| 1. |
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| 2. |
- Bergström, Göran, 1964, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 3. |
- Bergström, Göran, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - : Wolters Kluwer. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 4. |
- Engström, Gunnar, et al.
(author)
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Pulmonary function and atherosclerosis in the general population : causal associations and clinical implications
- 2024
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In: European Journal of Epidemiology. - : Springer Nature. - 0393-2990 .- 1573-7284. ; 39:1, s. 35-49
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Journal article (peer-reviewed)abstract
- Reduced lung function is associated with cardiovascular mortality, but the relationships with atherosclerosis are unclear. The population-based Swedish CArdioPulmonary BioImage study measured lung function, emphysema, coronary CT angiography, coronary calcium, carotid plaques and ankle-brachial index in 29,593 men and women aged 50–64 years. The results were confirmed using 2-sample Mendelian randomization. Lower lung function and emphysema were associated with more atherosclerosis, but these relationships were attenuated after adjustment for cardiovascular risk factors. Lung function was not associated with coronary atherosclerosis in 14,524 never-smokers. No potentially causal effect of lung function on atherosclerosis, or vice versa, was found in the 2-sample Mendelian randomization analysis. Here we show that reduced lung function and atherosclerosis are correlated in the population, but probably not causally related. Assessing lung function in addition to conventional cardiovascular risk factors to gauge risk of subclinical atherosclerosis is probably not meaningful, but low lung function found by chance should alert for atherosclerosis.
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| 5. |
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| 6. |
- Lindberg, Sara, et al.
(author)
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Expanded HILUS Trial: A Pooled Analysis of Risk Factors for Toxicity From Stereotactic Body Radiation Therapy of Central and Ultracentral Lung Tumors
- 2023
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In: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS. - 0360-3016 .- 1879-355X. ; 117:5, s. 1222-1231
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Journal article (peer-reviewed)abstract
- Purpose: Stereotactic body radiation therapy for tumors near the central airways implies high-grade toxic effects, as concluded from the HILUS trial. However, the small sample size and relatively few events limited the statistical power of the study. We therefore pooled data from the prospective HILUS trial with retrospective data from patients in the Nordic countries treated outside the prospective study to evaluate toxicity and risk factors for high-grade toxic effects. Methods and Materials: All patients were treated with 56 Gy in 8 fractions. Tumors within 2 cm of the trachea, the mainstem bronchi, the intermediate bronchus, or the lobar bronchi were included. The primary endpoint was toxicity, and the secondary endpoints were local control and overall survival. Clinical and dosimetric risk factors were analyzed for treatment-related fatal toxicity in univariable and multivariable Cox regression analyses.Results: Of 230 patients evaluated, grade 5 toxicity developed in 30 patients (13%), of whom 20 patients had fatal bronchopul-monary bleeding. The multivariable analysis revealed tumor compression of the tracheobronchial tree and maximum dose to the mainstem or intermediate bronchus as significant risk factors for grade 5 bleeding and grade 5 toxicity. The 3-year local control and overall survival rates were 84% (95% CI, 80%-90%) and 40% (95% CI, 34%-47%), respectively.Conclusions: Tumor compression of the tracheobronchial tree and high maximum dose to the mainstem or intermediate bronchus increase the risk of fatal toxicity after stereotactic body radiation therapy in 8 fractions for central lung tumors. Simi-lar dose constraints should be applied to the intermediate bronchus as to the mainstem bronchi.
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| 7. |
- Ljunggren, Mirjam, et al.
(author)
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Association between proteomics and obstructive sleep apnea phenotypes in a community-based cohort of women
- 2020
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In: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 29:4
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Journal article (peer-reviewed)abstract
- Proteomic‐based technologies offer new opportunities to identify proteins that might reflect the cardiometabolic stress caused by different aspects of sleep‐disordered breathing. We aimed to investigate whether severe obstructive sleep apnea and severe obstructive sleep apnea during rapid eye movement sleep are associated with changed levels of inflammatory and cardiac disease‐related proteins in a population‐based cohort of women. In the community‐based “Sleep and Health in Women” (SHE) cohort study, 400 women underwent polysomnography, anthropometric measurements and blood sampling. Two proteomic assays (Olink Proseek® Inflammation panel and Olink Proseek® Cardiovascular II panel), each measuring 92 proteins, were analysed in a subsample of 253 women. p‐Values were adjusted for multiple testing, with false discovery rate set at 10%. In unadjusted models, 57 proteins were associated with apnea−hypopnea index, 56 proteins with oxygen desaturation index and 64 proteins with rapid eye movement−apnea−hypopnea index. After adjustment for age, body mass index and plate, there were no significant associations between apnea−hypopnea index or oxygen desaturation index and any of the proteins. Severe obstructive sleep apnea during rapid eye movement sleep (rapid eye movement−apnea−hypopnea index ≥ 30) was associated with decreased levels of two anti‐inflammatory proteins; Sirt2 (q‐value .016) and LAP‐TGF‐β1 (q‐value .016). There was also a negative association between rapid eye movement−apnea−hypopnea index of ≥ 30 and Axin1 (q‐value .095), a protein thought to facilitate TGF‐β‐signalling. We conclude that severe obstructive sleep apnea during rapid eye movement sleep is associated with low levels of Sirt2, LAP‐TGF‐β1 and Axin1, anti‐inflammatory proteins involved in metabolic regulation and in the atherosclerotic process. For obstructive sleep apnea based on a whole night, the associations with cardiac and inflammatory proteins are weaker, and explained to a large extent by age and body mass index.
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| 8. |
- Malinovschi, Andrei, 1978-, et al.
(author)
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Consequences of Using Post- or Prebronchodilator Reference Values in Interpreting Spirometry
- 2023
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In: American Journal of Respiratory and Critical Care Medicine. - : American Thoracic Society. - 1073-449X .- 1535-4970. ; 208:4, s. 461-471
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Journal article (peer-reviewed)abstract
- RATIONALE: Post-bronchodilator (BD) spirometry is used for diagnosis of chronic obstructive pulmonary disease (COPD). However, pre-BD reference values are used for spirometry interpretation.OBJECTIVES: To compare the resulting prevalence rates of abnormal spirometry and study the consequences of using pre- or post-BD reference values generated within the Swedish CArdioPulmonary bioImage Study (SCAPIS) when interpreting post-BD spirometry in a general population.METHODS: SCAPIS reference values for post-BD and pre-BD spirometry were based on 10,156 and 1,498 never-smoking, healthy participants, respectively. We studied the associations of abnormal spirometry, defined by using pre- or post-BD reference values, with respiratory burden in the SCAPIS general population (28,851 individuals).MEASUREMENTS AND MAIN RESULTS: Bronchodilation resulted in higher predicted median and lower limit of normal (LLN) for FEV1/FVC ratio. The prevalence of post-BD FEV1/FVC < pre-bronchodilator LLN was 4.8% and that of post-BD FEV1/FVC < post-bronchodilator LLN was 9.9% for the general population. An additional 5.1% was identified as having an abnormal post-BD FEV1/FVC ratio and this group had more respiratory symptoms, emphysema (13.5% vs. 4.1%, p<0.001) and self-reported physician-diagnosed COPD (2.8% vs. 0.5%, p<0.001) than subjects with post-BD FEV1/FVC ratio > LLN for both pre- and post-bronchodilation).CONCLUSIONS: Pre- and post-bronchodilator spirometry reference values differ with regard to FEV1/FVC ratio. Use of post-bronchodilator reference values doubled the population prevalence of airflow obstruction; this was related to a higher respiratory burden. Using post-bronchodilator reference values when interpreting post-bronchodilator spirometry might enable identification of individuals with mild disease and be clinically relevant.
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| 9. |
- Pesonen, Ida, et al.
(author)
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High prevalence of interstitial lung abnormalities in middle-aged never-smokers
- 2023
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In: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 9:5
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Journal article (peer-reviewed)abstract
- BACKGROUND: Interstitial lung abnormalities (ILA) are incidental findings on chest computed tomography (CT). These patterns can present at an early stage of fibrotic lung disease. Our aim was to estimate the prevalence of ILA in the Swedish population, in particular in never-smokers, and find out its association with demographics, comorbidities and symptoms.METHODS: Participants were recruited to the Swedish CArdioPulmonary BioImage Study (SCAPIS), a population-based survey including men and women aged 50-64 years performed at six university hospitals in Sweden. CT scan, spirometry and questionnaires were performed. ILA were defined as cysts, ground-glass opacities, reticular abnormality, bronchiectasis and honeycombing.FINDINGS: Out of 29 521 participants, 14 487 were never-smokers and 14 380 were men. In the whole population, 2870 (9.7%) had ILA of which 134 (0.5%) were fibrotic. In never-smokers, the prevalence was 7.9% of which 0.3% were fibrotic. In the whole population, age, smoking history, chronic bronchitis, cancer, coronary artery calcium score and high-sensitive C-reactive protein were associated with ILA. Both ILA and fibrotic ILA were associated with restrictive spirometric pattern and impaired diffusing capacity of the lung for carbon monoxide. However, individuals with ILA did not report more symptoms compared with individuals without ILA.INTERPRETATION: ILA are common in a middle-aged Swedish population including never-smokers. ILA may be at risk of being underdiagnosed among never-smokers since they are not a target for screening.
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| 10. |
- Theorell-Haglöw, Jenny, et al.
(author)
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Sleep duration is associated with healthy diet scores and meal patterns : results from the population-based EpiHealth study
- 2020
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In: Journal of Clinical Sleep Medicine (JCSM). - : AMER ACAD SLEEP MEDICINE. - 1550-9389 .- 1550-9397. ; 16:1, s. 9-18
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Journal article (peer-reviewed)abstract
- Study Objectives: To investigate relationships between sleep duration and adherence to healthy diets, but also associations with meal patterns, in a large population-based cohort. Methods: Participants (n = 23,829, males and females, aged 45 to 75 years) from the Swedish EpiHealth cohort study were included in a cross-sectional analysis. The participants filled out an extensive Internet-based questionnaire, and also visited a test center for anthropometric measurements and blood sampling. Sleep duration was classified as short (< 6 h/night; n = 1,862), normal (6 to less fewer than 9 h/night; n = 19,907) and long sleep (>= 9 h/night; n = 858). In addition, a combination variable of sleep duration (short/normal/long) and sleep quality (good/poor) was constructed, giving six categories. Adherence to a healthy diet was assessed using the modified Mediterranean diet (mMED) score and the Healthy Nordic Food Index (HNFI) score based on food groups from a food frequency questionnaire. A regular meal pattern was considered if the participant had breakfast, lunch and dinner on a daily basis. Results: Compared with normal sleepers, short sleepers displayed lower adherence to a healthy diet when using both the mMED score (adjusted odds ratio = 0.70; 95% confidence interval 0.56-0.88) and the HNFI score (0.70; 0.56-0.88). When combining sleep duration and sleep quality, short sleepers with poor sleep quality showed an independent relationship with low adherence to a healthy diet (0.67; 0.52-0.86) compared with normal sleepers with good sleep quality. In addition, both short sleepers (0.71; 0.62-0.82) and long sleepers (0.75; 0.62-0.91) showed low adherence to regular meal patterns, compared with normal sleepers. Furthermore, short sleepers with poor sleep quality had reduced odds of having a regular meal pattern (0.67; 0.57-0.79) as compared with normal sleepers with good sleep quality. Conclusions: Short sleep duration combined with poor sleep quality is associated with low adherence to a healthy diet and regular meal patterns.
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| 11. |
- Theorell-Haglöw, Jenny, et al.
(author)
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Sleep duration is associated with healthy diet scores and meal patterns : Results from the population-based EpiHealth study
- 2020
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In: Journal of Clinical Sleep Medicine. - 1550-9389. ; 16:1, s. 9-18
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Journal article (peer-reviewed)abstract
- Study Objectives: To investigate relationships between sleep duration and adherence to healthy diets, but also associations with meal patterns, in a large population-based cohort. Methods: Participants (n = 23,829, males and females, aged 45 to 75 years) from the Swedish EpiHealth cohort study were included in a cross-sectional analysis. The participants filled out an extensive Internet-based questionnaire, and also visited a test center for anthropometric measurements and blood sampling. Sleep duration was classified as short (< 6 h/night; n = 1,862), normal (6 to less fewer than 9 h/night; n = 19,907) and long sleep (≥ 9 h/night; n = 858). In addition, a combination variable of sleep duration (short/normal/long) and sleep quality (good/poor) was constructed, giving six categories. Adherence to a healthy diet was assessed using the modified Mediterranean diet (mMED) score and the Healthy Nordic Food Index (HNFI) score based on food groups from a food frequency questionnaire. A regular meal pattern was considered if the participant had breakfast, lunch and dinner on a daily basis. Results: Compared with normal sleepers, short sleepers displayed lower adherence to a healthy diet when using both the mMED score (adjusted odds ratio = 0.70; 95% confidence interval 0.56-0.88) and the HNFI score (0.70; 0.56-0.88). When combining sleep duration and sleep quality, short sleepers with poor sleep quality showed an independent relationship with low adherence to a healthy diet (0.67; 0.52-0.86) compared with normal sleepers with good sleep quality. In addition, both short sleepers (0.71; 0.62-0.82) and long sleepers (0.75; 0.62-0.91) showed low adherence to regular meal patterns, compared with normal sleepers. Furthermore, short sleepers with poor sleep quality had reduced odds of having a regular meal pattern (0.67; 0.57-0.79) as compared with normal sleepers with good sleep quality. Conclusions: Short sleep duration combined with poor sleep quality is associated with low adherence to a healthy diet and regular meal patterns.
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| 12. |
- Torén, Kjell, 1952, et al.
(author)
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Chronic airflow limitation and its relation to respiratory symptoms among ever-smokers and never-smokers: a cross-sectional study
- 2020
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In: Bmj Open Respiratory Research. - : BMJ. - 2052-4439. ; 7:1
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Journal article (peer-reviewed)abstract
- Background The diagnosis of chronic obstructive pulmonary disease is based on the presence of persistent respiratory symptoms and chronic airflow limitation (CAL). CAL is based on the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1:FVC) after bronchodilation, and FEV1:FVC less than the fifth percentile is often used as a cut-off for CAL. The aim was to investigate if increasing percentiles of FEV1:FVC were associated withany respiratory symptom(cough with phlegm, dyspnoea or wheezing) in a general population sample of never-smokers and ever-smokers. Methods In a cross-sectional study comprising 15 128 adults (50-64 years), 7120 never-smokers and 8008 ever-smokers completed a respiratory questionnaire and performed FEV(1)and FVC after bronchodilation. We calculated theirz-scores for FEV1:FVC and defined the fifth percentile using the Global Lung Function Initiative (GLI) reference value, GLI(5)and increasing percentiles up to GLI(25). We analysed the associations between different strata of percentiles and prevalence ofany respiratory symptomusing multivariable logistic regression for estimation of OR. Results Among all subjects, regardless of smoking habits, the odds ofany respiratory symptomwere elevated up to the GLI(15-20)strata. Among never-smokers, the odds ofany respiratory symptomwere elevated at GLI(<5)(OR 3.57, 95% CI 2.43 to 5.23) and at GLI(5-10)(OR 2.57, 95% CI 1.69 to 3.91), but not at higher percentiles. Among ever-smokers, the odds ofany respiratory symptomwere elevated from GLI(<5)(OR 4.64, 95% CI 3.79 to 5.68) up to GLI(>= 25)(OR 1.33, 95% CI 1.00 to 1.75). Conclusions The association between percentages of FEV1:FVC and respiratory symptoms differed depending on smoking history. Our results support a higher percentile cut-off for FEV1:FVC for never-smokers and, in particular, for ever-smokers.
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| 13. |
- Torén, Kjell, 1952, et al.
(author)
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The ratio FEV1/FVC and its association to respiratory symptoms-A Swedish general population study
- 2021
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 41:2, s. 181-191
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Journal article (peer-reviewed)abstract
- Chronic airflow limitation (CAL) can be defined as fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) any respiratory symptom. In a cross-sectional general population study, 15,128 adults (50-64 years of age), 7,120 never-smokers and 8,008 ever-smokers completed a respiratory questionnaire and performed FEV1 and FVC after bronchodilation. We calculated different ratios of FEV1/FVC from 0.40 to 1.0 using 0.70 as reference category. We analysed odds ratios (OR) between different ratios and any respiratory symptom using adjusted multivariable logistic regression. Among all subjects, regardless of smoking habits, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.82, OR 0.48 (95% CI 0.41-0.56). Among never-smokers, the lowest odds for any respiratory symptom was at FEV1/FVC = 0.81, OR 0.53 (95% CI 0.41-0.70). Among ever-smokers, the odds for any respiratory symptom was lowest at FEV1/FVC = 0.81, OR 0.43 (95% CI 0.16-1.19), although the rate of inclining in odds was small in the upper part, that is FEV1/FVC = 0.85 showed similar odds, OR 0.45 (95% CI 0.38-0.55). We concluded that the odds for any respiratory symptoms continuously decreased with higher FEV1/FVC ratios and reached a minimum around 0.80-0.85, with similar results among never-smokers. These results indicate that the optimal threshold associated with respiratory symptoms may be higher than 0.70 and this should be further investigated in prospective longitudinal studies.
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| 14. |
- Åkerfeldt, Anna, et al.
(author)
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"Fridolin backar in i framtiden om digitala läromedel"
- 2021
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In: Dagens Nyheter. - 1101-2447. ; :2021-12-16
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Journal article (pop. science, debate, etc.)abstract
- Ingress: 23 forskare inom it- och utbildningsområdet: Regeringens utredare borde inte lyfta fram läsning på skärm som något negativt.Forskning visar att både tryckta och digitala läromedel behövs i skolan.
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| 15. |
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| 16. |
- Ädel, Eva, et al.
(author)
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Health-promoting and -impeding aspects of using peer-learning during clinical practice education : A qualitative study
- 2021
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In: Nurse Education in Practice. - : Elsevier. - 1471-5953 .- 1873-5223. ; 55
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Journal article (peer-reviewed)abstract
- AimThe aim of the present study was to elucidate health-promoting and -impeding aspects of peer-learning by examining nursing students' descriptions of learning together as peers, and how this might interact with their health.BackgroundPeer-learning is a useful strategy for teaching and learning in nursing students' clinical practice education. In the research, benefits such as improved cooperation and increased self-confidence have been described and labelled as health-promoting.DesignA qualitative descriptive approach Method Thirteen first-year nursing students aged 22-45 years, who had completed their first clinical practice education on a medical or surgical hospital ward, participated in one-on-one semi-structured interviews. The interviews were analyzed using qualitative content analysis.ResultWorking as a pair was primarily described as positive, as the peers felt basic support from each other, even though they described negative experiences that limited their own development and challenged their patience.ConclusionPeer-learning as a model for supervision in clinical practice incorporates valuable health-promoting aspects, as the students felt safe, supported, increased self-confidence, and participation. The interaction between peers helped them grow as human beings, and the mutual support the peers felt was a vital health-promoting aspect that limited the impact of the described health-impeding aspects, which included sometimes finding peer-learning trying, stressful and irritating.
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| 17. |
- Almqvist, Linnéa, et al.
(author)
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Clinical outcome of adult onset asthma in a 15 year follow-up
- 2020
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In: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 56:Suppl 64
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Journal article (other academic/artistic)abstract
- Background: Adult onset asthma is poorly studied and there are few long-term clinical follow-up studies.Aim: To study clinical characteristics of adult onset asthma in a 15-year follow-up.Method: Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, a cohort of n=309 subjects with adult onset asthma (aged 20-60 years) was recruited during 1995-99. The cohort was followed up in 2012-14 (n=205). Structured interviews and clinical examinations including spirometry were performed at both recruitment and follow-up. Skin prick tests were performed at recruitment and blood samples for cell counts and IgE at the follow-up. Asthma control was classified according to GINA 2006.Results: At follow-up n=182 (89%) still had asthma, while n=23 (11%) were in remission. Among individuals with persistent asthma, mean pre-bronchodilator FEV1 percent of predicted was 89.0 at follow-up, similar as recruitment 88.3. At recruitment 16.5% were smokers, and of these, 86.7% had quit smoking at follow-up. At follow-up, 39% had blood neutrophils ≥4.0x109/L, 23% had blood eosinophils ≥0.3x109/L, and 28% had specific IgE>0.35 IU/ml to any airborne allergen. Any respiratory symptoms were reported by 90% and 31% used medium or high dose inhaled corticosteroids (ICS), 20% low dose ICS whereas 20% had no treatment. 55% had controlled asthma, 32% partly controlled and 13% uncontrolled asthma.Conclusion: In this 15-year follow-up of adult onset asthma, the majority had persistent asthma. Smoking and high proportion using ICS may contribute to the stable lung function. Still, it should be noted that merely around every other had well controlled asthma.
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| 18. |
- Almqvist, Linnéa, et al.
(author)
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Remission of adult-onset asthma is rare: a 15-year follow-up study
- 2020
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In: Erj Open Research. - : European Respiratory Society (ERS). - 2312-0541. ; 6:4
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Journal article (peer-reviewed)abstract
- Background: There are few long-term clinical follow-up studies of adult-onset asthma. The aim of this article was to study clinical characteristics of adult-onset asthma in relation to remission and persistence of the disease in a 15-year follow-up. Methods: A cohort of 309 adults aged 20-60 years with asthma onset during the last 12 months verified by bronchial variability, was recruited between 1995 and 1999 from the general population in northern Sweden. The cohort was followed-up in 2003 (n=250) and between 2012 and 2014 (n=205). Structured interviews and spirometry were performed at recruitment and the follow-ups. Bronchial hyperreactivity (BHR) and skin-prick tests were performed at recruitment and blood samples were collected at the last follow-up. Remission of asthma was defined as no asthma symptoms and no use of asthma medication during the last 12 months. Results: Of eight individuals in remission in 2003, five had relapsed between 2012 and 2014 and in total, 23 (11%) were in remission, while 182 had persistent asthma. Those in remission had higher mean forced expiratory volume in 1 s % predicted at recruitment than those with persistent asthma (94.6 versus 88.3, p=0.034), fewer had severe BHR (27.3% versus 50.9%, p=0.037) and they had less body mass index increase (+1.6 versus +3.0, p=0.054). Of those with persistent asthma, 13% had uncontrolled asthma and they had higher levels of blood neutrophils than those with partly controlled or controlled asthma. Conclusion: Higher forced expiratory volume in 1 s % predicted and less-severe BHR was associated with remission of adult-onset asthma, but still, the proportion in remission in this 15-year follow-up was low.
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| 19. |
- Amid Hägg, Shadi, 1982-
(author)
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Sleep disturbances : Consequences and comorbidities
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Sleep disorders are common in the general population, with insomnia and sleep-related breathing disorders being the most common disorders. Since sleep has many important functions, such as a role in consolidation of memories and learning, energy conservation, cardiovascular and immune system regulation, it is not surprising that the disruption of normal sleep may lead to negative health effects and various comorbidities. Aim: The overall aim of this thesis was to investigate the impact of disturbed sleep on various consequences and comorbidities. Methods and results: Papers I and II were based on the Sleep and Health in Women (SHE), a population-based prospective study of women, where a questionnaire was sent to women in 2000 and 2010. In paper I, the study cohort comprised 4,320 women <67 years of age who answered both questionnaires and had worked during the follow-up period. In women, having a long history of insomnia symptoms was associated with an increased risk of self-reported occupational accidents.In paper II, the 4,882 participants who answered the questions regarding nocturnal gastroesophageal reflux and snoring in both questionnaires were included in the study cohort. Women with nocturnal gastroesophageal reflux and snoring were at an increased risk of developing daytime sleepiness and to involuntarily fall asleep during the day. Paper III was based on the RHINE-cohort with participants from seven Northern European centers. The study cohort in paper III comprised the 2,568 smokers in the baseline study that also reported being smokers or former smokers in the follow-up study. It was found that having insomnia symptoms or excessive daytime sleepiness decreases the chance of long-term smoking cessation, and that smoking increases the risk of incident difficulties inducing sleep. Paper IV was the population-based, cross-sectional GA2LEN-survey which was conducted in four major Swedish cities. Paper IV included the 25,901 participants who answered questions regarding both snoring and insomnia symptoms. The combination of snoring and insomnia symptoms was associated with an increased risk of hypertension, asthma, chronic obstructive pulmonary disease, and daytime sleepiness. Conclusions: Disturbed sleep, due to varying causes, influences the risk of occupational accidents, on the chance of successful smoking cessation, on the risk of daytime sleepiness, hypertension, and obstructive lung disease. In clinical consultation, it is important to always inquire about disturbed sleep as it can have an impact on many aspects of health.
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| 20. |
- Amid Hägg, Shadi, et al.
(author)
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Smokers with insomnia symptoms are less likely to stop smoking
- 2020
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In: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 170
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Journal article (peer-reviewed)abstract
- Objectives: Smoking is associated with sleep disturbances. The aim of this study was to analyze whether sleep disturbances are predictors of smoking cessation and whether continued smoking is associated with the development of sleep disturbances. Methods: A questionnaire was sent to randomly selected men and women in Northern Europe in 1999-2001 (RHINE II) and was followed up by a questionnaire in 2010-2012 (RHINE III). The study population consisted of 2568 participants who were smokers at baseline and provided data on smoking at follow-up. Insomnia symptoms were defined as having difficulty initiating and/or maintaining sleep and/or early morning awakening >= 3 nights/week. Multiple logistic regression analyses were performed to calculate odds ratios (OR). Results: Subjects with difficulty initiating sleep (adjusted odds ratio; 95% confidence interval: 0.6; 0.4-0.8), difficulty maintaining sleep (0.7; 0.5-0.9), early morning awakening (0.6; 0.4-0.8), any insomnia symptom (0.6; 0.5-0.8) or excessive daytime sleepiness (0.7; 0.5-0.8) were less likely to achieve long-term smoking cessation after adjustment for age, BMI, pack-years, hypertension, diabetes, chronic bronchitis, rhinitis, asthma, gender and BMI difference. There was no significant association between snoring and smoking cessation. In subjects without sleep disturbance at baseline, continued smoking increased the risk of developing difficulty initiating sleep during the follow-up period compared with those that had quit smoking (adj. OR 1.7, 95% CI 1.2-2.3). Conclusions: Insomnia symptoms and excessive daytime sleepiness negatively predict smoking cessation. Smoking is a risk factor for the development of difficulty initiating sleep. Treatment for sleep disturbances should be included in smoking-cessation programs.
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| 21. |
- Amid Hägg, Shadi, et al.
(author)
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The negative health effects of having a combination of snoring and insomnia
- 2022
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In: JOURNAL OF CLINICAL SLEEP MEDICINE. - : American Academy of Sleep Medicine (AASM). - 1550-9389 .- 1550-9397. ; 18:4, s. 973-981
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Journal article (peer-reviewed)abstract
- Study Objectives: Insomnia and snoring are common sleep disorders. The aim was to investigate the association of having a combination of insomnia symptoms and snoring with comorbidity and daytime sleepiness. Methods: The study population comprised 25,901 participants (16-75 years, 54.4% women) from 4 Swedish cities, who answered a postal questionnaire that contained questions on snoring, insomnia symptoms (difficulties initiating and/or maintaining sleep and/or early morning awakening), smoking, educational level, and respiratory and nonrespiratory disorders. Results: Snoring was reported by 4,221 (16.2%), while 9,872 (38.1%) reported 1 insomnia symptom. A total of 2,150 (8.3%) participants reported both insomnia symptoms and snoring. The association with hypertension (adjusted odds ratio [OR], 1.4; 95% confidence interval [Cl], 1.2-1.6), chronic obstructive pulmonary disease (adjusted OR, 1.8; 95% CI, 1.3-2.4), asthma (adjusted OR, 1.9; 95% CI, 1.6-2.3), daytime sleepiness (adjusted OR, 7.9; 95% CI, 7.1-8.8), and the use of hypnotics (adjusted OR, 7.5; 95% CI, 6.1-9.1) was highest for the group with both insomnia symptoms and snoring. Conclusions: Participants with both snoring and insomnia run an increased risk of hypertension, chronic obstructive pulmonary disease, asthma, daytime sleepiness, and use of hypnotics. It is important to consider snoring in patients seeking medical assistance for insomnia and, vice versa, in patients with snoring inquiring about insomnia.
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| 22. |
- Andersson, Maria, et al.
(author)
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Transport av dräktiga djur, transport av unga djur och åldersbestämning av foster
- 2023
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Reports (other academic/artistic)abstract
- De flesta lantbruksdjur transporteras endast enstaka gånger i livet och har därför sällan möjlighet att vänja sig vid transporter på ett sätt som skulle förebygga stress och bidra till en god transportupplevelse. Att skapa förutsättningar som minimerar påverkan på djuren och underlättar drivning av djuren är därför av stor vikt. Livdjurstransport eller transport till slakt kan vara en mycket stressfylld situation för djur. EFSA har under 2022 publicerat tre olika utlåtanden om transport av nötkreatur, små idisslare och gris. EFSA har i sina utlåtanden identifierat följande relevanta välfärdsrisker: social stress i samband med omgruppering, stress då djuren hanteras av ovarsamma människor eller av människor som de inte är vana vid, stress på grund av värme eller kyla, skador, rörelsestress (orsakat av fordonets rörelser), predationsstress (specifikt hos får som drivs med hund), hunger, törst, respiratoriska problem (specifikt hos nötkreatur), begränsade rörelsemöjligheter, svårigheter att vila och sensorisk överstimulering. Sammantaget kan dessa välfärdsrisker leda till ackumulerad och hög stress, rädsla, smärta, obehag och utmattning hos djuren.Nötkreatur, grisar och får är sociala djur som lätt stressas om de separeras från sin grupp. Att ta hänsyn till deras naturliga flockbeteende genom att t.ex. inte driva djur enskilt utan i grupp (undantag för vuxna handjur som ofta behöver hanteras enskilt) är därför viktigt både före, under och efter transport. Omgrupperingar och social stress riskerar att leda till aggressioner och oönskade beteenden då djuren kan komma att skada sig själva eller varandra.Djurs tidigare erfarenheter av att bli hanterade av människor påverkar deras upplevelse och stressnivå vid hantering i samband med transport. En mer vänlig hantering av djuren tidigt i livet kan underlätta hanteringen i samband med transport. Djurens rädsla utgör en välfärdsrisk, både för djuren själva och för den transportör som ska hantera dem. Utlastningsutrymmen och drivvägar behöver vara väl designade för att få ett bra flöde när djuren lastas respektive lastas av och den som hanterar djuren behöver ha god kunskap om djurens naturliga beteenden.Hunger och törst kan uppstå hos djur under tiden från lastning till transport och urlastning. Risken för att djuren ska uppleva hunger och törst ökar med längre transporttider. Unga djur har ett naturligt tätare födointag vilket man kan behöva ta hänsyn till vid transport genom att erbjuda djuren möjlighet att äta och dricka oftare än äldre djur. I nuläget finns det inga optimala lösningar på hur man ska kunna tillgodose behovet av vatten eller annan utfodring på transport då intaget även påverkas av stress och sociala faktorer utöver vana vid utrustningen.Djurtätheten på transportfordonet är en viktig faktor som påverkar djurens möjligheter att hålla balansen och att kunna ligga ned och vila, men även risken för skador och död. Behovet av att kunna ligga ned under transport ökar med transportens längd och huruvida djuren ligger ned är kopplat till vilket utrymme som ges, där större utrymme leder till att fler djur ligger ned.Sen dräktighet räknas som ett tillstånd då det inte är lämpligt att transportera ett djur eftersom transport under denna period kan leda till negativa konsekvenser för djurets välfärd och risker för avkomman. Dräktighet innebär ökad sårbarhet både fysiskt och fysiologiskt. För dräktiga djur innebär därför den stress som förflyttning, lastning, ny miljö, okända människor, rörlig och ostabil transport, transportfordonets förutsättningar, samt avsaknad av foder och vatten under längre perioder, en större påfrestning med en ökad risk för negativa konsekvenser, än för icke-dräktiga djur. Dräktiga djur har en ökad metabolism och värmeproduktion, framförallt under sen dräktighet, vilket gör dräktiga djur mer känsliga för värmestress än icke-dräktiga djur. Vidare blir fysisk ansträngning jobbigare för det dräktiga djuret beroende både på den ökade tyngden och dess påverkan på rörelseapparaten. Även cirkulationssystemet blir mer ansträngt med en förhöjd hjärtfrekvens som följd. Vid värmestress ökar dessutom andningsfrekvensen påtagligt.Kortisol har en viktig roll i slutet av dräktigheten och för att initiera förlossning. I slutet av dräktigheten stiger kortisolnivåerna i moderdjurets blod till följd av att fostrets kortisolproduktion ökar. Förhöjda kortisolnivåer till följd av stress och fysisk ansträngning i samband med lastning, hantering, omgruppering, transport och nya miljöer kan orsaka abort eller för tidig igångsättning av förlossningen. Flera studier visar att det även finns risker under andra delar av dräktigheten. Transport ökar till exempel risken för embryonala förluster under tidig dräktighet hos gris, framför allt under vecka två till fyra, vilket är en kortisolkänslig period. För nötkreatur finns det risk för embryonala förluster vid transporter under dräktighetens första två månader och studier på får har visat på negativa effekter på lamm och ökad risk för fosterdöd vid förhöjda kortisolnivåer hos tackan. Det finns även en risk för epigenetiska effekter hos fostren vid stress hos moderdjuret, vilka kan komma att påverka avkomman senare i livet.När hondjuren ökar i vikt genom fostertillväxt och ökad volym av fostervätskor, påverkas deras rörlighet och förmåga att hålla balansen vilket kan göra att både lastning och transport försvåras samt innebära en ökad risk för halkskador och fläkningsskador. Eventuella led- och klövproblem kan dessutom förvärras eller försvåra rörelsemöjligheterna, även om uppenbar hälta inte alltid kan ses. Den ökade storleken gör att dräktiga djur kräver större plats under transporten, både för att djuren i sig är större, men också för att de ska kunna parera rörelser och hålla balansen. Dräktiga grisar minskar sin aktivitetsnivå och har större behov av att ligga ned och vila vilket behöver tillgodoses under transport.I slutet av dräktigheten, oklart exakt när, sker en uppmjukning av vävnaderna i bäckenregionen vilket är mer påtagligt för nötkreatur än för små idisslare och suggor. Uppmjukningen kvarstår även en tid efter förlossningen. Uppmjukningen ger försämrad stabilitet vid rörelse, vilket innebär risker vid både lastning och transport. Det är därför viktigt att man tar hänsyn till detta och har god tidsmarginal vid transport av dräktiga eller nyförlösta djur, så att djuren inte riskerar att transporteras under den tid som bäckenet är instabilt.Den vetenskapliga evidensen för EU:s regel om 90 % av den förväntade dräktighetstiden som gräns för transport av dräktiga djur förefaller oklar. Rådet ställer sig bakom konklusionen i EFSA:s utlåtande om transport av nötkreatur, små idisslare och gris, om att vetenskapliga belägg för den exakta nu gällande gränsdragningen saknas, samtidigt som det är tydligt att långt gången dräktighet är en riskfaktor för negativ djurvälfärd under transport. I de aktuella utlåtandena finns dock flera studier citerade som visar på sårbarhet för de dräktiga djuren och deras foster under en period som i många fall är längre än de sista 10 % av dräktighetstiden samt att det finns en ökad sårbarhet även under andra delar av dräktigheten och att både moderdjur och foster kan påverkas negativt av att transporteras.Det finns risk för att den stress som en transport innebär kan leda till att det sent dräktiga djuret aborterar eller att förlossningen sätts igång under eller strax efter transport. Då det således föreligger risker för foster och moderdjur vid transport av dräktiga djur under stora delar av dräktighetsperioden anser Rådet att transport av dräktiga djur (nötkreatur, får och gris) om möjligt bör undvikas.Vid transport av unga kalvar, smågrisar och lamm måste hänsyn tas till flera faktorer, såsom ålder, immunförsvarets utveckling, djurens allmänna hälsostatus, huruvida djuren är avvanda eller inte, social stress, etc. Unga djur är generellt känsligare än vuxna djur, och påverkas än mer av att utsättas för hunger och törst, kalla och varma transporter, och begränsade möjligheter att vila under transport. Under perioden då det passiva immunförsvaret går ned samtidigt som det aktiva immunförsvaret är under uppbyggnad är djuren extra känsliga för infektioner.Hur väl ett ungt djur klarar en transport beror bl.a. på längden på transporten (ju längre transport desto större risk för djurens välfärd), samt djurets ålder och vikt. Tiden mellan två och fyra veckor är en känslig ålder för transport av kalvar. Enligt EFSA bör inte kalvar transporteras tidigare än vid fem veckors ålder och de bör väga minst 50 kg. För lamm rekommenderas att djuren transporteras först efter avvänjning. Vidare behöver hänsyn tas till djurens behov av foder och vatten, så att deras närings- samt vätskebehov tillgodoses. Hänsyn behöver även tas till på vilket sätt de är vana vid att inta foder och vatten, och om djuret hålls på liknande sätt i transporten som de är vana vid, exempelvis i samma grupp eller tillsammans med sin mamma. Det kan vara klokt att utfodra djuren innan transport för att minska risken för hunger under transporten. Vid mjölkgiva till kalv behöver tid ges för digestion innan transport för att minska risken för diarré.Icke avvanda djur upplever en större stress runt transport än avvanda djur (vid transport utan moderdjur) och det är därför bättre att företrädesvis transportera djuren efter avvänjning. Unga djur är heller inte motoriskt färdigutvecklade, vilket kan påverka deras balans under transport samt vid på- och avlastning. Yngre djur ligger ned oc
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| 23. |
- Axelsson, Arvid, et al.
(author)
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Tree species classification using Sentinel-2 imagery and Bayesian inference
- 2021
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In: International Journal of Applied Earth Observation and Geoinformation. - : Elsevier BV. - 1569-8432 .- 0303-2434. ; 100
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Journal article (peer-reviewed)abstract
- The increased temporal frequency of optical satellite data acquisitions provides a data stream that has the potential to improve land cover mapping, including mapping of tree species. However, for large area operational mapping, partial cloud cover and different image extents can pose challenges. Therefore, methods are needed to assimilate new images in a straightforward way without requiring a total spatial coverage for each new image. This study shows that Bayesian inference applied sequentially has the potential to solve this problem. To test Bayesian inference for tree species classification in the boreo-nemoral zone of southern Sweden, field data from the study area of Remningstorp (58°27′18.35″ N, 13°39′8.03″ E) were used. By updating class likelihood with an increasing number of combined Sentinel-2 images, a higher and more stable cross-validated overall accuracy was achieved. Based on a Mahalanobis distance, 23 images were automatically chosen from the period of 2016 to 2018 (from 142 images total). An overall accuracy of 87% (a Cohen’s kappa of 78.5%) was obtained for four tree species classes: Betula spp., Picea abies, Pinus sylvestris, and Quercus robur. This application of Bayesian inference in a boreo-nemoral forest suggests that it is a practical way to provide a high and stable classification accuracy. The method could be applied where data are not always complete for all areas. Furthermore, the method requires less reference data than if all images were used for classification simultaneously.
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| 24. |
- Axelsson, Christoffer, et al.
(author)
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The use of dual-wavelength airborne laser scanning for estimating tree species composition and species-specific stem volumes in a boreal forest
- 2023
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In: International Journal of Applied Earth Observation and Geoinformation. - : Elsevier BV. - 1569-8432 .- 1872-826X. ; 118
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Journal article (peer-reviewed)abstract
- The estimation of species composition and species-specific stem volumes are critical components of many forest inventories. The use of airborne laser scanning with multiple spectral channels may prove instrumental for the cost-efficient retrieval of these forest variables. In this study, we scanned a boreal forest using two channels: 532 nm (green) and 1064 nm (near infrared). The data was used in a two-step methodology to (1) classify species, and (2) estimate species-specific stem volume at the level of individual tree crowns. The classification of pines, spruces and broadleaves involved linear discriminant analysis (LDA) and resulted in an overall accuracy of 91.1 % at the level of individual trees. For the estimation of stem volume, we employed species-specific k-nearest neighbors models and evaluated the performance at the plot level for 256 field plots located in central Sweden. This resulted in root-mean-square errors (RMSE) of 36 m3/ha (16 %) for total volume, 40 m3/ha (27 %) for pine volume, 32 m3/ha (48 %) for spruce volume, and 13 m3/ha (87 %) for broadleaf volume. We also simulated the use of a monospectral near infrared (NIR) scanner by excluding features based on the green channel. This resulted in lower overall accuracy for the species classification (86.8 %) and an RMSE of 41 m3/ha (18 %) for the estimation of total stem volume. The largest difference when only the NIR channel was used was the difficulty to accurately identify broadleaves and estimate broadleaf stem volume. When excluding the green channel, RMSE for broadleaved volume increased from 13 to 26 m3/ha. The study thus demonstrates the added benefit of the green channel for the estimation of both species composition and species-specific stem volumes. In addition, we investigated how tree height influences the results where shorter trees were found to be more difficult to classify correctly.
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| 25. |
- Axelsson, Lena, et al.
(author)
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Processes toward the end of life and dialysis withdrawal Physicians' and nurses' perspectives
- 2020
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In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 27:2, s. 419-432
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Journal article (peer-reviewed)abstract
- Background: Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory. Aim: The aim was to explore physicians' and nurses' perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease. Research design and participants: A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data. Ethical considerations: Ethical approval was obtained (Dnr 2014/304-31). Findings and discussion: Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient's decision-making process, The challenge awaiting the family members' processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress. Conclusion: There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient's possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
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