| 1. |
- Larsson, Kjell
(författare)
-
Tätare uppdateringar behövs av riktlinjer vid astma och KOL
- 2020
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 117
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Rekommendationer för omhändertagande vid astma och kroniskt obstruktiv lungsjukdom (KOL) uppdateras av Läkemedelsverket cirka vart sjunde år och ligger till grund för diagnostik och behandling framför allt i primärvården. Internationella riktlinjer för omhändertagande av astma (Global initiative for asthma, GINA) och KOL (Global initiative for chronic obstructive lung disease, GOLD) uppdateras årligen för att ny kunskap om behandling snabbt ska nå patienterna.De långa intervallen mellan uppdateringarna innebär att rekommendationerna hinner bli inaktuella innan nästa version publiceras, och Sverige hamnar i otakt med internationella riktlinjer. Farmakologisk behandling uppdateras av regionala läkemedelskommittéer, men rekommendationerna skiljer sig i olika delar av landet och stäms ofta inte av mot internationella riktlinjer, vilket leder till ojämlik behandling över landet. Läkemedelsverkets kunskapsstöd Läkemedelsboken innehöll ett kapitel om astma och KOL där man vid behov kunde uppdatera riktlinjer för primärvården, men detta stöd har lagts ned.Vid astma rekommenderar riktlinjerna kortverkande beta-2-agonister vid behov som enda behandling vid lindrig astma (steg 1) samt som tillägg till underhållsbehandling vid svårare sjukdom vid symtomgenombrott [1]. Som alternativ vid svårare astma (steg 3–5) rekommenderas inhalationssteroider i fast kombination med formoterol (steroid + formoterol) vid behov i stället för kortverkande b2-agonister [1]. Vid lindrig astma ger steroid + formoterol vid behov som enda behandling bättre resultat än endast kortverkande beta-2-agonister vid behov [2-5]. Vidare har steroid + formoterol (inhalerat vid behov) lika god exacerbationsförebyggande effekt som regelbunden behandling med inhalationssteroider och kortverkande beta-2-agonister vid behov trots en betydligt lägre kortisonbelastning [3, 5].I juni 2019 uppdaterades GINA:s astmarekommendationer genomgripande [6]. Här rekommenderas steroid + formoterol vid behov vid alla svårighetsgrader av astma. Kortverkande beta-2-agonister (salbutamol, terbutalin) vid behov är struket som förstahandsalternativ. Data indikerar att endast kortverkande beta-2-agonister vid behov faktiskt ökar risken för svåra exacerbationer och astmarelaterad mortalitet. Genom tillägg av inhalationssteroid till en snabb- och långverkande beta-2-agonist reduceras risken signifikant [6]. Vidare rekommenderas steroid + formoterol vid behov som alternativ till regelbunden behandling med inhalationssteroider på steg 2. Riktlinjerna har redan godkänts i flera länder.Vid KOL-behandling är två viktiga mål att lindra symtom och förebygga exacerbationer. Basbehandlingen för att uppnå detta är långverkande antikolinergika. Tillägg av långverkande beta-2-agonist till långverkande antikolinergika ger ytterligare god effekt på symtom, men en mer blygsam tilläggseffekt på exacerbationer [8]. Vid KOL ges inhalationssteroid i syfte att förebygga exacerbation. Hög nivå av eosinofiler i blod förekommer ofta vid KOL. Nyare forskning visar att blodeosinofili varierar hos patienter med KOL. Inhalationssteroider förebygger exacerbationer mer effektivt hos KOL-patienter med eosinofili, och blodeosinofili kan vägleda den förebyggande behandlingen [9-12]. Kontroll av eosinofiler i blod förespråkas i det senaste GOLD-dokumentet inför val av terapi och nydiagnostiserad KOL. Vid KOL och samtidig eosinofili anges inhalationssteroid + långverkande beta-2-agonist som tänkbart förstahandsalternativ i förebyggande syfte [13].Vi anser att behandling av patienter med astma och/eller KOL i Sverige ska baseras på rekommendationer från Läkemedelverket och att de senaste landvinningarna inom området måste återfinnas i riktlinjerna. Läkemedelsverket bör uppdatera riktlinjerna kontinuerligt, helst årligen. Detta kan göras av en mindre grupp experter genom en begränsad arbetsinsats till låg kostnad. Potentiella bindningar eller jävsförhållanden: Samtliga författare har deltagit i expertgrupp och/eller föreläst/haft utbildningsuppdrag hos företag som verkar inom området.
|
|
| 2. |
- Alwis, Gayani, et al.
(författare)
-
A 2-year school-based exercise programme in pre-pubertal boys induces skeletal benefits in lumbar spine.
- 2008
-
Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 97, s. 1564-1571
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of this study was to evaluate if a general school-based exercise intervention programme in pre-pubertal boys would render site-specific benefits in bone mineral accrual and gain in femoral neck structure. Methods: Eighty boys aged 7-9 years were included in a curriculum-based exercise intervention programme comprising 40 min of general physical activity per school day (200 min/week) for 2 years. Fifty-seven age-matched boys, assigned to the general Swedish school curriculum of 60 min/week, served as controls. Bone mineral content was measured with dual X-ray absorptiometry of the total body, the third lumbar vertebra and hip. Specific software, the hip structural analyses, evaluated the structural properties of the femoral neck. Annual changes were compared. The level of physical activity was estimated through questionnaires and accelerometers. Results: The mean annual bone mineral content gain in third lumbar vertebra was 3.0 percentage points (p < 0.01) and in width 1.3 percentage points (p < 0.01) greater in the intervention than in the control group. The weekly duration of exercise estimated through the questionnaire correlated with gain in bone mineral content in third lumbar vertebra (r = 0.25, p = 0.005) and vertebra width (r = 0.20, p = 0.02). Conclusion: A school-based exercise intervention programme in pre-pubertal boys enhances the skeletal benefits at lumbar spine.
|
|
| 3. |
- Alwis, Gayani, et al.
(författare)
-
A school-curriculum-based exercise intervention program for two years in pre-pubertal girls does not influence hip structure.
- 2008
-
Ingår i: Dynamic Medicine. - : Springer Science and Business Media LLC. - 1476-5918. ; 7, s. 8-8
-
Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: It is known that physical activity during growth has a positive influence on bone mineral accrual, and is thus possibly one strategy to prevent osteoporosis. However, as bone geometry, independent of areal bone mineral density (aBMD), influences fracture risk, this study aimed to evaluate whether hip structure in pre-pubertal girls is also affected by a two-year exercise intervention program. METHODS: Forty-two girls aged 7-9 years in a school-curriculum-based exercise intervention program comprising 40 minutes of general physical activity per school day (200 minutes per week) were compared with 43 age-matched girls who participated in the general Swedish physical education curriculum comprising a mean of 60 minutes per week. The hip was scanned by dual energy X-ray absorptiometry (DXA) and the hip structural analysis (HSA) software was applied to evaluate bone mineral content (BMC, g), areal bone mineral density (aBMD, g/cm2), periosteal diameter, cross-sectional area (CSA, cm2), section modulus (Z, cm3) and cross-sectional moment of inertia (CSMI, cm4) of the femoral neck (FN). Annual changes were compared. Subjective duration of physical activity was estimated by questionnaire and objective level of everyday physical activity at follow-up by means of accelerometers worn for four consecutive days. All children remained at Tanner stage 1 throughout the study. Group comparisons were made by independent student's t-test between means and analyses of covariance (ANCOVA). RESULTS: At baseline, the two groups did not differ with regard to age, anthropometrics or bone parameters. No between-group differences were observed for annual changes in the FN variables measured. CONCLUSION: A two-year school-based moderately intense general exercise program for 7-9-year-old pre-pubertal girls does not influence structural changes in the FN.
|
|
| 4. |
- Alwis, Gayani, et al.
(författare)
-
Bone mineral accrual and gain in skeletal width in pre-pubertal school children is independent of the mode of school transportation - one-year data from the prospective observational pediatric osteoporosis prevention (POP) study.
- 2007
-
Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 8:1, s. 66-66
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Walking and cycling to school could be an important regular source of physical activity in growing children. The aim of this 12 months prospective observational study was thus to evaluate the effect of self-transportation to school on bone mineral accrual and gain in bone width in pre-pubertal children, both traits independently contributing to bone strength. Methods: Ninety-seven girls and 133 boys aged 7-9 years were recruited as a part of the Malmo Pediatric Osteoporosis Prevention (POP) Study in order to evaluate the influence of self-selected school transportation for the accrual of bone mineral and bone width. Children who walked or cycled to school were compared with children who went by bus or car. Bone mineral content (BMC) was measured by dual energy X-ray absorptiometry (DXA) in the lumbar spine (L2-L4), third lumbar vertebra (L3) and hip, and bone width was calculated at L3 and femoral neck (FN). Changes during the first 12 months were compared between the groups. Subjective duration of physical activity was estimated by a questionnaire and objective level of everyday physical activity at follow-up by accelerometers worn for four consecutive days. All children remained in Tanner stage 1 throughout the study. Comparisons were made by independent student's t-tests between means, ANCOVA and Fisher's exact tests. Results: There were no differences in baseline or annual changes in BMC or bone width when the transportation groups were compared. No differences were detected in objectively measured daily level of physical activity by accelerometer. All children reached above 60 minutes of moderate to intense daily physical activity per day, the international recommended level of daily physical activity according to the United Kingdom Expert Consensus Group. Conclusion: The everyday physical activity in these pre-pubertal children seems to be so high that the school transportation contributes little to their total level of physical activity. As a result, the choice of school transportation seems not to influence the accrual of bone mineral or gain in bone size during a I2-month follow-up period.
|
|
| 5. |
|
|
| 6. |
- Björk, Emma M., 1981-
(författare)
-
Mesoporous Building Blocks : Synthesis and Characterization of Mesoporous Silica Particles and Films
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Catalyst supports, drug delivery systems, hosts for nanoparticles, and solar cells are just some examples of the wide range of exciting applications for mesoporous silica. In order to optimize the performance of a specific application, controlling the material’s morphology and pore size is crucial. For example, short and separated particles are beneficial for drug delivery systems, while for molecular sieves, the pore size is the key parameter.In this thesis, mesoporous silica building blocks, crystallites, with hexagonally ordered cylindrical pores were synthesized, with the aim to understand how the synthesis parameters affect the particle morphology and pore size. The synthesis of the particles is performed using a sol-gel process, and in order to increase the pore size, a combination of low temperature, and additions of heptane and NH4F was used. By variations in the amounts of reagents, as well as other synthesis conditions, the particle morphology and pore size could be altered. Separated particles were also grown on or attached to substrates to form films. Also, a material with spherical pore structure was synthesized, for the first time using this method.It was found that a variation in the heptane concentration, in combination with a long stirring time, yields a transition between fiber and sheet morphologies. Both morphologies consist of crystallites, which for the fibers are joined end to end, while for the sheets they are attached side by side such that the pores are accessible from the sheet surface. The crystallites can be separated to a rod morphology by decreasing the stirring time and tuning the HCl concentration, and it was seen that these rods are formed within 5 min of static time, even though the pore size and unit cell parameters were evolving for another 30 min. Further studies of the effects of heptane showed that the shape and mesoscopic parameters of the rods are affected by the heptane concentration, up to a value where the micelles are fully saturated with heptane. It was also observed that the particle width increases with decreasing NH4F concentration, independent of heptane amount, and a platelet morphology can be formed. The formation time of the particles decrease with decreasing NH4F, and the growth mechanism for platelets was further studied. The pore sizes for various morphologies were altered by e.g. variations in the hydrothermal treatment conditions, or the method for removing the surfactants.The separated particles can be attached to substrates, either during the particle synthesis or by post grafting prior to calcination. The film formation during the one-pot-synthesis was studied and a formation mechanism including nucleation of elongated micelles on the substrate was suggested. During the post grafting film synthesis, the medium in which the particles are dispersed, as well as functionalization of both particle and substrate are crucial for the post grafting process. The pores are easily accessible independent of the method, even though they are aligned parallel to the substrate when the one-pot-method is used, while post grafting gives a perpendicular pore orientation.In summary, this work aims to give an understanding for the formation of the synthesized material, and how to tune the material properties by alterations in parameter space. Successful syntheses of four different particle morphologies and two new types of films were performed, and the pore size could easily be tuned by various methods.
|
|
| 7. |
- Dencker, Magnus, et al.
(författare)
-
Aerobic fitness related to cardiovascular risk factors in young children.
- 2012
-
Ingår i: European Journal of Pediatrics. - : Springer Science and Business Media LLC. - 1432-1076 .- 0340-6199. ; 171:4, s. 705-710
-
Tidskriftsartikel (refereegranskat)abstract
- Low aerobic fitness (maximum oxygen uptake (VO(2PEAK))) is predictive for poor health in adults. In a cross-sectional study, we assessed if VO(2PEAK) is related to a composite risk factor score for cardiovascular disease (CVD) in 243 children (136 boys and 107 girls) aged 8 to 11 years. VO(2PEAK) was assessed by indirect calorimetry during a maximal exercise test and scaled by body mass (milliliters per minute per kilogram). Total body fat mass (TBF) and abdominal fat mass (AFM) were measured by Dual-energy X-ray absorptiometry. Total body fat was expressed as a percentage of total body mass (BF%) and body fat distribution as AFM/TBF. Systolic and diastolic blood pressure (SDP and DBP) and resting heart rate (RHR) were measured. The mean artery pressure (MAP) and pulse pressure (PP) were calculated. Echocardiography, 2D-guided M-mode, was performed. Left atrial diameter (LA) was measured and left ventricular mass (LVM) and relative wall thickness (RWT) were calculated. Z scores (value for the individual - mean value for group)/SD were calculated by sex. The sum of z scores for DBP, SDP, PP, MAP, RHR, LVM, LA, RWT, BF%, AFM and AFM/TBF were calculated in boys and girls, separately, and used as composite risk factor score for CVD. Pearson correlation revealed significant associations between VO(2PEAK) and composite risk factor score in both boys (r = -0.48 P < 0.05) and in girls (r = -0.42, P < 0.05). One-way ANOVA analysis indicated significant differences in composite risk factor score between the different quartiles of VO(2PEAK) (P < 0.001); thus, higher VO(2PEAK) was associated with lower composite risk factor score for CVD. In conclusion, low VO(2PEAK) is associated with an elevated composite risk factor score for CVD in both young boys and girls.
|
|
| 8. |
- Dencker, Magnus, et al.
(författare)
-
BMI and objectively measured body fat and body fat distribution in prepubertal children.
- 2007
-
Ingår i: Clinical Physiology and Functional Imaging. - 1475-0961. ; 27:1, s. 12-16
-
Tidskriftsartikel (refereegranskat)abstract
- Background Body Mass Index (BMI) is often used as a surrogate estimate of body fat in epidemiological studies. This study explores the association between BMI, body fat and body fat distribution assessed by Dual-Energy X-Ray Absorptiometry (DXA) in younger children. Methods Cross-sectional study of 246 children (138 boys and 108 girls) aged 8-11 years. DXA was used to quantify abdominal fat mass (AFM), total body fat (TBF) and also total body fat as percentage of total body mass (BF%). Body fat distribution was calculated as AFM/TBF. Results We found close correlations between BMI vs. TBF, BF% and AFM (r = 0.94, r = 0.92 and r = 0.93) for boys and (r = 0.95, r = 0.92 and r = 0.95) for girls, respectively (P < 0.05 for all r-values). However, significantly lower correlation (P < 0.001 for difference between the r-values) existed for body fat distribution (r = 0.64 for boys and 0.73 for girls). Conclusion Percentage body fat, TBF and AFM were all closely associated with BMI, suggesting that BMI serves as a good surrogate marker for obesity in population studies. However, a significantly lower correlation existed for BMI vs. body fat distribution, which may be a limitation when BMI is used to study cardiovascular risk factors in epidemiological studies.
|
|
| 9. |
- Dencker, Magnus, et al.
(författare)
-
Body Fat, Abdominal Fat, and Body Fat Distribution Is Related to Left Atrial Diameter in Young Children.
- 2012
-
Ingår i: Obesity. - : Wiley. - 1930-739X .- 1930-7381. ; 20, s. 1104-1108
-
Tidskriftsartikel (refereegranskat)abstract
- In adults, the size of the left atria (LA) has important prognostic information. In obese adults, adolescents and children enlargement of LA have been observed. This has not been investigated on a population-based level in young children. We therefore assessed if total body fat mass (TBF), abdominal fat, and body fat distribution were related to LA diameter. Cross-sectional study of 244 children (boys = 137 and girls n = 107) aged 8-11 years, recruited from an urban population-based cohort. Dual-energy X-ray absorptiometry (DXA) measured total lean body mass, TBF, and abdominal fat mass (AFM). Body fat was also calculated as a percentage of body mass (BF%). Body fat distribution (AFM/TBF) was calculated. Echocardiography was performed with two-dimensional guided M-mode. LA diameter was measured and left ventricular mass (LVM) was calculated. Systolic blood pressure and diastolic blood pressure were measured and maturity assessed according to Tanner. There were significant (P < 0.05) univariate correlations for all children between TBF (r = 0.40), BF% (r = 0.32), AFM (r = 0.41), and AFM/TBF (r = 0.41) vs. LA diameter. Multiple regression analyses with the inclusion of possible confounders such as lean body mass, blood pressure, gender, age, and Tanner stage revealed that TBF, AFM, and AFM/TBF were all independently related to LA diameter. Differences in the different body fat measurements explained 6-9% of the variance in LA size. These results demonstrated that both total body fat, AFM, and body fat distribution are already at a young age negatively and independently associated to LA diameter.
|
|
| 10. |
- Dencker, Magnus, et al.
(författare)
-
Body fat, abdominal fat and body fat distribution related to cardiovascular risk factors in pre-pubertal children.
- 2012
-
Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 101:8
-
Tidskriftsartikel (refereegranskat)abstract
- Aim We analysed whether total body fat, abdominal fat and body fat distribution are associated with higher composite risk factor scores for cardiovascular disease (CVD) in young children. Methods Cross-sectional study of 238 children aged 8-11 years. Total body fat (TBF) and abdominal fat mass (AFM) were measured by DXA. TBF was expressed as a percentage of body weight (BF%). Body fat distribution was calculated as AFM/TBF. Maximal oxygen uptake (VO(2PEAK) ), systolic and diastolic blood pressure (SBP, DBP), and resting heart rate (RHR) were measured. Mean artery pressure (MAP) and pulse pressure (PP) were calculated. Left atrial diameter (LA) was measured, and left ventricular mass (LVM) and relative wall thickness (RWT) were calculated. Z-scores were calculated. Sum of z-scores for SBP, DBP, MAP, PP, RHR, LVM, LA, RWT, and -VO(2PEAK) were calculated in boys and girls, separately, and used as composite risk factor score. Results Pearson correlations between ln BF%, ln AFM and AFM/TBF versus composite risk factor score for boys were r=0.56, r=0.59, and r=0.48, all P<0.001, and for girls r=0.45, r=0.50, and r=0.48, all P<0.001. Conclusion Total body fat, abdominal fat and body fat distribution were all associated with higher composite risk factor scores for CVD in young children. © 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.
|
|
