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1.
  • Ek, Anna, et al. (author)
  • Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents
  • 2019
  • In: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 7:4
  • Journal article (peer-reviewed)abstract
    • BACKGROUND:Physical activity (PA) is already beneficial at the preschool age. In many countries, young children spend most of their days in the preschool setting, making it a common arena for PA interventions. Mobile health tools are becoming increasingly popular to promote PA in different populations; however, little is known about the interest for and how the preschool setting could incorporate such a tool.OBJECTIVE:This study aimed to examine how teachers and parents perceive PA in preschool-aged children in general and their perceptions of how a mobile phone app could be used to promote PA in the preschool setting.METHODS:Semistructured interviews were conducted with 15 teachers (93%, [14/15] women, mean age 43.5 years, 47%, [7/15] with a university degree and 10 parents [91%, 9/10] women, mean age 38.9 years, all with a university degree) recruited from 2 urban preschools in central Sweden. The interviews were recorded, fully transcribed, coded, and analyzed using thematic analysis by means of an inductive approach.RESULTS:The analysis revealed 4 themes: (1) children are physically active by nature, (2) the environment as a facilitator or a barrier, (3) prerequisites of the adult world, and (4) an app in the preschool setting-challenges and possibilities. Parents and teachers perceived preschoolers as being spontaneously physically active; however, high-intensity PA was perceived as low. The PA was specifically performed during the day in the preschool. Identified facilitators of PA were access to safe and engaging outdoor environments such as forests, spacious indoor areas, and adult involvement. Adult involvement was considered especially important for children preferring sedentary activities. Identified barriers for PA were restricted indoor and outdoor space, rules for indoor activities, and lack of adult involvement because of time constraints. The teachers perceived that they had limited skills and experiences using apps in general, although they also acknowledged the increasing role of technological tools in the curriculum. Thus, the teachers expressed an interest for an app designed as a support tool for them, especially for situations when PA was limited because of perceived barriers. They suggested the app to include accessible information regarding the health benefits of PA in children linked to a library of activities for different settings and seasons. Parents suggested interactive app features including problem-solving tasks and music and dance, but not video clips as they made children passive.CONCLUSIONS:Vigorous PA was perceived as low in preschool-aged children. Future tailoring of interventions in the preschool setting should work around barriers and support facilitators to PA, especially PA of high intensity. In such work, an app could serve as a source of inspiration for PA in different ages, settings, and seasons and thus reduce environmental and structural inequalities in the preschool setting.
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  • Gronholm-Nyman, Petra, et al. (author)
  • Limited Effects of Set Shifting Training in Healthy Older Adults
  • 2017
  • In: Frontiers in Aging Neuroscience. - : Frontiers Media S.A.. - 1663-4365. ; 9
  • Journal article (peer-reviewed)abstract
    • Our ability to flexibly shift between tasks or task sets declines in older age. As this decline may have adverse effects on everyday life of elderly people, it is of interest to study whether set shifting ability can be trained, and if training effects generalize to other cognitive tasks. Here, we report a randomized controlled trial where healthy older adults trained set shifting with three different set shifting tasks. The training group (n = 17) performed adaptive set shifting training for 5 weeks with three training sessions a week (45 min/session), while the active control group (n = 16) played three different computer games for the same period. Both groups underwent extensive pre-and post-testing and a 1-year follow-up. Compared to the controls, the training group showed significant improvements on the trained tasks. Evidence for near transfer in the training group was very limited, as it was seen only on overall accuracy on an untrained computerized set shifting task. No far transfer to other cognitive functions was observed. One year later, the training group was still better on the trained tasks but the single near transfer effect had vanished. The results suggest that computerized set shifting training in the elderly shows long-lasting effects on the trained tasks but very little benefit in terms of generalization.
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  • Lindqvist, Anna-Karin, et al. (author)
  • Active School Transportation in Winter Conditions: Biking Together Is Warmer
  • 2019
  • In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 16:2
  • Journal article (peer-reviewed)abstract
    • There has been a decline in children’s use of active school transportation (AST) while there is also limited research concerning AST in winter conditions. This study aimed to explore the prerequisites and experiences of schoolchildren and parents participating in an empowerment- and gamification-inspired intervention to promote students’ AST in winter conditions. Methods: Thirty-five students, who were aged 12–13 years, and 34 parents from the north of Sweden participated in the study. Data were collected using photovoice and open questions in a questionnaire and analyzed using qualitative content analysis. Results: The results show that involvement and togetherness motivated the students to use AST. In addition, during the project, the parents changed to have more positive attitudes towards their children’s use of AST. The students reported that using AST during wintertime is strenuous but rewarding and imparts a sense of pride. Conclusion: Interventions for increasing students’ AST in winter conditions should focus on the motivational aspects for both children and parents. For overcoming parental hesitation with regards to AST during winter, addressing their concerns and empowering the students are key factors. To increase the use of AST all year around, targeting the challenges perceived during the winter is especially beneficial.
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  • Olsson, Jens, et al. (author)
  • Miljön i Hanöbukten 2015-2017 : finns det ett samband mellan tillståndet för fisken, dess hälsa och belastningen av miljöfarliga ämnen?
  • 2018
  • Reports (other academic/artistic)abstract
    • Under slutet av 2000-talet inkom flertalet rapporter från allmänheten och fiskare i de västra delarna av Hanöbukten om låga förekomster av fisk, förekomst av sårskadad fisk och illaluktande vatten i området. Den här rapporten sammanfattar resultaten och slutsatserna från undersökningar i Västra Hanöbukten utförda under 2015-2017 med syfte att undersöka eventuella samband mellan miljöfarliga ämnen och fiskhälsa, samt orsakerna till uppkomsten av sårskadad fisk i området. Därtill presenteras resultaten från provfisken utförda i syfte att kartlägga bestånden av kustfisk i området. Följande fyra frågeställningar besvaras:Vilka eventuella samband mellan miljöfarliga ämnen och fiskhälsa har framkommit?Vilka orsaker till uppkomst av sårskadad fisk har dokumenterats?Vilka resultat har kartläggningen av kustfiskbestånd, miljöfarliga ämnen respektive fiskhälsa lett till?Vilka slutsatser kan dras gällande vilka arter och storleksklasser som påverkas mest av miljöfarliga ämnen?  Resultaten från analyserna av miljöfarliga ämnen i skrubbskädda och torsk visar inte på några generellt förhöjda halter av miljöfarliga ämnen i Västra Hanöbukten under 2015-2016 i jämförelse med referensstationerna Kvädöfjärden och Torhamn (Östra Hanöbukten, skrubbskädda) och sydöstra Gotland (torsk). För några miljögifter såsom DDE och PFOS var halterna hos skrubbskädda något högre i Västra Hanöbukten än i Kvädöfjärden, men halterna ligger under gränsvärden för båda dessa ämnen och inom den naturliga variation som är förväntad med hänsyn till inom- och mellanårsvariation i referensstationer. För torsk visade resultaten att sårskador som antas vara orsakade av nejonöga från Hanöbukten hade högre halter av PCB:er, DDT och dess metaboliter, bromerade flamskyddsmedel och PFAS (poly- och perfluorerade ämnen) jämfört med fiskar utan sårskador i området. Om de högre halterna av miljögifter i sårskadad fisk är ett resultat av lägre kondition och fettvikt hos fisken till följd av sårskadorna eller om gifterna i sig påverkar fisken negativt är idag oklart. För torsk med okända sårskador från Hanöbukten kunde ingen koppling göras mellan uppkomst av sårskador och de analyserade miljögifterna.  Undersökningarna av skrubbskäddans hälsa i Västra Hanöbukten visade på tydliga fysiologiska skillnader mellan skrubbskädda som fångats i området jämfört med referenslokalen Kvädöfjärden under 2015. Dessa skillnader kan tyda på påverkan av miljögifter. Men de undersökningar som genomfördes under 2016 och 2017 kunde emellertid inte belägga dessa tydliga skillnader när fisk från Västra Hanöbukten jämfördes med den från referensområdet Torhamn i östra Blekinge. Histopatologiska undersökningar på fisk insamlade 2017 visade även att fiskarna i Västra Hanöbukten är relativt friska. Orsaken till de möjligen episodiskt förekommande förändringarna av fiskens hälsotillstånd i Västra Hanöbukten under 2015 är inte känd, men kan vara ett resultat av variation mellan områden i olika omgivningsfaktorer som födotillgång och/eller vattentemperatur. Det kan dock inte uteslutas att de förändringarna i skrubbskädda som observerats kan vara orsakade av ett eller flera miljöfarliga ämnen som inte ingått i undersökningarna som presenteras i denna rapport.  Resultaten från provfiskena visar att fisksamhällets struktur och funktion i de västra delarna av Hanöbukten under 2015-2017 inte avviker i jämförelse med tidigare undersökningar i området och andra kustområden i södra Östersjön. Torsk och skrubbskädda är vanliga arter i fisksamhället i Västra Hanöbukten. Även om fångsterna av arterna generellt var låga i provfiskena under 2015-2017, avviker de inte tydligt från tidigare undersökningar i området och i andra kustområden i södra Östersjön utan speglar sannolikt förändringar under senare år i beståndssituationen för arterna i  Östersjön. Emellertid var också konditionen hos torsk och skrubbskädda låg i de västra delarna av Hanöbukten under 2015-2017, och det finns en antydan till lägre kondition hos båda arterna jämfört med andra kustområden i södra Östersjön som möjligen kan tyda på låg födotillgång i området. Frekvensen av fisk (framförallt torsk och skrubbskädda) med yttre fysiska avvikelser såsom bett, sårskador och deformationer verkar vara något förhöjd i Västra Hanöbukten jämfört med andra områden längs den svenska kusten. De typiska frätskador som allmänheten rapporterat i området kunde inte påvisas i provfiskena, och hudsår delvis sannolikt orsakade av andra djur som säl och nejonöga dominerade de yttre fysiska avvikelserna som noterades. Vad som orsakar övriga avvikelser är idag inte klarlagt, men skulle möjligen kunna kopplas till att fiskens låga kondition gör den mer känslig för yttre påverkan.  Med grund i de utförda undersökningar och erhållna resultat under 2015-2017 har inte några tydliga samband mellan miljöfarliga ämnen, fiskens hälsotillstånd och bestånd dokumenterats i Västra Hanöbukten. Det är därför inte heller möjligt att uttala sig om vilka storleksklasser av fisk som är känsligast för miljöfarliga ämnen. Förutom angrepp av andra djur som säl och nejonöga, har inte orsaken till de okända skador som observerats på fisken kunnat fastställas. Med utgångspunkt i de resultat som idag finns tillgängliga, kan det dock inte uteslutas att den avvikande hälsan hos skrubbskäddan i Västra Hanöbukten under 2015 och vissa av de yttre fysiska avvikelserna som noterades hos fisken under provfiskena kan ha orsakats av miljöfarliga ämnen.   Undersökningarna i Västra Hanöbukten under 2015-2017 har bidragit till en ökad kunskap om tillståndet för fisken i området gällande miljögiftsbelastning, hälsa, samhälle och bestånd, och huruvida det nuvarande tillståndet avviker från andra delar av Östersjön. Systemet i de västra delarna av Hanöbukten är relativt unikt i Sverige, med en öppen kust mot södra Östersjön, och informationen som presenteras i denna rapport bör utgöra en grund för en långsiktig miljöövervakning av fisken i området. En långsiktig miljöövervakning i Västra Hanöbukten medger även en framtida bedömning av miljötillståndet i området, och möjliggör samtidigt upptäckt och dokumentation av episodiska fenomen som påverkar fisksamhällets struktur och funktion, samt fiskens individuella hälsa och belastning av miljöfarliga ämnen.
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  • Wireklint Sundström, Birgitta, et al. (author)
  • ”Nationella riktlinjer behövs för ambulanspersonal”
  • 2017
  • In: Svenska Dagbladet. - 1101-2412. ; :2017-06-29
  • Journal article (pop. science, debate, etc.)abstract
    • Det är förödande att sänka kraven på ambulanspersonal. Därför efterlyser vi nationella riktlinjer och beslut som tydligt anger en lägsta utbildningsnivå för anställning inom ambulanssjukvården, skriver Nät­verket för ut­bildning av ambulanssjuksköterskor i en slutreplik.
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  • Baresel, Christian, et al. (author)
  • Läkemedelsrester och andra skadliga ämnen i avloppsreningsverk - koncentrationer, kvantifiering, beteende och reningsalternativ
  • 2015
  • Reports (other academic/artistic)abstract
    • Många läkemedelsrester och andra prioriterade substanser passerar igenom dagens avloppsreningsverk (ARV) och hamnar antingen i slammet eller i recipienten, ibland i nivåer som kan påverka vattenlevande organismer. Substanser som släpps ut via avlopps-reningsverk kan också anrikas i den akvatiska näringskedjan och orsaka effekter i högre organismer såsom fiskätande fåglar eller däggdjur, inklusive människor. Studier har också visat att antibiotika som hamnar i miljön kan bidra till uppkomsten av antibiotikaresistenta gener i bakterier, vilket är ett allvarligt globalt hot mot möjligheten att bota livshotande sjukdomar. Eftersom nuvarande vattenreningstekniker har utvecklats främst för att avlägsna partikulärt material samt kväve och fosfor är de oftast inte anpassade för att rena bort mikrobiellt stabila kemiska föroreningar. Utvärderingar av effektiviteten hos olika behandlingstekniker för avlägsnande av sådana ämnen baseras vanligtvis på analyser av förekomst av ett ämne i inkommande och utgående vatten från reningsverket. Det finns dock problem med detta tillvägagångssätt eftersom vissa ämnen metaboliseras till potentiellt mer skadliga substanser, som då inte automatiskt fångas i analysen. Dessutom kan vissa ämnen spontant bildas i reningsverken, vilket kan resultera i högre nivåer i utgående än i inkommande vatten. Ett ytterligare problem är att de utgående koncentrationerna ibland kan vara lägre än detektions-gränserna, men trots det ändå vara högre än eller nära etablerade risknivåer. This report is only available in Swedish.
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  • Baresel, Christian, et al. (author)
  • Pharmaceutical residues and other emerging substances in the effluent of sewage treatment plants
  • 2015
  • Reports (other academic/artistic)abstract
    • Pharmaceutical residues and other emerging substances pass through modern sewage treatment plants (STPs) and end up in the receiving waters and sludge. In several studies, recipient concentrations have been detected with expected effects on aquatic organisms. Chemicals released via STPs may also enter the aquatic food-web and cause effects in higher organisms such as fish-eating birds or mammals including humans. Studies have also shown that antibiotics in the environment may contribute to the increase of antibiotic resistant genes in bacteria, which is a serious threat to our possibility to cure life-threatening diseases on the global scale. Current STP treatment technologies are usually not fit to remove microbial stable chemical pollutants and the evaluation of the removal efficiency of the STP systems applied today, is not complete. The evaluation of the removal efficiency of the substances in the STP systems is usually based on chemical analysis of the presence of certain substances in influent and effluent waters. However, there are difficulties associated with this approach, e.g. since some substances are metabolized into potentially more harmful substances which are not captured in the analysis unless they are actively sought for. Furthermore, some substances are formed in the STPs, resulting in higher levels in effluents than in influents. In addition, effluent concentrations may sometimes be lower than the analytical detection limits, yet still higher than or close to established risk concentrations emphasizing the need for developments of the analytical methods.
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  • Bergstrand, Sara, et al. (author)
  • Microcirculatory responses of sacral tissue in healthy individuals and in patients on different pressure-redistribution mattresses
  • 2015
  • In: Journal of Wound Care. - : Mark Allen Group. - 0969-0700 .- 2052-2916. ; 24:8, s. 346-358
  • Journal article (peer-reviewed)abstract
    • Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.
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  • Drobin, Kimi, et al. (author)
  • Targeted Analysis of Serum Proteins Encoded at Known Inflammatory Bowel Disease Risk Loci
  • 2019
  • In: Inflammatory Bowel Diseases. - : Oxford University Press. - 1078-0998 .- 1536-4844. ; 25:2, s. 306-316
  • Journal article (peer-reviewed)abstract
    • Background: Few studies have investigated the blood proteome of inflammatory bowel disease (IBD). We characterized the serum abundance of proteins encoded at 163 known IBD risk loci and tested these proteins for their biomarker discovery potential.Methods: Based on the Human Protein Atlas (HPA) antibody availability, 218 proteins from genes mapping at 163 IBD risk loci were selected. Targeted serum protein profiles from 49 Crohn's disease (CD) patients, 51 ulcerative colitis (UC) patients, and 50 sex- and age-matched healthy individuals were obtained using multiplexed antibody suspension bead array assays. Differences in relative serum abundance levels between disease groups and controls were examined. Replication was attempted for CD-UC comparisons (including disease subtypes) by including 64 additional patients (33 CD and 31 UC). Antibodies targeting a potentially novel risk protein were validated by paired antibodies, Western blot, immuno-capture mass spectrometry, and epitope mapping.Results: By univariate analysis, 13 proteins mostly related to neutrophil, T-cell, and B-cell activation and function were differentially expressed in IBD patients vs healthy controls, 3 in CD patients vs healthy controls and 2 in UC patients vs healthy controls (q < 0.01). Multivariate analyses further differentiated disease groups from healthy controls and CD subtypes from UC (P < 0.05). Extended characterization of an antibody targeting a novel, discriminative serum marker, the laccase (multicopper oxidoreductase) domain containing 1 (LACC1) protein, provided evidence for antibody on-target specificity.Conclusions: Using affinity proteomics, we identified a set of IBD-associated serum proteins encoded at IBD risk loci. These candidate proteins hold the potential to be exploited as diagnostic biomarkers of IBD.
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  • Eiffener, Elodie, et al. (author)
  • The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes : Secondary findings from a randomized controlled trial
  • 2019
  • In: Pediatric Obesity. - : John Wiley & Sons. - 2047-6302 .- 2047-6310. ; 14:11
  • Journal article (peer-reviewed)abstract
    • Background: Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.Objectives: To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.Method: The study included 77 children (4‐6 years old, 53% girls, mean body mass index [BMI] z‐score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z‐score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.Results: Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z‐scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z‐scores.Conclusions: Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.
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  • Ek, Anna, et al. (author)
  • A Parent Treatment Program for Preschoolers With Obesity : A Randomized Controlled Trial
  • 2019
  • In: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 144:2
  • Journal article (peer-reviewed)abstract
    • Background And Objectives: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST).Methods: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (−0.5) was assessed with risk ratios.Results: A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: −0.45 to −0.15) compared with ST (0.07; 95% CI: −0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (−0.54; 95% CI: −0.77 to −0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST.Conclusion: A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.
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  • Ek, Anna, et al. (author)
  • A randomized controlled trial for overweight and obesity in preschoolers : the More and Less Europe study – an intervention within the STOP project
  • 2019
  • In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.METHODS/DESIGN: A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.DISCUSSION: This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.
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  • Ek, Anna, 1975-, et al. (author)
  • Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices : Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist
  • 2016
  • In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:1
  • Journal article (peer-reviewed)abstract
    • INTRODUCTION: Insight into parents' perceptions of their children's eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children's eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers' eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ).MATERIALS AND METHODS: Questionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators.RESULTS: 478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71).DISCUSSION: The CEBQ is a valid instrument for assessing parental perceptions of preschoolers' eating behaviors. Parental pressure to eat was strongly associated with children's food avoidance. Parental restriction, however, was more strongly associated with parents' concerns about their children's weights than with children's food approach. This suggests that childhood obesity interventions should address parents' perceptions of healthy weight alongside perceptions of healthy eating.
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21.
  • Ek, Anna, et al. (author)
  • Child behaviors associated with childhood obesity and parents’ self-efficacy to handle them : Confirmatory factor analysis of the Lifestyle Behavior Checklist
  • 2015
  • In: International Journal of Behavioral Nutrition and Physical Activity. - : Springer Science and Business Media LLC. - 1479-5868. ; 12
  • Journal article (peer-reviewed)abstract
    • Background: The development of family-based programs for child weight management requires an understanding of parents’ difficulties in managing children’s eating and physical activity behaviors; however, knowledge about the specific behaviors that parents find most difficult to address is still limited. The Lifestyle Behavior Checklist (LBC) is an Australian instrument that assesses parents’ perceptions of children’s obesity-related behaviors (the Problem scale), and parents’ self-efficacy in dealing with these behaviors (the Confidence scale). Our aims were 1) to examine the psychometric properties (the factor structure, internal reliability, construct and discriminative validity) of the LBC in parents of preschoolers in Sweden, using the Child Feeding Questionnaire (CFQ) as a criterion measure, 2) to study associations between the LBC and socio-demographic factors.Methods: The LBC and the CFQ (measuring parental feeding practices) were distributed to parents from 25 schools/preschools and to parents starting a childhood obesity intervention. To test the fit of the original four-factor model (misbehavior in relation to food, overeating, emotional correlates of being overweight, physical activity (24 items)) to the data, confirmatory factor analysis (CFA) was performed. Structural equation modelling was used to examine associations between the LBC and the CFQ and socio-demographic factors.Results: In a sample of 478 parents, a five-factor structure proved best fit to data, after excluding 6 items and allowing two pairs of error terms to correlate (TLI = 0.899; CFI = 0.918; RMSEA = 0.042; SRMR = 0.055). The Confidence scale indicated unidimensionality, therefore a hierarchical CFA with 5 first order factors and one second order factor was tested showing good fit. The validity of the LBC was proven by relevant associations with the CFQ and child weight status; parental responses differed depending on child weight status. The Confidence scale was not associated with any child or parent variables.Conclusions: In a large sample of Swedish parents of preschoolers, the LBC showed good psychometric properties, with relevant correlations to similar constructs. A five-factor structure showed best fit to data with moderate to high internal reliability. The LBC was shown to discriminate effectively between parents of normal weight children and parents of overweight/obese children.
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22.
  • Ek, Anna (author)
  • Early obesity : family-based risk factors and treatment interventions
  • 2016
  • Doctoral thesis (other academic/artistic)abstract
    • Background: The high prevalence of preschool obesity is a global concern. In order to support families through obesity interventions, we need a better understanding of underlying family-based risk factors. Specifically, there is a gap in the knowledge related to challenges that families face in everyday life. Thus, valid and reliable instruments to assess child and parental behaviors are required. Further, obesity treatment in early childhood seems to be more effective than treatment of adolescents but the support offered to parents needs to be optimized. Aims: The overall aim of this thesis was to examine the family’s role in early childhood obesity. Study I: To examine associations between infant growth and known early risk factors. Study II and III: To validate two questionnaires on child and parental behaviors related to obesity and to examine associations between potential confounders. Study IV: To describe the conceptual frame and design of a novel parent-only treatment program for early childhood obesity, the More and Less (ML) study. Study V: To examine the effects of a parent-only program as compared to standard care as a treatment for preschool obesity (primary outcome body mass index standard deviation score; BMI SDS). To assess the acceptance and feasibility of the parent-only program. Materials: Three samples of parents and preschoolers from Stockholm County were examined: Study I. 197 one-year-old children (52% girls, mean BMI SDS -0.4) and their parents (mean age 35 years, mean body mass index (BMI) 29, 54% had a university degree and 13% born in a non-Nordic country) participating in the Early Stockholm Obesity Prevention Project (Early STOPP) recruited from child health care centers in Stockholm County. Study II and III. A school sample of 431 parents of preschoolers recruited via 25 preschools/schools and a clinical sample of 47 parents from the ML study recruited through child health care centers. In this sample, 80% of the children were of normal weight and 20% had overweight or obesity (mean age 5.5 years, mean BMI SDS 0.2). The parents were 39 years old on average with mean BMI of 24; 70% had a university degree and 13% were born in a non-Nordic country. Study IV-V. 177 children aged 4-6 years with obesity (56% girls, mean age 5.2 years, mean BMI SDS 3.2) and their parents (mean age 38 years, mean BMI 29, 57% of foreign background, 40% had a university degree) were randomized to either parent-group treatment (n=89) or to standard treatment (n=88). Methods: Study I. Infant BMI SDS at 3, 6 and 12 months and rapid weight gain during the first year of life was compared between children at high and low risk of developing obesity based on parental BMI (n=144 high risk and n=53 low risk) and education level (n=57 high risk and n=139 low risk), adjusting for early life risk factors. Study II. We translated and validated the Lifestyle Behavior Checklist (LBC), a questionnaire measuring obesity-related child behaviors (Problem scale) and parents’ confidence (Confidence scale) in handling these behaviors. Parents’ understanding of the translated questions was assessed with cognitive interviews. Confirmatory factor analysis (CFA) was used to assess psychometric properties. We also examined associations between the LBC and the Child Feeding Questionnaire (CFQ), which measures parental feeding practices, and sociodemographic factors. Study III. We validated the Child Eating Behavior Questionnaire (CEBQ) with CFA. We also examined associations between child eating behaviors and CFQ parental feeding practices with structural equation modelling (SEM), adjusting for sociodemographic factors. Parents’ concern for their child being overweight was used as a mediator in the model. Study IV-V. We compared a parent-only program (10 sessions at 1.5 h/week) based on skills training in evidence-based positive parenting practices to standard treatment focused on lifestyle changes. BMI SDS (primary outcome) was measured at 3 and 6 months follow-up, adjusting for sociodemographic factors. Acceptance of the parent-only program by parents was assessed by mean scores on evaluation forms and by reviewing interviews with participants. The interviews were evaluated with thematic analysis. Results: Study I. Child BMI SDS during the first year of life was associated to parental education level but not to parental BMI. The associations could not be explained by previously known risk factors. No associations were found for rapid weight gain. Study II. A five factor structure of the LBC proved best fit to the data, introducing a new factor, Screen time. The validity of the LBC was proven by: correlations to the CFQ, associations to child BMI SDS and different scorings of parents of normal weight and overweight/obese children. The LBC Confidence scale proved to be unidimensional and was not associated to any child or parental characteristics. Study III. An eight factor structure of the CEBQ proved best fit to the data. Child’s small appetite was associated to higher levels of parental pressuring feeding practices. A large appetite in the child was not directly associated to restrictive feeding practices but indirectly via parental concern for the child being overweight. Study IV-V. Children in the parent-only group reduced their BMI SDS after 3 (0.21) and 6 months (0.42) compared to an increase of 0.01 at 3 months and 0.02 at 6 months in the standard treatment group (p < 0.001). The parent-only group children were four times more likely to reach a clinically significant reduction of 0.5 in BMI SDS. Children of Swedish parents with a university degree succeeded better in treatment. The program was highly accepted by parents. Conclusions: Parental education level is important for infant weight development as early as the first year of life, independent of parental BMI and other known early risk factors for childhood obesity. To be able to help families in treatment, we need to know what challenges the family faces in everyday life. Thus, valid and reliable instruments to assess child and parental behaviors are required. The LBC and the CEBQ are two such instruments. The associations found between child eating behavior and parental feeding practices suggest an important role for child health care practitioners to support appropriate feeding practices. Further, a parent -only program including skills training in positive parenting practices outperformed standard treatment of preschool obesity regarding child weight status. The program was well accepted by parents. This thesis strengthens the evidence for early initiated obesity interventions and elucidates considerations for reaching families of different socioeconomic backgrounds.
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23.
  • Ek, Anna, 1975-, et al. (author)
  • Parental concern about child weight is an important mediator of the effect of child eating behaviors on parental feeding practices : Results from a sample of 478 preschoolers and their parents
  • 2015
  • In: Proceedings of the 25th European Childhood Obesity Congress 2015. - Stockholm. ; , s. 28-28
  • Conference paper (peer-reviewed)abstract
    • Aim: To present a model for associations between preschoolers’ eating behaviors (measured with the Child Eating Behavior Questionnaire, CEBQ), and parental feeding practices (measured with the Child Feeding Questionnaire, CFQ).Methods: First, the original 8-factor structure of CEBQ was tested with Confirmatory factor analysis (CFA). Second, the associations between the two CEBQ dimensions of child eating (Food approach and Food avoidance) and the key CFQ parental feeding practices (Restriction and Pressure to eat) were examined with structural equation modelling (SEM). CFQ Concern for child weight and CFQ Perceived responsibility for child eating were used as mediators.Results: In a sample of 478 parents (81 % mothers, 87% of Nordic origin, 70 % with university degree) of children from Stockholm County (52 % girls, mean age 5.5 years, 20 % overweight/obese) the CFA demonstrated an acceptable fit (TLI=0.91, CFI=0.92, RMSEA=0.05) for a modified 8-factor structure. The SEM model, adjusted for child and parental characteristics, demonstrated that Food approach had a weak direct effect on Restriction, however, it had quite a strong (β: 0.30) indirect effect via concern, which resulted in a substantial total effect (β: 0.37). Further, there was a strong positive direct effect of Food avoidance on Pressure to eat (β: 0.71; p<0.001).Conclusion: The CEBQ proved to be a valid instrument for assessing parental perceptions of preschoolers’ eating behaviors. Parental controling behaviour towards children with big appetites was especially pronounced when parents were concerned for child weight, implying that parental cognitions shouldn’t be forgotten when designing obesity interventions.
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24.
  • Ek, Anna, et al. (author)
  • The More and Less Study : a randomized controlled trial testing different approaches to treat obesity in preschoolers
  • 2015
  • In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 15, s. 735-
  • Journal article (peer-reviewed)abstract
    • Background: While obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.Methods/design: This is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).Discussion: This study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.
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25.
  • Ek, C. Joakim, et al. (author)
  • Brain barrier properties and cerebral blood flow in neonatal mice exposed to cerebral hypoxia-ischemia
  • 2015
  • In: Journal of Cerebral Blood Flow and Metabolism. - : SAGE Publications. - 0271-678X .- 1559-7016. ; 35:5, s. 818-827
  • Journal article (peer-reviewed)abstract
    • Insults to the developing brain often result in irreparable damage resulting in long-term deficits in motor and cognitive functions. The only treatment today for hypoxic-ischemic encephalopathy (HIE) in newborns is hypothermia, which has limited clinical benefit. We have studied changes to the blood-brain barriers (BBB) as well as regional cerebral blood flow (rCBF) in a neonatal model of HIE to further understand the underlying pathologic mechanisms. Nine-day old mice pups, brain roughly equivalent to the near-term human fetus, were subjected to hypoxia-ischemia. Hypoxia-ischemia increased BBB permeability to small and large molecules within hours after the insult, which normalized in the following days. The opening of the BBB was associated with changes to BBB protein expression whereas gene transcript levels were increased showing direct molecular damage to the BBB but also suggesting compensatory mechanisms. Brain pathology was closely related to reductions in rCBF during the hypoxia as well as the areas with compromised BBB showing that these are intimately linked. The transient opening of the BBB after the insult is likely to contribute to the pathology but at the same time provides an opportunity for therapeutics to better reach the infarcted areas in the brain.
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26.
  • Ek, Caroline, et al. (author)
  • Using Compound-Specific and Bulk Stable Isotope Analysis for Trophic Positioning of Bivalves in Contaminated Baltic Sea Sediments
  • 2018
  • In: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 52:8, s. 4861-4868
  • Journal article (peer-reviewed)abstract
    • Stable nitrogen isotopes (delta N-15) are used as indicators of trophic position (TP) of consumers. Deriving TP from delta N-15 of individual amino acids (AAs) is becoming popular in ecological studies, because of lower uncertainty than TP based on bulk delta N-15 (TPbulk). This method would also facilitate biomagnification studies provided that isotope fractionation is unaffected by toxic exposure. We compared TPAA and TPbulk estimates for a sediment-dwelling bivalve from two coastal sites, a pristine and a contaminated. Chemical analysis of PCB levels in mussels, sediments, and pore water confirmed the expected difference between sites. Both methods, but in particular the TPAA underestimated the actual TP of bivalves. Using error propagation, the total uncertainty related to the analytical precision and assumptions in the TP calculations was found to be similar between the two methods. Interestingly, the significantly higher intercept for the regression between T-AA, and TPbulk in the contaminated site compared to the pristine site indicates a higher deamination rate due to detoxification as a result of chronic exposure and a higher N-15 fractionation. Hence, there is a need for controlled experiments on assumptions underlying amino acid-specific stable isotope methods in food web and bimagnification studies.
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27.
  • Ek, Peter, et al. (author)
  • A combination of naso- and oropharyngeal swabs improves the diagnostic yield of respiratory viruses in adult emergency department patients
  • 2019
  • In: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 51:4, s. 241-248
  • Journal article (peer-reviewed)abstract
    • Background: Along with the current development of molecular diagnostic methods of respiratory viruses, the bedside patient sampling techniques need to be evaluated. We here asked the question whether the addition of an oropharynx swab to the traditional nasopharynx swab might improve the diagnostic yield of multiplex PCR analysis. Ct values from the two sampling sites were compared as well as patient tolerability. Methods: In an emergency department in Malmö, Sweden, 98 adult patients with respiratory disease were sampled both from the nasopharynx and oropharynx for virus diagnostics by PCR. Results: Influenza (AH1, AH3, B), human metapneumovirus (hMPV) or respiratory syncytial virus (RSV) were detected by PCR in 58 subjects. The diagnostic yield was improved by combining nasopharyngeal and oropharyngeal sampling–a virus was detected in another 6 patients compared to traditional nasopharyngeal sampling (p =.031, McNemar’s test). In 38/55 subjects viral load was higher in the nasopharynx than in the oropharynx. Self-reported discomfort was significantly lower from oropharyngeal sampling than from nasopharyngeal sampling. Conclusions: Adding an oropharynx sample to a nasopharynx sample increased the diagnostic yield of respiratory viruses. Oropharyngeal sampling was well tolerated.
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28.
  • Ek, Staffan, et al. (author)
  • A 28-nm FD-SOI 115-fs Jitter PLL-Based LO System for 24-30-GHz Sliding-IF 5G Transceivers
  • 2018
  • In: IEEE Journal of Solid-State Circuits. - 0018-9200. ; 53:7, s. 1988-2000
  • Journal article (peer-reviewed)abstract
    • A system for local oscillator (LO) signal generation in 5G millimeter-wave (mmW) multi-antenna transceivers is presented. The system is modular with one phase locked loop (PLL) per antenna element transceiver, and a test circuit implemented in 28-nm fully depleted silicon on insulator (FD-SOI) CMOS features two such PLLs and a 491.52 MHz crystal oscillator (XO) generating a common frequency reference. A fractional-N architecture is employed to achieve high-frequency resolution, and the quantization noise is reduced using a novel frequency divider, which achieves full integer resolution while still using a pre-scaler. The system covers the 3rd Generation Partnership Project (3GPP) bands n257 and n258, achieved by a digital coarse tuning of the voltage-controlled oscillator (VCO). The chip area of each PLL is 0.11 mm², and 0.029 mm² for the XO. The total power consumption of the system is 35 mW, where each PLL consumes 15.4 mW and the XO consumes 0.84 mW. The total rms jitter from 20-kHz to 500-MHz offset for a 26-GHz carrier is just 115 fs, corresponding to an FOMj of -244 dB, which is the best reported figure for a fractional-N PLL above 15 GHz. The error-vector magnitude (EVM) due to phase noise is -34.6 dBc using an orthogonal frequency-division multiplexing (OFDM) signal with 120-kHz sub-carrier spacing, sufficient to support 256 QAM.
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29.
  • Ek, Stina, et al. (author)
  • Predicting First-Time Injurious Falls in Older Men and Women Living in the Community : Development of the First Injurious Fall Screening Tool
  • 2019
  • In: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 20:9, s. 1163-
  • Journal article (peer-reviewed)abstract
    • Objectives: The aim of this study was to create a screening tool to predict first-time injurious falls in community-living older men and women. Design: Longitudinal cohort study between 2001 and 2009. Setting: The Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), Sweden. Participants: Community-living older adults (n = 2808; 1750 women and 1058 men) aged >= 60 years (mean age 73, standard deviation 10.3). Measurements: The outcome was injurious falls within 5 years from baseline survey. Data on the risk factors for falls were collected through interviews, clinical examinations, and tests at baseline. Several previously established fall risk factors were identified for the development of the screening tool. The tool was formulated based on the beta coefficients from sex-specific multivariate Cox proportional hazards models. The discriminative power was assessed using Harrell C statistic. Results: Old age, living alone, being dependent in instrumental activities of daily living, and impaired balance were the factors included in the final score of the First Injurious Fall (FIF) screening tool. The predictive values (Harrell C statistic) for the scores were 0.75 for women and 0.77 for men. The sensitivity and specificity at the Youden cut-off points were 0.69 and 0.70 for women, and 0.72 and 0.71 for men. Conclusions and Implications: The FIF screening tool for first injurious fall in older persons consists of 3 questions and a physical test (5-second 1-leg standing balance with eyes open). Quick and easy to administer, it could be ideal for use in primary care or public health to identify older men and women at high fall risk, who may benefit from primary preventive interventions.
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30.
  • Ek, Stina, et al. (author)
  • Risk Factors for Injurious Falls in Older Adults : The Role of Sex and Length of Follow-Up
  • 2019
  • In: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 67:2, s. 246-253
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: To identify sex-specific associations between risk factors and injurious falls over the short (<4 years) and long (4-10 years) term.DESIGN: Longitudinal cohort study between 2001 and 2011.SETTING: Swedish National Study on Aging and Care, Kungsholmen, Sweden.PARTICIPANTS: Community-dwelling adults aged 60 and older (N = 3,112).MEASUREMENTS: An injurious fall was defined as a fall that required inpatient or outpatient care. Information was collected on participant and exposure characteristics using structured interviews, clinical examinations, and physical function tests at baseline.RESULTS: The multivariate model showed that, in the short term, living alone (hazard ratio (HR)=1.83, 95% confidence interval (CI)=1.13-2.96), dependency in instrumental activities of daily living (IADLs) (HR=2.59, 95% CI=1.73-3.87), and previous falls (HR=1.71, 95% CI=1.08-2.72) were independently associated with injurious falls in women. Low systolic blood pressure (HR=1.96, 95% CI=1.04-3.71), impaired chair stands (HR=3.00, 95% CI=1.52-5.93), and previous falls (HR=2.81, 95% CI=1.32-5.97) were associated with injurious falls in men. Long-term risk factors were underweight (HR=2.03, 95% CI=1.40-2.95), cognitive impairment (HR=1.49, 95% CI=1.08-2.06), fall-risk increasing drugs (HR=1.67, 95% CI=1.27-2.20 for >= 2 drugs), and IADL dependency (HR=1.58, 95% CI=1.32-5.97) for women and smoking (HR=1.71, 95% CI=1.03-2.84), heart disease (HR=2.20, 95% CI=1.5-3.24), impaired balance (HR=1.68, 95% CI=1.08-2.62), and a previous fall (HR=3.61, 95% CI=1.98-6.61) for men.CONCLUSION: Men and women have different fall risk profiles, and these differences should be considered when developing preventive strategies. Some risk factors were more strongly predictive of injurious falls over shorter than longer periods and vice versa, suggesting that it may be possible to identify older men and women at short-and long-term risk of injurious falls.
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31.
  • Ek, Stina, et al. (author)
  • Risk Profiles for Injurious Falls in People Over 60 : A Population-Based Cohort Study
  • 2018
  • In: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press (OUP). - 1079-5006 .- 1758-535X. ; 73:2, s. 233-239
  • Journal article (peer-reviewed)abstract
    • Background: Although falls in older adults are related to multiple risk factors, these factors have commonly been studied individually. We aimed to identify risk profiles for injurious falls in older adults by detecting clusters of established risk factors and quantifying their impact on fall risk. Methods: Participants were 2,566 people, aged 60 years and older, from the population-based Swedish National Study on Aging and Care in Kungsholmen. Injurious falls was defined as hospitalization for or receipt of outpatient care because a fall. Cluster analysis was used to identify aggregation of possible risk factors including chronic diseases, fall-risk increasing drugs (FRIDs), physical and cognitive impairments, and lifestyle-related factors. Associations between the clusters and injurious falls over 3, 5, and 10 years were estimated using flexible parametric survival models. Results: Five clusters were identified including: a healthy, a well-functioning with multimorbidity, a well-functioning, with multimorbidity and high FRID consumption, a physically and cognitively impaired, and a disabled cluster. The risk of injurious falls for all groups was significantly higher than for the first cluster of healthy individuals in the reference category. Hazard ratios (95% confidence intervals) ranged from 1.71 (1.02-2.66) for the second cluster to 12.67 (7.38-21.75) for the last cluster over 3 years of follow-up. The highest risk was observed in the last two clusters with high burden of physical and cognitive impairments. Conclusion: Risk factors for injurious fall tend to aggregate, representing different levels of risk for falls. Our findings can be useful to tailor and prioritize clinical and public health interventions.
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32.
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33.
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34.
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35.
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36.
  • Ekstedt, Mirjam, et al. (author)
  • Sleep differences in one-year-old children were related to obesity risks based on their parents' weight according to baseline longitudinal study data
  • 2017
  • In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 106:2, s. 304-311
  • Journal article (peer-reviewed)abstract
    • AIM: Parental obesity is the predominant risk factor for child obesity. We compared sleep in one-year-old children with different obesity risks, based on parental weight, and explored associations with weight, parental sleep and family factors.METHODS: Baseline data from 167 families participating in a longitudinal obesity prevention programme was used. Sleep patterns were compared between groups with high and low obesity risks, based on parental weight, and associations between child sleep and weight status, family obesity risk and parental sleep were explored. Sleep was assessed using child sleep diaries and standard parental questionnaires.RESULTS: Later bedtime, longer sleep onset latency and lower sleep efficiency were observed among children in the high-risk group. Child sleep onset latency was associated with the family obesity risk (β = 0.25, p = 0.001), child bedtime with both maternal (β = 0.33, p < 0.01) and paternal bedtime (β = 0.22, p < 0.05) and child sleep efficiency with maternal sleep quality (β = 0.20, p < 0.01). The child's bedtime was weakly associated with their body mass index (β = 0.17, p < 0.05).CONCLUSION: Sleep differed between one-year-old children with high or low obesity risks, based on their parents' body mass index, and was associated with the family obesity risk and parental sleep. The child's bedtime was weakly associated with their weight status.
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37.
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38.
  • Gorokhova, Elena, et al. (author)
  • Bacteria-Mediated Effects of Antibiotics on Daphnia Nutrition
  • 2015
  • In: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 49:9, s. 5779-5787
  • Journal article (peer-reviewed)abstract
    • In polluted environments, contaminant effects may be manifested via both direct toxicity to the host and changes in its microbiota, affecting bacteria host interactions. In this context, particularly relevant is exposure to antibiotics released into environment. We examined effects of the antibiotic trimethoprim on microbiota of Daphnia magna and concomitant changes in the host feeding. In daphnids exposed to 0.25 mg L-1 trimethoprim for 24 h, the microbiota was strongly affected, with (1) up to 21-fold decrease in 16S rRNA gene abundance and (2) a shift from balanced communities dominated by Curvibacter, Aquabacterium, and Limnohabitans in controls to significantly lower diversity under dominance of Pelomonas in the exposed animals. Moreover, decreased feeding and digestion was observed in the animals exposed to 0.25-2 mg L-1 trimethoprim for 48 h and then fed C-14-labeled algae. Whereas the proportion of intact algal cells in the guts increased with increased trimethoprim concentration, ingestion and incorporation rates as well as digestion and incorporation efficiencies decreased significantly. Thus, antibiotics may impact nontarget species via changes in their microbiota leading to compromised nutrition and, ultimately, growth. These bacteria-mediated effects in nontarget organisms may not be unique for antibiotics, but also relevant for environmental pollutants of various nature.
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39.
  • Henriksson, Pontus, 1982-, et al. (author)
  • Physical fitness in relation to later body composition in pre-school children
  • 2019
  • In: Journal of Science and Medicine in Sport. - : Elsevier. - 1440-2440 .- 1878-1861. ; 22:5, s. 574-579
  • Journal article (peer-reviewed)abstract
    • ObjectivesAlthough physical fitness is considered a marker of health in youth, little is known whether physical fitness in pre-school age is related to later body composition. Thus, this study investigated (i) associations of physical fitness at 4.5 years of age with body composition 12 months later and (ii) whether improvements in physical fitness during the 12-month follow-up were associated with changes in body composition.DesignThis study included 142 children, measured at 4.5 and 5.5 years, from the control group of the MINISTOP trial.MethodsPhysical fitness (cardiorespiratory fitness, lower- and upper-body muscular strength and motor fitness) was measured using the PREFIT test battery. Body composition was assessed using air-displacement plethysmography.ResultsIn adjusted regression analyses, greater cardiorespiratory fitness, lower-body muscular strength and motor fitness at 4.5 years were associated with a lower fat mass index at 5.5 years (standardized β= −0.182 to −0.229, p ≤ 0.028). Conversely, greater cardiorespiratory fitness, lower- and upper-body muscular strength as well as motor fitness at 4.5 years of age were associated with a higher fat-free mass index (standardized β = 0.255–0.447, p ≤ 0.001). Furthermore, improvements in cardiorespiratory fitness, lower-body muscular strength and motor fitness during the 12-month follow-up period were associated with decreases in fat mass index and/or % fat mass.ConclusionsIn conclusion, the results of this study provide evidence of the importance of physical fitness early in life. Nevertheless, further studies are needed in order to clarify the influence of physical fitness in the pre-school age with later health outcomes.
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40.
  • Husby, Simon, et al. (author)
  • miR-18b overexpression identifies mantle cell lymphoma patients with poor outcome and improves the MIPI-B prognosticator
  • 2015
  • In: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 125:17, s. 2669-2677
  • Journal article (peer-reviewed)abstract
    • Recent studies show that mantle cell lymphoma (MCL) express aberrant microRNA (miRNA) profiles; however, the clinical effect of miRNA expression has not previously been examined and validated in large prospective homogenously treated cohorts. We performed genome-wide miRNA microarray profiling of 74 diagnostic MCL samples from the Nordic MCL2trial (screening cohort). Prognosticmi RNAs were validated in diagnostic MCL samples from 94 patients of the independent Nordic MCL3 trial (validation cohort). Three miRNAs (miR-18b, miR-92a, and miR-378d) were significantly differentially expressed in patients who died of MCL in both cohorts. MiR-18b was superior to miR-92a and miR-378d in predicting high risk. Thus, we generated a new biological MCL International Prognostic Index (MIPI-B)-miR prognosticator, combining expression levels of miR-18b with MIPI-B data. Compared to the MIPI-B, this prognosticator improved identification of high-risk patients with regard to cause-specific, overall, and progression free survival. Transfection of 2 MCL cell lines with miR-18b decreased their proliferation rate without inducing apoptosis, suggesting that miR-18b may render MCL cells resistant to chemotherapy by decelerating cell proliferation. We conclude that overexpression of miR-18b identifies patients with poor prognosis in 2 large prospective MCL cohorts and adds prognostic information to the MIPI-B. MiR-18b may reduce the proliferation rate of MCL cells as a mechanism of chemoresistance.
  •  
41.
  • Jensen, Kristian Vestergaard, et al. (author)
  • Diagnostic pitfalls in vitamin B6-dependent epilepsy caused by mutations in the PLPBP gene.
  • 2019
  • In: JIMD reports. - : Wiley. - 2192-8304 .- 2192-8312. ; 50:1, s. 1-8
  • Journal article (peer-reviewed)abstract
    • Vitamin B6-responsive epilepsies are a group of genetic disorders including ALDH7A1 deficiency, PNPO deficiency, and others, usually causing neonatal onset seizures resistant to treatment with common antiepileptic drugs. Recently, biallelic mutations in PLPBP were shown to be a novel cause of vitamin B6-dependent epilepsy with a variable phenotype. The different vitamin B6-responsive epilepsies can be detected and distinguished by their respective biomarkers and genetic analysis. Unfortunately, metabolic biomarkers for early detection and prognosis of PLPBP deficiency are currently still lacking. Here, we present data from two further patients with vitamin B6-dependent seizures caused by variants in PLPBP, including a novel missense variant, and compare their genotype and phenotypic presentation to previously described cases. Hyperglycinemia and hyperlactatemia are the most consistently observed biochemical abnormalities in pyridoxal phosphate homeostasis protein (PLPHP) deficient patients and were present in both patients in this report within the first days of life. Lactic acidemia, the neuroradiological, and clinical presentation led to misdiagnosis of a mitochondrial encephalopathy in two previously published cases with an early fatal course. Similarly, on the background of glycine elevation in plasma, glycine encephalopathy was wrongly adopted as diagnosis for a patient in our report. In this regard, lactic acidemia as well as hyperglycinemia appear to be diagnostic pitfalls in patients with vitamin B6-responsive epilepsies, including PLPHP deficiency.In vitamin B6-responsive epilepsies, including PLPHP deficiency, there are several diagnostic pitfalls, including lactic acidemia as well as hyperglycinemia, highlighting the importance of a pyridoxine trial, and genetic testing.
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42.
  • Karalija, Nina, 1984-, et al. (author)
  • Cardiovascular factors are related to dopamine integrity and cognition in aging
  • 2019
  • In: Annals of Clinical and Translational Neurology. - : Wiley-Blackwell. - 2328-9503. ; 6:11, s. 2291-2303
  • Journal article (peer-reviewed)abstract
    • Objective: The aging brain undergoes several changes, including reduced vascular, structural, and dopamine (DA) system integrity. Such brain changes have been associated with age‐related cognitive deficits. However, their relative importance, interrelations, and links to risk factors remain elusive.Methods: The present work used magnetic resonance imaging and positron emission tomography with 11C‐raclopride to jointly examine vascular parameters (white‐matter lesions and perfusion), DA D2‐receptor availability, brain structure, and cognitive performance in healthy older adults (n = 181, age: 64–68 years) from the Cognition, Brain, and Aging (COBRA) study.Results: Covariance was found among several brain indicators, where top predictors of cognitive performance included caudate and hippocampal integrity (D2DR availability and volumes), and cortical blood flow and regional volumes. White‐matter lesion burden was negatively correlated with caudate DA D2‐receptor availability and white‐matter microstructure. Compared to individuals with smaller lesions, individuals with confluent lesions (exceeding 20 mm in diameter) had reductions in cortical and hippocampal perfusion, striatal and hippocampal D2‐receptor availability, white‐matter microstructure, and reduced performance on tests of episodic memory, sequence learning, and processing speed. Higher cardiovascular risk as assessed by treatment for hypertension, systolic blood pressure, overweight, and smoking was associated with lower frontal cortical perfusion, lower putaminal D2DR availability, smaller grey‐matter volumes, a larger number of white‐matter lesions, and lower episodic memory performance.Interpretation: Taken together, these findings suggest that reduced cardiovascular health is associated with poorer status for brain variables that are central to age‐sensitive cognitive functions, with emphasis on DA integrity.
  •  
43.
  • Koning, Gabriella, et al. (author)
  • Magnesium induces preconditioning of the neonatal brain via profound mitochondrial protection.
  • 2019
  • In: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism. - 1559-7016. ; 39:6, s. 1038-1055
  • Journal article (peer-reviewed)abstract
    • Magnesium sulphate (MgSO4) given to women in preterm labor reduces cerebral palsy in their offspring but the mechanism behind this protection is unclear, limiting its effective, safe clinical implementation. Previous studies suggest that MgSO4 is not neuroprotective if administered during or after the insult, so we hypothesised that MgSO4 induces preconditioning in the immature brain. Therefore, we administered MgSO4 at various time-points before/after unilateral hypoxia-ischemia (HI) in seven-day-old rats. We found that MgSO4 treatment administered as a bolus between 6 days and 12h prior to HI markedly reduced the brain injury, with maximal protection achieved by 1.1mg/g MgSO4 administered 24h before HI. As serum magnesium levels returned to baseline before the induction of HI, we ascribed this reduction in brain injury to preconditioning. Cerebral blood flow was unaffected, but mRNAs/miRNAs involved in mitochondrial function and metabolism were modulated by MgSO4. Metabolomic analysis (H+-NMR) disclosed that MgSO4 attenuated HI-induced increases in succinate and prevented depletion of high-energy phosphates. MgSO4 pretreatment preserved mitochondrial respiration, reducing ROS production and inflammation after HI. Therefore, we propose that MgSO4 evokes preconditioning via induction of mitochondrial resistance and attenuation of inflammation.
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44.
  • Källman, Ulrika, et al. (author)
  • Blood flow responses over sacrum in nursing home residents during one hour bed rest
  • 2016
  • In: Microcirculation. - : WILEY-BLACKWELL. - 1073-9688 .- 1549-8719. ; 23:7, s. 530-539
  • Journal article (peer-reviewed)abstract
    • ObjectivesTo describe individual BF responses in a nursing home resident population for one-hour periods of bed rest. MethodsBF was measured for one hour over the sacrum in 0 degrees supine position and 30 degrees supine tilt position in 25 individuals aged 65 y or older while lying on a pressure-redistributing mattress. Measurements were made at three tissue depths (1, 2, and 10 mm) using the noninvasive optical techniques, LDF and PPG. ResultsEleven participants had a PIV response at 1mm depth in both positions and seven participants had a lack of this response at this depth and positions. The BF response at 1mm depth appeared immediately and remained over, or below, baseline for the entire 60min of loading in both positions. These BF patterns were also seen in deeper tissue layers. ConclusionsThe cutaneous BF response among the nursing home residents was distinct, appeared early, and remained during the one hour of loading.
  •  
45.
  • Källman, Ulrika, 1968- (author)
  • Evaluation of Repositioning in Pressure Ulcer Prevention
  • 2015
  • Doctoral thesis (other academic/artistic)abstract
    • Introduction: To reduce the risk for pressure ulcers, repositioning of immobile patients is an important standard nursing practice. However, knowledge on how this preventive intervention is carried out among elderly immobile patients is limited and to what extent patients perform minor movements between nursing staff-induced repositionings is largely unknown, but these movements might have implications for the repositioning intervention. Different lying positions are used in repositioning schedules, but there is lack of evidence to recommend specific positions.Aim: The overall aim of this thesis was to describe and evaluate how repositioning procedures work in practice in the care of elderly immobile patients. The aim was also to compare the effects of different positions with regard to interface pressure, skin temperature, and tissue blood flow in elderly patients lying on a pressure-redistribution mattress.Methods: This thesis consists of four quantitative studies. In Study I, 62 elderly immobile patients were included. All movements the patients made, either with help from the nursing staff or spontaneously, were registered continuously over the course of three days. Study II served to pilot the procedure for Study III. Tissue blood flow and skin temperature were measured in hospital patients (n = 20) for 5 minutes in two supine, two semi-Fowler, and two lateral positions. In Study III, a new sample was recruited (n = 25) from three nursing homes. Measurement of interface pressure was added, and the measurements were extended from 5 minutes to 1 hour. The six positions were reduced to four by excluding the two semi-Fowler positions. Blood flow was measured using photopletysmography (Study II-IV) and laser Doppler flowmetry (Studies III and IV). In Study IV a deeper analysis of the individual pressure-induced vasodilation (PIV) responses was performed on the sample from Study III. An age of 65 years or older was an inclusion criterion in all studies.Results: Study I showed that there was a large variation in the extent to which the elderly immobile patients made spontaneous movements, and these movements were positively related to taking analgesics and negatively related to taking psycholeptics. Patients scored as high risk for pressure ulcer development were repositioned more frequently than patients scored as low risk. However, the spontaneous movement frequency was not associated with any risk scores. Study II showed that the different lying positions influenced the blood flow in different ways. In Study III, it was found that the overall blood flow response during one hour of loading was significantly higher in the 30° supine tilt position than in the 0° supine, 30° lateral, and 90° lateral positions. The overall blood flow in the 90° lateral position did not differ compared to the 30° lateral position, although the interface pressure was significant higher in the 90° lateral position. In patients lacking a PIV response (Study IV), the blood flow decreased immediately and remained below baseline during the one hour of loading.Conclusions: Although elderly and immobilized, some patients frequently perform minor movements while others do not. Patients who cannot perform minor movements are important for the nursing staff to identify because they very likely need more intensive repositioning interventions. The spontaneous movement frequency was not associated with the risk assessment score, and this implies that some immobile patients assessed as low risk might need to be repositioned as often as patients assessed as high risk. Of the positions evaluated, the 30° supine tilt position was concluded to be most beneficial. There was no great difference in how the blood flow was affected in the 90° lateral position compared to the 30° lateral position, which question the appropriateness of the recommendation to avoid the 90° lateral position. The patients with lacking a PIV response might be particularly vulnerable to  pressure, which also implies that these patients might need to be repositioned more frequently.
  •  
46.
  • Källman, Ulrika, et al. (author)
  • Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
  • 2016
  • In: International Wound Journal. - : Wiley-Blackwell. - 1742-4801 .- 1742-481X. ; 13:6, s. 1168-1175
  • Journal article (peer-reviewed)abstract
    • The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.
  •  
47.
  • Källman, Ulrika, et al. (author)
  • Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents
  • 2015
  • Other publication (other academic/artistic)abstract
    • Background. Pressure induced vasodilation (PIV) protects the skin from pressure induced ischemia. PIV responses at individual level during a long-term measurement period have not previously been described in an elderly population in a clinically relevant situation.Aim. To describe individual PIV responses in a nursing home resident population for 1-hour periods of bed rest.Method. From May 2011 to August 2012, blood flow at three tissue depths was measured for one hour over the sacrum in 0° supine position and 30° supine tilt position in 25 individuals aged 65 years or older while lying on a pressure redistributing mattress. Measurements were made using the non-invasive optical techniques Laser Doppler Flowmetry (LDF) and photoplethysmography. The individuals were divided into a PIV group and a non-PIV group based upon the LDF data.Results. In the PIV group, the blood flow in almost all cases increased immediately and remained over baseline for the entire 60 minutes of loading in both positions, while the blood flow decreased immediately and remained below baseline in the non-PIV group. These blood flow patterns were also seen in deeper tissue layers although a PIV response was most common in the underlying tissue in both groups.Conclusion. The cutaneous blood flow response among the nursing home residents was distinct, appeared early and remained during the one hour of loading in both the PIV and non-PIV group. The non-PIV group may be more vulnerable to pressure and thus may be at risk for pressure ulcer development. More research is needed in order to verify the results.
  •  
48.
  • Källman, Ulrika, et al. (author)
  • The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents
  • 2015
  • In: Biological Research for Nursing. - : Sage Publications. - 1099-8004 .- 1552-4175. ; 17:2, s. 142-151
  • Journal article (peer-reviewed)abstract
    • Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30 supine tilt and 0 supine positions and over the trochanter major in 30lateral and 90lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.Results: Interface pressure was significantly higher in the 0supine and 90lateral positions than in 30supine tilt and 30 lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30 supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.Conclusion: The 30supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.
  •  
49.
  • Lee, Eunjung, et al. (author)
  • Pleiotropic Analysis of Cancer Risk Loci on Esophageal Adenocarcinoma Risk.
  • 2015
  • In: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 24:11
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Several cancer-associated loci identified from genome-wide association studies (GWAS) have been associated with risks of multiple cancer sites, suggesting pleiotropic effects. We investigated whether GWAS-identified risk variants for other common cancers are associated with risk of esophageal adenocarcinoma (EA) or its precursor, Barrett's esophagus.METHODS: We examined the associations between risks of EA and Barrett's esophagus and 387 SNPs that have been associated with risks of other cancers, by using genotype imputation data on 2,163 control participants and 3,885 (1,501 EA and 2,384 Barrett's esophagus) case patients from the Barrett's and Esophageal Adenocarcinoma Genetic Susceptibility Study, and investigated effect modification by smoking history, body mass index (BMI), and reflux/heartburn.RESULTS: After correcting for multiple testing, none of the tested 387 SNPs were statistically significantly associated with risk of EA or Barrett's esophagus. No evidence of effect modification by smoking, BMI, or reflux/heartburn was observed.CONCLUSIONS: Genetic risk variants for common cancers identified from GWAS appear not to be associated with risks of EA or Barrett's esophagus.IMPACT: To our knowledge, this is the first investigation of pleiotropic genetic associations with risks of EA and Barrett's esophagus. Cancer Epidemiol Biomarkers Prev; 24(11); 1801-3. ©2015 AACR.
  •  
50.
  • Lindberg, Louise, et al. (author)
  • Low grandparental social support combined with low parental socioeconomic status is closely associated with obesity in preschool-aged children: a pilot study
  • 2015
  • In: Pediatric Obesity. - : Wiley. - 2047-6302 .- 2047-6310.
  • Journal article (peer-reviewed)abstract
    • While the influence of parental socioeconomic status (SES) on children’s weight status is well known, the impact of other family-related aspects such as parental and grandparental social support is less understood. This study investigates the importance of parents’ SES and social support (functional and structural) for weight status in a clinical sample of preschoolers 4–6 years old with obesity (n = 39, 56% girls; 73% of parents were overweight/obese, 50% were of non-Swedish origin). Linear regression analyses, simple and multiple, were performed on SES and social support with child BMI SDS (body mass index standard deviation score) as the dependent variable. The results show that parents’ income and low emotional support from paternal grandparents were significantly associated with more severe obesity. The association between parental income and the child’s BMI SDS was stronger among parents who had low emotional support from their own parents. In conclusion, grandparental social support may be protective against childhood obesity.
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