| 1. |
- Brännström, Johanna
(författare)
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Assessment of patients with late diagnosis and missed opportunities in the Swedish HIV-1 epidemic
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Discovered in 1983, with a possibility to diagnose since 1985, and with efficient treatment existing now for two decades, HIV-1 still ranks among the top ten causes of death globally. Approximately 40 million people are living with HIV-1 worldwide; almost half still not diagnosed. In Europe one third are estimated to be unaware of their infection and half are diagnosed late, with consequences in terms of increased morbidity, mortality, risk of onward transmissions and higher health care costs. The aim of this thesis was to assess the extent of late diagnosis of HIV-1 infection in Sweden and to analyse whom gets diagnosed late and why. For Paper I we conducted a retrospective study of all patients diagnosed with AIDS (n=487), reported to the Swedish Centre of Infectious Disease Control (SMI) 1996-2002, concluding that the patients diagnosed late (here defined as simultaneous HIV/AIDS) represented an increasing proportion of patients with AIDS in Sweden. Migrants, persons infected heterosexually and persons aged over 40; all had a higher probability of a late diagnosis. For Paper II we conducted a cross-sectional national cohort-study including all newly HIV-1 diagnosed patients at 12 Swedish clinics. Data were collected from the National quality register InfCare HIV (n=575) and additional questionnaires (n=409) from the clinics. 58% were Late Presenters (LP), presenting for care with CD4+ T-cells < 350/mm3 +/- AIDS. Age (with increasing odds by increasing age) or being a migrant had a distinct association with being a LP. Half of the migrants had lived in Sweden for > 1 year at diagnosis and two thirds had a missed opportunity at immigration. However, if born abroad, but reported to be infected in Sweden, there was no difference in LP compared to the Swedish born. One quarter of all patients had missed opportunities within Swedish healthcare, presenting with HIV- and/or AIDS-associated symptoms, without an offer of HIV-testing. 16% had a history of selfneglected symptoms. In Paper III we further analysed the missed presentations at seeking healthcare, the HIV- and AIDS- associated symptoms neglected by the patients and also assessed the initiator of the HIV-test. Migrants were less likely both to neglect their symptoms and to be missed at health care compared to individuals born in Sweden. Also men who have sex with men (MSM) were less likely to neglect their symptoms compared to those with a heterosexually acquired infection. Patients with a history of drug use, a previous negative test (mainly MSM) and those infected abroad were more likely to take the initiative to test, whereas the opposite held for patients >50 years and those previously missed at presentation. The predominance of migrants in Papers II-III, and results indicating that the number of domestic infections might be underestimated in this group, made us want to investigate this further. In Paper IV we applied a CD4+ T-cell decline trajectory model to a subsample of the Swedish migrant cohort (n= 1244) to compare estimates of country of HIV acquisition with the clinical reports. The model estimated that 17% had acquired the HIV infection after immigration, whereas the doctor’s estimate was 11%. Phylogenetic analysis was performed in discordant patients to explore whether this would favour the model or the doctor’s estimate. A higher concordance was found with the CD4 model estimates than with the clinical reports (30% vs. 17%). In summary my thesis shows a high proportion of late HIV-1 diagnosis in Sweden, but also emphasizes that there are several opportunities to improve this. Activities to increase societal awareness, continuous promotion and normalization of the HIV-test, education of health care professionals including further implementation of indicator-guided testing and an extended testing and primary prevention aimed at migrants are all important steps forward
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| 2. |
- Brännström, Jonas, et al.
(författare)
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Listening effort and fatigue in native and non-native primary school children
- 2021
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Ingår i: Journal of Experimental Child Psychology. - : Elsevier BV. - 0022-0965 .- 1096-0457. ; 210
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Tidskriftsartikel (refereegranskat)abstract
- Background noise makes listening effortful and may lead to fatigue. This may compromise classroom learning, especially for children with a non-native background. In the current study, we used pupillometry to investigate listening effort and fatigue during listening comprehension under typical (0 dB signal-to-noise ratio [SNR]) and favorable (+10 dB SNR) listening conditions in 63 Swedish primary school children (7–9 years of age) performing a narrative speech–picture verification task. Our sample comprised both native (n = 25) and non-native (n = 38) speakers of Swedish. Results revealed greater pupil dilation, indicating more listening effort, in the typical listening condition compared with the favorable listening condition, and it was primarily the non-native speakers who contributed to this effect (and who also had lower performance accuracy than the native speakers). Furthermore, the native speakers had greater pupil dilation during successful trials, whereas the non-native speakers showed greatest pupil dilation during unsuccessful trials, especially in the typical listening condition. This set of results indicates that whereas native speakers can apply listening effort to good effect, non-native speakers may have reached their effort ceiling, resulting in poorer listening comprehension. Finally, we found that baseline pupil size decreased over trials, which potentially indicates more listening-related fatigue, and this effect was greater in the typical listening condition compared with the favorable listening condition. Collectively, these results provide novel insight into the underlying dynamics of listening effort, fatigue, and listening comprehension in typical classroom conditions compared with favorable classroom conditions, and they demonstrate for the first time how sensitive this interplay is to language experience.
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| 3. |
- Brännström, Jonas, et al.
(författare)
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The Influence of Language Background on Dichotic Listening in Primary School Children
- 2023
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Ingår i: Perspectives of the ASHA Special Interest Groups. - 2381-473X. ; 8:2, s. 298-307
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Dichotic speech tests are commonly used in audiological assessments of children with suspected listening difficulties, which may have a range of origins. In Sweden, today, one in four primary schoolchildren has a foreign background, which means that a large proportion of children will be assessed through the medium of a language that they speak at school, but it is not the language they regularly speak at home. This study examines dichotic listening ability among children attending primary schools in two cities in southern Sweden with a high proportion of recent immigrants.Method: In this study, 82 Swedish second and third graders aged 7–9 years with varying Swedish language exposure performed a dichotic listening task, under free recall and directed conditions. They also performed backward digit span as a measure of working memory and crosslinguistic nonword repetition, which is central for language learning.Results: We found no effect of Swedish language exposure on dichotic listening performance. Right ear was not significantly better than the left ear in either free or directed recall indicating no right ear advantage. Dichotic listening performance was significantly better in free recall compared with directed recall. Dichotic listening was related to working memory capacity. After controlling for working memory capacity, nonword repetition showed a significant positive association with dichotic listening under free recall but not directed recall.Conclusions: Test language exposure and knowledge do not seem to influence primary school children's performance on a dichotic digit task. Performance was related to working memory capacity and the complex skill of perceiving, coding, and producing novel words in a nonword repetition task. In clinical practice, both tests of working memory capacity and crosslinguistic nonword repetition may inform the interpretation of dichotic listening results in children with diverse language backgrounds.
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| 4. |
- Carlie, Johanna, et al.
(författare)
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Development of an Auditory Passage Comprehension Task for Swedish Primary School Children of Cultural and Linguistic Diversity
- 2021
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Ingår i: Journal of Speech, Language, and Hearing Research. - : American Speech-Language-Hearing Association. - 1558-9102 .- 1092-4388. ; 64:10
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Tidskriftsartikel (refereegranskat)abstract
- Purpose This study reports on the development of an auditory passage comprehension task for Swedish primary school children of cultural and linguistic diversity. It also reports on their performance on the task in quiet and in noise. Method Eighty-eight children aged 7-9 years and showing normal hearing participated. The children were divided into three groups based on presumed language exposure: 13 children were categorized as Swedish-speaking monolinguals, 19 children were categorized as simultaneous bilinguals, and 56 children were categorized as sequential bilinguals. No significant difference in working memory capacity was seen between the three language groups. Two passages and associated multiple-choice questions were developed. During development of the passage comprehension task, steps were taken to reduce the impact of culture-specific prior experience and knowledge on performance. This was achieved by using the story grammar principles, universal topics and plots, and simple language that avoided complex or unusual grammatical structures and words. Results The findings indicate no significant difference between the two passages and similar response distributions. Passage comprehension performance was significantly better in quiet than in noise, regardless of language exposure group. The monolinguals outperformed both simultaneous and sequential bilinguals in both listening conditions. Conclusions Because the task was designed to minimize the effect of cultural knowledge on auditory passage comprehension, this suggests that compared with monolinguals, both simultaneous and sequential bilinguals have a disadvantage in auditory passage comprehension. As expected, the findings demonstrate that noise has a negative effect on auditory passage comprehension. The magnitude of this effect does not relate to language exposure. The developed auditory passage comprehension task seems suitable for assessing auditory passage comprehension in primary school children of linguistic and cultural diversity.
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| 5. |
- Carlie, Johanna, et al.
(författare)
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The Effect of Background Noise, Bilingualism, Socioeconomic Status, and Cognitive Functioning on Primary School Children's Narrative Listening Comprehension
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Ingår i: Journal of Speech, Language, and Hearing Research. - 1558-9102. ; , s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study focuses on 7- to 9-year-old children attending primary school in Swedish areas of low socioeconomic status, where most children's school language is their second language. The aim was to better understand what factors influence these children's narrative listening comprehension both in an ideal listening condition (in quiet) and for the primary school classroom, a typical listening condition (with multitalker babble noise).METHOD: A total of 86 typically developing 7- to 9-year-olds performed a narrative listening comprehension test (Lyssna, Förstå och Minnas [LFM]; English translation: Listen, Comprehend, and Remember) in two listening conditions: quiet and multitalker babble noise. They also performed the crosslinguistic nonword repetition test and a digit span backwards (DSB) test. A predictive statistical model including these factors, the children's degree of school language exposure, parental education level, and age was derived.RESULTS: Listening condition had the strongest predictive value for LFM performance, followed by school language exposure and nonword repetition accuracy. Parental education level was also a significant predictor. There was a significant three-way interaction effect between listening condition, age, and DSB performance.CONCLUSIONS: Multitalker babble noise has a negative effect on children's narrative listening comprehension. The effect of multitalker babble noise could be explained by age differences in the ability to allocate working memory capacity during the narrative listening comprehension task, suggesting that younger children may be more vulnerable for missing information when listening in background noise than their older peers.SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25209248.
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| 6. |
- Forslund, Maria, 1978, et al.
(författare)
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Health-Related Quality of Life in perimenopausal women with PCOS
- 2022
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Ingår i: Clinical and Experimental Obstetrics and Gynecology. - : IMR Press. - 0390-6663. ; 49:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several studies have shown that younger women with polycystic ovary syndrome (PCOS) have decreased Health-Related Quality of Life (HRQoL) compared with women in general. Method: In this study peri- and postmenopausal women previously diagnosed with PCOS (n = 27) were compared with randomly selected, age-matched controls (n = 94). Mean age of the study participants was 52 years. Structured interviews and Short Form (SF)-36 questionnaires were used. Results: No differences in SF-36 scores were found, median for the physical summary score was 54 vs. 57, for women with PCOS and controls, respectively; and 53 vs. 53 for the mental summary score, with no differences in any of the eight dimensions of HRQoL. There were no significant difference in prevalence of depression and/or anxiety. The use of drugs for mood disorders was 22% in both groups. Conclusion: PCOS women of peri- and postmenopausal ages had similar HRQoL compared with age-matched controls.
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| 7. |
- Forslund, Maria, 1978, et al.
(författare)
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Higher menopausal age but no differences in parity in women with polycystic ovary syndrome compared with controls.
- 2019
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 98:3, s. 320-326
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Tidskriftsartikel (refereegranskat)abstract
- To address the question of whether women with polycystic ovary syndrome (PCOS) reach menopause later than age-matched controls, we conducted a follow-up cohort study of women with well-characterized PCOS that was diagnosed 24years ago. The hypothesis was that women with PCOS would reach menopause later than non-PCOS women. Parity during these 24years was also studied.Twenty-seven women diagnosed with PCOS in 1992 (mean age 29.5years) were re-examined in 2016 (mean age 52.4years). Randomly selected women, n =94 (mean age 52.4years), from the same geographic area included in the World Health Organization MONICA study, Gothenburg, Sweden, served as controls.The mean menopausal age in women with PCOS was higher than in controls (53.3±2.2years vs 49.3±3.5years, P<0.01). Serum-follicle stimulating hormone levels were lower in the PCOS women than in controls (31.0±28.1IU/L vs 52.3±37.7IU/L, P=0.01). There was no difference in parity between women with PCOS (1.9±1.3 children, range 0-4) and controls (1.7±1.0, range 0-4 children).Women with PCOS reached menopause 4years later and had lower serum-follicle stimulating hormone compared with age-matched controls. Neither parity nor nulliparity differed between women with PCOS and controls.
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| 8. |
- Forslund, Maria, 1978, et al.
(författare)
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Morbidity and mortality in PCOS: A prospective follow-up up to a mean age above 80 years
- 2022
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Ingår i: European Journal of Obstetrics and Gynecology and Reproductive Biology. - : Elsevier BV. - 0301-2115 .- 1872-7654. ; 271, s. 195-203
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Despite the clear evidence of increased cardiovascular disease (CVD) risk factors, the long-term effect on CVD and mortality is still uncertain in women with PCOS, especially in the elderly. Studies in elderly women with PCOS are lacking. The objective was to study morbidity/mortality in PCOS women compared with a reference group up to a mean age above 80 years. Study design: A well-defined cohort of women with PCOS, examined in 1987 and 2008, was re-examined 32 years later in 2019 (age range 72–91 years), in parallel with an age-matched reference group. For deceased women register data was used, for women alive interviews were done, and medical records studied. Blood pressure and blood tests were analyzed. Morbidity and mortality data was available in 35/36 women with PCOS, and in 99/118 women in the reference group. Results: At mean age 81 years there was no difference in all-cause mortality (HR 1.1, ns), CVD-related mortality (HR 1.7, ns), all CVD (HR 1.2, ns), hypertension (HR 1.8, ns), type 2 diabetes (HR 1.7, ns), in levels of blood lipids, glucose, insulin or thyroid hormones. Comparing baseline data from the deceased and living women with PCOS, no differences were found regarding age, menopausal age, BMI, HOMA-IR, FAI, total testosterone or SHBG. However, deceased women with PCOS had a higher WHR (0.87 vs. 0.80; p-value < 0.01) at baseline. Conclusions: No evidence of increased all-cause mortality or CVD was found in women with PCOS. The elevated testosterone levels and CVD risk profile in PCOS present during perimenopause do not seem to be associated with increased CVD morbidity/mortality risk later in life. © 2022 The Authors
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| 9. |
- Forslund, Maria, 1978, et al.
(författare)
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Reproductive hormones and anthropometry: a follow-up of PCOS and controls from perimenopause to above 80 years of age.
- 2021
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 106:2, s. 421-430
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of knowledge about hormonal and anthropometric changes in women with polycystic ovary syndrome (PCOS) after the menopause.To study reproductive hormones and anthropometry in women with PCOS up to an age above 80 years.Prospective cohort study.University Hospital.A well-defined cohort of women with PCOS, previously examined in 1987 and 2008 (21 years period) was re-examined in 2019 (11 years period). Of the original cohort (n = 37), 22 women were still alive and 21 (age range 72-91 years) participated. Comparisons were made with age-matched controls (n = 55) from the original control cohort (BMI similar to PCOS women). The results were compared with results from 1987 and 2008.Hormonal measurements and physical examination.FSH, LH, testosterone, SHBG, free androgen index (FAI), hirsutism score, BMI, and waist-hip ratio (WHR).At mean age 81 years, FSH levels were lower in women with PCOS (50 vs. 70 IU/L) who were still more hirsute than controls (33% vs. 4%). No differences were found in FAI, testosterone, SHBG or LH levels, BMI or WHR.From perimenopausal age until the present age, levels of testosterone and FAI continued to decline in women with PCOS. SHBG levels continued to increase with age. FSH had not changed over time during the last eleven years.Women with PCOS at ages 72-91 had lower FSH levels, remained clinically hyperandrogenic and had similar FAI and body composition as controls.
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| 10. |
- Forslund, Maria, 1978, et al.
(författare)
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Type 2 diabetes mellitus in women with polycystic ovary syndrome during a 24-year period: importance of obesity and abdominal fat distribution.
- 2020
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Ingår i: Human reproduction open. - : Oxford University Press (OUP). - 2399-3529. ; 2020:1
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Tidskriftsartikel (refereegranskat)abstract
- What are the predictive factors for later development of type 2 diabetes (T2DM) in women with polycystic ovary syndrome (PCOS)?Obesity and abdominal fat distribution in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24years later when lifestyle factors were similar to controls.Women with PCOS have an increased prevalence of T2DM.A longitudinal and cross-sectional study was performed. Women with PCOS were examined in 1992 and in 2016. Randomly selected, age-matched women from the general population served as controls.Women with PCOS (n=27), attending an outpatient clinical at a tertiary care centre for infertility or hirsutism were diagnosed in 1992 (mean age 30years) and re-examined in 2016 (mean age 52years). Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease (WHO MONICA-GOT) 2008, aged 38-68years, served as controls (n=94), and they were previously examined in 1995. At both at baseline and at follow-up, women had blood samples taken, underwent a clinical examination and completed structured questionnaires, and the women with PCOS also underwent a glucose clamp test at baseline.None of women with PCOS had T2DM at baseline. At the 24-year follow-up, 19% of women with PCOS had T2DM versus 1% of controls (P<0.01). All women with PCOS who developed T2DM were obese and had waist-hip ratio (WHR) >0.85 at baseline. No difference was seen between women with PCOS and controls regarding use of high-fat diet, Mediterranean diet or amount of physical activity at follow-up at peri/postmenopausal age. However, women with PCOS had a lower usage of a high-sugar diet as compared to controls (P=0.01). The mean increases in BMI and WHR per year were similar in women with PCOS and controls during the follow-up period.The small sample size of women with PCOS and the fact that they were recruited due to infertility or hirsutism make generalization to women with milder forms of PCOS uncertain.Obesity and abdominal fat distribution, but not hyperandrogenism per se, in women with PCOS in the mid-fertile years were the major risk factors for T2DM development 24years later when peri/postmenopausal. Lifestyle factors were similar to controls at that time.The study was financed by grants from the Swedish state under the agreement between the Swedish government and the country councils, the ALF-agreement (ALFGBG-718611), the Gothenburg Medical Association GLS 694291 and 780821, the Swedish Heart Lung Foundation and Hjalmar Svensson Foundation. The authors have no conflict of interest.
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