| 1. |
- Bonnert, Marianne, et al.
(författare)
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Internet-delivered cognitive-behaviour therapy for anxiety related to asthma : study protocol for a randomised controlled trial
- 2024
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Ingår i: BMJ Open Respiratory Research. - : BMJ Publishing Group Ltd. - 2052-4439. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There is an established association between asthma and anxiety. The overlap between asthma symptoms and symptoms of anxiety may cause individuals to overestimate their asthma severity and restrict their daily activities leading to a low quality of life. There is currently weak evidence for treatments targeting anxiety related to asthma, but cognitive–behavioural therapy (CBT) has shown some promising but mixed results. The current randomised controlled trial will investigate if exposure-based internet-delivered CBT (Internet-CBT) is more effective than treatment as usual+medical education (TAU+ME) to relieve symptoms of anxiety and asthma control.Methods and analysis 90 participants will be randomised 1:1 to 8 weeks of Internet-CBT or TAU+ME. The primary outcome, the patient-reported Catastrophising Asthma Scale, will be analysed from baseline to the primary endpoint at 16 weeks using hierarchical linear mixed model of the slope over time. Secondary outcomes, such as asthma control, quality of life and forced expiratory volume in 1 s, will be analysed correspondingly.Ethics and dissemination All participants will be informed about the study and leave their consent before study entry. All results will be analysed at group level and reported through publication in a peer-reviewed scientific journal within the field. The study received ethical approval by the Swedish Ethical Review Authority in January 2020 (ID: 2019-05985; 2022-01117-02).
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| 2. |
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| 3. |
- Bergström, Sten-Erik
(författare)
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Asthma and allergy in teenagers and young adults, risk-factors and T-cell regulation
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Asthma is one of the most common chronic diseases among teenagers and young adults. The prevalence of asthma among young adults in Sweden is approximately 7-10%. Despite this, only a limited number of studies have focused on asthma, allergy and allergic inflammation in this age group. The aims of this thesis are to study the consequences of asthma and allergy in teenagers and young adults, incidence and riskfactors for death due to asthma, and deterioration in asthma prior and following transfer from pediatric to adult health care. As allergic inflammation is involved in a majority of asthma patients in this age-group we have further investigated a T cell mediated inflammatory mechanism with possible implications in monitoring and modulating autoimmune and allergic diseases. Paper I: During the 1994-2003 period 37 deaths due to asthma were identified. The incidence of asthma in 1-34 year-olds decreased during the period from 1.54 to 0.53 per million. Common risk-factors were under-treatment, poor adherence to prescribed treatment and adverse psychosocial situation. An alarming finding was that 11/37 deaths was probably caused by food allergy and 8/37 were associated with exposure to pet dander. Paper II: In a 5-year prospective follow-up study to identify risk factors for deterioration of asthma following transfer from pediatric to adult health care 150 teenagers with asthma were enrolled. Skin prick test at entrance revealed that 89% were sensitized towards at least one of tested allergens. A minority performed with impaired lung function without deterioration during the five-year follow up, while bronchial hyper responsiveness (BHR) was present in 71% of the subjects at entrance and among 59% at follow-up. Risk for persistence of BHR after five years was elevated by poor adherence and attenuated by regular physical activity. Working capacity decreased significantly during the study period without any correlation to risk factors examined. Paper III: Interactions between the low-density lipoprotein receptor-related protein 1(LRP1) and thrombospondin-1 (TSP-1) is necessarily for T cell motility and that the motogenic LRP/TSP-1 mechanism antagonizes adhesion to ICAM-1 and fibronectin as well as TCR induced proliferative responses. This cascade mediates regulatory effects of IL-2 and IL-4. In addition expression of TSP-1, with known ability to protect against inflammation, was increased by IL-2. Paper IV: T cell activation induces arrest of T cell motility through down-regulation of LRP1 synthesis a concomitant up-regulation of TSP-1 synthesis providing a mechanism for enhancement of adhesion of T cells to APC´s stimulating proliferative responses. Despite this arrest of motility, co-ligation with CD28 maintains a basal motility level by enhancing transport of LRP1 to the cell surface. Paper V: Patients with allergy and psoriasis showed impaired T cell motility and decreased TSP-1 expression compared to healthy controls. IL-2 was shown to up-regulate the impaired motility in patient to the same level as in controls indicating a reversible state probably excluding a constitutional defect.
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| 4. |
- Bergström, Sten-Erik, et al.
(författare)
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Asthma mortality among Swedish children and young adults, a 10-year study
- 2008
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 102:9, s. 1335-1341
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous reports indicate that morbidity and mortality from asthma have increased during the past decades. Here, the mortality rate associated with asthma and possible risk factors in children and young adults in Sweden during the period 1994-2003 were evaluated. METHODS: The medical profession was asked to report suspected cases of death from asthma in individuals 1-34 years of age. All death certificates containing relevant ICD codes were reviewed. Medical records and autopsy reports were assessed and telephone interviews with next-of-kin performed. RESULTS: During the 10-year period 37 deaths due to asthma were identified. The median age at the time of death was 27 years and 6 of the deceased were younger than 15. The overall incidence of death from asthma decreased from 1.54 deaths per million in 1994 to 0.53 per million in 2003. Common risk factors were under-treatment (23/37), poor adherence to prescribed treatment (17/37) and adverse psychosocial situation (19/37). An alarming finding was that 11 of the 37 deaths were probably caused by food allergy and for 8 subjects death was associated with exposure to pet dander. The death certificates were found to contain inaccuracies with 30% of those for whom asthma was reported as the underlying cause having died from other causes. CONCLUSION: Asthma mortality in children and young adults in Sweden decreased between 1994 and 2003. Food allergy and inadequate treatment were the major risk factors for such a death. Recognition and special care of patients with asthma who have shown signs of non-compliance, denial or severe food allergy must be encouraged.
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| 5. |
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| 6. |
- Gillman, Anna, et al.
(författare)
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Primary tuberculosis infection in 35 children at a Swedish day care center
- 2008
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Ingår i: The Pediatric Infectious Disease Journal. - 0891-3668 .- 1532-0987. ; 27:12, s. 1078-82
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND METHOD: The decline of tuberculosis (TB) in the Swedish population since the middle of the 20th century resulted in decreased awareness of the disease. Increased migration from TB-endemic countries has resulted in new cases and risk of transmission. A day care provider was diagnosed with cavitary TB after being symptomatic for 5 months. We describe the contact tracing at the day care center, the clinical and radiographic findings, and treatment of the infected children. RESULTS: We stratified the children by contact with the source case and examined the most exposed first. Thirty-two of 53 attending and 3 of 84 visiting preschool children were infected. All of them had spent at least 3 days at the center. Symptoms were usually mild and nonspecific. Seventeen children had pulmonary radiographic changes compatible with primary TB, and one had miliary TB. The radiographic resolution was slow, with normalization in 50% after 12 months. Eighteen months after termination of treatment, there have been no relapses. The children with latent infection were treated with rifampin for 4 months and none has developed TB. CONCLUSIONS: The manifestations of primary TB in children today are similar to those described 50-70 years ago. The tuberculin skin test is an effective tool for contact tracing in an unvaccinated, previously nonexposed childhood population. Rapid detection of contagious patients and thorough contact investigation remain our most important means to reduce transmission.
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| 7. |
- Kälkner, Karl-Mikael, et al.
(författare)
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Positron emission tomography (PET) with 11C-5-hydroxytryptophan (5-HTP) in patients with metastatic hormone-refractory prostatic adenocarcinoma
- 1997
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Ingår i: Nuclear Medicine and Biology. - 0969-8051 .- 1872-9614. ; 24:4, s. 319-325
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Tidskriftsartikel (refereegranskat)abstract
- The discovery of neuroendocrine differentiation in hormone-refractory prostatic adenocarcinoma has opened a potentially new therapeutic approach in this group of patients with a poor prognosis and few effective therapy modalities. Based on previous findings of increased uptake of 11C-5-hydroxytryptophan (11C-5-HTP) in neuroendocrine tumours using the PET technique, this tracer was applied in the study of 10 patients with metastatic hormone-refractory prostatic adenocarcinoma. In three patients, the study was repeated after treatment. An increased uptake of 11C-5-HTP was observed in all investigated skeletal lesions, although the magnitude of the uptake was moderate. The difference between the standard uptake values (SUV) in normal bone and metastatic lesions was significant (p < 0.001). A kinetic analysis of the uptake of 11C-5-HTP demonstrates an increase during the first minutes followed by a wash-out and a stabilization of the tissue/blood ratio at about 2. The Patlak plots demonstrated a gradual increase in the transport rate during the first 20 to 30 min, after which a constant level was observed. The SUV varied between patients and between lesions over time and treatment. The uptake of 11C-5-HTP discriminates metastatic lesions from normal bone and may thus aid in the diagnosis and, potentially, in treatment monitoring of metastatic hormone-refractory prostatic adenocarcinoma. Uptake kinetics are characterized by a wash-out and cannot alone be used as proof of neuroendocrine differentiation in hormone-refractory prostatic adenocarcinoma.
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| 8. |
- Li, Shu Shun, et al.
(författare)
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T lymphocyte expression of thrombospondin-1 and adhesion to extracellular matrix components.
- 2002
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Ingår i: European Journal of Immunology. - 0014-2980 .- 1521-4141. ; 32:4, s. 1069-1079
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Tidskriftsartikel (refereegranskat)abstract
- The mechanisms controlling the formation of pseudopodia and other active cell edges in T lymphocytes are not understood. We show here that T lymphocytes express thrombospondin-1 (TSP-1). TSP-1 in T lymphocytes has a high turnover as shown by the fact that brefeldin and monensin rapidly increase while cycloheximide tend to decrease the cellular TSP-1 content. T cell TSP-1 is preferentially stored intracellularly and shows variable cell surface expression. T lymphocyte adhesion to fibronectin and collagen type IV induces TSP-1 expression on the cell surface via a brefeldin sensitive mechanism. A monoclonal antibody to TSP-1 inhibits the flattening and pseudopodia formation of the adherent T cells. Furthermore, the same antibody to TSP-1 also exerts an inhibitory effect on T cell migration in the absence of exogenous TSP-1. These results indicate that endogenous TSP-1 is part of an adhesion-dependent mechanism controlling cytoplasmic spreading and migration in T lymphocytes.
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| 9. |
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| 10. |
- Sundell, Kerstin, et al.
(författare)
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Quality of life in adolescents with asthma, during the transition period from child to adult.
- 2011
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Ingår i: Clinical Respiratory Journal. - 1752-6981. ; 5:4, s. 195-202
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The present investigation was designed to evaluate the health-related quality of life (HRQOL) of adolescents with asthma between the age of 16 and 21, when they are transferred from paediatric to adult care. Methods: In this prospective study, 156 teenagers (69 females) with asthma were screened employing spirometry, a histamine challenge, skin prick test for allergy and filled out the 'Living with Asthma Questionnaire' both at the time of entry into the study and after 2 and 5 years of follow-up. An exercise test and questions concerning regular performed exercise were carried out at baseline and 5 years later. Results: At all three time-points, the HRQOL of the men was generally better than that of the women. At the same time, the HRQOL of both genders was significantly better, both in terms of the overall scores (P < 0.001) as well as the scores for most of the individual domains, in connection with the 5-year follow-up. The young women who exercised regularly at the time of their entry exhibited better HRQOL at this time than those who did not (P < 0.001), whereas regular exercise had no impact on the HRQOL of the young men. The women with severe asthma demonstrated a poorer HRQOL than those suffering from mild-to-moderate asthma. Conclusion: The HRQOL of adolescents with asthma improves with age. The pronounced positive correlation between regular exercise and HRQOL in female adolescents with asthma revealed here deserves special attention in the care of young women and deserves further exploration.
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