| 1. |
- Amcoff, Karin, 1975-, et al.
(författare)
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Concordance in Anti-OmpC and Anti-I2 Indicate the Influence of Genetic Predisposition : Results of a European Study of Twins with Crohn's Disease
- 2016
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Ingår i: Journal of Crohn's & Colitis. - Oxford, United Kingdom : Oxford University Press. - 1873-9946 .- 1876-4479. ; 10:6, s. 695-702
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: An adaptive immunological response to microbial antigens has been observed in Crohn's disease (CD). Intriguingly, this serological response precedes the diagnosis in some patients and has also been observed in healthy relatives. We aimed to determine whether genetic factors are implicated in this response in a CD twin cohort.Methods: In total, 82 twin pairs (Leuven n = 13, Maastricht n = 8, Örebro n = 61) took part: 81 pairs with CD (concordant monozygotic n = 16, discordant monozygotic n = 22, concordant dizygotic n = 3, discordant dizygotic n = 40) and 1 monozygotic pair with both CD and ulcerative colitis. Serology for Pseudomonas fluorescens-related protein (anti-I2), Escherichia coli outer membrane porin C (anti-OmpC), CBir1flagellin (anti-CBir1) and antibodies to oligomannan (anti-Saccharomyces cerevisiae antibody [ASCA]) was determined by standardized enzyme-linked immunoassay.Results: All markers were more often present in CD twins than in their healthy twin siblings. Using the intraclass correlation coefficient (ICC), agreements in concentrations of anti-OmpC and anti-I2 were observed in discordant monozygotic but not in discordant dizygotic twin pairs with CD (anti-OmpC, ICC 0.80 and -0.02, respectively) and (anti-I2, ICC 0.56 and 0.05, respectively). In contrast, no agreements were found in anti-CBir, immunoglobulin (Ig) G ASCA and ASCA IgA.Conclusions: We show that anti-I2 and anti-CBir1 statuses have specificity for CD and confirm previous reported specificities for anti-OmpC and ASCA. Based on quantitative analyses and observed ICCs, genetics seems to predispose to the anti-OmpC and anti-I2 response but less to ASCA and anti-CBir1 responses.
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| 2. |
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| 3. |
- Dahl, JoAnne, et al.
(författare)
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Behavioral medicine treatment in chronic constipation with paradoxical anal sphincter contraction
- 1991
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Ingår i: Diseases of the Colon & Rectum. - 0012-3706 .- 1530-0358. ; 34:9, s. 769-776
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Tidskriftsartikel (refereegranskat)abstract
- Nine women and five children with severe chronic constipation received behavioral medicine therapy. Before treatment, all patients had a paradoxical contraction of the external anal sphincter at defecation attempts as demonstrated with electromyography and/or anorectal manometry. An electromyographic biofeedback device connected to an anal probe was used for the training that was performed on a regular toilet seat during five 1-hour sessions. Thirteen of the patients improved considerably and could learn to defecate spontaneously, and the use of laxatives ceased or diminished. Simultaneously with improvement, the paradoxical anal contraction disappeared. The results remained after 6 months, although two of the patients had received booster sessions of biofeedback training during follow-up.
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| 4. |
- Halfvarson, Jonas, 1970-, et al.
(författare)
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Inflammatory bowel disease in a Swedish twin cohort : a long-term follow-up of concordance and clinical characteristics
- 2003
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Ingår i: Gastroenterology. - 0016-5085 .- 1528-0012. ; 124:7, s. 1767-1773
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims:In 1988, we reported the first twin study in inflammatory bowel disease. The aim of the current study was to follow up these twins regarding new cases of inflammatory bowel disease and Crohn’s disease characteristics using the Vienna classification.Methods:The official Swedish population register and the cause of death register were used to search for the twins. All living patients were interviewed.Results:Three monozygotic twins earlier classified as healthy had been diagnosed with inflammatory bowel disease (ulcerative colitis, n = 2; Crohn’s disease, n = 1). Retrospectively, all 3 were symptomatic at the original survey. This changed the pair concordance in monozygotic twins from 6.3% to 18.8% in ulcerative colitis and from 44.4% to 50.0% in Crohn’s disease. A high degree of concordance regarding age at diagnosis, disease location at diagnosis and during the course, and disease behavior was found in concordant monozygotic twin pairs with Crohn’s disease. Seven of 9 pairs were identical in 3 or more of these disease characteristics compared with an expected number of 1.5 (P = 0.000076).Conclusions:This study confirms that the genetic influence is stronger in Crohn’s disease than in ulcerative colitis. A remarkable phenotype similarity within concordant pairs with Crohn’s disease was found using the Vienna classification.
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| 5. |
- Halfvarson, Jonas, 1970-, et al.
(författare)
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Inflammatory bowel disease in a Swedish twin cohort : a long-term follow-up of concordance and clinical characteristics
- 2003
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Ingår i: Gastroenterology. - : Elsevier BV. - 0016-5085 .- 1528-0012. ; 124:7, s. 1767-1773
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: In 1988, we reported the first twin study in inflammatory bowel disease. The aim of the current study was to follow up these twins regarding new cases of inflammatory bowel disease and Crohn's disease characteristics using the Vienna classification.METHODS: The official Swedish population register and the cause of death register were used to search for the twins. All living patients were interviewed.RESULTS: Three monozygotic twins earlier classified as healthy had been diagnosed with inflammatory bowel disease (ulcerative colitis, n = 2; Crohn's disease, n = 1). Retrospectively, all 3 were symptomatic at the original survey. This changed the pair concordance in monozygotic twins from 6.3% to 18.8% in ulcerative colitis and from 44.4% to 50.0% in Crohn's disease. A high degree of concordance regarding age at diagnosis, disease location at diagnosis and during the course, and disease behavior was found in concordant monozygotic twin pairs with Crohn's disease. Seven of 9 pairs were identical in 3 or more of these disease characteristics compared with an expected number of 1.5 (P = 0.000076).CONCLUSIONS: This study confirms that the genetic influence is stronger in Crohn's disease than in ulcerative colitis. A remarkable phenotype similarity within concordant pairs with Crohn's disease was found using the Vienna classification.
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| 6. |
- Halfvarson, Jonas, 1970-, et al.
(författare)
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Longitudinal concordance for clinical characteristics in a Swedish-Danish twin population with inflammatory bowel disease
- 2007
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Ingår i: Inflammatory Bowel Diseases. - New York, NY : Raven Press. - 1078-0998 .- 1536-4844. ; 13:12, s. 1536-1544
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The genetic influence on disease course in inflammatory bowel disease (IBD) remains unknown. We therefore aimed to study longitudinal concordance for clinical characteristics and longitudinal stability using the Montreal Classification in an IBD twin population. METHODS: A total of 158 twins with ulcerative colitis (UC) (18 belonging to 9 concordant monozygotic pairs) and 141 twins with Crohn's disease (CD) (34 belonging to 17 concordant monozygotic pairs) were enrolled. Medical notes were scrutinized for clinical characteristics at diagnosis and after 10 years. Using the binominal distribution, we tested the hypothesis that clinical characteristics were independent within individuals in disease concordant monozygotic pairs. RESULTS: In CD, location was identical in 11/17 monozygotic concordant pairs at diagnosis (P = 0.008) and in 11/16 pairs after 10 years (P = 0.02). Behavior at diagnosis was identical in 13/17 pairs (P = 0.03) and in 11/16 pairs after 10 years (P = 0.01). Monozygotic UC twins were concordant (within 5 years) for age at diagnosis (6/9 pairs; P < 0.001) and symptomatic onset (4/9 pairs; P = 0.02) but not for extent of disease at diagnosis or after 10 years. The Montreal Classification did not demonstrate longitudinal stability, either regarding location or behavior of CD or extent of UC. CONCLUSIONS: The high phenotypic concordance, both at diagnosis and longitudinally, in monozygotic twins with CD supports a genetic influence not only on disease occurrence but also on disease course. This contrasts with UC, where the genetic impact appears less. Montreal Classification characteristics changed over time and should be used cautiously.
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| 7. |
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| 8. |
- Tysk, Lennart, et al.
(författare)
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Allt färre patienter i sluten psykiatrisk vård : Förändringar i Gästrikland 1985-1993
- 1994
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; :10, s. 480-483
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Tidskriftsartikel (refereegranskat)abstract
- Den psykiatriska vården har genomgått genomgripande förändringar på senare år. I Gästrikland genomfördes omorganisationen huvdsakligen under andra hälften av 1980-talet. Då minskades den slutna vården till förmån för en utbyggd och decentraliserad öppen vård. Under 1990-talet förändrades förutsättningarna genom att nya regler får vårdköp mellan sjukvårdsdistrikten infördes. Samtidigt minskade de ekonomiska ramarna. Detta kan ha bidragit till att slutenvården fortsatt att minska. Genom patientinventeringar 1985, innan förändingsarbetet tog fart, 1991, efter sektoriseringens genomförande och 1993, i skedet efter sektoriseringen, kunde förändringar i patientsammansättning och vårdtider avläsas. Drivkraften bakom förändringarna diskuteras.
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| 9. |
- Tysk, Lennart, et al.
(författare)
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Psychiatric inpatient care and the availability of hospital beds : A comparison of three catchment areas
- 1990
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 44:6, s. 559-561
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Tidskriftsartikel (refereegranskat)abstract
- Psychiatric inpatient care and the availability of hospital beds: A comparison of three catchment areas. The psychiatric care in Gävleborg county was formerly centralized to a mental hospital and a small psychiatric department at a general hospital. It was then decided that the care system should be reorganized. The county was divided into three catchment areas. Each of these will have a comprehensive psychiatric care with both in- and out-patient facilities, but the intramural care will be reduced considerably. During the reorganization phase an almost experimental situation existed, as accessibility and availability of hospital beds differed among the three sectors. The inpatients for each sector were counted, and some patient characteristics were compared. Except for a considerable difference in the use of hospital beds small differences were otherwise noted. The sector with the smallest number of inpatients had relatively more schizophrenic patients. The accessibility and availability of hospital beds seemed to decide the number of inpatients even when deinstitutionalization was an accepted common goal. Local habits and traditions may also be important.
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| 10. |
- Wessén, Bernice, et al.
(författare)
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En uppföljning av långtidsvårdade patienter som skrivits ut från sjukhus i samband med psykiatrins omdaning
- 1991
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 45:1, s. 41-45
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Tidskriftsartikel (refereegranskat)abstract
- The so-called sectorization of the psychiatric care system has been connected with deinstitutionalization and possibly also a forced discharge from hospital for some long-term inpatients. In Gävleborg County 96 patients who had been hospitalized for at least 1 year were discharged in the years 1984-88, when the reduction of hospital beds was at its peak. Their situation was investigated in the autumn of 1989, when members of the psychiatric staff evaluated their living conditions and asked the patients to complete a questionnaire. At that time 19 patients had been readmitted to hospital, 4 had moved to other parts of the country, and 3 were dead. Thus at least 70 were still living outside institutions, but 2 of these could not be reached. The material consists of the other 68 patients. Forty of them were diagnosed as being schizophrenic. Twenty-two patients had spent some time in hospital after the index discharge. Forty-three lived in their own lodgings, 14 in group homes, and 11 in homes for the elderly. Forty-one lived alone, and this was more often the case for male patients. Only one had a job and earned his living, but 41 took part in some organized activity like work therapy or study groups. About 50% of the patients had regular contact (at least once a month) with the local psychiatric department, and the same frequency was noted for regular contact with the district nurses. Only seven patients had no such contacts. According to the staffs judgement, about two of three patients had enough psychosocial support and a satisfactory quality of life. Resources for rehabilitation, activation, and social contacts were reported to be inadequate. The patients had a more positive view and were largely satisfied with their living conditions. Only four wanted to return to the hospital. The schizophrenic patients tended to have a more satisfactory life situation according to the staff, and they were also rehospitalized less frequently than other patient categories. There is a notable group of chronically ill patients with other psychiatric diagnoses, which need as much support as the schizophrenic group. When resources are lacking, the need for cooperation with social authorities, primary care, and clients' organizations is apparent.
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