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1.
  • Rönmark, Eva, et al. (författare)
  • High incidence and persistence of airborne allergen sensitization up to age 19 years
  • 2017
  • Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : Wiley-Blackwell. - 0105-4538 .- 1398-9995. ; 72:5, s. 723-730
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Longitudinal population-based studies about the natural history of allergic sensitization are rare. The aim was to study incidence and persistence of airborne allergen sensitization up to young adulthood and risk factors for early and late onset of sensitization.METHODS: All children aged 7-8 years in two municipalities in Northern Sweden were invited to a parental questionnaire and skin prick tests (SPTs) to ten airborne allergens, and 2148 (88%) participated. The protocol was repeated at age 11-12 and 19 years, and 1516 participated in all three examinations.RESULTS: Prevalence of any positive SPT increased from 20.6% at age 7-8 years to 30.6% at 11-12 years, and 42.1% at 19 years. Animals were the primary sensitizers at age 7-8 years, 16.3%, followed by pollen, 12.4%. Mite and mold sensitization was low. Mean annual incidence of any positive SPT varied between 2.8 and 3.4/100 per year, decreased by age for animal, and was stable for pollen. Sensitization before age 7-8 years was independently associated with family history of allergy, OR 2.1 (95% CI 1.6-2.8), urban living, OR 1.9 (95% CI 1.2-2.9), and male sex, OR 1.3 (95% CI 1.0-1.7), and negatively associated with birth order, OR 0.8 (95% CI 0.7-1.0), and furry animals at home, OR 0.7 (95% CI 0.7-0.9). Incidence after age 11-12 years was associated only with family history of allergy. Multisensitization at age 19 years was significantly associated with early age at sensitization. Remission of sensitization was uncommon.CONCLUSION: The increasing prevalence of allergic sensitization by age was explained by high incidence and persistence. After age 11-12 years, the factors urban living, number of siblings, and male sex lost their importance.
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2.
  • Schyllert, Christian, 1983- (författare)
  • Social determinants in asthma : population-based studies on asthma and respiratory symptoms in relation to occupation, occupational exposure and socioeconomic status
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Background: Asthma is one of the most common chronic obstructive airway diseases among children and adults, with a prevalence between 6-11% in European countries. It is also the most common work-related occupational respiratory disease. There are different methods to classify occupational exposure and, even though there is no clear consensus on which method is the most accurate, the single-item question on exposure to the composite measure vapour, gas, dust or fumes (VGDF) is commonly used in epidemiological research. Low socioeconomic status is associated with asthma and also behavioural factors such as smoking and over-weight, which by themselves are risk factors for asthma. Socioeconomic status is, however, truly a multifaceted concept and using only one measure does not encompass its entire effect on health-related outcomes. Asthma does also have a negative impact on the quality of life among adolescents: they report less physical fitness compared to their peers and more school absenteeism due to respiratory symptoms. Still, research on whether childhood asthma has any impact on socioeconomic status in young adulthood is scarce.Aim: The overall aim is to study social determinants of health such as socioeconomic status, occupation and occupational exposure and their relationship with asthma and respiratory symptoms among adults and further, to evaluate if asthma during childhood or adolescence is associated with social determinants in young adulthood.Method: This thesis includes four papers based on data from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Papers I-III are cross-sectional studies among adults; a structured interview from clinical examinations between 2002-04 (paper I, n=4036) and postal questionnaire surveys from 2006 (paper II, n=9992) and 2016 (paper III, n=6854) with the addition of register-based data in paper III. Paper IV is a longitudinal prospective cohort study; the first OLIN paediatric cohort followed from 7 to 19 years of age and a postal questionnaire follow-up at ages 27-28 in 2015 (n=2017). Asthma was defined as physician diagnosis (paper I) together with respiratory symptoms (paper II-IV) or use of asthma medication (paper IV). In paper IV asthma was further categorized based on age of onset and p v and adolescence. Main or longest held occupation was used to categorize occupational and socioeconomic groups. In papers III and IV additional measures of socioeconomic status were included; educational level (papers III and IV) and income (paper III). In all papers, occupational exposure to vapour and/or gas, dust and fumes (VGDF or GDF) were taken into consideration and in paper I further divided into subgroups based on a detailed questionnaire on occupational exposure.Results: In paper I we found that the association between occupational exposure to VGDF and asthma and rhinitis was driven by the component of chemicals rather than dusts. In paper II, the ISCO-based manual Swedish Standard Classification of Occupations (SSYK) and the manual Socioeconomic classification (SEI), could both identify occupational and socioeconomic groups at risk for respiratory symptoms and asthma, while the older ISCO-based manual Nordic Classification of Occupations (NYK) was not as sensitive.In paper III, behavioural risk factors for respiratory symptoms and asthma such as smoking and obesity and, occupational exposure to GDF were associated with low educational level. Interaction analyses between income level and sex revealed different patterns among women and men. Among women, low income was associated with all respiratory symptoms as well as asthma, while among men only with productive cough.In paper IV, early onset asthma was associated with lower educational level in young adulthood, especially not continuing after compulsory school. Further, those with asthma during childhood or adolescence did not seem to refrain from smoking at age 19, nor did they as young adults seem to avoid occupations with known or expected exposure to GDF.Conclusions: Increased automation in industries have decreased the number of manual workers in industries with typically dirty tasks, meaning that the interrelationships between the subgroups included in VGDF may have changed. This may also affect the meaning of occupational exposure to VGDF, at least with regard to asthma and rhinitis, and according to our findings exposure to the component of chemicals may be the most important. We also found that the use of an ISCO-based manual (SSYK) as well as socioeconomic classification based on job-title (SEI) can be useful and easily applicable tools to identify occupational and socioeconomic groups at risk for respiratory symptoms and asthma. Further, low socioeconomic status is associated with respiratory vi symptoms and asthma. It seems as these associations relies more on low income than low educational level. Low educational level as well as low income are furthermore related to known behavioural risk factors for respiratory symptoms and asthma such as obesity, smoking and, also potentially modifiable risk factors as occupational exposure to gas dust or fumes. Having a persisting asthma since childhood is associated with lower educational level as a young adult. This may, in turn, be related with behavioural risk factors as discussed above and, there were no indications that those with child or adolescent asthma refrained from smoking at age 19. Neither did they in young adulthood avoid occupations with known or expected exposure to gas, dust or fumes, such as manufacturing, construction and transportation work. To conclude, our results indicate a vicious circle with regard to the relationship between the studied social determinants of health and asthma and respiratory symptoms.
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3.
  • Selberg, Stina, et al. (författare)
  • Asthma control and acute health care visits among young adults with asthma : A population‐based study
  • 2019
  • Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 75:12, s. 3525-3534
  • Tidskriftsartikel (refereegranskat)abstract
    • AimsTo study asthma control and acute health care visits among young adults with asthma.BackgroundDespite the access to effective treatment and nursing interventions, poor asthma control is still common among individuals with asthma. However, studies describing clinical characteristics among young adults with asthma are rare.DesignA population‐based cohort study.MethodsIn 2015, as a part of the OLIN pediatric cohort I (recruited in 1996 at age 7‐8yr), N=2291 young adults (27‐28 yr) completed a postal questionnaire survey including questions on asthma and respiratory symptoms. Of these, N=280 (12%) were identified as having current asthma and were further studied.ResultsOf those with current asthma, women reported respiratory symptoms and smoking to a greater extent than men. Approximately one‐fourth had uncontrolled asthma and acute health care visits due to asthma was reported by 15% of women and 8% of men. Uncontrolled asthma was associated with smoking, lower educational level, use of reliever treatment most days and acute health care visits. Acute health care visits due to asthma were associated with periodic use of regular controller treatment also after adjustment for uncontrolled asthma.ConclusionThe result indicate poor adherence to asthma treatment which may lead to decreased asthma control and acute health care visits.ImpactMost young adults with asthma are diagnosed and treated in primary care, ideally in a team with a nurse. The main findings highlight the need for evidenced‐based nursing interventions, contributing to a more efficient asthma management in primary care.
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5.
  • Kuiper, I. N., et al. (författare)
  • Associations of Preconception Exposure to Air Pollution and Greenness with Offspring Asthma and Hay Fever
  • 2020
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1660-4601 .- 1661-7827. ; 17:16
  • Tidskriftsartikel (refereegranskat)abstract
    • We investigated if greenness and air pollution exposure in parents' childhood affect offspring asthma and hay fever, and if effects were mediated through parental asthma, pregnancy greenness/pollution exposure, and offspring exposure. We analysed 1106 parents with 1949 offspring (mean age 35 and 6) from the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Mean particulate matter (PM(2.5)and PM10), nitrogen dioxide (NO2), black carbon (BC), ozone (O-3) (mu g/m(3)) and greenness (normalized difference vegetation index (NDVI)) were calculated for parents 0-18 years old and offspring 0-10 years old, and were categorised in tertiles. We performed logistic regression and mediation analyses for two-pollutant models (clustered by family and centre, stratified by parental lines, and adjusted for grandparental asthma and education). Maternal medium PM(2.5)and PM(10)exposure was associated with higher offspring asthma risk (odds ratio (OR) 2.23, 95%CI 1.32-3.78, OR 2.27, 95%CI 1.36-3.80), and paternal high BC exposure with lower asthma risk (OR 0.31, 95%CI 0.11-0.87). Hay fever risk increased for offspring of fathers with medium O(3)exposure (OR 4.15, 95%CI 1.28-13.50) and mothers with high PM(10)exposure (OR 2.66, 95%CI 1.19-5.91). The effect of maternal PM(10)exposure on offspring asthma was direct, while for hay fever, it was mediated through exposures in pregnancy and offspring's own exposures. Paternal O(3)exposure had a direct effect on offspring hay fever. To conclude, parental exposure to air pollution appears to influence the risk of asthma and allergies in future offspring.
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6.
  • Eliason, Gabriella, et al. (författare)
  • Physical performance and muscular characteristics in different stages of COPD
  • 2009
  • Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley-Blackwell Publishing Inc.. - 0905-7188 .- 1600-0838. ; 19:6, s. 865-870
  • Tidskriftsartikel (refereegranskat)abstract
    • This study has examined exercise capacity and muscle morphology in patients with different severities of chronic obstructive pulmonary disease (COPD). Twenty-three patients and 12 healthy matched controls were recruited. Based on the severity of airflow obstruction, patients were divided into two subgroups. Exercise capacity was determined using a 6-min walk test. Muscle fiber composition, fiber area and number of satellite cells/muscle fiber were determined in muscle biopsies using immunohistochemistry. A progressive decline in exercise capacity was noted with ascending disease severity. Furthermore, a correlation between reduction in exercise capacity and changes in muscle fiber composition was observed in COPD. The group with severe and very severe COPD had a lower proportion of type I and a higher proportion of type IIa fibers compared with the other groups. In severe and very severe COPD, a reduction in fiber area of type IIa fibers was also seen. The number of satellite cells/muscle fiber did not differ between the groups. In conclusion, a decline in exercise capacity occurs already in mild and moderate COPD, indicating that the 6-min walk test is a reliable indicator of disease severity. Furthermore, changes in skeletal muscle morphology are associated with disease severity while muscle regenerative capacity is not altered.
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7.
  • Lindqvist, A, et al. (författare)
  • Artery blood pressure oscillation after active standing up: an indicator of sympathetic function in diabetic patients
  • 1997
  • Ingår i: Clinical Physiology. - : John Wiley and Sons. - 1365-2281. ; 17:2, s. 159-169
  • Tidskriftsartikel (refereegranskat)abstract
    • Dynamic artery blood pressure (Finapres) response to active standing up, normally consisting of initial rise, fall and recovery above the baseline (overshoot), was compared with the early steady-state artery blood pressure level to measure sympathetic vasomotor function in healthy subjects (n = 23, age 35 +/- 9 years; mean +/-SD) and in type I diabetic patients without autonomic neuropathy (AN) (group 1: n = 18, 38 +/- 13 years), with AN but no cardiovascular drugs (group 2a: n = 7, 44 +/- 11 years) and with both AN and cardiovascular drugs (group 2b: n = 10, 47 +/- 7 years). Systolic and diastolic overshoot were similar in the control (15 +/- 13/15 +/- 11 mmHg) and group 1 subjects. Systolic overshoot disappeared in 57% of patients in group 2a (-1 +/- 9 mmHg; P < 0.03), whereas artery blood pressure still overshot in diastole (8 +/- 7 mmHg; NS). Systolic overshoot disappeared in all patients in group 2b (-22 +/- 22 mmHg; P < 0.0006) and diastolic overshoot disappeared in 60% of these patients (-6 +/- 16 mmHg; P = 0.0006). Systolic early steady-state level was not lower in group 2a than in group 1 (NS), but it was impaired in group 2b (P < 0.006), in which six diabetic patients had a pathological response beyond the age-related reference values. There was a strong association between the overshoot and steady-state levels (P for chi 2 < 0.001, n = 58). Overshoot of the control subjects and patients in group 2b correlated to their respective steady-state blood pressure levels (r > or = 0.76; P < or = 0.001). In conclusion, baroreceptor reflex-dependent overshoot of the artery blood pressure after active standing up diminishes with the development of AN and it is associated with the early steady-state level of the artery blood pressure.
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8.
  • Piltén, Carina, et al. (författare)
  • Lung recruitment--a nurse and/or physician task. A national survey on requirements for education, regulations and guidelines.
  • 2009
  • Ingår i: Intensive & Critical Care Nursing. - 0964-3397 .- 1532-4036. ; 25:1, s. 4-9
  • Tidskriftsartikel (refereegranskat)abstract
    • International and national guidelines on requirements for performing lung recruitment manoeuvres are lacking. This paper presents a nationwide descriptive survey of the occurrence of and conditions for lung recruitment in adult patients treated with mechanical ventilation in intensive care units (ICUs) in Sweden. All ICUs except neurological, cardiac, paediatric and neonatal ICUs were invited (N=73); of these, 60 ICUs participated in the study (82%). The main outcome measures were prevalence of lung recruitment, whether ICU nurses and/or physicians carried out lung recruitment, requirements for nurses to perform lung recruitment and the existence of local guidelines. Lung recruitment was performed at 92% of the ICUs. Only physicians performed lung recruitment at 27 ICUs (49%), and in 28 units (51%) both physicians and nurses performed this treatment. Lung recruitment was performed more often in units where both physicians and nurses performed lung recruitment than in units where only physicians performed the manoeuvres (46% vs. 12%, p=0.03). Further, local guidelines on lung recruitment manoeuvres were more common in units where both physicians and nurses performed this treatment (71% vs. 41%, p=0.02). The results suggest that recommendations of repeated and prompt lung recruitment manoeuvres are better met if nurses, along with physicians, perform lung recruitment.
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9.
  • Svanborg, E., et al. (författare)
  • Palatal Sensory Function Worsens in Untreated Snorers but not in CPAP-Treated Patients With Sleep Apnea, Indicating Vibration-Induced Nervous Lesions
  • 2020
  • Ingår i: Chest. - : Elsevier. - 0012-3692 .- 1931-3543. ; 157:5, s. 1296-1303
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Signs of both motor and sensory nervous lesions have previously been shown in the upper airway of patients with OSA and habitual snorers. Snoring per se may damage all upper airway neurons over time, thereby causing progression to manifest sleep apnea. To test this hypothesis, nonsnoring subjects, untreated snorers, and CPAP-treated patients underwent repeated sensory testing of the soft palate in a prospective long-term study. Methods: Cold detection threshold (CDT) testing at the soft palate and lip with a thermode and nocturnal respiratory recordings were performed in 2008 to 2009 with retesting 6 to 7 years later. Results: In 25 untreated snorers, palatal CDT worsened from a median (25th-75th percentile range) 4.2°C (3.2-5.9) to 11.0°C (7.0-17.4) (P < .001). The apnea-hypopnea index increased from a median 7.0 to 14.0 events/h (P < .05). There was no significant correlation between changes in CDT and the apnea-hypopnea index. In 21 nonsnoring control subjects, palatal CDT increased from a median 3.2°C to 5.6°C (P < .005). In 19 CPAP-treated patients, palatal CDT did not significantly change; eight patients had improved values. CDTs worsened significantly more in the snorers group than in the control subjects (P < .05) and the CPAP-treated patients (P < .001). There was no significant difference between control subjects and CPAP-treated patients. Conclusions: CDT worsened considerably over time in untreated snorers, significantly more than in nonsnoring control subjects and CPAP-treated patients. Untreated snorers therefore risk developing poor sensitivity in the upper airway. In contrast, efficient treatment of OSA seems to protect the sensory innervation, as the CPAP-treated group maintained their sensitivity to cold and, in some cases, the sensitivity even improved. 
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10.
  • Protudjer, Jennifer L. P., et al. (författare)
  • Household Costs Associated with Objectively Diagnosed Allergy to Staple Foods in Children and Adolescents
  • 2015
  • Ingår i: Journal of Allergy and Clinical Immunology-In Practice. - : Elsevier. - 2213-2198 .- 2213-2201. ; 3:1, s. 68-75
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: We previously reported that indirect and intangible costs burden households with a food allergic adult. We now extend our investigation to households with food allergic children and adolescents. OBJECTIVE: The objective of this study was to estimate direct, indirect, and intangible costs of food allergy in households with a child and/or adolescent with objectively diagnosed allergy to staple foods (cow's milk, hen's egg, and/or wheat), and to compare these costs with age-and sex-matched controls. METHODS: Direct and indirect cost parent-reported data collected via the Food Allergy Socio-Economic Questionnaire of 84 children (0-12 years) and 60 adolescents (13-17 years) with objectively diagnosed allergy to staple foods ("cases") and age- and sex-matched controls (n = 94 children; n = 56 adolescents) were compared. Annual household costs were calculated. Total household costs included direct plus indirect costs. Intangible costs included parent-reported health of their child and/or adolescent, standard of living, and perceptions of well-being. RESULTS: Amongst cases, total household costs were higher by (sic)3961 for children and (sic)4792 for adolescents versus controls (P < .05), and were driven by direct (eg, medications) and indirect (eg, time with health care professionals) costs. For children only, a history of anaphylaxis was associated with higher direct costs than no anaphylaxis ((sic)13,016 vs (sic)10,044, P < .05). Intangible costs (eg, parent-reported health of a child and/or adolescent) were significantly impacted amongst cases versus controls (P < .01). CONCLUSION: Households with a child and/or adolescent with objectively diagnosed allergy to staple foods have higher total household costs than controls. Direct and indirect costs were significantly higher for cases versus controls amongst children only. Amongst both age groups, such allergy adversely impacted intangible costs. (C) 2015 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.
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