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Karlsson, B., Burell, G., Kristiansson, P., Björkegren, K., Nyberg, F. & Svärdsudd, K. (2019). Decline of substance P levels after stress management with cognitive behaviour therapy in women with the fibromyalgia syndrome. Scandinavian Journal of Pain, 19(3), 473-482
Open this publication in new window or tab >>Decline of substance P levels after stress management with cognitive behaviour therapy in women with the fibromyalgia syndrome
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2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 3, p. 473-482Article in journal (Refereed) Published
Abstract [en]

Background and aims: Substance P (CSF-SP) is known to be elevated in females with fibromyalgia syndrome (FMS). The aims of this study were to evaluate the effect of cognitive behaviour therapy (CBT) on plasma SP levels in women with FMS and to find possible clinical behavioural correlates to plasma SP level changes. Methods: Forty-eight women with FMS were randomly allocated into two groups. Group 1 received the CBT treatment intervention over the course of 6 months while group 2 was waitlisted. CBT was given with a protocol developed to diminish stress and pain. After 6 months, group 2 was given the same CBT treatment as well. All were followed up 1 year after the start of CBT treatment. This approach allowed for two analytical designs a randomised controlled trial (RCT) (n=24 vs. n=24) and a before-and-after treatment design (n=48). All women were repeatedly evaluated by the West Haven-Yale Multidimensional Pain Inventory (MPI) and three other psychometric questionnaires and plasma SP was analysed. Results: In the RCT design, the plasma SP level was 8.79 fmol/mL in both groups at the start of the trial, after adjustment for initial differences. At the end of the RCT, the plasma SP level was 5.25 fmol/mL in the CBT intervention group compared to 8.39 fmol/mL in the control group (p=0.02). In the before-and-after design, the plasma SP was reduced by 33% (p <0.01) after CBT, but returned to the pre-treatment level at follow-up 1 year after the start of CBT treatment. Plasma SP was associated with the MPI dimensions experienced "support from spouses or significant others" and "life control". Conclusions: Plasma SP might be a marker of the effect of CBT in FMS associated with better coping strategies and reduced stress rather than a biochemical marker of pain.

Place, publisher, year, edition, pages
Walter de Gruyter, 2019
Keywords
fibromyalgia, substance P, cognitive behaviour therapy, stress, Westhaven-Yale Multidimensional Pain Inventory, Montgomery-Asberg Depression Rating Scale
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-390922 (URN)10.1515/sjpain-2018-0324 (DOI)000473300500007 ()30796851 (PubMedID)
Funder
Swedish Research Council, 9459Swedish Rheumatism Association, 51/04Swedish Social Insurance Agency, 11124
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-15Bibliographically approved
Larsson, A., Carlsson, L., Karlsson, B. & Lipcsey, M. (2019). Rapid testing of red blood cell parameters in primary care patients using HemoScreen™ point of care instrument. BMC Family Practice, 20(1), Article ID 77.
Open this publication in new window or tab >>Rapid testing of red blood cell parameters in primary care patients using HemoScreen™ point of care instrument
2019 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 20, no 1, article id 77Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with anemia are frequently encountered in primary care. Once anemia is detected, it is essential to define the type and identify the underlying cause prior to initiation of treatment. In most cases, the cause can be determined using information from the patient history, physical exam, and complete blood counts (CBC). Point of care testing of blood cell counts would speed up the work up of anemia patients. The aim of the present study was to evaluate if the HemoScreen™ instrument (PixCell Medical, Yokneam Ilit, Israel) could be used for primary care samples. It is a POCT instrument that utilizes single sample cuvettes and image analysis of full blood count including RBC, Hemoglobin, MCV, MCH, platelets, WBC, and WBC 5-part differential.

METHODS: We compared the HemoScreen™ and the Sysmex XN instrument results of 100 primary care patient samples focusing on the total white blood cells, red blood cell parameters RBC, Hemoglobin, MCH, MCV and platelets.

RESULTS: Deming correlations between the HemoScreen™ and the Sysmex XN instruments for the CBC were WBCHemoScreen™ = 1.016* WBCSysmex + 0.34; r = 0.981, RBCHemoScreen™ = 0.988* RBCSysmex + 0.015; r = 0.974, HemoglobinHemoScreen™ = 1.081* HemoglobinSysmex - 11.25; r = 0.964, MCHHemoScreen™ = 0.978* MCHSysmex + 0.78; r = 0.939, MCVHemoScreen™ = 0.963* MCVSysmex + 8.68; r = 0.946, PlateletsHemoScreen™ = 0.964* PlateletsSysmex + 25.7; r = 0.953.

CONCLUSION: The HemoScreen™ instrument could provide rapid and accurate test results for evaluation of the red blood cell parameters in primary care. This new technology is interesting as it allows the analysis red blood cell parameters also at small primary care centers.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Anemia, Iron deficiency, red blood cells, Method evaluation, Point of care testing, Primary care
National Category
Infectious Medicine
Identifiers
urn:nbn:se:uu:diva-385060 (URN)10.1186/s12875-019-0971-2 (DOI)000470712600001 ()31174471 (PubMedID)
Available from: 2019-06-10 Created: 2019-06-10 Last updated: 2019-06-26Bibliographically approved
Olsson, E., Norlund, F., Pingel, R., Burell, G., Gulliksson, M., Larsson, A., . . . Held, C. (2018). The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial. Upsala Journal of Medical Sciences, Supplement, 123(3), 167-173
Open this publication in new window or tab >>The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial
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2018 (English)In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 123, no 3, p. 167-173Article in journal (Refereed) Published
Abstract [en]

Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.

Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.

Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.

Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.

Keywords: Biomarkers, CBT, CHD, inflammation, stress management

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-356841 (URN)10.1080/03009734.2018.1490829 (DOI)000446977000005 ()30086659 (PubMedID)
Funder
Vårdal Foundation, V96-160Vårdal Foundation, V98-403Vårdal Foundation, 2014-0114Swedish Heart Lung Foundation, E010-95Swedish Heart Lung Foundation, E019-96Swedish Heart Lung Foundation, E019-98Swedish Heart Lung Foundation, E010-00Swedish Heart Lung Foundation, E009-01Swedish Heart Lung Foundation, E45-04Swedish Heart Lung Foundation, K-97-21x-12256-01ASwedish Heart Lung Foundation, K98-21X-12256-02BSwedish Heart Lung Foundation, K99-21X-12256-03CSwedish Heart Lung Foundation, 2009-1093Swedish National Board of Health and Welfare, 1471-601:Var95-161Forte, Swedish Research Council for Health, Working Life and Welfare, F0196/99Forte, Swedish Research Council for Health, Working Life and Welfare, 2001-1049Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4947
Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2018-12-10Bibliographically approved
Khezri, B. S., Cederblad, M., Helmersson-Karlqvist, J., Karlsson, B., Melhus, H. & Larsson, A. (2017). Seasonal variability of NT-proBNP in Swedish primary care patients. Chronobiology International, 34(10), 1473-1477
Open this publication in new window or tab >>Seasonal variability of NT-proBNP in Swedish primary care patients
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2017 (English)In: Chronobiology International, ISSN 0742-0528, E-ISSN 1525-6073, Vol. 34, no 10, p. 1473-1477Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to determine if there is a seasonal variation in the widely used heart failure marker NT-proBNP. The study included all primary care requests for NT-proBNP in the county of Uppsala, Sweden, between January 2007 and December 2015. For seasonal variation, the NT-proBNP results for individual months were compared. The NT-proBNP values were highest in July to September, but there was also a minor peak in December-January. In conclusion, a seasonal periodicity for NT-proBNP was demonstrated in primary care patients. The data could be useful for practitioners for evaluation of NT-proBNP results and monitoring of patients with heart failure.

Place, publisher, year, edition, pages
Taylor & Francis, 2017
Keywords
Heart failure, natriuretic peptide, seasonal variation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-335291 (URN)10.1080/07420528.2017.1366500 (DOI)000423083600013 ()28910541 (PubMedID)
Available from: 2017-12-03 Created: 2017-12-03 Last updated: 2018-03-15Bibliographically approved
Karlsson, B., Burell, G., Anderberg, U. M. & Kurt, S. (2015). Cognitive behaviour therapy in women with fibromyalgia: A randomized cllinical trial. Scandinavian Journal of Pain, 9, 11-21
Open this publication in new window or tab >>Cognitive behaviour therapy in women with fibromyalgia: A randomized cllinical trial
2015 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 9, p. 11-21Article in journal (Refereed) Published
Abstract [en]

Background and aims

Stress has been pointed out as an important influential factor in the development and maintaining of the fibromyalgia syndrome (FMS). Since stress may worsen the pain experience, the development of individual strategies for coping with stress is essential to reduce the impact of FMS on daily life. The aim of the study was to investigate whether a group based stress management cognitive behaviour therapy (CBT) programme could influence self-reported stress, wellbeing and life control, as well as self-reported pain behaviour in female FMS patients.

Methods

48 female FMS patient were randomized into a cognitive behaviour therapy treatment group (n = 24) and a waitlist control group (n = 24). When the 6 months waitlist period was over the control group received the same CBT programme. This allowed two analytical approaches, one based on the randomized controlled trial design and one based on a before-and-after design to improve the statistical power of the study. Four psychometric instruments were used: The West Haven-Yale Multidimensional Pain Inventory (three parts, MPI-1 to MPI-3), the Maastricht Questionnaire, the Everyday Life Stress, and the Montgomery-Åsberg Depression rating scale – self-reported. Primary outcome was the MPI-1 dimension ‘life control’, secondary outcomes were the MPI-1 dimensions ‘interference’, ‘affective distress’ and ‘support from spouses or significant others’, the various MPI-2 dimensions, the ‘general activity level’ in the MPI-3 dimension, and ‘vital exhaustion’, ‘stress behaviour’, and ‘depression’. The only tertiary outcome was the MPI-1 dimension ‘pain severity’.

Results

In the RCT design the West Haven-Yale Multidimensional Pain Inventory dimensions ‘life control’, ‘interference from pain’, ‘affective distress’, ‘support from spouses or significant others’, and ‘distracting responses’ and ratings for depression improved in the treatment group as compared with the control group. In the before-and after design these improvements were maintained and enhanced during 1-year follow-up, and so was the ‘vital exhaustion’ and ‘stress behaviour’. ‘Pain severity’ was rated higher after the intervention.

Conclusions

Cognitive behaviour therapy improved the life control in a female population with FMS. Coping behaviour in response to chronic pain was improved at the same time and in spite of higher subjective ratings of pain. Positive effects were seen on depression, vital exhaustion and stress behaviour. The effects of therapy were maintained and enhanced during the follow up period. It appears that women with FMS after the CBT treatment, according to this protocol obtained tools leading to better acceptance of their disorder.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-292588 (URN)10.1016/j.sjpain.2015.04.027 (DOI)
Available from: 2016-05-04 Created: 2016-05-04 Last updated: 2018-01-10Bibliographically approved
Helmersson-Karlqvist, J., Karlsson, B., Fredricsson, A. & Larsson, A. (2014). Evaluation of the Alere D-dimer test for point of care testing. Journal of Thrombosis and Thrombolysis, 38(2), 250-252
Open this publication in new window or tab >>Evaluation of the Alere D-dimer test for point of care testing
2014 (English)In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 38, no 2, p. 250-252Article in journal (Refereed) Published
Abstract [en]

The primary care regularly sees patients that have symptoms that could be due to thromboembolic diseases. It would be valuable to be able to rule out deep venous thrombosis or pulmonary embolism using Wells score and a negative D-dimer testing already at the primary care unit. This requires a validated D-dimer assay suitable for primary care use. We compared D-dimer results obtained with the new point of care analyzer Alere Triage(®) and the central hospital laboratory STA-R Evolution analyzer from the same patient samples (n = 102). We also calculated the total coefficient of variation (CV) for the Alere method. The two methods showed a good linear correlation (R(2) = 0.977) and a slope of 0.975. CV for the Alere D-dimer method was well below 10 %. The study shows that the Alere D-dimer assay and the central laboratory standard assay show similar results. We suggest that the Alere D-dimer assay could be used in primary care in combination with Wells score to reduce referrals to the emergency unit.

National Category
Clinical Laboratory Medicine
Identifiers
urn:nbn:se:uu:diva-220521 (URN)10.1007/s11239-013-1043-4 (DOI)000338706400018 ()24381121 (PubMedID)
Available from: 2014-03-17 Created: 2014-03-17 Last updated: 2017-12-05Bibliographically approved
Karlsson, B., Burell, G., Kristiansson, P., Björkegren, K., Nyberg, F. & Svärdsudd, K. (2014). Neuropeptide Y levels are reduced after cognitive behavioural therapy (CBT) in women with fibromyalgia (FMS). In: : . Paper presented at International Congress of Behavioral Medicine (pp. P569-P569).
Open this publication in new window or tab >>Neuropeptide Y levels are reduced after cognitive behavioural therapy (CBT) in women with fibromyalgia (FMS)
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2014 (English)Conference paper, Published paper (Other academic)
Series
International Journal of Behavioral Medicine, ISSN 1070-5503.12529 21(S1) S1-S216 (2014)
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-237138 (URN)
Conference
International Congress of Behavioral Medicine
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2018-01-19
Karlsson, B., Anderberg, U.-M., Burell, G., Nyberg, F. & Svärdsudd, K. (2012). Substance P (SP) levels are reduced after distress management with cognitive behavioural therapy (CBT) in women with the fibromyalgia syndrome (FMS): A randomised controlled clinical study. In: : . Paper presented at International Congress of Behavioral Medicine 2012 (pp. 316-316).
Open this publication in new window or tab >>Substance P (SP) levels are reduced after distress management with cognitive behavioural therapy (CBT) in women with the fibromyalgia syndrome (FMS): A randomised controlled clinical study
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2012 (English)Conference paper, Published paper (Refereed)
Series
International journal of Behavioral Medicine, ISSN 1070-5503 . 12529 19(S1) S1-S342 (2012)
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-222278 (URN)
Conference
International Congress of Behavioral Medicine 2012
Available from: 2014-04-09 Created: 2014-04-09 Last updated: 2018-01-11
Karlsson, B., Burell, G., Anderberg, U. & Svärdsudd, K. (2010). A randomised clinical trial of stress management in women with the fibromyalgia syndrome (FMS). In: Int J Behav Med: (pp. S90).
Open this publication in new window or tab >>A randomised clinical trial of stress management in women with the fibromyalgia syndrome (FMS)
2010 (English)In: Int J Behav Med, 2010, p. S90-Conference paper, Published paper (Refereed)
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-222307 (URN)
Available from: 2014-04-10 Created: 2014-04-10 Last updated: 2018-01-11
Karlson, B., Leijd, B. & Hellström, K. (1986). On the influence of vitamin K-rich vegetables and wine on the effectiveness of warfarin treatment. Acta medica Scandinavica, 220(4), 347-350
Open this publication in new window or tab >>On the influence of vitamin K-rich vegetables and wine on the effectiveness of warfarin treatment
1986 (English)In: Acta medica Scandinavica, ISSN 0001-6101, Vol. 220, no 4, p. 347-350Article in journal (Refereed) Published
Abstract [en]

Thrombotest (TT) values were studied in patients fed an ordinary diet and on continuous and well controlled warfarin therapy because of deep venous thrombosis or pulmonary embolism. The aim was to characterize the effect of single and multiple administrations (daily during one week) of vitamin K1 (Konakion), vitamin K-rich vegetables such as spinach and broccoli, and table wine. Single administration of 250 micrograms vitamin K1, 250 g spinach, 250 g broccoli and 37.5 cl wine did not result in TT-values outside the therapeutic range. However, when Konakion, broccoli and spinach were given daily during one week the TT-values tended to rise above the therapeutic limit, requiring dose adjustment. On the basis of this study it appears that excessive intake of vitamin K-rich food and a moderate intake of alcohol on one occasion may be permitted during anticoagulant therapy.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-237131 (URN)10.1111/j.0954-6820.1986.tb02776.x (DOI)3541503 (PubMedID)
Available from: 2014-11-27 Created: 2014-11-27 Last updated: 2018-01-11Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-4566-5079

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