| 1. |
- Lundström, Emeli, et al.
(författare)
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HLA-DRB1*04/*13 alleles are associated with vascular disease and antiphospholipid antibodies in systemic lupus erythematosus
- 2013
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 72:6, s. 1018-1025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES:Vascular disease is common in systemic lupus erythematosus (SLE) and patients with antiphospholipid antibodies (aPL) are at high risk to develop arterial and venous thrombosis. Since HLA class II genotypes have been linked to the presence of pro-thrombotic aPL, we investigated the relationship between HLA-DRB1 alleles, aPL and vascular events in SLE patients.METHODS:665 SLE patients of Caucasian origin and 1403 controls were included. Previous manifestations of ischaemic heart disease, ischaemic cerebrovascular disease (ICVD) and venous thromboembolism (together referred to as any vascular events (AVE)) were tabulated. aPL were measured with ELISA. Two-digit HLA-DRB1 typing was performed by sequence-specific primer-PCR.RESULTS: HLA-DRB1*04 was more frequent among SLE patients with ICVD compared to unaffected patients. This association remained after adjustment for known traditional cardiovascular risk factors. HLA-DRB1*13 was associated with AVE. All measured specificities of aPL—cardiolipin IgG and IgM, β2-glycoprotein-1 IgG, prothrombin (PT) IgG and a positive lupus anticoagulant test were associated with HLA-DRB1*04—while HLA-DRB1*13 was associated with IgG antibodies (β2-glycoprotein-1, cardiolipin and PT). In patients with the combined risk alleles, HLA-DRB1*04/*13, there was a significant additive interaction for the outcomes AVE and ICVD.CONCLUSIONS:The HLA-DRB1*04 and HLA-DRB1*13 alleles are associated with vascular events and an aPL positive immune-phenotype in SLE. Results demonstrate that a subset of SLE patients is genetically disposed to vascular vulnerability.
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| 2. |
- Sandling, Johanna K., et al.
(författare)
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A candidate gene study of the type I interferon pathway implicates IKBKE and IL8 as risk loci for SLE
- 2011
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Ingår i: European Journal of Human Genetics. - : Springer Science and Business Media LLC. - 1018-4813 .- 1476-5438. ; 19:4, s. 479-484
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Tidskriftsartikel (refereegranskat)abstract
- Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease in which the type I interferon pathway has a crucial role. We have previously shown that three genes in this pathway, IRF5, TYK2 and STAT4, are strongly associated with risk for SLE. Here, we investigated 78 genes involved in the type I interferon pathway to identify additional SLE susceptibility loci. First, we genotyped 896 single-nucleotide polymorphisms in these 78 genes and 14 other candidate genes in 482 Swedish SLE patients and 536 controls. Genes with P<0.01 in the initial screen were then followed up in 344 additional Swedish patients and 1299 controls. SNPs in the IKBKE, TANK, STAT1, IL8 and TRAF6 genes gave nominal signals of association with SLE in this extended Swedish cohort. To replicate these findings we extracted data from a genomewide association study on SLE performed in a US cohort. Combined analysis of the Swedish and US data, comprising a total of 2136 cases and 9694 controls, implicates IKBKE and IL8 as SLE susceptibility loci (P(meta)=0.00010 and P(meta)=0.00040, respectively). STAT1 was also associated with SLE in this cohort (P(meta)=3.3 × 10(-5)), but this association signal appears to be dependent of that previously reported for the neighbouring STAT4 gene. Our study suggests additional genes from the type I interferon system in SLE, and highlights genes in this pathway for further functional analysis.
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| 3. |
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| 4. |
- Sigurdsson, Snaevar, et al.
(författare)
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A risk haplotype of STAT4 for systemic lupus erythematosus is over-expressed, correlates with anti-dsDNA and shows additive effects with two risk alleles of IRF5
- 2008
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Ingår i: Human Molecular Genetics. - : Oxford University Press (OUP). - 0964-6906 .- 1460-2083. ; 17:18, s. 2868-2876
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Tidskriftsartikel (refereegranskat)abstract
- Systemic lupus erythematosus (SLE) is the prototype autoimmune disease where genes regulated by type I interferon (IFN) are over-expressed and contribute to the disease pathogenesis. Because signal transducer and activator of transcription 4 (STAT4) plays a key role in the type I IFN receptor signaling, we performed a candidate gene study of a comprehensive set of single nucleotide polymorphism (SNPs) in STAT4 in Swedish patients with SLE. We found that 10 out of 53 analyzed SNPs in STAT4 were associated with SLE, with the strongest signal of association (P = 7.1 x 10(-8)) for two perfectly linked SNPs rs10181656 and rs7582694. The risk alleles of these 10 SNPs form a common risk haplotype for SLE (P = 1.7 x 10(-5)). According to conditional logistic regression analysis the SNP rs10181656 or rs7582694 accounts for all of the observed association signal. By quantitative analysis of the allelic expression of STAT4 we found that the risk allele of STAT4 was over-expressed in primary human cells of mesenchymal origin, but not in B-cells, and that the risk allele of STAT4 was over-expressed (P = 8.4 x 10(-5)) in cells carrying the risk haplotype for SLE compared with cells with a non-risk haplotype. The risk allele of the SNP rs7582694 in STAT4 correlated to production of anti-dsDNA (double-stranded DNA) antibodies and displayed a multiplicatively increased, 1.82-fold risk of SLE with two independent risk alleles of the IRF5 (interferon regulatory factor 5) gene.
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| 5. |
- Sigurdsson, Snaevar, et al.
(författare)
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Comprehensive evaluation of the genetic variants of interferon regulatory factor 5 (IRF5) reveals a novel 5 bp length polymorphism as strong risk factor for systemic lupus erythematosus
- 2008
-
Ingår i: Human Molecular Genetics. - : Oxford University Press (OUP). - 0964-6906 .- 1460-2083. ; 17:6, s. 872-881
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Tidskriftsartikel (refereegranskat)abstract
- We analyzed a comprehensive set of single-nucleotide polymorphisms (SNPs) and length polymorphisms in the interferon regulatory factor 5 (IRF5) gene for their association with the autoimmune disease systemic lupus erythematosus (SLE) in 485 Swedish patients and 563 controls. We found 16 SNPs and two length polymorphisms that display association with SLE (P < 0.0005, OR > 1.4). Using a Bayesian model selection and averaging approach we identified parsimonious models with exactly two variants of IRF5 that are independently associated with SLE. The variants of IRF5 with the highest posterior probabilities (1.00 and 0.71, respectively) of being causal in SLE are a SNP (rs10488631) located 3' of IRF5, and a novel CGGGG insertion-deletion (indel) polymorphism located 64 bp upstream of the first untranslated exon (exon 1A) of IRF5. The CGGGG indel explains the association signal from multiple SNPs in the IRF5 gene, including rs2004640, rs10954213 and rs729302 previously considered to be causal variants in SLE. The CGGGG indel contains three or four repeats of the sequence CGGGG with the longer allele containing an additional SP1 binding site as the risk allele for SLE. Using electrophoretic mobility shift assays we show increased binding of protein to the risk allele of the CGGGG indel and using a minigene reporter assay we show increased expression of IRF5 mRNA from a promoter containing this allele. Increased expression of IRF5 protein was observed in peripheral blood mononuclear cells from SLE patients carrying the risk allele of the CGGGG indel. We have found that the same IRF5 allele also confers risk for inflammatory bowel diseases and multiple sclerosis, suggesting a general role for IRF5 in autoimmune diseases.
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| 6. |
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| 7. |
- Ahlström, Gerd, et al.
(författare)
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A comprehensive rehabilitation programme tailored to the needs of adults with muscular dystrophy.
- 2006
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 20:2, s. 132-141
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess if activities of daily living (ADL), coping and quality of life could be improved in adults with muscular dystrophy through a comprehensive rehabilitation programme. DESIGN: Quasi-experimental, controlled clinical study comparing patients with similar age and disease aspects. SETTING: Two different counties in Sweden, being either study or control setting. SUBJECTS: The study group comprised 37 adults (21 women, 16 men; mean age 50 years), while the control group comprised 39 people (25 women, 14 men; mean age 46 years). INTERVENTIONS: Four rehabilitation sessions tailored to different medical, physical and psychosocial needs of the patients, comprising a total of 10 days over a period of 18 months. MAIN MEASURES: ADL, the Mental Adjustment to Cancer Scale measuring coping strategies, the Sickness Impact Profile measuring health-related quality of life, the Hospital Anxiety and Depression Scale, and the Psychosocial Well-being Questionnaire. RESULTS: No significant differences were found between groups with regard to the outcome measures. There was increased dependence on others in ADL after 18 months in both groups, but it was more pronounced in the control group. Furthermore, a clear trend was observed in the data with regard to coping patterns, the control group using more coping strategies such as 'Helplessness/hopelessness' (P= 0.057), 'Anxious preoccupation' (P = 0.085) and 'Fatalistic' (P= 0.073) when being compared to the study group. CONCLUSIONS: No apparent effects on ADL were found from the rehabilitation programme, although there was a tendency of reduction of maladaptive coping patterns in the study group. This initial study may provide the rationale and basis for a randomized controlled trial.
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| 8. |
- Ahlström, Gerd, et al.
(författare)
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Disability and quality of life in individuals with muscular dystrophy.
- 1996
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Ingår i: Scandinavian Journal of Rehabilitation Medicine. - 0036-5505 .- 1940-2228. ; 28:3, s. 147-157
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Tidskriftsartikel (refereegranskat)abstract
- In the county of Orebro, Sweden, 32 individuals with myotonic disorders and 25 with other types of muscular dystrophy were examined. Disability was assessed with functional tests and standardized observations of muscle function (mainly based on those proposed by Dr. Brooke), a new self-administered questionnaire regarding the Activities of Daily Living (ADL) and the ADL staircase (based on Katz ADL index). The results of the different tests of disability were highly correlated. The Sickness Impact Profile and the Kaasa test were used for assessing the quality of life, and no significant differences were found between the groups of muscular dystrophy. In an explanatory factor analysis three main factors of disability were found. The factors "walk and move" and "finger function" were fair to good associated with the quality of life. This study offers an approach for research on the consequences of muscular dystrophy using established as well as new methods.
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| 9. |
- Ahlström, Gerd, et al.
(författare)
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Epidemiology of neuromuscular diseases, including the postpolio sequelae, in a Swedish county.
- 1993
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Ingår i: Neuroepidemiology. - 0251-5350 .- 1423-0208. ; 12:5, s. 262-269
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Tidskriftsartikel (refereegranskat)abstract
- The epidemiology of neuromuscular diseases was studied in the county of Orebro, Sweden (study population 270,000). Several different sources of data were utilized, compared and validated. On the prevalence of day (January 1, 1988) 474 patients were identified. The rate per 100,000 population was 92 for the postpolio sequelae (PPS) and 84 for the other neuromuscular diseases (motor neuron disease 9, hereditary neuropathies 9, myoneural disorders 16, myotonic disorders 19, muscular dystrophies 20 and myositis 11). Of the patients with the PPS, 80% reported late-onset symptoms. On the basis of an expanded survey including all medical records in one health care district, the prevalence of the PPS was estimated to be 186/100,000 population.
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| 10. |
- Ahlström, Gerd, et al.
(författare)
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Intervenering för bättre livskvalitet.
- 1997
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Ingår i: Rapport från forskningskonferensen Människa, handikapp, livsvillkor. - Örebro : Psykiatri och habilitering, Örebro läns landsting.
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Konferensbidrag (refereegranskat)
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| 11. |
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| 12. |
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| 13. |
- Ahlström, Gerd, et al.
(författare)
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Respiratory function, electrocardiography and quality of life in individuals with muscular dystrophy.
- 1994
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Ingår i: Chest. - 0012-3692 .- 1931-3543. ; 106:1, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- All individuals in a Swedish county afflicted with any type of hereditary muscular dystrophy (MD) were identified and 57 (85 percent) of eligible individuals in the age range 16 to 64 were included in the study. Respiratory disturbances were estimated by means of spirometry and analysis of arterial blood gases, and 58 percent yielded abnormal results on at least one of these examinations. Elevated PCO2 was found more commonly than reduced forced vital capacity (FVC) and there was a moderate association between these parameters. Respiratory symptoms, most commonly breathlessness, were encountered in 79 percent. Pathologic ECG recordings were found in 21 individuals (37 percent). Conduction disturbances and affection of the myocard were most frequent in myotonic dystrophy. Quality of life was assessed by means of the Sickness Impact Profile instrument and the Kaasa test. The results showed that quality of life was significantly related to FVC and to the symptom of abnormal fatigue. Respiratory and cardiac parameters showed a greater number of significant correlations with measures of functional ability than with subjective well-being.
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| 14. |
- Bergh, Gunnar, et al.
(författare)
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En svensk magister håller
- 2007
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Ingår i: Upsala Nya Tidning. - Uppsala : Uppsala Nya Tidning. - 1104-0173. ; :2 april
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 15. |
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| 16. |
- Dahlbom, Kathe, et al.
(författare)
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Muscular dystrophy in adults : a five-year follow-up.
- 1999
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Ingår i: Scandinavian Journal of Rehabilitation Medicine. - : Informa UK Limited. - 0036-5505 .- 1940-2228. ; 31:3, s. 178-184
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to describe the natural history of adults with hereditary muscular dystrophies, including myotonic dystrophy, with respect to muscular function, ventilation and electrocardiogram. In a prospective study, 46 subjects were followed over a period of five years. In 1991 and 1996, their muscle function was assessed according to an observation scheme and their lung vital capacity was measured by spirometer. Electrocardiograms were obtained in 1991, 1993 and 1996. Deterioration of muscular function was seen with regard to both the functional muscle tests and the vital capacity. The proportion of pathological electrocardiograms increased from 38% in 1991 to 54% in 1996 in the 26 patients with myotonic dystrophy without an increase in clinically detected cardiac abnormalities. Timely examinations using standard methods can reveal medically important information on deterioration, which often passes clinically unnoticed because of the insidious progress of the diseases.
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| 17. |
- Ek, Åsa, et al.
(författare)
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Perceived workplace safety culture among Swedish electricians
- 2015
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Ingår i: [Host publication title missing].
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Konferensbidrag (refereegranskat)abstract
- Accidents and injuries caused by electricity are work environment risks for electricians. About a 100 cases are reported annually to the Swedish Work Environment Authority. The safety culture at the electricians’ workplaces can affect the successfulness of safety management and the prevention of injuries. This paper presents preliminary questionnaire and interview findings on the perceived workplace safety culture of 523 male electricians who have experienced an electrical injury or accident. The results show a general need for increased safety awareness and motivation for safe work performance on different organisational levels. They also show a need for increased visibility of the management at the workplaces, increased commitment to safety, improved communication with the staff, and the need for increased reporting of incidents and experience feedback in order to achieve well-functioning learning for safety. The preliminary findings offer us a better understanding of the driving forces and barriers to efficient safety management and to safety culture improvements in this industry sector.
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| 18. |
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Elolyckor i arbetet
- 2017
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- I en utvidgad slutrapport från forskningsprojektet ”Elolyckor i arbetet – en undersökning om sena följder av strömgenomgång” redovisas resultat från en stor enkätstudie till elektriker och personer som anmält elolycksfall till Arbetsmiljöverket, och fördjupade kliniska undersökningar av en grupp elektriker som hade kvarstående besvär efter strömgenomgång. En tydlig strävan har varit att erfarenheter från projektet ska kunna leda till ett bättre omhändertagande av dem som drabbats av en elolycka, såväl på arbetsplatsen som inom hälso- och sjukvården och ge fördjupad förståelse för betydelsen av det förebyggande elsäkerhetsarbetet.
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| 19. |
- Gateva, Vesela, et al.
(författare)
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A large-scale replication study identifies TNIP1, PRDM1, JAZF1, UHRF1BP1 and IL10 as risk loci for systemic lupus erythematosus
- 2009
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 41:11, s. 1228-1233
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Tidskriftsartikel (refereegranskat)abstract
- Genome-wide association studies have recently identified at least 15 susceptibility loci for systemic lupus erythematosus (SLE). To confirm additional risk loci, we selected SNPs from 2,466 regions that showed nominal evidence of association to SLE (P < 0.05) in a genome-wide study and genotyped them in an independent sample of 1,963 cases and 4,329 controls. This replication effort identified five new SLE susceptibility loci (P < 5 x 10(-8)): TNIP1 (odds ratio (OR) = 1.27), PRDM1 (OR = 1.20), JAZF1 (OR = 1.20), UHRF1BP1 (OR = 1.17) and IL10 (OR = 1.19). We identified 21 additional candidate loci with P< or = 1 x 10(-5). A candidate screen of alleles previously associated with other autoimmune diseases suggested five loci (P < 1 x 10(-3)) that may contribute to SLE: IFIH1, CFB, CLEC16A, IL12B and SH2B3. These results expand the number of confirmed and candidate SLE susceptibility loci and implicate several key immunologic pathways in SLE pathogenesis.
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| 20. |
- Gunnarsson, Cecilia, 1970-, et al.
(författare)
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Abnormal expression of 17β-hydroxysteroid dehydrogenases in breast cancer predicts late recurrence
- 2001
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Ingår i: Cancer Research. - 0008-5472 .- 1538-7445. ; 61:23, s. 8448-8451
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Tidskriftsartikel (refereegranskat)abstract
- The 17β-hydroxysteroid dehydrogenase (17β-HSD) enzymes are involved in the interconversion of biologically active and inactive sex steroids and are considered to play a critical role in the in situ metabolism of estrogen, especially in estrogen-dependent breast cancer. The gene encoding 17β-HSD type 2 is located at 16q24.1-2, and earlier studies have shown that allelic loss in this region is an early and frequent event in breast cancer progression. Recurrence of hormone-dependent breast cancer frequently occurs several years after the primary treatment. The aim of this study was to investigate whether the expression of 17β-HSD types 1 and 2 differs in tumors from patients with late relapses (>5 years) compared with controls without recurrence after long-term follow-up. Using real-time reverse transcription-PCR, we found that the normal mammary gland expressed both 17β-HSD types 1 and 2, whereas the tumors frequently lacked detectable levels of type 2. Only 10% of the estrogen receptor-positive tumors expressed type 2, whereas 31% of the ERnegative tumors did so (P = 0.031). In a case-control series of 84 patients, a high level of 17β-HSD type 1 indicated increased risk to develop late relapse of breast cancer (odds ratio, 3.0; 95% confidence interval, 1.0–12.6; P = 0.041), whereas retained expression of type 2 indicated decreased risk (odds ratio, 0.25; 95% confidence interval, 0.05–1.2; P = 0.050). In multivariate analysis of the estrogen receptor-positive patients, the absence of 17β-HSD type 2 combined with a high expression of type 1 showed prognostic significance (P = 0.016) in addition to DNA aneuploidy (P = 0.0058), whereas progesterone receptor status did not (P = 0.71). These findings suggest that abnormal expression of 17β-HSD isoforms has prognostic significance in breast cancer and that altered expression of these enzymes may have importance in breast cancer progression.
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| 21. |
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| 22. |
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| 23. |
- Gunnarsson, Lars-Gunnar, 1948-, et al.
(författare)
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Alzheimer’s Disease and Occupational Exposures : A Systematic Literature Review and Meta-Analyses
- 2018
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Ingår i: Alzheimer's Disease & Treatment. - : Open Access ebooks. - 9789387500266
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Bokkapitel (refereegranskat)abstract
- Six systematic literature reviews together with meta-analyses have been published on the associations between Alzheimer’s disease and occupational risk factors. Our meta-analyses were based only on studies fulfilling good standards of scientific quality. We scrutinized the 54 relevant original publications found using a checklist proposed by the MOOSE-group together with a new elaborated protocol. Thus our results are not hampered by bias from studies of lower scientific quality. Thirty publications fulfilled good scientific standards and were thus used in our meta-analyses. Exposures to electromagnetic fields were concerned in 12 publications. The weighted relative risk estimate was 1.35 (95% confidence interval: 1.08-1.70). Exposure to pesticides or other chemicals resulted in the statistically significant relative risk 1.5 while exposure to metals involved no increase of risk. A high degree of work complexity (especially in relation to people) and long education were both protective against Alzheimer’s disease. Based on ten studies the weighted relative risk was 0.47 (95% CI: 0.35-0.63). Both work-related risk factors and protective factors are discussed in relation to possible pathophysiological mechanisms.
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| 24. |
- Gunnarsson, Lars-Gunnar, 1948-, et al.
(författare)
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Amyotrophic Lateral Sclerosis and Occupational Exposures : A Systematic Literature Review and Meta-Analyses
- 2018
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 15:11
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Forskningsöversikt (refereegranskat)abstract
- Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of occupational risk factors for amyotrophic lateral sclerosis (ALS). Methods: We identified 79 original publications on associations between work and ALS. The MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines were used to ensure high scientific quality, and reliable protocols were applied to classify the articles. Thirty-seven articles fulfilled good scientific standards, while 42 were methodologically deficient and thus were excluded from our meta-analyses. Results: The weighted relative risks for the various occupational exposures were respectively; 1.29 (95% confidence interval (CI): 0.97⁻1.72; six articles) for heavy physical work, 3.98 (95% CI: 2.04⁻7.77; three articles) for professional sports, 1.45 (95% CI: 1.07⁻1.96; six articles) for metals, 1.19 (95% CI: 1.07⁻1.33; 10 articles) for chemicals, 1.18 (95% CI: 1.07⁻1.31; 16 articles) for electromagnetic fields or working with electricity, and 1.18 (95% CI: 1.05⁻1.34; four articles) for working as a nurse or physician. Conclusions: Meta-analyses based only on epidemiologic publications of good scientific quality show that the risk of ALS is statistically significantly elevated for occupational exposures to excessive physical work, chemicals (especially pesticides), metals (especially lead), and possibly also to electromagnetic fields and health care work. These results are not explained by publication bias.
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| 25. |
- Gunnarsson, Lars-Gunnar, 1948-, et al.
(författare)
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Epidemiologiskt påvisade samband mellan Parkinsons sjukdom och faktorer i arbetsmiljön
- 2014
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Ingår i: Systematiska kunskapsöversikter. - Göteborg : Göteborgs universitet. - 9789185971503 ; , s. 11-79
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Bokkapitel (refereegranskat)abstract
- Epidemiological evidence on associations between work environment and Parkinson’s disease. Lars-Gunnar Gunnarsson, assistant professor at School of Medicine, Örebro University, Sweden andLennart Bodin, professor emeritus, Department of Statistics, Örebro University, Sweden and senior researcher at Institute of Environmental Medicine, Karolinska Institute, Sweden.In this systematic literature review we identified 93 original publications on associations between work and Parkinson’s disease (PD). GRADE guidelines were used to secure high scientific quality and reliable guidelines were applied to classify the papers. Forty-nine papers fulfilled high quality standards while 44 were methodologically deficient and thus were excluded from our meta-analyses.Twenty five publications concerned work exposure to pesticides. The weighted relative risk (RR) estimate was 1.72 (95% confidence interval 1.46-2.04). A funnel plot and tests indicated that some publication bias concerning smaller studies might have been present. The risk estimate was not influenced by study design (case-control, cohort or cross section study) or gender. Higher estimates were found when there was a hereditary taint or onset below age 60.In 15 publications exposure to electromagnetic fields was considered and there was no indication of risk, RR 1.07 (95% confidence interval 0.98-1.18).Meta-analyses of ten studies on exposure for metals showed a statistically diminished risk estimate, RR 0.85 (95% confidence interval 0.82-0.89). A proposed explanation to this seemingly beneficial effect is hormesis meaning that exposures of a low-moderate dosage of toxic agents can induce neuroprotective mechanisms.
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| 26. |
- Gunnarsson, Lars-Gunnar, 1948-, et al.
(författare)
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Epidemiologiskt undersökta samband mellan Alzheimers sjukdom och faktorer i arbetsmiljön
- 2015
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Rapport (refereegranskat)abstract
- Epidemiological evidence on associations between work environment and Alzheimers disease Lars-Gunnar Gunnarsson, assistant professor at School of Medicine, Örebro University, Sweden andLennart Bodin, professor emeritus, Department of Statistics, Örebro University, Sweden and senior researcher at Institute of Environmental Medicine, Karolinska Institute, Sweden.In this systematic literature review we identified 50 original publications on associations between work and Alzheimer’s disease. GRADE guidelines were used to secure high scientific quality and reliable guidelines were applied to classify the papers. Thirty-one papers fulfilled high quality standards while 19 were methodologically deficient and thus were excluded from our meta-analyses.Twenty-seven studies concerned exposure to electromagnetic fields and two published meta-analyses indicated a weighted relative risk (RR) reaching 2.0. Our meta-analysis was only based on twelve high quality publications and the weighted relative risk included statistically over chemicals was evaluated in seven studies and the weighted RR was 1.55 (95% confidence interval 1.19-2.02). Only some few publications concerned pesticides and other chemicals and the weighted RR indicated increased risk.Higher education and work complexity were evaluated in eleven publications and our meta-analysis show a reduced the risk for Alzheimer’s disease. The weighted RR was 0.47 (95% confidence interval 0.35-0.63). Both factors were independently and additively protective.There are indications of an association between ALS and exposure to heavy muscle work especially in combination with muscle trauma, i.e. professional football players are reported to have an elevated risk. More studies are needed with more precise measures on these exposures.
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| 27. |
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| 28. |
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| 29. |
- Gunnarsson, Lars-Gunnar, 1948-, et al.
(författare)
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Occupational Exposures and Neurodegenerative Diseases : A Systematic Literature Review and Meta-Analyses
- 2019
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 16:3
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Forskningsöversikt (refereegranskat)abstract
- Objectives: To carry out an integrated and stratified meta-analysis on occupational exposure to electromagnetic fields (EMFs), metals and pesticides and its effects on amyotrophic lateral sclerosis (ALS) and Parkinson's and Alzheimer's disease, and investigate the possibility of publication bias.Methods: In the current study, we updated our recently published meta-analyses on occupational exposures in relation to ALS, Alzheimer's and Parkinson's disease. Based on 66 original publications of good scientific epidemiological standard, according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines, we analysed subgroups by carrying out stratified meta-analyses on publication year, statistical precision of the relative risk (RR) estimates, inspection of the funnel plots and test of bias.Results: Based on 19 studies the weighted RR for occupational exposure to EMFs was 1.26 (95% confidence interval (CI) 1.07-1.50) for ALS, 1.33 (95% CI 1.07-1.64) for Alzheimer's disease and 1.02 (95% CI 0.83-1.26) for Parkinson's disease. Thirty-one studies concerned occupational exposure to pesticides and the weighted RR was 1.35 (95% CI 1.02-1.79) for ALS, 1.50 (95% CI 0.98-2.29) for Alzheimer's disease and 1.66 (95% CI 1.42-1.94) for Parkinson's disease. Finally, 14 studies concerned occupational exposure to metals and only exposure to lead (five studies) involved an elevated risk for ALS or Parkinson's disease and the weighted RR was 1.57 (95% CI 1.11-2.20). The weighted RR for all the non-lead exposures was 0.97 (95% CI 0.88-1.06).Conclusions: Exposure to pesticides increased the risk of getting the mentioned neurodegenerative diseases by at least 50%. Exposure to lead was only studied for ALS and Parkinson's disease and involved 50% increased risk. Occupational exposure to EMFs seemed to involve some 10% increase in risk for ALS and Alzheimer's disease only.
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| 30. |
- Gunnarsson, Lars-Gunnar
(författare)
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On the occurrence and possible causes of motor neuron disease in Sweden
- 1992
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A series of investigations have been performed to study secular trends of motor neuron disease (MND) morbidity and mortality in Sweden, to identify time and/or space clusters, if any, and to uncover risk factors. The occurrence of the disease was estimated from incidence, prevalence and mortality rates, and the strength of various determinants was evaluated by means of the case-control approach, using population controls. The studies comprised different periods of time between 1961 and 1990.The mortality rate from MND in Sweden, for both genders taken together, doubled from 1961 to 1985, reaching 2.5 per 100,000 person-years, and the incidence rates were of a similar magnitude. The age-specific mortality rates peaked at 70 to 75 years of age. Regarding separate birth cohorts the peak was less clear, however, and the mortality rates tended to increase continuously with advancing age. An epidemic of MND was identified in the county of Skaraborg during the period 1973-1984, when three times as many males as expected had onset of MND, especially involving the farm-working population. In the community surveys involving the counties of Viirmland and Skaraborg the 50% survival rate was slightly more than two years.Among males high adjusted odds ratios were obtained for electricity work (0R=6.7, 95% Cl 1.0-32.1), welding (0R=3.7, 95% Cl 1.1-13.0) and exposure to impregnating agents (0R=3.5, 95% Cl 0.9-13.1). Heredity with regard to a neurodegenerative disease and/or thyroid disease yielded OR=2.1, 95% Cl 1.0-4.3. The highest odds ratio was found for the combination of such heredity, exposure to solvents and male gender (0R=l5.6, 95% Cl 2.8-87.0).In sum, an increase in MND seems to have taken place during the last few decades. The regional epidemic especially among males in agricultural work, the high risk estimates regarding some occupational exposures of mainly chemical nature, and the interaction with heredity, indicate that environmental factors might play a role in the pathogenesis of MND, and that a subpopulation might be particularly susceptible.
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| 31. |
- Gunnarsson, Lars-Gunnar, 1948-, et al.
(författare)
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Parkinson's disease and occupational exposures : a systematic literature review and meta-analyses
- 2017
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health. - 0355-3140 .- 1795-990X. ; 43:3, s. 197-209
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Forskningsöversikt (refereegranskat)abstract
- Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of relevant risk factors for Parkinson's disease.Methods: Our search identified 103 original publications on associations between work and Parkinson's disease. GRADE guidelines were used to ensure high scientific quality, and reliable guidelines were applied to classify the papers. Of the 103 articles, 47 fulfilled good scientific standards while 56 were methodologically deficient and thus excluded from our meta-analyses.Results: A total of 23 publications concerned work exposure to pesticides. The weighted relative risk estimate was 1.67 (95% confidence interval 1.42-1.97). A funnel plot and bias test indicated that some publication bias concerning smaller studies might have been present. The risk estimate was not influenced by study design (case-control, cohort, or cross-sectional study) or gender. Higher estimates were found when there was a hereditary taint or onset below age 60. Studies on exposure to metals or electromagnetic fields did not show increased risk.Conclusions: Using an elaborated quality protocol, there is now strong evidence that exposure to any pesticide involves a ≥50% increased risk for developing Parkinson's disease.
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| 32. |
- Gunnarsson, Lars-Gunnar, 1948-, et al.
(författare)
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Systematiska kunskapsöversikter; : 7. Epidemiologiskt påvisade samband mellan Amyotrofisk Lateral Skleros (ALS) och faktorer i arbetsmiljön
- 2014
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Rapport (refereegranskat)abstract
- MetodVid systematisk litteraturgenomgång identifierade vi 61 relevanta epidemiologiska publikationer med originaldata över samband mellan ALS och exponeringar i arbetslivet. Samtliga artiklar granskades och 34 av dessa studier uppfyllde kriterierna för god vetenskaplig kvalitetResultat Bekämpningsmedel och andra kemikalier har i sju studier värderats med hjälp av frågeformulär/intervjuer. Våra metaanalyser visade att riskskattningarna var något högre för fall-kontrollstudier än för kohortstudier (1,82 respektive 1,47) och sammantaget blev riskmåttet 1,67 (95% konfidensintervall 1,14-2,44). Höga och statistiskt signifikant ökade risker rapporteras i de tre studier som fokuserade på jordbruksarbete; riskmått 2,4-4,7. Ett möjligt samband finns också mellan ALS och yrkesmässig exponering för metaller.Tungt och långvarigt muskelarbete ofta i kombination med muskeltrauma kunna öka risken för ALS med RR runt 2,0. Till denna risk grupp hör professionella fotbollsspelare i europeisk och amerikansk fotboll. Däremot verkar inte fysisk aktivitet i arbetet och på fritiden påverka risken för att drabbas av ALS.I 14 metodologiskt relevanta publikationer granskas eventuellt samband mellan ALS och exponering för elektromagnetiska fält (EMF) och/eller arbete med elektriskt utrustning. Våra egna metaanalyser samt tre publicerade metaanalyser indikerade en låg riskökning. Sammanvägd analys av exponeringar och resultat indikerar att också andra exponeringar än EMF skulle kunna förklara sambandet, t ex muskeltrauma till följd av elstötar.DiskussionLongitudinella epidemiologiska studier indikerar att ALS huvudsakligen drabbar personer som har en ökad sårbarhet (en genetisk disposition) för att sjukdomsprocessen skall starta. I kombination med olika exponeringar blir nervcellens sjukdomsbörda för stor så att sjukdomsprocessen startar.
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| 33. |
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| 34. |
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| 35. |
- Isaksson, Ann-Kristin
(författare)
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Chronic sorrow and quality of life in patients with multiple sclerosis
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to increase our understanding and knowledge of patients’ experiences of living with multiple sclerosis (MS). A mixed-method design was used, including both qualitative and quantitative methods. Thirty-one immunologically treated MS patients were randomly selected and matched with patients without immunological treatment. Matching criteria were gender, impairment, time since diagnosis and age. One patient dropped out and therefore the final sample consisted of 61 patients. All 61 were interviewed (Studies I, III and IV) and completed the 36-item Short Form health survey questionnaire (SF-36), the Subjective estimation of Quality of Life questionnaire (SQoL), the Self-reported Impairment Check-list (SIC) (Study II) and the Montgomery–Asberg Depression Rating Scale questionnaire (MADRS) (Study III). The interviews were subjected to content analysis. Initial symptoms and being diagnosed with MS were described in terms of becoming vulnerable and remaining in that vulnerability long after the diagnosis. Eventually the patients were able to manage this emotional distress and acquired strength in their illness situation (Study I). In the matched analysis, 29 pairs of patients were included after internal drop-out. There were no statistically significant differences between the treatment and control groups. Concerning the total group of 61 patients, the self-reported impairment check-list showed that they had various problems of impairment, most evident in balance and walking. The score on health-related quality of life (SF-36) was reduced, disclosing a negative influence on vitality, physical role and function. However, subjective quality of life (SQoL) was not reduced, showing that the patients estimated their well-being to be quite unaffected (Study II). Thirty-eight of the 61 patients (62%) experienced chronic sorrow (Study III). The group were not depressed in general, only four having mild symptoms of depression, revealing that chronic sorrow is a particular form of emotional distress in MS. Chronic sorrow was experienced in terms of loss of hope, loss of control over the body and loss of integrity and dignity. When the patients could not adequately manage their sorrow and lacked support, they were struggling with their vulnerability. In the successful management of MS, losses and emotional distress are managed in such a way as to enhance personal growth, appreciation and trust in life. The theoretical model of chronic sorrow facilitated the sorting of the empirical data and the linking of these data to theory, showing the usefulness of the model (Study IV).
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| 36. |
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| 37. |
- Isaksson, Ann-Kristin, 1961-, et al.
(författare)
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Quality of life and impairment in patients with multiple sclerosis
- 2005
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Ingår i: Journal of Neurology, Neurosurgery and Psychiatry. - : BMJ. - 0022-3050 .- 1468-330X. ; 76:1, s. 64-69
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aims of this study were to describe the quality of life in patients with multiple sclerosis (MS) given immunological treatment and in those not given immunological treatment and to investigate the relationship between impairment and quality of life. METHODS: Twenty nine patients given immunological treatment were matched with the same number of patients not given such treatment. Matching variables were sex, Kurtzke's Expanded Disability Status Scale (EDSS), years since diagnosis, and age (total n = 58). The patients were interviewed using the self-reported impairment checklist and they answered two questionnaires on quality of life, the 36-Item Short-Form Health Survey (SF-36) and the Subjective Estimation of Quality of Life (SQoL). RESULTS: The self-reported impairment checklist captured a more differentiated picture of the patients' symptoms of MS than the EDSS. Health related quality of life was markedly reduced, while the subjective quality of life was less affected. There was a stronger association between self-reported ratings of impairment and health related quality of life on the SF-36 than between impairment and global ratings of quality of life on the SQoL. Subjective quality of life on the SQoL was not directly dependent on impairment expressed in physical limitations. There were no statistically significant differences between the treated and untreated groups. A non-significant trend towards better health related quality of life was found in favour of the treated group with respect to emotional role, physical role, and social function on the SF-36. CONCLUSIONS: The self-reported impairment checklist and SF-36 proved to be valuable complements to the well established EDSS in describing the diverse symptoms of MS. Measuring both health related quality of life and subjective wellbeing provides valuable knowledge about the consequences of MS.
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| 38. |
- Isaksson, Ann-Kristin, et al.
(författare)
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The presence and meaning of chronic sorrow in patients with multiple sclerosis
- 2007
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Ingår i: Journal of Clinical Nursing. - Oxford : Blackwell. - 0962-1067 .- 1365-2702. ; 16:11C, s. 315-324
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Tidskriftsartikel (refereegranskat)abstract
- AIM AND OBJECTIVES: The aim of this study was to explore the presence and meaning of chronic sorrow and the presence of depression in a fairly large group of persons with multiple sclerosis (MS). BACKGROUND: MS is a chronic and progressive neurological disease with a variety of symptoms. The patients have to live with losses of different kinds. A few earlier studies have used the concept of chronic sorrow to illustrate the emotional situation of such patients. METHOD: Sixty-one patients were interviewed about the occurrence of chronic sorrow and, thereafter, screened for depression. Thirty-eight (62%) of them fulfilled the criteria for chronic sorrow. The interviews were analysed with latent content analysis. RESULTS: Seven themes describe the losses that caused sorrow: loss of hope, loss of control over the body, loss of integrity and dignity, loss of a healthy identity, loss of faith that life is just, loss of social relations and loss of freedom. The sorrow was constantly present or periodically overwhelming. Only four of the 38 patients with chronic sorrow had symptoms of being mildly depressed. CONCLUSION: Chronic sorrow meant loss of hope, of control over the body, of integrity and of identity. The concept of chronic sorrow complements that of depression in providing important new knowledge relevant to understanding the consequences MS can have for the individual. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the meaning of chronic sorrow can contribute to the nurse's ability to give psychological support and promote a sense of hope and control in the MS patient.
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| 39. |
- Johanson, Per, 1963, et al.
(författare)
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Prognostic value of ST-segment resolution-when and what to measure.
- 2003
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Ingår i: European heart journal. - 0195-668X. ; 24:4, s. 337-45
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Tidskriftsartikel (refereegranskat)abstract
- Analyses of ST-segment resolution during acute myocardial infarction has, during recent years, challenged coronary angiography as gold-standard for predicting myocardial reflow and future risk. We have previously reported that continuous ST-monitoring can be done accurately in the clinical setting. We now set out to compare the prognostic value of previously suggested cut-offs for ST-segment resolution, and determine the times to measure these.
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| 40. |
- Johansson, Ann-Christin, et al.
(författare)
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Pain, disability and coping reflected in the diurnal cortisol variability in patients scheduled for lumbar disc surgery
- 2008
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Ingår i: European Journal of Pain. - Amsterdam : Elsevier. - 1090-3801 .- 1532-2149. ; 12:5, s. 633-640
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Tidskriftsartikel (refereegranskat)abstract
- Background: Symptoms of lumbar disc herniation can be induced by both mechanical compression of the nerve roots and by biochemical irritants from the disc tissues. Proinflammatory cytokines, as well as stress are potent stimulators of the hypothalamic–pituitary–adrenal axis, reflected in enhanced release of cortisol from the adrenal cortex. Altered cortisol production is also associated to behaviour and coping patterns.The aim of the present study was to explore the relation between pain, physical function, psychosocial factors and quality of life to the diurnal cortisol variability, in patients with lumbar disc herniation.Method: This study had a cross-sectional design. Forty-two patients with lumbar disc herniation, verified by magnetic resonance imaging and a clinical examination by an orthopaedic surgeon, were included in the study. All patients were scheduled for disc surgery. The diurnal cortisol variability was examined before surgery. The patients were dichotomised into two groups based on low or high diurnal cortisol variability. Pain, disability, work related stress, quality of life, coping and fear avoidance beliefs, were estimated by standardised questionnaires.Results: The low diurnal cortisol variability group was distinguished by a higher median score regarding leg pain at activity and significantly more disability (p < 0.05). The patients with a low diurnal cortisol variability had significantly lower coping self-statement scores, but higher pain coping catastrophising scores (p < 0.05).Conclusion: Patients with lumbar disc herniation and a low diurnal cortisol variability had lower physical function, perceived lower possibilities of influencing their pain, and were more prone to catastrophise than patients with lumbar disc herniation and a high diurnal cortisol variability.
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| 41. |
- Jönsen, Andreas, et al.
(författare)
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Mutations in genes encoding complement inhibitors CD46 and CFH affect the age at nephritis onset in patients with systemic lupus erythematosus
- 2011
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 13, s. R206-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Inherited deficiencies of several complement components strongly predispose to systemic lupus erythematosus (SLE) while deficiencies of complement inhibitors are found in kidney diseases such as atypical hemolytic uremic syndrome (aHUS). METHODS: The exons of complement inhibitor genes: CD46 and CFH (factor H) were fully sequenced using Sanger method in SLE patients with nephritis originating from two cohorts from southern and mid Sweden (n = 196). All identified mutations and polymorphisms were then analyzed in SLE patients without nephritis (n = 326) and healthy controls (n = 523). RESULTS: We found non-synonymous, heterozygous mutations in CFH in 6.1% patients with nephritis in comparison to 4.0% and 5.4% in patients without nephritis and controls, respectively. No associations of SLE or nephritis with common variants in CFH (V62I/Y402H/E936D) were found. Furthermore, we found two non-synonymous heterozygous mutations in CD46 in SLE patients but not in controls. The A353V polymorphism, known to affect function of CD46, was found in 6.6% of nephritis patients vs 4.9% and 6.1% of the non-nephritis SLE patients and controls. The presence of mutations in CD46 and CFH did not predispose to SLE or nephritis but was associated with earlier onset of nephritis. Furthermore, we found weak indications that there is one protective and one risk haplotype predisposing to nephritis composed of several polymorphisms in non-coding regions of CD46, which were previously implicated in aHUS. CONCLUSION: SLE nephritis is not associated with frequent mutations in CFH and CD46 as found in aHUS but these may be modifying factors causing earlier onset of nephritis.
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| 42. |
- Larsson, D. G. Joakim, 1969, et al.
(författare)
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Release of active pharmaceutical ingredients from Indian bulk drug manufacture – environmental fate and effects on antibiotic resistance development, microbial ecosystems and vertebrate physiology
- 2008
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Ingår i: 2008 Society of Environmental Toxicology and Chemistry, November 16-20, Tampa, USA.
-
Konferensbidrag (refereegranskat)abstract
- Last year, we published a paper showing extraordinary high levels of several drugs in treated effluent from a plant receiving process water from about 90 bulk drug manufacturers from the Hyderabad region in India. Particularly, the levels of various fluoroquinolones (up to 31 mg/L) called for more information on the potential development of antibiotic resistance of exposed bacteria, as well as potential ecological effects on microbial ecosystems. In this study we will present the first characterization of 93 strains of bacteria sampled inside the treatment facility for their sensitivity/resistance to 39 different antibiotics. Furthermore, controlled exposure experiments suggest that the treated effluent affects the functional structure of natural freshwater microbial communities at a dilution of 1:1000. Short to medium-term exposure experiments with frogs and fish demonstrate sublethal effects of the treated effluent at similar dilutions, suggesting that expected environmental effects are not restricted to disturbed microorganism communities. Data on the fate of different pharmaceuticals in a gradient up and downstream from the treatment facility will be presented, as well as levels in drinking water wells in seven nearby villages, showing a transport of drugs via the groundwater. We conclude that the environmental impact of drug production in the Hyderabad region is of great environmental concern. We will also present summary data on the origin of active substances present in pharmaceutical products on the Swedish market, implying an international responsibility for improving the environmental pollution situation related to bulk drug production in India.
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| 43. |
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| 44. |
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| 45. |
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| 46. |
- Latorre-Margalef, Neus, et al.
(författare)
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Effects of influenza A virus infection on migrating mallard ducks
- 2009
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Ingår i: Proceedings of the Royal Society of London. Biological Sciences. - : The Royal Society. - 0962-8452 .- 1471-2954. ; 276:1659, s. 1029-1036
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Tidskriftsartikel (refereegranskat)abstract
- The natural reservoir of influenza A virus is waterfowl, particularly dabbling ducks (genus Anas). Although it has long been assumed that waterfowl are asymptomatic carriers of the virus, a recent study found that low-pathogenic avian influenza (LPAI) infection in Bewick's swans (Cygnus columbianus bewickii) negatively affected stopover time, body mass and feeding behaviour. In the present study, we investigated whether LPAI infection incurred ecological or physiological costs to migratory mallards (Anas platyrhynchos) in terms of body mass loss and staging time, and whether such costs could influence the likelihood for long-distance dispersal of the avian influenza virus by individual ducks. During the autumn migrations of 2002-2007, we collected faecal samples (n = 10 918) and biometric data from mallards captured and banded at Ottenby, a major staging site in a flyway connecting breeding and wintering areas of European waterfowl. Body mass was significantly lower in infected ducks than in uninfected ducks (mean difference almost 20 g over all groups), and the amount of virus shed by infected juveniles was negatively correlated with body mass. There was no general effect of infection on staging time, except for juveniles in September, in which birds that shed fewer viruses stayed shorter than birds that shed more viruses. LPAI infection did not affect speed or distance of subsequent migration. The data from recaptured individuals showed that the maximum duration of infection was on average 8.3 days (s.e. 0.5), with a mean minimum duration of virus shedding of only 3.1 days (s.e. 0.1). Shedding time decreased during the season, suggesting that mallards acquire transient immunity for LPAI infection. In conclusion, deteriorated body mass following infection was detected, but it remains to be seen whether this has more long-term fitness effects. The short virus shedding time suggests that individual mallards are less likely to spread the virus at continental or intercontinental scales.
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| 47. |
- Linga-Reddy, M. V. Prasad, et al.
(författare)
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A polymorphic variant in the MHC2TA gene is not associated with systemic lupus erythematosus
- 2007
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Ingår i: Tissue Antigens. - : Wiley. - 0001-2815 .- 1399-0039. ; 70:5, s. 412-414
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Tidskriftsartikel (refereegranskat)abstract
- Single-nucleotide polymorphisms (SNPs) in the major histocompatibility complex class II transactivator (MHC2TA) gene encoding the class II transactivator have been associated with multiple sclerosis, rheumatoid arthritis, and myocardial infarction in the Swedish population. We used a case-control approach to investigate the prevalence of a relevant variant in Swedish systemic lupus erythematosus (SLE) cohorts to determine whether SLE shares the same MHC2TA susceptibility allele as the other diseases. No differences were observed between cases and control subjects at either the allele or genotype levels. Furthermore, no significant correlations were found when comparing different clinical and serological SLE phenotypes. This particular polymorphism rs3087456 of the MHC2TA gene does not appear to influence genetic susceptibility to SLE in the Swedish population. We conclude that our data support neither allelic nor genotype association between the MHC2TA SNP and SLE.
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| 48. |
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| 49. |
- Nilsagård, Ylva, et al.
(författare)
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Clinical relevance using timed walk tests and 'timed up and go' testing in persons with multiple sclerosis
- 2007
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Ingår i: Physiotherapy Research International. - London : Whurr Publishers. - 1358-2267 .- 1471-2865. ; 12:2, s. 105-14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: One must understand the potentials and limitations of all tests used to evaluate interventions. The aim of the present study was to clarify the reproducibility, smallest percentage difference needed to be able to detect a genuine change and correlation regarding the 10-m and 30-m timed walks (10TW 30TW) and the 'timed up and go' (TUG) test in people with moderate multiple sclerosis (MS).METHOD: A repeated-measures design was used, with randomization into two groups and different time intervals used for testing. The 10TW and 30TW were performed three times and TUG twice at each testing. Self-selected speed was used for 10TW and forced speed (quickly but safely) for 30TW and TUG. Forty-three people were tested on three occasions within one week. Each person was tested at approximately the same time of the day and by the same physiotherapist on each occasion.RESULTS: The reproducibility was very high. For a single testing occasion, the intraclass correlation was 0.97 for the 10TW and 0.98 for the 30TW and TUG. The smallest percentage difference needed to be able to detect a genuine change in the entire study group was approximately -23% or +31% for either the 1OTW or TUG. It was evident from the 30TW testing results that lower values applied to those with less (-14% to +17%) rather than more (-38% or +60%) disability. The correlation between all tests for the entire study group was 0.85 (0.76-0.91).CONCLUSION: It is sufficient to use only one attempt and to choose only one of the tests when evaluating people with moderate MS. In the case of the 30TW greater attention must be paid to the degree of disability when determining the smallest percentage difference needed to establish a genuine change, than
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| 50. |
- Nilsagård, Ylva, et al.
(författare)
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Evaluation of a single session with cooling garment for persons with multiple sclerosis-a randomized trial
- 2006
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 1748-3107 .- 1748-3115. ; 1:4, s. 225-233
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. This research investigates the objective and subjective effects of wearing the Rehband® cooling garment. Method. A multi-centre, randomized crossover study was conducted regarding 43 heat-sensitive persons with multiple sclerosis (MS), comparing active treatment with placebo. Subjects were tested immediately before and after intervention. Ten- (10TW) and 30-metre timed walk (30TW), oral temperature, spasticity, standing balance and timed up and go (TUG) and nine-hole peg test (NHPT) performance were measured. A study-specific questionnaire was used to evaluate subjective experiences. Results. Active treatment produced statistically significant objective improvement in 10TW, 30TW, one-legged stance, tandem stance (right) and TUG; statistically significant subjective improvement was also found in fatigue, spasticity, weakness, balance, gait, transfers, ability to think clearly and time to recover. The coherence between the objective and subjective results indicates clinical relevance from the subjects' perspective. There were no statistically significant differences between treatments in terms of oral temperature, spasticity (measured by the modified Ashworth scale), tandem stance (left), step test or NHPT, or subjective signs such as difficulty in dressing, dysarthria or pain. Conclusions. Active cooling with a Rehband® vest is likely to have a positive effect on everyday life in heat-sensitive persons with MS.
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