| 11. |
- KARLSSON WALLMAN, JOHAN, et al.
(author)
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Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis : Observational Data from Southern Sweden
- 2016
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In: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 43:7, s. 1292-1299
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Journal article (peer-reviewed)abstract
- Objective. To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA). Methods. Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005-2010. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare (patient care and drugs) and work loss costs (patients <65 yrs) were studied in separate regression models, comparing standardized â coefficients by nonparametric bootstrapping to assess which measure best reflects costs. Analyses were conducted based on both individual means (linear regression, comparing between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs. Results. Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work loss costs were also more closely associated with EQ-5D than DAS28. The results of the linear models for healthcare costs were standardized β = 0.21 (95% CI 0.15-0.27), 0.16 (0.11-0.21), and -0.15 (-0.21 to -0.10) for HAQ/DAS28/EQ-5D, respectively (p <0.05 for HAQ vs DAS28/EQ-5D). For work loss costs, the results were standardized β = 0.43 (95% CI 0.39-0.48), 0.27 (0.23-0.32), and -0.34 (-0.38 to 0.29) for HAQ/DAS28/EQ-5D, respectively (p <0.05 for HAQ vs DAS28/EQ-5D and for EQ-5D vs DAS28). Conclusion. Overall, HAQ disability is a better marker of RA costs than DAS28 or EQ-5D HRQOL.
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| 12. |
- KARLSSON WALLMAN, JOHAN, et al.
(author)
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Work disability in non-radiographic axial spondyloarthritis patients before and after start of anti-TNF therapy: a population-based regional cohort study from southern Sweden
- 2017
-
In: Rheumatology. - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 56:5, s. 716-724
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Journal article (peer-reviewed)abstract
- Objective. The aim was to assess work-loss days before and after commencement of anti-TNF treatment in patients with non-radiographic axial spondylarthritis (nr-axSpA). Methods. Bionaive nr-axSpA patients (n = 75), aged 17-62 years, fulfilling the Assessment of SpondyloArthritis international Society criteria for axial spondyloarthritis and starting anti-TNF treatment during 2004-11, were retrieved from the observational South Swedish Arthritis Treatment Group study. Patient information was linked to Swedish Social Insurance Agency data on sick leave and disability pension from 1 year before to 2 years after anti-TNF initiation. Matched population references were included for comparison and to adjust for secular trends. Results. The nr-axSpA patients had a median age of 35 years and disease duration of 6 years at the start of treatment. During the 2 years after anti-TNF initiation, mean work-loss days (including both sick leave and disability pension) in the nr-axSpA group decreased significantly from 3.4 to 1.9 times more than among the population references. The effect was seen on sick leave, whereas disability pension levels remained similar in both groups throughout. Conclusion. Anti-TNF therapy in nr-axSpA was associated with a significant and sustained improvement of work disability over 2 years. However, the proportion of work-loss days remained almost twice as high as in the general population at the end of follow-up.
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| 13. |
- Köhler, Per, et al.
(author)
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Influence of probe flexibility and gelatin embedding on neuronal density and glial responses to brain implants.
- 2015
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
-
Journal article (peer-reviewed)abstract
- To develop long-term high quality communication between brain and computer, a key issue is how to reduce the adverse foreign body responses. Here, the impact of probe flexibility and gelatine embedding on long-term (6w) tissue responses, was analyzed. Probes of same polymer material, size and shape, flexible mainly in one direction, were implanted in rat cerebral cortex (nimplants = 3 x 8) in two orientations with respect to the major movement direction of the brain relative to the skull: parallel to (flex mode) or transverse to (rigid mode). Flex mode implants were either embedded in gelatin or non-embedded. Neurons, activated microglia and astrocytes were visualized using immunohistochemistry. The astrocytic reactivity, but not microglial response, was significantly lower to probes implanted in flex mode as compared to rigid mode. The microglial response, but not astrocytic reactivity, was significantly smaller to gelatin embedded probes (flex mode) than non-embedded. Interestingly, the neuronal density was preserved in the inner zone surrounding gelatin embedded probes. This contrasts to the common reports of reduced neuronal density close to implanted probes. In conclusion, sheer stress appears to be an important factor for astrocytic reactivity to implanted probes. Moreover, gelatin embedding can improve the neuronal density and reduce the microglial response close to the probe.
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| 14. |
- Lee, Heui Chang, et al.
(author)
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Histological evaluation of flexible neural implants; Flexibility limit for reducing the tissue response?
- 2017
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In: Journal of Neural Engineering. - : IOP Publishing. - 1741-2560 .- 1741-2552. ; 14:3
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Journal article (peer-reviewed)abstract
- Objective. Flexible neural probes are hypothesized to reduce the chronic foreign body response (FBR) mainly by reducing the strain-stress caused by an interplay between the tethered probe and the brain's micromotion. However, a large discrepancy of Young's modulus still exists (3-6 orders of magnitude) between the flexible probes and the brain tissue. This raises the question of whether we need to bridge this gap; would increasing the probe flexibility proportionally reduce the FBR? Approach. Using novel off-stoichiometry thiol-enes-epoxy (OSTE+) polymer probes developed in our previous work, we quantitatively evaluated the FBR to four types of probes with different softness: silicon (∼150 GPa), polyimide (1.5 GPa), OSTE+Hard (300 MPa), and OSTE+Soft (6 MPa). Main results. We observed a significant reduction in the fluorescence intensity of biomarkers for activated microglia/macrophages and blood-brain barrier (BBB) leakiness around the three soft polymer probes compared to the silicon probe, both at 4 weeks and 8 weeks post-implantation. However, we did not observe any consistent differences in the biomarkers among the polymer probes. Significance. The results suggest that the mechanical compliance of neural probes can mediate the degree of FBR, but its impact diminishes after a hypothetical threshold level. This infers that resolving the mechanical mismatch alone has a limited effect on improving the lifetime of neural implants.
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| 15. |
- Mogard, Elisabeth, et al.
(author)
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Chronic pain and assessment of pain sensitivity in patients with established axial Spondyloarthritis – a cross-sectional study
- 2018
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Conference paper (peer-reviewed)abstract
- Background/Purpose: Pain remains a common and debilitating symptom in arthritis, despite good options to treat inflammation. In axial spondyloarthritis (axSpA), data on chronic pain remain scarce. Objective: To assess self-reported and observed aspects of pain in subgroups of axial spondyloarthritis (axSpA), and to investigate associations between these pain aspects and different health outcome measures. Methods: A cross-sectional study of patients with axSpA (ankylosing spondylitis (AS) and undifferentiated spondyloarthritis (USpA, based on ICD10 codes)), consecutively enrolled in the SPARTAKUS cohort (n=226). Of 197 patients, for whom all relevant information was available, 173 patients fulfilled the ASAS axSpA criteria, and 115 the modified New York criteria. We investigated self-reported pain (intensity, duration, and distribution) and categorized patients into chronic widespread pain, chronic regional pain and no chronic pain. In addition, pain sensitivity (pain threshold, pain tolerance and temporal summation of pain), was assessed by computerized cuff pressure algometry (CPA). Comparisons between AS and USpA and between women and men were performed using Student`s t-test or Chi-squared test. Associations of pain sensitivity measures and different health outcome measures, adjusted for age and sex, were analyzed by multivariate linear regression. Results: All assessed pain measures, except for number of pain regions, were similar in AS and USpA. Almost 50% of the axSpA patients, reported chronic widespread pain (AS 42%, USpA 53%), which was more pronounced in women (60% vs. 34% for men, p<0.001). For pain sensitivity measures, women had lower pain tolerance as compared to men (AS (p=0.03), USpA (p=0.01)), while pain threshold was lower only for women with USpA (p<0.01) (Table). Furthermore, irrespective of diagnosis subgroup, lower pain tolerance was associated with higher disease activity, more fatigue and less spinal mobility. Conclusion: In this population-based, cross-sectional study of established axial spondyloarthritis, chronic widespread pain was common, affecting 50% of the patients. A clear sex difference was found, with women reporting worse measures for both self-reported pain and pain sensitivity. Overall, lower pain tolerance was associated with worse disease activity, fatigue and spinal mobility. CPA shows promising results regarding assessment of pain sensitivity and provides additional information in pain evaluation in AxSpA. © 2018 American College of Rheumatology
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| 16. |
- Olofsson, Tor, et al.
(author)
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Elevated faecal calprotectin is linked to worse disease status in axial spondyloarthritis : Results from the SPARTAKUS cohort
- 2019
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In: Rheumatology (United Kingdom). - : Oxford University Press (OUP). - 1462-0324 .- 1462-0332. ; 58:7, s. 1176-1187
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Journal article (peer-reviewed)abstract
- Objectives. To examine faecal calprotectin (F-calprotectin) levels and presence of anti-Saccharomyces cerevisiae antibodies (ASCA) and their associations with disease subtype and current status in axial SpA (axSpA). Methods. F-calprotectin and ASCA in serum were compared between consecutive patients with a clinical axSpA diagnosis, classified as non-radiographic axSpA (nr-axSpA; n = 40) or AS (n = 90), and with healthy controls (n = 35). Furthermore, standard axSpA outcome measures were compared between axSpA patients (nr-axSpA and AS combined) with elevated vs normal F-calprotectin, ASCA IgA and IgG, respectively. Results. Elevated F-calprotectin (≥50 mg/kg) was observed in 27% of nr-axSpA patients, 38% of AS patients and 6% of controls. F-calprotectin was significantly higher in AS vs nr-axSpA [AS: geometric mean 41 (95% CI 32, 54) mg/kg; nr-axSpA: 24 (95% CI 16, 38) mg/kg; P = 0.037], and in each axSpA subtype vs controls. Overall, worse disease activity and physical function scores were observed among axSpA patients with elevated vs normal F-calprotectin levels, with significant differences regarding patient's visual analogue scale for global health, ASDAS using CRP, and BASFI (adjusted for age, sex, NSAID use, anti-rheumatic treatments, and CRP). ASCA titres and seropositivity (≥10 U/ml) were similar in nr-axSpA (IgA/IgG-seropositivity: 8%/26%) and AS (7%/28%), and clinical outcome measures did not differ between patients with elevated vs normal ASCA IgA or IgG, respectively. Compared with controls (IgA/IgG-seropositivity: 0%/17%), ASCA IgA was significantly higher in both axSpA subtypes, and IgG was significantly higher in the AS group. Conclusion. In patients with axSpA, gut inflammation measured by elevated F-calprotectin is associated with worse disease activity and physical function, and may be a marker of more severe disease.
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| 17. |
- Olofsson, Tor, et al.
(author)
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Irritable Bowel Syndrome and Its Impact on Patient-Reported Outcomes in Axial Spondyloarthritis : Is It an Overlooked Comorbidity?
- 2017
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In: Arthritis & Rheumatology. - : John Wiley & Sons. - 2326-5191 .- 2326-5205. ; 69:Suppl. 10
-
Journal article (other academic/artistic)abstract
- Background/Purpose: While inflammatory bowel disease (IBD) is a well-known comorbidity in axial spondyloarthritis (SpA), little is known about functional bowel problems, such as irritable bowel syndrome (IBS), in these patients. In the general population, the IBS prevalence has been estimated to be around 11%.[1] In the present study, we examined the frequency of IBS-symptoms and their relation to patient-reported outcomes in an ongoing survey of axial SpA patients.Methods: Consecutive axial SpA patients were examined and classified as non-radiographic axial SpA (nr-axSpA; ASAS criteria; n=37) or ankylosing spondylitis (AS; modified New York criteria; n=68). Patients with known IBD were excluded. The ROME III questionnaire was used to assess IBS criteria fulfillment,[2] and faecal (F) calprotectin was measured by a commercially available ELISA kit.Results: Overall, 30% of patients fulfilled the IBS criteria (n=31; 32%/28% of nr-axSpA/AS patients, no significant between-group difference; Figure 1). In 11 of these subjects (35%), F-calprotectin was, however, also elevated (≥50 mg/kg; F-calprotectin was available in 86 of the 105 patients; Figure 2), making it hard to rule out inflammation rather than functional disease as cause of the symptoms. Applying a stricter definition of IBS, i.e. a combination of fulfilled IBS criteria and a non-pathologic F-calprotectin level (<50 mg/kg), this was met by 19% of the patients (n=16; 23%/16% of nr-axSpA/AS patients, no significant between-group difference; Figure 1). Irrespective of F-calprotectin levels, the presence of IBS symptoms was associated with worse patient-reported outcomes, especially regarding disease activity and health-related quality of life (Table).Conclusion: In axial SpA patients without known IBD, IBS-symptoms were substantially more common than described for the general population, affecting almost 1/3 of patients, and were linked to worse patient-reported outcomes. To establish the true IBS prevalence in the cohort would require colonoscopy of certain subjects, although even based on a highly conservative definition (fulfillment of IBS criteria and F-calprotectin <50 mg/kg) the observed prevalence was >1.5 times higher than that reported in the general population.
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| 18. |
- Olofsson, Tor, et al.
(author)
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Patient-Reported Outcomes Are More Important Than Objective Inflammatory Markers for Sick Leave in Biologics-Treated Patients With Rheumatoid Arthritis
- 2018
-
In: Arthritis Care and Research. - : Wiley. - 2151-464X .- 2151-4658. ; 70:11, s. 1712-1716
-
Journal article (peer-reviewed)abstract
- Objective: To study the impact of common noncomposite disease activity measures on sick leave in biologics-treated patients with rheumatoid arthritis (RA). Methods: Data from study visits by biologics-treated RA patients of working age (<65 years) in the observational South Swedish Arthritis Treatment Group Register between 2005 and 2011, were included (5,118 visits by 941 patients). We performed association analyses between various noncomposite disease activity measures at each visit and the number of days of sick leave during the subsequent month; this information was retrieved from the Social Insurance Agency. Adjusted separate generalized estimating equation regression models were used, and analyses were stratified according to sick leave status for the month preceding each visit (no, partial, or full sick leave). Results are presented as standardized beta coefficients for comparability. Results: Among modifiable noncomposite disease activity measures, patient's assessment of pain and disease activity scored on a visual analog scale (VAS) were most strongly associated with subsequent sick leave, irrespective of baseline sick leave status. Generally, measures that were more objective (swollen joint count, erythrocyte sedimentation rate, and C-reactive protein) had less impact on sick leave compared with variables that were more subjective (patient's pain and global scores on a VAS, evaluator's global assessment of disease activity on a 5-grade Likert scale, and tender joint count). Conclusion: Measures of disease activity that are more subjective have a greater impact on sick leave in biologics-treated patients with RA compared with variables that are more objective, suggesting a stronger focus on subjective measures when targeting work loss or intervening to reduce it.
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| 19. |
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| 20. |
- Wallman Lundåsen, Susanne, 1971-, et al.
(author)
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Civilsamhälle, social sammanhållning och tillit : Rapport till Kommissionen för ett socialt hållbart Stockholm
- 2016
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Reports (other academic/artistic)abstract
- Stockholms stad har inrättat Kommissionen för ett socialt hållbart Stockholm med uppdraget att analysera skillnader i livsvillkor i kommunen och föreslå åtgärder för att minska skillnader och främja en socialt hållbar utveckling i Stockholm.Kommissionens arbete bedrivs av förvaltningsorganisationen inom fyra utpekade utvecklingsområden och ska enligt direktiv vila på vetenskaplig grund och genomföras i samverkan med fristående forskare. De forskare som kopplas till kommissionens arbete ska ta fram vetenskapliga underlag med förslag till åtgärder inom avgränsade fördjupningsområden som bidrar till att stärka den sociala hållbarheten i kommunen. Denna rapport är ett sådant underlag.Kommissionen för ett socialt hållbart Stockholm ska beakta forskarnas underlag i framtagandet av delrapporter med egna rekommendationer och åtgärder inom det aktuella fördjupningsområdet. Dessa fördjupningar utarbetas med regelbundenhet fram till slutet av 2017, samtidigt som konkreta åtgärder kan implementeras.
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