| 1. |
- Bridel, Claire, et al.
(författare)
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Diagnostic Value of Cerebrospinal Fluid Neurofilament Light Protein in Neurology : A Systematic Review and Meta-analysis
- 2019
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Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149 .- 2168-6157. ; 76:9, s. 1035-1048
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Forskningsöversikt (refereegranskat)abstract
- Importance Neurofilament light protein (NfL) is elevated in cerebrospinal fluid (CSF) of a number of neurological conditions compared with healthy controls (HC) and is a candidate biomarker for neuroaxonal damage. The influence of age and sex is largely unknown, and levels across neurological disorders have not been compared systematically to date.Objectives To assess the associations of age, sex, and diagnosis with NfL in CSF (cNfL) and to evaluate its potential in discriminating clinically similar conditions.Data Sources PubMed was searched for studies published between January 1, 2006, and January 1, 2016, reporting cNfL levels (using the search terms neurofilament light and cerebrospinal fluid) in neurological or psychiatric conditions and/or in HC.Study Selection Studies reporting NfL levels measured in lumbar CSF using a commercially available immunoassay, as well as age and sex.Data Extraction and Synthesis Individual-level data were requested from study authors. Generalized linear mixed-effects models were used to estimate the fixed effects of age, sex, and diagnosis on log-transformed NfL levels, with cohort of origin modeled as a random intercept.Main Outcome and Measure The cNfL levels adjusted for age and sex across diagnoses.Results Data were collected for 10 059 individuals (mean [SD] age, 59.7 [18.8] years; 54.1% female). Thirty-five diagnoses were identified, including inflammatory diseases of the central nervous system (n = 2795), dementias and predementia stages (n = 4284), parkinsonian disorders (n = 984), and HC (n = 1332). The cNfL was elevated compared with HC in a majority of neurological conditions studied. Highest levels were observed in cognitively impaired HIV-positive individuals (iHIV), amyotrophic lateral sclerosis, frontotemporal dementia (FTD), and Huntington disease. In 33.3% of diagnoses, including HC, multiple sclerosis, Alzheimer disease (AD), and Parkinson disease (PD), cNfL was higher in men than women. The cNfL increased with age in HC and a majority of neurological conditions, although the association was strongest in HC. The cNfL overlapped in most clinically similar diagnoses except for FTD and iHIV, which segregated from other dementias, and PD, which segregated from atypical parkinsonian syndromes.Conclusions and Relevance These data support the use of cNfL as a biomarker of neuroaxonal damage and indicate that age-specific and sex-specific (and in some cases disease-specific) reference values may be needed. The cNfL has potential to assist the differentiation of FTD from AD and PD from atypical parkinsonian syndromes.
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| 2. |
- Sharrack, Basil, et al.
(författare)
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Autologous haematopoietic stem cell transplantation and other cellular therapy in multiple sclerosis and immune-mediated neurological diseases : updated guidelines and recommendations from the EBMT Autoimmune Diseases Working Party (ADWP) and the Joint Accreditation Committee of EBMT and ISCT (JACIE)
- 2020
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Ingår i: Bone Marrow Transplantation. - : Springer Nature. - 0268-3369 .- 1476-5365. ; 55:2, s. 283-306
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Tidskriftsartikel (refereegranskat)abstract
- These updated EBMT guidelines review the clinical evidence, registry activity and mechanisms of action of haematopoietic stem cell transplantation (HSCT) in multiple sclerosis (MS) and other immune-mediated neurological diseases and provide recommendations for patient selection, transplant technique, follow-up and future development. The major focus is on autologous HSCT (aHSCT), used in MS for over two decades and currently the fastest growing indication for this treatment in Europe, with increasing evidence to support its use in highly active relapsing remitting MS failing to respond to disease modifying therapies. aHSCT may have a potential role in the treatment of the progressive forms of MS with a significant inflammatory component and other immune-mediated neurological diseases, including chronic inflammatory demyelinating polyneuropathy, neuromyelitis optica, myasthenia gravis and stiff person syndrome. Allogeneic HSCT should only be considered where potential risks are justified. Compared with other immunomodulatory treatments, HSCT is associated with greater short-term risks and requires close interspeciality collaboration between transplant physicians and neurologists with a special interest in these neurological conditions before, during and after treatment in accredited HSCT centres. Other experimental cell therapies are developmental for these diseases and patients should only be treated on clinical trials.
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| 3. |
- Arlien-Soborg, Mai C., et al.
(författare)
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Acromegaly management in the Nordic countries: A Delphi consensus survey
- 2024
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Ingår i: Clinical Endocrinology. - : WILEY. - 0300-0664 .- 1365-2265.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 4. |
- Arlien-Søborg, Mai C., et al.
(författare)
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Acromegaly management in the nordic countries : a Delphi consensus survey
- 2024
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Ingår i: Clinical Endocrinology. - : John Wiley & Sons. - 0300-0664 .- 1365-2265.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Acromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.Methods: A Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1−7). Consensus was defined as ≥80% of panelists rating their agreement as ≥5 or ≤3 on the Likert-type scale.Results: Consensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.Conclusion: This consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 5. |
- Bergström, Sven, et al.
(författare)
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Molecular characterization of Borrelia burgdorferi isolated from Ixodes ricinus in northern Sweden.
- 1992
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 24:2, s. 181-188
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Tidskriftsartikel (refereegranskat)abstract
- Ixodes ricinus ticks, harbouring Borrelia burgdorferi, were found in an area in northern Sweden, not thought to be endemic for Lyme borreliosis. This investigation took place at Norrbyskär, an island situated in the Bothnian Gulf, 63 degrees 33'N/19 degrees 52'E. One of 42 nymphal and 8/43 adult I. ricinus ticks collected carried spirochetes as seen by phase contrast microscopy. Pure bacterial cultures were obtained from 2 of the ticks. Western blot analysis using species-specific monoclonal antibodies showed that the isolated spirochetes were B. burgdorferi. The identity of the isolated spirochetes was confirmed by DNA amplification using B. burgdorferi OspA and flagellin gene specific oligonucleotides as well as partial DNA sequencing of the respective OspA and flagellin genes. The 2 isolated spirochaete populations were different as shown by their protein profiles in sodium dodecyl sulphate polyacrylamide gels. Moreover, the demonstration of Lyme borreliosis in a patient from the island of Norrbyskär indicates the need for clinical consideration of this disease in northern Sweden.
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| 6. |
- Brage, Christina, 1950-, et al.
(författare)
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PEER OBSERVATION OF TEACHING IN A LIBRARY SETTING : A PILOT STUDY
- 2016
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Ingår i: ICERI2016 Proceedings 9th annual International Conference of Education, Research and Innovation, Seville, Spain. 14-16 November, 2016. - : IATED. - 9788461758951 ; , s. 6827-6832
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Konferensbidrag (refereegranskat)abstract
- This paper explores participant perceptions of the impact of a Peer Observation of Teaching scheme offered to teaching librarians at Linköping University library.Information literacy sessions or support are offered to almost all students in all courses at Linköping University. Instructional duties have become a common expectation for librarians working in academic libraries. As a teaching librarian you normally divide your time between reference services, collection development and information literacy instruction. But without little formal training in the teaching role you can become very insecure. It’s not uncommon that you feel left alone especially in the support of continuing professional development. Therefore it’s necessary for academic librarians to talk and reflect about their teaching. Peer observation through critical friends is one way to demonstrate that we are reflecting on the quality of our teaching, learning and assessment practices. The relationship between critical friends is one that encourages and cultivates constructive critique. But it’s important that the main conditions exists, besides the obvious trust and commitment, namely to have knowledge of the context of the teaching environment. The librarians at Linköping University teach the “same” students and face the same challenges.In preparation for the introduction of a peer observation of teaching scheme, a seminar was offered to staff. Our hope was that the librarians involved could see that this initiative could lead to professional development that improves both teaching practices and hopefully also student performance. Many senior librarians are themselves, experienced, effective teachers and therefore, they were likely to be competent observers of various aspects of the teaching conducted at the library. The librarian requesting observation met the observing librarian to discuss the objectives of the observation. A limited number of focused objectives was chosen that could address specific items on which the librarian desired feedback. The observing librarian attended the library session and took notes on the session with the objectives in mind.We assessed the effort by using two types of data collection tools, a questionnaire and semi-structured interviews. The latter were used to add depth and quality of the data collected in the questionnaire. Information was collected from all participants. The questionnaire consisted of closed questions to gain relevant factual data. A pilot questionnaire was answered and assessed by two critical friends ensuring that the questions were clear and valid. The preliminary results indicated that most of the participants were satisfied with the possibility to be able to self-reflect on how this process positively can impact their teaching skills. The peer observation process seemed to provide both the observee and the observer with the opportunity to mutually enhance the quality of their teaching practice. It also provided an opportunity to disseminate good practice amongst colleagues by sharing thoughts on teaching practice and supporting each other’s development of teaching skills.This process was not about getting everyone to teach in the same way, it was about helping individuals to reflect on and evaluate their own approach to teaching. It was expected that both parties in the observation would benefit from the discussions arising.
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| 7. |
- Brandén, Jennie, et al.
(författare)
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Utsatthet för sexuellt våld bland samiska kvinnor i Sverige : den Samiska HLV studien 2021
- 2023
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Ingår i: Tidsskrift for kjønnsforskning. - Oslo. - 0809-6341 .- 1891-1781. ; 47:2-3, s. 113-129
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Tidskriftsartikel (refereegranskat)abstract
- Frågan om sexuellt våld har under de senaste åren fått ett allt större utrymme i Sápmi. I denna artikel, som baseras påden populationsbaserade studien «Samisk hälsa på lika villkor» (Samisk HLV) 2021, undersöks utsatthet för sexuelltvåld bland samiska kvinnor och män i Sverige jämfört med kvinnor och män i Sveriges befolkning. Analysen visaratt sexuellt våld mot kvinnor utgör ett mycket omfattande samhällsproblem i det samiska samhället, i minst sammaomfattning som i övriga Sverige. Samiska kvinnor rapporterar en signifikant högre utsatthet för flera former av sexuelltvåld jämfört med kvinnor i Sverige, däribland utsatthet för våldtäkt och våldtäktsförsök. Analysen visar även attsamiska kvinnor är mer benägna att söka vård samt polisanmäla efter övergreppet, vilket nyanserar bilden av en tystnadkring sexuellt våld i Sápmi. Utifrån ett urfolksfeministiskt perspektiv belyser artikeln hur könade och kolonialamaktrelationer samspelar vad gäller utsatthet för sexuellt våld i Sverige och att positionen som både kvinna och sameökar utsattheten för sexuellt våld, medan att vara man och same inte gör det. Sammantaget pekar artikeln på att bådekön och samisk tillhörighet har betydelse för utsatthet för sexuellt våld och därmed på vikten av att inkludera samiskaperspektiv i framtida forskning om, och politiska insatser mot, sexuellt våld.
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| 8. |
- Brandén, Jennie, 1984-, et al.
(författare)
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Våld mot samiska kvinnor
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I den här rapporten presenterar vi resultat från forskningsprojektet ”Våld mot samiska kvinnor” som 2021-2024 genomförts av forskargruppen Lávvuo vid Umeå Universitet, på uppdrag av Sámediggi (Sametinget i Sverige).Rapporten består av en kvantitativ och en kvalitativ del, samt fem åtgärdsförslag riktade till Sveriges regering.De kvantitativa resultaten i korthetDen kvantitativa delen av rapporten baseras på enkätundersökningen Samisk hälsa på lika villkor som genomfördes 2021. Resultaten har jämförts med Sveriges befolkning genom den nationella enkäten Sexuell och reproduktiv hälsa genomförd 2017. Det övergripande mönstret är att kvinnor är betydligt mer utsatta för våld än män, samt att samiska kvinnor 2021 uppger en högre våldsutsatthet än kvinnor i Sverige 2017, för de flesta typer av våld.Över hälften av de samiska kvinnorna har utsatts för sexuellt våld (55,5 procent), sju av tio har utsatts för psykiskt våld (68,5 procent) och nästan var tredje för fysiskt våld (27,9 procent).En större andel samiska kvinnor än kvinnor i Sverige i stort uppger utsatthet för de grövsta formerna av sexuellt våld, såsom våldtäktsförsök (14,1 jämfört med 10,6 procent) och våldtäkt (10,3 jämfört med 7,0 procent).En större andel samiska kvinnor än kvinnor i Sverige i stort uppger utsatthet för psykiskt våld, både sammantaget (68,5 jämfört med 50,9 procent) och vad gäller alla de former av psykiskt våld som undersöktes.Även när det gällde fysiskt våld rapporterade samiska kvinnor (27,9 procent) en högre utsatthet jämfört med kvinnor i Sverige (22,0 procent).Samiska kvinnors utsatthet för våld varierar med både ålder och geografi. Överlag var utsattheten högst bland kvinnor yngre än 45 år. Geografiskt var utsattheten för sexuellt och fysiskt våld högre bland samiska kvinnor i mellersta och södra Sverige, med undantag av Stockholmsområdet. För psykiskt våld hade samiska kvinnor i Jämtland Härjedalen en högre utsatthet.Det finns flera starka samband mellan olika typer av våldsutsatthet och psykisk och fysisk ohälsa. Upprepad våldsutsatthet (fler än en gång) är förenat med ännu högre risk för ohälsa, särskilt psykisk ohälsa. Starkast är detta samband när det gäller stress och självmordstankar.När det gäller diskriminering och rasism uppger en betydande andel av samer i Sverige att de utsatts någon gång i livet. Liksom för andra former av våld i denna undersökning visar analysen att en högre andel samiska kvinnor (44,5 procent) utsatts jämfört med samiska män (37,0 procent).HBTQ-samer är mer våldsutsatta än andra samer. Detta gäller sexuellt våld (64,6 jämfört med 30,9 procent), psykiskt våld (81,7 jämfört med 58,4 procent) och fysiskt våld (43,8 jämfört med 25,5 procent).De kvalitativa resultaten i korthetDen kvalitativa delen baseras på intervjuer med professionella som arbetar inom samhällets stödstrukturer för våldsutsatta i olika delar av den svenska delen av Sápmi.Intervjustudien visar att våld mot samiska kvinnor är en fråga som behöver förstås i relation till den bredare politiska och historiska, koloniala, och könade kontext som våldet utspelar sig i.Frågan om våld mot samiska kvinnor osynliggörs och beskrivs som svår att adressera – både i det samiska samhället och i majoritetssamhället.Kunskapen om det samiska samhället är låg inom samhällets stödstrukturer. Deltagare beskrev att samiska perspektiv saknas i styrdokument kring mäns våld mot kvinnor och i befintlig terminologi. Detta gör att förhållanden i det samiska samhället som kan påverka den våldsutsattas situation negligeras i mötet med samiska klienter, patienter och brukare som utsätts för våld.Frågan om våld mot samiska kvinnor beskrevs som ”känslig” och ”laddad”. Sammantaget framträder ett stigma kring frågan och en oro för att ”göra fel” eller bidra till fördomar och rasism mot samer, både i det samiska samhället och majoritetssamhället.Problemet med våld mot samiska kvinnor beskrevs som svår att adressera inom en redan marginaliserad samisk kontext, där värnandet av samiska kollektiva rättigheter har prioriterats.Det finns en rad särskilda förhållanden knutna till det samiska samhället som är viktiga att ha kunskap om och vara lyhörd för i mötet med våldsutsatta samiska personer och i arbetet för att motverka våld mot samiska kvinnor.Närheten och lokalkännedomen i mindre samhällen beskrevs som styrkor, men samtidigt lyftes utmaningar såsom bristande anonymitet, resurser, kompetens och insatser. Svårigheten att vara anonym och långa geografiska avstånd till samhällets stöd beskrevs som extra påtagligt i det samiska samhället. Stark samhörighet i det samiska samhället beskrevs som positivt men också potentiellt problematiskt när det gäller den utsattas situation.Bristande tillit till myndigheter bland samer är en potentiell barriär för att nå och stötta våldsutsatta samiska kvinnor. Den bristande tilliten relaterades till både historiska och samtida erfarenheter av okunskap, förtryck, rasism och diskriminering.Deltagare beskrev ojämställdhet och tystnad kring våld mot kvinnor i det samiska samhället, och att våld mot kvinnor ofta hanteras internt. Tystnaden knöts till en lojalitet med samiska män, ett ideal att samiska kvinnor ska vara starka och klara sig själva, samt en vilja att skydda familjen och det samiska kollektivet.Ett centralt hinder för utsatta kvinnor att lämna en våldsam relation beskrevs vara rädslan för att uppbrottet skulle innebära förlust av deras samiska sammanhang. Ens samiska identitet beskrevs till exempel som nära knuten till platsen och markerna och därmed som svår att upprätthålla vid flytt till en annan ort för att söka skydd.Åtgärdsförslag till Sveriges regeringBaserat på de utvecklingsbehov som identifierats genom detta forskningsprojekt utmynnar rapporten i fem åtgärdsförslag riktade till den svenska regeringen.Uppdra åt Sametinget att följa upp och samordna arbetet för att motverka våld mot samiska kvinnor.Utforma en nationell policy för att motverka våld mot samiska kvinnor.Utveckla stödstrukturer för våldsutsatta samiska kvinnor och flickor.Genomför kortsiktiga utbildningsinsatser.Säkra långsiktig kunskapsproduktion och kompetenshöjning.
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| 9. |
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| 10. |
- Burman, Maria, et al.
(författare)
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Body Mass Index, Mini Nutritional Assessment, and their Association with Five-Year Mortality in Very Old People
- 2015
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Ingår i: The Journal of Nutrition, Health & Aging. - Paris : Springer. - 1279-7707 .- 1760-4788. ; 19:4, s. 461-467
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: to investigate the prevalence of malnutrition and the association between Body Mass Index (BMI), Mini Nutritional Assessment (MNA) and five-year mortality in a representative population of very old (>85 years) people.DESIGN: A prospective cohort study.SETTING: A population-based study of very old people in northern Sweden and western Finland, living in institutional care or in the community.PARTICIPANTS: Out of 1195 potential participants, 832 were included (mean age 90.2±4.6 years).MEASUREMENTS: Nutritional status was assessed using BMI and MNA and the association of those two variables with five-year mortality was analyzed.RESULTS: The mean BMI value for the whole population was 25.1±4.5 kg/m2, with no difference between genders (P=0.938). The mean MNA score was 22.5±4.6 for the whole sample, and it was lower for women than for men (P<0.001). Thirteen percent were malnourished (MNA<17) and 40.3% at risk of malnutrition (MNA 17-23.5) according to MNA. Also, 34.8% of those with a MNA score <17 still had a BMI value ≥22.2 kg/m2. A BMI value <22.2 kg/m2 and a MNA score<17 were associated with lower survival. The association with mortality seemed to be J-shaped for BMI, and linear for MNA.CONCLUSIONS: Malnutrition according to MNA was common, but a substantial portion of those with a low MNA score still had a high BMI value, and vice versa. The association with mortality appeared to be J-shaped for BMI, and linear for MNA. The MNA seems to be a good measurement of malnutrition in very old people, and BMI might be misleading and could underestimate the prevalence of malnutrition, especially in women.
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| 11. |
- Burman, Maria, et al.
(författare)
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Is malnutrition a risk factor for incident urinary tract infection among older people in residential care facilities?
- 2018
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Ingår i: Journal of Nursing Home Research. - : SERDI. - 2496-0799. ; 4, s. 49-55
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Tidskriftsartikel (refereegranskat)abstract
- Background: Malnutrition and urinary tract infections (UTI) are common among older people living in residential care facilities.Objectives: To determine whether malnutrition is a risk factor for incident urinary tract infection in people aged ≥65 years living in residential care facilities.Design, Setting, and Participants: A prospective cohort study of people living in residential care facilities in northern Sweden (N=373). Data from the Frail Older People-Activity and Nutrition and Umeå Dementia and Exercise studies were used.Measurements: Malnutrition was assessed using the Mini Nutritional Assessment (MNA). Risk factors for UTI were explored using univariate and multivariate Cox proportional hazard regression analyses. Maximum follow-up time was 9 months.Results: The incidence of UTI was 460/1000 person-years; 85/276=30.8% of women and 16/97=16.5% of men contracted UTIs. History of UTI (hazard ratio [HR] 2.804, 95% confidence interval [CI] 1.824–4.311), heart failure (HR 2.101, 95% CI 1.368–3.225), hypertension (HR 1.656, 95% CI 1.095–2.504), and low Mini-Mental State Examination (MMSE) score (HR 0.937, 95% CI 0.892–0.985) were associated independently with higher risk of incident UTI in multivariate analyses. Malnutrition was not associated with UTI in the whole sample or in women; MNA score was associated with UTI in men in univariate analysis (HR 0.841, 95% CI 0.750–0.944).Conclusion: The incidence of UTI was high in residential care facilities and individuals with histories of UTI, heart failure, hypertension, or cognitive impairment were more likely to be affected. Malnutrition was not a risk factor for UTI in the whole sample or in women, but may constitute a risk for UTI among men.
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| 12. |
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| 13. |
- Burman, Maria, 1983-
(författare)
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Malnutrition and obesity among older adults, assessed by Mini Nutritional Assessment and the body mass index, respectively : prevalence and associations with mortality and urinary tract infection
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- INTRODUCTION: Malnutrition and obesity are health concerns among older (aged ≥ 65 years) adults, but the combination of them have not been studied thoroughly nor have they been thoroughly investigated in very old (aged ≥ 85 years) adults. The aims of this thesis were to investigate the prevalence, trends in prevalence and associations with mortality of malnutrition and obesity, assessed by Mini Nutritional Assessment (MNA) and the body mass index (BMI), respectively, and to examine the combined effects of these conditions on mortality. Malnutrition as a risk factor for urinary tract infection (UTI) was also investigated. MATERIAL AND METHODS: The studies reported on in papers I and II were conducted with data from the Umeå85+/Gerontological Regional Database study, a population-based study of cohorts of very old adults. Data from all four Swedish cohorts (2000–2002, 2005–2007, 2010–2012 and 2015–2017), and from the 2000–2002 and 2005–2007 Swedish cohorts and a 2005–2006 Finnish cohort, respectively, were used. In the paper I study, trends in the prevalence of malnutrition (by MNA score) and obesity (by BMI) were investigated across cohorts. In the paper II study, the associations of MNA scores and BMI with 5-year mortality were investigated. The study reported on in paper III was conducted with data from the Senior Alert national quality registry; associations of Mini Nutritional Assessment–Short Form (MNA-SF) scores, BMI and 2-year mortality in older adults living in residential care facilities in Sweden were investigated. The study reported on in paper IV was conducted with data from the Frail Older People–Activity and Nutrition and Umeå Dementia and Exercise studies; risk factors for UTI among older adults in residential care facilities were investigated. RESULTS: In the paper I study, mean BMI increased between 2000–2002 and 2015–2017 and the prevalence of obesity were 13.4% and 18.3%, respectively; the prevalences of underweight were 7.6% and 3.0%, respectively. Mean MNA scores increased between 2000–2002 and 2010–2012 and were slightly lower in 2015–2017. The prevalence of malnutrition according to MNA scores in the four cohorts were 12.2%, 6.4%, 5.1% and 8.7%, respectively, and the prevalence of at risk thereof were 31.8%–37.2%. In the paper II study, 13.3% of participants were malnourished, and 40.3% at risk thereof according to MNA scores, and malnutrition was more common among women than men. Twenty-five percent of the population had BMIs ≥28.0 kg/m2. Of those with malnutrition according to MNA scores, 17.4% had BMIs ≥ 24.7 kg/m2; of those with good nutritional status according to MNA scores, 13.8% had BMIs < 22.2 kg/m2. Compared to malnutrition according to MNA, lesser mortality was found in individuals with good nutritional status. Compared to individuals with BMI <22.2 kg/m2, lesser mortality was found in those with BMI ≥28.0 kg/m2. In the paper III study, 14.6% of the population was malnourished, and 45.0% at risk of malnutrition according to MNA-SF scores and 16.0% were obese. Compared to individuals with good nutritional status, greater mortality was found in those with malnutrition according to MNA-SF. Mortality was greater among underweight than among normal-weight participants and lesser among participants with obesity, including severe obesity. Higher BMIs were also associated with reduced mortality in subgroups defined by MNA-SF scores. In the paper IV study, malnutrition according to MNA scores was not a risk factor for UTI in the whole sample or in women. In men, the MNA score was associated with UTI in univariate analysis. CONCLUSIONS: The results of this thesis highlight the importance of nutritional screening in older adults in residential care facilities and in very old adults, since malnutrition risk was common and associated with greater mortality among these populations. Malnutrition according to MNA was not a clear risk factor for UTI in older adults living in residential care facilities. Time trends indicated an increasing prevalence of obesity whereas no change in nutritional status according to MNA was observed among very old adults, although these trends need further investigation. The results also confirmed that higher BMIs were beneficial for survival in these populations, and in the residential care population this seems to apply also for BMIs reflecting severe obesity. Finally, in the residential care population, regardless of nutritional status according to MNA-SF, higher BMIs were associated with better survival.
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| 14. |
- Burman, Maria, et al.
(författare)
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Närmare varandra : Nio veckor till en starkare parrelation
- 2018
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Relationsproblem är vanliga och påverkar oss på många plan. Denna självhjälpsbok får par att se hur problemen inte ligger hos den ena eller andra partnern utan uppstår i samspelet mellan dem. Paren guidas till att hitta mönster och ömma punkter i sitt samspel och får hjälp att bygga vidare på styrkor de har som par.
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| 15. |
- Burman, Maria, et al.
(författare)
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Obesity may increase survival, regardless of nutritional status : a Swedish cohort study in nursing homes
- 2022
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: To investigate the associations between the body mass index (BMI), Mini Nutritional Assessment-Short Form (MNA-SF) scores, and 2-year mortality.Methods: A nationwide cohort study using data from a national quality register of older (age ≥ 65 years) nursing home residents (N = 47,686). Individuals were categorized according to BMI as underweight (< 18.5 kg/m2), normal-weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (class I, 30.0-34.9 kg/m2; class II, 35.0-39.9 kg/m2; class III, ≥ 40.0 kg/m2). Participants' nutritional status were categorized as good (MNA-SF score 12-14), at risk of malnutrition (MNA-SF score 8-11), or malnutrition (MNA-SF score 0-7). Associations with mortality were analysed using Cox proportional-hazards models.Results: At baseline, 16.0% had obesity, and 14.6% were malnourished. During 2 years of follow-up, 23,335 (48.9%) individuals died. Compared with normal-weight individuals, mortality was greater among underweight individuals [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.55-1.69] and lesser among individuals with class I (HR 0.63, 95% CI 0.60-0.66), class II (HR 0.62, 95% CI 0.56-0.68), and class III (HR 0.80, 95% CI 0.69-0.94) obesity. Compared with individuals with good nutritional status, mortality was increased for those with malnutrition (HR 2.98,95% CI 2.87-3.10). Lower mortality among obese individuals was also seen in subgroups defined according to MNA-SF scores.Conclusions: Among older nursing home residents, obesity, including severe obesity, was associated with lower 2-year mortality. Higher BMIs were associated with better survival, regardless of nutritional status according to MNA-SF.
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| 16. |
- Burman, Maria, et al.
(författare)
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Prevalence of obesity and malnutrition in four cohorts of very old adults, 2000–2017
- 2022
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Ingår i: The Journal of Nutrition, Health & Aging. - : Springer. - 1279-7707 .- 1760-4788. ; 26:7, s. 706-713
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Investigate trends in the prevalence of obesity and malnutrition among very old adults (age ≥ 85 years) between 2000 and 2017.Design, Setting, Participants, Measurements: A study with data from the Umeå 85+/Gerontological regional database population-based cohort study of very old adults in northern Sweden. Every 5 years from 2000–2002 to 2015–2017, comprehensive assessments of participants were performed during home visits (N=1602). Body mass index (BMI) classified participants as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Mini Nutritional Assessment (MNA) scores classified participants as malnourished (0 to <17), at risk of malnutrition (17–23.5), and having good nutritional status (24–30). Prevalence and trends were examined using analysis of variance and chi-squared tests, including subgroup analyses of nursing home residents.Results: Between 2000–2002 and 2015–2017, the mean BMI increased from 24.8± 4.7 to 26.0± 4.7 kg/m2. The prevalence of obesity and underweight were 13.4% and 7.6%, respectively, in 2000–2002 and 18.3% and 3.0%, respectively, in 2015–2017. The mean MNA score increased between 2000–2002 and 2010–2012 (from 23.2± 4.7 to 24.2± 3.6), and had decreased (to 23.3± 4.2) by 2015–2017. The prevalence of malnutrition was 12.2%, 5.1%, and 8.7% in 2000–2002, 2010–2012, and 2015–2017, respectively. Subgroup analyses revealed similar BMI and MNA score patterns among nursing home residents.Conclusions: Among very old adults, the mean BMI and prevalence of obesity seemed to increase between 2000–2002 and 2015–2017. Meanwhile, the nutritional status (according to MNA scores) seemed to improve between 2000–2002 and 2010–2012, it declined by 2015–2017.
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| 17. |
- Burman, Monica, Professor, 1962-, et al.
(författare)
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Women's human rights in the governance of the Arctic : gender equality and violence against indigenous women
- 2018
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Ingår i: The Yearbook of Polar Law. - : Brill | Nijhoff. - 1876-8814 .- 2211-6427. - 9789004342415 ; 9:1, s. 53-78
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies show a lack of deference and activities when it comes to women's human rights and gender equality in the multi-level governance of the Arctic. According to the Committee on the Elimination of Discrimination against Women, women in the Arctic are vulnerable, in particular indigenous and rural women. Their rights are not upheld in the Arctic states for example when it comes to exposure to violence, equal participation in governing bodies, and economic self-support. The public governing bodies have almost no focus on gender equality at all, despite far-reaching international obligations and, for several of the states, national ambitious agendas for gender equality politics. International instruments with obligations to strive for gender equality, such as the CEDAW, the ILO Convention 169 and UNDRIP, are scarcely referred to and not sufficiently implemented by the public governance bodies. The aim of this article is to raise awareness of the obligations set up by human rights documents to promote women' rights in the governance of the Arctic, in order to put pressure on the states to develop strategies for a future gender equal governance. We have a special focus on the general lack of awareness within public governance, and on men's intimate partner violence against indigenous women.
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| 18. |
- Burt, Richard K, et al.
(författare)
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Association of nonmyeloablative hematopoietic stem cell transplantation with neurological disability in patients with relapsing-remitting multiple sclerosis
- 2015
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Ingår i: Journal of the American Medical Association (JAMA). - : American Medical Association (AMA). - 0098-7484 .- 1538-3598. ; 313:3, s. 275-284
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: No current therapy for relapsing-remitting multiple sclerosis (MS) results in significant reversal of disability.OBJECTIVE: To determine the association of nonmyeloablative hematopoietic stem cell transplantation with neurological disability and other clinical outcomes in patients with MS.DESIGN, SETTING, AND PARTICIPANTS: Case series of patients with relapsing-remitting MS (n = 123) or secondary-progressive MS (n = 28) (mean age, 36 years; range, 18-60 years; 85 women) treated at a single US institution between 2003 and 2014 and followed up for 5 years. Final follow-up was completed in June 2014.INTERVENTIONS: Treatment with cyclophosphamide and alemtuzumab (22 patients) or cyclophosphamide and thymoglobulin (129 patients) followed by infusion of unmanipulated peripheral blood stem cells.MAIN OUTCOMES AND MEASURES: Primary end point was reversal or progression of disability measured by change in the Expanded Disability Status Scale (EDSS) score of 1.0 or greater (score range, 0-10). Secondary outcomes included changes in the Neurologic Rating Scale (NRS) score of 10 or greater (score range, 0-100), Multiple Sclerosis Functional Composite (MSFC) score, quality-of-life Short Form 36 questionnaire scores, and T2 lesion volume on brain magnetic resonance imaging scan.RESULTS: Outcome analysis was available for 145 patients with a median follow-up of 2 years and a mean of 2.5 years. Scores from the EDSS improved significantly from a pretransplant median of 4.0 to 3.0 (interquartile range [IQR], 1.5 to 4.0; n = 82) at 2 years and to 2.5 (IQR, 1.9 to 4.5; n = 36) at 4 years (P < .001 at each assessment). There was significant improvement in disability (decrease in EDSS score of ≥1.0) in 41 patients (50%; 95% CI, 39% to 61%) at 2 years and in 23 patients (64%; 95% CI, 46% to 79%) at 4 years. Four-year relapse-free survival was 80% and progression-free survival was 87%. The NRS scores improved significantly from a pretransplant median of 74 to 88.0 (IQR, 77.3 to 93.0; n = 78) at 2 years and to 87.5 (IQR, 75.0 to 93.8; n = 34) at 4 years (P < .001 at each assessment). The median MSFC scores were 0.38 (IQR, -0.01 to 0.64) at 2 years (P < .001) and 0.45 (0.04 to 0.60) at 4 years (P = .02). Total quality-of-life scores improved from a mean of 46 (95% CI, 43 to 49) pretransplant to 64 (95% CI, 61 to 68) at a median follow-up of 2 years posttransplant (n = 132) (P < .001). There was a decrease in T2 lesion volume from a pretransplant median of 8.57 cm3 (IQR, 2.78 to 22.08 cm3) to 5.74 cm3 (IQR, 1.88 to 14.45 cm3) (P < .001) at the last posttransplant assessment (mean follow-up, 27 months; n = 128).CONCLUSIONS AND RELEVANCE: Among patients with relapsing-remitting MS, nonmyeloablative hematopoietic stem cell transplantation was associated with improvement in neurological disability and other clinical outcomes. These preliminary findings from this uncontrolled study require confirmation in randomized trials.
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| 19. |
- Burt, Richard K., et al.
(författare)
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Blogs cannot separate wheat from chaff
- 2017
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 358:6363, s. 602-602
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 20. |
- Burt, Richard K., et al.
(författare)
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Effect of Nonmyeloablative Hematopoietic Stem Cell Transplantation vs Continued Disease-Modifying Therapy on Disease Progression in Patients With Relapsing-Remitting Multiple Sclerosis : A Randomized Clinical Trial
- 2019
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Ingår i: Journal of the American Medical Association (JAMA). - : AMER MEDICAL ASSOC. - 0098-7484 .- 1538-3598. ; 321:2, s. 165-174
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Hematopoietic stem cell transplantation (HSCT) represents a potentially useful approach to slow or prevent progressive disability in relapsing-remitting multiple sclerosis (MS).OBJECTIVE To compare the effect of nonmyeloablative HSCT vs disease-modifying therapy (DMT) on disease progression.DESIGN, SETTING, AND PARTICIPANTS Between September 20, 2005, and July 7, 2016, a total of 110 patients with relapsing-remitting MS, at least 2 relapses while receiving DMT in the prior year, and an Expanded Disability Status Scale (EDSS; score range, 0-10 [10 = worst neurologic disability]) score of 2.0 to 6.0 were randomized at 4 US, European, and South American centers. Final follow-up occurred in January 2018 and database lock in February 2018.INTERVENTIONS Patients were randomized to receive HSCT along with cyclophosphamide (200mg/kg) and antithymocyte globulin (6mg/kg) (n = 55) or DMT of higher efficacy or a different class than DMT taken during the previous year (n = 55).MAIN OUTCOMES AND MEASURES The primary end point was disease progression, defined as an EDSS score increase after at least 1 year of 1.0 point or more (minimal clinically important difference, 0.5) on 2 evaluations 6 months apart, with differences in time to progression estimated as hazard ratios. RESULTS Among 110 randomized patients (73 [66%] women; mean age, 36 [SD, 8.6] years), 103 remained in the trial, with 98 evaluated at 1 year and 23 evaluated yearly for 5 years (median follow-up, 2 years; mean, 2.8 years). Disease progression occurred in 3 patients in the HSCT group and 34 patients in the DMT group. Median time to progression could not be calculated in the HSCT group because of too few events; it was 24 months (interquartile range, 18-48 months) in the DMT group (hazard ratio, 0.07; 95% CI, 0.02-0.24; P < .001). During the first year, mean EDSS scores decreased (improved) from 3.38 to 2.36 in the HSCT group and increased (worsened) from 3.31 to 3.98 in the DMT group (between-group mean difference,-1.7; 95% CI,-2.03 to -1.29; P < .001). There were no deaths and no patients who received HSCT developed nonhematopoietic grade 4 toxicities (such as myocardial infarction, sepsis, or other disabling or potential life-threatening events).CONCLUSIONS AND RELEVANCE In this preliminary study of patients with relapsing-remitting MS, nonmyeloablative HSCT, compared with DMT, resulted in prolonged time to disease progression. Further research is needed to replicate these findings and to assess long-term outcomes and safety.
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| 21. |
- Burt, Richard K., et al.
(författare)
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New autoimmune diseases after autologous hematopoietic stem cell transplantation for multiple sclerosis
- 2021
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Ingår i: Bone Marrow Transplantation. - : Springer Nature. - 0268-3369 .- 1476-5365. ; 56:7, s. 1509-1517
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Forskningsöversikt (refereegranskat)abstract
- Secondary autoimmune diseases (2ndADs), most frequently autoimmune cytopenias (AICs), were first described after allogeneic hematopoietic stem cell transplantation (HSCT) undertaken for malignant and hematological indications, occurred at a prevalence of similar to 5-6.5%, and were attributed to allogeneic immune imbalances in the context of graft versus host disease, viral infections, and chronic immunosuppression. Subsequently, 2ndADs were reported to complicate roughly 2-14% of autologous HSCTs performed for an autoimmune disease. Alemtuzumab in the conditioning regimen has been identified as a risk for development of 2ndADs after either allogeneic or autologous HSCT and is consistent with the high rates of 2ndADs when using alemtuzumab as monotherapy. Due to the significant consequences but variable incidence, depending on conditioning regimen, of 2ndADs and similarity in known immune reconstitution kinetics after autologous HSCT for autoimmune diseases and after alemtuzumab monotherapy, we propose that an imbalance between B and T lineage regeneration early after HSCT may underlie the pathogenesis of 2ndADs.
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| 22. |
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| 23. |
- Carlbring, Per, et al.
(författare)
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Närmare varandra – starkare parrelation på nio veckor
- 2018
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Konferensbidrag (populärvet., debatt m.m.)abstract
- Relationsproblem påverkar oss på många plan. I boken Närmare varandra ges hjälp att hitta ömma punkter i samspelet och att bygga vidare på de styrkor som paret redan har. Boken bygger på en svensk KBT-manual som är vetenskapligt prövad. Majoriteten av de par som gick igenom bokens övningar blev mer nöjda med sin relation. Psykologerna Per Carlbring och Maria Burman i samtal med Anna Bennich.
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| 24. |
- Carlsson, Ninni, 1962, et al.
(författare)
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”Visa i handling vad arbetet mot mäns våld är värt”
- 2019
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Ingår i: Svenska Dagbladet. ; 2019:4 april
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Mitt i debatten om Josefin Nilsson och det våld mot henne som närstående berättar om i SVT-dokumentären ”Älska mig för den jag är”, tillkännager regeringen, C och L att de föreslår 45 miljoner i vårbudget för att bekämpa mäns våld mot kvinnor. Flera medier kallar det en storsatsning men är det verkligen det, frågar våldsforskare, #metoo-upprop och organisationer. Med hjälp av aktuell forskning argumenterar de för att detta är långt ifrån tillräckligt, kräver större vårbudget mot mäns våld mot kvinnor och bjuder in riksdag och regering till dialog.
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| 25. |
- Greco, Raffaella, et al.
(författare)
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Autologous hematopoietic stem cell transplantation in neuromyelitis optica : A registry study of the EBMT Autoimmune Diseases Working Party
- 2015
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Ingår i: Multiple Sclerosis Journal. - : SAGE Publications. - 1352-4585 .- 1477-0970. ; 21:2, s. 189-197
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Neuromyelitis optica (NMO) is an inflammatory autoimmune disorder of the central nervous system, hallmarked by pathogenic anti-aquaporin 4 antibodies. NMO prognosis is worse compared with multiple sclerosis.OBJECTIVE:The European Group for Blood and Marrow Transplantation (EBMT) Autoimmune Diseases Working Party (ADWP) conducted a retrospective survey to analyze disease outcome following autologous stem cell transplantation (ASCT).METHODS:This retrospective multicenter study assessed the efficacy and safety of ASCT in 16 patients suffering from refractory NMO reported to the EBMT registry between 2001 and 2011.RESULTS:Fifteen patients were successfully mobilized with cyclophosphamide (Cy) and G-CSF, one with G-CSF alone. All patients received an unmanipulated autologous peripheral blood stem cell graft, after conditioning with BEAM plus anti-thymocyte globulin (ATG, n = 9 patients), thiotepa-Cy (n = 3) or Cy (200 mg/kg) plus ATG (n = 4). After a median follow-up of 47 months, three of 16 cases were progression and treatment free, while in the remaining 13 patients further treatments were administered for disability progression or relapse after ASCT. Altogether, relapse-free survival at three and five years was 31% and 10%, respectively, while progression-free survival remained 48% at three and five years.CONCLUSIONS:In these NMO patients, highly resistant to conventional treatment, ASCT allows for temporary control of the disease, despite a tendency to progress or relapse in the long term.
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| 26. |
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| 27. |
- Igreja, Susana, et al.
(författare)
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Assessment of p27 (cyclin-dependent kinase inhibitor 1B) and aryl hydrocarbon receptor-interacting protein (AIP) genes in multiple endocrine neoplasia (MEN1) syndrome patients without any detectable MEN1 gene mutations
- 2009
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Ingår i: Clinical Endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 70:2, s. 259-264
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Tidskriftsartikel (refereegranskat)abstract
- Germline mutations in the MEN1 gene predispose to the multiple endocrine neoplasia (MEN1) syndrome; however, approximately 10-20% of patients with MEN1 do not have a detectable MEN1 mutation. A rat strain with multiple endocrine tumours, a phenotypic overlap of both MEN1 and MEN2, has been reported to have a homozygous germline p27 (CDKN1B) mutation. Recently, two MEN1 mutation-negative MEN1 syndrome patients have been identified to harbour a germline CDKN1B mutation. The recently identified gene AIP can also cause familial isolated pituitary adenoma, but no other specific tumour is associated with this syndrome. The objective of this study was to evaluate the possible contribution of CDKN1B and AIP germline mutations in a cohort of MEN1 mutation-negative MEN1 syndrome patients. Eighteen sporadic and three familial cases of MEN1 mutation-negative MEN1 syndrome were studied (18 pituitary adenomas, 12 hyperparathyroidism, 10 neuroendocrine tumours including 2 ACTH-secreting lesions and one adrenal nodular hyperplasia). Clinical data and genomic DNA were analysed for mutations in the CDKN1B and AIP genes. There were no mutations in the coding region or exon/intron junction of the CDKN1B and AIP genes in any patient. Although we have a limited number of patients in our cohort, our data is consistent with others in the literature suggesting that CDKN1B and AIP mutations are extremely rare in MEN1 syndrome. Our results suggest that mutations in the CDKN1B and AIP genes are relatively uncommon in MEN1 mutation-negative MEN1 syndrome patients.
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| 28. |
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| 29. |
- Johansen, Kari, et al.
(författare)
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Norovirus strains belonging to the GII.4 genotype dominate as a cause of nosocomial outbreaks of viral gastroenteritis in Sweden 1997-2005 - Arrival of new variants is associated with large nation-wide epidemics
- 2008
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Ingår i: Journal of Clinical Virology. - : Elsevier BV. - 1386-6532 .- 1873-5967. ; 42:2, s. 129-134
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Tidskriftsartikel (refereegranskat)abstract
- Background: In recent years an increase of the incidence of nosocomial outbreaks caused by noroviruses has been observed throughout Sweden, with high peaks noted in the winter seasons 2002/2003 and 2004/2005, respectively. Objectives: To phylogenetically characterize norovirus strains causing nosocomial outbreaks from 1997 to 2005 and estimate the impact of norovirus-like disease on the Swedish health care system during the peak season 2002/2003 when a new variant of norovirus occurred. Study design: Stool samples from 115 randomly selected nosocomial outbreaks occurring during 1997-2005 throughout Sweden were studied by RT-PCR and sequencing. In addition, to investigate the impact on the health-care system, a questionnaire was distributed to infection control units (n = 90) serving all Swedish hospitals, nursing homes and other health-care institutions during the largest epidemic of nosocomial outbreaks. Results: Sequencing of 279 nucleotides of the norovirus RNA polymerase gene in stools containing norovirus RNA showed that strains belonging to the GII.4 genotype dominated. Each of the two large epidemics was due to a new variant within this cluster. The questionnaire revealed that 30,000-35,000 episodes of nosocomial norovirus-like infections occurred in 80 of 82 major Swedish hospitals affected in 2002/2003. Conclusion: New norovirus variants within the cluster GGII.4 may have a major impact on the health-care system. (c) 2008 Elsevier B.V. All rights reserved.
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| 30. |
- Kalincik, Tomas, et al.
(författare)
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Comparative Effectiveness of Autologous Hematopoietic Stem Cell Transplant vs Fingolimod, Natalizumab, and Ocrelizumab in Highly Active Relapsing-Remitting Multiple Sclerosis
- 2023
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Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149 .- 2168-6157. ; 80:7, s. 702-713
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Tidskriftsartikel (refereegranskat)abstract
- Importance Autologous hematopoietic stem cell transplant (AHSCT) is available for treatment of highly active multiple sclerosis (MS).Objective To compare the effectiveness of AHSCT vs fingolimod, natalizumab, and ocrelizumab in relapsing-remitting MS by emulating pairwise trials.Design, Setting, and Participants This comparative treatment effectiveness study included 6 specialist MS centers with AHSCT programs and international MSBase registry between 2006 and 2021. The study included patients with relapsing-remitting MS treated with AHSCT, fingolimod, natalizumab, or ocrelizumab with 2 or more years study follow-up including 2 or more disability assessments. Patients were matched on a propensity score derived from clinical and demographic characteristics.Exposure AHSCT vs fingolimod, natalizumab, or ocrelizumab.Main outcomes Pairwise-censored groups were compared on annualized relapse rates (ARR) and freedom from relapses and 6-month confirmed Expanded Disability Status Scale (EDSS) score worsening and improvement.Results Of 4915 individuals, 167 were treated with AHSCT; 2558, fingolimod; 1490, natalizumab; and 700, ocrelizumab. The prematch AHSCT cohort was younger and with greater disability than the fingolimod, natalizumab, and ocrelizumab cohorts; the matched groups were closely aligned. The proportion of women ranged from 65% to 70%, and the mean (SD) age ranged from 35.3 (9.4) to 37.1 (10.6) years. The mean (SD) disease duration ranged from 7.9 (5.6) to 8.7 (5.4) years, EDSS score ranged from 3.5 (1.6) to 3.9 (1.9), and frequency of relapses ranged from 0.77 (0.94) to 0.86 (0.89) in the preceding year. Compared with the fingolimod group (769 [30.0%]), AHSCT (144 [86.2%]) was associated with fewer relapses (ARR: mean [SD], 0.09 [0.30] vs 0.20 [0.44]), similar risk of disability worsening (hazard ratio [HR], 1.70; 95% CI, 0.91-3.17), and higher chance of disability improvement (HR, 2.70; 95% CI, 1.71-4.26) over 5 years. Compared with natalizumab (730 [49.0%]), AHSCT (146 [87.4%]) was associated with marginally lower ARR (mean [SD], 0.08 [0.31] vs 0.10 [0.34]), similar risk of disability worsening (HR, 1.06; 95% CI, 0.54-2.09), and higher chance of disability improvement (HR, 2.68; 95% CI, 1.72-4.18) over 5 years. AHSCT (110 [65.9%]) and ocrelizumab (343 [49.0%]) were associated with similar ARR (mean [SD], 0.09 [0.34] vs 0.06 [0.32]), disability worsening (HR, 1.77; 95% CI, 0.61-5.08), and disability improvement (HR, 1.37; 95% CI, 0.66-2.82) over 3 years. AHSCT-related mortality occurred in 1 of 159 patients (0.6%).Conclusion In this study, the association of AHSCT with preventing relapses and facilitating recovery from disability was considerably superior to fingolimod and marginally superior to natalizumab. This study did not find evidence for difference in the effectiveness of AHSCT and ocrelizumab over a shorter available follow-up time.
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| 31. |
- Niemelä, Valter, et al.
(författare)
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Proenkephalin Decreases in Cerebrospinal Fluid with Symptom Progression of Huntington's Disease
- 2021
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Ingår i: Movement Disorders. - : Wiley. - 0885-3185 .- 1531-8257. ; 36:2, s. 481-491
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Tidskriftsartikel (refereegranskat)abstract
- Objective Identifying molecular changes that contribute to the onset and progression of Huntington's disease (HD) is of importance for the development and evaluation of potential therapies. Methods We conducted an unbiased mass-spectrometry proteomic analysis on the cerebrospinal fluid of 12 manifest HD patients (ManHD), 13 pre-manifest (preHD), and 38 controls. A biologically plausible and significant possible biomarker was validated in samples from a separate cohort of patients and controls consisting of 23 ManHD patients and 23 controls. Results In ManHD compared to preHD, 10 proteins were downregulated and 43 upregulated. Decreased levels of proenkephalin (PENK) and transthyretin were closely linked to HD symptom severity, whereas levels of 15 upregulated proteins were associated with symptom severity. The decreased PENK levels were replicated in the separate cohort where absolute quantitation was performed. Conclusions We hypothesize that declining PENK levels reflect the degeneration of medium spiny neurons (MSNs) that produce PENK and that assays for PENK may serve as a surrogate marker for the state of MSNs in HD. (c) 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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| 32. |
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| 33. |
- Papakokkinou, Eleni, et al.
(författare)
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Excess Morbidity Persists in Patients With Cushing’s Disease During Long-term Remission : A Swedish Nationwide Study
- 2020
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - Washington : Oxford University Press. - 0021-972X .- 1945-7197. ; 105:8, s. 2616-2624
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Tidskriftsartikel (refereegranskat)abstract
- Context: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined.Objective: To investigate comorbidities in patients with CD.Design, setting, and patients: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status.Main outcomes: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission.Results: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission.Conclusion: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.
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| 34. |
- Pränting, Maria, et al.
(författare)
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The cyclotide cycloviolacin O2 from Viola odorata has potent bactericidal activity against Gram-negative bacteria
- 2010
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Ingår i: Journal of Antimicrobial Chemotherapy. - : Oxford University Press (OUP). - 0305-7453 .- 1460-2091. ; 65:9, s. 1964-1971
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To determine the antibacterial activity of small cyclic plant proteins, i.e. cyclotides, and the importance of the surface exposed charged residues for activity.METHODS:Prototypic cyclotides, including the Möbius kalata B1 and the bracelet cycloviolacin O2 (cyO2), were isolated using reversed-phase HPLC. Initial activity screenings were conducted using radial diffusion assays (RDAs) and MIC assays with Salmonella enterica serovar Typhimurium LT2, Escherichia coli and Staphylococcus aureus as test strains. For the most active peptide, cyO2, time-kill kinetics was determined in sodium phosphate buffer (containing 0.03% trypticase soy broth) against several Gram-negative and Gram-positive bacterial species. Charged residues in cyO2 were chemically modified and activity was determined in time-kill assays.RESULTS:CyO2 was the most active cyclotide and efficiently inhibited the growth of S. enterica serovar Typhimurium LT2 and E. coli in RDAs and MIC assays, while the other peptides were less active. In time-kill assays, cyO2 also had bactericidal activity against the Gram-negative species Klebsiella pneumoniae and Pseudomonas aeruginosa. In contrast, none of the cyclotides had high activity against S. aureus. Chemical masking of the charged Glu and Lys residues in cyO2 caused a near total loss of activity against Salmonella, while masking Arg caused a less pronounced activity reduction.CONCLUSIONS:CyO2 is a cyclotide with potent activity against Gram-negative bacteria. The charged residues in cyO2 are all required for optimum antibacterial activity. In combination with its previously demonstrated cytotoxic activity against cancer cells and the general stability of cyclotides, cyO2 provides a promising scaffold for future drug design.
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| 35. |
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| 36. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study
- 2019
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : ENDOCRINE SOC. - 0021-972X .- 1945-7197. ; 104:6, s. 2375-2384
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Tidskriftsartikel (refereegranskat)abstract
- Context: Whether patients with Cushing disease (CD) in remission have increased mortality is still debatable. Objective: To study overall and disease-specific mortality and predictive factors in an unselected nationwide cohort of patients with CD. Design, Patients, and Methods: A retrospective study of patients diagnosed with CD, identified in the Swedish National Patient Registry between 1987 and 2013. Medical records were systematically reviewed to verify the diagnosis. Standardized mortality ratios (SMRs) with 95% CIs were calculated and Cox regression models were used to identify predictors of mortality. Results: Of 502 identified patients with CD (n = 387 women; 77%), 419 (83%) were confirmed to be in remission. Mean age at diagnosis was 43 (SD, 16) years and median follow-up was 13 (interquartile range, 6 to 23) years. The observed number of deaths was 133 vs 54 expected, resulting in an overall SMR of 2.5 (95% CI, 2.1 to 2.9). The commonest cause of death was cardiovascular diseases (SMR, 3.3; 95% CI, 2.6 to 4.3). Excess mortality was also found associated with infections and suicide. For patients in remission, the SMR was 1.9 (95% CI, 1.5 to 2.3); bilateral adrenalectomy and glucocorticoid replacement therapy were independently associated with increased mortality, whereas GH replacement was associated with improved outcome. Conclusion: Findings from this large nationwide study indicate that patients with CD have excess mortality. The findings illustrate the importance of achieving remission and continued active surveillance, along with adequate hormone replacement and evaluation of cardiovascular risk and mental health.
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| 37. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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The incidence of Cushing’s disease : a nationwide Swedish study
- 2019
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Ingår i: Pituitary. - : Springer. - 1386-341X .- 1573-7403. ; 22:2, s. 179-186
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies on the incidence of Cushing’s disease (CD) are few and usually limited by a small number of patients. The aim of this study was to assess the annual incidence in a nationwide cohort of patients with presumed CD in Sweden.Methods: Patients registered with a diagnostic code for Cushing’s syndrome (CS) or CD, between 1987 and 2013 were identified in the Swedish National Patient Registry. The CD diagnosis was validated by reviewing clinical, biochemical, imaging, and histopathological data.Results: Of 1317 patients identified, 534 (41%) had confirmed CD. One-hundred-and-fifty-six (12%) patients had other forms of CS, 41 (3%) had probable but unconfirmed CD, and 334 (25%) had diagnoses unrelated to CS. The mean (95% confidence interval) annual incidence between 1987 and 2013 of confirmed CD was 1.6 (1.4–1.8) cases per million. 1987–1995, 1996–2004, and 2005–2013, the mean annual incidence was 1.5 (1.1–1.8), 1.4 (1.0–1.7) and 2.0 (1.7–2.3) cases per million, respectively. During the last time period the incidence was higher than during the first and second time periods (P < 0.05).Conclusion: The incidence of CD in Sweden (1.6 cases per million) is in agreement with most previous reports. A higher incidence between 2005 and 2013 compared to 1987–2004 was noticed. Whether this reflects a truly increased incidence of the disease, or simply an increased awareness, earlier recognition, and earlier diagnosis can, however, not be answered. This study also illustrates the importance of validation of the diagnosis of CD in epidemiological research.
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| 38. |
- Svensson, Eva-Maria, 1958, et al.
(författare)
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The Role of International Human Rights Law in the Governance of the Arctic Regarding Women's Rights
- 2016
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Ingår i: The Role of Law in Polar Governance.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Previous studies show a lack of deference and activities when it comes to gender equality and women’s human rights in the governance of the Arctic (Lahey et.al 2014; Lahey et.al 2016). When it comes to indigenous women’s rights, the situation is more complicated. Frequently, a dichotomy is constructed between two perceived discourses, western women’s rights and indigenous women’s rights. This dichotomy and the colonial context can hinder gender equality promotion in the governance. The effects of this might be serious, given that gender equality is not a prioritized task within the governance of the Arctic. The situation for women in the Arctic is vulnerable, according to the CEDAW Committee. The rights of indigenous women are not upheld in several of the Arctic states (according to several UN reports) when it comes to various issues such as violence, economic self-support, participation in governing bodies etc. At the same time, CEDAW and also international treaties and declarations such as the ILO Convention 169 and UNDRIP, are scarcely referred to and implemented on all levels of governance and by governance bodies. The focus in this presentation will be on implementation, and the lack thereof, of CEDAW and other human rights documents relevant for women’s right’s in the governance of the Arctic, and on strategies for a future gender equal governance.
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| 39. |
- Vouzouneraki, Konstantina, et al.
(författare)
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Temporal relationship of sleep apnea and acromegaly: a nationwide study
- 2018
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Ingår i: Endocrine. - : Springer Science and Business Media LLC. - 1355-008X .- 1559-0100. ; 62:2, s. 456-463
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Tidskriftsartikel (refereegranskat)abstract
- PurposePatients with acromegaly have an increased risk of sleep apnea, but reported prevalence rates vary largely. Here we aimed to evaluate the sleep apnea prevalence in a large national cohort of patients with acromegaly, to examine possible risk factors, and to assess the proportion of patients diagnosed with sleep apnea prior to acromegaly diagnosis.MethodsCross-sectional multicenter study of 259 Swedish patients with acromegaly. At patients' follow-up visits at the endocrine outpatient clinics of all seven university hospitals in Sweden, questionnaires were completed to assess previous sleep apnea diagnosis and treatment, cardiovascular diseases, smoking habits, anthropometric data, and S-IGF-1 levels. Daytime sleepiness was evaluated using the Epworth Sleepiness Scale. Patients suspected to have undiagnosed sleep apnea were referred for sleep apnea investigations.ResultsOf the 259 participants, 75 (29%) were diagnosed with sleep apnea before the study start. In 43 (57%) of these patients, sleep apnea had been diagnosed before the diagnosis of acromegaly. After clinical assessment and sleep studies, sleep apnea was diagnosed in an additional 20 patients, yielding a total sleep apnea prevalence of 37%. Higher sleep apnea risk was associated with higher BMI, waist circumference, and index finger circumference. Sleep apnea was more frequent among patients with S-IGF-1 levels in the highest quartile.ConclusionSleep apnea is common among patients with acromegaly, and is often diagnosed prior to their acromegaly diagnosis. These results support early screening for sleep apnea in patients with acromegaly and awareness for acromegaly in patients with sleep apnea.
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| 40. |
- Wegerstad, Linnéa, et al.
(författare)
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Om erotik, makt och sexualbrottens sexualitet
- 2011
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Ingår i: På vei: Kjønn og rett i Norden. - 9789170611049 ; , s. 273-297
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Bokkapitel (refereegranskat)abstract
- In this chapter I examine the concept of sexual offenses in Swedish criminal law: How is the sexuality of sexual offenses constructed? The material analyzed consists of preparatory works and case law on sexual offenses. Inspired by law professor Katherine M. Franke, the analysis is theoretically grounded in two diverse understandings of sexuality: Sexuality as erotic and sexuality as a dense transfer point for relations of power. In the article I argue that the sexuality of sexual offenses – such as it is constructed in Swedish criminal law on sexual offences – reflects an image of sexuality as pleasurable and mutual. Hence, it is a sexuality created as erotic. Further, a consequence of this construction of sexuality is discussed in the article, namely that sexuality as erotic renders invisible the many different ways in which sexuality is used as a tool in relations of power. Finally, different theoretical understandings of the relation between gender and sexual violations in criminal law are shortly discussed.
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| 41. |
- Öhman, Ann, et al.
(författare)
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'The public health turn on violence against women' : Analysing Swedish healthcare law, public health and gender-equality policies
- 2020
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- This article focuses on policy and law concerning violence against women as a public health issue. In Sweden, violence against women is recently recognized as a public health problem; we label this shift "The public health turn on violence against women". The new framing implies increased demands on the Swedish healthcare sector and its’ ability to recognise violence and deal with it in terms of prevention and interventions. The aim was to describe and discuss the main content and characteristics of Swedish healthcare law, and national public health and gender-equality policies representing the public health turn on violence against women. Through discursive policy analysis, we investigate how the violence is described, what is regarded to be the problem and what solutions and interventions that are suggested in order to solve the problem. Healthcare law articulates violence against women as an ordinary healthcare issue and the problem as shortcomings to provide good healthcare for victims, but without specifying what the problem or the legal obligation for the sector is. The public health problem is rather loosely defined, and suggested interventions are scarce and somewhat vague. The main recommendations for healthcare are to routinely ask patients about violence exposure. Violence against women is usually labelled "violence within close relationships" in the policies, and it is not necessarily described as a gender equality problem. While violence against women in some policy documents is clearly framed as a public health problem, such a framing is absent in others, or is transformed into a gender-neutral problem of violence within close relationships. It is not clearly articulated what the framing should lead to in terms of the healthcare sector's obligations, interventions and health promotions, apart from an ambivalent discourse on daring to ask about violence.
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