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  • 201. Kårefjärd, Ann
    et al.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Effects of dog-assisted intervention on quality of life in nursing home residents with dementia2019In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 26, no 6, p. 433-440Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention.

    AIM: This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia.

    MATERIALS AND METHODS: A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated.

    RESULTS: The participants' total scores improved significantly between baseline and post-test 1 (p = < 0.001) and worsened significantly at post-test 2 (p = 0.025). The largest effect size was found for the item 'Verbalization suggests discomfort' (p = 0.001).

    CONCLUSION: The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia.

    SIGNIFICANCE: The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.

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  • 202.
    Laaveri, Tinja
    et al.
    Univ Helsinki, Div Infect Dis, Inflammat Ctr, POB 348, FIN-00029 Helsinki, Hus, Finland.;Helsinki Univ Hosp, POB 348, FIN-00029 Helsinki, Hus, Finland..
    Sterne, Jesper
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Sormland Cty Council, Clin Res Ctr, Eskilstuna, Sweden..
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Sormland Cty Council, Clin Res Ctr, Eskilstuna, Sweden.;Karolinska Inst, Dept Med Solna, Infect Dis Unit, SE-17176 Stockholm, Sweden..
    Kantele, Anu
    Univ Helsinki, Div Infect Dis, Inflammat Ctr, POB 348, FIN-00029 Helsinki, Hus, Finland.;Helsinki Univ Hosp, POB 348, FIN-00029 Helsinki, Hus, Finland.;Karolinska Inst, Dept Med Solna, Infect Dis Unit, SE-17176 Stockholm, Sweden.;Univ Helsinki, Dept Med, FIN-00029 Helsinki, Hus, Finland..
    Systematic review of loperamide: No proof of antibiotics being superior to loperamide in treatment of mild/moderate travellers' diarrhoea2016In: Travel Medicine and Infectious Disease, ISSN 1477-8939, E-ISSN 1873-0442, Vol. 14, no 4, p. 299-312Article, review/survey (Refereed)
    Abstract [en]

    Looking at the worldwide emergency of antimicrobial resistance, international travellers appear to have a central role in spreading the bacteria across the globe. Travellers' diarrhoea (TD) is the most common disease encountered by visitors to the (sub) tropics. Both TD and its treatment with antibiotics have proved significant independent risk factors of colonization by resistant intestinal bacteria while travelling. Travellers should therefore be given preventive advice regarding TD and cautioned about taking antibiotics: mild or moderate TD does not require antibiotics. Logical alternatives are medications with effects on gastrointestinal function, such as loperamide. The present review explores literature on loperamide in treating TD. Adhering to manufacturer's dosage recommendations, loperamide offers a safe and effective alternative for relieving mild and moderate symptoms. Moreover, loperamide taken singly does no predispose to contracting MDR bacteria. Most importantly, we found no proof that would show antibiotics to be significantly more effective than loperamide in treating mild/moderate TD.

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  • 203.
    Landén Ludvigsson, Maria
    et al.
    Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden.;Cty Council Ostergotland, Dept Rehabil & Med, Rehab Vast..
    Peolsson, Anneli
    Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, 58183 Linköping, Sweden.
    Dedering, Åsa
    Karolinska Univ Hosp, Allied Hlth Professionals Funct, Huddinge, Sweden.;Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden..
    Johansson, Gun
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, Stockholm, Sweden..
    Bernfort, Lars
    Linkoping Univ, Dept Med & Hlth Sci, Div Hlth Care Anal, Linkoping, Sweden..
    Cost-effectiveness of neck-specific exercise with or without a behavioral approach versus physical activity prescription in the treatment of chronic whiplash-associated disorders: Analyses of a randomized clinical trial2017In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 25, article id e7274Article in journal (Refereed)
    Abstract [en]

    Background: Fifty percent of people injured by whiplash still report neck pain after 1 year and costs associated with whiplash associated disorders (WAD) are mostly attributed to health service and sick-leave costs in chronic conditions. With increasing health care expenditures the economic impact of interventions needs to be considered.

    Objective: To analyze the cost-effectiveness of physiotherapist-led neck-specific exercise without (NSE) or with a behavioral approach (NSEB), or prescription of physical activity (PPA) in chronic WAD, grade 2 to 3.

    Methods: This is a secondary cost-effectiveness analysis of a multicenter randomized clinical trial of 216 participants with chronic WAD grade 2 to 3. The interventions were physiotherapist-led neck-specific exercise without or with a behavioral approach, or prescription of physical activity for 12 weeks. Incremental cost-effectiveness ratios (ICERs) were determined after 1 year and bootstrapped cost-effectiveness planes and sensitivity analyses of physiotherapy visits were performed. Health care and production loss costs were included and quality-adjusted life years (QALYs) were estimated, using the Euroqol-5D questionnaire. Comparisons with the Short Form-6D, and neck disability index (NDI) were also made.

    Results: The 1-year follow-up was completed by 170 participants (79%). Both physiotherapist-led groups improved in health related quality of life. The intervention cost alone, per quality-adjusted life year (QALY) gain in the NSE group was US$12,067. A trend for higher QALY gains were observed in the NSEB group but the costs were also higher. The ICERs varied depending on questionnaire used, but the addition of a behavioral approach to neck-specific exercise alone was not cost-effective from a societal perspective (ICER primary outcome $127,800 [95% confidence interval [CI], 37,816-711,302]). The sensitivity analyses confirmed the results. The prescription of physical activity did not result in any QALY gain and the societal costs were not lower.

    Conclusion: Neck-specific exercise was cost-effective from a societal perspective in the treatment of chronic WAD compared with the other exercise interventions. ICERS varied depending on health-related quality of life questionnaires used, but the addition of a behavioral approach was not cost-effective from a societal perspective. The prescription of physical activity did not result in any QALY gain and was thus not considered a relevant option.

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  • 204. Landén Ludvigsson, Maria
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Dedering, Åsa
    Falla, Deborah
    Peolsson, Anneli
    Factors associated with pain and disability reduction following exercise interventions in chronic whiplash2016In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 2, p. 307-315Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Some studies support the prescription of exercise for people with whiplash-associated disorders (WAD); however, the response is highly variable. Further research is necessary to identify factors which predict response.

    METHODS:

    This is a secondary analysis of a randomized, multicentre controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioural approach, or prescription of physical activity for 12 weeks. Treatment response, defined as a clinical important reduction in pain or disability, was registered after 3 and 12 months, and factors associated with treatment response were explored using logistic regression.

    RESULTS:

    Participation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12 months. Patients in this group had up to 5.3 times higher odds of disability reduction and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain vs. disability).

    CONCLUSION:

    Factors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for individuals with chronic WAD.

  • 205. Landén Ludvigsson, Maria
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Jull, Gwendolen
    Trygg, Johan
    Peolsson, Anneli
    Mechanical properties of the trapezius during scapular elevation in people with chronic whiplash associated disorders: A case-control ultrasound speckle tracking analysis2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 21, p. 177-182Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Approximately 50% of people with Whiplash Associated Disorders (WAD) report longstanding symptoms. The upper trapezius is commonly painful yet its mechanical properties are not fully understood.

    OBJECTIVES:

    This study examined the deformation of different depths of the upper trapezius muscle during a scapular elevation task (shoulder shrugging) before and following loaded arm abduction.

    DESIGN AND METHODS:

    A cross-sectional case-control study of 36 people (26 female and 10 male, mean age 38 (SD 11)) with chronic WAD and 36 controls, matched for age and gender. Real-time ultrasound recordings of upper trapezius were taken during both scapular elevation tasks. Post-process speckle tracking analysis was undertaken of three different sections of the upper trapezius muscle (superficial, middle, deep).

    RESULTS:

    The WAD group had lower deformation of the superficial section of the upper trapezius compared to the control group in both concentric and eccentric phases of scapular elevation (p < 0.05) especially before the loaded arm abduction. After arm abduction, the deformation of the trapezius was reduced in both groups but only significantly in the WAD-group (p = 0.03). Within-group analysis revealed that the control group least engaged the deep section of upper trapezius during the task (p < 0.01).

    CONCLUSION:

    This study, measuring mechanical deformation of the upper trapezius during a scapular elevation task indicates that persons with WAD may display different patterns in engagement of the muscle sections than those in the control group. Further research is needed to replicate and understand the reasons for and implications of this possible change in motor strategy within upper trapezius. Clinical Trials.gov, Number: NCT01547624.

  • 206. Landén Ludvigsson, Maria
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Peolsson, Anneli
    The effect of three exercise approaches on health-related quality of life, and factors associated with its improvement in chronic whiplash-associated disorders: analysis of a randomized controlled trial.2019In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 28, no 2, p. 357-368Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim was to evaluate whether neck-specific exercise, with (NSEB) or without (NSE) a behavioural approach, improves health-related quality of life (HRQoL) compared to physical activity prescription (PPA) in chronic whiplash-associated disorders (WAD) grades 2 and 3. A secondary aim was to identify factors associated with HRQoL and HRQoL improvement following exercise interventions.

    METHODS: This is a secondary analysis of a multicentre randomized clinical trial. Participants (n = 216) with chronic WAD grades 2 and 3 were randomized to 12 weeks of PPA or physiotherapist-led NSE or NSEB. The EQ-5D 3L/EQ-VAS and SF-36v2 physical (PCS) and mental (MCS) component summaries were collected together with several neck-related and psychosocial outcomes at baseline, after 3, 6 and 12 months, and were analysed with linear mixed models (all time points) and multivariate linear regressions (baseline, 6 months).

    RESULTS: NSE/NSEB resulted in better outcomes than PPA (EQ-VAS and SF-36 PCS, both groups, p < 0.01) but not in a higher EQ-5D score. Improvement over time was seen in EQ-5D/EQ-VAS for the NSEB group (p < 0.01), and for NSE/NSEB as measured with the PCS (p < 0.01). Factors associated with baseline HRQoL and change to 6 months in HRQoL (R2 = 0.38-0.59) were both neck-related and psychosocial (e.g. depression, work ability).

    CONCLUSION: Neck-specific exercise, particularly with a behavioural approach, may have a more positive impact on HRQoL than physical activity prescription in chronic WAD grades 2 and 3. HRQoL is however complex, and other factors also need to be considered. Factors associated with HRQL and improvements in HRQoL following exercise are multidimensional.

    TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, No. NCT01528579.

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  • 207.
    Landén Ludvigsson, Maria
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden;Linkoping Univ, Dept Rehabil, Ostergotland Cty Council, Rehab Vast, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Widh, Simon
    Linkoping Univ, Dept Med & Hlth Sci, Cty Council Ostergotland, Rorelse Halsa, Linkoping, Sweden.
    Peolsson, Anneli
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden.
    Exercise, headache, and factors associated with headache in chronic whiplash: Analysis of a randomized clinical trial2019In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 98, no 48, article id e18130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Almost 40% of individuals with chronic whiplash-associated disorders (WAD) report headache after 5 years, making it one of the most common persistent symptoms besides neck pain, but randomized treatment studies are lacking. This study aimed to evaluate the effect of 3 different exercise approaches on headache in chronic WAD grades 2 and 3, and to identify potential factors associated with such headache, and whether they differ depending on 3 different aspects of such headache (current headache, maximum headache, or headache bothersomeness).

    METHODS: This was an analysis of a randomized clinical trial of people with chronic WAD and headache (n = 188), who were randomized to either 12 weeks of neck-specific exercise without (NSE) or with a behavioral approach (NSEB) or physical activity prescription (PPA). Data were collected at baseline and at 3, 6, and 12 months. Physical and psychosocial factors were tested for association with headache. Multivariate regression models and linear mixed models were used.

    RESULTS: The NSE/NSEB groups reported reduced headache both over time and compared to PPA. Up to 51% (NSE) and 61% (NSEB) reported at least 50% reduction in their headache at 12 months. The PPA group was not improved over time. Neck pain and dizziness were associated with headache regardless of aspect of headache. The only associated psychosocial factor was anxiety, which was associated with headache bothersomeness. Other factors were mainly physical, and up to 51% of the variance was explained.

    CONCLUSION: Headache in chronic WAD, may be reduced with neck-specific exercise with or without a behavioral approach. Chronic headache was associated with neck pain and dizziness regardless of aspect tested. Other factors associated with headache in chronic WAD were mainly physical rather than psychosocial.

    TRIAL REGISTRATION NUMBER: Clinical Trials.gov, no: NCT015285.

  • 208.
    Larsson, Anders
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Palm, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Insulin-like growth factor binding protein-1 (IGFBP-1) during normal pregnancy2013In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 29, no 2, p. 129-132Article in journal (Refereed)
    Abstract [en]

    Background:

    Insulin-like growth factor (IGF) binding protein-1 (IGFBP-1) is the main binder of IGFs in secretory endometrium and decidualized stromal endometrial cells and IGFBP-1 has been shown to modulate IGF bioactivities and influence fetal growth. To be able to evaluate IGFBP-1 values during pregnancy it is important to establish normal values in pregnant women.

    Materials & Methods:

    We have studied IGFBP-1 concentrations in maternal plasma from 52 healthy women with normal singleton pregnancies. Several plasma samples were collected from each woman and the samples were grouped according to gestational age into the following periods: week 7-17; week 17-24; week 24-28; week 28-31; week 31-34; week 34-38; -2 to 0 weeks prior to delivery and postpartum (>6 weeks after delivery).

    Results:

    The 2.5 and 97.5 percentiles for IGFBP-1 were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference values.

    Conclusions:

    IGFBP-1 is increased during pregnancy compared to postpartum. Two peaks, at week 17-24 and just before delivery, were observed.

  • 209.
    Larsson, Mattias Holmqvist
    et al.
    Linkoping Univ, Dept Psychiat, Linkoping, Sweden; Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden.
    Falkenström, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden.
    Andersson, Gerhard
    Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden; Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Holmqvist, Rolf
    Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden.
    Alliance ruptures and repairs in psychotherapy in primary care2018In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 28, no 1, p. 123-136Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The association between alliance level and outcome in psychotherapy has been extensively studied. One way to expand this knowledge is to study alliance patterns. The main aims of this study were to examine how frequent alliance patterns with ruptures or rupture-repair episodes were in a naturalistic sample of psychotherapies in primary care, and if three alliance patterns (a Rupture pattern, a Repair pattern, and a No Rupture pattern) were differentially associated with treatment outcome.

    METHOD: The psychotherapies (N = 605) included a wide range of different treatment orientations and patient diagnoses. Alliance patterns were studied at session-to-session level, using patient-rated alliance scores. Outcome data were analyzed using longitudinal multilevel modeling with a slopes-as-outcomes model.

    RESULTS: The Repair pattern accounted for 14.7% (n = 89) of the treatments, 10.7% (n = 65) exhibited a Rupture pattern, and 74.5% (n = 451) contained no ruptures. The Rupture pattern was associated with inferior treatment outcomes. The Repair pattern was, in longer treatments, associated with better outcomes than the No Rupture pattern.

    CONCLUSIONS: The results support theory about the importance of ruptures in the therapeutic alliance and suggest that identification of alliance ruptures is important in alliance-outcome research, for feedback purposes in clinical practice, and in training of therapists.

  • 210.
    Lee, Catherine J.
    et al.
    Univ Utah, Huntsman Canc Inst, Utah Blood & Marrow Transplant Program, 2000 Circle Hope,Room 2152, Salt Lake City, UT 84112 USA..
    Kim, Soyoung
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Heath & Equ, Div Biostat, Milwaukee, WI 53226 USA..
    Tecca, Heather R.
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Bo-Subait, Stephanie
    Natl Marrow Donor Program Be Match, CIBMTR, Minneapolis, MN USA..
    Phelan, Rachel
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Brazauskas, Ruta
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Heath & Equ, Div Biostat, Milwaukee, WI 53226 USA..
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA..
    Hamilton, Betty K.
    Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA..
    Battiwalla, Minoo
    Sarah Cannon Bone Marrow Transplant Program, Hematol Branch, Nashville, TN USA..
    Majhail, Navneet S.
    Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA..
    Lazarus, Hillard M.
    Case Western Reserve Univ, Univ Hosp Case Med Ctr, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA..
    Shaw, Peter J.
    Childrens Hosp Westmead, Westmead, NSW, Australia..
    Marks, David, I
    Univ Hosp Bristol Natl Hlth Serv Trust, Adult Bone Marrow Transplant, Bristol, Avon, England..
    Litzow, Mark R.
    Mayo Clin, Div Hematol & Transplant Ctr, Rochester, MN USA..
    Chhabra, Saurabh
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan..
    DeFilipp, Zachariah
    Massachusetts Gen Hosp, Blood & Marrow Transplant Program, Boston, MA 02114 USA..
    Hildebrandt, Gerhard C.
    Univ Kentucky, Markey Canc Ctr, Lexington, KY USA..
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
    Kasow, Kimberly A.
    Univ N Carolina, Pediat Hematol Oncol & Bone Marrow & Stem Cell Tr, Chapel Hill, NC 27515 USA..
    Liesveld, Jane L.
    Univ Rochester, Med Ctr, Dept Med, Rochester, NY 14642 USA..
    Rotz, Seth J.
    Cleveland Clin Childrens Hosp, Dept Pediat Hematol Oncol & Blood & Marrow Transp, Cleveland, OH USA..
    Badawy, Sherif M.
    Ann & Robert H Lurie Childrens Hosp Chicago, Div Hematol Oncol & Stem Cell Transplant, Chicago, IL 60611 USA.;Northwestern Univ, Dept Pediat, Feinberg Sch Med, Chicago, IL 60611 USA..
    Bhatt, Neel S.
    Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA..
    Yared, Jean A.
    Univ Maryland, Dept Med, Greenebaum Comprehens Canc Ctr, Blood & Marrow Transplantat Program,Div Hematol O, Baltimore, MD 21201 USA..
    Page, Kristin M.
    Duke Univ, Med Ctr, Div Pediat Blood & Marrow Transplantat, Durham, NC USA..
    Arellano, Martha L.
    Emory Univ, Winship Canc Inst, Atlanta, GA 30322 USA..
    Kent, Michael
    Levine Childrens Hosp, Charlotte, NC USA..
    Farhadfar, Nosha
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA..
    Seo, Sachiko
    Dokkyo Med Univ, Dept Haematol & Oncol, Mibu, Tochigi, Japan..
    Hematti, Peiman
    Univ Wisconsin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI USA..
    Freytes, Cesar O.
    Texas Transplant Inst, San Antonio, TX USA..
    Rovo, Alicia
    Univ Spital Bern, Inselspital, Bern, Switzerland..
    Ganguly, Siddhartha
    Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA..
    Nathan, Sunita
    Rush Univ, Med Ctr, Chicago, IL 60612 USA..
    Burns, Linda
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Shaw, Bronwen E.
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Muffly, Lori S.
    Stanford Univ, Div Blood & Marrow Transplantat, Stanford, CA 94305 USA..
    Late effects after ablative allogeneic stem cell transplantation for adolescent and young adult acute myeloid leukemia2020In: BLOOD ADVANCES, ISSN 2473-9529, Vol. 4, no 6, p. 983-992Article in journal (Refereed)
    Abstract [en]

    There is marked paucity of data regarding late effects in adolescents and young adults (AYAs) who undergo myeloablative conditioning (MAC) allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML). We evaluated late effects and survival in 826 1-year disease-free survivors of MAC HCT for AYA AML, with an additional focus on comparing late effects based upon MAC type (total body irradiation [TBI] vs high-dose chemotherapy only). The estimated 10-year cumulative incidence of subsequent neoplasms was 4% (95% confidence interval [CI], 2%-6%); 10-year cumulative incidence of nonmalignant late effects included gonadal dysfunction (10%; 95% CI, 8%-13%), cataracts (10%; 95% CI, 7%-13%), avascular necrosis (8%; 95% CI, 5%-10%), diabetes mellitus (5%; 95% CI, 3%-7%), and hypothyroidism (3%; 95% CI, 2%-5%). Receipt of TBI was independently associated with a higher risk of cataracts only (hazard ratio [HR], 4.98; P < .0001) whereas chronic graft-versus-host disease (cGVHD) was associated with an increased risk of cataracts (HR, 3.22; P = .0006), avascular necrosis (HR, 2.49; P = .006), and diabetes mellitus (HR, 3.36; P = .03). Estimated 10-year overall survival and leukemia-free survival were 73% and 70%, respectively, and did not differ on the basis of conditioning type. In conclusion, late effects among survivors of MAC HCT for AYA AML are frequent and are more closely linked to cGVHD than type of conditioning.

  • 211. Lennie, Terry A
    et al.
    Andreae, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Rayens, Mary Kay
    Song, Eun Kyeung
    Dunbar, Sandra B
    Pressler, Susan J
    Heo, Seongkum
    Kim, JinShil
    Moser, Debra K
    Micronutrient Deficiency Independently Predicts Time to Event in Patients With Heart Failure.2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 17, article id e007251Article in journal (Refereed)
    Abstract [en]

    Background Dietary micronutrient deficiencies have been shown to predict event-free survival in other countries but have not been examined in patients with heart failure living in the United States. The purpose of this study was to determine whether number of dietary micronutrient deficiencies in patients with heart failure was associated with shorter event-free survival, defined as a combined end point of all-cause hospitalization and death. Methods and Results Four-day food diaries were collected from 246 patients with heart failure (age: 61.5±12 years; 67% male; 73% white; 45% New York Heart Association [NYHA] class III / IV ) and analyzed using Nutrition Data Systems for Research. Micronutrient deficiencies were determined according to methods recommended by the Institute of Medicine. Patients were followed for 1 year to collect data on all-cause hospitalization or death. Patients were divided according to number of dietary micronutrient deficiencies at a cut point of ≥7 for the high deficiency category versus <7 for the no to moderate deficiency category. In the full sample, 29.8% of patients experienced hospitalization or death during the year, including 44.3% in the high-deficiency group and 25.1% in the no/moderate group. The difference in survival distribution was significant (log rank, P=0.0065). In a Cox regression, micronutrient deficiency category predicted time to event with depression, NYHA classification, comorbidity burden, body mass index, calorie and sodium intake, and prescribed angiotensin-converting enzyme inhibitors, diuretics, or β-blockers included as covariates. Conclusions This study provides additional convincing evidence that diet quality of patients with heart failure plays an important role in heart failure outcomes.

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  • 212.
    Leung, Ting Fan
    et al.
    Chinese Univ Hong Kong, Dept Paediat, Shatin, Hong Kong, Peoples R China..
    Liu, Anthony Pak-Yin
    Univ Hong Kong, Li Ka Shing Fac Med, Dept Paediat & Adolescent Med, Hong Kong, Hong Kong, Peoples R China..
    Lim, Fong Seng
    Natl Healthcare Grp Polyclin, Singapore, Singapore.;Natl Univ Singapore, Singapore, Singapore..
    Thollot, Franck
    AFPA, Esseys Les Nancy, France..
    Oh, Helen May Lin
    Changi Gen Hosp, Div Infect Dis, Singapore, Singapore..
    Lee, Bee Wah
    Natl Univ Singapore, Singapore, Singapore.;Mt Elizabeth Med Ctr, Singapore, Singapore..
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Stockholm, Sweden..
    Tan, Ngiap Chuan
    SingHlth Polyclin, Singapore, Singapore.;DUKE NUS Grad Med Sch, Singapore, Singapore..
    Rouzier, Roman
    Inst Curie, Paris, France..
    De Simoni, Stephanie
    GSK, Rixensart, Belgium..
    Suryakiran, Pemmaraju
    GSK, Bangalore, Karnataka, India..
    Hezareh, Marjan
    Chiltern Int GSK, Wavre, Belgium..
    Thomas, Florence
    GSK, Wavre, Belgium..
    Folschweiller, Nicolas
    GSK, Wavre, Belgium..
    Struyf, Frank
    GSK, Wavre, Belgium..
    Comparative immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine and 4vHPV vaccine administered according to two- or three-dose schedules in girls aged 9-14 years: Results to month 36 from a randomized trial2018In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 36, no 1, p. 98-106Article in journal (Refereed)
    Abstract [en]

    This observer-blind study (clinicaltrials.gov NCT01462357) compared the immunogenicity and safety of two doses (2D) of the HPV-16/18 AS04-adjuvanted vaccine (2D of AS04-HPV-16/18) vs. two or three doses of the 4vHPV vaccine [2D or 3D of 4vHPV] in 1075 healthy girls aged 9-14 years. Girls were randomized (1:1:1) to receive 2D of AS04-HPV-16/18 at months (M) 0, 6 (N = 359), 2D of 4vHPV at MO, 6 (N = 358) or 3D of 4vHPV at MO, 2, 6 (N = 358). 351, 339 and 346 girls, respectively, returned for the concluding visit at M36. Superiority was demonstrated at M7 and M12; comparison of the immune response to both vaccine antigens was made between 2D of AS04-HPV-16/18 and 2D or 3D of 4vHPV at subsequent time points in the according-to-protocol immunogenicity cohort (ATP-I; N = 958 at M36) and the total vaccinated cohort (TVC: N = 1036 at M36). HPV-16/18-specific T-cell- and B-cell-mediated immune responses and safety were also investigated. At M36, anti-HPV-16/18 ELISA responses in the 2D AS04-HPV-16/18 group remained superior to those of the 2D and 3D 4vHPV groups. In the M36 TVC, geometric mean titers were 2.78-fold (HPV-16) and 6.84-fold (HPV-18) higher for 2D of AS04-HPV-16/18 vs. 2D of 4vHPV and 2.3-fold (HPV-16) and 4.14-fold (HPV-18) higher vs. 3D of 4vHPV. Results were confirmed by vaccine pseudovirion-based neutralisation assay. Numbers of circulating CD4(+) T cells and B cells appeared similar across groups. Safety was in line with the known safety profiles of both vaccines. In conclusion, superior HPV-16/18 antibody responses were elicited by 2D of the AS04-HPV-16/18 compared with 2D or 3D of the 4vHPV vaccine in girls aged 9-14 years.

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  • 213. Leung, Ting Fan
    et al.
    Liu, Anthony Pak-Yin
    Lim, Fong Seng
    Thollot, Franck
    Oh, Helen May Lin
    Lee, Bee Wah
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Tan, Ngiap Chuan
    Rouzier, Roman
    Friel, Damien
    De Muynck, Benoit
    De Simoni, Stephanie
    Suryakiran, Pemmaraju
    Hezareh, Marjan
    Folschweiller, Nicolas
    Thomas, Florence
    Struyf, Frank
    Comparative immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine and HPV-6/11/16/18 vaccine administered according to 2-and 3-dose schedules in girls aged 9-14 years: Results to month 12 from a randomized trial2015In: Human Vaccines & Immunotherapeutics, ISSN 2164-5515, E-ISSN 2164-554X, Vol. 11, no 7, p. 1689-1702Article in journal (Refereed)
    Abstract [en]

    This observer-blind study (clinicaltrials.gov NCT01462357) compared the immunogenicity and safety of 2 doses of the HPV-16/18 AS04-adjuvanted vaccine (HPV-16/18(2D)) vs. 2 or 3 doses of the HPV-6/11/16/18 vaccine (HPV-6/11/16/18(2D) and HPV-6/11/16/18(3D)) in healthy girls aged 9-14 y. Girls were randomized (1:1:1) to receive HPV-16/18(2D) at months (M) 0,6 (N = 359), HPV-6/11/16/18(2D) at M0,6 (N = 358) or HPV-6/11/16/18(3D) at M0,2,6 (N = 358). The primary objective was non-inferiority/superiority of HPV-16/18 antibodies by ELISA for HPV-16/18(2D) vs. HPV-6/11/16/18(2D) at M7 in the according-to-protocol immunogenicity cohort (ATP-I) and total vaccinated cohort, respectively. Secondary objectives included non-inferiority/superiority of HPV-16/18(2D) vs. HPV-6/11/16/18(3D) at M7, non-inferiority/superiority at M12, HPV-16/18 neutralizing antibodies, frequencies of T-cells/B-cells, reactogenicity and safety. Antibody responses at M7 for HPV-16/18(2D) were superior to those for HPV-6/11/16/18(2D) and HPV-6/11/16/18(3D) (lower limit of 95% confidence interval for geometric mean titer ratio (GMR) was >1): HPV-16/18(2D)/HPV-6/11/16/18(2D) GMRs were 1.69 [1.49-1.91] for anti-HPV-16 and 4.52 [3.97-5.13] for anti-HPV-18; HPV-16/18(2D)/HPV-6/11/16/18(3D) GMRs were 1.72 [1.54-1.93] for anti-HPV-16 and 3.22 [2.82-3.68] for anti-HPV-18; p = 0.0001 for all comparisons. Non-inferiority/superiority was also demonstrated at M12. Among initially seronegative girls in the ATP-I, neutralizing antibody titers were at least 1.8-fold higher for HPV-16/18(2D) vs. HPV-6/11/16/18(2D) and HPV-6/11/16/18(3D) at M7 and M12. Frequencies of HPV-16/18-specific T-cells and B-cells were in similar ranges between groups. Reactogenicity and safety were in line with the known profile of each vaccine. In conclusion, superior HPV-16/18 antibody responses were elicited by 2 doses of the HPV-16/18 AS04-adjuvanted vaccine compared with 2 or 3 doses of the HPV-6/11/16/18 vaccine in girls (9-14years).

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  • 214.
    Liew, Bernard X. W.
    et al.
    Univ Birmingham, Ctr Precis Rehabil Spinal Pain CPR Spine, Sch Sport Exercise & Rehabil Sci, Coll Life & Environm Sci, Birmingham B15 2TT, W Midlands, England.
    Scutari, Marco
    Univ Oxford, Dept Stat, Oxford, England.
    Peolsson, Anneli
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.
    Ludvigsson, Maria L.
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden;Cty Council Ostergotland, Rehab Vast, Dept Rehabil, Motala, Sweden;Cty Council Ostergotland, Rehab Vast, Dept Med & Hlth, Motala, Sweden.
    Falla, Deborah
    Univ Birmingham, Ctr Precis Rehabil Spinal Pain CPR Spine, Sch Sport Exercise & Rehabil Sci, Coll Life & Environm Sci, Birmingham B15 2TT, W Midlands, England.
    Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks2019In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 35, no 8, p. 647-655Article in journal (Refereed)
    Abstract [en]

    Objectives: The present study's objective was to understand the causal mechanisms underpinning the recovery of individuals with whiplash-associated disorders (WAD). We applied Bayesian Networks (BN) to answer 2 study aims: (1) to identify the causal mechanism(s) of recovery underpinning neck-specific exercise (NSE), and (2) quantify if the cyclical pathway of the fear-avoidance model (FAM) is supported by the present data.

    Materials and Methods: We analyzed a prospective cohort data set of 216 individuals with chronic WAD. Fifteen variables were used to build a BN model: treatment group (NSE with or without a behavioral approach, or general physical activity), muscle endurance, range of motion, hand strength, neck proprioception, pain catastrophizing, fear, anxiety, depression, self-efficacy, perceived work ability, disability, pain intensity, sex, and follow-up time.

    Results: The BN model showed that neck pain reduction rate was greater after NSE compared with physical activity prescription (beta=0.59 points per month [P<0.001]) only in the presence of 2 mediators: global neck muscle endurance and perceived work ability. We also found the following pathway of variables that constituted the FAM: anxiety, followed by depressive symptoms, fear, catastrophizing, self-efficacy, and consequently pain.

    Conclusions: We uncovered 2 mediators that explained the mechanisms of effect behind NSE, and proposed an alternative FAM pathway. The present study is the first to apply BN modelling to understand the causal mechanisms of recovery in WAD. In doing so, it is anticipated that such analytical methods could increase the precision of treatment of individuals with chronic WAD.

  • 215.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Arestedt, K. A.
    Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden..
    Strömberg, A. S.
    Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden..
    Chung, M. C.
    Univ Kentucky, Coll Nursing, Lexington, KY 40506 USA..
    Do patients and caregivers perceived control impact depression and well-being in patients with heart failure and partners?2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, p. S71-S71Article in journal (Other academic)
  • 216.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kato, Naoko P
    van der Wal, Martje Hl
    Brons, Maaike
    Luttik, Marie Louise
    van Veldhuisen, Dirk J
    Strömberg, Anna
    Jaarsma, Tiny
    Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors.2020In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id 1474515120902317Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Patients' self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied.

    AIMS: (1) To describe the trajectory of patients' self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour.

    METHODS: In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour.

    RESULTS: Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05).

    CONCLUSION: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.

  • 217.
    Liljeroos, Maria L.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden..
    Stromberg, A.
    Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden..
    Introducing nurse-led heart failure clinics in Swedish primary care settings2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no S1, p. S56-S57Article in journal (Other academic)
  • 218.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden..
    Strömberg, A.
    Linkoping Univ, Div Nursing Sci, Dept Med & Hlth Sci, Linkoping, Sweden..
    Chung, M.
    Univ Kentucky, Coll Nursing, Lexington, KY 40506 USA..
    Patients and caregivers symptoms of depressive symptoms mediate the relationship between perceived control and well-being2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, p. S19-S19Article in journal (Other academic)
  • 219.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden; Sue & Bill Gross School of Nursing, University of California Irvine, CA, USA.
    Introducing nurse-led heart failure clinics in Swedish primary care settings2019In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 21, no 1, p. 103-109Article in journal (Refereed)
    Abstract [en]

    AIM: According to clinical guidelines, it is recommended that patients with heart failure (HF) receive structured multidisciplinary care at nurse-led HF clinics in order to optimise treatment and avoid preventable readmissions. Today, there are HF clinics with specialist-trained nurses at almost all Swedish hospitals, but HF clinics remain scarce in primary care (PC). The aim of this study was two-fold: firstly, to evaluate the effects of systematically implementing nurse-led HF clinics in PC settings with regard to hospital healthcare utilisation and evidence-based HF treatment, and secondly to explore patients' experiences of HF clinics in PC.

    METHODS AND RESULTS: The study had a pre-post design. Annual measurement were done between 2010-2017 regarding in-hospital healthcare consumption and medical treatment. Data from 2011-2017 after the implementation of HF clinics in PC in one county council Sweden were compared with baseline data collected before the implementation in 2010. The implementation of HF clinics in PC significantly reduced the number of HF-related hospital admissions by 27% (P < 0.001), HF hospital days by 27.3% (P < 0.001) and HF emergency room visits by 24% (P < 0.001). Further, patients were to a higher extent medically treated according to guidelines and satisfied with the care they received at the PC HF clinic.

    CONCLUSION: Nurse-led HF clinics in PC seem to be effective in reducing the need for in-hospital care and provide high quality person-centred care.

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  • 220.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Division of Nursing Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Division of Nursing Sciences, Linköping University, Linköping, Sweden.
    Årestedt, Kristofer
    Division of Nursing Sciences, Linköping University, Sweden.
    Chung, Misook L
    College of Nursing, University of Kentucky, USA.
    Mediation effect of depressive symptoms in the relationship between perceived control and wellbeing in patients with heart failure and their partners2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 527-534Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners.

    AIM: The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners.

    METHODS: In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately.

    RESULTS: We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners.

    CONCLUSION: Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed.

  • 221.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linköping University, Department of Medicine and Health Sciences, Linköping.
    Ågren, Susanna
    Linköping University, Department of Medicine and Health Sciences, Linköping.; Linköping University, Department of Cardiothoracic Surgery, Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Linköping.
    Stromberg, Anna
    Linköping University, Department of Medicine and Health Sciences, Linköping.; Linköping University, Department of Cardiology, Linköping.; University of California Irvine, Sue and Bill Gross School of Nursing, Irvine.
    Dialogues between nurses, patients with heart failure and their partners during a dyadic psychoeducational intervention: a qualitative study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 12, article id e018236Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe nurses’ documentation of the content in a psychoeducational intervention inspired by Stuifbergen’s model addressing cognitive, supportive and behavioural needs of patient–partner dyads affected by heart failure.

    Design: A descriptive qualitative design was used analysing nurses’ documentation in a dialogue guide based on a health promotion model.

    Settings: The dialogue guide was used during three nurse-led sessions at two heart failure clinics in Sweden with patients affected with heart failure and their partners during the years 2005–2008.

    Participants: The dialogue guides from 71 patient–partner dyads were analysed using direct deductive content analyses. Patients’ mean age was 69 years and 31% were female, partners’ mean age was 67 years and 69% were female.

    Results: The findings supported the conceptual health promotion model and identified barriers, recourses and self-efficacy described by the dyads within each category.

    Conclusion: The dyads described that during the sessions, they had gained enhanced knowledge and greater confidence to handle their life situation and expressed that they needed psychoeducational support during the whole illness trajectory. The results may guide and help to improve content and quality when caring for patients affected with heart failure and their partners and also when designing new interventions.

    Trial registration number: NCT02398799; Post-results.

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  • 222.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Ågren, Susanna
    Jaarsma, Tiny
    Strömberg, Anna
    Perceived caring needs in patient-partner dyads affected by heart failure: a qualitative study2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2928-38Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the perceived caring needs in patient-partner dyads affected by heart failure to develop an understanding of potential areas of support.

    BACKGROUND: Being affected by heart failure has a great impact on both the patient and the partner but until now contemporary care has remained patient focused.

    DESIGN: A qualitative study design was used.

    METHODS: Eight focus group interviews were performed, which included nineteen patients diagnosed with heart failure and their cohabiting partner. Patients were aged between 55-89 years and partners' ages ranged from 48-87 years. Data were analysed using qualitative content analyses.

    RESULTS: The dyads perceived that caring needs could be summarised in two themes 'Dyads perceive a need for continuous guidance through the different phases of the illness trajectory' and 'Dyads perceive a need to share burden and support with each other and others'. The dyads described a need to learn more about heart failure to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital, and having someone who cared about the well-being of the partners was perceived as comforting. Both the patient and the partner need to be present at the clinic visits. Receiving the same information and being able to ask questions reduce insecurity. Meeting others in the same situation and sharing the burden in group sessions were proposed as an opportunity to support each other and others.

    CONCLUSIONS: There is a need to improve education and support for patient-partner dyads affected by heart failure.

    RELEVANCE TO CLINICAL PRACTICE: The result shows the importance to provide continuous healthcare contacts throughout the illness trajectory. Furthermore, partners should be included at follow-up, and support groups should be organised so that dyads can meet and support each other.

  • 223.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Ågren, Susanna
    Jaarsma, Tiny
    Årestedt, Kristofer
    Strömberg, Anna
    Long Term Follow-Up after a Randomized Integrated Educational and Psychosocial Intervention in Patient-Partner Dyads Affected by Heart Failure2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 9, article id e0138058Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To date, contemporary heart failure care remains patient-focused, but awareness of the partners' and families' situation is increasing. Randomized studies have mainly evaluated the short-term effects of dyadic interventions. Therefore, the aim of this study was to determine the 24-month effects of an intervention with psych-educational support in dyads of heart failure patients and their partners.

    METHODS: This study used a randomized study design and 155 patient-partner dyads were enrolled. The intervention included a nurse-led program of three sessions addressing psychoeducational support.

    RESULTS: The intervention did not have any effect on health, depressive symptoms or perceived control among the patient-partner dyads after 24 months. Furthermore, time to first event did not differ significantly between the intervention group and the control patients.

    CONCLUSION: This study may be regarded as a first step in trying to understand dyads' need for supportive care. Individualized and more targeted interventions seem necessary to achieve a higher impact on dyad outcomes.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT02398799.

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  • 224.
    Liljeroos, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden.; Malarsjukhuset, Dept Med, Eskilstuna, Sweden..
    Ågren, Susanna
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden.; Cty Council Ostergotland, Dept Cardiothorac Surg, Linkoping, Sweden..
    Jaarsma, Tiny
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden..
    Årestedt, Kristofer
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden.; Linnaeus Univ, Fac Hlth Social Work & Behav Sci, Sch Hlth & Caring Sci, Kalmar, Sweden..
    Strömberg, Anna
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden.; Cty Council Ostergotland, Dept Cardiol, Linkoping, Sweden..
    Long-term effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure: a randomized controlled trial2017In: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 26, no 2, p. 367-379Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Partners of patients with heart failure provide both practical and emotional support. Many partners assume caregiving responsibilities without being aware of the burden related with this role.

    OBJECTIVE: Our work has established that a psycho-educational intervention has benefits at 3, but not at 12 months for patients with heart failure. Further we had not described the long-term effects in caregivers. This study aimed to determine the 24-months effects of a dyadic psycho-educational intervention on caregiver burden and morbidity in partners of patients with heart failure and study factors associated with a change in caregiver burden.

    DESIGN: A randomized controlled study design, with a follow-up assessment after 24 months.

    SETTING AND PARTICIPANTS: Partners to patients with heart failure were recruited from two hospitals in the southeast of Sweden.

    INTERVENTION: A three session nurse-led psycho-educational program was tested and included psychosocial support to maintain the partners' physical and mental functions, and perceived control. Several instrument were used to measure caregiver burden, perceived control, physical and mental health, depression and morbidity.

    RESULTS: One hundred fifty-five partners were included. There were no significant differences in any index of caregiver burden or morbidity among the partners in the intervention and control groups after 24 months. Overall, the mean total caregiver burden was found to be significantly increased compared to baseline (36 ± 12 vs 38 ± 14, p < 0.05). A younger partner, less comorbidity, higher levels of perceived control, better physical health and less symptoms of depression in patients, and better mental health in the partners were factors associated with absence of increased caregiver burden over time.

    DISCUSSION AND CONCLUSION: Our intervention did not significantly decrease caregiver burden or morbidity. Over time, several aspects of burden increased in both groups. To improve outcomes, individualized and targeted interventions might be beneficial. REGISTERED ON CLINICALTRIALS.

    GOV IDENTIFIER: NCT02398799.

  • 225. Lilliengren, Peter
    et al.
    Falkenström, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Sandell, Rolf
    Mothander, Pia Risholm
    Werbart, Andrzej
    Secure Attachment to Therapist, Alliance, and Outcome in Psychoanalytic Psychotherapy With Young Adults2015In: Journal of counseling psychology, ISSN 0022-0167, E-ISSN 1939-2168, Vol. 62, no 1, p. 1-13Article in journal (Refereed)
    Abstract [en]

    Using a novel approach to assess attachment to therapist from patient narratives (Patient Attachment to Therapist Rating Scale; PAT-RS), we investigated the relationships between secure attachment to therapist, patient-rated alliance, and outcome in a sample of 70 young adults treated with psychoanalytic psychotherapy. A series of linear mixed-effects models, controlling for length of therapy and therapist effects, indicated that secure attachment to therapist at termination was associated with improvement in symptoms, global functioning, and interpersonal problems. After controlling for the alliance, these relationships were maintained in terms of symptoms and global functioning. Further, for the follow-up period, we found a suppression effect indicating that secure attachment to therapist predicted continued improvement in global functioning, whereas the alliance predicted deterioration when both variables were modeled together. Although limited by the correlational design, this study suggests that the development of a secure attachment to therapist is associated with treatment gains as well as predictive of posttreatment improvement in functioning. Future research should investigate the temporal development of attachment to therapist and its interaction with alliance and outcome more closely. To ensure differentiation from patient-rated alliance, observer-based measurement of attachment to therapist should be considered.

  • 226. Lindberg, Magnus
    et al.
    Berg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Some Observations on Reporting Quality of Life in Treatment of Psoriasis in Outpatient Clinics2013In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 93, no 2, p. 210-211Article in journal (Refereed)
  • 227. Lindberg, Magnus
    et al.
    Bingefors, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Meding, Birgitta
    Berg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Hand eczema and health-related quality of life; a comparison of EQ-5D and the Dermatology Life Quality Index (DLQI) in relation to the hand eczema extent score (HEES)2013In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 69, no 3, p. 138-143Article in journal (Refereed)
    Abstract [en]

    Background. Health-related quality of life (HRQoL) is associated with the extent and severity of hand eczema. We still lack a consensus about which HRQoL instrument to use as the standard, and how to measure the extent and severity of hand eczema. Objectives. To compare the Dermatology Life Quality Index (DLQI) with EQ-5D (a standardized instrument for use as a measure of health outcome), and to evaluate how the Hand Eczema Extent Score (HEES) relates to these instruments. Methods. Ninety-three patients (61 females) were included. The HEES was recorded by a dermatologist, and the DLQI and EQ-5D by the patients. The results were analysed with factor analysis and non-parametric statistics. Results. The DLQI and EQ-5D showed decreased HRQoL. Using factor analysis, we could not establish an association between the DLQI and EQ-5D. There were, however, correlations between the DLQI and the HEES (0.31), the EQ(index) and the HEES (-0.32), the DLQI and the EQ(VAS) (-0.62), and the DLQI and the EQ(index) (-0.67) (the EQ(VAS) and the EQ(index) are calculated from EQ-5D). Conclusions. We could not link factors in the DLQI to EQ-5D, which has previously been done for SF-36 (Short Form 36). On the basis of this, we cannot recommend EQ-5D over SF-36 for hand eczema studies. The DLQI correlates with the EQ(VAS) and the EQ(index), and can probably be used as an approximation for EQ-5D. Our findings with the HEES are interesting, as it can be used by patients.

  • 228.
    Lindblad, Ida
    et al.
    The Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Engström, Ann-Charlotte
    Child and Youth Psychiatry, Stockholm County Council, Södertälje, Sweden.
    Nylander, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Pediatric Endocrinology.
    Fernell, Elisabeth
    The Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Adolescents with type 1 diabetes mellitus and attention-deficit/hyperactivity disorder require specific support from healthcare professionals2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 12, p. 1994-1997Article in journal (Refereed)
    Abstract [en]

    AIM: Managing type 1 diabetes mellitus requires efficient cognitive and executive skills, and adolescents who have attention-deficit/hyperactivity disorder (ADHD) may face specific challenges. This study explored young people's experiences of diabetes treatment and care.

    METHOD: In a population-based study, comprising 175 patients aged 5-16 years with type 1 diabetes mellitus in two Swedish counties, we found that eight also met criteria for ADHD. Six of these, aged 14.5-16 years, participated 2013-2014 in interviews that targeted aspects of their diabetes treatment. Conducted by two psychologists, these used the inductive qualitative, semi-structured interview format.

    RESULTS: The two boys and four girls all reported difficulties in creating routines for their diabetes treatment and that problems were aggravated during stress. They had been criticised by their parents and the diabetes team when their blood levels indicated inadequate diabetes control. They requested ongoing information, involvement of their friends, group meetings and easy access to the healthcare system during difficult times.

    CONCLUSION: Patients with type 1 diabetes mellitus and concomitant ADHD faced problems with their diabetes management, especially during stressful situations. Diabetes care provision should pay particular attention to patients with co-existing neuropsychiatric and neurodevelopmental disorders such as ADHD.

  • 229. Lindbäck, Camilla
    et al.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Mälardalens högskola.
    To be on sick-leave due to heart failure: a qualitative perspective2015In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 18-19, p. 1732-1738Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of the present study was to explore and describe meanings of being on sick leave due to heart failure.

    Methods: The study was conducted in Sweden during 2011-2012. Five men and one woman, aged 46 to 62, were interviewed. A reflective life-world research approach based on phenomenological philosophy was used. The result of the analysis is presented in three themes.

    Results: To be on sick leave due to heart failure implies a life situation characterized by anxiety, insecurity and uncertainty. When rehabilitation professionals do not take on their professional responsibility, sick listed people with heart failure perceive they are dismissed and abandoned. If rehabilitation professionals take on their professional responsibility it can be experienced as supportive.

    Conclusions: People who are on sick leave due to heart failure are abandoned by rehabilitation professionals and they lack opportunities to participate in their own sick leave/rehabilitation processes. Rehabilitation professionals need to take more responsibility and allow the patients to participate by connecting and recognizing patients as equal human beings. The present results can be used by rehabilitation professionals to reflect on and discuss the needs of people on sick leave due to heart failure. Implications for Rehabilitation Heart failure is a chronic condition implying a complicated life-situation. People with heart failure experience abandonment by rehabilitation professionals and lack participation in their own rehabilitation process. In order to support people on sick leave due to heart failure collaboration and coordination between rehabilitation professionals are needed.

  • 230.
    Lindqvist, Karin
    et al.
    Erica Fdn, Odengatan 9, S-11424 Stockholm, Sweden.
    Falkenström, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Linkoping, Sweden.
    Sandell, Rolf
    Lund Univ, Lund, Sweden.
    Holmqvist, Rolf
    Linkoping Univ, Linkoping, Sweden.
    Ekeblad, Annika
    Linkoping Univ, Linkoping, Sweden.
    Thorén, Agneta
    Erica Fdn, Odengatan 9, S-11424 Stockholm, Sweden.
    Multilevel Exploratory Factor Analysis of the Feeling Word Checklist-242017In: Assessment (Odessa, Fla.), ISSN 1073-1911, E-ISSN 1552-3489, Vol. 24, no 7, p. 907-918Article in journal (Refereed)
    Abstract [en]

    Emotional reactions are a vital part of the therapeutic relationship. The Feeling Word Checklist-24 (FWC-24) is an instrument asking the clinician (or the patient) to report to what degree he or she has experienced various feelings during a therapeutic interaction. The aim of this study was to assess the factor structure of the clinician-rated FWC-24 when taking dependencies in the data into account. The sample was deliberately heterogeneous and consisted of 4,443 ratings made by 101 psychotherapists working with different psychotherapy methods in relation to 191 patients of different ages, genders, and with different primary diagnoses. A random intercept-only model revealed large intraclass correlation coefficients at the therapist level, indicating that a multilevel analysis was warranted. A two-level exploratory factor analysis with therapists as the between level and patients plus sessions as the within level was conducted. The items from FWC-24 were found to be best represented by four factors on the between level and four factors on the within level. The factor structures were largely similar on the two levels and were labeled Engaged, Inadequate, Relaxed, and Moved. The different factors explained different amounts of variance on different levels, indicating that some factors are more therapist dependent and some more patient dependent.

  • 231.
    Lipcsey, Miklós
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bellomo, R
    Hemodynamic management of septic shock2015In: Minerva Anestesiologica, ISSN 0375-9393, E-ISSN 1827-1596, Vol. 81, no 11, p. 1262-1272Article in journal (Refereed)
    Abstract [en]

    We present a review of the hemodynamic management of septic shock. Although substantial amount of evidence is present in this area, most key decisions on the management of these patients remain dependent on physiological reasoning and on pathophysiological principles rather than randomized controlled trials. During primary (early) resuscitation, restoration of adequate arterial pressure and cardiac output using fluids and vasopressor and/or inotropic drugs is guided by basic hemodynamic monitoring and physical examination in the emergency department. When more advanced level of monitoring is present in these patients, i.e. during secondary resuscitation (later phase in the emergency department and in the ICU), hemodynamic management can be guided by more advanced measurements of the macro--circulation. Our understanding of the microcirculation in septic shock is limited and reliable therapeutic modalities to optimize it do not yet exist. No specific hemodynamic treatment strategy, be it medications including fluids, monitoring devices or treatment algorithms has yet been proved to improve outcome. Moreover, there is virtually no data on the optimal management of the resolution phase of septic shock. Despite these gaps in knowledge, the data from observational studies and trials suggests that mortality in septic shock has been generally decreasing during the last decade.

  • 232. Liu, Hien Duong
    et al.
    Ahn, Kwang Woo
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA..
    Hu, Zhen-Huan
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA..
    Beitinjaneh, Amer
    Univ Miami, Sylvester Canc Ctr, Dept Hematol & Oncol, Miami, FL USA..
    Rizzieri, David
    Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA..
    Grunwald, Michael R.
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA..
    Sabloff, Mitchell
    Univ Ottawa, Dept Med, Div Hematol, Ottawa, ON, Canada.;Ottawa Hosp Res Inst, Ottawa, ON, Canada..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden..
    Bajel, Ashish
    Royal Melbourne Hosp, Dept Haematol & Bone Marrow Transplant, Parkville, Vic, Australia..
    Bredeson, Christopher
    Ottawa Hosp Res Inst, Ottawa, ON, Canada.;Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada..
    Daly, Andrew
    Tom Baker Canc Clin, Dept Med, Calgary, AB, Canada.;Tom Baker Canc Clin, Dept Oncol, Calgary, AB, Canada..
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan..
    Majhail, Navneet
    Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA..
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL USA..
    Gupta, Vikas
    Univ Hlth Network, Princess Margaret Canc Ctr, Blood & Marrow Transplant Program, Toronto, ON, Canada..
    Gerds, Aaron
    Cleveland Clin, Taussig Canc Inst, Hematol Oncol & Blood Disorders, Cleveland, OH 44106 USA..
    Malone, Adriana
    Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA..
    Tallman, Martin
    Mem Sloan, Dept Med, Leukemia Serv, New York, NY USA..
    Reshef, Ran
    Columbia Univ, Med Ctr, Blood & Marrow Transplantat Program, New York, NY USA.;Columbia Univ, Med Ctr, Columbia Ctr Translat Immunol, New York, NY USA..
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Pediat Bone Marrow Transplant, Bristol, Avon, England..
    Copelan, Edward
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA..
    Gergis, Usama
    New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med Oncol, Hematol Malignancies & Bone Marrow Transplant, New York, NY USA..
    Savoie, Mary Lynn
    Tom Baker Canc Clin, Div Hematol & Hematol Malignancies, Calgary, AB, Canada..
    Ustun, Celalettin
    Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN 55455 USA..
    Litzow, Mark R.
    Mayo Clin Rochester, Div Hematol, Rochester, MN USA.;Mayo Clin Rochester, Transplant Ctr, Rochester, MN USA..
    Cahn, Jean-Yves
    Univ Hosp, Dept Hematol, Grenoble, France..
    Kindwall-Keller, Tamila
    Univ Virginia Hlth Syst, Div Hematol Oncol, Charlottesville, VA USA..
    Akpek, Gorgun
    Banner MD Anderson Canc Ctr, Stem Cell Transplantat & Cellular Therapy Program, Gilbert, AZ USA..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Aljurf, Mahmoud
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia..
    Rowe, Jacob M.
    Shaare Zedek Med Ctr, Dept Hematol, Jerusalem, Israel..
    Wiernik, Peter H.
    Our Lady Mercy Med Ctr, Bronx, NY USA..
    Hsu, Jack W.
    Shands HealthCare, Dept Med, Div Hematol & Oncol, Gainesville, FL USA.;Univ Florida, Gainesville, FL USA..
    Cortes, Jorge
    Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Leukemia, Houston, TX 77030 USA..
    Kalaycio, Matt
    Cleveland Clin Fdn, Dept Hematol & Med Oncol, 9500 Euclid Ave, Cleveland, OH 44195 USA..
    Maziarz, Richard
    Oregon Hlth & Sci Univ, Knight Canc Inst, Adult Blood & Marrow Stem Cell Transplant Program, Portland, OR 97201 USA..
    Sobecks, Ronald
    Cleveland Clin Fdn, Dept Hematol & Med Oncol, 9500 Euclid Ave, Cleveland, OH 44195 USA..
    Popat, Uday
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Houston, TX 77030 USA..
    Alyea, Edwin
    Dana Farber Canc Inst, Ctr Hematol Oncol, Boston, MA 02115 USA..
    Saber, Wael
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Allogeneic Hematopoietic Cell Transplantation for Adult Chronic Myelomonocytic Leukemia2017In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 23, no 5, p. 767-775Article in journal (Refereed)
    Abstract [en]

    Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for patients with chronic myelomonocytic leukemia (CMML); however, few data exist regarding prognostic factors and transplantation outcomes. We performed this retrospective study to identify prognostic factors for post-transplantation outcomes. The CMML-specific prognostic scoring system (CPSS) has been validated in subjects receiving nontransplantation therapy and was included in our study. From 2001 to 2012, 209 adult subjects who received HCT for CMML were reported to the Center for International Blood and Marrow Transplant Research. The median age at transplantation was 57 years (range, 23 to 74). Median follow-up was 51 months (range, 3 to 122). On multivariate analyses, CPSS scores, Karnofsky performance status (KPS), and graft source were significant predictors of survival (P = .004, P = .01, P = .01, respectively). Higher CPSS scores were not associated with disease-free survival, relapse, or transplantation-related mortality. In a restricted analysis of subjects with relapse after HCT, those with intermediate-2/high risk had a nearly 2-fold increased risk of death after relapse compared to those with low/intermediate-1 CPSS scores. Respective 1-year, 3-year, and 5-year survival rates for low/intermediate-1 risk subjects were 61% (95% confidence interval [CI], 52% to 72%), 48% (95% CI, 37% to 59%), and 44% (95% CI, 33% to 55%), and for intermediate-2/high risk subjects were 38% (95% CI, 28% to 49%), 32% (95% CI, 21% to 42%), and 19% (95% CI, 8% to 29%). We conclude that higher CPSS score at time of transplantation, lower KPS, and a bone marrow graft are associated with inferior survival after HCT. Further investigation of CMML disease-related biology may provide insights into other risk factors predictive of post-transplantation outcomes. (C) 2017 American Society for Blood and Marrow Transplantation.

  • 233. Loden, Marie
    et al.
    Nilsson, Gert
    Parvardeh, Masomeh
    Carne, Kristina Neimert
    Berg, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Dermatology and Venereology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    No skin reactions to mineral powders in nickel-sensitive subjects2012In: Contact Dermatitis, ISSN 0105-1873, E-ISSN 1600-0536, Vol. 66, no 4, p. 210-214Article in journal (Refereed)
    Abstract [en]

    Background. Cosmetic products are known to be able to induce contact dermatitis. Contact dermatitis may also be induced by nickel, and it is estimated that up to 17% of women are allergic to nickel.

    Objectives. The aim of the present study was to investigate whether nickel sensitized individuals react to make-up products containing pigments with nickel as an impurity.

    Patients/Materials/Methods. Twenty-three individuals with a clinical history of nickel allergy and/or with positive patch test reactions to nickel were exposed to mineral make-up products and individual pigments dispersed in alkylbenzoate (50%) in small Finn Chambers (R) for 48 hr. The skin reactions were evaluated visually and with a non-invasive instrument that quantifies skin erythema.

    Results. The results showed that 74% of the included individuals showed a visible reaction to the positive control nickel sulfate, and a significant correlation was found between the visual and instrumental readings. However, none of the nickel sensitive individuals reacted to the test products. A subgroup analysis of the 50% most sensitive individuals also confirmed the absence of skin reactions to the powders.

    Conclusions. The bioavailability of the trace amounts of nickel in the particles was below the level needed to elicit an eczematous reaction in any of the nickel-sensitized individuals.

  • 234.
    Lopez-Fauqued, Marta
    et al.
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Campora, Laura
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Delannois, Frederique
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    El Idrissi, Mohamed
    GSK, Rixensart, Belgium.
    Oostvogels, Lidia
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium;CureVac AG, Tubingen, Germany.
    De Looze, Ferdinandus J.
    AusTrials Pty Ltd, Sherwood, Qld, Australia;Univ Queensland, Sch Med, Brisbane, Qld, Australia.
    Diez-Domingo, Javier
    Fdn Fomento Invest Sanitaria & Biomed, Vaccine Res Unit, Valencia, Spain.
    Heineman, Thomas C.
    GSK, King Of Prussia, PA USA;Halozyme Therapeut, San Diego, CA USA.
    Lal, Himal
    GSK, King Of Prussia, PA USA;Pfizer Vaccine Inc, Collegeville, PA USA.
    McElhaney, Janet E.
    Hlth Sci North Res Inst, Sudbury, ON, Canada.
    McNeil, Shelly A.
    Dalhousie Univ, Canadian Ctr Vaccinol, Halifax, NS, Canada;Dalhousie Univ, IWK Hlth Ctr, Halifax, NS, Canada;Dalhousie Univ, Nova Scotia Hlth Author, Halifax, NS, Canada.
    Yeo, Wilfred
    Univ Wollongong, Sch Med, Wollongong, NSW, Australia.
    Tavares-Da-Silva, Fernanda
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Ahonen, Anitta
    Univ Tampere, Jarvenpaa Vaccine Clin, Tampere, Finland.
    Avelino-Silva, Thiago Junquera
    Univ Sao Paulo, Sch Med, Sao Paulo, Brazil.
    Fernando Barba-Gomez, Jose
    Inst Dermatol Jalisco, Guadalajara, Jalisco, Mexico.
    Berglund, Johan
    Blekinge Inst Technol, Karlskrona, Sweden.
    Brotons Cuixart, Carlos
    EAP Sardenya, Barcelona, Spain.
    Caso, Covadonga
    Hosp Clin San Carlos, Madrid, Spain.
    Chlibek, Roman
    Univ Def, Fac Mil Hlth Sci, Brno, Czech Republic.
    Choi, Won Suk
    Korea Univ, Coll Med, Seoul, South Korea.
    Cunningham, Anthony L.
    Univ Sydney, Westmead Inst Med Res, Sydney, NSW, Australia.
    Desole, Maria Guiseppina
    Serv Igiene Pubbl, Sassari, Italy.
    Eizenberg, Peter
    Doctors Ivanhoe, Ivanhoe, Australia.
    Esen, Meral
    Univ Clin Tubingen, Inst Tropenmed, Tubingen, Germany.
    Espie, Emmanuelle
    GSK, Brussels, Belgium.
    Gervais, Pierre
    Q&T Res Sherbrooke, Sherbrooke, PQ, Canada.
    Ghesquiere, Wayne
    Univ British Columbia, Vancouver, BC, Canada.
    Godeaux, Olivier
    GSK, Brussels, Belgium.
    Gorfinkel, Iris
    York Univ, N York, ON, Canada.
    Hui, David Shu Cheong
    Prince Wales Hosp, Hong Kong, Peoples R China.
    Hwang, Shinn-Jang
    Taipei Vet Gen Hosp, Taipei, Taiwan;Natl Yang Ming Univ, Sch Med, Taipei, Taiwan.
    Korhonen, Tiina
    Univ Tampere, Sch Med, Vaccine Res Ctr, Tampere, Finland.
    Kovac, Martina
    GSK, New York, NY USA.
    Ledent, Edouard
    GSK, Rixensart, Belgium.
    Leung, Edward
    Hong Kong Assoc Gerontol, Hong Kong, Peoples R China.
    Levin, Myron J.
    Univ Colorado, Anschutz Med Campus, Aurora, CO USA.
    Narejos Perez, Silvia
    CAP Centelles, Centelles, Spain.
    Neto, Jose Luiz
    Inst AZ Pesquisa & Ensino, Curitiba, Parana, Brazil.
    Pauksen, Karlis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Poder, Airi
    Kliiniliste Uuringute Keskus, Tartu, Estonia.
    Rodriguez de la Pinta, Maria Luisa
    Hosp Puerta de Hierro, Madrid, Spain.
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Schwarz, Tino F.
    Standort Juliusspital, Wurzburg, Germany.
    Smetana, Jan
    Univ Def, Fac Mil Hlth Sci, Brno, Czech Republic.
    Staniscia, Tommaso
    Univ G dAnnunzio, Chieti, Italy.
    Tinoco, Juan Carlos
    Hosp Gen Durango, Durango, Mexico.
    Toma, Azhar
    Manna Res, Toronto, ON, Canada.
    Vastiau, Ilse
    GSK, Ave Fleming 20, B-1300 Wavre, Belgium.
    Vesikari, Timo
    Univ Tampere, Tampere, Finland.
    Volpi, Antonio
    AO Univ Policlin Tor Vergata, Rome, Italy.
    Watanabe, Daisuke
    Kobe Univ, Grad Sch Med, Kobe, Hyogo, Japan.
    Weckx, Lily Yin
    Univ Fed Sao Paulo, Sao Paulo, Brazil.
    Zahaf, Toufik
    GSK, Brussels, Belgium.
    Safety profile of the adjuvanted recombinant zoster vaccine: Pooled analysis of two large randomised phase 3 trials2019In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 37, no 18, p. 2482-2493Article in journal (Refereed)
    Abstract [en]

    Background: The ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) phase 3 clinical trials showed that the adjuvanted recombinant zoster vaccine (RZV) was >= 90% efficacious in preventing herpes zoster in adults. Here we present a comprehensive overview of the safety data from these studies.

    Methods: Adults aged >= 50 (ZOE-50) and >= 70 (ZOE-70) years were randomly vaccinated with RZV or placebo. Safety analyses were performed on the pooled total vaccinated cohort, consisting of participants receiving at least one dose of RZV or placebo. Solicited and unsolicited adverse events (AEs) were collected for 7 and 30 days after each vaccination, respectively. Serious AEs (SAEs) were collected from the first vaccination until 12 months post-last dose. Fatal AEs, vaccination-related SAEs, and potential immune-mediated diseases (pIMDs) were collected during the entire study period.

    Results: Safety was evaluated in 14,645 RZV and 14,660 placebo recipients. More RZV than placebo recipients reported unsolicited AEs (50.5% versus 32.0%); the difference was driven by transient injection site and solicited systemic reactions that were generally seen in the first week post-vaccination. The occurrence of overall SAEs (RZV: 10.1%; Placebo: 10.4%), fatal AEs (RZV: 4.3%; Placebo: 4.6%), and pIMDs (RZV: 1.2%; Placebo: 1.4%) was balanced between groups. The occurrence of possible exacerbations of pIMDs was rare and similar between groups. Overall, except for the expected local and systemic symptoms, the safety results were comparable between the RZV and Placebo groups irrespective of participant age, gender, or race.

    Conclusions: No safety concerns arose, supporting the favorable benefit-risk profile of RZV. 

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  • 235.
    Ludvigsson, Maria Landen
    et al.
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Motala, Sweden..
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden.;Cty Council Sormland, Katrineholm, Sweden..
    Dedering, Asa
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Physiotherapy, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Phys Therapy, Stockholm, Sweden..
    Peolsson, Anneli
    Linkoping Univ, Div Physiotherapy, Dept Med & Hlth Sci, SE-58183 Linkoping, Sweden..
    One- And Two-Year Follow-Up Of A Randomized Trial Of Neck Specific Exercise With Or Without A Behavioural Approach Compared With Prescription Of Physical Activity In Chronic Whiplash Disorder2016In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 48, no 1, p. 56-64Article in journal (Refereed)
    Abstract [en]

    Objective: To explore whether neck-specific exercise, with or without a behavioural approach, has benefits after 1 and 2 years compared with prescribed physical activity regarding pain, self-rated functioning/disability, and self-efficacy in management of chronic whiplash. Design: Follow-up of a randomized, assessor blinded, clinical trial. Patients: A total of 216 volunteers with chronic whiplash associated disorders, grades 2 or 3. Methods: Participants were randomized to 1 of 3 exercise interventions: neck-specific exercise with or without a behavioural approach, or physical activity prescription. Self-rated pain (visual analogue scale), disability/functioning (Neck Disability Index/Patient Specific Functional Scale) and self-efficacy (Self-Efficacy Scale) were evaluated after 1 and 2 years. Results: Both neck-specific exercise groups maintained more improvement regarding disability/functioning than the prescribed physical activity group at both time-points (p <= 0.02). At 1 year, 61% of subjects in the neck-specific group reported at least 50% pain reduction, compared with 26% of those in the physical activity prescription group (p < 0.001), but at 2 years the difference was not significant. Conclusion: After 1-2 years, participants with chronic whiplash who were randomized to neck-specific exercise, with or without a behavioural approach, remained more improved than participants who were prescribed general physical activity.

  • 236.
    Ludvigsson, Maria Landen
    et al.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden;Linkoping Univ, Dept Rehabil, Cty Council Ostergotland, Rehab Vast, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden .
    Peolsson, Anneli
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, Linkoping, Sweden.
    Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash: Analyses of a randomized clinical trial2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 12409Article in journal (Refereed)
    Abstract [en]

    Up to 90% of people with neurological deficits following a whiplash injury do not recover and cervical muscle dysfunction is common. The aim of this multicentre, randomized controlled trial was to examine whether two versions of neck-specific exercise or prescription of physical activity (PPA) can improve radiating arm pain and clinical signs that can be associated with neurological deficits in people with chronic whiplash associated disorders (WAD). Participants with chronic WAD, arm symptoms and signs associated with neurological deficits (n = 171) were randomized to: 12 weeks of neck-specific exercise without (NSE) or with a behavioural approach (NSEB), or PPA. Pain/bothersomeness frequency, six measures of arm pain/paraesthesia (VAS scales), and four clinical neurological tests were evaluated after 3 months. The NSE group reported the lowest frequency and lowest levels of arm pain, the highest proportion of participants with at least 50% pain reduction and the highest proportion of normal arm muscle force. The NSEB group reported increased normal tendon reflexes. No improvements were recorded for the PPA group. Neck-specific exercise may improve arm pain and decrease signs of neurological deficits, but the addition of a behavioural approach does not seem to be of additional benefit.

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  • 237. Ludvigsson, Maria Landén
    et al.
    Peterson, Gunnel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    O'Leary, Shaun
    Dedering, Asa
    Peolsson, Anneli
    The Effect of Neck-specific Exercise with, or without a Behavioral Approach, on Pain, Disability and Self-efficacy in Chronic Whiplash-associated Disorders: A Randomized Clinical Trial2015In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 31, no 4, p. 249-303Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:: The aim of this study was to compare the effect on self-rated pain, disability and self-efficacy of three interventions for the management of chronic Whiplash Associated Disorders (WAD): physiotherapist-led neck-specific exercise, physiotherapist-led neck-specific exercise with the addition of a behavioral approach, or prescription of physical activity.

    METHODS:: Two hundred and sixteen volunteers with chronic WAD participated in this randomized, assessor blinded, clinical trial of three exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index) and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at three and six months.

    RESULTS:: The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P<0.01) in the two neck-specific exercise groups (29-48%) compared to the prescription of physical activity group (5%) at three months. At six months 39-44% of the patients in the two neck-specific groups and 28% in the prescription of physical activity group reported substantial pain reduction. Reduction of disability was also larger in the two neck-specific exercise groups at both three and six months (P<0.02). Self-efficacy was only improved in the neck-specific exercise group without a behavioral approach (P=0.02). However there were no significant differences in any outcomes between the two physiotherapist-led neck-specific exercise groups.

    DISCUSSION:: Neck-specific exercise resulted in superior outcomes compared to prescription of physical activity in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.

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  • 238.
    Lännerström, Linda
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Sick Leave Questions in Telephone Nursing: Perspectives of Persons on Sick Leave and Registered Nurses in Primary Health Care2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim and methods: To explore experiences of being on sick leave by interviewing 16 persons on sick leave and using a phenomenological approach. To explore registered nurses’ work in the care of persons on sick leave by performing three focus group discussions with registered nurses. To explore the effect and experiences of an educational intervention in social insurance medicine with registered nurses by studying the effect of a randomized controlled study with 100 registered nurses and by interviewing 12 registered nurses who participated in the intervention.

    Findings: The essential meaning of being on long-term sick leave was losing one’s independence. This loss was connected to mostly negative experiences of being absent from work, the social insurance rules, and experiences in encounters with many professionals.

    The registered nurses’ work in handling sick leave questions included assessing, dispositioning, supporting, and collaborating actions. They expressed lacking competence, had different understandings of their role, and experienced stress connected to contradictory demands in their roles as carers, co-workers, and distributors of organizational resources.

    The short educational intervention in social insurance medicine seemed to have had an effect, but due to the small study population, the effect was inconclusive. The process evaluation showed that the educational intervention was perceived to have contributed to registered nurses gaining role clarity in their work with sick leave questions. The registered nurses described increasing their knowledge and skills as well as taking on more of the traditional actions related to telephone nursing, for example giving more information and being more attentive, coaching, and encouraging towards patients.

    Conclusions: Being on long-term sick leave can be experienced negatively, and can be connected to several dimensions of life. Registered nurses at the studied primary health care centres had a role in the care of patients on sick leave, but had different understandings of their role that affected how they handled telephone calls with them. The educational intervention failed to show a conclusive effect due to the rather small study population. However, the registered nurses experienced that participating had enhanced their competence.

    List of papers
    1. Losing independence: the lived experience of being long-term sick-listed
    Open this publication in new window or tab >>Losing independence: the lived experience of being long-term sick-listed
    2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 745-Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Sickness absence is a multifaceted problem. Much is known about risk factors for being long-term sick-listed, but there is still little known about the various aftermaths and experiences of it. The aim of this qualitative study was to describe, analyze and understand long-term sickness-absent people's experiences of being sick-listed.

    METHODS: The design was descriptive and had a phenomenological approach. Sixteen long-term sickness-absent individuals were purposively sampled from three municipalities in Sweden in 2011, and data were collected through semi-structured, individual interviews. The interview questions addressed how the participants experienced being sick-listed and how the sick-listing affected their lives. Transcribed interviews were analysed using Giorgi's phenomenological method.

    RESULTS: The interviews revealed that the participants' experiences of being sick-listed was that they lost their independence in the process of stepping out of working society, attending the mandatory steps in the rehabilitation chain and having numerous encounters with professionals. The participants described that their life-worlds were radically changed when they became sick-listed. Their experiences of their changing life-worlds were mostly highly negative, but there were also a few positive experiences. The most conspicuous findings were the fact that stopping working brought with it so many changes, the participants' feelings of powerlessness in the process, and their experiences of offensive treatment by and/or encounters with professionals.

    CONCLUSIONS: Sick-listed persons experienced the process of being on long-term sickness absent as very negative. The negative experiences are linked to consequences of stopping to work, consequences of social insurance rules and to negative encounters with professionals handling the sickness absence. The positive experiences of being sick-listed were few in the present study. There is a need to further examine the extent of these negative experiences are and how they affect sick-listed people's recovery and return to work. Long-term sickness absence; sick leave; experiences; interviews; phenomenology; Sweden.

    Keywords
    long-term sickness absence, sick leave, experiences, interviews, phenomenology, Sweden
    National Category
    Other Basic Medicine
    Research subject
    Family Medicine
    Identifiers
    urn:nbn:se:uu:diva-205547 (URN)10.1186/1471-2458-13-745 (DOI)000323311900001 ()23938128 (PubMedID)
    Available from: 2013-08-19 Created: 2013-08-19 Last updated: 2018-10-04Bibliographically approved
    2. Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres
    Open this publication in new window or tab >>Nurses' experiences of managing sick-listing issues in telephone advisory services at primary health care centres
    2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 4, p. 857-863Article in journal (Refereed) Published
    Abstract [en]

    Introduction:

    Over the last decade Swedish health care has focused on improving the management of sick-listing issues. At primary health care centres sick-listing is mainly dealt with by the patient’s physician but when patients have requests related to sick-listing and contact the telephone advisory service nurses will be involved. The aim of this study was to describe nurses’ experiences of managing sick-listing issues in telephone advisory services in a primary health care setting.

    Methods:

    The study was a qualitative focus group study. Data collection was conducted in three focus group conversations in a county in central Sweden in 2009. The conversations were recorded, transcribed and analyzed using qualitative content analysis. The study included fourteen nurses, purposively sampled as having current experience of telephone advisory services at primary health care centres.

    Findings:

    The management of sick-listing issues was described by the nurses as Nurses Actions which were affected by Enabling conditions and Obstructing conditions. The Nurses’ Actions included making an assessment for appropriate action, making an appointment and/or giving information and guidance to the patient and/or monitoring patient’s rights. Enabling conditions included documentation, routines, supportive co-operation and training in insurance medicine. The obstructing conditions were related to patients’ expectations, co-operation with other professionals, lack of training and the nurses’ professional role.

    Conclusion:

    The nurses experienced stress and difficulties related to being gatekeepers and related to the act of balancing different demands from patients, co-workers and the organisation. This in combination with the lack of training caused the nurses to state that they did not want responsibility for managing sick-listing issues. Sufficient documentation, education, routines, support of and discussions with other professionals at the primary health care centre could be ways of improving nurses’ and other professionals’ management of sick-listing issues.

    Keywords
    sick listing, telephone advisory services, primary health care, nursing, focus group, qualitative content analysis
    National Category
    Medical and Health Sciences
    Research subject
    Caring Sciences
    Identifiers
    urn:nbn:se:uu:diva-185457 (URN)10.1111/j.1471-6712.2012.01093.x (DOI)000328140200010 ()
    Available from: 2012-11-25 Created: 2012-11-25 Last updated: 2018-10-04Bibliographically approved
    3. The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.
    Open this publication in new window or tab >>The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.
    (English)Manuscript (preprint) (Other academic)
    National Category
    General Practice
    Identifiers
    urn:nbn:se:uu:diva-362239 (URN)
    Available from: 2018-10-02 Created: 2018-10-02 Last updated: 2018-10-04
    4. Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention
    Open this publication in new window or tab >>Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention
    2019 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 2, p. 236-244Article in journal (Refereed) Published
    Abstract [en]

    Aim

    To describe how a short educational intervention in social insurance medicine was experienced by Registered Nurses and what changes it brought to their work with sick leave questions in telephone nursing.

    Design

    Qualitative explorative interview study.

    Methods

    Interviews with 12 purposively sampled Registered Nurses were conducted and analysed using manifest content analysis.

    Results

    The intervention increased Registered Nurses’ knowledge of the sick leave process and changed their work habits as they now have more of the skills needed to handle sick leave questions. In this way, they gained role clarity in their work with sick leave questions. The new knowledge included rules and regulations, actors’ roles and patients’ experiences. Learning from peers, reflecting and having the opportunity to ask questions were also described as increasing their knowledge. The skills following the participation were described as knowing what to say and do and knowing where to turn for support.

    Keywords
    cluster randomized controlled study, educational intervention, interviews, sick leave, social insurance medicine, telephone nursing
    National Category
    Nursing
    Identifiers
    urn:nbn:se:uu:diva-361653 (URN)10.1002/nop2.201 (DOI)000461835600004 ()30918675 (PubMedID)
    Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2019-05-07Bibliographically approved
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  • 239.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Holmström, Inger K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Malardalen Univ, Sch Hlth Care & Social Welf, Vasteras, Sweden.
    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.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Possible causes of experiencing problems with sick leave questions in telephone nursing2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 4, p. 249-253Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Registered nurses at primary health care centres in Sweden receive about 20 million telephone calls annually. Questions related to sick leave occur regularly. Previous studies conclude that those calls often are perceived as problematic. The aim of this study was to explore factors associated with problems regarding sick leave questions in telephone nursing.

    METHODS: A questionnaire was distributed to all registered nurses (n = 185) working with telephone nursing in 26 Swedish primary health care centres, of whom 114 (61.6%) responded. Based on the results of a Spearman correlation analysis a logistic regression analysis was performed of significant exposure variables on outcome (perceived problems).

    RESULTS: Significant exposure variables were: experience of telephone nursing, age, being educated in social insurance medicine, and frequency of telephone calls with sick leave questions. Young age was associated with more problems than old age. Those having education in social insurance medicine reported fewer problems than those who had not, and so did those having few telephone calls with sick leave questions as compared with those who had many.

    CONCLUSIONS: Young age, lack of education in insurance medicine, and high frequency of sick leave questions increased the perceived problem level in telephone nursing.

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  • 240.
    Lännerström, Linda
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens Högskola, Akademien för hälsa, vård och välfärd Mälardalen University School of health, care and social welfare.
    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.
    Wallman, Thorne
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    The effect of a short educational intervention in social insurance medicine: A randomised controlled trial.Manuscript (preprint) (Other academic)
  • 241.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    von Celsing, Anna-Sophia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Registered nurses' work with sick leave questions by telephone in primary health care2017In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 26, no 5/6, p. 641-647Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES:

    To describe registered nurses' work with sick leave questions by telephone.

    BACKGROUND:

    In Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses' work with sick leave questions has not been studied, except for two qualitative interview studies.

    DESIGN:

    A descriptive cross-sectional study.

    METHODS:

    A questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis.

    RESULTS:

    Response rate was 62% (n = 114). Registered nurses (n = 105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n = 78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were 'often' booking appointments with physicians (n = 67) and 'seldom' providing information on social insurance rules ('never' n = 51). The registered nurses expressed a great need for more education.

    CONCLUSION:

    Registered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine.

    RELEVANCE TO CLINICAL PRACTICE:

    There is a need to educate and train registered nurses in social insurance medicine to provide high-quality nursing for patients on or at risk for sick leave.

  • 242.
    Lännerström, Linda
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Wallman, Thorne
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Losing independence: the lived experience of being long-term sick-listed2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 745-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sickness absence is a multifaceted problem. Much is known about risk factors for being long-term sick-listed, but there is still little known about the various aftermaths and experiences of it. The aim of this qualitative study was to describe, analyze and understand long-term sickness-absent people's experiences of being sick-listed.

    METHODS: The design was descriptive and had a phenomenological approach. Sixteen long-term sickness-absent individuals were purposively sampled from three municipalities in Sweden in 2011, and data were collected through semi-structured, individual interviews. The interview questions addressed how the participants experienced being sick-listed and how the sick-listing affected their lives. Transcribed interviews were analysed using Giorgi's phenomenological method.

    RESULTS: The interviews revealed that the participants' experiences of being sick-listed was that they lost their independence in the process of stepping out of working society, attending the mandatory steps in the rehabilitation chain and having numerous encounters with professionals. The participants described that their life-worlds were radically changed when they became sick-listed. Their experiences of their changing life-worlds were mostly highly negative, but there were also a few positive experiences. The most conspicuous findings were the fact that stopping working brought with it so many changes, the participants' feelings of powerlessness in the process, and their experiences of offensive treatment by and/or encounters with professionals.

    CONCLUSIONS: Sick-listed persons experienced the process of being on long-term sickness absent as very negative. The negative experiences are linked to consequences of stopping to work, consequences of social insurance rules and to negative encounters with professionals handling the sickness absence. The positive experiences of being sick-listed were few in the present study. There is a need to further examine the extent of these negative experiences are and how they affect sick-listed people's recovery and return to work. Long-term sickness absence; sick leave; experiences; interviews; phenomenology; Sweden.

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  • 243.
    Lännerström, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wallman, Thorne
    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, Centrum för klinisk forskning i Sörmland (CKFD).
    Kaminsky, Elenor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola, Västerås, Sweden.
    Holmström, Inger K
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Mälardalens högskola, Västerås, Sweden.
    Gaining role clarity in working with sick leave questions - Registered Nurses' experiences of an educational intervention2019In: Nursing Open, E-ISSN 2054-1058, Vol. 6, no 2, p. 236-244Article in journal (Refereed)
    Abstract [en]

    Aim

    To describe how a short educational intervention in social insurance medicine was experienced by Registered Nurses and what changes it brought to their work with sick leave questions in telephone nursing.

    Design

    Qualitative explorative interview study.

    Methods

    Interviews with 12 purposively sampled Registered Nurses were conducted and analysed using manifest content analysis.

    Results

    The intervention increased Registered Nurses’ knowledge of the sick leave process and changed their work habits as they now have more of the skills needed to handle sick leave questions. In this way, they gained role clarity in their work with sick leave questions. The new knowledge included rules and regulations, actors’ roles and patients’ experiences. Learning from peers, reflecting and having the opportunity to ask questions were also described as increasing their knowledge. The skills following the participation were described as knowing what to say and do and knowing where to turn for support.

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  • 244.
    Lövvik, Tone S.
    et al.
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Gynaecol & Obstet, Trondheim, Norway.
    Carlsen, Sven M.
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Endocrinol, Trondheim, Norway.
    Salvesen, Öyvind
    Norwegian Univ Sci & Technol, Dept Publ Hlth & Nursing, Trondheim, Norway.
    Steffensen, Berglind
    Univ Hosp Iceland, Dept Obstet & Gynaecol, Reykjavik, Iceland.
    Bixo, Marie
    Umea Univ, Dept Clin Sci, Umea, Sweden.
    Gomez-Real, Francisco
    Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway;Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Lönnebotn, Marianne
    Haukeland Hosp, Dept Obstet & Gynaecol, Bergen, Norway.
    Hestvold, Kristin, V
    Vestre Viken Hosp Trust, Womens Clin, Drammen, Norway.
    Zabielska, Renata
    Vestfold Hosp Trust, Womens Clin, Tonsberg, Norway.
    Hirschberg, Angelica L.
    Karolinska Univ Hosp, Dept Gynecol & Reprod Med, Stockholm, Sweden;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Trouva, Anastasia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Thorarinsdottir, Solveig
    Telemark Hosp Trust, Womens Clink, Skien, Norway.
    Hjelle, Sissel
    Alesund Hosp, Womens Clin, Alesund, Norway.
    Berg, Ann Hilde
    Innlandet Hosp Trust, Womens Clink, Lillehammer, Norway.
    Andrae, Frida
    Nordlands Hosp Trust, Womens Clin, Bodo, Norway.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Mohlin, Johanna
    Umea Univ, Dept Clin Sci, Umea, Sweden;Sadersjukhuset, Stockholm, Sweden.
    Underdal, Maria
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Gynaecol & Obstet, Trondheim, Norway.
    Vanky, Eszter
    Norwegian Univ Sci & Technol, Dept Clin & Mol Med, N-7491 Trondheim, Norway;St Olavs Univ Hosp, Dept Gynaecol & Obstet, Trondheim, Norway.
    Use of metformin to treat pregnant women with polycystic ovary syndrome (PregMet2): a randomised, double-blind, placebo-controlled trial2019In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 7, no 4, p. 256-266Article in journal (Refereed)
    Abstract [en]

    Background: Women with polycystic ovary syndrome (PCOS) have an increased risk of pregnancy complications. Epi-analysis of two previous randomised controlled trials that compared metformin with placebo during pregnancy in women with PCOS showed a significant reduction in late miscarriages and preterm births in the metformin group. The aim of this third randomised trial (PregMet2) was to test the hypothesis that metformin prevents late miscarriage and preterm birth in women with PCOS.

    Methods: PregMet2 was a randomised, placebo-controlled, double-blind, multicentre trial done at 14 hospitals in Norway, Sweden, and Iceland. Singleton pregnant women with PCOS aged 18-45 years were eligible for inclusion. After receiving information about the study at their first antenatal visit or from the internet, women signed up individually to participate in the study. Participants were randomly assigned (1: 1) to receive metformin or placebo by computer-generated random numbers. Randomisation was in blocks of ten for each country and centre; the first block had a random size between one and ten to assure masking. Participants were assigned to receive oral metformin 500 mg twice daily or placebo during the first week of treatment, which increased to 1000 mg twice daily or placebo from week 2 until delivery. Placebo tablets and metformin tablets were identical and participants and study personnel were masked to treatment allocation. The primary outcome was the composite incidence of late miscarriage (between week 13 and week 22 and 6 days) and preterm birth (between week 23 and week 36 and 6 days), analysed in the intention-to-treat population. Secondary endpoints included the incidence of gestational diabetes, preeclampsia, pregnancy-induced hypertension, and admission of the neonate to the neonatal intensive care unit. We also did a post-hoc individual participant data analysis of pregnancy outcomes, pooling data from the two previous trials with the present study. The study was registered with ClinicalTrials. gov, number NCT01587378, and EudraCT, number 2011-002203-15.

    Findings: The study took place between Oct 19, 2012, and Sept 1, 2017. We randomly assigned 487 women to metformin (n=244) or placebo (n=243). In the intention-to-treat analysis, our composite primary outcome of late miscarriage and preterm birth occurred in 12 (5%) of 238 women in the metformin group and 23 (10%) of 240 women in the placebo group (odds ratio [OR] 0.50, 95% CI 0.22- 1.08; p = 0.08). We found no significant differences for our secondary endpoints, including incidence of gestational diabetes (60 [25%] of 238 women in the metformin group vs 57 [24%] of 240 women in the placebo group; OR 1.09, 95% CI 0.69-1.66; p=0.75). We noted no substantial between-group differences in serious adverse events in either mothers or offspring, and no serious adverse events were considered drug-related by principal investigators. In the post-hoc pooled analysis of individual participant data from the present trial and two previous trials, 18 (5%) of 397 women had late miscarriage or preterm delivery in the metformin group ]compared with 40 (10%) of 399 women in the placebo group (OR 0.43, 95% CI 0.23-0.79; p=0.004). Interpretation In pregnant women with PCOS, metformin treatment from the late first trimester until delivery might reduce the risk of late miscarriage and preterm birth, but does not prevent gestational diabetes. 

  • 245. Mahindra, Anuj
    et al.
    Raval, Girindra
    Mehta, Paulette
    Brazauskas, Ruta
    Zhang, Mei-Jie
    Zhong, Xiaobo
    Bird, Jennifer M
    Freytes, César O
    Hale, Gregory A
    Herzig, Roger
    Holmberg, Leona A
    Kamble, Rammurti T
    Kumar, Shaji
    Lazarus, Hillard M
    Majhail, Navneet S
    Marks, David I
    Moreb, Jan S
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Saber, Wael
    Savani, Bipin N
    Schiller, Gary J
    Tay, Jason
    Vogl, Dan T
    Waller, Edmund K
    Wiernik, Peter H
    Wirk, Baldeep
    Lonial, Sagar
    Krishnan, Amrita Y
    Dispenzieri, Angela
    Brandenburg, Nancy A
    Gale, Robert Peter
    Hari, Parameswaran
    New Cancers after Autotransplantations for Multiple Myeloma2015In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 4, p. 738-745Article in journal (Refereed)
    Abstract [en]

    We describe baseline incidence and risk factors for new cancers in 4161 persons receiving autotransplants for multiple myeloma in the United States from 1990 to 2010. Observed incidence of invasive new cancers was compared with expected incidence relative to the US population. The cohort represented 13,387 person-years at-risk. In total, 163 new cancers were observed, for a crude incidence rate of 1.2 new cancers per 100 person-years and cumulative incidences of 2.6% (95% confidence interval [CI], 2.09 to 3.17), 4.2% (95% CI, 3.49 to 5.00), and 6.1% (95% CI, 5.08 to 7.24) at 3, 5, and 7 years, respectively. The incidence of new cancers in the autotransplantation cohort was similar to age-, race-, and gender-adjusted comparison subjects with an observed/expected (O/E) ratio of 1.00 (99% CI, .81 to 1.22). However, acute myeloid leukemia and melanoma were observed at higher than expected rates with O/E ratios of 5.19 (99% CI, 1.67 to 12.04; P = .0004), and 3.58 (99% CI, 1.82 to 6.29; P < .0001), respectively. Obesity, older age, and male gender were associated with increased risks of new cancers in multivariate analyses. This large data set provides a baseline for comparison and defines the histologic type specific risk for new cancers in patients with MM receiving postautotransplantation therapies, such as maintenance.

  • 246. Malki, Ninoa
    et al.
    Hägg, Sara
    Tiikkaja, Sanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Koupil, Ilona
    Sparén, Pär
    Ploner, Alexander
    Short-term and long-term case-fatality rates for myocardial infarction and ischaemic stroke by socioeconomic position and sex: a population-based cohort study in Sweden, 1990-1994 and 2005-20092019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, article id e026192Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Case-fatality rates (CFRs) for myocardial infarction (MI) and ischaemic stroke (IS) have decreased over time due to better prevention, medication and hospital care. It is unclear whether these improvements have been equally distributed according to socioeconomic position (SEP) and sex. The aim of this study is to analyse differences in short-term and long-term CFR for MI and IS by SEP and sex between the periods 1990-1994 to 2005-2009 for the entire Swedish population.

    DESIGN: Population-based cohort study based on Swedish national registers.

    METHODS: We used logistic regression and flexible parametric models to estimate short-term CFR (death before reaching the hospital or on the disease event day) and long-term CFR (1 year case-fatality conditional on surviving short-term) across five distinct SEP groups, as well as CFR differences (CFRDs) between SEP groups for both MI and IS from 1990-1994 to 2005-2009.

    RESULTS: Overall short-term CFR for both MI and IS decreased between study periods. For MI, differences in short-term and long-term CFR between the least and most favourable SEP group were generally stable, except in long-term CFR among women; intermediate SEP groups mostly managed to catch up with the most favourable SEP group. For IS, short-term CFRD generally decreased compared with the most favourable group; but long-term CFRD were mostly stable, except for an increase for older subjects.

    CONCLUSION: Despite a general decline in CFR for MI and IS across all SEP groups and both sexes as well as some reductions in CFRD, we found persistent and even increasing CFRD among the least advantaged SEP groups, older patients and women. We speculate that targeted prevention rather than treatment strategies have the potential to reduce these inequalities.

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  • 247.
    Maret-Ouda, John
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Santoni, Giola
    Artama, Miia
    Ness-Jensen, Eivind
    Svensson, Jan F
    von Euler-Chelpin, My
    Lagergren, Jesper
    Aspiration pneumonia after antireflux surgery among neurologically impaired children with GERD.2020In: Journal of Pediatric Surgery, ISSN 0022-3468, E-ISSN 1531-5037, article id S0022-3468(19)30934-0Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Aspiration pneumonia is a common and serious complication to gastroesophageal reflux disease (GERD) among neurologically impaired children. Medication of GERD does not effectively prevent aspiration pneumonia, and whether antireflux surgery with fundoplication is better in this respect is uncertain. The objective was to determine whether fundoplication prevents aspiration pneumonia among children with neurological impairment and GERD.

    METHODS: This was a population-based cohort study from Denmark, Finland, Norway and Sweden, consisting of neurologically impaired children with GERD who underwent fundoplication. The risk of aspiration pneumonia before fundoplication (preoperative person-time) was compared with the risk after surgery (postoperative person-time). Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs). Except for confounding adjusted for by means of the "crossover like" design, the HRs were adjusted for age, sex, year of entry and respiratory diseases.

    RESULTS: Among 578 patients (median age 3.5 years), the preoperative person-time was 956 years and the postoperative person-time was 3324 years. Fundoplication was associated with 56% decreased overall HR of aspiration pneumonia (HR 0.44, 95% CI 0.27-0.72), and the HRs decreased over time after surgery. The risk of other types of pneumonia than aspiration pneumonia was not clearly decreased after fundoplication (HR 0.79, 95% CI 0.59-1.08). The 30-day mortality rate was 0.7% and the complication rate was 3.6%.

    CONCLUSIONS: Antireflux surgery decreases, but does not eliminate, the risk of aspiration pneumonia among neurologically impaired children with GERD. Fundoplication may be a treatment option when aspiration pneumonia is a recurrent problem in these children.

    TYPE OF STUDY: Cohort study.

    LEVEL OF EVIDENCE: Prognosis study-level I.

  • 248. Marks, David I
    et al.
    Woo, Kwang Ahn
    Zhong, Xiaobo
    Appelbaum, Frederick R
    Bachanova, Veronika
    Barker, Juliet N
    Brunstein, Claudio G
    Gibson, John
    Kebriaei, Partow
    Lazarus, Hillard M
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Perales, Miguel-Angel
    Pidala, Joseph
    Savani, Bipin
    Rocha, Vanderson
    Eapen, Mary
    Unrelated umbilical cord blood transplant for adult acute lymphoblastic leukemia in first and second complete remission: a comparison with allografts from adult unrelated donors.2014In: Haematologica (online), ISSN 0390-6078, E-ISSN 1592-8721, Vol. 99, no 2, p. 322-8Article in journal (Refereed)
    Abstract [en]

    Allogeneic hematopoietic cell transplantation has an established role in the treatment of adults with acute lymphoblastic leukemia whose survival when recipients of grafts from adult unrelated donors approaches that of recipients of grafts from sibling donors. Our aim was to determine the role of mismatched unrelated cord blood grafts in transplantation for 802 adults with acute lymphoblastic leukemia in first or second complete remission. Using Cox regression we compared outcomes after 116 mismatched single or double cord blood transplants, 546 peripheral blood progenitor cell transplants and 140 bone marrow transplants. The characteristics of the recipients and their diseases were similar except cord blood recipients were younger, more likely to be non-Caucasians and more likely to have a low white blood cell count at diagnosis. There were differences in donor-recipient human leukocyte antigen-match depending on the source of the graft. Most adult donor transplants were matched at the allele-level considering human leukocyte antigens-A, -B, -C and -DRB1. In contrast, most cord blood transplants were mismatched and considered antigen-level matching; 57% were mismatched at two loci and 29% at one locus whereas only 29% of adult donor transplants were mismatched at one locus and none at two loci. There were no differences in the 3-year probabilities of survival between recipients of cord blood (44%), matched adult donor (44%) and mismatched adult donor (43%) transplants. Cord blood transplants engrafted slower and were associated with less grade 2-4 acute but similar chronic graft-versus-host disease, relapse, and transplant-related mortality. The survival of cord blood graft recipients was similar to that of recipients of matched or mismatched unrelated adult donor grafts and so cord blood should be considered a valid alternative source of stem cells for adults with acute lymphoblastic leukemia in the absence of a matched unrelated adult donor.

  • 249.
    Marusik, C
    et al.
    Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
    Frykholm, C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Ericson, Katharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical and experimental pathology.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Diagnosis of Placental Mesenchymal Dysplasia with a focus on magnetic resonance imaging (MRI)2017In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 49, no 3, p. 410-412Article in journal (Refereed)
  • 250.
    Mauri, Davide
    et al.
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;PACMeR Athens, Evidence Based Dept, Athens, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Kalopita, Konstantina
    Alexandra Gen Hosp, Dept Anaesthesiol & Pain Med, Athens, Greece.
    Tsali, Lampriani
    PACMeR Athens, Evidence Based Dept, Athens, Greece.
    Polyzos, Nikolaos P.
    Hosp Univ Dexeus, Barcelona, Spain.
    Valachis, Antonis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Filis, Panagiotis
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Zarkavelis, Georgios
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Georgopoulos, Christos
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Zafeiri, Georgia
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Yerolatsite, Melina
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Papaioannou, Nikolaos
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Kapoulitsa, Fani
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Valsamidis, Dimitrios
    Alexandra Gen Hosp, Dept Anaesthesiol & Pain Med, Athens, Greece.
    Peponi, Evangelia
    Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece;Univ Hosp Ioannina, Dept Radiotherapy, Ioannina, Greece.
    Vrekoussis, Thomas
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece.
    Ntellas, Panagiotis
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Tzamachou, Eleftheria
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Pentheroudakis, Georgios
    Univ Hosp Ioannina, Dept Med Oncol, S Niarchos Ave, Ioannina 45500, Greece;Soc Study Clonal Heterogene Neoplasia EMEKEN, Ioannina, Greece.
    Cancer pain ... who cares?: International and national patterns of evidence-based global guide-lines recommendations for physicians on the Web (2011 vs. 2018)2020In: Journal of B.U.ON. (JBUON), ISSN 1107-0625, Vol. 25, no 1, p. 62-73Article in journal (Refereed)
    Abstract [en]

    Purpose: Although pain is a common event during treatment of cancer, its assessment and management remains suboptimal in everyday clinical practice at global level.

    Methods: Considering both the important role of Internet in daily life and that clinical guidelines are important for translating evidence in clinical practice, we performed a prospective study to scrutinize the magnitude of updated evidence-based cancer-pain guideline recommendation for physicians on the web. Changes over-time at a global level were scrutinized at two time points: 2011 for baseline and 2018 at first follow-up. Both anesthesiology and oncology societies were analyzed.

    Results: In 2011 we scrutinized 181,00 WebPages and 370 eligible societies were identified; 364 of these were eligible for analyses both in 2011 and 2018. The magnitude of cancer pain updated and evidence-based guideline recommendations on the web for health care providers was extremely low at global level and at any time point considered 1.1% (4/364) in 2011 and 4.7% (17364) in 2018. Continental and intercontinental patterns, National's highest developmental index, oncology tradition and economic-geographic areas were not found to influence cancer pain web-guideline provision. In 2018, pain & supportive care societies provided the highest rate of updated evidence-based cancer-pain guidelines for clinicians. Only 3/25 medical oncology societies and 1/34 radiation oncology societies, provided own or e-link (to other societies) evidence-based guidelines in their websites.

    Conclusions: Major medical oncology and radiation oncology societies - at global level - fail to produce updated cancer pain recommendations for their physicians, with most of these providing no or inconsistent or outdated guidelines.

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