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1.
  • Glimelius, Bengt, et al. (författare)
  • U-CAN : a prospective longitudinal collection of biomaterials and clinical information from adult cancer patients in Sweden.
  • 2018
  • Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 57:2, s. 187-194
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Progress in cancer biomarker discovery is dependent on access to high-quality biological materials and high-resolution clinical data from the same cases. To overcome current limitations, a systematic prospective longitudinal sampling of multidisciplinary clinical data, blood and tissue from cancer patients was therefore initiated in 2010 by Uppsala and Umeå Universities and involving their corresponding University Hospitals, which are referral centers for one third of the Swedish population.Material and Methods: Patients with cancer of selected types who are treated at one of the participating hospitals are eligible for inclusion. The healthcare-integrated sampling scheme encompasses clinical data, questionnaires, blood, fresh frozen and formalin-fixed paraffin-embedded tissue specimens, diagnostic slides and radiology bioimaging data.Results: In this ongoing effort, 12,265 patients with brain tumors, breast cancers, colorectal cancers, gynecological cancers, hematological malignancies, lung cancers, neuroendocrine tumors or prostate cancers have been included until the end of 2016. From the 6914 patients included during the first five years, 98% were sampled for blood at diagnosis, 83% had paraffin-embedded and 58% had fresh frozen tissues collected. For Uppsala County, 55% of all cancer patients were included in the cohort.Conclusions: Close collaboration between participating hospitals and universities enabled prospective, longitudinal biobanking of blood and tissues and collection of multidisciplinary clinical data from cancer patients in the U-CAN cohort. Here, we summarize the first five years of operations, present U-CAN as a highly valuable cohort that will contribute to enhanced cancer research and describe the procedures to access samples and data.
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2.
  • Christensen, Sarah Friis, et al. (författare)
  • Healthcare resource utilization in patients with myeloproliferative neoplasms: A Danish nationwide matched cohort study
  • 2022
  • Ingår i: European Journal of Haematology. - : John Wiley & Sons. - 0902-4441 .- 1600-0609.
  • Tidskriftsartikel (refereegranskat)abstract
    • Few studies have assessed healthcare resource utilization (HRU) in patients with Philadelphia-negative myeloproliferative neoplasms (MPN) using a matched cohort design. Further, no detailed assessment of HRU in the years preceding an MPN diagnosis exists. We conducted a registry-based nationwide Danish cohort study, including patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN diagnosed between January 2010 and December 2016. HRU data were summarized annually from 2 years before MPN diagnosis until emigration, death, or end of study (December 2017). We included 3342 MPN patients and 32 737 comparisons without an MPN diagnosis, matched on sex, age, region of residence, and level of education. During the study period, the difference in HRU (rate ratio) between patients and matched comparisons ranged from 1.0 to 1.5 for general practitioner contacts, 0.9 to 2.2 for hospitalizations, 0.9 to 3.8 for inpatient days, 1.0 to 4.0 for outpatient visits, 1.3 to 2.1 for emergency department visits, and 1.0 to 4.1 for treatments/examinations. In conclusion, MPN patients had overall higher HRU than the matched comparisons throughout the follow-up period (maximum 8 years). Further, MPN patients had substantially increased HRU in both the primary and secondary healthcare sector in the 2 years preceding the diagnosis.
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3.
  • Christensen, Sarah Friis, et al. (författare)
  • Labor Market Attachment in Patients with Myeloproliferative Neoplasms: A Nationwide Matched Cohort Study
  • 2021
  • Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 138:Suppl 1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Myeloproliferative neoplasms (MPNs) are characterized by a substantial symptom burden, risk of debilitating complications (e.g., thrombosis), and increased comorbidity. Recently, three comprehensive questionnaire studies (Mesa 2016, Harrison 2017, Jingbo 2018) have reported a high impact of MPNs on patients' ability to work. However, no registry-based studies have assessed labor market attachment (LMA) of MPN patients and matched nonMPN comparisons.AIM: To assess the pre- and post-diagnostic LMA of MPN patients and matched nonMPN comparisons.METHODS: We conducted a descriptive, registry-based nationwide cohort study, using data from the Danish National Chronic Myeloid Neoplasia Registry including all Danish MPN patients diagnosed between January 2010 and December 2016. Population-based cohorts of nonMPN comparisons were constructed by 1:10 matching on age, sex, level of education, and region of residence. Data on LMA were retrieved from the Danish Register for Evaluation of Marginalization, which holds information on all public transfer payments in Denmark. Data were linked using the unique civil registration number, which identifies all Danish citizens. The LMA endpoints were defined for each individual as working (not receiving any type of transfer payment), unemployed, receiving transfer payment for either sick leave, disability pension, age pension, or other health-related benefits (e.g., wage-subsidized employment). We assessed LMA weekly for each individual from two years before diagnosis until death, emigration, or two years after the diagnosis. For each cohort, we presented LMA as proportions with 95% confidence intervals (CIs), as well as the proportion of individuals who died during follow-up.RESULTS: The study included 3,342 MPN patients (1,140 essential thrombocythemia [ET]; 1,109 polycythemia vera [PV]; 533 myelofibrosis [MF]; and 560 unspecified MPN [MPN-U]) and 32,737 nonMPN comparisons (11,181 nonET; 10,873 nonPV; 5,217 nonPMF; and 5,466 nonMPN-U). The median age at time of diagnosis was: ET 67 years (interquartile range [IQR], 55-76); PV, 69 years (IQR, 61-77); PMF, 73 years (IQR, 66-79); and MPN-U, 72 years (IQR, 63-80).At time of MPN diagnosis, the majority of MPN patients and nonMPN comparisons received age pension (range: ET, 52.1% [95% CI, 49.2-55.0] to nonMF, 70.3% [95% CI, 69.1-71.6]). The proportions working were: ET, 35.1% (95% CI, 32.3-37.9) vs. nonET, 37.3% (95% CI, 36.5-38.2); PV, 22.6% (95% CI, 20.2-25.1) vs. nonPV, 30.8% (95% CI, 29.9-31.7); MF, 23.8% (95% CI, 20.2-27.4) vs. nonMF, 23.6% (95% CI, 22.5-24.8); and MPN-U, 22.1% (95% CI,18.7- 25.6) vs. nonMPN-U, 27.8% (95% CI, 26.6-29.0). Across MPN subtypes, a larger proportion of patients than comparisons were on sick leave: ET, 3.5% (95% CI, 2.4-4.6) vs. nonET, 1.3% (95% CI, 1.1-1.5); PV, 5.5% (95% CI, 4.2-6.8) vs. nonPV, 0.9% (95% CI, 0.7-1.1); MF (not applicable due to small numbers) vs. nonMF, 0.6% (95% CI, 0.4-0.8); and MPN-U, 3.0% (95% CI, 1.6- 4.5) vs. nonMPN-U, 1.0% (95% CI, 0.7-1.3). Regarding disability pension, the proportions ranged from 4.1% (95% CI, 2.4-5.8) to 5.0% (95% CI, 3.7-6.3) among patients and from 3.1% (95% CI, 2.6-3.6) to 4.7% (95% CI, 4.3-5.1) among comparisons. For both MPN patients and nonMPN comparisons, few were unemployed (≤3.3%) or received other health-related benefits (≤1.6%).Two years preceding diagnosis, the proportion of PV and MPN-U patients working was slightly lower than the matched comparisons: PV, 31.0% (95% CI, 28.4-33.8) vs. nonPV, 34.3% (95% CI, 33.5-35.2) and MPN-U, 28.2% (95% CI, 24.6-32.1) vs. nonMPN-U, 32.0% (95% CI, 30.7-33.2), while this difference was not observed between ET and MF patients and their respective comparisons.From two years before to two years after diagnosis, we observed slightly larger reductions in the proportion working among MPN patients than among comparisons. Among MPN patients, the proportion on sick leave including other health-related benefits, increased during the study period, while it remained unchanged among comparisons. The proportion of patients and comparisons on disability pension remained stable.CONCLUSION: Overall, our findings showed that Danish patients with ET, PV, MF, and MPN-U had slightly impaired LMA already two years before diagnosis and up to two years after diagnosis. Thus, fewer patients were working and more patients transferred to sick leave compared with matched individuals without MPN.
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4.
  • Christensen, Sarah, et al. (författare)
  • Healthcare resource utilization in patients with myeloproliferative neoplasms: a nationwide matched cohort study
  • 2021
  • Ingår i: HemaSphere. - : Ovid Technologies (Wolters Kluwer Health). - 2572-9241. ; 5:S2, s. 529-530
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Myeloproliferative neoplasms (MPNs) are associated with severe complications and a substantial symptom burden – frequently emerging several years before diagnosis. Due to the chronic nature ofthe diseases, MPN patients have a lifelong need for treatment and care. However, only few studies have assessed MPN healthcare resource utilization (HRU) compared with matched cohorts, and no detailed assessments of HRU in the years preceding MPN diagnosis exist.Aims: To assess the pre- and post-diagnostic HRU of MPN patients compared with matched cohorts of nonMPN comparisons.Methods: We conducted this descriptive, register-based nationwide cohort study, utilizing data from the Danish National Chronic Myeloid Neoplasia Registry on all MPN patients diagnosed between January 2010 and December 2016, and data on HRU from the Danish National Patient Registry and the Danish National Health Service Registry. Populationbased cohorts of nonMPN comparisons were constructed by 1:10 matchingon age, sex, level of education, and region of residence. Data were linkedusing the unique civil registration number, which identifies all Danish citizens. HRU was summarized over each year for all cohorts from twoyears before date of MPN diagnosis and until emigration, death, or endof study (31 December 2017). HRU was calculated as annual number ofhealthcare contacts (inpatient days, outpatient consultations, treatmentsand examinations, and general practitioner [GP] visits) divided by person-years at risk and compared using rate ratios with 95% CI.Results: The study population included 3,342 MPN patients (1,140 essential thrombocythemia [ET]; 1,109 polycythemia vera [PV]; 533 primary myelofibrosis [PMF]; and 560 unspecified MPN [MPN-U]) and 32,737 nonMPN comparisons (11,181 nonET; 10,873 nonPV; 5,217 nonPMF; and 5,466 nonMPN-U). The median age was 67 (ET), 69 (PV), 73 (PMF), and 72 years (MPN-U), and the mean follow-up was 3.8 (ET), 3.8(PV), 3.1 (PMF), and 3.3 years (MPN-U). A total of 750 (22.4%) MPNpatients and 4,627 (14.1%) nonMPN comparisons died during follow-up.In nearly all years of follow-up, MPN patients had a higher HRU thannonMPN comparisons (Figure, rate ratio>1). Rate ratios for outpatientconsultations were largest at the time of diagnosis: ET, 2.7 (95%CI, 2.6-2.9); PV, 3.4 (95%CI, 3.2-3.6); PMF, 4.0 (95%CI, 3.7-4.4); and MPN-U,3.7 (95%CI, 3.4-4.0). For most MPN subtypes, rate ratios also peaked attime of diagnosis for treatment and examinations. In contrast, the largest rate ratio for PV was in the last year of follow-up: 3.5 (95%CI, 2.8-4.3). Across MPN subtypes, rate ratios for GP visits varied from 1.0 to1.5 during follow-up without any considerable fluctuations. Interestingly, increased rate ratios for inpatients days were evident 2 years before diagnosis: ET, 1.8 (95%CI, 1.7-1.9); PV, 1.3, (95%CI, 1.2-1.3); PMF, 1.4(95%CI, 1.2-1.5); and MPN-U, 1.7 (95%CI, 1.6-1.9). During follow-up,notable increases in rate ratios were observed, e.g., PMF 3.0 (95%CI 2.4-3.6) and PV 3.8 (95%CI 3.0-4.8) in year 5 and 7, respectively.Summary/Conclusion: Overall, compared with matched nonMPN comparisons, MPN patients had a higher HRU throughout the study period. This was consistent across MPN subtypes and HRU measures. Within the limitations of small numbers toward end of follow-up and lack ofmatching on comorbidity, our findings confirmed a consistent HRU burden after MPN diagnosis. Equally important, our study revealed substantial increases in HRU two years before MPN diagnosis, warrantingfurther exploration of the pre-diagnostic period, including the potentialbenefits of early detection.
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5.
  • Dahlin, Anna M, 1979-, et al. (författare)
  • Colorectal cancer prognosis depends on T-cell infiltration and molecular characteristics of the tumor
  • 2011
  • Ingår i: Modern Pathology. - : Elsevier BV. - 0893-3952 .- 1530-0285. ; 24, s. 671-682
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to relate the density of tumor infiltrating T cells to cancer-specific survival in colorectal cancer, taking into consideration the CpG island methylator phenotype (CIMP) and microsatellite instability (MSI) screening status. The T-cell marker CD3 was stained by immunohistochemistry in 484 archival tumor tissue samples. T-cell density was semiquantitatively estimated and scored 1-4 in the tumor front and center (T cells in stroma), and intraepithelially (T cells infiltrating tumor cell nests). Total CD3 score was calculated as the sum of the three CD3 scores (range 3-12). MSI screening status was assessed by immunohistochemistry. CIMP status was determined by quantitative real-time PCR (MethyLight) using an eight-gene panel. We found that patients whose tumors were highly infiltrated by T cells (total CD3 score ≥7) had longer survival compared with patients with poorly infiltrated tumors (total CD3 score ≤4). This finding was statistically significant in multivariate analyses (multivariate hazard ratio, 0.57; 95% confidence interval, 0.31-1.00). Importantly, the finding was consistent in rectal cancer patients treated with preoperative radiotherapy. Although microsatellite unstable tumor patients are generally considered to have better prognosis, we found no difference in survival between microsatellite unstable and microsatellite stable (MSS) colorectal cancer patients with similar total CD3 scores. Patients with MSS tumors highly infiltrated by T cells had better prognosis compared with intermediately or poorly infiltrated microsatellite unstable tumors (log rank P=0.013). Regarding CIMP status, CIMP-low was associated with particularly poor prognosis in patients with poorly infiltrated tumors (multivariate hazard ratio for CIMP-low versus CIMP-negative, 3.07; 95% confidence interval, 1.53-6.15). However, some subset analyses suffered from low power and are in need of confirmation by independent studies. In conclusion, patients whose tumors are highly infiltrated by T cells have a beneficial prognosis, regardless of MSI, whereas the role of CIMP status in this context is less clear.
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6.
  • Eriksson Sörman, Daniel, 1974-, et al. (författare)
  • Occupational cognitive complexity and episodic memory in old age
  • 2021
  • Ingår i: Intelligence. - : Elsevier. - 0160-2896 .- 1873-7935. ; 89
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to investigate occupational cognitive complexity of main lifetime occupation in relation to level and 15-year change in episodic memory recall in a sample of older adults (≥ 65 years, n = 780). We used latent growth curve modelling with occupational cognitive complexity (O*NET indicators) as independent variable. Subgroup analyses in a sample of middle-aged (mean: 49.9 years) men (n = 260) were additionally performed to investigate if a general cognitive ability (g) factor at age 18 was predictive of future occupational cognitive complexity and cognitive performance in midlife. For the older sample, a higher level of occupational cognitive complexity was related to a higher level of episodic recall (β = 0.15, p < .001), but the association with rate of change (β = 0.03, p = .64) was not statistically significant. In the middle-aged sample, g at age 18 was both directly (β = 0.19, p = .01) and indirectly (via years of education after age 18, ab = 0.19) predictive of midlife levels of occupational cognitive complexity. Cognitive ability at age 18 was also a direct predictor of midlife episodic recall (β = 0.60, p ≤ 0.001). Critically, entry of the early adult g factor attenuated the association between occupational complexity and cognitive level (from β = 0.21, p = .01 to β = 0.12, p = .14). Overall, our results support a pattern of preserved differentiation from early to late adulthood for individuals with different histories of occupational complexity.
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7.
  • Fahlén, Josef, 1974-, et al. (författare)
  • The introduction of gender quotas in sport governing bodies and the conceptualizations of 'adequate' representation
  • 2019
  • Ingår i: Book of Abstracts 2019 International Sociology of Sport Conference. - : University of Otago. ; , s. 18-18
  • Konferensbidrag (refereegranskat)abstract
    • The purpose of this study is twofold. First, we aim to construct knowledge on the conceptualizations of democratic representation that underpin selection processes to sport organization boards. Second, we seek to examine responses to policy tools used to achieve 'adequate' representation in sport governance (e.g., gender quotas) that these conceptualizations of representation may give rise to in order to be able to discuss some of the uninteded consequences that may follow on the use of policy tools in this area. The analysis draws on data from interviews with representatives of 62 (out of 72) Swedish National Sport Organizations' nomination committees and focuses on the relationship between views of representation and stances towards an impeding introduction of a mandatory 40/60 board gender quota in all governing bodies in Swedish voluntary sport. The analysis elucidates, first, that conceptualizations among the interviewees may be categorized as either 'standing for' or 'acting for' views of representation (Fenichel Pitkin, 1972). Second, responsiveness to the introduction of a gender quota is shown to be related to these views of representation, with the dominating acting for view of representation being linked to a sceptic stance towards a quota. These findings suggest that employing policy tools such as gender quotas runs the risk of giving rise to two uninteded consequences: 1) creating overrepresentation of a gender in a board not matching the gender distribution in the membership-cadre (something that may be viewed as undemocratic); and 2) overshadowing other, equally important, representation categories (e.g., age or geographic origin). 
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8.
  • Fahrenholtz, Ida Lysdahl, et al. (författare)
  • Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes
  • 2022
  • Ingår i: Frontiers in Sports and Active Living. - : Frontiers Media S.A.. - 2624-9367. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Relative energy deficiency in sport (RED-S) is a complex syndrome describing health and performance consequences of low energy availability (LEA) and is common among female endurance athletes. Various underlying causes of LEA have been reported, including disordered eating behavior (DE), but studies investigating the association with exercise addiction and food intolerances are lacking. Therefore, the aim of this cross-sectional study was to investigate the association between DE, exercise addiction and food intolerances in athletes at risk of LEA compared to those with low risk. Female endurance athletes, 18-35 years, training >= 5 times/week were recruited in Norway, Sweden, Ireland, and Germany. Participants completed an online-survey comprising the LEA in Females Questionnaire (LEAF-Q), Exercise Addiction Inventory (EAI), Eating Disorder Examination Questionnaire (EDE-Q), and questions regarding food intolerances. Of the 202 participants who met the inclusion criteria and completed the online survey, 65% were at risk of LEA, 23% were at risk of exercise addiction, and 21% had DE. Athletes at risk of LEA had higher EDE-Q and EAI scores compared to athletes with low risk. EAI score remained higher in athletes with risk of LEA after excluding athletes with DE. Athletes at risk of LEA did not report more food intolerances (17 vs. 10%, P = 0.198), but were more frequently reported by athletes with DE (28 vs. 11%, P = 0.004). In conclusion, these athletes had a high risk of LEA, exercise addiction, and DE. Exercise addiction should be considered as an additional risk factor in the prevention, early detection, and targeted treatment of RED-S among female endurance athletes.
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9.
  • Henriksson, Anna, et al. (författare)
  • Does inflammation markers or treatment type moderate exercise intensity effects on changes in muscle strength in cancer survivors participating in a 6-month combined resistance- and endurance exercise program? : Results from the Phys-Can trial
  • 2023
  • Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central (BMC). - 2052-1847. ; 15:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Resistance exercise has a beneficial impact on physical function for patients receiving oncological treatment. However, there is an inter-individual variation in the response to exercise and the tolerability to high-intensity exercise. Identifying potential moderating factors, such as inflammation and treatment type, for changes in muscle strength is important to improve the effectiveness of exercise programs. Therefore, we aimed to investigate if inflammation and type of oncological treatment moderate the effects of exercise intensity (high vs. low-moderate) on muscular strength changes in patients with breast (BRCA) or prostate cancer (PRCA).METHODS: Participants with BRCA (n = 286) and PRCA (n = 65) from the Physical training and Cancer study (Phys-Can) were included in the present study. Participants performed a combined resistance- and endurance exercise program during six months, at either high or low-moderate intensity. Separate regression models were estimated for each cancer type, with and without interaction terms. Moderators included in the models were treatment type (i.e., neo/adjuvant chemotherapy-yes/no for BRCA, adjuvant androgen deprivation therapy (ADT)-yes/no for PRCA)), and inflammation (interleukin 6 (IL6) and tumor necrosis factor-alpha (TNFα)) at follow-up.RESULTS: For BRCA, neither IL6 (b = 2.469, 95% CI [- 7.614, 12.552]) nor TNFα (b = 0.036, 95% CI [- 6.345, 6.418]) levels moderated the effect of exercise intensity on muscle strength change. The same was observed for chemotherapy treatment (b = 4.893, 95% CI [- 2.938, 12.724]). Similarly, for PRCA, the effect of exercise intensity on muscle strength change was not moderated by IL6 (b = - 1.423, 95% CI [- 17.894, 15.048]) and TNFα (b = - 1.905, 95% CI [- 8.542, 4.732]) levels, nor by ADT (b = - 0.180, 95% CI [- 11.201, 10.841]).CONCLUSIONS: The effect of exercise intensity on muscle strength is not moderated by TNFα, IL6, neo/adjuvant chemotherapy, or ADT, and therefore cannot explain any intra-variation of training response regarding exercise intensity (e.g., strength gain) for BRCA or PRCA in this setting.TRIAL REGISTRATION: ClinicalTrials.gov NCT02473003.
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10.
  • Henriksson, Maria L, et al. (författare)
  • Colorectal Cancer Cells Activate Adjacent Fibroblasts Resulting in FGF1/FGFR3 Signaling and Increased Invasion.
  • 2011
  • Ingår i: American Journal of Pathology. - : Elsevier. - 0002-9440 .- 1525-2191. ; 178:3, s. 1387-1394
  • Tidskriftsartikel (refereegranskat)abstract
    • Cancer-associated fibroblasts expressing fibroblast activation protein (FAP) have been implicated in the invasive behavior of colorectal cancer. In this study, we use FAP expression as a marker of fibroblast activation and analyze the effect of activated fibroblasts on colorectal cancer migration and invasion in experimental cell studies. We also investigated the expression pattern of FAP in cancer-associated fibroblasts during transformation from benign to malignant colorectal tumors. In immunohistochemical analyses, FAP was expressed in fibroblasts in all colorectal cancer samples examined, whereas all normal colon, hyperplastic polyps, or adenoma samples were negative. In in vitro studies, conditioned medium from colon cancer cells, but not adenoma cells, activated fibroblasts by inducing FAP expression. These activated fibroblasts increased the migration and invasion of colon cancer cells in Boyden chamber experiments and in a three-dimensional cell culture model. We identify fibroblast growth factor 1/fibroblast growth factor receptor 3 (FGF1/FGFR-3) signaling as mediators leading to the increased migration and invasion. Activated fibroblasts increase their expression of FGF1, and by adding a fibroblast growth factor receptor inhibitor, as well as an FGF1-neutralizing antibody, we reduced the migration of colon cancer cells. Our findings provide evidence of a possible molecular mechanism involved in the cross talk between cancer cells and fibroblasts leading to cancer cell invasion.
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11.
  • Jansson, Sven-Arne, et al. (författare)
  • Costs of COPD by disease severity
  • 2011
  • Ingår i: European Respiratory Journal. - 0903-1936 .- 1399-3003. ; 38:Suppl 55
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic and disabling diseases worldwide, and the societal costs are high.Aim: To estimate the societal costs of COPD in Sweden and to examine the relationship between disease severity and costs.Methods: The study sample was identified in earlier clinical examinations of general population cohorts within the OLIN (Obstructive Lung Disease in Northern Sweden) studies. The cohort consisted initially of 993 subjects fulfilling COPD spirometric criteria (GOLD). In 2009-2010, telephone interviews on resource utilization were made to a sample of 244 subjects, stratified by disease severity. Interviews were performed quarterly to minimize the risk of recall bias. A non-parametric Mann-Whitney U-test was used to test cost differences between groups; p-values adjusted by Bonferroni correction. Unit costs from 2010 were applied.Results: A highly significant relationship was found between disease severity and costs. The mean annual total cost per patient in relation to disease severity (GOLD) was: stage I €811; II €2,660; III €7,068; and IV €20,665. Indirect costs were higher than direct costs in all severity stages. For direct costs, main cost drivers were hospitalizations in stage III and IV, and drugs in stage I and II, respectively. The main cost driver in indirect costs was productivity loss due to early retirement, except in stage I where the driver was sick-leave. In comparison with a similar study performed in 1999 a numerical increase in mean annual total costs per patient was observed (ns).Conclusions: The results indicate that the societal costs of COPD in Sweden are substantial, and the costs increase considerably by disease severity.
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12.
  • Jansson, Sven-Arne, et al. (författare)
  • Health economic costs of COPD in Sweden by disease severity - Has it changed during a ten years period?
  • 2013
  • Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 107:12, s. 1931-1938
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The objectives of the presented study were to estimate societal costs of COPD in Sweden, the relationship between costs and disease severity, and possible changes in the costs during the last decade. Methods: Subjects with COPD derived from the general population in Northern Sweden were interviewed by telephone regarding their resource utilisation and productivity losses four times quarterly during 2009-10. Mean annual costs were estimated for each severity stage of COPD. Results: A strong relationship was found between disease severity and costs. Estimated mean annual costs per subject of mild, moderate, severe and very severe COPD amounted to 596 (SEK 5686), 3245 (SEK 30,957), 5686 (SEK 54,242), and 17,355 euros (SEK 165,569), respectively. The main cost drivers for direct costs were hospitalisations (for very severe COPD) and drugs (all other severity stages). The main cost driver for indirect costs was productivity loss due to sick-leave (for mild COPD) and early retirement (all other severity stages). Costs appeared to be lower in 2010 than in 1999 for subjects with severe and very severe COPD, but higher for those with mild and moderate COPD. Conclusion: Our results show that costs of COPD are strongly related to disease severity, and scaling the data to the whole Swedish population indicates that the total costs in Sweden amounted to 1.5 billion euros (SEK 13.9 bn) in 2010. In addition, costs have decreased since 1999 for subjects with severe and very severe COPD, but increased for those with mild and moderate COPD. (C) 2013 Elsevier Ltd. All rights reserved.
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13.
  • Jansson, Sven-Arne, et al. (författare)
  • Sjukvårdskostnader och läkemedelsanvändning hos individer med KOL i Sverige
  • 2010
  • Ingår i: Svenska läkaresällskapets handlingar: Hygiea. - 0349-1722. ; 119:1, s. 92-92
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Bakgrund Kroniskt obstruktiv lungsjukdom (KOL) är en av de vanligast förekommande sjukdomarna i Sverige och medför stort lidande för de drabbade. De samhällsekonomiska kostnaderna till följd av sjukdomen är höga. Syftet var att studera sjukvårdskostnader (sjukhusinläggningar och öppenvårdsbesök) och läkemedelsanvändning hos individer med respektive utan KOL.Metod Studiepopulationen är identifierad sedan tidigare i kliniska undersökningar av populationsbaserade kohorter inom OLIN-studierna (Obstruktiv Lungsjukdom i Norrbotten). Kohorten innehöll ursprungligen 993 individer, vilka alla uppfyllde kriterierna (GOLD) för KOL; samt en lika stor ålders- och könsmatchad kontrollgrupp utan sjukdomen. Dessa individer har sedan 2005 kallats till årliga intervjuer och kliniska undersökningar. Deltagandegraden har varit >85% varje år. Analysen är baserad på data om resurskonsumtion insamlade år 2006 (n=772 KOL, n=802 icke-KOL). Enhetskostnader från Norra Sjukvårdsregionens prislista 2010 har använts.Resultat Bland individer med KOL uppgick genomsnittliga sjukvårdskostnaden för alla sjukdomar till 14 299 kr per individ och år jämfört med 11 312 kr för individer utan KOL (p=0,16). Uppdelat i svårighetsgrad var motsvarande kostnader: stadium 1 – 11 657 kr (p=0,92), 2 – 17 552 kr (p=0,12), 3+4 – 22 226 kr (p<0,01). En mindre del av kostnaderna hänfördes till luftvägssjukdomar; 10,5% bland individer med KOL och 6,2% bland individer utan KOL. Kostnader för luftvägssjukdomar var signifikant högre bland individer med KOL och ökade med sjukdomens svårighetsgrad. Individer med KOL uppvisade 20% högre kostnader för andra sjukdomar jämfört med individer utan KOL. Andelen individer med KOL som använde luftvägsmediciner ökade med sjukdomens svårighetsgrad (stadium 1 - 29,6%, 2 - 51,5% respektive 3+4 - 84,8%). Andelen individer som använde läkemedel mot andra sjukdomar än luftvägssjukdomar tenderade att vara högre bland individer med KOL jämfört med individer utan KOL, framförallt i svårare grader av sjukdomen.Sammanfattning Sjukvårdskostnader och andelen individer som använde läkemedel var högre bland individer med KOL och ökade med sjukdomens svårighetsgrad. Resultaten tyder på att utöver sjukdomen i sig, är även komorbiditet en bidragande orsak till de högre kostnaderna. Det är av stor vikt, både samhällsekonomiskt och för patientens bästa, att upptäcka och diagnostisera KOL i ett tidigt stadium för att förhindra att sjukdomen fortskrider till allvarligare stadier.
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14.
  • Kjellander, Christian, et al. (författare)
  • Costs of Hospital Care and Productivity Loss Due to Sickle Cell Disease in Sweden: A Retrospective Study
  • 2022
  • Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 25:1, s. S248-S248
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Sickle cell disease (SCD) is an inherited disorder of hemoglobin, associated with significant morbidity and mortality. Although the disease is most prevalent in Africa, it has been increasingly common in Western countries due to migration. The number of SCD patients in Sweden is unknown and the comprehensive national registries in Sweden provide a unique opportunity to address the objective to assess the burden of SCD.Methods: Using Sweden’s national patient registry, the 1-year prevalence of SCD with crisis (at least one registration of ICD-10 code D57.0 during the identification period, 2001-2018) was estimated during a 13-year follow-up period (2006-2018). Costs for hospital care of SCD (any ICD-10 D57) were estimated through hospital remuneration amounts based on diagnosis-related group. Productivity losses due to sick leave or disability for SCD, from the Swedish Social Insurance Agency, were assessed for working-age patients (18-65 years) and costed with Swedish mean salary, plus social security contributions.Results: The 1-year prevalence of SCD with crisis increased during the follow-up period from 139 patients in year 2006 to 260 in 2018. A total of 2,427 inpatients stays were recorded with SCD (ICD-10 D57) as main reason for stay (observed in 2,632 SCD patient years) over the study period. In addition, 7,213 outpatient visits due to SCD were recorded. These stays and visits were estimated to cost 76.4 million (M) Swedish Krona (SEK) and 31.0 M SEK, respectively. Productivity losses due to sick leaves and disability pension amounted to 14.8 M SEK and 68.3 M SEK, respectively.Conclusions: This study demonstrates that SCD with crisis is associated with economic burden to society, health care and patients in Sweden and increasing prevalence and costs over the years of follow up. In total, for the years 2006-2018, the cost of hospital care and productivity losses for SCD amounted to 190.6 M SEK.
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15.
  • Kjellander, Christian, et al. (författare)
  • Economic burden of sickle cell disease in Sweden : a population-based national register study with 13 years follow up
  • 2023
  • Ingår i: Frontiers in Hematology. - : Frontiers Media S.A.. - 2813-3935. ; 2
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Sickle cell disease (SCD) describes a group of inherited disorders of hemoglobin. Globally, SCD occurs in approximately 300,000-400,000 births annually and is most prevalent in malaria-endemic countries. However, migration has impacted the epidemiology of SCD but data on the matter are scarce. The objective of this study was to describe the epidemiology, treatment uptake, and economic burden of SCD in Sweden, a country with substantial immigration over the last decades.Methods: This nationwide retrospective observational registry cohort study identified patients with SCD from 2001 to 2018 and followed them from 2006 to 2018. Using data from high-quality population-based Swedish registers, we estimated prevalence, treatment uptake, and SCD-related health care resource use, sick leave and disability pension.Results: Between 2006 and 2018 the number of patients with SCD increased from 504 to 670; inpatient hospital stays and outpatient visits increased by 200% and 300%, respectively. Patients with pain crises had approximately twice the number of inpatient episodes and outpatient visit per year, and had higher productivity losses compared to patients without crises.Conclusion: In an era of emerging treatments for SCD, we have, to the best of our knowledge, for the first time comprehensively described epidemiological and economic aspects of SCD in a country where the disease is still rare and not well recognized by the healthcare system.
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16.
  • Kjellander, Christian, et al. (författare)
  • Sickle Cell Disease in Sweden - Prevalence and Resource Use Estimated through Population-Based National Registers
  • 2021
  • Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 138:Suppl 1, s. 2040-
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Sickle cell disease (SCD) is an autosomal recessive disorder characterized by abnormal hemoglobin. SCD causes hemolytic anemia, vaso-occlusion leading to vaso-occlusive crises (VOC) and contributing to organ damage and early death. SCD is most prevalent in sub-Saharan Africa and the Middle East, but also countries such as Brazil, India and US, have comparatively high frequencies of SCD. Global migration has contributed to a greater geographical spread. The prevalence of SCD in Sweden is unknown.OBJECTIVE: The primary objectives of this study were to estimate the 1-year prevalence of SCD and SCD-associated resource use in Sweden. Secondary objectives were to estimate birth incidence, treatment patterns and survival.PATIENTS: Patients with an ICD-10 diagnosis code for SCD (any D57 [excluding D57.3, sickle cell trait]) were identified from the Swedish Patient Registry (between January 1 st 2001 and June 30 th 2018). Patients were assessed for 1-year prevalence and resource use per calendar year for a follow-up period of 13 years (2006-2018).METHODS: Patients were considered prevalent from birth or immigration to death or emigration. Resource use from specialized care, including all events recorded in the registry with any D57 as the main diagnosis was assessed in the follow up period 2006-2018 as number of outpatient visits and inpatient stays. Costs for this hospital resource use were estimated through remuneration amounts based on diagnosis related groups. Data on sick leave days and days with disability pension due to SCD in patients in working age (18-65 years) were retrieved from the Swedish Social Security Agency and costed with the mean salary in Sweden, plus social security contributions. Costs are reported in 2019 Swedish Krona (SEK, ≈$ 0.1).RESULTS: One-year prevalence of all SCD diagnosis increased from 504 patients (5.53 per 100,000 population) in 2006 to 670 patients (6.55 per 100,000 population) in 2018. The 1-year prevalence of SCD patients ever recorded with an ICD-10 code for SCD with VOC (D57.0) increased from 139 patients (1.53 per 100,000 population) in 2006 to 260 patients (2.54 per 100,000 population) in 2018. The proportion of prevalent patients that were born in Sweden decreased over the years, from approximately 55% in the beginning of the study period to 45% in the end of the study period. The mean and median age of the SCD population decreased over the study period. Individuals with SCD and VOC were, on average younger than the other SCD (D57) subgroups.Birth incidence was captured by calendar year 2006-2018 and was highest in 2007 with 15 children born with SCD. For Swedish-born children with SCD during the patient identification time (n=123), the mean time to identification in the registers was 2.6 years (SD 2.7, range 0-16 years).Hospital outpatient visits and inpatient stays with SCD (all events with D57 recorded) as main diagnosis increased from 57 to 189, and 250 to 1,003, respectively, over the years 2006-2018. This corresponded to costs of inpatient care increasing from 1.4 million (M) SEK in 2006 to 7.3 M SEK in 2018 and costs of outpatient visits increasing from 0.9 M SEK in 2006 to 4.6 M SEK in 2018. The vast majority of costs were incurred in individuals ever recorded with a SCD with VOC diagnosis (D57.0). The most frequent hospital treatment was blood transfusion, with 8-11% of patients receiving transfusion in each year studied, especially common in SCD and VOC diagnosis. The prescribed treatment with the highest increase of uptake over the study period were hydroxyurea, vitamins and paracetamol in all SCD.Individuals in working age had on average 2.3 days of sick leave per patient-year due to SCD (D57), and approximately 4% of these patients received disability benefits because of their SCD.During the follow-up period, the median age at death was 74 years for all SCD and 69 years for SCD with crisis, this is 7-10 years and 12-15 years less compared to the Swedish general population respectively.CONCLUSION: This study demonstrates that the prevalence, hospital resource use and associated costs have increased substantially in Sweden. In an era of emerging treatments for SCD we have for the first time comprehensively described epidemiological-, disease-related and economical aspects of SCD in Sweden.
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17.
  • Lindholm, Lars, et al. (författare)
  • A cost-effectiveness analysis of a community based CVD program in Sweden based on a retrospective register cohort
  • 2018
  • Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 18
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Several large scale community-based cardiovascular disease prevention programs were initiated in the 80s, and one was the Västerbotten Intervention Programme, Sweden. As an initial step in 1985, a pilot study was introduced in the Norsjö municipality that combined individual disease prevention efforts among the middle-aged population with community-oriented health promotion activities. All citizens at 30, 40, 50, and 60 years of age were invited to a physical examination combined with a healthy dialogue at the local primary health care centre. Västerbotten Intervention Program is still running following the same lines and is now a part of the ordinary public health in the county. The purpose of this study is to estimate the costs of running Västerbotten Intervention Programme from 1990 to 2006, versus the health gains and savings reasonably attributable to the program during the same time period. Methods: A previous study estimated the number of prevented deaths during the period 1990-2006 which can be attributed to the programme. We used this estimate and calculated the number of QALYs gained, as well as savings in resources due to prevented non-fatal cases during the time period 1990 to 2006. Costs for the programmes were based on previously published scientific articles as well as current cost data from the county council, who is responsible for the programme. Result: The cost per QALY gained from a societal perspective is SEK 650 (Euro 68). From a health care sector perspective, the savings attributable to the VIP exceeded its costs. Conclusion: Our analysis shows that Västerbotten Intervention Programme is extremely cost-effective in relation to the Swedish threshold value (SEK 500000 per QALY gained or Euro 53,000 per QALY gained). Other research has also shown a favorable effect of Västerbotten Intervention Programme on population health and the health gap. We therefore argue that all health care organizations, acting in settings reasonably similar to Sweden, have good incentive to implement programs like Västerbotten Intervention Programme.
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18.
  • Ling, Agnes, 1976-, et al. (författare)
  • TAP1 down-regulation elicits immune escape and poor prognosis in colorectal cancer
  • 2017
  • Ingår i: Oncoimmunology. - 2162-4011 .- 2162-402X. ; 6:11
  • Tidskriftsartikel (refereegranskat)abstract
    • The anti-tumor immune response has been shown to be of great prognostic importance in colorectal cancer (CRC) and so has the tumors ability for immune evasion. Our aim of this study was to investigate tumor factors that influence immunity. We used a gene expression array to search for potential mechanisms of tumor immune escape. One candidate gene identified was TAP1, involved in antigen presentation by MHC class I. TAP1 protein expression was evaluated by immunohistochemistry in 436 CRC patients of the Colorectal Cancer in Umeå Study cohort. We found a significant association between a downregulated expression of TAP1 and low infiltration of various subtypes of lymphocytes as well as macrophages. A downregulated expression of TAP1 was further found to be independent of molecular characteristics, suggesting TAP1 down-regulation to reach beyond the well described highly immunogenic MSI CRCs. A low expression of TAP1 was also significantly associated with poor prognosis in patients with CRC, a result that stayed significant in tumor front of early stage tumors (stage I-II) through multivariable analyses. Furthermore, we found that TAP1 expression was inversely correlated with methylation at sites in close proximity to the promoter region. In summary, our results show down-regulation of TAP1 to be a general mechanism of tumor immune escape in CRC and a poor prognostic factor in stage I-II CRC patients. We also suggest that methylation of the TAP1 gene may be a putative mechanism for TAP1 downregulation.
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19.
  • Lundberg, Ida V, et al. (författare)
  • SOX2 expression is regulated by BRAF and contributes to poor patient prognosis in colorectal cancer
  • 2014
  • Ingår i: PLOS ONE. - : Public library of science. - 1932-6203. ; 9:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Sporadic colorectal cancer (CRC) is a common malignancy and also one of the main causes of cancer deaths worldwide. Aberrant expression of the transcription factor SOX2 has recently been observed in several cancer types, but its role in CRC has not been fully elucidated. Here we studied the expression of SOX2 in 441 CRC patients by immunohistochemistry and related the expression to clinicopathological and molecular variables and patient prognosis. SOX2 was expressed in 11% of the tumors and was significantly associated to BRAF(V600E) mutation, but not to KRAS mutations (codon 12 and 13). SOX2 positivity was correlated to poor patient survival, especially in BRAF(V600E) mutated cases. In vitro studies showed that cells expressing the constitutively active BRAF(V600E) had increased SOX2 expression, a finding not found in cells expressing KRAS(G12V). Furthermore, blocking downstream BRAF signalling using a MEK-inhibitor resulted in a decreased expression of SOX2. Since SOX2 overexpression has been correlated to increased migration and invasion, we investigated the SOX2 expression in human CRC liver metastasis and found that a SOX2 positive primary CRC also had SOX2 expression in corresponding liver metastases. Finally we found that cells overexpressing SOX2 in vitro showed enhanced expression of FGFR1, which has been reported to correlate with liver metastasis in CRC. Our novel findings suggest that SOX2 expression is partly regulated by BRAF signalling, and an increased SOX2 expression may promote CRC metastasis and mediate a poor patient prognosis.
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20.
  • Nielsen, Rune, et al. (författare)
  • Cost effectiveness of adding budesonide/formoterol to tiotropium in COPD in four Nordic countries
  • 2013
  • Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 107:11, s. 1709-1721
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Assess the cost effectiveness of budesonide/formoterol (BUD/FORM) Turbuhaler(®)+tiotropium (TIO) HandiHaler(®) vs. placebo (PBO)+TIO in patients with chronic obstructive pulmonary disease (COPD) eligible for inhaled corticosteroids/long-acting β2-agonists (ICS/LABA).METHODS: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial. The study included 659 patients with pre-bronchodilator forced expiratory volume in 1 s ≤ 50% and ≥1 exacerbation requiring systemic glucocorticosteroids or antibiotics the preceding year. Patients received BUD/FORM 320/9 μg bid + TIO 18 μg qd or PBO bid + TIO 18 μg qd. Effectiveness was defined as the number of severe exacerbations (hospitalisation/emergency room visit/systemic glucocorticosteroids) avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from CLIMB was combined with Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs (2010). The incremental cost-effectiveness ratios (ICERs) for BUD/FORM + TIO vs. PBO + TIO were estimated using descriptive statistics and uncertainty around estimates using bootstrapping. Analyses were conducted from the societal and healthcare perspectives in Denmark, Finland, Norway and Sweden.RESULTS: From a societal perspective, the ICER was estimated at €174/severe exacerbation avoided in Finland while BUD/FORM + TIO was dominant in the other countries. From the healthcare perspective, ICERs were DKK 1580 (€212), €307 and SEK 1573 (€165) per severe exacerbation avoided for Denmark, Finland and Sweden, respectively, while BUD/FORM + TIO was dominant in Norway. Including antibiotics decreased ICERs by 8-15%. Sensitivity analyses showed that results were overall robust.CONCLUSION: BUD/FORM + TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries. (ClinicalTrials.gov Identifier: NCT00496470).
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21.
  • Nielsen, Rune, et al. (författare)
  • Cost-effectiveness of adding budesonide/formoterol to tiotropium in severe COPD patients in four Nordic countries
  • 2012
  • Ingår i: European Respiratory Journal. ; 40:Suppl 56
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To assess the cost-effectiveness of budesonide/formoterol (B/F)+tiotropium (TIO) versus placebo (PBO)+TIO for the treatment of chronic obstructive pulmonary disease (COPD) patients eligible for inhaled corticosteroid/ long-acting β2-agonist from societal and healthcare perspectives in Denmark, Finland, Norway and Sweden.Method: The cost-effectiveness analysis was based on the 12-week, randomised, double-blind CLIMB trial (NCT00496470) of 659 COPD patients with pre-bronchodilator FEV1 ≤50%, and at least one severe exacerbation (hospitalisation, emergency room visit or systemic glucocorticosteroids) the preceding year. Subjects were treated with B/F 320/9µg bid+TIO 18µg qd or PBO bid+TIO 18µg qd. Effectiveness was defined as the number of exacerbations avoided. A sub-analysis included antibiotics in the definition of an exacerbation. Resource use from the trial was combined with 2010 Danish (DKK), Finnish (€), Norwegian (NOK) and Swedish (SEK) unit costs. The incremental cost-effectiveness ratios (ICERs) were estimated by bootstrapping.Results: From a societal perspective, the ICER was estimated at €174 per exacerbation avoided (pEA) in Finland while B/F+TIO was dominant in the other countries. From a healthcare perspective, B/F+TIO was dominant in Norway and the ICERs were estimated at DKK 1,580 (€212), €307, SEK 1,573 (€165) pEA for Denmark, Finland and Sweden, respectively. Including antibiotics decreased ICERs by 8-15%. Sensitivity analyses showed that results were overall robust.Conclusion: The results indicate that B/F+TIO represents a clinical and economic benefit to health systems and society for the treatment of COPD in the Nordic countries.
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22.
  • Renström, Anna, 1970-, et al. (författare)
  • Developing athletes into cooperative learners : the potential in viewing coaches as educators and coaching as teaching
  • 2024
  • Ingår i: Sport, Education and Society. - : Routledge. - 1357-3322 .- 1470-1243.
  • Tidskriftsartikel (refereegranskat)abstract
    • Talent development environments are usually group-based, meaning athletes comprise each other’s learning context. Consequently, athletes’ ability to learn with and from each other is essential. This implies that there is a key role for coaches to play in cultivating reciprocal, cooperative athletes and creating talent environments in which participants can ‘learn to learn’. The aim of this study was to create knowledge on day-to-day coaching conduct that supports the development of athletes’ reciprocal abilities. Observations of 75 h of football (soccer) lessons within the Swedish Football Association’s school sports programme – a cornerstone of the FA’s talent development system, located in upper secondary schools – were carried out over the course of three school semesters, and included in-depth interviews with the teacher-coaches. Data were analysed using the five key teaching pillars within a cooperative learning approach: positive interdependence, individual accountability, face-to-face interaction, interpersonal skills and group processing. Findings show how teacher-coaches engage in activities that focus on organization of lessons and structuring of group work to create situations where individuals are motivated to learn, but also motivated to support other group members’ learning. Thereby, teacher-coaches place more emphasis on positive interdependence, individual accountability, face-to-face interaction. In contrast, findings also show how teacher-coaches to a lesser extent perform coaching conduct associated with lesson content that has the potential to develop the skills and abilities required to participate in and benefit from group work – interpersonal skills, and group processing. This means that while teacher-coaches seem well-equipped to create learning environments that support reciprocal learning, they may benefit from challenging the role of the coach as an expert and tackle the preconceptions around cooperative behaviours that athletes bring from club football contexts. Taken together, these findings point to the need for a better understanding of overlapping learning sites within talent systems.
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23.
  • Renström, Anna, 1970-, et al. (författare)
  • Pupil-athletes' Learning Dispositions and Their Potential Effects in School Sports-situated Talent Development Programs
  • 2019
  • Ingår i: Journal of Athlete Development and Experience. - Arkansas, USA : Bowling Green State University. - 2642-9276. ; 1:3, s. 130-143
  • Tidskriftsartikel (refereegranskat)abstract
    • There is a worldwide increase in efforts to support talents' development towards elite athletes. The focus of the study was the learning processes among athletes that facilitate this development. Drawing on the learning dispositions concept (Carr & Claxton, 2002), the aim was to create knowledge on the prevalence and possible consequences of variability in learning patterns among pupils enrolled in Nationell Idrottsutbildning Fotboll (NIUF)—a highly selective soccer talent development programme within upper secondary schools in Sweden. In-depth semi-structured interviews were carried out with a total of 13 pupils in their first or second year of NIUF. The data analysis benefited from iterative movement between the data and key learning dispositions: resilience, reciprocity, and playfulness. The findings show a variation in the strength of these dispositions between pupils, particularly with regard to the reciprocity and playfulness dispositions. We propose that individuals who display a comparably stronger manifestation of learning dispositions are better equipped to benefit from the learning opportunities of such programmes. This implies that there is a key role for coaches/educators to play in constructing an environment in which participants may ‘learn to learn'.
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24.
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25.
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26.
  • Skille, Eivind Å., et al. (författare)
  • Government policy for indigenous (Sámi) sport – A chain of legitimating acts?
  • 2019
  • Ingår i: Book of Abstracts for the World Congress of Sociology of Sport 2019. ; , s. 19-19
  • Konferensbidrag (refereegranskat)abstract
    • When Norwegian state policy repeatedly abandons the organization of indigenous (Sámi) sport (SVL-N) in order to honour the implicit contract with the organization of conventional (Norwegian sport, NIF), six elements of legitimating acts are in play: legitimacy-seeking organisation, subject, sources, strategy, bases and scenario. These elements intersect within each phase of the policy process: agenda setting, policy formulation, policy implementation and evaluation. As visible when focusing on the legitimacy-seeking organization and subject, the goal for sport clubs is, to legitimate themselves, and providing support to sport is a core task of local authorities. So when municipalities and local NIF federated sport clubs legitimate each other, Sámi sport organizations are excluded from the legitimating chain. Focusing on a national example, youth sport is both a subject, and it is a strategy used by NIF to legitimate implementation of other policies such as supporting and arranging mega events. When substantial strategies are coupled with symbolic strategies, the risk for so-called ceremonial conformity decoupling is immanent. In conclusion, consequences—often unintended—resulting from legitimating acts in one phase have legitimacy-related implications for other phases of the policy process. That said, being included in the chain is the core issue to receive economic support for sport. Consequently, a newcomer such as the SVL-N struggles to set itself on the agenda of sport policy because acts in other phases consciously legitimate the NIF structure and its member organizations.
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27.
  • Skille, Eivind Å., et al. (författare)
  • (Lack of) government policy for indigenous (Sámi) sport : A chain of legitimating and de-legitimating acts
  • 2022
  • Ingår i: International Review for the Sociology of Sport. - : Sage Publications. - 1012-6902 .- 1461-7218. ; 57:1, s. 112-128
  • Tidskriftsartikel (refereegranskat)abstract
    • While colonization as policy is formally a historic phenomenon in Norway and elsewhere, many former structures of state organization – including their relationship to sport – remain under post-colonial conditions. This paper is concerned with how the Norwegian government contributes to creating a situation, which includes the Norwegian sports confederation (NIF) but excludes the indigenous people Sámi's sports organisation. Based on existing data and literature, we analyse how the state favours NIF through a chain of legitimating acts. Thus, sport is a preserve of colonization, where a one-sided legitimation parallels a de-legitimation of the overarching sport policy goal of sport-for-all. However, there are signs of change whereby actors are challenging NIF’s monopoly and 'older' state-sport regimes.
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28.
  • Skille, Eivind Å., et al. (författare)
  • Private football academies - friend or foe? : an analysis of Norwegian media's framing of arguments about private football academies and the monopoly of organized sport
  • 2023
  • Ingår i: International Review for the Sociology of Sport. - : Sage Publications. - 1012-6902 .- 1461-7218. ; 58:8, s. 1263-1281
  • Tidskriftsartikel (refereegranskat)abstract
    • Private football academies challenge the monopoly of Norwegian voluntary and democratic sport. Using field theory and framing approach as analytical perspectives, this article presents a media analysis that reveals that, first, association football and private academies agree on the fact that Norwegian football is not good enough and must improve. Second, they disagree on whether to improve it within association football exclusively or supplemented by private actors that are inspired by the international football field. Third, there is a negative popular view of private acad­emies as too expensive, unconcerned with children's best interests, in violation of Norwegian sport's regulations for children's sport, and-in sum-thus being accused of destroying 'sport for all'. However, by employing the analytical concepts of habitus and fields, the article also shows how actors partake in several subfields-often on both sides of the private-association barder. 
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29.
  • Skovgaard Svingel, Lise, et al. (författare)
  • Labor market affiliation of patients with myeloproliferative neoplasms : a population-based matched cohort study
  • 2023
  • Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X.
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Patients with myeloproliferative neoplasms (MPNs) suffer from substantial symptoms and risk of debilitating complications, yet observational data on their labor market affiliation are scarce.Material and methods: We conducted a descriptive cohort study using data from Danish nationwide registries, including patients diagnosed with MPN in 2010-2016. Each patient was matched with up to ten comparators without MPN on age, sex, level of education, and region of residence. We assessed pre- and post-diagnosis labor market affiliation, defined as working, unemployed, or receiving sickness benefit, disability pension, retirement pension, or other health-related benefits. Labor market affiliation was assessed weekly from two years pre-diagnosis until death, emigration, or 31 December 2018. For patients and comparators, we reported percentage point (pp) changes in labor market affiliation cross-sectionally from week −104 pre-diagnosis to week 104 post-diagnosis.Results: The study included 3,342 patients with MPN and 32,737 comparators. From two years pre-diagnosis until two years post-diagnosis, a larger reduction in the proportion working was observed among patients than comparators (essential thrombocythemia: 10.2 [95% CI: 6.3–14.1] vs. 6.8 [95% CI: 5.5–8.0] pp; polycythemia vera: 9.6 [95% CI: 5.9–13.2] vs. 7.4 [95% CI: 6.2–8.7] pp; myelofibrosis: 8.1 [95% CI: 3.0–13.2] vs. 5.8 [95% CI: 4.2–7.5] pp; and unclassifiable MPN: 8.0 [95% CI: 3.0–13.0] vs. 7.4 [95% CI: 5.7–9.1] pp). Correspondingly, an increase in the proportion of patients receiving sickness benefits including other health-related benefits was evident around the time of diagnosis.Conclusion: Overall, we found that Danish patients with essential thrombocythemia, polycythemia vera, myelofibrosis, and unclassifiable MPN had slightly impaired labor market affiliation compared with a population of the same age and sex. From two years pre-diagnosis to two years post-diagnosis, we observed a larger reduction in the proportion of patients with MPN working and a greater proportion receiving sickness benefits compared with matched individuals.
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30.
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31.
  • Stenling, Anna, et al. (författare)
  • Lifetime risk predictions for cardiovascular diseases : competing risks analyses on a population-based cohort in Sweden
  • 2020
  • Ingår i: Atherosclerosis. - : Elsevier. - 0021-9150 .- 1879-1484. ; 312, s. 90-98
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aims: There are guideline discussions on a lifetime approach to cardiovascular risk. Many of the available risk models estimate the short-term, usually 10-year risk of non-fatal and fatal cardiovascular diseases (CVD) grouped together. We aimed to develop lifetime risk models for non-fatal coronary heart disease, stroke, heart failure and death from CVD and non-CVD.Methods: We included 92,915 individuals who had participated in a community-based lifestyle intervention programme at 40, 50 and/or 60 years of age. Their collected data on selected risk factors were linked to register data on hospitalizations and death. Parametric multivariable survival regression with a competing risks approach was employed to model cause-specific hazards, which were translated into cumulative incidence functions to provide the risk of experiencing each event separately. All analyses were performed gender-age wise. For illustrative purposes, "better" and "worse" risk profiles were created by setting three modifiable risk factors to the best and worst levels, respectively.Results: Most of the risk factors qualified for inclusion in the regressions. Men had a higher risk of cardiovascular events and the events occurred at a younger age than women. In the created risk profiles, where serum total cholesterol, smoking status and blood pressure were modified, an excessive number of CVD events were observed in the worse profiles.Conclusions: Using these models, the lifetime risk of each of the first CVD events can be estimated for different risk factor profiles. Since the predictions are diagnosis specific, the estimates are more accurate.
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32.
  • Stenling, Cecilia, 1981-, et al. (författare)
  • Exclusion and inclusion in puzzling together the NSO-board : Hierarchies of criteria in board nomination processes
  • 2017
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • The focus of this study is what arguably has been, and continues to be, one of the biggest challenges of member-based federated sport systems: members’ (un)equal access to the decision making bodies that govern their sport participation. For example, in Sweden, a country often held forward as an exemplar of equality and diversity (World Economic Forum, 2016), 11 out of 71 NSO boards have zero or one female member on their board (Swedish Research Council for Sport Science, 2016a) and at sport club level, 75% of clubs lack board members under the age of 25 (Swedish Research Council for Sport Science, 2016b). The problem of skewed representation is especially troubling in systems built on the principles of democracy because it undermines the legitimacy of the governance system as such. The current situation thus calls for knowledge on how representation is constructed (e.g., Burton, 2015; Elling, Hovden, & Knoppers, 2016; Hoye & Cuskelly, 2007; King, 2016). This study addresses this need by creating knowledge on NSO board nomination processes and the manner in which they (re)shape NSO board composition. While most previous studies on sport board composition (e.g., Adriaanse Schofield, 2014; Claringbould & Knoppers, 2007; Fundberg, 2009; Hovden, 2000; Ottesten, Skirstad, Pfister, Habermann, 2010) have paid special attention to the over- or underrepresentation of particular social (or other) categories (e.g., gender), we aim to inductively capture the variety of meanings concerning the ideal board member that are mobilized during board nomination processes. Theoretically informed by cultural sociology and the concept of repertoires of meaning, drawn from Swidler’s (1986, 2003) “repertoire theory,” we investigate election committees’ use of certain explanations as they perform their task of nominating individuals for election. In doing so, we address the following research questions. First, what repertories of meaning are mobilized in board nomination processes? Second, how are the criteria that are immanent in these repertoires of meaning weighed against each other, and how does this process work as inclusionary or exclusionary? We recognize the need for both fine-grained data, qualitative data, and many data points that allow for comparisons and ultimately construction of patterns. To satisfy all these criteria, we conduct telephone interviews aided by an interview guide with a limited, very carefully selected, number of interview questions. Our aim is to conduct interviews with the chairperson of the election committee of each of the 71 Swedish NSOs. Data collection is halfway through and will be finalized in the coming months. Data analysis, which will be conducted in the months leading up to the SMAANZ conference, will be conducted using Miles and Huberman’s (1994, p. 61) “accounting-scheme guided approach”, employing a mixture of predetermined and emergent codes.
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33.
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34.
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35.
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36.
  • Stenling, Cecilia, 1981-, et al. (författare)
  • Gate-keeping nonprofit governance : evaluative criteria and their rankings in nomination committee selection processes
  • 2021
  • Ingår i: Research handbook on nonprofit governance. - : Edward Elgar Publishing. - 9781788114905 - 9781788114912 ; , s. 279-293
  • Bokkapitel (refereegranskat)abstract
    • This chapter explores Swedish national sport federation nomination committees’ use of evaluative criteria in board composition processes. As such, the chapter responds to more general calls for a broadened consideration of relevant governance actors and to appeals for attention to governance processes in member-based federations. We demonstrate the breadth of criteria at play in the processes of nomination of board members and the ways in which these are traded-off against each other to form value-based hierarchies. Based on the empirical analysis reported in the chapter, we discuss key characteristics of nomination committees’ work and propose a research agenda for this crucial but neglected governance function in nonprofit organizations. 
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37.
  • Stenling, Cecilia, 1981-, et al. (författare)
  • Hierarchies of criteria in NSO board-nomination processes : insights from nomination committees' work
  • 2020
  • Ingår i: European Sport Management Quarterly. - : Routledge. - 1618-4742 .- 1746-031X. ; 20:5, s. 636-654
  • Tidskriftsartikel (refereegranskat)abstract
    • Research question: The purpose of this paper is to create knowledge on board-selection processes and their outcomes in terms of board composition. We address two research questions: (1) What evaluative criteria are at play in board-selection processes; and (2) what hierarchies of criteria are formed when evaluative criteria are ranked? The significance of the study lies in contemporary considerations of good governance, in sport members’ (un)equal access to positions of power, and in how issues of representation relate to the legitimacy of sport governance systems and to broader societal patterns of representation, influence, and democracy.Research methods: Nomination committees are increasingly used worldwide to further good governance in sport organizations. Our analysis builds on interviews with representatives of 61 out of 71 Swedish national sport organizations’ nomination committees.Results and Findings: Our study shows that trade-offs are made not between gender and merit, as previously suggested, but between and among a wide variety of representation criteria and a wide variety of efficiency criteria. We show how tensions between criteria result in trade-offs that imply a ranking of criteria into seven types of hierarchies, only one of which prioritizes a representation-based board composition.Implications: Because rankings of multiple evaluative criteria impact any single criterion of interest (e.g. gender), future studies should take into account the range of evaluative criteria at play. For sport management and policy practitioners alike, we provide a tool to understand and address (in)adequate representation but also an imperative to consider the meaning of adequate representation.
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38.
  • Stenling, Cecilia, 1981-, et al. (författare)
  • The gatekeepers of sport governance : nomination committees' shaping potential in national sport organizations' board composition processes
  • 2023
  • Ingår i: European Sport Management Quarterly. - : Routledge. - 1618-4742 .- 1746-031X. ; 23:2, s. 586-603
  • Tidskriftsartikel (refereegranskat)abstract
    • Research Question: The purpose of this paper is to construct knowledge on the working processes of nomination committees (NCs) in sport and analyze their potential to shape board composition. The significance of such an effort lies in its potential to shed light on the processes preceding the structures and practices created for the wielding of power in sport organizations.Research Methods: This paper reports findings based on telephone interviews with NCs of 64 Swedish national sport organizations.Results and Findings: The analyses show how NC processes may be distinguished into six components: election of the NC at the general assembly (GA), monitoring of the incumbent board, preparation for nominee identification, assembly of a list of potential nominees, evaluation of potential nominees, and submission of proposed nominees to the GA. Within and across these components, the analyses reveal three aspects particularly powerful in their potential to shape board composition: degree of formalization, network reliance, and transparency.Implications: These findings have implications for research and practice. Regarding the former, the study provides a baseline description that can be used in future explorations of the NC process and its determinants and effects in varying contexts. As for the latter, the findings suggest that sport organizations carry an untapped potential in considering NCs’ shaping potential, regardless of whether an ‘adequate’ board is one that is equipped to improve organizational efficiency or one that safeguards representation and democracy.
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39.
  • Stenling, Cecilia, 1981-, et al. (författare)
  • The meaning of democracy in an era of good governance : Views of representation and their implications for board composition
  • 2023
  • Ingår i: International Review for the Sociology of Sport. - : Sage Publications. - 1012-6902 .- 1461-7218. ; 58:1, s. 108-125
  • Tidskriftsartikel (refereegranskat)abstract
    • Contemporary sport governance contexts are marked by a trend towards efficiency-based board composition and an increasing use of instruments aimed to (re)shape boards. Yet, democratic governance is integral to many countries' sport systems, and research tells us that representation still matters in sport governance. Considering this, the aim with this paper is to provide researchers and practitioners with a vocabulary to understand and address issues of representation in board composition. The paper builds on interviews with nomination committee representatives of 62 Swedish national sport federations (NSFs). The analysis provides insights into the meaning and implications of four distinct views of representation, along with an interpretation of potential responses to board-shaping instruments engendered by these views.
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40.
  • Strittmatter, Anna-Maria, 1988-, et al. (författare)
  • Sport policy analysis revisited : the sport policy process as an interlinked chain of legitimating acts
  • 2018
  • Ingår i: International Journal of Sport Policy and Politics. - : Routledge. - 1940-6940 .- 1940-6959. ; 10:4, s. 621-635
  • Tidskriftsartikel (refereegranskat)abstract
    • By providing an analytical framework that draws on a conceptualisation of legitimacy in organisation studies, this paper demonstrates that the sport policy process can be understood as an interlinked chain of legitimating acts. Based on recent suggestions in organisation theory literature on how to approach legitimacy and legitimation, we applied the framework on a small sample of published sport policy studies to demonstrate its utility. By applying the framework, six interweaved and interweaving elements of the legitimating act within sport policy processes were identified: legitimacy-seeking organisation, subject, source(s), strategy, bases and scenario. The analysis shows that each of the six elements works by intersecting within each phase of the policy process. The main conclusion is that consequences – often unintended – resulting from legitimating acts in one phase have legitimacy-related implications for the other phases of the policy process. As pressing as pinpointing the use of all elements of the framework is, it is equally important to distinguish each of the elements in order to fulfil the analytical potential of the proposed framework. Since sport policy processes in practice rely primarily on organisations and organisational action, future sport policy research would benefit from this type of framework connecting organisations and organising to policy processes.
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41.
  • Strittmatter, Anna-Maria, 1988-, et al. (författare)
  • Structural and Cultural Othering : An Organizational Culture Perspective on Young People’s Participation in Decision-making in Sport Organizations
  • 2024
  • Ingår i: Young - Nordic Journal of Youth Research. - : Sage Publications. - 1103-3088 .- 1741-3222. ; 32:4, s. 360-377
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this article is to examine the role played by organizational culture in young people’s continuing underrepresentation in decision-making bodies, despite structural changes, in the context of Norwegian sport organizations. Data is based on a questionnaire centred on the experiences of young people in sport governance (n = 32 youth representatives) and semi-structured interviews with young (under 26 years) and older representatives of organizations affiliated with the Norwegian Olympic and Paralympic Committee and Confederations of Sports (n = 10). Findings show that Norwegian sport organizations foster a cultural understanding of young people which takes its structural expression in the separation of elements that are ‘othering’ the youth. Youth have also limited access to resources of power as a result of a lack of trust in older leaders. Prevailing culture mirrors an adult society in which young people need to upgrade their level of professionalism through education before they are invited to decision-making processes.
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42.
  • Strittmatter, Anna-Maria, 1988-, et al. (författare)
  • Youth representatives as agents of institutional change : the circumscribing effects of role prescriptions in sport governance
  • 2024
  • Ingår i: International Journal of Sport Policy and Politics. - : Routledge. - 1940-6940 .- 1940-6959. ; 16:3, s. 449-463
  • Tidskriftsartikel (refereegranskat)abstract
    • Conceptualising the youth representative as an institutional role, we explore the institutional shaping of youth representatives as change agents in the governance of sport organisations. Focusing on how these shaping conditions who the youth representative can be and what determines the scope of their role fulfilment, including the impact of their work on established institutional orders, allows us to examine the shaping of agency related to governance institutions. Data is drawn from a questionnaire centred on the experiences of young people in sport governance (n = 32) and semi-structured interviews with 10 representatives of organisations affiliated with the Norwegian Olympic and Paralympic Committee and Confederations of Sports. The role of the youth representatives is scripted in terms of who the representatives ought to be and what they ought to do. The scripting associated with the operationalisation of this ambition into role pre- and proscriptions stands in stark contrast to the ideal of youth representatives as agents of institutional change. Our study of the scripting of institutional roles has theoretical implications because it shows how normative typifications that link notions of actors with actorhood circumscribe institutional work pertaining to change.
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43.
  • Thorn, Jörgen, 1965, et al. (författare)
  • Improved prediction of COPD in at-risk patients using lung function pre-screening in primary care: a real-life study and cost-effectiveness analysis
  • 2012
  • Ingår i: Primary Care Respiratory Journal. - : Springer Science and Business Media LLC. - 1471-4418 .- 1475-1534. ; 21:2, s. 159-166
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The importance of identifying chronic obstructive pulmonary disease (COPD) at an early stage is recognised. Improved and easily accessible identification of individuals at risk of COPD in primary care is needed to select patients for spirometry more accurately. Aims: To explore whether use of a mini-spirometer can predict a diagnosis of COPD in patients at risk of COPD in primary care, and to assess its cost-effectiveness in detecting patients with COPD. Methods: Primary care patients aged 45-85 years with a smoking history of >= 15 pack-years were selected. Data were collected on the Clinical COPD Questionnaire (CCQ), Medical Research Council (MRC) dyspnoea scale and smoking habits. Lung function (forced expiratory volume in 1 and 6 s; FEV1 and FEV6, respectively) was measured by mini-spirometer (copd-6), followed by diagnostic standard spirometry (COPD diagnosis post-bronchodilation ratio of FEV1 to forced vital capacity (FVC) <0.7). Time consumed was recorded. Univariate logistic regression and receiver operating characteristic (ROC) curves were used. Results: A total of 305 patients (57% females) of mean (SD) age 61.2 (8.4) years, mean (SD) total CCQ 1.0 (0.8) and mean (SD) MRC 0.8 (0.8) were recruited from 21 centres. COPD was diagnosed in 77 patients (25.2%) by standard diagnostic spirometry. Using the copd-6 device, mean (SD) FEV1/FEV6 was 68 (8)% in patients with COPD and 78 (10)% in patients without COPD. Sensitivity and specificity at a FEV1/FEV6 cut-off of 73% were 79.2% and 80.3%, respectively. The area under the ROC curve was 0.84. Screening with the copd-6 device significantly predicted COPD. Gender, CCQ, and MRC were not found to predict COPD. Conclusions: Using the copd-6 as a pre-screening device, the rate of COPD diagnoses by standard diagnostic spirometry increased from 25.2% to 79.2%. Although the sensitivity and specificity of the copd-6 could be improved, it might be an important device for pre-screening of COPD in primary care and may reduce the number of unnecessary spirometric tests performed. (C) 2012 Primary Care Respiratory Society UK. All rights reserved. J Thorn et al. Prim Care Respir J 2012; 21(2): 159-166 http://dx.doi.org/10.4104/pcrj.2011.00104
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44.
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45.
  • Thorn, Jörgen, et al. (författare)
  • Pre-screening av rökare med mini-spirometer leder till förbättrad prediktion av KOL
  • 2010
  • Ingår i: Svenska läkaresällskapets handlingar: Hygiea. - 0349-1722. ; 119:1, s. 78-78
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • BakgrundTidig diagnos av kroniskt obstruktiv lungsjukdom (KOL), i kombination med rökstopp är viktigt för att förhindra vidare sjukdomsprogress. I primärvården är det önskvärt med lättillgänglig diagnostik för att om möjligt selektera patienter för spirometri. I denna studie undersöks värdet av pre-screening av lungfunktion av patienter i riskzonen för KOL (NCT01013922).MetodPatienter 45 år och äldre, med rökhistorik ≥ 15 paketår inkluderades. Uppgifter kring bl. a. rökvanor och medicinsk historik samlades in. Hälsorelaterad livskvalitet och grad av dyspné undersöktes med frågeformulär (CCQ och MRC-skalan). Lungfunktion (FEV1 och FEV6) mättes initialt med en mini-spirometer, (copd-6, Vitalograph), följt av fullständig standardspirometri inklusive reversibilitetstest (KOL diagnos = FEV1/FVC post-bronkdilatation < 70). Tidsåtgång för spirometri noterades; kostnader beräknas baserat på genomsnittlig sjuksköterskelön. Univariat logistisk regression och ROC (receiver operating characteristic curves) användes.ResultatTotal inkluderades 305 patienter från 21 primärvårdsenheter; 57 % kvinnor, medelålder (standardavvikelse, SD) 61,2 (8,4) år, FEV1/FVC 75,3 (10,2), paketår 30,2 (11,5). KOL diagnostiserades hos 83 patienter (27,2 %). Patienter med KOL hade en genomsnittlig FEV1/FEV6 kvot på 69,0 (9,1), rökare utan KOL 77,7 (9,6). Copd-6 (FEV1/FEV6) kunde med statistisk signifikans prediktera KOL. Sensitivitet och specificitet vid en FEV1/FEV6 cut off på 73,0 var 73,5 % respektive 79,7 %; arean under ROC kurvan var 0,80. Kostnaderna för en copd-6 mätning (tidsåtgång 4,2 minuter) var SEK 19,41, respektive SEK 147 (32,3 minuter) för en standardspirometri. Kostnaden för att detektera en KOL patient, med urval för spirometri baserat endast på ålder och antal paketår, var SEK 542. Genom att pre-selektera individer för spirometri med hjälp av copd-6 kunde kostnaden reduceras till SEK 283. Detta sker dock till priset av att 8,4 % lägre total detektion av KOL patienter till följd av begränsningar vad gäller sensitiviteten hos copd-6. Kön, CCQ eller MRC hade inget prediktivt värde.SammanfattningPre-screening med copd-6 för att selektera patienter med risk för KOL (≥ 45 år; ≥ 15 paketår) före utförande av standardspirometri kunde signifikant prediktera KOL. Användning av copd-6 kan minska kostnaden för att identifiera KOL patienter inom primärvården, men sensitiviteten och specificiteten är i denna studie begränsad.
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46.
  • Uddhammar, Agneta, et al. (författare)
  • Increased mortality due to cardiovascular disease in patients with giant cell arteritis in Northern Sweden
  • 2002
  • Ingår i: Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 29:4, s. 737-742
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To study the cause of death pattern in patients with giant cell arteritis (GCA) or polymyalgia rheumatica (PMR). and to analyze the effect of the disease, or its therapy, on the risk of a cardiovascular event (CVE). Methods. Patients with biopsy proven GCA or with PMR, whose condition was diagnosed between 1973 and 1979, were followed until December 31, 1995. The standardized mortality ratio (SMR) was estimated using data for the population of V sterbotten, Northern Sweden, as reference value. Information for sex, age at diagnosis, erythrocyte sedimentation rate (ESR) at diagnosis, corticosteroid therapy, comorbidity from diagnosis, and date and cause of death was collected. Results. A total of 136 patients with GCA and 35 with PMR were identified. At the time of followup 114 patients with GCA and 25 with PMR were deceased. The overall mortality was significantly increased in the female patients, SMR = 133 (95% Cl 110-162). Death due to cardiovascular disease (CVD) was significantly increased in both women and men, SMR = 149 (95% CI 118-189) and 158 (95% Cl 112-224), respectively, and mainly due to ischemic heart disease. An excess mortality was found in women with the hi-hest ESR, the highest prescribed dose of prednisolone at diagnosis, or a daily prednisolone dose of 10 mg or more one year after diagnosis. In multiple Cox regression analysis, male sex and hypertension significantly increased the risk of a CVE. Conclusion. Death due to CVD was increased in patients with GCA. Increased mortality was related to either the corticosteroid therapy itself or insufficient control of inflammation.
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47.
  • Van Guelpen, Bethany, et al. (författare)
  • Low folate levels may protect against colorectal cancer.
  • 2006
  • Ingår i: Gut. - : BMJ. - 0017-5749 .- 1468-3288. ; 55:10, s. 1461-6
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND AND AIMS: Dietary folate is believed to protect against colorectal cancer (CRC). However, few studies have addressed the role of circulating levels of folate. The aim of this study was to relate prediagnostic plasma folate and homocysteine concentrations and the methylenetetrahydrofolate reductase (MTHFR) 677C>T and 1298A>C polymorphisms to the risk of developing CRC. SUBJECTS: Subjects were 226 cases and 437 matched referents from the population based Northern Sweden Health and Disease Cohort. RESULTS: We observed a bell-shaped association between plasma folate concentrations and CRC risk; multivariate odds ratio for middle versus lowest quintile 2.00 (95% confidence interval (CI) 1.13-3.56). In subjects with follow up times greater than the median of 4.2 years however, plasma folate concentrations were strongly positively related to CRC risk; multivariate odds ratio for highest versus lowest quintile 3.87 (95% CI 1.52-9.87; p trend = 0.007). Homocysteine was not associated with CRC risk. Multivariate odds ratios for the MTHFR polymorphisms were, for 677 TT versus CC, 0.41 (95% CI 0.19-0.85; p trend = 0.062), and for 1298 CC versus AA, 1.62 (95% CI 0.94-2.81; p trend = 0.028). Interaction analysis suggested that the result for 1298A>C may have been largely due to linkage disequilibrium with 677C>T. The reduced CRC risk in 677 TT homozygotes was independent of plasma folate status. CONCLUSIONS: Our findings suggest a decreased CRC risk in subjects with low folate status. This possibility of a detrimental component to the role of folate in carcinogenesis could have implications in the ongoing debate in Europe concerning mandatory folate fortification of foods.
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48.
  • Wikberg, Maria L., et al. (författare)
  • High intratumoral expression of fibroblast activation protein (FAP) in colon cancer is associated with poorer patient prognosis.
  • 2013
  • Ingår i: Tumor Biology. - : Springer Netherlands. - 1010-4283 .- 1423-0380. ; 34:2, s. 1013-1020
  • Tidskriftsartikel (refereegranskat)abstract
    • -An active stroma is important for cancer cell invasion and metastasis. We investigated the expression of fibroblast activation protein (FAP) in relation to patient prognosis in colorectal cancer. Colorectal cancer specimens from 449 patients were immunohistochemically stained with a FAP antibody and evaluated in the tumor center and tumor front using a semiquantitative four-level scale. FAP was expressed by fibroblasts in 85-90 % of the tumors examined. High versus no/low expression in the tumor center was associated with poor prognosis (multivariate hazard ratio, HR = 1.72; 95 % CI 1.07-2.77, p = 0.025). FAP expression in the tumor front, though more frequent than in the tumor center, was not associated with prognosis. FAP expression in the tumor center was more common in specimens with positive microsatellite instability (MSI) screening status and in patients with high CpG island methylator phenotype (CIMP) status. However, inclusion of MSI screening status and CIMP status in the multivariate analysis strengthened the risk estimates for high FAP expression in the tumor center (HR = 1.89; 95 % CI 1.13-3.14; p = 0.014), emphasizing the role of FAP as an independent prognostic factor. Stromal FAP expression is common in colorectal cancer, and we conclude that high FAP expression in the tumor center, but not the tumor front, is an independent negative prognostic factor.
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