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| 3. |
- Filho, Luimar, et al.
(författare)
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The effect of N, C, Cr, and Nb content on silicon nitride coatings for joint applications
- 2020
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Ingår i: Materials. - : MDPI AG. - 1996-1944. ; 13:8
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Tidskriftsartikel (refereegranskat)abstract
- Ceramic coatings are an alternative to achieve or maintain a high wear resistance of metallic surfaces, and simultaneously allow for a reduction in metal ion release. Silicon nitride based (SiNx) coatings deposited by high power impulse magnetron sputtering (HiPIMS) have shown potential for use in joint implants seen from an improved chemical stability in combination with a good adhesion. The aim of this study was to investigate the effect of N, C, Cr and Nb content on the tribocorrosive performance of 3.7 to 8.8 µm thick SiNx coatings deposited by HiPIMS onto CoCrMo discs to improve the mechanical properties and/or chemical stability of SiNx .Coating composition was evaluated by X-ray photoelectron spectroscopy (XPS) and the surface roughness by Vertical Scanning Interferometry (VSI). Hardness and Young’s modulus were investigated by nanoindentation and coating adhesion was measured by scratch tests. Multidirectional wear tests against UHMWPE pins were performed for 2 million cycles in bovine serum solution (25%) at 37°C, at an estimated contact pressure of 2.1 MPa.Coatings with a relatively low hardness tended to fail earlier in the wear test, due to chemical reactions and eventually dissolution, accelerated by the tribological contact. In fact, while no definite correlation could be observed between coating composition (N: 42.6-55.5 at%, C: 0-25.7 at%, Cr: 0 or 12.8 at%, and Nb: 0-24.5 at%) and wear performance, it was apparent that high-purity and/or -density coatings (i.e. low oxygen content and high nitrogen content) were desirable to prevent coating and/or counter surface wear. Coatings deposited with a higher energy fulfilled the target profile in terms of low surface roughness (Ra<20nm), adequate adhesion (Lc2>30N), chemical stability over time in the tribocorrosive environment, as well as low polymer wear, presenting potential for a future application in joint bearings.
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| 6. |
- Axling, Ulrika, et al.
(författare)
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Effects of rose hip intake on risk markers of type 2 diabetes and cardiovascular disease: a randomized, double-blind, cross-over investigation in obese persons.
- 2012
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Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 1476-5640 .- 0954-3007. ; 66:5, s. 585-590
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVES:In studies performed in mice, rose hip powder has been shown to both prevent and reverse high-fat diet-induced obesity and glucose intolerance as well as reduce plasma levels of cholesterol. The aim of this study was to investigate whether daily intake of rose hip powder over 6 weeks exerts beneficial metabolic effects in obese individuals.SUBJECTS/METHODS:A total of 31 obese individuals with normal or impaired glucose tolerance were enrolled in a randomized, double-blind, cross-over study in which metabolic effects of daily intake of a rose hip powder drink over 6 weeks was compared with a control drink. Body weight, glucose tolerance, blood pressure, blood lipids and markers of inflammation were assessed in the subjects.RESULTS:In comparison with the control drink, 6 weeks of daily consumption of the rose hip drink resulted in a significant reduction of systolic blood pressure (-3.4%; P=0.021), total plasma cholesterol (-4.9%; P=0.0018), low-density lipoprotein (LDL) cholesterol (-6.0%; P=0.012) and LDL/HDL ratio (-6.5%; P=0.041). The Reynolds risk assessment score for cardiovascular disease was decreased in the rose hip group compared with the control group (-17%; P=0.007). Body weight, diastolic blood pressure, glucose tolerance, and plasma levels of high-density lipoprotein (HDL) cholesterol, triglycerides, incretins and markers of inflammation did not differ between the two groups.CONCLUSIONS:Daily consumption of 40 g of rose hip powder for 6 weeks can significantly reduce cardiovascular risk in obese people through lowering of systolic blood pressure and plasma cholesterol levels.European Journal of Clinical Nutrition advance online publication, 14 December 2011; doi:10.1038/ejcn.2011.203.
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| 8. |
- Carlsson, Georg, et al.
(författare)
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N-2 fixation in three perennial Trifolium species in experimental grasslands of varied plant species richness and composition
- 2009
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Ingår i: Plant Ecology. - : Springer Science and Business Media LLC. - 1385-0237 .- 1573-5052. ; 205, s. 87-104
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Tidskriftsartikel (refereegranskat)abstract
- This study is the first to investigate quantitative effects of plant community composition and diversity on N-2 fixation in legumes. N-2 fixation in three perennial Trifolium species grown in field plots with varied number of neighbouring species was evaluated with the N-15 natural abundance method (two field sites, several growing seasons, no N addition) and the isotope dilution method (one site, one growing season, 5 g N m(-2)). The proportion of plant N derived from N-2 fixation, pNdfa, was generally high, but the N addition decreased pNdfa, especially in species-poor communities. Also following N addition, the presence of grasses in species-rich communities increased pNdfa in T. hybridum and T. repens L., while legume abundance had the opposite effect. In T. repens, competition for light from grasses appeared to limit growth and thereby the amount of N-2 fixed at the plant level, expressed as mg N-2 fixed per sown seed. We conclude that the occurrence of diversity effects seems to be largely context dependent, with soil N availability being a major determinant, and that species composition and functional traits are more important than species richness regarding how neighbouring plant species influence N-2 fixation in legumes.
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| 11. |
- Dalborg, Cecilia, 1966-, et al.
(författare)
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Craft breweries and local place development – Perspectives from a Scandinavian context
- 2023
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Ingår i: Local Economy. - : Sage Publications. - 0269-0942 .- 1470-9325. ; 38:2, s. 155-176
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Tidskriftsartikel (refereegranskat)abstract
- In recent decades, the craft beer sector has grown rapidly, and it has been studied across the world through various lenses. In Norway and Sweden, the sector is a well-established complement to large-scale beer producers, but it has yet to be thoroughly studied. Previous studies show that the location of a brewery is important in terms of marketing and branding approaches, but also that craft brewers contribute to place development. The aim of this study is to explore how context affects the possibilities of craft breweries to contribute to local place development. The study results are built on a web-survey, answered by 201 craft beer brewers in Norway and Sweden. The findings show that brewers, especially those located in rural areas, struggle under tough conditions regarding profit margins, as well as troublesome and limiting legislation. Place is considered very important, but breweries in rural areas use place-connection to a higher extent. Tourism is important, especially for breweries located in rural areas, and changes in regulation could increase the importance even more. The results of this study show that there exist contextual differences which also have an impact on the extent to which the brewers can contribute to their local community.
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| 12. |
- Ekeus, Cecilia, et al.
(författare)
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Vacuum assisted birth and risk for cerebral complications in term newborn infants : a population-based cohort study
- 2014
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 14, s. 36-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have focused on cerebral complications among newborn infants delivered by vacuum extraction (VE). The aim of this study was to determine the risk for intracranial haemorrhage and/or cerebral dysfunction in newborn infants delivered by VE and to compare this risk with that after cesarean section in labour (CS) and spontaneous vaginal delivery, respectively. Methods: Data was obtained from Swedish national registers. In a population-based cohort from 1999 to 2010 including all singleton newborn infants delivered at term after onset of labour by VE (n = 87,150), CS (75,216) or spontaneous vaginal delivery (n = 851,347), we compared the odds for neonatal intracranial haemorrhage, traumatic or non-traumatic, convulsions or encephalopathy. Logistic regressions were used to calculate adjusted (for major risk factors and indication) odds ratios (AOR), using spontaneous vaginal delivery as reference group. Results: The rates of traumatic and non-traumatic intracranial hemorrhages were 0.8/10,000 and 3.8/1,000. VE deliveries provided 58% and 31.5% of the traumatic and non-traumatic cases, giving a ten-fold risk [AOR 10.05 (4.67-21.65)] and double risk [AOR 2.23 (1.57-3.16)], respectively. High birth weight and short mother were associated with the highest risks. Infants delivered by CS had no increased risk for intracranial hemorrhages. The risks for convulsions or encephalopathy were similar among infants delivered by VE and CS, exceeding the OR after non-assisted spontaneous vaginal delivery by two-to-three times. Conclusion: Vacuum assisted delivery is associated with increased risk for neonatal intracranial hemorrhages. Although causality could not be established in this observational study, it is important to be aware of the increased risk of intracranial hemorrhages in VE deliveries, particularly in short women and large infants. The results warrant further studies in decision making and conduct of assisted vaginal delivery.
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| 13. |
- Elvander, Charlotte, et al.
(författare)
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The influence of fetal head circumference on labor outcome : a population-based register study
- 2012
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 91:4, s. 470-475
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate the association between postnatal head circumference and the occurrence of the three main indications for instrumental delivery, namely prolonged labor, signs of fetal distress and maternal distress. We also studied the association between postnatal fetal head circumference and the use of vacuum extraction and emergency cesarean section. Design. Population-based register study. Setting. Nationwide study in Sweden. Population. A total of 265 456 singleton neonates born to nulliparous women at term between 1999 and 2008 in Sweden. Methods. Register study with data from the Swedish Medical Birth Register. Main outcome measures. Prolonged labor, signs of fetal distress, maternal distress, use of vacuum extraction and emergency cesarean section. Results. The prevalence of each outcome increased gradually as the head circumference increased. Compared with women giving birth to a neonate with average size head circumference (35 cm), women giving birth to an infant with a very large head circumference (3941 cm) had significantly higher odds of being diagnosed with prolonged labor [odds ratio (OR) 1.49, 95% confidence interval (CI) 1.331.67], signs of fetal distress (OR 1.73, 95% CI 1.492.03) and maternal distress (OR 2.40, 95% CI 1.962.95). The odds ratios for vacuum extraction and cesarean section were thereby elevated to 3.47 (95% CI 3.103.88) and 1.22 (95% CI 1.041.42), respectively. The attributable risk proportion percentages associated with vacuum extraction and cesarean section were 46 and 39%, respectively among the cases exposed to a head circumference of 3741 cm. Conclusions. Large fetal head circumference is associated with complicated labor and is etiological to a considerable proportion of assisted vaginal births and emergency cesarean sections.
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| 14. |
- Filho, Luimar Correa, et al.
(författare)
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The Effect of Coating Density on Functional Properties of SiNx Coated Implants
- 2019
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Ingår i: Materials. - : MDPI AG. - 1996-1944. ; 12:20
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Tidskriftsartikel (refereegranskat)abstract
- Ceramic coatings may be applied onto metallic components of joint replacements for improved wear and corrosion resistance as well as enhanced biocompatibility, especially for metal-sensitive patients. Silicon nitride (SiNx) coatings have recently been developed for this purpose. To achieve a high coating density, necessary to secure a long-term performance, is however challenging, especially for sputter deposited SiNx coatings, since these coatings are insulating. This study investigates the time-dependent performance of sputter-deposited SiNx based coatings for joint applications. SiNx coatings with a thickness in the range of 4.3–6.0 µm were deposited by reactive high power impulse magnetron sputtering onto flat discs as well as hip heads made of CoCrMo. SiNx compositional analysis by X-ray photoelectron spectroscopy showed N/Si ratios between 0.8 and 1.0. Immersion of the flat disks in fetal bovine serum solution over time as well as short-term wear tests against ultra-high molecular weight polyethylene (UHMWPE) discs showed that a high coating density is required to inhibit tribocorrosion. Coatings that performed best in terms of chemical stability were deposited using a higher target power and process heating.
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| 15. |
- Filho, Luimar, et al.
(författare)
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Towards Functional Silicon Nitride Coatings for Joint Replacements
- 2019
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Ingår i: Coatings. - : MDPI AG. - 2079-6412. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- Silicon nitride (SiNx) coatings are currently under investigation as bearing surfaces for joint implants, due to their low wear rate and the good biocompatibility of both coatings and their potential wear debris. The aim of this study was to move further towards functional SiNx coatings by evaluating coatings deposited onto CoCrMo surfaces with a CrN interlayer, using different bias voltages and substrate rotations. Reactive direct current magnetron sputtering was used to coat CoCrMo discs with a CrN interlayer, followed by a SiNx top layer, which was deposited by reactive high-power impulse magnetron sputtering. The interlayer was deposited using negative bias voltages ranging between 100 and 900 V, and 1-fold or 3-fold substrate rotation. Scanning electron microscopy showed a dependence of coating morphology on substrate rotation. The N/Si ratio ranged from 1.10 to 1.25, as evaluated by X-ray photoelectron spectroscopy. Vertical scanning interferometry revealed that the coated, unpolished samples had a low average surface roughness between 16 and 33 nm. Rockwell indentations showed improved coating adhesion when a low bias voltage of 100 V was used to deposit the CrN interlayer. Wear tests performed in a reciprocating manner against Si3N4 balls showed specific wear rates lower than, or similar to that of CoCrMo. The study suggests that low negative bias voltages may contribute to a better performance of SiNx coatings in terms of adhesion. The low wear rates found in the current study support further development of silicon nitride-based coatings towards clinical application.
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| 16. |
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| 18. |
- Goyenola, Cecilia, et al.
(författare)
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Theoretical prediction and synthesis of CSxFy thin films
- 2016
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Ingår i: The Journal of Physical Chemistry C. - : American Chemical Society (ACS). - 1932-7447 .- 1932-7455. ; 120:17, s. 9527-9534
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Tidskriftsartikel (refereegranskat)abstract
- A new carbon-based compound: CSxFy was addressed by density functional theory calculations and synthesized by reactive magnetron sputtering. Geometry optimizations and energy calculations were performed on graphene-like model systems containing sulfur and fluorine atoms. It is shown that [S+F] concentrations in the range of 0−10 at.%, structural ordered characteristics similar to graphene pieces containing ring defects are energetically feasible. The modeling predicts that CSxFy thin films with graphite and fullerene-like characteristics may be obtained for the mentioned concentration range. Accordingly, thin films were synthesized from a graphite solid target and sulfur hexafluoride as reactive gas. In agreement with the theoretical prediction, transmission electron microscopy characterization and selected area electron diffraction confirmed the presence of small ordered clusters with graphitic features in a sample containing 0.4 at.% of S and 3.4 at.% of F.
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| 19. |
- Hajdarevic, Senada, et al.
(författare)
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Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis : a qualitative study
- 2023
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Ingår i: BJGP Open. - : Royal College of General Practitioners. - 2398-3795. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral.Aim: To explore European PCPs’ experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis.Design & setting: A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer.Method: Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data.Results: A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients’ descriptions did not suggest cancer; distracting factors reduced PCPs’ cancer suspicions; patients’ hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately.Conclusion: The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The ‘Swiss cheese’ model of accident causation showed how the themes related to each other.
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| 20. |
- Högberg, Cecilia, et al.
(författare)
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Could it be colorectal cancer? : general practitioners' use of the faecal occult blood test and decision making - a qualitative study
- 2015
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Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 16:1, s. 153-161
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Abdominal complaints are common reasons for contacting primary care physicians, and it can be challenging for general practitioners (GPs) to identify patients with suspected colorectal cancer (CRC) for referral to secondary care. The immunochemical faecal occult blood test (iFOBT) is used as a diagnostic aid in primary care, but it is unclear how test results are interpreted. Studies show that negative tests are associated with a risk of delayed diagnosis of CRC and that some patients with positive tests are not investigated further. The aim of this study was to explore what makes GPs suspect CRC and to investigate their practices regarding investigation and referral, with special attention on the use of iFOBTs.METHOD: Semi-structured individual interviews were conducted with eleven purposely selected GPs and registrars in Region Jämtland Härjedalen, Sweden, and subjected to qualitative content analysis.RESULTS: In the analysis of the interviews four categories were identified that described what made the physicians suspect CRC and their practices. Careful listening-with awareness of the pitfalls: Attentive listening was described as essential, but there was a risk of being misled by, for example, the patient's own explanations. Tests can help-the iFOBT can also complicate the diagnosis: All physicians used iFOBTs to various extents. In the absence of guidelines, all found their own ways to interpret and act on the test results. To refer or not to refer-safety margins are necessary: Uncertainty was described as a part of everyday work and was handled in different ways. Common vague symptoms could be CRC and thus justified referral with safety margins. Growing more confident-but also more humble: With increasing experience, the GPs described becoming more confident in their decisions but they were also more cautious.CONCLUSIONS: Listening carefully to the patient's history was essential. The iFOBT was frequently used as support, but there were considerable variations in the interpretation and handling of the results. The diagnostic process can be described as navigating uncertain waters with safety margins, while striving to keep the patient's best interests in mind. The iFOBT may be useful as a diagnostic aid in primary care, but more research and evidence-based guidelines are needed.
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| 21. |
- Högberg, Cecilia, et al.
(författare)
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Diagnosing colorectal cancer and inflammatory bowel disease in primary care : The usefulness of tests for faecal haemoglobin, faecal calprotectin, anaemia and iron deficiency: A prospective study
- 2017
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 52:1, s. 69-75
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Abdominal complaints are common reasons to consult primary care but they are seldom caused by colorectal cancer (CRC), high-risk adenomas (HRAs), or inflammatory bowel disease (IBD). Reliable diagnostic aids would be helpful in deciding which patients to refer for bowel imaging. Our aim was to assess the value of a faecal immunochemical test (FIT) and a faecal calprotectin (FC) test in detecting CRC, HRAs and IBD in primary care, and the value of combining these tests with anaemia and iron-deficiency tests.MATERIALS AND METHODS: This prospective study included 373 consecutive patients that received a FIT or a FC test ordered by a primary care physician. We collected samples for FITs, FC tests, full blood counts and iron-deficiency tests. Physicians were instructed to refer patients with a positive FIT or FC test (cut-off ≥100μg/g) for bowel imaging. The patients' presenting symptoms were recorded. Patients were followed for 2 years.RESULTS: The best test for detecting CRC and IBD was the combination of the FIT and haemoglobin concentration. This test had a sensitivity, specificity, positive predictive value and negative predictive value of 100%, 61.7%, 11.7% and 100%, respectively. The FIT detected a significantly larger proportion of CRC, HRAs and IBD than the FC test (0.92 versus 0.46, 95% confidence interval 0.22-0.67).CONCLUSION: A negative FIT combined with a normal haemoglobin concentration could rule out CRC and IBD with a high degree of safety. This could be useful in prioritising referrals for bowel imaging from primary care.
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| 22. |
- Högberg, Cecilia, 1953-
(författare)
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Diagnosing colorectal cancer in primary care : the value of symptoms, faecal immunochemical tests, faecal calprotectin and anaemia
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women worldwide. Adenomas can be precursors to CRC, and inflammatory bowel disease (IBD) can present with the same symptoms as CRC. The majority of patients with CRC initially consult primary care. Symptoms associated with CRC are also common among primary care patients, but seldom caused by any significant disease. Reliable diagnostic aids would be helpful in deciding which patients to refer. Faecal immunochemical tests (FITs) are commonly used for this purpose in primary care in Sweden, but there is little evidence to support this use. Faecal calprotectin (FC) has been suggested as an additional test.Aim: To explore how doctors in primary care investigate patients with suspected CRC, the value of FITs, symptoms and presence of anaemia in diagnosing CRC and adenomas in primary care, and whether FC tests could contribute to diagnosis.Methods: Three studies (1-3) were carried out in Region Jämtland Härjedalen, Sweden. There was no screening programme for CRC. We used a point of care qualitative dip-stick 3-sample FIT with a cut-off of 25-50μg haemoglobin/g faeces, and a calprotectin enzyme-linked immunosorbent assay (ELISA) test with a cut-off of 100 μg/g faeces. 1: A retrospective, population-based study including all patients diagnosed with CRC or adenomas with high-grade dysplasia (HGD) during the period 2005-2009 that initially consulted primary care. Symptoms, FIT results, anaemia and time to diagnosis were retrieved from medical records. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated from FIT results at the region’s health centres 2008- 2009. (Paper I.) 2: A prospective cohort study including consecutive patients where primary care doctors requested FITs and/or FC tests, at four health centres, from 30 Jan 2013 to 31 May 2014. FITs, FC tests, haemoglobin and iron deficiency tests were analysed; patients and doctors answered questionnaires about symptoms. Patients were examined with bowel imaging or followed for two years. Findings of CRC, adenomas with HGD, adenomas with low grade dysplasia (LGD) ≥1 cm and IBD were registered. (Papers II and III.) 3: A qualitative study of interviews with eleven primary care doctors. We explored what made them suspect CRC, and their practices regarding investigation and referral with particular attention to their use of FITs. Qualitative content analysis with an inductive approach was used for the analysis. (Paper IV.)Results: 1: Paper I: Of 495 patients 323 (65.3%) started the investigation in primary care. FITs were analysed in 215. In 23 cases with CRC, FITs were negative; 15 (65.2%) had anaemia. In 33 cases with CRC, FITs were performed due to asymptomatic anaemia; 10 (30.3%) had negative FITs. The time from start of investigation, to the diagnosis of CRC or adenomas with HGD, was significantly longer for patients with negative FITs.2: 377 patients (9 diagnosed with CRC, 10 with IBD) were included. Paper II: Concordance of positive answers about symptoms from patients and doctors was generally low. Rectal bleeding (recorded by 43.5% of patients and 25.6% of doctors) was the only symptom related to CRC and IBD. The FIT showed a better PPV than rectal bleeding for CRC and IBD. When patients recorded rectal bleeding, the FIT had a PPV of 22.6% and a NPV of 98.9% for CRC and IBD. Paper III: The best test for detecting CRC and IBD was the combination of a positive FIT and/or anaemia with a sensitivity, specificity, PPV and NPV of 100%, 61.7%, 11.7% and 100% respectively. The FC test had no additional value to the FIT alone. The sensitivity, specificity, PPV and NPV of the FIT for CRC in study 1 was estimated at 88.4%, 73.3%, 6.2% and 99.7% respectively. In study 2, corresponding figures were 88.9%, 67.4%, 6.3% and 99.6% respectively.3: Paper IV: We identified four categories: “Careful listening – with awareness of the pit-falls”, “tests can help – the FIT can also complicate the diagnosis”, “to refer or not to refer – safety margins are necessary”, and “growing more confident – but also more humble”. All doctors had found their own way to handle FIT results in the absence of guidelines.Conclusion: The diagnostic process when suspecting CRC can be described as navigating uncertain waters with safety margins. FITs were often used by primary care doctors but with considerable variations in interpretation and handling of results. Rectal bleeding was the only symptom related to CRC and IBD, but the FIT showed a better PPV than rectal bleeding. The combination of a negative FIT and no anaemia may be useful as a rule-out test when CRC is suspected in primary care, and this potentially also applies when patients present with rectal bleeding. Further studies are needed to confirm this and to determine the optimal FIT cut-off value for this use.
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| 23. |
- Högberg, Cecilia, et al.
(författare)
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Diagnosing colorectal cancer in primary care : cohort study in Sweden of qualitative faecal immunochemical tests, haemoglobin levels, and platelet counts
- 2020
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Ingår i: British Journal of General Practice. - London : Royal College of General Practitioners. - 0960-1643 .- 1478-5242. ; 70:701, s. E843-E851
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Tidskriftsartikel (refereegranskat)abstract
- Background Colorectal cancer (CRC) diagnostics are challenging in primary care and reliable diagnostic aids are desired. Qualitative faecal immunochemical tests (FITs) have been used for suspected CRC in Sweden since the mid-2000s, but evidence regarding their effectiveness is scarce. Anaemia and thrombocytosis are both associated with CRC. Aim To evaluate the usefulness of qualitative FITs requested for symptomatic patients in primary care, atone and combined with findings of anaemia and thrombocytosis, in the diagnosis of CRC. Design and setting A population-based cohort study using electronic health records and data from the Swedish Cancer Register, covering five Swedish regions. Method Patients aged >= 18 years in the five regions who had provided FITs requested by primary care practitioners from 1 January 2015 to 31 December 2015 were identified. FIT and blood-count data were registered and all CRC diagnoses made within 2 years were retrieved. Diagnostic measurements were calculated. Results In total, 15 789 patients provided FITs (four different brands); of these patients, 304 were later diagnosed with CRC. Haemoglobin levels were available for 13 863 patients, and platelet counts for 10 973 patients. Calculated for the different FIT brands only, the sensitivities for CRC were 81.6%-100%; specificities 65.7%-79.5%: positive predictive values 4.7%-8.1%; and negative predictive values 99.5%-100%. Calculated for the finding of either a positive FIT or anaemia, the sensitivities increased to 88.9-100%. Adding thrombocytosis did not further increase the diagnostic performance. Conclusion Qualitative FITs requested in primary care seem to be useful as rule in tests for referral when CRC is suspected. A negative FIT and no anaemia indicate a low risk of CRC.
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| 24. |
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| 25. |
- Högberg, Cecilia, et al.
(författare)
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Faecal immunochemical tests for the diagnosis of symptomatic colorectal cancer in primary care : the benefit of more than one sample
- 2017
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Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 35:4, s. 369-372
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Faecal immunochemical tests (FITs) are used to screen for colorectal cancer (CRC) and as diagnostic aids in symptomatic patients. However, the number of samples per FIT varies. It is unclear if there is any advantage to analyse multiple-sample FITs in symptomatic patients.Design and setting: This is a post hoc analysis of a retrospective study that included all cases of CRC and adenomas with high-grade dysplasia (HGD) between 2005 and 2009 in the county of Jamtland, Sweden.Subjects: All patients with CRC and adenomas with HGD that initially presented with symptoms to primary care and delivered FITs.Main outcome measure: The likelihood of a positive FIT in cases of CRC and adenomas with HGD; when analysing one, two or three samples.Results: Of 195 patients, 160 delivered three-sample FITs. Using the 139 cases in which at least one sample was positive, the likelihood of detecting a positive sample upon analysis of only one of the three samples was 0.91 (95% CI: 0.85-0.95), indicating that 13 positive cases may have been missed.Conclusion: Use of a one-sample FIT instead of a three-sample FIT as a diagnostic aid may result in the missing of one tenth of symptomatic CRCs and adenomas with HGD.
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| 26. |
- Högberg, Cecilia, et al.
(författare)
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Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer
- 2013
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:4, s. 209-214
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HGD) in patients initially presenting to primary care. Design. A retrospective population-based study. Setting and subjects. All 495 cases of CRC and adenomas with HGD diagnosed in the county of Jamtland, Sweden from 2005 to 2009. Results. Of 495 patients 323 (65%) initially presented to primary care. IFOBTs were performed in 215 of 323 (67%) patients. The sensitivity of iFOBT for CRC and adenomas with HGD was 88% (83% when patients with a history of rectal bleeding were excluded). Of 34 patients with anaemia found en passant, 10 had negative iFOBTs. Time to diagnosis was longer for patients with negative iFOBTs (p < 0.0005). Conclusion. IFOBT might be helpful in selecting which patients to refer for colonoscopy. However, iFOBT has a limited sensitivity as a diagnostic test for CRC and adenomas with HGD. Relying only on iFOBT for colonoscopy referral could delay diagnosis, especially for patients with anaemia found en passant.
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| 27. |
- Högberg, Cecilia, et al.
(författare)
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Närståendes erfarenheter av webbaserat stöd under pågående specialiserad hemsjukvård : ’Närstående.se’
- 2023
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Konferensbidrag (refereegranskat)abstract
- Bakgrund Stöd till närstående är en grundläggande del av palliativ vård. Stödinterventioner som erbjudits i grupp in-real-life har utvärderats med positiva effekter. Det kan dock vara svårt för närstående att delta på grund av svårigheter att lämna den sjuke och formatet passar heller inte alla. Webbaserade lösningar kan möjliggöra för fler att ta del av stöd utifrån egna förutsättningar och behov. Olika alternativ finns men mer kunskap om webbaserat stöd behövs.Syfte Att undersöka närståendes erfarenheter av stöd i samband med deltagande i en webbaserad intervention ’Närstående.se’ under pågående specialiserad hemsjukvård.Metod Webbsidan ’Närstående.se’ är baserad på tidigare forskning och innehåller kortare filmer där vårdpersonal (autentisk) samtalar med närstående (skådespelare) om ämnen som ofta är angelägna för närstående. Filmerna kompletteras med fördjupande texter och på webbsidan finns ett modererat chattforum. Studien ingår i ett projekt med randomiserad kontrollerad design. Kvalitativa intervjuer genomfördes med 7 närstående varav 5 partners, 1 syskon och 1 dotter, mellan 46–80 år. Data analyserades med kvalitativ innehållsanalys.Resultat Möjligheten att vid behov och i lugn och ro ta del av stöd hemifrån uppskattades. Närstående uttryckte att det genom ’Närstående.se’ kunde vara lättare att närma sig frågor om svår sjukdom och död. Användning av webbsidan gav närstående igenkänning, bekräftelse och normaliserande av svåra känslor. Att ta del av webbsidan bidrog till att svåra ämnen hamnade i fokus vilket kunde underlätta samtal inom familjen. Webbsidan hade använts i olika omfattning men vetskapen om att ha tillgång till den upplevdes som en trygghet.Konklusion Närstående upplever att webbaserat stöd finns när de behöver det. Att närstående kan välja att ta del av specifikt stöd vid behov innebär att stödet blir personcentrerat och anpassat för deras behov.
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| 28. |
- Högberg, Cecilia, et al.
(författare)
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Patient-reported and doctor-reported symptoms when faecal immunochemical tests are requested in primary care in the diagnosis of colorectal cancer and inflammatory bowel disease : a prospective study
- 2020
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Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rectal bleeding and a change in bowel habits are considered to be alarm symptoms for colorectal cancer and they are also common symptoms for inflammatory bowel disease. However, most patients with these symptoms do not have any of these diseases. Faecal immunochemical tests (FITs) for haemoglobin are used as triage tests in Sweden and other countries but little is known about the symptoms patients have when FITs are requested.Objective: Firstly, to determine patients’ symptoms when FITs are used as triage tests in primary care and whether doctors record the symptoms that patients report, and secondly to evaluate the association between symptoms, FIT results and possible prediction of colorectal cancer or inflammatory bowel disease.Methods and materials: This prospective study included 364 consecutive patients for whom primary care doctors requested a FIT. Questionnaires including gastrointestinal symptoms were completed by patients and doctors.Results: Concordance between symptoms reported from patients and doctors was low. Rectal bleeding was recorded by 43.5% of patients versus 25.6% of doctors, FITs were negative in 58.3 and 52.7% of these cases respectively. The positive predictive value (PPV) of rectal bleeding recorded by patients for colorectal cancer or inflammatory bowel disease was 9.9% (95% confidence interval [CI] 5.2–14.7); for rectal bleeding combined with a FIT the PPV was 22.6% (95% CI 12.2–33.0) and the negative predictive value (NPV) was 98.9% (95% CI 96.7–100). For patient-recorded change in bowel habits the PPV was 6.1% (95% CI 2.4–9.8); for change in bowel habits combined with a FIT the PPV was 18.2% (95% CI 9.1–30.9) and the NPV 100% (95% CI 90.3–100).Conclusions: Doctors should be aware that, during consultations, they do not record all symptoms experienced by patients. FITs requested in primary care, when found positive, may potentially be of help in prioritising referrals, also when patients present with rectal bleeding or change in bowel habits.
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| 29. |
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| 30. |
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| 31. |
- Högberg, Cecilia, et al.
(författare)
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Patients’ experiences of using the Integrated Palliative care Outcome Scale for a person-centered care : A qualitative study in the specialized palliative home-care context
- 2019
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Ingår i: Nursing Inquiry. - : Wiley. - 1320-7881 .- 1440-1800. ; 26:4
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore patients’ experiences of using the Integrated Palliative care Outcome Scale (IPOS) during specialized palliative home care. The study adopted a qualitative approach with an interpretive descriptive design. Interviews were performed with 10 patients, of whom a majority were diagnosed with incurable cancer. Our findings suggest that the use of IPOS as a basis for conversation promotes safe care by making the patients feel confident that the care provided was adapted to them which gives them a sense of safety. IPOS facilitated discussions between patients and nurses about care needs. The patients believed that using IPOS enabled reflection on their well-being and life situation. In conclusion, the study finds that using IPOS is beneficial and provide ways to enable person-centered care and with advantage could be used in specialized palliative home care. The results may help overcome barriers and facilitate the use of patient-reported outcome measures (PROMs). To enable the use of PROMs such as IPOS in palliative home care, nurses need education and opportunities to develop routines that enable patients’ voice to be heard and thereby compose a basis for care.
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| 32. |
- Högberg, Cecilia, et al.
(författare)
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Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care : a cohort study
- 2020
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 35, s. 2035-2040
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Tidskriftsartikel (refereegranskat)abstract
- Background Rectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC. Methods Results of all FITs requested in primary care for symptomatic patients in the orebro region during 2015 were retrieved. Data on each patient's history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden. Results A total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1-13.4) and negative predictive value 99.7% (95% CI 99.2-100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6-10.9) and 100% (95% CI 99.6-100). Conclusion The diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.
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| 33. |
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| 34. |
- Högberg, Cecilia, et al.
(författare)
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Use of faecal immunochemical tests common in patients with suspected colorectal cancer but unrelated to travel distance to secondary care : a population-based study from Swedish primary care
- 2022
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Group. - 0281-3432 .- 1502-7724. ; 40:4, s. 459-465
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Tidskriftsartikel (refereegranskat)abstract
- Background Evidence is increasing for the use of faecal immunochemical tests (FITs) for occult blood as diagnostic tools when colorectal cancer can be suspected. FITs have been used for this purpose in Swedish primary care since around 2005 despite absence of supporting guidelines. To our knowledge, the extent of this use has not been studied. Objective To investigate the use of FITs as diagnostic tools, and if the use was related to patient age, sex and travel time from primary care to diagnostic facilities in secondary care. Design Population-based retrospective study using data from electronic health records. Setting and subjects Patients >= 18 years that provided FITs in primary care in five Swedish health care regions during 2015. Driving times from their primary care centres to secondary care were calculated. Main outcome measures The proportion of patients that provided FITs was calculated for each region, different age intervals and grouped driving times. Results 18,913 patients provided FITs. The proportion of listed patients in the five regions that provided FITs increased with age: 0.86-1.2% for ages <65 years, 3.6-4.1% for ages 65-79 years and 3.8-6.1% for ages >= 80 years. Differences between the regions were small. There was no overall correlation between the proportion of patients that provided FITs and driving time to secondary care. Conclusion FITs were used extensively in Swedish primary care with a higher use in older age groups. There was no tendency towards a higher use of FITs at primary care centres with longer driving times to secondary care.
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| 35. |
- Högberg, Dan, et al.
(författare)
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Towards Dynamic Ergonomics Analysis of Work Sequences in Virtual Environments
- 2007
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Ingår i: Proceedings of the 17th International Conference on Flexible Automation and Intelligent Manufacturing (2007 FAIM), Philadelphia, USA, June 2007. - 9781427620927 - 142762092X ; , s. 581-588
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Konferensbidrag (refereegranskat)abstract
- Computer aided visualization and simulation enables early assessment of important design parameters of future products and production systems. Typically, humans affect the system performance, and in order to achieve the expected system efficiency ergonomics needs to be considered in the design process in addition to the more technical or logistical matters. Hence, there is a call for ergonomics to be a natural part of the product and production system design process, also at virtual stages. This paper portrays and discusses two cases where company-specific ergonomics guidelines were implemented into digital human modeling systems for performing static work analyses. Albeit useful, the approach of evaluating static postures gives a reduced picture of the actual situation since the work usually involves a series of movements and tasks. A recently commenced research project aims to enhance knowledge on how to estimate accumulated ergonomic load over time. This knowledge is eventually to be implemented in DHM tools to support objective ergonomics analysis of complete work sequences in virtual environments.
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| 36. |
- Högberg, Hans, et al.
(författare)
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Reactive sputtering of CSx thin solid films using CS2 as precursor
- 2020
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Ingår i: Vacuum. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0042-207X .- 1879-2715. ; 182
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Tidskriftsartikel (refereegranskat)abstract
- We deposit CSx thin solid films by reactive direct current magnetron sputtering of a C target in an argon plasma, using carbon disulfide (CS2) as a precursor to film growth. We investigate the influence of the partial pressure of the CS2 vapor introduced into the plasma on the composition, the chemical bonding structure, the structural, and the mechanical properties as determined by x-ray photoelectron spectroscopy (XPS), Raman spectroscopy, scanning electron microscopy (SEM), and nanoindentation for films deposited at 150 and 300 degrees C. The Raman and the XPS results indicate that S atoms are incorporated in mostly sp(2) bonded C network. These results agree with previous ab-initio theoretical findings obtained by modeling of the CSx compound by the Synthetic Growth Concept. The microstructure of the films as well as the results of their Raman characterization and the nano mechanical testing results all point out that with the increasing S content some spa bonding is admixed in the predominantly sp(2) bonded CSx network, leading to typical amorphous structure with short and interlocked graphene-like planes for S contents between 2% and 8%. We conclude that CSx thin solid films deposited by using CS2 as a precursor would be CSx films deposited at low temperature of similar to 150 degrees C and with an S content in the region of 6 at.% may be interesting candidates for applications as hard/elastic protective coatings.
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| 37. |
- Kautto, Ethel, et al.
(författare)
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What happens to food choices when a gluten-free diet is required? : A prospective longitudinal population-based study among Swedish adolescent with coeliac disease and their peers
- 2014
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Ingår i: Journal of Nutritional Science. - : Cambridge University Press. - 2048-6790. ; 3:e2
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Tidskriftsartikel (refereegranskat)abstract
- A dietary survey was performed during a large screening study in Sweden among 13-year-old adolescents. The aim was to study how the intake of food groups was affected by a screening-detected diagnosis of celiac disease (CD) and its gluten-free (GF) treatment. Food intake, was reported using a food frequency questionnaires (FFQ) and intake reported by the adolescents who was screened to CD was compared with the intake of two same-aged referent groups: i) adolescents diagnosed to CD prior screening and ii) adolescents without CD.. The food intake groups were measured at baseline before the screening-detected cases were aware of their CD, and 12-18 months later.The result showed that the food intakes are affected by a screen detected CD and its dietary treatment. Many flour-based foods were reduced such as pizza, fish fingers, and pastries. The result also indicated that the bread intake was lower before the screened diagnosis compared to the other studied groups, but increased afterwards. Specially manufactured GF-products (e.g. pasta and bread) were frequently used in the screened CDgroup after changing to a GF-diet. Our results suggest that changing to a GF-diet reduces the intake of some popular foods, and the ingredients on the plate are altered, but this do not necessarily include a change of food groups. The availability of manufactured GF-replacement products makes it possible for adolescents to keep many of their old food habits when diagnosed with CD in Sweden.
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| 38. |
- Koskela, Tuomas H., et al.
(författare)
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What would primary care practitioners do differently after a delayed cancer diagnosis? : Learning lessons from their experiences
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 42:1, s. 123-131
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians’ (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis.Design: A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data.Setting and subjects: A primary care study, with narratives from 159 PCPs in 23 European countries.Main outcome measures: PCPs’ narratives on the question ‘If you saw this patient with cancer presenting in the same way today, what would you do differently?Results: The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and ‘I wouldn’t do anything differently’.Conclusion (Implications): To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients’ clinical conditions.
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| 39. |
- Lai, Chung-Chuan, et al.
(författare)
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Synthesis and properties of CSxFy thin films deposited by reactive magnetron sputtering in an Ar/SF6 discharge
- 2017
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Ingår i: Journal of Physics. - : IOP PUBLISHING LTD. - 0953-8984 .- 1361-648X. ; 29:19
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Tidskriftsartikel (refereegranskat)abstract
- A theoretical and experimental study on the growth and properties of a ternary carbon-based material, CSxFy, synthesized from SF6 and C as primary precursors is reported. The synthetic growth concept was applied to model the possible species resulting from the fragmentation of SF6 molecules and the recombination of S-F fragments with atomic C. The possible species were further evaluated for their contribution to the film growth. Corresponding solid CSxFy thin films were deposited by reactive direct current magnetron sputtering from a C target in a mixed Ar/SF6 discharge with different SF6 partial pressures (P-SF6). Properties of the films were determined by x-ray photoelectron spectroscopy, x-ray reflectivity, and nanoindentation. A reduced mass density in the CSxFy films is predicted due to incorporation of precursor species with a more pronounced steric effect, which also agrees with the low density values observed for the films. Increased P-SF6 leads to decreasing deposition rate and increasing density, as explained by enhanced fluorination and etching on the deposited surface by a larger concentration of F/F-2 species during the growth, as supported by an increment of the F relative content in the films. Mechanical properties indicating superelasticity were obtained from the film with lowest F content, implying a fullerene-like structure in CSxFy compounds.
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| 40. |
- Land, Cecilia, et al.
(författare)
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Non-contact web tension profile measurement of baggy paper webs
- 2008
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Konferensbidrag (populärvet., debatt m.m.)abstract
- The web tension profile can detect potentially baggy areas even when the web tension ishigh enough to mask them. Web tension profiles and web length profile were measuredwith a new non-contact measuring unit, where the web flows on air cushions to avoiddisturbing the web path and tension. Bagginess was produced by winding plastic film ofthickness 7 microns into paper rolls. Three different paper grades, MG paper and liner withtwo different grammages, were tested. There was a decrease in web tension in theposition where the plastic had been rolled in, i.e. the ridge had become a baggy lane. Thelane was most baggy closest to the roll core
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| 41. |
- López, Alejandro, 1983-, et al.
(författare)
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Morphology and adhesion of silicon nitride coatings upon soaking in fetal bovine serum
- 2018
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Ingår i: 15th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering and 3rd Conference on Imaging and Visualization, Lisbon, March 26-29, 2018.
-
Konferensbidrag (refereegranskat)abstract
- Total hip joint replacements are considered successful in providing patients with close- to-normal lives; however, revision surgeries still represent an individual and socioeconomic burden due to wear and failure of the implants, which occurs at a rate of 3-10% at 10 years. Therefore, eorts are being made to increase the lifespan of articial prostheses. Because of the impossibility to avoid wear debris, functional silicon nitride coatings are being developed due their low wearing, particle solubility and good biological response. However, a compromise needs to be found between coating reactivity and durability.A HIPIMS process was used to sputter a CrN interlayer followed by a SiNx top layer using 1- and 3-fold rotation in an industrial deposition system (CemeCon AG, Würselen, Germany). In order to measure the adhesion of the coatings to the cobalt-chromium-molybdenum substrates a scratch test was used, consisting of generating a scratch with a Rockwell C diamond stylus, at an increasing load from 0 to 100 N, at a displacement rate of 6mm/min. The samples were immersed in 25% fetal bovine serum solution to mimic synovial joint uid and scratched aer 0, 1, 3, 6 weeks periods in this solution. The cross-section of the coatings was assessed through Focused Ion Beam at 30kV for milling and 5kV for secondary electron imaging of the surface.The coatings demonstrated a high nitrogen content, previously shown to be benecial in terms of low dissolution rates. The deposition conditions and coating morphology were found to have an eect on the dissolution rate and thereby also the spallation failure of the coatings. These results are informative for the further development of these coatings into parts of functional 3D implants.
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| 42. |
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| 43. |
- Lööv, Anna, 1990-, et al.
(författare)
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Diagnostic accuracy for colorectal cancer of a quantitative faecal immunochemical test in symptomatic primary care patients : a study protocol
- 2022
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Ingår i: Diagnostic and prognostic research. - : BioMed Central (BMC). - 2397-7523. ; 6:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is increasing evidence supporting the use of faecal immunochemical tests (FIT) in patients reporting symptoms associated with colorectal cancer (CRC), but most studies until now have focused on selected subjects already referred for investigation. We therefore set out to determine the accuracy and predictive values of FIT in a primary care population.METHOD: A prospective, multicentre, single-gated comparative diagnostic study on quantitative FIT in patients aged 40 years and above presenting in primary care with symptoms associated with CRC will be conducted. Patients representing the whole spectrum of severity of such symptoms met with in primary care will be eligible and identified by GPs. Participants will answer a short form on symptoms during the last month. They will provide two faecal samples from two separate days. Analyses will be performed within 5 days (QuikRead go®, Aidian Oy). The analytical working range is 10-200 μg Hb/g faeces. Reference test will be linked to the Swedish Colorectal Cancer Registry up to 2 years after inclusion. Accuracy, area under ROC curves, and predictive values will be calculated for one FIT compared to the highest value of two FIT and at cutoff < 10, 10-14.9, 15-19.9 and ≥ 20 μg Hb/g faeces. Subgroup analyses will be conducted for patients with anaemia and those reporting rectal bleeding. A model-based cost-effectiveness analysis based on the clinical accuracy study will be performed. Based on previous literature, we hypothesized that the sensitivity of the highest value of two FIT at cutoff 10 μg Hb/g faeces will be 95% (95% CI + / - 15%). The prevalence of CRC in the study population was estimated to be 2%, and the rate of non-responders to be 1/6. In all, 3000 patients will be invited at 30 primary care centres.DISCUSSION: This study will generate important clinical real-life structured data on accuracy and predictive values of FIT in the most critical population for work-up of CRC, i.e. patients presenting with at times ambiguous symptoms in primary care. It will help establish the role of FIT in this large group.
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| 44. |
- Namatovu, Fredinah, et al.
(författare)
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Maternal and perinatal conditions and the risk of developing celiac disease during childhood
- 2016
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Celiac disease (CD) is increasing worldwide, which might be due to the changing environmental and lifestyle exposures. We aimed to explore how conditions related to maternity, delivery and the neonatal period influence CD onset during childhood. Methods: Using Sweden's national registers we had access to information on 1 912 204 children born between 1991 and 2009, 6 596 of whom developed CD before 15 years of age. Logistic regression analyses were performed to determine how CD is associated with maternity, delivery and the neonatal period. Results: Regardless of sex, a reduction in CD risk was observed in children born to mothers aged >= 35 years (odds ratio [OR] 0.8; 95 % confidence interval [CI] 0.7-0.9) and with high maternal income (OR 0.9; 95 % CI 0.8-0.9). Being a second-born child, however, was positively associated with CD. Among boys, elective caesarean delivery increased the risk of CD (OR 1.2; 95 % CI 1.0-1.4), while maternal overweight (OR 0.9; 95 % CI 0.8-0.9), premature rupture of the membrane (OR 0.4; 95 % CI 0.2-0.8) and low birth weight showed a negative association. Girls had an increased CD risk compared to boys and in girls the risk was increased by repeated maternal urinary tract infections (OR 1.1; 95 % CI 1.0-1.2). Conclusions: Elective caesarean delivery and repeated maternal urinary tract infections during pregnancy are associated with increased risk of CD onset during childhood, suggesting the role of dysbiosis during early life. High maternal age and high income reduced the risk of CD, which might be due to infant-feeding practices and life style.
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| 45. |
- Olsson, Cecilia, 1971-, et al.
(författare)
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Adaption of the Quality From the Patient’s Perspective Instrument for Use in Assessing Gynecological Cancer Care and Patients’ Perceptions of Quality Care Received
- 2022
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Ingår i: Cancer Care Research Online. - : Wolters Kluwer. - 2691-3623. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Research focusing on patients’ perceptions of the quality of gynecological cancer care is needed.Objective: To adapt the Quality from the Patient’s Perspective instrument for use in gynecological cancer care (QPP-GynCa) and describe patients’ perceptions of their quality of care in terms of the care received and the subjective importance of the aspects of care.Methods: A cross-sectional study 6–8 months after diagnosis was conducted, involving 1511 patients (response rate of 50.4%) included in the Swedish quality registry for gynecologic cancer.Results: The exploratory factor analysis (n = 1431) resulted in the QPP-GynCa with a 5-factor structure and an eigenvalue of ≥1, explaining 73.1% of the total scale variance. The final 27-item version of the QPP-GynCa consisted of 18 items with 8 additional single items and 1 global single item. The Cronbach’s alpha was acceptable for most factors (>.80). Subjective importance scores were higher than corresponding quality of care scores for care received (P ≤ .01)in all dimensions, factors, and items.Conclusions: The QPP-GynCa instrument reflects all 4 dimensions of the theoretical model of quality of care and achieved good validity as a reliable instrument in assessing the quality of gynecological cancer care.Implication for Practice: Information related to self-care, aspects of sexuality, and reducing patient waiting times need improvement.What Is Foundational: This study contributes to a better understanding of quality of gynecological cancer treatment and care. The validated QPP-GynCa instrument will be a platform for more research on how this group of patients experience their received care, as well as importance of each aspect of care.
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| 46. |
- Rydén, Petra, 1972-, et al.
(författare)
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What happens with the healthiness of the diet among Swedish adolescent boys and girls when a gluten-free diet is required?
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objectives To explore how diagnosis of celiac disease (CD) in early adolescence affects overall food intake and healthiness of the diet in comparison with age- and sex matched controls and children with CD diagnosed in early childhood. Methods This is a longitudinal dietary sub-study of a school-based CD-screening of 12-year-olds (ETICS - Exploring the Iceberg of Coeliacs in Sweden), a part of the PreventCD project. The dietary study was conducted in 2005-2008 and included the following groups resulting from the screening: I) screening-detected CD cases (n=80), II) previously diagnosed CD cases (n=28), and III) two samples of age- and sex matched non-CD children (admission, n=619; follow-up, n=447). All CD cases completed two food-frequency-and-amount-questionnaires (FFQ), covering the previous four weeks; one at admission and one at a follow-up 18-24 months later. The screening-detected CD cases completed the first FFQ before a gluten free diet was initiated. The non-CD children consisted of a cross-sectional sample at each time point, and thus only completed one FFQ each (i.e. either at admission or follow-up). The Goldberg cut-off method was used to validate reported energy intake. The food choices at admission and follow-up were compared among the three groups, and the healthiness of the diet evaluated using two Swedish dietary indexes. Results and Conclusion Intakes of most food groups were similar at baseline. The adolescents diagnosed with CD did only minor changes in their overall food choices. Visible changes were reductions within food groups where gluten-free alternatives are not readily available, such as pastries and pizza. In contrast, total intake of bread and pasta did not change. All three groups scored fairly low on the dietary indexes at both time points, and there is an obvious need to improve the healthiness of the adolescent diet, whether CD is present or not.
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| 47. |
- Schmidt, Susann, et al.
(författare)
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SiNx Coatings Deposited by Reactive High Power Impulse Magnetron Sputtering: Process Parameters Influencing the Nitrogen Content
- 2016
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Ingår i: ACS Applied Materials and Interfaces. - : AMER CHEMICAL SOC. - 1944-8244 .- 1944-8252. ; 8:31, s. 20386-20396
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Tidskriftsartikel (refereegranskat)abstract
- Reactive high power impulse magnetron sputtering (rHi-PIMS) was used to deposit silicon nitride (SiNx) coatings for biomedical applications. The SiNx growth and plasma characterization were conducted in an industrial coater, using Si targets and N-2 as reactive gas. The effects of different N-2-to-Ar flow ratios between 0 and 0.3, pulse frequencies, target power settings, and substrate temperatures on the discharge and the N content of SiNx coatings were investigated. Plasma ion mass spectrometry shows high amounts of ionized isotopes during the initial part of the pulse for discharges with low N-2-to-Ar flow ratios of amp;lt;0.16, while signals from ionized molecules rise with the N-2-to-Ar flow ratio at the pulse end and during pulse off times. Langmuir probe measurements show electron temperatures of 2-3 eV for nonreactive discharges and 5.0-6.6 eV for discharges in transition mode. The SiNx coatings were characterized with respect to their composition, chemical bond structure, density, and mechanical properties by X-ray photoelectron spectroscopy, X-ray reflectivity, X-ray diffraction, and nanoindentation, respectively. The SiNx deposition processes and coating properties are mainly influenced by the Nz-to-Ar flow ratio and thus by the N content in the SiNx films and to a lower extent by the HiPIMS frequencies and power settings as well as substrate temperatures. Increasing N2-to-Ar flow ratios lead to decreasing growth rates, while the N content, coating densities, residual stresses, and the hardness increase. These experimental findings were corroborated by density functional theory calculations of precursor species present during rHiPIMS.
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| 48. |
- Skjöldebrand, Charlotte, et al.
(författare)
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Influence of Substrate Heating and Nitrogen Flow on the Composition, Morphological and Mechanical Properties of SiNx Coatings Aimed for Joint Replacements
- 2017
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Ingår i: Materials. - : MDPI AG. - 1996-1944. ; 10:2
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Tidskriftsartikel (refereegranskat)abstract
- Silicon nitride (SiNx) coatings are promising for joint replacement applications due to their high wear resistance and biocompatibility. For such coatings, a higher nitrogen content, obtained through an increased nitrogen gas supply, has been found to be beneficial in terms of a decreased dissolution rate of the coatings. The substrate temperature has also been found to affect the composition as well as the microstructure of similar coatings. The aim of this study was to investigate the effect of the substrate temperature and nitrogen flow on the coating composition, microstructure and mechanical properties. SiNx coatings were deposited onto CoCrMo discs using reactive high power impulse magnetron sputtering. During deposition, the substrate temperatures were set to 200 degrees C, 350 degrees C or 430 degrees C, with nitrogen-to-argon flow ratios of 0.06, 0.17 or 0.30. Scanning and transmission electron spectroscopy revealed that the coatings were homogenous and amorphous. The coatings displayed a nitrogen content of 23-48 at.% (X-ray photoelectron spectroscopy). The surface roughness was similar to uncoated CoCrMo (p = 0.25) (vertical scanning interferometry). The hardness and Young's modulus, as determined from nanoindentation, scaled with the nitrogen content of the coatings, with the hardness ranging from 12 +/- 1 GPa to 26 +/- 2 GPa and the Young's moduli ranging from 173 +/- 8 GPa to 293 +/- 18 GPa, when the nitrogen content increased from 23% to 48%. The low surface roughness and high nano-hardness are promising for applications exposed to wear, such as joint implants.
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| 49. |
- Villads Jensen, Kurt, et al.
(författare)
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Recensioner
- 2022
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Ingår i: Fornvännen. - Stockholm : Kungl. Vitterhets Historie och Antikvitets Akademien. - 0015-7813 .- 1404-9430. ; 117:4, s. 285-294
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Recension (refereegranskat)
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| 50. |
- Waller, Maria, et al.
(författare)
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A primary care lifestyle programme suitable for socioeconomically vulnerable groups - an observational study.
- 2016
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Ingår i: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 34:4, s. 352-359
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Tidskriftsartikel (refereegranskat)abstract
- To explore whether a primary health care (PHC) health promotion programme reaches and engages socioeconomically vulnerable groups in a community to the same extent as higher socioeconomic groups.Comparison of level of engagement and lifestyle improvements stratified by socioeconomic vulnerability level.Hisingen PHC catchment area (130,000 inhabitants) Gothenburg, Sweden.Men and women aged 18-79, visiting any of the eight public PHC centres during an eight-month period 2007-2008, were presented with a short intervention health questionnaire and offered a health dialogue with a nurse, including a health profile, p-glucose and blood pressure check. Participants were classified according to four socioeconomic vulnerability factors: education, employment, ethnicity and living situation.Out of 3691 participants, 27% had low education (Hisingen community level 23%), 18% were unemployed (community level 22%), and 16% were born outside Scandinavia (community level 22%). At the one-year follow-up, 2121 (57%) attended. At baseline, 3% of the individuals in the sample had three out of four socioeconomic vulnerability factors, 17% had two vulnerability factors, 43% had one vulnerability factor, and 37% had no vulnerability factors. Improved biological markers were seen in all vulnerability groups (1-3) and odds ratios for improvement were significantly higher in the most socioeconomically vulnerable group for smoking and stress compared to the group with no vulnerability factors.Socioeconomically vulnerable groups were reached and lifestyle changes were accomplished to the same extent as in the higher socioeconomic groups in a PHC lifestyle intervention programme. KEY POINTS Primary care plays a major part in prevention of chronic diseases. However, non-pharmacological primary and secondary prevention is often less successful, especially concerning socioeconomically vulnerable groups. The health promoting intervention programme "Pro-Health" reached and engaged socioeconomically vulnerable groups. Participants from the socioeconomically vulnerable groups had comparable odds for lifestyle improvements after one year, compared to participants without vulnerability factors.
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