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1.
  • Vaernesbranden, Magdalena R., et al. (författare)
  • Placental human papillomavirus infections and adverse pregnancy outcomes
  • 2024
  • Ingår i: PLACENTA. - 0143-4004 .- 1532-3102. ; 152, s. 23-30
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Knowledge on prevalence and association of human papillomavirus (HPV) in third trimester placentae and adverse pregnancy outcomes is limited. We investigated the prevalence of placental HPV at delivery, explored urine HPV characteristics associated with placental HPV and whether placental HPV increased the risk adverse pregnancy outcomes. Methods: Pregnant women were enrolled in the Scandinavian PreventADALL mother-child cohort study at midgestation. Human papillomavirus genotyping was performed on placental biopsies collected at delivery (n = 587) and first-void urine at midgestation and delivery (n = 556). Maternal characteristics were collected by questionnaires at gestational week 18 and 34. Adverse pregnancy outcomes were registered from chart data including hypertensive disorders of pregnancy, gestational diabetes mellitus and newborns small for gestational age. Uni- and multivariable regression models were used to investigate associations. Results: Placental HPV was detected in 18/587 (3 %). Twenty-eight genotypes were identified among the 214/ 556 (38 %) with midgestational urine HPV. Seventeen of the 18 women with placental HPV were midgestational HPV positive with 89 % genotype concordance. Midgestational high-risk-(HR)-HPV and high viral loads of Anyor HR-HPV were associated with placental HPV. Persisting HPV infection from midgestation to delivery was not associated with placental HPV. Adverse pregnancy outcomes were seen in 2/556 (0.4 %) of women with placental HPV. Discussion: In this general cohort of pregnant women, the prevalence of placental HPV was 3 %, and midgestational urinary HPV 38 %. High HPV viral load increased the risk for placental HPV infections. We observed no increased risk for adverse pregnancy outcomes in women with placental HPV.
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2.
  • Ali, Zaheer, et al. (författare)
  • Intussusceptive Vascular Remodeling Precedes Pathological Neovascularization
  • 2019
  • Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - : Lippincott Williams & Wilkins. - 1079-5642 .- 1524-4636. ; 39:7, s. 1402-1418
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective—Pathological neovascularization is crucial for progression and morbidity of serious diseases such as cancer, diabetic retinopathy, and age-related macular degeneration. While mechanisms of ongoing pathological neovascularization have been extensively studied, the initiating pathological vascular remodeling (PVR) events, which precede neovascularization remains poorly understood. Here, we identify novel molecular and cellular mechanisms of preneovascular PVR, by using the adult choriocapillaris as a model.Approach and Results—Using hypoxia or forced overexpression of VEGF (vascular endothelial growth factor) in the subretinal space to induce PVR in zebrafish and rats respectively, and by analyzing choriocapillaris membranes adjacent to choroidal neovascular lesions from age-related macular degeneration patients, we show that the choriocapillaris undergo robust induction of vascular intussusception and permeability at preneovascular stages of PVR. This PVR response included endothelial cell proliferation, formation of endothelial luminal processes, extensive vesiculation and thickening of the endothelium, degradation of collagen fibers, and splitting of existing extravascular columns. RNA-sequencing established a role for endothelial tight junction disruption, cytoskeletal remodeling, vesicle- and cilium biogenesis in this process. Mechanistically, using genetic gain- and loss-of-function zebrafish models and analysis of primary human choriocapillaris endothelial cells, we determined that HIF (hypoxia-induced factor)-1α-VEGF-A-VEGFR2 signaling was important for hypoxia-induced PVR.Conclusions—Our findings reveal that PVR involving intussusception and splitting of extravascular columns, endothelial proliferation, vesiculation, fenestration, and thickening is induced before neovascularization, suggesting that identifying and targeting these processes may prevent development of advanced neovascular disease in the future.Visual Overview—An online visual overview is available for this article.
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3.
  • Bay, Annika, 1970- (författare)
  • Being physically active as an adult with congenital heart disease
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Due to advances in medical and surgical care adults with congenital heart disease (CHD) is a growing and aging population, that now outnumbers the children with CHD. In general, adults with CHD have reduced aerobic exercise capacity and nearly half of the patients do not reach current recommendations on physical activity. It is known that a low level of physical activity is associated with an increased risk for acquired cardiovascular disease. Studies has shown that adults with CHD are at the same, or even higher risk as the general population, for developing acquired cardiovascular disease.Aim: The overall aim was to explore physical activity in adults with CHD with respect to associated factors, exercise self-efficacy and their own experiences.Methods: This thesis is based on four papers. Paper I included 471 adults with CHD from three tertiary care centres in Sweden. The participants completed questionnaires measuring patient reported outcomes (e.g. SF-12) including physical activity level. Paper II was based on data from 79 adults with CHD from two tertiary care centers in Sweden and 42 matched controls. All participants completed questionnaires on exercise self-efficacy and quality of life, wore an activity monitor during four consecutive days and performed muscle endurance tests. Paper I and II were of cross-sectional design and analyses were done using logistic regression. In paper III and IV data were collected through structured interviews for 14 participants. They were asked about their experiences of being physically active (paper III), what they considered as physical activities, and their experiences of enablers and barriers to physical activity (paper IV). Qualitative content analysis was used in papers III and IV.Results: Physical activity level (paper I) and exercise self-efficacy (paper II) were strongly associated with age where those over 40 years had a lower level of physical activity and lower exercise self-efficacy. Further, in paper I, it appeared that patient reported outcomes from SF-12 were strongly associated with physical activity level. In paper II, exercise self-efficacy was associated with performance in a muscle endurance tests. Paper III revealed an overall theme – It´s like balancing on a slackline that illustrates how adults with CHD described themselves in relation to physical activity. This overall theme consisted of four themes: (1) Being an adventurer – enjoying the challenges of physical activity; (2) Being a realist – adapting to physical ability; (3) Being a non-doer – lacking prerequisites for physical activity and (4) Being an outsider – feeling excluded depending on physical ability. In paper IV, the analysis revealed a description of what adults with CHD consider to be physical activity and considered as enablers and barriers for physical activity. Four categories appeared; physical aspects, psychological aspects, psychosocial aspects and environmental aspects. In the psychosocial aspect, social support and encouragement in childhood to be physically active and no restrictions from e.g. parents, teachers and health care increased physical activity in adulthood.Conclusions: Age, social support and accepting physical limitations seem to have an important impact regarding physical activity level and exercise self-efficacy. In contrast, the complexity of CHD and other medical factors appear to be of less importance for adults with CHD in relation to physical activity. In order to support adults with CHD to increase their physical activity and reach their full potential, it is important to explore and consider the various aspects that may affect physical activity in this population.
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4.
  • Bay, Annika, et al. (författare)
  • Enablers and barriers for being physically active : experiences from adults with congenital heart disease
  • 2021
  • Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 20:3, s. 276-284
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In general, adults with congenital heart disease have reduced exercise capacity and many do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and to counteract acquired cardiovascular disease, therefore enablers and barriers for being physically active are important to identify.Aim: To describe what adults with complex congenital heart diseases consider as physical activity, and what they experience as enablers and barriers for being physically active. Methods: A qualitative study using semi-structured interviews in which 14 adults with complex congenital heart disease (seven women) participated. The interviews were analysed using qualitative content analysis.Results: The analysis revealed four categories considered enablers and barriers - encouragement, energy level, approach and environment. The following is exemplified by the category encouragement as an enabler: if one had experienced support and encouragement to be physically active as a child, they were more positive to be physically active as an adult. In contrast, as a barrier, if the child lacked support and encouragement from others, they had never had the opportunity to learn to be physically active.Conclusion: It is important for adults with congenital heart disease to have the opportunity to identify barriers and enablers for being physically active. They need knowledge about their own exercise capacity and need to feel safe that physical activity is not harmful. This knowledge can be used by healthcare professionals to promote, support and eliminate misconceptions about physical activity. Barriers can potentially be transformed into enablers through increased knowledge about attitudes and prerequisites. © The European Society of Cardiology 2020.
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6.
  • Bay, Annika, 1970-, et al. (författare)
  • Exercise self-efficacy (ESE) in adults with congential heart disease
  • 2017
  • Ingår i: European Heart Journal. - 0195-668X .- 1522-9645. ; 38:Suppl. 1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Many adults with congenital heart disease (CHD) have reduced aerobic exercise capacity and impaired muscle function. However, it is largely unknown which factors have influence on the confidence to perform exercise training, i.e. Exercise Self-Efficacy (ESE).Aims: To identify factors related to low ESE, and thus identify potential targets for rehabilitation and thereby enhance the potential for being physically active.Methods: Seventy-nine adults with CHD; simple lesions n=38 (women n=16), complex lesions n=41 (women n=17) (mean age 36.7±14.6 years) and 42 age and sex matched controls were recruited. All participants completed questionnaires on ESE, quality of life (EQ-5D), and physical activity (international physical activity questionnaire, IPAQ), and performed muscle endurance tests.Results: ESE was categorised into low (<26 points, n=24) and high (≥26 points, n=55). Patients with low ESE were older (45.2±15.4 vs. 32.6±12.5 years, p=0.002), more often had prescribed medication (67% vs. 44%, p=0.06), higher New York Heart Association functional class (NYHA) (≥ III) (25% vs. 7%, p=0.03) and performed fewer shoulder flexions (30.9±16.1 vs. 45.9±23.9, p=0.01) compared with those with high ESE. In the high ESE group, ESE did not differ from controls (33.8±3.9 vs. 33.4±6.1, p=0.74). In linear multivariate analysis age (B;-0.18, 95% CI -0.28- -0.08), smoking (B;-3.73, 95% CI -7.17- -0.28), EQ-5Dindex <1 (B;-3.33, 95% CI -6.08- -0.57) and number of shoulder flexions (B; 0.09, 95% CI 0.03–0.16) were independently associated with ESE.Conclusion: Many adults with CHD have low ESE. Rehabilitation targeting quality of life, smoking cessation and muscle training may improve ESE, and thus enhance the potential for being physically active in this population.
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7.
  • Bay, Annika, et al. (författare)
  • Exercise self-efficacy in adults with congenital heart disease
  • 2018
  • Ingår i: International Journal of Cardiology: Heart and vasculature. - : Elsevier. - 2352-9067. ; 18, s. 7-11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Physical activity improves health, exercise tolerance and quality of life in adults with congenital heart disease (CHD), and exercise training is in most patients a high-benefit low risk intervention. However, factors that influence the confidence to perform exercise training, i.e. exercise self-efficacy (ESE), in CHD patients are virtually unknown. We aimed to identify factors related to low ESE in adults with CHD, and potential strategies for being physically active.Methods: Seventy-nine adults with CHD; 38 with simple lesions (16 women) and 41 with complex lesions (17 women) with mean age 36.7 ± 14.6 years and 42 matched controls were recruited. All participants completed questionnaires on ESE and quality of life, carried an activity monitor (Actiheart) during four consecutive days and performed muscle endurance tests.Results: ESE in patients was categorised into low, based on the lowest quartile within controls, (≤ 29 points, n = 34) and high (> 29 points, n = 45). Patients with low ESE were older (42.9 ± 15.1 vs. 32.0 ± 12.4 years, p = 0.001), had more complex lesions (65% vs. 42%, p = 0.05) more often had New York Heart Association functional class III (24% vs. 4%, p = 0.01) and performed fewer shoulder flexions (32.5 ± 15.5 vs. 47.7 ± 25.0, p = 0.001) compared with those with high ESE. In a logistic multivariate model age (OR; 1.06, 95% CI 1.02-1.10), and number of shoulder flexions (OR; 0.96, 95% CI 0.93-0.99) were associated with ESE.Conclusion: In this study we show that many adults with CHD have low ESE. Age is an important predictor of low ESE and should, therefore, be considered in counselling patients with CHD. In addition, muscle endurance training may improve ESE, and thus enhance the potential for being physically active in this population.
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8.
  • Bay, Annika, 1970-, et al. (författare)
  • Facilitators and barriers for physical activity in adults with congenital heart disease
  • 2018
  • Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 39:suppl_1, s. 1120-1121
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A majority of adults with congenital heart disease (CHD) have reduced exercise capacity and do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and counteract acquired cardiovascular disease. This study illuminates aspects that may be relevant for performing physical activity.Purpose: To describe facilitators and barriers for physical activity in adults with CHD.Methods: Semi-structured interviews were performed individually with fourteen adults (age 19–68 years, women=7) with complex CHD. The interviews were analyzed using qualitative content analysis.Results: Aspects that may enable or inhibit physical activity were found in two domains; Facilitators and Barriers, which both consisted of four categories physical, psychological, psychosocial and environmental aspects (Table 1).
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9.
  • Bay, Annika, 1970-, et al. (författare)
  • It ́s like balancing on a slackline : A description from adults living with congenital heart disease
  • 2018
  • Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 28:Suppl. S1, s. S37-S37
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Several studies have shown that adults with congenital heart disease have reduced exercise capacity and do not reach the recommended daily level of physical activity. With this in view, it is of great importance to investigate how this population experiences physical activity. The aim of the study is to illuminate how adults with congenital heart disease describes themselves in relation to physical activity.Methods: Semi-structured interviews with fourteen adults with complex congenital heart disease were performed. Patients were recruited from the clinic waiting list, based on their scheduled follow up and diagnosis. Interviews were analysed by qualitative content analysis.Results: The overall theme It´s like balancing on a slackline illustrates how adults with congenital heart disease described themselves in relation to physical activity. The overall theme consists of four themes: Being an adventurer- enjoying the challenges of physical activity, Being a realist- adapting to physical ability, Beinga non-doer- lacking prerequisites for physical activity and Being an outsider- feeling excluded depending on physical ability.Conclusions: The descriptions on themselves as a physically active were not constant or one-dimensional and the descriptions varied during the interviews, related to different time periods in life. It meant that they could described themselves as being an adventurer liking tough challenges, but at the same time describing themselves as being a non-doer with uncertainty over their physical strength. The findings point out specific factors for adults with CHD that might constitute as obstacles, but also possibilities for being physically active.
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10.
  • Bay, Annika, et al. (författare)
  • It's like balancing on a slackline : A description of how adults with congenital heart disease describe themselves in relation to physical activity
  • 2018
  • Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:15-16, s. 3131-3138
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS AND OBJECTIVES: To illuminate how adults with CHD describe themselves in relation to physical activity.BACKGROUND: Several studies have shown that adults with congenital heart disease (CHD) have reduced exercise capacity and do not reach the recommended daily level of physical activity. With this in view, it is of immense importance to investigate how this population experiences physical activity.DESIGN: Qualitative study with semi-structured interviews analysed with qualitative content analysis.METHODS: Semi-structured interviews were individually performed with fourteen adults (women=7, age 19-68 years) with complex CHD. Patients were purposively recruited from the clinic waiting list, based on a scheduled follow-up and diagnosis.RESULTS: The overall theme, It's like balancing on a slackline, illustrates how adults with CHD described themselves in relation to physical activity. This overall theme consisted of four subthemes: (1) Being an adventurer- enjoying the challenges of physical activity; (2) Being a realist- adapting to physical ability; (3) Being a non-doer- lacking prerequisites for physical activity; and (4) Being an outsider- feeling excluded depending on physical ability.CONCLUSIONS: Adults with CHD seem to have a diverse relationship to physical activity and it involves various aspects throughout the lifespan. The findings point out factors that might constitute as obstacles for being physically active, specific for people with chronic conditions like CHD. This highlights the importance of further exploring the hindering and facilitating factors for being physically active in order to get a deeper understanding of how to support adults with CHD to be physically active.RELEVANCE TO CLINICAL PRACTICE: Given the diverse relationship to physical activity, nurses have to further investigate the patients' relationship to physical activity, in order to support a healthy lifestyle. Nurses and allied health professionals should offer individualized exercise prescriptions and education about suitable physical activities in relation to physical ability. This article is protected by copyright. All rights reserved.
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11.
  • Bay, Annika, et al. (författare)
  • Patient reported outcomes are associated with physical activity level in adults with congenital heart disease.
  • 2017
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 243, s. 174-179
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: In general, adults with congenital heart disease (CHD) have impaired exercise capacity, and approximately 50% do not reach current recommendations on physical activity. Herein we analysed factors associated with physical activity level (PAL) in adults with CHD by using patient-reported outcomes (PRO).METHODS: Patients with CHD (n=471) were randomly selected from the national register on CHD and categorized according to complexity of lesions - simple (n=172, 39.1±14.6years), moderate (n=212, 39±14.1years), and severe (n=87, 31.7±10.7years). Participants completed a standardized questionnaire measuring PRO-domains including PAL. Variables associated with PAL were tested in multivariate logistic regression.RESULTS: PAL was categorized into high (≥3 METs ≥2.5h/week, n=192) and low (≥3 METs <2.5h/week, n=279). Patients with low PAL were older (42.6 vs. 35.8years, p≤0.001), had more prescribed medications (51% vs. 39%, p=0.009), more symptoms (25% vs. 16%, p=0.02) and comorbidity (45% vs. 34% p=0.02). Patients with low PAL rated a lower quality of life (76.6 vs. 83.4, p<0.001), satisfaction with life (25.6 vs. 27.3, p=0.003), a lower Physical Component Summary score (PCS) (78.1 vs. 90.5, p<0.001) and Mental Component Summary score (MCS) (73.5 vs. 79.5, p<0.001). Complexity of heart lesion was not associated with PAL. The included PROs - separately tested in the model, together with age were associated with PAL.CONCLUSIONS: PCS and MCS are stronger associated with PAL than age and medical factors. The use of these PROs could therefore provide valuable information of benefit for individualized advice regarding physical activity to patients with CHD.
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12.
  • Bonagas, Nadilly, et al. (författare)
  • Pharmacological targeting of MTHFD2 suppresses acute myeloid leukemia by inducing thymidine depletion and replication stress
  • 2022
  • Ingår i: NATURE CANCER. - : Springer Science and Business Media LLC. - 2662-1347. ; 3:2, s. 156-
  • Tidskriftsartikel (refereegranskat)abstract
    • The folate metabolism enzyme MTHFD2 (methylenetetrahydrofolate dehydrogenase/cyclohydrolase) is consistently overexpressed in cancer but its roles are not fully characterized, and current candidate inhibitors have limited potency for clinical development. In the present study, we demonstrate a role for MTHFD2 in DNA replication and genomic stability in cancer cells, and perform a drug screen to identify potent and selective nanomolar MTHFD2 inhibitors; protein cocrystal structures demonstrated binding to the active site of MTHFD2 and target engagement. MTHFD2 inhibitors reduced replication fork speed and induced replication stress followed by S-phase arrest and apoptosis of acute myeloid leukemia cells in vitro and in vivo, with a therapeutic window spanning four orders of magnitude compared with nontumorigenic cells. Mechanistically, MTHFD2 inhibitors prevented thymidine production leading to misincorporation of uracil into DNA and replication stress. Overall, these results demonstrate a functional link between MTHFD2-dependent cancer metabolism and replication stress that can be exploited therapeutically with this new class of inhibitors. Helleday and colleagues describe a nanomolar MTHFD2 inhibitor that causes replication stress and DNA damage accumulation in cancer cells via thymidine depletion, demonstrating a potential therapeutic strategy in AML tumors in vivo.
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13.
  • Brusini, Irene, et al. (författare)
  • Fully automatic estimation of the waist of the nerve fiber layer at the optic nerve head angularly resolved
  • 2021
  • Ingår i: Progress in Biomedical Optics and Imaging - Proceedings of SPIE. - : SPIE-Intl Soc Optical Eng. ; , s. 1D1-1D8
  • Konferensbidrag (refereegranskat)abstract
    • The present project aims at developing a fully automatic software for estimation of the waist of the nerve fiber layer in the Optic Nerve Head (ONH) angularly resolved in the frontal plane as a tool for morphometric monitoring of glaucoma. The waist of the nerve fiber layer is here defined as Pigment epithelium central limit –Inner limit of the retina – Minimal Distance, (PIMD). 3D representations of the ONH were collected with high resolution OCT in young not glaucomatous eyes and glaucomatous eyes. An improved tool for manual annotation was developed in Python. This tool was found user friendly and to provide sufficiently precise manual annotation. PIMD was automatically estimated with a software consisting of one AI model for detection of the inner limit of the retina and another AI model for localization of the Optic nerve head Pigment epithelium Central limit (OPCL). In the current project, the AI model for OPCL localization was retrained with new data manually annotated with the improved tool for manual annotation both in not glaucomatous eyes and in glaucomatous eyes. Finally, automatic annotations were compared to 3 annotations made by 3 independent annotators in an independent subset of both the not glaucomatous and the glaucomatous eyes. It was found that the fully automatic estimation of PIMD-angle overlapped the 3 manual annotators with small variation among the manual annotators. Considering interobserver variation, the improved tool for manual annotation provided less variation than our original annotation tool in not glaucomatous eyes suggesting that variation in glaucomatous eyes is due to variable pathological anatomy, difficult to annotate without error. The small relative variation in relation to the substantial overall loss of PIMD in the glaucomatous eyes compared to the not glaucomatous eyes suggests that our software for fully automatic estimation of PIMD-angle can now be implemented clinically for monitoring of glaucoma progression.
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14.
  • Camilla, Sandberg, et al. (författare)
  • Habitual Physical Activity in Adults with Congenital Heart Disease Compared with Age- and Sex- Matched Controls
  • 2016
  • Ingår i: Canadian Journal of Cardiology. - : Elsevier BV. - 0828-282X .- 1916-7075. ; 32:4, s. 547-553
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Most adult patients with congenital heart disease (CHD) have reduced aerobic exercise capacity. Their habitual physical activity (PA) level is, however, less well studied. In this study habitual PA level in a cohort of adults with CHD compared to healthy age and gender matched controls was investigated.Methods: Eighty adults with CHD, classed as either “complex” (n=40) or “simple” (n=40), and 42 healthy controls were studied with a combined uniaxial accelerometer and heart rate monitor worn during 4 consecutive days. We analysed 1) the time spent during ≥ moderate/vigorous PA, 2) accelerometer counts/day and 3) to what extent the World Health Organization recommendations on PA were reached.Results: Patients with simple lesions had higher total accelerometer counts/day compared to both patients with complex lesions and controls (simple lesions; median (IQR) 107.7(63.4) vs. complex lesions; 72.8(53.5) and controls; 78.3(49.6), p≤0.001 and p=0.002). Furthermore, no differences in time spent during ≥ moderate-to-vigorous PA was found between patients and controls. In addition 46% of the patients with simple lesions, 55% of the patients with complex lesions and 44% of the controls did not reach the W.H.O.-recommended level of daily PA, but no significant differences between groups were found. There were no differences in achieving recommended PA level between patients in NYHA I vs. NYHA II+III.Conclusions: Patients with CHD follow the same PA-level pattern as the general population. Broad strategies promoting an active lifestyle are needed across the population and especially for patients with complex CHD and impaired NYHA class.
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  • Daelman, Bo, et al. (författare)
  • Frailty and cognitive function in middle-aged and older adults with congenital heart disease
  • 2024
  • Ingår i: Journal of the American College of Cardiology. - : Elsevier. - 0735-1097 .- 1558-3597. ; 83:12, s. 1149-1159
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies have shown that older people with CHD have higher morbidity, health care use, and mortality. To maintain longevity and quality of life, understanding their evolving medical and psychosocial challenges is essential.Objectives: The authors describe the frailty and cognitive profile of middle-aged and older adults with CHD to identify predictor variables and to explore the relationship with hospital admissions and outpatient visits.Methods: Using a cross-sectional, multicentric design, we included 814 patients aged ≥40 years from 11 countries. Frailty phenotype was determined using the Fried method. Cognitive function was assessed by the Montreal Cognitive Assessment.Results: In this sample, 52.3% of patients were assessed as robust, 41.9% as prefrail, and 5.8% as frail; 38.8% had cognitive dysfunction. Multinomial regression showed that frailty was associated with older age, female sex, higher physiologic class, and comorbidities. Counterintuitively, patients with mild heart defects were more likely than those with complex lesions to be prefrail. Patients from middle-income countries displayed more prefrailty than those from higher-income countries. Logistic regression demonstrated that cognitive dysfunction was related to older age, comorbidities, and lower country-level income.Conclusions: Approximately one-half of included patients were (pre-)frail, and more than one-third experienced cognitive impairment. Frailty and cognitive dysfunction were identified in patients with mild CHD, indicating that these concerns extend beyond severe CHD. Assessing frailty and cognition routinely could offer valuable insights into this aging population.
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  • Ekblom Bak, Elin, 1981-, et al. (författare)
  • Accelerometer derived physical activity and subclinical coronary and carotid atherosclerosis : cross-sectional analyses in 22 703 middle-aged men and women in the SCAPIS study
  • 2023
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:11
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: The aim included investigation of the associations between sedentary (SED), low-intensity physical activity (LIPA), moderate-to-vigorous intensity PA (MVPA) and the prevalence of subclinical atherosclerosis in both coronaries and carotids and the estimated difference in prevalence by theoretical reallocation of time in different PA behaviours.DESIGN: Cross-sectional.SETTING: Multisite study at university hospitals.PARTICIPANTS: A total of 22 670 participants without cardiovascular disease (51% women, 57.4 years, SD 4.3) from the population-based Swedish CArdioPulmonary bioImage study were included. SED, LIPA and MVPA were assessed by hip-worn accelerometer.PRIMARY AND SECONDARY OUTCOMES: Any and significant subclinical coronary atherosclerosis (CA), Coronary Artery Calcium Score (CACS) and carotid atherosclerosis (CarA) were derived from imaging data from coronary CT angiography and carotid ultrasound.RESULTS: High daily SED (>70% ≈10.5 hours/day) associated with a higher OR 1.44 (95% CI 1.09 to 1.91), for significant CA, and with lower OR 0.77 (95% CI 0.63 to 0.95), for significant CarA. High LIPA (>55% ≈8 hours/day) associated with lower OR for significant CA 0.70 (95% CI 0.51 to 0.96), and CACS, 0.71 (95% CI 0.51 to 0.97), but with higher OR for CarA 1.41 (95% CI 1.12 to 1.76). MVPA above reference level, >2% ≈20 min/day, associated with lower OR for significant CA (OR range 0.61-0.67), CACS (OR range 0.71-0.75) and CarA (OR range 0.72-0.79). Theoretical replacement of 30 min of SED into an equal amount of MVPA associated with lower OR for significant CA, especially in participants with high SED 0.84 (95% CI 0.76 to 0.96) or low MVPA 0.51 (0.36 to 0.73).CONCLUSIONS: MVPA was associated with a lower risk for significant atherosclerosis in both coronaries and carotids, while the association varied in strength and direction for SED and LIPA, respectively. If causal, clinical implications include avoiding high levels of daily SED and low levels of MVPA to reduce the risk of developing significant subclinical atherosclerosis.
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18.
  • Gonzalez, Manuel, et al. (författare)
  • Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients : study protocol for a multi-center randomized controlled trial
  • 2019
  • Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Cardiac rehabilitation (CR) programs addressing risk factor management, educational interventions, and exercise contribute to reduce mortality after myocardial infarction (MI). However, the fulfillment of guideline-recommended CR targets is currently unsatisfactory. eHealth, i.e., the use of electronic communication for healthcare, including the use of mobile smartphone applications combined with different sensors and interactive computerized programs, offers a new array of possibilities to provide clinical care. The present study aims to assess the efficacy of a web-based application (app) designed to support persons in adhering to lifestyle advice and medication as a complement to traditional CR programs for improvement of risk factors and clinical outcomes in patients with MI compared with usual care. METHODS/DESIGN: An open-label multi-center randomized controlled trial is being conducted at different CR centers from three Swedish University Hospitals. The aim is to include 150 patients with MI < 75 years of age who are confident smartphone and/or Internet users. In addition to participation in CR programs according to the usual routine at each center, patients randomized to the intervention arm will receive access to the web-based app. A CR nurse reviews the patients' self-reported data twice weekly through a medical interface at the clinic. The primary outcome of the study will be change in submaximal exercise capacity (in watts) between 2 and 4 weeks after discharge and when the patient has completed his/her exercise program at the CR center, usually around 3-6 months post-discharge. Secondary outcomes include changes in self-reported physical activity, objectively assessed physical activity by accelerometry, self-rated health, dietary, and smoking habits, body mass index, blood pressure, blood lipids, and glucose/HbA1c levels between inclusion and follow-up visits during the first year post-MI. Additionally, we will assess uptake and adherence to the application, the number of CR staff contacts, and the incidence of cardiovascular events at 1 and 3 years after the MI. Patient recruitment started in 2016, and the first study results are expected in the beginning of 2019. DISCUSSION: The present study will add evidence to whether electronic communication can be used to improve traditional CR programs for patients after MI. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03260582 . Retrospectively registered on 24 August 2017.
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19.
  • Hansson, Lena, 1967-, et al. (författare)
  • Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation
  • 2022
  • Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 32:6, s. 861-868
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction/aim: Young patients with Fontan circulation may have low serum 25-hydroxyvitamin D levels, an affected liver, and unhealthy body compositions. This study aimed to explore the association between vitamin D intake/levels, liver biomarkers, and body composition in young Fontan patients.Method: We collected prospective data in 2017 to 2018, obtained with food-frequency questionnaires, biochemical analyses of liver biomarkers, and dual-energy X-ray absorptiometry scans in 44 children with Fontan circulation. Body compositions were compared to matched controls (n = 38). Linear regression analyses were used to investigate associations of biomarkers, leg pain, and lean mass on serum levels of 25-hydroxyvitamin D. Biomarkers were converted to z scores and differences were evaluated within the Fontan patients.Results: Our Fontan patients had a daily mean vitamin D intake of 9.9 µg and a mean serum 25-hydroxyvitamin D of 56 nmol/L. These factors were not associated with fat or lean mass, leg pain, or biomarkers of liver status. The Fontan patients had significantly less lean mass, but higher fat mass than controls. Male adolescents with Fontan circulation had a greater mean abdominal fat mass than male controls and higher cholesterol levels than females with Fontan circulation.Conclusion: Vitamin D intake and serum levels were not associated with body composition or liver biomarkers in the Fontan group, but the Fontan group had lower lean mass and higher fat mass than controls. The more pronounced abdominal fat mass in male adolescents with Fontan circulation might increase metabolic risks later in life.
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20.
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21.
  • Holmlund, Lena, et al. (författare)
  • Health‐related quality of life in patients with heart failure eligible for treatment with sacubitril–valsartan
  • 2020
  • Ingår i: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 7:2, s. 556-562
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: To describe and compare self‐reported health‐related quality of life between younger and older patients with severe heart failure eligible for treatment with sacubitril–valsartan and to explore the association between health‐related quality of life and age, NYHA classification, systolic blood pressure and NT‐proBNP level.Design: Cross‐sectional study.Methods: A total of 59 patients, eligible for treatment with sacubitril–valsartan were consecutively included and divided into a younger (≤75 years) and older group (>75 years). Health‐related quality of life was assessed using the Kansas City Cardiomyopathy Questionnaire and the EuroQol 5‐dimensions. Data were collected between June 2016 and January 2018. The STROBE checklist was used.Results: There were no differences in overall health‐related quality of life between the age groups. The older patients reported lower scores in two domains measured with the Kansas City Cardiomyopathy Questionnaire, namely self‐efficacy (67.0 SD 22.1 vs. 78.8 SD 19.7) and physical limitation (75.6 SD 19.0 vs. 86.3 SD 14.4). Higher NYHA class was independently associated with lower Kansas City Cardiomyopathy Questionnaire Overall Summary Score.
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22.
  • Hultman, Karin, 1980, et al. (författare)
  • Maternal taurine supplementation in the late pregnant rat stimulates postnatal growth and induces obesity and insulin resistance in adult offspring
  • 2007
  • Ingår i: J Physiol. ; 579(Pt 3):Jan 11, s. 823-33
  • Tidskriftsartikel (refereegranskat)abstract
    • An adequate supply of taurine during foetal life is important for normal beta-cell development and insulin action and an altered availability of taurine may program glucose metabolism in utero and result in type 2 diabetes in adult age. We examined whether maternal taurine supplementation in late pregnant rats affects postnatal growth, adult body composition, insulin sensitivity and endogenous insulin secretion in intra-uterine growth restricted (IUGR) and normal offspring. Uterine artery ligation or sham operations were performed on gestational day (GD) 19. Taurine supplementation was given to half of the dams from GD 18 until term resulting in four groups of offspring: sham (n= 22), sham/taurine (n= 22), IUGR (n= 22) and IUGR/taurine (n= 24). The offspring were studied at 12 wks of age. In offspring with normal birth weight, foetal taurine supplementation markedly stimulated postnatal growth. In sham/taurine females, fat depots, plasma free fatty acid and leptin concentrations were increased and insulin sensitivity was reduced. Insulin sensitivity was unaltered in IUGR and IUGR/taurine offspring. However, whereas IUGR offspring showed little catch-up growth, 50 % of IUGR/taurine animals displayed complete catch-up at 12 wks of age and these animals had increased fat depots and reduced insulin sensitivity. In conclusion, taurine supplementation in late gestation results in accelerated postnatal growth, which was associated with adult obesity and insulin resistance both in IUGR and normal offspring. This effect was particularly evident in females. These data suggest that foetal taurine availability is an important determinant for postnatal growth, insulin sensitivity and fat accumulation.
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23.
  • Hörnberg, Kristina, et al. (författare)
  • Isotemporal Substitution of Time Between Sleep and Physical Activity : Associations With Cardiovascular Risk Factors in Early Rheumatoid Arthritis
  • 2021
  • Ingår i: ACR Open Rheumatology. - : John Wiley & Sons. - 2578-5745. ; 3:3, s. 138-146
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: We aimed to determine relationships between objectively measured nightly sleep, sedentary behavior (SB), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) with risk factors for cardiovascular disease (CVD) in patients with early rheumatoid arthritis (RA). Furthermore, we aimed to estimate consequences for these risk factors of theoretical displacements of 30 minutes per day in one behavior with the same duration of time in another.Methods: This cross-sectional study included 78 patients with early RA. Nightly sleep, SB, LPA, and MVPA were assessed by a combined heart rate and accelerometer monitor. Associations with risk factors for CVD were analyzed using linear regression models and consequences of reallocating time between the behaviors by isotemporal substitution modeling.Results: Median (Q1-Q3) nightly sleep duration was 4.6 (3.6-5.8) hours. Adjusted for monitor wear time, age, and sex, 30-minutes-longer sleep duration was associated with favorable changes in the values β (95% confidence interval [CI]) for waist circumference by -2.2 (-3.5, -0.9) cm, body mass index (BMI) by -0.9 (-1.4, -0.4) kg/m2 , body fat by -1.5 (-2.3, -0.8)%, fat-free mass by 1.6 (0.8, 2.3)%, sleeping heart rate by -0.8 (-1.5, -0.1) beats per minute, and systolic blood pressure by -2.5 (-4.0, -1.0) mm Hg. Thirty-minute decreases in SB, LPA, or MVPA replaced with increased sleep was associated with decreased android fat and lower systolic blood pressure levels. Replacement of SB or LPA with MVPA yielded lower BMIs.Conclusion: Shorter sleep during the night is common among patients with early RA and is associated with adverse risk factors for CVD.
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24.
  • Hörnberg, Kristina, et al. (författare)
  • Physical activity in early and long-standing RA : relations to disease activity, cardiovascular risk factors and subclinicalatherosclerosis
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: The excess risk for cardiovascular disease (CVD) in Rheumatoid Arthritis (RA), is partly attributable to traditional cardiovascular risk factors for CVD and systemic inflammation, factors known to be modified by physical activity.Objectives: The aim of this cross-sectional study was to objectively measure and compare the level of physical activity in patients with early and long-standing RA, and to investigate its associations with disease activity, risk factors for CVD and measures of subclinical atherosclerosis.Methods: This study included 84 patients with early and 37 with long-standing RA (disease duration, mean [SD] 1.4 [0.4] and 16.3 [2.3] years respectively). Physical activity was measured using a combined accelerometer and heart rate monitor and included total physical activity (counts /min), proportion of moderate to vigorous physical activity (MVPA) and sedentary time. Further assessments were; disease activity (Erythrocyte sedimentation rate [ESR], Disease activity score [DAS28]), functional ability (Health Assessment Questionnaire [HAQ]), risk factors for CVD (blood lipids, i.e., triglycerides, high density lipoprotein [HDL], low density protein [LDL], blood glucose, blood pressure, waist circumference, body mass index [BMI]), body fat and subclinical atherosclerosis (pulse wave velocity [PWV], augmentation index [AIx] and carotid intima-media thickness [cIMT]).Results: Physical activity variables did not differ between patients with early and long-standing RA. Thirty- seven % of the patients with early and 43% of the patients with long-standing RA did not reach WHOs recommended levels of MVPA. Univariate linear regression analyses with the two groups combined, showed associations between total physical activity and younger age, lower values for HAQ and ESR, as well as more beneficial values for blood glucose, triglycerides, waist circumference, BMI, body fat, sleeping heart rate (SHR), systolic and diastolic blood pressure, aortic blood pressure and pulse pressure (PP), AIx, PWV, and cIMT. After adjusting each variable for age, sex, disease duration and Actiheart wear time, associations remained for all variables except triglycerides, aortic PP, PWV, AIx and cIMT. In a final regression model, the association with ESR was no longer evident. More time spent in MVPA was associated with younger age and with favourable values of blood glucose, HDL, LDL, waist circumference, SHR and PWV. After the same adjustments, associations remained for HAQ, HDL, blood glucose and SHR.Conclusions: Physical activity behaviour was similar in patients with early and long-standing RA. Total physical activity as well as more time spent in moderate to vigorous physical activity were associated with more favourable risk factors for CVD and measures of subclinical atherosclerosis. Patients with lower functional ability were less physically active. These results stress the importance of promoting physical activity in patients with RA. 
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25.
  • Hörnberg, Kristina, et al. (författare)
  • Physical activity in rheumatoid arthritis : relationship to cardiovascular risk factors, subclinical atherosclerosis, and disease activity
  • 2020
  • Ingår i: Scandinavian Journal of Rheumatology. - : Taylor & Francis Group. - 0300-9742 .- 1502-7732. ; 49:2, s. 112-121
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To investigate associations between physical activity and risk factors for cardiovascular disease (CVD), subclinical atherosclerosis, and disease activity in patients with early and long-standing rheumatoid arthritis (RA).Method: This cross-sectional study included 84 patients with early and 37 with long-standing RA (disease duration, mean ± sd: 1.4 ± 0.4 and 16.3 ± 2.3 years, respectively). Physical activity was measured using a combined accelerometer and heart-rate monitor. Further assessments were disease activity (erythrocyte sedimentation rate, Disease Activity Score in 28 joints), functional ability (Health Assessment Questionnaire), risk factors for CVD (blood lipids, i.e. triglycerides, high-density lipoprotein, low-density lipoprotein; blood glucose, blood pressure, sleeping heart rate, waist circumference, body mass index, and body fat), and subclinical atherosclerosis (pulse-wave velocity, augmentation index, and carotid intima–media thickness).Results: Physical activity variables did not differ between patients with early and long-standing RA. However, 37% of the patients with early and 43% of those with long-standing RA did not reach the World Health Organization’s recommended levels of moderate to vigorous physical activity (MVPA). In a final multiple regression model, adjusted for age, gender, disease duration, and activity monitor wear time, higher total physical activity was associated with lower body fat and higher functional ability. With the same adjustments, more time spent in MVPA was associated with lower high-density lipoprotein and lower sleeping heart rate.Conclusions: Physical activity was associated with more favourable risk factors for CVD. However, many patients were physically inactive, stressing the importance of promoting physical activity in RA.
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26.
  • Johansson, Karna, 1982- (författare)
  • Altered body composition in adults with complex congenital heart disease
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction: Thanks to achievements in paediatric heart surgery and medicine, the population of adults with surgically repaired or palliated congenital heart defects is growing. Many of these adults have reduced exercise capacity, weaker muscular strength and shorter height, all of which suggest an altered body composition.The overall aim of this thesis was to evaluate the body composition, in terms of bone, muscle and fat mass, in adults with complex congenital heart disease (CHD). Changes as such may be of prognostic importance and thus suggest future therapeutic targets outside the traditional hunting grounds of the cardiologist.Material and methods: The overall material consisted of two cohorts. The first cohort, recruited in a Swedish multicentre study, comprised 73 adult patients with complex CHD and 73 controls, matched for age and sex. Participants were examined with full body dual-energy x-ray absorptiometry (DXA), providing muscle, bone and fat mass for arms, legs and trunk respectively (papers I and II).The second cohort, recruited within a single centre study, comprised 49 adult patients with complex CHD and 49 age and sex matched controls. Participants were examined with peripheral quantitative computed tomography (pQCT), providing slices of forearm and calf, describing muscle, bone and fat area and corresponding density (papers III and IV). Muscular strength in selected muscle groups was also evaluated in both cohorts.Results: More than half of the adults with complex CHD had a pathologically low skeletal muscle mass and strength compared to controls, a trait referred to as sarcopenia. There was a strong association between forearm muscle mass and grip strength.Bone mass was lower in adults with complex CHD, according to both DXA and pQCT analyses, also when adjusting for shorter height. Patients also had lower full body bone mineral density (BMD) as measured with DXA. However, analysis of BMD in limbs with pQCT showed no such reduction. Despite this latter finding, the strength-strain index (a surrogate marker for bone strength provided by pQCT in the lower limbs) was still lower in patients compared to controls.Female patients had a higher amount of fat, both in terms of fat mass and proportion of fat, in comparison to controls. The fat mass was predominantly distributed around the internal organs, known as visceral adipose tissue. Male patients showed no such difference regarding fat mass compared to controls.Conclusion: Consequences of living with complex CHD go far beyond the heart; this young population presents a reduced skeletal muscle mass as well as reduced bone strength – both premature traits of frailty, prone to increase with further ageing. Also, women with complex CHD have an increased amount of visceral adipose tissue, which may elevate the risk of acquired heart disease.The extent of future complications remains to be seen. However, the standard treatments for both sarcopenia and osteoporosis include optimal nutritional intake and increased physical exercise. These measures should start sooner rather than later, preferably evaluated through existing quality registers and interventional trials.
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27.
  • Johansson, Karna, 1982-, et al. (författare)
  • Grip strength is a good marker of sarcopenia in adults with complex congenital heart disease
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Adults with congenital heart disease (CHD) have a low muscle mass (measured with Dual energy x-ray absorptiometry). Our aims were to confirm these results using peripheral quantitative computed tomography (pQCT), and to study the relationship between muscle cross sectional area (CSA) and isometric muscle strength. Methods: In this cross sectional study, we performed pQCT and tested isometric muscle strength in the forearm and calf of 49 adults with complex CHD and 49 age and sex matched controls (for each group: mean age 36±15.5 years; n=23 females, 47%). Results: In the forearm, after adjusting for height, patients had lower muscle CSA and lower isometric strength compared to controls (women: 24.1±6.7 vs. 26.2±6.7 cm2, p=0.05 and 30.0±1.0 vs. 33.4±1.0 kg, p=0.03; men: 36.0±1.2 vs. 42.5±1.2 cm2, p=0.001 and 47.2±1.9 vs. 53.4±1.9 kg, p=0.03). In addition, both patients and controls had strong correlations between muscle CSA and isometric strength. In the calf, female patients did not have lower muscle CSA than controls after correcting for height (60.5±1.4 vs. 62.7±1.4cm2, p=0.3), whereas men did (69.9±1.7 vs. 80.3±1.7 cm2, p<0.001). Isometric strength in the calf was lower in female patients than controls (487±35 vs. 614±35 N, p=0.02) but not in males (588±44 vs. 697±44 N, p=0.08), and there was no correlation with muscle CSA. Conclusion: In conclusion, adults with complex CHD have low forearm muscle CSA as assessed with pQCT. Grip strength correlates well with forearm muscle CSA and may serve as an indirect measurement of muscle mass.
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28.
  • Johansson, Karna, 1982-, et al. (författare)
  • Reduced bone strength in adults with complex congenital heart disease
  • Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
    • Objective To study bone mineral density (BMD) and skeletal strength in adults with complex congenital heart disease (CHD) in comparison to a matched control group.MethodsPeripheral quantitative computed tomography (pQCT) was performed on standardized sites of the radius and tibia in 49 adults with complex CHD, and in 49 age and sex matched controls (n = 23 [47 %] female, mean age 36 ± 15.5 years.) Strength for lateral and anterior acting forces in the radius and tibia were presented, respectively, in terms of x- and y-Strength-Strain Index (SSI).Results Patients had similar total BMD as controls in both the radius (807 ± 82 vs. 792 ± 75 mg/cm3, p = 0.3) and tibia (663 ± 86 vs.689 ± 67 mg/cm3, p = 0.1). In the radius, patients had a lower xSSI than controls (154 ± 46 vs. 175 ± 54 mm3, p = 0.04) but a similar ySSI (178 ± 58 vs. 195 ± 55 mm3, p = 0.1). In the tibia, patients had a lower xSSI (1492 ± 399 vs. 1780 ± 372 mm3, p < 0.001) as well as ySSI (1066 ± 304 vs. 1250 ± 281, p = 0.002). In a multiple linear regression model, only height was independently associated with decreased skeletal strength in patients tibia in terms of xSSI [F(2,46) = 40.002, p < 0.001, R2 = 0.635]. Being a patient, with single ventricle physiology or other diagnose of complex CHD, was independently associated with decreased tibia xSSI [F(2,95) = 7.085, p = 0.001, η2 = 0.13].Conclusion Adults with complex CHD had reduced strength in the radius and tibia, despite a normal BMD as assessed with pQCT. Whether their reduced bone strength entails increased risk of future fractures is currently unknown.
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29.
  • Johansson, Karna, 1982-, et al. (författare)
  • Reduced bone strength in adults with moderate or complex congenital heart disease
  • 2021
  • Ingår i: International Journal of Cardiology Congenital Heart Disease. - : Elsevier. - 2666-6685. ; 6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: We aimed to study bone mineral density (BMD) and skeletal strength in the growing population of adults with moderate or complex congenital heart disease (CHD).Methods: Peripheral quantitative computed tomography (pQCT) was performed on the radius and tibia in 49 adults with moderate or complex CHD, and in 49 age and sex matched controls (n = 23 [47%] female, mean age 36 +/- 15.5 years.) Strength in the radius and tibia were presented, respectively, in terms of Strength-Strain Index (SSI).Results: Patients had similar total BMD as controls in both the radius (807 +/- 82 vs. 792 +/- 75 mg/cm(3), p = 0.3) and tibia (663 +/- 86 vs. 689 +/- 67 mg/cm(3), p = 0.1). In the radius, patients had a lower xSSI than controls (154 +/- 46 vs. 175 +/- 54 mm(3), p = 0.04) but a similar ySSI (178 +/- 58 vs. 195 +/- 55 mm(3), p = 0.1). In the tibia, patients had a lower xSSI (1492 +/- 399 vs. 1780 +/- 372 mm(3), p < 0.001) as well as ySSI (1066 +/- 304 vs. 1250 +/- 281, p = 0.002). In a multiple linear regression model, only height was independently associated with decreased skeletal strength in patients tibia in terms of xSSI [F(2,46) = 40.002, p < 0.001, R-2 = 0.635].Conclusion: Adults with moderate or complex CHD had reduced strength in the radius and tibia, despite a normal BMD as assessed with pQCT. Their reduced bone strength could increase the risk of future fractures.
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30.
  • Jun, Seong-Hwan, et al. (författare)
  • Reconstructing clonal tree for phylo-phenotypic characterization of cancer using single-cell transcriptomics
  • 2023
  • Ingår i: Nature Communications. - : Springer Nature. - 2041-1723. ; 14:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Functional characterization of the cancer clones can shed light on the evolutionary mechanisms driving cancer's proliferation and relapse mechanisms. Single-cell RNA sequencing data provide grounds for understanding the functional state of cancer as a whole; however, much research remains to identify and reconstruct clonal relationships toward characterizing the changes in functions of individual clones. We present PhylEx that integrates bulk genomics data with co-occurrences of mutations from single-cell RNA sequencing data to reconstruct high-fidelity clonal trees. We evaluate PhylEx on synthetic and well-characterized high-grade serous ovarian cancer cell line datasets. PhylEx outperforms the state-of-the-art methods both when comparing capacity for clonal tree reconstruction and for identifying clones. We analyze high-grade serous ovarian cancer and breast cancer data to show that PhylEx exploits clonal expression profiles beyond what is possible with expression-based clustering methods and clear the way for accurate inference of clonal trees and robust phylo-phenotypic analysis of cancer. The functional changes of individual clones in single cell RNA sequencing (scRNA-seq) data remain elusive. Here, the authors develop PhylEx that integrates bulk genomics data with co-occurrences of mutations revealed by scRNA-seq data and apply it to high-grade serous ovarian cancer cell line and breast cancer datasets.
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31.
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32.
  • Klevebring, Daniel, et al. (författare)
  • Exome sequencing of contralateral breast cancer identifies metastatic disease
  • 2015
  • Ingår i: Breast Cancer Research and Treatment. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0167-6806 .- 1573-7217.
  • Tidskriftsartikel (refereegranskat)abstract
    • Women with contralateral breast cancer (CBC) have significantly worse prognosis compared to women with unilateral cancer. A possible explanation of the poor prognosis of patients with CBC is that in a subset of patients, the second cancer is not a new primary tumor but a metastasis of the first cancer that has potentially obtained aggressive characteristics through selection of treatment. Exome and whole-genome sequencing of solid tumors has previously been used to investigate the clonal relationship between primary tumors and metastases in several diseases. In order to assess the relationship between the first and the second cancer, we performed exome sequencing to identify somatic mutations in both first and second cancers, and compared paired normal tissue of 25 patients with metachronous CBC. For three patients, we identified shared somatic mutations indicating a common clonal origin thereby demonstrating that the second tumor is a metastasis of the first cancer, rather than a new primary cancer. Accordingly, these patients all developed distant metastasis within 3 years of the second diagnosis, compared with 7 out of 22 patients with non-shared somatic profiles. Genomic profiling of both tumors help the clinicians distinguish between true CBCs and subsequent metastases.
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33.
  • Larsson, Lena, et al. (författare)
  • Adults with congenital heart disease overestimate their physical activity level
  • 2019
  • Ingår i: IJC Heart and Vasculature. - : Elsevier BV. - 2352-9067. ; 22, s. 13-17
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Physical activity reduces the risk of acquired cardiovascular disease, which is of great importance in patients with congenital heart disease (CHD). There are diverging data whether physical activity level (PAL) differs between patients with CHD and controls. Furthermore, it is unknown if PAL can be reliably assessed in patients with CHD using self-reported instruments. Methods: Seventy-five patients with CHD (mean age 37.5 ± 15.5 years, women n = 29 [38.7%]) and 42 age and sex matched controls completed the International Physical Activity Questionnaire (IPAQ) and carried the activity monitor Actiheart over 4 days. Time spent at ≥3 METS ≥21.4 min/day, i.e. reaching the WHO recommendation for PAL to promote health, was used as the outcome measure. Data on PAL obtained from IPAQ were compared with Actiheart. Results: The proportion of individuals reaching target PAL according to IPAQ was similar in patients with CHD and controls (70.7%vs.76.2%, p = 0.52) as well as between patients with simple and complex lesions. There was an overall difference between IPAQ and Actiheart in detecting recommended PAL (72.6%vs.51.3%, p < 0.001). In a subgroup analysis, this difference was also detected in patients but was borderline for controls. The negative predictive value for IPAQ in detecting insufficient PAL was higher in patients than in controls (73%vs.40%). Conclusions: The proportion of persons reaching sufficient PAL to promote health was similar in patients and controls. The self-reported instrument overestimated PAL in relation to objective measurements. However, with a high negative predictive value, IPAQ is a potentially useful tool for detecting patients with insufficient PAL.
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34.
  • Larsson, Lena, et al. (författare)
  • Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects
  • 2019
  • Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 280, s. 57-60
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Atrial septal defect (ASD) is a congenital heart lesion that often remains undiagnosed until adulthood. The reasons for this may be multifactorial. It is, however, known that closure of a hemodynamically significant ASD improves exercise capacity. This study aimed to explore whether the aerobic capacity in late adolescence is associated with time to diagnosis and intervention in adult men with late diagnosis of an atrial shunt.Methods: The Swedish Military Conscription Service Register contains data on exercise tests performed in late adolescence. By linking these data with the National Patient Register, 254 men with a later intervention for an ASD were identified.Results: Interventions were performed at a mean of 26.5 +/- 7.9 years after the initial exercise tests. The mean absolute workload among those with a later diagnosed ASD was similar to those without a later diagnosed ASD (274 +/- 51W vs. 276 +/- 52 W, p = 0.49). Men with a higher exercise capacity (>= 1 SD) had their intervention earlier (21.9 +/- 8.6 years vs. 27.5 +/- 7.4 years, p < 0.001).Conclusions: The aerobic exercise capacity was similar in adolescent men with later interventions for ASD compared to the reference population. Furthermore, those with high exercise capacity appeared to be diagnosed earlier. Thus, low exercise capacity may not be a feature of ASD during adolescence, but rather develop later in life as a natural progression of the disease.
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35.
  • Larsson, Lena, et al. (författare)
  • Geographical variation and predictors of physical activity level in adults with congenital heart disease
  • 2019
  • Ingår i: International Journal of Cardiology : Heart & Vasculature. - : Elsevier. - 2352-9067. ; 22, s. 20-25
  • Tidskriftsartikel (refereegranskat)abstract
    • Physical activity is important to maintain and promote health. This is of particular interest in patients with congenital heart disease(CHD) where acquired heart disease should be prevented. The World Health Organization (WHO) recommends a minimum of 2.5 h/week of physical activity exceeding 3 metabolic equivalents (METS) to achieve positive health effects. It is unknown whether physical activity levels (PAL) in adult CHD patients differ by country of origin.Methods3896 adults with CHD recruited from 15 countries over 5 continents completed self-reported instruments, including the Health Behaviour Scale (HBS-CHD), within the APPROACH-IS project. For each patient, we calculated whether WHO recommendations were achieved or not. Associated factors were investigated using Generalized Linear Mixed Models.ResultsOn average, 31% reached the WHO recommendations but with a great variation between geographical areas (India: 10%–Norway: 53%). Predictors for physical activity level in line with the WHO recommendations, with country of residence as random effect, were male sex (OR 1.78, 95%CI 1.52–2.08), NYHA-class I (OR 3.10, 95%CI 1.71–5.62) and less complex disease (OR 1.46, 95%CI 1.16–1.83). In contrast, older age (OR 0.97, 95%CI 0.96–0.98), lower educational level (OR 0.41, 95%CI 0.26–0.64) and being unemployed (OR 0.57, 95%CI 0.42–0.77) were negatively associated with reaching WHO recommendations.ConclusionsA significant proportion of patients with CHD did not reach the WHO physical activity recommendations. There was a large variation in physical activity level by country of origin. Based on identified predictors, vulnerable patients may be identified and offered specific behavioral interventions.
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36.
  • Larsson, Lena, et al. (författare)
  • Geographical variation in and predictors of physical activity level in adults with congenital heart disease
  • 2018
  • Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 39, s. 242-243
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Physical activity is important to maintain and promote health. This is of particular interest in patients with congenital heart disease (CHD) where acquired heart disease should be prevented. The World Health Organization (WHO) recommends a minimum of 2.5 hours/week of physical activity exceeding 3 metabolic equivalents (METS) to achieve positive health effects. It is unknown whether physical activity levels (PAL) in adult CHD patients differ by country of origin.Methods: 4028 adults with CHD recruited from 15 countries over 5 continents completed self-reported instruments, including the Health Behaviour Scale (HBS-CHD), within a multicenter project. For each patient, we calculated whether WHO recommendations were achieved or not. Associated factors were investigated using Generalized Linear Mixed Models.Results: On average, 27% reached the WHO recommendations but with a great variation between geographical areas (Japan: 9% - Norway: 49%) (Figure). Predictors for PAL in line with the WHO recommendations, with country of residence as random effect, were male sex (OR 1.68, 95% CI 1.43–1.97), NYHA-class I (OR 2.79, 95% CI 1.54–5.06) and less complex disease (OR 1.28, 95% CI 1.02–1.62). In contrast, older age (OR 0.97, 95% CI 0.97–0.98), lower educational level (OR 0.41, 95% CI 0.26–0.65) and being unemployed (OR 0.58, 95% CI 042–0.78) were negatively associated with reaching WHO recommendations.Conclusions: A significant proportion of patients with CHD did not reach the WHO physical activity recommendations. There was a large variation in PAL by country of origin. Based on identified predictors, vulnerable patients may be identified and offered specific behavioural interventions.
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37.
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38.
  • Nielsen, Natalie, 1972- (författare)
  • The Erasmus Learning Journey : Students’ Experiences from a Mobility Period Abroad
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of this thesis is to gain knowledge and understanding of students’ learning through a mobility period abroad. Student mobility is a topic that attracts great scholarly attention internationally and has also gained increased attention in Sweden lately, both in terms of policy aims related to student mobility as well as attracting scholarly interest. Whilst there is a vast body of knowledge in relation to student mobility, it has largely focused on identifying and measuring different learning outcomes as regards specific skills and competencies acquired from participation in study abroad programs (Streightwieser & Light, 2018). Less research has focused on what students themselves experience and learn from participation in a mobility period abroad and if and how they personally develop and undergo change from the study abroad experience. This thesis takes the students’ perspective in order to increase knowledge about student learning from a mobility period abroad. The study presents a cross-sectional study that explored students’ motives, experiences and self-reported outcomes of participation in the Erasmus program. The data are based on semi-structured interviews with 45 Erasmus alumni from Stockholm University and the interviews were conducted as reflective conversations. The following research questions were formulated to achieve the aim of the thesis; why do students in higher education seek the study abroad experience? What experiences do students describe in relation to their learning and personal development? What learning processes can be identified in these experiences?The theoretical framework is grounded in theories of adult learning and development, which aims to understand how students learn from their experiences. Jarvis’ concepts of ‘harmony’ and ’disjuncture’ and Mezirow’s concept of ‘perspective transformation’ is used to identify the different learning journeys in relation to different motives, experiences and outcomes. The results show that students learn new knowledge and skills as well as questioning assumptions and changing assumptions following the Erasmus stay. From the results, five different learning journeys are identified including a positive learning journey, a neutral learning journey, a highly reflective learning journey and two transformative learning journeys as being either a reactive or a pro-active process. A positive learning journey involves an outcome of learning of different skills and gaining new or deepened academic and cultural knowledge; a neutral learning journey involves an outcome of “a sense being the same” following the Erasmus stay; a highly reflective learning journey involves an outcome of increased self-awareness and cultural awareness; a reactive transformative learning journey involves an outcome of having changed view of oneself and/or others; and a proactive transformative learning journey involves a changed view of oneself, or towards others and/or life. These different learning journeys show that the study abroad experience is not a “one size fits all” experience as students who decide to study abroad during their time in higher education come from different backgrounds and have different experiences during the mobility period abroad and thus have different learning journeys, i.e. engaging in different processes of learning. The identification of a pro-active transformative learning journey contributes to the elaboration of the theory of transformative learning by employing Jarvis’ concept of ‘disjuncture’ as being both reactive in relation to a social experience (external) that causes internal ‘disjuncture’ (either cognitively or emotively) as well as being pro-active by internal ’disjuncture’ in wanting to change and challenge one’s assumptions in different areas.
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39.
  • Nordin, Fredrik, et al. (författare)
  • Concurrent validity of a fixated hand-held dynamometer for measuring isometric knee extension strength in adults with congenital heart disease
  • 2020
  • Ingår i: European Journal of Physiotherapy. - : Taylor & Francis. - 2167-9169 .- 2167-9177. ; 22:4, s. 206-211
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The purpose of this study was to examine the concurrent validity of a fixated hand-held dynamometer (HHD) in comparison to a load cell in measurement of maximal isometric knee extension force in adults with congenital heart disease (CHD) and healthy adults.Methods: Fourteen adults with CHD and fourteen healthy adults were included. Each participant was tested three times with each method and the mean of the top two results for each participant and method was used in analysis.Results: The agreement between the two methods was excellent in both groups (intraclass correlation coefficient [ICC], 95% confidence interval [CI]) 0.98 (0.92–1.00) in the CHD group and ICC 0.99 (0.96–1.00) in the healthy group). There was a small difference of 19.5 Newton or 4.8% (p<.05) between the two methods in the CHD group. No significant difference was seen between the two methods in the healthy group (p>.05).Conclusions: The fixated HHD demonstrated excellent concurrent validity when compared to a load cell among adults with CHD as well as in healthy adults. Thus, in a healthy population the methods can be used interchangeably, however, a small difference between the methods is seen in the CHD group.
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40.
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41.
  • Sandberg, Camilla, et al. (författare)
  • Adults with complex congenital heart disease have impaired skeletal muscle function and reduced confidence in performing exercise training
  • 2015
  • Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 22:12, s. 1523-1530
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Adults with congenital heart disease (ACHD) usually have reduced aerobic exercise capacity compared with controls. However, their skeletal muscle function is less studied. Material and methods In this cross-sectional study, unilateral isotonic shoulder flexion, unilateral isotonic heel-lift, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were tested in 85 patients with ACHD (35 women, mean age 36.814.8 years), classed as either complex' (n=43) or simple' (n=42), and 42 age and gender matched controls (16 women, mean age 36.914.9). Maximum number of shoulder flexions and heel-lifts were measured. MIP/MEP was tested using a handheld respiratory pressure meter. Exercise self-efficacy, measuring confidence in performing exercise training, was evaluated. Results Adults with complex lesions performed fewer shoulder flexions compared with controls and patients with simple lesions (28.2 +/- 11.1 vs. 63.6 +/- 40.4, p<0.001 and 28.2 +/- 11.1 vs. 54.9 +/- 24.9, p<0.001), as well as fewer heel-lifts compared with controls and patients with simple lesions (17.6 +/- 7.7 vs. 26.3 +/- 12.8, p<0.001 and 17.6 +/- 7.7 vs. 23.2 +/- 7.0, p=0.024), lower MIP than controls (80.7 +/- 26.7 vs. 111.1 +/- 29.9cm H2O, p<0.001) and lower MEP compared with controls (110.8 +/- 39.9 vs. 141.8 +/- 39.5, p<0.001). Their exercise self-efficacy was lower than controls (28.0 +/- 8.3 vs. 33.4 +/- 6.1, p=0.002). In a linear regression model complex heart lesions were independently associated with impaired limb muscle function. Conclusion Adults with complex congenital heart disease have impaired skeletal muscle function compared with patients with simple lesions and healthy controls. They also had lower confidence in performing exercise training. Thus, this population might have a potential for rehabilitation focusing on improving muscle function and confidence in performing exercise training.
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42.
  • Sandberg, Camilla, et al. (författare)
  • Adults with congenital heart disease have impaired calf muscle oxygenation compared to control subjects
  • 2019
  • Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 40:Supplement_1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundPeripheral muscle factors are presumed to be important contributors to the reduced exercise capacity in congenital heart disease (CHD), but the mechanisms are poorly understood.PurposeTo investigate if muscle oxygenation in the calf muscle is impaired in adults with complex CHD in comparison to controls.MethodSeventy-four adults with complex CHD (35.6±14.3 years, females n=22) were recruited from centers specialized in adult CHD. Seventy-four age and gender matched subjects were recruited as controls. Muscle oxygenation was successfully determined using near-infrared spectroscopy on the medial portion of m. gastrocnemiusin 63 patients and 67 controls. Measurements were made at rest, during venous occlusion to estimate blood flow (BF – indicated by the slope increase of total haemoglobin, HbT), at the start of isotonic unilateral heel-lifts to exhaustion, and immediately after exercise.ResultsIn comparison to controls, patients had a lower muscle saturation (StO2) at rest, albeit not statistically significant, (66±17% vs. 60±19%, p=0.07), and a lower BF (0.38±0.21 vs. 0.31±0.21 HbTx3.5sec–1, p=0.07). For exercise, compared to the controls, patients had a slower desaturation rate at exercise onset (−11.7±5.8% vs. −7.7±4.3%. StO2x3.5sec–1, p<0.001), and both a slower resaturation rate (6.1±3.8% vs. 3.9±3.7% StO2x3.5sec–1, p=0.002) and a slower half recovery time (16.8±11.1 vs. 28.6±21.2 sec, p<0.001) post exercise.ConclusionThe lower muscle oxygenation and blood flow at rest, and the slower oxygenation kinetics during exercise may give insight to the mechanism for the reduced exercise capacity commonly found in adults with complex CHD. This finding may also provide implications for design of rehabilitation programs for these patients.
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43.
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44.
  • Sandberg, Camilla, et al. (författare)
  • Complex adult congenital heart disease is associated with impaired skeletal muscle function
  • 2013
  • Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 383-383
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Complex congenital heart disease is often associatedwith impaired physical functioning, usually measured as peak oxygen uptake in an exercise test. Skeletal muscle function is, however, less studied in these patients.Methods: Unilateral isotonic shoulder flexion was tested in 79 adultpatients (mean age 36.6±14.8 years, 31 females) with congenital heartdisease, classed as either "complex" (n=41, 51.9%) or "simple" (n=38, 48.1%). The patients were sitting comfortably in a chair with their back touching the wall and holding a weight (2 kg for women and 3 kg for men) in the hand of the tested side. The patients were asked to elevate the arm, from 0 to 90 degrees flexion, as many times as possible. The pace of 20 contractions per minute was held using a metronome.Results: Patients with complex lesions performed less shoulder flexions compared with patients with simple lesions (29.2±10.0 vs. 54.6±25.8, p<0.001). In univariate analysis including a number of demographic and clinical variables, only complexity of cardiac lesion (p<0.001) and on-going cardiac medications (p=0.012) were associated with shouldermuscle function, of which complexity (p<0.001) remained significant in multivariate analysis.Conclusion: There is a marked difference in shoulder muscle functionbetween patients with complex and simple congenital heart disease. Such differences might affect ability to perform daily activities and contribute to impaired overall physical functioning. Rehabilitation targeting muscle function may be indicated in patients with complexcongenital heart disease.
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45.
  • Sandberg, Camilla, et al. (författare)
  • Despite reductions in muscle mass and muscle strength in adults with CHD, the muscle strength per muscle mass relationship does not differ from controls
  • 2021
  • Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 31:5, s. 792-798
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Patients with CHD exhibit reduced isometric muscle strength and muscle mass; however, little is known how these parameters relate. Therefore, the aim was to investigate the relation between isometric limb muscle strength and muscle mass for patients in comparison to age- and sex-matched control subjects.METHODS: Seventy-four patients (35.6 ± 14.3 years, women n = 22) and 74 matched controls were included. Isometric muscle strength in elbow flexion, knee extension, and hand grip was assessed using dynamometers. Lean mass, reflecting skeletal muscle mass, in the arms and legs was assessed with dual-energy x-ray absorptiometry.RESULTS: Compared to controls, patients had lower muscle strength in elbow flexion, knee extension, and hand grip, and lower muscle mass in the arms (6.6 ± 1.8 kg versus 5.8 ± 1.7 kg, p < 0.001) and legs (18.4 ± 3.5 kg versus 15.9 ± 3.2 kg, p < 0.001). There was no difference in achieved muscle force per unit muscle mass in patients compared to controls (elbow flexion 0.03 ± 0.004 versus 0.03 ± 0.005 N/g, p = 0.5; grip strength 0.008 ± 0.001 versus 0.008 ± 0.001 N/g, p = 0.7; knee extension 0.027 ± 0.06 versus 0.028 ± 0.06 N/g, p = 0.5). For both groups, muscle mass in the arms correlated strongly with muscle strength in elbow flexion (patients r = 0.86, controls, r = 0.89), hand grip (patients, r = 0.84, controls, r = 0.81), and muscle mass in the leg to knee extension (patients r = 0.64, controls r = 0.68).CONCLUSION: The relationship between isometric muscle strength and limb muscle mass in adults with CHD indicates that the skeletal muscles have the same efficiency as in healthy controls.
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46.
  • Sandberg, Camilla, et al. (författare)
  • Height, weight and body mass index in adults with congenital heart disease
  • 2015
  • Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 187, s. 219-226
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: High BMI is a risk factor for cardiovascular disease and, in contrast, low BMI is associated with worse prognosis in heart failure. The knowledge on BMI and the distribution in different BMI-classes in adults with congenital heart disease (CHD) are limited. Methods and results: Data on 2424 adult patients was extracted from the Swedish Registry on Congenital Heart Disease and compared to a reference population (n = 4605). The prevalence of overweight/obesity (BMI >= 25) was lower in men with variants of the Fontan procedure, pulmonary atresia (PA)/double outlet right ventricle (DORV) and aortic valve disease (AVD) (Fontan 22.0% and PA/DORV 15.1% vs. 43.0%, p = 0.048 and p < 0.001) (AVD 37.5% vs. 49.3%, p < 0.001). Overt obesity (BMI >= 30) was only more common in women with AVD (12.8% vs. 9.0%, p = 0.005). Underweight (BMI < 18.5) was generally more common in men with CHD (complex lesions 4.9% vs. 0.9%, p < 0.001 and simple lesions 3.2% vs. 0.6%, <0.001). Men with complex lesions were shorter than controls in contrast to females that in general did not differ from controls. Conclusion: Higher prevalence of underweight in men with CHD combined with a lower prevalence of over-weight/obesity in men with some complex lesions indicates that men with CHD in general has lower BMI compared to controls. In women, only limited differences between those with CHD and the controls were found. The complexity of the CHD had larger impact on height in men. The cause of these gender differences as well as possible significance for prognosis is unknown. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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47.
  • Sandberg, Camilla, et al. (författare)
  • Home-based interval training increases endurance capacity in adults with complex congenital heart disease
  • 2018
  • Ingår i: Congenital Heart Disease. - : Computers, Materials and Continua (Tech Science Press). - 1747-079X .- 1747-0803. ; 13:2, s. 254-262
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectiveThe beneficial effects of exercise training in acquired heart failure and coronary artery disease are well known and have been implemented in current treatment guidelines. Knowledge on appropriate exercise training regimes for adults with congenital heart disease is limited, thus further studies are needed. The aim of this study was to examine the effect of home-based interval exercise training on maximal endurance capacity and peak exercise capacity. MethodsTwenty-six adults with complex congenital heart disease were recruited from specialized units for adult congenital heart disease. Patients were randomized to either an intervention group12 weeks of home-based interval exercise training on a cycle ergometer (n=16), or a control group (n=10). The latter was instructed to maintain their habitual physical activities. An incremental cardiopulmonary exercise test and a constant work rate cardiopulmonary exercise test at 75% of peak workload were performed preintervention and postintervention. ResultsTwenty-three patients completed the protocol and were followed (intervention n=13, control n=10). Postintervention exercise time at constant work rate cardiopulmonary exercise test increased in the intervention group compared to controls (median[range] 12[-4 to 52]min vs 0[-4 to 5]min, P=.001). At incremental cardiopulmonary exercise test, peak VO2 increased 15% within the intervention group (P=.019) compared to 2% within the control group (P=.8). However, in comparison between the groups no difference was found (285[-200 to 535] ml/min vs 17[-380 to 306] ml/min, P=.10). In addition, peak workload at incremental cardiopulmonary exercise test increased in the intervention group compared to controls (20[-10 to 70]W vs 0[-20 to 15]W, P=.003). ConclusionHome-based interval exercise training increased endurance capacity and peak exercise capacity in adults with complex congenital heart disease. Aerobic endurance might be more relevant than peak oxygen uptake with regard to daily activities, and therefore a more clinically relevant measure to evaluate.
  •  
48.
  • Sandberg, Camilla, et al. (författare)
  • Impaired knee extension muscle strength in adolescents but not in children with Fontan circulation
  • 2020
  • Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 30:8, s. 1138-1143
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Impaired isometric muscle strength was previously reported in adults with Fontan circulation. However, it is unclear if this impairment is present in children and adolescents with Fontan circulation. We investigated isometric muscle strength of the lower limb in patients (6–18 years) with Fontan circulation in comparison with healthy controls.Method: In this cross-sectional study, 43 patients (6–18 years) with Fontan circulation and 43 age- and sex-matched controls were included. Isometric knee extension and plantar flexion muscle strength were assessed using dynamometry (Newton, N). Lean mass of the legs was assessed with dual-energy X-ray absorptiometry. Analyses were performed on group level (n = 43), and for subgroups that included children aged 6–12 years (n = 18) and adolescents aged 13–18 years (n = 25).Results: On group level, the patients with Fontan circulation had impaired isometric knee extension strength in comparison with the controls (p = 0.03). In subgroup analyses, impaired isometric knee extension strength was present in the adolescents (p = 0.009) but not in the children groups. For plantar flexion, there was no difference between patients and controls. There was no difference in lean mass between patients and controls (9.6 ± 4.3 kg vs. 10.8 ± 5.6 kg, p = 0.31). However, the lean mass was highly correlated to isometric knee extension strength (patients r = 0.89, controls r = 0.96, p < 0.001) and isometric plantar flexion strength (patients r = 0.7, controls r = 0.81, p < 0.001).Conclusion: The finding of impaired isometric knee extension muscle strength in adolescents (13–18 years) with Fontan circulation and no corresponding impairment in the children group (6–12 years) could imply that isometric muscle strength gets more impaired with age.
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49.
  • Sandberg, Camilla, et al. (författare)
  • Impaired Skeletal Muscle Endurance in Adults With Complex Congenital Heart Disease is Associated With Local Muscle Oxygenation Kinetics
  • 2018
  • Ingår i: Circulation. - 0009-7322 .- 1524-4539. ; 138, s. A15914-
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Adults with complex congenital heart disease show reduced aerobic exercise capacity and impaired skeletal muscle function compared to healthy peers. Peripheral muscle factors are presumed to be important contributors, but the mechanisms are poorly understood. Hypothesis: Muscle oxygenation is associated with reduced skeletal muscle endurance in adults with complex CHD. Methods: Sixty-four adults with complex congenital heart disease (mean age 36.9±14.8 years, females n=19) were recruited from centers specialized in congenital heart disease. Seventy-four age and gender matched healthy peers were recruited as controls. Muscle oxygen saturation was successfully determined on the anterior portion of the deltoid muscle using near-infrared spectroscopy for 57 patients and 71 controls. Measurements were made at baseline, during isotonic shoulder flexions (0-90°) to exhaustion and during 60 seconds of recovery. Results: The adults with complex CHD performed fewer shoulder flexions (38±15 vs. 69±40, p <0.001), had lower muscle oxygen saturation at rest (58±17% vs. 69±18%, p <0.001), a slower desaturation rate at exercise onset (-9.5±5.9%/sec vs. -15.1±6.5%/sec, p <0.001), and a slower resaturation rate post exercise (3.9±2.8%/sec vs. 5.4±3.6%/sec, p =0.008) compared to the controls. Conclusions: A distinct association was found between muscle oxygenation kinetics and early muscle fatigue for adults with complex CHD. Our findings may give insight to the underlying mechanisms for the reduced aerobic exercise capacity for these patients, and therefore provide implications for design of exercise training protocols in this population. [ABSTRACT FROM AUTHOR]
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