| 1. |
- Bergenheim, Anna, et al.
(författare)
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Stress levels predict substantial improvement in pain intensity after 10 to 12years in women with fibromyalgia and chronic widespread pain: a cohort study.
- 2019
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Ingår i: BMC rheumatology. - : Springer Science and Business Media LLC. - 2520-1026. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies of prognosis for women with Fibromyalgia (FM) or chronic widespread pain (CWP) show contradictory results. However, some women appear to improve in pain and other core symptoms over time. There is limited knowledge about predictors of substantial improvement in pain intensity over a longer period of time. The primary objective of this study was to investigate the natural course of pain intensity and distribution of pain over 10 to 12years in a cohort of 166 women with FM or CWP. Secondarily we wanted to investigate predictors of substantial improvement (≥50%) in pain intensity after 10 to 12years.The study is a longitudinal prospective cohort study. 166 women with FM or CWP were followed up after 10 to 12years. 126 women (76%) participated in the follow-up and completed a battery of questionnaires concerning pain intensity, pain distribution and other physical and mental aspects of health. Differences in symptoms within the cohort over 10 to 12years and predictors of substantial improvement (≥50%) in pain intensity were calculated.Pain had improved at the 10 to 12year follow-up (p<0.001) with a mean change of -9.2mm (SD 23.3, 95% CI: -13.3; -5.0) for pain intensity and-2.0 sites (SD 4.2, 95% CI: -2.7; -1.2) for pain distribution. Nine percent of the 126 women showed an individual moderate improvement in pain intensity while 16% showed a substantial improvement at the follow-up as compared to baseline. Lower symptoms of stress and higher pain intensity at baseline predicted higher probability of reporting at least 50% less pain intensity after 10 to 12years as compared to baseline.A majority of women with FM and CWP appear to have a positive course of pain over time, which should be communicated to these patients in health care. Reducing stress levels might contribute to better chances of improvement over time.Clinicaltrials.gov NCT02872129, registered 06/30/2016.
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| 2. |
- Danielski, Itai, 1973-
(författare)
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Energy performance of residential buildings : projecting, monitoring and evaluating
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Energy security and climate change mitigation have been discussed in Sweden since the oil crisis in the 1970s. Sweden has since then increased its share of renewable energy resources to reach the highest level among the EU member states, but is still among the countries with the highest primary energy use per capita. Not least because of that, increasing energy efficiency is important and it is part of the Swedish long term environmental objectives. Large potential for improving energy efficiency can be found in the building sector, mainly in the existing building stock but also in new constructions.Buildings hold high costs for construction, service and maintenance. Still, their energy efficiency and thermal performance are rarely validated after construction or renovation. As energy efficiency become an important aspects in building design there is a need for accurate tools for assessing the energy performance both before and after building construction. In this thesis criteria for energy efficiency in new residential buildings are studied. Several building design aspects are discussed with regards to final energy efficiency, energy supply-demand interactions and social aspects. The results of this thesis are based on energy modelling, energy measurements and one questionnaire survey. Several existing residential buildings were used as case studies.The results show that pre-occupancy calculations of specific final energy demand in residential buildings is too rough an indicator to explicitly steer towards lower final energy use in the building sector. Even post occupancy monitoring of specific final energy demand does not always provide a representative image of the energy efficiency of buildings and may result with large variation among buildings with similar thermal efficiency. A post occupancy method of assessing thermal efficiency of building fabrics using thermography is presented. The thermal efficiency of buildings can be increased by design with low shape factor. The shape factor was found to have a significant effect on the final energy demand of buildings and on the use of primary energy. In Nordic climates, atria in multi-storey apartment buildings is a design that have a potential to increase both energy efficiency (by lower shape factor) and enhance social interactions among the occupants.
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| 3. |
- Danielski, Itai, et al.
(författare)
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Heated atrium in multi-storey apartment buildings, a design with potential to enhance energy efficiency and to facilitate social interactions
- 2016
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Ingår i: Building and Environment. - : Elsevier. - 0360-1323 .- 1873-684X. ; 106, s. 352-364
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Tidskriftsartikel (refereegranskat)abstract
- The design concept of conditioned atria gains increasing popularity in commercial and service buildings all over the world, but is still not a common building design in the residential sector. This study investigates the potential of such design in residential buildings in Nordic climates as means to enhance both energy efficiency as well as social interaction among residents. Energy modelling was used to compare energy efficiency among designs of residential buildings with and without atrium and to identify important design parameters. Social interaction was analysed, based on a survey evaluating the perception of residents living in an existing multi-storey apartment building designed with a heated atrium in the north of Sweden.The results show that heated atrium in Nordic climates have a potential to reduce the total final energy demand while at the same time increase the conditioned space of the building. To positively impact energy efficiency, the atrium should fulfil three requirements: (i) it should be designed to reduce the shape factor for the whole building; (ii) it should have the minimum glazed area that comply with the building requirements concerning natural light and visual comfort; and (iii) adjustable solar shading should be installed in the atrium’s façades to avoid unwanted overheating. The survey results indicate that the additional space created by the atrium has a potential to facilitate and promote social interaction among residents and to increases a sense of neighbourliness and belongingness, which are often discussed as important parameters in relation to social sustainability.
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| 4. |
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| 5. |
- Lennmyr, Emma, et al.
(författare)
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Survival in adult acute lymphoblastic leukaemia (ALL) : A report from the Swedish ALL Registry
- 2019
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Ingår i: European Journal of Haematology. - : WILEY. - 0902-4441 .- 1600-0609. ; 103:2, s. 88-98
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: As new, effective therapies emerge for acute lymphoblastic leukaemia (ALL), the results of clinical trials need to relate to standard of care.Methods: We used the population-based Swedish ALL Registry to evaluate characteristics, treatment and long-term outcome in 933 patients with diagnosis between 1997 and 2015.Results: The median age was 53 years. The frequency of Philadelphia (Ph)-positive leukaemia was 34% of examined B-ALL with a peak incidence at 50-59 years. Five-year overall survival (OS) improved between 1997-2006 and 2007-2015; in patients 18-45 years from 50% (95% CI 43-57) to 65% (95% CI 58-72), 46-65 years from 25% (95% CI 18-32) to 46% (95% CI 37-55) and >65 years from 7% (95% CI 2.6-11) to 11% (95% CI 5.9-16) (P < 0.05). Men with Ph-neg B-ALL 46-65 years had inferior OS compared with women (P < 0.01). Standardised mortality ratio was 5.7 (95% CI 5.0-6.3) for patients who survived 5 years from diagnosis. In multivariable analysis, Ph-positive disease was not associated with impaired prognosis but with lower risk of death in 2007-2015.Conclusions: In a population-based cohort, OS has improved in adult ALL, especially for Ph-positive disease but for middle-aged men with Ph-negative B-ALL outcome was poor. Cure without late toxicity or relapse is still desired.
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| 6. |
- Salih Joelsson, Lana, 1969-, et al.
(författare)
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Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women
- 2017
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Ingår i: European psychiatry. - : Cambridge University Press (CUP). - 0924-9338 .- 1778-3585. ; 45, s. 212-219
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundInfertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.MethodsFour hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.ResultsThe prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise < 2 h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09–1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04–1.49).ConclusionsWomen pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.
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| 7. |
- Salih Joelsson, Lana, et al.
(författare)
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Do subfertile women adjust their habits when trying to conceive?
- 2016
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 121:3, s. 184-191
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Tidskriftsartikel (refereegranskat)abstract
- AbstractAIM:The aim of this study was to investigate lifestyle habits and lifestyle adjustments among subfertile women trying to conceive.MATERIALS AND METHODS:Women (n = 747) were recruited consecutively at their first visit to fertility clinics in mid-Sweden. Participants completed a questionnaire. Data were analyzed using logistic regression, t tests, and chi-square tests.RESULTS:The response rate was 62% (n = 466). Mean duration of infertility was 1.9 years. During this time 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. In this sample, 23.9% of the women were overweight (body mass index, BMI 25-29.9 kg/m(2)), and 12.5% were obese (BMI ≥30 kg/m(2)). Obese women exercised more and changed to healthy diets more frequently than normal-weight women (odds ratio 7.43; 95% confidence interval 3.7-14.9). Six out of ten women (n = 266) took folic acid when they started trying to conceive, but 11% stopped taking folic acid after some time. Taking folic acid was associated with a higher level of education (p < 0.001).CONCLUSIONS:Among subfertile women, one-third were overweight or obese, and some had other lifestyle factors with known adverse effects on fertility such as use of tobacco. Overweight and obese women adjusted their habits but did not reduce their body mass index. Women of fertile age would benefit from preconception counseling, and the treatment of infertility should routinely offer interventions for lifestyle changes.KEYWORDS:Alcohol consumption; assisted reproduction; diet; infertility; lifestyle; obesity; pregnancy; tobacco use
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| 8. |
- Salih Joelsson, Lana, et al.
(författare)
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Investigating the effect of lifestyle risk factors upon the number of aspirated and mature oocytes in in vitro fertilization cycles : interaction with antral follicle count
- 2019
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:8
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Tidskriftsartikel (refereegranskat)abstract
- There is evidence demonstrating that certain lifestyle factors have a detrimental effect on fertility. Since such factors often coexist, possible synergistic effects merit further investigation. Thus we aimed to examine the cumulative impact of lifestyle factors on in vitro fertilization (IVF) early reproductive treatment outcomes and their interaction with measures of ovarian reserve. Materials and methods By following women who were starting their first fresh IVF cycle in 2 cohorts, the "Lifestyle study cohort" (hypothesis generating cohort, n = 242) and the "UppSTART study" (validation cohort, n = 432) in Sweden, we identified two significant risk factors acting independently, smoking and BMI, and then further assessed their cumulative effects. Results Women with both these risk factors had an Incidence Rate Ratio (IRR) of 0.75 [(95% CI 0.61-0.94)] regarding the number of aspirated oocytes compared to women without these risk factors. Concerning the proportion of mature oocytes in relation to the total number of aspirated oocytes, the interaction between BMI and Antral Follicle Count (AFC) was significant (p-value 0.045): the lower the value of AFC, the more harmful the effect of BMI with the outcome. Conclusions Data shows that there is an individual as well as a cumulative effect of smoking and BMI on the number of aspirated and mature oocytes in fresh IVF treatment cycles. AFC might modify associations between BMI and the proportion of mature oocytes in relation to the total number of aspirated oocytes. These results highlight the importance of lifestyle factors on IVF early reproductive outcomes and provide additional evidence for the importance of preconception guidance for the optimization of IVF cycle outcome.
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| 9. |
- Salih Joelsson, Lana
(författare)
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Lifestyle and Reproductive Health among Women prior to Conception
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Health and lifestyle is of great importance when women intend to become pregnant, as well as during pregnancy. It is crucial that people seeking for infertility are aware of which lifestyle changes they can undertake to enhance the likelihood of treatment success. The overall aim of this project was to investigate the extent to which women comply with recommendations for lifestyle changes during the time they try to conceive and during early pregnancy and the impact of lifestyle risk factors on treatment results in sub-fertile women. Lifestyle factors and mental health at baseline and lifestyle changes women made while they were trying to conceive were assessed by a study-specific questionnaire. Both pregnant women and non-pregnant sub-fertile women in the mid-Sweden region were included. The level of pregnancy planning was associated with planning behavior. Only one-third of all pregnant women took folic acid one month prior to conception, 17% used tobacco daily and 11% used alcohol weekly three months before conception. In the sub-fertile non-pregnant women cohort, 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. Among sub-fertile women, one-third were overweight or obese. Pregnant women who conceived with Assisted Reproductive Technology (ART) reported lower rates of anxiety and depression symptoms compared to sub-fertile women. They also showed no difference in depression and anxiety symptoms compared to women who conceived naturally. Among sub-fertile women undergoing their first IVF treatment cycle, an independent as well as a cumulative effect of smoking and BMI on the number of aspirated oocytes and the proportion of mature oocytes was observed, especially among women with low ovarian reserve. In conclusion, approximately half of the women in our studies retained habits with negative effects on fertility. This is worrying because the harmful consequences of negative lifestyle factors are well established. These negative lifestyle factors are easy to detect and adjust at an early stage in the assessment process and might allow for optimization of fertility treatment and pregnancy outcomes.
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