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  • Andersson, Gerhard, et al. (författare)
  • Internet-based treatment of stress urinary incontinence : a randomised controlled study with focus on pelvic floor muscle training
  • 2013
  • Ingår i: BJU International. - 1464-4096. ; 112:3, s. 362-372
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To compare two treatment programmes for stress urinary incontinence (SUI) without face-to-face contact: one Internet-based and one sent by post.Patients and Methods Randomised, controlled trial conducted in Sweden 2009-2011. Computer-generated block-randomisation, allocation by independent administrator. No 'blinding'. The study included 250 community-dwelling women aged 18-70 years, with SUI >= 1 time/week. Consecutive online recruitment. The women had 3 months of either; (i) An Internet-based treatment programme (124 women), including e-mail support and cognitive behavioural therapy assignments or (ii) A treatment programme sent by post (126). Both programmes focused mainly on pelvic floor muscle training.Primary outcomes symptom-score (International Consultation on Incontinence Questionnaire Short Form, ICIQ-UI SF) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life, ICIQ-LUTSQoL).Secondary outcomes (i) Patient Global Impression of Improvement, (ii) Incontinence aids, (iii) Patient satisfaction, (iv) Health-specific QoL (EQ5D-Visual Analogue Scale), and (v) Incontinence episode frequency. Follow-up after 4 months via self-assessed postal questionnaires.Results In all, 12% (30 women) were lost to follow-up. Intention-to-treat analysis showed highly significant improvements (P < 0.001) with large effect sizes (>0.8) with both interventions, but there were no significant differences between groups in primary outcomes. The mean (SD) changes in symptom-score were: Internet 3.4 (3.4), Postal 2.9 (3.1) (P = 0.27). The mean (SD) changes in condition-specific QoL were: Internet 4.8 (6.1), Postal 4.6 (6.7) (P = 0.52). Compared with the postal-group, more participants in the Internet-group perceived they were much or very much improved (40.9% (43/105) vs 26.5% (30/113), P = 0.01), reported reduced usage of incontinence aids (59.5% (47/79) vs 41.4% (34/82), P = 0.02) and were satisfied with the treatment programme (84.8% (89/105) vs 62.9% (71/113), P < 0.001). Health-specific QoL improved in the Internet-group (mean change 3.7 (10.9), P = 0.001), but not in the postal-group (1.9 (13.0), P = 0.13). Overall, 69.8% (120/172) of participants reported complete lack of leakage or reduced number of leakage episodes by >50%.Conclusions Concerning primary outcomes, treatment effects were similar between groups whereas for secondary outcomes the Internet-based treatment was more effective. Internet-based treatment for SUI is a new, promising treatment alternative.
  • Arndt, Toni, et al. (författare)
  • Modelling human musculoskeletal functional movements using ultrasound imaging
  • 2010
  • Ingår i: BMC Medical Imaging. - 1471-2342. ; 10, s. 9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A widespread and fundamental assumption in the health sciences is that muscle functions are related to a wide variety of conditions, for example pain, ischemic and neurological disorder, exercise and injury. It is therefore highly desirable to study musculoskeletal contributions in clinical applications such as the treatment of muscle injuries, post-surgery evaluations, monitoring of progressive degeneration in neuromuscular disorders, and so on.The spatial image resolution in ultrasound systems has improved tremendously in the last few years and nowadays provides detailed information about tissue characteristics. It is now possible to study skeletal muscles in real-time during activity.Methods: The ultrasound images are transformed to be congruent and are effectively compressed and stacked in order to be analysed with multivariate techniques. The method is applied to a relevant clinical orthopaedic research field, namely to describe the dynamics in the Achilles tendon and the calf during real-time movements.Results: This study introduces a novel method to medical applications that can be used to examine ultrasound image sequences and to detect, visualise and quantify skeletal muscle dynamics and functions.Conclusions: This new objective method is a powerful tool to use when visualising tissue activity and dynamics of musculoskeletal ultrasound registrations.
  • Olen, Ola, et al. (författare)
  • Usefulness of Symptoms to Screen for Celiac Disease
  • 2014
  • Ingår i: Pediatrics. - American Academy of Pediatrics. - 0031-4005. ; 133:2, s. 211-218
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To describe the frequency of symptoms and associated conditions among screening-detected celiac disease (CD) cases and non-CD children and to evaluate questionnaire-based case-finding targeting the general population. METHODS: In a population-based CD screening of 12-year-olds, children and their parents completed questionnaires on CD-associated symptoms and conditions before knowledge of CD status. Questionnaire data for those who had their CD detected in the screening (n = 153) were compared with those of children with normal levels of CD markers (n = 7016). Hypothetical case-finding strategies were also evaluated. Questionnaires were returned by 7054 ( 98%) of the children and by 6294 ( 88%) of their parents. RESULTS: Symptoms were as common among screening-detected CD cases as among non-CD children. The frequency of children with screening-detected CD was similar when comparing the groups with and without any CD-related symptoms (2.1% vs 2.1%; P =.930) or CD-associated conditions (3.6% vs 2.1%; P =.07). Case-finding by asking for CD-associated symptoms and/or conditions would have identified 52 cases (38% of all cases) at a cost of analyzing blood samples for 2282 children (37%) in the study population. CONCLUSIONS: The current recommended guidelines for finding undiagnosed CD cases, so-called active case-finding, fail to identify the majority of previously undiagnosed cases if applied in the general population of Swedish 12- year-olds. Our results warrant further studies on the effectiveness of CD case-finding in the pediatric population, both at the clinical and population-based levels.
  • Brink, Mikael, et al. (författare)
  • Multiplex analyses of antibodies against citrullinated peptides in individuals prior to development of rheumatoid arthritis
  • 2013
  • Ingår i: Arthritis and Rheumatism. - Wiley-Blackwell. - 0004-3591. ; 65:4, s. 899-910
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: The presence of antibodies against cyclic citrullinated peptides has been demonstrated to precede the symptom onset of rheumatoid arthritis (RA) by several years. Antibodies against 10 citrullinated autoantigen-derived peptides were analysed for reactivity before onset of symptoms. METHODS: In the Medical Biobank of Northern Sweden 409 individuals were identified, of whom 386 provided 717 samples, obtained before onset of symptoms of RA (median time 7.4 (IQR 9.3) years); 1305 population based controls were also identified. Antibodies to 10 citrullinated peptides; fibrinogen (Fib) Fibα573, Fibα591, Fibß36-52, Fibß72, Fibß74, α-enolase (CEP-1), Type II Collagen citC1(III) , filaggrin, vimentin (Vim)2-17, and Vim60-75 were analysed using a microarray system. RESULTS: The antibody fluorescence intensity of Fibß36-52, Fibß74, CEP-1, citC1(III) , and filaggrin was significantly increased in pre-disease individuals compared with controls (p<0.001). The levels of the earliest detectable antibodies (Fibα591 and Vim60-75) fluctuated over time, with only a slight increase after onset of disease. Antibodies against Fibß36-52, CEP-1 and filaggrin increased gradually reaching the highest levels of all antibodies before symptom onset. A cluster of antibodies, citC1(III) , Fibα573 and Fibß74 increased only slightly before onset of symptoms but prominently after disease onset. The odds ratio for development of RA with a combination of CEP-1 and Fibß36-52 antibodies (<3.35 years pre-dating) was 38.8 (CI95%14.5-103.5) compared with having either. CONCLUSION: Development of an immune response towards citrullinated peptides is initially restricted but expands with time to induce a more specific response with increasing levels towards onset of symptoms, particularly invoving antibodies against CEP-1, Fibß36-52 and filaggrin.
  • Tsilingaridis, Georgios, et al. (författare)
  • Detection of approximal caries in 5-year-old Swedish children
  • 2005
  • Ingår i: Caries Research. ; 39:2, s. 92-99
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to assess how accurately some commonly used risk factors/risk markers (predictors) for caries development could identify children with and without approximal caries as judged from bitewing radiography. 267 consecutive 5-year-old children from two Swedish cities participated. Three experienced dentists examined the children. The predictors were the overall dmfs value (canines and molars), the number of occlusal dmfs, the frequency of intake of between meal sugary products, visible plaque on free smooth surfaces of second primary molars, toothbrushing habits, and (before bitewing examination) an overall judgement by the examining dentist. The mean dmfs without bitewing examination (BW) was 0.40 (SD = 1.22). Twelve percent of the children had at least one dentin lesion and 33 % at least one enamel lesion that were detected from BW only. The gain from adding BW to clinical examination amounted to a mean of 1.2 approximal enamel and/or dentin lesions. Results: The ability to correctly identify children with approximal caries from the predictors was limited; sensitivity ranged from 0.27 to 0.75 and specificity ranged from 0.41 to 0.93. The single best predictor was the dentist's overall judgement with an average precision of 73 %; average sensitivity for the presence of enamel and dentin lesions was 0.48 and for the presence of dentin lesions 0.66. The rest of the predictors added little to the predictive power. It is concluded that 33 % of the 5-year-olds, representing a low caries prevalence population, benefited from BW. The ability to identify these children from the predictors was, however, limited.
  • Moritz, Thomas, et al. (författare)
  • Serum metabolite signature predicts the acute onset of diabetes in spontaneously diabetic congenic BB rats
  • 2011
  • Ingår i: Metabolomics. - Springer. - 1573-3882. ; 7:4, s. 593-603
  • Tidskriftsartikel (refereegranskat)abstract
    • The clinical presentation of type 1 diabetes is preceded by a prodrome of beta cell autoimmunity. We probed the short period of subtle metabolic abnormalities, which precede the acute onset of diabetes in the spontaneously diabetic BB rat, by analyzing the serum metabolite profile detected with combined gas chromatography/mass spectrometry (GC/MS) and liquid chromatography/mass spectrometry (LC/MS). We found that the metabolite pattern prior to diabetes included 17 metabolites, which differed between individual diabetes prone (DP) BB rats and their age and sex matched diabetes resistant (DR) littermates. As the metabolite signature at the 40 days of age baseline failed to distinguish DP from DR, there was a brief 10-day period after which the diabetes prediction pattern was observed, that includes fatty acids (e.g. oleamide), phospholipids (e.g. phosphocholines) and amino acids (e.g. isoleucine). It is concluded that distinct changes in the serum metabolite pattern predict type 1 diabetes and precede the appearance of insulitis in spontaneously diabetic BB DP rats. This observation should prove useful to dissect mechanisms of type 1 diabetes.
  • Myléus, Anna, et al. (författare)
  • Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic
  • 2009
  • Ingår i: Journal of Pediatric Gastroenterology and Nutrition. - 0277-2116. ; 49:2, s. 170-176
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective:: Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases. Patients and Methods:: All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease. Results:: Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33). Conclusions:: The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.
  • Thøgersen, Anna M, et al. (författare)
  • Interactions between fibrinolysis, lipoproteins and leptin related to a first myocardial infarction.
  • 2004
  • Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation. - 1741-8267. ; 11:1, s. 33-40
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The summarized importance of haemostatic and metabolic variables (insulin, lipids including lipoprotein (a) [Lp(a)] and leptin) in predicting first myocardial infarction, as well as possible interactions among these variables, have not been reported. DESIGN: A prospective case-control study nested within the Northern Sweden Health and Disease Cohort. METHODS: Sixty-two men diagnosed with a first myocardial infarction were sex- and age-matched with 124 controls. Conditional logistic regression was conducted including established risk factors, plasma levels of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA) mass concentration, von Willebrand factor, insulin, proinsulin, specific insulin, apolipoprotein A-I (apo A-I), Lp(a), and leptin. Interaction analysis was also performed for tPA, apo A-I, Lp(a), leptin and proinsulin. RESULTS: Smoking, low plasma levels of apo A-I and high plasma levels of cholesterol, Lp(a), tPA, PAI-1, proinsulin and leptin were associated with myocardial infarction in univariate conditional logistic regression analysis. High tPA [odds ratio (OR), 21.3; 95% confidence interval (CI), 2.04-222] and Lp(a) (OR, 7.21; 95% CI, 1.31-39.8) and low apo A-I (OR, 0.15; 95% CI, 0.02-0.93) remained significant risk determinants in multivariate analysis with smoking habits, body mass index, hypertension, cholesterol, and diabetes included as covariates. There were non-significant synergic interactions between high Lp(a) and leptin and tPA, respectively, and between high Lp(a) and low apo A-I. CONCLUSION: Plasma levels of tPA, Lp(a), and apo A-I are independently associated with subsequent development of a first myocardial infarction in men.
  • Johansson, Lars, 1961-, et al. (författare)
  • A survey of teenager unnatural deaths in northern Sweden 1981-2000
  • 2005
  • Ingår i: Accident Analysis and Prevention. - 0001-4575. ; 37:2, s. 253-258
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.SETTING: The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.MATERIAL AND METHODS: All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.RESULTS: Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.CONCLUSIONS: Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.
  • Kuhl, Jeanette, et al. (författare)
  • Metabolomics as a tool to evaluate exercise-induced improvements in insulin sensitivity
  • 2008
  • Ingår i: Metabolomics. - Springer Boston. ; 4:3, s. 273-82
  • Tidskriftsartikel (refereegranskat)abstract
    • Exercise affects substrate utilisation and insulin sensitivity, which in turn improve blood glucose and lipid levels in subjects with type 2 diabetes (T2D). However, making long-lasting lifestyle-changes might be more realistic if the results were easier to record. Screening for biomarkers reflecting metabolic fitness could thus serve as a tool for maintained motivation. The aim of this study was to test the possibility that metabolomics can be used to identify individuals with improved insulin sensitivity as a result of increased physical activity. Healthy and diabetic subjects were investigated before and after 3 months of exercise to determine various metabolic parameters. Insulin sensitivity was determined by hyperinsulinemic euglycemic clamps and found to be improved in the diabetic men. Plasma was collected during the clamp and analyzed through GC/TOFMS. Healthy subjects could be distinguished from diabetics by means of low molecular-weight compounds (LMC) in plasma independently of gender or exercise, and exercise induced differences in LMC patterns both for healthy and T2D subjects. Forty-four significant metabolites were found to explain differences between LMC patterns obtained from trained and non-trained diabetics. Among these compounds, 17 could be annotated and 5 classified. Inositol-1-phosphate showed the highest correlation to insulin sensitivity in diabetic men, whereas an as yet unknown fatty acid correlated best with insulin sensitivity in women. Both metabolites were better correlated to insulin sensitivity than glucose. Finally, the finding that inostitol-1-phosphate negatively correlates with insulin sensitivity in diabetic men, was validated using samples obtained from a similar training study on diabetic men. 
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