| 1. |
- Bengtsson, Johan
(författare)
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Negative symptoms, repetitive transcranial magnetic stimulation and heart rate variability in schizophrenia and depression
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Negative symptoms comprise anhedonia, avolition, and blunted affect. Although first described in schizophrenia, these symptoms share phenomenology with the depressive state. Pharmacological treatment has not been successful in reducing negative symptoms. Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological treatment option for moderate to severe depression. There have also been attempts to treat negative symptoms in both schizophrenia and depression with rTMS.Cardiovascular disease is common in schizophrenia and depression. Heart rate variability (HRV) is an established proxy for cardiac autonomic functioning and numerous studies have found lower HRV in patients with schizophrenia and depression. The impact of psychopharmacological treatment on HRV has been extensively studied and anticholinergic compounds have been found to decrease HRV.Lastly, since the most commonly used rTMS depression targets are also the brain regions involved in central autonomic regulation, there is reason to consider a potential effect of rTMS on HRV.The overall aim of this thesis was to investigate negative symptoms, rTMS, and HRV in schizophrenia and depression.Study I was a validation study of a Swedish translation of the Clinical Assessment Interview for Negative Symptoms (CAINS). Thirty-four patients with schizophrenia were interviewed and it was concluded that the Swedish version of the CAINS exhibited acceptable psychometric properties.Study II was a double-blind randomized controlled trial of rTMS for negative symptoms in schizophrenia and depression. There was a significant decrease of negative symptoms in the depression group, but not in the schizophrenia group. There were no effects on overall depressive symptoms in either group.Study III assessed determinants of HRV in schizophrenia, depression, and healthy controls. The results indicated lower HRV in both patient groups, even after controlling for several factors, and also that anticholinergic burden impacted HRV.In Study IV, the relationship between HRV and the functional and structural connectivity of the anterior cingulate cortex was investigated in patients with schizophrenia and compared with that in healthy controls. It was found that connectivity with the cerebellum might play a role in the autonomic modulation network in patients with schizophrenia.Lastly, in Study V, the effect of a treatment course with rTMS on HRV was investigated in patients with depression, as well as HRV’s relationship to symptom change. No effects on HRV were detected, nor any correlations between HRV and symptom change. Further, baseline HRV could not predict treatment response.
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| 2. |
- Bengtsson, Johan, et al.
(författare)
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Theta burst transcranial magnetic stimulation of the dorsomedial prefrontal cortex in schizophrenia and depression
- 2015
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Ingår i: Brain Stimulation. - : Elsevier BV. - 1935-861X.
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Konferensbidrag (refereegranskat)abstract
- Negative symptoms in schizophrenia and core depressive symptoms share phenomenology and repetitive transcranial magnetic stimulation (rTMS) is a treatment modality for both conditions. The most common treatment site has been the dorsolateral prefrontal cortex (DLPFC) but there might be more optimal targets. Furthermore, the implementation of the currently approved protocols is hampered by the long duration. More intense stimulation protocols such as the theta burst stimulation (TBS) are significantly shorter and may be as effective and safe.The overall aim of this project is to evaluate the treatment effect of TBS on poor motivation and anhedonia in schizophrenia and depression and to explore the neurobiological correlates of these deficits.The dorsomedial prefrontal cortex (dmPFC) is a key cortical area in networks associated with motivation and anhedonia and it is affected in both schizophrenia and depression. The dmPFC has recently been identified as a possible site of stimulation and is now within reach by new angled coils that have deeper tissue penetration.Our study will enroll 38 patients with schizophrenia, 38 patients with depression and 38 healthy volunteers. Patients will be given daily TBS (totally 2400 pulses, 1200 on each hemisphere) over the dmPFC during 10 days. Target symptoms will be assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS). We will also assess cortical excitability with paired-pulse stimulation and the pre-attentive memory function with mismatch negativity (MMN), spontaneous motor activity (assessed with 24 hours accelerometer) as well as autonomic nervous system tone (assessed by skin conductance, heart rate variability and breathing pattern). In addition, we will evaluate cognitive function (speed of processing, verbal fluency, auditory and working memory, visuospatial ability) during rest and stress.
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| 3. |
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| 5. |
- Marcusson, Jan, et al.
(författare)
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Proactive healthcare for frail elderly persons : study protocol for a prospective controlled primary care intervention in Sweden
- 2019
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.
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| 6. |
- Parsmo, Rasmus, et al.
(författare)
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BRAVE ECO – Benchmark for Reduction of Anchoring Vessels’ Emissions – Enabling Change of Operation
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This feasibility study aims to evaluate the possibilities to reduce air emissions from ships anchored in port areas and, then especially the Port of Gothenburg. For this purpose, the study uses two main approaches. Firstly, it analyses the reasons and legal/business aspects for anchoring. Secondly, this study develops a reproducible calculation model for anchored vessels' CO2 emissions. Regulation of anchoring sites are not entirely clear since international regulation partly applies, also it is not clear who is responsible for the anchoring sites. This implies that the port´s scope of action is limited mainly to the ships that are calling the port. However, also emission from other ships at in the port area has been evaluated in this study to get a broader perspective. This pre-study provides both qualitative and quantitative findings and it is produced using mixed methods, including workshops with relevant port stakeholders. It also involves different scientific disciplines and several authors from the Port of Gothenburg Authority, IVL Swedish Environmental Research Institute, Maritime Studies at Chalmers University of Technology and the School of Business, Economics and Law at the University of Gothenburg. Furthermore, in connection to this study, one bachelor's thesis and two master's theses have been carried out. The results show that it is mainly tanker ships that are anchoring in Gothenburg and that their main reasons for anchoring are related to awaiting Laycan or waiting for an available berth. The companies involved in the study generally combine time charter and voyage charter contracts to access vessel capacity. The inputs from the workshops, the interviews conducted with stakeholders and the international literature are “rather” consistent: combining just in time arrival with slow steaming has a great potential for making a business case and to reduce fuel consumption and thereby emissions. However, there are many barriers which needs to be addressed, such as: lack of trust, improving information sharing (actors now communicate via phone or email), loss of income (due to demurrage), attitudes in the industry, the “first come, first serve” concept, risk of missing estimated time of arrival and port infrastructure. Even if there are many barriers, several actors in the port already have experience of combining just in time arrival and slow steaming. In this study, we develop a reproducible emission calculation model that calculates CO2eq emissions. The emissions are partly calculated by using the ships’ positions (AIS-data) from 2019, to extract the time spent at anchor. The emission model calculates the anchored vessels' total CO2eq emissions, but the model also calculates the theoretical potential for avoiding emission by using the time at anchor to slow steam. The results show that all tanker ships that anchored outside the port in 2019, could theoretically have reduced their emissions with about 30 ktonnes CO2eq, if they would have been notified of delays 24 hours before arrival and then reduced their speed to 10 knots. The results also show that using time to slow steam have a much greater potential to reduce emissions than if the ships would only reduce the time at anchor (by using fewer ships to perform the same transport work). This is especially true for the initial speed reductions (10-14 knots). This study also evaluates the emission calculation methods and assesses the uncertainties, by comparing different sources and underlying assumptions with real world data. The study argues that it is problematic to just use default values proposed in the global emission inventory issued by the International Maritime Organization (IMO). Using default values for estimating emission makes it harder to estimate the real effect of a new policy, regulation, or incentive in the port. However, a better emission inventory requires that on-board visits are made or that data is obtained digitally. The largest calculation uncertainties now are for boiler fuel consumption and bunker ships fuel consumption at the anchorage areas.
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| 7. |
- Svensson, Johan, 1964, et al.
(författare)
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Endocrine, liver-derived IGF-I is of importance for spatial learning and memory in old mice.
- 2006
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Ingår i: The Journal of endocrinology. - : Bioscientifica. - 0022-0795 .- 1479-6805. ; 189:3, s. 617-27
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Tidskriftsartikel (refereegranskat)abstract
- IGF-I is a neuroprotective hormone, and neurodegenerative disorders, including Alzheimer's disease, have been associated with decreased serum IGF-I concentration. In this study, IGF-I production was inactivated in the liver of adult mice (LI-IGF-I(-/-)), resulting in an approximately 80-85% reduction of circulating IGF-I concentrations. In young (6-month-old) mice there was no difference between the LI-IGF-I(-/-) and the control mice in spatial learning and memory as measured using the Morris water maze test. In old (aged 15 and 18 months) LI-IGF-I(-/-) mice, however, the acquisition of the spatial task was slower than in the controls. Furthermore, impaired spatial working as well as reference memory was observed in the old LI-IGF(-/-) mice. Histochemical analyses revealed an increase in dynorphin and enkephalin immunoreactivities but decreased mRNA levels in the hippocampus of old LI-IGF-I(-/-) mice. These mice also displayed astrocytosis and increased metabotropic glutamate receptor 7a-immunoreactivity. These neurochemical disturbances suggest synaptic dysfunction and early neurodegeneration in old LI-IGF-I(-/-) mice. The decline in serum IGF-I with increasing age may therefore be important for the age-related decline in memory function.
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| 8. |
- Trägårdh, Björn, 1950, et al.
(författare)
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Fri eller ställd. Om friställda industriarbetare i periferin - exemplet Lear i Bengsfors
- 2002
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I mars 1999 lämnade Lear Corporation i Bengtsfors beskedet att verksamheten tillverkning av säten till Volvo skulle läggas ner. Lear var kommunens i särklass största privata arbetsgivare med drygt 860 anställda och samtliga blev friställda. Rapporten är den tredje i en fristående serie rapporer och här diskuterar frågan om de friställda blev fria eller ställda utifrån en analys som utgår från begrepp som livsstil och socialkaraktär. Av de friställda valdes 80 ut för att intervjuas utifrån en slumptalstabell. Av dessa kom 33 att intervjuas och indirekt ytterligare fem av de friställda. Analys visade att de intervjuade kunde delas upp i tre kategorier utifrån hur de reagerat på uppsägningen och hur de sedan förhållit sig till sitt fortsatta arbetsliv. Två av dessa grupper karakteriseras som ställda av nedläggningen. Den största gruppen benämns 'Fabriksfolket', individer som ville fortsätta som industriarbetare, men som fick svårigheter att finna nytt arbete i en stagnerande bransch. Också den minsta gruppen, 'Skogsfolket', blev ställda av nedläggningen, men bara därför att den medförde otrygg inkomst helst ville dessa individer ha ett friare och naturnära arbete, gärna i skogen. Den tredje gruppen benämns 'Sökarna', bestod främst av lite yngre individer upplevde sig mer fria än ställda av nedläggningen, då de nu kunde pröva mer utmanande och utvecklande arbetslivsbanor. Rapporten avslutas med en diskussion om den roll som offentliga organisationer spelade för de friställda EU, staten, regionen, kommunalförbundet och kommunen.
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