, and prostate cancer within a Nordic healthcare setting. Design A follow-up to a cross-sectional, mixed-methods, single-centre study. Setting A Nordic, tertiary cancer clinic.

    Participants: A total of 244 participants with breast, lung and prostate cancer were initially identified, of which 138 first-line treatment participants were eligible for this study. First-line treatment participants (n=138) surpassed the expected cases (n=108).

    Interventions: Not applicable as this was an observational study. Primary and secondary outcome measures The study’s primary endpoint was the rate of guideline adherence. The secondary endpoint involved assessing treatment toxicity in the form of adverse events.

    Results: Guideline-adherent treatment was observed in 114 (82.6%) cases. First-line treatment selection appeared uninfluenced by participants’ education, occupation, income or self-reported health literacy. A minority (3.6%) experienced difficulties following treatment instructions, primarily with oral cancer medications.

    Conclusions: The findings indicated lesser cancer health disparities regarding guideline adherence and treatment toxicity within the Nordic healthcare framework. A causal connection may not be established; however, the findings contribute to discourse on equitable cancer health provision.

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  • 47.
    Schmidt, Viktor
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Mukka, Sebastian
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Orthopaedics.
    Bergdahl, Carl
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ekholm, Carl
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Brüggemann, Anders
    Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden.
    Wolf, Olof
    Department of Surgical Sciences/Orthopaedics, Uppsala University, Uppsala, Sweden.
    Epidemiology, treatment, and mortality of 3,983 scapula fractures from the Swedish fracture register2024In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Scapula fractures are relatively uncommon, accounting for <1% of all fractures and approximately 3-5% of shoulder girdle fractures. This study comprehensively describes the epidemiology, fracture classification, treatment, and mortality associated with scapula fractures within a large adult Swedish population.

    METHODS: This observational study included all patients ≥18 years old at the time of injury with a scapula fracture (ICD S42.1) registered in the Swedish Fracture Register between March 2011 and June 2020. Variables studied were age, sex, and injury mechanism, including energy level, fracture classification, associated fractures, treatment, and mortality.

    RESULTS: We included 3,930 patients (mean age 58 years, SD 18, 64% men) with 3,973 scapula fractures. Some 22% of the fractures were caused by high-energy trauma and 21% had at least one associated fracture. High energy-injuries were most common in glenoid neck (44%) and scapular body (35%) fractures. However, same-level falls were the most common cause of glenoid rim (62%) and intra-articular glenoid (55%) fractures. Clavicle fractures (9%) and proximal humerus fractures (5%) were the most commonly associated fractures. The most common fracture types were the glenoid rim (n=1,289, 32%) and scapular body (n=1,098, 28%) fractures. Nonoperative treatment was performed in 81% of patients. Glenoid rim and intra-articular glenoid fractures were treated operatively in over 30% of cases. The mortality rate for the whole cohort was 4% at 1 year.

    CONCLUSIONS: Scapula fractures are predominately sustained by men. High energetic injuries and associated fractures are present in one in five patients. Nonoperative treatment is chosen in four of five patients, but for some fracture types one in three undergo surgery.

  • 48.
    Sherif, Amir
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
    Don't throw out the baby with the bath water!: Editorial comment to DaBlaCa-17: nationwide observational study in Denmark on survival before and after implementation of neoadjuvant chemotherapy prior to cystectomy for muscle-invasive bladder cancer2024In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 59, p. 117-118Article in journal (Refereed)
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  • 49.
    Sitohy, Mahmoud
    et al.
    Biochemistry Department, Faculty of Agriculture, Zagazig University, Zagazig, Egypt.
    Enan, Gamal
    Botany and Microbiology Department, Faculty of Science, Zagazig University, Zagazig, Egypt.
    Abdel-Shafi, Seham
    Botany and Microbiology Department, Faculty of Science, Zagazig University, Zagazig, Egypt.
    El-Wafa, Neveen Abou
    Botany and Microbiology Department, Faculty of Science, Zagazig University, Zagazig, Egypt.
    El-Gazzar, Nashwa
    Botany and Microbiology Department, Faculty of Science, Zagazig University, Zagazig, Egypt.
    Osman, Ali
    Biochemistry Department, Faculty of Agriculture, Zagazig University, Zagazig, Egypt.
    Sitohy, Basel
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Clinical Immunology. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention.
    Mapping pathogenic bacteria resistance against common antibiotics and their potential susceptibility to methylated white kidney bean protein2024In: BMC Microbiology, E-ISSN 1471-2180, Vol. 24, no 1, article id 49Article in journal (Refereed)
    Abstract [en]

    As antibiotics cannot inhibit multidrug-resistant bacteria (MDR), continuous research is mandatory to find other antibacterials from natural resources. Native legume proteins and their modified forms exhibited broad spectra of high antimicrobial activities. Sixteen bacterial isolates were mapped for antibiotic resistance, showing resistance in the range of (58-92%) and (42-92%) in the case of the Gram-negative and Gram-positive bacteria, respectively. White native Phaseolus vulgaris protein (NPP) was isolated from the seeds and methylated (MPP). The MIC range of MPP against 7 MDR bacteria was 10-25 times lower than NPP and could (1 MIC) considerably inhibit their 24 h liquid growth. MPP showed higher antibacterial effectiveness than Gentamycin, the most effective antibiotic against Gram-positive bacteria and the second most effective against Gram-negative bacteria. However, MPP recorded MICs against the seven studied MDR bacteria in the 1-20 µg/mL range, the same for Gentamycin. The combination of Gentamycin and MPP produced synergistic effects against the seven bacteria studied, as confirmed by the Transmission Electron Microscopic images. The antimicrobial activity of MPP against the seven MDR bacteria remained stable after two years of cold storage at 8-10 °C as contrasted to Gentamycin, which lost 20-72% of its antimicrobial effectiveness.

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  • 50.
    Strömberg, Ulf
    et al.
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden.
    Berglund, Anders
    EpiStat AB, Uppsala, Sweden.
    Carlsson, Stefan
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Urology, Karolinska University Hospital Solna, Stockholm, Sweden.
    Thellenberg-Karlsson, Camilla
    Umeå University, Faculty of Medicine, Department of Diagnostics and Intervention. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Lambe, Mats
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Lissbrant, Ingela Franck
    Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Stattin, Pär
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Bratt, Ola
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Socioeconomic inequality in prostate cancer diagnostics, primary treatment, rehabilitation, and mortality in Sweden2024In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215Article in journal (Refereed)
    Abstract [en]

    We designed a nationwide study to investigate the association between socioeconomic factors (household income and education) and different aspects of prostate cancer care, considering both individual- and neighbourhood-level variables. Data were obtained from Prostate Cancer data Base Sweden (PCBaSe), a research database with data from several national health care registers including clinical characteristics and treatments for nearly all men diagnosed with prostate cancer in Sweden. Four outcomes were analysed: use of pre-biopsy magnetic resonance imaging (MRI) in 2018–2020 (n = 11,843), primary treatment of high-risk non-metastatic disease in 2016–2020 (n = 6633), rehabilitation (≥2 dispensed prescriptions for erectile dysfunction within 1 year from surgery in 2016–2020, n = 6505), and prostate cancer death in 7770 men with high-risk non-metastatic disease diagnosed in 2010–2016. Unadjusted and adjusted odds and hazard ratios (OR/HRs) with 95% confidence intervals (CIs) were calculated. Adjusted odds ratio (ORs) comparing low versus high individual education were 0.74 (95% CI 0.66–0.83) for pre-biopsy MRI, 0.66 (0.54–0.81) for primary treatment, and 0.82 (0.69–0.97) for rehabilitation. HR gradients for prostate cancer death were significant on unadjusted analysis only (low vs. high individual education HR 1.41, 95% CI 1.17–1.70); co-variate adjustments markedly attenuated the gradients (low vs. high individual education HR 1.10, 95% CI 0.90–1.35). Generally, neighbourhood-level analyses showed weaker gradients over the socioeconomic strata, except for pre-biopsy MRI. Socioeconomic factors influenced how men were diagnosed with prostate cancer in Sweden but had less influence on subsequent specialist care. Neighbourhood-level socioeconomic data are more useful for evaluating inequality in diagnostics than in later specialist care.

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