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  • 1. Aavik, Einari
    et al.
    Lumivuori, Henri
    Leppänen, Olli
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Wirth, Thomas
    Hakkinen, Sanna-Kaisa
    Braesen, Jan-Hinrich
    Beschorner, Ulrich
    Zeller, Thomas
    Braspenning, Maarten
    van Criekinge, Wim
    Makinen, Kimmo
    Yla-Herttuala, Seppo
    Global DNA methylation analysis of human atherosclerotic plaques reveals extensive genomic hypomethylation and reactivation at imprinted locus 14q32 involving induction of a miRNA cluster2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 16, 993-U23 p.Article in journal (Refereed)
    Abstract [en]

    Aims Genetics can explain just above 10% of the observed heritability in cardiovascular diseases. Epigenetics is about to provide some further explanations, but the information needed for that is in the accumulation phase. Genome-wide DNA methylation analysis has revealed thousands of genes, which are epigenetically differentially regulated in atherosclerotic plaques. Our results point to an additional level of complexity that needs to be integrated into the aetiology of atherogenesis.We conducted a genome-wide analysis to identify differentially methylated genes in atherosclerotic lesions. Methods DNA methylation at promoters, exons and introns was identified by massive parallel sequencing. Gene expression was analysed by microarrays, qPCR, immunohistochemistry and western blots. Results Globally, hypomethylation of chromosomal DNA predominates in atherosclerotic plaques and two-thirds of genes showing over 2.5-fold differential in DNA methylation are up-regulated in comparison to healthy mammary arteries. The imprinted chromatin locus 14q32 was identified for the first time as an extensively hypomethylated area in atherosclerosis with highly induced expression of miR127, -136, -410, -431, -432, -433 and capillary formation-associated gene RTL1. The top 100 list of hypomethylated promoters exhibited over 1000-fold enrichment for miRNAs, many of which mapped to locus 14q32. Unexpectedly, also gene body hypermethylation was found to correlate with stimulated mRNA expression. Conclusion Significant changes in genomic methylation were identified in atherosclerotic lesions. The most prominent gene cluster activated via hypomethylation was detected at imprinted chromosomal locus 14q32 with several clustered miRNAs that were up-regulated. These results suggest that epigenetic changes are involved in atherogenesis and may offer new potential therapeutic targets for vascular diseases.

  • 2.
    Abu Hamdeh, Sami
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Marklund, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Lannsjö, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Howells, Tim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Raininko, Raili
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Enblad, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Extended anatomical grading in diffuse axonal injury using MRI: Hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome2017In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 5, no 34, 341-352 p.Article in journal (Refereed)
    Abstract [en]

    Clinical outcome after traumatic diffuse axonal injury (DAI) is difficult to predict. In this study, three magnetic resonance imaging (MRI) sequences were used to quantify the anatomical distribution of lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction. Thirty patients (mean 31.2 years ±14.3 standard deviation) with severe DAI (Glasgow Motor Score [GMS] <6) examined with MRI within 1 week post-injury were included. Diffusion-weighted (DW), T2*-weighted gradient echo and susceptibility-weighted (SWI) sequences were used. Extended Glasgow outcome score was assessed after 6 months. Number of DW lesions in the thalamus, basal ganglia, and internal capsule and number of SWI lesions in the mesencephalon correlated significantly with outcome in univariate analysis. Age, GMS at admission, GMS at discharge, and low proportion of good monitoring time with cerebral perfusion pressure <60 mm Hg correlated significantly with outcome in univariate analysis. Multivariate analysis revealed an independent relation with poor outcome for age (p = 0.005) and lesions in the mesencephalic region corresponding to substantia nigra and tegmentum on SWI (p  = 0.008). We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages (stage I—hemispheric lesions, stage II—corpus callosum lesions, stage III—brainstem lesions, and stage IV—substantia nigra or mesencephalic tegmentum lesions); all are subdivided by age (≥/<30 years).

  • 3. Alwin, J
    et al.
    Krevers, B
    Johansson, Ulla I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Josephsson, S
    Haraldsson, U
    Boström, C
    Rosshagen, A
    Persson, J
    Health economic and process evaluation of AT interventions for persons with dementia and their relatives: A suggested assessment model2007In: Technology and Disability, ISSN 1055-4181, Vol. 19, no 2-3, 61-71 p.Article in journal (Refereed)
    Abstract [en]

    There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article.

  • 4.
    Andrae, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Ingen ska behöva "lida av cellförändringar". Screeningsprogrammen bör ses över län för län: [No one should suffer because of "cervical cytology". Screening programs should be revised in each county]2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, no 23, 2792-2794 p.Article in journal (Other academic)
  • 5.
    Andrae, Bengt
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Andersson, Therese M-L
    Lambert, Paul C
    Kemetli, Levent
    Silfverdal, Lena
    Strander, Björn
    Ryd, Walter
    Dillner, Joakim
    Törnberg, Sven
    Sparén, Pär
    Screening and cervical cancer cure: population based cohort study2012In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 344, e900- p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.

    DESIGN: Nationwide population based cohort study.

    SETTING: Sweden.

    PARTICIPANTS: All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years.

    MAIN OUTCOME MEASURES: Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age, histopathological type, and FIGO (International Federation of Gynecology and Obstetrics) stage.

    RESULTS: In the screening ages, the cure proportion for women with screen detected invasive cancer was 92% (95% confidence interval 75% to 98%) and for symptomatic women was 66% (62% to 70%), a statistically significant difference in cure of 26% (16% to 36%). Among symptomatic women, the cure proportion was significantly higher for those who had been screened according to recommendations (interval cancers) than among those overdue for screening: difference in cure 14% (95% confidence interval 6% to 23%). Cure proportions were similar for all histopathological types except small cell carcinomas and were closely related to FIGO stage. A significantly higher cure proportion for screen detected cancers remained after adjustment for stage at diagnosis (difference 15%, 7% to 22%).

    CONCLUSIONS: Screening is associated with improved cure of cervical cancer. Confounding cannot be ruled out, but the effect was not attributable to lead time bias and was larger than what is reflected by down-staging. Evaluations of screening programmes should consider the assessment of cure proportions.

  • 6.
    Andrae, Bengt
    et al.
    Uppsala University, Interfaculty Units, Centrum för klinisk forskning, Gävleborg.
    Kemetli, Levent
    Sparén, Pär
    Silfverdal, Lena
    Strander, Björn
    Ryd, Walter
    Dillner, Joakim
    Törnberg, Sven
    Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden.2008In: J Natl Cancer Inst, ISSN 1460-2105, Vol. 100, no 9, 622-9 p.Article in journal (Refereed)
    Abstract [en]

    Background: The effectiveness of cervical cancer screening programs differs widely in different populations. The reasons for these differences are unclear. Routine and comprehensive audits have been proposed as an ethically required component of screening. We performed a nationwide audit of the effectiveness of the Swedish cervical cancer screening program.

    Methods: We identified all invasive cervical cancer cases that were diagnosed in Sweden from January 1, 1999, through December 31, 2001, and had been reported to the Swedish Cancer Registry (n = 1230 cases). We verified the diagnoses by histopathologic rereview and matched each case subject to five (population-based) age-matched control subjects who were identified from the National Population Register. The Pap smear screening histories for case and control subjects were reviewed for a 6-year period using the National Cervical Cancer Screening Register, which contains data on essentially all relevant cytological and histological diagnoses in Sweden. Odds ratios (ORs), and their 95% confidence intervals (CIs), of cervical cancer according to screening history were calculated in conditional logistic regression models. All statistical tests were two-sided.

    Results: Women who had not had a Pap smear within the recommended screening interval had higher risk of cervical cancer than women who had been screened (OR = 2.52, 95% CI = 2.19 to 2.91). This risk was similarly increased for all age groups (Phomogeneity = .96). The risk for nonsquamous cell cervical cancers (OR = 1.59, 95% CI = 1.20 to 2.11) was also increased. Women who had not had a Pap smear within the recommended screening interval had a particularly high risk of advanced cancers (OR = 4.82, 95% CI = 3.61 to 6.44). Among women who had been screened within the recommended interval, those with abnormal Pap smears had a higher risk of cervical cancer than those with normal smears (OR = 7.55, 95% CI = 5.88 to 9.69) and constituted 11.5% of all women with cervical cancer.

    Conclusions: Nonadherence to screening intervals was the major reason for cervical cancer morbidity. The screening program was equally effective for women of all ages and was also effective against nonsquamous cancers.

  • 7. Arbyn, Marc
    et al.
    Rebolj, Matejka
    De Kok, Inge M C M
    Fender, Murielle
    Becker, Nikolaus
    O'Reilly, Marian
    Andrae, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    The challenges of organising cervical screening programmes in the 15 old member states of the European Union2009In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 45, no 15, 2671-2678 p.Article in journal (Refereed)
    Abstract [en]

    Cervical cancer incidence and mortality can be reduced substantially by organised cytological screening at 3 to 5 year intervals, as was demonstrated in the Nordic countries, the United Kingdom, the Netherlands and parts of Italy. Opportunistic screening, often proposed at yearly schedules, has also reduced the burden of cervical cancer in some, but not all, of the other old member states (belonging to the European Union since 1995) but at a cost that is several times greater. Well organised screening programmes have the potential to achieve greater participation of the target population at regular intervals, equity of access and high quality. Despite the consistent evidence that organised screening is more efficient than non-organised screening, and in spite of the Cancer Screening Recommendations of the European Council, health authorities of eight old member states (Austria, Belgium, France, Germany, Greece, Luxembourg, Portugal and Spain) have not yet started national organised implementation of screening for cervical cancer. A decision was made by the Irish government to extend their pilot programme nationally while new regional programmes commenced in Portugal and Spain. Introduction of new methods of prevention, such as HPV screening and prophylactic HPV vaccination, can reduce the burden further, but this will require a high level of organisation with particular attention needed for the maximisation of population coverage, compliance with evidence-based guidelines, monitoring of data enabling continued evaluation and improvement of the preventive programmes.

  • 8. Armuand, Gabriela M.
    et al.
    Rodriguez-Wallberg, Kenny A.
    Wettergren, Lena
    Ahlgren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Enblad, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Höglund, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Lampic, Claudia
    Sex Differences in Fertility-Related Information Received by Young Adult Cancer Survivors2012In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 30, no 17, 2147-2153 p.Article in journal (Refereed)
    Abstract [en]

    Purpose The aim was to investigate male and female cancer survivors' perception of fertility-related information and use of fertility preservation (FP) in connection with cancer treatment during reproductive age.

    Methods The study sample consisted of cancer survivors diagnosed from 2003 to 2007 identified in population-based registers in Sweden. Inclusion criteria included survivors who were age 18 to 45 years at diagnosis and had lymphoma, acute leukemia, testicular cancer, ovarian cancer, or female breast cancer treated with chemotherapy. Of 810 eligible participants, 484 survivors (60% response rate) completed a postal questionnaire.

    Results The majority of male participants reported having received information about treatment impact on fertility (80%) and FP (68%), and more than half of the men banked frozen sperm (54%). Among women, less than half (48%) reported that they received information about treatment impact on fertility, and 14% reported that they received information about FP. Only seven women (2%) underwent FP. Predictors for receiving information about treatment impact on fertility were a pretreatment desire to have children (odds ratio [OR], 3.5), male sex (OR, 3.2), and being <= 35 years of age at diagnosis (OR, 2.0). Predictors for receiving information about FP included male sex (OR, 14.4), age <= 35 at diagnosis (OR, 5.1), and having no children at diagnosis (OR, 2.5).

    Conclusion Our results show marked sex differences regarding the receipt of fertility-related information and use of FP. There is an urgent need to develop fertility-related information adapted to female patients with cancer to improve their opportunities to participate in informed decisions regarding their treatment and future reproductive ability.

  • 9.
    Arvidsson, Patrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Granlund, Mats
    The Relationship Between Intelligence Quotient and Aspects of Everyday Functioning and Participation for People Who Have Mild and Borderline Intellectual Disabilities.2016In: JARID: Journal of applied research in intellectual disabilities, ISSN 1360-2322, E-ISSN 1468-3148Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study explored the relationship between intelligence quotient (IQ) and aspects of everyday functioning/participation in individuals (age 16-40) who have a mild/borderline intellectual disability (IQ 55-85).

    METHOD: Correlations were examined between IQ and (i) self-rated (n = 72) ability, participation as performance (how often an activity is performed), important participation restriction (not/seldom performing an activity perceived as important) and general well-being and (ii) proxy-rated (n = 41) ability and participation as performance.

    RESULTS: No significant correlations between IQ and any of the explored measures were found. However, the effect sizes of the correlations between IQ and ability were considered as small but not negligible.

    CONCLUSIONS: The results support the notion that IQ is a poor predictor of general aspects of everyday functioning in persons with mild/borderline intellectual disability. The result indicates that self-ratings partly generate other information than proxy ratings which may be important for assessments of supportive requirements and diagnosis.

  • 10.
    Arvidsson, Patrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Granlund, Mats
    Thyberg, Ingrid
    Thyberg, Mikael
    Important aspects of participation and participation restrictions in people with a mild intellectual disability2014In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, no 15, 1264-1272 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: This study explored a possibility to assess the concepts of participation and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) by combining self-ratings of the perceived importance with the actual performance of different everyday activities in people with a mild intellectual disability. Method: Structured interviews regarding 68 items from the ICF activity/participation domain were conducted (n = 69). The items were ranked by perceived importance, performance and by combined measures. Furthermore, the measures were related to a single question about subjective general well-being. Results: Rankings of performance highlighted about the same items as "important participation", while rankings of low performance addressed quite different items compared with "important participation restriction". Significant correlations were found between subjective general well-being and high performance (r = 0.56), high performance/high importance (important participation) (r = 0.56), low performance (r = -0.56) and low performance/high importance (important participation restriction; r -0.55). Conclusions: The results support the clinical relevance of the ICF and the studied selection of 68 items. Although performance only may sometimes be a relevant aspect, knowledge about the relationship between the perceived importance and the actual performance is essential for clinical interventions and for research aiming to understand specific needs regarding participation.

  • 11.
    Arvidsson, Patrik
    et al.
    Uppsala University, Interfaculty Units, Centrum för klinisk forskning, Gävleborg.
    Granlund, Mats
    Thyberg, Mikael
    Factors Related to Self-Rated Participation in Adolescents and Adults with Mild Intellectual Disability – A Systematic Literature Review2008In: Journal of Applied Research in Intellectual Disabilities, Vol. 21, 277-291 p.Article in journal (Refereed)
    Abstract [en]

    Background Self-rated participation is a clinically relevant

    intervention outcome for people with mild intellectual

    disability. The aim of this systematic review was to

    analyse empirical studies that explored relationships

    between either environmental factors or individual characteristics

    and aspects of participation in young adults

    with mild intellectual disability.

    Method Four databases were used, 756 abstracts examined

    and 24 studies were evaluated in-depth.

    Results Four aspects of participation were found:

    involvement, perceptions of self, self-determination and

    psychological well-being. Reported environmental factors

    were: social support, choice opportunity, living conditions,

    school, work and leisure, attitudes, physical

    availability and society. Reported individual characteristics

    were adaptive and social skills.

    Conclusions There is a relative lack of studies of factors

    influencing self-rated participation and existing studies

    are difficult to compare because of disparity regarding

    approaches, conceptual frameworks, etc. For adequate

    interventions, it seems important to study how profiles

    of participation are influenced by different patterns of

    environmental factors and individual characteristics.

    Keywords: adaptive behaviour, environmental factors,

    ICF, self rating

  • 12.
    Arvidsson, Patrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Granlund, Mats
    Thyberg, Mikael
    How are the activity and participation aspects of the ICF used?: Examples from studies of people with intellectual disability2015In: NeuroRehabilitation (Reading, MA), ISSN 1053-8135, E-ISSN 1878-6448, Vol. 36, no 1, 45-49 p.Article, review/survey (Refereed)
    Abstract [en]

    INTRODUCTION: Interdisciplinary differences regarding understanding the International Classification of Functioning, Disability and Health (ICF) concepts activity/participation may hinder its unifying purpose. In the ICF model, functioning (and disability) is described as a tripartite concept: 1) Body structures/functions, 2) Activities, and 3) Participation. Activities refer to an individual perspective on disability that does not tally with the basic structure of social models. OBJECTIVE: To review how activity and participation are actually used in studies of intellectual disability (ID). CONCLUSION: Based on 16 papers, four different usages of activity/participation were found. 1) Theoretical reference to tripartite ICF concept with attempts to use it. 2) Theoretical reference to tripartite ICF concept without actual use of activities. 3) "Atheoretical" approach with implicit focus on participation. 4) Theoretical reference to bipartite concept with corresponding use of terms. The highlighted studies have in common a focus on participation. However, the usage of the term "activity" differs both within and between studies. Such terminology will probably confuse interdisciplinary communication rather than facilitating it. Also, the use of an explicit underlying theory differs, from references to a tripartite to references to a bipartite concept of disability. This paper is focused on ID, but the discussed principles regarding the ICF and interdisciplinary disability theory are applicable to other diagnostic groups within rehabilitation practices.

  • 13. Astrand, Per
    et al.
    Engquist, Bo
    Anzén, Bengt
    Bergendal, Tom
    Hallman, Mats
    Uppsala University, Interfaculty Units, Centrum för klinisk forskning, Gävleborg.
    Karlsson, Ulf
    Kvint, Sven
    Lysell, Leif
    Rundcranz, Torgil
    A three-year follow-up report of a comparative study of ITI Dental Implants and Bråemark System implants in the treatment of the partially edentulous maxilla.2004In: Clin Implant Dent Relat Res, ISSN 1523-0899, Vol. 6, no 3, 130-41 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many longitudinal studies of different implant systems have been published but few controlled randomized investigations have been reported. A 1-year report of a comparative study of ITI Dental Implant System implants (Straumann AG, Waldenburg, Switzerland) and Branemark System implants (Nobel Biocare AB, Gothenburg, Sweden) has been published by the present authors. This paper is a 3-year follow-up of that randomized study. PURPOSE: The aim of the study was to compare the outcome of fixed partial prostheses supported by ITI or Branemark implants. The outcome was evaluated primarily in terms of survival rates and changes in marginal bone level. MATERIAL AND METHODS: The study group comprised 28 patients with anterior residual dentition in the maxilla. The patients were provided with two to four implants on each side of the dentition and were randomly allocated to Branemark implants or ITI implants; 77 ITI implants and 73 Branemark implants were inserted. After 6 months abutment connections were made to both ITI and Branemark implants. All patients were provided with fixed partial prostheses of gold-ceramic. The patients were followed up annually with clinical and radiographic examinations for 3 years RESULTS: Two Branemark implants and two ITI implants were lost. The Branemark implants were lost before loading whereas the ITI implants were lost because of periimplantitis. The survival rate for both groups was 97.3%. The mean marginal bone level of the Branemark implants was situated 1.8 mm from the reference point at both the baseline and the 3-year examinations. The corresponding values for the ITI implants were 1.4 mm at baseline and 1.3 mm after 3 years. There was no significant difference between the implant systems with regard to bone level or bone level change. A steady state of the marginal bone level was calculated to have been reached after 3 years for 95.5% of the Branemark implants and 87.1% of the ITI implants. Periimplantitis (infection including pus and bone loss) was observed with seven ITI implants but with none of the Branemark implants. This difference was statistically significant. CONCLUSIONS: No statistically significant differences were found between the implants studied, except for the frequency of periimplantitis, which was higher for the ITI implants. The survival rates were high, and the marginal bone loss was small for both systems.

  • 14.
    Basu, Samar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Helmersson, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Bioaktiva isoprostaner : nya markörer för oxidativ stress och inflammationsrelaterade sjukdomar2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 5, 274-278 p.Article in journal (Refereed)
    Abstract [en]

    Oxidativ stress (fria radikaler) tros vara orsaken till åldrande och flera sjukdomar, däri bland arterioskleros, men det har saknats en pålitlig metodik för att påvisa aktiviteten av fria radikaler in vivo. Här presenteras isoprostaner som nya och tillförlitliga markörer för mätning av oxidativ stress in vivo genom indirekt mätning av radikalreaktioner. Isoprostaner kan ses i ökad mängd vid flera sjukdomstillstånd som är associerade med oxidativ stress och inflammation, till exempel kardiovaskulära sjukdomar, sjukdomar som är associerade med en ökad kardiovaskulär risk samt lungsjukdomar. Mätning av isoprostaner kan vidare ge ökad kunskap om fria radikalers fysiologiska roll och antioxidanternas roll vid sjukdomar samt vara ett verktyg vid utveckling av nya läkemedel mot oxidativ stress.

  • 15. Batista, N
    et al.
    Perez-Manga, G
    Constenla, M
    Ruiz, A
    Carabantes, F
    Castellanos, J
    Gonzalez Baron, M
    Villman, K
    Söderberg, M
    Ahlgren, J
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology. Interfaculty Units, Centrum för klinisk forskning, Gävleborg.
    Casinello, J
    Regueiro, P
    Murias, A
    Phase II study of capecitabine in combination with paclitaxel in patients with anthracycline-pretreated advanced/metastatic breast cancer.2004In: Br J Cancer, ISSN 0007-0920, Vol. 90, no 9, 1740-6 p.Article in journal (Refereed)
    Abstract [en]

    The addition of oral capecitabine to docetaxel improves response rate, time to progression (TTP) and overall survival in anthracycline-pretreated metastatic breast cancer (MBC). This phase II study evaluates the efficacy and safety of a 21-day cycle of oral capecitabine (1000 mg m(-2) twice daily, days 1-14) plus i.v. paclitaxel (175 mg m(-2), day 1) in anthracycline-pretreated advanced/MBC. In all, 73 patients were enrolled at 13 Swedish and Spanish centres. The objective response rate was 52% (95% confidence interval (CI): 40-63%) in the intent-to-treat population, including complete responses in 11%. Disease was stabilised in a further 29%. The median time to disease progression (TTP) was 8.1 months and the median overall survival was 16.5 months. The combination was generally well tolerated with a predictable safety profile. The most common treatment-related nonhaematological adverse events were hand-foot syndrome (42%), alopecia (30%) and diarrhoea (26%). The only treatment-related Grade 3/4 adverse events occurring in >5% of patients were alopecia (22%) and hand-foot syndrome (11%). Grade 3/4 neutropenia and lymphocytopenia were reported in 12 and 14% of patients, respectively. Capecitabine plus paclitaxel is highly active with a favourable safety profile in anthracycline-pretreated MBC.

  • 16. Bazargani, Farhan
    et al.
    Feldmann, Ingalill
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Bondemark, Lars
    Three-dimensional analysis of effects of rapid maxillary expansion on facial sutures and bones: a systematic review2013In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 83, no 6, 1074-1082 p.Article, review/survey (Refereed)
    Abstract [en]

    Objective:

    To evaluate the evidence on three-dimensional immediate effects of rapid maxillary expansion (RME) treatment on growing patients as assessed by computed tomography/cone beam computed tomography (CT/CBCT) imaging.

    Materials and Methods:

    The published literature was searched through the PubMed, Embase, and Cochrane Library electronic databases from January 1966 to December 2012. The inclusion criteria consisted of randomized controlled trials, prospective controlled studies, and prospective case-series. Two reviewers extracted the data independently and assessed the quality of the studies.

    Results:

    The search strategy resulted in 73 abstracts or full-text articles, of which 10 met the inclusion criteria. When treating posterior crossbites with a RME device, the existing evidence points out that the midpalatal suture opening is around 20%-50% of the total screw expansion. There seems to be no consistent evidence on whether the midpalatal sutural opening is parallel or triangular. The effect on the nasal cavity dimensions after RME seems to be apparent and indicates an enlargement between 17% and 33% of the total screw expansion. Circummaxillary sutures, particularly the zygomaticomaxillary and frontomaxillary sutures and also spheno-occipital synchondrosis, appear to be affected by the maxillary expansion. Overall, however, the changes were small and the evidence not conclusive.

    Conclusions:

    CT imaging proved to be a useful tool for assessment of treatment effects in all three dimensions. The majority of the articles were judged to be of low quality, and therefore, no evidence-based conclusions could to be drawn from these studies.

  • 17.
    Bendrik, Regina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Reg Gavleborg, Gavle, Sweden..
    Kallings, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Swedish Sch Sport & Hlth Sci, Stockholm, Sweden..
    Broms, K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Reg Gavleborg, Gavle, Sweden..
    Emtner, Morgan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Maximal Step-Up Test A New Functional Test In Hip Or Knee Osteoarthritis2016In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 24, S471-S471 p.Article in journal (Other academic)
  • 18.
    Berggard, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Pharmacology.
    Damberg, Mattias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Oreland, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Pharmacology.
    Brainstem levels of transcription factor AP-2 in rat are changed after treatment with phenelzine, but not with citalopram2005In: BMC Pharmacology, ISSN 1471-2210, Vol. 5, 1- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Before therapeutic effect is obtained after treatment with antidepressant drugs, like serotonin selective reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAO-Is) there is an initial lag-period of a few weeks. Neuronal adaptations on a molecular level are supposed to be involved in the initiation of the antidepressant effect. Transcription factor AP-2 is essential for neuronal development and many genes involved in the brainstem monoaminergic systems have binding sites for AP-2 in their regulatory regions. The genotype of the AP-2beta isoform has been associated with e.g. anxiety-related personality traits and with platelet MAO activity. In addition, previous studies have shown that the levels of AP-2alpha and AP-2beta in rat whole brain were decreased after 10 days of treatment with citalopram (SSRI) and imipramine (TCA), and were increased with phenelzine (MAO-I). RESULTS: In the present study, we report that treatment with citalopram for 1, 7 or 21 days did not have effect on the AP-2 levels in rat brainstem. However, after treatment with phenelzine for 1, 7 or 21 days the levels of AP-2alpha and AP-2beta had increased after 7 days, but had returned to control levels at day 21. CONCLUSION: The decrease in AP-2 levels in rat whole brain previously seen after treatment with citalopram does not seem to be localised to the brainstem, it may rather occur in the monoaminergic terminal projection areas. The present data suggest that the increase in AP-2 levels previously seen in rat whole brain after subchronic treatment with phenelzine is located in the brainstem. It cannot, however, be excluded that other brain regions are involved.

  • 19.
    Bergkvist, Leif
    et al.
    Uppsala University, Interfaculty Units, Centre for Clinical Research.
    Liljegren, Göran
    Ahlgren, Johan
    Centrum för klinisk forskning, Gävleborg.
    Lidin, Annika
    Holmqvist, Marit
    Holmberg, Lars
    Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    [Registries contribute to better breast cancer care]2004In: Lakartidningen, ISSN 0023-7205, Vol. 101, no 34, 2579-81 p.Article in journal (Refereed)
  • 20.
    Berglund, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Wigertz, Annette
    Adolfsson, Jan
    Ahlgren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Fornander, Tommy
    Wärnberg, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Lambe, Mats
    Impact of comorbidity on management and mortality in women diagnosed with breast cancer2012In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 135, no 1, 281-289 p.Article in journal (Refereed)
    Abstract [en]

    To investigate associations between comorbidity burden, management, and mortality in women with breast cancer. A total of 42,646 women diagnosed with breast cancer between 1992 and 2008 were identified in two Clinical Quality Registers in Central Sweden. Breast cancer-specific, conditional breast cancer, competing-cause and all-cause mortality were estimated in relation to comorbidity burden assessed by the Charlson comorbidity index. All analyses were stratified by stage at diagnosis using competing risk analyses, and all-cause mortality was estimated as a function of follow-up time. Following adjustment for age and calendar period, breast conserving surgery was significantly less likely to be offered to women with severe comorbidity (OR 0.63; 95 % CI 0.58-0.69). Similarly, the proportion treated with radiotherapy, tamoxifen, or chemotherapy was lower in women with severe compared to those with no comorbidity. In women with early stage disease, breast cancer-specific mortality was higher among patients with severe comorbidity (sHR 1.47; 95 % CI 1.11-1.94). In all stages of breast cancer, conditional breast cancer and competing-cause mortality were elevated in women with severe comorbidity. For all stages, the relative risk of all-cause mortality between women with severe versus no comorbidity varied by time since diagnosis, and was most pronounced at early follow-up. Comorbidity affects treatment decisions and mortality. In women with early stage breast cancer, severe comorbidity was associated not only with conditional breast cancer, competing-cause and all-cause mortality, but also breast cancer-specific mortality. The observed differences in breast cancer-specific mortality may be due to less extensive treatment, impaired tumor defense and differences in general health status and lifestyle factors.

  • 21.
    Bergqvist, Michael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. Umea Univ, Dept Radiat Sci, Umea, Sweden.
    Holgersson, Georg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Bondarenko, Igor
    Grechanaya, Elena
    Maximovich, Alexey
    Andor, György
    Klockare, Maria
    Thureson, Marcus
    Jerling, Markus
    Harmenberg, Johan
    Phase II randomized study of the IGF-1R pathway modulator AXL1717 compared to docetaxel in patients with previously treated, locally advanced or metastatic non-small cell lung cancer2017In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 53, no 3, 441-447 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The primary objective of this study was to compare the progression-free survival (PFS) at 12 weeks between patients treated with IGF-1R pathway modulator AXL1717 (AXL) and patients treated with docetaxel (DCT).

    MATERIAL AND METHODS: The study was conducted at 19 study centers in five countries. A total of 99 patients with previously treated, locally advanced or metastatic non-small cell lung cancer (NSCLC) of the squamous cell carcinoma (SCC) or adenocarcinoma (AC) subtypes in need of additional treatment were randomized and treated with either 300 or 400 mg of AXL as daily BID treatment (58 patients) or DCT given as 75 mg/m(2) in three-week cycles (41 patients) as monotherapy in a 3:2 ratio for each NSCLC subtype. Patients were treated in the primary study treatment period for a maximum of four treatment cycles.

    RESULTS: The 12-week PFS rate, median PFS and overall survival (OS), as well Kaplan-Meier hazard ratio for PFS and OS, did not show any statistically significant differences between the treatment groups. For the primary endpoint, the AXL group had a lower percentage of patients (25.9%) who were progression-free at Week 12 as compared to the DCT group (39.0%), although the difference was not statistically significant. The most notable difference in the incidence of treatment emergent adverse effects (TEAEs) was the lower incidence of treatment-related grade 3/4 neutropenia in patients treated with AXL.

    CONCLUSION: These results suggest neither of the treatments to be superior of the other when treating locally advanced or metastatic NSCLC. Considering the lower incidence of grade 3/4 neutropenia in the AXL group this treatment warrants further research.

  • 22. Bergström, Stefan
    et al.
    Ahlgren, Johan
    Uppsala University, Interfaculty Units, Centrum för klinisk forskning, Gävleborg.
    Hagberg, Hans
    [Erythropoietin can reduce the effect of radiotherapy]2004In: Lakartidningen, ISSN 0023-7205, Vol. 101, no 41, 3160-1 p.Article in journal (Refereed)
  • 23.
    Bertilsson, Ann-Sofie
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Ekstam, Lisa
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.; Lund Univ, Dept Hlth Sci, Lund, Sweden.; Karolinska Univ Hosp, Dept Occupat Therapy, Huddinge, Sweden .
    Tham, Kerstin
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.; Karolinska Univ Hosp, Dept Occupat Therapy, Huddinge, Sweden.
    Andersson, Magnus
    Karolinska Inst, Dept Clin Neurosci, Solna, Sweden.; Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
    von Koch, Lena
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.; Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
    Johansson, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    A cluster randomized controlled trial of a client-centred, activities of daily living intervention for people with stroke: One year follow-up of caregivers2016In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 30, no 8, 765-775 p.Article in journal (Refereed)
    Abstract [en]

    Objective: Compare caregiver burden, provision of informal care, participation in everyday occupationsand life satisfaction of caregivers to people with stroke, who either had received a client-centred, activitiesof daily living intervention or usual activities of daily living interventions.

    Design: A multicentre cluster randomized controlled trial in which 16 rehabilitation units were randomlyassigned to deliver a client-centred, activities of daily living intervention or usual activities of daily livinginterventions. Caregiver outcomes were compared cross-sectionally at 12 months and changes inoutcomes between three and 12 months after people with stroke were included in the study.

    Setting: Inpatient and outpatient rehabilitation.

    Participants: Caregivers of people with stroke enrolled in the trial.

    Intervention: A client-centred, activities of daily living intervention aiming to increase agency in dailyactivities and participation in everyday life for people after stroke.

    Main measures: Caregiver Burden Scale, Occupational Gaps Questionnaire, LiSat-11.

    Results: There were no differences in outcomes between caregivers in the client-centred, activities ofdaily living (n = 88) and the usual activities of daily living (n = 95) group at 12 months. The caregiver burdenscore was 42.7 vs. 41.8, p = 0.75, mean occupational gaps were 3.5 vs. 4.0, p = 0.52 and satisfaction with lifewas 53% vs. 50%, p = 0.87. There were no differences in changes between three and 12 months. However,within groups there were significant differences in caregiver burden, factor general strain, for caregivers inthe client-centred, activities of daily living group, and in provision of informal care for the usual activitiesof daily living group.

    Conclusion: The client-centred intervention did not bring about any difference between caregivergroups,but within groups some difference was found for caregiver burden and informal care.

  • 24. Bertilsson, Ann-Sofie
    et al.
    Ranner, Maria
    von Koch, Lena
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Johansson, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Ytterberg, Charlotte
    Guidetti, Susanne
    Tham, Kerstin
    A client-centred ADL intervention: three-month follow-up of a randomized controlled trial2014In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 21, no 5, 377-391 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to study a client-centred activities of daily living (ADL) intervention (CADL) compared with the usual ADL intervention (UADL) in people with stroke regarding: independence in ADL, perceived participation, life satisfaction, use of home-help service, and satisfaction with training and, in their significant others, regarding: caregiver burden, life satisfaction, and informal care. Methods: In this multicentre study, 16 rehabilitation units were randomly assigned to deliver CADL or UADL. The occupational therapists who provided the CADL were specifically trained. Eligible for inclusion were people with stroke treated in a stroke unit 3 months after stroke, dependent in two ADL, not diagnosed with dementia, and able to understand instructions. Data were collected at inclusion and three months thereafter. To detect a significant difference between the groups in the Stroke Impact Scale (SIS) domain "participation", 280 participants were required. Intention-to-treat analysis was applied. Results: At three months, there was no difference in the outcomes between the CADL group (n = 129) and the UADL group (n = 151), or their significant others (n = 87/n = 93) except in the SIS domain "emotion" in favour of CADL (p = 0.04). Conclusion: The CADL does not appear to bring about short-term differences in outcomes and longer follow-ups are required.

  • 25.
    Bertilsson, Ann-Sofie
    et al.
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, S-14183 Stockholm, Sweden..
    Von Koch, Lena
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, S-14183 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden..
    Tham, Kerstin
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, S-14183 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Occupat Therapy, Huddinge, Sweden..
    Johansson, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, S-14183 Stockholm, Sweden..
    Client-centred ADL intervention after stroke: Significant others' experiences2015In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 22, no 5, 377-386 p.Article in journal (Refereed)
    Abstract [en]

    Background: Client-centredness is a prominent contemporary concept in rehabilitation. However, there is a lack of knowledge on if and how a client-centred rehabilitation approach is incorporated in the everyday life of significant others of people who receive such rehabilitation. Objective: Explore and describe if and how a client-centred ADL intervention (CADL) was integrated in the everyday lives of significant others of people with stroke. Materials and methods: Qualitative longitudinal design, with a grounded theory approach. Seven significant others, who cohabited with persons receiving a CADL intervention, were interviewed during the first year. Findings: One core category was identified: "Taking responsibility and achieving balance with respect to self-esteem in order to get on with everyday life". The integration of the CADL was a process. A key aspect was that as the person with stroke acted upon his/her own desired activity goals the significant others were encouraged to act on their own needs. Conclusions: Enablement is important also for the significant others of people with stroke. One way of enabling significant others to maintain an active lifestyle and find respite in everyday life might be to enable people with stroke to formulate and act upon their desired activity goals.

  • 26.
    Björn, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Josephson, Malin
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rissén, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Prominent attractive qualities of nurses work in operating room departments: A questionnaire study2015In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, no 4, 877-889 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive.

    OBJECTIVE: To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context.

    METHODS: The AWQ was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data.

    RESULTS: Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original AWQ, Cronbach's alpha varied between 0.57-0.90.

    CONCLUSIONS: Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the AWQ and the results suggest that the questionnaire can be useful in a health care context.

  • 27.
    Björn, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Lindberg, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. University of Gävle.
    Rissén, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Significant factors for work attractiveness and how these differ from the current work situation among operating department nurses2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 1-2, 109-116 p.Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim was to examine significant factors for work attractiveness and how these differ from the current work situation among operating department nurses. A second objective was to examine the associations between age, gender, length of employment, work engagement, work ability, self-rated health indicators and attractiveness of the current work situation.

    BACKGROUND: The attractiveness of work is rarely taken into account in research on nurse retention. To expand this knowledge, it is relevant to examine factors that make work attractive and their associations with related concepts.

    DESIGN: Correlational, cross-sectional survey using a convenience sample.

    METHODS: Questionnaires were answered by 147 nurses in four operating departments in Sweden. Correlation and regression analyses were conducted.

    RESULTS: The nurses rated the significance of all factors of work attractiveness higher than they rated those factors in their current work situation; salary, organisation and physical work environment had the largest differences. The most significant attractive factors were relationships, leadership and status. A statistically significant positive correlation between work engagement and attractive work was found. In the multiple regression model, the independent variables work engagement and older age significantly predicted work attractiveness.

    CONCLUSIONS: Several factors should be considered in the effort to increase work attractiveness in operating departments and thereby to encourage nurse retention. Positive aspects of work seem to unite work engagement and attractive work, while work ability and self-rated health indicators are other important dimensions in nurse retention.

    RELEVANCE TO CLINICAL PRACTICE: The great discrepancies between the significance of attractive factors and the current work situation in salary, organisation and physical work environment suggest ways in which work attractiveness may be increased. To discover exactly what needs to be improved may require a deeper look into the construct of the examined factors.

  • 28.
    Björnsson, Eyþór
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm .
    Lúdviksdóttir, Dóra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm .
    Hedenström, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Eriksson, Britt-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Venge, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Jansson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Airway hyperresponsiveness, peak flow variability and inflammatory markers in non-asthmatic subjects with respiratory infections2007In: Clinical Respiratory Journal, ISSN 1752-6981, Vol. 1, no 1, 42-50 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to characterise non-asthmatic subjects with asthma-like symptoms during a common cold, particularly in relation to airway hyperresponsiveness (AHR). Materials and Methods: Subjects with acute respiratory infections and a group of controls (n = 20 + 20), age 20-65 years, underwent bronchial provocations with methacholine, adenosine and cold air. All were non-smokers and had no history of asthma or heart disease. Those with infection had asthma-like symptoms (> , 2). Measurements of exhaled nitric oxide (eNO), serum levels of eosinophil cationic protein (ECP), eosinophil peroxidase, myeloperoxidase and human neutrophil lipocalin were made at each provocation. A 17-day symptom and peak flow diary was calculated. Results: No differences between the two groups were found, regarding responsiveness to methacholine, adenosine or cold air challenge, as well as the inflammatory markers measured. In the infected group, the mean (standard deviation) ECP was higher in those with AHR to methacholine or cold air [15.7 (6.5) and 11.4 (4.2) mg/L, respectively; P < , 0.05], furthermore, eNO was higher in the infected group [116 ( 54) and 88 ( 52) nL/min, respectively, P = 0.055]. The infected group had, at all times, more symptoms and higher peak flow, with a decrease in the symptoms (P = 0.02) and a tendency to change in peak flow variation (P = 0.06). Conclusion: AHR does not seem to be the main cause of asthma-like symptoms in adults with infectious wheezing. Peak flow variation and symptom prevalence during the post-infection period may imply airway pathology different from AHR.

  • 29.
    Blomberg, Carl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Nilsson, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Holgersson, Georg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science.
    Edlund, Per
    Bergqvist, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Adwall, Linda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Ekman, Simon
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Brattström, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Bergström, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Randomized Trials of Systemic Medically-treated Malignant Mesothelioma: A Systematic Review2015In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 35, no 5, 2493-2501 p.Article, review/survey (Refereed)
    Abstract [en]

    Malignant pleural mesothelioma (MPM) is a rare but aggressive malignancy mainly localized to the pleura. Malignant mesothelioma grows highly invasive into surrounding tissue and has a low tendency to metastasize. The median overall survival (OS) of locally advanced or metastatic disease without treatment is 4-13 months but, during recent years, improvement in survival has been achieved since treatment for patients with mesothelioma has improved with better palliative care, systemic medical treatment, surgery and improved diagnostics methods. The present review aims at describing available data from randomized trials considering systemic medical treatment for this patient category.

  • 30.
    Boll, Madeleine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Boström Lindberg, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Physiotherapists’ understanding and approach to health promotion work in compulsory school: perceiving and supporting coherence2010In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 26, no 5, 318-326 p.Article in journal (Refereed)
    Abstract [en]

    Gaining knowledge in the field of health promotion may help physiotherapists acquire a new understanding of the way movement promotes health, as related to environmental influences. The aim of the present study was to describe how physiotherapists working in a programme of health promotion in compulsory school understand and approach their work. Seven physiotherapists in primary care, working partly with health promotion in compulsory school, were interviewed. A descriptive design of qualitative content analysis was chosen to analyse interviews that had already been conducted in a local evaluation of the programme. This resulted in a main theme, described as Perceiving and Supporting Coherence. This understanding and approach were discussed in relation to challenges of a historically embedded constitution of physiotherapy when entering the area of health promotion in compulsory school.

  • 31. Brage, M.
    et al.
    Holmlund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Johansson, A.
    Humoral immune response to Aggregatibacter actinomycetemcomitans leukotoxin2011In: Journal of Periodontal Research, ISSN 0022-3484, E-ISSN 1600-0765, Vol. 46, no 2, 170-175 p.Article in journal (Refereed)
    Abstract [en]

    Background and Objective: Periodontal disease is an inflammatory condition caused by bacterial infections that result in loss of the tooth supporting tissue. The periodontal pathogens produce virulence factors with capacity to affect the host immune response. Aggregatibacter actinomycetemcomitans is a periodontal pathogen that produces a leukotoxin that specifically affects human leukocytes. The aims of the present study were to examine the presence and function of systemic antibodies to the leukotoxin. Material and Methods: One hundred and ninety-seven middle-aged (57 +/- 5 years) Swedes with well-documented periodontal status and medical factors related to cardiovascular diseases were studied. These data have been published previously. The serum samples were examined for the presence of leukotoxin antibodies by western blot and the capacity to neutralize leukotoxicity in an activity assay with leukotoxin and cultured leukemic cells. Results: The results showed a high prevalence (57%) of antibodies against A. actinomycetemcomitans leukotoxin in the analyzed population. These antibodies were correlated with leukotoxin neutralizing capacity as well as with the ELISA titers of A. actinomycetemcomitans-specific IgA and IgG. In addition, high levels of leukotoxin antibodies were correlated with increasing age, but not with periodontal disease parameters or cardiovascular risk factors. Conclusion: Systemic antibodies against A. actionmycetemcomitans leukotoxin were common in this adult Swedish population. These antibodies might contribute to limit the systemic effects of the infection.

  • 32.
    Brandén, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    A 20-year follow-up of a case with tracheobronchopathia osteochondroplastica2013In: Journal of bronchology & interventional pulmonology, ISSN 1948-8270, Vol. 20, no 1, 84-86 p.Article in journal (Refereed)
    Abstract [en]

    A 39-year-old woman underwent bronchoscopy because of shortness of breath and audible breathing upon exertion. An advanced tracheobronchopathia osteochondroplastica was diagnosed. Twenty years later, the woman's health status is stable, she has no cough or excessive mucous production, but she does suffer from effort dyspnea. Difficulties may arise if there is need for intubation in patients with tracheobronchopathia osteochondroplastica because of the nodules protruding inward from the cartilage rings.

  • 33.
    Brandén, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Wallgren, Stig
    Hogberg, Hans
    Koyi, Hirsh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Computer tomography-guided core biopsies in a county hospital in Sweden: Complication rate and diagnostic yield2014In: Annals of Thoracic Medicine, ISSN 1817-1737, E-ISSN 1998-3557, Vol. 9, no 3, 149-153 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Core biopsies are valuable in obtaining sufficient tissue to ensure diagnosis of diseases in the thorax. OBJECTIVE: To evaluate the complication rate and the diagnostic yield in computer tomography (CT)-guided core biopsies performed in a county hospital in Sweden. METHODS: Medical journals, spirometry results, pathology reports and CT scans were reviewed in 463 consecutive cases, where a transthoracic core biopsy was performed between January 2005 and December 2010. Of these 380 (82%) were lung lesions, 48 (10%) were mediastinal lesions and 35 (8%) were pleural lesions. RESULTS: All patients underwent a chest X-ray 4 hours post-biopsy and pneumothorax was seen in 156/463 (34%) patients: 137 after lung biopsy and 17 after mediastinal biopsy. Chest tube insertion was required for 27 (17%) of these patients (6% of all core biopsies). Small intraparenchymal hemorrhages and hemoptysis were observed with subjective difficulty in one case. The diagnostic yield for the 463 patients was 212 (46%) cases of lung cancer, 188 (41%) benign lesions and 39 (8%) pulmonary metastases. CONCLUSIONS: A transthoracic core biopsy ensures diagnosis with a low complication rate and is suitable as an outpatient procedure. An increased risk for pneumothorax was observed when the biopsied lesion was small or when emphysema was in the path of the biopsy needle. Reduced lung function pre-biopsy or emphysema in the path of the biopsy needle increased the need for chest tube treatment of pneumothorax. A CT-guided core biopsy is safe and applicable in a county hospital.

  • 34.
    Bröms, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Prevalence and co-occurrence of parentally reported possible asthma and allergic manifestations in pre-school children2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, 764- p.Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to make an in-depth analysis of the prevalence and co-occurrence in pre-school children of possible asthma and atopic manifestations. Methods: In Sweden 74%-84% of preschool children, depending on age, attend municipality organised day-care centres. Parents of 5,886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded to a postal questionnaire regarding symptoms indicating prevalent possible asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. Possible asthma was defined as any of the four criteria wheezing four times or more during the last year, physician diagnosis and current wheezing, ever had asthma and current wheezing, and current use of inhalation steroids, all based on questionnaire responses. Results: The overall prevalence of possible asthma was 8.9%, of eczema 21.7%, of rhinitis 8.1%, and of food allergy 6.6%. There was a highly significant co-occurrence between possible asthma and all atopic manifestations, 35.7% having any of the manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of possible asthma, presence of pollen allergy with presence of rhinitis, and presence of food allergy with presence of eczema. Assessed from plots of age-specific prevalence of possible asthma, rhinitis, eczema and food allergy, the prevalence of all manifestations increased from one to three years of age and then decreased, except for rhinitis where the prevalence increased until six years of age, indicating no specific ordered sequence. Conclusions: Parentally reported possible asthma, eczema and food allergy had a curvilinear prevalence course across age with a maximum at age 3, while rhinitis prevalence increased consistently with age. Co-occurrence between possible asthma and atopic manifestations was common, and some combinations were more common than others, but there was no evidence of a specific ordered onset sequence.

  • 35.
    Bröms, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Norbäck, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Sundelin, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Svärdsudd, Kurt F
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Effect of degree of urbanisation on age and sex-specific asthmaprevalence in Swedish preschool children2009In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, 303- p.Article in journal (Refereed)
    Abstract [en]

    Background: There are few studies on age and sex-specific asthma   prevalence in the age range 1-6 years. The purpose of this report was   to estimate age and sex specific asthma prevalence in preschool   children and to analyse the influence of possible demographic and   geographic determinants.   Methods: All 70 allergen avoidance day-care centres and 140 matched   ordinary day-care centres across Sweden were sampled. The parents of   all 8,757 children attending these day-care centres received the   International Study of Asthma and Allergies in Childhood (ISAAC)   written questionnaire, supplemented with questions on medical   treatment, physician assessed asthma diagnosis, and other asthma   related questions. The response rate was 68%.   Results: The age specific asthma prevalence, adjusted for the   underlying municipality population size, was among boys 9.7% at age 1,   11.1% at age 2, 11.4 at age 3, 10.5 at age 4, 8.7 at age 5, and 6.4 at   age 6. The corresponding proportions among girls were 8.9%, 9.9%, 9.8%,   8.8%, 7.0%, and 5.0%, on average 9.6% for boys and 8.2% for girls,   altogether 8.9%. In addition to age and sex the prevalence increased by   municipality population density, a proxy for degree of urbanisation.   Moreover, there was a remaining weak geographical gradient with   increasing prevalence towards the north and the west.   Conclusion: The age-specific asthma prevalence was curvilinear with a   peak around age 3 and somewhat higher for boys than for girls. The   asthma prevalence increased in a slowly accelerating pace by   municipality population density as a proxy for degree of urbanisation.

  • 36.
    Byström, Sanna
    et al.
    KTH Royal Inst Technol, Affin Prote, SciLifeLab, S-17165 Solna, Sweden..
    Fredolini, Claudia
    KTH Royal Inst Technol, Affin Prote, SciLifeLab, S-17165 Solna, Sweden..
    Edqvist, Per-Henrik D
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Nyaiesh, Etienne-Nicholas
    KTH Royal Inst Technol, Affin Prote, SciLifeLab, S-17165 Solna, Sweden..
    Drobin, Kimi
    KTH Royal Inst Technol, Affin Prote, SciLifeLab, S-17165 Solna, Sweden..
    Uhlen, Mathias
    KTH Royal Inst Technol, Affin Prote, SciLifeLab, S-17165 Solna, Sweden..
    Bergqvist, Michael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Gavle Sjukhus, S-80188 Gavle, Sweden.;Umea Univ, Dept Radiat Sci, S-90187 Umea, Sweden..
    Ponten, Fredrik
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical and experimental pathology.
    Schwenk, Jochen M.
    KTH Royal Inst Technol, Affin Prote, SciLifeLab, S-17165 Solna, Sweden..
    Affinity Proteomics Exploration of Melanoma Identifies Proteins in Serum with Associations to T-Stage and Recurrence2017In: Translational Oncology, ISSN 1944-7124, E-ISSN 1936-5233, Vol. 10, no 3, 385-395 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Blood-based proteomic profiling may aid and expand our understanding of diseases and their different phenotypes. The aim of the presented study was to profile serum samples from patients with malignant melanoma using affinity proteomic assays to describe proteins in the blood stream that are associated to stage or recurrence of melanoma. MATERIAL AND METHODS: Multiplexed protein analysis was conducted using antibody suspension bead arrays. A total of 232 antibodies against 132 proteins were selected from (i) a screening with 4595 antibodies and 32 serum samples from melanoma patients and controls, (ii) antibodies used for immunohistochemistry, (iii) protein targets previously related with melanoma. The analysis was performed with 149 serum samples from patients with malignant melanoma. Antibody selectivity was then assessed by Western blot, immunocapture mass spectrometry, and epitope mapping. Lastly, indicative antibodies were applied for IHC analysis of melanoma tissues. RESULTS: Serum levels of regucalcin (RGN) and syntaxin 7 (STX7) were found to be lower in patients with both recurring tumors and a high Breslow's thickness (T-stage 3/4) compared to low thickness (T-stage 1/2) without disease recurrence. Serum levels of methylenetetrahydrofolate dehydrogenase 1-like (MTHFD1L) were instead elevated in sera of T3/4 patients with recurrence. The analysis of tissue sections with S100A6 and MTHFD1L showed positive staining in a majority of patients with melanoma, and S100A6 was significantly associated to T-stage. CONCLUSIONS: Our findings provide a starting point to further study RGN, STX7, MTHFD1L and S100A6 in serum to elucidate their involvement in melanoma progression and to assess a possible contribution to support clinical indications.

  • 37. Cristescu, S. M.
    et al.
    Mandon, J.
    Harren, F. J. M.
    Merilainen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Högman, Marieann
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
    Methods of NO detection in exhaled breath2013In: Journal of Breath Research, ISSN 1752-7155, Vol. 7, no 1, 017104- p.Article in journal (Refereed)
    Abstract [en]

    There is still an unexplored potential for exhaled nitric oxide (NO) in many clinical applications. This study presents an overview of the currently available methods for monitoring NO in exhaled breath and the use of the modelling of NO production and transport in the lung in clinical practice. Three technologies are described, namely chemiluminescence, electrochemical sensing and laser-based detection with their advantages and limitations. Comparisons are made in terms of sensitivity, time response, size, costs and suitability for clinical purposes. The importance of the flow rate for NO sampling is discussed from the perspective of the recent recommendations for standardized procedures for online and offline NO measurement. The measurement of NO at one flow rate, such as 50 ml s(-1), can neither determine the alveolar site/peripheral contribution nor quantify the difference in NO diffusion from the airways walls. The use of NO modelling (linear or non-linear approach) can solve this problem and provide useful information about the source of NO. This is of great value in diagnostic procedures of respiratory diseases and in treatment with anti-inflammatory drugs.

  • 38. Dasmah, A.
    et al.
    Sennerby, L.
    Rasmusson, L.
    Hallman, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Intramembraneous bone tissue responses to calcium sulfate: an experimental study in the rabbit maxilla2011In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 22, no 12, 1404-1408 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study was to histologically examine the responses of intramembraneous bone to calcium sulfate (CaS) and evaluate the resorption and replacement process.

    Material and methods: Fourteen rabbits were used in this study. Defect healing without any filling material was compared with CaS. Five millimetres wide and 4 mm deep defects were drilled with a trephine bur on both sides of the edentulous space between the incisors and the molars. Test vs. control sites were randomly selected and thereby compared in each animal. The animals were killed after 2, 4 and 8 weeks for histological examination.

    Results: After 2 weeks, the specimens showed a great extent of degradation of CaS. No signs of the material could be seen after 4 and 8 weeks. There were no statistically significant differences in bone regeneration between the test and control sites within the 8 weeks group in this study. However, there was tendency of more blood vessels in the test sites after 4 weeks of healing.

    Conclusion: The present study showed that CaS does not interfere with intramembraneous bone healing. In this animal model, the CaS exhibited resorption/degradation early in the healing process while seemingly stimulating angiogenesis. However, there was no significant increase in bone regeneration in the sites treated with CaS during an 8 week period of healing and observation time, as compared with a control defect.

  • 39. Dasmah, Amir
    et al.
    Hallman, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Sennerby, Lars
    Rasmusson, Lars
    A Clinical and Histological Case Series Study on Calcium Sulfate for Maxillary Sinus Floor Augmentation and Delayed Placement of Dental Implants2012In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 14, no 2, 259-265 p.Article in journal (Refereed)
    Abstract [en]

    Background: Maxillary sinus floor augmentation is a procedure that is indicated in cases when the volume of the posterior maxillary bone is inadequate. The goal of this treatment is to obtain sufficient amount of bone tissue in order to gain osseointegration of endosseous implants. Purpose: The purpose of this study was to conduct a clinical and histological analysis of calcium sulfate (CaS) as bone graft substitute in sinus floor augmentation.

    Material and Methods: Ten patients with edentulous maxillas were included in this study. They had moderate to severe atrophy of the posterior maxilla. Surgiplaster (Classimplant(R), Rome, Italy) was used as graft material in the maxillary sinus and was covered by BioGide(R) (Geistlish Pharmaceutical, Wolhusen, Switzerland). After 4 months of graft healing, 40 dental implants were placed and a biopsy for histomorphometry was taken at these occasions. The specimens were viewed by light microscope, and the extent of bone regeneration and remaining graft material was evaluated. Radiographs were taken at the time of sinus augmentation and after 4 months of graft healing.

    Results: At the time of abutment surgery, one implant was considered as a failure and was consequently removed, giving a survival rate of 97.5% after 1 year of loading. Radiographs showed a mean of 26.5% shrinkage of the augmented area. A significant resorption of CaS was noted with a mean value of 8.8% of remaining graft material after 4 months of healing. The biopsies also revealed new bone formation with a mean value of 21.2% of the total biopsy area. Histology showed signs of an acellular substitution of CaS with bone-like tissue.

    Conclusion: The results of this study show that new bone regeneration occurs in the maxillary sinus after augmentation with CaS. This enabled successful placement, integration, and loading of dental implants in the posterior maxilla, as only 1 of 40 implants was lost during 1 year of follow-up.

  • 40. De Petris, Luigi
    et al.
    Brandén, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.
    Herrmann, Richard
    Sanchez, Betzabe Chavez
    Koyi, Hirsh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden.
    Linderholm, Barbro
    Lewensohn, Rolf
    Linder, Stig
    Lehtiö, Janne
    Diagnostic and prognostic role of plasma levels of two forms of cytokeratin 18 in patients with non-small-cell lung cancer2011In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 47, no 1, 131-137 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    Cytokeratin 18 (CK18) can be used as a serum biomarker for carcinoma cell death, whereas caspase-cleaved (ccCK18) fragments reflect tumour apoptosis. We explored the potential diagnostic and prognostic role of circulating CK18 and ccCK18 in patients with non-small-cell lung cancer (NSCLC) in comparison with Cyfra 21.1, a fragment of cytokeratin 19.

    METHODS:

    Subject cohorts consisted of 200 healthy blood donors (HBD), 113 patients with benign lung diseases (BLD) and 179 NSCLC cases. Plasma levels of ccCK18, total CK18 and Cyfra 21.1 were determined with ELISA assays.

    RESULTS:

    Plasma levels of ccCK18 and total CK18 were higher in the NSCLC group compared to the HBD and BLD cohorts (p<0.0001). Using a cut-off of 104 U/L for ccCK18 and 302 U/L for total CK18 (95% specificity in the HBD group) the diagnostic accuracy of both CK18 forms to distinguish between NSCLC and BLD cases was 56%, whereas it was 94% for Cyfra 21.1. Multivariate survival analysis showed that total CK18 was a stronger prognostic factor than both ccCK18 and Cyfra 21.1 (HR 0.64 for low versus high total CK18 levels, 95% confidence interval (CI) 0.50-0.82; p=0.0004) in the entire NSCLC cohort and in 78 patients with locally advanced or metastatic disease treated with chemoradiotherapy or first-line chemotherapy (HR 0.70 95% CI 0.52-0.94; p=0.018).

    CONCLUSIONS:

    Cyfra 21.1 is a useful diagnostic biomarker for NSCLC. Total CK18 shows a promising potential as prognostic marker in NSCLC patients, independently of the therapeutical intervention. In contrast, ccCK18 was not of prognostic value in NSCLC, suggesting that tumour necrosis is of particular importance in this disease.

  • 41. Devenney, Irene
    et al.
    Norrman, Gunilla
    Uppsala University, Interfaculty Units, Centrum för klinisk forskning, Gävleborg.
    Oldaeus, Göran
    Strömberg, Leif
    Fälth-Magnusson, Karin
    A new model for low-dose food challenge in children with allergy to milk or egg.2006In: Acta Paediatr, ISSN 0803-5253, Vol. 95, no 9, 1133-9 p.Article in journal (Refereed)
    Abstract [en]

    Division of Paediatrics, Department of Molecular and Clinical Medicine, Faculty of Health Sciences, Linköping University, Linköping, and Paediatric Clinic, County Hospital Ryhov, Fonköping, Sweden. irene.devenney@lio.se

    BACKGROUND: Atopic eczema and food allergy are common in early childhood. Children seem to gradually develop tolerance to milk and egg, and it is a relief for families when their child can tolerate small amounts of these basic foods, even if larger doses may still cause symptoms. AIM: To develop a model for low-dose oral food challenge, facilitating re-/introduction of milk or egg. METHODS: In 39 children sensitized to milk and/or egg, we performed 52 challenges using a new standardized model for low-dose oral food challenge. The recipes were validated for blinding with sensorial tests. RESULTS: Four children challenged to milk had a positive challenge outcome. There were no significant differences with respect to family history, associated atopic manifestations, nutritional supply, eczema severity, or skin-prick test compared with the non-reacting children, but total and specific IgE values were significantly higher. All but two of the non-reacting children were able to introduce milk and egg into their diet without problems. CONCLUSION: We report recipes and a protocol to be used for standardized open and double-blind placebo-controlled low-dose food challenge in young children, enabling the introduction of small amounts of egg and milk into the diet during tolerance development.

  • 42.
    Djavani, K
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences. Interfaculty Units, Centrum för klinisk forskning, Gävleborg.
    Wanhainen, A
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Björck, M
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Intra-abdominal hypertension and abdominal compartment syndrome following surgery for ruptured abdominal aortic aneurysm.2006In: Eur J Vasc Endovasc Surg, ISSN 1078-5884, Vol. 31, no 6, 581-4 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the importance of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), based on the December 2004 consensus definition, on outcome after surgery for ruptured abdominal aortic aneurysm (rAAA). METHODS: Twenty-seven patients underwent open surgery for rAAA after the introduction of intra-abdominal pressure (IAP) measurements among patients at risk of IAH. Case-records were reviewed retrospectively. Seventeen patients underwent IAP-monitoring. RESULTS: Of eight patients with IAP <21 mmHg none developed colonic ischaemia or ACS. Of four patients with IAP 21-25 mmHg (IAH grade III), two underwent colonic resection. One patient treated with open abdomen died from cardiac arrhythmia. Five patients had IAP >25 mmHg (IAH grade IV). All developed ACS. Two were not decompressed and both developed pulmonary complications, one died. Two underwent colonic resection and one was treated with open abdomen, all three survived. Of 10 patients not monitored for IAP, one died of cardiac complications, but no patient developed signs of colonic ischaemia or ACS. Mortality at 30 days and 1 year was 3/27 (11%). CONCLUSION: IAH and ACS were common among patients undergoing surgery for rAAA. The ACS consensus definition seems appropriate in this clinical context. Monitoring IAP, and timely decompression of patients with IAH might improve outcome after surgery for rAAA.

  • 43.
    Djavani-Gidlund, Khatereh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    A comparative study of extra- and intraluminal sigmoid colonic tonometry to detect colonic hypoperfusion after operation for abdominal aortic aneurysm2011In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 42, no 3, 302-308 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: There is no ideal method to monitor colonic perfusion after abdominal aortic aneurysm (AAA) repair. The aim was to evaluate extraluminal sigmoid colon tonometry, comparing with the established intraluminal method.

    Methods: Eighteen patients were monitored with both methods, 10 after elective and eight after ruptured AAA repair. One tonometric catheter was placed inside the sigmoid colon (intraluminal) and another extraluminally in close contact with the serosa of the sigmoid colon (extraluminal). Intra- and extraluminal partial pressure of carbon dioxide (pCO2) were measured every 10 min during 48 h postoperatively, 1536 simultaneous measurements. Intraluminal pH (pHi) and extraluminal pH (pHe) were calculated, and intra-abdominal pressure (IAP) was measured, every 4 h. Colonic ischaemia was defined as pHi ≤ 7.1.

    Results: Mean pHi was 7.18 ± 0.11 and mean pHe was 7.28 ± 0.09. With a pHe cut-off value of ≤7.2, the sensitivity and specificity to detect colonic ischaemia were 95% and 95%, respectively. Accuracy was 95% and the positive and negative predictive values 0.80 and 0.99, respectively. The positive likelihood ratio was 19 and the negative likelihood ratio 0.05.

    Conclusion: Extraluminal tonometry may serve as a screening test: A pHe-value <7.2 indicates suspected colonic ischaemia, meriting further investigation. It was not able to evaluate the severity of ischaemia.

  • 44.
    Djureinovic, Dijana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Hallström, Bjorn M.
    KTH Royal Inst Technol, Sci Life Lab, Stockholm, Sweden..
    Horie, Masafumi
    Univ Tokyo, Grad Sch Med, Dept Resp Med, Tokyo, Japan..
    Mattsson, Johanna Sofia Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    La Fleur, Linnea
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Fagerberg, Linn
    KTH Royal Inst Technol, Sci Life Lab, Stockholm, Sweden..
    Brunnström, Hans
    Reg Labs Reg Skane, Dept Pathol, Lund, Sweden..
    Lindskog, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Madjar, Katrin
    Tech Univ Dortmund, Dept Stat, Dortmund, Germany..
    Rahnenfuehrer, Joerg
    Tech Univ Dortmund, Dept Stat, Dortmund, Germany..
    Ekman, Simon
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Ståhle, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Koyi, Hirsh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Brandén, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Edlund, Karolina
    Tech Univ Dortmund, Leibniz Res Ctr Working Environm & Human Factors, Dortmund, Germany..
    Hengstler, Jan G.
    Tech Univ Dortmund, Leibniz Res Ctr Working Environm & Human Factors, Dortmund, Germany..
    Lambe, Mats
    Univ Uppsala Hosp, Reg Canc Ctr, Uppsala, Sweden..
    Saito, Akira
    Univ Tokyo, Grad Sch Med, Dept Resp Med, Tokyo, Japan..
    Botling, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular tools.
    Pontén, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Uhlen, Mathias
    KTH Royal Inst Technol, Sci Life Lab, Stockholm, Sweden..
    Micke, Patrick
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Profiling cancer testis antigens in non-small-cell lung cancer2016In: JCI INSIGHT, ISSN 2379-3708, Vol. 1, no 10, e86837Article in journal (Refereed)
    Abstract [en]

    Cancer testis antigens (CTAs) are of clinical interest as biomarkers and present valuable targets for immunotherapy. To comprehensively characterize the CTA landscape of non-small-cell lung cancer (NSCLC), we compared RNAseq data from 199 NSCLC tissues to the normal transcriptome of 142 samples from 32 different normal organs. Of 232 CTAs currently annotated in the Caner Testis Database (CTdatabase), 96 were confirmed in NSCLC. To obtain an unbiased CTA profile of NSCLC, we applied stringent criteria on our RNAseq data set and defined 90 genes as CTAs, of which 55 genes were not annotated in the CTdatabase, thus representing potential new CTAs. Cluster analysis revealed that CTA expression is histology dependent and concurrent expression is common. IHC confirmed tissue-specific protein expression of selected new CTAs (TKTL1, TGIF2LX, VCX, and CXORF67). Furthermore, methylation was identified as a regulatory mechanism of CTA expression based on independent data from The Cancer Genome Atlas. The proposed prognostic impact of CTAs in lung cancer was not confirmed, neither in our RNAseq cohort nor in an independent meta-analysis of 1,117 NSCLC cases. In summary, we defined a set of 90 reliable CTAs, including information on protein expression, methylation, and survival association. The detailed RNAseq catalog can guide biomarker studies and efforts to identify targets for immunotherapeutic strategies.

  • 45.
    Doohan, Isabelle
    et al.
    Umea Univ, Ctr Res & Dev Disaster Med, Dept Surg & Perioperat Sci, Sect Surg, Umea, Sweden.;Umea Univ, Dept Nursing, Umea, Sweden.;Umea Univ, Artic Res Ctr, Umea, Sweden..
    Björnstig, Ulf
    Umea Univ, Ctr Res & Dev Disaster Med, Dept Surg & Perioperat Sci, Sect Surg, Umea, Sweden..
    Östlund, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Linnaeus Univ, Ctr Collaborat Palliat Care, Kalmar Vaxjo, Sweden..
    Saveman, Britt-Inger
    Umea Univ, Dept Nursing, Umea, Sweden.;Umea Univ, Artic Res Ctr, Umea, Sweden..
    Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, 165-174 p.Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery. Methods The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis. Results Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four core cases of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash. Conclusion The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery.

  • 46.
    Dorell, Åsa
    et al.
    Umeå universitet, Institutionen för omvårdnad.
    Östlund, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Sundin, Karin
    Umeå universitet, Institutionen för omvårdnad.
    Nurses' perspective of conducting family conversation2016In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 11, 30867Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Nurses are in a prime position to manage to support families that have a family member living in a residential home for older people. Nurses' attitudes about meeting patients' family members vary. Studies describe that some nurses consider family members as a burden. But some nurses consider family members a resource and think it is important to establish good relationships with them.

    AIM: The aim of this study was to describe how registered nurses (RNs) experienced to participate in and conduct the intervention Family Health Conversations (FamHCs) with families in residential homes for older people.

    METHODS: The intervention FamHC was accomplished at three residential homes for older people. FamHC is a family systems nursing (FSN) intervention developed to support families facing the ill health of someone in the family. One RN from each residential home conducted the conversations. The RNs wrote diary notes directly after each conversation. The RNs were also interviewed 1 month after they had each conducted four FamHCs. The diary notes and the interviews were analysed separately by qualitative content analysis, and the findings were then summarized in one theme and further discussed together.

    FINDINGS: The main findings were that the RNs experience the conversations as a valuable professional tool involving the whole family. The RNs grasped that silence can be a valuable tool and had learned to attentively listen to what the families were saying without interrupting, allowing them and the families to reflect upon what the family members said.

    CONCLUSION: The findings show that the FamHC can be helpful for RNs in their work, helping them to perceive and understand the needs and desires of the families.

  • 47.
    Eaker, Sonja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Dickman, Paul W.
    Hellström, Vivan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Transplantation Surgery.
    Zack, Matthew M.
    Ahlgren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Regional differences in breast cancer survival despite common guidelines2005In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 14, no 12, 2914-8 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Despite a uniform regional breast cancer care program, breast cancer survival differs within regions. We therefore examined breast cancer survival in relation to differences in diagnostic activity, tumor characteristics, and treatment in seven Swedish counties within a single health care region. METHODS: We conducted a population-based observational study using a clinical breast cancer register in one Swedish health care region. Eligible women (n = 7,656) ages 40 to 69 years diagnosed with primary breast cancer between 1992 and 2002 were followed up until 2003. The 7-year relative survival ratio was used to estimate breast cancer survival. Excess mortality was modeled using Poisson regression to study differences in survival between counties. RESULTS: The 7-year relative survival for breast cancer patients was significantly lower (up to 7% in absolute risk difference) in one county (county A) compared with the others. This difference existed only among women diagnosed before 1998, ages 50 to 59 years, and was strongest among stage II breast cancer patients. Adjustment for amount of diagnostic activity eliminated the survival differences among the counties. The amount of diagnostic activity was also lower in county A during the same time period. After county A, during 1997-1998, began to adhere strictly to the regional breast cancer care program, neither any survival differences nor diagnostic activity differences were observed. INTERPRETATIONS: Markers of diagnostic activity explained survival differences within our region, and the underlying mechanisms may be several. Low diagnostic activity may entail later diagnosis or inadequate characterization of the tumor and thereby missed treatment opportunities. Strengthening of multidisciplinary management of breast cancer can improve survival.

  • 48.
    Eaker, Sonja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Halmin, Märit
    Bellocco, Rino
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Ahlgren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Lambe, Mats
    Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden)2009In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 124, no 1, 180-187 p.Article in journal (Refereed)
    Abstract [en]

    Epidemiologic studies have shown that cancer survival is poorer in low compared with high socioeconomic groups. We investigated whether these differences were associated with disparities in tumour characteristics and management. This cohort study was based on 9,908 women aged 20-79 years at diagnosis with primary breast cancer identified in a Swedish population-based clinical register. Information on socioeconomic standing was obtained from a social database. The 5-year cause-specific survival (CSS) and mortality hazard ratios (HR) were estimated by Cox proportional hazard models to assess differences in survival between socioeconomic groups while adjusting for diagnostic intensity, tumour characteristics and treatment. Following adjustment for age, year and stage at diagnosis, the risk of dying of breast cancer was 35% lower among women with high education compared with that of low education (HR = 0.65, 95% CI 0.53-0.80). When compared with women with high education, a lower percentage of women with low education had been investigated for proliferation (84 vs. 76%) or hormone receptor status (89 vs. 81%), had tumours <or=20 mm (68 vs. 64%), were treated at a main hospital (75 vs. 68%) and had received radiation treatment (80 vs. 67%) or chemotherapy (31 vs. 18%). However, these proportional differences could not explain the observed social gradient in survival. To minimize social differences in breast cancer survival, further research should address not only factors leading to inequities in management but also focus on patient factors such as health awareness, comorbidity burden and compliance to adjuvant treatment.

  • 49.
    Eaker, Sonja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Wigertz, Annette
    Lambert, Paul C
    Bergkvist, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Ahlgren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Research and Development, Gävleborg.
    Lambe, Mats
    Breast cancer, sickness absence, income and marital status: A study on life situation 1 year prior diagnosis compared to 3 and 5 years after diagnosis2011In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, no 3, e18040- p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Improved cancer survival poses important questions about future life conditions of the survivor. We examined the possible influence of a breast cancer diagnosis on subsequent working and marital status, sickness absence and income.

    MATERIALS:

    We conducted a matched cohort study including 4,761 women 40-59 years of age and registered with primary breast cancer in a Swedish population-based clinical register during 1993-2003, and 2,3805 women without breast cancer. Information on socioeconomic standing was obtained from a social database 1 year prior and 3 and 5 years following the diagnosis. In Conditional Poisson Regression models, risk ratios (RRs) and 95% confidence intervals (CIs) were estimated to assess the impact of a breast cancer diagnosis.

    FINDINGS:

    Three years after diagnosis, women who had had breast cancer more often had received sickness benefits (RR = 1.49, 95% CI 1.40-1.58) or disability pension (RR = 1.47, 95% CI 1.37-1.58) than had women without breast cancer. We found no effect on income (RR = 0.99), welfare payments (RR = 0.98), or marital status (RR = 1.02). A higher use of sickness benefits and disability pension was evident in all stages of the disease, although the difference in use of sickness benefits decreased after 5 years, whereas the difference in disability pension increased. For woman with early stage breast cancer, the sickness absence was higher following diagnosis among those with low education, who had undergone mastectomy, and had received chemo- or hormonal therapy. Neither tumour size nor presence of lymph nodes metastasis was associated with sickness absence after adjustment for treatment.

    INTERPRETATION:

    Even in early stage breast cancer, a diagnosis negatively influences working capacity both 3 and 5 years after diagnosis, and it seems that the type of treatment received had the largest impact. A greater focus needs to be put on rehabilitation of breast cancer patients, work-place adaptations and research on long-term sequelae of treatment.

  • 50.
    Edman, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Ctr Oral Rehabil, S-79127 Falun, Sweden..
    Ohrn, K.
    Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    Nordstrom, B.
    Adm Ctr Publ Dent Serv, Falun, Sweden..
    Holmlund, A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Natl Dent Serv Gavleborg, Gavle, Sweden.;Uppsala Univ Reg Gavleborg, Clin Res Ctr, Gavle, Sweden..
    Hellberg, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Clin Res Ctr, Falun, Sweden..
    Trends over 30years in the prevalence and severity of alveolar bone loss and the influence of smoking and socio-economic factors: based on epidemiological surveys in Sweden 1983-20132015In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 13, no 4, 283-291 p.Article in journal (Refereed)
    Abstract [en]

    ObjectiveEpidemiological studies of the prevalence of periodontitis over an extended time using the same methodology to investigate and classify periodontitis are sparse in the literature. Smoking and socio-economic factors have been proven to increase the risk for periodontal disease. The objective of this study was to investigate 30-year time trends, using the same methodology to classify the prevalence and severity in alveolar bone loss (ABL) and to investigate the influence of tobacco and socio-economic factors. MethodsFour cross-sectional epidemiological studies in an adult population were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008 and 2013. Random samples of 787-1133 individuals aged 35-85 who answered a questionnaire about tobacco use and socio-economic factors were radiographically and clinically examined. A number of teeth, ABL and calculus visible on radiographs were registered. The severity of ABL as detected on radiographs was classified into no bone loss, moderate or severe. ResultsThe prevalence of moderate ABL decreased from 45% in 1983 to 16% in 2008, but increased to 33% in 2013 (P<0.05). The prevalence of severe ABL remained the same from 1983 (7%) to 2013 (6%). Calculus visible on radiographs increased from 22% in 2008 to 32% in 2013 (P<0.05). Socio-economic factors had limited impact on the severity of ABL. ConclusionModerate ABL and calculus visible on radiographs significantly increased between 2008 and 2013. Smoking was the strongest factor associated with ABL overall.

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