| 1. |
- Andersson, Ulrika, et al.
(författare)
-
PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care
- 2023
-
Ingår i: Journal of hypertension. - : LIPPINCOTT WILLIAMS & WILKINS. - 1473-5598 .- 0263-6352. ; 41:2, s. 246-253
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To increase the proportion of individuals with hypertension obtaining a blood pressure (BP) of less than 140/90 mmHg by improving the management of hypertension in daily life from a person-centred perspective. METHODS: In this unblinded randomized controlled trial, we tested an interactive web-based self-management system for hypertension. A total of 949 patients with hypertension from 31 primary healthcare centres (PHCCs) in Sweden were randomized 1 : 1 to either the intervention or usual care group. The intervention included daily measurement - via the participant's mobile phone - of BP and pulse and reports of well being, symptoms, lifestyle, medication intake and side effects for eight consecutive weeks. It also included reminders and optional motivational messages. The primary outcome was the proportion of participants obtaining BP of less than 140/90 mmHg at 8 weeks and 12 months. Significance was tested by Pearson's chi 2 -test. RESULTS: A total of 862 patients completed the trial, 442 in the intervention group and 420 in the control group. The primary outcome (BP <140/90 mmHg) at 8 weeks was achieved by 48.8% in the intervention group and 39.9% in the control group ( P = 0.006). At 12 months, 47.1% (intervention) and 41.0% (control group) had a BP less than 140/90 mmHg ( P = 0.071). CONCLUSION: The proportion of participants with a controlled BP of less than 140/90 mmHg increased after using the interactive system for self-management of hypertension for 8 weeks compared with usual care. Although the trend continued, there was no significant difference after 12 months. The results indicate that the effect of the intervention is significant, but the long-term effect is uncertain. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT03554382).
|
|
| 2. |
- Andersson, Ulrika, et al.
(författare)
-
PERSON-CENTREDNESS IN HYPERTENSION MANAGEMENT USING INFORMATION TECHNOLOGY (PERHIT) : A RANDOMISED CONTROLLED TRIAL IN PRIMARY HEALTH CARE
- 2022
-
Ingår i: Journal of Hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 1473-5598 .- 0263-6352. ; 40, s. 197-197
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- OBJECTIVE: Few studies address results from use of new technology and patient participation in hypertension management. The PERHIT Study is a multicentre randomised controlled trial with the aim to evaluate the effects of a person-centred approach using a web-based, interactive self-management system through the patient´s own mobile phone on blood-pressure and well-being. Primary aim is the degree of achieved blood pressure (BP) control after eight weeks and one year. In addition, person-centeredness, usefulness, daily life activities in relation to BP values, awareness of risk and health care costs are studied. DESIGN AND METHOD: The PERHIT study was performed in four regions in southern Sweden. Following inclusion, more than 900 patients from 31 primary health care centres were randomised to two groups. In the intervention group (INT), patients were provided with a web-based self-management support system including a home-BP monitor. For eight consecutive weeks, they measured BP and performed self-reports regarding well-being, symptoms, lifestyle, medication intake and side effects every evening via their mobile phone. They could also receive motivational messages and reminders throughout the intervention period. Both patients and professionals had access to graphic feedback of reported values through a secure web portal. Patients in the control (CON) group received standard treatment as usual. RESULTS: The primary outcome (BP < 140/90 mmHg) was achieved by 48.5% and 47.1% in the INT, and by 40.4% and 40.9% in the CON group after 8 weeks (p = 0.016) and 12 months (p = 0.067), respectively. Both patients and professionals experienced the system as a useful resource for communication regarding BP and lifestyle. They described that it could be used to support a constructive and person-centred partnership between patients and professionals. CONCLUSIONS: Blood pressure control was significantly better after eight weeks, but not after one year, following an intervention based on use of mobile phones, feedback and interaction between patients and primary care professionals compared to standard care. The system can be a tool toward a new way of working and help patients reach a controlled BP and play a role in a more person-centred and individually adapted hypertension management.
|
|
| 3. |
|
|
| 4. |
- Antonsson, Tobias, et al.
(författare)
-
Differences in Health-Related Quality of Life After Gastric Bypass Surgery : a Cross-Sectional Study
- 2021
-
Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 31:7, s. 3194-3202
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Gastric bypass (GBP) is a surgical method with good evidence of sustainable weight loss, reduced obesity-related comorbidities, and improved health-related quality of life (HRQoL). However, long-term data post-GBP is scarce on HRQoL related to other factors than weight loss, such as impact of socio-economic, age, and gender. Aim: To investigate long-term HRQoL in GBP patients. Methods: The study was conducted as a cross-sectional study covering 3 to 9 years post-GBP measuring HRQoL using RAND-36. Association to weight loss, time since surgery, gender, educational level, occupation, and age was analyzed. The participants were included on the basis that they had received a GBP that was performed by Region Skåne, the southernmost administrative healthcare region in Sweden. Recruitment to the study was by mail invitation for an online survey. Results: Of the total population of 5310 persons receiving the questionnaire, 1339 of the 1372 responders fulfilled the inclusion criteria. Those with low educational level, unemployed, persons on sick leave or disability support, and those with less weight loss reported the lowest HRQoL. The longer time since surgery, the lower the HRQoL. Conclusion: Less weight loss, longer time since GBP, lower educational level, and lower degree of employment all affect HRQoL negatively after GBP surgery. Graphical abstract: [Figure not available: see fulltext.]
|
|
| 5. |
- Midlöv, Patrik, et al.
(författare)
-
PERson-centredness in hypertension management using information technology (PERHIT): a protocol for a randomised controlled trial in primary health care
- 2020
-
Ingår i: Blood Pressure. - : TAYLOR & FRANCIS LTD. - 0803-7051 .- 1651-1999. ; 29:3, s. 149-156
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: For primary health care (PHC), hypertension is the number one diagnosis for planned health care visits. The treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. In spite of efficient antihypertensive medications, a low percentage of patients reach a well-controlled BP. The PERson-centredness in Hypertension management using Information Technology (PERHIT) Study is a multicentre randomised controlled trial. PERHIT is designed to evaluate the effect of supporting self-management on systolic blood pressure by the use of information technology in Swedish primary health care. Materials and Methods: After inclusion, 900 patients from 36 PHC centres are randomised to two groups. In the intervention group, patients are provided with a self-management support system including a home-BP monitor and further requested to perform self-reports and measure BP every evening for eight consecutive weeks. In the control group, patients receive treatment as usual. Results: The primary outcome will be the change in systolic blood pressure in patients with hypertension. In addition, person-centredness, daily life activities, awareness of risk and health care costs will also be evaluated. Conclusion: The results of this randomised controlled trial with assessment of blood pressure and same-day self-reports will provide patients a tool to understand the interplay between blood pressure and lifestyle applicable to primary health care. The self-management support system may be of importance for improved adherence to treatment and persistence to treatment recommendations.
|
|
| 6. |
- Torngren, Kristina, et al.
(författare)
-
Association of coronary calcium score with endothelial dysfunction and arterial stiffness
- 2020
-
Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150. ; 313, s. 70-75
-
Tidskriftsartikel (refereegranskat)abstract
- Background and aims: The aim of the study was to determine potential associations between endothelial dysfunction and arterial stiffness, measured by peripheral arterial tonometry, and coronary artery calcium score (CACS) assessed by computed tomography (CT). Methods and results: The BIG3 study is a prospective longitudinal, non-interventional, pulmonary-cardiovascular cohort study exploring the three major smoking-induced diseases: cardiovascular disease, chronic obstructive pulmonary disease, and lung cancer, in a 45–75 aged cohort (mean 62 years), enriched in smokers. Computed tomography of the chest with assessment of CACS was performed in a selected subset of the participants (n = 2080). Peripheral arterial tonometry (EndoPAT) was used to assess endothelial function and arterial stiffness measured as reactive hyperaemia index (RHI) and augmentation index (AI), respectively. We observed significant associations of CACS, endothelial dysfunction, and arterial stiffness with several risk factors for coronary heart disease including age, sex, BMI, diabetes mellitus, and blood pressure. There was significant association of CACS, classified into three levels of severity, with RHI and AI (p = 0.0005 and p = 0.0009, respectively). For groups of increasing CACS (0, 1–400 and > 400 Agatston score), RHI decreased from median 1.89 (1.58–2.39), and 1.93 (1.62–2.41) to 1.77 (1.51–2.10). AI increased from median 14.3 (5.7–25.2), and 16.4 (8.1–27.6) to 18.0 (9.1–29.2). RHI, but not AI, remained significantly associated with CACS after risk factors adjustment. Conclusions: In this large study of coronary artery calcium and vascular function, we found an association between CACS and both endothelial dysfunction and arterial stiffness, indicating that they may reflect similar mechanisms for development of cardiovascular disease.
|
|
| 7. |
- Wennersten, André
(författare)
-
Human neural stem cell transplantation in experimental brain trauma
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Traumatic brain injury (TBI) is the leading cause of death and disability in young adults in the industrialized world. Human neural stem/progenitor cells (hNSCs) can be expanded in culture and have the ability to differentiate into the major cell types of the adult brain. These properties make them candidates for therapeutic transplantation in cases of neurological injuries and diseases that involve cell loss. The project was initiated to expand the knowledge on, and refine the techniques used in, hNSC xenografting to the traumatized brain. The weight-drop cortical contusion model was evaluated with focus on the delayed cell death. Neurons were found to be the cell type predominantly affected by the delayed cell death in this experimental model of TBI. Furthermore, an increase and redistribution of the pro-apoptotic protein Bax was evident at 6 days post injury indicating a wide window for potential therapeutic intervention. The model simulates aspects of the clinical histopathology and the subsequent xenograft investigations were carried out in this experimental model for TBI. Cryo-preserved hNSCs were xenografted to the medial limit of the lesion and the ipsilateral hippocampus immediately after injury in immunosuppressed rats. The human cells survived and increased in number between 2 and 6 weeks post surgery indicating that the xenografted cells proliferated. This was corroborated by the expression of the proliferation antigen Ki-67. A low proportion of the hNSC-derived cells differentiated to astrocytes and neurons. An increase in the proportion of human cells that expressed the neuronal marker NeuN was observed between 2 and 6 weeks in the hippocampus. A marker for degenerating neurons, Fluoro-Jade, was used to investigate if there was any difference in host neuroprotection between viable and non-viable hNSCs xenografted to the lesion. The results indicated that non-viable hNSCs increase neurodegeneration while viable hNSCs exerted some neuroprotection at 6 days post surgery. Immunosuppressive treatment has several serious side effects. To determine if immunosuppression can be shortened two immunosuppression regimes were compared; one group was given immunosuppression throughout the whole 6 weeks of the experiment while the other group was taken of immunosuppressant at 3 weeks post surgery. There were no differences in number of hNSC-derived cells, proliferation, migration or differentiation. In addition, 5/8 animals in a pilot group that was allowed to survive for six months after 3 weeks of immunosuppression still had surviving grafts. The ability to control grafted hNSCs in the environment of the traumatized brain is desirable. Polymer rods with slow-release kinetics was manufactured and implanted in the center of the lesion to investigate if administration of trophic factors could affect the xenografted hNSCs. The animals were immunosuppressed during the first 3 weeks and were allowed to survive 3 and 6 months. The pooled values from the 3 and 6 month groups were used for comparisons. Release of basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF) did not increase the survival of xenografted hNSCs significantly. However, grafts receiving rods with rat serum albumin displayed increased survival compared to grafts receiving rods without any factor. Moreover, retinoic acid decreased the proportion of nestin-positive human cells. In conclusion, hNSCs xenografted to a clinically relevant model of TBI survive, differentiate and have effects on host neuroprotection. Decreased immunosuppression can be achieved without short-term effects on the xenografted hNSCs and both long-term survival and differentiation of hNSCs can be modulated by short-term release of bioactive molecules in situ.
|
|
| 8. |
- Wollmer, Per, et al.
(författare)
-
Within-session reproducibility of forced oscillometry
- 2021
-
Ingår i: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 41:5, s. 401-407
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The forced oscillation technique (FOT) provides detailed information about the mechanics of the respiratory system, while requiring minimal co-operation by the patient. FOT may be abnormal in subjects with normal spirometry and appears to be more closely related to airway symptoms. It is, therefore, attractive in epidemiological studies, where a large number of different examinations are made in each subjects in a short period of time. Current technical standards recommend the mean of three consecutive measurements to be used, but there is limited information regarding within-session variability of FOT measurements.OBJECTIVE: The purpose of this study was to examine the within-session variability in FOT measurements in a large, population-based sample.METHODS: We performed three consecutive FOT measurements in 700 subjects using the impulse oscillometry system. The first measurement was compared to the mean of three measurements for resistance at 5 and 20 Hz (R5 and R20, respectively), R5-R20, reactance at 5 Hz (X5) and resonant frequency (fres ).RESULTS: The differences between the first and the mean of three measurements (median, interquartile range) were minimal, for example 0.002, -0.008 to 0.014 kPa L-1 s for R5 and -0.001, -0.008 to 0.005 kPa L-1 s for X5. Findings were numerically similar for men and women as well as for subjects with and without airflow obstruction at spirometry.CONCLUSIONS: We conclude that, whereas in clinical situations, three FOT measurements are to be preferred, a single measurement may suffice in epidemiological studies.
|
|
