| 1. |
- Bergenfelz, Caroline, et al.
(författare)
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Systemic Monocytic-MDSCs Are Generated from Monocytes and Correlate with Disease Progression in Breast Cancer Patients.
- 2015
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5
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Tidskriftsartikel (refereegranskat)abstract
- Myeloid-derived suppressor cells (MDSCs) are highly immunosuppressive myeloid cells, which increase in cancer patients. The molecular mechanism behind their generation and function is unclear. Whereas granulocytic-MDSCs correlate with poor overall survival in breast cancer, the presence and relevance of monocytic-MDSCs (Mo-MDSCs) is unknown. Here we report for the first time an enrichment of functional blood Mo-MDSCs in breast cancer patients before they acquire a typical Mo-MDSC surface phenotype. A clear population of Mo-MDSCs with the typical cell surface phenotype (CD14+HLA-DRlow/-CD86low/-CD80low/-CD163low/-) increased significantly first during disease progression and correlated to metastasis to lymph nodes and visceral organs. Furthermore, monocytes, comprising the Mo-MDSC population, from patients with metastatic breast cancer resemble the reprogrammed immunosuppressive monocytes in patients with severe infections, both by their surface and functional phenotype but also at their molecular gene expression profile. Our data suggest that monitoring the Mo-MDSC levels in breast cancer patients may represent a novel and simple biomarker for assessing disease progression.
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| 2. |
- Bergenfelz, Caroline, et al.
(författare)
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Wnt5a induces a tolerogenic phenotype of macrophages in sepsis and breast cancer patients.
- 2012
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Ingår i: Journal of immunology. - : The American Association of Immunologists. - 1550-6606 .- 0022-1767. ; 188:11, s. 5448-5458
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Tidskriftsartikel (refereegranskat)abstract
- A well-orchestrated inflammatory reaction involves the induction of effector functions and, at a later stage, an active downregulation of this potentially harmful process. In this study we show that under proinflammatory conditions the noncanonical Wnt protein, Wnt5a, induces immunosuppressive macrophages. The suppressive phenotype induced by Wnt5a is associated with induction of IL-10 and inhibition of the classical TLR4-NF-κB signaling. Interestingly, this phenotype closely resembles that observed in reprogrammed monocytes in sepsis patients. The Wnt5a-induced feedback inhibition is active both during in vitro LPS stimulation of macrophages and in patients with sepsis caused by LPS-containing, Gram-negative bacteria. Furthermore, using breast cancer patient tissue microarrays, we find a strong correlation between the expression of Wnt5a in malignant epithelial cells and the frequency of CD163(+) anti-inflammatory tumor-associated macrophages. In conclusion, our data point out Wnt5a as a potential target for an efficient therapeutic modality in severe human diseases as diverse as sepsis and malignancy.
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| 3. |
- Bergenfelz, Caroline, et al.
(författare)
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Wnt5a inhibits human monocyte derived myeloid dendritic cell generation.
- 2013
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Ingår i: Scandinavian Journal of Immunology. - : Wiley. - 1365-3083 .- 0300-9475. ; 78:2, s. 194-204
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Tidskriftsartikel (refereegranskat)abstract
- Wnt5a is a non-canonical Wnt protein that is expressed at elevated levels in inflammatory conditions. Its role in inflammation remains unclear, although it is known that Wnt5a is expressed at a higher level in monocyte-derived myeloid dendritic cells (Mo-mDCs) than in monocytes and macrophages. The function of Wnt5a in dendritic cells (DCs) remains relatively unexplored. Here, we found that under Mo-mDC culture conditions, Wnt5a inhibited the generation of CD14(+/low) Mo-mDCs while promoting the generation of CD14(+/++) CD16(+) monocytes. We could further show that stimulation of monocytes with rWnt5a induced a rapid IL-6 production and that the rWnt5a treated Mo-mDC differentiation was restored upon blocking of IL-6. Also conditioned media from Wnt5a stimulated human breast cancer cells producing IL-6, specifically inhibited Mo-mDC differentiation. These observations are strengthened by our finding that patients with sepsis, a disease involving elevated Wnt5a and IL-6 levels, also showed a significant increase in the CD14(+) CD16(++) /CD14(+/++) CD16(+) monocyte populations, which was accompanied by a significant decrease in circulating mDCs. We finally show that under typical Mo-mDC culture conditions, monocytes isolated from sepsis patients as compared to healthy controls, preferentially differentiated into CD14(+/++) HLA-DR(++) cells. We suggest that Wnt5a is a possible candidate mediator for the CD14(+/++) CD16(+) monocyte accumulation seen in infectious disease and cancer patients. This article is protected by copyright. All rights reserved.
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| 4. |
- Esamai, Fabian, et al.
(författare)
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Cerebral malaria in children : Serum and cerebrospinal fluid TNF-α and TGF-ß levels and their relationship to clinical outcome
- 2003
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Ingår i: Journal of Tropical Pediatrics. - : Oxford University Press (OUP). - 0142-6338 .- 1465-3664. ; 49:4, s. 216-223
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Tidskriftsartikel (refereegranskat)abstract
- This was a prospective study conducted at the Moi Teaching and Referral Hospital, Eldoret, Kenya. Twenty‐three children admitted to the hospital with cerebral (CM) and 10 children with noncerebral malaria (NCM) were studied. The aim of the study was to establish and compare levels of tumour necrosis factor (TNF‐α) and transforming growth factor (TGF‐β1) in these children. Serum and cerebrospinal fluid (CSF) cytokine levels were assayed using ELISA kits. In serum, TGF‐β1 and TNF‐α decreased over 5 days after admission to the hospital in both groups of patients with CM and NCM. In the CSF of cerebral cases the levels of TNF‐α and TGF‐β1 were low and inversely related. Children in deeper coma had lower levels in serum of TGF‐β and higher levels of TNF‐α than those in lighter levels of coma. The serum TNF‐α levels in CM children were the same irrespective of the duration of illness before admission, but children with NCM who had been sick for a shorter duration before admission tended to have higher serum levels of TNF‐α and higher levels of TGF‐β than those with a longer duration of illness before admission. In conclusion, this study shows that TNF‐α and TGF‐β1 may not be useful in predicting the outcome for CM. They may, however, be useful in detecting children at risk of developing deep coma. TNF‐α and TGF‐β levels were inversely related both in serum and CSF.
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| 5. |
- Idh, Jonna, et al.
(författare)
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Kinetics of the QuantiFERON((R))-TB Gold In-Tube test during treatment of patients with sputum smear-positive tuberculosis in relation to initial TST result and severity of disease
- 2010
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 42:9, s. 650-657
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Tidskriftsartikel (refereegranskat)abstract
- Abstract The QuantiFERON((R))-TB Gold In-Tube test (QFN) measures interferon-gamma production in response to Mycobacterium tuberculosis antigens. Our aim was to assess the kinetics of the QFN and initial tuberculin skin test (TST) result in relation to severity of disease in a tuberculosis (TB) endemic area. Smear-positive TB patients (n = 71) were recruited at Gondar University Hospital, Ethiopia. The TST, QFN, CD4+ cell count and clinical symptoms (TB score) were assessed and followed up during treatment. From baseline to 7 months after treatment, there was a significant decrease in QFN reactivity (93.8% to 62.5% in HIV-negative/TB; 70.3% to 33.3% in HIV-positive/TB patients) down to a level comparable to a control group of blood donors (51.2%). The agreement between TST and QFN was poor in TB patients compared to healthy controls. A negative TST correlated to more advanced TB in contrast to a negative QFN test. We conclude that the QFN reactivity is significantly reduced at the end of treatment against active TB to the background level of healthy blood donors, and that the agreement between TST and QFN is poor including correlation to the severity of disease.
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| 6. |
- Janols, Helena, et al.
(författare)
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A high frequency of MDSCs in sepsis patients, with the granulocytic subtype dominating in gram-positive cases.
- 2014
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Ingår i: Journal of Leukocyte Biology. - 1938-3673. ; 96:5, s. 685-693
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Tidskriftsartikel (refereegranskat)abstract
- The causative microorganisms dictate the type of MDSC generated in sepsis patients, and a large proportion of PMN-MDSCs in gram-positive sepsis includes immunosuppressive myeloid blasts. MDSCs constitute a heterogeneous population of immature myeloid cells that potently suppress immune responses. They were identified originally in cancer patients and have since been reported to occur also in chronic inflammation, autoimmunity, and even bacterial infections. Human MDSCs are commonly divided into Mo-MDSCs and granulocytic (PMN-MDSCs) subtypes. To what extent the bona fide cancer MDSCs are representative of the proposed MDSCs found in other diseases is not well known. PMN-MDSCs have been found previously to be enriched among LDGs in density gradient-centrifuged blood. In this study, we analyzed potential MDSCs in sepsis patients with different causative microorganisms, using total peripheral blood compared with density gradient-centrifuged blood. We found a high frequency of typical CD14(+)HLA-DR(low) Mo-MDSCs in all sepsis patients, whereas the typical PMN-MDSCs, as well as a prominent CD14(low) PMN-MDSC-like population, appeared preferentially in gram-positive cases. The CD14(low) PMN-MDSC variant was demonstrated to suppress T cell proliferation in vitro via a ROS-dependent mechanism, to display an increased IL-10:TNF-α ratio, and to present with signs of immaturity: blast morphology and low cytokine levels. We conclude that a spectrum of cells with MDSC features is enriched in sepsis and that the microbial origin of sepsis contributes to the substantial interindividual patient variation in the MDSC pattern.
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| 7. |
- Janols, Helena
(författare)
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Biomarkers in sepsis and other severe infections
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Infectious diseases constitute a major global health problem. The presenting clinical picture results from a mixture of direct toxic actions by the microbiological agent and of the immune response mounted by the host. There is often a rapid onset, which may constitute a diagnostic and therapeutic challenge, whereas in other cases an extensive investigation over a long time period can fail to identify a causal microbial agent. The aim with this thesis was to study the cellular immune response with phenotypical assays, in patients with severe infections with focus on sepsis. We assessed if our findings could serve as biomarkers and provide valuable diagnostic and possible also therapeutic information. In the first part (paper I) we examined surface markers on white blood cells from patients with severe infections. In some instances our analysis could differentiate between infections of bacterial and viral origin. In the second part (paper II-IV) we examined the incidence and nature of the immune alterations found in patients with sepsis and septic shock. We identified a protein (Wnt5a) that inhibited differentiation of monocytes to monocyte-derived myeloid dendritic cells (Mo-mDC), which may play a role in the DC depletion often seen in sepsis. Also, as indicated by cell surface phenotype, a large inter-individual variation of immune activation and immunosuppression was detected in patients with sepsis, with a dominance of immunosuppression in patients with septic shock. Finally, different types of immature myeloid immunosuppressive cells, myeloid-derived suppressor cells (MDSCs) were found in patients with sepsis; Mo-MDSCs were preferentially expanded in patients with gram-negative sepsis, whereas granulocytic MDSCs (PMN-MDSCs) accumulated in patients with gram-positive sepsis. We conclude that the immune response during severe infections shows large inter-individual variations and biomarker guided therapy could be useful in individualised treatment.
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| 8. |
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| 9. |
- Janols, Helena, et al.
(författare)
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Early treatment response evaluated by a clinical scoring system correlates with the prognosis of pulmonary tuberculosis patients in Ethiopia : A prospective follow-up study.
- 2012
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 44:11, s. 828-834
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Tidskriftsartikel (refereegranskat)abstract
- Background: In resource-limited settings the monitoring of tuberculosis (TB) patients is challenging, and early identification of TB patients with a high mortality risk is important. The aim of this study was to investigate prospectively whether early changes in a clinical scoring system (TB score) can predict treatment outcome in Ethiopian patients with pulmonary tuberculosis. Method: TB patients (n = 250) and blood donors (n = 82) were recruited prospectively at Gondar University Hospital, Ethiopia. Clinical scoring was performed using an interview-based questionnaire and clinical examination. Results: Among TB patients (53.6% of whom were HIV co-infected) the median TB score declined from week 0 to week 2 (8 (interquartile range (IQR) 6-9) vs 4 (IQR 2-6)) and dropped to a low level at week 8, which was still significantly higher than that found in blood donors (2 (IQR 1-4) vs 0 (IQR 0-1), p < 0.0001). Patients who died had a significantly higher TB score at week 0, week 2, and week 8 than survivors. Mortality was associated with a failure to achieve a decrease greater than 25% in the TB score at 2 weeks. Baseline CD4 + cell counts (< 200 cells/mm(3)) were associated with mortality but not with initial TB score results. Conclusions: The TB score was increased during the first 2 months of treatment among patients who died. Failure to achieve a greater than 25% decrease in TB score after 2 weeks of treatment was associated with increased mortality. Repeated clinical scoring during the intensive phase of TB treatment could be useful to identify high-risk patients.
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| 10. |
- Janols, Helena, et al.
(författare)
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Heterogeneity among septic shock patients in a set of immunoregulatory markers.
- 2014
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Ingår i: European Journal of Clinical Microbiology & Infectious Diseases. - : Springer Science and Business Media LLC. - 1435-4373 .- 0934-9723. ; 33:3, s. 313-324
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Tidskriftsartikel (refereegranskat)abstract
- Immune activation is a regular feature of sepsis, but the incidence and nature of the ensuing inflammation-resolving and immunosuppressive component is less well understood. In this study, we compared immunoregulatory markers on blood leukocytes from patients with Gram-negative or Gram-positive sepsis or septic shock, and compared this to blood from patients with severe virosis or healthy controls. To this end, blood from 32 patients with sepsis, including ten cases with shock, and 12 patients with severe virosis were analysed by flow cytometry for the expression levels of monocyte HLA-DR, CD11c, CD14 and CD40, and for frequencies of CD163(+)-suppressive monocytes, HLA-DR(+) or CD40(+)-activated T cells and Tregs. Plasma cytokine levels were analysed as a functional measurement. Signs of immunosuppression dominated in the septic shock and Gram-positive sepsis groups, whereas monocyte activation was common in Gram-negative sepsis patients without shock. However, the main finding was the large inter-individual variation of immune activation and immunosuppression, with no correlation to prognosis among the shock patients. The pronounced inter-individual variation in the analysed monocyte and lymphocyte markers forms a strong argument that, when immunomodulatory treatment is considered in a sepsis patient, it should be personalised and guided by a detailed immune status assessment.
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| 11. |
- Janols, Helena, et al.
(författare)
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Lymphocyte and monocyte flow cytometry immunophenotyping as a diagnostic tool in uncharacteristic inflammatory disorders.
- 2010
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Ingår i: BMC Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Patients with uncharacteristic inflammatory symptoms such as long-standing fatigue or pain, or a prolonged fever, constitute a diagnostic and therapeutic challenge. The aim of the present study was to determine if an extended immunophenotyping of lymphocytes and monocytes including activation markers can define disease-specific patterns, and thus provide valuable diagnostic information for these patients. METHODS: Whole blood from patients with gram-negative bacteraemia, neuroborreliosis, tuberculosis, acute mononucleosis, influenza or a mixed connective tissue disorders, as diagnosed by routine culture and serology techniques was analysed for lymphocyte and monocyte cell surface markers using a no-wash, no-lyse protocol for multi-colour flow cytometry method. The immunophenotyping included the activation markers HLA-DR and CD40. Plasma levels of soluble TNF alpha receptors were analysed by ELISA. RESULTS: An informative pattern was obtained by combining two of the analysed parameters: (i), the fractions of HLA-DR-expressing CD4+ T cells and CD8+ T cells, respectively, and (ii), the level of CD40 on CD14+ CD16- monocytes. Patients infected with gram-negative bacteria or EBV showed a marked increase in monocyte CD40, while this effect was less pronounced for tuberculosis, borrelia and influenza. The bacterial agents could be distinguished from the viral agents by the T cell result; CD4+ T cells reacting in bacterial infection, and the CD8+ T cells dominating for the viruses. Patients with mixed connective tissue disorders also showed increased activation, but with similar engagement of CD4+ and CD8+ T cells. Analysis of soluble TNF alpha receptors was less informative due to a large inter-individual variation. CONCLUSION: Immunophenotyping including the combination of the fractions of HLA-DR expressing T cell subpopulations with the level of CD40 on monocytes produces an informative pattern, differentiating between infections of bacterial and viral origin. Furthermore, a quantitative analysis of these parameters revealed the novel finding of characteristic patterns indicating a subacute bacterial infection, such as borreliosis or tuberculosis, or a mixed connective tissue disorder. The employed flow cytometric method is suitable for clinical diagnostic laboratories, and may help in the assessment of patients with uncharacteristic inflammatory symptoms.
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| 12. |
- Janols, Rebecka, et al.
(författare)
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A method for co-designing theory-based behaviour change systems for health promotion
- 2017
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Ingår i: Studies in Health Technology and Informatics. - Amsterdam : IOS Press. - 0926-9630 .- 1879-8365. ; 235, s. 368-372
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Tidskriftsartikel (refereegranskat)abstract
- A methodology was defined and developed for designing theory-based behaviour change systems for health promotion that can be tailored to the individual. Theories from two research fields were combined with a participatory action research methodology. Two case studies applying the methodology were conducted. During and between group sessions the participants created material and designs following the behaviour change strategy themes, which were discussed, analysed and transformed into a design of a behaviour change system. Theories in behavioural change and persuasive technology guided the data collection, data analyses, and the design of a behaviour change system. The methodology has strong emphasis on the target group's participation in the design process. The different aspects brought forward related to behaviour change strategies defined in literature on persuasive technology, and the dynamics of these are associated to needs and motivation defined in literature on behaviour change. It was concluded that the methodology aids the integration of theories into a participatory action research design process, and aids the analyses and motivations of design choices.
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| 13. |
- Janols, Rebecka, et al.
(författare)
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A Pilot Study on Personalised Coaching to Increase Older Adults' Physical and Social Activities
- 2017
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Ingår i: Ambient Intelligence - Software and Applications - 8th International Symposium on Ambient Intelligence (ISAmI 2017). - Cham : Springer. - 9783319611181 - 9783319611174 ; , s. 140-148
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Konferensbidrag (refereegranskat)abstract
- The aim of this research is to conduct a pilot study of a prototype that provides feedback using theory-based motivating messages developed by older adults, in a context of every day activities that include both physical and social activities. The prototype mobile application integrated the messages, a motivational model, and a personalization module that selects motivational messages based on preferences, motivational profile and the situation. The four participating older adults used the application for planning and following up social and physical activities. They found the messages entertaining and appreciated the dialogues with the application. They used the dialogues primarily to reinforce their satisfaction regarding conducted activities and did not necessarily tell the truth about conduced activities in the interaction with the application. The results are preliminary, but give valuable implications for further development of the personalisation module towards more purposeful use of ambient information, and aspects to explore in future user studies.
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| 14. |
- Janols, Rebecka, et al.
(författare)
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A study on motivational messages for supporting seniors to increase physical activity and social participation
- 2017
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Ingår i: ECCE '17. - New York, NY, USA : ACM Digital Library. - 9781450352567 ; , s. 57-58
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Konferensbidrag (refereegranskat)abstract
- The aim is to develop an adaptive computer-based intervention that gives seniors personalized support for increasing physical and social activity. The user-centered studies have been conducted. The results indicate that the seniors need to be categorized based on their preferences regarding a sub-set of messages.
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| 15. |
- Janols, Rebecka, et al.
(författare)
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Older adults as designers of behavior change strategies to increase physical activity : report of a participatory design process
- 2022
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Ingår i: Frontiers In Public Health. - : Frontiers Media S.A.. - 2296-2565. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the significant value of physical activity for the health of older adults, this population often fails to achieve recommended activity levels. Digital interventions show promise in providing support for self-managed physical activity. However, more information is needed about older adults' preferences for digital support to change physical activity behaviors as well as the process of designing them. The aim of this paper was to describe the participatory design process in which older adults were involved in the co-creation of digitally supported behavioral change strategies to support self-managed physical activity, and how the results were integrated in a prototype.Methods: The participatory design process involved with nine older adults and two researchers. The participants were divided in two groups, and each group participated in three workshops and completed home tasks in between workshops. Following an iterative design process influenced by theories of behavior change, the workshops and home tasks were continuously analyzed, and the content and process were developed between groups and the next set of workshops. Prototypes of a mobile health (mHealth) solution for fall preventive exercise for older adults were developed in which the conceptualized strategies were integrated. To support coherence in reporting and evaluation, the developed techniques were mapped to the Behavior Change Technique Taxonomy v1 and the basic human psychosocial needs according to the Self-determination Theory.Results: The results highlight different preferences of older adults for feedback on physical activity performance, as well as the importance of transparency regarding the identification of the sender of feedback. Preferences for content and wording of feedback varied greatly. Subsequently, the design process resulted in a virtual health coach with three different motivational profiles and tools for goal setting and self-monitoring. These behavior change strategies were integrated in the exercise application Safe Step v1. The conformity of the design concepts with the needs of Self-determination Theory and Behavior Change Technique Taxonomy v1 are presented.Conclusion: The participatory design process exemplifies how older adults successfully contributed to the design of theory-based digital behavior change support, from idea to finished solution. Tailoring feedback with a transparent sender is important to support and not undermine motivation.
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| 16. |
- Johnsson, Helena, et al.
(författare)
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3D computer visualisation in timber construction : some important parameters
- 2006
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Ingår i: Architectural Engineering and Design Management. - : Informa UK Limited. - 1745-2007 .- 1752-7589. ; 2:3, s. 161-175
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Tidskriftsartikel (refereegranskat)abstract
- Timber building structures are seldom considered because of a lack of timber construction knowledge among many clients and professionals. 3D computer visualization (3D VIZ) is a possible way of communicating the aesthetics of a visible timber structure and visualizing complex timber connections. This paper investigates the potential for 3D VIZ to communicate visible timber structures during the different phases of the construction process. Furthermore, important parameters (controllable in 3D VIZ) for communicating a timber structure are identified. Through an Internet-based Delphi study, the usefulness of 3D VIZ for timber structures has been evaluated by professionals representing different competencies in the construction process. The results show that structural complexity, intended beholder (professional or non-professional) and current construction phase influence the benefit of 3D VIZ. The level of detail in the visualization is heavily dependent on whether the communication is internal (between professionals) or external (between professionals and clients/users). The impact of parameters needed, such as textures, surface structures and realistic lighting, have been described.
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| 17. |
- Kisiel, Marta A., 1984-, et al.
(författare)
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Agreement between reported questionnaire data and medical records on diagnosis and COVID-19 symptoms at onset
- 2023
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Ingår i: European Clinical Respiratory Journal. - : Taylor & Francis. - 2001-8525. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess whether there was agreement between self-reported data in a survey and medical records regarding diagnoses and symptoms at COVID-19 onset. The impact of sociodemographic factors on agreement between the two data sources was also assessed. Cross-sectional data were extracted from a Swedish longitudinal cohort study. In total, 401 non-hospitalized patients with a polymerase chain reaction-confirmed COVID-19 infection responded to a survey and agreed to a review of their electronic medical records. Agreement, estimated using the kappa statistic, sensitivity, and specificity were calculated for nine diagnoses and eleven symptoms. Differences between subgroups based on sociodemographic factors were assessed. The agreement between the self-reported data and medical records was at a substantial to moderate level for diagnoses such as diabetes mellitus (kappa 0.65, sensitivity 86%) and hypertension (kappa 0.59, sensitivity 56%) and at a fair level for more difficult-to-define conditions such as ongoing immunosuppressive treatment (kappa 0.27, sensitivity 25%). The agreement between the two data sources on symptoms was between fair and poor (kappa 0.36 for fever; kappa 0.05 for fatigue). Agreement for some diagnoses and symptoms varied across some sociodemographic subgroups, e.g. agreement in diabetes mellitus was significantly better in males (kappa 1.0) than females (kappa 0.52, homogeneity tests p = 0.02). In general, kappa values were lower for symptoms than diagnoses. The agreement between the two sources varied with diagnoses and symptoms and was also influenced by sociodemographic factors. This study illustrates that it is important to consider type of data used in the epidemiological studies as different information sources differ with quality and accuracy.
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| 18. |
- Kisiel, Marta A., 1984-, et al.
(författare)
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Clustering Analysis Identified Three Long COVID Phenotypes and Their Association with General Health Status and Working Ability
- 2023
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 12:11
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Tidskriftsartikel (refereegranskat)abstract
- Background/aim: This study aimed to distinguish different phenotypes of long COVID through the post-COVID syndrome (PCS) score based on long-term persistent symptoms following COVID-19 and evaluate whether these symptoms affect general health and work ability. In addition, the study identified predictors for severe long COVID.Method: This cluster analysis included cross-sectional data from three cohorts of patients after COVID-19: non-hospitalized (n = 401), hospitalized (n = 98) and those enrolled at the post-COVID outpatient's clinic (n = 85). All the subjects responded to the survey on persistent long-term symptoms and sociodemographic and clinical factors. K-Means cluster analysis and ordinal logistic regression were used to create PCS scores that were used to distinguish patients' phenotypes.Results: 506 patients with complete data on persistent symptoms were divided into three distinct phenotypes: none/mild (59%), moderate (22%) and severe (19%). The patients with severe phenotype, with the predominating symptoms were fatigue, cognitive impairment and depression, had the most reduced general health status and work ability. Smoking, snuff, body mass index (BMI), diabetes, chronic pain and symptom severity at COVID-19 onset were factors predicting severe phenotype.Conclusion: This study suggested three phenotypes of long COVID, where the most severe was associated with the highest impact on general health status and working ability. This knowledge on long COVID phenotypes could be used by clinicians to support their medical decisions regarding prioritizing and more detailed follow-up of some patient groups.
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| 19. |
- Kisiel, Marta, 1984-, et al.
(författare)
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Absenteeism Costs Due to COVID-19 and Their Predictors in Non-Hospitalized Patients in Sweden : A Poisson Regression Analysis
- 2023
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:22
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study aimed to estimate absenteeism costs and identify their predictors in non-hospitalized patients in Sweden.Methods: This cross-sectional study’s data were derived from the longitudinal project conducted at Uppsala University Hospital. The mean absenteeism costs due to COVID-19 were calculated using the human capital approach, and a Poisson regression analysis was employed to determine predictors of these costs.Results: The findings showed that the average absenteeism cost due to COVID-19 was USD 1907.1, compared to USD 919.4 before the pandemic (p < 0.001). Notably, the average absenteeism cost for females was significantly higher due to COVID-19 compared to before the pandemic (USD 1973.5 vs. USD 756.3, p = 0.001). Patients who had not fully recovered at the 12-month follow-up exhibited significantly higher costs than those without symptoms at that point (USD 3389.7 vs. USD 546.7, p < 0.001). The Poisson regression revealed that several socioeconomic factors, including age, marital status, country of birth, educational level, smoking status, BMI, and occupation, along with COVID-19-related factors such as severity at onset, pandemic wave, persistent symptoms at the follow-up, and newly introduced treatment for depression after the infection, were significant predictors of the absenteeism costs.Conclusions: Our study reveals that the mean absenteeism costs due to COVID-19 doubled compared to the year preceding the pandemic. This information is invaluable for decision-makers and contributes to a better understanding of the economic aspects of COVID-19.
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| 20. |
- Kisiel, Marta, 1984-, et al.
(författare)
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Patterns and predictors of sick leave among Swedish non-hospitalized healthcare and residential care workers with Covid-19 during the early phase of the pandemic
- 2021
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:12
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Tidskriftsartikel (refereegranskat)abstract
- Healthcare and residential care workers represent two occupational groups that have, in particular, been at risk of Covid-19, its long-term consequences, and related sick leave. In this study, we investigated the predictors of prolonged sick leave among healthcare and residential workers due to non-hospitalized Covid-19 in the early period of the pandemic. This study is based on a patient register (n = 3209) and included non-hospitalized healthcare or residential care service workers with a positive RT- PCR for SARS-CoV-2 (n = 433) between March and August 2020. Data such as socio-demographics, clinical characteristics, and the length of sick leave because of Covid-19 and prior to the pandemic were extracted from the patient’s electronic health records. Prolonged sick leave was defined as sick leave ≥ 3 weeks, based on the Swedish pandemic policy. A generalized linear model was used with a binary distribution, adjusted for age, gender, and comorbidity in order to predict prolonged sick leave. Of 433 (77% women) healthcare and residential care workers included in this study, 14.8% needed longer sick leave (> 3 weeks) due to Covid-19. Only 1.4% of the subjects were on sick leave because of long Covid. The risk of sick leave was increased two-fold among residential care workers (adjusted RR 2.14 [95% CI 1.31–3.51]). Depression/anxiety (adjusted RR 2.09 [95% CI 1.31–3.34]), obesity (adjusted RR 1.96 [95% CI 1.01–3.81]) and dyspnea at symptom onset (adjusted RR 2.47 [95% CI 1.55–3.92]), sick leave prior to the pandemic (3–12 weeks) (adjusted RR 2.23 [95% CI 1.21–4.10]) were associated with longer sick leave. From a public health perspective, considering occupational category, comorbidity, symptoms at onset, and sick leave prior to the pandemic as potential predictors of sick leave in healthcare may help prevent staff shortage.
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| 21. |
- Kisiel, Marta, 1984-, et al.
(författare)
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Predictors of post-COVID-19 and the impact of persistent symptoms in non-hospitalized patients 12 months after COVID-19, with a focus on work ability
- 2022
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Ingår i: Upsala Journal of Medical Sciences. - : Upsala Medical Society. - 0300-9734 .- 2000-1967. ; 127:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Better knowledge of long-term symptoms following coronavirus disease 2019 (COVID-19), the so-called post-COVID-19, in non-hospitalized patients is needed. The aim of this study was to study persisent symptoms up to 12 months after COVID-19 in non-hospitalized patients and their impact on work ability. We also investigated predictors of persistent symptoms.Methods: This study encompassed non-hospitalized adult subjects with a COVID-19 infection confirmed via positive nasopharyngeal swab polymerase chain reaction test during the first wave of the pandemic in Uppsala, Sweden. In total, 566 subjects were sent a survey via e-mail or post with an invitation to participate in the survey 12 months post-diagnosis. The majority of subjects were healthcare workers, as this group was prioritized for testing.Results: A total of 366 subjects responded, with 47% reporting persistent symptoms 12 months after their COVID-19 diagnosis. The most commonly reported symptoms at this time were impaired sense of smell and/or taste and fatigue. Among the predictors of persistent symptoms were being born abroad, lower physical fitness compared with peers before COVID-19, body mass index >25 kg/m2, cooccurrence of hypertension and chronic pain, and having more than seven of the general COVID-19 symptoms at the onset. Respondents with symptoms after 12 months self-reported negatively about their general health and work ability.Conclusions: This study indicated that many people who had mild COVID-19 might have a variety of long-term symptoms. It highlights the importance of considering work ability after mild COVID-19.
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| 22. |
- Krifors, Anders, et al.
(författare)
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Influenza-associated invasive aspergillosis in patients admitted to the intensive care unit in Sweden : a prospective multicentre cohort study
- 2024
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Ingår i: Infectious Diseases. - : Taylor & Francis. - 2374-4235 .- 2374-4243. ; 56:2, s. 110-115
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The purpose of this study was to prospectively investigate the incidence of influenza-associated pulmonary aspergillosis (IAPA) in influenza patients admitted to intensive care units in Sweden.METHODS: The study included consecutive adult patients with PCR-verified influenza A or B in 12 Swedish intensive care units (ICUs) over four influenza seasons (2019-2023). Patients were screened using serum galactomannan and β-d-glucan tests and fungal culture of a respiratory sample at inclusion and weekly during the ICU stay. Bronchoalveolar lavage was performed if clinically feasible. IAPA was classified according to recently proposed case definitions.RESULTS: The cohort included 55 patients; 42% were female, and the median age was 59 (IQR 48-71) years. All patients had at least one galactomannan test, β-d-glucan test and respiratory culture performed. Bronchoalveolar lavage was performed in 24 (44%) of the patients. Five (9%, 95% CI 3.8% - 20.4%) patients were classified as probable IAPA, of which four lacked classical risk factors. The overall ICU mortality was significantly higher among IAPA patients than non-IAPA patients (60% vs 8%, p = 0.01).CONCLUSIONS: The study represents the first prospective investigation of IAPA incidence. The 9% incidence of IAPA confirms the increased risk of invasive pulmonary aspergillosis among influenza patients admitted to the ICU. Therefore, it appears reasonable to implement a screening protocol for the early diagnosis and treatment of IAPA in influenza patients receiving intensive care.TRIAL REGISTRATION: ClinicalTrials.gov NCT04172610, registered November 21, 2019.
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| 23. |
- Lindgren, Helena, et al.
(författare)
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Personalised Persuasive Coaching to Increase Older Adults' Physical and Social Activities: a Motivational Model
- 2017
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Ingår i: Advances in Practical Applications of Cyber-Physical Multi-Agent Systems: The PAAMS Collection. - Cham : Springer. - 9783319599298 - 9783319599304 ; , s. 170-182
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Konferensbidrag (refereegranskat)abstract
- The overall aim of this research is to develop an adaptive digital coaching system that gives seniors personalized support for increasing physical activity, and promoting participation in social activity and their own care. The main research question is how can different behavioral and motivational factors of an individual be formally integrated into the knowledge base of a coach agent for generating support tailored to the individual’s needs and preferences in a specific situation?The results include a theory-based motivational model incorporating different person-centric factors, and an algorithm for generating the adaptive and persuasive behavior of the agent that aims to motivate the individual. These are integrated in a mobile coaching application together with a set of theory-based motivating messages targeting primarily physical and social activities. Future work includes the development of methods for handling conflicting motives, and user studies.
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| 24. |
- Lindgren, Helena, et al.
(författare)
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Towards a Multipurpose Goal Model for Personalised Digital Coaching
- 2017
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Ingår i: Agents and Multi-Agent Systems for Health Care. - Cham : Springer. ; , s. 94-116
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Konferensbidrag (refereegranskat)abstract
- Supporting human actors in daily living activities for improv- ing health and wellbeing is a fundamental goal for assistive technology. The personalization of the support provided by assistive technology in the form of digital coaching requires user models that handle potentially conflicting goals and motives. The aim of this research is to extend a motivational model implemented in an assistive technology, and outline a team of assistive agents with supplementary goals following the human’s different properties, orchestrated by a companion agent based on the multipurpose motivational model for the human actor who is to be supported. The multi- purpose motivational model and supportive arguments relating to different motives are exemplified based on a use case from an earlier pilot user study of the assistive technology. Future work includes user studies to validate the model.
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| 25. |
- Lipcsey, Miklós, et al.
(författare)
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Urine Hydrogen Peroxide Levels and Their Relation to Outcome in Patients with Sepsis, Septic Shock, and Major Burn Injury
- 2022
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Ingår i: Biomedicines. - : MDPI AG. - 2227-9059. ; 10:4
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Tidskriftsartikel (refereegranskat)abstract
- Hydrogen peroxide (H2O2) and oxidative stress have been suggested as possible instigators of both the systemic inflammatory response and the increased vascular permeability associated with sepsis and septic shock. We measured H2O2 concentrations in the urine of 82 patients with severe infections, such as sepsis, septic shock, and infections not fulfilling sepsis-3 criteria, in patients with major burn injury with associated systemic inflammation, and healthy subjects. The mean concentrations of H2O2 were found to be lower in patients with severe infections compared to burn injury patients and healthy subjects. Patients with acute kidney injury (AKI), vs. those without AKI, in all diagnostic groups displayed higher concentrations of urine H2O2 (p < 0.001). Likewise, urine concentrations of H2O2 were higher in non-survivors as compared to survivors (p < 0.001) at day 28 in all diagnostic groups, as well as in patients with severe infections and burn injury (p < 0.001 for both). In this cohort, increased H2O2 in urine is thus associated with mortality in patients with sepsis and septic shock as well as in patients with burn injury.
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