| 1. |
- Asp, Anna M., et al.
(author)
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Cardiac remodelling and functional alterations in mild-to-moderate renal dysfunction: Comparison with healthy subjects
- 2015
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In: Clinical Physiology and Functional Imaging. - : Wiley. - 1475-0961 .- 1475-097X. ; 35:3, s. 223-230
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Journal article (peer-reviewed)abstract
- © 2014 The Authors. Introduction: Left ventricular (LV) hypertrophy (LVH) and reduced LV function correlate with poor prognosis in patients with chronic kidney disease (CKD). Our aim is to investigate whether mild-to-moderate CKD is associated with cardiac abnormalities. Methods: Echocardiography, including tissue Doppler imaging, was performed in 103 patients with CKD at stages 2-3 and 4-5, and in 53 healthy controls. The systolic (s′) and diastolic myocardial velocity (e′), and the transmitral diastolic flow velocity (E) were measured, and E/e′ was calculated. Results: Patients with chronic kidney disease had higher mean E/e′ than controls (mean E/e′: controls 5·00 ± 1·23 versus CKD 4-5 6·36 ± 1·71, P < 0·001 and versus CKD 2-3 5·69 ± 1·47, P = 0·05), indicating altered diastolic function in the patients. The CKD groups showed lower longitudinal systolic function than controls, as assessed by atrio-ventricular plane displacement and s′ (mean s′: controls 11·5 ± 1·9 cm s < sup > -1 < /sup > versus CKD 4-5 10·4 ± 2·1 cm s < sup > -1 < /sup > , P = 0·03 and versus CKD 2-3 10·4 ± 2·1 cm s < sup > -1 < /sup > , P = 0·02). The prevalence of LVH was higher in patients with CKD than in controls (controls 13% versus CKD 4-5 37%, P = 0·006 and versus CKD 2-3 30%, P = 0·03). Conclusion: Alterations in systolic and diastolic myocardial function can be seen in mild-to-moderate CKD compared with controls, indicating that cardiac involvement starts early in CKD, which may be a precursor of premature cardiac morbidity.
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| 2. |
- Forsberg, Lena, et al.
(author)
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Bröstimplantat kan försvåra diagnostik av hjärtsjukdomar : Inför kirurgi bör patienten informeras om vilka konsekvenser bröstimplantat kan ha för framtida hjärtdiagnostik [Cosmetic breast implants can influence cardiac imaging]
- 2022
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In: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 119
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Research review (peer-reviewed)abstract
- Cosmetic breast implants are increasing in popularity. The presence of foreign material overlying the anterior wall of the heart can influence cardiac imaging and lead to misdiagnosis of cardiac disease. Echocardiography is commonly used in patients for evaluation of cardiac structure and function. Breast implants can cause impaired quality of the echocardiographic images because of an interaction between the implant material and the ultrasound beam, and as a consequence this can lead to a decreased diagnostic accuracy. In myocardial perfusion imaging breast implant can induce attenuation artifacts, which can be mistaken for myocardial infarction. The number of indications for cardiac MRI examinations are increasing, but also with this technique the presence of breast implants can induce artefacts that impair the possibilities to optimal quality. Women considering breast augmentation should be informed of the risk that the procedure can result in impaired quality of different cardiac imaging modalities.
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| 3. |
- Nilsson, Mikael, et al.
(author)
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Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting?
- 2012
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In: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 12, s. 5-
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Journal article (peer-reviewed)abstract
- Background: The compressed curriculum in modern knowledge-intensive medicine demands useful tools to achieve approved learning aims in a limited space of time. Web-based learning can be used in different ways to enhance learning. Little is however known regarding its optimal utilisation. Our aim was to investigate if the individual learning styles of medical students influence the choice to use a web-based ECG learning programme in a blended learning setting. Methods: The programme, with three types of modules (learning content, self-assessment questions and interactive ECG interpretation training), was offered on a voluntary basis during a face to face ECG learning course for undergraduate medical students. The Index of Learning Styles (ILS) and a general questionnaire including questions about computer and Internet usage, preferred future speciality and prior experience of E-learning were used to explore different factors related to the choice of using the programme or not. Results: 93 (76%) out of 123 students answered the ILS instrument and 91 the general questionnaire. 55 students (59%) were defined as users of the web-based ECG-interpretation programme. Cronbach's alpha was analysed with coefficients above 0.7 in all of the four dimensions of ILS. There were no significant differences with regard to learning styles, as assessed by ILS, between the user and non-user groups; Active/Reflective; Visual/Verbal; Sensing/Intuitive; and Sequential/Global (p = 0.56-0.96). Neither did gender, prior experience of E-learning or preference for future speciality differ between groups. Conclusion: Among medical students, neither learning styles according to ILS, nor a number of other characteristics seem to influence the choice to use a web-based ECG programme. This finding was consistent also when the usage of the different modules in the programme were considered. Thus, the findings suggest that web-based learning may attract a broad variety of medical students.
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| 4. |
- Nyberg, Andre, et al.
(author)
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Low-load/high-repetition elastic band resistance training in patients with COPD : a randomized, controlled, multicenter trial
- 2015
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In: Clinical Respiratory Journal. - : John Wiley & Sons. - 1752-6981 .- 1752-699X. ; 9:3, s. 278-288
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Journal article (peer-reviewed)abstract
- Background: High-repetitive resistance training is recommended to increase peripheral muscular endurance in healthy adults, however the effects of resistance training with this design on exercise capacity and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD) is unknown.Objective: Investigate if low load / high repetition elastic band resistance training (RT) could improve functional capacity, muscular function, endurance cycle capacity or HRQOL in patients with COPD.Methods: A prospective, randomized controlled multicentre trial was constructed with concealed allocation, blinded outcome assessment, and intention-to-treat analysis. A total of 44 patients with moderate to very severe COPD (FEV1 44.6% predicted) were included. Patients were randomized to either the experimental group receiving eight weeks of RT (3 sessions/week) in combination with patient education (four occasions) or the control group receiving the patient education alone.Results: At post-tests, the between-group differences were in favor of the experimental group on the 6 minute walk test (mean difference (95% confidence interval)): 34 meters (14 to 54) and the 6 minute pegboard and ring test (20 rings (3 to 37). No difference between groups was found on the chronic respiratory disease questionnaire (0.1 (-0.2 to 0.4). On secondary outcomes, results were in favor of the experimental group regarding upper extremity endurance capacity, muscular function and depression but no difference was seen between groups on endurance cycle capacity and HRQOL.Conclusion: RT can increase functional capacity and muscular function but not cycle endurance capacity and HRQOL in patients with moderate to severe COPD.
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| 5. |
- Rickenlund, Anette, et al.
(author)
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Effects of oral contraceptives on body composition and physical performance in female athletes.
- 2004
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In: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 36:5, s. S34-S34
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Journal article (peer-reviewed)abstract
- Menstrual disturbances are common among female athletes, and oral contraceptives (OCs) are often recommended as estrogen substitution. However, there is little information about the effects of OC use in athletes, and there is great concern that OCs might impair physical performance. The aim of this study was to investigate the effects of OC use on body composition and physical performance in female athletes. Twenty-six endurance athletes (13 with oligo-/amenorrhea and 13 regularly menstruating athletes) and 12 sedentary controls were examined before and after 10 months of treatment with a low dose, monophasic, combined OC. Significant changes in body composition were recorded in the athletes, but not in the controls. There was an increase in weight and fat mass only in athletes with oligo-/amenorrhea. These changes were associated with a decrease in ovarian androgens. OC treatment also increased bone mineral density, with the largest increase in athletes with a low bone mineral density at baseline. Despite significant changes in body composition, little impact on physical performance was recorded. We have demonstrated that OC treatment in female athletes has predominantly beneficial effects on body composition without adverse effects on physical performance and could be used for the prevention of osteoporosis in athletic amenorrhea. However, it cannot be excluded that a marked increase in fat mass might have unfavorable effects for athletic performance in individual women.
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| 6. |
- Rickenlund, Anette
(author)
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Hormonal mechanisms of menstrual disturbances, metabolic disorders and effects of oral contraceptives in female athletes
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Background: During the last decades the number of women participating in sports has increased dramatically. Although exercise has beneficial health effects for most of these women, we now realize that strenuous exercise may also have serious medical consequences. Menstrual dysfunction is common among athletes and the exact mechanisms are not known. The metabolic consequences of long-standing amenorrhea are serious including increased bone resorption and possibly deleterious effects on the cardiovascular system. Oral contraceptives (OCs) are often used for treatment of estrogen deficiency but there are no studies evaluating the effects of this treatment in athletes. The aims of this work were to study mechanisms of menstrual disturbances and associated metabolic disorders in endurance athletes. Furthermore, to evaluate effects of OCs on bone mineral density (BMD), endothelial function and physical performance in athletes. Methods: Age- and body mass index-matched groups of endurance athletes with menstrual disturbance, regularly cycling athletes and sedentary controls, all together 51 subjects, were examined before and after -10 months of treatment with a low-dose, monophasic, combined OC. Baseline hormonal status and diurnal profiles of pituitary hormones and steroid hormones were investigated. Body composition including BMD was examined by dual energy X-ray absorptiometry and physical performance was evaluated by endurance and strength tests. Blood lipids were analyzed and endothelial function was studied by ultrasound assessment of flow-mediated vasodilatation (FMD). Results: The majority of athletes with menstrual disturbance had a hormonal profile in accordance with hypothalamic inhibition of the reproductive system including decreased diurnal LH-pulsatility and peak amplitude of prolactin and increased diurnal secretion of cortisol and growth hormone. This group of athletes had the lowest fat mass and BMD among all groups. In addition, we identified a hyperandrogenic subgroup of athletes with menstrual disturbance, having increased diurnal secretion of testosterone, increased LH/FSH ratio and decreased serum levels of SHBG. This subgroup had an anabolic body composition with the highest total BMD and lean body mass among the groups. The hyperandrogenic subgroup also had the highest V02max and the highest performance values in general. Athletes with amenorrhea had impaired endothelial function and an unfavorable lipid profile, whereas oligomenorrheic athletes had the most favorable lipid profile and an intermediate FMD. OC treatment caused a significant change in weight and fat mass only in the athlete group with menstrual disturbance. OC treatment also increased BMD in athletes with the largest increase in those with a low BMD at baseline. Despite significant changes in body composition, only a small impact on physical performance was recorded during OC. Endothelial dysfunction in amenorrheic athletes was improved by OC treatment. Conclusions: Menstrual disturbances in female athletes are often explained as a consequence of hypothalamic inhibition due to energy deficiency. This thesis suggests essential hyperandrogenism, such as polycystic ovary syndrome as an alternative mechanism underlying menstrual disturbance in athletes, especially oligomenorrhea. This condition may imply an advantage for physical performance. Amenorrhea in athletes is associated with endothelial dysfunction and an unfavorable lipid profile. OC treatment has predominantly beneficial effects on body composition, BMD and endothelial function without adverse effects on physical performance and could be used for prevention of osteoporosis in athletic amenorrhea.
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| 7. |
- Rickenlund, Anette, et al.
(author)
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Hyperandrogenicity is an alternative mechanism underlying oligomenorrhea or amenorrhea in female athletes and may improve physical performance.
- 2003
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In: Fertility and Sterility. - : Elsevier BV. - 0015-0282 .- 1556-5653. ; 79:4, s. 947-55
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate endocrine mechanisms underlying oligomenorrhea or amenorrhea in female athletes. DESIGN: Cross-sectional study. SETTING: Women's health clinical research unit at a university hospital. PATIENT(S): Age- and BMI-matched groups of athletes active in endurance sports with and without menstrual disturbances and regularly cycling sedentary controls. INTERVENTION(S): Groups were compared with respect to endocrine status, body composition, and physical performance. MAIN OUTCOME MEASURE(S): Identification of a subgroup of oligomenorrheic or amenorrheic athletes with increased androgen levels and anabolic body composition. RESULT(S): A subgroup of 8 of 25 athletes with menstrual disturbances had significantly higher serum levels of free and total testosterone, androstenedione, LH-FSH ratio, and lower SHBG levels than did all other groups. Other oligomenorrheic or amenorrheic athletes had normal values comparable to those in regularly menstruating athletes and controls. The hyperandrogenic subgroup showed a more anabolic body composition, with higher total bone mineral density and upper-lower fat mass ratio than did oligomenorrheic or amenorrheic athletes with normal androgen levels. The hyperandrogenic subgroup had the highest VO2 max and the highest performance values in general. CONCLUSION(S): Menstrual disturbances in female athletes are often explained as a consequence of hypothalamic inhibition and caloric deficiency. We suggest that essential hyperandrogenism is an alternative mechanism underlying oligomenorrhea or amenorrhea in some female athletes and may imply an advantage for physical performance.
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| 8. |
- Wallin, Helena, et al.
(author)
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Gradual reduction in exercise capacity in chronic kidney disease is associated with systemic oxygen delivery factors.
- 2018
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In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 13:12
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Journal article (peer-reviewed)abstract
- The cause of reduced exercise capacity (ExCap) in chronic kidney disease (CKD) is multifactorial. The aim of this study was to investigate determinants of aerobic ExCap in patients with mild to severe CKD not undergoing dialysis.We included 52 individuals with CKD stage 2-3, 47 with stage 4-5, and 54 healthy controls. Peak workload and peak heart rate (HR) were assessed by a maximal cycle exercise test. Cardiac function including stroke volume (SV) and vascular stiffness were evaluated by ultrasound at rest. Handgrip strength, body composition, haemoglobin level and self-reported physical activity were assessed.Peak workload (221±60, 185±59, 150±54 W for controls, CKD 2-3 and CKD 4-5 respectively), peak HR (177±11, 161±24, 144±31 beats/min) and haemoglobin level (14.2±1.2, 13.5±1.4, 12.2±1.3 g/dL) were all three significantly lower in CKD 2-3 than in controls, (p = 0.001, 0.001 and 0.03 respectively) and were even lower in stages 4-5 CKD than in CKD 2-3 (p = 0.01, 0.001 and <0.001 respectively). Resting SV and lean body mass did not differ between groups and handgrip strength was significantly lower only in CKD 4-5 compared to controls (p = 0.02). Peak workload was strongly associated with the systemic oxygen delivery factors: SV, peak HR and haemoglobin level. These three factors along with age, sex and height2 explained 82% of variation in peak workload. Peak HR contributed most to the variation; the peripheral variables handgrip strength and vascular stiffness did not improve the explanatory value in regression analysis.In this cross-sectional study of CKD patients not on dialysis, aerobic ExCap decreased gradually with disease severity. ExCap was associated mainly with systemic oxygen delivery factors, in particular peak HR. Neither muscle function and mass, nor vascular stiffness were independent determinants of aerobic ExCap in this group of CKD patients.
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