| 1. |
- Abarenkov, Kessy, et al.
(author)
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Annotating public fungal ITS sequences from the built environment according to the MIxS-Built Environment standard – a report from a May 23-24, 2016 workshop (Gothenburg, Sweden)
- 2016
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In: MycoKeys. - : Pensoft Publishers. - 1314-4057 .- 1314-4049. ; 16, s. 1-15
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Journal article (peer-reviewed)abstract
- Recent molecular studies have identified substantial fungal diversity in indoor environments. Fungi and fungal particles have been linked to a range of potentially unwanted effects in the built environment, including asthma, decay of building materials, and food spoilage. The study of the built mycobiome is hampered by a number of constraints, one of which is the poor state of the metadata annotation of fungal DNA sequences from the built environment in public databases. In order to enable precise interrogation of such data – for example, “retrieve all fungal sequences recovered from bathrooms” – a workshop was organized at the University of Gothenburg (May 23-24, 2016) to annotate public fungal barcode (ITS) sequences according to the MIxS-Built Environment annotation standard (http://gensc.org/mixs/). The 36 participants assembled a total of 45,488 data points from the published literature, including the addition of 8,430 instances of countries of collection from a total of 83 countries, 5,801 instances of building types, and 3,876 instances of surface-air contaminants. The results were implemented in the UNITE database for molecular identification of fungi (http://unite.ut.ee) and were shared with other online resources. Data obtained from human/animal pathogenic fungi will furthermore be verified on culture based metadata for subsequent inclusion in the ISHAM-ITS database (http://its.mycologylab.org).
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| 2. |
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| 3. |
- Abbott, Allan, et al.
(author)
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Analgesic prescriptions received by patients before commencing the BOA model of care for osteoarthritis: a Swedish national registry study with matched reference and clinical guideline benchmarking
- 2022
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 93, s. 51-58
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Journal article (peer-reviewed)abstract
- Background and purpose - Swedish clinical guidelines for osteoarthritis (OA) prioritize patient education, exercise, and-if necessary-weight reduction before considering adjunct pharmacological intervention. Contrariwise, we investigated the proportion and type of dispensed analgesic prescriptions in Sweden received by patients during 3 years before commencing non-pharmacological primary care interventions for OA (2008-2016) compared with the general population. Furthermore, we analyzed the proportion of analgesic prescriptions dispensed before (2008-2012) compared with after (2012-2016) guideline publication in terms of concordance with clinical guideline recommendations. Patients and methods - Patients with hip or knee OA (n = 72,069) from the Better Management of OA national quality register receiving non-pharmacological interventions in primary care between 2008 and 2016 were included (OA cohort). An age, sex, and residence matched reference cohort (n = 216,207) was formed from the Swedish Total Population Register. Based on a period 3 years prior to inclusion in the OA cohort, Swedish Prescribed Drug Register data was linked to both the OA and reference cohorts. Results - Compared with the reference cohort, a distinctly larger proportion of the OA cohort had dispensed prescriptions for most types of analgesics, increasing exponentially each year prior to commencing non-pharmacological intervention. Since guideline publication, the proportion of the OA cohort having no dispensed prescription analgesics prior to non-pharmacological primary care intervention concordantly increased by 5.0% (95% CI 4.2-5.9). Furthermore, dispensed prescriptions concordantly decreased for non-selective NSAIDs -8.6% (CI -9.6 to -7.6), weak opioids -6.8% (CI -7.7 to -5.9), glucosamine -9.5% (CI -9.8 to -8.8). and hyaluronic acid -1.6% (CI -1.8 to -1.5) but discordantly increased for strong opioids 2.8% (CI 2.1-3.4) and glucocorticoid intra-articular injection for hip OA 2.1% (CI 1.0-3.1). Interpretation - In Sweden, dispensed prescription of analgesics commonly occurred before initiating non-pharmacological primary care interventions for OA but reduced modestly after guideline publication, which prioritizes non-pharmacological before pharmacological interventions. Additional modest improvements occurred in the stepped-care prioritization of analgesic prescription types. However, future strategies are required to curb an increase of strong opioids prescription for OA and glucocorticoid intra-articular injection for hip OA.
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| 4. |
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| 5. |
- Ahlquist, Mårten, et al.
(author)
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Rhodium(I) hydrogenation in water : Kinetic studies and the detection of an intermediate using C-13{H-1} PHIPNMR spectroscopy
- 2007
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In: Inorganica Chimica Acta. - : Elsevier BV. - 0020-1693 .- 1873-3255. ; 360:5, s. 1621-1627
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Journal article (peer-reviewed)abstract
- The mechanism for hydrogenation of dimethylmaleate in water using cationic rhodium complexes with water-soluble bi-dentate phosphines has been investigated using kinetics and a novel method for the indirect detection of intermediates in catalytic hydrogenation reactions, whereby a late intermediate was detected. A mechanism is proposed involving fast, irreversible substrate binding followed by a rate-determining reaction with dihydrogen.
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| 6. |
- Blomqvist, Göran, 1963-, et al.
(author)
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Damning från flygaskstabiliserade grusvägar
- 2012
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Reports (other academic/artistic)abstract
- Obundna vägar dammar genom trafikens framfart över dem. Sådan damning kan leda till trafiksäkerhets- och hälsorisker, olägenheter för närboende och ett accelererat nedbrytande av grusvägens slitlager. Det har funnits misstanke om att grusvägar där bärlagret stabiliserats med inblandning av flygaska skulle damma mer än konventionella grusvägar. Därför undersöktes damningen vid två fältlokaler där både asksträckor och konventionellt byggda sträckor fanns. Forskningsuppgiften var att jämföra damningen och svara på frågan om askvägar dammar mer än de konventionellt byggda vägarna. Dessutom skulle spridningen av damm till omgivningen kartläggas och förekomsten av aska i det uppvirvlade dammet detekteras. Projektet genomförs som ett samarbetsprojekt mellan VTI, SGI och Högskolan Dalarna, men även IVL har varit med i projektgruppen. Resultaten riktar sig till planerare och drift- och underhållsansvariga hos väghållare, entreprenörer och myndigheter. Fältmätningarna har innefattat såväl väletablerade som innovativa mätmetoder för bestämning av damning och sådana faktorer som påverkar damning som grusslitlagrets vattenkvot och kornstorleksfördelning.
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| 7. |
- Borgquist, Ola, et al.
(author)
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Micro- and macromechanical effects on the wound bed of negative pressure wound therapy using gauze and foam.
- 2010
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In: Annals of Plastic Surgery. - 1536-3708. ; 64:6, s. 789-793
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Journal article (peer-reviewed)abstract
- Negative pressure wound therapy (NPWT) results in 2 types of tissue deformation, macrodeformation (ie, wound contraction) and microdeformation (ie, the interaction of tissue and dressing on a microscopic level). These effects have been delineated for one type of wound filler, foam, but not for gauze. The mechanical deformation initiates a signaling cascade which ultimately leads to wound healing. The aim of the present study was to examine the effect of gauze and foam on macro- and microdeformation during treatment with negative pressure. An in vivo porcine peripheral wound model was used. NPWT was applied for 72 hours at 0, -75, and -125 mm Hg, using either foam or gauze as wound filler. The mechanical effects of NPWT were examined by measuring the wound surface area reduction and by histologic analysis of the wound bed tissue. Similar degrees of wound contraction (macrodeformation) were seen during NPWT regardless if foam or gauze was used. After negative pressure had been discontinued, the wound stayed contracted. There was no difference in wound contraction between -75 and -125 mm Hg. Biopsies of the wound bed revealed a repeating pattern of wound surface undulations and small tissue blebs ("tissue mushrooms") were pulled into the pores of the foam dressing and the spaces between the threads in the gauze dressing (microdeformation). This pattern was obvious in wounds treated both with foam and gauze, at atmospheric pressure (0 mm Hg) as well as at subatmospheric pressures (-75 and -125 mm Hg). The degrees of micro- and macrodeformation of the wound bed are similar after NPWT regardless if foam or gauze is used as wound filler.
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| 8. |
- Bost, Jeremy P., et al.
(author)
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Novel endosomolytic compounds enable highly potent delivery of antisense oligonucleotides
- 2022
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In: Communications Biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 5:1
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Journal article (peer-reviewed)abstract
- The therapeutic and research potentials of oligonucleotides (ONs) have been hampered in part by their inability to effectively escape endosomal compartments to reach their cytosolic and nuclear targets. Splice-switching ONs (SSOs) can be used with endosomolytic small molecule compounds to increase functional delivery. So far, development of these compounds has been hindered by a lack of high-resolution methods that can correlate SSO trafficking with SSO activity. Here we present in-depth characterization of two novel endosomolytic compounds by using a combination of microscopic and functional assays with high spatiotemporal resolution. This system allows the visualization of SSO trafficking, evaluation of endosomal membrane rupture, and quantitates SSO functional activity on a protein level in the presence of endosomolytic compounds. We confirm that the leakage of SSO into the cytosol occurs in parallel with the physical engorgement of LAMP1-positive late endosomes and lysosomes. We conclude that the new compounds interfere with SSO trafficking to the LAMP1-positive endosomal compartments while inducing endosomal membrane rupture and concurrent ON escape into the cytosol. The efficacy of these compounds advocates their use as novel, potent, and quick-acting transfection reagents for antisense ONs.
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| 9. |
- Buhlin, K., et al.
(author)
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Periodontal treatment influences risk markers for atherosclerosis in patients with severe periodontitis
- 2009
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In: Atherosclerosis. - : Elsevier. - 0021-9150 .- 1879-1484. ; 206:2, s. 518-522
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Journal article (peer-reviewed)abstract
- This study investigated the effect of mechanical infection control for periodontitis and periodontal surgery on the prevalence of well-established risk factors for atherosclerosis, and plasma levels of cytokines, antibodies against heat shock proteins and markers of systemic inflammation. Sixty-eight patients between 39 and 73 years of age with severe periodontitis who had been referred to four specialist periodontology clinics in Sweden were investigated. A fasting venous blood sample was taken at baseline and additional samples were collected after 3 and 12 months. A total of 54 patients underwent periodontal treatment. The periodontal treatment was successful, as pathogenic gingival pockets decreased significantly. Plasma glucose, lipids and markers of systemic inflammation were not significantly altered after 3 months. One year after the initial treatment, HDL-C concentrations were significantly increased (Δ0.08 mmol/L) whereas LDL-C concentrations decreased (Δ0.23 mmol/L). Haptoglobin concentrations were also lower. Interleukin-18 and interferon-γ levels were also lower after 12 months (60 ng/L (-23%) and 11 ng/L (-97%) respectively). Treatment had no effect on plasma levels of IgA, IgG1, IgG2 antibodies against heat shock proteins. In conclusion, this study indicates that standard treatment for periodontal disease induces systemic changes in several biochemical markers that reflect the risk for atherosclerosis.
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| 10. |
- Buhlin, K., et al.
(author)
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Risk factors for atherosclerosis in cases with severe periodontitis
- 2009
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In: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 36:7, s. 541-549
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Journal article (peer-reviewed)abstract
- Aim: Studies have reported on an association between cardiovascular disease (CVD) and periodontitis. The purpose of this case-control study was to provide an insight into this association by determining the plasma levels of some risk markers for CVD in cases with periodontitis.Materials and Methods: Sixty-eight cases with periodontitis, mean age 53.9 (SD 7.9) years, and 48 randomly selected healthy controls, mean age 53.1 (SD 7.9) years, were investigated. Fasting blood plasma was analysed for glucose, lipids, markers systemic inflammation, cytokines and antibodies against heat shock proteins (Hsp). The associations between periodontitis and the various substances analysed in plasma were calculated using a multivariate logistic regression model, which compensated for age, gender, smoking and body mass index.Results: The regression analyses revealed a significant association between periodontitis and high levels of C-reactive protein (CRP) [odds ratio (OR) 4.0, confidence interval (CI) 1.4-11.4] and fibrinogen (OR 8.7, CI 2.6-28.4), IL-18 (OR 6.5, CI 2.2-19.5), and decreased levels of IL-4 (OR 0.12, CI 0.0-0.5). The study showed increased levels of antibodies against Hsp65 (OR 2.8, CI 1-7.6) and 70 (OR 2.9, CI 1.1-7.8) and decreased levels of antibodies against Hsp60 (OR 0.3, CI 0.1-0.8).Conclusions: Periodontitis was associated with increased levels of CRP, glucose, fibrinogen and IL-18, and with decreased levels of IL-4.
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| 11. |
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| 12. |
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| 13. |
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| 14. |
- Dalin, Frida, 1984-, et al.
(author)
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Clinical and immunological characteristics of Autoimmune Addison's disease : a nationwide Swedish multicenter study
- 2017
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In: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 102:2, s. 379-389
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Journal article (peer-reviewed)abstract
- CONTEXT: Studies on clinical and immunological features of Autoimmune Addison's disease (AAD) are needed to understand the disease burden and increased mortality.OBJECTIVE: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors.DESIGN, SETTING AND PARTICIPANTS: Cross sectional, population-based study. 660 AAD patients were included utilizing the Swedish Addison Registry (SAR) 2008-2014. When analyzing cardiovascular risk factors, 3,594 individuals from the population-based survey in Northern Sweden, MONICA (MONItoring of Trends and Determinants of CArdiovascular Disease), served as controls.MAIN OUTCOME MEASURE: Prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.RESULTS: Sixty percent of the SAR cohort consisted of females. Mean age at diagnosis was significantly higher for females than for males (36.8 vs. 31.1 years). The proportion of 21-hydroxylase autoantibody positive patients was 83% and 62% of patients had one or more associated autoimmune diseases, more frequently coexisting in females (p<0.0001). AAD patients had lower BMI (p<0.0001) and prevalence of hypertension (p=0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of patients; with the mean dose 28.1±8.5 mg/day. The mean hydrocortisone equivalent dose normalized to body surface was 14.8±4.4 mg/m(2)/day. Higher hydrocortisone equivalent dose was associated with higher incidence of hypertension (p=0.046).CONCLUSIONS: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients do not have increased prevalence of overweight, hypertension, T2DM or hyperlipidemia. However, high glucocorticoid replacement doses may be a risk factor for hypertension.
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| 15. |
- Debevec, Tadej, et al.
(author)
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Acute short-term hyperoxia followed by mild hypoxia does not increase EPO production : resolving the "normobaric oxygen paradox''
- 2012
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In: European Journal of Applied Physiology. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 112:3, s. 1059-1065
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Journal article (peer-reviewed)abstract
- Recent findings suggest that besides renal tissue hypoxia, relative decrements in tissue oxygenation, using a transition of the breathing mixture from hyperoxic to normoxic, can also stimulate erythropoietin (EPO) production. To further clarify the importance of the relative change in tissue oxygenation on plasma EPO concentration [EPO], we investigated the effect of a consecutive hyperoxic and hypoxic breathing intervention. Eighteen healthy male subjects were assigned to either IHH (N = 10) or CON (N = 8) group. The IHH group breathed pure oxygen (F(i)O(2) ~ 1.0) for 1 h, followed by a 1-h period of breathing a hypoxic gas mixture (F(i)O(2) ~ 0.15). The CON group breathed a normoxic gas mixture (F(i)O(2) ~ 0.21) for the same duration (2 h). Blood samples were taken just before, after 60 min, and immediately after the 2-h exposure period. Thereafter, samples were taken at 3, 5, 8, 24, 32, and 48 h after the exposure. During the breathing interventions, subjects remained in supine position. There were significant increases in absolute [EPO] within groups at 8 and 32 h in the CON and at 32 h only in the IHH group. No significant differences in absolute [EPO] were observed between groups following the intervention. Relative (∆[EPO]) levels were significantly lower in the IHH than in the CON group, 5 and 8 h following exposure. The tested protocol of consecutive hyperoxic-hypoxic gas mixture breathing did not induce [EPO] synthesis stimulation. Moreover, the transient attenuation in ∆[EPO] in the IHH group was most likely due to a hyperoxic suppression. Hence, our findings provide further evidence against the "normobaric O(2) paradox" theory.
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| 16. |
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| 17. |
- Ekerhult, Teresa, et al.
(author)
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Ectopic Germinal Centres with B and T Cells and Follicular Dendritic Cell Networks in Urethral Stricture Tissue: Possible Avenue for Immunological Treatments
- 2021
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In: European Urology Open Science. - : Elsevier BV. - 2666-1691 .- 2666-1683. ; 27, s. 88-93
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Journal article (peer-reviewed)abstract
- Background: The underlying cause of a urethral stricture can sometimes be obscure. It is possible that an injury to the urethra induces an immunological cascade that generates scar tissue and fibrosis, eventually resulting in a stricture. If such immuno-logical reactions could be better elucidated, immunological therapies could possibly emerge. Objective: To evaluate if ectopic germinal centres exist in urethral stricture disease. Design, setting, and participants: Resected stricture specimens from 45 patients undergoing open bulbar urethroplasty with excision and anastomosis were assessed. Histopathological characteristics, such as fibrosis (grade I & ndash;III), inflammation, and scle-rosis, were evaluated using immunostaining for CD3 (T cells), CD20 (B cells), and CD21 (follicular dendritic cells). Outcome measurements and statistical analysis: The primary outcome measure was the presence or absence of a germinal centre. The secondary outcome was evaluation of any correlation between the degree of fibrosis and germinal centres. Fisher & rsquo;s exact test was used for univariate analysis. Results and limitations: In six patients, ectopic germinal centres were found. In ten patients, there was no inflammation at all. There was no correlation found between the degree of fibrosis and the abundance of immunohistochemically detected immune cells. Conclusions: Ectopic germinal centres, with B and T cells as well as follicular dendritic cell networks, do exist in urethral stricture disease. This finding may open up for novel research avenues on the possibility of adopting immunological treatments for urethral stricture disease. Patient summary: In patients with a narrowing of the urethra due to any kind of trauma, we looked for the presence of centres of immunological reaction in urethral tissue. We identified these immunological centres (also called germinal centres) in some patients. This intriguing finding suggests that immunological treatments may have potential for men with scar tissue in a narrowed urethra. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creati-vecommons.org/licenses/by-nc-nd/4.0/).
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| 18. |
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| 19. |
- Felton, Adam, et al.
(author)
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Keeping pace with forestry : Multi-scale conservation in a changing production forest matrix
- 2020
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In: Ambio. - : Springer. - 0044-7447 .- 1654-7209. ; 49:5, s. 1050-1064
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Journal article (peer-reviewed)abstract
- The multi-scale approach to conserving forest biodiversity has been used in Sweden since the 1980s, a period defined by increased reserve area and conservation actions within production forests. However, two thousand forest-associated species remain on Sweden's red-list, and Sweden's 2020 goals for sustainable forests are not being met. We argue that ongoing changes in the production forest matrix require more consideration, and that multi-scale conservation must be adapted to, and integrated with, production forest development. To make this case, we summarize trends in habitat provision by Sweden's protected and production forests, and the variety of ways silviculture can affect biodiversity. We discuss how different forestry trajectories affect the type and extent of conservation approaches needed to secure biodiversity, and suggest leverage points for aiding the adoption of diversified silviculture. Sweden's long-term experience with multi-scale conservation and intensive forestry provides insights for other countries trying to conserve species within production landscapes.
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| 20. |
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| 21. |
- Grönkvist, Mikael, et al.
(author)
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Inter- and intraregional ventilation inhomogeneity in hypergravity and after pressurization of an anti-G suit
- 2003
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In: Journal of applied physiology. - : American Physiological Society. - 8750-7587 .- 1522-1601. ; 94:4, s. 1353-1364
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Journal article (peer-reviewed)abstract
- This study assessed the effects of increased gravity in the head-to-foot direction (+G(z)) and anti-G suit (AGS) pressurization on functional residual capacity (FRC), the volume of trapped gas (V(TG)), and ventilation distribution by using inert- gas washout. Normalized phase III slope (Sn(III)) analysis was used to determine the effects on inter- and intraregional ventilation inhomogeneity. Twelve men performed multiple-breath washouts of SF(6) and He in a human centrifuge at +1 to +3 G(z) wearing an AGS pressurized to 0, 6, or 12 kPa. Hypergravity produced moderately increased FRC, V(TG), and overall and inter- and intraregional inhomogeneities. In normogravity, AGS pressurization resulted in reduced FRC and increased V(TG), overall, and inter- and intraregional inhomogeneities. Inflation of the AGS to 12 kPa at +3 G(z) reduced FRC markedly and caused marked gas trapping and intraregional inhomogeneity, whereas interregional inhomogeneity decreased. In conclusion, increased +G(z) impairs ventilation distribution not only between widely separated lung regions, but also within small lung units. Pressurizing an AGS in hypergravity causes extensive gas trapping accompanied by reduced interregional inhomogeneity and, apparently, results in greater intraregional inhomogeneity.
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| 22. |
- Grönkvist, Mikael J, et al.
(author)
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Contributions of lower limb and abdominal compression to ventilation inhomogeneity in hypergravity
- 2005
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In: Respir Physiol Neurobiol. - : Elsevier BV. - 1569-9048 .- 1878-1519. ; 148:1-2, s. 113-23
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Journal article (peer-reviewed)abstract
- Gravito-inertial load in the head-to-foot direction (Gz) and compression of the lower body half by an anti-G suit (AGS) are both known to influence ventilation distribution in the lungs. To study the interaction of Gz and AGS and to asses the separate contributions from lower limbs and abdominal compressions to large and small-scale ventilation inhomogeneities nine males performed SF6/He vital capacity (VC) single-breath washouts at 1, 2, and 3 Gz in a centrifuge, with abdominal and/or lower limbs compressions. SF6/He and (SF6-He) phase III slopes were used for determination of overall and small-scale ventilation inhomogeneity. Closing volume and phase IV height were used as measures of large-scale inhomogeneity. VC decreased marginally with G-load but markedly with lower limbs compression. Small-scale ventilation inhomogeneity increased slightly with G-load, but substantially with AGS pressurization. Small-scale ventilation inhomogeneity increased with AGS pressurization. Large-scale inhomogeneity increased markedly with G-load. Translocation of blood to the lungs might be the key determinant for changes in small-scale ventilation inhomogeneity when pressurizing an AGS.
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| 23. |
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| 24. |
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| 25. |
- Gustafsson, Jan, et al.
(author)
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APSI - svår autoimmun sjukdom med endokrina och icke-endokrina symtom
- 2004
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 101:24, s. 2096-2103
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Journal article (peer-reviewed)abstract
- Autoimmune polyglandular syndrome type I (APS I) is an autosomal recessive disorder characterized by a combination of autoimmune manifestations affecting endocrine and non-endocrine organs. APS I usually presents in childhood. The three most common manifestations are chronic mucocutaneous candidiasis, hypoparathyroidism and Addison's disease. At least two of these must be present to fulfill the diagnostic criteria of this syndrome. The spectrum of other associated diseases includes gonadal insufficiency, alopecia, vitiligo and chronic active hepatitis. APS I is caused by a mutation in the AIRE-gene (autoimmune regulator) located on chromosome 21. Analysis of specific autoantibodies against intracellular enzymes, particularly enzymes in the synthesis of steroids and neurotransmittors, can be used in the diagnosis of APS I and to predict different manifestations of the disease.
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| 26. |
- Gustafsson, Johanna, et al.
(author)
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Predictors of the first cardiovascular event in patients with systemic lupus erythematosus : a prospective cohort study
- 2009
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In: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 11:6, s. R186-
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Journal article (peer-reviewed)abstract
- INTRODUCTION :Cardiovascular disease (CVD) is a major cause of premature mortality among Systemic lupus erythematosus (SLE) patients. Many studies have measured and evaluated risk factors for premature subclinical atherosclerosis, but few studies are prospective and few have evaluated risk factors for hard endpoints, i.e. clinically important cardiovascular events (CVE). We investigated the impact of traditional and lupus associated risk factors for the first ever CVE in a longitudinal cohort of SLE patients.METHODS : A total of 182 SLE patients (mean age 43.9 years) selected to be free of CVE were included. Cardiovascular and autoimmune biomarkers were measured on samples collected after overnight fasting at baseline. Clinical information was collected at baseline and at follow up. End point was the first ever CVE (ischemic heart, cerebrovascular or peripheral vascular disease or death due to CVD). Impact of baseline characteristics/biomarkers on the risk of having a first CVE was evaluated with Cox regression.RESULTS :Follow up was 99.5% after a mean time of 8.3 years. Twenty-four patients (13%) had a first CVE. In age-adjusted Cox regression, any positive antiphospholipid antibody (aPL), elevated markers of endothelial activation (von Willebrand factor (vWf), soluble vascular cellular adhesion molecule-1 (sVCAM-1)) and fibrinogen predicted CVEs. Of SLE manifestations, arthritis, pleuritis and previous venous occlusion were positively associated with future CVEs while thrombocytopenia was negatively associated. Among traditional risk factors only age and smoking were significant predictors. In a multivariable Cox regression model age, any positive aPL, vWf and absence of thrombocytopenia were all predictors of the first CVE.CONCLUSIONS : In addition to age, positive aPL, biomarkers indicating increased endothelial cell activity/damage, and absence of thrombocytopenia were independent predictors of CVEs in this prospective study. Our results indicate that activation of the endothelium and the coagulation system are important features in SLE related CVD. Furthermore, we observed that the risk of CVEs seems to differ between subgroups of SLE patients.
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| 27. |
- Gustafsson, Kristin, 1976-, et al.
(author)
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Health status of individuals referred to first-line intervention for hip and knee osteoarthritis compared with the general population: an observational register-based study
- 2021
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In: Bmj Open. - London, United Kingdom : BMJ. - 2044-6055. ; 11:9
-
Journal article (peer-reviewed)abstract
- Objectives To describe the prevalence of comorbidities in a population referred to standardised first-line intervention (patient education and exercise) for hip and knee osteoarthritis (OA), in comparison with the general population. Furthermore, we aimed to evaluate if eventual differences were associated with socioeconomic inequalities. Design Register-based study. Setting Primary healthcare, Sweden. Participants Individuals with hip and/or knee OA included in the Better Management for Patients with Osteoarthritis Register between 2008 and 2016 and and an age-matched, sex-matched and residence-matched reference cohort (1:3) from the general Swedish population. Outcome measures Comorbidities were identified with the RxRisk Index, the Elixhauser Comorbidity Index and the Charlson Comorbidity Index, and presented with descriptive statistics as (1) individual diseases, (2) disease categories and (3) scores for each index. The prevalence of comorbidities in the two populations was tested using logistic regression, with separate analyses for age groups and the most affected joint. We then adjusted the analyses for socioeconomic status. Results In this OA population, 85% had >= 1 comorbidity compared with 78% of the reference cohort (OR; 1.62 (95% CI 1.59 to 1.66)). Cardiovascular/blood diseases were the most common comorbidities in both populations (OA, 59%; reference, 54%), with OR; 1.22 (95% CI 1.20 to 1.24) for the OA population. Younger individuals with OA were more comorbid than their matched references overall, and population differences decreased with age (eg, >= 3 comorbidities, aged <= 45 years OR; 1.74 (95% CI 1.52 to 1.98), >= 81 years OR; 0.95 (95% CI 0.87 to 1.04)). Individuals with knee OA were more comorbid than those with hip OA overall. Adjustment for socioeconomic status did not change the estimates. Conclusion Comorbidities were more common among individuals with hip and knee OA than among matched references from the general population. The differences could not be explained by socioeconomic status.
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| 28. |
- Gustafsson, Kristin, 1976-
(author)
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Hip and Knee Osteoarthritis : Who Are the Patients Referred to First-Line Intervention and What Happens to Them?
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Background: First-line intervention to address osteoarthritis (OA) should include patient education, exercise therapy, and weight control if needed. Replacement surgery may be appropriate for patients who do not receive sufficient relief from non-surgical interventions. However, predicting the course of OA can be challenging. Some patients experience stable symptoms over time, while others may have a rapid increase in pain and functional impairment. This thesis aims to improve understanding of which patients are referred to first-line intervention for hip and knee OA and to identify factors that affect long-term outcomes in these patients.Methods: The thesis includes studies of patients with hip and knee OA referred to a standardized first-line intervention programme. Study A (papers I, II, IV, V) is a register-based observational study that uses the Swedish Osteoarthritis Register (SOAR) to identify an OA population (n = 72 069). Data from the SOAR was merged with data from the Swedish Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare. The study also includes a matched reference cohort (n = 216 207) from the general Swedish population for comparison. Papers I and II compare socioeconomic status (SES) and comorbidities of the OA population in the SOAR with the reference cohort. Study B (paper III) is a qualitative study involving 16 patients with hip and knee OA who expressed a desire for surgery at referral to first-line intervention. The study includes interviews regarding the patients’ perspectives on healthcare and self-management of OA. Paper IV examines the time to replacement surgery and prognostic factors for surgery in the OA population. Paper V identifies factors associated with poorer patient-reported outcomes 1 year after hip replacement surgery.Results: The OA population had higher SES and higher odds of having comorbidities than the reference cohort. The differences in comorbidities were greater in younger individuals and those with knee OA. Patients who expressed a desire for surgery before participating in first-line intervention described their perspectives on healthcare and self-management as a multifaceted picture of needs, expectations, and individual choices. Findings range from a passive approach towards managing the OA, described as a lack of control, a sense of being left alone by healthcare, having doubts and mistrusting the care provided, to a more active attitude manifested as a will to take control over the OA, instead of the OA taking control over the patient’s life. Of the patients registered in the SOAR, 46% with hip OA and 20% with knee OA were estimated to progress to replacement surgery within 5 years. The strongest prognostic factors were expressing a desire for surgery and having more severe OA symptoms. In addition, higher SES and the presence of comorbidities had an impact on the risk of progression to surgery. Among those who had undergone a hip replacement, 5%–11% showed poor patient-reported outcomes regarding pain, health-related quality of life, and satisfaction 1 year after surgery. Factors associated with poor outcomes were being older, classified as Charnley C (musculoskeletal comorbidities), or having several comorbidities, particularly depression.Conclusions: Higher SES in the OA population referred to first-line intervention than in the general population indicates that OA care in Sweden may not be equal. The higher prevalence of comorbidities in the OA population suggests that OA care should include improving overall health. Furthermore, first-line OA intervention should be tailored to each patient’s perspectives to achieve the lifestyle changes that the interventions strive to accomplish, especially in patients expressing a desire for surgery at referral. Patients with hip and knee OA differ in their progression to surgery. Those with hip OA tend to progress faster and undergo replacement surgery more often than those with knee OA. Expressing a desire for surgery and having severe OA symptoms are prognostic factors, but other non-OA-related factors play a significant role. However, a large proportion of patients with OA do not require surgery within 5 years after referral to first-line intervention, especially those with knee OA. Identifying depression at the stage of referral to first-line OA intervention would allow increased time to optimize treatments and may help improve patient-reported outcomes after surgery.
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| 29. |
- Gustafsson, Kristin, et al.
(author)
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Perspectives on health care and self-management of osteoarthritis among patients who desire surgery: A qualitative interview study
- 2023
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In: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040.
-
Journal article (peer-reviewed)abstract
- Background Expressing a desire for surgery before participating in first-line osteoarthritis (OA) interventions (patient education and exercise therapy) has been shown to contribute to poorer outcomes from the interventions, but we lack knowledge on how these patients reflect on health care and self-management of OA.Objectives To explore and describe patients' perspectives of health care and self-management of OA among those expressing a desire for surgery before participating in first-line OA interventions.Methods Sixteen patients with hip or knee OA referred to participate in a standardized first-line OA intervention program in primary health care in Sweden were included in the study. We used individual semi-structured interviews to collect data, which were analyzed using inductive qualitative content analysis.Results One theme of meaning "A multifaceted picture of needs, expectations, and individual choices" and five categories were identified as perspectives from the participants regarding health care and self-management of OA: 1) lacking control and needing support; 2) standing alone in an unsupportive environment; 3) going with the flow; 4) having expectations; and 5) taking ownership.Conclusion Patients who express a desire for surgery before participating in first-line interventions for OA are not a homogeneous group. They describe a broad range of perspectives on how they reason and reflect on health care and self-management of OA based on their own needs, expectations, and choices. Findings from this study strengthen insights on the importance of exploring the patient's perspectives and individualizing OA interventions to achieve the lifestyle changes that first-line interventions strive to accomplish.
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| 30. |
- Gustafsson, Kristin, 1976-, et al.
(author)
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Progression to arthroplasty surgery among patients with hip and knee osteoarthritis : a study from the Swedish BOA Register
- 2022
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In: The bone & joint journal. - London : British Editorial Society of Bone and Joint Surgery. - 2049-4408 .- 2049-4394. ; 104-B:7, s. 792-800
-
Journal article (peer-reviewed)abstract
- AIMS: The aim of this study was to estimate time to arthroplasty among patients with hip and knee osteoarthritis (OA), and to identify factors at enrolment to first-line intervention that are prognostic for progression to surgery. METHODS: In this longitudinal register-based observational study, we identified 72,069 patients with hip and knee OA in the Better Management of Patients with Osteoarthritis Register (BOA), who were referred for first-line OA intervention, between May 2008 and December 2016. Patients were followed until the first primary arthroplasty surgery before 31 December 2016, stratified into a hip and a knee OA cohort. Data were analyzed with Kaplan-Meier and multivariable-adjusted Cox regression. RESULTS: At five years, Kaplan-Meier estimates showed that 46% (95% confidence interval (CI) 44.6 to 46.9) of those with hip OA, and 20% (95% CI 19.7 to 21.0) of those with knee OA, had progressed to arthroplasty. The strongest prognostic factors were desire for surgery (hazard ratio (HR) hip 3.12 (95% CI 2.95 to 3.31), HR knee 2.72 (95% CI 2.55 to 2.90)), walking difficulties (HR hip 2.20 (95% CI 1.97 to 2.46), HR knee 1.95 (95% CI 1.73 to 2.20)), and frequent pain (HR hip 1.56 (95% CI 1.40 to 1.73), HR knee 1.77 (95% CI 1.58 to 2.00)). In hip OA, the probability of progression to surgery was lower among those with comorbidities (e.g. ≥ four conditions; HR 0.64 (95% CI 0.59 to 0.69)), with no detectable effects in the knee OA cohort. Instead, being overweight or obese increased the probability of OA progress in the knee cohort (HR 1.25 (95% CI 1.15 to 1.37)), but not among those with hip OA. CONCLUSION: Patients with hip OA progressed faster and to a greater extent to arthroplasty than patients with knee OA. Progression was strongly influenced by patients' desire for surgery and by factors related to severity of OA symptoms, but factors not directly related to OA symptoms are also of importance. However, a large proportion of patients with OA do not seem to require surgery within five years, especially among those with knee OA. Cite this article: Bone Joint J2022;104-B(7):792-800.
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| 31. |
- Gustafsson, Kristin, et al.
(author)
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Responders to first-line osteoarthritis treatment had reduced frequency of hip and knee joint replacements within 5 years : an observational register-based study of 44,311 patients
- 2024
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In: Acta Orthopaedica. - : Medical Journals Sweden. - 1745-3674 .- 1745-3682. ; 95, s. 373-379
-
Journal article (peer-reviewed)abstract
- Background and purpose: First-line treatment (education, exercise) for patients with hip and knee osteoarthritis (OA) aims to reduce pain and improve function. We aimed to compare progression to joint replacement within 5 years between responders and non-responders to first-line treatment for hip and knee OA, respectively.Methods: This observational study included data for 30,524 knee OA and 13,787 hip OA patients from the Swedish Osteoarthritis Register, linked with the Swedish Arthroplasty Register, Statistics Sweden, and the Swedish Prescribed Drug Register. The primary prognostic factor was change in pain between baseline and 3-month followup, measured on a numeric rating scale (0–10, best to worst) where an improvement of ≥ 2 was classified as responder and ≤ 1 as non-responder. The main outcome was progression to joint replacement surgery within 5 years, assessed using baseline adjusted multivariable Cox regression analyses.Results: At 5 years, in hip OA, 35% (95% confidence interval [CI] 32.2–37.2) of the responders and 48% (CI 45.9–49.5) of the non-responders and in knee OA 14% (CI 13.0–15.3) of the responders and 20% (CI 18.8–20.8) of the non-responders had progressed to joint replacement. Being a responder to the treatment was associated with having a lower probability of progression to surgery for both hip OA (hazard ratio [HR] 0.4, CI 0.4–0.5) and knee OA (HR 0.6, CI 0.5–0.6).Conclusion: Patients with hip or knee OA who experienced pain relief after a first-line OA treatment program were less likely to progress to joint replacement surgery.
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| 32. |
- Gustafsson, Kristin, et al.
(author)
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Socioeconomic status of patients in a Swedish national self-management program for osteoarthritis compared with the general population-a descriptive observational study
- 2020
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 21:1
-
Journal article (peer-reviewed)abstract
- Background First-line treatment for hip and knee osteoarthritis (OA) including education and supervised exercises, delivered as a self-management program, is considered one of the mainstays in OA treatment. However, the socioeconomic profile of the population that utilizes first-line treatment for hip and knee OA is unclear. The aim of this study was to describe the socioeconomic status (SES) of a population referred to a self-management program for OA, in comparison with that of the general Swedish population. Methods This is a cross-sectional study including 72,069 patients with hip or knee OA enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2008 and 2016, and registered before participation in a structured OA self-management program. A reference cohort (n = 216,207) was selected from the general Swedish population by one-to-three matching by year of birth, sex and residence. Residential municipality, country of birth, marital status, family type, educational level, employment, occupation, disposable income and sick leave were analyzed. Results The BOA population had higher educational level than the reference group, both regarding patients with hip OA (77.5% vs 70% with >= 10 years of education), and with knee OA (77% vs 72% with >= 10 years of education). Their average disposable income was higher (median [IQR] in Euro (euro), for hip euro17,442 [10,478] vs euro15,998 [10,659], for knee euro17,794 [10,574] vs euro16,578 [11,221]). Of those who worked, 46% of patients with hip OA and 45% of the reference group had a blue-collar occupation. The corresponding numbers for knee OA were 51 and 44% respectively. Sick leave was higher among those with hip and knee OA (26%) than those in the reference groups (13% vs 12%). Conclusions The consistently higher SES in the BOA population compared with the general population indicates that this self-management program for OA may not reach the more socioeconomically disadvantaged groups, who are often those with a higher disease burden.
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| 33. |
- Gustafsson, Kristin, 1976-, et al.
(author)
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Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis
- 2018
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In: BMJ Open. - : BMJ. - 2044-6055. ; 8:10
-
Journal article (peer-reviewed)abstract
- Introduction Hip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery. Methods and analysis This nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden. Ethics and dissemination The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059-16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.
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| 34. |
- Gustafsson, Karin, 1980, et al.
(author)
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Tumour-loaded alpha-type 1-polarized Dendritic Cells from Patients with Chronic Lymphocytic Leukaemia Produce a Superior NK-, NKT- and CD8(+) T Cell-attracting Chemokine Profile
- 2011
-
In: Scandinavian Journal of Immunology. - 0300-9475. ; 74:3, s. 318-326
-
Journal article (peer-reviewed)abstract
- Tumour-loaded dendritic cells (DCs) from patients with chronic lymphocytic leukaemia (CLL) matured using an α-type 1-polarized DC cocktail (IL-1β/TNF-α/IFN-α/IFN-γ/poly-I:C;αDC1) were recently shown to induce more functional CD8+ T cells against autologous tumour cells in vitro than DCs matured with the ‘standard’ cocktail (IL-1β/TNF-α/IL-6/PGE2;PGE2DCs). However, the ability of vaccine DCs to induce a type 1-polarized immune response in vivo probably relies on additional features, including their ability to induce a CXCR3-dependent recruitment of NK cells into vaccine-draining lymph nodes. Moreover, their guiding of rare tumour-specific CD8+ T cells to sites of DC–CD4+ T cell interactions by secretion of CCL3 and CCL4 is needed. We therefore analysed the chemokine profile and the lymphocyte-attracting ability in vitro of monocyte-derived PGE2DCs and αDC1s from patients with CLL. αDC1s produced much higher levels of CXCR3 ligands (CXCL9/CXCL10/CXCL11) than PGE2DCs. Functional studies further demonstrated that αDC1s were superior recruiters of both NK and NKT cells. Moreover, αDC1s produced higher levels of CCL3/CCL4 upon CD40 ligation. These findings suggest that functional αDC1s, derived from patients with CLL, produce a desirable NK-, NKT- and CD8+ T cell-attracting chemokine profile which may favour a guided and Th1-deviated priming of CD8+ T cells, supporting the idea that αDC1-based vaccines have a higher immunotherapeutic potential than PGE2DCs.
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| 35. |
- Gustafsson, Karin, et al.
(author)
-
Tumour-loaded alpha-type 1-polarized Dendritic Cells from Patients with Chronic Lymphocytic Leukaemia Produce a Superior NK-, NKT- and CD8(+) T Cell-attracting Chemokine Profile
- 2011
-
In: Scandinavian Journal of Immunology. - : Wiley. - 0300-9475 .- 1365-3083. ; 74:3, s. 318-326
-
Journal article (peer-reviewed)abstract
- Tumour-loaded dendritic cells (DCs) from patients with chronic lymphocytic leukaemia (CLL) matured using an a-type 1-polarized DC cocktail (IL-1 beta/TNF-alpha/IFN-alpha/IFN-gamma/poly-I:C;alpha DC1) were recently shown to induce more functional CD8(+) T cells against autologous tumour cells in vitro than DCs matured with the 'standard' cocktail (IL-1 beta/TNF-alpha/IL-6/PGE(2);PGE(2)DCs). However, the ability of vaccine DCs to induce a type 1-polarized immune response in vivo probably relies on additional features, including their ability to induce a CXCR3-dependent recruitment of NK cells into vaccine-draining lymph nodes. Moreover, their guiding of rare tumour-specific CD8(+) T cells to sites of DC-CD4(+) T cell interactions by secretion of CCL3 and CCL4 is needed. We therefore analysed the chemokine profile and the lymphocyte-attracting ability in vitro of monocyte-derived PGE(2)DCs and alpha DC1s from patients with CLL. alpha DC1s produced much higher levels of CXCR3 ligands (CXCL9/CXCL10/CXCL11) than PGE(2)DCs. Functional studies further demonstrated that alpha DC1s were superior recruiters of both NK and NKT cells. Moreover, alpha DC1s produced higher levels of CCL3/CCL4 upon CD40 ligation. These findings suggest that functional alpha DC1s, derived from patients with CLL, produce a desirable NK-, NKT- and CD8(+) T cell-attracting chemokine profile which may favour a guided and Th1-deviated priming of CD8(+) T cells, supporting the idea that alpha DC1-based vaccines have a higher immunotherapeutic potential than PGE(2)DCs.
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| 36. |
- Gustafsson, Kristin, 1976-, et al.
(author)
-
What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA? : A Register-based Study
- 2023
-
In: Clinical Orthopaedics and Related Research. - : LIPPINCOTT WILLIAMS & WILKINS. - 0009-921X .- 1528-1132. ; 481:9, s. 1732-1742
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Some patients report long-term pain or no improvement in health-related quality of life (HRQoL) or are dissatisfied after THA. However, factors associated with these poorer patient-reported outcomes after surgery are inconsistent and have typically been studied in the late phase of hip osteoarthritis (OA) among patients already eligible for surgery. Earlier identification of risk factors would provide time to address modifiable factors, helping to improve patients' pain, HRQoL, and satisfaction after surgery and reduce the burden on orthopaedic clinics by referring patients who are better prepared for surgery.QUESTIONS/PURPOSES: We analyzed data from patients with hip OA referred to a first-line OA intervention program in primary healthcare at a stage when they had not been referred for THA, and asked: (1) What percentage of patients who proceed to THA report lack of improvement in pain, lack of improvement in HRQoL as measured by the EQ-5D, or are not satisfied with surgery 1 year after THA? (2) What associations exist between baseline factors at referral to this first-line OA intervention program and these poorer patient-reported outcomes 1 year after THA?METHODS: We included 3411 patients with hip OA (mean age 67 ± 9 years, 63% [2160 of 3411] women) who had been referred for first-line OA interventions between 2008 and 2015 and subsequently underwent THA for OA. All patients were initially identified through the Swedish Osteoarthritis Register, which follows and evaluates patients in a standardized national first-line OA intervention program. Then, we identified those who were also registered in the Swedish Arthroplasty Register with a THA during the study period. We included only those with complete patient-reported outcome measures for pain, HRQoL, and satisfaction preoperatively and 1-year postoperatively, representing 78% (3411 of 4368) of patients, who had the same baseline characteristics as nonrespondents. Multiple logistic regression was used to assess the associations between 14 baseline factors and the aforementioned patient-reported outcomes of pain, HRQoL, and satisfaction 1 year after THA, adjusted for all included factors.RESULTS: Five percent (156 of 3411) of the study population lacked improvement in pain, 11% (385 of 3411) reported no improvement in HRQoL, and 10% (339 of 3411) reported they were not satisfied with surgery 1 year after THA. Charnley Class C (multiple-joint OA or another condition that affects the ability to walk) was associated with all outcomes: lack of improvement in pain (OR 1.84 [95% CI 1.24 to 2.71]; p = 0.002), lack of improvement in HRQoL (OR 1.83 [95% CI 1.42 to 2.36]; p < 0.001), and not being satisfied (OR 1.40 [95% CI 1.07 to 1.82]; p = 0.01). Older age was associated with a lack of improvement in pain (OR per year 1.03 [95% CI 1.01 to 1.05]; p = 0.02), lack of improvement in HRQoL (OR per year 1.04 [95% CI 1.03 to 1.06]; p < 0.001), and not being satisfied (OR per year 1.03 [95% CI 1.01 to 1.05]; p < 0.001). Depression was associated with a lack of improvement in pain (OR 1.54 [95% CI 1.00 to 2.35]; p = 0.050) and with not being satisfied (OR 1.50 [95% CI 1.11 to 2.04]; p = 0.01) but not with a lack of improvement in HRQoL (OR 1.04 [95% CI 0.76 to 1.43]; p = 0.79). Having four or more comorbidities was associated with a lack of improvement in HRQoL (OR 2.08 [95% CI 1.39 to 3.10]; p < 0.001) but not with a lack of improvement in pain and not being satisfied.CONCLUSION: The results of this study showed that older age, Charley Class C, and depression in patients with first-line OA interventions were risk factors associated with poorer outcomes regarding pain, HRQoL, and satisfaction after THA. Screening patients with hip OA for depression early in the disease course would provide increased time to optimize treatments and may contribute to better patient-reported pain, HRQoL, and satisfaction after future THA. Further research should focus on identifying the optimal time for surgery in patients with depression, as well as what targeted interventions for depression can improve outcome of surgery in these patients.LEVEL OF EVIDENCE: Level III, therapeutic study.
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| 37. |
- Gustafsson, K., et al.
(author)
-
What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA? A Register-based Study
- 2023
-
In: Clinical Orthopaedics and Related Research. - 0009-921X. ; 481:9, s. 1732-1742
-
Journal article (peer-reviewed)abstract
- BackgroundSome patients report long-term pain or no improvement in health-related quality of life (HRQoL) or are dissatisfied after THA. However, factors associated with these poorer patient-reported outcomes after surgery are inconsistent and have typically been studied in the late phase of hip osteoarthritis (OA) among patients already eligible for surgery. Earlier identification of risk factors would provide time to address modifiable factors, helping to improve patients' pain, HRQoL, and satisfaction after surgery and reduce the burden on orthopaedic clinics by referring patients who are better prepared for surgery.Questions/purposesWe analyzed data from patients with hip OA referred to a first-line OA intervention program in primary healthcare at a stage when they had not been referred for THA, and asked: (1) What percentage of patients who proceed to THA report lack of improvement in pain, lack of improvement in HRQoL as measured by the EQ-5D, or are not satisfied with surgery 1 year after THA? (2) What associations exist between baseline factors at referral to this first-line OA intervention program and these poorer patient-reported outcomes 1 year after THA?MethodsWe included 3411 patients with hip OA (mean age 67 & PLUSMN; 9 years, 63% [2160 of 3411] women) who had been referred for first-line OA interventions between 2008 and 2015 and subsequently underwent THA for OA. All patients were initially identified through the Swedish Osteoarthritis Register, which follows and evaluates patients in a standardized national first-line OA intervention program. Then, we identified those who were also registered in the Swedish Arthroplasty Register with a THA during the study period. We included only those with complete patient-reported outcome measures for pain, HRQoL, and satisfaction preoperatively and 1-year postoperatively, representing 78% (3411 of 4368) of patients, who had the same baseline characteristics as nonrespondents. Multiple logistic regression was used to assess the associations between 14 baseline factors and the aforementioned patient-reported outcomes of pain, HRQoL, and satisfaction 1 year after THA, adjusted for all included factors.ResultsFive percent (156 of 3411) of the study population lacked improvement in pain, 11% (385 of 3411) reported no improvement in HRQoL, and 10% (339 of 3411) reported they were not satisfied with surgery 1 year after THA. Charnley Class C (multiple-joint OA or another condition that affects the ability to walk) was associated with all outcomes: lack of improvement in pain (OR 1.84 [95% CI 1.24 to 2.71]; p = 0.002), lack of improvement in HRQoL (OR 1.83 [95% CI 1.42 to 2.36]; p < 0.001), and not being satisfied (OR 1.40 [95% CI 1.07 to 1.82]; p = 0.01). Older age was associated with a lack of improvement in pain (OR per year 1.03 [95% CI 1.01 to 1.05]; p = 0.02), lack of improvement in HRQoL (OR per year 1.04 [95% CI 1.03 to 1.06]; p < 0.001), and not being satisfied (OR per year 1.03 [95% CI 1.01 to 1.05]; p < 0.001). Depression was associated with a lack of improvement in pain (OR 1.54 [95% CI 1.00 to 2.35]; p = 0.050) and with not being satisfied (OR 1.50 [95% CI 1.11 to 2.04]; p = 0.01) but not with a lack of improvement in HRQoL (OR 1.04 [95% CI 0.76 to 1.43]; p = 0.79). Having four or more comorbidities was associated with a lack of improvement in HRQoL (OR 2.08 [95% CI 1.39 to 3.10]; p < 0.001) but not with a lack of improvement in pain and not being satisfied. ConclusionThe results of this study showed that older age, Charley Class C, and depression in patients with first-line OA interventions were risk factors associated with poorer outcomes regarding pain, HRQoL, and satisfaction after THA. Screening patients with hip OA for depression early in the disease course would provide increased time to optimize treatments and may contribute to better patient-reported pain, HRQoL, and satisfaction after future THA. Further research should focus on identifying the optimal time for surgery in patients with depression, as well as what targeted interventions for depression can improve outcome of surgery in these patients.
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| 38. |
- Gustafsson, Mats, 1966-, et al.
(author)
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Partikelspriding vid byggnation av väg med aska : Modellöversikt, undersökning av fuktighetsgradens betydelse för damning och karaktärisering av partiklar från flygaska
- 2009
-
Reports (other academic/artistic)abstract
- Aska från förbränning kan ha mycket goda egenskaper såsom byggnadsmaterial i vägkroppar. Denna användning förutsätter dock att askan inte har några allvarligare miljö- och hälsoeffekter. Då aska kan damma kraftigt vid hantering har frågan om damningens omfattning och dammets egenskaper visat sig vara av stor betydelse för att bedöma riskerna för miljöpåverkan vid användning. Inandningsbara partiklar i vår omgivningsluft är ett problem som uppmärksammas alltmer och betraktas som en av våra allvarligaste hälsorelaterade föroreningar.Föreliggande projekt har haft som syfte att:beskriva lämpliga modeller för beräkning av emission och spridning av aska i luften vid byggnation av väg där aska ingårutvärdera en ny metod att undersöka fukthaltens betydelse för damning från flygaskaundersöka egenskaper hos flygaska som gör det möjligt att identifiera aska i prover av luftburna partiklar.Målgruppen är askleverantörer, entreprenörer och konsulter med behov av kunskap om askors damning. Projektets delmoment har omfattat:en litteraturstudie för att identifiera lämpliga modellverktyg för att beskriva emission och spridning av damm från vägbyggnation med askaen metodstudie där en utrustning kallad Duster, har utvärderats för att bedöma betydelsen av askans fuktighet för damning, samten elektronmikroskopstudie där morfologi och sammansättning hos några askor, cement och Merit har studerats för att finna sätt att identifiera askpartiklar i dammprover.
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| 39. |
- Gustafsson, Ola, et al.
(author)
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A fibrous membrane suspends the multifocal lens in the eyes of lampreys and African lungfishes.
- 2010
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In: Journal of Morphology. - : Wiley. - 1097-4687 .- 0362-2525. ; 271:8, s. 980-989
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Journal article (peer-reviewed)abstract
- The sharpness and thus information content of the retinal image in the eye depends on the optical quality of the lens and its accurate positioning in the eye. Multifocal lenses create well-focused color images and are present in the eyes of all vertebrate groups studied to date (mammals, reptiles including birds, amphibians, and ray-finned fishes) and occur even in lampreys, i.e., the most basal vertebrates with well-developed eyes. Results from photoretinoscopy obtained in this study indicate that the Dipnoi (lungfishes), i.e., the closest piscine relatives to tetrapods, also possess multifocal lenses. Suspension of the lens is complex and sophisticated in teleosts (bony fishes) and tetrapods. We studied lens suspension using light and electron microscopy in one species of lamprey (Lampetra fluviatilis) and two species of African lungfish (Protopterus aethiopicus aethiopicus and Protopterus annectens annectens). A fibrous and highly transparent membrane suspends the lens in both of these phylogenetically widely separated vertebrate groups. The membrane attaches to the lens approximately along the lens equator, from where it extends to the ora retinalis. The material forming the membrane is similar in ultrastructure to microfibrils in the zonule fibers of tetrapods. The membrane, possibly in conjunction with the cornea, iris, and vitreous body, seems suitable for keeping the lens in the correct position for well-focused imaging. Suspension of the lens by a multitude of zonule fibers in tetrapods may have evolved from a suspensory membrane similar to that in extant African lungfishes, a structure that seems to have appeared first in the lamprey-like ancestors of allextant vertebrates.
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| 40. |
- Gustafsson, Ola, et al.
(author)
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Early evolution of multifocal optics for well-focused colour vision in vertebrates.
- 2008
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In: Journal of Experimental Biology. - : The Company of Biologists. - 1477-9145 .- 0022-0949. ; 211:10, s. 1559-1564
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Journal article (peer-reviewed)abstract
- Jawless fishes (Agnatha; lampreys and hagfishes) most closely resemble the earliest stage in vertebrate evolution and lamprey-like animals already existed in the Lower Cambrian [about 540 million years ago (MYA)]. Agnathans are thought to have separated from the main vertebrate lineage at least 500 MYA. Hagfishes have primitive eyes, but the eyes of adult lampreys are well-developed. The southern hemisphere lamprey, Geotria australis, possesses five types of opsin genes, three of which are clearly orthologous to the opsin genes of jawed vertebrates. This suggests that the last common ancestor of all vertebrate lineages possessed a complex colour vision system. In the eyes of many bony fishes and tetrapods, well-focused colour images are created by multifocal crystalline lenses that compensate for longitudinal chromatic aberration. To trace the evolutionary origins of multifocal lenses, we studied the optical properties of the lenses in four species of lamprey (Geotria australis, Mordacia praecox, Lampetra fluviatilis and Petromyzon marinus), with representatives from all three of the extant lamprey families. Multifocal lenses are present in all lampreys studied. This suggests that the ability to create well-focused colour images with multifocal optical systems also evolved very early.
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| 41. |
- Gustafsson, Ola
(author)
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Evolution of Vertebrate Eyes: a study on lens suspension and optical proterties
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Many fishes have well-developed visual systems with color vision capabilities. The crystalline lens is the major refractive element in a fish eye since the cornea is optically inactive underwater. A typical fish eye has a large pupil and a lens of short focal length, features that increase light gathering ability. They lead also to short depth of focus, which makes the eye particularly susceptible to defocus. The focal length of the crystalline lens depends on the wavelength of light. Multifocal lenses that compensate for the resulting chromatic defocus are common in teleosts and tetrapods. Such a lens focuses different wavelengths by specific zones. The refractive powers of the lens zones are matched to the spectral sensitivity of the retina, such that the lens acts as a matched filter. My results indicate that this kind of lens is present in the most basal vertebrates with well-developed eyes, the lampreys (Paper II), and all other basal fish groups investigated, such as lungfishes (Paper II), sharks, rays, sturgeons (Paper III), bichirs, and gars (Paper IV). Detailed vision undisturbed by body movements requires exact positioning and robust stabilization of the lens. Accommodative adjustments of focus are particularly beneficial if the eye has short depth of focus. Different types of lens suspension and accommodative mechanism have been described in vertebrates. However, the information on phylogenetically basal vertebrates available in the classical literature is incomplete and has recently been shown to be erroneous with regard to teleosts. I have identified three types of lens suspension and accommodative mechanism. The lamprey/sarcopterygian type was found in lampreys and lungfishes (Paper II). It has evolved further in the terrestrial sarcopterygians (tetrapods) that are able to accommodate by changing lens shape. The chondrichthyan type of lens suspension and accommodation by lens protraction occurs in sharks and rays (Paper III). Surprisingly, it was found also in sturgeons (Paper III) that are usually classified as Actinopterygii. All other actinopterygians investigated so far (bichirs, gars, and teleosts) possess a different type of lens suspension and accommodate by lens retraction (Paper IV). Except for sturgeons, the distribution of lens suspension types and accommodative mechanisms is consistent with the most generally accepted phylogeny of vertebrates. It is as yet unresolved whether sturgeons (Chondrostei, Acipenseriformes) have undergone an evolutionary reversion with respect to these characters or are incorrectly classified as Actinopterygii.
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| 42. |
- Gustafsson, Ola, et al.
(author)
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Flat tube heat exchangers - Direct and indirect noise levels in heat pump applications
- 2014
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In: Applied Thermal Engineering. - : Elsevier BV. - 1359-4311. ; 66:1-2, s. 104-112
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Journal article (peer-reviewed)abstract
- In the outdoor unit of an air-source heat pump the fan is a major noise source. The noise level from the fan is dependent on its state of operation: high air-flow and high pressure drop often result in higher noise levels. In addition, an evaporator that obstructs an air flow is a noise source in itself, something that may contribute to the total noise level. To be able to reduce the noise level, heat exchanger designs other than the common finned round tubes were investigated in this study. Three types of heat exchanger were evaluated to detect differences in noise level and air-side heat transfer performance at varying air flow. The measured sound power level from all the heat exchangers was low in comparison to the fan sound power level (direct effect). However, the heat exchanger design was shown to have an important influence on the sound power level from the fan (indirect effect). One of the heat exchangers with flat tubes was found to have the lowest sound power level, both direct and indirect, and also the highest heat transfer rate. This type of flat tube heat exchanger has the potential to reduce the overall noise level of a heat pump while maintaining heat transfer efficiency.
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| 43. |
- Gustafsson, Ola, et al.
(author)
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Heat exchanger design aspects related to noise in heat pump applications
- 2016
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In: Applied Thermal Engineering. - : Elsevier. - 1359-4311 .- 1873-5606. ; 93, s. 742-749
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Journal article (peer-reviewed)abstract
- An increased use of heat pumps is one of the measures that can be taken to reduce energy consumption on a large scale. For a wider acceptance, and major heat pump market expansion, it is crucial to develop heat pumps that cause minimal disturbance. Results from field measurements made by SP Technical Research Institute of Sweden indicate that the use of indirect heat pumps has potential to significantly reduce the outdoor noise level of ambient air heat pumps. The noise level caused by such heat pumps has been shown to be highly influenced by the design of the air-to-fluid heat exchanger. The overall purpose of this study is to propose a design of an air-to-fluid heat exchanger that allows for a well performing system as well as a low level of noise and cost. Two different types of heat exchangers, with flat tubes and round tubes, are compared theoretically. According to the modelling results, a heat exchanger with flat tubes and plain fins is the most suitable out of the studied designs due to its low heat transfer resistance on the tube side. The round tube heat exchangers showed to be significantly less suitable, displacing more than twice the volume.
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| 44. |
- Gustafsson, Ola, et al.
(author)
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NOISE LEVEL IN RELATION TO ENERGY PERFORMANCE OF AIR-TO-AIR HEAT PUMPS
- 2011
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In: 10th international heat pump conference.
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Conference paper (peer-reviewed)abstract
- With increased use of air source heat pumps, a possible barrier for further market growth and customer acceptance is their noise level. The disturbance is both an issue for the owner of the heat pump and the neighbors since both the indoor and the outdoor units radiate sound. The purpose of this study is to create an understanding of the noise generation of air-to-air heat pumps and relate this to their energy performance. This knowledge is then to be used in continued work when describing the total disturbance of a heat pump.Two heat pumps, both of inverter type and with different noise performance were selected for measurements. Energy performance, in the form of Coefficient of Performance (COP), was evaluated at different operating conditions. Measurements of the sound power level were performed on both the outdoor and the indoor units. Results show that the sound level from the indoor units is independent of the outdoor conditions. The noise from the outdoor units varies with different climates and the variation is particularly large at part load conditions.
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| 45. |
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| 46. |
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| 47. |
- Gustafsson, Ola, et al.
(author)
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Sturgeons, sharks, and rays have multifocal crystalline lenses and similar lens suspension apparatuses.
- 2012
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In: Journal of Morphology. - : Wiley. - 1097-4687 .- 0362-2525. ; 273:7, s. 746-753
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Journal article (peer-reviewed)abstract
- Crystalline lenses with multiple focal lengths in monochromatic light (multifocal lenses) are present in many vertebrate groups. These lenses compensate for chromatic aberration and create well-focused color images. Stabilization of the lens within the eye and the ability to adjust focus are further requirements for vision in high detail. We investigated the occurrence of multifocal lenses by photorefractometry and lens suspension structures by light and electron microscopy in sturgeons (Acipenseriformes, Chondrostei) as well as sharks and rays (Elasmobranchii, Chondrichthyes). Multifocal lenses were found in two more major vertebrate groups, the Chondrostei represented by Acipenseriformes and Chondrichthyes represented by Elasmobranchii. The lens suspension structures of sturgeons, sharks, and rays are more complex than described previously. The lens is suspended by many delicate suspensory fibers in association with a ventral papilla in all groups studied. The arrangements of the suspensory fibers are most similar between sturgeons and sharks. In rays, the lens is suspended by a smaller ventral papilla and the suspensory fibers are arranged more concentrically to the lens. J. Morphol., 2012. © 2012 Wiley Periodicals, Inc.
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| 48. |
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| 49. |
- Gustafsson, P M, et al.
(author)
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Effects of hypergravity and anti-G suit pressure on intraregional ventilation distribution during VC breaths
- 2001
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In: Journal of applied physiology. - : American Physiological Society. - 8750-7587 .- 1522-1601. ; 91:2, s. 637-644
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Journal article (peer-reviewed)abstract
- The effects of increased gravity in the head-to-foot direction (+G(z)) and pressurization of an anti-G suit (AGS) on total and intraregional intra-acinar ventilation inhomogeneity were explored in 10 healthy male subjects. They performed vital capacity (VC) single-breath washin/washouts of SF(6) and He in +1, +2, or +3 G(z) in a human centrifuge, with an AGS pressurized to 0, 6, or 12 kPa. The phase III slopes for SF(6) and He over 25-75% of the expired VC were used as markers of total ventilation inhomogeneity, and the (SF(6) -- He) slopes were used as indicators of intraregional intra-acinar inhomogeneity. SF(6) and He phase III slopes increased proportionally with increasing gravity, but the (SF(6) -- He) slopes remained unchanged. AGS pressurization did not change SF(6) or He slopes significantly but resulted in increased (SF(6) -- He) slope differences at 12 kPa. In conclusion, hypergravity increases overall but not intraregional intra-acinar inhomogeneity during VC breaths. AGS pressurization provokes increased intraregional intra-acinar ventilation inhomogeneity, presumably reflecting the consequences of basilar pulmonary vessel engorgement in combination with compression of the basilar lung regions.
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| 50. |
- Gustafsson, Rita, et al.
(author)
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Esophageal Dysmotility is More Common Than Gastroparesis in Diabetes Mellitus and is Associated With Retinopathy.
- 2011
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In: Review of Diabetic Studies. - 1614-0575. ; 8:2, s. 268-275
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Journal article (peer-reviewed)abstract
- Gastroparesis is a well-known complication of diabetes mellitus, both in symptomatic and asymptomatic patients. Esophageal dysmotility has also been described, but is not as well-characterized. The etiology and effect of these complications need to be clarified. The aim of the present study was to evaluate esophageal and gastric motility, complications, gastrointestinal symptoms, and plasma biomarkers in a cross-sectional study comprising patients with diabetes mellitus.
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