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1.	Risto, Olof, et al. (författare) Elderly men with a history of distal radius fracture have significantly lower calcaneal bone density and free androgen index than age-matched controls 2012 Ingår i: The Aging Male. - : Informa Healthcare. - 1368-5538 .- 1473-0790. ; 15:1, s. 59-62 Tidskriftsartikel (refereegranskat)abstract Background: Age related bone loss is widely accepted as related to decreased serum levels of circulating sex hormones. Epidemiological data also show distal radius fractures in men to be a sensitive marker of bone fragility. The aim of this study was to assess if men with a history of distal radius fracture have lower bone mass density (BMD), lower free androgen index (FAI), lower total testosterone (T) and lower bio-available testosterone (Bio-T) than healthy age-matched controls. Patients and methods: A case-control study is based on consecutive cases treated for low energy distal radius fracture at our department and age-matched controls. Thirty-nine men treated between 1997-2004 and 45 age-matched controls underwent calcaneal bone density measurements (t-score) and analyses of T, Bio-T and serum hormone binding globulin (SHBG). Results: The fracture group had lower BMD (p andlt; 0.01) and lower FAI (p = 0.01). Linear regression analysis showed a correlation between Bio-T and t-scores (p = 0.03). Using analysis of covariance, a significant difference with lower Bio-T in the fracture group was shown. Conclusion: Bio-T seems to correlate with BMD in elderly men and may serve as a marker for increased fracture risk in this patient group.
2.	Boström, A., et al. (författare) Risk factors for acute and overuse sport injuries in Swedish children 11 to 15 years old : What about resistance training with weights? 2016 Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : John Wiley & Sons. - 0905-7188 .- 1600-0838. ; 26:3, s. 317-323 Tidskriftsartikel (refereegranskat)abstract To determine the 1-year self-reported incidence of overuse and traumatic sport injuries and risk factors for injuries in children participating in a summer sports camp representing seven different sports. 4363 children, 11 to 15 years old participating in a summer camp in seven different sports answered a questionnaire. Injury in this cross-sectional study was defined as a sport-related trauma or overload leading to pain and dysfunction preventing the person from participation in training or competition for at least 1 week. A number of risk factors for injury were investigated such as sex, age, number of hours spent on training in general, and on resistance training with weights. Nearly half [49%, 95% confidence interval (CI) 48–51%] of the participants had been injured as a result of participation in a sport during the preceding year, significantly more boys than girls (53%, 95% CI 50–55% vs 46%, 95% CI 43–48%; P < 0.001). Three factors contributed to increased incidence of sport injuries: age, sex, and resistance training with weights. Time spent on resistance training with weights was significantly associated with sport injuries in a logistic regression analysis. In children age 11 to 15 years, the risk of having a sport-related injury increased with age and occurred more often in boys than in girls. Weight training was the only modifiable risk factor that contributed to a significant increase in the incidence of sport injuries.
3.	Enblom, Anna, et al. (författare) Getting the grip on nonspecific treatment effects: emesis in patients randomized to acupuncture or sham compared to patients receiving standard care. 2011 Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 6:3 Tidskriftsartikel (refereegranskat)abstract It is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than standard care.
4.	Enblom, Anna, et al. (författare) Radiotherapy-induced Emesis in Patients Treated with Acupuncture, Sham Acupuncture or Standard Care : Effects of Unspecific Acupuncture Mechanisms 2010 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Background: It is not known if acupuncture or sham reduces radiotherapy-induced emesis more than standard care. Methods: Cancer patients were randomized to verum (skin penetrating) acupuncture (n = 109) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106) performed with a telescopic nonpenetrating needle at a sham point during the whole radiotherapy period. The verum and sham treated patients were compared to a reference cohort receiving standard care only (n = 62). All patients received radiotherapy over abdominal or pelvic regions. The occurrence of emesis in each group was compared using replies documented in questionnaires after a mean dose of 27 Gray. Findings: Nausea (p=0.001) and vomiting were experienced during the preceding week by 37 and 7%, respectively, in the verum group, 38 and 7% in the sham group and 63 and 15% in the standard care group. The nausea intensity in the acupuncture cohort was lower (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p=0.002). Almost all the verum and sham treated patients (95%) expected antiemetic effects from their treatment. Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (relative risk 1.6; 95 % confidence interval 1.2-2.4). Interpretations: Both verum acupuncture and nonpenetrating sham acupuncture seem to reduce nausea and vomiting during radiotherapy, possibly by psychobiological mechanisms related to the extra care and expectancy.
5.	Frisk, Jessica, et al. (författare) Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes 2012 Ingår i: Supportive Care in Cancer. - : Springer. - 0941-4355 .- 1433-7339. ; 20:4, s. 715-724 Tidskriftsartikel (refereegranskat)abstract PURPOSE: Evaluate effects of electro-acupuncture (EA) and hormone therapy (HT) on health-related quality-of-life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms. METHODS: Forty-five women, randomized to EA (n = 27) for 12 weeks or HT (n = 18) for 24 months, were followed for up to 2 years. Distress caused by, and numbers of, hot flushes, hours slept and times woken up/night, Psychological and General Well-being Index (PGWB) and Women's Health Questionnaire (WHQ) were registered before and during treatment and at 6, 9, 12, 18 and 24 months after start of treatment. RESULTS: After 12 weeks of EA (n = 19), WHQ improved from 0.32 (IQR 0.23-0.53) at baseline to 0.24 (IQR 0.12-0.39; p < 0.001) and PGWB from 78 (IQR 53-89) to 79 (IQR 68-93; p = 0.002). All sleep parameters improved and Hot Flush Score (HFS) decreased by 80%. At 12 months, WHQ, PGWB and all sleep parameters remained significantly improved (n = 14) and HFS decreased by 65%. After 12 weeks of HT (n = 18), WHQ improved from 0.29 (IQR 0.15-0.44) at baseline to 0.15 (IQR 0.05-0.22; p = 0.001), PGWB from 75 (IQR 59-88) to 90 (62-97; p = 0.102) and three of five sleep parameters improved. CONCLUSION: Both EA and HT increased HRQoL and sleep, probably through decreasing numbers of and distress by hot flushes. Although flushes decreased less in the EA group than in the HT group, HRQoL improved at least to the same extent maybe due to other effects of EA, not induced by HT, e.g. on anxiety, vitality and sleep, supported by subscale analyses. EA should be further evaluated as treatment for women with breast cancer and climacteric complaints, since HT no longer can be recommended for these women.
6.	Gladh, Mathias, 1971-, et al. (författare) Prevalence of symptoms possibly related to PADAM, in a Swedish population aged 55, 65 and 75 years 2005 Ingår i: Maturitas. - : Elsevier BV. - 0378-5122 .- 1873-4111. ; 50:3, s. 161-166 Tidskriftsartikel (refereegranskat)abstract Objectives: With age there is an average decline in the concentration of biologically active testosterone. It is still controversial if this leads to a clinically relevant deficit, "partial androgen deficiency of the ageing man" (PADAM). Our objective was to investigate the prevalence of a series of symptoms possibly associated with PADAM in an assumed normal-population of older men. Methods: We developed a questionnaire including items about symptoms possibly associated with PADAM as well as background data covering demography, medical history, mood status, medication, castration therapy, as well as smoking, exercise and alcohol habits. The 10 items of the ADAM-questionnaire, designed to predict low bio-available T, were also included. The questionnaire was sent to all 1885 men 55, 65 or 75-years-old, living in Linköping, Sweden. Results: We identified a number of symptoms that differed significantly (P<0.01) between age groups, e.g., "increased abdominal circumference", "decrease in muscle strength and/or endurance", "decreased libido", "less strong erection" and "lack of energy". From factorial analysis we found that the symptoms co-varied in four different groups. Conclusion: The prevalence of a number of symptoms differed significantly between age groups, but we cannot infer that there is a causal connection between an average age-dependent decline in testosterone function and these symptoms. There are several other ways to interpret these results like the existence of concurrent somatic and/or mood disorders or ageing as such. For this purpose further studies including measurements of testosterone concentrations relating to the findings of this study have to be performed. © 2004 Elsevier Ireland Ltd. All rights reserved.
7.	Götmar, Anders, et al. (författare) Symptoms in peri- and postmenopausal women in relation to testosterone concentrations. Data fromThe Women's Health in the Lund Area (WHILA) study 2008 Ingår i: Climacteric. - : Informa UK Limited. - 1369-7137 .- 1473-0804. ; 11:4, s. 304-314 Tidskriftsartikel (refereegranskat)abstract Objectives: The aim of this study was to investigate possible associations between androgen concentrations in perimenopausal women and symptoms that may be associated with low androgen concentrations in the blood. Methods: All women born 1935 to 1945 living in a defined geographic area in Sweden (n=10766) were invited to a screening program that included physical and laboratory examinations and a questionnaire. Three groups were identified; premenopausal women, women on hormone replacement therapy (HRT) and postmenopausal women without HRT. Concentrations of testosterone (T), androstendione, Sex Hormone Binding Globulin and estradiol were measured. Waist Hip Ratio, Body Mass Index and Free Testosterone Index (FTI) were calculated. Results: 6908 women participated. The women on HRT had lower T and FTI and were less satisfied with mood and energy (p<0.05). Women with hot flushes had higher T and FTI and women reporting coldness had lower concentrations (p<0.05). Sexual well-being were not correlated to T or FTI (p>0.05). Conclusions: Lower T concentrations were associated with lower quality of life in perimenopausal women but not to sexual well-being. There must be other factors than decrements in sex hormones that contribute to the emergence of some perimenopausal symptoms.
8.	Hammar, Mats, 1950-, et al. (författare) Few oligo-amenorrheic athletes have vasomotor symptoms 2000 Ingår i: Maturitas. - 0378-5122 .- 1873-4111. ; 34:3, s. 219-225 Tidskriftsartikel (refereegranskat)abstract Objective: To assess whether women with athletic oligo-amenorrhea have vasomotor symptoms. Material and methods: A mailed questionnaire was sent to 252 female athletes about vasomotor symptoms. Identical questions were also mailed to 1523 peri- and postmenopausal women. Results: The prevalence of vasomotor symptoms was low in female athletes with oligo- and amenorrhea and similar to that found in athletes with regular menstruations. The prevalence was significantly lower than in menopausal women. Although more than a third of the menopausal women had hormone replacement therapy, 30% of them still had vasomotor symptoms at least every week compared with only 2% of the oligo-amenorrheic athletes. Conclusion: Vasomotor symptoms are very uncommon in oligo-amenorrheic athletes, although many of them are hypoestrogenic. It was suggested that one factor contributing to these symptoms around menopause is low hypothalamic activity of ▀-endorphins, which makes the thermoregulatory centre labile. On the other hand, supraphysiological activity in hypothalamic ▀-endorphins may cause the oligo-amenorrhea in athletes, but may stabilise the thermoregulatory centre and thus prevent hot flushes. (C) 2000 Elsevier Science Ireland Ltd.
9.	Järvstråt, Lotta, et al. (författare) Use of hormone therapy in Swedish women aged 80 years or older 2015 Ingår i: Menopause. - 1072-3714 .- 1530-0374. ; 22:3, s. 275-278 Tidskriftsartikel (refereegranskat)abstract Objective: Menopausal symptoms such as hot flashes and night sweats may persist for 10 to 20 years or even longer. Information about the extent to which older women use hormone therapy is limited. The aim of this study was to determine the use of hormone therapy in Swedish women aged 80 years or older.Methods: The study is based on national register data on dispensed drug prescriptions (ie, prescribed therapy that has been provided to individuals by pharmacies) for hormone therapy and local low-dose estrogens.Results: Of 310,923 Swedish women who were aged at least 80 years, 609 (0.2%) were new users of hormone therapy. A total of 2,361 women (0.8%) were current users of hormone therapy. The median duration of hormone therapy use in new users was 257 days (25th to 75th percentiles, 611-120 d). About one in six women aged 80 years or older had used local vaginal estrogen therapy for at least four 3-month periods. The drugs were mainly prescribed by gynecologists and general practitioners.Conclusions: Our results show that a number of women aged 80 years or older still use hormone therapy and that most women who started a new treatment period had only one or two dispensations despite the median duration of treatment being more than half a year. Because at least some of the women aged 80 years or older who used hormone therapy probably did so owing to persistent climacteric symptoms, vasomotor symptoms and hormone therapy are still relevant issues that need to be discussed when counseling women around and after age 80.
10.	Lindh-Åstrand, Lotta, et al. (författare) Hormone therapy might be underutilized in women with early menopause. 2015 Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 30:4, s. 848-852 Tidskriftsartikel (refereegranskat)abstract STUDY QUESTION Are Swedish women age 40–44 years with assumed early menopause ‘undertreated’ by hormone therapy (HT)?SUMMARY ANSWER Many women with probable early menopause discontinue their HT after a short period of time. Thus, they fail to complete the recommended replacement up to age 51–52 years, the average age of menopause.WHAT IS KNOWN ALREADY Spontaneous early menopause occurs in ∼5% of women age 40–45 years. Regardless of the cause, women who experience hormonal menopause due to bilateral oophorectomy before the median age of spontaneous menopause are at increased risk of cardiovascular disease, neurological disease, osteoporosis, psychiatric illness and even death.STUDY DESIGN, SIZE, DURATION The study is descriptive, and epidemiological and was based on the use of national registers of dispensed drug prescriptions (HT) linking registers from the National Board of Health and Welfare and Statistics Sweden from 1 July 2005 until 31 December 2011.PARTICIPANTS/MATERIALS, SETTING, METHODS The study population consisted of 310 404 women, 40–44 years old on 31 December 2005 who were followed from 1 July 2005 until 31 December 2011.MAIN RESULTS AND THE ROLE OF CHANCE Only 0.9% of women 40–44 years old started HT during the study period. A majority of these women used HT <1 year.LIMITATIONS, REASONS FOR CAUTION We do not know the indications that led to the prescription of HT but assume that early onset of menopause was the main reason. Because of the study design—making a retrospective study of registers—we can only speculate on the reasons for most of the women in this group discontinuing HT. Another limitation of this study is that we have a rather short observation time. However, we have up to now only been able to collect and combine the data since July 2005.WIDER IMPLICATIONS OF THE FINDINGS As the occurrence of spontaneous early menopause in women age 40–45 is reported to be ∼5%, the fact that <1% of Swedish women age 40–44 are prescribed HT, and can be shown also to have had the medication dispensed at a pharmacy suggests an unexpectedly low treatment rate. Some women with early menopause may have used combined contraceptives as supplementation therapy, but in Sweden HT is the recommended treatment for early menopause so any such women are not following this recommendation. Women who experience early menopause are at increased risk for overall morbidity and mortality, and can expect to benefit from HT until they have reached at least the median age of spontaneous menopause. It is therefore important to individualize the information given these women and to convey new knowledge in this area to gynaecologists and physicians in general as well as the recommendation that women in this group continue HT at least until the average age for spontaneous menopause is reached.
11.	Lindh Åstrand, Lotta, et al. (författare) Use of hormone therapy (HT) among Swedish women with contraindications - A pharmacoepidemiological cohort study 2019 Ingår i: Maturitas. - : ELSEVIER IRELAND LTD. - 0378-5122 .- 1873-4111. ; 123, s. 55-60 Tidskriftsartikel (refereegranskat)abstract Objectives: To assess how women in Sweden with breast cancer (BC), endometrial cancer (EC), and/or pulmonary embolism (PE) were dispensed menopausal hormone therapy (HT). Study design: A retrospective study of Swedish women aged 40 years or more on 31 December 2005 (n = 2,863,643), followed through to December 2011. The study analysed three mandatory national healthcare registries: the Swedish Prescribed Drug Register, the National Inpatient Register and the Cancer Register. New users were defined as having a first dispensation after at least a 9-month break, and thus were possible to identify from April 2006. New users with at least one of the diagnoses BC, EC or PE before the first dispensation were classified as having a relative or absolute contraindication for HT. Main outcome measures: The relative risks of having HT dispensed after being diagnosed with BC, EC and/or PE. Results: In total, 171,714 women had at least one of the diagnoses BC, EC or PE. The relative risk of having hormone therapy dispensed (current and new users) after being diagnosed with any of the diagnoses was significantly lower (PE, IRR 0.11, 95% CI 0.10-0.12;/ BC, IRR 0.12, 95% CI 0.11-0.13; EC, IRR 0.43, CI 0.40-0.46) than for women without these diagnoses. Conclusions: One in about 250 women started treatment with HT after being diagnosed with BC, PE or EC. Swedish prescribers seem to be well aware of the recommendations for HT use in women with contraindications. A few women, however, are prescribed HT despite having BC, EC or PE, possibly after careful evaluation of the risks and benefits and giving informed consent. Women with a history of PE were prescribed transdermal HT to a larger extent than women in general, in line with results from observational studies.
12.	Spetz, Anna-Clara, et al. (författare) Change in testosterone concentrations over time is a better predictor than the actual concentrations for symptoms of late onset hypogonadism 2011 Ingår i: The Aging Male. - : Informa Healthcare. - 1368-5538 .- 1473-0790. ; 14:4, s. 249-256 Tidskriftsartikel (refereegranskat)abstract Background. Symptoms of late-onset hypogonadism (LOH) and concentrations of testosterone (T) and bioavailable testosterone (BT) were studied in relation to the data from the same men 5 years earlier. less thanbrgreater than less thanbrgreater thanMethods. In 2008, 282 men, aged 60-82 years, answered a questionnaire regarding demographic data, medical history, different symptoms of LOH and the 10 questions from the Androgen Decline in Aging Males (ADAM)-questionnaire. Blood samples were analysed for concentrations of T and calculations were made for BT. less thanbrgreater than less thanbrgreater thanResults. A total of 87.2% of the questionnaires were returned and analysed, and 75.2% of the responders gave blood samples. The oldest third of the men were most affected by LOH symptoms (p andlt; 0.05). Both T and BT concentrations decreased during the 5 years (p andlt; 0.05) but only the symptom less strong erections changed significantly (p andlt; 0.05). Men reporting one of the four specific symptoms from the ADAM-questionnaire for the first time in 2008 had a higher loss of T and BT than men who had unchanged or fewer symptoms than that reported in 2003. less thanbrgreater than less thanbrgreater thanConclusions. The magnitude of the decrease in concentrations is a better predictor of LOH than are the actual concentrations of T and BT. A combination of symptoms predicts LOH better than any single symptom.
13.	Spetz, Anna-Clara, 1973-, et al. (författare) Hot flushes in a male population aged 55, 65, and 75 years, living in the community of Linköping, Sweden 2003 Ingår i: Menopause. - : Ovid Technologies (Wolters Kluwer Health). - 1072-3714 .- 1530-0374. ; 10:1, s. 81-87 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE:Hot flushes are as common in castrated men as in menopausal women. We investigated whether hot flushes exist in a normal aging male population and to what extent.DESIGN:A questionnaire was sent to all men living in Linköping, Sweden, who were 55, 65, and 75 years old ( = 1,885). The questionnaire asked for demographic data, medical history, mood status, medication, castrational therapy, and smoking, exercise, and alcohol habits, among other items. We asked specifically for current hot flushes unrelated to exercise or a warm environment.RESULTS:Of the questionnaires received, 1,381 were eligible for evaluation; 33 were analyzed separately because these men had been castrated. Hot flushes of any frequency were reported by 33.1% of noncastrated men, 4.3% reported flushes at least a few times per week, and 1.3% reported daily flushes. Half of the men reporting flushes were also bothered by them, ie, almost every sixth man in total. We found a relation between occurrence of hot flushes and other symptoms thought to be related to low testosterone concentration, such as decreased muscle strength or endurance, decreased enjoyment of life, sadness or grumpiness, and lack of energy ( < 0.05).CONCLUSIONS:Hot flushes occur in one third of a population of noncastrated older men, approximately half of whom consider flushes as bothersome. Neither the mechanisms nor whether the symptoms would respond to testosterone supplementation is known. Androgen substitution to treat symptoms possibly related to a male climacteric is still controversial. Studies are needed to evaluate the needs for and the effects of androgen treatment on vasomotor symptoms.
14.	Spetz, Anna-Clara, et al. (författare) Symptoms of testosterone deficiency in early middle aged men 2012 Ingår i: The Aging Male. - : Informa Healthcare. - 1368-5538 .- 1473-0790. ; 15:2, s. 78-84 Tidskriftsartikel (refereegranskat)abstract Symptoms of testosterone deficiency and concentrations of testosterone (T) and bioavailable testosterone (BT) were studied in 35-and 45-year-old men. Methods: A questionnaire, was sent to all 35-and 45-year-old men in Linkoping, Sweden (n = 1998). The questionnaire has earlier been used for 55- to 75-year-old men and included demographic data, medical history, different symptoms possibly of T deficiency and the 10 questions from the "ADAM-questionnaire". Totally 200 men randomly selected among the men who answered the questionnaire were asked to give blood samples for analysis of T-and BT-concentrations. Results: A total of 38.7% of the questionnaires were returned and analysed, and 43.5% of the 200 randomly selected men gave blood samples. The older age group reported more symptoms that may be connected to low B and BT and had lower T-and BT-concentrations. Less strong erections and higher alcohol consumption were associated with lower concentrations of BT in 45-year-old men. Conclusions: The burden of symptoms possibly related to low T concentrations were higher in 45-year-old men, and BT and T were lower. However, due to the low answer frequency and number of blood samples analyzed no general conclusions can be drawn.
15.	Spetz, Anna-Clara, 1973-, et al. (författare) Testosterone correlated to symptoms of partial androgen deficiency in aging men (PADAM) in an elderly Swedish population 2007 Ingår i: Menopause. - : Ovid Technologies (Wolters Kluwer Health). - 1072-3714 .- 1530-0374. ; 14:6, s. 999-1005 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To investigate the prevalence of different symptoms of partial androgen deficiency in aging men (PADAM) and to correlate them with blood concentrations of testosterone and bioavailable testosterone. DESIGN: A total of 370 men, aged 55 to 75 years, were invited to one of three primary healthcare centers in Sweden. They were asked to complete a questionnaire regarding demographic data, medical history, mood status, medication, castration therapy and smoking, exercise and alcohol habits, as well as different symptoms of PADAM. The 10 questions from a previously used questionnaire (the ADAM questionnaire) were included. The men were offered blood tests for analyses of testosterone, follicle stimulating hormone, luteinizing hormone, steroid hormone-binding globulin, and albumin. From these test results, we calculated the bioavailable testosterone. RESULTS: Of the questionnaires sent out, 81.6% were returned and eligible for evaluation. Blood samples were obtained from 85.8% of men answering the questionnaire. Many of the symptoms, including five from the ADAM questionnaire, were more common in older age groups (P < 0.05). Three symptoms, deterioration in work performance, decreased strength and/or endurance, and bothersome hot flushes, were associated with low bioavailable testosterone and/or testosterone (P < 0.05). Testosterone and bioavailable testosterone did not differ between age groups, but bioavailable testosterone was higher in men with three or fewer symptoms on the ADAM questionnaire. CONCLUSIONS: Symptoms associated with PADAM often occur in an elderly population, but we could only find an association between three symptoms and blood testosterone concentrations, one being bothersome hot flushes. It is likely that these symptoms have a more complex background than only PADAM. ©2007The North American Menopause Society.
16.	Sundell, Micaela, et al. (författare) Pulmonary embolism in menopausal hormone therapy : a population-based register study 2022 Ingår i: Climacteric. - : Taylor & Francis. - 1369-7137 .- 1473-0804. ; 25:6, s. 615-621 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: Oral but not transdermal menopausal hormone therapy (MHT) increases the risk of venous thromboembolism. There is no evidence regarding the risk of the serious complication pulmonary embolism (PE). The aim was to investigate the risk of PE in women using MHT depending on administration route, type of progestin and treatment duration.METHOD: The population-based case-control study covered 1,771,253 women aged 40-69 years, during 2006-2015. Diagnoses of PE (n = 13,974) and drug dispensations were received from national validated registers.RESULTS: Current MHT users had a higher risk of PE than non-users (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.05-1.26). First ever users had the highest risk (OR 2.07, 95% CI 1.23-3.50). Transdermal administration was not associated with increased risk of PE. The OR was slightly but non-significantly higher with estrogen combined with medroxyprogesterone acetate than with norethisterone acetate.DISCUSSION: The risk of PE was significantly increased in users of oral but not transdermal MHT, with the highest risk in first ever users of oral estrogen combined with medroxyprogesterone acetate. The risk was considerably lower in women with recurrent treatment, probably because of the healthy user effect.CONCLUSION: PE was most common close to initiation of oral treatment. Transdermal MHT did not increase the risk of PE.
17.	Zaborowska, Ewa, et al. (författare) Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women – an analysis of two prospective, parallel, randomised studies 2007 Ingår i: Climacteric. - : Climacteric. - 1369-7137 .- 1473-0804. ; 10:1, s. 38-45 Tidskriftsartikel (refereegranskat)abstract Objective: To assess if transdermal or oral estrogens, acupuncture and applied relaxation decrease the number of menopausal hot flushes/24 h and improve climacteric symptoms, as assessed by the Kupperman index, more than transdermal placebo treatment. Setting: An outpatient clinic at a Swedish university hospital. Methods: A total of 102 postmenopausal women were recruited to two studies performed in parallel. In Study I, the women were randomized between transdermal placebo or estrogen treatment and, in Study II, between oral estrogens, acupuncture or applied relaxation for 12 weeks. Climacteric symptoms were measured with daily logbooks on hot flushes. Women completed the assessment questionnaire for the Kupperman index at baseline and after 12 weeks. Results: The number of flushes/24 h decreased significantly after 4 and 12 weeks in all groups except the placebo group. Both at 4 and 12 weeks, acupuncture decreased the number of flushes more (p < 0.05; p < 0.01, respectively) than placebo. At 12 weeks, applied relaxation decreased the number of flushes more (p < 0.05) than placebo. The Kupperman index score decreased in all groups except the placebo group. The decrease in score was significantly greater in all treatment groups than in the placebo group (p < 0.01). Conclusion: Acupuncture and applied relaxation both reduced the number of hot flushes significantly better than placebo and should be further evaluated as alternatives to hormone therapy in women with menopausal vasomotor complaints.
18.	Aberg, Fredrik, et al. (författare) A Dynamic Aspartate-to-Alanine Aminotransferase Ratio Provides Valid Predictions of Incident Severe Liver Disease 2021 Ingår i: HEPATOLOGY COMMUNICATIONS. - : John Wiley & Sons. - 2471-254X. ; 5:6, s. 1021-1035 Tidskriftsartikel (refereegranskat)abstract The aspartate-to-alanine aminotransferase ratio (AAR) is associated with liver fibrosis, but its predictive performance is suboptimal. We hypothesized that the association between AAR and liver disease depends on absolute transaminase levels and developed and validated a model to predict liver-related outcomes in the general population. A Cox regression model based on age, AAR, and alanine aminotransferase (ALT) level (dynamic AAR [dAAR]) using restricted cubic splines was developed in Finnish population-based health-examination surveys (FINRISK, 2002-2012; n = 18,067) with linked registry data for incident liver-related hospitalizations, hepatocellular carcinoma, or liver death. The model was externally validated for liver-related outcomes in a Swedish population cohort (Swedish Apolipoprotein Mortality Risk [AMORIS] subcohort; n = 126,941) and for predicting outcomes and/or prevalent fibrosis/cirrhosis in biopsied patients with nonalcoholic fatty liver disease (NAFLD), chronic hepatitis C, or alcohol-related liver disease (ALD). The dynamic AAR model predicted liver-related outcomes both overall (optimism-corrected C-statistic, 0.81) and in subgroup analyses of the FINRISK cohort and identified persons with >10% risk for liver-related outcomes within 10 years. In independent cohorts, the C-statistic for predicting liver-related outcomes up to a 10-year follow-up was 0.72 in the AMORIS cohort, 0.81 in NAFLD, and 0.75 in ALD. Area-under-the-curve (AUC) for detecting prevalent cirrhosis was 0.80-0.83 in NAFLD, 0.80 in hepatitis C, but only 0.71 in ALD. In ALD, model performance improved when using aspartate aminotransferase instead of ALT in the model (C-statistic, 0.84 for outcome; AUC, 0.82 for prevalent cirrhosis). Conclusion: A dAAR score provides prospective predictions for the risk of incident severe liver outcomes in the general population and helps detect advanced liver fibrosis/cirrhosis. The dAAR score could potentially be used for screening the unselected general population and as a trigger for further liver evaluations.
19.	Agardh, Carl-David, et al. (författare) Region Skåne. Samverkan universitet-sjukvård krävs för att utveckla den kliniska forskningen 2002 Ingår i: Läkartidningen. - 0023-7205. ; 99:51-52, s. 6-5225 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
20.	Almen-Christensson, Anna, et al. (författare) Prevention of menstrual migraine with perimenstrual transdermal 17-beta-estradiol: a randomized, placebo-controlled, double-blind crossover study 2011 Ingår i: Fertility and Sterility. - : Elsevier Science B.V., Amsterdam.. - 0015-0282 .- 1556-5653. ; 96:2, s. 498-500 Tidskriftsartikel (refereegranskat)abstract he effect of treatment with percutaneous E(2) (100 mu g/24 h) during 2 weeks perimenstrually on the number and severity of menstrual migraine attacks was studied in 27 women in a randomized, placebo-controlled, double-blind, crossover trial. We were not able to demonstrate any difference between E(2) supplementation and placebo on the number or severity of migraine attacks, but both regimens showed significant effects compared with before treatment.
21.	Arnfred, Signe, et al. (författare) Re-thinking Africa : A Contribution to the Swedish Government White Paper on Africa 2007 Rapport (övrigt vetenskapligt/konstnärligt)
22.	Arthur, Rhonda, et al. (författare) Association between baseline serum glucose, triglycerides and total cholesterol, and prostate cancer risk categories 2016 Ingår i: Cancer Medicine. - : Wiley. - 2045-7634. ; 5:6, s. 1307-1318 Tidskriftsartikel (refereegranskat)abstract Lifestyle-related risk factors such as hyperglycemia and dyslipidemia have been associated with several cancers. However, studies exploring their link with prostate cancer (PCa) clinicopathological characteristics are sparse and inconclusive. Here, we investigated the associations between serum metabolic markers and PCa clinicopathological characteristics. The study comprised 14,294 men from the Swedish Apolipoprotein MOrtality RISk (AMORIS) cohort who were diagnosed with PCa between 1996 and 2011. Univariate and multivariable logistic regression were used to investigate the relation between glucose, triglycerides and total cholesterol and PCa risk categories, PSA, Gleason score, and T-stage. Mean age at time of PCa diagnosis was 69 years. Men with glucose levels >6.9 mmol/L tend to have PSA<4 mu g/L, while those with glucose levels of 5.6-6.9 mmol/L had a greater odds of PSA>20 mu g/L compared to PSA 4.0-9.9 mu g/L. Hypertriglyceridemia was also positively associated with PSA>20 mu g/L. Hyperglycemic men had a greater odds of intermediate-and high-grade PCa and advanced stage or metastatic PCa. Similarly, hypertriglyceridemia was positively associated with high-grade PCa. There was also a trend toward an increased odds of intermediate risk localized PCa and advanced stage PCa among men with hypertriglyceridemia. Total cholesterol did not have any statistically significant association with any of the outcomes studied. Our findings suggest that high serum levels of glucose and triglycerides may influence PCa aggressiveness and severity. Further investigation on the role of markers of glucose and lipid metabolism in influencing PCa aggressiveness and severity is needed as this may help define important targets for intervention.
23.	Arthur, Rhonda, et al. (författare) Serum glucose, triglycerides, and cholesterol in relation to prostate cancer death in the Swedish AMORIS study 2019 Ingår i: Cancer Causes and Control. - : Springer. - 0957-5243 .- 1573-7225. ; 30:2, s. 195-206 Tidskriftsartikel (refereegranskat)abstract Purpose: Lifestyle-related conditions such as obesity are associated with prostate cancer progression, but the associations with hyperglycemia and dyslipidemia are unclear. This study, therefore, aims to examine the association of glucose, triglycerides, and total cholesterol with prostate cancer death. Methods: From the Swedish AMORIS cohort, we selected 14,150 men diagnosed with prostate cancer between 1996 and 2011 who had prediagnostic measurements of serum glucose, triglycerides, and total cholesterol. Multivariable Cox proportional hazards regressionmodels were used to determine the hazard ratios for death in relation to the aforementioned metabolic markers. Results: Using clinical cut-off points, a non-significant positive association was observed between glucose and prostate cancer death. When compared to those with glucose in the lowest quartile, those in the highest quartile had greater risk of prostate cancer death (HR 1.19; 95% CI 1.02-1.39). However, neither total cholesterol nor triglycerides were associated with prostate cancer death. Glucose and triglycerides were positively associated with overall, cardiovascular, and other deaths. Hypercholesterolemia was only associated with risk of CVD death. Conclusion: Our results suggest that glucose levels may influence prostate cancer survival, but further studies using repeated measurements are needed to further elucidate how glucose levels may influence prostate cancer progression.
24.	Asplund, Maria. E., 1970, et al. (författare) Dynamics and fate of blue carbon in a mangrove-seagrass seascape : influence of landscape configuration and land-use change 2021 Ingår i: Landscape Ecology. - : Springer. - 0921-2973 .- 1572-9761. ; 36, s. 1489-1509 Tidskriftsartikel (refereegranskat)abstract Context Seagrass meadows act as efficient natural carbon sinks by sequestering atmospheric CO2 and through trapping of allochthonous organic material, thereby preserving organic carbon (C-org) in their sediments. Less understood is the influence of landscape configuration and transformation (land-use change) on carbon sequestration dynamics in coastal seascapes across the land-sea interface. Objectives We explored the influence of landscape configuration and degradation of adjacent mangroves on the dynamics and fate of C-org in seagrass habitats. Methods Through predictive modelling, we assessed sedimentary C-org content, stocks and source composition in multiple seascapes (km-wide buffer zones) dominated by different seagrass communities in northwest Madagascar. The study area encompassed seagrass meadows adjacent to intact and deforested mangroves. Results The sedimentary C-org content was influenced by a combination of landscape metrics and inherent habitat plant- and sediment-properties. We found a strong land-to-sea gradient, likely driven by hydrodynamic forces, generating distinct patterns in sedimentary C-org levels in seagrass seascapes. There was higher C-org content and a mangrove signal in seagrass surface sediments closer to the deforested mangrove area, possibly due to an escalated export of C-org from deforested mangrove soils. Seascapes comprising large continuous seagrass meadows had higher sedimentary C-org levels in comparison to more diverse and patchy seascapes. Conclusion Our results emphasize the benefit to consider the influence of seascape configuration and connectivity to accurately assess C-org content in coastal habitats. Understanding spatial patterns of variability and what is driving the observed patterns is useful for identifying carbon sink hotspots and develop management prioritizations.
25.	Baldanzi, Gabriel, et al. (författare) Accelerometer-based physical activity is associated with the gut microbiota in 8416 individuals in SCAPIS. 2024 Ingår i: EBioMedicine. - : Elsevier. - 2352-3964. ; 100 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Previous population-based studies investigating the relationship between physical activity and the gut microbiota have relied on self-reported activity, prone to reporting bias. Here, we investigated the associations of accelerometer-based sedentary (SED), moderate-intensity (MPA), and vigorous-intensity (VPA) physical activity with the gut microbiota using cross-sectional data from the Swedish CArdioPulmonary bioImage Study.METHODS: In 8416 participants aged 50-65, time in SED, MPA, and VPA were estimated with hip-worn accelerometer. Gut microbiota was profiled using shotgun metagenomics of faecal samples. We applied multivariable regression models, adjusting for sociodemographic, lifestyle, and technical covariates, and accounted for multiple testing.FINDINGS: Overall, associations between time in SED and microbiota species abundance were in opposite direction to those for MPA or VPA. For example, MPA was associated with lower, while SED with higher abundance of Escherichia coli. MPA and VPA were associated with higher abundance of the butyrate-producers Faecalibacterium prausnitzii and Roseburia spp. We observed discrepancies between specific VPA and MPA associations, such as a positive association between MPA and Prevotella copri, while no association was detected for VPA. Additionally, SED, MPA and VPA were associated with the functional potential of the microbiome. For instance, MPA was associated with higher capacity for acetate synthesis and SED with lower carbohydrate degradation capacity.INTERPRETATION: Our findings suggest that sedentary and physical activity are associated with a similar set of gut microbiota species but in opposite directions. Furthermore, the intensity of physical activity may have specific effects on certain gut microbiota species.FUNDING: European Research Council, Swedish Heart-Lung Foundation, Swedish Research Council, Knut and Alice Wallenberg Foundation.
26.	Berin, Emilia, et al. (författare) Contraceptive knowledge and attitudes among women seeking induced abortion in Kathmandu, Nepal 2014 Ingår i: International Journal of Women's Health. - : Dove Medical Press. - 1179-1411. ; 6:1, s. 335-341 Tidskriftsartikel (refereegranskat)abstract Objective: To map the knowledge about and attitudes toward birth control methods among women in Kathmandu, Nepal, and to compare the results between women seeking an induced abortion and a control group. Method: This was a cross-sectional cohort study with matched controls. Women aged 15-49 years seeking medical care at the Department of Gynecology and Obstetrics at Kathmandu Medical College were included and interviewed. A case was defined as a woman who sought an elective medical or surgical abortion. A control was defined as a woman who sought medical care at the outpatient department or had already been admitted to the ward for reasons other than elective abortion. A questionnaire developed for the study - dealing with different demographic characteristics as well as knowledge about and attitudes toward contraceptives - was filled out based on the interview. Results: A total of 153 women were included: 64 women seeking an abortion and 89 controls. Women seeking an abortion had been pregnant more times than the control group and were more likely to have been informed about contraceptives. Women with higher education were less likely to seek an abortion than women with lower education. There was no significant difference in knowledge about and attitudes toward contraceptives between cases and controls. The women considered highest possible effectiveness to be the most important feature when deciding on a birth control method. Conclusion: Women seeking abortion in Kathmandu had shorter education and a history of more pregnancies and deliveries than women in the control group. Education and counseling on sex and reproduction as well as on contraceptive methods probably need to be improved in Nepal to avoid unwanted pregnancies. Attitudes about contraceptives need to be further investigated to develop better and more effective methods to educate women about family planning in order to increase reproductive health. © 2014 Berin et al.
27.	Berin, Emilia, et al. (författare) Effects of resistance training on quality of life in postmenopausal women with vasomotor symptoms 2022 Ingår i: Climacteric. - : Taylor & Francis Ltd. - 1369-7137 .- 1473-0804. ; 25:3, s. 264-270 Tidskriftsartikel (refereegranskat)abstract Objective Most women experience vasomotor symptoms (VMS) around menopause that may affect quality of life negatively. Effective pharmacological treatment exists but is not recommended for all women, and there is a demand for alternatives to reduce symptoms and improve quality of life. The objective of this study was to investigate the effect of a resistance training intervention on health-related quality of life (HRQoL) in postmenopausal women with VMS. Methods This open randomized controlled trial included 65 postmenopausal women >45 years old with daily VMS. The participants were randomized to 15 weeks of resistance training three times per week or an untreated control group. The Womens Health Questionnaire (WHQ) and Short Form Health Survey (SF-36) were used to assess HRQoL at baseline and after 15 weeks. Results The resistance training group improved compared to the control group in the WHQ domains of VMS (p = 0.002), sleep problems (p = 0.003) and menstrual symptoms (p = 0.01) from baseline to post intervention. No significant between-group differences were found in SF-36 summary scores, or in any of the domains. Conclusion In postmenopausal women with moderate to severe VMS, resistance training three times per week for 15 weeks improved menopause-specific HRQoL.
28.	Berin, Emilia, et al. (författare) Postmenopausal womens experiences of a resistance training intervention against vasomotor symptoms : a qualitative study 2022 Ingår i: BMC Women's Health. - : BMC. - 1472-6874. ; 22:1 Tidskriftsartikel (refereegranskat)abstract Introduction: Resistance training may be an effective intervention to improve menopausal symptoms and increase womens quality of life. However, most postmenopausal women do not perform regular resistance training. The purpose of this study was to explore postmenopausal womens experiences of participation in a resistance-training intervention to find barriers and motivators for the training. Methods: Fifteen postmenopausal women with low physical activity, who participated in a randomized controlled trial evaluating the effect of a resistance-training program on vasomotor symptoms and health-related outcomes, were consecutively recruited to this qualitative study. After completion of the 15-week resistance-training program, they took part in individual semi-structured interviews, followed by a telephone interview 1 year later. All interviews were transcribed verbatim and thematic analysis was used to analyse the data. Results: The analysis generated three themes that were involved at different time points. These were: "Trigger-Hopes of symptom relief", "An evolving motivation as a driving force for change" and "Finding new triggers". Accountability, and continuous professional and emotional support, were factors that fueled the womens motivation to perform regular resistance training during the study. Resistance training improved general well-being and most women experienced improvement in vasomotor symptoms. The womens motivation changed from being driven by a wish to improve bothersome symptoms, into a wish to achieve feelings of well-being and enjoyment. The change was seen regardless of effects of the intervention on vasomotor symptoms. Conclusion: This first qualitative evaluation of physical exercise as an intervention to treat vasomotor symptoms in postmenopausal women, found that the symptoms acted as a motivational trigger to initiate resistance training in low-active women. The motivation to exercise changed during the intervention from a wish to ameliorate symptoms into something the women did for enjoyment and well-being in general. This change in motivating factors may have contributed to a behavior change since all participants had increased their physical activity after 1 year regardless of effects on VMS.
29.	Berin, Emilia, 1992- (författare) Resistance Training and Physical Activity in Postmenopausal Women : Effects on Vasomotor Symptoms, Quality of Life and Microcirculation 2023 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Background Menopause is a physiological event, but is associated with bothersome symptoms as well as physical changes that affect women’s health. About 75 % of women experience vasomotor symptoms (hot flushes and night sweats) related to menopause that often reduce quality of life. The vasomotor symptoms may be attributed to dysfunctional temperature regulation centrally in the hypothalamus and peripherally in the skin’s circulation. The most effective treatment for vasomotor symptoms is menopausal hormone therapy, but not all women are able to, or want to, use it. In addition to the impact on quality of life, studies have associated vasomotor symptoms and menopause with macrovascular endothelial dysfunction. Previous studies on the association of these factors with the skin’s microcirculatory function are small and few. Observational studies have associated physical activity and exercise with less vasomotor symptoms, but the evidence from intervention trials is of low quality and the results are ambiguous. Physical activity has established general health effects, and could potentially decrease vasomotor symptoms by effects on endogenous opioids centrally, and by more efficient thermoregulation peripherally. The aim of this thesis was to investigate the effect of resistance training on vasomotor symptoms and health-related quality of life in postmenopausal women, and to explore the women’s experiences of the training to find barriers and facilitators. We also aimed to investigate whether the skin’s microcirculatory function differed between women regarding menopausal status, vasomotor symptoms, menopausal hormone therapy, and physical activity. Material and methods The first study was an open randomized controlled trial including 65 postmenopausal women with moderate to severe vasomotor symptoms and low physical activity levels. We randomized the women to 15 weeks of resistance training (intervention) or unchanged physical activity (control). The participants registered vasomotor symptoms daily in a diary, and answered health-related quality of life questionnaires at baseline and at 15 weeks. The first 15 women to finish the intervention were recruited to a qualitative study. The women’s experiences of the resistance training intervention were explored in individual interviews after the intervention period, and all were followed-up with telephone interviews after one year. The third study was cross-sectional, including 1148 women from Linköping, 50-64 years old, who participated in the Swedish CArdioPulmonary bioImage Study (SCAPIS). These women answered a questionnaire about menopausal status, vasomotor symptoms and menopausal hormone therapy use, and wore accelerometers for seven days to assess physical activity. The skin’s microcirculation was assessed at rest and during post-occlusive reactive hyperemia. Results Moderate to severe vasomotor symptoms per 24 hours decreased significantly more in the group of women randomized to resistance training compared with the control group (mean difference -2.7, 95% CI -4.2 to -1.3). The resistance training group improved in domains of menopause-specific health-related quality of life compared with the control group but there was little impact on generic health-related quality of life. In the qualitative study we found that the vasomotor symptoms acted as a “trigger” for the women to become motivated to exercise. Their motivation then evolved from being driven by hopes of symptom relief into being driven by a wish for general well-being, which was still a driving force after one year. Microvascular function did not differ between postmenopausal and premenopausal women, or between women with or without vasomotor symptoms or menopausal hormone therapy. Women with higher levels of objectively measured and self-reported physical activity had a better reactivity of the skin’s microcirculation. The differences remained significant after adjusting for BMI, smoking, hypertension, diabetes, and education. Conclusions Resistance training could be effective for decreasing vasomotor symptoms and improving some aspects of health-related quality of life in motivated postmenopausal women. The vasomotor symptoms themselves spurred motivation to exercise, indicating they present an opportunity to increase physical activity. When a woman seeks medical advice for vasomotor symptoms, this could be a chance for health care professionals to help her initiate or increase exercise. Women who performed more physical activity and exercise had better skin microvascular function, but no association with VMS was found. Future studies are needed to investigate what type and dose of exercise is the most effective to reduce vasomotor symptoms and whether there is a way to predict for whom exercise will or will not be an effective intervention.
30.	Berin, Emilia, et al. (författare) Resistance training for hot flushes in postmenopausal women: A randomised controlled trial 2019 Ingår i: Maturitas. - : ELSEVIER IRELAND LTD. - 0378-5122 .- 1873-4111. ; 126, s. 55-60 Tidskriftsartikel (refereegranskat)abstract Objectives: To investigate the effect of 15 weeks of resistance training on the frequency of moderate to severe hot flushes in postmenopausal women. Study design: Postmenopausal women with at least 4 moderate or severe hot flushes or night sweats per day day were randomized to a 15-week resistance training intervention or unchanged physical activity. Participants did not exercise regularly at baseline and had not used any therapy for hot flushes two months prior to study entry. The resistance training was performed three times per week and the program contained 8 exercises performed with 8-12 repetitions in 2 sets. Loads were set individually from eight-repetition maximum-strength tests and increased progressively. Main outcome measures: The primary outcome was change in mean moderate or severe hot flushes per day from baseline to week 15, assessed with symptom diaries. Secondary outcomes included change in hot flush score and time spent on physical activity. Results: Between November 19, 2013, and October 26, 2016, 65 women were enrolled; 58 completed the trial and were included in the analyses. The mean age was 55 and the mean number of moderate or severe hot flushes per day at baseline was 7.1; there were no baseline differences between groups. The frequency of hot flushes decreased more in the intervention group than in the control group (mean difference -2.7, 95% CI -4.2 to -1.3). The mean percentage change was -43.6% (-56.0 to -31.3) in the intervention group and -2.0% (16.4-12.4) in the control group. Conclusion: A 15-week resistance-training program decreased the frequency of moderate and severe hot flushes among postmenopausal women and could be an effective and safe treatment option to alleviate vasomotor symptoms.
31.	Berin, Emilia, et al. (författare) Resistance training for hot flushes in postmenopausal women: Randomized controlled trial protocol 2016 Ingår i: Maturitas. - : ELSEVIER IRELAND LTD. - 0378-5122 .- 1873-4111. ; 85, s. 96-103 Tidskriftsartikel (refereegranskat)abstract Objectives: Hot flushes and night sweats affect 75% of all women after menopause and is a common reason for decreased quality of life in mid-aged women. Hormone therapy is effective in ameliorating symptoms but cannot be used by all women due to contraindications and side effects. Engagement in regular exercise is associated with fewer hot flushes in observational studies, but aerobic exercise has not proven effective in randomized controlled trials. It remains to be determined whether resistance training is effective in reducing hot flushes and improves quality of life in symptomatic postmenopausal women. The aim of this study is to investigate the effect of standardized resistance training on hot flushes and other health parameters in postmenopausal women. Study design: This is an open, parallel-group, randomized controlled intervention study conducted in Linkoping, Sweden. Sixty symptomatic and sedentary postmenopausal women with a mean of at least four moderate to severe hot flushes per day or 28 per week will be randomized to an exercise intervention or unchanged physical activity (control group). The intervention consists of 15 weeks of standardized resistance training performed three times a week under supervision of a physiotherapist. Main outcome measures: The primary outcome is hot flush frequency assessed by self-reported hot flush diaries, and the difference in change from baseline to week 15 will be compared between the intervention group and the control group. Conclusion: The intention is that this trial will contribute to the evidence base regarding effective treatment for hot flushes. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
32.	Berlin, Gösta, et al. (författare) Effects of age, gender and menstrual cycle on platelet function assessed by impedance aggregometry 2019 Ingår i: Platelets. - : TAYLOR & FRANCIS INC. - 0953-7104 .- 1369-1635. ; 30:4, s. 473-479 Tidskriftsartikel (refereegranskat)abstract Platelets are needed to prevent or arrest bleeding and aggregate at the site of injury upon vascular damage. Platelets express receptors for estrogens which might affect the function of the platelets and their hemostatic ability. The aim was to identify possible differences in platelet function related to age, gender, and phases of the menstrual cycle by use of impedance aggregometry with Multiplate. In the first part of the study, platelet function was assessed in 60 healthy individuals (30 men and 30 women) in each of three age groups (20-25, 40-45, and 60-65 years). In the second part of the study, the platelet function was analyzed on four occasions during the menstrual cycle in women without oral contraceptives (OCs) (n = 17) and compared to 19 women on OCs and 18 men of similar age (20-40 years). For the women on OCs, aggregation was analyzed once during the tablet-free week and once late during the period with OCs. The men were sampled once. Women of younger age (amp;lt;45 years) had significantly higher agonist-induced aggregation response than both men and post-menopausal women (60-65 years). The agonist-induced aggregation response did not differ between phases of the menstrual cycle or OC use. The results suggest that estradiol and/or progesterone affect spontaneous aggregation since it was found to be lowest in the mid-luteal phase. Spontaneous aggregation was significantly lower in women on OCs than in both men and women without OCs. Our findings indicate that fertile age is associated with higher aggregation response capacity of the platelets, possibly to prevent excessive bleeding during menstruation, but this response capacity is not altered during the menstrual cycle or by use of OCs.
33.	Berlin, Gösta, et al. (författare) Östergötland satsar på klinisk forskning 2011 Ingår i: Läkartidningen. - Stockhom : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 108:3, s. 81-84 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Flera rapporter har visat att svensk klinisk forskning under senare år har tappat mark i förhållande till omvärlden.Inom Östergötland har landstinget och den medicinska fakulteten vid Linköpings universitet (Hälsouniversitet) tagit gemensamma initiativ för att ge bättre förutsättningar för klinisk forskning kombinerat med sjukvårdsarbete. Åtgärdsplanen »FoU i befattningsutvecklingen« slår fast sjukvårdens uppdrag och roll inom klinisk forskning. Årliga FoU-bokslut görs för sjukvårdsenheterna. Projektet »Från student till docent« syftar till att rekrytera studenter från de olika utbildningarna i vård och medicin till forskning redan under studietiden och därefter ge möjligheter att bedriva forskarutbildning och fortsatt forskning kombinerat med klinisk karriär. Tidsbegränsade forskningsbefattningar inom sjukvården har inrättats för medarbetare med legitimationsyrken. Infrastrukturen kring klinisk forskning med olika typer av kompetensstöd för den enskilda forskaren har stärkts.
34.	Birch Tyrberg, Rasmus, et al. (författare) Students’ and teachers’ attitudes towards PBL-curriculum components in a medical programme : a follow-up study 2021 Ingår i: MedEdPublish. - : Association for Medical Education in Europe. - 2312-7996. ; 10:1 Tidskriftsartikel (refereegranskat)abstract Objective: The aim was to explore students' and teachers' attitudes towards horizontal and vertical integration and other components of the curriculum, and to compare these results with data from a study at our medical school published in 2002.Methods: A questionnaire with 17 questions regarding different components of our curriculum was sent to students and staff at our medical school. They were asked to rate the importance of different components on a Likert scale from 1-6. We compared the answers between the two groups, and also compared them with the results from 2002.Results: Horizontal and vertical integration were rated as very important components (Teachers (n=283) median 5 and 5, Students (n=596) 6 and 5 respectively). Students valued lectures and clinical rotations more highly than teachers. Teachers considered laboratory training, training in searching scientific literature, scientific projects, basic education in ethics, reading and discussion of fictional literature, interprofessional components and examinations as significantly more important than the students did.Conclusions: Attitudes have remained positive towards horizontal and vertical integration despite major changes in the curriculum. The majority of the components of our curriculum were well appreciated, indicating that our curriculum is robust, but some components warrant inspection and possible revision.
35.	Borud, Einar Kristian, et al. (författare) The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial 2009 Ingår i: MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY. - : Ovid Technologies (Wolters Kluwer Health). - 1072-3714. ; 16:3, s. 484-493 Tidskriftsartikel (refereegranskat)abstract Objective: This study compared the effectiveness of individualized acupuncture plus self-care versus self-care alone on hot flashes and health-related quality of life in postmenopausal women. Methods: This study involved a multicenter, pragmatic, randomized, controlled trial with two parallel arms. Participants were postmenopausal women experiencing, on average, seven or more hot flashes per 24 hours during seven consecutive days. The acupuncture group received 10 acupuncture treatment sessions and advice on self-care, and the control group received advice on self-care only. The frequency and severity (0-10 scale) of hot flashes were registered in a diary. Urine excretion of calcitonin gene-related peptide was assessed at baseline and after 12 weeks. The primary endpoint was change in mean hot flash frequency from baseline to 12 weeks. The secondary endpoint was change in health-related quality of life measured by the Womens Health Questionnaire. Results: Hot flash frequency decreased by 5.8 per 24 hours in the acupuncture group (n = 134) and 3.7 per 24 hours in the control group (n = 133), a difference of 2.1 (P < 0.001). Hot flash intensity decreased by 3.2 units in the acupuncture group and 1.8 units in the control group, a difference of 1.4 (P < 0.001). The acupuncture group experienced statistically significant improvements in the vasomotor, sleep, and somatic symptoms dimensions of the Womens Health Questionnaire compared with the control group. Urine calcitonin gene-related peptide excretion remained unchanged from baseline to week 12. Conclusions: Acupuncture plus self-care can contribute to a clinically relevant reduction in hot flashes and increased health-related quality of life in postmenopausal women.
36.	Boström, Gunilla, et al. (författare) Alla läkare - inte bara cheferna - behöver utbildning i ledarskap. 2000 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 97, s. 1703-1710 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
37.	Brynhildsen, Jan, 1962-, et al. (författare) Attitudes among students and teachers on vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum 2002 Ingår i: Medical teacher. - : Informa UK Limited. - 0142-159X .- 1466-187X. ; 24:3, s. 286-288 Tidskriftsartikel (refereegranskat)abstract Important elements in the curriculum at the Faculty of Health Sciences in Link÷ping are vertical integration, i.e. integration between the clinical and basic science sections of the curriculum, and horizontal integration between different subject areas. Integration throughout the whole curriculum is time-consuming for both teachers and students and hard work is required for planning, organization and execution. The aim was to assess the importance of vertical and horizontal integration in an undergraduate medical curriculum, according to opinions among students and teachers. In a questionnaire 102 faculty teachers and 106 students were asked about the importance of 14 different components of the undergraduate medical curriculum including vertical and horizontal integration. They were asked to assign between one and six points to each component (6 points = extremely important for the quality of the curriculum, 1 point = unimportant). Students as well as teachers appreciated highly both forms of integration. Students scored horizontal integration slightly but significantly higher than the teachers (median 6 vs 5 points, p=0.009, Mann-Whitney U-test), whereas teachers scored vertical integration higher than students (6 vs 5, p=0.019, Mann-Whitney U-test). Both students and teachers considered horizontal and vertical integration to be highly important components of the undergraduate medical programme. We believe both kinds of integration support problem-based learning and stimulate deep and lifelong learning and suggest that integration should always be considered deeply when a new curriculum is planned for undergraduate medical education.
38.	Brynhildsen, Jan, 1962-, et al. (författare) Follow-Up of Patients With Low Back Pain During Pregnancy 1998 Ingår i: Obstetrics and Gynecology. - : American College of Obstetricians and Gynecologists (ACOG). - 0029-7844 .- 1873-233X. ; 91:2, s. 182-186 Tidskriftsartikel (refereegranskat)abstract Objective: To identify the long-term risk for low back pain among women with previous severe low back pain during pregnancy.Methods: In a previous prospective study, 79 pregnant women developed low back pain severe enough to require sick leave. Twelve years later a questionnaire was sent to 62 of these women and 84 controls who did not develop severe low back pain during pregnancy. The questionnaire asked about occupation, low back pain in general and during later pregnancies, and sick leave due to low back pain. There were also questions regarding use of oral contraceptives and its possible relation to low back pain.Results: The response rate was 84% in the back pain group and 80% among controls. The two groups were similar according to the percentage of women having had another pregnancy (33 of 52 [63%] versus 39 of 67 [58%]) but ten (19%) of the women with previous low back pain stated they had refrained from another pregnancy because of their fear of low back pain compared with only one control. Almost all women (31 of 33) with previous severe low back pain experienced the same symptoms in a subsequent pregnancy, compared with 17 of 39 (44%) controls. Even when they were not pregnant, women with previous low back pain suffered more often and used more sick leave due to low back pain (44 of 52 versus 43 of 67, chi(2) = 5.68, P < .05). The location (sacroiliac joint or lumbar affection) of the previous low back pain did not affect the long-term prognosis. In a logistic regression model, previous low back pain during pregnancy was the only independent risk factor for low back pain during a subsequent pregnancy, whereas an occupation involving physical demand did not affect the results. However, together with previous low back pain during pregnancy, heavy occupation increased the risk for current nonpregnant low back pain.Conclusion: Women with severe low back pain during pregnancy have an extremely high risk for experiencing a new episode of severe low back pain during another pregnancy and when not pregnant.
39.	Brynhildsen, Jan, 1962-, et al. (författare) Is Hormone Replacement Therapy a Risk Factor for Low Back Pain Among Postmenopausal Women? 1998 Ingår i: Spine. - : Wolters Kluwer. - 0362-2436 .- 1528-1159. ; 23:7, s. 809-813 Tidskriftsartikel (refereegranskat)abstract Study Design: Cross-sectional study with two age cohorts.Objective: To assess whether women receiving hormone replacement therapy after menopause have a higher prevalence of back problems than women who do not receive such treatment.Background: Back pain is a common medical problem: throughout life and especially during pregnancy. Hormonal factors have been proposed as a possible contributor.Patients and Methods: A validated postal questionnaire was sent in early 1995 to all 1324 women of 55 years and 56 years of age residing in Linkoping, Sweden. This questionnaire included questions about current rent hormone replacement treatment, previous and current back problems, medical care for back problems, parity, exercise and smoking habits, and occupation.Results: The questionnaire was returned by 84.7% of the women. There was a significant, albeit weak, positive association between current use of hormone replacement treatment and low back pain. Previous back problems during pregnancy was a strong risk factor for current back pain, whereas neither current smoking nor regular physical exercise was a risk factor according to multiple logistic regression analysis. The interaction of smoking and an occupation involving heavy lifting significantly affected back pain.Conclusions: Women receiving hormone replacement treatment had a slightly, but significantly, higher prevalence of current back pain than nonusers (48% vs. 42%, respectively, P < 0.05), which could not be explained by differences in occupation, smoking habits, or current physical activity. Although the association be-tween hormone replacement therapy and back problems is weak and probably of minor clinical importance, it is speculated that hormonal effects on joints and ligaments may be involved.
40.	Brynhildsen, Jan, 1962-, et al. (författare) Lipids and clotting factors during low dose transdermal estradiol/norethisterone use 2005 Ingår i: Maturitas. - : Elsevier. - 0378-5122 .- 1873-4111. ; 50:4, s. 344-352 Tidskriftsartikel (refereegranskat)abstract Objective: To demonstrate the effects of 2-year transdermal continuous combined low-dose estradiol (0.025 mg/day) and norethisterone acetate (0.125 mg/day) on lipid/lipoprotein profile and coagulation/fibrinolysis.Methods: A double-blind, randomized, multicenter, parallel, 1-year trial enrolled 266 healthy women at least 2 years post menopause. Patients received either 0.025 mg estradiol and 0.125 mg norethisterone acetate daily or placebo transdermally. One hundred and thirty five women completed a second year open follow-up (96 had used Estragest TTS, 39 placebo during the first year), where all women had the estradiol/norethisterone patch. Lipid/lipoprotein profile and coagulation/fibrinolysis parameters were studied at 0, 24, 48, 72 and 96 weeks.Results: In women on estradiol/norethisterone total cholesterol, Lp(a) and VLDL cholesterol decreased significantly more than in the placebo group after 24 weeks and LDL cholesterol after 48 weeks. Women on estradiol/norethisterone had no change in HDL, triglycerides or Lp(a), an increased HDL/total cholestrol ratio and decreased LDL, VLDL and total cholesterol at 48 weeks compared to placebo. Women with active treatment also showed a significant reduction compared with the placebo group of Factor VII and antithrombin III at 24 and 48 weeks and a reduction of fibrinogen at 24 weeks. These changes persisted over the second year.Conclusions: A continuous combined low-dose transdermal patch daily delivering 0.025 mg estradiol and 0.125 mg norethisterone acetate provided beneficial effects on lipid/lipoprotein profile and coagulation/fibrinolysis. The changes were similar to those previously described after higher dose oral and transdermal estrogen/progestogen regimens. (c) 2004 Elsevier Ireland Ltd. All rights reserved.
41.	Brynhildsen, Jan, 1962-, et al. (författare) Low dose transdermal estradiol/norethisterone acetate treatment over 2 years does not cause endometrial proliferation in postmenopausal women 2002 Ingår i: Menopause. - : Raven Press. - 1072-3714 .- 1530-0374. ; 9:2, s. 137-144 Tidskriftsartikel (refereegranskat)abstract Objective: We investigated the effects of 2-year transdermal continuous combined estradiol (0.025 mg/day) and norethisterone acetate (0.125 mg/day) (Estragest TTS) on bleeding and on the endometrium. Design: This double-blind, randomized, multicenter, parallel, 1-year trial enrolled 266 healthy women at least 2 years past menopause with intact uteri. Patients received a transdermal patch delivering either 0.025 mg estradiol and 0.125 mg norethisterone acetate daily or placebo. Of the 266 women initially included, 135 (96 Estragest TTS, 39 placebo) completed a second year open follow-up, where all women had the estradiol/norethisterone patch. Endometrial biopsies were performed at weeks 0, 48 (n = 171), and 96 (n =109). Effects on endometrial morphology and uterine bleeding were studied. Results: The overall incidence of endometrial hyperplasia after treatment with the estradiol/norethisterone acetate patch for one year was 0.8% with only one case of atypical hyperplasia. There were no clinically significant changes in endometrial thickness in either treatment group. The proportion of bleed-free patients with the estradiol/norethisterone acetate transdermal system increased from 55% in cycles 1-3 to 83% in cycles 10-12. By the 12th cycle, 92% of patients receiving estradiol/norethisterone acetate patches were bleed-free. No additional hyperplasia was seen during the second year follow-up. Conclusions: A continuous combined transdermal patch delivering 0.025 mg estradiol/day and 0.125 mg norethisterone acetate/day provided good endometrial protection. The dose maintained a consistently high rate of amenorrhea in postmenopausal women.
42.	Brynhildsen, Jan, 1962-, et al. (författare) Motion motverkar menopausens minus. Gynnsamma effekter på både kropp och själ : [Exercise counteracts the negative effects of menopause. Positive effects on both body and soul] 1994 Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 91:23, s. 2323-2325 Tidskriftsartikel (refereegranskat)
43.	Brynhildsen, Jan, 1962-, et al. (författare) Oral contraceptive use among female elite athletes and age-matched controls and its relation to low back pain 1997 Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 76:9, s. 873-878 Tidskriftsartikel (refereegranskat)abstract Background: Exogenous and endogenous female sex steroids may influence the risk of low back pain. The fact that back pain is a very common symptom during pregnancy supports this theory. Back pain is also more common among female than male athletes. Oral contraceptives have been suggested to increase the risk of low back pain.Objective: To evaluate whether the prevalence of low back pain is higher among oral contraceptive users than non-users and if it differs between women taking part in different sports.Methods: A questionnaire was sent to female elite athletes in volleyball (n=205), basketball (n=150), and soccer (n=361) as well as to age-matched controls (n=113). The questionnaire comprised questions about age, constitution, occupation, parity and use of contraceptive method as well as previous and current back pain and possible consequences of the back problems.Results: The response rate was 85%. Between 42% and 52% of the women in the different groups used oral contraceptives. The groups were similar in most background variables, except that the volleyball and basketball players were taller. The prevalence of current low back pain was between 21% and 34% in the different athlete groups with an average of 30%, whereas only 18% of the controls suffered from low back pain (p<0.01). The prevalence of low back pain within each group, athletes as well as controls, was similar in women who used, and did not use oral contraceptives.Conclusions: This study does not support the theory that low back pain is affected by the use of oral contraceptives. Instead, constitutional factors and mechanical stress during intense physical activity is probably more important.
44.	Brynhildsen, Jan, 1962-, et al. (författare) Oral contraceptives and low back pain: Attitudes among physicians, midwives and physiotherapists 1995 Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 74:9, s. 714-717 Tidskriftsartikel (refereegranskat)abstract Background: Only few indications have appeared in the literature concerning a possible relationship between the use of oral contraceptives and low back pain. In our,daily work we often meet women who have been recommended to abandon their use of oral contraceptives depending on coexisting low back pain. In order to assess the opinions of a possible relationship between oral contraceptives and low back pain this study was undertaken.Methods: A validated questionnaire was sent out to physicians, physiotherapists and midwives dealing with either contraceptive counselling or low back pain. A modified questionnaire was sent to medical- and physiotherapist students to assess whether the opinions were a result of the education or the working experience.Results: A total of 225 questionnaires were sent out and 206 (91%) were returned. Sixteen percent thought there was a relationship between the use of oral contraceptives and risk of low back pain. Thirty percent had seen patients with low back pain that was interpreted as being affected by use of oral contraceptives. Twenty-five percent recommended at least some patients with low back pain to change their contraceptive method. Among the students there was a difference in opinion between the first and the last year students indicating that their opinions had been influenced by their education.Conclusions: Evidently many professionals dealing with oral contraceptives and low back pain believe that there is a relationship between oral contraceptives and low back pain, despite the lack of scientific evidence. These recommendations might influence the contraceptive safety for the individual woman and the possible relationship between use of oral contraceptives and low back pain should therefore be more thoroughly investigated before general recommendations are given.
45.	Collste, L, et al. (författare) Gör administrativ medicin till läroämne för läkarkåren! 1999 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 96, s. 1809-1810 Tidskriftsartikel (populärvet., debatt m.m.)
46.	Crafoord, Kristina, 1950- (författare) Genital prolapse surgery : A study of methods, clinical outcome and impact of pelvic floor muscle function 2009 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Objective: To evaluate whether a shift in the extent of genital prolapse surgery occurred between 1983 and 1993. If such a shift occurred, the need for subsequent prolapse surgery; the prevalence of symptoms of pelvic floor dysfunction (PFD) in women six years after vaginal prolapse surgery. And also to analyze predictive factors and the subjective and objective outcomes of prolapse surgery at long term follow up. To evaluate whether neurophysiologic findings of the pelvic floor muscles and anorectal manometry measurements respectively are associated with pre- and postoperative symptoms and the extent of prolapse.Methods/material: A retrospective study of 542 consecutive patients, operated on for genital prolapse, with primary surgery during 1983 and 1993 in three Swedish hospitals was conducted. Data were obtained from the patient records and were analyzed with emphasis on demographic, clinical and surgical data. A postal questionnaire with validated questions concerning symptoms of PFD was in 1999 sent to women operated in 1993 for primary POP and no subsequent POP surgery.A prospective study of 42 women with genital prolapse, stage 2-3, scheduled for vaginal prolapse surgery was carried out. Preoperatively the women were examined with anorectal manometry, pudendal nerve neurography and concentric needle electromyography of the pubococcygeus muscles and the external anal sphincter muscle. Posterior colporrhaphy was part of the prolapse surgery in all women. Anatomical and subjective outcomes were evaluated six years postoperatively.Results: A shift from complete to selective repairs was seen between the two time periods, and posterior repair was often omitted in the latter period. The prevalence of subsequent prolapse surgery increased in the 1990s and the increase was more common in women with a selective repair than in those with complete repair. At long term, PFD-symptoms commonly occurred and were found to be associated with the extent of the prolapse surgery. Symptoms of prolapse and bowel emptying improved significantly after POP surgery in the prospective study. The cure rates of rectocele and apical descent were high, but low concerning cystocele. The results of the neurophysiologic investigations and anal sphincter pressures showed associations with the symptoms and the extent of the prolapse; the individual characteristics showed no discriminatory values.Conclusion: The extent of the surgical prolapse procedures changed between the two study periods and the extent of subsequent surgery also was greater in the second period. Symptoms of PFD and recurrence of prolapse, especially of the anterior compartment, were frequently seen. Prolapse and bowel symptoms were associated with the function of pelvic floor muscles but neither the results of the neurophysiologic nor the anorectal manometry measurements of the pelvic floor muscles were found to predict anatomical or subjective outcomes of POP surgery. More knowledge is needed of the pathophysiology of PFD in order to develop better means of prevention and to optimize treatment of POP. Development of new methods for identifying all defects of the pelvic floor and surgical techniques for restitution is also warranted for improving outcome of surgical treatment of genital prolapse.
47.	Dahle, L. O., et al. (författare) Problem-based medical education : development of a theoretical foundation and a science-based professional attitude 1997 Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 31:6, s. 416-424 Tidskriftsartikel (refereegranskat)abstract Problem-based learning, combined with early patient contact, integration between different subject areas, elements of multiprofessional education, and special emphasis on the development of communications skills has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping. Critics have questioned the depth of the scientific and theoretical aspects of the curriculum. Through a series of specific measures in the organization of the curriculum and examinations, and due to the pedagogical principles involved per se, our claim is that students graduating at Linköping do possess the required theoretical knowledge and a scientific attitude to the practice of medicine, at least equivalent to that obtained in a more conventional medical curriculum. One such specific measure is that all students perform one field study and two scientific studies during the course of the curriculum. An investigation of student opinions regarding the value of performing scientific projects of their own have shown that these projects have had a positive impact on the students' general scientific attitude and their willingness to engage in future scientific work. The specific skills acquired, as confirmed by oral examinations, were largely determined by the scientific nature of the chosen field of study. Our graduates have not yet progressed far enough in their careers for comparisons to be made on the basis of the Swedish Licensing Board Internship Examinations, but continuing evaluations of students, graduates and licensed doctors emerging from the curriculum will provide future evi-dence as to whether our present evaluation is correct.
48.	Dahle, L. O., et al. (författare) Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum : examples and experiences from Linköping, Sweden 2002 Ingår i: Medical teacher. - : Taylor & Francis. - 0142-159X .- 1466-187X. ; 24:3, s. 280-285 Tidskriftsartikel (refereegranskat)abstract Problem-based learning (PBL), combined with early patient contact, multiprofessional education and emphasis on development of communications skills, has become the basis for the medical curriculum at the Faculty of Health Sciences in Link ping (FHS), Sweden, which was started in 1986. Important elements in the curriculum are vertical integration, i.e. integration between the clinical and basic science parts of the curriculum and horizontal integration between different subject areas. This article discusses the importance of vertical integration in an undergraduate medical curriculum, according to experiences from the Faculty of Health Sciences in Link ping, and also give examples on how it has been implemented during the latest 15 years. Results and views put forward in published articles concerning vertical integration within undergraduate medical education are discussed in relation to the experiences in Link ping. Vertical integration between basic sciences and clinical medicine in a PBL setting has been found to stimulate profound rather than superficial learning, and thereby stimulates better understanding of important biomedical principles. Integration probably leads to better retention of knowledge and the ability to apply basic science principles in the appropriate clinical context. Integration throughout the whole curriculum entails a lot of time and work in respect of planning, organization and execution. The teachers have to be deeply involved and enthusiastic and have to cooperate over departmental borders, which may produce positive spin-off effects in teaching and research but also conflicts that have to be resolved. The authors believe vertical integration supports PBL and stimulates deep and lifelong learning.
49.	Dahlgren, Lars Owe, et al. (författare) Biographical-Item: Nils-Holger Areskog IN MEMORIAM in JOURNAL OF INTERPROFESSIONAL CARE, vol 25, issue 2, pp 161-162 2011 Annan publikation (övrigt vetenskapligt/konstnärligt)abstract n/a
50.	Ekblad, S., et al. (författare) Disturbances in postural balance are common in postmenopausal women with vasomotor symptoms 2000 Ingår i: Climacteric. - : Informa UK Limited. - 1369-7137 .- 1473-0804. ; 3:3, s. 192-198 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: To establish the prevalence of unsteadiness and rotatory vertigo in peri- and postmenopausal women, and whether balance disturbances are more common in women with vasomotor symptoms and without hormone replacement therapy (HRT). METHOD: A validated questionnaire was sent to all 1523 women aged 54 or 55 years in Linköping, Sweden. RESULTS: Daily or weekly unsteadiness was reported by 5%, and daily or weekly rotatory vertigo by 4% of all women. The frequency of vasomotor symptoms correlated with reported unsteadiness (rs = 0.23, p < 0.001). Fourteen per cent of women with daily vasomotor symptoms reported weekly or daily unsteadiness, compared with 3% of those without vasomotor symptoms (odds ratio (OR) 7.58, 95% confidence interval (CI) 3.72-15.45). The frequency of vasomotor symptoms correlated with rotatory vertigo (rs = 0.19, p < 0.001). Ten per cent of women with daily vasomotor symptoms reported weekly or daily rotatory vertigo, compared with 2% of women without vasomotor symptoms (OR 5.21, 95% CI 1.07-25.52). No correlation was seen between vasomotor symptoms and falls. Users of HRT had the same prevalence of balance disturbances as non-users. CONCLUSIONS: Women with frequent vasomotor symptoms seem to run a greater risk of unsteadiness and rotatory vertigo than do women without symptoms. This association may not be explained by means of a cross-sectional study, but there might exist a causal connection between vasomotor symptoms and balance disturbances.

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