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Sökning: WFRF:(Björck Karin)

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1.
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2.
  • Andréasson, Karin, et al. (författare)
  • Body mass index in adolescence, risk of type 2 diabetes and associated complications: A nationwide cohort study of men
  • 2022
  • Ingår i: EClinicalMedicine. - : Elsevier BV. - 2589-5370. ; 46
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Obesity is a predominant factor in development of type 2 diabetes but to which extent adolescent obesity influences adult diabetes is unclear. We investigated the association between body mass index (BMI) in young men and subsequent type 2 diabetes and how, in diagnosed diabetes, adolescent BMI relates to glycemic control and diabetes complications. Methods Baseline data from the Swedish Conscript Register for men drafted 1968-2005 was combined with data from the National Diabetes and Patient registries. Diabetes risk was estimated through Cox regression and Kaplan-Meier survival estimates. Relationships between BMI, glycemic control and diabetes complications were assessed through multiple linear and logistic regression. Findings Among 1,647,826 men, 63,957 (3.88%) developed type 2 diabetes over a median follow-up of 29.0 years (IQR[21.0-37.0]). The risk of diabetes within 40 years after conscription was nearly 40% in individuals with adolescent BMI >= 35 kg/m(2). Compared to BMI 18.5-<20 kg/m(2) (reference), diabetes risk increased in a linear fashion from HR 1.18(95%CI 1.15-1.21) for BMI 20-<22.5 kg/m(2) to HR 15.93(95%CI 14.88-17.05) for BMI >= 35 kg/m(2), and a difference in age at onset of 11.4 years was seen. Among men who developed diabetes, higher adolescent BMI was associated with higher HbA1c levels and albuminuria rates. Interpretation Rising adolescent BMI was associated with increased risk of type 2 diabetes diagnosed at a younger age, with poorer metabolic control, and a greater prevalence of albuminuria, all suggestive of worse prognosis. Copyright (C) 2022 The Authors. Published by Elsevier Ltd.
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3.
  • Bager, Johan-Emil, et al. (författare)
  • Treatment of hypertension in old patients without previous cardiovascular disease.
  • 2019
  • Ingår i: Journal of hypertension. - 1473-5598. ; 37:11, s. 2269-2279
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to compare the risk of cardiovascular disease (CVD) - nonfatal acute myocardial infarction (AMI) or stroke - at blood pressure levels that meet current recommendations with risk at lower levels, particularly in older patients.We identified patients with hypertension aged 40-90 years from a primary care register. Patients with a history of cancer, diabetes mellitus or CVD were excluded. Patients were divided into age groups (40-75 and 76-90), and four groups of SBP 110-129, 130-139 (reference), 140-149 and ≥150mmHg. We used the Kaplan-Meier estimator to study incidence of AMI, stroke and a composite of the two. Cox proportional-hazards regression was used to estimate hazard ratios for outcomes.We included 31704 patients: 26663 were 40-75 years old and 5041 were 76-90 years old. Mean follow-up was 2 years. Although no significant differences in risk of any outcome were found in the younger group, low blood pressure was associated with the lowest risk in the older group. Older patients in the 110-129mmHg group had a lower incidence of CVD (15.9/1000 vs. 25.3/1000 person-years) than the reference group. After adjustment for covariates, the hazard ratio of CVD in older patients in the 110-129mmHg group compared with the reference group was 0.60 (95% confidence interval 0.40-0.92).Blood pressure levels lower than those currently recommended are not harmful among older patients. The association between lower SBP and lesser risk of CVD may instead suggest a beneficial effect of lower SBP.
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4.
  • Bager, Johan-Emil, et al. (författare)
  • Trends in blood pressure, blood lipids, and smoking from 259 753 patients with hypertension in a Swedish primary care register: results from QregPV.
  • 2022
  • Ingår i: European journal of preventive cardiology. - : Oxford University Press (OUP). - 2047-4881 .- 2047-4873. ; 29:1, s. 158-166
  • Tidskriftsartikel (refereegranskat)abstract
    • To describe 8-year trends in blood pressure (BP) control, blood lipid control, and smoking habits in patients with hypertension from QregPV, a primary care register in the Region of Västra Götaland, Sweden.QregPV features clinical data on BP, low-density lipoprotein cholesterol (LDL-C), and smoking habits in 392 277 patients with hypertension or coronary heart disease or diabetes mellitus or any combination of the three diagnoses. Data from routine clinical practice have been automatically reported on a monthly basis to QregPV from all primary care centres in Västra Götaland (population 1.67 million) since 2010. Additional data on diagnoses, dispensed drugs and socioeconomic factors were acquired through linkage to regional and national registers. We identified 259 753 patients with hypertension, but without coronary heart disease and diabetes mellitus, in QregPV. From 2010 to 2017, the proportion of patients with BP <140/90mmHg increased from 38.9% to 49.1%, while the proportion of patients with LDL-C <2.6mmol/L increased from 19.7% to 21.1% and smoking decreased from 15.7% to 12.3%. However, in 2017, only 10.0% of all patients with hypertension had attained target levels of BP <140/90mmHg, LDL-C<2.6mmol/L while being also non-smokers. The remaining 90.0% were still exposed to at least one uncontrolled, modifiable risk factor for cardiovascular disease.These regionwide data from eight consecutive years in 259 753 patients with hypertension demonstrate a large potential for risk factor improvement. An increased use of statins and antihypertensive drugs should, in addition to lifestyle modifications, decrease the risk of cardiovascular disease in these patients.
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5.
  • Bergman, Annika, et al. (författare)
  • Genome-wide linkage scan for breast cancer susceptibility loci in Swedish hereditary non-BRCA1/2 families : Suggestive linkage to 10q23.32-q25.3
  • 2007
  • Ingår i: Genes, Chromosomes and Cancer. - : John Wiley & Sons. - 1045-2257 .- 1098-2264. ; 46:3, s. 302-309
  • Tidskriftsartikel (refereegranskat)abstract
    • The two breast cancer genes BRCA1 and BRCA2 were identified more than 10 years ago and, depending on population, mutations in these genes are responsible for a varying percentage of familial breast cancer. In more than half the families, the increased risk of breast cancer cannot be explained by mutations in these genes, and the goal of this study was to locate novel susceptibility genes. One of the main difficulties in identifying the cause of hereditary non-BRCA1/BRCA2 breast cancer is genetic heterogeneity, possibly due to multiple, incompletely penetrant susceptibility genes, along with ethnic and geographic differences. In this study, one large family and 13 small to medium-sized families with multiple cases of breast cancer were analyzed by genome-wide linkage analysis. The genome scan was performed by genotype analysis of 10,000 SNP markers on microarrays. The strongest evidence of linkage (HLOD 2.34) was obtained on chromosome region 10q23.32-q25.3. A further two regions were identified, with LOD scores above 2.10 on 12q14-q21 and 19p13.3-q12. In a subset of families of western Swedish origin, two regions generated LOD scores exceeding 1.8: 10q23.32-q25.3 and 19q13.12-q13.32. The large family in the study exceeded LOD 1.5 in three regions: 10q23.32-q25.3, 19q13.12-q13.32, and 17p13. Our results indicate that one or more of the suggested regions may harbor genes that are involved in the development of breast cancer. 
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6.
  • Bernhoff, Karin, et al. (författare)
  • Iatrogenic popliteal artery injury in non arthroplasty knee surgery
  • 2015
  • Ingår i: The Bone &amp; Joint Journal. - 2049-4394 .- 2049-4408. ; 97B:2, s. 192-196
  • Tidskriftsartikel (refereegranskat)abstract
    • We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intraoperatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support.
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7.
  • Bernhoff, Karin, 1972-, et al. (författare)
  • Incidence and Outcome of Popliteal Artery Injury Associated with Knee Dislocations, Ligamentous Injuries, and Close to Knee Fractures : A Nationwide Population Based Cohort Study
  • 2021
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier. - 1078-5884 .- 1532-2165. ; 61:2, s. 297-304
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Arterial injury in knee trauma is rare but can be devastating if the diagnosis is delayed. The frequency of concomitant arterial injury resulting from knee dislocations remains unclear, and from knee fractures it remains unknown. The primary aim was to investigate the incidence of arterial injury in knee trauma requiring hospitalisation. Secondary aims were to identify risk factors and describe outcome. Methods: Traumatic popliteal artery injury and knee trauma were identified by International Classification of Diseases (ICD)-10 codes from the Swedish National Inpatient registry (NPR), 1998-2014 and linked with data using the unique personal identification number with the National Registry for vascular surgery (Swedvasc). Risk factors for popliteal artery injury (PAI) such as cause of injury, comorbidities and injury severity were extracted from the NPR. Socio-economic status data and population count came from Statistics Sweden, and cause and date of death from the Swedish Cause of Death Registry. Results: A total of 71 149 admissions due to all knee trauma were identified, and 359 with simultaneous PAls. Some of those injuries were non-orthopaedic. The proportion of PAI after knee dislocation ranged between 3.4% (46/1370 dislocations or multiligamentous injuries) and 8.2% (46/564 dislocations), and 0.2% after fracture close to the knee (60/36 483). The most common causes of injury with PAI were falls causing knee dislocations and motor vehicle accidents (MVAs) causing fractures. The fact that all 46 injuries occurring after multiligamentous injuries were classified as knee dislocations is probably explained by the fact that the ICD codes are chosen retrospectively when the patient leaves the hospital. Conclusion: PAI after knee dislocation is not uncommon, and most frequently caused by a fall. PAI associated with knee fracture is rare and mostly caused by a MVA, while in low energy knee fractures PAI is practically non-existent.
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8.
  • Bernhoff, Karin, 1972- (författare)
  • Orthopaedic Patients with Lower Limb Vascular Injuries
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Vascular injuries in lower limbs are rare but serious events. If not detected and managed correctly and timely they can lead to permanent functional impairment and even limb loss. The increasing number of orthopaedic interventions, worldwide, makes awareness of this problem among orthopaedic surgeons important.The overall aim of this thesis was to describe lower limb orthopaedic injuries with associated concomitant arterial injuries, especially to the popliteal artery. Epidemiology, mechanisms of injury, management, outcomes and the patient perspective were all addressed. The research questions were generated from clinical praxis. Vascular injuries are rare events, but by using as the National Patient (NPR) and National Vascular registries (Swedvasc) a relatively speaking large cohort was studied. Deep interviews with qualitative study method were used to investigate the patients’ perspective.In papers I and II iatrogenic popliteal artery injuries (PAI) in knee-replacements, and in non-knee-replacements, were investigated. The number of knee arthroplasties in Sweden increased 1987-2008, but not the frequency of iatrogenic PAI. The most common mechanism of injury was sharp, directly to the artery. One third of the injuries resulted in pseudo-aneurysms. This was an unexpected and important finding, since these patients were often diagnosed late, resulting in poor outcome.Paper III. The interviewed patients narrated substantial functional, cosmetic and psychological impairments,4-17 years after their accidents, yet they described their lives as “normal”. Patients with saved limbs reported a need for better interpersonal support in their rehabilitation and adaptation back to “normal” life.Paper IV. Popliteal artery injury is feared in knee dislocations and fractures. The proportion incidence of vascular injury was previously reported to be 2-60%. In this large population-based study, the incidence proportion in knee dislocations was 3.4-8.2%, depending on the definition of dislocation/ligamentous injury. In knee fractures the incidence proportion was lower, only 0.2%. The dominating cause of arterial injury in knee dislocations was fall, in knee fractures it was motor vehicle accidents. Amputation- free survival after arterial injury was inferior in knee fractures compared with knee dislocations.In conclusion, PAI is a serious injury but on sequences can be limited by awareness and timely action.
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9.
  • Bernhoff, Karin, et al. (författare)
  • Patient Experiences of Life Years After Severe Civilian Lower Extremity Trauma With Vascular Injury
  • 2016
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 52:5, s. 690-695
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Severe lower limb trauma with arterial injury is often devastating for the individual. Many studies describe how to manage these injuries when they occur. Short-term functional outcome is quite well described, but the patients are often young, and their suffering is physical, mental, and social from a lifelong perspective. The aim of this study was to report patient experiences of their lives several years after their accidents, and to explore mechanisms of how to improve management.METHOD: The Swedvasc registry was searched for participants from 1987 to 2011, living in the region of Uppsala, Sweden. Some amputated participants were added from the Walking Rehabilitation Center. There were five reconstructed patients with an intact limb, and three with amputations. In depth interviews were conducted and systematically analyzed, using A Giorgi's descriptive phenomenological method.RESULTS: Eight patients participated, five with reconstructed and three with amputated limbs. Life affecting functional impairments were described by all patients. The patients undergoing amputation had received more structured follow up and support through the Walking Rehabilitation Center. The satisfaction with the cosmetic result was poorer than expected. All patients had developed strategies of how to cope with their impairments and stated they now lived "normal lives."CONCLUSIONS: Despite substantial physical, psychological, and cosmetic impairments years after severe lower limb trauma, the participants described life as "normal" and mainly satisfactory. Transition to the new situation could have been facilitated by more frequent and continuous follow up after discharge from hospital, in particular among the non-amputated patients who tend to be lost to follow up. Findings also indicate that family members have to be acknowledged, strengthened, and supported.
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10.
  • Bernhoff, Karin, et al. (författare)
  • Popliteal artery injury in knee arthroplasty : a population based, nationwide study
  • 2013
  • Ingår i: Journal of Bone and Joint Surgery. - 0301-620X .- 2044-5377. ; 95:12, s. 1645-1649
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Popliteal artery injury (PAI) is a feared but rare complication during knee arthroplasty (KA). The aim was to study PAI during KA: Type of injury, treatment and outcome.Thirty-two cases were identified in the national Swedish vascular registry (Swedvasc) and the Swedish Patient Insurance databases. Prospective data from the registries was supplemented with case-records, including long-term follow-up.Twenty-five injuries (78%) were due to penetrating, seven to blunt trauma. Three different presentations of injury were identified: Bleeding (n=14), ischaemia (n=7) and false aneurysm formation (n=11). Five (16%) cases were during revision KA. Twelve injuries (38%) were detected intraoperatively, eight (25%) within 24 hours (range 3-24) and twelve (38%) >24 hours postoperatively (range 2-90), 28 (88%) were treated with open surgery. Patency at 30 days was 97% (one amputation). Twenty-five (78%) patients had residual symptoms at the end of follow-up (median 546 days, range: 24-1251). Six of the seven patients with complete recovery had an early diagnosis of the PAI during the procedure, and were treated by a vascular surgeon in the same hospital.Outcome after popliteal artery injury during KA is often negatively affected by diagnostic and therapeutic delay. Bleeding and pseudoaneurysm were the most common clinical presentations.
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12.
  • Björck, Hanna, et al. (författare)
  • Association of genetic variation on chromosome 9p21.3 and arterial stiffness
  • 2009
  • Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 265:3, s. 373-381
  • Tidskriftsartikel (refereegranskat)abstract
    • Genome wide association studies have consistently reported associations between a region on chromosome 9p21.3 and a broad range of vascular diseases, such as coronary artery disease (CAD), aortic and intracranial aneurysms and type-2 diabetes (T2D). However, clear associations with intermediate phenotypes have not been described so far. To shed light on a possible influence of this chromosomal region on arterial wall integrity, we analysed associations between single nucleotide polymorphisms (SNPs) and degree of stiffness of the abdominal aorta in elderly individuals.A total of 400 subjects, 212 men and 188 women, aged 70-88 years were included. Arterial stiffness was examined at the midpoint between the renal arteries and the aortic bifurcation. Two CAD- and aneurysm-associated SNPs (rs10757274 and rs2891168) and one T2D-associated SNP (rs1081161) within the 9p21.3 region were genotyped. Aortic compliance and distensibility coefficients were higher in carriers of the rs10757274G and rs2891168G alleles in men reflecting a decrease in aortic stiffness. Adjustment for age and mean arterial pressure had no effect on these associations. The two SNPs were not associated with intima-media thickness or lumen diameter of the abdominal aorta. There were no associations between the rs10811661 SNP and any measure of aortic stiffness.Impaired mechanical properties of the arterial wall may explain the association between chromosome 9p21.3 polymorphisms and vascular disease.
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13.
  • Björck, Hanna, et al. (författare)
  • Gender-specific association of the plasminogen activator inhibitor-1 4G/5G polymorphism with central arterial blood pressure
  • 2011
  • Ingår i: American Journal of Hypertension. - New York, USA : Nature Publishing Group. - 0895-7061 .- 1941-7225. ; 24:7, s. 802-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The functional plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism has previously been associated with hypertension. In recent years, central blood pressure, rather than brachial has been argued a better measure of cardiovascular damage and clinical outcome. The aim of this study was to investigate the possible influence of the 4G/5G polymorphism on central arterial blood pressure in a cohort of elderly individuals.Methods: We studied 410 individuals, 216 men and 194 women, aged 70-88. Central pressures and pulse waveforms were calculated from the radial artery pressure waveform by the use of the SphygmoCor system and a generalized transfer function. Brachial pressure was recorded using oscillometric technique (Dinamap, Critikon, Tampa, FL). PAI-1 antigen was determined in plasma.Results: The results showed that central pressures were higher in women carrying the PAI-1 4G/4G genotype compared to female carriers of the 5G/5G genotype, (P = 0.025, P = 0.002, and P = 0.002 for central systolic-, diastolic-, and mean arterial pressure, respectively). The association remained after adjustment for potentially confounding factors related to hypertension. No association of the PAI-1 genotype with blood pressure was found in men. Multiple regression analysis revealed an association between PAI-1 genotype and plasma PAI-1 levels (P = 0.048).Conclusions: Our findings show a gender-specific association of the PAI-1 4G/5G polymorphism with central arterial blood pressure. The genotype effect was independent of other risk factors related to hypertension, suggesting that impaired fibrinolytic potential may play an important role in the development of central hypertension in women.
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14.
  • Brinch, Rebecca, 1973- (författare)
  • Att växa sidledes : Tematik, barnsyn och konstnärlig gestaltning i Suzanne Ostens scenkonst för unga
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of this thesis is to highlight and discuss the artistic force, potential and significance of performing arts for children and young audiences through the example of the work by Suzanne Osten. The focus of this research is on themes, notions of the child and artistic expressions and strategies. The dissertation discusses both the aesthetic and the political aspects of Osten’s theatre for young audiences and takes an interdisciplinary approach, combining theatre and performance studies and childhood studies. A fundamental assumption is that childhood is not a fixed or stable phase that manifests itself in one particular way for all children during all times. Another assumption is that theatre is more than what is visually apparent on stage. What is staged does not take place inside a vacuum, but is closely connected to the surrounding society and culture. To study theatre for young audiences as a cultural expression is therefore, to a great extent, also about analysing notions of the child.Five performances have been selected, all for young audiences: Paddakvariet (The Toad Aquarium, 1988, for ages 10 and over), Delfinen (The Dolphin, 1992, for ages 3 and over), Irinias nya liv (Irina’s New Life, 1996, for ages 9 and over), Flickan, mamman och soporna (The Girl, the Mother and the rubbish, 1998, for ages 7 and over), and Lammungarnas fest (The Baa-lambs Holiday, 2014, for ages 13 and over). A model for performance analysis has been constructed, based on hermeneutics and semiotics, complemented by three key theoretical concepts. Firstly focalization, as used by theatre scholar Maaike Bleeker, in order to understand the interaction between the spectator and the visions produced by the apparatus of performance. The reasoning of theatre scholar Gay McAuley about space in performance is used to examine how space is utilized and retained in the performances, while the notion of utopian performative by theatre scholar Jill Dolan provides tools to discuss how moments of ‘feeling utopia’ are a significant part of the selected works which raises questions of the transformative and affective power of theatre. In order to contextualize and historicise the analyses, the response of the performances is also taken into account drawing mainly on theatre reviews.As a whole the analyses show Osten’s theatre for young audiences as an ongoing research project problematizing the situation and position of children in society, as well as the view of art for children. Ostens performances for young audiences exhibit and make possible notions of a child outside of the norm in late 20th and early 21st century childhood discourses both within research and society as a whole. Osten’s theatre and artistry are identified as growing sideways, developing in unexpected directions while disrupting ideas about childhood and adulthood, and also what can be viewed as theatre for children and theatre for adults. The dissertation states that Osten’s theatre for young audiences can be seen as pioneering, not only in the field of children’s theatre, but also for the development and renewal of Swedish theatre in general.
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15.
  • Carlhed, Carina, 1967- (författare)
  • Medicinens lyskraft och skuggor : ― om trosföreställningar och symbolisk makt i habiliteringen 1960–1980
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The dissertation examines the formation of specific groups, their interests and positions related to children with disabilities and their education and care in Sweden developed during 1960-1980. The theoretical framework is based on Pierre Bourdieu’s sociological theory of social space, which assumes that social life is based on symbolic and cultural systems of beliefs with respectively specific doxas and symbolic economies. Consequently, the analysis has focused on the agents’ position-takings and their struggle for recognition and preferential rights of interpretations. The reconstruction of a “habilitation sphere” was conducted through agents, their positions of interests and position-takings as analytical tools. The positions were mainly reconstructed on articles in journals of 10 professional organizations covering 6 occupations and 4 disability organizations. The occupational groups were paediatric doctors/child psychiatrists, physiotherapists, occupational therapists, social workers, psychologists and pre-school teachers. The other positions were related to the county council union, four disability organizations (DHR, FUB, RBU and HCK), two of which were parent organizations and in addition, the research field of social medicine. Other materials were e.g. reports of commissions of inquiry. In order to explore the social foundations of the occupational positions, materials from archives have been used. The conclusion shows the significance of: a) historical structures related to the exceptional position of medicine in society, the development of the Swedish health care system in general and the organizations of “special” children, b) commissions of inquiry as consecration authorities and processes of social mobilization, both important contributions in shaping symbolic economies, c) myths and ideologies in the exercising of symbolic power, d) alliances between the state and medicine, and between occupational groups and clients. The analysis also shows the strengths of the doxas which could work as a shield for the agents but also as obstacles for external agents when entering the habilitation sphere. The dissertation examines the formation of specific groups, their interests and positions related to children with disabilities and their education and care in Sweden developed during 1960-1980. The theoretical framework is based on Pierre Bourdieu’s sociological theory of social space, which assumes that social life is based on symbolic and cultural systems of beliefs with respectively specific doxas and symbolic economies. Consequently, the analysis has focused on the agents’ position-takings and their struggle for recognition and preferential rights of interpretations. The reconstruction of a “habilitation sphere” was conducted through agents, their positions of interests and position-takings as analytical tools. The positions were mainly reconstructed on articles in journals of 10 professional organizations covering 6 occupations and 4 disability or-ganizations. The occupational groups were paediatric doctors/child psychiatrists, physiothera-pists, occupational therapists, social workers, psychologists and pre-school teachers. The other positions were related to the county council union, four disability organizations (DHR, FUB, RBU and HCK), two of which were parent organizations and in addition, the research field of social medicine. Other materials were e.g. reports of commissions of inquiry. In order to explore the social foundations of the occupational positions, materials from archives have been used. The conclusion shows the significance of: a) historical structures related to the exceptional position of medicine in society, the development of the Swedish health care system in general and the organizations of “special” children, b) commissions of inquiry as consecration authorities and processes of social mobilization, both important contributions in shaping symbolic economies, c) myths and ideologies in the exercising of symbolic power, d) alliances between the state and medicine, and between occupational groups and clients. The analysis also shows the strengths of the doxas which could work as a shield for the agents but also as obstacles for external agents when entering the habilitation sphere.
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16.
  • Carlhed, Carina, 1967- (författare)
  • Medicinens lyskraft och skuggor : ― om trosföreställningar och symbolisk makt i habiliteringen 1960―1980
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • BAKGRUND Bakgrunden till denna avhandling är att erbjuda ett alternativt sätt att förstå habiliteringspraktik. Den teoretiska ramen i avhandlingen är Pierre Bourdieus fältteori, vilket innebär ett antagande att det sociala livet bygger på symboliska och kulturella trossystem med hithörande doxor, med egna slags symboliska ekonomier och dominansförhållanden. Analysen har inneburit att rekonstruera och analysera ett kampfält, det vill säga att studera agenter som företräder olika intressen och deras kamp för erkännande och tolkningsföreträde. Vad som framkommer i denna avhandling kan hjälpa till att belysa varför habiliteringen blev som den blev. SYFTE Avhandlingens syfte är att analysera trosföreställningar och symbolisk makt inom habiliteringsområdet - det vill säga det symboliska kraftfält som skapades av specifika gruppers formering, intressen och ställningstaganden kring barn och ungdomar med handikapp i Sverige under perioden 1960-1980. METOD Avhandlingen har en historiesociologisk ansats. I analysen har intressepositioner rekonstruerats utifrån tidskrifter som är knutna till fackförbund, intresseorganisationer samt till det socialmedicinska forskningsfältet. Bakom dessa tidskrifter finns således mobiliserade grupper som agerar kollektivt genom sina föreningar och förbund. Tidskrifterna är knutna till yrkesgrupper: läkare, sjukgymnaster, arbetsterapeuter, förskollärare, socionomer och psykologer samt till Förbundet för utvecklingsstörda barn, ungdomar och vuxna - FUB, Riksförbundet för Rörelsehindrade barn och ungdomar - RBU och Handikapporganisationernas centralkommitté - HCK (idag HSO). Även arkivmaterial avseende löner för de olika yrkesgrupperna har använts. Analysen har huvudsakligen rört gruppernas positioneringar i förhållande till den dominanta doxan men också den sociala basen för gruppernas positioner. RESULTAT Avhandlingens konklusion visar betydelsen av: a) historiska strukturer avseende medicinens särställning i samhället och utvecklingen av hälso- och sjukvården i stort samt omhändertagandet av barn med funktionshinder. b) offentliga utredningar som konsekrationsinstanser och sociala mobiliseringsprocesser var viktiga delar i uppbyggandet av symboliska ekonomier. c) myter och ideologier i utövandet av symbolisk makt. d) allianser mellan stat och medicinen samt mellan yrkesgrupper och klienter. Avhandlingen visar också styrkan i doxorna och vilka konsekvenser det kunde innebära att lämna ett socialt fält man var skolad inom. Samklangen mellan doxa och fält fanns inte riktigt i det nya sammanhanget, vilket innebär ett slags strukturella glapp. Konsekvenserna kunde vara att man hamnade i en parialiknande situation utan skydd från det fält man lämnade, likt en "avfälling" och dessutom att det mottagande fältet inte riktigt erkände dem. SLUTSATS Inom medicinens fält konstituerades under den här tidsperioden en "habiliteringssfär" där medicinens doxa var dominant. Genom sociala mobiliseringsprocesser och klassificeringsstrider bidrog dessa till skapandet av olika grupperingar, symboler och ömsesidiga erkännanden av vissa symboliska värden rörande hur man skulle se på omhändertagandet av barn med handikapp.BAKGRUND Bakgrunden till denna avhandling är att erbjuda ett alternativt sätt att förstå habiliteringspraktik. Den teoretiska ramen i avhandlingen är Pierre Bourdieus fältteori, vilket innebär ett antagande att det sociala livet bygger på symboliska och kulturella trossystem med hithörande doxor, med egna slags symboliska ekonomier och dominansförhållanden. Analysen har inneburit att rekonstruera och analysera ett kampfält, det vill säga att studera agenter som företräder olika intressen och deras kamp för erkännande och tolkningsföreträde. Vad som framkommer i denna avhandling kan hjälpa till att belysa varför habiliteringen blev som den blev. SYFTE Avhandlingens syfte är att analysera trosföreställningar och symbolisk makt inom habiliteringsområdet - det vill säga det symboliska kraftfält som skapades av specifika gruppers formering, intressen och ställningstaganden kring barn och ungdomar med handikapp i Sverige under perioden 1960-1980. METOD Avhandlingen har en historiesociologisk ansats. I analysen har intressepositioner rekonstruerats utifrån tidskrifter som är knutna till fackförbund, intresseorganisationer samt till det socialmedicinska forskningsfältet. Bakom dessa tidskrifter finns således mobiliserade grupper som agerar kollektivt genom sina föreningar och förbund. Tidskrifterna är knutna till yrkesgrupper: läkare, sjukgymnaster, arbetsterapeuter, förskollärare, socionomer och psykologer samt till Förbundet för utvecklingsstörda barn, ungdomar och vuxna - FUB, Riksförbundet för Rörelsehindrade barn och ungdomar - RBU och Handikapporganisationernas centralkommitté - HCK (idag HSO). Även arkivmaterial avseende löner för de olika yrkesgrupperna har använts. Analysen har huvudsakligen rört gruppernas positioneringar i förhållande till den dominanta doxan men också den sociala basen för gruppernas positioner. RESULTAT Avhandlingens konklusion visar betydelsen av: a) historiska strukturer avseende medicinens särställning i samhället och utvecklingen av hälso- och sjukvården i stort samt omhändertagandet av barn med funktionshinder. b) offentliga utredningar som konsekrationsinstanser och sociala mobiliseringsprocesser var viktiga delar i uppbyggandet av symboliska ekonomier. c) myter och ideologier i utövandet av symbolisk makt. d) allianser mellan stat och medicinen samt mellan yrkesgrupper och klienter. Avhandlingen visar också styrkan i doxorna och vilka konsekvenser det kunde innebära att lämna ett socialt fält man var skolad inom. Samklangen mellan doxa och fält fanns inte riktigt i det nya sammanhanget, vilket innebär ett slags strukturella glapp. Konsekvenserna kunde vara att man hamnade i en parialiknande situation utan skydd från det fält man lämnade, likt en "avfälling" och dessutom att det mottagande fältet inte riktigt erkände dem. SLUTSATS Inom medicinens fält konstituerades under den här tidsperioden en "habiliteringssfär" där medicinens doxa var dominant. Genom sociala mobiliseringsprocesser och klassificeringsstrider bidrog dessa till skapandet av olika grupperingar, symboler och ömsesidiga erkännanden av vissa symboliska värden rörande hur man skulle se på omhändertagandet av barn med handikapp.
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17.
  • Dikaiou, Pigi, et al. (författare)
  • Obesity, overweight and risk for cardiovascular disease and mortality in young women
  • 2021
  • Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 28:12, s. 1351-1359
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims The aim of this study was to investigate the relation between body mass index (BMI) in young women, using weight early in pregnancy as a proxy for pre-pregnancy weight, and risk for early cardiovascular disease (CVD) and mortality. Methods and results In this prospective, registry-based study, we used weight data in early pregnancy from women, registered in the Swedish Medical Birth Registry, and who gave birth between 1982 and 2014 (n = 1,495,499; median age 28.3 years). Of the women, 118,212 (7.9%) were obese (BMI >= 30 kg/m(2)) and 29,630 (2.0%) severely obese (BMI >= 35 kg/m(2)). After a follow-up of median 16.3 years, we identified 3295 and 4375 cases of acute myocardial infarction (AMI) and ischemic stroke (IS) corresponding to 13.4 and 17.8 per 100,000 observation years, respectively, occurring at mean ages of 49.8 and 47.3 years. Compared to women with a BMI 20-<22.5 kg/m(2), the hazard ratio (HR) of AMI increased with higher BMI from 1.40 (95% confidence interval (CI) 1.27-1.54) among women with BMI 22.5-<25.0 kg/m(2) to 4.71 (95% CI 3.88-5.72) among women with severe obesity, with similar findings for IS and CVD death, after adjustment for age, pregnancy year, parity and comorbidities at baseline. Women with BMI 30-<35.0 and >= 35 kg/m(2) had increased all-cause mortality with adjusted HR 1.53 (95% CI 1.43-1.63) and 1.83 (95% CI 1.63-2.05), respectively. Conclusion A significant increase in the risk for early AMI, IS and CVD death was noticeable in overweight young women, with a marked increase in obese women.
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18.
  • Edqvist, Jon, 1988, et al. (författare)
  • Severe COVID-19 Infection in Type 1 and Type 2 Diabetes During the First Three Waves in Sweden.
  • 2023
  • Ingår i: Diabetes care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 46:3, s. 570-578
  • Tidskriftsartikel (refereegranskat)abstract
    • Type 2 diabetes is an established risk factor for hospitalization and death in COVID-19 infection, while findings with respect to type 1 diabetes have been diverging.Using nationwide health registries, we identified all patients aged ≥18 years with type 1 and type 2 diabetes in Sweden. Odds ratios (ORs) describe the general and age-specific risk of being hospitalized, need for intensive care, or dying, adjusted for age, socioeconomic factors, and coexisting conditions, compared with individuals without diabetes. Machine learning models were used to find predictors of outcomes among individuals with diabetes positive for COVID-19.Until 30 June 2021, we identified 365 (0.71%) and 11,684 (2.31%) hospitalizations in 51,402 and 504,337 patients with type 1 and 2 diabetes, respectively, with 67 (0.13%) and 2,848 (0.56%) requiring intensive care unit (ICU) care and 68 (0.13%) and 4,020 (0.80%) dying (vs 7,824,181 individuals without diabetes [41,810 hospitalizations (0.53%), 8,753 (0.11%) needing ICU care, and 10,160 (0.13%) deaths). Although those with type 1 diabetes had moderately raised odds of being hospitalized (multiple-adjusted OR 1.38 [95% CI 1.24-1.53]), there was no independent effect on ICU care or death (OR of 1.21 [95% CI 0.94-1.52] and 1.13 [95% CI 0.88-1.48], respectively). Age and socioeconomic factors were the dominating features for predicting hospitalization and death in both types of diabetes.Type 2 diabetes was associated with increased odds for all outcomes, whereas patients with type 1 diabetes had moderately increased odds of hospitalization but not ICU care and death.
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19.
  • Fegraeus, Kim, et al. (författare)
  • An endothelial regulatory module links blood pressure regulation with elite athletic performance
  • 2024
  • Ingår i: PLOS Genetics. - : Public Library of Science (PLoS). - 1553-7390 .- 1553-7404. ; 20:6
  • Tidskriftsartikel (refereegranskat)abstract
    • The control of transcription is crucial for homeostasis in mammals. A previous selective sweep analysis of horse racing performance revealed a 19.6 kb candidate regulatory region 50 kb downstream of the Endothelin3 (EDN3) gene. Here, the region was narrowed to a 5.5 kb span of 14 SNVs, with elite and sub-elite haplotypes analyzed for association to racing performance, blood pressure and plasma levels of EDN3 in Coldblooded trotters and Standardbreds. Comparative analysis of human HiCap data identified the span as an enhancer cluster active in endothelial cells, interacting with genes relevant to blood pressure regulation. Coldblooded trotters with the sub-elite haplotype had significantly higher blood pressure compared to horses with the elite performing haplotype during exercise. Alleles within the elite haplotype were part of the standing variation in pre-domestication horses, and have risen in frequency during the era of breed development and selection. These results advance our understanding of the molecular genetics of athletic performance and vascular traits in both horses and humans.
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20.
  • Freiholtz, David, et al. (författare)
  • SPP1/osteopontin : a driver of fibrosis and inflammation in degenerative ascending aortic aneurysm?
  • 2023
  • Ingår i: Journal of Molecular Medicine. - : Springer Nature. - 0946-2716 .- 1432-1440. ; 101:10, s. 1323-1333
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract: Degenerative ascending aortic aneurysm (AscAA) is a silent and potentially fatal disease characterized by excessive vascular inflammation and fibrosis. We aimed to characterize the cellular and molecular signature for the fibrotic type of endothelial mesenchymal transition (EndMT) that has previously been described in degenerative AscAA. Patients undergoing elective open-heart surgery for AscAA and/or aortic valve repair were recruited. Gene expression in the intima-media of the ascending aorta was measured in 22 patients with non-dilated and 24 with dilated aortas, and candidate genes were identified. Protein expression was assessed using immunohistochemistry. Interacting distal gene enhancer regions were identified using targeted chromosome conformation capture (HiCap) in untreated and LPS-treated THP1 cells, and the associated transcription factors were analyzed. Differential expression analysis identified SPP1 (osteopontin) as a key gene in the signature of fibrotic EndMT in patients with degenerative AscAA. The aortic intima-media expression of SPP1 correlated with the expression of inflammatory markers, the level of macrophage infiltration, and the aortic diameter. HiCap analysis, followed by transcription factor binding analysis, identified ETS1 as a potential regulator of SPP1 expression under inflammatory conditions. In conclusion, the present findings suggest that SPP1 may be involved in the development of the degenerative type of AscAA. Key messages: In the original manuscript titled “SPP1/osteopontin, a driver of fibrosis and inflammation in degenerative ascending aortic aneurysm?” by David Freiholtz, Otto Bergman, Saliendra Pradhananga, Karin Lång, Flore-Anne Poujade, Carl Granath, Christian Olsson, Anders Franco-Cereceda, Pelin Sahlén, Per Eriksson, and Hanna M Björck, we present novel findings on regulatory factors on osteopontin (SPP1) expression in immune cells involved in degenerative ascending aortic aneurysms (AscAA). The central findings convey: SPP1 is a potential driver of the fibrotic endothelial-to-mesenchymal transition in AscAA.SPP1/osteopontin expression in AscAA is predominately by immune cells.ETS1 is a regulatory transcription factor of SPP1 expression in AscAA immune cells.
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21.
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22.
  • Friberg, Camilla, et al. (författare)
  • Analysis of chromosome 5q31-32 and psoriasis: confirmation of a susceptibility locus but no association with SNPs within SLC22A4 and SLC22A5.
  • 2006
  • Ingår i: The Journal of investigative dermatology. - : Elsevier BV. - 0022-202X. ; 126:5, s. 998-1002
  • Tidskriftsartikel (refereegranskat)abstract
    • We have previously reported a region on chromosome 5q as a possible susceptibility region for psoriasis. This cytokine cluster-rich region has also been suggested as a susceptibility locus in other autoimmune or inflammatory diseases including Crohn's disease (CD) and rheumatoid arthritis (RA). Three specific single-nucleotide polymorphisms (SNPs) have been reported to associate with RA and CD and to change the functional activity of two organic cation transporters, solute carrier family 22 member 4/5 (SLC22A4) and (SLC22A5). In this study, we have analyzed these SNPs for an association with psoriasis. We have also performed a denser linkage analysis of this region with an additional 31 microsatellite markers. We were not able to detect any association with any of the three SNPs analyzed. However, our linkage result supports the involvement of this region in the etiology of psoriasis. We obtained a peak non-parametric linkage value of 3.1 for marker D5S436 in a subgroup of patients with joint complaints. This result supports the findings in another study of psoriasis patients originating from Iceland in which the authors obtained a peak logarithm of the odds score of 2.6 for marker D5S2090, only 2 Mb from D5S436. This suggests a psoriasis susceptibility locus on chromosome 5q32 that is involved in the arthritic phenotype of the disease.
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23.
  • Gustavsson, Jaana, 1974, et al. (författare)
  • FTO gene association with coronary heart disease is not reduced by physical activity
  • 2013
  • Ingår i: European Journal of Epidemiology. Non-communicable disease epidemic: epidemiology in action (EuroEpi 2013 and NordicEpi 2013), Aarhus, Denmark, 11-14 August, 2013. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 28:Supplement 1
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)
  •  
24.
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25.
  • Gustavsson, Jaana, 1974, et al. (författare)
  • FTO Genotype, Physical Activity, and Coronary Heart Disease Risk in Swedish Men and Women
  • 2014
  • Ingår i: Circulation: Cardiovascular Genetics. - 1942-325X .- 1942-3268. ; 7:2, s. 171-177
  • Tidskriftsartikel (refereegranskat)abstract
    • Background—Variants in the fat mass– and obesity-associated gene (FTO) predisposing to obesity and diabetes mellitus have also been associated with cardiovascular disease. Physical activity has been suggested to attenuate the FTO effect on obesity, but it is unknown whether this is also true for cardiovascular disease. Therefore, we explored whether physical activity modifies the FTO association with coronary heart disease (CHD). Methods and Results—FTO rs9939609 (T>A) polymorphism was genotyped in 2 Swedish population–based case–control studies with 1743 CHD cases and 4402 population controls (25–74 years of age; 41% women). Leisure time physical activity was assessed by questionnaires, and 3 levels were defined: low, medium, and high. Overall, carriers of the FTO A allele had an increased risk of CHD (odds ratio, 1.20; 95% confidence interval, 1.06–1.37) adjusted for age, sex, study, and body mass index. Although A-allele carriers with low physical activity had the highest CHD risk (odds ratio, 3.30; 95% confidence interval, 2.44–4.46) compared with those with TT genotype and high activity, the effects of FTO genotype and physical activity on CHD risk were approximately additive, indicating the absence of additive interaction. The stratum-specific relative risks of CHD from the A allele in subjects with low, medium, and high physical activity were odds ratio 1.11 (95% confidence interval, 0.77–1.60), 1.22 (1.04–1.44), and 1.38 (1.06–1.80), respectively, but the suggested multiplicative interaction was not significant. Conclusions—FTO rs9939609 A-allele carriers have an increased CHD risk, and the association is not counteracted by increased physical activity. (Circ Cardiovasc Genet. 2014;7:171-177.)
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26.
  • Gustavsson, Jaana, 1974, et al. (författare)
  • Interaction of apolipoprotein E genotype with smoking and physical inactivity on coronary heart disease risk in men and women.
  • 2012
  • Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 220:2, s. 486-492
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Apolipoprotein E genotype (APOE) polymorphism affects lipid levels and coronary heart disease (CHD) risk. However, these associations may be modified by lifestyle factors. Therefore, we studied whether smoking, physical inactivity or overweight interact with APOE on cholesterol levels and CHD risk. METHODS: Combining two Swedish case-control studies yielded 1735 CHD cases and 4654 population controls (3747 men, 2642 women). Self-reported questionnaire lifestyle data included smoking (ever [current or former regular] or never) and physical inactivity (mainly sitting leisure time). We obtained LDL cholesterol levels and APOE genotypes. CHD risk was modelled using logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for relevant covariates. RESULTS: Smoking interacted with APOE on CHD risk; adjusted ORs for ever versus never smoking were 1.45 (95% CI 1.00-2.10) in ɛ2 carriers, 2.25 (95% CI 1.90-2.68) in ɛ3 homozygotes and 2.37 (95% CI 1.85-3.04) in ɛ4 carriers. Female ɛ4 carriers had OR 3.62 (95% CI 2.32-5.63). The adjusted ORs for physical inactivity were 1.09 (95% CI 0.73-1.61), 1.34 (95% CI 1.12-1.61), and 1.79 (95% CI 1.38-2.30) in ɛ2, ɛ3ɛ3 and ɛ4 groups, respectively. No interaction was seen between overweight and APOE for CHD risk, or between any lifestyle factor and APOE for LDL cholesterol levels. CONCLUSION: The APOE ɛ2 allele counteracted CHD risk from smoking in both genders, while the ɛ4 allele was seen to potentiate this risk mainly in women. Similar ɛ2 protection and ɛ4 potentiation was suggested for CHD risk from physical inactivity.
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27.
  • Halldin, Anna-Karin, 1969, et al. (författare)
  • Obesity in Middle Age Increases Risk of Later Heart Failure in Women - Results from the Prospective Population Study of Women and H70 Studies in Gothenburg, Sweden.
  • 2017
  • Ingår i: Journal of cardiac failure. - : Elsevier BV. - 1532-8414 .- 1071-9164. ; 23:5, s. 363-369
  • Tidskriftsartikel (refereegranskat)abstract
    • Obesity has been shown to be a risk factor for heart failure, but whether the association varies by age is not understood.To examine the impact of obesity/overweight on the risk of developing heart failure in women of different ages by analysing prospective data from 2 population studies.Data were obtained from the Population Study of Women in Gothenburg and the Gerontological and Geriatric Population Studies concerning Body Mass Index (BMI) collected in 1980 or later. Follow-up ended 2006. Cox proportional hazard methods were used to determine associations between developing HF and BMI in 2574 women, 1243 aged 26-65 and 1331 aged 66-76 at baseline.Women aged 26-65 years at baseline with BMI≥30 had an increased risk of developing heart failure (hazard ratio (HR) 2.61, 95% confidence interval (CI) 1.56-4.35) even when controlling for age, glucose, smoking, alcohol consumption, s-triglycerides, and systolic blood pressure (reference group: women with BMI 18.5-22.4). Obese older women 66-76 years at baseline did not show increased risk of developing HF (HR 0.55, 95% CI 0.23-1.29).Obesity in middle aged women increases their risk of developing heart failure later in life. In contrast, obesity in late life shows no association with heart failure.
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28.
  • Holm, Karin, et al. (författare)
  • Activation of the contact system at the surface of Fusobacterium necrophorum: a possible virulence mechanism in Lemierre's syndrome.
  • 2011
  • Ingår i: Infection and Immunity. - 1098-5522. ; 79:8, s. 3284-3290
  • Tidskriftsartikel (refereegranskat)abstract
    • Fusobacterium necrophorum causes Lemièrre's syndrome, a serious disease with septic thrombophlebitis of the internal jugular vein, pulmonary involvement and systemic inflammation. The contact system is a link between inflammation and coagulation and contact activation by the bacteria could therefore contribute to the abnormal coagulation and inflammation seen in patients with Lemièrre's syndrome. In this study, F. necrophorum was found to bind radiolabeled high molecular weight kininogen (HK), a central component of the contact system. Binding was inhibited by the addition of unlabeled HK and domain D5 of HK, but not by other components of the contact system, indicating a specific interaction mediated through the D5 region. Binding of HK was significantly reduced after pre-treatment of the bacteria with trypsin, suggesting that surface proteins are involved in HK binding. Incubation of the bacteria with human plasma resulted in a breakdown pattern of HK suggestive of bradykinin release, and bradykinin was also detected in the supernatant. In addition, we show that factor XI (FXI), another component of the contact system, binds to F. necrophorum, and that the bound FXI reconstitutes the activated partial thromboplastin time (aPTT) of FXI-deficient plasma. Thrombin activity was detected at the surface of the bacteria following incubation with plasma, indicating that the intrinsic pathway of coagulation is activated at the surface. This activity was completely blocked by inhibitors of the contact system. The combined results show that the contact system is activated at the surface of F. necrophorum, suggesting a pathogenic role for this system in Lemièrre's syndrome.
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29.
  • Jeansson, Marie, 1971, et al. (författare)
  • Adriamycin Alters Glomerular Endothelium to Induce Proteinuria
  • 2009
  • Ingår i: J Am Soc Nephrol. - 1533-3450 .- 1046-6673. ; 20:1, s. 114-22
  • Tidskriftsartikel (refereegranskat)abstract
    • The pathophysiology underlying the nephrotic syndrome is becoming clear for several inherited podocytopathies; the mechanisms of injury that lead to the acquired forms of this disease are not well understood. We explored these mechanisms using the mouse model of adriamycin-induced proteinuria. We estimated the fractional clearances for FITC-Ficolls, albumin, and neutral albumin in cooled, isolated, perfused kidneys (cIPK) in situ. Treatment with adriamycin led to a significant increase in the fractional clearance of albumin and of Ficoll with radii larger than 20 A. Neutral albumin (33.4 A) and similarly sized Ficoll behaved similarly to each other. In addition, adriamycin led to a significant loss of charge density and size selectivity of the glomerular barrier. The thickness of the glomerular endothelial surface layer (i.e., or the glycocalyx) in adriamycin-treated animals was only 20% of that in normal animals. Finally, several proteoglycans were downregulated in isolated glomeruli. In summary, adriamycin thins the glomerular glycocalyx, perhaps by downregulating proteoglycan synthesis, and alters glomerular charge- and size selectivity. These data suggest that the glomerular endothelium may play a role in the pathogenesis of proteinuric renal diseases.
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30.
  • Kroksmark, Anna-Karin, et al. (författare)
  • Myotonic dystrophy: muscle involvement in relation to disease type and size of expanded CTG-repeat sequence
  • 2005
  • Ingår i: Dev Med Child Neurol. - 0012-1622. ; 47:7, s. 478-85
  • Tidskriftsartikel (refereegranskat)abstract
    • This study aimed to: classify a cohort of children and adolescents with myotonic dystrophy (dystrophia myotonica: DM) into congenital and childhood onset forms; estimate CTG expansion size; and quantify muscle strength, contractures, and motor function in children with DM and compare results with those of controls. Participants were clinically examined, medical records were reviewed, and isometric muscle strength, contractures, and motor function were measured. Participants were: 42 children with DM (18 females, 24 males; mean age 8y 9mo [SD 4y 7mo], range 10mo to 17y) and 42 age- and sex-matched, healthy controls. Children with DM were divided into three groups: severe congenital (n=13), mild congenital (n=15), and childhood (n=14). Children with childhood DM were significantly weaker than controls (wrist and ankle dorsiflexors [p=0.0044, p=0.0044 respectively]; hip abductors and flexors [p=0.0464, p=0.0217]; and knee flexors and extensors: [p=0.0382, p=0.0033]). Children with mild congenital DM were significantly weaker than controls in all assessed muscle groups. Contractures and skeletal deformities were more frequent at time of investigation than at birth, suggesting that foot and spine deformities in particular increase over time. Motor function score was significantly lower for children with DM than for controls. Children with severe congenital DM had the lowest motor function, with correlation between motor function and size of CTG repeat (p=-0.743). Children found jumping, heel standing, and head lifting the most difficult items to perform but few had difficulty walking, running, or stair climbing. DM in children is a heterogeneous disorder with a wide spectrum of muscle involvement, and owing to increased risk of contractures and skeletal deformities, regular follow-ups are recommended.
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31.
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32.
  • Ljungberg, Liza, 1980-, et al. (författare)
  • Is ACE level rather than ACE genotype a risk factor for cardiovascular disease?
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Polymorphism in the angiotensin-converting enzyme gene (ACE I/D polymorphism) is associated with the level of ACE in plasma. However, there are large variations in plasma ACE level among individuals with the same genotype. Furthermore, ACE D/D genotype has been associated with increased risk for cardiovascular disease. The aim of this study was to investigate variations in plasma ACE levels in order to elucidate the associations between circulating ACE levels, ACE genotype, known cardiovascular risk factors and cardiovascular diseases (CVDs). Methods and Results: Plasma ACE levels and ACE genotype were analysed in a Swedish population consisting of 672 elderly men and women. Association between ACE-genotype, levels of circulating ACE and known cardiovascular risk factors and CVDs were analyzed. The results showed increased plasma ACE levels in individuals with hypertension (p=0.003), ischemic heart disease (p=0.03), in smokers (p=0.011) and in individuals with heredity for CVDs (p=0.031). Furthermore, treatment with ACE inhibitors increased the level of ACE in plasma (p<0.001). No association was found between D/D genotype and CVD. Instead, ischemic heart disease was more frequent among carriers of the I/I genotype (p=0.009). Conclusion: Although plasma ACE levels are strongly influenced by ACE genotype, there are large variations in plasma ACE level among carriers of the same genotype. Our data does not support an association between ACE D/D polymorphism and CVDs but indicates an association to increased level of ACE in the circulation, suggesting that ACE level rather than ACE genotype is the crucial factor associated with risk for CVDs.
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33.
  • Ljungberg, Liza, et al. (författare)
  • The association between circulating angiotensin-converting enzyme and cardiovascular risk in the elderly : A cross-sectional study.
  • 2011
  • Ingår i: jraas. Journal of the renin-angiotensin-aldosterone system. - London, United Kingdom : SAGE. - 1470-3203 .- 1752-8976. ; 12:3, s. 281-289
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: A polymorphism in the angiotensin-converting enzyme gene (ACE I/D polymorphism) has been associated with increased risk for cardiovascular disease (CVD). This polymorphism affects the level of circulating ACE, but there is great individual variation, even between those with the same genotype. Few previous studies have investigated the link between circulating ACE and cardiovascular risk. The aim of this study was to investigate this association, and to examine the relationship between ACE level, ACE genotype and CVD. MATERIALS AND METHODS: The study population consisted of 322 men and 350 women aged 69-87. Plasma ACE level was determined using enzyme-linked immunosorbent assay (ELISA), and ACE genotype was analysed using PCR followed by gel electrophoresis. RESULTS: In men, ACE levels increased with increasing number of cardiovascular risk factors (p = 0.003). There was a significant association in men between increased ACE level and both diabetes (p = 0.007) and smoking (p = 0.037). CONCLUSIONS: This study shows that cardiovascular risk factors (such as smoking and diabetes) are associated with higher levels of circulating ACE in men. High ACE levels may represent one of the cellular mechanisms involved in producing the vascular damage associated with cardiovascular risk factors.
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34.
  • Ljungberg, Liza U., 1980-, et al. (författare)
  • Impaired abdominal aortic wall integrity in elderly men carrying the angiotensin-converting enzyme D allele
  • 2011
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - London, United Kingdom : W. B. Saunders Co. Ltd.. - 1078-5884 .- 1532-2165. ; 42:3, s. 309-16
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: A polymorphism in the angiotensin-converting-enzyme gene (ACE I/D) has been associated with abdominal aortic aneurysm and a link between aortic aneurysm and aortic stiffness has been suggested. This study aimed to explore the links between ACE I/D polymorphism, circulating ACE and abdominal aortic wall integrity as reflected by abdominal aortic wall stiffness.Material: A total of 212 men and 194 women, aged 70-88 years, were studied.Methods: Mechanical properties of the abdominal aorta were determined using the Wall Track System, ACE genotype using the polymerase chain reaction (PCR) and circulating ACE level by enzyme-linked immunosorbent assay (ELISA).Results: In men, pulsatile diameter change differed between genotypes (II 0.70, ID 0.55 and DD 0.60 mm, P = 0.048), whereas a tendency was seen for distensibility coefficient (DC) (II 10.38, ID 7.68 and ID 8.79, P = 0.058). Using a dominant model (II vs. ID/DD), men carrying the ACE D allele had lower pulsatile diameter change (P = 0.014) and DC (P = 0.017) than II carriers. Multiple regression analyses showed additional associations between the D allele and increased stiffness β, and reduced compliance coefficient.Conclusion: Men carrying the ACE D allele have stiffer abdominal aortas compared with II carriers. Deranged abdominal aortic stiffness indicates impaired vessel wall integrity, which, along with other local predisposing factors, may be important in aneurysmal disease.
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35.
  • Lorant, Tomas, 1975-, et al. (författare)
  • Safety, immunogenicity, pharmacokinetics, and efficacy of degradation of anti-HLA antibodies by IdeS (imlifidase) in chronic kidney disease patients
  • 2018
  • Ingår i: American Journal of Transplantation. - : Elsevier BV. - 1600-6135 .- 1600-6143. ; 18:11, s. 2752-2762
  • Tidskriftsartikel (refereegranskat)abstract
    • Safety, immunogenicity, pharmacokinetics, and efficacy of the IgG-degrading enzyme of Streptococcus pyogenes (IdeS [imlifidase]) were assessed in a single-center, open-label ascending-dose study in highly sensitized patients with chronic kidney disease. Eight patients with cytotoxic PRAs (median cytotoxic PRAs of 64%) at enrollment received 1 or 2 intravenous infusions of IdeS on consecutive days (0.12 mg/kg body weight ×2 [n = 3]; 0.25 mg/kg ×1 [n = 3], or 0.25 mg/kg ×2 [n = 2]). IgG degradation was observed in all subjects after IdeS treatment, with <1% plasma IgG remaining within 48 hours and remaining low up to 7 days. Mean fluorescence intensity values of HLA class I and II reactivity were substantially reduced in all patients, and C1q binding to anti-HLA was abolished. IdeS also cleaved the IgG-type B cell receptor on CD19+ memory B cells. Anti-IdeS antibodies developed 1 week after treatment, peaking at 2 weeks. A few hours after the second IdeS infusion, 1 patient received a deceased donor kidney offer. At enrollment, the patient had a positive serum crossmatch (HLA-B7), detected by complement-dependent cytotoxicity, flow cytometry, and multiplex bead assays. After IdeS infusion (0.12 mg/kg ×2) and when the HLA-incompatible donor (HLA-B7+) kidney was offered, the HLA antibody profile was negative. The kidney was transplanted successfully.
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36.
  • Malmström, Johan, et al. (författare)
  • Streptococcus pyogenes in human plasma: adaptive mechanisms analyzed by mass spectrometry based proteomics.
  • 2012
  • Ingår i: Journal of Biological Chemistry. - 1083-351X. ; 287:2, s. 1415-1425
  • Tidskriftsartikel (refereegranskat)abstract
    • Streptococcus pyogenes is a major bacterial pathogen and a potent inducer of inflammation causing plasma leakage at the site of infection. A combination of label free quantitative mass spectrometry-based proteomics strategies were used to measure how the intracellular proteome homeostasis of S. pyogenes is influenced by the presence of human plasma, identifying and quantifying 842 proteins. In plasma the bacterium modifies its production of 213 proteins, and the most pronounced change was the complete down-regulation of proteins required for fatty acid biosynthesis (FAB). Fatty acids are transported by albumin (HSA) in plasma. S. pyogenes expresses HSA-binding surface proteins, and HSA carrying fatty acids reduced the amount of FAB proteins to the same extent as plasma. The results clarify the function of HSA-binding proteins in S. pyogenes and underline the power of the quantitative mass spectrometry strategy used here to investigate bacterial adaptation to a given environment.
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37.
  • Mourtzinis, Georgios, 1974, et al. (författare)
  • Primary aldosteronism and thyroid disorders in atrial fibrillation: A Swedish nationwide case-control study
  • 2018
  • Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 25:7, s. 694-701
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Atrial fibrillation is associated with hyperthyroidism. Patients with primary aldosteronism have an increased prevalence of atrial fibrillation. However, the prevalence of primary aldosteronism in the atrial fibrillation population is unknown. Aim This nationwide case-control study aimed to compare the prevalence of primary aldosteronism and thyroid disorders in patients with atrial fibrillation with that of age- and sex-matched controls. Methods We identified all atrial fibrillation cases in Sweden between 1987 and 2013 (n=713,569) by using the Swedish National Patient Register. A control cohort without atrial fibrillation was randomly selected from the Swedish Total Population Register with a case to control ratio of 1:2. This control cohort was matched for age, sex and place of birth (n=1,393,953). Results The prevalence of primary aldosteronism in December 2013 was 0.056% in the atrial fibrillation cohort and 0.024% in controls. At the same time, the prevalence of hypothyroidism was 5.9% in the atrial fibrillation cohort and 3.7% in controls. The prevalence of hyperthyroidism was 2.3% in the atrial fibrillation cohort and 0.8% in controls. Conclusion This study shows, for the first time, a doubled prevalence of primary aldosteronism in a large cohort of patients with atrial fibrillation compared with the general population. There is also an increased prevalence of hypo- and hyper-thyroidism in patients with atrial fibrillation compared with the general population.
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38.
  • Novak, Masuma, 1969, et al. (författare)
  • Gender differences in the prevalence of metabolic syndrome in 50-year-old Swedish men and women with hypertension born in 1953
  • 2013
  • Ingår i: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527 .- 0950-9240. ; 27, s. 56-61
  • Tidskriftsartikel (refereegranskat)abstract
    • To investigate potential gender differences in the role of hypertension as a risk factor for metabolic syndrome (MetS) we used a random population sample of 50-year-old men (n=595) and women (n=667; all born in 1953) who were examined in 2003-2004. Systolic (SBP) and diastolic (DBP) blood pressure values were dichotomized at >/=140 mm Hg and >/=90 mm Hg, respectively. MetS was defined using NCEP (National Cholesterol Education Programme) and IDF (International Diabetes Federation) criteria. MetS was more prevalent in men than in women (NCEP 16% versus 10%, P=0.003; IDF 26% versus 16%, P=0.000) and systolic hypertension was more common in men than in women (high SBP 24% versus 18%, P=0.003; high DBP 29% versus 24%, P=0.074). Women with high SBP had about a seven-fold increased NCEP risk compared with normotensive women (odds ratio (OR) 6.91, confidence interval (CI) 2.90-16.42), whereas high SBP in men was associated with about a three-fold increased NCEP risk (OR 2.72, CI 1.69-4.38). A similar pattern was observed for the IDF criterion of MetS. All interaction terms (sex x hypertension) were significant at P<0.01. At middle age, despite that fewer women had hypertension or MetS than men, hypertension carries a relatively greater risk for MetS in women than in men.Journal of Human Hypertension advance online publication, 1 December 2011; doi:10.1038/jhh.2011.106.
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39.
  • Ravn, Hans, et al. (författare)
  • Popliteal Artery Aneurysm in Women
  • 2017
  • Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 54:6, s. 738-743
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES:Ninety-five per cent of those operated on for popliteal artery aneurysm (PA) are men. Thus, PAs in women are difficult to investigate. The aim was to study the disease in women.METHODS:Women treated for PA in 1987-2012, prospectively registered in the Swedish vascular registry, Swedvasc, supplemented by case records, were compared with the larger male cohort. Survival was determined through cross linkage with the National Population Registry.RESULTS:1509 patients (men and women), 1872 legs, were identified; of these 74 patients (4.9%) were women, 81 legs (4.3%). The median age was 70 years in women versus 69 in men. Twenty-nine centres operated on women (range 1-7 women/centre). There were no time trends in the proportion of women operated on (p=.5). Bilateral PA occurred in 9.5% of women and 27.0% of men (p=.002). For symptomatic aneurysms, there was a larger proportion of small aneurysms (<2 cm) among women than men (24% vs. 8%, p=.005), there was no such difference in asymptomatic aneurysms. Distribution between asymptomatic and symptomatic PA was 31% versus 69%, similar to men. The prevalence of concomitant aneurysms in the aorto-iliac and femoral arteries, and the frequency of presenting symptoms were similar compared with men. Three PA were ruptured (3.7%). Thrombolysis was used in 23 of 45 legs treated for acute ischaemia (51%). Eight legs were treated with endovascular stent grafts (9.8%), compared with 7.9% in men (p=.5). Seven legs were amputated (8.6%). Crude survival was similar to men.CONCLUSIONS:PA is similar in women and men, but bilateral disease was less common in women and symptomatic PA were more often <2 cm in diameter. Women had the same survival as men, despite women generally having better life expectancy. Although the largest series ever published on women with PA, the sample size is small, making it prone to type II statistical error.
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40.
  • Sundström, Johan, Professor, 1971-, et al. (författare)
  • Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
  • 2019
  • Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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41.
  • Welfordsson, Paul, et al. (författare)
  • Feasibility of alcohol interventions in cardiology: A qualitative study of clinician perspectives in Sweden
  • 2024
  • Ingår i: European Journal of Cardiovascular Nursing. - : Oxford Academic. - 1474-5151 .- 1873-1953.
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim:To identify barriers and facilitators to implementing alcohol screening and brief interventions (SBI) in cardiology services.Methods and results:Qualitative study. Individual, semi-structured interviews were conducted with 24 clinical cardiology staff (doctors, nurses, assistant nurses) of varying experience levels, and from various clinical settings (high dependency unit, ward, outpatient clinic), in three regions of Sweden. Reflexive thematic analysis was used, with deductive coding applying the Capability, Opportunity, Motivation (COM-B) theoretical framework. A total of 41 barriers and facilitators were identified, including twelve related to capability, nine to opportunity, and 20 to motivation. Four themes were developed: 1. Uncharted territory, where clinicians expressed a need to address alcohol use but lacked knowledge and a roadmap for implementing SBI; 2. Cardiology as a cardiovascular specialty, where tasks were prioritized according to established roles; 3. Alcohol stigma, where alcohol was reported to be a sensitive topic that staff avoid discussing with patients; 4. Window of opportunity, where staff expressed potential for implementing SBI in routine cardiology care.Conclusion:Findings suggest that opportunities exist for early identification and follow-up of hazardous alcohol use within routine cardiology care. Several barriers, including low knowledge, stigma, a lack of ownership, and a greater focus on other risk factors must be addressed prior to the implementation of SBI in cardiology. To meet current clinical guidelines, there is a need to increase awareness and to improve pathways to addiction care. In addition, there may be a need for clinicians dedicated to alcohol interventions within cardiology services.
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42.
  • Welfordsson, Paul, et al. (författare)
  • Mixed messages? Exposure to reports about alcohol’s suggested cardiovascular effects and hazardous alcohol use : a cross-sectional study of patients in cardiology care
  • 2024
  • Ingår i: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Hazardous alcohol use is a leading risk factor for disability and death, yet observational studies have also reported reduced cardiovascular disease mortality among regular, low-level drinkers. Such findings are refuted by more recent research, yet have received significant media coverage. We aimed to explore: (1) how patients with cardiovascular diseases access health information about moderate drinking and cardiovascular health; (2) the perceived messages these sources convey, and (3) associations with own level of alcohol use.Methods: We conducted a cross-sectional survey of patients in cardiology services at three hospitals in Sweden. The study outcome was hazardous alcohol use, assessed using the AUDIT-C questionnaire and defined as ≥ 3 in women and ≥ 4 in men. The exposure was accessing information sources suggesting that moderate alcohol consumption can be good for the heart, as opposed to accessing information that alcohol is bad for the heart. Health information sources were described using descriptive statistics. Gender, age and education were adjusted for in multiple logistic regression analyses.Results: A total of 330 (66.3%) of 498 patients (mean age 70.5 years, 65% males) who had heard that drinking moderately can affect the heart described being exposed to reports that moderate alcohol use can be good for the heart, and 108 (21.7%) met criteria for hazardous alcohol use. Health information sources included newspapers (32.9%), television (29.2%), healthcare staff (13.4%), friends/family (11.8%), social media (8.9%) and websites (3.7%). Participants indicated that most reports (77.9%) conveyed mixed messages about the cardiovascular effects of moderate drinking. Exposure to reports of healthy heart effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use (OR = 1.67, 95%CI = 1.02–2.74).Conclusions: This study suggests that many patients in cardiology care access health information about alcohol from media sources, which convey mixed messages about the cardiovascular effects of alcohol. Exposure to reports that moderate drinking has protective cardiovascular effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use. Findings highlight a need for clear and consistent messages about the health effects of alcohol.
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43.
  • Welmer, Anna-Karin, et al. (författare)
  • Study protocol for the 'preventing functional decline in acutely hospitalised older patients (PREV_FUNC)' study : effects of two multicomponent exercise programmes on physical function - a three-armed randomised controlled trial
  • 2023
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:8
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Acutely hospitalised older patients often live with frailty and have an increased risk of impaired physical function. Previous studies suggest that exercise might mitigate the risk of physical impairment; however, further research is needed to compare the effect of different types of exercise interventions. In this paper, we report a protocol for a trial that aims to examine (1) if multicomponent exercise interventions (interventions that include both mobility and strengthening exercises) have effects on physical function compared with usual care in older adults and (2) if a comprehensive multicomponent exercise programme is more effective than a simple multicomponent exercise programme that only include walking and sit-to-stand exercises.Methods and analysis: This is a three-armed randomised controlled trial, with two intervention groups (comprehensive and simple exercise programme) and a control group receiving usual care. We will include 320 participants aged >= 75 years from geriatric medical departments of four hospitals in Stockholm, Sweden. Assessments will be conducted at hospital admission, discharge and 3 months thereafter concerning physical function (primary outcome), activities of daily living, health-related quality of life, sarcopenia and falls. The number of readmissions will be registered up to 1 year after discharge. Data will be analysed with linear mixed effects models, according to the intention-to-treat approach.Ethics and dissemination: Ethical approval for this trial has been granted by the Swedish Ethical Review Authority (approval number 2022-03032-01). Data collection will consider the information requirement, the requirement of consent, confidentiality obligations and the utilisation requirement. Trial findings will be disseminated through multiple channels, including scientific publications and conferences, and workshops with healthcare professionals and the public.
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