| 1. |
- Andersson, Lars-Göran, et al.
(författare)
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Thallium-201 Myocardial Imaging at Rest in Male Orienteers and Other Endurance Athletes
- 2001
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 106:1, s. 59-66
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Tidskriftsartikel (refereegranskat)abstract
- During the period 1979 to 1992, 16 sudden unexpected cardiac deaths were known to have occurred in young Swedish orienteers. Autopsy indicated myocarditis to be the most frequent finding, most often combined with extensive myocardial fibrosis. The aim of the present investigation was to explore whether young male orienteers show a higher frequency than other young elite endurance athletes (controls) in the occurrence of Thallium-201 myocardial perfusion defects at rest, suggestive of fibrosis evoked by myocarditis. Thallium-201 perfusion abnormalities at rest were more frequently found in the controls than in the orienteers (26% vs. 12%, p=0.03). Uneven Tl-201 perfusion was associated with left ventricular mass (r=0.32, r=0.24, p<0.01, p=0.02) and body weight (r=0.30, r=0.31, p<0.01, p=0.03) in orienteers and controls, respectively. Echocardiographic left ventricular wall motion abnormalities were found in 11 athletes (9 orienteers and 2 controls) but only two displayed an abnormal Thallium-201 perfusion scan at rest. Perfusion abnormalities at rest did not occur more frequently in the orienteers but were commonly found in both groups of apparently healthy athletes making it futile to discern abnormals from normals. Thallium-201 perfusion aberrations were not associated with left ventricular wall motion abnormalities obtained by echocardiography.
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| 2. |
- Damm, S., et al.
(författare)
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Wall motion abnormalities in male elite orienteers are aggravated by exercise
- 1999
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Ingår i: Clinical Physiology. - : Wiley. - 0144-5979 .- 1365-2281. ; 19:2, s. 121-126
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Tidskriftsartikel (refereegranskat)abstract
- During the period 1979-92, 16 (15 men and one woman) sudden unexpected cardiac deaths occurred among young Swedish orienteers. This finding indicated a sharp increase in the death rate of orienteers, and necropsy demonstrated that myocarditis was a common histopathological finding. Therefore, an extensive non-invasive cardiac investigation was performed. A total of 59 male élite orienteers (mean age 23 years) and 36 cross-country skiers and middle-distance runners (mean age 22 years), serving as controls, were examined by both echocardiography at rest and radionuclide ventriculography at rest and during exercise. Wall motion abnormalities were found in eight orienteers using echocardiography. The purpose of this study was to examine whether the group of orienteers with wall motion abnormalities found using echocardiography had a smaller increase in ejection fraction from rest to exercise using radionuclide ventriculography than the rest of the orienteers and the controls, indicating an aggravation of the wall motion abnormalities during exercise. There were no significant differences in the ejection fraction at rest between the groups. In the orienteers with wall motion abnormalities (group 1), 62% (five out of eight) had less than a 0.05 unit increase in left ventricular ejection fraction compared with 27% (14 out of 51) of the remaining orienteers (group 2) and 19% (7 out of 36) of the controls (group 3). A comparison of athletes in group 1 with those in groups 2 and 3 combined revealed a statistically significant difference (P < 0.05). The divergent response in left ventricular ejection fraction during exercise suggests an aggravation of the wall motion abnormalities with exercise. Both the echocardiographic and the radionuclide ventriculographic findings indicate that the orienteers in group 1 had concealed left ventricular damage.
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| 3. |
- Cowan O., George, et al.
(författare)
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Rickettsial Infections (Section 7, Chapter 49)
- 2008
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Ingår i: Mansons's Tropical Diseases. - : Saunders. - 1416044701 - 9781416044703 ; , s. 885-902
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
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| 5. |
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| 6. |
- Finnveden, Göran, et al.
(författare)
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Evaluation of integration of sustainable development in higher education in Sweden
- 2020
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Ingår i: International Journal of Sustainability in Higher Education. - : Emerald Group Publishing Limited. - 1467-6370 .- 1758-6739. ; 21:4, s. 685-698
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Since 2006, higher education institutions (HEIs) in Sweden, should according to the Higher Education Act, promote sustainable development (SD). In 2016, the Swedish Government asked the Swedish higher education authority to evaluate how this study is proceeding. The authority chose to focus on education. This paper aims to produce a report on this evaluation. Design/methodology/approach All 47 HEIs in Sweden were asked to write a self-evaluation report based on certain evaluation criteria. A panel was appointed consisting of academics and representatives for students and working life. The panel wrote an evaluation of each HEI, a report on general findings and recommendations, and gave an overall judgement of each HEI in two classes as follows: the HEI has well-developed processes for integration of SD in education or the HEI needs to develop their processes. Findings Overall, a mixed picture developed. Most HEIs could give examples of programmes or courses where SD was integrated. However, less than half of the HEIs had overarching goals for integration of SD in education or had a systematic follow-up of these goals. Even fewer worked specifically with pedagogy and didactics, teaching and learning methods and environments, sustainability competences or other characters of education for SD. Overall, only 12 out of 47 got a higher judgement. Originality/value This is a unique study in which all HEIs in a country are evaluated. This provides unique possibilities for identifying success factors and barriers. The importance of the leadership of the HEIs became clear.
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| 7. |
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| 8. |
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| 9. |
- McGill, Svena, et al.
(författare)
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Bartonella spp. seroprevalence in healthy Swedish blood donors
- 2005
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 37:10, s. 723-730
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Tidskriftsartikel (refereegranskat)abstract
- Serum samples were collected from healthy blood donors in 5 regions in Sweden in 1999, i.e. from the local Blood Centres (collecting facilities) in Boden, Jönköping, Lund, Skövde, and Uppsala. In total, 498 serum samples (63% males, 37% females) were received and tested by immunofluorescence assay for antibodies against B. elizabethae, B. grahamii, B. henselae (Houston-1), B. henselae (Marseille), B. quintana, and B. vinsonii subsp. vinsonii. An overall Bartonella spp. seroprevalence of 16.1% was found, with a predominance of immunoreactivity to B. elizabethae, at 14.1%; B. grahamii, 2.6%; B. henselae (Houston-1), 1.2%; B. henselae (Marseille), 1.8%; B. quintana, 0.2%; and B. vinsonii subsp. vinsonii, 0.0%. Univariate and multivariate analyses of epidemiological and demographical information revealed an increased rate of B. elizabethae seropositivity in blood donors working outdoors, being out in the wild a minimum of once a week, hunting moose, having cat contact, and travelling to Eastern Europe. Living in the southern region of Sweden (Lund area) was associated with decreased seropositivity to B. elizabethae.
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| 10. |
- Söfteland, John M., 1977, et al.
(författare)
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COVID-19 in solid organ transplant recipients : A national cohort study from Sweden
- 2021
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Ingår i: American Journal of Transplantation. - : John Wiley & Sons. - 1600-6135 .- 1600-6143. ; 21:8, s. 2762-2773
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Tidskriftsartikel (refereegranskat)abstract
- Solid organ transplant (SOT) recipients run a high risk for adverse outcomes from COVID-19, with reported mortality around 19%. We retrospectively reviewed all known Swedish SOT recipients with RT-PCR confirmed COVID-19 between March 1 and November 20, 2020 and analyzed patient characteristics, management, and outcome. We identified 230 patients with a median age of 54.0 years (13.2), who were predominantly male (64%). Most patients were hospitalized (64%), but 36% remained outpatients. Age >50 and male sex were among predictors of transition from outpatient to inpatient status. National early warning Score 2 (NEWS2) at presentation was higher in non-survivors. Thirty-day all-cause mortality was 9.6% (15.0% for inpatients), increased with age and BMI, and was higher in men. Renal function decreased during COVID-19 but recovered in most patients. SARS-CoV-2 antibodies were identified in 78% of patients at 1-2 months post-infection. Nucleocapsid-specific antibodies decreased to 38% after 6-7 months, while spike-specific antibody responses were more durable. Seroprevalence in 559 asymptomatic patients was 1.4%. Many patients can be managed on an outpatient basis aided by risk stratification with age, sex, and NEWS2 score. Factors associated with adverse outcomes include older age, male sex, greater BMI, and a higher NEWS2 score.
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| 11. |
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| 12. |
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| 13. |
- Benyamin, Gad, et al.
(författare)
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Arsenic is decreased in target organs during viral infection in mice
- 2006
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Ingår i: Journal of Trace Elements in Medicine and Biology. - : Elsevier BV. - 0946-672X .- 1878-3252. ; 20:2, s. 121-126
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Tidskriftsartikel (refereegranskat)abstract
- Arsenic (As), a potentially toxic trace element, has been shown to influence viral replication and resistance to microbial infection. However, the impact of infection on the normal As status in target organs involved in the disease process has not been studied to date. In the present study, As was measured through inductively coupled plasma mass spectrometry in the plasma, liver, spleen, kidney, heart, pancreas and brain at days 1 and 3 of coxsackievirus B3 infection in female Balb/c mice. The severity of the infection was assessed from clinical signs of disease. The infection changed plasma As in a biphasic pattern with a small increase (n.s.) at day 1 that turned into a decreasing trend (13%, p<0.05) by day 3. In the liver, spleen, heart, pancreas and kidney As was unchanged at day 1 but, at day 3, it had decreased by 71% (p<0.01), 64% (p<0.01), 55% (p<0.01), 63% (p<0.01) and 73% (p<0.01), respectively. In the brain, As went unchanged. The pathophysiological interpretation of these findings requires further research.
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| 14. |
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| 15. |
- Edvinsson, Marie, 1976-
(författare)
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Chlamydophila pneumoniae in Cardiovascular Diseases : Clinical and Experimental Studies
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chlamydophila pneumoniae (C. pneumoniae) has been suggested as a stimulator of chronic inflammation in atherosclerosis. C. pneumoniae DNA was demonstrated in aortic biopsies in 50% of patients with stable angina pectoris or acute coronary syndrome undergoing coronary artery bypass grafting. C. pneumoniae mRNA, a marker of replicating bacteria, was demonstrated in 18% of the aortic biopsies. Inflammation may have a role in the pathogenesis of thoracic aortic aneurysm, aortic dissection and aortic valve stenosis. C. pneumoniae DNA was demonstrated in aortic biopsies in 26% of thoracic aortic aneurysm patients and in 11% of aortic dissection patients undergoing thoracic surgery and in 22% of stenotic aortic heart valves from patients undergoing aortic valve replacement. No bacterial mRNA was demonstrated in these aortic biopsies, nor in the valves, suggesting that the infection has passed into a persistent state. C. pneumoniae DNA was demonstrated in peripheral blood mononuclear cells in only 5% of aortic valve stenosis patients and not in thoracic aortic aneurysm or aortic dissection patients, suggesting that the bacterium disseminated to the cardiovascular tissue long before the patient required surgery. The copper/zinc ratio in serum, a marker of infection/inflammation, was significantly elevated in thoracic aortic aneurysm patients, supporting an inflammatory pathogenesis. Patients positive for C. pneumoniae in the aortic valve had more advanced coronary atherosclerosis, further supporting a possible role for C. pneumoniae in atherosclerosis. Mice were infected with C. pneumoniae that disseminated to all organs investigated (i.e. lungs, heart, aorta, liver and spleen). Trace element concentrations were altered in infected animals with an increased copper/zinc ratio in serum, a progressively increased iron concentration in the liver and a progressively decreased iron concentration in serum. Iron is important for C. pneumoniae metabolism, and a changed iron homeostasis was noted in infected mice by alterations in iron-regulating proteins, such as DMT1 and hepcidin.
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| 16. |
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| 17. |
- Edvinsson, Marie, et al.
(författare)
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Persistent Chlamydophila pneumoniae infection in thoracic aortic aneurysm and aortic dissection?
- 2010
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 115:3, s. 181-186
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Chlamydophila pneumoniae (C. pneumoniae) has been associated with atherosclerosis and abdominal aortic aneurysm and is probably disseminated by peripheral blood mononuclear cells (PBMC). Viable and metabolically active bacteria can be demonstrated by the presence of bacterial mRNA and on-going dissemination by the presence of bacteria in PBMC. The aim of this study was to determine the prevalence of C. pneumoniae DNA and mRNA in aortic biopsies and C. pneumoniae DNA in PBMC in thoracic aortic aneurysm and aortic dissection patients. Design. Real-time PCR was used to detect C. pneumoniae DNA and mRNA in biopsies and C. pneumoniae DNA in PBMC. Results. C. pneumoniae DNA was found in biopsies in 26% (6/23) of aneurysm patients and 11% (2/18) of dissection patients but in none of the forensic autopsy controls. C. pneumoniae mRNA was not found in any biopsy, and all PBMC were C. pneumoniae-negative. Conclusions. Presence of C. pneumoniae DNA but not mRNA in aortic biopsies and no evidence of C. pneumoniae in PBMC suggest that the infection in the aorta has passed into a state of persistence.
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| 18. |
- Edvinsson, Marie, et al.
(författare)
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Presence of Chlamydophila pneumoniae DNA but not mRNA in stenotic aortic heart valves
- 2010
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 143:1, s. 57-62
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Tidskriftsartikel (refereegranskat)abstract
- Background: The pathogenesis of aortic valve stenosis may involve inflammation and we have previously demonstrated Chlamydophila pneumoniae (C. pneumoniae) DNA in stenotic aortic heart valves. Dissemination of these bacteria is probably mediated by alveolar macrophages. Bacterial DNA alone does not indicate whether the bacteria are viable and replicating. This study aimed to investigate the presence of C. pneumoniae mRNA, a marker of replicating bacteria, and C. pneumoniae DNA in stenotic aortic valves and the prevalence of C. pneumoniae in peripheral blood mononuclear cells (PBMC).Methods: DNA was extracted from heart valves and PBMC and mRNA from heart valves from 76 patients undergoing aortic valve replacement surgery. C. pneumoniae DNA and mRNA were measured by real-time PCR targeting the ompA gene.Results: C. pneumoniae DNA was demonstrated in 22% of heart valves and in 5% of PBMC. C. pneumoniae mRNA was not detected in any valve. Patients positive for C. pneumoniae in the valve underwent coronary artery by-pass grafting more often (p = 0.01) and suffered from angina pectoris (p = 0.02) and arterial hypertension (p = 0.03) more often than patients negative for C. pneumoniae in the valve.Conclusions: These findings support a role for C. pneumoniae in the pathogenesis of aortic valve stenosis and indicate that the bacteria disseminate from the respiratory tract long before the patients were in need of surgery and that the valve infection thereafter entered into a persistent and non-replicative state. Moreover, patients positive for C. pneumoniae in the valve more often needed by-pass grafting because of more advanced coronary disease.
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| 19. |
- Ehrenborg, Christian, 1970-
(författare)
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Bartonella Infections in Sweden: : Clinical Investigations and Molecular Epidemiology
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Characteristically, in infections that are caused by the zoonotic pathogen Bartonella naturally infected reservoir hosts are asymptomatic, where infected incidental, non-natural, hosts develop symptomatic disease. Cat-scratch disease (CSD) is a well known example. Bartonella infections in humans may be self-limiting or fulminant and affect different organ systems. The objectives of the present thesis were to (1) identify and characterise Bartonella infection cases in Sweden, (2) to investigate certain human populations regarding Bartonella infections, and (3) compare natural populations of different Bartonella species. Cases with typical and atypical CSD were recognised by using a combination of PCR and serology. Gene sequence comparisons of different genes in B. henselae isolates from the United States and Europe showed that ftsZ gene variation is a useful tool for Bartonella genotyping. Myocarditis was a common finding among Swedish elite orienteers succumbing to sudden unexpected cardiac death (SUCD). The natural cycle of Bartonella spp., the life style of orienteers, elevated antibody titres to Bartonella antigens, Bartonella DNA amplified from myocardium and the lack of another feasible explanation make Bartonella a plausible aetiological factor. The first reported case of Bartonella endocarditis (B. quintana) was identified in an immunocompromised patient who underwent heart valve replacement. The patient had been body louse-infested during his childhood. It is hypothesised that a chronic B. quintana infection was activated by the immunosuppression. There was no evidence of an ongoing trench fever (TF) epidemic in a Swedish homeless population, although an increased risk for exposure to Bartonella antigens was demonstrated. The lack of louse infestation might explain the absence of B. quintana bacteremia and low B. quintana antibody titres. Comparisons of genetic loci and the whole genomes of environmental B. grahamii isolates from the Uppsala region, Sweden displayed variants that were not related to specific host species but to geographic locality. Natural boundaries seemed to restrict gene flow.
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| 20. |
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| 21. |
- Ehrenborg, Christian, et al.
(författare)
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First known case of Bartonella quintana endocarditis in Sweden
- 2009
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 41:1, s. 73-75
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Tidskriftsartikel (refereegranskat)abstract
- In this report, we present the first known case of Bartonella endocarditis in Sweden. IgG antibody titres to Bartonella spp. were elevated but blood cultures remained negative. Sequencing of a gltA fragment from DNA extracted from heart valve tissue specimens revealed sequence homology with B. quintana.
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| 22. |
- Ehrenborg, Christian, et al.
(författare)
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High Bartonella spp. seroprevalence in a Swedish homeless population but no evidence of trench fever
- 2008
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 40:3, s. 208-215
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Tidskriftsartikel (refereegranskat)abstract
- Blood samples and epidemiological data were collected from 50 homeless patients in central Stockholm, Sweden. Sera were analysed for antibodies to B. henselae, B. quintana, B. elizabethae and B. grahamii. Whole blood was cultured and used as substrate for a newly developed quantitative real time polymerase chain reaction (QPCR) specifically targeting Bartonella spp. DNA. 61 matched blood donor sera were used as controls. Homeless patients were significantly more often seropositive to Bartonella spp. than controls (OR 7.58 (3.30-17.39), p<0.05). Reactivity to the B. elizabethae antigen was dominating, although the difference between patients and controls was most significant in seroreactivity to the B. henselae antigen. There was no evidence of an ongoing B. quintana epidemic. The absence of louse infestation could explain the lack of B. quintana bacteraemia and the failure to amplify Bartonella DNA.
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| 23. |
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| 24. |
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| 25. |
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| 26. |
- Fohlman, Jan, et al.
(författare)
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Antiviral treatment with WIN 54954 reduces mortality in murine Coxsackie virus B3 myocarditis
- 1996
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Ingår i: Circulation. - 0009-7322 .- 1524-4539. ; 94:9, s. 2254-2259
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Coxsackieviruses B (CBVs) are dominant causative agents in myocarditis and are associated with pathogenesis is some cases of dilated cardiomyopathy, a clinical entity with a poor survival without heart transplantation. METHODS AND RESULTS: In vitro, the antiviral agent WIN 54 954 was shown to inhibit replication of CBV3 at a minimal inhibitory concentration value of 0.02 mg/L. Administration of WIN 54 954, 100 mg/kg BID PO, beginning on the day of infection resulted in complete protection from enteroviral mortality (P < .01). WIN 54 954 treatment did not abrogate the inflammatory reaction in the myocardium. No difference was found in the expression of surface lymphocyte subset markers. At 3 weeks, macrophages seemed to dominate the inflammatory reaction, regardless of treatment. There was no difference in CBV3 antibody titers, indicating that WIN 54 954 does not interfere with the development of protective immunity. Complement factors C3 and B were synthesized at a higher level during infection and correlated well with the degree of inflammatory reaction. CONCLUSIONS: The results show that WIN 54 954 is a potent antiviral agent with a highly significant effect on survival in CBV-induced myocarditis in the A/J mouse if treatment is started early. It is suggested that the reduction in mortality seen with WIN 54 954 administration is due to an inhibitory effect on virus replication in affected organs that does not interfere with cellular or humoral immunity.
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| 27. |
- Fohlman, Jan, et al.
(författare)
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Enteroviroser i nya skepnader
- 1997
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Ingår i: Läkartidningen. ; 94, s. 2555-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 28. |
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| 29. |
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| 30. |
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| 31. |
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| 32. |
- Friman, Göran, et al.
(författare)
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Identifying patients in dental settings at risk of cardiovascular disease and diabetes
- 2013
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Ingår i: Cardiovascular system. - : Herbert open access journals. - 2052-4358. ; 1:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of our study was to identify patients in a dental setting at risk of already having or developing high blood pressure or high plasma glucose, investigate possible associations between these conditions and periodontal status and explore the correlation between screening results and follow-up assessments concerning the need for medical treatment and/or lifestyle changes performed by medical staff.Methods: A total of 170 dental patients were consecutively included at their regular yearly check-up visit. Data on age, weight, height, amount and use of tobacco and medication for cardiovascular disease and diabetes mellitus were collected, as well as data about systolic and diastolic blood pressure, in addition to pulse and plasma glucose. Clinical and radiographic examinations revealed data about periodontal status by probing periodontal pockets and measuring marginal alveolar bone loss by means of x-rays. Patients who exceeded normal diastolic blood pressure and plasma glucose values were referred for diagnosis and care.Results: Thirty-nine patients exhibiting high values were provided referrals and 24 or 14.1% of the 170 participants required additional care. The correlation between oral and medical health care concerning blood pressure recorded was 64.5% (p<0.001), while the correlation was 40.0% (p<0.001) concerning plasma glucose. Among middle aged men and elderly subjects, the data revealed/showed a significant correlation between marginal alveolar bone loss and high systolic blood pressure (p=0.001).Conclusions: The correlation between oral health care and medical health care registrations based on blood pressure and plasma glucose indicates that it may be appropriate for dental professionals to perform opportunistic medical screening and refer risk patients to the medical care system before complications occur. In order to identify medical risk patients in dental settings on the basis of high blood pressure, a suggestion may be to examine middle-aged men and elderly patients of both sexes who exhibit radiographic markers for marginal alveolar bone loss.
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| 33. |
- Friman, Göran
(författare)
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Infections and training
- 1995
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Ingår i: The Finnish Society for Research in Sport and physical Education. In: Jukka Viitsalo and Urho Kujala (eds): The Ways to Win. Helsinki.. ; , s. 13-
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 34. |
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| 35. |
- Friman, Göran
(författare)
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Infektioner i hjärta och blodkärl
- 1995
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Ingår i: Infektionsmedicin - epidemiologi, klinik och terapi: Iwarson-Norrby (red). - : Säve Förlag, Partille. ; , s. 414-
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 36. |
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| 37. |
- Friman, Göran, DDS PhD, 1956-, et al.
(författare)
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Medical screening in dental settings : A qualitative study of the views of authorities and organizations Health Services Research
- 2015
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Ingår i: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The practice of identifying individuals with undiagnosed diabetes mellitus type II or undiagnosed hypertension by medical screening in dental settings has been received positively by both patients and dentistry professionals. This identification has also shown to be cost-effective by achieving savings and health benefits, but no investigation has been made of the attitudes of authorities and organizations. The aim of this study was to describe the views of authorities and organizations. Results: Thirteen authorities and organizations were interviewed of the sample of 20 requested. Seven approached authorities and organizations did not believe it was relevant to participate in the study. The manifest analysis resulted in four categories: medical screening ought to be established in the society; dentistry must have relevant competence to perform medical screening; medical screening requires cooperation between dentistry and health care; and dentistry is not the only context where medical screening could be performed. The latent analysis resulted in an emerging theme: positive to, but uncertain about, the concept of medical screening in dental settings. The spokespersons for the approached authorities and organizations had a positive view of medical screening but the respondents experienced a lack of facts concerning the scientific communities’ position, guidelines and procedures in the topic. Conclusions and implications: Approached authorities and organizations generally had a positive view of medical screening in dental settings but were uncertain about the concept. Further scientific knowledge and guidelines concerning the topic are needed before it can be commonly introduced and additional research on implementation strategies and long-term follow-up of medical screening are needed.
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| 38. |
- Friman, Göran
(författare)
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Medical screening in dental settings
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Findings have shown medical screening in dental settings to be cost-effective by achieving both financial savings and health benefits. The general purpose of this thesis was to study the possibility of early identification of individuals with undiagnosed diseases in a cooperative effort between dentistry and healthcare. The aims were to identify patients in a dental setting at risk of having or developing high blood pressure or high plasma glucose, and to investigate possible associations between these conditions and periodontal status, followed by a seven-year term study of the correlation between initial screening results and the progression of health. Further on, the patients’ experiences as well as the attitudes of some relevant authorities and organizations were explored. Methods: A total of 170 dental patients were consecutively included at their regular annual check-up. Data on age, weight, height, amount and use of tobacco and pharmacological treatments for cardiovascular disease and diabetes were collected through self-reported information in a written health declaration, along with data on systolic and diastolic blood pressure, and plasma glucose. Clinical and radiographic examinations revealed data about periodontal status by probing periodontal pockets and measuring marginal alveolar bone loss by means of x-rays. Patients who exceeded normal diastolic blood pressure and plasma glucose values were referred to healthcare for diagnosis and care. With a strategic sampling of patients, authorities and organizations, 17 patients and 13 representatives for authorities and organizations were interviewed. The interviews were recorded and transcribed. The transcriptions were coded and categorized in a manifest analysis, followed by a latent, interpretive analysis. The initial screening’s 170 participants were then asked to take part in a seven-year follow-up study. Data were collected through a repeated written health declaration. Results: Thirty-nine patients exhibiting risk values were provided referrals and 24 (14.1%) of the 170 participants required additional care. The correlation between dentistry and health care concerning blood pressure was 64.5% (p<0.001), while the correlation was 40.0% (p<0.001) concerning plasma glucose. Among middle-aged men and elderly subjects, the data showed a significant correlation between marginal alveolar bone loss and high systolic blood pressure (p<0.001). The manifest analysis of the patients’ experience resulted in three categories: Positive attitude to screening but dental professionals need to have specific knowledge of medical screening; Dental care provides continuity but is not a neutral environment; and Feedback on the medical screening results and desired cooperation between dental and healthcare services. The manifest analysis of the approached authorities and organizations resulted in four categories: Medical screening ought to be established in the society; Dentistry must have relevant competence to perform medical screening; Dentistry is not the only context where medical screening could be performed; and Medical screening requires cooperation between dentistry and healthcare. The latent analysis of the patients’ experiences pointed out the importance of the patient feeling that the procedure is carried out properly and safely, and identified requests for clear feedback concerning the results of the screening. The representatives for the authorities and organizations were positive to, but uncertain about, the concept of medical screening in dental settings. They requested further scientific knowledge and guidelines as well as long-term follow-up of medical screening. The follow-up study consisted of 151 participants. The risk for pharmacological treatments for hypertension after seven years for those not receiving pharmacological treatment at the initial screening was 54.2 times greater (p<0.0001 CI 9.8-300.3) for those with a systolic blood pressure >160 mm Hg than for those with a systolic blood pressure <140 mm Hg. Regarding diabetes, it was not possible to do risk calculations due to the limited group sizes. The changes in treatment were not significant. Conclusions: An opportunistic medical screening seems to identify at least one in ten patients with undiagnosed hypertension or incorrect pharmacological treatment, and risk patients referred by dentistry who are not considered to require further healthcare interventions may benefit from an annual screening. The results also emphasize the need for increased cooperation between dentistry and healthcare.
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| 39. |
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| 40. |
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| 41. |
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| 42. |
- Friman, Göran, et al.
(författare)
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Samband munhälsa och allmän hälsa
- 2019
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Ingår i: Hälsan i Värmland. - : Karlstads universitet och Landstinget i Värmland.
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 43. |
- Friman, Göran, DDS PhD, 1956-, et al.
(författare)
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Seven-Year Follow-Up of Screening for Hypertension and Diabetes at a Dental Clinic
- 2019
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Ingår i: Journal of Dentistry and Oral Sciences. - : Maples. - 2582-3736. ; :2, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the distribution of risk, diagnosis and pharmacological treatments for diabetes and hypertension after seven years among patients provided with opportunistic medical screening in a dental setting.Material and Methods: The initial screening’s 170 participants were asked to take part in a seven-year follow-up study. Data were collected through self-reported information in a written health declaration. Outcome measures:• Number of study participants who had passed away• Prescription of antidiabetics or antihypertensives• Changes in weight and height to calculate body mass index (BMI)Results: The follow-up study consisted of 151 participants. Twenty had passed away. The risk needs for medicating with antihypertensive drugs after seven years for those not receiving pharmacological treatment at the initial screening was 3.7 times greater (p=0.025 CI 1.2-11.3) for participants with a diastolic blood pressure (BP) ≥ 90 mm Hg (85 for diabetics) than for the others. The risk was 3.9 times greater (p=0.020 CI 1.2-12.6) for those with a systolic BP of 140-159 mm Hg and 54.2 times greater (p<0.0001 CI 9.8-300.3) for those with a systolic BP ≥ 160 mm Hg than for those with a systolic BP 140 mm Hg. There were no changes in BMI.Conclusion: At least one in ten cases of incorrect medication or undiagnosed hypertension may be identifiable through opportunistic medical screening.
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| 47. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Hepatic clearance of polyethylene glycol 900 and mannitol in the pig.
- 1988
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Ingår i: Digestion. - 0012-2823. ; 39:3, s. 172-80
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Tidskriftsartikel (refereegranskat)abstract
- Fluid phase markers like erythritol and mannitol have been used to study canalicular bile secretion in the liver. It has recently been suggested that these molecules cross the ductular epithelium and thereby their biliary clearance may underestimate the canalicular bile flow. In the present study, the hepatic clearance of polyethylene glycol 900 (PEG 900), a fluid phase marker that has been used in studies of the kidney, was compared to the clearance of mannitol in the pig. We found that the hepatic clearance of PEG 900 exceeded that of mannitol by a factor of 55. After intravenous bolus injections, both mannitol and PEG 900 appeared within 1 min in bile while significant proportions of inulin were seen only after 7 min. The hepatic clearances of both mannitol and PEG 900 positively correlated to the bile acid secretion rate and were not affected by secretin infusion. The high hepatic clearance of PEG 900 compared to mannitol may be explained by a higher fluid flux into the canaliculi than previously estimated and a continuous ductular reabsorption of fluid and mannitol. Another possibility is an active transcellular vesicular transport of this molecule--an explanation that is not supported by the immediate appearance of PEG 900 in bile following an intravenous bolus injection nor by the finding that hepatic clearance of labeled PEG was not affected by a load of unlabeled marker.
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| 48. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Hepatobiliary compensation for the loss of gallbladder function after cholecystectomy. An experimental study in the cat.
- 1990
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Ingår i: Scandinavian journal of gastroenterology. - 0036-5521. ; 25:3, s. 307-14
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Tidskriftsartikel (refereegranskat)abstract
- The side effects of the removal of a functioning gallbladder are surprisingly few, and it has been suggested, but never demonstrated, that the hepatobiliary tract then adjusts to compensate for the loss of gallbladder function. In this study the effects of cholecystectomy on bile acid kinetics, bile flow, and biliary clearance of mannitol were studied in cats 6-8 weeks after cholecystectomy. An enhanced recycling rate of a diminished bile acid pool was found. The bile flow was reduced and the bile acid concentration in hepatic bile was increased, but fasting bile acid secretion rate was not changed. Both when the bile acid secretion rate was reduced by drainage via an acute bile fistula and when it was enhanced by intravenous infusion of glycocholic acid, there was a lower bile acid-independent flow in the cholecystectomy group. This reduced bile flow after cholecystectomy was not explained by the higher proportion of deoxycholic acid present in the bile of the cholecystectomized animals. Biliary clearance of mannitol, which is supposed to reflect the canalicular inflow, was not reduced, indicating that the reduction in bile flow is explained by a reduced fluid secretion or an enhanced fluid reabsorption in the bile ductules and ducts after cholecystectomy. In this manner the bile ducts compensate for the loss of the absorptive function of the gallbladder after cholecystectomy.
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| 49. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Intussusception at four separate locations in the small intestine. Case report.
- 1988
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Ingår i: Acta chirurgica Scandinavica. - 0001-5482. ; 154:7-8, s. 485-6
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Tidskriftsartikel (refereegranskat)abstract
- A case of intussusception at four different locations in the small intestine is reported. Operative reduction of the interponates were performed with an uneventful postoperative course. The treatment of intussusception in adults is discussed and the literature is reviewed.
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| 50. |
- Friman, Styrbjörn, 1948, et al.
(författare)
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Liver transplantation for cholangiocarcinoma: Selection is essential for acceptable results.
- 2011
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 46:3, s. 370-375
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background and aims. Cholangiocarcinoma (CCA) is considered a contraindication for liver transplantation by most liver transplant centers. The aim of this study has been to report our results as well as to explore factors that influence patient survival after liver transplantation for CCA. Patients. All transplant patients with CCA in Norway, Sweden and Finland during 1984-2005 were included (n = 53). Thirty-three patients (62%) had intrahepatic CCA. Twenty-one patients (40%) had a more advanced tumor (>TNM stage 2). Thirty-four of the 53 recipients (64%) had primary sclerosing cholangitis (PSC). Results. Patients with TNM stage ≤2 transplanted after 1995 had a 5-year survival rate of 48%. The overall 5-year patient survival rate was 25%. There was no difference in survival between patients with extrahepatic and intrahepatic CCA. The 5-year survival rate among patients with TNM stage ≤2 was 36%. Patients with TNM stage >2 had a 10% 5-year survival rate; the difference was significant at p < 0.01. Patients transplanted after 1995 had a significantly better 5-year survival rate than pre-1995 patients (38% vs. 0%, p < 0.01). Patients transplanted after 1995 with TNM ≤2 and CA 19-9 ≤100 had the 5-year survival of 58%. Conclusion. By selecting CCA patients with TNM stage ≤2 and a CA 19-9 ≤100 a reasonable 5-year survival rate is possible. We think that CCA in selected cases can be an acceptable indication for liver transplantation.
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