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Sökning: L773:1178 2021 OR L773:1176 6328

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1.
  • Kindgren, Erik, 1977-, et al. (författare)
  • Prevalence of ADHD and Autism Spectrum Disorder in Children with Hypermobility Spectrum Disorders or Hypermobile Ehlers-Danlos Syndrome: A Retrospective Study
  • 2021
  • Ingår i: Neuropsychiatric Disease and Treatment. - : DOVE MEDICAL PRESS LTD. - 1176-6328 .- 1178-2021. ; 17, s. 379-388
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) are both characterized by generalized hypermobility, in combination with pain, affected proprioception, and pronounced fatigue. Clinical observation indicates that behavioral problems, hyperactivity, and autistic traits are overrepresented in children with those conditions. The purpose of this retrospective study was to establish the prevalence of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among children with HSD and hEDS treated in our clinic since 2012. Subjects and Methods: Since Ehlers-Danlos syndrome (EDS) diagnostic criteria and international classification were changed in 2017, we equate the older diagnosis EDS hypermobility type with the newer hEDS and the older hypermobility syndrome with HSD. A registry search from the computerized medical record system found 201 children (88 boys, 113 girls) aged 6– 18 years who were treated at our pediatrics department with the diagnoses HSD or EDS. All medical records (113 with HSD, 88 with EDS) were reviewed, and key symptoms such as fatigue and pain, as well as diagnosis of ADHD/ASD, were recorded. Results: All EDS cases could be classified as hEDS. Of the entire study cohort, 16% had a verified ADHD diagnosis and a further 7% were undergoing ADHD diagnostic investigation. Significantly more children with hEDS had ADHD compared to children with HSD (p=0.02). In the age group 15– 16 years, 35% of those with hEDS had ADHD and, among those aged 17– 18 years, ADHD was present in 46%. Children with coexisting ADHD showed a significantly higher proportion of associated symptoms such as fatigue, sleep-problems, and urinary tract problems. ASD had been verified in 6% of the children. Of those with ASD, 92% had sleep problems. Conclusion: This study shows a strong association between HSD or hEDS and ADHD or ASD. Therefore, children with HSD or hEDS may need to be routinely screened for neuropsychiatric symptoms.
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2.
  • Grauman, Åsa, 1982-, et al. (författare)
  • Communicating test results from a general health checkup: the public’s preferences from a discrete choice experiment survey
  • 2021
  • Ingår i: Patient Related Outcome Measures. - : Springer Nature. - 1179-271X. ; 14:5, s. 649-660
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Health checks can detect risk factors and initiate prevention of cardiovascular diseases but there is no consensus on how to communicate the results. The aim of this study was to investigate the preferences of the general population for communicating health check results.Methods: A randomly selected sample of the Swedish population aged 40–70 years completed a discrete choice experiment survey that included questions on sociodemographics, lifestyle and health and 15 choice questions consisting of six attributes (written results, notification method, consultation time, waiting time, lifestyle recommendation and cost). Data were analyzed with a latent class analysis (LCA). Relative importance of the attributes and predicted uptake for several scenarios were estimated.Results: In the analysis, 432 individuals were included (response rate 29.6%). A three-class LCA model best fit the data. Cost was the most important attribute in all classes. Preferences heterogeneity was found for the other attributes; in Class 1, receiving consultation time and the written results were important, respondents in Class 2 dominated on costs and respondents in Class 3 found consultation time, waiting time and lifestyle recommendations to be important. Health literate respondents were more likely to belong to Class 3. The predicted uptake rates ranged from 7 to 88% for different health checks with large differences across the classes.Conclusions: Cost was most important when deciding whether to participate in a health check. Although cost was the most important factor, it is not sufficient to offer health checks free-of-charge if other requirements regarding how the test results are communicated are not in place; participants need to be able to understand their results.
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3.
  • Jimenez-Moreno, A. Cecilia, et al. (författare)
  • Patient Preferences in Rare Diseases: A Qualitative Study in Neuromuscular Disorders to Inform a Quantitative Preference Study
  • 2021
  • Ingår i: Patient. - : Springer Science and Business Media LLC. - 1178-1653 .- 1178-1661.
  • Tidskriftsartikel (refereegranskat)abstract
    • IntroductionIt has become increasingly important to include patient preference information in decision-making processes for drug development. As neuromuscular disorders represent multisystem, debilitating, and progressive rare diseases with few treatment options, this study aimed to explore unmet health care needs and patient treatment preferences for two neuromuscular disorders, myotonic dystrophy type 1 (DM1) and mitochondrial myopathies (MM) to inform early stages of drug development.MethodsFifteen semi-structured interviews and five focus group discussions (FGDs) were held with DM1 and MM adult patients and caregivers. Topics discussed included (1) reasons for study participation; (2) disease signs/symptoms and their impact on daily lives; (3) top desired benefits; and (4) acceptability of risks and tolerance levels for a hypothetical new treatment. Data were analyzed following a thematic ‘code’ approach.ResultsA total of 52 participants representing a wide range of disease severities participated. ‘Muscle strength’ and ‘energy and endurance’ were the disease-related unmet needs most often mentioned. Additionally, improved ‘balance’, ‘cognition’ and ‘gut function’ were the top desired treatment benefits, while ‘damage to the liver, kidneys or eyes’ was the most concerning risk. Factors influencing their tolerance to risks related to previously having experienced the risk and differentiation between permanent and temporary risks. A few differences were elicited between patients and caregivers.ConclusionsThis qualitative study provided an open forum to elicit treatment-desired benefits and acceptable risks to be established by patients themselves. These findings can inform decisions for developing new treatments and the design of clinical trials for DM1 and MM.
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4.
  • Pinto, Cathy Anne, et al. (författare)
  • Comparing Patient Preferences for Antithrombotic Treatment During the Acute and Chronic Phases of Myocardial Infarction: A Discrete-Choice Experiment
  • 2021
  • Ingår i: Patient. - : Springer Science and Business Media LLC. - 1178-1653 .- 1178-1661.
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundAntithrombotic drugs are used as preventive treatment in patients with a prior myocardial infarction (MI) in both the acute and chronic phases of the disease. To support patient-centered benefit–risk assessment, it is important to understand the influence of disease stage on patient preferences.ObjectiveThe aim of this study was to examine patient preferences for antithrombotic treatments and whether they differ by MI disease phase.MethodsA discrete-choice experiment was used to elicit preferences of adults in the acute (≤ 365 days before enrolment) or chronic phase (> 365 days before enrolment) of MI for key ischemic events (risk of cardiovascular [CV] death, non-fatal MI, and non-fatal ischemic stroke) and bleeding events (risk of non-fatal intracranial hemorrhage and non-fatal other severe bleeding). Preference data were analyzed using the multinomial logit model. Trade-offs between attributes were calculated as the maximum acceptable increase in the risk of CV death for a decrease in the risk of the other outcomes. To assess the potential effect of sociodemographic and clinical characteristics on patient preferences, subgroups were introduced as interaction terms in logit models.ResultsThe evaluable population included 155 patients with MI in the acute phase of disease and 180 in the chronic phase. The overall population was 82% male, mean age was 64.2 ± 9.6 years, and 93% had not experienced bleeding events or key ischemic events other than MI. Patients valued reduction in the risk of non-fatal intracranial hemorrhage more than CV death (p < 0.01) and CV death more than non-fatal ischemic events (p < 0.01). Preferences were similar in the acute and chronic populations (p = 0.17). However, older patients valued reduction in risk of MI more than younger patients (p = 0.04), and patients with bleeding risk factors valued reduction in the risk of CV death (p = 0.01) and MI (p = 0.01) less than patients without bleeding risk factors. Also, patients who were at high risk of future ischemic events valued reduction of the risk of CV death less than those at low risk (p = 0.01).ConclusionPatient preferences for antithrombotic treatments were unaffected by disease stage but varied by bleeding risk and other factors. This heterogeneity in preferences is an important consideration because it can affect the benefit–risk balance and the acceptability of antithrombotic treatments to patients.Key PointsPatient preferences for antithrombotic treatment attributes were similar between the acute and chronic phases of myocardial infarction.Patients with myocardial infarction are willing to accept significant increases in the mortality risk to avoid increases in non-fatal bleeding events.
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  • Shekhawat, Pooja Kanwar, et al. (författare)
  • Serendipita indica : Harnessing its versatile potential for food and nutritional security
  • 2021
  • Ingår i: Physiological and molecular plant pathology. - : Elsevier. - 0885-5765 .- 1096-1178. ; 116
  • Tidskriftsartikel (refereegranskat)abstract
    • Quantity as well as quality of food is a major concern for increasing human population. Serendipita indica, a root endophytic fungus, has multifarious applications in agriculture. It increases nutrient and water uptake, carbon assimilation efficiency and stress-resistance which in turn enhances the growth and yield of plants. Moreover, it improves contents of minerals, fatty acids and essential oil, composition of oil, and fruit firmness in different plants. It also enhances the production of secondary metabolites having medicinal properties. This review highlights the role of Serendipita indica in increasing crop production and improving food quality. The underlying mechanism has also been illustrated.
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7.
  • Hayer, Juliette, et al. (författare)
  • Four novel picornaviruses detected in Magellanic Penguins (Spheniscus magellanicus) in Chile
  • 2021
  • Ingår i: Virology. - : Elsevier BV. - 0042-6822 .- 1178-122X. ; 560, s. 116-123
  • Tidskriftsartikel (refereegranskat)abstract
    • Members of the Picornaviridae family comprise a significant burden on the poultry industry, causing diseases such as gastroenteritis and hepatitis. However, with the advent of metagenomics, a number of picornaviruses have now been revealed in apparently healthy wild birds. In this study, we identified four novel viruses belonging to the family Picornaviridae in healthy Magellanic penguins, a near threatened species. All samples were subsequently screened by RT-PCR for these new viruses, and approximately 20% of the penguins were infected with at least one of these viruses. The viruses were distantly related to members of the genera Hepatovirus, Tremovirus, Gruhelivirus and Crahelvirus. Further, they had more than 60% amino acid divergence from other picornaviruses, and therefore likely constitute novel genera. Our results demonstrate the vast undersampling of wild birds for viruses, and we expect the discovery of numerous avian viruses that are related to hepatoviruses and tremoviruses in the future.
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8.
  • Kjellsdotter, Anna, et al. (författare)
  • Together for the future – development of a digital website to support chronic obstructive pulmonary disease self-management : A qualitative study
  • 2021
  • Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press Ltd. - 1178-2390. ; 14, s. 757-766
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Symptom burden, impaired functional performance and decreased quality of life are not only consequences of the underlying physiological disorder chronic obstructive pulmonary disease (COPD) but also dependent on a patient’s ability to learn to live with and manage their illness. A digital website may be important for empowering patients with COPD to learn about and self-manage their illness. The aim of this study was to describe a developing process of a digital COPD-web as a part of a self-management education program for persons living with COPD. Methods: A qualitative approach with a phenomenological perspective was used. The study was based on group and individual interviews with a multidisciplinary COPD-team and patients who developed the COPD-web. Results: The developing process appears as a person-centred and holistic self-care approach both in content and development. Developing a digital COPD-web requires ongoing multi-disciplinary collaboration and spawns a sense of pride that reinforces shared responsibility. The phenomenon consists of four constituents: learning by participating in development, the patient perspective as guiding approach, responsibility and motivation as driving forces and digital technology as a knowledge arena. Conclusion: The results indicate that constructive collaboration between a multidisciplinary COPD-team and patients as co-creators in an ongoing creative and reflective process is a key concept to develop a digital COPD-web with a holistic approach. Digital resources in the future might create time and space for reflective conversations in a COPD-web with virtual chatrooms. 
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9.
  • Andersson, Pia, et al. (författare)
  • Impaired oral health in older orthopaedic in-care patients : The influence of medication and morbidity
  • 2021
  • Ingår i: Clinical Interventions in Aging. - : Dove Medical Press Ltd.. - 1176-9092 .- 1178-1998. ; 16, s. 1691-1702
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication. Material and Methods: The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy. Results: Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy. Conclusion: The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.
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10.
  • Andersén, Heidi, et al. (författare)
  • Influence of childhood exposure to a farming environment on age at asthma diagnosis in a population-based study
  • 2021
  • Ingår i: Journal of Asthma and Allergy. - : Dove Press. - 1178-6965. ; 14, s. 1081-1091
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Asthma is a heterogeneous disease, and factors associated with different asthma phenotypes are poorly understood. Given the higher prevalence of farming exposure and late diagnosis of asthma in more rural Western Finland as compared with the capital of Helsinki, we investigated the relationship between childhood farming environment and age at asthma diagnosis.Methods: A cross-sectional population-based study was carried out with subjects aged 20– 69 years in Western Finland. The response rate was 52.5%. We included 3864 participants, 416 of whom had physician-diagnosed asthma at a known age and with data on the childhood environment. The main finding was confirmed in a similar sample from Helsinki. Participants were classified as follows with respect to asthma diagnosis: early diagnosis (0– 11 years), intermediate diagnosis (12–39 years), and late diagnosis (40–69 years).Results: The prevalence of asthma was similar both without and with childhood exposure to a farming environment (11.7% vs 11.3%). Allergic rhinitis, family history of asthma, ex-smoker, occupational exposure, and BMI ≥ 30 kg/m2 were associated with a higher like-lihood of asthma. Childhood exposure to a farming environment did not increase the odds of having asthma (aOR, 1.10; 95% CI, 0.87–1.40). It did increase the odds of late diagnosis (aOR, 2.30; 95% CI, 1.12–4.69), but the odds were lower for early (aOR, 0.49; 95% CI, 0.30–0.80) and intermediate diagnosis of asthma (aOR, 0.75; 95% CI, 0.47–1.18).Conclusion: Odds were lower for early diagnosis of asthma and higher for late diagnosis of asthma in a childhood farming environment. This suggests a new hypothesis concerning the etiology of asthma when it is diagnosed late.
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11.
  • Andersen, H., et al. (författare)
  • Influence of Childhood Exposure to a Farming Environment on Age at Asthma Diagnosis in a Population-Based Study
  • 2021
  • Ingår i: Journal of Asthma and Allergy. - 1178-6965. ; 14, s. 1081-1091
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Asthma is a heterogeneous disease, and factors associated with different asthma phenotypes are poorly understood. Given the higher prevalence of farming exposure and late diagnosis of asthma in more rural Western Finland as compared with the capital of Helsinki, we investigated the relationship between childhood farming environment and age at asthma diagnosis. Methods: A cross-sectional population-based study was carried out with subjects aged 2069 years in Western Finland. The response rate was 52.5%. We included 3864 participants, 416 of whom had physician-diagnosed asthma at a known age and with data on the childhood environment. The main finding was confirmed in a similar sample from Helsinki. Participants were classified as follows with respect to asthma diagnosis: early diagnosis (011 years), intermediate diagnosis (12-39 years), and late diagnosis (40-69 years). Results: The prevalence of asthma was similar both without and with childhood exposure to a farming environment (11.7% vs 11.3%). Allergic rhinitis, family history of asthma, exsmoker, occupational exposure, and BMI >= 30 kg/m(2) were associated with a higher likelihood of asthma. Childhood exposure to a farming environment did not increase the odds of having asthma (aOR, 1.10; 95% CI, 0.87-1.40). It did increase the odds of late diagnosis (aOR, 2.30; 95% CI, 1.12-4.69), but the odds were lower for early (aOR, 0.49; 95% CI, 0.30-0.80) and intermediate diagnosis of asthma (aOR, 0.75; 95% CI, 0.47-1.18). Conclusion: Odds were lower for early diagnosis of asthma and higher for late diagnosis of asthma in a childhood farming environment. This suggests a new hypothesis concerning the etiology of asthma when it is diagnosed late.
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13.
  • Andersson, Pia, 1955-, et al. (författare)
  • Impaired oral health in older orthopaedic in-care patients : The influence of medication and morbidity
  • 2021
  • Ingår i: Clinical Interventions in Aging. - 1176-9092 .- 1178-1998. ; 16, s. 1691-1702
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Fall-related injuries are prevalent in older patients and often lead to increased morbidity, medication, and impaired functions. We studied older trauma patients with the aim to describe their oral health in comparison to morbidity and medication.Material and Methods: The study included 198 patients, ≥65 years, admitted with an orthopedic trauma. Oral examinations included number of natural teeth, dental implants, missing, decayed and restored teeth, root remnants, and pocket depth. Data on comorbidities and medication were assembled. Statistical analyses were carried out with logistic regression models, adjusted for age, gender, comorbidity, and polypharmacy.Results: Overall, 198 patients participated, 71% women, mean age 81 years (±7.9), 85% resided in their own homes, 86% had hip fractures. Chronic diseases and drug use were present in 98.9%, a mean of 6.67 in Charlson comorbidity index (CCI), 40% heart diseases, 17% diabetes, and 14% dementia. Ninety-one percent were dentate (181), mean number of teeth 19.2 (±6.5), 24% had decayed teeth, 97% filled teeth, 44% <20 teeth, and 26% oral dryness. DFT (decayed, filled teeth) over mean were identified in patients with diabetes (p=0.037), COPD (p=0.048), polypharmacy (p=0.011), diuretics (p=0.007), and inhalation drugs (p=0.032). Use of ≥2 strong anticholinergic drugs were observed in patients with <20 teeth and DFT over mean (p=0.004, 0.003). Adjusted for age, gender, CCI, and polypharmacy.Conclusion: The study showed that impaired oral health was prevalent in older trauma patients and that negative effects on oral health were significantly associated with chronic diseases and drug use. The results emphasize the importance of identifying orthogeriatric patients with oral health problems and to stress the necessity to uphold good oral care during a period when functional decline can be expected.
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14.
  • Athlin, Åsa, 1971-, et al. (författare)
  • Prediction of Mortality Using Different COPD Risk Assessments : A 12-Year Follow-Up
  • 2021
  • Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press Ltd.. - 1176-9106 .- 1178-2005. ; 16, s. 665-675
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: A multidimensional approach in the risk assessment of chronic obstructive pulmonary disease (COPD) is preferable. The aim of this study is to compare the prognostic ability for mortality by different COPD assessment systems; spirometric staging, classification by GOLD 2011, GOLD 2017, the age, dyspnea, obstruction (ADO) and the dyspnea, obstruction, smoking, exacerbation (DOSE) indices.Patients and Methods: A total of 490 patients diagnosed with COPD were recruited from primary and secondary care in central Sweden in 2005. The cohort was followed until 2017. Data for categorization using the different assessment systems were obtained through questionnaire data from 2005 and medical record reviews between 2000 and 2003. Kaplan-Meier survival analyses and Cox proportional hazard models were used to assess mortality risk. Receiver operating characteristic curves estimated areas under the curve (AUC) to evaluate each assessment systems´ ability to predict mortality.Results: By the end of follow-up, 49% of the patients were deceased. The mortality rate was higher for patients categorized as stage 3-4, GOLD D in both GOLD classifications and those with a DOSE score above 4 and ADO score above 8. The ADO index was most accurate for predicting mortality, AUC 0.79 (95% CI 0.75-0.83) for all-cause mortality and 0.80 (95% CI 0.75-0.85) for respiratory mortality. The AUC values for stages 1-4, GOLD 2011, GOLD 2017 and DOSE index were 0.73, 0.66, 0.63 and 0.69, respectively, for all-cause mortality.Conclusion: All of the risk assessment systems predict mortality. The ADO index was in this study the best predictor and could be a helpful tool in COPD risk assessment.
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  • Bielecka-Dabrowa, Agata, et al. (författare)
  • Left ventricular diastolic dysfunction as predictor of unfavorable prognosis after ESUS
  • 2021
  • Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press. - 1178-2390. ; 14, s. 617-627
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Identification of echocardiographic, hemodynamic and biochemical predictors of unfavorable prognosis after embolic strokes of undetermined etiology (ESUS) in patients at age <65.Patients and Methods: Out of 520 ischemic stroke patients we selected 64 diagnosed with ESUS and additional 36 without stroke but with similar risk profile. All patients underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer and measurements of selected biomarkers. Follow-up time was 12 months.Results: Nine percent of patients died, and recurrent ischemic stroke occurred in 9% of patients only in the ESUS group. Atrial fibrillation (AF) occurred in 10% of patients and the ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization. The outcome of re-hospitalization was 28% in the ESUS group and 17% in the control group. In the multivariate analysis mean early diastolic (E’) mitral annular velocity (OR 0.75, 95% CI: 0.6–0.94; p=0.01) was significantly associated with cardiovascular hospitalizations. The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E’) (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E’ was independently associated with composite endpoint (death, hospitalization and recurrent stroke) (OR 1.90, 95% CI 1.1–3.2, p=0.01).Conclusion: The indices of diastolic dysfunction are significantly associated with unfavorable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during the first 2 months after ESUS to detect potential AF.
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18.
  • Chen, Xuan, et al. (författare)
  • Prevalence of Abdominal Obesity in Chinese Middle-Aged and Older Adults with a Normal Body Mass Index and Its Association with Type 2 Diabetes Mellitus : A Nationally Representative Cohort Study from 2011 to 2018
  • 2021
  • Ingår i: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. - 1178-7007. ; 14, s. 4829-4841
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Few studies have focused on the prevalence of abdominal obesity in Chinese middle-aged and older adults with a normal body mass index (BMI). Furthermore, it is still unclear whether abdominal obesity is an independent risk factor for type 2 diabetes mellitus (T2DM). Participants with a normal BMI are usually neglected during assessments of abdominal obesity-associated T2DM risk since the current recommendations for medical interventions are mainly focused on overall body mass index rather than fat deposition patterns. Methods: In this study, 7942 normal-BMI participants aged over 45 years from the China Health and Retirement Longitudinal Study were included to assess the prevalence of abdominal obesity defined by waist circumference (WC) or waist-to-height ratio (WHtR). In addition, 4348 normal-BMI individuals with no diabetes at baseline were included to evaluate the association between abdominal obesity and the risk of T2DM with the Cox proportional hazards model. Results: The prevalence (95% confidence interval, CI) of increased WC and substantially increased WC among adults with a normal BMI was 22.0% (21.1%-22.9%) and 18.1% (17.3%-19.0%), respectively. The adjusted hazard ratios and 95% CIs for T2DM incidence were 1.39 (1.05–1.85) and 1.89 (1.42–2.53) for those with increased WC and substantially increased WC, respectively, compared to the individuals with a normal WC. Similar HRs were obtained for the association between WHtR and the risk of T2DM. In prediabetic patients, the HRs (95% CIs) for new-onset T2DM for those with increased WC and substantially increased WC were 1.85 (1.27–2.69) and 2.46 (1.67–3.61), respectively, when compared with individuals with normal WC. This positive association was observed in women but not in men or adults with normal glucose tolerance (NGT). Conclusion: Abdominal obesity is highly prevalent among middle-aged and older Chinese adults with a normal BMI, and maintaining a normal waist circumference may be beneficial in the prevention of T2DM.
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19.
  • Chen, Yong, et al. (författare)
  • Albumin/Globulin Ratio as Yin-Yang in Rheumatoid Arthritis and Its Correlation to Inflamm-Aging Cytokines
  • 2021
  • Ingår i: Journal of Inflammation Research. - 1178-7031. ; 14, s. 5501-5511
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Inflamm-aging is a novel-concept in rheumatoid arthritis (RA) with accelerating aging process. We try to find a correlation between serum albumin/globulin (A/G) ratio and clinical biochemical parameters, incidence of aging-related diseases (ARDs) as well as inflammaging-related molecules.PATIENTS AND METHODS: Healthy controls (HC) and RA patients were compared with their clinical biochemical parameters including albumin and globulin levels, A/G ratio, and levels of serum lipids. Incidence of ARDs in RA was compared with A/G ratio, having a cut off value of 1.2. Expression levels of leptin and Trf2 genes in PBMCs, and inflammatory factors like IL-1β, IL-6, IL-8 and TNF-ɑ between HC and RA patients were compared, and correlated with the A/G ratio.RESULTS: Compared to HC, RA patients had decreased levels of albumin, while globulin levels were found to be increased, which led to a significantly lower A/G ratio in RA patients. A/G ratio rather than ESR and CRP had significant correlation with dyslipidemia in RA patients. Patients with A/G <1.2 had a higher risk of ARDs than patients with A/G >1.2. The RR was 2.48 (95% CI: 1.79 to 3.64, p <0.0001). In addition, A/G ratio has positively correlated to leptin and Trf2 expression, while an inverse correlation was observed with the levels of inflamm-aging related cytokines like IL-6, IL-8 and TNF-ɑ.CONCLUSION: A decreased A/G ratio in RA patients has significantly correlated with dyslipidemia and ARDs, as well as inflammaging- related adipokine and pro-inflammatory cytokines. Thus, A/G ratio could be a reliable marker for evaluating the inflammaging process during clinical management in ARDs.
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20.
  • Darba, Josep, et al. (författare)
  • Economic Evaluation of the Use of FeNO for the Diagnosis and Management of Asthma Patients in Primary Care in Sweden
  • 2021
  • Ingår i: ClinicoEconomics and Outcomes Research. - : Dove Medical Press. - 1178-6981. ; 13, s. 289-297
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To determine the economic impact of the fraction of exhaled nitric oxide (FeNO) in asthma diagnosis and management in primary care in Sweden. Methods: An economic model has been developed to determine the economic impact of the fraction of exhaled nitric oxide (FeNO) in asthma diagnosis and management in primary care in Sweden. The model includes the use and cost of commonly used tests, the associated outcomes and diagnostic accuracy. We compared FeNO with spirometry and reversibility testing, methacholine challenge test, allergy testing, and blood eosinophil count. One-way sensitivity analyses were performed to confirm the robustness of results. Results: Adding FeNO measurement in asthma diagnosis resulted in cost savings of SEK 672 per patient by the fourth year. The use of FeNO testing in asthma management proved to be a dominant strategy when compared with each other test except methacholine challenge test. Sensitivity analyses confirmed the robustness of the results. Conclusion: Introducing FeNO testing in clinical practice for the diagnosis and management of asthma in primary care in Sweden is less costly than standard methods while providing similar health benefits.
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21.
  • Dong, Huan-Ji, 1981-, et al. (författare)
  • Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry
  • 2021
  • Ingår i: Journal of Pain Research. - : Dove medical press Ltd. - 1178-7090. ; 14, s. 1863-1873
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight.Objective: This study investigated whether obese patients with chronic pain lost weight after completing IMMPR in specialist pain units. The association of pain relief and weight change over time was also examined.Methods: Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used (N=224), including baseline and 12-month follow-up after IMMPR from 2016 to 2018. Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviours, psychological distress, and health-related quality of life (HRQoL). A reduction of at least 5% of initial weight indicates clinically significant weight loss. Patients were classified into three groups based on the pain relief levels after IMMPR: pain relief of clinical significance (30% or more reduction of pain intensity); pain relief without clinical significance (less than 30% reduction of pain intensity); and no pain relief. Linear mixed regression models were used to examine the weight changes among the groups with different pain relief levels.Results: A significant reduction of pain intensity was found after IMMPR (p < 0.01, effect size Cohen's d = 0.34). A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss (20.2%~24.3%, p = 0.47). Significant improvements were reported regarding physical activity behaviour, psychological distress, and HRQoL, but weight change was not associated with changes of pain intensity.Conclusion: About one-fifth of obese patients achieved significant weight reduction after IMMPR. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.
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22.
  • Fernandez-Anez, Nieves, et al. (författare)
  • Current Wildland Fire Patterns and Challenges in Europe : A Synthesis of National Perspectives
  • 2021
  • Ingår i: Air, Soil and Water Research. - : SAGE Publications. - 1178-6221. ; 14, s. 1-19
  • Forskningsöversikt (refereegranskat)abstract
    • Changes in climate, land use, and land management impact the occurrence and severity of wildland fires in many parts of the world. This is particularly evident in Europe, where ongoing changes in land use have strongly modified fire patterns over the last decades. Although satellite data by the European Forest Fire Information System provide large-scale wildland fire statistics across European countries, there is still a crucial need to collect and summarize in-depth local analysis and understanding of the wildland fire condition and associated challenges across Europe. This article aims to provide a general overview of the current wildland fire patterns and challenges as perceived by national representatives, supplemented by national fire statistics (2009–2018) across Europe. For each of the 31 countries included, we present a perspective authored by scientists or practitioners from each respective country, representing a wide range of disciplines and cultural backgrounds. The authors were selected from members of the COST Action “Fire and the Earth System: Science & Society” funded by the European Commission with the aim to share knowledge and improve communication about wildland fire. Where relevant, a brief overview of key studies, particular wildland fire challenges a country is facing, and an overview of notable recent fire events are also presented. Key perceived challenges included (1) the lack of consistent and detailed records for wildland fire events, within and across countries, (2) an increase in wildland fires that pose a risk to properties and human life due to high population densities and sprawl into forested regions, and (3) the view that, irrespective of changes in management, climate change is likely to increase the frequency and impact of wildland fires in the coming decades. Addressing challenge (1) will not only be valuable in advancing national and pan-European wildland fire management strategies, but also in evaluating perceptions (2) and (3) against more robust quantitative evidence.
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23.
  • Fernberg, Ulrika, 1979-, et al. (författare)
  • Higher Total Physical Activity is Associated with Lower Arterial Stiffness in Swedish, Young Adults : The Cross-Sectional Lifestyle, Biomarkers, and Atherosclerosis Study
  • 2021
  • Ingår i: Vascular Health and Risk Management. - : DovePress. - 1176-6344 .- 1178-2048. ; 17, s. 175-185
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Arterial stiffness describes the rigidity of the arterial walls and is associated withrisk factors for cardiovascular disease (CVD). Arterial stiffness predicts future events andmortality, and the predictive value is stronger in younger versus older subjects. The aims ofthe present study were, firstly, to present data on physical activity (PA) and time spentsedentary, in the population of Swedish, young adults. Secondly, to explore the associationbetween PA and arterial stiffness.Material and Methods: Self-reported healthy, non-smoking, Swedish, young adults, 18–25years old, participated in the cross-sectional Lifestyle, Biomarkers and Atherosclerosis(LBA) study. The daily PA was objectively measured with an accelerometer for 1 week.Of the 834 participants, 658 individuals had valid registrations. The arterial stiffness measures, pulse wave velocity (PWV) and augmentation index (AIx) were measured withapplanation tonometry.Results: Women were on overall more physically active than men, they spent 214 min/dayin light PA (LPA) compared to men who spent 202 min/day. Women took significantly moresteps per day than men, 7796 vs 7336 steps/day, and spent less time sedentary, 523 min/day,compared to men who spent 547 min/day sedentary. In total, 76% of the individuals spent onaverage at least 30 minutes per day in the recommended moderate and vigorous PA (MVPA).Lower arterial stiffness was associated with more MVPA and total PA in the total population.Conclusion: We conclude that in this age group of young, self-reported healthy adults18–25 years, it is important to highlight the health-enhancing possibilities of time spent inphysical activity on the vascular function, measured as PWV and AIx. It is of high relevancein a public health perspective to expand preventive efforts beyond the high-risk groups andencourage young adults to be physically active.
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24.
  • Gerdle, Björn, et al. (författare)
  • Spreading of Pain in Patients with Chronic Pain is Related to Pain Duration and Clinical Presentation and Weakly Associated with Outcomes of Interdisciplinary Pain Rehabilitation : A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
  • 2021
  • Ingår i: Journal of Pain Research. - : Dove Medical Press LTD. - 1178-7090. ; 14, s. 173-187
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The extent to which pain is distributed across the body (spreading of pain) differs largely among patients with chronic pain conditions and widespread pain has been linked to poor quality of life and work disability. A longer duration of pain is expected to be associated with more widespread pain, but studies are surprisingly scarce. Whether spreading of pain is associated with clinical presentation and treatment outcome in patients seen in interdisciplinary multimodal pain rehabilitation programs (IMMRPs) is unclear. The association between spreading of pain and (1) pain duration (2) clinical presentation (eg, pain intensity, pain-related cognitions, psychological distress, activity/participation aspects and quality of life) and (3) treatment outcome were examined. Methods: Data from patients included in the Swedish Quality Registry for Pain Rehabilitation were used (n=39,916). A subset of patients that participated in IMMRPs (n=14,666) was used to examine whether spreading of pain at baseline predicted treatment outcome. Spreading of pain was registered using 36 predefined anatomical areas which were summarized and divided into four categories: 1-6 regions with pain (20.6% of patients), 7-12 regions (26.8%), 13-18 regions (22.0%) and 19-36 regions (30.6%). Results: More widespread pain was associated with a longer pain duration and a more severe clinical picture at baseline with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference and pain duration). Widespread pain was associated with a poorer overall treatment outcome following IMMRPs at both post-treatment and at a 12-month follow-up, but effect sizes were small. Discussion: Spreading of pain is an indicator of the duration and severity of chronic pain and to a limited extent to outcomes of IMMRP. Longer pain duration in those with more widespread pain supports the concept of early intervention as clinically important and implies a need to develop and improve rehabilitation for patients with chronic widespread pain.
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25.
  • Glock, Hanna, et al. (författare)
  • Attitudes, Barriers, and Concerns Regarding Telemedicine Among Swedish Primary Care Physicians : A Qualitative Study
  • 2021
  • Ingår i: International Journal of General Medicine. - 1178-7074. ; 14, s. 9237-9246
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The primary care physician's traditional patient contacts are challenged by the rapidly accelerating digital transformation. In a quantitative survey analysis based on the theory of planned behavior, we found high behavioral intention to use telemedicine among Swedish primary care physicians, but low reported use. The aim of this study was to further examine the physicians' experiences regarding telemedicine, with a focus on possible explanations for the gap between intention and use, through analysis of the free-text comments supplied in the survey.MATERIAL AND METHODS: The material was collected through a web-based survey which was sent out to physicians at 160 primary health care centers in southern Sweden from May to August 2019. The survey covered four areas: general experiences of telemedicine, digital contacts, chronic disease monitoring with digital tools, and artificial intelligence. A total of 100 physicians submitted one or more free-text comments. These were analyzed using qualitative content analysis with an inductive approach.RESULTS: The primary care physicians expressed attitudes towards telemedicine that focused on clinical usefulness. Barriers to use were the loss of personal contact with patients and a deficient technological infrastructure. The major concerns were that these factors would result in patient harm and an increased workload. The connection between intention and use postulated by the theory of planned behavior was not applicable in this context, as external factors in the form of availability and clinical usefulness of the specific technology were major impediments to use despite a generally positive attitude.CONCLUSION: All telemedicine tools must be evaluated regarding clinical usefulness, patient safety, and effects on staff workload, and end users should be included in this process. Utmost consideration is needed regarding how to retain the benefits of personal contact between patient and provider when digital solutions are introduced.
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26.
  • Golestani, M., et al. (författare)
  • Lifestyle risk factor assessment through who step approach in Tabriz, Iran
  • 2021
  • Ingår i: ClinicoEconomics and Outcomes Research. - 1178-6981. ; 13, s. 487-492
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to assess the lifestyle behaviour and risk factors for lifestyle-related diseases in East Azerbaijan province, Iran. Methods: A household study using a two-stage cluster sampling method was performed. Tabriz city was randomly selected for data collection among five geographic regions in the East-Azerbaijan province. Short WHO-STEP and Ultra-short version of Socio-Economic Status assessment questionnaire were used. Six hundred households were asked to respond to the STEP questionnaire. Results: A total of 1196 people have participated in the study. People with higher socioeconomic status consumed more fruits, vegetables and fish than the people with lower socioeconomic status. People with academic education less likely to be hypertensive com-pared to people with non-academic education. People with a medium socioeconomic status are less likely to be hypertensive than people with high socioeconomic status. The majority of participants had poor dietary habits. In this study, 17.22%, 7.53% and 4.35% of respon-dents had hypertension, diabetes and depression, respectively. Conclusion: Considering that lifestyle-related risk factors are common among people. Due to the direct link between lifestyle and the occurrence of many chronic diseases, campaigns for and training programs to implement healthy lifestyle habits are recommended. 
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27.
  • Hermann, Monica, et al. (författare)
  • Polypharmacy and Potential Drug-Drug Interactions in Home-Dwelling Older People : A Cross-Sectional Study
  • 2021
  • Ingår i: Journal of Multidisciplinary Healthcare. - 1178-2390. ; 14, s. 589-597
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Risks associated with polypharmacy and drug-drug interactions represent a challenge in drug treatment, especially in older adults. The aim of the present study was to assess the use of prescription and non-prescription drugs and the frequency of potential drug-drug interactions in home-dwelling older individuals.Methods: A cross-sectional study design was applied. Data were collected during preventive home visits among individuals aged ≥75 in three separate communities of Western Norway. A questionnaire, which was filled out by the individual, their next-of-kin, and the nurse performing the home visit was used for the collection of demographic and clinical data (age, sex, medication use, diagnoses, need of assistance with drug administration). Potential drug-drug interactions were identified electronically by IBM Micromedex Drug Interaction Checking. Point prevalence of potential drug-drug interactions and polypharmacy (≥5 drugs) were calculated. Binary logistic regression analyses were performed to assess factors potentially associated with polypharmacy or potential drug-drug interactions.Results: Among the 233 individuals (mean age 78±3 years, 46% male) included in the study, 43% used ≥5 drugs, 3.4% ≥10 drugs, while 4.3% used no drugs. In 54% of the 197 individuals using two or more drugs, at least one potential drug-drug interaction was detected. Low-dose aspirin and simvastatin were most frequently involved in potential drug-drug interactions. In total, 25% of the individuals reported current use of drugs sold over the counter of which more than 95% were analgesic drugs. Potential drug-drug interactions involving ibuprofen were identified in nine of 11 (82%) individuals using over-the-counter ibuprofen.Conclusion: The study revealed a high prevalence of polypharmacy and potential drug-drug interactions with both prescription and non-prescription drugs in older home-dwelling individuals. Close monitoring of the patients at risk of drug-drug interactions, and increased awareness of the potential of over-the-counter drugs to cause drug-drug interactions, is needed.
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28.
  • Huang, Renlun, et al. (författare)
  • Research Trends and Regulation of CCL5 in Prostate Cancer
  • 2021
  • Ingår i: OncoTargets and Therapy. - : Dove Medical Press. - 1178-6930. ; 14, s. 1417-1427
  • Forskningsöversikt (refereegranskat)abstract
    • Prostate cancer (PCa) is considered as the most common cancer of urologic neoplasms, and its development and prognosis are associated with many factors. Chemokine receptor signaling combine with advances in advanced clinicopathological characteristics have provided new insights into the molecular landscape of prostate cancer. Chemokine (C-C motif) ligand 5 (CCL5) is an important member of the CC subfamily of chemokines. The expression of chemokine CCL5 is positively correlated with poor prognostic features in patients with PCa. Current study suggested that CCL5/CCR5 axis plays a significant role in the proliferation, metastasis, angiogenesis, drug resistance of prostate cancer cells and promotes self-renewal of prostate cancer stem cells (PCSCs). Due to the major domination in CCL5 by prostate cancer and the high cancer-specific mortality with prostate cancer, research on the CCL5/CCR5 axis effective antagonists is widespread application. However, challenges for precision oncology of CCL5/CCR5 axis and effective antagonists in CRPC remain. Herein, we summarized the crucial role of CCL5 in promoting the development of PCa and discussed the antitumor application of the antagonists of CCL5/CCR5 axis.
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29.
  • Håkonsen, Helle, 1980, et al. (författare)
  • Intra-individual variability in self-reported use of non-steroidal anti-inflammatory and analgesic medicines depending on mode of data collection - observations from the Population Study of Women in Gothenburg, Sweden
  • 2021
  • Ingår i: International Journal of General Medicine. - 1178-7074. ; 14, s. 3243-3250
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Self-report by questionnaire is one of the main methods to collect data on drug utilization. There are several modes of data collection by questionnaire, differing in the way of delivering the questionnaire to respondents and in the administration of the questions, both influencing the recall and participation rates. The aim of this study was to compare different modes of data collection for self-reported use of non-steroidal anti-inflammatory (NSAIDs) and analgesic medicines. Methods: Data on 573 women (38 or 50 years) were retrieved from the Population Study of Women in Gothenburg. Data on medicine use were collected using two different modes: (1) a self-administered questionnaire with closed-ended medicine-specific questions; and (2) an interviewer-administered questionnaire with open-ended questions. Cohen’s kappa statistics were applied to assess the agreement of the two modes. Results: The proportion of participants that reported use of NSAIDs and analgesics was higher with the self-administered questionnaire compared with the interviewer-administered questionnaire (69.3% vs 58.5%, p < 0.001). The overall agreement between the two modes of data collection was fair (Ⱪ=0.27), ranging from none for antimigraine preparations to fair (Ⱪ=0.36) for NSAIDs. A higher proportion of the participants aged 38 years reported use of NSAIDs and analgesics compared with the 50-year olds. In the regression model using data from the self-administered questionnaire, all four categories of bodily pain were significant predictors for use of NSAIDs and analgesics. The most severe reported bodily pain was the only significant predictor in the model using data from the interviewer-administered questionnaire. Conclusion: This study showed that use of a self-administered questionnaire with closed-ended medicine-specific questions identified more users of NSAIDs and analgesic medicines compared with an interviewer-administered questionnaire with open-ended questions. Reported use according to the self-administered questionnaire was also more strongly associated with experienced pain.
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30.
  • Imbeault, S., et al. (författare)
  • Blockade of KAT II Facilitates LTP in Kynurenine 3-Monooxygenase Depleted Mice
  • 2021
  • Ingår i: International Journal of Tryptophan Research. - : SAGE Publications. - 1178-6469. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • Excess of brain kynurenic acid (KYNA), a neuroactive metabolite of the kynurenine pathway, is known to elicit cognitive dysfunction. In the present study, we investigated spatial working memory in mice with elevated levels of KYNA, induced by targeted deletion of kynurenine 3-monooxygenase (KMO), as well as long-term potentiation (LTP) of field excitatory postsynaptic potentials (fEPSPs) in hippocampal brain slices from these mice. The KMO knock-out (KMO-/-) mice performed more poorly in the spatial working memory task as compared to their wild-type (WT) counterparts, as reflected by fewer correct choices in a T-maze. Both fEPSPs, or LTP, did not significantly differ between the 2 mouse strains. However, administration of PF-04859989, a kynurenine aminotransferase (KAT) II inhibitor, limiting the production of KYNA, facilitated fEPSP and enhanced LTP to a greater extent in hippocampal slices from KMO-/- mice compared to WT mice. The results of the present study point to an essential role for KYNA in modulating LTP in the hippocampus of KMO-/- mice which may account for their dysfunctional spatial working memory.
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31.
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32.
  • Kaptain, Rina Juel, et al. (författare)
  • New Insights into Activities of Daily Living Performance in Chronic Obstructive Pulmonary Disease
  • 2021
  • Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press. - 1176-9106 .- 1178-2005. ; 16, s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: There have been calls for more knowledge of activities of daily living (ADL) performance in order to address interventions in pulmonary rehabilitation effectively. Everyday technology (ET) has become an integrated dimension of ADL, impacting the ways in which ADL is performed. To improve everyday functioning and quality of life, the use of ADL and ET use needs to be evaluated and addressed effectively in interventions. Therefore, the aim of this study was twofold: 1) to explore the quality of ADL performance, and 2) to investigate the relationship between observation and self-reported ADL performance and ability to use everyday technologies in people living with COPD.Methods: This cross-sectional study involved 84 participants aged 46-87 years. Participants were recruited through healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were collected using standardized assessments that investigated different ADL perspectives: self-reported ADL tasks and ET use, observed motor and process ability, and need for assistance. Data were analysed and presented using descriptive statistics and Pearson's correlation coefficient.Results: The most affected ADL tasks were mobility within or outside the home, lower dressing, bathing, pedicuring, cooking, shopping, cleaning and washing clothes. New insights into the quality of ADL performance in people living with COPD were presented in terms of detailed ADL motor skills and ADL process skills, as well as the predicted need for support to function in the community. Moreover, new insights into the relationship between observation and self-reported ADL performance (r=0.546, p<0.01; r=0.297, p<0.01) and between ADL performance and self-perceived ability to use ET (r=0.524, p<0.01; r=0.273, p<0.05; r=0.044, p=0.692) were presented.Conclusion: Overall, the knowledge from the present study is valuable for focusing interventions that address challenging ADL performance and ET use through relevant and realistic activities. The ability to use ET is important to evaluate and target pulmonary rehabilitation.
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33.
  • Kjellsdotter, Anna, et al. (författare)
  • Together for the Future – Development of a Digital Website to Support Chronic Obstructive Pulmonary Disease Self-Management: A Qualitative Study
  • 2021
  • Ingår i: Journal of Multidisciplinary Healthcare. - : Informa UK Limited. - 1178-2390. ; 14, s. 757-766
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Symptom burden, impaired functional performance and decreased quality of life are not only consequences of the underlying physiological disorder chronic obstructive pulmonary disease (COPD) but also dependent on a patient's ability to learn to live with and manage their illness. A digital website may be important for empowering patients with COPD to learn about and self-manage their illness. The aim of this study was to describe a developing process of a digital COPD-web as a part of a self-management education program for persons living with COPD.Methods: A qualitative approach with a phenomenological perspective was used. The study was based on group and individual interviews with a multidisciplinary COPD-team and patients who developed the COPD-web.Results: The developing process appears as a person-centred and holistic self-care approach both in content and development. Developing a digital COPD-web requires ongoing multidisciplinary collaboration and spawns a sense of pride that reinforces shared responsibility. The phenomenon consists of four constituents: learning by participating in development, the patient perspective as guiding approach, responsibility and motivation as driving forces and digital technology as a knowledge arena.Conclusion: The results indicate that constructive collaboration between a multidisciplinary COPD-team and patients as co-creators in an ongoing creative and reflective process is a key concept to develop a digital COPD-web with a holistic approach. Digital resources in the future might create time and space for reflective conversations in a COPD-web with virtual chatrooms.
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34.
  • Larsson, Kjell, et al. (författare)
  • Adherence to treatment recommendations for chronic obstructive pulmonary disease-results from the Swedish national airway register
  • 2021
  • Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : DovePress. - 1176-9106 .- 1178-2005. ; 16, s. 909-918
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Swedish guidelines adhere to the international GOLD document regarding management of chronic obstructive pulmonary disease (COPD). Based on data from the Swedish National Airway Register (SNAR) the aim was to evaluate adherence to guidelines of pharmacological treatment of COPD in Swedish primary and secondary care.Methods: During a period of 18 months, data on symptoms (CAT, mMRC), lung function, exacerbation history and pharmacological treatment from 15,595 COPD patients from 853 primary care and 125 secondary care clinics were collected from SNAR. Patients with a co-diagnosis of asthma were excluded. Patients were divided into four treatment groups: no pharmacological treatment, short-acting bronchodilators alone, long-acting bronchodilators alone and ICS alone or in combination with bronchodilators.Results: Of the patients, 29% were in GOLD group A, 58% in group B, 2% in group C and 11% in group D. CAT score was ≥10 and mMRC score was below 2 in 30.9% of the patients and mMRC score was ≥2 and CAT score <10 in 4.2% of the patients. In 61.4% of the patients, no exacerbation was registered during the last year. Long-acting bronchodilators were prescribed for 78% and ICS for 46% of all patients. In groups A, B, C and D, respectively, 21%, 11%, 11% and 5% did not receive any inhaler therapy; 67%, 81%, 81% and 90% received long-acting bronchodilators; 33%, 46%, 55% and 71% received any ICS containing therapy and 19%, 34%, 39% and 61% received triple therapy.Discussion: Data from the SNAR indicate that only a minority of COPD patients were untreated. There was a liberal use of ICS containing drug combinations in subjects who do not have an indication for ICS. A considerable proportion of subjects at high risk of exacerbations did not receive ICS treatment.
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35.
  • Larsson, K., et al. (författare)
  • Adherence to Treatment Recommendations for Chronic Obstructive Pulmonary Disease - Results from the Swedish National Airway Register
  • 2021
  • Ingår i: International Journal of Chronic Obstructive Pulmonary Disease. - 1178-2005. ; 16, s. 909-918
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Swedish guidelines adhere to the international GOLD document regarding management of chronic obstructive pulmonary disease (COPD). Based on data from the Swedish National Airway Register (SNAR) the aim was to evaluate adherence to guidelines of pharmacological treatment of COPD in Swedish primary and secondary care. Methods: During a period of 18 months, data on symptoms (CAT, mMRC), lung function, exacerbation history and pharmacological treatment from 15,595 COPD patients from 853 primary care and 125 secondary care clinics were collected from SNAR. Patients with a co-diagnosis of asthma were excluded. Patients were divided into four treatment groups: no pharmacological treatment, short-acting bronchodilators alone, long-acting bronchodilators alone and ICS alone or in combination with bronchodilators. Results: Of the patients, 29% were in GOLD group A, 58% in group B, 2% in group C and 11% in group D. CAT score was >= 10 and mMRC score was below 2 in 30.9% of the patients and mMRC score was >= 2 and CAT score <10 in 4.2% of the patients. In 61.4% of the patients, no exacerbation was registered during the last year. Long-acting bronchodilators were prescribed for 78% and ICS for 46% of all patients. In groups A, B, C and D, respectively, 21%, 11%, 11% and 5% did not receive any inhaler therapy; 67%, 81%, 81% and 90% received long-acting bronchodilators; 33%, 46%, 55% and 71% received any ICS containing therapy and 19%, 34%, 39% and 61% received triple therapy. Discussion: Data from the SNAR indicate that only a minority of COPD patients were untreated. There was a liberal use of ICS containing drug combinations in subjects who do not have an indication for ICS. A considerable proportion of subjects at high risk of exacerbations did not receive ICS treatment.
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36.
  • Larsson, Kjell, et al. (författare)
  • The Impact of Exacerbation Frequency on Clinical and Economic Outcomes in Swedish COPD Patients : The ARCTIC Study
  • 2021
  • Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Taylor & Francis. - 1176-9106 .- 1178-2005. ; 16, s. 701-713
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The aim of this study was to assess the association between exacerbation frequency and clinical and economic outcomes in patients with COPD.Patients and Methods: Electronic medical record data linked to National Health Registries were collected from COPD patients at 52 Swedish primary care centers (2000-2014). The outcomes analyzed were exacerbation rate, mortality, COPD treatments, lung function and healthcare costs during the follow-up period. Based on the exacerbation rate two years before index date, the patients were initially classified into three groups, either 0, 1 or >= 2 exacerbations per year. After the index date, the classification into exacerbation groups was updated each year based on the exacerbation rate during the last year of follow-up. A sensitivity analysis was conducted excluding patients with asthma diagnosis from the analysis.Results: In total 18,586 COPD patients were analyzed. A majority of the patients (60-70%) who either have had no exacerbation or frequent exacerbations (>= 2/year) during the preindex period remained in their group (ie, with 0 or >= 2 annual exacerbations) during up to 11 years of follow-up. Compared with having no exacerbation, mortality was higher in patients having 1 (HR; 2.06 [1.93-2.201) and >= 2 (4.58 [4.33-4.841) exacerbations at any time during the follow-up. Lung function decline was more rapid in patients with frequent exacerbations and there was an almost linear relationship between exacerbations frequency and mortality. Total healthcare costs were higher in the frequent exacerbation group (>= 2/year) than in patients with no or one exacerbation annually (p<0.0001 for both). The results did not differ from the main analysis after exclusion of patients with a concurrent asthma diagnosis.Conclusion: In addition to faster lung function decline and increased mortality, frequent exacerbations in COPD patients imply a significant economic burden.
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37.
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38.
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39.
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40.
  • Pergolizzi, Joseph V., Jr., et al. (författare)
  • Transdermal Buprenorphine for Acute Pain in the Clinical Setting : A Narrative Review
  • 2021
  • Ingår i: Journal of Pain Research. - : Taylor & Francis. - 1178-7090. ; 14, s. 871-879
  • Forskningsöversikt (refereegranskat)abstract
    • Transdermal buprenorphine is indicated for chronic pain management, but as its role in the clinical management of acute pain is less clear, this narrative review examines studies of the patch for acute pain, mainly in the postoperative setting. Although perhaps better known for its role in opioid rehabilitation programs, buprenorphine is also an effective analgesic that is a Schedule III controlled substance. Although buprenorphine is a partial agonist at the mu-opioid receptor, it is erroneous to think of the agent as a partial analgesic; it has full analgesic efficacy and unique attributes among opioids, such as a ceiling for respiratory depression and low "drug likeability" among those who take opioids for recreational purposes. Transdermal buprenorphine has been most thoroughly studied for acute pain control in postoperative patients. Postoperative pain follows a distinct and predictable trajectory depending on the type of surgery and patient characteristics. Overall, when the patch is applied prior to surgery and left in place for the prescribed seven days, it was associated with reduced postoperative pain, lower consumption of other analgesics, and patient satisfaction. Transdermal buprenorphine has been evaluated in clinical studies of patients undergoing gynecological surgery, hip fracture surgery, knee or hip arthroscopy/arthroplasty, shoulder surgery, and spinal surgery. Transdermal buprenorphine may also be appropriate pain medication for controlling pain during postsurgical orthopedic rehabilitation programs. Transdermal buprenorphine may result in typical opioid-associated side effects but with less frequency than other opioids. Despite clinical reservations about transdermal buprenorphine and its potential role in acute pain management in the clinical setting, clinical acceptance may be hampered by the fact that it is off-label and buprenorphine is better known as an opioid maintenance agent rather than an analgesic.
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41.
  • Pikkemaat, Miriam, et al. (författare)
  • Swedish Primary Care Physicians' Intentions to Use Telemedicine : A Survey Using a New Questionnaire - Physician Attitudes and Intentions to Use Telemedicine (PAIT)
  • 2021
  • Ingår i: International Journal of General Medicine. - : Dove Medical Press. - 1178-7074. ; 14, s. 3445-3455
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians' intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine. Methods: An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine. Results: The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p<0.01) for Intentions to use digital contacts (R-2 = 0.54), chronic disease monitoring with digital tools (R-2 = 0.47) and artificial intelligence (R-2 = 0.54). A structural validation of a preliminary instrument - Physician Attitudes and Intention to use Telemedicine (PAIT) - containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach's alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79. Conclusion: Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians' self-efficacy towards using them.
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42.
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43.
  • Rodrigues Junior, Dorival Mendes, et al. (författare)
  • MicroRNA-1252-5p Associated with Extracellular Vesicles Enhances Bortezomib Sensitivity in Multiple Myeloma Cells by Targeting Heparanase
  • 2021
  • Ingår i: OncoTargets and Therapy. - : Dove Medical Press. - 1178-6930. ; 14, s. 455-467
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Multiple myeloma (MM) remains an incurable disease, and patient survival requires a better understanding of this malignancy's molecular aspects. Heparanase (HPSE) is highly expressed in aggressive MM cells and related to tumor growth, metastasis, and bortezomib (BTZ) resistance. Thus, targeting HPSE seems to be a promising approach for MM treatment, and because microRNAs (miRNAs) have emerged as potential regulators of HPSE expression, the use of extracellular vesicles (EVs) can allow the efficient delivery of therapeutic miRNAs.Methods: We used prediction algorithms to identify potential miRNAs that regulate negatively HPSE expression. RT-qPCR was performed to assess miRNAs and HPSE expression in MM lines (U266 and RPMI-8226). Synthetic miRNA mimics were electroporated in MM cells to understand the miRNA contribution in HPSE expression, glycosaminoglycans (GAGs) profile, cell proliferation, and cell death induced by BTZ. EVs derived from HEK293T cells were engineered with miRNAs to evaluate their therapeutic potential combined with BTZ.Results: It revealed a direct association between BTZ sensitivity, HPSE, and miR-1252-5p expressions. Moreover, overexpression of miR-1252-5p significantly reduced HPSE expression and HPSE enzymatic activity in MM cells. The higher level of miR-1252-5p was correlated with a reduction of cell viability and higher sensitivity to BTZ. Further, EVs carrying miR-1252-5p increased MM cells' sensitivity to BTZ treatment.Conclusion: These results showed that miR-1252-5p could negatively regulate HPSE in MM, indicating the use of EVs carrying miR-1252-5p as a potential novel BTZ sensitization approach in MM cells.
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44.
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45.
  • Rönnebjerg, Lina, et al. (författare)
  • Severe asthma in a general population study : Prevalence and clinical characteristics
  • 2021
  • Ingår i: Journal of Asthma and Allergy. - : Dove Medical Press. - 1178-6965. ; 14, s. 1106-1115
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Current guidelines primarily use medication levels to distinguish severe asthma from other types of asthma. In addition, severe asthma must also be uncontrolled at high-intensity treatment or become uncontrolled if treatment level is decreased. To date, only a few studies have used this definition to investigate the prevalence and clinical characteristics of severe asthma in population-based samples. Therefore, the aim of this study was to evaluate the prevalence and clinical characteristics of individuals with severe asthma in the population-representative West Sweden Asthma Study.Materials and Methods: In this cross-sectional population-based study, a randomly selected sample (n=1172) and a separate asthma sample (n=744) underwent clinical examinations, completed a structured interview and responded to questionnaires. Severe asthma was defined as at least one feature of uncontrolled asthma despite treatment in line with the Global Initiative for Asthma (GINA) steps 4/5. This treatment level required a minimum medium dose of inhaled corticosteroids (ICS) plus a second controller or oral corticosteroids.Results: The prevalence of severe asthma was 1.1% in the adult random sample and 9.5% within the asthma sample. Individuals with severe asthma were older and had more symptoms, activity limitations, heart disease and blood neutrophils compared to those with other asthma. They also had lower lung function and despite these impairments, 32% did not have annual contact with a healthcare provider.Conclusion: The prevalence of severe asthma was higher compared to previous studies, and many individuals with severe asthma did not have regular contact with healthcare providers. Due to the high burden of symptoms and impairments for individuals with severe asthma, it is important that the healthcare system implement strategies to improve follow-up and evaluate these patients according to existing guidelines.
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46.
  • Rönnebjerg, Lina, et al. (författare)
  • Severe Asthma in a General Population Study: Prevalence and Clinical Characteristics
  • 2021
  • Ingår i: Journal of Asthma and Allergy. - 1178-6965. ; 14, s. 1105-1115
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Current guidelines primarily use medication levels to distinguish severe asthma from other types of asthma. In addition, severe asthma must also be uncontrolled at high-intensity treatment or become uncontrolled if treatment level is decreased. To date, only a few studies have used this definition to investigate the prevalence and clinical characteristics of severe asthma in population-based samples. Therefore, the aim of this study was to evaluate the prevalence and clinical characteristics of individuals with severe asthma in the population-representative West Sweden Asthma Study. Materials and Methods: In this cross-sectional population-based study, a randomly selected sample (n=1172) and a separate asthma sample (n=744) underwent clinical examinations, completed a structured interview and responded to questionnaires. Severe asthma was defined as at least one feature of uncontrolled asthma despite treatment in line with the Global Initiative for Asthma (GINA) steps 4/5. This treatment level required a minimum medium dose of inhaled corticosteroids (ICS) plus a second controller or oral corticosteroids. Results: The prevalence of severe asthma was 1.1% in the adult random sample and 9.5% within the asthma sample. Individuals with severe asthma were older and had more symptoms, activity limitations, heart disease and blood neutrophils compared to those with other asthma. They also had lower lung function and despite these impairments, 32% did not have annual contact with a healthcare provider. Conclusion: The prevalence of severe asthma was higher compared to previous studies, and many individuals with severe asthma did not have regular contact with healthcare providers. Due to the high burden of symptoms and impairments for individuals with severe asthma, it is important that the healthcare system implement strategies to improve follow-up and evaluate these patients according to existing guidelines.
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47.
  • Saifullah, Bullo, et al. (författare)
  • A Novel Para-Amino Salicylic Acid Magnesium Layered Hydroxide Nanocomposite Anti-Tuberculosis Drug Delivery System with Enhanced in vitro Therapeutic and Anti-Inflammatory Properties
  • 2021
  • Ingår i: International Journal of Nanomedicine. - : Dove Medical Press. - 1176-9114 .- 1178-2013. ; 16, s. 7035-7050
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Mycobacterium tuberculosis infections are associated with severe local inflammatory reactions, which may be life-threatening and lead to tuberculosis pathogenesis and associated complications. Inorganic nanolayers have been vastly exploited for biomedical applications (especially in drug delivery) because of their biocompatible and biodegradable nature with the ability to release a drug in a sustained manner. Herein, we report a new nanodelivery system of inorganic nanolayers based on magnesium layered hydroxides (MgLH) and a successfully intercalated anti-tuberculosis drug para-aminosalicylic acid (PAS). Methods: The designed anti-tuberculosis nanodelivery composite, MgLH-PAS, was prepared by a novel co-precipitation method using MgNO3 as well MgO as starting materials. Results: The designed nano-formulation, PAS-MgLH, showed good antimycobacterial and antimicrobial activities with significant synergistic anti-inflammatory effects on the suppression of lipopolysaccharide (LPS) stimulated inflammatory mediators in RAW 264.7 macrophages. The designed nano-formulation was also found to be biocompatible with human normal lung cells (MRC-5) and 3T3 fibroblast cells. Furthermore, the in vitro release of PAS from PAS-MgLH was found to be sustained in human body simulated phosphate buffer saline (PBS) solutions of pH 7.4 and pH 4.8. Discussion: The results of the present study are highly encouraging for further in vivo studies. This new nanodelivery system, MgLH, can be exploited in the delivery of other drugs and in numerous other biomedical applications as well.
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48.
  • Sakko, M, et al. (författare)
  • Antibacterial Activity of 2-Hydroxyisocaproic Acid (HICA) Against Obligate Anaerobic Bacterial Species Associated With Periodontal Disease
  • 2021
  • Ingår i: Microbiology insights. - : SAGE Publications. - 1178-6361. ; 14, s. 11786361211050086-
  • Tidskriftsartikel (refereegranskat)abstract
    • Topical antiseptics are used to assist and further increase the effect of mechanical biofilm eradication and to potentially prevent new biofilm formation in periodontal treatment. This is of importance in treatment-resistant infections with 10% prevalence of all periodontitis cases to avoid the need for antibiotic therapy. The purpose of this study was to evaluate the antimicrobial activity of DL-2-hydroxyisocaproic acid on human pathogenic obligate anaerobic bacteria related to periodontitis. In this study antimicrobial activity of 2-hydroxyisocaproic acid was observed against 14 bacterial reference strains and clinical isolates of obligate anaerobic bacterial species using a microdilution method in 1.25 to 160 mg/mL concentrations of 2-hydroxyisocaproic acid. The 11 strains of bacteria included in this study are typically associated with periodontal disease; Porphyromonas gingivalis, Fusobacterium nucleatum, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and Parvimonas micra. Three strains of Cutibacterium acnes, normally associated with skin diseases, were tested for comparison. 90% inhibitory concentration was determined at 48 hours and minimum bactericidal concentration was determined after 72 hours incubation. The 2-hydroxyisocaproic acid was bactericidal at ⩾160 mg/mL for all isolates tested. The reference strain of T. forsythia, and the reference strain and the clinical isolates of C. acnes were the most tolerant ones. The reference strains and clinical isolates of F. nucleatum and A. actinomycetemcomitans were killed at ⩾40 mg/mL concentration. In conclusion, topical use of 2-hydroxyisocaproic acid could eventually be a well-tolerated and useful method in the therapy of patients with difficult-to-treat periodontal disease or other superficial infections to avoid unnecessary antibiotic use and the emergence of antibiotic resistance.
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49.
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50.
  • Sandheimer, Christine, et al. (författare)
  • Implementation of a Care Manager Organization and Its Association with Health Care Contacts and Psychotherapy: A Register-Based Study of Real-Life Outcomes at Primary Health Care Centers in Sweden.
  • 2021
  • Ingår i: International Journal of General Medicine. - 1178-7074. ; 14, s. 5621-5630
  • Tidskriftsartikel (refereegranskat)abstract
    • A care manager organization, based on a collaborative care model, was implemented in the primary health care service in Region Västra Götaland, Sweden, to improve the care of persons with common mental disorders (CMDs). We aimed to investigate the association between the care manager organization and number of health care contacts, and the extent of psychotherapy among female and male patients with CMD compared to primary health care centers (PHCCs) offering usual care, in the introductory year of implementation with one year follow-up.This register-based study included all PHCCs in the region, which were analyzed in two groups depending on their care manager status. The study periods were 2015.09.01-2016.08.31 (first year) and 2016.09.01-2017.08.31 (second year). Data on health care contacts and psychotherapy per PHCC were obtained from a health care register. The mean number and proportion of visits to different health care professionals, and the proportion of patients with short-term versus long-term psychotherapy were measured. A linear mixed-effects model for cross-sectional and longitudinal analysis was implemented as well as a generalized linear regression model for possible interaction effects of PHCC characteristic on care manager status and outcomes.PHCCs with a care manager organization had more nurse contacts (p = 0.001 for both year 1 and year 2) compared to PHCCs with usual care. PHCCs with usual care had a significantly lower proportion of visits to psychotherapists and a higher proportion of both female and male patients receiving short-term psychotherapy (1-5 sessions vs ≥6) over time and compared to PHCCs with a care manager organization.With a care manager organization, nurse contacts increased at the PHCCs. However, this did not negatively influence the visits to a general practitioner and to psychotherapists. This evaluation showed that the care manager organization at PHCC level implies higher accessibility and sustainability of care for up to two years after implementation.
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