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1.	Fransson, Per, et al. (author) Five-year prospective patient evaluation of bladder and bowel symptoms after dose-escalated radiotherapy for prostate cancer with the Beamcath (R) technique 2006 In: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier. - 0360-3016 .- 1879-355X. ; 66:2, s. 430-438 Journal article (peer-reviewed)abstract Purpose: Late side effects were prospectively evaluated up to 5 years after dose-escalated external beam radiotherapy (EBRT) and were compared with a previously treated series with conventional conformal technique.Methods and Materials: Bladder and bowel symptoms were prospectively evaluated with the Prostate Cancer Symptom Scale (PCSS) questionnaire up to 5 years posttreatment. In all, 257 patients completed the questionnaire 5 years posttreatment. A total of 168 patients were treated with the conformal technique at doses <71 Gy, and 195 were treated with the dose-escalated stereotactic BeamCath® technique comprising three dose levels: 74 Gy (n = 68), 76 Gy (n = 74), and 78 Gy (n = 53).Results: For all dose groups analyzed together, 5 years after treatment, urinary starting problems decreased and urinary incontinence increased in comparison to baseline values. No increase in other bladder symptoms or frequency was detected. When comparing dose groups after 5 years, both the 74-Gy and 78-Gy groups reported increased urinary starting problems compared with patients given the conventional dose (<71 Gy). No increased incontinence was seen in the 76-Gy or the 78-Gy groups. Bowel symptoms were slightly increased during the follow-up period in comparison to baseline. Dose escalation with stereotactic EBRT (74–78 Gy) did not increase gastrointestinal late side effects after 5 years in comparison to doses <71 Gy.Conclusion: Dose-escalated EBRT with the BeamCath® technique with doses up to 78 Gy is tolerable, and the toxicity profile is similar to that observed with conventional doses <71 Gy.
2.	Sundström, Johan, Professor, 1971-, et al. (author) Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults 2019 In: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025 Journal article (peer-reviewed)abstract BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
3.	Fransson, Per, et al. (author) Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer (HYPO-RT-PC) : patient-reported quality-of-life outcomes of a randomised, controlled, non-inferiority, phase 3 trial 2021 In: The Lancet Oncology. - : Elsevier. - 1470-2045 .- 1474-5488. ; 22:2, s. 235-245 Journal article (peer-reviewed)abstract BACKGROUND: The HYPO-RT-PC trial compared conventionally fractionated radiotherapy with ultra-hypofractionated radiotherapy in patients with localised prostate cancer. Ultra-hypofractionation was non-inferior to conventional fractionation regarding 5-year failure-free survival and toxicity. We aimed to assess whether patient-reported quality of life (QOL) differs between conventional fractionation and ultra-hypofractionation up to 6 years after treatment in the HYPO-RT-PC trial.METHODS: HYPO-RT-PC is a multicentre, open-label, randomised, controlled, non-inferiority, phase 3 trial done in 12 centres (seven university hospitals and five county hospitals) in Sweden and Denmark. Inclusion criteria were histologically verified intermediate-to-high-risk prostate cancer (defined as T1c-T3a with one or two of the following risk factors: stage T3a; Gleason score ≥7; and prostate-specific antigen 10-20 ng/mL with no evidence of lymph node involvement or distant metastases), age up to 75 years, and WHO performance status 0-2. Participants were randomly assigned (1:1) to conventional fractionation (78·0 Gy in 39 fractions, 5 days per week for 8 weeks) or ultra-hypofractionation (42·7 Gy in seven fractions, 3 days per week for 2·5 weeks) via a minimisation algorithm with stratification by trial centre, T-stage, Gleason score, and prostate-specific antigen. QOL was measured using the validated Prostate Cancer Symptom Scale (PCSS) and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire (EORTC QLQ-C30) at baseline, the end of radiotherapy, months 3, 6, 12, and 24 after radiotherapy, every other year thereafter up to 10 years, and at 15 years. The primary endpoint (failure-free survival) has been reported elsewhere. Here we report QOL, a secondary endpoint analysed in the per-protocol population, up to 6 years after radiotherapy. The HYPO-RT-PC trial is registered with the ISRCTN registry, ISRCTN45905321.FINDINGS: Between July 1, 2005, and Nov 4, 2015, 1200 patients were enrolled and 1180 were randomly assigned (conventional fractionation n=591, ultra-hypofractionation n=589); 1165 patients (conventional fractionation n=582, ultra-hypofractionation n=583) were included in this QOL analysis. 158 (71%) of 223 patients in the conventional fractionation group and 146 (66%) of 220 in the ultra-hypofractionation group completed questionnaires at 6 years. The median follow-up was 48 months (IQR 25-72). In seven of ten bowel symptoms or problems the proportion of patients with clinically relevant deteriorations at the end of radiotherapy was significantly higher in the ultra-hypofractionation group than in the conventional fractionation group (stool frequency [p<0·0001], rush to toilet [p=0·0013], flatulence [p=0·0013], bowel cramp [p<0·0001], mucus [p=0·0014], blood in stool [p<0·0001], and limitation in daily activity [p=0·0014]). There were no statistically significant differences in the proportions of patients with clinically relevant acute urinary symptoms or problems (total 14 items) and sexual functioning between the two treatment groups at end of radiotherapy. Thereafter, there were no clinically relevant differences in urinary, bowel, or sexual functioning between the groups. At the 6-year follow-up there was no difference in the incidence of clinically relevant deterioration between the groups for overall urinary bother (43 [33%] of 132 for conventional fractionation vs 33 [28%] of 120 for ultra-hypofractionation; mean difference 5·1% [95% CI -4·4 to 14·6]; p=0·38), overall bowel bother (43 [33%] of 129 vs 34 [28%] of 123; 5·7% [-3·8 to 15·2]; p=0·33), overall sexual bother (75 [60%] of 126 vs 59 [50%] of 117; 9·1% [-1·4 to 19·6]; p=0·15), or global health/QOL (56 [42%] of 134 vs 46 [37%] of 125; 5·0% [-5·0 to 15·0]; p=0·41).INTERPRETATION: Although acute toxicity was higher for ultra-hypofractionation than conventional fractionation, this long-term patient-reported QOL analysis shows that ultra-hypofractionation was as well tolerated as conventional fractionation up to 6 years after completion of treatment. These findings support the use of ultra-hypofractionation radiotherapy for intermediate-to-high-risk prostate cancer.
4.	Hergens, Maria-Pia, et al. (author) Use of Scandinavian Moist Smokeless Tobacco (Snus) and the Risk of Atrial Fibrillation 2014 In: Epidemiology. - 1044-3983 .- 1531-5487. ; 25:6, s. 872-876 Journal article (peer-reviewed)abstract BACKGROUND: Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate.METHODS:: To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression.RESULTS:: The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers.CONCLUSION:: Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.
5.	Nyqvist, Johanna, et al. (author) Differences in health related quality of life in the randomised ARTSCAN study; accelerated vs. conventional radiotherapy for head and neck cancer. A five year follow up 2016 In: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 118:2, s. 335-341 Journal article (peer-reviewed)abstract Background and purpose: Health related quality of life (HRQoL) was assessed in the randomised, prospective ARTSCAN study comparing conventional radiotherapy (CF) with accelerated radiotherapy (AF) for head and neck cancer. Material and methods: 750 patients with squamous cell carcinoma (of any grade and stage) in the oral cavity, oro-, or hypopharynx or larynx (except T1-2, NO glottic carcinoma) without distant metastases were randomised to either conventional fractionation (2 Gy/day, 5 days/week in 49 days, total dose 68 Gy) or accelerated fractionation (1.1 + 2.0 Gy/day, 5 days/week in 35 days, total dose 68 Gy). HRQoL was assessed with EORTC QLQ-C30, QLQ-H&N35 and HADS at baseline, at end of radiotherapy (eRT) and at 3 and 6 months and 1, 2 and 5 years after start of treatment. Results: The AF group reported HRQoL was significantly lower at eRT and at 3 months for most symptoms, scales and functions. Few significant differences were noted between the groups at 6 months and 5 years. Scores related to functional oral intake never reached baseline. Conclusion: In comparison to CF, AF has a stronger adverse effect on HRQoL in the acute phase.
6.	Rasmusson, Elisabeth, et al. (author) Erectile Dysfunction and Absorbed Dose to Penile Base Structures in a Randomized Trial Comparing Ultrahypofractionated and Conventionally Fractionated Radiation Therapy for Prostate Cancer 2020 In: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier. - 0360-3016 .- 1879-355X. ; 107:1, s. 143-151 Journal article (peer-reviewed)abstract Purpose: To study the relationships between absorbed dose to penile base structures and erectile dysfunction (ED) in patients treated with ultrahypofractionated (UHF) radiation therapy (RT) or conventionally fractionated (CF) RT for prostate cancer.Methods and Materials: This dose-response study comprises 673 patients (57%) of the 1180 per-protocol patients included in the HYPO-RT-PC trial (median follow-up 5, years), where patients were randomized to CF (39 × 2.0 Gy, 8 weeks) or UHF (7 × 6.1 Gy, 2.5 weeks). No androgen deprivation therapy was allowed. Only patients with erectile function sufficient for intercourse at baseline and complete RT data were included in this study. Erectile function was assessed by physician at regular follow-ups. The main endpoint was severe ED (EDs). The penile bulb (PB) and crus were retrospectively delineated on the treatment planning computed tomography scans. Dose-volume descriptors were derived from EQD2 converted dose matrices (α/β = 3 Gy). Univariable and multivariable Cox proportional hazard regression and logistic regression were used to find predictors for EDS.Results: No significant difference in EDs was found between CF and UHF. During the follow-up period, EDs occurred in 27% of the patients in both treatment groups. Average (median) PB mean dose, Dmean, was 24.5 (20.2) in CF and 18.7 (13.1) Gy3 in UHF. Age was the only significant predictor for EDs in Cox analyses. All dose-volume variables contributed significantly in univariable logistic regression at 2-year follow-up. Age and near maximum dose (D2%) were significant predictors for EDs in multivariable logistic regression analyses at both 1 and 2 years.Conclusions: The frequency of EDS was similar in the CF and UHF treatment groups. Age at radiation therapy was the strongest predictor for EDs, followed by dose to PB, and was most evident for younger patients. We propose D2 % <50 Gy3 and Dmean <20 Gy3 to the PB as the primary objectives to be applied in the treatment planning process.
7.	Sveistrup, Joen, et al. (author) Prospective assessment of urinary, gastrointestinal and sexual symptoms before, during and after image-guided volumetric modulated arc therapy for prostate cancer 2015 In: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 49:1, s. 58-69 Journal article (peer-reviewed)abstract Objective: The aim of this study was to prospectively assess the development of 24 urinary, gastrointestinal and sexual symptoms in patients with prostate cancer (PCa) during and after image-guided volumetric modulated arc therapy (IG-VMAT).Material and methods: A total of 87 patients with PCa participated in this study. The patients were asked to complete a modified version of the Prostate Cancer Symptom Scale (PCSS) questionnaire before radiotherapy (RT) (baseline), at the start of RT, at the end of RT and 1 year after RT. Changes in symptoms at the start of RT, at the end of RT and 1 year after RT compared to baseline were analysed by a mixed model analysis of repeated measurements with the following covariates: age, comorbidity, smoking and androgen deprivation therapy (ADT).Results: All urinary problems except for haematuria increased significantly at the end of RT compared to baseline. One year after RT, there was no longer any difference compared to baseline for any of the urinary symptoms. All gastrointestinal symptoms except for nausea increased significantly at the end of RT. One year after RT, patients also reported slightly higher degrees of stool frequency, bowel leakage, planning of toilet visits, flatulence, mucus, gastrointestinal bleeding and impact of gastrointestinal bother on daily activities compared to baseline. All sexual symptoms increased significantly at all times compared to baseline. The use of ADT was associated with worse sexual symptoms.Conclusions: IG-VMAT is a safe treatment for PCa, with few and mild changes in urinary and gastrointestinal symptoms 1 year after RT compared to baseline. Sexual symptoms deteriorated both during and after RT. The use of ADT was associated with worse sexual symptoms.
8.	Widmark, Anders, et al. (author) Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. 2009 In: Lancet. - : Elsevier. - 1474-547X .- 0140-6736. ; 373:9660, s. 301-8 Journal article (peer-reviewed)abstract Several studies have shown the efficacy of endocrine therapy in combination with radiotherapy in high-risk prostate cancer. To assess the effect of radiotherapy, we did an open phase III study comparing endocrine therapy with and without local radiotherapy, followed by castration on progression.
9.	Widmark, Anders, et al. (author) Ultra-hypofractionated versus conventionally fractionated radiotherapy for prostate cancer : 5-year outcomes of the HYPO-RT-PC randomised, non-inferiority, phase 3 trial 2019 In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 394:10196, s. 385-395 Journal article (peer-reviewed)abstract Background: Hypofractionated radiotherapy for prostate cancer has gained increased attention due to its proposed high radiation-fraction sensitivity. Recent reports from studies comparing moderately hypofractionated and conventionally fractionated radiotherapy support the clinical use of moderate hypofractionation. To date, there are no published randomised studies on ultra-hypofractionated radiotherapy. Here, we report the outcomes of the Scandinavian HYPO-RTPC phase 3 trial with the aim to show non-inferiority of ultra-hypofractionation compared with conventional fractionation.Methods: In this open-label, randomised, phase 3 non-inferiority trial done in 12 centres in Sweden and Denmark, we recruited men up to 75 years of age with intermediate-to-high-risk prostate cancer and a WHO performance status between 0 and 2. Patients were randomly assigned to ultra-hypofractionation (42.7 Gy in seven fractions, 3 days per week for 2.5 weeks) or conventional fractionated radiotherapy (78.0 Gy in 39 fractions, 5 days per week for 8 weeks). No androgen deprivation therapy was allowed. The primary endpoint was time to biochemical or clinical failure, analysed in the per-protocol population. The prespecified non-inferiority margin was 4% at 5 years, corresponding to a critical hazard ratio (HR) limit of 1.338. Physician-recorded toxicity was measured according to the Radiation Therapy Oncology Group (RTOG) morbidity scale and patient-reported outcome measurements with the Prostate Cancer Symptom Scale (PCSS) questionnaire. This trial is registered with the ISRCTN registry, number ISRCTN45905321.Findings: Between July 1, 2005, and Nov 4, 2015, 1200 patients were randomly assigned to conventional fractionation (n=602) or ultra-hypofractionation (n=598), of whom 1180 (591 conventional fractionation and 589 ultra-hypofractionation) constituted the per-protocol population. 1054 (89%) participants were intermediate risk and 126 (11%) were high risk. Median follow-up time was 5.0 years (IQR 3.1-7.0). The estimated failure-free survival at 5 years was 84% (95% CI 80-87) in both treatment groups, with an adjusted HR of 1.002 (95% CI 0.758-1.325; log-rank p=0.99). There was weak evidence of an increased frequency of acute physician-reported RTOG grade 2 or worse urinary toxicity in the ultra-hypofractionation group at end of radiotherapy (158 [28%] of 569 patients vs 132 [23%] of 578 patients; p=0.057). There were no significant differences in grade 2 or worse urinary or bowel late toxicity between the two treatment groups at any point after radiotherapy, except for an increase in urinary toxicity in the ultra-hypofractionation group compared to the conventional fractionation group at 1-year follow-up (32 [6%] of 528 patients vs 13 [2%] of 529 patients; (p=0.0037). We observed no differences between groups in frequencies at 5 years of RTOG grade 2 or worse urinary toxicity (11 [5%] of 243 patients for the ultra-hypofractionation group vs 12 [5%] of 249 for the conventional fractionation group; p=1.00) and bowel toxicity (three [1%] of 244 patients vs nine [4%] of 249 patients; p=0.14). Patient-reported outcomes revealed significantly higher levels of acute urinary and bowel symptoms in the ultra-hypofractionation group compared with the conventional fractionation group but no significant increases in late symptoms were found, except for increased urinary symptoms at 1-year follow-up, consistent with the physician-evaluated toxicity.Interpretation: Ultra-hypofractionated radiotherapy is non-inferior to conventionally fractionated radiotherapy for intermediate-to-high risk prostate cancer regarding failure-free survival. Early side-effects are more pronounced with ultra-hypofractionation compared with conventional fractionation whereas late toxicity is similar in both treatment groups. The results support the use of ultra-hypofractionation for radiotherapy of prostate cancer. Copyright (C) 2019 Elsevier Ltd. All rights reserved.
10.	Al-Husseini, Ali, et al. (author) Long-term postural control in elite athletes following mild traumatic brain injury 2022 In: Frontiers in Neurology. - : Frontiers Media S.A.. - 1664-2295. ; 13 Journal article (peer-reviewed)abstract Background: Traumas to the head and neck are common in sports and often affects otherwise healthy young individuals. Sports-related concussions (SRC), defined as a mild traumatic brain injury (mTBI), may inflict persistent neck and shoulder pain, and headache, but also more complex symptoms, such as imbalance, dizziness, and visual disturbances. These more complex symptoms are difficult to identify with standard health care diagnostic procedures.Objective: To investigate postural control in a group of former elite athletes with persistent post-concussive symptoms (PPCS) at least 6 months after the incident.Method: Postural control was examined using posturography during quiet stance and randomized balance perturbations with eyes open and eyes closed. Randomized balance perturbations were used to examine motor learning through sensorimotor adaptation. Force platform recordings were converted to reflect the energy used to maintain balance and spectrally categorized into total energy used, energy used for smooth corrective changes of posture (i.e., <0.1 Hz), and energy used for fast corrective movements to maintain balance (i.e., >0.1 Hz).Results: The mTBI group included 20 (13 males, mean age 26.6 years) elite athletes with PPCS and the control group included 12 athletes (9 males, mean age 26.4 years) with no history of SRC. The mTBI group used significantly more energy during balance perturbations than controls: +143% total energy, p = 0.004; +122% low frequency energy, p = 0.007; and +162% high frequency energy, p = 0.004. The mTBI subjects also adapted less to the balance perturbations than controls in total (18% mTBI vs. 37% controls, p = 0.042), low frequency (24% mTBI vs. 42% controls, p = 0.046), and high frequency (6% mTBI vs. 28% controls, p = 0.040). The mTBI subjects used significantly more energy during quiet stance than controls: +128% total energy, p = 0.034; +136% low-frequency energy, p = 0.048; and +109% high-frequency energy, p = 0.015.Conclusion: Athletes with previous mTBI and PPCS used more energy to stand compared to controls during balance perturbations and quiet stance and had diminished sensorimotor adaptation. Sports-related concussions are able to affect postural control and motor learning.
11.	Bergenius, J., et al. (author) Short Vestibulo-Ocular Reflex Time-Constant in Complete Unilateral Vestibular Lesions 1995 In: American Journal of Otology. - 0192-9763. ; 16:6, s. 787-792 Journal article (peer-reviewed)
12.	Bergström, Malin, et al. (author) Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children? 2015 In: Journal of Epidemiology and Community Health. - : BMJ Publishing Group. - 0143-005X .- 1470-2738. ; 69:8, s. 769-774 Journal article (peer-reviewed)abstract Background In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parents respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children. Methods We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between childrens psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as childrens satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model. Results Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent-child relationships was associated with childrens psychosomatic health but could not explain the differences between children in the different living arrangements. Conclusions Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of childrens postseparation living arrangements.
13.	Bergström, Malin, et al. (author) Living in two homes-a Swedish national survey of wellbeing in 12 and 15 year olds with joint physical custody 2013 In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 13 Journal article (peer-reviewed)abstract Background The practice of joint physical custody, where children spend equal time in each parent's home after they separate, is increasing in many countries. It is particularly common in Sweden, where this custody arrangement applies to 30 per cent of children with separated parents. The aim of this study was to examine children's health-related quality of life after parental separation, by comparing children living with both parents in nuclear families to those living in joint physical custody and other forms of domestic arrangements.Methods Data from a national Swedish classroom study of 164,580 children aged 12 and 15-years-old were analysed by two-level linear regression modelling. Z-scores were used to equalise scales for ten dimensions of wellbeing from the KIDSCREEN-52 and the KIDSCREEN-10 Index and analysed for children in joint physical custody in comparison with children living in nuclear families and mostly or only with one parent.Results Living in a nuclear family was positively associated with almost all aspects of wellbeing in comparison to children with separated parents. Children in joint physical custody experienced more positive outcomes, in terms of subjective wellbeing, family life and peer relations, than children living mostly or only with one parent. For the 12-year-olds, beta coefficients for moods and emotions ranged from -0.20 to -0.33 and peer relations from -0.11 to -0.20 for children in joint physical custody and living mostly or only with one parent. The corresponding estimates for the 15-year-olds varied from -0.08 to -0.28 and from -0.03 to -0.13 on these subscales. The 15-year-olds in joint physical custody were more likely than the 12-year-olds to report similar wellbeing levels on most outcomes to the children in nuclear families.Conclusions Children who spent equal time living with both parents after a separation reported better wellbeing than children in predominantly single parent care. This was particularly true for the 15-year-olds, while the reported wellbeing of 12-years-olds was less satisfactory. There is a need for further studies that can account for the pre and post separation context of individual families and the wellbeing of younger age groups in joint physical custody.
14.	Bertilsson, Johan, et al. (author) Efficiency of Simulated Realistic Scenarios to Provide High Psychological Stress Training for Police Officers 2013 In: The Evolution of Policing : Worldwide Innovations and Insights - Worldwide Innovations and Insights. - 9781466567153 ; , s. 219-235 Book chapter (peer-reviewed)
15.	Bertilsson, Johan, et al. (author) Opportunities and Challenges of Research Collaboration between Police Authorities and University Organizations 2014. - 1 In: Economic Development, Crime, and Policing : Global Perspectives - Global Perspectives. - : Routledge. - 9781482204568 - 9780429255571 ; , s. 163-180 Book chapter (peer-reviewed)
16.	Bertilsson, Johan, et al. (author) Stress Levels Escalate When Repeatedly Performing Tasks Involving Threats 2019 In: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 10, s. 1562-1562 Journal article (peer-reviewed)abstract Police work may include performing repeated tasks under the influence of psychological stress, which can affect perceptual, cognitive and motor performance. However, it is largely unknown how repeatedly performing stressful tasks physically affect police officers in terms of heart rate and pupil diameter properties. Psychological stress is commonly assessed by monitoring the changes in these biomarkers. Heart rate and pupil diameter was measured in 12 male police officers when performing a sequence of four stressful tasks, each lasting between 20 and 130 s. The participants were first placed in a dimly illuminated anteroom before allowed to enter a brightly lit room where a scenario was played out. After each task was performed, the participants returned to the anteroom for about 30 s before performing the next sequential task. Performing a repeated sequence of stressful tasks caused a significant increase in heart rate (p = 0.005). The heart rate started to increase already before entering the scenario room and was significantly larger just after starting the task than just before starting the task (p < 0.001). This pattern was more marked during the first tasks (p < 0.001). Issuance of a verbal "abort" command which terminated the tasks led to a significant increase of heart rate (p = 0.002), especially when performing the first tasks (p = 0.002). The pupil diameter changed significantly during the repeated tasks during all phases but in a complex pattern where the pupil diameter reached a minimum during task 2 followed by an increase during tasks 3 and 4 (p ≤ 0.020). During the initial tasks, the pupil size (p = 0.014) increased significantly. The results suggest that being repeatedly exposed to stressful tasks can produce in itself an escalation of psychological stress, this even prior to being exposed to the task. However, the characteristics of both the heart rate and pupil diameter were complex, thus, the findings highlight the importance of studying the effects and dynamics of different stress-generating factors. Monitoring heart rate was found useful to screen for stress responses, and thus, to be a vehicle for indication if and when rotation of deployed personnel is necessary to avoid sustained high stress exposures.
17.	Bertilsson, Johan, et al. (author) Towards systematic and objective evaluation of police officer performance in stressful situations 2020 In: Police Practice and Research. - : Informa UK Limited. - 1561-4263 .- 1477-271X. ; 21:6, s. 655-669 Journal article (peer-reviewed)abstract To ensure a continuous high standard of police units, it is critical to recruit people who perform well in stressful situations. Today, this selection process includes performing a large series of tests, which still may not objectively reveal a person’s capacity to handle a life-threatening situation when subjected to high levels of stress. To obtain more systematic and objective data, 12 police officers were exposed to six scenarios with varying levels of threat while their heart rate and pupil size were monitored. The scenarios were filmed and six expert evaluators assessed the performance of the police officers according to seven predefined criteria. Four of the scenarios included addressing a moderate threat level task and the scenarios were executed in a rapid sequence. Two further scenarios included a familiar firearm drill performed during high and low threat situations. The results showed that there was a large agreement between the experts in how they judged the performance of the police officers (p < 0.001). Performance increased significantly over tasks in four of the seven evaluation criteria (p ≤ 0.037). There was also a significant effect of pupil size (p = 0.004), but not heart rate, when comparing the different sequential scenarios. Moreover, a high level of threat considerably impaired the motor performance of the police officers during the firearms drill (p = 0.002). Finally, the pupil seemed to systematically dilate more when a threat appeared immediately than with a delay in the scenarios (p = 0.007). We conclude that systematic and quantitative judgments from experts provide valuable and reliable information about the performance of participants in realistic and stressful policing scenarios. Furthermore, objective physiological measures of heart rate and pupil size may help to explain and understand why performance sometimes deteriorates.
18.	Bjorndal, Lars, et al. (author) Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy 2010 In: European Journal of Oral Sciences. - : Wiley. - 0909-8836 .- 1600-0722. ; 118:3, s. 290-297 Journal article (peer-reviewed)abstract Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (−22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.
19.	Björeland, Ulrika, et al. (author) Hyaluronic acid spacer in prostate cancer radiotherapy : dosimetric effects, spacer stability and long-term toxicity and PRO in a phase II study 2023 In: Radiation Oncology. - : BioMed Central (BMC). - 1748-717X. ; 18:1 Journal article (peer-reviewed)abstract BACKGROUND: Perirectal spacers may be beneficial to reduce rectal side effects from radiotherapy (RT). Here, we present the impact of a hyaluronic acid (HA) perirectal spacer on rectal dose as well as spacer stability, long-term gastrointestinal (GI) and genitourinary (GU) toxicity and patient-reported outcome (PRO).METHODS: In this phase II study 81 patients with low- and intermediate-risk prostate cancer received transrectal injections with HA before external beam RT (78 Gy in 39 fractions). The HA spacer was evaluated with MRI four times; before (MR0) and after HA-injection (MR1), at the middle (MR2) and at the end (MR3) of RT. GI and GU toxicity was assessed by physician for up to five years according to the RTOG scale. PROs were collected using the Swedish National Prostate Cancer Registry and Prostate cancer symptom scale questionnaires.RESULTS: There was a significant reduction in rectal V70% (54.6 Gy) and V90% (70.2 Gy) between MR0 and MR1, as well as between MR0 to MR2 and MR3. From MR1 to MR2/MR3, HA thickness decreased with 28%/32% and CTV-rectum space with 19%/17% in the middle level. The cumulative late grade ≥ 2 GI toxicity at 5 years was 5% and the proportion of PRO moderate or severe overall bowel problems at 5 years follow-up was 12%. Cumulative late grade ≥ 2 GU toxicity at 5 years was 12% and moderate or severe overall urinary problems at 5 years were 10%.CONCLUSION: We show that the HA spacer reduced rectal dose and long-term toxicity.
20.	Brantberg, K, et al. (author) Large vestibular evoked myogenic potentials in response to bone-conducted sounds in patients with superior canal dehiscence syndrome 2004 In: Audiology and Neurotology. - : S. Karger AG. - 1421-9700 .- 1420-3030. ; 9:3, s. 173-182 Journal article (peer-reviewed)abstract Dehiscence of the superior semicircular canal is a 'new' vestibular entity. Among these patients, the vestibular evoked myogenic potentials (VEMP) in response to air-conducted sounds are large. In the present study, VEMP in response to bone-conducted sounds were studied in 5 normal subjects, in 3 patients after ( unilateral) labyrinthectomy and in 4 patients with ( unilateral) superior canal dehiscence syndrome. The bone-conducted sound stimulus was a 250- and a 500-tone burst delivered monaurally on the mastoid using standard bone conductors. Among the normals, bone-conducted sounds delivered monaurally caused VEMP bilaterally. There was, however, a transcranial attenuation for the 500-Hz stimulus, but less so for the 250-Hz stimulus. Among the patients with labyrinthectomy there were VEMP on the healthy side, but not on the lesioned side, irrespective of whether the bone-conducted sounds were presented behind the healthy or the operated ear. Among the patients with superior canal dehiscence syndrome, the VEMP on the affected side were larger than on the healthy side. This suggests that there is also vestibular hypersensitivity for bone-conducted sounds in these patients.
21.	Brantberg, Krister, et al. (author) Symmetry measures of vestibular evoked myogenic potentials using objective detection criteria 2001 In: International Journal of Audiology. - : Informa UK Limited. - 1708-8186. ; 30:3, s. 189-196 Journal article (peer-reviewed)abstract Vestibular evoked myogenic potentials (VEMP) has been put forward as a test to evaluate the symmetry of saccular function. In the present study, the symmetry of VEMP was evaluated in 23 healthy subjects using automatic analysis. In response to binaural clicks with a stimulus repetition rate of 4/s all subjects revealed significant VEMP on both sides. The ipsilateral response to monaural clicks was similar to the response to binaural clicks. Although there were large interindividual variations in amplitude, there were only small variations in latency. VEMP measurements were also assessed using different stimulus rates. At the higher stimulus rates there was a decrease in the VEMP amplitude but there were only small changes in the latency. These findings might suggest that amplitude measures are more likely than latency measures to reveal small vestibular lesions.
22.	Brantberg, Krister, et al. (author) Vestibular evoked myogenic potentials in response to skull taps for patients with vestibular neuritis 2003 In: Journal of Vestibular Research-Equilibrium & Orientation. - 0957-4271 .- 1878-6464. ; 13:2-3, s. 121-130 Journal article (peer-reviewed)abstract In recent years it has been demonstrated that loud clicks generate short latency vestibular evoked myogenic potentials (VEMP). It has also been demonstrated that skull tap stimulation evokes similar VEMP. In the present study, the differences between the click-induced and the skull-tap induced VEMP were studied in 18 patients at onset of vestibular neuritis. Gentle skull taps were delivered manually above each ear on the side of the skull and on the forehead midline. The muscular responses were recorded over both sternocleidomastoid muscles using skin electrodes. Abnormal skull tap VEMP were found in the majority of the patients (10/18, 56%). However, only 4/18 (22%) showed asymmetry in the click-induced VEMP. The high percentage of abnormal skull tap VEMP might suggest that this response is not only dependent on the inferior division of the vestibular nerve, because the inferior division of this nerve is usually spared in vestibular neuritis. Moreover, the patients with abnormal skull tap VEMP differed from those with normal VEMP in their settings of the subjective visual horizontal with static head tilt in the roll plane. This might suggest that skull tap VEMP are (also) related to utricular function.
23.	Byenfeldt, Marie, 1967-, et al. (author) Influence of Probe Pressure on Ultrasound-Based Shear Wave Elastography of the Liver Using Comb-Push 2-D Technology 2019 In: Ultrasound in Medicine and Biology. - : Elsevier. - 0301-5629 .- 1879-291X. ; 45:2, s. 411-428 Journal article (peer-reviewed)abstract It has been postulated that in the liver, applying increased probe pressure during ultrasound-based shear wave elastography (SWE) might lead to a false increase in the SWE result. We aimed to determine the influence of increased intercostal probe pressure when performing SWE of the liver. We also investigated the number of measurements required to achieve technically successful and reliable SWE examinations. This prospective, clinical study included 112 patients and 2240 SWE measurements of the liver. We applied probe pressure intercostally, to reduce the skin-to-liver capsule distance (SCD), which could stabilize the SWE signal and thus increase the number of technically successful measurements. We performed 10 measurements with maximum probe pressure and 10 with normal pressure in each patient. Thus, two analysis groups were compared for differences. Compared with normal pressure, maximum probe pressure significantly reduced the SCD (p < 0.001) and significantly increased the number of technically successful measurements from 981 to 1098, respectively (p < 0.001). The SWE results with normal and maximum probe pressure were 5.96 kPa (interquartile range: 2.41) and 5.45 kPa (interquartile range: 1.96), respectively (p < 0.001). In obese patients, a large SCD poses a diagnostic challenge for ultrasound SWE. We found that maximum intercostal probe pressure could reduce the SCD and increase the number of technically successful measurements, without falsely increasing the SWE result. Only three measurements were required to achieve technically successful and reliable SWE examinations.
24.	Byenfeldt, Marie, 1967-, et al. (author) On patient related factors and their impact on ultrasound-based shear wave elastography of the liver 2018 In: Ultrasound in Medicine and Biology. - : Elsevier. - 0301-5629 .- 1879-291X. ; 44:8, s. 1606-1615 Journal article (peer-reviewed)abstract The aim of the study was to investigate patient-related factors associated with either reliable or poorly reliable measurement results of ultrasound-based shear wave elastography (SWE) of the liver. A total of 188 patients were analyzed prospectively with binary logistic regression using the interquartile range/median as cutoff to define two groups based on reliable and poorly reliable SWE results. SWE results correlated significantly with liver biopsy. Factors associated with reliable SWE results (i.e., no negative impact on measurements) were age, sex, cirrhosis, antiviral and/or cardiovascular medication, smoking habits and body mass index. Factors associated with poorly reliable SWE results were increased skin-to-liver capsule distance (odds ratio = 3.08, 95% confidence interval: 1.70-5.60) and steatosis (odds ratio =2.89, 95% confidence interval: 1.33-6.28). These findings indicate that the interquartile range/median as a quality parameter is useful in avoiding poorly reliable SWE results. How best to examine patients with increased skin-to-liver capsule distance is a matter of some controversy, as the incidences of obesity, diabetes and metabolic syndrome are increasing worldwide; however, our results indicate that reliable SWE results can be obtained in this group of patients by using ultrasound-based SWE. (Email: marie.byenfeldt@umu.se, Marie.byenfeldt@aleris.se )
25.	Byenfeldt, Marie, 1967- (author) Ultrasound based shear wave elastography of the liver : a non-invasive method for evaluation of liver disease 2020 Doctoral thesis (other academic/artistic)abstract Background: Detecting liver disease at an early stage is important, given that early intervention decreases the risk of developing cirrhosis and subsequently hepatocellular cancer (HCC). The non-invasive ultrasound-based shear wave elastography (SWE) has been used clinically for a decade to assess liver stiffness. This method is reliable, rapid and can be performed in an outpatient setting without known risks for the patient. However, increased variance in SWE results has been detected, without clear explanation. Factors that affect SWE results needs to be identified. Data are insufficient regarding the reliability of SWE with different body positions and probe pressures. Men have higher SWE results than women, also for unclear reasons. Increasing the reliability of SWE is crucial for understanding how factors such as overweight and obesity, cardiovascular and antiviral medication, age, sex, smoking habits, hepatic steatosis and cirrhosis affect SWE results.Aims: The overall aim of the studies included in this thesis was to increase the reliability of SWE liver. The specific aims were to investigate patient-related factors associated with increased uncertainty in SWE results. Another aim was to investigate the influence of increased intercostal probe pressure on liver stiffness assessment with SWE liver. The final aims were to investigate the influence of postural changes, sagittal abdominal diameter (SAD) and skin-to-liver capsule distance (SCD) on SWE results, along with sex-based differences for SWE results and cardiovascular medication.Methods: All enrolled participants in these studies were consecutive patients with various liver diseases presenting at the radiology department Östersunds Hospital. The patients were examined using SWE liver method at the ultrasound unit between April 2014 and May 2018. Inclusion criteria were that participants be adults (age ≥18 years) who had provided written consent for participating in the study. The exclusion criterion was an inability to communicate. Current guidelines for SWE of the liver were used in the thesis with the following exceptions: In study II, increased intercostal probe pressure was used, and in study III, postural change was used. Study I included 188 patients; study II included 112 patients, and studies III and IV involved 200 patients. The four studies were conducted as cross-sectional and clinical trial, using quantitative methods.Results: Factors associated with low variance for SWE results were age, sex, and presence of cirrhosis, the use of antiviral and/or cardiovascular medication, smoking habits, and body mass index. Factors associated with increased uncertainty in SWE results were increased SCD and the presence of steatosis. With increased probe pressure SCD decreased and the quality of shear wave increased. The results showed that the number of required measurements can be reduced. A postural change to left decubitus decreased SCD. For patients with increased SAD and increased SWE result in the supine position, SWE result decreased with a postural change to left decubitus. The SWE results, SCD and SAD significantly differed between women and men. SWE results was higher in the presence of increased SAD (≥23 cm) among men, but not among women.Conclusions: SWE of the liver is a reliable, non-invasive method for diagnosing liver disease. Results in this thesis suggest that for patients with SCD ≥2.5 cm, shear wave measures could be of poor quality and the SWE exam less reliable. In these cases, increased probe pressure may facilitate a reliable SWE exam. With such adjustments in probe pressure, the ultrasound-based SWE method can be superior for examination in patients with overweight or obesity. An effect of SAD ≥23 cm was seen for men with liver fibrosis only, which may explain the higher SWE result for men compared to women. Depending on the severity of liver disease and SAD, a postural change to left decubitus can produce a different outcome. As SAD increased, liver stiffness did, as well. Increased SAD thus is linked to increased liver stiffness, indicating that SAD should be taken into account when performing SWE of the liver.
26.	Carlsson, Sigrid, 1982, et al. (author) Population-based study of long-term functional outcomes after prostate cancer treatment 2016 In: BJU International. - : John Wiley & Sons. - 1464-4096 .- 1464-410X. ; 117:6B, s. E36-E45 Journal article (peer-reviewed)abstract OBJECTIVE: To evaluate long-term urinary, sexual and bowel functional outcomes after prostate cancer treatment at a median follow-up of 12 years (IQR 11-13).PATIENTS AND METHODS: In this nationwide, population-based study, we identified from the National Prostate Cancer Register, Sweden, 6,003 men diagnosed with localized prostate cancer (clinical local stage T1-2, any Gleason score, prostate specific antigen < 20 ng/mL, NX or N0, MX or M0) between 1997 and 2002 who were ≤70 years at diagnosis. 1,000 prostate cancer-free controls were selected, matched for age and county of residence. Functional outcomes were evaluated with a validated self-reported questionnaire.RESULTS: Responses were obtained from 3,937/6,003 cases (66%) and 459/1,000 (46%) controls. Twelve years post diagnosis, at a median age of 75 years, the proportion of cases with adverse symptoms was 87% for erectile dysfunction or sexually inactive, 20% for urinary incontinence and 14% for bowel disturbances. The corresponding proportions for controls were 62%, 6% and 7%, respectively. Men with prostate cancer, except those on surveillance, had an increased risk of erectile dysfunction, compared to control men. Radical prostatectomy was associated with increased risk of urinary incontinence (odds ratio; OR 2.29 [95% CI 1.83-2.86] and radiotherapy increased the risk of bowel dysfunction (OR 2.46 [95% CI 1.73-3.49]) compared to control men. Multi-modal treatment, in particular including androgen deprivation therapy (ADT), was associated with the highest risk of adverse effects; for instance radical prostatectomy followed by radiotherapy and ADT was associated with an OR of 3.74 [95 CI 1.76-7.95] for erectile dysfunction and OR 3.22 [95% CI 1.93-5.37] for urinary incontinence.CONCLUSION: The proportion of men who suffer long-term impact on functional outcomes after prostate cancer treatment was substantial.
27.	Dahl, Mats, et al. (author) Analysis of eyewitness testimony in a police shooting with fatal outcome - Manifestations of spatial and temporal distortions 2018 In: Cogent Psychology. - : Taylor & Francis. - 2331-1908. ; 5:1 Journal article (peer-reviewed)abstract Eyewitness statements are commonly used in the criminal justice system and viewed as having a high-probative value, especially when the witness has no motive to lie, other witness recollection corroborates the account, orthe witness is highly confident. A fatal police shooting incident in Sweden had 13 witnesses (nine civilians and four police officers) and was also filmed with two mobile phones. All interviews were conducted before witnesses viewed the films, allowing for the analysis of discrepancies between their statements and the videos. In this incident, a police patrol was sent to find out a man who was reported to have attacked two persons with a knife. When found, the perpetrator refused to obey the officer's commands, and the police eventually shot at him. The analysis showed clear differences between the witness testimonies and the film. Elements associated with perceived threat, for example, the assailant's armament and movement direction and number of shots fired, were remembered fairly accurately. However, most witnesses poorly recollected when, that is, after which shot, the assailant fell to the ground. Moreover, memory of the actual order of events was altered and important aspects omitted that were crucial from a legal point of view.
28.	Einarsson, Einar Jón, et al. (author) Decreased postural control in adult survivors of childhood cancer treated with chemotherapy 2016 In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6 Journal article (peer-reviewed)abstract The objective of cancer treatment is to secure survival. However, as chemotherapeutic agents can affect the central and peripheral nervous systems, patients must undergo a process of central compensation. We explored the effectiveness of this compensation process by measuring postural behaviour in adult survivors of childhood cancer treated with chemotherapy (CTS). We recruited sixteen adults treated with chemotherapy in childhood for malignant solid (non-CNS) tumours and 25 healthy age-matched controls. Subjects performed posturography with eyes open and closed during quiet and perturbed standing. Repeated balance perturbations through calf vibrations were used to study postural adaptation. Subjects were stratified into two groups (treatment before or from 12 years of age) to determine age at treatment effects. Both quiet (p = 0.040) and perturbed standing (p ≤ 0.009) were significantly poorer in CTS compared to controls, particularly with eyes open and among those treated younger. Moreover, CTS had reduced levels of adaptation compared to controls, both with eyes closed and open. Hence, adults treated with chemotherapy for childhood cancer may suffer late effects of poorer postural control manifested as reduced contribution of vision and as reduced adaptation skills. These findings advocate development of chemotherapeutic agents that cause fewer long-term side effects when used for treating children.
29.	Einarsson, Einar Jón, et al. (author) Elevated visual dependency in young adults after chemotherapy in childhood 2018 In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:2 Journal article (peer-reviewed)abstract Chemotherapy in childhood can result in long-term neurophysiological side-effects, which could extend to visual processing, specifically the degree to which a person relies on vision to determine vertical and horizontal (visual dependency). We investigated whether adults treated with chemotherapy in childhood experience elevated visual dependency compared to controls and whether any difference is associated with the age at which subjects were treated. Visual dependency was measured in 23 subjects (mean age 25.3 years) treated in childhood with chemotherapy (CTS) for malignant, solid, non-CNS tumors. We also stratified CTS into two groups: those treated before 12 years of age and those treated from 12 years of age and older. Results were compared to 25 healthy, age-matched controls. The subjective visual horizontal (SVH) and vertical (SVV) orientations was recorded by having subjects position an illuminated rod to their perceived horizontal and vertical with and without a surrounding frame tilted clockwise and counter-clockwise 20 from vertical. There was no significant difference in rod accuracy between any CTS groups and controls without a frame. However, when assessing visual dependency using a frame, CTS in general (p = 0.006) and especially CTS treated before 12 years of age (p = 0.001) tilted the rod significantly further in the direction of the frame compared to controls. Our findings suggest that chemotherapy treatment before 12 years of age is associated with elevated visual dependency compared to controls, implying a visual bias during spatial activities. Clinicians should be aware of symptoms such as visual vertigo in adults treated with chemotherapy in childhood.
30.	Einarsson, Einar-Jon, et al. (author) Long term hearing degeneration after platinum-based chemotherapy in childhood. 2010 In: International Journal of Audiology. - : Informa UK Limited. - 1708-8186 .- 1499-2027. ; 49:10, s. 765-771 Journal article (peer-reviewed)abstract The aim of this study was to investigate long-term development of hearing in subjects who had received platinum-based chemotherapy in childhood or adolescence. Another aim was to assess the self-reported hearing loss handicap and compare it to audiometric measurements. Medical records from individuals diagnosed with childhood cancer and treated with platinum-based chemotherapy between 1985 and 2000 at the University Hospital in Lund Sweden were reviewed retrospectively. Fifteen subjects, who fulfilled the eligibility criteria set for the study, underwent a thorough audiometric evaluation. The results show that the hearing loss, in subjects with ototoxicity had increased after the end of treatment, to include also the lower frequencies. The largest deterioration in hearing thresholds, up to 55 dB HL, was found at frequencies above 2 kHz. The findings also reveal that the subjects have a considerably greater hearing loss handicap and disability than would be expected from the results of the audiometric evaluations. The conclusion of this study is that children and adolescence treated with platinum-based chemotherapy should have regular audiometric follow-up examinations, also many years after the end of treatment. Furthermore, assessments of self-reported hearing disability should be made during and after chemotherapy.
31.	Einarsson, Einar-Jon, et al. (author) Oculomotor Deficits after Chemotherapy in Childhood. 2016 In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:1, s. 1-17 Journal article (peer-reviewed)abstract Advances in the diagnosis and treatment of pediatric malignancies have substantially increased the number of childhood cancer survivors. However, reports suggest that some of the chemotherapy agents used for treatment can cross the blood brain barrier which may lead to a host of neurological symptoms including oculomotor dysfunction. Whether chemotherapy at young age causes oculomotor dysfunction later in life is unknown. Oculomotor performance was assessed with traditional and novel methods in 23 adults (mean age 25.3 years, treatment age 10.2 years) treated with chemotherapy for a solid malignant tumor not affecting the central nervous system. Their results were compared to those from 25 healthy, age-matched controls (mean age 25.1 years). Correlation analysis was performed between the subjective symptoms reported by the chemotherapy treated subjects (CTS) and oculomotor performance. In CTS, the temporal control of the smooth pursuit velocity (velocity accuracy) was markedly poorer (p<0.001) and the saccades had disproportionally shorter amplitude than normal for the associated saccade peak velocity (main sequence) (p = 0.004), whereas smooth pursuit and saccade onset times were shorter (p = 0.004) in CTS compared with controls. The CTS treated before 12 years of age manifested more severe oculomotor deficits. CTS frequently reported subjective symptoms of visual disturbances (70%), unsteadiness, light-headedness and that things around them were spinning or moving (87%). Several subjective symptoms were significantly related to deficits in oculomotor performance. To conclude, chemotherapy in childhood or adolescence can result in severe oculomotor dysfunctions in adulthood. The revealed oculomotor dysfunctions were significantly related to the subjects' self-perception of visual disturbances, dizziness, light-headedness and sensing unsteadiness. Assessments of oculomotor function may, thus, offer an objective method to track and rate the level of neurological complications following chemotherapy.
32.	Einarsson, Einar-Jon, et al. (author) Severe difficulties with word recognition in noise after platinum chemotherapy in childhood, and improvements with open-fitting hearing-aids. 2011 In: International Journal of Audiology. - : Informa UK Limited. - 1708-8186 .- 1499-2027. ; 50, s. 642-651 Journal article (peer-reviewed)abstract To investigate word recognition in noise in subjects treated in childhood with chemotherapy, study benefits of open-fitting hearing-aids for word recognition, and investigate whether self-reported hearing-handicap corresponded to subjects' word recognition ability. Design: Subjects diagnosed with cancer and treated with platinum-based chemotherapy in childhood underwent audiometric evaluations. Study Sample: Fifteen subjects (eight females and seven males) fulfilled the criteria set for the study, and four of those received customized open-fitting hearing-aids. Results: Subjects with cisplatin-induced ototoxicity had severe difficulties recognizing words in noise, and scored as low as 54% below reference scores standardized for age and degree of hearing loss. Hearing-impaired subjects' self-reported hearing-handicap correlated significantly with word recognition in a quiet environment but not in noise. Word recognition in noise improved markedly (up to 46%) with hearing-aids, and the self-reported hearing-handicap and disability score were reduced by more than 50%. Conclusions: This study demonstrates the importance of testing word recognition in noise in subjects treated with platinum-based chemotherapy in childhood, and to use specific custom-made questionnaires to evaluate the experienced hearing-handicap. Open-fitting hearing-aids are a good alternative for subjects suffering from poor word recognition in noise. Sumario Objectivo: Investigar el reconocimiento de palabras en ruido en sujetos tratados en la infancia con quimioterapia, los beneficios en el estudio de la adaptación abierta de auxiliares auditivos para el reconocimiento de palabras e investigar si el impedimento auditivo auto-reportado corresponde a la capacidad de reconocimiento de palabras del sujeto. Diseño: Se evaluó audiométricamente a sujetos que había sido diagnosticados con cáncer y tratados con una quimioterapia basada en platino en la infancia. Muestra del Estudio: Quince sujetos (8 mujeres y 7 hombres) cumplieron los criterios establecidos para el estudio y cuatro de ellos recibieron auxiliares auditivos de adaptación abierta, hecha a la medida. Resultados: Los sujetos con ototoxicidad inducida por cisplatino tuvieron dificultades severas para reconocer palabras en ruido y tuvieron puntuaciones tan bajas como 54% por debajo de las de referencia, estandarizadas por edad y por grado de pérdida auditiva. Los auto-reportes de impedimento auditivo de los sujetos con hipoacusia correlacionaron significativamente con el reconocimiento de palabra en un ambiente silencioso pero no en ruido. El reconocimiento de palabras en ruido mejoró marcadamente (hasta en un 46%) con los auxiliares auditivos, y el impedimento y discapacidad auditiva auto-reportados se redujeron en más del 50%. Conclusiones: Este estudio demuestra la importancia de evaluar el reconocimiento de palabras en ruido en sujetos tratados con quimioterapias basadas en platino en la infancia, y de usar cuestionarios específicos, hechos a la medida, para evaluar la disminución auditiva experimentada. Los auxiliares auditivos de adaptación abierta son una buena alternativa para sujetos que sufren de un pobre reconocimiento de palabras en ruido
33.	Ekblad, Jonas, et al. (author) Analysis Method for Multi-Stimulus Multi-Response Posturography 1996 Conference paper (peer-reviewed)
34.	Ekvall Hansson, Eva, et al. (author) Gait flexibility among older persons significantly more impaired in fallers than non-fallers-a longitudinal study 2021 In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:13, s. 1-13 Journal article (peer-reviewed)abstract Gait disorders are a relevant factor for falls and possible to measure with wearable devices. If a wearable sensor can detect differences in gait parameters between fallers and non-fallers has not yet been studied. The aim of this study was to measure and compare gait parameters, vestibular function, and balance performance between fallers and non-fallers among a group of older persons. Participants were senior members (n = 101) of a Swedish non-profit gymnastic association. Gait parameters were obtained using an inertial measurement unit (IMU) that the participants wore on the leg while walking an obstacle course and on an even surface. Vestibular function was assessed by the Head-shake test, the Head impulse test, and the Dix-Hallpike maneuver. Balance was assessed by the Timed Up and Go, the Timed Up and Go manual, and the Timed Up and Go cognitive tests. Falls during the 12-month follow-up period were monitored using fall diaries. Forty-two persons (41%) had fallen during the 12-month follow-up. Fallers had more limited ability to vary their gait (gait flexibility) than non-fallers (p < 0.001). No other differences between fallers and non-fallers were found. The use of gait flexibility, captured by an IMU, seems better for identifying future fallers among healthy older persons than Timed Up and Go or Timed Up and Go combined with a cognitive or manual task.
35.	Ekvall Hansson, Eva, et al. (author) Gait flexibility among older persons significantly more impaired in fallers than non-fallers-a longitudinal study 2021 In: International Journal of Environmental Research and Public Health. - : MDPI Multidisciplinary Digital Publishing Institute. - 1661-7827 .- 1660-4601. ; 18:13, s. 1-13 Journal article (peer-reviewed)abstract Gait disorders are a relevant factor for falls and possible to measure with wearable devices. If a wearable sensor can detect differences in gait parameters between fallers and non-fallers has not yet been studied. The aim of this study was to measure and compare gait parameters, vestibular function, and balance performance between fallers and non-fallers among a group of older persons. Participants were senior members (n = 101) of a Swedish non-profit gymnastic association. Gait parameters were obtained using an inertial measurement unit (IMU) that the participants wore on the leg while walking an obstacle course and on an even surface. Vestibular function was assessed by the Head-shake test, the Head impulse test, and the Dix-Hallpike maneuver. Balance was assessed by the Timed Up and Go, the Timed Up and Go manual, and the Timed Up and Go cognitive tests. Falls during the 12-month follow-up period were monitored using fall diaries. Forty-two persons (41%) had fallen during the 12-month follow-up. Fallers had more limited ability to vary their gait (gait flexibility) than non-fallers (p < 0.001). No other differences between fallers and non-fallers were found. The use of gait flexibility, captured by an IMU, seems better for identifying future fallers among healthy older persons than Timed Up and Go or Timed Up and Go combined with a cognitive or manual task.
36.	Eriksson, Frida, 1986, et al. (author) Interpretative and predictive modelling of Joint European Torus collisionality scans 2019 In: Plasma Physics and Controlled Fusion. - : Institute of Physics Publishing (IOPP). - 0741-3335 .- 1361-6587. ; 61:11 Journal article (peer-reviewed)abstract Transport modelling of Joint European Torus (JET) dimensionless collisionality scaling experiments in various operational scenarios is presented. Interpretative simulations at a fixed radial position are combined with predictive JETTO simulations of temperatures and densities, using the TGLF transport model. The model includes electromagnetic effects and collisions as well as (E)over-right-arrow x (b)over-right-arrow shear in Miller geometry. Focus is on particle transport and the role of the neutral beam injection (NBI) particle source for the density peaking. The experimental 3-point collisionality scans include L-mode, and H-mode (D and H and higher beta D plasma) plasmas in a total of 12 discharges. Experimental results presented in (Tala et al 2017 44th EPS Conf.) indicate that for the H-mode scans, the NBI particle source plays an important role for the density peaking, whereas for the L-mode scan, the influence of the particle source is small. In general, both the interpretative and predictive transport simulations support the experimental conclusions on the role of the NBI particle source for the 12 JET discharges.
37.	Fransson, Anders, et al. (author) Prioriterade grupper i komvux : anpassning av rekrytering, studievägledning och undervisning till prioriterade grupper 1990 Reports (other academic/artistic)abstract Om rekrytering och anpassning av komvux till proriterade grupper
38.	Fransson, Claes, et al. (author) Late spectral evolution of the ejecta and reverse shock in SN 1987a 2013 In: Astrophysical Journal. - 0004-637X .- 1538-4357. ; 768:1, s. 88- Journal article (peer-reviewed)abstract We present observations with the Very Large Telescope and Hubble Space Telescope (HST) of the broad emission lines from the inner ejecta and reverse shock of SN 1987A from 1999 February until 2012 January (days 4381-9100 after explosion). We detect broad lines from H alpha, H beta, Mg I], Na I, [O I], [Ca II], and a feature at similar to 9220 angstrom. We identify the latter line with Mg II lambda lambda 9218, 9244, which is most likely pumped by Ly alpha fluorescence. H alpha and H beta both have a centrally peaked component extending to similar to 4500 km s(-1) and a very broad component extending to greater than or similar to 11,000 km s(-1), while the other lines have only the central component. The low-velocity component comes from unshocked ejecta, heated mainly by X-rays from the circumstellar environment, whereas the very broad component comes from faster ejecta passing through the reverse shock, created by the collision with the circumstellar ring. The flux in H alpha from the reverse shock has increased by a factor of four to six from 2000 to 2007. After that there is a tendency of flattening of the light curve, similar to what may be seen in the optical lines from the shocked ring. The core component seen in H alpha, [Ca II], and Mg II has experienced a similar increase, which is consistent with that found from HST photometry. The energy deposition of the external X-rays is calculated using explosion models for SN 1987A and we predict that the outer parts of the unshocked ejecta will continue to brighten because of this. The external X-ray illumination also explains the edge-brightened morphology of the ejecta seen in the HST images. We finally discuss evidence for dust in the ejecta from line asymmetries.
39.	Fransson, Per, et al. (author) 15-year prospective follow-up of patient-reported outcomes of late bowel toxicity after external beam radiotherapy for localized prostate cancer. A comparison with age-matched controls 2007 In: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 46:4, s. 517-524 Journal article (peer-reviewed)abstract We have previously described patient-reported outcomes of late side effects induced by conventional external beam radiotherapy (EBRT), 4 and 8 years after treatment, in 181 patients with localized prostate cancer compared with 141 age-matched controls. In the present study, we compare bowel side effects 15 years after EBRT with the same controls, and with the results of our previous 4-year and 8-year follow-ups. Of the 181 patients and 141 controls at the 4-year follow-up, 45 patients (25%) and 79 controls (56%) were still alive at the 15-year follow-up. Bowel symptoms were assessed using the symptom-specific questionnaire Prostate Cancer Symptom Scale (PCSS), which was sent to these 45 patients and 79 age-matched controls with a mean follow-up time of 15 years (162–197 months) after EBRT. The answer frequency was 64% in the patient group and 52% in the control group. The mean age was 78 years in both groups. At the 15-year follow-up, 39% of the patients and 84% of the controls reported no bowel problems (p <0.001), while 16% of the patients and 0% of the controls reported “Quite a few/many” problems with mucus in the stools (p <0.001). “Quite a bit/much” stool leakage was reported by 20% of the patients at the 15-year follow-up, in comparison to 4% of the patients at the 4-year follow-up (ns). The proportion of patients reporting late bowel symptoms was unchanged 15 years after EBRT in comparison to the 4-year follow-up. Increased bowel symptoms were seen in patients in comparison to the age-matched controls.
40.	Fransson, Per-Anders, et al. (author) Adaptation of Multi-Segmented Body Movements during Vibratory Proprioceptive and Galvanic Vestibular Stimulation. 2007 In: Journal of Vestibular Research. - 1878-6464. ; 17:1, s. 47-62 Journal article (peer-reviewed)abstract Control of orthograde posture and use of adaptive adjustments constitutes essential topics of human movement control, both in maintenance of static posture and in ensuring body stability during locomotion. The objective was to investigate, in twelve normal subjects, how head, shoulder, hip and knee movements and torques induced towards the support surface were affected by vibratory proprioceptive and galvanic vestibular stimulation, and to investigate whether movement pattern, body posture and movement coordination were changed over time. Our findings suggest that the adaptive process to enhance stability involves both alteration of the multi-segmented movement pattern and alteration of body posture. The magnitude of the vibratory stimulation intensity had a prominent influence on the evoked multi-segmented movement pattern. The trial conditions also influenced whether the posture were altered and if these posture adjustments were done directly at stimulation onset or gradually over a longer period. Moreover, the correlation values showed that the subjects, primarily during trials with vibratory stimulation alone, significantly increased the body movement coordination at stimulation onset and maintained this movement pattern throughout the stimulation period. Furthermore, when exposed to balance perturbations the test subjects synchronized significantly the head and torso movements in anteroposterior direction during all trial conditions.
41.	Fransson, Per-Anders, et al. (author) Adaptation to Vibratory Perturbations in Postural Control 2003 In: IEEE Engineering in Medicine and Biology Magazine. - 2154-2287. ; 22:2, s. 53-57 Journal article (peer-reviewed)
42.	Fransson, Per-Anders (author) Analysis of Adaptation in Human Postural Control 2005 Doctoral thesis (other academic/artistic)abstract The ability to obtain correct balance control information and adjust motor performance appropriately are essential elements in effective postural control. However, functional disorders may affect the reliability of receptor information and ability to carry out corrective motions needed to maintain balance. This emphasizes the importance of rapid and accurate adaptation processes that can optimize the use of available sensor and motor resources. The presented studies aimed to investigate the role of adaptation in human postural control during upright stance, while submitted to balance perturbations evoked by vibratory proprioceptive or galvanic vestibular stimulation, and when different constraints affected the sensory input or motor output. The postural control performance was assessed with posturography and analyzed with respect to variance, correlation, GARCH or MIMO methods, or by a special new method designed to quantify adaptation in postural control.Postural control could, both quantitatively and qualitatively, substantially change movement patterns when submitted to balance perturbations. Three different methods seemed to be used to improve balance control: 1) Suppression of the balance disturbances evoked by the perturbations, 2) Adoption of a favorable posture that had better properties to withstand the disturbances, 3) Use of the gained experiences acquired from previous occasions of exposure to the balance perturbations. These adaptive methods could be manipulated separately and act at different time scales.Postural control adapted the body posture and responses to balance perturbations similarly to repetitive galvanic vestibular and vibratory proprioceptive stimulation. The location of the disturbed somatosensory receptors, e.g., calf or neck muscle receptors, were of minor importance for the movement control strategy used. Moreover, elderly people used similar adaptive methods as middle-aged people, by altering posture and suppressing the effects of balance perturbation.Even though adaptation could have a substantial effect on postural control, the findings imply that adaptation could not entirely compensate for the differences imposed by internal or external constraints such as biomechanics or effects on sensory information. Although the adaptive adjustments were similar during vibration and galvanic stimulation, the two kinds of stimulation induced different movement responses. Moreover, the findings suggest that deficits found of postural control in elderly were not associated with inactive or inappropriate adaptation ability, but probably associated with sensory or motor deficits in their original balance control.Access to visual information had marked effect on the balance control during all trial conditions investigated, in terms of reduced influence of balance perturbations and decreased body movements above 0.1 Hz. Reduced sensory information from the cutaneous mechanoreceptors in the feet substantially increased the body movements, reflected by significantly increased torque variance. However, the effects of disturbed mechanoreceptors information were rapidly compensated for within 100 seconds. Postural control was affected substantially both by decreased muscle force in proportion to body weight, and by fatigued triceps surae muscles. Decreased muscle force significantly increased the body sway induced by balance perturbations compared with fatigued triceps surae muscles. Postural control adaptation was able to reduce but not fully compensate for the changed muscular efficiency caused by decreased muscle force or fatigued muscles. To conclude, in the evaluation of postural control, it is important to consider sensory deficits, decreased motor control efficiency as well as adaptation insufficiencies, and regard such factors in future therapeutic methods.
43.	Fransson, Per-Anders, et al. (author) Analysis of Postural Control Adaptation during Galvanic and Vibratory Stimulation 2001 In: Proc. 23rd Annual EMBS International Conference (EMBC2001). ; , s. 1170-1173 Conference paper (peer-reviewed)abstract The objective for this study was to investigate whether the postural control adaptation during galvanic stimulation of the vestibular nerve were similar to that found during vibration stimulation to the calf muscles. A method for adaptation analysis was used to analyze the evoked changes of posture, stimulus responses and the motion dynamics. The adaptive adjustments of postural control were similar during galvanic and vibratory stimulation, which suggests that the adaptation operate in the same way independent of the receptor systems affected by the disturbance. There was however a difference in the dynamic feedback properties of the measured responses.
44.	Fransson, Per-Anders, et al. (author) Analysis of Short- and Long-Term Effects of Adaptation in Human Postural Control 2002 In: Biological Cybernetics. - : Springer Science and Business Media LLC. - 1432-0770 .- 0340-1200. ; 86:5, s. 355-365 Journal article (peer-reviewed)abstract The short-term (i.e., days) and long-term (i.e., months) effects of adaptation to posturography examinations were investigated in 12 normal subjects who were repeatedly examined for five consecutive days and again after 90 days. The examinations were conducted both with eyes open and closed, and the perturbations were evoked by a pseudorandomly applied vibration stimulation to the calf muscles. The evoked anteroposterior responses were analyzed with a method considering adaptation in the slow changes in posture and in the stimulus-response relationship. Repetition of examinations on a daily basis revealed a gradual improvement of postural-control performance. The body sway induced by the stimulation was significantly reduced and the dynamical properties changed. Most of the improvements remained after 90 days, but some parameters such as the complexity of the control system used were increased to the initial level. The results confirm previous observations that postural control contains several partially independent adaptive processes, observed in terms of alteration of posture and as a progressive reduction of body sway induced by stimulation. The method used for the adaptation analysis in this study could be applied to analyze biological systems with multiple individual adaptive processes with different time courses or characteristics, or where the adaptation processes are related to multiple internal or external factors.
45.	Fransson, Per-Anders, et al. (author) Balance Control and Adaptation during Vibratory Perturbations in Middle-Aged and Elderly Humans. 2004 In: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6327 .- 1439-6319. ; 91:5-6, s. 595-603 Journal article (peer-reviewed)abstract The objective was to investigate if healthy elderly people respond and adapt differently to postural disturbances compared to middle-aged people. Thirty middle-aged (mean age 37.8 years, range 24–56 years) and forty healthy elderly subjects (mean age 74.6 years, range 66–88 years) were tested with posturography. Body sway was evoked by applying pseudorandom vibratory stimulation to the belly of the gastrocnemius muscles of both legs simultaneously. The tests were performed both with eyes open and eyes closed. The anteroposterior body sway was measured with a force platform and analyzed with a method that considers the adaptive changes of posture and stimulation responses. The results showed that middle-aged people generally used a different postural control strategy as compared to the elderly. The elderly responded more rapidly to vibratory perturbation, used more high-frequency (>0.1 Hz) motions and the motion dynamics had a higher degree of complexity. Moreover, the elderly had diminished ability to use visual information to improve balance control. Altogether, despite having an effective postural control adaptation similar to that of middle-aged people, the elderly had more difficultly in withstanding balance perturbations. These findings suggest that the balance control deterioration associated with aging cannot be fully compensated for by postural control adaptation.
46.	Fransson, Per-Anders, et al. (author) Changes in multi-segmented body movements and EMG activity while standing on firm and foam support surfaces. 2007 In: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6327 .- 1439-6319. ; 101:1, s. 81-89 Journal article (peer-reviewed)abstract Postural control ensures stability during both static posture and locomotion by initiating corrective adjustments in body movement. This is particularly important when the conditions of the support surface change. We investigated the effects of standing on a compliant foam surface using 12 normal subjects (mean age 26 years) in terms of: linear movements at the head, shoulder, hip and knee; EMG activity of the tibialis anterior and gastrocnemius muscles and torques towards the support surface. As subjects repeated the trials with eyes open or closed, we were also able to determine the effects of vision on multi-segmented body movements during standing upon different support surface conditions. As expected, EMG activity, torque variance values and body movements at all measured positions increased significantly when standing on foam compared with the firm surface. Linear knee and hip movements increased more, relative to shoulder and head movements while standing on foam. Vision stabilized the head and shoulder movements more than hip and knee movements while standing on foam support surface. Moreover, vision significantly reduced the tibialis anterior EMG activity and torque variance during the trials involving foam. In conclusion, the foam support surface increased corrective muscle and torque activity, and changed the firm-surface multi-segmented body movement pattern. Vision improved the ability of postural control to handle compliant surface conditions. Several essential features of postural control have been found from recording movements from multiple points on the body, synchronized with recording torque and EMG.
47.	Fransson, Per-Anders, et al. (author) Deep Brain Stimulation in the Subthalamic Nuclei Alters Postural Alignment and Adaptation in Parkinson’s Disease 2021 In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:12 Journal article (peer-reviewed)abstract Parkinson’s disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.
48.	Fransson, Per-Anders, et al. (author) Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson's disease 2021 In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:12 Journal article (peer-reviewed)abstract Parkinson's disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.
49.	Fransson, Per-Anders, et al. (author) Direction of galvanically-induced vestibulo-postural responses during active and passive neck torsion 2000 In: Acta Oto-Laryngologica. - : Informa UK Limited. - 1651-2251 .- 0001-6489. ; 120:4, s. 500-503 Journal article (peer-reviewed)abstract The direction of a postural response induced by galvanic vestibular stimulation depends on the head and trunk position. The relative importance of afferent information (proprioception) and efferent motor command/corollary discharge is unknown. We studied the direction of body sway evoked by galvanic vestibular stimulation in 9 healthy subjects during active and passive head positioning at 0 degrees frontal position, 35 degrees to the left, and 75 degrees to the right, using a custom-built collar. At 0 degrees and 75 degrees there were no significant differences in sway direction between active and passive head positioning. The galvanic stimulation invoked sway toward the anode, mainly in the inter-aural direction. The sway direction differed significantly between active and passive positioning at 35 degrees to the side (p < 0.05). When the head was actively kept in this position, the body sway was mainly in an inter-aural direction. The sway shifted to a naso-occipital direction when the head was passively positioned at 35 degrees. Our results indicate that the afferent proprioceptive information has the largest influence on the direction of the galvanically-induced postural response, although some dependence on efferent motor commands and non-linear cervical proprioception cannot be ruled out entirely.
50.	Fransson, Per-Anders, et al. (author) Effects of 24-hour and 36-hour sleep deprivation on smooth pursuit and saccadic eye movements. 2008 In: Journal of Vestibular Research. - 1878-6464. ; 18:4, s. 209-222 Journal article (peer-reviewed)abstract Sleep restrictions and sleep deprivation have become common in modern society, as many people report daily sleep below the recommended 8 hours per night. This study aimed to examine the effects of sleep deprivation on oculomotor performance by recording smooth pursuit and saccadic eye movements after 24 and 36 hours of sleep deprivation. Another objective was to determine whether detected changes in oculomotor performance followed fluctuations according to a circadian rhythm and/or subjective Visuo-Analogue sleepiness Scale scores. Oculomotor responses were recorded from 18 subjects using electronystagmography, and comprised measurements of accuracy (i.e., the percentage of time the eye movement velocity was within the target velocity boundaries), velocity and latency. Continuous EEG recordings were used to validate that subjects had remained awake throughout the 36-hour period. Our findings showed that sleep deprivation deteriorated smooth pursuit gain, smooth pursuit accuracy and saccade velocity. Additionally, the ratio between saccade velocity and saccade amplitude was significantly decreased by sleep deprivation. However, as the length of sleep deprivation increased, only smooth pursuit gain deteriorated further, whereas there were signs of improvement in smooth pursuit accuracy measurements. The latter observation suggests that smooth pursuit accuracy might be affected by the circadian rhythm of alertness. Surprisingly, high subjective scores of sleepiness correlated in most cases with better saccade performance, especially after 36 hours of sleep deprivation, suggesting that awareness of sleepiness might make subjects perform better during saccade assessments. To conclude, oculomotor function clearly decreased after sleep deprivation, but the performance deteriorations were complex and not necessarily correlated with subjectively felt sleepiness.

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