| 1. |
- Laukka, Erika J, 1986-, et al.
(författare)
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Olfactory impairment and domain‐specific cognitive decline : A 12‐year population‐based study
- 2023
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Ingår i: Alzheimer's & Dementia. - : John Wiley & Sons. - 1552-5260 .- 1552-5279. ; 19:S18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Olfactory impairment has been associated with both cognitive impairment and dementia and Alzheimer’s disease (AD). This study aimed to investigate the association between olfactory dysfunction (OD) and change trajectories in different cognitive domains in aging. Method: Participants (n = 2473, mean age = 72 years, 61% female) from the population-based Swedish National study on Aging and Care-Kungsholmen (SNAC-K) were repeatedly assessed with tasks measuring episodic memory, semantic memory, verbal fluency, and perceptual speed across 12 years. OD was measured at baseline and participants were categorized as normosmic, hyposmic, or anosmic based on the Sniffin’ Sticks odor identification task. Linear mixed-effects models were used to assess the associations between baseline OD and rates of cognitive decline. Result: OD was related to poorer baseline performance and faster rates of decline during follow-up in all examined domains, as well as in global cognition. Associations were generally more pronounced for anosmia compared to hyposmia. Conclusion: Olfactory impairment is associated with accelerated decline in aging across a wide range of cognitive domains.
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| 2. |
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| 3. |
- Adman, Per, et al.
(författare)
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171 forskare: ”Vi vuxna bör också klimatprotestera”
- 2019
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Ingår i: Dagens nyheter (DN debatt). - Stockholm. - 1101-2447.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- DN DEBATT 26/9. Vuxna bör följa uppmaningen från ungdomarna i Fridays for future-rörelsen och protestera eftersom det politiska ledarskapet är otillräckligt. Omfattande och långvariga påtryckningar från hela samhället behövs för att få de politiskt ansvariga att utöva det ledarskap som klimatkrisen kräver, skriver 171 forskare i samhällsvetenskap och humaniora.
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| 4. |
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| 5. |
- Granrud, Marie Dahlen, et al.
(författare)
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Health Care Personnel's Perspectives on Quality of Palliative Care During the COVID-19 Pandemic - A Cross-Sectional
- 2023
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Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press. - 1178-2390. ; 16, s. 2893-2903
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The provision of high-quality palliative care is challenging, especially during a pandemic like COVID-19. The latter entailed major consequences for health care systems and health care personnel (HCP) in both specialist and community health care services, in Norway and worldwide. The aim of this study was to explore how the HCP perceived the quality of palliative care in nursing homes, medical care units, and intensive care units during the COVID-19 pandemic. Methods: This study had a cross-sectional design. A total of 290 HCP from Norway participated in the study (RR = 25.8%) between October and December 2021. The questionnaire comprised items concerning respondents' demographics and quality of care, the latter measured by the short form of the Quality from the Patient's Perspective-Palliative Care instrument, adapted for HCP. The STROBE checklist was used. Results: This study shows that the HCP scored subjective importance as higher in all dimensions, items and single items than their perception of the actual care received. This could indicate a need for improvement in all areas. Information about medication, opportunity to participate in decisions about medical and nursing care and continuity regarding receiving help from the same physician and nurse are examples of areas for improvement. Conclusion: Study results indicate that HCP from nursing homes, medical care units, and intensive care units perceived that quality of palliative care provided was not in line with what they perceived to be important for the patient. This indicate that it was challenging to provide high-quality palliative care during the COVID-19 pandemic.
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| 6. |
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| 7. |
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| 8. |
- Tingvall, Claes, 1953, et al.
(författare)
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Saving lives beyond 2020: The next steps
- 2022
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Ingår i: The Vision Zero Handbook: Theory, Technology and Management for a Zero Casualty Policy. - Cham : Springer International Publishing. ; , s. 789-839
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Road safety analysis can be used to understand what has been successful in the past and what needs to be changed in order to be successful to reduce severe road trauma going forward and ultimately what's needed to achieve zero. This chapter covers some of the tools used to retrospectively evaluate real-life benefits of road safety measures and methods used to predict the combined effects of interventions in a road safety action plan as well as to estimate if they are sufficient to achieve targets near-term and long-term. Included are also a brief overview of methods to develop boundary conditions on what constitutes a Safe System for different road users. Further to that, the chapter lists some arguments for the need of high-quality mass and in-depth data to ensure confidence in the results and conclusions from road safety analysis. Finally, a few key messages are summarized.
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| 9. |
- Aili, Katarina, et al.
(författare)
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Sleep problems and fatigue as a predictor for the onset of chronic widespread painover a 5- and 18-year perspective : a 20-year prospective study
- 2018
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 77, s. 87-87
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Tidskriftsartikel (refereegranskat)abstract
- Background: If localised pain represent one end of a pain spectra, with overall better general health, chronic widespread pain (CWP) and fibromyalgia represent the other end of the spectra with worse general health and more comorbidities with other somatic diseases and mental illness. Sleep problems and fatigue are common among individuals reporting CWP and previous research indicate that sleep problems may be an important predictor for pain prognosis.Objectives: The aim of this population-based study was to investigate if sleep problems and fatigue predict the onset of CWP 5 and 18 years later.Methods: In order to get more stable baseline classifications of CWP, a wash-out period was used, including only individuals who had not reported CWP (according to ACR 1990 criteria for fibromyalgia) at baseline (−98) and three years prior baseline (−95). In all, data from 1249 individuals entered the analyses for the 5 year follow-up (−03) and 791 entered for the 18 year follow-up (−16). Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for CWP. Binary logistic regression analysis were used for analyses.Results: All investigated parameters predicted the onset of CWP five years later (problems with initiating sleep (OR 1.91; 1.16–3.14), maintaining sleep (OR 1.85; 1.14–3.01), early awakening (OR 2.0; 1.37–3.75), non-restorative sleep (OR 2.27; 1.37–3.75) and fatigue (OR 3.70; 1.76–7.84)) in a model adjusted for age, gender, socio-economy and mental health. All parameters except problems with early awakening predicted the onset of CWP also 18 years later. In all, 785 individuals did not report any of the sleeping problems at baseline (fatigue not included), 268 reported one of the problems, 167 two, 128 three and 117 subjects reported to have all four sleep problems. Reporting all four sleep problems was significantly associated with CWP at follow-up at both time points when adjusting for age, gender, socio economy and mental health (OR 4.00; 2.03–7.91 and OR 3.95; 1.90–8.20); adjusting for age, gender, socio economy and number of pain regions (OR 2.94; 1.48–5.82 and OR 2.65; 1.24–5.64) and in a model adjusting for age, gender, socio economy and pain severity (OR 2.97;1.53–5.76; and OR 3.02;1.47–6.21) for the 5 year and 18 year follow-up respectively, compared to not reporting any of the sleep problems at baseline.Conclusions: Both sleeping problems and fatigue predicts the onset of CWP 5- and 18 years later. The results highlight the importance of the assessment of sleep quality in the clinic.
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| 10. |
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| 11. |
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| 12. |
- Hultenheim Klintberg, Ingrid, 1959, et al.
(författare)
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Shall we use cryotherapy in the treatment in surgical procedures, in acute pain or injury, or in long term pain or dysfunction? - A systematic review
- 2021
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Ingår i: Journal of Bodywork and Movement Therapies. - : Elsevier BV. - 1360-8592. ; 27, s. 368-387
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This review aimed to evaluate the certainty of evidence for the use of cryotherapy in patients with musculoskeletal disorders. Methods: PubMed, Embase, Cochrane Library and AMED were searched from January 2000 to January 2018 (update June 2019) for systematic reviews (SRs) and randomized controlled trials (RCTs) reporting outcomes on pain, swelling, range of motion (ROM), function, blood loss, analgesic use, patient satisfaction and adverse advents. The papers were categorised into: surgical procedures, acute pain or injury and long-term pain or dysfunction. Methodological quality and risk of bias were assessed using the AMSTAR and the Swedish Health Technology Assessment instruments. Level of certainty of evidence was synthesized using GRADE. Study selection: Eight SRs and 50 RCTs from a total of 6027 ( thorn 839) were included. In total 34 studies evaluated cryotherapy in surgical procedures, twelve evaluated cryotherapy use in acute pain or injury and twelve studies evaluated cryotherapy in long-term pain and dysfunction. Results: The certainty of evidence is moderate (GRADE III) after surgical procedures to reduce pain, improve ROM, for patient satisfaction and few adverse events are reported. Cryotherapy in acute pain and injury or long-term pain and dysfunction show positive effects but have a higher number of outcomes with low certainty of evidence (GRADE II). Conclusion: Cryotherapy may safely be used in musculoskeletal injuries and dysfunctions. It is well tolerated by patients. More advanced forms of cryotherapy may accentuate the effect. Future research is needed where timing, temperature for cooling, dose (time) and frequency are evaluated. (C) 2021 Elsevier Ltd. All rights reserved.
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| 13. |
- Larsson, D. G. Joakim, 1969, et al.
(författare)
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Ethinyloestradiol – an undesired fish contraceptive?
- 1999
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Ingår i: Aquatic Toxicology. - 0166-445X .- 1879-1514. ; 45:2-3, s. 91-97
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Tidskriftsartikel (refereegranskat)abstract
- Environmental oestrogens are natural or synthetic substances present in the environment, which imitate the effects of endogenous oestrogen. Oestrogenic substances were identified by gas chromatography/mass spectrometry in effluent water from a Swedish sewage treatment works receiving mainly domestic wastewater. Substances found include the synthetic oestrogen used in contraceptives 17 alpha-ethinyloestradiol (4.5 ng l(-1)), the natural oestrogens oestrone (5.8 ng l(-1)) and 17 beta-oestradiol (1.1 ng l(-1)), and the weaker non-steroidal oestrogens 4-nonylphenol (840 ng l(-1)) and bisphenol A (490 ng l(-1)). Ethinyloestradiol exceeded levels shown to be oestrogenic to fish by 45 times. The oestrogenicity of the effluent water was investigated by introducing juvenile rainbow trout (Oncorhynchus mykiss) in cages downstream of the sewage treatment works. After 2 weeks, all oestrogens indicated were present in the bile of the fish, and the oestrogen inducible protein, vitellogenin, was found in large amounts in the plasma (1.5 mg ml(-1)), as determined by enzyme-linked immunosorbent assay and Western blotting. Thus, a widely used synthetic oestrogen affects the endocrine systems of fish exposed to sewage effluent water.
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| 14. |
- Larsson, Hanna, 1981-, et al.
(författare)
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Patients’ experiences regarding severe leg wound infection associated with coronary artery bypass grafting : A qualitative study
- 2023
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Ingår i: Journal of Vascular Nursing. - : Elsevier. - 1062-0303 .- 1532-6578. ; 41:1, s. 12-18
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionCoronary artery bypass grafting (CABG) is the most common cardiac surgery throughout the world. The most commonly used graft is the saphenous vein. Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2% to 20%. Surgical site infection can be long-lasting, and the wound healing can be difficult and also presumably troublesome for the patient. CABG patients’ experiences of severe infection in the harvesting site have not been studied before.Aim: The aim of this study was to describe patients’ experiences associated with acquiring a severe infection in the harvesting site after CABG.Method A qualitative study with descriptive design was conducted at the department of vascular and cardiothoracic surgery in a Swedish university hospital from May to December 2018. Patients diagnosed with a severe surgical site infection in the harvesting site following CABG were included. Data from 16 face-to-face interviews were analysed with inductive qualitative content analysis.Result The main category, varying impact on body and mind, was the core of the patients’ experiences of severe wound infection in the harvesting site after CABG. Two generic categories were identified: physical impact and thoughts about the complication. The patients described experiencing different degrees of pain, anxiety, and limitation in daily life.Conclusion These findings indicate that a severe infection in the harvesting site after CABG was experienced as an important issue with varying impact. Overall, the participants experienced pain, anxiety, and limitations in daily life. However, most of them were satisfied with the outcome after the wound had healed. Patients should be advised to seek care at an early stage if symptoms of infection occur. Improved individual pain management is needed for those with severe pain, and varied experiences imply a need for person-centred care.
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| 15. |
- Larsson, Hanna, 1981-, et al.
(författare)
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Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery : a national cross-sectional study in Sweden
- 2020
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Ingår i: Journal of Cardiothoracic Surgery. - : BioMed Central (BMC). - 1749-8090. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients' risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons.METHODS: A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden.RESULTS: Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, "no-touch" by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres.CONCLUSIONS: In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.
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| 16. |
- Larsson, Maria, et al.
(författare)
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Health Related Quality of Life in Advanced Non Small Cell Lung Cancer : Correlates and Comparisons to Normative Data
- 2012
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Ingår i: European Journal of Cancer Care. - : Hindawi Limited. - 0961-5423 .- 1365-2354. ; 21:5, s. 642-649
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to describe self-reported HRQoL in patients with advanced non small cell lung cancer (NSCLC) and to investigate the associations to stage of disease, age, gender, weight loss and performance status. Further, the study aimed to compare patients’ health related quality of life with that of the Swedish general population. Data on HRQoL were collected within a multi-centre randomised controlled trial. A total of 334 patients were included between 1998 and 2001. The EORTC QLQ-C30 and QLQ-LC13 were used to assess HRQoL. HRQoL data for comparison with the Swedish population were derived from a random sample of the Swedish population. Patients reported a markedly impaired HRQoL compared to the normal population. There were statistically and clinically significant differences with regard to almost all QLQ-C30 functional and symptom scales. Global Health Status, Physical Functioning, Role Functioning and Emotional Functioning were markedly deteriorated. The most prominent symptoms were Dyspnoea, Fatigue, Coughing, Insomnia, Appetite Loss and Pain. A low performance status, younger age, female gender and a more advanced disease were independently associated with a worse HRQoL. Additional studies are required to gain increased insight into this seriously ill group of patients and their need of supportive care.
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| 17. |
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| 18. |
- Malm, Karina, et al.
(författare)
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Discussions of lifestyle habits as an integral part of care management in patients with established rheumatoid arthritis
- 2018
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 77, s. 1817-1817
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Tidskriftsartikel (refereegranskat)abstract
- Background: Rheumatoid arthritis (RA) is associated with an increased risk of developing comorbidities which are known to be associated with lifestyle-related habits; such as having a sedentary lifestyle, having an unhealthy diet, smoking, and over-consumption of alcohol. In 2010, the European League Against Rheumatism (EULAR) published general guidelines on risk management in patients with RA, with an update 2017 (1,2) in which health professionals are encouraged to prioritize discussions with patients regarding their lifestyle and it is of interest to study the extent to which these discussions actually occur.Objectives: To study if lifestyle habits; physical activity, diet, smoking and alcohol had been discussed with patients having RA during health care visits.Methods: A cross-sectional postal survey in 2017 included 1542 eligible patients from the BARFOT (Better Anti-Rheumatic Pharmacotherapy) study. All patients received a questionnaire including lifestyle habits (physical activity, diet, smoking, and alcohol), and whether these habits had been discussed during health care visits. There was also a question regarding if they would have wanted such a discussion.Results: 1,061 patients (68%) responded to the survey (mean age 67 years (SD 13); 73% women). Physical activity was discussed with 49% of the patients (figure 1A). Those who reported that they were active on a health-enhancing level were more likely to have discussed physical activity with health professionals. Diet had been discussed with 23% of the patients (figure 1B). Patients who reported a non-traditional mixed diet were more likely to have discussed diet. Smoking was discussed with 25% of the patients (figure 1C). Current smokers had more often discussed smoking habits with healthcare professionals compared with never smokers (32% vs. 17%; p=0.000). Alcohol had been discussed with 17% of the patients (figure 1D). Of the patients with hazardous drinking habits, 77% had not had a discussion regarding alcohol.
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| 19. |
- Malm, Karina, et al.
(författare)
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Quality of Life in Patient with Established Rheumatoid Arthritis : A Qualitative Study
- 2016
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 75:Suppl 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fatigue, pain, stiffness and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) that may affect quality of life. Quality of life is an individual experience composed of a wide range of factors, including physical health, psychological state, level of independence, social relationships, and the patients' relationship to salient features of their environment. There is a need to describe and assess quality of life in chronic diseases like established RA. Previous research has mainly focused on disease-specific instruments for assessing quality of life. A deeper understanding of patients' experience of quality of life in established RA is important in both clinical research and daily clinical practice.Objectives: To describe variations in patients' experiences of quality of life in established RA.Methods: The study had a qualitative design with a phenomenographic approach, including 22 interviews with patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort, BARFOT, a long time follow up study of early RA. Patients were strategically selected by gender (14 women and 8 men), age (30 to 84 years old), disease duration (8–23 years), function as measured by HAQ (0–1.38), and quality of life as measured by EQ5D (0.52–1.00). The interviews were recorded, transcribed verbatim and coded into categories.Results: Four categories emerged from the patients' experiences of quality of life in established RA: well-being, freedom, empowerment, and participation. Quality of life as well-being meant pleasure and being physical active. Quality of life as freedom meant dependence or independence in the ability to manage daily life activities. Quality of life as empowerment meant different coping strategies, such as positive thinking and resources to manage fatigue, pain and physical function. Quality of life as participation meant togetherness in different contexts with other people.Conclusions: Quality of life in established RA could be understood by the patients in different ways. The patients experienced quality of life as well-being, freedom, empowerment, and participation. This is important knowledge when evaluating the concept of quality of life in RA research, and for health professionals when promoting quality of life in patients with RA.
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| 20. |
- Malm, Karina, et al.
(författare)
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THU0628-HPR Lifestyle Habits Relates to Quality of Life in Patient with Longstanding Rheumatoid Arthritis
- 2015
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 74:Suppl. 2, s. 1318-1318
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fatigue, pain, stiffness, impaired muscle function and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) and these may be related to lifestyle habits such as physical activity, diet, smoking and alcohol.There is limited knowledge about how patient with longstanding RA understand their lifestyles habits in relation to their disease and quality of life.Objectives: To describe experiences of how lifestyle habits relate to quality of life in patients with longstanding RA. Methods: A qualitative study with a deductive content analysis design, including 17 patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort. BARFOT is a long time follow up study of early RA. Informants were strategically selected by gender (ten women and seven men), age (range 30-84 years), disease duration (8-23 years), function as measured by HAQ, and quality of life as measured by EQ5D. Semi-structured interviews focused on four lifestyle habits (main categories); Physical activity, Diet, Smoking, and Alcohol. The interviews were recorded, transcribed verbatim and coded into subcategories within each of the four main categories.Results: In patients with longstanding RA quality of life was related to the four given main categories (lifestyle habits). Each main category included two to three subcategories; (1) Physical activity means barrier, opportunities and well-being, (2) Diet means shame, well-being and social relationship, (3) Smoking means reward and fear, and (4) Alcohol means ambivalence and social relationship.Conclusions: In longstanding RA, lifestyle habits relates to quality of life through both positive and negative experiences. This has to be taken into account in clinical care for a better understanding of how patients conceive and adherer to advice on lifestyle.References: Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.
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| 21. |
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| 22. |
- Petrov Fieril, Karolina, et al.
(författare)
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Experiences of exercise during pregnancy among women who perform regular resistance training: A qualitative study
- 2014
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 94:8, s. 1135-1143
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Tidskriftsartikel (refereegranskat)abstract
- Background. Women who are pregnant and healthy are recommended to do 30 minutes or more of light to moderate exercise a day on most, if not all, days of the week. However, only 1 of 6 pregnant women in the United States and northern Europe follows these recommendations. Little attention has been given to the experience of exercise in pregnancy. Objectives. The aim of the study was to describe experiences of exercise during pregnancy among women who performed regular resistance training. Design. This was a qualitative, inductive content analysis study. Methods. Seventeen pregnant women who exercised on a regular basis participated in individual semistructured, face-to-face interviews that were recorded, transcribed, coded, and condensed into subcategories and categories. Results. Four categories emerged (subcategories within parentheses): (1) positive impact on body and mind (reduced pregnancy-related problems, increased self-confidence and sense of control, immediate positive feedback, and effects on lifestyle and quality of life); (2) expected benefits and facilitators (knowledge of health benefits, part of one's lifestyle, preventing pregnancy-related problems, social support, staying in good shape, and healthy living with regard to the fetus); (3) new exercise barriers (physical limitations, taking care not to harm oneself or the fetus, uncertainty or lack of knowledge, sense of exclusion at the fitness center, lack of understanding on the part of others, and the pregnancy itself provided an easy excuse); and (4) overcoming exercise barriers (lowering the intensity of exercise, modifying the type of exercise, changing exercise goals, and being extra attentive during exercise). Conclusion. Pregnant women strived to exercise if the exercise facilitators outweighed the barriers. As the study described facilitators, barriers, and strategies for how to overcome exercise barriers, the results can be useful in exercise promotion in healthy pregnancy. © 2014 American Physical Therapy Association.
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| 23. |
- Rafsten, Lena, et al.
(författare)
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Gothenburg Very Early Supported Discharge study (GOTVED) : a randomised controlled trial investigating anxiety and overall disability in the first year after stroke
- 2019
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Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 19, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine.METHODS: A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients' degree of overall disability, measured by the modified Rankin Scale (mRS).RESULTS: No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke.CONCLUSIONS: The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit.TRIAL REGISTRATION: Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).
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| 24. |
- Stollenwerk, Maria M, 1959-, et al.
(författare)
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Very low-density lipoprotein induces interleukin-1beta expression in macrophages
- 2005
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Ingår i: Biochemical and Biophysical Research Communications - BBRC. - : Elsevier. - 0006-291X .- 1090-2104. ; 335:2, s. 603-608
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Tidskriftsartikel (refereegranskat)abstract
- Elevated plasma level of very low-density lipoprotein (VLDL) is a risk factor for coronary heart disease. We investigated the effect of VLDL on expression of the pro-inflammatory cytokine interleukin-1beta (IL-1beta) in human peripheral blood monocyte-derived macrophages. IL-1beta mRNA and protein expression was analysed by PCR and ELISA, respectively. Caspase activation was assessed by immunoblotting. Apart from potentiating lipopolysaccharide-induced secretion of IL-1beta, VLDL alone induced secretion of IL-1beta from human monocyte-derived macrophages. This effect was suppressed by an inhibitor of caspase-1, the protease which cleaves pro-IL-1beta. VLDL treatment activated caspase-1, as indicated by increased levels of the caspase-1 p20 subunit. Furthermore, VLDL increased IL-1beta mRNA expression, which was associated with activation of transcription factor AP-1. Inhibition of caspase-1 did not influence IL-1beta mRNA expression. In conclusion, VLDL induces IL-1beta mRNA expression, caspase-1 activation, and IL-1beta release from macrophages, suggesting that VLDL can promote inflammation in atherosclerotic lesions.
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| 25. |
- Sylwander, Charlotte, 1992-, et al.
(författare)
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Pressure pain thresholds and the associations with chronic widespread pain, knee osteoarthritis and obesity in individuals with knee pain
- 2020
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Konferensbidrag (refereegranskat)abstract
- Approximate 30% of individuals with symptomatic knee osteoarthritis (OA) had developed chronic widespread pain (CWP) over a period of 20 years [1]. In order to prevent CWP in those with knee pain, it is important to study associated factors.Objectives:The aim was to study pressure pain thresholds among individuals with knee pain with or without radiographic changes, and associations with CWP, radiographic knee OA, and obesity.Methods:Out of 300 individuals with knee pain (with or without radiographic changes) from an ongoing longitudinal study, 279 conducted pressure pain thresholds (PPT) measurement at baseline in this cross-sectional study (71% women; mean age 51 years). The PPT were measured using a computerized pressure algometry on eight predefined tender points (Figure 1) out of the 18 points as part of the definition of fibromyalgia [2]. PPTs were dichotomised based on the lowest tertial vs the two higher tertials for each of the eight points. A group that had ≥4 points with low PPT (low PPT group) was compared to a group that had <4 low PPT (not low PPT group). A pain mannequin categorised the participants in three different pain groups: CWP, chronic regional pain (CRP), and no chronic pain (NCP) according to the definition of the ACR [2]. Radiographic knee OA was defined according to the Ahlbäck five grading scale as having score ≥1 vs score 0 [3]. Obesity was measured by bioimpedance measuring BMI and visceral fat area (VFA, cm2). To study associations, a crude logistic regression model controlled for age and sex was used including main and significant variablesFigure 1Differences in mean PPT in the eight tender pointsResults:The prevalence of CWP was 37% and higher in the low PPT group compared to those in the not low PPT group (Table 1). No differences were found between the groups in BMI, VFA or radiographic knee OA (Table 1). The low PPT group had significantly lower mean PPT on all eight tender points, was younger, had more pain sites, and more cases of fibromyalgia compared to the group with not low PPT (Table 1, Figure 1). Age (OR 0.95; 95% CI 0.92–0.97), having CWP (OR 3.00; CI 1.66–5.06), fibromyalgia (OR 21.91; CI 2.45–194.69) and increased number of pain sites (OR 1.13; CI 1.05–1.22) were associated with low PPT.Table 1.Descriptive statistics for the whole sample and for the groups: low PPT and not low PPTAlln = 279Low PPTn = 99Not low PPTn = 180p-valueAge, mean years (sd)51 (9)49 (9)53 (8)<0.001Women, n (%)197 (71%)69 (70%)128 (71%)0.804Pain group, n (%)<0.001 NCP/CRP160 (63%)41 (47%)119 (71%) CWP95 (37%)46 (53%)49 (29%)Numbers of pain sites, mean (sd)5 (4)6 (5)4 (3)0.003Fibromyalgia, n (%)8 (3%)7 (9%)1 (1%)0.001Knee OA Ahlbäck, n (%)59 (23%)16 (18%)43 (26%)0.132BMI, n (%)127 (48%)42 (47%)85 (48%)0.801 Normal Overweight/Obese139 (52%)48 (53%)91 (52%)VFA, mean cm2(sd)114 (54)115 (51)113 (55)0.788Conclusion:Baseline characteristics of individuals with knee pain showed a higher prevalence of CWP than in the general population [4]. In the group with low PPT, the prevalence was even higher. The study found associations between CWP and low PPT, however, almost half of the individuals with low PPT reported NCP/CRP. Moreover, a third in the group that not had low PPT reported CWP. The development of widespread pain in individuals with knee pain needs to be further studied over time to increase the knowledge of CWP’s origin in order to prevent the condition.References:[1]Bergman et al. BMC Musculoskelet Disord. 2019;20:592[2]Wolfe et al. Arthritis Rheum. 1990;33:160-72[3]Ahlbäck. Acta Radiol Diagn (Stockh). 1968:7-72[4]Andrews et al. Eur J Pain. 2018;22:5-18Disclosure of Interests:None declared
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| 26. |
- Tagt, Jonas, et al.
(författare)
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Long-term cadmium exposure and fractures, cardiovascular disease, and mortality in a prospective cohort of women
- 2022
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Ingår i: Environment International. - : Elsevier. - 0160-4120 .- 1873-6750. ; 161
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cadmium (Cd) is a toxic metal, which the non-smoking population is mainly exposed to through diet. Current health-based guidance values are based on renal toxicity; however, emerging evidence suggests that bone and the cardiovascular system might be more sensitive to Cd exposure. Objective: To assess the association of urinary Cd (U-Cd) with incidence of fractures, myocardial infarction, heart failure, ischemic stroke and mortality in postmenopausal women. Methods: We used data from 4024 women, aged 56-85 in the population-based prospective Swedish Mammography Cohort-Clinical. U-Cd was measured by ICP-MS at baseline (2004-2009) and categorized into tertiles. Incident cases of the outcomes were ascertained via register linkage through 2019. Multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression. Results: The median U-Cd at baseline was 0.33 mu g/g creatinine (cr) (5-95 percentiles 0.15-0.77). We ascertained the following incident cases: 903 first fracture of any type, 149 myocardial infarction, 174 heart failure, 162 ischemic stroke and 545 total deaths during the approximately 11 years of follow-up. U-Cd was dose-dependently associated with risk of any fracture (HR: 1.20, 95% CI: 1.01 to 1.43, ptrend: 0.04) and all-cause mortality (HR: 1.38, 95% CI: 1.10 to 1.74, ptrend: <0.01) when comparing the highest tertile of U-Cd (median 0.54 mu g/g cr) with the lowest (median 0.20 mu g/g cr). No clear associations were observed for myocardial infarction, heart failure or stroke. Discussion: Long-term Cd exposure might be associated with risk of fractures and all-cause mortality at lower levels than previously suggested.
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| 27. |
- Thalén-Lindström, Annika, 1965-, et al.
(författare)
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Validation of the Distress Thermometer in a Swedish population of oncology patients; accuracy of changes during six months
- 2013
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Ingår i: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 17:5, s. 625-631
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To validate the Swedish version of the Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS) for screening of distress and to explore how well DT measures changes of distress during six months in a population of heterogeneous oncology patients. Methods: The DT was translated into Swedish according to the forward- and back-translation procedure. HADS total score >= 15 was used as gold standard. Consecutive patients were invited to participate at their first visit to the Oncology department. The HADS and the DT were completed at baseline and after I, 3 and 6 months. Results: 462 baseline and 321 six-month assessments were completed. The patients had a variety of cancer diagnoses (n = 42). Most patients (95%) received active treatment. The DT compared favourably with the HADS. The area under the curve was 0.86 (95% CI, 0.82-0.90). DT >= 4 showed a sensitivity of 87%, a specificity of 73%, a positive predictive value (PPV) of 52% and a negative predictive value (NPV) of 95% at baseline. The results from the 1, 3 and 6 months assessments were equivalent baseline results. The DT means changed in the same direction as HADS at all points of assessment. Patients with distress reported statistically significantly more problems in all categories on the associated 'Problem List' compared to non-distressed patients. Conclusion: The Swedish version of the DT with a score >= 4 is valid for screening of distress in heterogeneous oncology patients. Its ability to measure changes in distress over time is comparable to HADS. (c) 2012 Elsevier Ltd. All rights reserved.
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