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  • 351.
    Sperber, Jesper
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Protective Mechanical Ventilation in Inflammatory and Ventilator-Associated Pneumonia Models2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Severe infections, trauma or major surgery can each cause a state of systemic inflammation. These causes for systemic inflammation often coexist and complicate each other. Mechanical ventilation is commonly used during major surgical procedures and when respiratory functions are failing in the intensive care setting. Although necessary, the use of mechanical ventilation can cause injury to the lungs and other organs especially under states of systemic inflammation. Moreover, a course of mechanical ventilator therapy can be complicated by ventilator-associated pneumonia, a factor greatly influencing mortality. The efforts to avoid additional ventilator-induced injury to patients are embodied in the expression ‘protective ventilation’.

    With the use of pig models we have examined the impact of protective ventilation on systemic inflammation, on organ-specific inflammation and on bacterial growth during pneumonia. Additionally, with a 30-hour ventilator-associated pneumonia model we examined the influence of mechanical ventilation and systemic inflammation on bacterial growth. Systemic inflammation was initiated with surgery and enhanced with endotoxin. The bacterium used was Pseudomonas aeruginosa.

    We found that protective ventilation during systemic inflammation attenuated the systemic inflammatory cytokine responses and reduced secondary organ damage. Moreover, the attenuated inflammatory responses were seen on the organ specific level, most clearly as reduced counts of inflammatory cytokines from the liver. Protective ventilation entailed lower bacterial counts in lung tissue after 6 hours of pneumonia. Mechanical ventilation for 24 h, before a bacterial challenge into the lungs, increased bacterial counts in lung tissue after 6 h. The addition of systemic inflammation by endotoxin during 24 h increased the bacterial counts even more. For comparison, these experiments used control groups with clinically common ventilator settings.

    Summarily, these results support the use of protective ventilation as a means to reduce systemic inflammation and organ injury, and to optimize bacterial clearance in states of systemic inflammation and pneumonia.

    List of papers
    1. Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis
    Open this publication in new window or tab >>Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis
    Show others...
    2013 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 12, p. e83182-Article in journal (Refereed) Published
    Abstract [en]

    Low tidal volume ventilation is beneficial in patients with severe pulmonary dysfunction and would, in theory, reduce postoperative complications if implemented during routine surgery. The study aimed to investigate whether low tidal volume ventilation and high positive end-expiratory pressure (PEEP) in a large animal model of postoperative sepsis would attenuate the systemic inflammatory response and organ dysfunction. Thirty healthy pigs were randomized to three groups: Group Prot-7h, i.e. protective ventilation for 7 h, was ventilated with a tidal volume of 6 mL x kg-1 for 7 h; group Prot-5h, i.e. protective ventilation for 5 h, was ventilated with a tidal volume of 10 mL x kg-1 for 2 h, after which the group was ventilated with a tidal volume of 6 mL x kg-1; and a control group that was ventilated with a tidal volume of 10 mL x kg-1 for 7 h. In groups Prot-7h and Prot-5h PEEP was 5 cmH2O for 2 h and 10 cmH2O for 5 h. In the control group PEEP was 5 cmH2O for the entire experiment. After surgery for 2 h, postoperative sepsis was simulated with an endotoxin infusion for 5 h. Low tidal volume ventilation combined with higher PEEP led to lower levels of interleukin 6 and 10 in plasma, higher PaO2/FiO2, better preserved functional residual capacity and lower plasma troponin I as compared with animals ventilated with a medium high tidal volume and lower PEEP. The beneficial effects of protective ventilation were seen despite greater reductions in cardiac index and oxygen delivery index. In the immediate postoperative phase low VT ventilation with higher PEEP was associated with reduced ex vivo plasma capacity to produce TNF-α upon endotoxin stimulation and higher nitrite levels in urine. These findings might represent mechanistic explanations for the attenuation of systemic inflammation and inflammatory-induced organ dysfunction.

    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:uu:diva-213610 (URN)10.1371/journal.pone.0083182 (DOI)000328731800101 ()24349457 (PubMedID)
    Available from: 2013-12-30 Created: 2013-12-30 Last updated: 2018-01-11Bibliographically approved
    2. Evaluating the effects of protective ventilation on organ-specific cytokine production in porcine experimental postoperative sepsis
    Open this publication in new window or tab >>Evaluating the effects of protective ventilation on organ-specific cytokine production in porcine experimental postoperative sepsis
    Show others...
    2015 (English)In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 15, article id 60Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Protective ventilation with lower tidal volume (VT) and higher positive end-expiratory pressure (PEEP) reduces the negative additive effects of mechanical ventilation during systemic inflammatory response syndrome. We hypothesised that protective ventilation during surgery would affect the organ-specific immune response in an experimental animal model of endotoxin-induced sepsis-like syndrome.

    METHODS: 30 pigs were laparotomised for 2 hours (h), after which a continuous endotoxin infusion was started at 0.25 micrograms × kg(-1) × h(-1) for 5 h. Catheters were placed in the carotid artery, hepatic vein, portal vein and jugular bulb. Animals were randomised to two protective ventilation groups (n = 10 each): one group was ventilated with VT 6 mL × kg(-1) during the whole experiment while the other group was ventilated during the surgical phase with VT of 10 mL × kg(-1). In both groups PEEP was 5 cmH2O during surgery and increased to 10 cmH2O at the start of endotoxin infusion. A control group (n = 10) was ventilated with VT of 10 mL × kg(-1) and PEEP 5 cm H20 throughout the experiment. In four sample locations we a) simultaneously compared cytokine levels, b) studied the effect of protective ventilation initiated before and during endotoxemia and c) evaluated protective ventilation on organ-specific cytokine levels.

    RESULTS: TNF-alpha levels were highest in the hepatic vein, IL-6 levels highest in the artery and jugular bulb and IL-10 levels lowest in the artery. Protective ventilation initiated before and during endotoxemia did not differ in organ-specific cytokine levels. Protective ventilation led to lower levels of TNF-alpha in the hepatic vein compared with the control group, whereas no significant differences were seen in the artery, portal vein or jugular bulb.

    CONCLUSIONS: Variation between organs in cytokine output was observed during experimental sepsis. We see no implication from cytokine levels for initiating protective ventilation before endotoxemia. However, during endotoxemia protective ventilation attenuates hepatic inflammatory cytokine output contributing to a reduced total inflammatory burden.

    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-253174 (URN)10.1186/s12890-015-0052-9 (DOI)000354840700001 ()25958003 (PubMedID)
    Available from: 2015-05-23 Created: 2015-05-23 Last updated: 2017-12-04Bibliographically approved
    3. Protective Ventilation Reduces Pseudomonas Aeruginosa Growth in a Porcine Pneumonia Model
    Open this publication in new window or tab >>Protective Ventilation Reduces Pseudomonas Aeruginosa Growth in a Porcine Pneumonia Model
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-282600 (URN)
    Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2016-05-12
    4. Exposure to Mechanical Ventilation and Endotoxin for 24 Hours Before Infection Influences Pseudomonas Aeruginosa Growth During Experimental Porcine Ventilator-Associated Pneumonia
    Open this publication in new window or tab >>Exposure to Mechanical Ventilation and Endotoxin for 24 Hours Before Infection Influences Pseudomonas Aeruginosa Growth During Experimental Porcine Ventilator-Associated Pneumonia
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Anesthesiology and Intensive Care
    Identifiers
    urn:nbn:se:uu:diva-282601 (URN)
    Available from: 2016-04-05 Created: 2016-04-05 Last updated: 2016-05-12
  • 352.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Evaluating the effects of protective ventilation on organ-specific cytokine production in porcine experimental postoperative sepsis2015In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 15, article id 60Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Protective ventilation with lower tidal volume (VT) and higher positive end-expiratory pressure (PEEP) reduces the negative additive effects of mechanical ventilation during systemic inflammatory response syndrome. We hypothesised that protective ventilation during surgery would affect the organ-specific immune response in an experimental animal model of endotoxin-induced sepsis-like syndrome.

    METHODS: 30 pigs were laparotomised for 2 hours (h), after which a continuous endotoxin infusion was started at 0.25 micrograms × kg(-1) × h(-1) for 5 h. Catheters were placed in the carotid artery, hepatic vein, portal vein and jugular bulb. Animals were randomised to two protective ventilation groups (n = 10 each): one group was ventilated with VT 6 mL × kg(-1) during the whole experiment while the other group was ventilated during the surgical phase with VT of 10 mL × kg(-1). In both groups PEEP was 5 cmH2O during surgery and increased to 10 cmH2O at the start of endotoxin infusion. A control group (n = 10) was ventilated with VT of 10 mL × kg(-1) and PEEP 5 cm H20 throughout the experiment. In four sample locations we a) simultaneously compared cytokine levels, b) studied the effect of protective ventilation initiated before and during endotoxemia and c) evaluated protective ventilation on organ-specific cytokine levels.

    RESULTS: TNF-alpha levels were highest in the hepatic vein, IL-6 levels highest in the artery and jugular bulb and IL-10 levels lowest in the artery. Protective ventilation initiated before and during endotoxemia did not differ in organ-specific cytokine levels. Protective ventilation led to lower levels of TNF-alpha in the hepatic vein compared with the control group, whereas no significant differences were seen in the artery, portal vein or jugular bulb.

    CONCLUSIONS: Variation between organs in cytokine output was observed during experimental sepsis. We see no implication from cytokine levels for initiating protective ventilation before endotoxemia. However, during endotoxemia protective ventilation attenuates hepatic inflammatory cytokine output contributing to a reduced total inflammatory burden.

  • 353.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lung protective ventilation induces immunotolerance and nitric oxide metabolites in porcine experimental postoperative sepsis2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 12, p. e83182-Article in journal (Refereed)
    Abstract [en]

    Low tidal volume ventilation is beneficial in patients with severe pulmonary dysfunction and would, in theory, reduce postoperative complications if implemented during routine surgery. The study aimed to investigate whether low tidal volume ventilation and high positive end-expiratory pressure (PEEP) in a large animal model of postoperative sepsis would attenuate the systemic inflammatory response and organ dysfunction. Thirty healthy pigs were randomized to three groups: Group Prot-7h, i.e. protective ventilation for 7 h, was ventilated with a tidal volume of 6 mL x kg-1 for 7 h; group Prot-5h, i.e. protective ventilation for 5 h, was ventilated with a tidal volume of 10 mL x kg-1 for 2 h, after which the group was ventilated with a tidal volume of 6 mL x kg-1; and a control group that was ventilated with a tidal volume of 10 mL x kg-1 for 7 h. In groups Prot-7h and Prot-5h PEEP was 5 cmH2O for 2 h and 10 cmH2O for 5 h. In the control group PEEP was 5 cmH2O for the entire experiment. After surgery for 2 h, postoperative sepsis was simulated with an endotoxin infusion for 5 h. Low tidal volume ventilation combined with higher PEEP led to lower levels of interleukin 6 and 10 in plasma, higher PaO2/FiO2, better preserved functional residual capacity and lower plasma troponin I as compared with animals ventilated with a medium high tidal volume and lower PEEP. The beneficial effects of protective ventilation were seen despite greater reductions in cardiac index and oxygen delivery index. In the immediate postoperative phase low VT ventilation with higher PEEP was associated with reduced ex vivo plasma capacity to produce TNF-α upon endotoxin stimulation and higher nitrite levels in urine. These findings might represent mechanistic explanations for the attenuation of systemic inflammation and inflammatory-induced organ dysfunction.

  • 354.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Nyberg, Axel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Exposure to Mechanical Ventilation and Endotoxin for 24 Hours Before Infection Influences Pseudomonas Aeruginosa Growth During Experimental Porcine Ventilator-Associated PneumoniaManuscript (preprint) (Other academic)
  • 355.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Nyberg, Axel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Protective Ventilation Reduces Pseudomonas Aeruginosa Growth in a Porcine Pneumonia ModelManuscript (preprint) (Other academic)
  • 356.
    Sperber, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Centre for Clinical Research Sörmland, Department of Anesthesiology & Intensive Care Mälarsjukhuset, SE-631 88 Eskilstuna, Sweden.
    Nyberg, Axel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Centre for Clinical Research Sörmland, Department of Anesthesiology & Intensive Care Mälarsjukhuset, SE-631 88 Eskilstuna, Sweden.
    Lipcsey, Miklós
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    Sjölin, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Castegren, Markus
    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 Surgical Sciences, Hedenstierna laboratory. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Perioperative Medicine and Intensive Care, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Protective ventilation reduces Pseudomonas aeruginosa growth in lung tissue in a porcine pneumonia model2017In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 5, article id 40Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mechanical ventilation with positive end expiratory pressure and low tidal volume, i.e. protective ventilation, is recommended in patients with acute respiratory distress syndrome. However, the effect of protective ventilation on bacterial growth during early pneumonia in non-injured lungs is not extensively studied. The main objectives were to compare two different ventilator settings on Pseudomonas aeruginosa growth in lung tissue and the development of lung injury.

    METHODS: A porcine model of severe pneumonia was used. The protective group (n = 10) had an end expiratory pressure of 10 cm H2O and a tidal volume of 6 ml x kg-1. The control group (n = 10) had an end expiratory pressure of 5 cm H2O and a tidal volume of 10 ml x kg-1. 1011 colony forming units of Pseudomonas aeruginosa were inoculated intra-tracheally at baseline, after which the experiment continued for 6 h. Two animals from each group received only saline, and served as sham animals. Lung tissue samples from each animal were used for bacterial cultures and wet-to-dry weight ratio measurements.

    RESULTS: The protective group displayed lower numbers of Pseudomonas aeruginosa (p < 0.05) in the lung tissue, and a lower wet-to-dry ratio (p < 0.01) than the control group. The control group deteriorated in arterial oxygen tension/inspired oxygen fraction, whereas the protective group was unchanged (p < 0.01).

    CONCLUSIONS: In early phase pneumonia, protective ventilation with lower tidal volume and higher end expiratory pressure has the potential to reduce the pulmonary bacterial burden and the development of lung injury.

  • 357.
    Stefansson, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Sormland Cty Council, Ctr Clin Res, Kungsgatan 41, SE-63188 Eskilstuna, Sweden.
    Askling, H. H.
    Karolinska Inst, Dept Med, Div Infect Dis, SE-17176 Stockholm, Sweden.
    Rombo, L.
    Malarsjukhuset, Dept Infect Dis, SE-63188 Eskilstuna, Sweden.
    A single booster dose of diphtheria vaccine is effective for travelers regardless of time interval since previous doses2018In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 25, article id tay041Article in journal (Refereed)
    Abstract [en]

    Our study showed the immune response before and after a booster against diphtheria given within the 20-year interval recommended in Sweden or after a prolonged interval. Of 40 travellers, 10/13 in recommended interval group were immune before booster and 19/27 with a delayed interval. After booster, 13/13 versus 26/27 were protected. One booster was sufficient to achieve immunity regardless of the interval.

  • 358.
    Sterne, Jesper
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Infektionskliniken, Mälarsjukhuset, 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). Infektionskliniken, Mälarsjukhuset, Eskilstuna, Sweden.
    Loperamid ordineras alltför sällan vid turistdiarré: Resultat av enkät till infektionsläkare2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 9-10, p. 466-468Article in journal (Refereed)
  • 359.
    Svensson, Tobias
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Kättström, Magdalena
    Hammarlund, Ylva
    Roth, Daniel
    Andersson, Per-Ola
    Svensson, Magnus
    Nilsson, Ingmar
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Cherif, Honar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.
    Kimby, Eva
    Conjugated Pneumococcal Vaccine Triggers a Better Immune Response than Polysaccharide Pneumococcal Vaccine in Patients with Chronic Lymphocytic Leukemia: A Randomized Study by the Swedish CLL group2018In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 36, no 25, p. 3701-3707Article in journal (Refereed)
    Abstract [en]

    Aim: To determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent conjugated pneumococcal vaccine (PCV13), Prevenar13®, compared with a 23-valent capsular polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response.

     

    Background: Patients with CLL have an increased risk for infection and Streptococcus pneumoniae is one of the most common pathogens with high morbidity.  Patients with CLL are known to respond poorly to the traditionally used polysaccharide vaccines. Conjugation of polysaccharide to protein carriers renders a thymus-dependent, memory-inducing and more immunogenic vaccine. In patients with CLL, there is no consensus on a recommendation for pneumococcal vaccination, due to a lack of comparative studies.

     

    Methods: 128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n=63) or PPSV23 (n=65) after stratification by IgG levels and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, at one and at six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA).

     

    Results: PCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. The proportion of patients with good response (defined as response in 8 of 12 common serotypes according to predefined response criteria) was higher in PCV13 recipients than in PPSV23 recipients after one month (40% vs. 22%, p=0.034) as well as after six months (33% vs. 17%, p=0.041). Never did PPSV23 trigger a better immune response for any of the serotypes, than PCV13, regardless of analysis. For two of the serotypes, OPA GMTs were lower at the six months than at the one-month follow up. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated.

     

    Conclusions: In patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for many serotypes common for the two vaccines. PCV13 should be considered as a part in vaccination programs against Streptococcus pneumoniae for these patients and administered as early as possible during the course of the disease. 

  • 360.
    Säfstrom, Emma
    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; Nykoping Hosp, Sormland Cty Council, Nykoping, Sweden.
    Jaarsma, Tiny
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden.
    Stromberg, Anna
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden;Linkoping Univ, Dept Cardiol, Linkoping, Sweden.
    Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization2018In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 177Article in journal (Refereed)
    Abstract [en]

    Background: The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients' perspective and from a medical chart review. Methods: This was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman's rank correlation coefficient and Chi square. A P value of 0. 05 was considered significant. Results: A total of 121 patients were included in the study, mean age 82.5 (+/- 6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization. Conclusion: Most patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.

  • 361.
    Söderberg, Anna Karin
    et al.
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Elfors, Caroline
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Larsson, Mattias Holmqvist
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 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, S-58183 Linkoping, Sweden.
    Holmqvist, Rolf
    Linkoping Univ, Dept Behav Sci & Learning, S-58183 Linkoping, Sweden.
    Emotional availability in psychotherapy: The usefulness and validity of the Emotional Availability Scales for analyzing the psychotherapeutic relationship2014In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381, Vol. 24, no 1, p. 91-102Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess whether a modified version of the Emotional Availability Scales (EAS), created to assess interaction quality between parents and children, could be applied to psychotherapy sessions and whether emotional availability (EA), as assessed by the modified EAS-T, was associated with client- and therapist-rated working alliance. EAS-T was used to assess 42 sessions from 16 therapies. The therapies came from the LURIPP project, comparing IPT with BRT for depressed clients. The results showed that sessions could be reliably rated with EAS-T. Most rating scales had acceptable variance. The client's perception of task alliance was associated with several of the EA subscales (sensitivity, nonhostility, responsiveness) assessed over therapies, whereas the perception of bond was associated with Structure on EAS.

  • 362.
    Söderlund, Anne
    et al.
    Mälardalens högskola.
    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, Caring Sciences.
    Sterling, Michele
    University of Queensland, Australia.
    Stålnacke, Britt-Marie
    Umeå universitet.
    Exploring patients’ experiences of the whiplash injury-recovery process: A meta-synthesis2018In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 11, p. 1263-1271Article, review/survey (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to conduct a meta-synthesis to analyze qualitative research findings and thereby understand patients’ experiences of whiplash-associated disorders (WAD) and the injury-recovery process. Materials and methods: A qualitative meta-synthesis, which is an interpretive integration of existing qualitative findings, was performed. The databases PubMed, PsychINFO, Scopus, and Web of Science were searched. The Critical Assessment Skills Programme was used to assess the quality of the included studies. Results: Four studies were included. The synthesis resulted in several codes, 6 categories, and 3 themes (distancing from normalcy, self-efficacy in controlling the life situation after the injury, and readjustment and acceptance) that described the participants’ pain beliefs, their WAD-related life situation and their future expectations and acceptance. Changes in self-image were difficult to cope with and likely led to perceived stigmatization. Struggling with feelings of loss of control appeared to lead to low confidence and insecurity. Focusing on increasing knowledge and understanding the pain and its consequences were believed to lead to better strategies for handling the situation. Furthermore, recapturing life roles, including returning to work, was challenging, but an optimistic outlook reinforced symptom improvements and contributed to feelings of happiness. Conclusion: The results of the present study provide a comprehensive understanding of patients’ complex, multifaceted experiences of WAD, and the injury-recovery process. The findings can guide us in the development of new ways to evaluate and manage WAD. The results also indicate that a more patient-centered approach is needed to determine the depth and breadth of each patient’s problems.

  • 363.
    Söderström, U
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Samuelsson, U
    Sahlqvist, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Åman, J
    Impaired metabolic control and socio-demographic status in immigrant children at onset of Type 1 diabetes2014In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 11, p. 1418-1423Article in journal (Refereed)
    Abstract [en]

    AIM:

    The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type 1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status.

    METHODS AND DESIGN:

    This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13 415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type 1 diabetes.

    RESULTS:

    The proportion of low capillary pH (< 7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P < 0.001)]. HbA1c was also higher [95 mmol/mol (10.8%) vs. 88 mmol/mol (10.2%), respectively (P < 0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA1c was 0.983 (95% CI 0.976-0.991) and for plasma glucose was 0.953 (95% CI 0.933-0.973).

    CONCLUSION:

    Children born to immigrant parents have lower capillary pH and higher HbA1c at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.

  • 364.
    Söderström, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Pediatrics, Mälarsjukhuset Hospital, Eskilstuna, Sweden.
    Samuelsson, Ulf
    Division of Paediatrics, Department of Molecular and Clinical Medicine, Linkoping University, Linköping, Sweden; Department of Pediatrics, The University Hospital in Linköping, Linköping, Sweden.
    Åman, Jan
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    National Swedish study of immigrant children with type 1 diabetes showed impaired metabolic control after three years of treatment2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 8, p. 935-939Article in journal (Refereed)
    Abstract [en]

    AIM: This study examined the clinical status and socio-demographic conditions of children with type 1 diabetes at baseline and after three years of treatment, comparing those born to immigrant parents and Swedish parents.

    METHODS: This observational nationwide population-based cohort-study used prospectively collected registry data from Swediabkids, the National Quality Registry for Paediatric Diabetes in Sweden from 2000-2010. Of the 13,415 children with type 1 diabetes, there were 879 born to immigrant parents. We selected three children born to Swedish parents from the same registry for each immigrant child matching them by gender, age and year of diabetes onset (n=2627; with 10 control children missing probably due to the matching procedure).

    RESULTS: Immigrant children had a higher median glycated haemoglobin level (HbA1c) than their Swedish peers, but there was no difference in the frequency of hypoglycaemia or keto-acidosis between the two cohorts. A linear regression model with HbA1c as a dependent variable showed that insulin units per kilogram of body weight were the main reason for inferior metabolic control.

    CONCLUSION: Children with type 1 diabetes born to immigrant parents had inferior metabolic control three years after disease onset compared to children with Swedish born parents. Social family support and educational coping programmes are needed to improve treatment outcomes in immigrants with diabetes. This article is protected by copyright. All rights reserved.

  • 365.
    Ternby, Ellen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Annerén, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC Obstet, Stockholm, Sweden.
    Ingvoldstad, Charlotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC Obstet, Stockholm, Sweden.
    Why do pregnant women accept or decline prenatal diagnosis for Down syndrome?2016In: Journal of community genetics, ISSN 1868-310X, Vol. 7, no 3, p. 237-242Article in journal (Refereed)
    Abstract [en]

    To investigate if actual knowledge of Down syndrome (DS), influences the decision to accept or decline prenatal diagnosis (PND). Secondary aims were to elucidate reasons for accepting or declining PND and investigate differences between the accepting and declining group in perceived information, knowing someone with DS and thoughts about decision-making. A questionnaire was completed by 76 pregnant women who underwent invasive testing and 65 women who declined tests for chromosomal aberrations in Uppsala, Sweden. Apart from one question no significant differences were found in knowledge of DS between women declining or accepting PND for DS. Both groups had varying and in several respects low levels of knowledge about DS and its consequences. Most common reasons to accept PND were 'to ease my worries' and 'to do all possible tests to make sure the baby is healthy'. Corresponding statements declining PND were 'termination of pregnancy is not an option' and 'because invasive tests increase the risk of miscarriage'. More women declining PND knew someone with DS. Knowledge of DS at these levels is not a major factor when women decide to accept or decline PND for DS. Their choice is mostly based on opinions and moral values.

  • 366.
    Ternby, Ellen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ingvoldstad, Charlotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Department of Clinical Science, Intervention and Technology (CLINTEC), Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden.
    Annerén, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Midwives and information on prenatal testing with focus on Down syndrome2015In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 35, no 12, p. 1202-1207Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate midwives' knowledge of prenatal diagnosis especially Down syndrome, information given by midwives to parents, expectant parents' requests for information and how midwives perceive their own competence to give information.

    METHOD: A cross-sectional, prospective study with a questionnaire was completed by 64 out of 70 midwives working in the outpatient antenatal care in Uppsala County, Sweden.

    RESULTS: The midwives had varying and in some areas low levels of knowledge about Down syndrome. Information about Down syndrome was most often given only when asked for or when there was an increased probability of a Down syndrome pregnancy. The most common questions from expectant parents concerned test methods and risk assessments while questions regarding symptoms of Down syndrome and consequences of having a child with Down syndrome were uncommon. The majority (83-89%) had insufficient or no education regarding different prenatal tests. Only 2 midwives (3%) had received education about Down syndrome and 10% felt they had sufficient knowledge to inform about the syndrome. More education about prenatal tests and Down syndrome was desired by 94%.

    CONCLUSION: It is important to ensure that midwives in antenatal care have sufficient knowledge to inform expectant parents about the conditions screened for.

  • 367.
    Ternby, Ellen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Ingvoldstad, Charlotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Annerén, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    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.
    Information and knowledge about Down syndrome among women and partners after first trimester combined testing2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 3, p. 329-32Article in journal (Refereed)
    Abstract [en]

    We assessed reasons among women and partners for choosing combined ultrasound-biochemistry testing, information and knowledge about Down syndrome and decisions concerning invasive procedures and termination of pregnancy in a prospective cohort study in Uppsala County. In all 105 pregnant women and 104 partners coming for a combined ultrasound-biochemistry test answered a questionnaire. The most common reason for a combined ultrasound-biochemistry test was "to perform all tests possible to make sure the baby is healthy". Internet and midwives were the most common sources of information. Seventy-two percent had not received information on what it means to live with a child with Down syndrome. Many expectant parents perceived information as insufficient. Both women and partners had varying or low levels of knowledge about medical, cognitive and social consequences of Down syndrome. Twenty-five percent had not decided on an invasive test if indicated and only 42% would consider termination of pregnancy with a Down syndrome diagnosis.

  • 368. Thitasan, Anchalee
    et al.
    Aytar, Osman
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Velandia, Marianne
    Young people's health and risk behaviours in relation to their sexual orientation: A cross-sectional study of Thailand and Sweden.2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, p. 67-74, article id S1877-5756(18)30291-XArticle in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study examined the associations between sexual orientation of young people and their health and risk behaviours in Thailand and Sweden, and to explore similarities and differences between the countries.

    STUDY DESIGN: A cross-sectional study using data from the Life and Health - Young surveys in Thailand and Sweden. Three different statistical analyses were used to examine the associations of the variables.

    RESULTS: In total, 3869 students aged 16-18 years old were included: 1488 Thai students and 2381 Swedish students. Significantly more Thai (20%) than Swedish (9%) students identified themselves as bisexual, homosexual or unsure (p < .001). Bivariate analysis showed that, in Thailand, self-harm was more often reported by the homosexual, unsure, and bisexual groups than by the heterosexual group (p = .005). In Sweden, early sexual debut was more often reported by the unsure, bisexual, and homosexual groups than by the heterosexual group (p = .033). Multiple logistic regression analysis showed that homosexual and unsure sexual orientations were significantly associated with self-harm (p < .05) among Thai students. Unsure sexual orientation was significantly associated with early sexual debut (p = .04) among Swedish students. Multiple correspondence analysis indicated that sexual orientation was associated with health and risk behaviours, and varied by different subcategories of students' backgrounds such as country, sexual orientation, family structure and adult support.

    CONCLUSIONS: Sexual minority young people reported more risk behaviours and poorer health than their heterosexual counterparts. The findings are useful for policy programmes on sexual and reproductive health and rights of young people.

  • 369.
    Treleaven, Julia
    et al.
    Univ Queensland, NHMRC CCRE Spinal Pain Injury & Hlth, Brisbane, Qld, Australia..
    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, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden..
    Ludvigsson, Maria Landen
    Linkoping Univ, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Stockholm, Sweden..
    Kammerlind, Ann-Sofi
    Linkoping Univ, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden.;Cty Council Jonkoping, Futurum Acad Healthcare, Jonkoping, Sweden..
    Peolsson, Anneli
    Linkoping Univ, Fac Hlth Sci, Physiotherapy, Dept Med & Hlth Sci, Linkoping, Sweden..
    Balance, dizziness and proprioception in patients with chronic whiplash associated disorders complaining of dizziness: A prospective randomized study comparing three exercise programs2016In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 22, p. 122-130Article in journal (Refereed)
    Abstract [en]

    Background: Dizziness and unsteadiness are common symptoms following a whiplash injury. Objective: To compare the effect of 3 exercise programs on balance, dizziness, proprioception and pain in patients with chronic whiplash complaining of dizziness.

    Design: A sub-analysis of a randomized study.

    Methods: One hundred and forty subjects were randomized to either a physiotherapist-guided neck-specific exercise (NSE), physiotherapist-guided neck-specific exercise, with a behavioural approach (NSEB) or prescription of general physical activity (PPA) group. Pre intervention, 3, 6 and 12 months post baseline they completed the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ), Visual Analogue Scales (VAS) for, dizziness at rest and during activity and physical measures (static and dynamic clinical balance tests and head repositioning accuracy (HRA)).

    Results: There were significant time by group differences with respect to dizziness during activity and UCLA-Q favouring the physiotherapy led neck specific exercise group with a behavioural approach. Within group analysis of changes over time also revealed significant changes in most variables apart from static balance. Conclusion: Between and within group comparisons suggest that physiotherapist led neck exercise groups including a behavioural approach had advantages in improving measures of dizziness compared with the general physical activity group, although many still complained of dizziness and balance impairment. Future studies should consider exercises specifically designed to address balance, dizziness and cervical proprioception in those with persistent whiplash.

  • 370.
    Trouva, Anastasia
    et al.
    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, S-10401 Stockholm, Sweden..
    Calissendorff, Jan
    Karolinska Inst, Dept Clin Sci & Educ, Sodersjukhuset, S-10401 Stockholm, Sweden..
    Vanky, Eszter
    St Olavs Hosp, Inst Lab Med Childrens & Womens Hlth, Trondheim, Norway.;St Olavs Hosp, Dept Obstet & Gynecol, Trondheim, Norway..
    Hirschberg, Angelica
    Karolinska Inst, Dept Womens & Childrens Hlth, S-10401 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Obstet & Gynecol, Stockholm, Sweden..
    Thyroid hormone function in pregnant women with polycystic ovary syndrome treated with metformin or placebo2016In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 32, p. 71-72Article in journal (Other academic)
  • 371.
    Turcotte, Lucie M.
    et al.
    Univ Minnesota, Blood & Marrow Transplant Program, Minneapolis, MN 55455 USA.
    Wang, Tao
    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.
    Hemmer, Michael T.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Spellman, Stephen R.
    Natl Marrow Donor Program Be Match, Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA.
    Arora, Mukta
    Univ Minnesota, Dept Med, Med Ctr, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA.
    Couriel, Daniel
    Utah Blood & Marrow Transplant Program, Salt Lake City, UT USA.
    Alousi, Amin
    Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX 77030 USA.
    Pidala, Joseph
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Abdel-Azim, Hisham
    Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA USA.
    Ahmed, Ibrahim
    Childrens Mercy Hosp & Clin, Dept Hematol Oncol & Bone Marrow Transplantat, Kansas City, MO USA.
    Beitinjaneh, Amer
    Univ Miami, Miami, FL USA.
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA.
    Byrne, Michael
    Vanderbilt Univ, Med Ctr, Nashville, TN USA.
    Callander, Natalie
    Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA.
    Chao, Nelson
    Duke Univ, Med Ctr, Dept Med, Div Cell Therapy & Hematol, Durham, NC 27710 USA.
    Choi, Sung Wong
    Univ Michigan, Ann Arbor, MI 48109 USA.
    DeFilipp, Zachariah
    Massachusetts Gen Hosp, Blood & Marrow Transplant Program, Boston, MA 02114 USA.
    Gadalla, Shahinaz M.
    NCI, Div Canc Epidemiol & Genet, NIH, Clin Genet Branch, Rockville, MD USA.
    Gale, Robert Peter
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England.
    Gergis, Usama
    New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med Oncol, Hematolg Malignancies & Bone Marrow Transplant, New York, NY USA.
    Hashmi, Shahrukh
    Mayo Clin, Dept Internal Med, Rochester, MN USA;King Faisal Specialist Hosp & Res Ctr, Ctr Oncol, Riyadh, Saudi Arabia.
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA.
    Holmberg, Leona
    Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA.
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan.
    Kamble, Rammurti T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA.
    Lehmann, Leslie
    Boston Childrens Hosp, Dana Farber Canc Inst, Boston, MA USA.
    MacMillan, Margaret A.
    Univ Minnesota, Dept Med, Med Ctr, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA.
    McIver, Zachariah
    Wake Forest Baptist Hlth, Winston Salem, NC USA.
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Norkin, Maxim
    Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA.
    O'Brien, Tracey
    Sydney Childrens Hosp, Kids Canc Ctr, Blood & Marrow Transplant Program, Sydney, NSW, Australia.
    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, Div Therapeut Immunol, Stockholm, Sweden.
    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.
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
    Schouten, Harry C.
    Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands.
    Seo, Sachiko
    Natl Canc Res Ctr East, Dept Hematol & Oncol, Chiba, Japan.
    Solh, Melhem
    Northside Hosp, Blood & Marrow Transplant Grp Georgia, Atlanta, GA USA.
    Verdonck, Leo
    Isala Clin, Dept Hematol Oncol, Zwolle, Netherlands.
    Vij, Ravi
    Washington Univ, Sch Med, Div Hematol & Oncol, St Louis, MO USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Yared, Jean
    Univ Maryland, Dept Med, Blood & Marrow Transplantat Program, Div Hematol Oncol,Greenebaum Canc Ctr, Baltimore, MD 21201 USA.
    Horowitz, Mary M.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Knight, Jennifer M.
    Med Coll Wisconsin, Dept Psychiat, Milwaukee, WI 53226 USA.
    Verneris, Michael R.
    Univ Colorado Denver, Aurora, CO USA.
    Correspondence: Donor body mass index does not predict graft versus host disease following hematopoietic cell transplantation2018In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 53, no 7, p. 932-937Article in journal (Other academic)
  • 372.
    Urbano-Ispizua, Alvaro
    et al.
    Univ Barcelona, Hosp Clin, IDIBAPS, Dept Hematol, Barcelona, Spain.;Inst Res Josep Carreras, Barcelona, Spain..
    Pavletic, Steven Z.
    NCI, Expt Transplantat & Immunol Branch, Ctr Canc Res, Bethesda, MD 20892 USA..
    Flowers, Mary E.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Klein, John P.
    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..
    Zhang, Mei-Jie
    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..
    Carreras, Jeanette
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Montoto, Silvia
    Barts Hlth NHS Trust, St Bartholomews Hosp, Dept Haematooncol, London, England..
    Perales, Miguel-Angel
    Mem Sloan Kettering Canc Ctr, Dept Med, Bone Marrow Transplant Serv, New York, NY 10021 USA..
    Aljurf, Mahmoud D.
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia..
    Akpek, Goerguen
    Banner MD Anderson Canc Ctr, Hematol Oncol Sect, Gilbert, AZ USA..
    Bredeson, Christopher N.
    Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada.;Ottawa Hosp, Res Inst, Ottawa, ON, Canada..
    Costa, Luciano J.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Dandoy, Christopher
    Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA..
    Freytes, Cesar O.
    South Texas Vet Hlth Care Syst, San Antonio, TX USA.;Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA..
    Fung, Henry C.
    Temple Hlth, Fox Chase Canc Ctr, Dept Med Oncol, Philadelphia, PA USA..
    Gale, Robert Peter
    Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Gibson, John
    Royal Prince Alfred Hosp, Inst Haematol, Camperdown, NSW 2050, Australia..
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Hayashi, Robert J.
    Washington Univ, Sch Med, Dept Pediat, Div Pediat Hematol Oncol, St Louis, MO 63110 USA..
    Inamoto, Yoshihiro
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Inwards, David J.
    Mayo Clin, Div Hematol, Rochester, MN USA..
    Lazarus, Hillard M.
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA..
    Maloney, David G.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Martino, Rodrigo
    Hosp Santa Creu & Sant Pau, Div Hematol, Barcelona, Spain..
    Munker, Reinhold
    Louisiana State Univ Hlth, Dept Internal Med, Div Hematol Oncol, Shreveport, LA USA..
    Nishihori, Taiga
    Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Med Oncol, Tampa, FL 33612 USA..
    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..
    Rizzieri, David A.
    Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA..
    Reshef, Ran
    Univ Penn, Dept Med, Abramson Canc Ctr, Med Ctr, Philadelphia, PA 19104 USA..
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Schouten, Harry C.
    Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands..
    Smith, Sonali M.
    Univ Chicago, Hematol Oncol Sect, Chicago, IL 60637 USA..
    Socie, Gerard
    Hop St Louis, Dept Hematol, Paris, France..
    Wirk, Baldeep
    SUNY Stony Brook, Med Ctr, Dept Internal Med, Stony Brook, NY 11794 USA..
    Yu, Lolie C.
    Louisiana State Univ, Med Ctr, Childrens Hosp, Div Hematol Oncol,Ctr Canc & Blood Disorders, New Orleans, LA USA..
    Saber, Wael
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    The Impact of Graft-versus-Host Disease on the Relapse Rate in Patients with Lymphoma Depends on the Histological Subtype and the Intensity of the Conditioning Regimen2015In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 10, p. 1746-1753Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to analyze the impact of graft-versus-host disease (GVHD) on the relapse rate of different lymphoma subtypes after allogeneic hematopoietic cell transplantation (allo-HCT). Adult patients with a diagnosis of Hodgkin lymphoma, diffuse large B cell lymphoma, follicular lymphoma (FL), peripheral T cell lymphoma, or mantle cell lymphoma (MCL) undergoing HLA-identical sibling or unrelated donor hematopoietic cell transplantation between 1997 and 2009 were included. Two thousand six hundred eleven cases were included. A reduced-intensity conditioning (RIC) regimen was used in 62.8% of the transplantations. In a multivariate analysis of myeloablative cases (n = 970), neither acute (aGVHD) nor chronic GVHD (cGVHD) were significantly associated with a lower incidence of relapse/progression in any lymphoma subtype. In contrast, the analysis of RIC cases (n = 1641) showed that cGVHD was associated with a lower incidence of relapse/progression in FL (risk ratio [RR],.51; P = 3.049) and in MCL (RR,.41; P = .019). Patients with FL or MCL developing both aGVHD and cGVHD had the lowest risk of relapse (RR,.14; P = .007; and RR,.15; P = .0019, respectively). Of interest, the effect of GVHD on decreasing relapse was similar in patients with sensitive disease and chemoresistant disease. Unfortunately, both aGVHD and cGVHD had a deleterious effect on treatment-related mortality and overall survival (OS) in FL cases but did not affect treatment-related mortality, OS or PFS in MCL. This study reinforces the use of RIC allo-HCT as a platform for immunotherapy in FL and MCL patients.

  • 373. Ursing, Johan
    et al.
    Eksborg, Staffan
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Bergqvist, Yngve
    Blessborn, Daniel
    Rodrigues, Amabelia
    Kofoed, Poul-Erik
    Chloroquine Is Grossly Under Dosed in Young Children with Malaria: Implications for Drug Resistance2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 1, p. e86801-Article in journal (Refereed)
    Abstract [en]

    Background: Plasmodium falciparum malaria is treated with 25 mg/kg of chloroquine (CQ) irrespective of age. Theoretically, CQ should be dosed according to body surface area (BSA). The effect of dosing CQ according to BSA has not been determined but doubling the dose per kg doubled the efficacy of CQ in children aged <15 years infected with P. falciparum carrying CQ resistance causing genes typical for Africa. The study aim was to determine the effect of age on CQ concentrations. Methods and Findings: Day 7 whole blood CQ concentrations were determined in 150 and 302 children treated with 25 and 50 mg/kg, respectively, in previously conducted clinical trials. CQ concentrations normalised for the dose taken in mg/kg of CQ decreased with decreasing age (p<0.001). CQ concentrations normalised for dose taken in mg/m(2) were unaffected by age. The median CQ concentration in children aged <2 years taking 50 mg/kg and in children aged 10-14 years taking 25 mg/kg were 825 (95% confidence interval [CI] 662-988) and 758 (95% CI 640-876) nmol/l, respectively (p = 0.67). The median CQ concentration in children aged 10-14 taking 50 mg/kg and children aged 0-2 taking 25 mg/kg were 1521 and 549 nmol/l. Adverse events were not age/concentration dependent. Conclusions: CQ is under-dosed in children and should ideally be dosed according to BSA. Children aged <2 years need approximately double the dose per kg to attain CQ concentrations found in children aged 10-14 years. Clinical trials assessing the efficacy of CQ in Africa are typically performed in children aged <5 years. Thus the efficacy of CQ is typically assessed in children in whom CQ is under dosed. Approximately 3 fold higher drug concentrations can probably be safely given to the youngest children. As CQ resistance is concentration dependent an alternative dosing of CQ may overcome resistance in Africa.

  • 374. Ursing, Johan
    et al.
    Kofoed, Poul-Erik
    Rodrigues, Amabelia
    Blessborn, Daniel
    Thoft-Nielsen, Rikke
    Björkman, Anders
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Similar efficacy and tolerability of double-dose chloroquine and artemether-lumefantrine for treatment of Plasmodium falciparum infection in Guinea-Bissau: a randomized trial2011In: The Journal of infectious diseases, ISSN 1537-6613, Vol. 203, no 1, p. 109-116Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    In 2008, Guinea-Bissau introduced artemether-lumefantrine for treatment of uncomplicated malaria. Previously, 3 times the standard dose of chloroquine, that was probably efficacious against Plasmodium falciparum with the resistance-associated chloroquine-resistance transporter (pfcrt) 76T allele, was routinely used. The present study compared the efficacy and tolerability of a double standard dose of chloroquine with the efficacy and tolerability of artemether-lumefantrine.

    METHODS:

    In a randomized open-label clinical trial, artemether-lumefantrine or chloroquine (50 mg/kg) were given as 6 divided doses over 3 days to children aged 6 months - 15 years who had uncomplicated P. falciparum monoinfection. Drug concentrations were measured on day 7. P. falciparum multidrug resistance gene N86Y and pfcrt K76T alleles were identified.

    RESULTS:

    The polymerase chain reaction-adjusted day 28 and 42 treatment efficacies were 162 (97%) of 168 and 155 (97%) of 161, respectively, for artemether-lumefantrine and 150 (95%) of 158 and 138 (94%) of 148, respectively, for chloroquine. When parasites with resistance-associated pfcrt 76T were treated, the day 28 efficacy of chloroquine was 87%. No severe drug-related adverse events were detected. Symptom resolution was similar with both treatments.

    CONCLUSIONS:

    Both treatments achieved the World Health Organization-recommended efficacy for antimalarials that will be adopted as policy. High-dose chloroquine treatment regimes should be further evaluated with the aim of assessing chloroquine as a potential partner drug to artemisinin derivatives.

    CLINICAL TRIALS REGISTRATION:

    NCT00426439

  • 375.
    Ursing, Johan
    et al.
    Indepth Network, Projecto Saude Bandim, Bissau, Guinea Bissau.;Karolinska Inst, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden. Danderyd Hosp, Dept Infect Dis, Stockholm, Sweden. Sormland Cty Council, Clin Res Ctr, Eskilstuna, Sweden. Uppsala Univ, Borlange, Sweden. Dalarna Univ Coll, Borlange, Sweden. Kolding Cty Hosp, Dept Paediat, Kolding, Denmark..
    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, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden. Danderyd Hosp, Dept Infect Dis, Stockholm, Sweden.
    Bergqvist, Yngve
    Borlange, Sweden. Dalarna Univ Coll, Borlange, Sweden..
    Rodrigues, Amabelia
    Indepth Network, Projecto Saude Bandim, Bissau, Guinea Bissau..
    Kofoed, Poul-Erik
    Indepth Network, Projecto Saude Bandim, Bissau, Guinea Bissau;Kolding Cty Hosp, Dept Paediat, Kolding, Denmark..
    High-Dose Chloroquine for Treatment of Chloroquine-Resistant Plasmodium falciparum Malaria2016In: Journal of Infectious Diseases, ISSN 0022-1899, E-ISSN 1537-6613, Vol. 213, no 8, p. 1315-1321Article in journal (Refereed)
    Abstract [en]

    Background. Due to development of multidrug-resistant Plasmodium falciparum new antimalarial therapies are needed. In Guinea-Bissau, routinely used triple standard-dose chloroquine remained effective for decades despite the existence of "chloroquine-resistant" P. falciparum. This study aimed to determine the in vivo efficacy of higher chloroquine concentrations against P. falciparum with resistance-conferring genotypes. Methods. Standard or double-dose chloroquine was given to 892 children aged < 15 years with uncomplicated malaria during 3 clinical trials (2001-2008) with >= 35 days follow-up. The P. falciparum resistance-conferring genotype (pfcrt 76T) and day 7 chloroquine concentrations were determined. Data were divided into age groups (< 5, 5-9, and 10-14 years) because concentrations increase with age when chloroquine is prescribed according to body weight. Results. Adequate clinical and parasitological responses were 14%, 38%, and 39% after standard-dose and 66%, 84%, and 91% after double-dose chloroquine in children aged < 5, 5-9, and 10-14 years, respectively, and infected with P. falciparum genotypes conferring chloroquine resistance (n = 195, P < .001). In parallel, median chloroquine concentrations were 471, 688, and 809 nmol/L for standard-dose and 1040, 1494, and 1585 nmol/L for double-dose chloroquine. Conclusions. Chloroquine resistance is dose dependent and can be overcome by higher, still well-tolerated doses.

  • 376. Ursing, Johan
    et al.
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Rodrigues, Amabelia
    Aaby, Peter
    Kofoed, Poul-Erik
    Malaria Transmission in Bissau, Guinea-Bissau between 1995 and 2012: Malaria Resurgence Did Not Negatively Affect Mortality2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 7, p. e101167-Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: As Plasmodium falciparum prevalence decreases in many parts of Sub-Saharan Africa, so does immunity resulting in larger at risk populations and increased risk of malaria resurgence. In Bissau, malaria prevalence decreased from ?50% to 3% between 1995 and 2003. The epidemiological characteristics of P. falciparum malaria within Bandim health and demographic surveillance site (population similar to 100000) between 1995 and 2012 are described. METHODS AND FINDINGS: The population was determined by census. 3603 children aged <15 years that were enrolled in clinical trials at the Bandim health centre (1995-2012) were considered incident cases. The mean annual malaria incidence per thousand children in 1995-1997, 1999-2003, 2007, 2011, 2012 were as follows; age <5 years 22 -> 29 -> 4 -> 9 -> 3, age 5-9 years 15 -> 28 -> 4 -> 33 -> 12, age 10-14 years 9 -> 15 -> 1 -> 45 -> 19. There were 4 campaigns (2003-2010) to increase use of insecticide treated bed nets (ITN) amongst children <5 years. An efficacious high-dose chloroquine treatment regime was routinely used until artemisinin based combination therapy (ACT) was introduced in 2008. Long lasting insecticide treated bed nets (LLIN) were distributed in 2011. By 2012 there was 1 net per 2 people and 97% usage. All-cause mortality decreased from post-war peaks in 1999 until 2012 in all age groups and was not negatively affected by malaria resurgence. CONCLUSION: The cause of decreasing malaria incidence (1995-2007) was probably multifactorial and coincident with the use of an efficacious high-dose chloroquine treatment regime. Decreasing malaria prevalence created a susceptible group of older children in which malaria resurged, highlighting the need to include all age groups in malaria interventions. ACT did not hinder malaria resurgence. Mass distribution of LLINs probably curtailed malaria epidemics. All-cause mortality was not negatively affected by malaria resurgence.

  • 377.
    Ustun, Celalettin
    et al.
    Rush Univ, Div Hematol Oncol Cell Therapy, Chicago, IL 60612 USA.
    Kim, Soyoung
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Inst Hlth & Equ, Div Biostat, Milwaukee, WI 53226 USA.
    Chen, Min
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Beitinjaneh, Amer M.
    Univ Miami, Dept Hematol, Miami, FL USA.
    Brown, Valerie, I
    Penn State Hershey Childrens Hosp & Coll Med, Div Pediat Oncol Hematol, Dept Pediat, Hershey, PA USA.
    Dahi, Parastoo B.
    Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA.
    Daly, Andrew
    Tom Baker Canc Clin, Calgary, AB, Canada.
    Diaz, Miguel Angel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.
    Freytes, Cesar O.
    Texas Transplant Inst, San Antonio, TX USA.
    Ganguly, Siddhartha
    Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA.
    Hashmi, Shahrukh
    Mayo Clin, Dept Internal Med, Rochester, MN USA;King Faisal Specialist Hosp & Res Ctr, Oncol Ctr, Riyadh, Saudi Arabia.
    Hildebrandt, Gerhard C.
    Univ Kentucky, Markey Canc Ctr, Lexington, KY USA.
    Lazarus, Hillard M.
    Case Western Reserve Univ, Dept Med, Stem Cell Transplant Program, Univ Hosp Cleveland,Div Hematol & Oncol, Cleveland, OH 44106 USA.
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL 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.
    Page, Kristin M.
    Duke Univ, Med Ctr, Div Pediat Blood & Marrow Transplantat, Durham, NC USA.
    Papanicolaou, Genovefa
    Mem Sloan Kettering Canc Ctr, Infect Dis Serv, New York, NY 10021 USA.
    Saad, Ayman
    Ohio State Univ, Div Hematol, Columbus, OH 43210 USA.
    Seo, Sachiko
    Dokkyo Med Univ, Dept Haematol & Oncol, Mibu, Tochigi, Japan.
    William, Basem M.
    Ohio State Univ, Div Hematol, Columbus, OH 43210 USA.
    Wingard, John R.
    Univ Florida, Dept Med, Div Hematol & Oncol, Gainesville, FL USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Yared, Jean A.
    Univ Maryland, Blood & Marrow Transplantat Program, Div Hematol Oncol, Dept Med,Greenebaum Comprehens Canc Ctr, Baltimore, MD 21201 USA.
    Perales, Miguel-Angel
    Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplant Serv, 1275 York Ave, New York, NY 10021 USA.
    Auletta, Jeffery J.
    Nationwide Childrens Hosp, Blood & Marrow Transplant Program, Columbus, OH USA;Nationwide Childrens Hosp, Host Def Program, Div Hematol Oncol & Blood Marrow & Transplant, Columbus, OH USA;Nationwide Childrens Hosp, Div Infect Dis, Columbus, OH USA.
    Komanduri, Krishna, V
    Univ Miami, Dept Hematol, Miami, FL USA.
    Lindemans, Caroline A.
    Univ Utrecht, Univ Med Ctr Utrecht, Pediat Blood & Marrow Transplantat Program, Utrecht, Netherlands;Princess Maxima Ctr Pediat Oncol, Utrecht, Netherlands.
    Riches, Marcie L.
    Univ North Carolina Chapel Hill, Div Hematol Oncol, Chapel Hill, NC USA.
    Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR12019In: BLOOD ADVANCES, ISSN 2473-9529, Vol. 3, no 17, p. 2525-2536Article in journal (Refereed)
    Abstract [en]

    Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged >= 40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receiving MAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95% CI, 36-42]; P = .046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCT was greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.

  • 378.
    Uy, G. L.
    et al.
    Washington Univ, Sch Med, Dept Med, St Louis, MO 63110 USA..
    Costa, L. J.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Hari, P. N.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Zhang, M-J
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA..
    Huang, J-X
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Anderson, K. C.
    Dana Farber Canc Inst, Hematol Oncol Treatment Ctr, Boston, MA 02115 USA..
    Bredeson, C. N.
    Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada.;Ottawa Hosp, Res Inst, Ottawa, ON, Canada..
    Callander, N. S.
    Univ Wisconsin, Carbone Canc Ctr, Madison, WI USA..
    Cornell, R. F.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Perez, M. A. D.
    Univ Nino Jesus, Serv Oncohematol, Hosp Infantil, Madrid, Spain..
    Dispenzieri, A.
    Mayo Clin, Dept Hematol, Rochester, MN USA..
    Freytes, C. O.
    South Texas Vet Hlth Care Syst, San Antonio, TX USA.;Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA..
    Gale, R. P.
    Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Garfall, A.
    Univ Penn, Abramson Canc Ctr, Perelman Ctr Adv Med, Div Hematol Oncol, Philadelphia, PA 19104 USA..
    Gertz, M. A.
    Mayo Clin, Dept Hematol, Rochester, MN USA..
    Gibson, J.
    Royal Prince Alfred Hosp, Dept Haematol, Inst Haematol, Camperdown, NSW 2050, Australia..
    Hamadani, M.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Lazarus, H. M.
    Univ Hosp, Seidman Canc Ctr, Case Med Ctr, Cleveland, OH USA..
    Kalaycio, M. E.
    Cleveland Clin, Hematol Oncol & Blood Disorders, Cleveland, OH 44106 USA..
    Kamble, R. T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Dept Hematol & Oncol, Houston, TX 77030 USA..
    Kharfan-Dabaja, M. A.
    Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL 33612 USA..
    Krishnan, A. Y.
    City Hope Natl Med Ctr, Dept Hematol Oncol, Duarte, CA 91010 USA..
    Kumar, S. K.
    Mayo Clin, Dept Hematol, Rochester, MN USA..
    Kyle, R. A.
    Mayo Clin, Dept Hematol, Rochester, MN USA..
    Landau, H. J.
    Mem Sloan Kettering Canc Ctr, Bone Marrow Transplant Serv, New York, NY 10021 USA..
    Lee, C. H.
    Royal Adelaide Hosp, SA Pathol, Haematol & Bone Marrow Transplant Unit, Adelaide, SA 5000, Australia..
    Maiolino, A.
    Univ Fed Rio de Janeiro, Hosp Univ Clementinio Fraga Filho, Rio De Janeiro, Brazil..
    Marks, D. I.
    Univ Hosp Bristol NHS Trust, Pediat Bone Marrow Transplant, Bristol, Avon, England..
    Mark, T. M.
    New York Presbyterian Hosp Cornell, Dept Med, New York, NY USA..
    Munker, R.
    Louisiana State Univ Hlth Shreveport, Dept Internal Med, Hematol Oncol Sect, Shreveport, LA USA..
    Nishihori, T.
    Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL 33612 USA..
    Olsson, R. 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..
    Ramanathan, M.
    UMass Mem Med Ctr, Dept Med, Div Hematol Oncol, Worcester, MA USA..
    Rodriguez, T. E.
    Loyola Univ, Med Ctr, Bone Marrow Transplant Program, Chicago, IL 60611 USA..
    Saad, A. A.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA..
    Savani, B. N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Schiller, G. J.
    Univ Calif Los Angeles, Ctr Hlth Sci, Bone Marrow Transplant Program, Los Angeles, CA 90024 USA..
    Schouten, H. C.
    Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands..
    Schriber, J. R.
    Virginia G Piper Canc Ctr, Canc Transplant Inst, Scottsdale, AZ USA.;Arizona Oncol, Scottsdale, AZ USA..
    Scott, E.
    Oregon Hlth & Sci Univ, Ctr Hematol Malignancies, Portland, OR 97201 USA..
    Seo, S.
    Fred Hutchinson Canc Res Ctr, Dept Vaccine & Infect Dis, Seattle, WA 98104 USA..
    Sharma, M.
    Thomas Jefferson Univ, Dept Hematol Oncol, Philadelphia, PA 19107 USA..
    Ganguly, S.
    Univ Kansas, Med Ctr, Div Hematol & Oncol, Blood & Marrow Transplantat, Kansas City, KS 66103 USA..
    Stadtmauer, E. A.
    Univ Penn, Abramson Canc Ctr, Perelman Ctr Adv Med, Div Hematol Oncol, Philadelphia, PA 19104 USA..
    Tay, J.
    Univ Ottawa, Dept Med, Ottawa, ON, Canada..
    To, L. B.
    Royal Adelaide Hosp, SA Pathol, Haematol & Bone Marrow Transplant Unit, Adelaide, SA 5000, Australia..
    Vesole, D. H.
    Hackensack Univ, Med Ctr, Hackensack, NJ USA..
    Vogl, D. T.
    Univ Penn, Abramson Canc Ctr, Perelman Ctr Adv Med, Div Hematol Oncol, Philadelphia, PA 19104 USA..
    Wagner, J. L.
    Thomas Jefferson Univ, Dept Hematol Oncol, Philadelphia, PA 19107 USA..
    Wirk, B.
    Seattle Canc Care Alliance, Seattle, WA USA..
    Wood, W. A.
    Univ N Carolina, Dept Med, Div Hematol Oncol, Chapel Hill, NC USA..
    D'Souza, A.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA..
    Contribution of chemotherapy mobilization to disease control in multiple myeloma treated with autologous hematopoietic cell transplantation2015In: Bone Marrow Transplantation, ISSN 0268-3369, E-ISSN 1476-5365, Vol. 50, no 12, p. 1513-1518Article in journal (Refereed)
    Abstract [en]

    In patients with multiple myeloma (MM) undergoing autologous hematopoietic cell transplantation (auto-HCT), peripheral blood progenitor cells may be collected following mobilization with growth factor alone (GF) or cytotoxic chemotherapy plus GF (CC+GF). It is uncertain whether the method of mobilization affects post-transplant outcomes. We compared these mobilization strategies in a retrospective analysis of 968 patients with MM from the Center for International Blood and Marrow Transplant Research database who received an auto-Ha in the US and Canada between 2007 and 2012. The kinetics of neutrophil engraftment (>= 0.5 x 10(9)/L) was similar between groups (13 vs 13 days, P=0.69) while platelet engraftment (>= 20 x 10(9)/L) was slightly faster with CC+GF (19 vs 18 days, P=0.006). Adjusted 3-year PFS was 43% (95% confidence interval (CI) 38-48) in GF and 40% (95% CI 35-45) in CC+GF, P=0.33. Adjusted 3-year OS was 82% (95% CI 78-86) vs 80% (95% CI 75-84), P=0.43 and adjusted 5-year OS was 62% (95% CI 54-68) vs 60% (95% CI 52-67), P=0.76, for GF and CC+GF, respectively. We conclude that MM patients undergoing auto-Ha have similar outcomes irrespective of the method of mobilization and found no evidence that the addition of chemotherapy to mobilization contributes to disease control.

  • 379.
    Vahlberg, Birgit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Holmbäck, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Eriksson, Staffan
    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 Neuroscience, Physiotherapy. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Protocol and pilot study of a short message service-guided training after acute stroke/transient ischemic attack to increase walking capacity and physical activity2018In: Preventive medicine reports, ISSN 2211-3355, Vol. 11, p. 109-114Article in journal (Refereed)
    Abstract [en]

    Physical activity in community-living individuals after a stroke is usually scarce. This protocol describes a study that will evaluate a method to increase physical activity by performing a 3-month outdoor walking and muscle strengthening program and will examine the 3-month and 1-year effects of this program on individuals with acute stroke (AS) or transient ischemic attack (TIA). In a prospective randomized controlled trial in Uppsala, Sweden, 80 individuals with AS or TIA who maintained cognitive and motor function will be randomized into groups for continuous training for three months or for regular standard care. The training will be supervised by daily cellphone-delivered messages (short message services; SMS), and the intensity, duration and workload will be gradually increased. The primary outcome is a change in walking capacity according to the 6-Minute Walk Test and chair-rising at three months. Secondary outcomes include mobility, gait speed, handgrip strength, body composition (fat mass and muscle mass), biochemical risk-markers, health-related quality of life, and cardiovascular events. Adherence to the training program will be documented with a self-reported diary and step counts over two weeks. The major study started in November 2016, and results are expected in 2019. In a pilot study of 15 subjects post-stroke (mean-age 65 years), we observed improved walking capacity (increasing from 23 to 255 m) and chair-rising (decreasing 2.42 s) from baseline to three months. SMS-guided outdoor training will be tested as a potential therapeutic strategy to increase physical activity and thereby improve walking capacity and physical function following a stroke.

  • 380.
    Valachis, Antonis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Garmo, Hans
    Kings Coll London, Sch Med, Div Canc Studies, Canc Epidemiol Unit, London, England..
    Weinman, John
    Kings Coll London, Inst Pharmaceut Sci, London SE1 9NH, England..
    Fredriksson, Irma
    Karolinska Inst, Karolinska Univ Hosp, Dept Mol Med & Surg, Stockholm, Sweden..
    Ahlgren, Johan
    Univ Orebro, Fac Med & Hlth, Dept Oncol, Orebro, Sweden..
    Sund, Malin
    Umea Univ, Dept Surg & Perioperat Sci, S-90185 Umea, Sweden..
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery. Kings Coll London, Sch Med, Div Canc Studies, Canc Epidemiol Unit, London, England..
    Effect of selective serotonin reuptake inhibitors use on endocrine therapy adherence and breast cancer mortality: a population-based study2016In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 159, no 2, p. 293-303Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to investigate whether the concomitant use of selective serotonin reuptake inhibitors (SSRI) with tamoxifen influences the risk of death due to breast cancer, and we also investigated the association between SSRI use and adherence to oral endocrine therapy (ET). We analyzed data from BCBaSe Sweden, which is a database created by the data linkage of Registries from three different regions of Sweden. To investigate the association between ET adherence and SSRI use, we included all women who were diagnosed with non-distant metastatic ER-positive invasive breast cancer from July 2007 to July 2011 and had at least one dispensed prescription of oral tamoxifen or aromatase inhibitor. To investigate the role of concurrent administration of SSRI and tamoxifen on breast cancer prognosis, we performed a nested case-control study. In the adherence cohort, 9104 women were included in the analyses. Women who received SSRI, either before or after breast cancer diagnosis, were at higher risk for low adherence to ET. However, when the overlapping period between SSRI use and ET was > 50 %, no excess risk for low adherence was observed. Non-adherence (< 80 %) to ET was significantly associated with worse breast cancer survival (OR 4.07; 95 % CI 3.27-5.06). In the case-control study, 445 cases and 11125 controls were included. The concomitant administration of SSRI and tamoxifen did not influence breast cancer survival, neither in short-term (OR 1.41; 95 % CI 0.74-2.68) nor in long-term SSRI users (OR 0.85; 95 % CI 0.35-2.08). Concomitant SSRI and tamoxifen use does not seem to increase risk for death due to breast cancer. Given the positive association between continuing antidepressive pharmacotherapy for a longer period of time and adherence to ET, it is essential to capture and treat depression in breast cancer patients to secure adherence to ET.

  • 381.
    Valachis, Antonis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Mamounas, Eleftherios P.
    Univ Florida, Hlth Canc Ctr Orlando Hlth, Comprehens Breast Program, Orlando, FL USA.
    Mittendorf, Elizabeth A.
    Univ Texas MD Anderson Canc Ctr, Dept Breast Surg Oncol, Houston, TX 77030 USA.
    Hayashi, Naoki
    St Lukes Int Hosp, Dept Breast Surg, Tokyo, Japan.
    Ishitobi, Makoto
    Osaka Int Canc Inst, Dept Breast Surg, Osaka, Japan;Osaka Int Canc Inst, Dept Endocrine Surg, Osaka, Japan.
    Natoli, Clara
    Univ G DAnnunzio, Dept Oral Med & Biotechnol Sci, Chieti, Italy.
    Fitzal, Florian
    Med Univ Vienna, Dept Surg, Breast Hlth Ctr, Vienna, Austria.
    Rubio, Isabel T.
    Univ Hosp VAll dHebron, Breast Canc Ctr, Breast Surg Oncol, Barcelona, Spain.
    Tiezzi, Daniel G.
    Univ Sao Paulo, Ribeirao Preto Med Sch, Breast Dis Div, Dept Gynecol & Obstet, Sao Paulo, Brazil.
    Shin, Hee-Chul
    Chung Ang Univ Hosp, Dept Surg, Seoul, South Korea.
    Anderson, Stewart J.
    Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Natl Surg Adjuvant Breast & Bowel Project,Biostat, Pittsburgh, PA 15261 USA.
    Hunt, Kelly K.
    Univ Texas MD Anderson Canc Ctr, Dept Breast Surg Oncol, Houston, TX 77030 USA.
    Matsuda, Naoko
    St Lukes Int Hosp, Dept Breast Surg, Tokyo, Japan.
    Ohsumi, Shozo
    NHO Shikoku Canc Ctr, Dept Breast Oncol, Matsuyama, Ehime, Japan.
    Totomi, Athina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Nilsson, Cecilia
    Vastmanlands Cty Hosp, Ctr Clin Res, Vasteras, Sweden.
    Risk factors for locoregional disease recurrence after breast‐conserving therapy in patients with breast cancer treated with neoadjuvant chemotherapy: An international collaboration and individual patient meta‐analysis2018In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 124, no 14, p. 2923-2930Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several studies have reported a high risk of local disease recurrence (LR) and locoregional disease recurrence (LRR) in patients with breast cancer after neoadjuvant chemotherapy (NCT) and breast-conserving therapy (BCT). The objective of the current study was to identify potential risk factors for LR and LRR after NCT and BCT. METHODS: Individual patient data sets from 9 studies were pooled. The outcomes of interest were the occurrence of LR and/or LRR. A 1-stage meta-analytic approach was used. Cox proportional hazards regression models were applied to identify factors that were predictive of LR and LRR, respectively. RESULTS: A total of 9 studies (4125 patients) provided their data sets. The 10-year LR rate was 6.5%, whereas the 10-year LRR rate was 10.3%. Four factors were found to be associated with a higher risk of LR: 1) estrogen receptor-negative disease; 2) cN+disease; 3) a lack of pathologic complete response in axilla (pN0); and 4) pN2 to pN3 disease. The predictive score for LR determined 3 risk groups: a low-risk, intermediate-risk, and high-risk group with 10-year LR rates of 4.0%, 7.9%, and 20.4%, respectively. Two additional factors were found to be associated with an increased risk of LRR: cT3 to cT4 disease and a lack of pathologic complete response in the breast. The predictive score for LRR determined 3 risk groups; a low-risk, intermediate-risk, and high-risk group with 10-year LRR rates of 3.2%, 10.1%, and 24.1%, respectively. CONCLUSIONS: BCT after NCT appears to be an oncologically safe procedure for a large percentage of patients with breast cancer. Two easy-to-use clinical scores were developed that can help clinicians to identify patients at higher risk of LR and LRR after NCT and BCT and individualize the postoperative treatment plan and follow-up.

  • 382.
    Valachis, Antonis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Samonis, George
    Kofteridi, Diamantis R.
    The Role of Aerosolized Colistin in the Treatment of Ventilator-Associated Pneumonia: A Systematic Review and Metaanalysis2015In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 43, no 3, p. 527-533Article in journal (Refereed)
    Abstract [en]

    Objectives: The present meta-analysis and systematic review evaluated the efficacy and safety of aerosolized colistin as adjunctive therapy to IV antimicrobials or as monotherapy in the treatment of ventilator-associated pneumonia. Design: The databases of MEDLINE and Cochrane Library up to June 2013 and all reference lists of the included studies and relevant reviews were searched. Studies were eligible if the efficacy and safety of aerosolized colistin in the treatment of ventilator-associated pneumonia was evaluated. An overall effect estimate for all dichotomous data as an odds ratio with 95% CI was calculated by the Mantel-Haenszel or the DerSimonian and Laird method depending on the statistical heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to interpret the findings. Interventions: None. Measurements and Main Results: Sixteen studies fulfilled the inclusion criteria: eight were comparing adjunctive aerosolized versus IV colistin (seven observational cohort or case-control studies and one randomized trial) and were meta-analyzed, and eight were single arm and were only systematically reviewed. The Grading of Recommendations Assessment, Development, and Evaluation approach showed limitations of the study design and presence of inconsistency in most of the outcomes, but no obvious indirectness or imprecision of results reporting. Based on the above assessments, the quality of evidence presented for each outcome ranged from "very low" to "low:" A significant improvement in clinical response (odds ratio, 1.57; 95% CI, 1.14-2.15; p = 0.006; = 37%), microbiological eradication (odds ratio, 1.61; 95% CI, 1.11-2.35; p = 0.01; I-2= 0%), and infection-related mortality (odds ratio, 0.58; 95% CI, 0.34-0.96; p = 0.04; I-2 = 46%) was observed with the addition of aerosolized colistin to IV treatment, whereas the addition of aerosolized colistin did not affect overall mortality (odds ratio, 0.74; 95% CI, 0.54-1.01; p = 0.06; I-2 = 25%) or nephrotoxicity (odds ratio, 1.18; 95% CI, 0.76-1.83; p= 0.45; I-2= 0%). Conclusion: Based on the present results and awaiting further evidence from randomized trials, aerosolized colistin is associated with improved outcome in the treatment of ventilator-associated pneumonia although the level of evidence was low.

  • 383.
    Valachis, Antonis
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Ullenhag, Gustav
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Discrepancy in BRAF status among patients with metastatic malignant melanoma: A meta-analysis2017In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 81, p. 106-115Article, review/survey (Refereed)
    Abstract [en]

    The incidence of malignant melanoma is growing rapidly. Approximately half of the cases are BRAF mutated, making treatment with kinase inhibitors a (MEK and BRAF inhibitors) preferred choice in the advanced setting. The vast majority of these patients will benefit from the treatment. It is therefore of vital importance that the BRAF analysis is reliable and reflects the true nature of the tumour. Intraindividual tumour BRAF heterogeneity may exist, and changes of BRAF status over time might occur. We reviewed the literature by searching the PubMed database and 630 potentially relevant studies were identified. Thereafter, studies that investigated intralesional heterogeneity only, studies with <= 10 patients and studies that did not include adequate data to calculate discrepancy rates were excluded. Twenty-two studies met our inclusion criteria and were included in the meta-analysis. The pooled discrepancy rate between primary and metastatic lesions was 13.4% (95% confidence interval [CI]: 9.2-18.2%) while it was 7.3% (95% CI: 3.3-12.6) between two metastatic lesions. The number of patients whose tumoural BRAF status was changed from mutation to wild type and from wild type to mutation, respectively, was comparable. We conclude that a clinically meaningful discrepancy rate in BRAF status both between primary-metastatic and metastatic-metastatic melanoma lesions exists. Our results support the polyclonal model of melanomas in which subclones with different BRAF status co-exist in the same melanoma lesion. In addition, the results indicate a need for biopsy of a metastatic lesion for subsequent BRAF analysis when treatment with kinase inhibitors is considered.

  • 384.
    Valdimarsdottir, Ragnheidur
    et al.
    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.
    Valgeirsdóttir, Heiddis
    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), Clinical Obstetrics.
    Wikström, Anna-Karin
    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), Clinical Obstetrics.
    Kallak, Theodora Kunovac
    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.
    Elenis, Evangelia
    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.
    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, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Ubhayasekera, Kumari
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Bergquist, Jonas
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Piltonen, Terhi T
    Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit Oulu, Finland.
    Pigny, Pascal
    Laboratoire de Biochimie & Hormonologie, Centre de Biologie Pathologie, Centre Hospitalier Régional Universitaire, CHU de Lille, Lille, France;Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172 Lille, France.
    Giacobini, Paolo
    Jean-Pierre Aubert Research Center (JPArc), Laboratory of Development and Plasticity of the Neuroendocrine Brain, Inserm, UMR-S 1172 Lille, France;University of Lille, FHU 1,000 Days for Health, School of Medicine Lille, France.
    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.
    Pregnancy and neonatal complications in women with polycystic ovary syndrome in relation to second-trimester anti-Müllerian hormone levels2019In: Reproductive Biomedicine Online, ISSN 1472-6483, E-ISSN 1472-6491, Vol. 39, no 1, p. 141-148Article in journal (Refereed)
    Abstract [en]

    RESEARCH QUESTION: An association has been found between high anti-Müllerian hormone (AMH) levels during pregnancy and the development of polycystic ovary syndrome (PCOS)-like phenotypic traits in mouse offspring. The aim of this study was to determine whether AMH levels are associated with maternal testosterone levels, and whether high AMH concentration influences the risk of developing PCOS-related adverse pregnancy outcomes.

    DESIGN: Maternal serum AMH, testosterone and sex hormone binding globulin levels were measured in blood samples taken in early second-trimester pregnancies from women with PCOS (n = 159) and healthy controls matched for body mass index (n = 320). Possible associations with preeclampsia, gestational hypertension, gestational diabetes, preterm birth and birthweight was explored by logistic and linear regression models.

    RESULTS: Women with PCOS had higher AMH, higher total testosterone levels and higher free androgen index than controls (P < 0.001 for all three parameters). Among women with PCOS, high testosterone levels (B = 2.7; β = 0.26; P = 0.001) and low first trimester body mass index (B = -0.5; β = -0.17; P = 0.043) remained independently associated with AMH. High AMH levels were associated with decreased risk of gestational hypertension (adjusted OR 0.55; 95% CI 0.34 to 0.87), but no association was found with other adverse pregnancy outcomes or birthweight.

    CONCLUSIONS: Women with PCOS had higher AMH levels during pregnancy compared with controls, but high AMH was not associated with increased risk of adverse pregnancy outcomes or birthweight.

  • 385. van Schaarenburg, Rosanne A.
    et al.
    Schejbel, Lone
    Truedsson, Lennart
    Topaloglu, Rezan
    Al-Mayouf, Sulaiman M.
    Riordan, Andrew
    Simon, Anna
    Kallel-Sellami, Maryam
    Arkwright, Peter D.
    Ahlin, Anders
    Hagelberg, Stefan
    Nielsen, Susan
    Shayesteh, Alexander
    Morales, Adelaida
    Tam, Schuman
    Genel, Ferah
    Berg, Stefan
    Ketel, Arnoldus G.
    van den Berg, J. Merlijn
    Kuijpers, Taco W.
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Huizinga, Tom W. J.
    Lankester, Arjan C.
    Trouw, Leendert A.
    Marked variability in clinical presentation and outcome of patients with C1q immunodeficiency2015In: Journal of Autoimmunity, ISSN 0896-8411, E-ISSN 1095-9157, Vol. 62, p. 39-44Article in journal (Refereed)
    Abstract [en]

    Objective: Globally approximately 60 cases of C1q deficiency have been described with a high prevalence of Systemic Lupus Erythematosus (SLE). So far treatment has been guided by the clinical presentation rather than the underlying C1q deficiency. Recently, it was shown that C1q production can be restored by allogeneic hematopoietic stem cell transplantation. Current literature lacks information on disease progression and quality of life of C1q deficient persons which is of major importance to guide clinicians taking care of patients with this rare disease. Methods: We performed an international survey, of clinicians treating C1q deficient patients. A high response rate of >70% of the contacted clinicians yielded information on 45 patients with C1q deficiency of which 25 are published. Results: Follow-up data of 45 patients from 31 families was obtained for a median of 11 years after diagnosis. Of these patients 36 (80%) suffer from SLE, of which 16 suffer from SLE and infections, 5 (11%) suffer from infections only and 4(9%) have no symptoms. In total 9 (20%) of the C1q deficient individuals had died. All except for one died before the age of 20 years. Estimated survival times suggest 20% case-fatality before the age of 20, and at least 50% of patients are expected to reach their middle ages. Conclusion: Here we report the largest phenotypic data set on C1q deficiency to date, revealing high variance; with high mortality but also a subset of patients with an excellent prognosis. Management of C1q deficiency requires a personalized approach.

  • 386. Venkatesan, Meera
    et al.
    Gadalla, Nahla B
    Stepniewska, Kasia
    Dahal, Prabin
    Nsanzabana, Christian
    Moriera, Clarissa
    Price, Ric N
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Rosenthal, Philip J
    Dorsey, Grant
    Sutherland, Colin J
    Guérin, Philippe
    Davis, Timothy M E
    Ménard, Didier
    Adam, Ishag
    Ademowo, George
    Arze, Cesar
    Baliraine, Frederick N
    Berens-Riha, Nicole
    Björkman, Anders
    Borrmann, Steffen
    Checchi, Francesco
    Desai, Meghna
    Dhorda, Mehul
    Djimdé, Abdoulaye A
    El-Sayed, Badria B
    Eshetu, Teferi
    Eyase, Frederick
    Falade, Catherine
    Faucher, Jean-François
    Fröberg, Gabrielle
    Grivoyannis, Anastasia
    Hamour, Sally
    Houzé, Sandrine
    Johnson, Jacob
    Kamugisha, Erasmus
    Kariuki, Simon
    Kiechel, Jean-René
    Kironde, Fred
    Kofoed, Poul-Erik
    LeBras, Jacques
    Malmberg, Maja
    Mwai, Leah
    Ngasala, Billy
    Nosten, Francois
    Nsobya, Samuel L
    Nzila, Alexis
    Oguike, Mary
    Otienoburu, Sabina Dahlström
    Ogutu, Bernhards
    Ouédraogo, Jean-Bosco
    Piola, Patrice
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Schramm, Birgit
    Somé, A Fabrice
    Thwing, Julie
    Ursing, Johan
    Wong, Rina P M
    Zeynudin, Ahmed
    Zongo, Issaka
    Plowe, Christopher V
    Sibley, Carol Hopkins
    Polymorphisms in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance 1 genes: parasite risk factors that affect treatment outcomes for P. falciparum malaria after artemether-lumefantrine and artesunate-amodiaquine.2014In: The American journal of tropical medicine and hygiene, ISSN 1476-1645, Vol. 91, no 4, p. 833-43Article in journal (Refereed)
    Abstract [en]

    Adequate clinical and parasitologic cure by artemisinin combination therapies relies on the artemisinin component and the partner drug. Polymorphisms in the Plasmodium falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multidrug resistance 1 (pfmdr1) genes are associated with decreased sensitivity to amodiaquine and lumefantrine, but effects of these polymorphisms on therapeutic responses to artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) have not been clearly defined. Individual patient data from 31 clinical trials were harmonized and pooled by using standardized methods from the WorldWide Antimalarial Resistance Network. Data for more than 7,000 patients were analyzed to assess relationships between parasite polymorphisms in pfcrt and pfmdr1 and clinically relevant outcomes after treatment with AL or ASAQ. Presence of the pfmdr1 gene N86 (adjusted hazards ratio = 4.74, 95% confidence interval = 2.29 - 9.78, P < 0.001) and increased pfmdr1 copy number (adjusted hazards ratio = 6.52, 95% confidence interval = 2.36-17.97, P < 0.001 : were significant independent risk factors for recrudescence in patients treated with AL. AL and ASAQ exerted opposing selective effects on single-nucleotide polymorphisms in pfcrt and pfmdr1. Monitoring selection and responding to emerging signs of drug resistance are critical tools for preserving efficacy of artemisinin combination therapies; determination of the prevalence of at least pfcrt K76T and pfmdr1 N86Y should now be routine.

  • 387.
    von Celsing, Anna-Sophia
    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).
    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.
    Predicting return to work among sickness-certified patients in general practice: Properties of two assessment tools2014In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, no 3, p. 268-277Article in journal (Refereed)
    Abstract [en]

    Abstract Aim. The purpose was to analyse the properties of two models for the assessment of return to work after sickness certification, a manual one based on clinical judgement including non-measurable information ('gut feeling'), and a computer-based one. Study population. All subjects aged 18 to 63 years, sickness-certified at a primary health care centre in Sweden during 8 months (n = 943), and followed up for 3 years. Methods. Baseline information included age, sex, occupational status, sickness certification diagnosis, full-time or part-time current sick-leave, and sick-leave days during the past year. Follow-up information included first and last day of each occurring sick spell. In the manual model all subjects were classified, based on baseline information and gut feeling, into a high-risk (n = 447) or a low-risk group (n = 496) regarding not returning to work when the present certificate expired. It was evaluated with a Cox's analysis, including time and return to work as dependent variables and risk group assignment as the independent variable, while in the computer-based model the baseline variables were entered as independent variables. Results. Concordance between actual return to work and return to work predicted by the analysis model was 73%-76% during the first 28-180 days in the manual model, and approximately 10% units higher in the computer-based model. Based on the latter, three nomograms were constructed providing detailed information on the probability of return to work. Conclusion. The computer-based model had a higher precision and gave more detailed information than the manual model.

  • 388.
    von Dobeln, Gabriella Alexandersson
    et al.
    Karolinska Inst, Dept Oncol & Pathol, Stockholm, Sweden..
    Nilsson, Magnus
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Adell, Gunnar
    Linkoping Univ, Dept Oncol, Linkoping, Sweden.;Linkoping Univ, Dept Clin & Expt Med, Linkoping, Sweden..
    Johnsen, Gjermund
    Univ Trondheim Hosp, St Olavs Hosp, Dept Gastrointestinal Surg, Trondheim, Norway..
    Hatlevoll, Ingunn
    Univ Trondheim Hosp, St Olavs Hosp, Dept Oncol, Trondheim, Norway..
    Tsai, Jon
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Lundell, Lars
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Lund, Mikael
    Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Lind, Pehr
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Oncol & Pathol, Stockholm, Sweden..
    Pulmonary function and cardiac stress test after multimodality treatment of esophageal cancer2016In: Practical Radiation Oncology, ISSN 1879-8500, E-ISSN 1879-8519, Vol. 6, no 3, p. E53-E59Article in journal (Refereed)
    Abstract [en]

    Purpose: Curative treatment of esophageal cancer is accompanied by frequent and sometimes severe side effects. However, prospectively collected data on side effects are scarce. The aim of this study was to evaluate if pulmonary function and exercise capacity were affected in the acute setting after neoadjuvant treatment and if there were long-lasting effects after neoadjuvant treatment and surgery. We also aimed to investigate whether the addition of radiation therapy to chemotherapy would aggravate side effects. Methods and materials: A cohort of 97 patients enrolled in the randomized NeoRes trial was used for the present analysis. The patients had been randomized to receive 3 cycles of cisplatin and fluorouracil with or without concurrent radiation therapy to 40 Gy. A cardiac stress test on a stationary bicycle and a spirometry were performed before and after neoadjuvant treatment and 1 to 2 years later after surgery provided that the cancer had not recurred. Results: We found impairment in pulmonary function measured as vital capacity and forced expiratory volume in 1 second and a decrease in exercise capacity after neoadjuvant treatment and 1 to 2 years later after surgery. We did not detect any differences between patients treated with chemoradiation therapy and those treated with chemotherapy alone. Conclusions: Multimodality treatment of esophageal cancer caused short-term and lasting impairments in pulmonary function and exercise capacity. The reductions were not aggravated by the addition of radiation therapy to neoadjuvant chemotherapy.

  • 389. von Holst, S
    et al.
    Picelli, S
    Edler, D
    Lenander, C
    Dalén, J
    Hjern, F
    Lundqvist, N
    Lindforss, U
    Påhlman, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
    Smedh, K
    Törnqvist, A
    Holm, J
    Janson, M
    Andersson, M
    Ekelund, S
    Olsson, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Ghazi, S
    Papadogiannakis, N
    Tenesa, A
    Farrington, S M
    Campbell, H
    Dunlop, M G
    Lindblom, A
    Association studies on 11 published colorectal cancer risk loci2010In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 103, no 4, p. 575-580Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Recently, several genome-wide association studies (GWAS) have independently found numerous loci at which common single-nucleotide polymorphisms (SNPs) modestly influence the risk of developing colorectal cancer. The aim of this study was to test 11 loci, reported to be associated with an increased or decreased risk of colorectal cancer: 8q23.3 (rs16892766), 8q24.21 (rs6983267), 9p24 (rs719725), 10p14 (rs10795668), 11q23.1 (rs3802842), 14q22.2 (rs4444235), 15q13.3 (rs4779584), 16q22.1 (rs9929218), 18q21.1 (rs4939827), 19q13.1 (rs10411210) and 20p12.3 (rs961253), in a Swedish-based cohort. METHODS: The cohort was composed of 1786 cases and 1749 controls that were genotyped and analysed statistically. Genotype-phenotype analysis, for all 11 SNPs and sex, age of onset, family history of CRC and tumour location, was performed. RESULTS: Of eleven loci, 5 showed statistically significant odds ratios similar to previously published findings: 8q23.3, 8q24.21, 10p14, 15q13.3 and 18q21.1. The remaining loci 11q23.1, 16q22.1, 19q13.1 and 20p12.3 showed weak trends but somehow similar to what was previously published. The loci 9p24 and 14q22.2 could not be confirmed. We show a higher number of risk alleles in affected individuals compared to controls. Four statistically significant genotype-phenotype associations were found; the G allele of rs6983267 was associated to older age, the G allele of rs1075668 was associated with a younger age and sporadic cases, and the T allele of rs10411210 was associated with younger age. CONCLUSIONS: Our study, using a Swedish population, supports most genetic variants published in GWAS. More studies are needed to validate the genotype-phenotype correlations.

  • 390.
    Vrooman, Lynda M.
    et al.
    Dana Farber Boston Childrens Canc & Blood Disorde, Dept Pediat, 450 Brookline Ave, Boston, MA 02215 USA.
    Millard, Heather R.
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Brazauskas, Ruta
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA.
    Majhail, Navneet S.
    Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, Cleveland, OH 44106 USA.
    Battiwalla, Minoo
    NHLBI, Hematol Branch, Bethesda, MD 20892 USA.
    Flowers, Mary E.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Div Hematol Oncol, Dept Med, Nashville, TN 37235 USA.
    Akpek, Gorgun
    Rush Univ, Med Ctr, Dept Internal Med, Stem Cell Transplantat & Cell Therapy, Chicago, IL 60612 USA.
    Aljurf, Mahmoud
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia.
    Bajwa, Rajinder
    Nationwide Childrens Hosp, Div Hematol Oncol BMT, Columbus, OH USA.
    Baker, K. Scott
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA.
    Beitinjaneh, Amer
    Univ Miami, Div Hematol & Oncol, Miami, FL USA.
    Bitan, Menachem
    Tel Aviv Sourasky Med Ctr, Dept Pediat Hematol Oncol, Tel Aviv, Israel.
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Hematol, Orange, CA 92668 USA.
    Chow, Eric
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA.
    Dandoy, Christopher
    Cincinnati Childrens Hosp Med Ctr, Div Bone Marrow Transplant & Immune Deficiency, Cincinnati, OH 45229 USA.
    Dietz, Andrew C.
    Univ Southern Calif, Childrens Hosp Los Angeles, Div Hematol Oncol, Blood & Marrow Transplantat, Los Angeles, CA USA.
    Diller, Lisa
    Dana Farber Boston Childrens Canc & Blood Disorde, Dept Pediat, 450 Brookline Ave, Boston, MA 02215 USA.
    Gale, Robert Peter
    Imperial Coll London, Hematol Res Ctr, Dept Med, Div Expt Med, London, England.
    Hashmi, Shahrukh K.
    Mayo Clin, Div Hematol, Dept Internal Med, Rochester, MN USA.
    Hayashi, Roberti
    Washington Univ, Sch Med, Div Pediat Hematol Oncol, Dept Pediat, St Louis, MO USA.
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Div Hematol Oncol Bone Marrow Transplantat, Dept Med, Madison, WI 53792 USA.
    Kamble, Rammurti T. f
    Baylor Coll Med, Div Hematol & Oncol, Ctr Cell & Gene Therapy, Houston, TX 77030 USA.
    Kasow, Kimberly A.
    Univ North Carolina Chapel Hill, Div Hematol Oncol, Dept Pediat, Chapel Hill, NC USA.
    Kletzel, Morris
    Ann & Robert H Lurie Childrens Hosp Chicago, Div Hematol Oncol & Stem Cell Transplant, Dept Pediat, Chicago, IL 60611 USA.
    Lazarus, Hillard M.
    Univ Hosp Cleveland, Med Ctr, Div Hematol & Oncol, Seidman Canc Ctr, Cleveland, OH 44106 USA.
    Malone, Adriana K.
    Icahn Sch Med Mt Sinai, Div Hematol Oncol, Tisch Canc Inst, New York, NY 10029 USA.
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.
    O'Brien, Tracey A.
    Sydney Childrens Hosp, Kids Canc Ctr, Blood & Marrow Transplant Program, Sydney, NSW, Australia.
    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, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden.
    Ringden, Olle
    Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden.
    Seo, Sachiko
    East Hosp, Natl Canc Res Ctr, Kashiwa, Chiba, Japan.
    Steinberg, Amir
    Icahn Sch Med Mt Sinai, Div Hematol Oncol, Tisch Canc Inst, New York, NY 10029 USA.
    Yu, Lolie C.
    Louisiana State Univ, Childrens Hosp, Med Ctr, Div Hematol Oncol,Ctr Canc & Blood Disorders, New Orleans, LA USA.
    Warwick, Anne
    Uniformed Serv Univ Hlth Sci, Dept Pediat, Bethesda, MD 20814 USA.
    Shaw, Bronwen
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Duncan, Christine
    Dana Farber Boston Childrens Canc & Blood Disorde, Dept Pediat, 450 Brookline Ave, Boston, MA 02215 USA.
    Survival and Late Effects after Allogeneic Hematopoietic Cell Transplantation for Hematologic Malignancy at Less than Three Years of Age2017In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 23, no 8, p. 1327-1334Article in journal (Refereed)
    Abstract [en]

    Very young children undergoing hematopoietic cell transplantation (HCT) are a unique and vulnerable population. We analyzed outcomes of 717 patients from 117 centers who survived relapse free for year after allogeneic myeloablative HCT for hematologic malignancy at <3 years of age, between 1987 and 2012. The median follow-up was 8.3 years (range, 1.0 to 26.4 years); median age at follow-up was 9 years (range, 2 to 29 years). Ten-year overall and relapse-free survival were 87% (95% confidence interval [CI], 85% to 90%) and 84% (95% CI, 81% to 87%). Ten-year cumulative incidence of relapse was 11% (95% CI, 9% to 13%). Of 84 deaths, relapse was the leading cause (43%). Chronic graft-versus-host-disease 1 year after HCT was associated with increased risk of mortality (hazard ratio [HR], 2.1; 95% CI, 1.3 to 3.3; P=.0018). Thirty percent of patients experienced >= 1 organ toxicity/late effect >1 year after HCT. The most frequent late effects included growth hormone deficiency/growth disturbance (10-year cumulative incidence, 23%; 95% CI, 19% to 28%), cataracts (18%; 95% CI, 15% to 22%), hypothyroidism (13%; 95% CI, 10% to 16%), gonadal dysfunction/infertility requiring hormone replacement (3%; 95% CI, 2% to 5%), and stroke/seizure (3%; 95% CI, 2% to 5%). Subsequent malignancy was reported in 3.6%. In multivariable analysis, total body irradiation (TBI) was predictive of increased risk of cataracts (HR, 17.2; 95% CI, 7.4 to 39.8; P <.001), growth deficiency (HR, 3.5; 95% CI, 2.2 to 5.5; P <.001), and hypothyroidism (HR, 5.3; 95% CI, 3.0 to 9.4; P <.001). In summary, those who survived relapse free year after HCT for hematologic malignancy at <3 years of age had favorable overall survival. Chronic graft-versus host-disease and TBI were associated with adverse outcomes. Future efforts should focus on reducing the risk of relapse and late effects after HCT at early age.

  • 391.
    Vrooman, Lynda
    et al.
    Dana Farber Canc Inst, Boston, MA 02115 USA..
    Millard, Heather
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Brazauskas, Ruta
    Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA..
    Majhail, Navneet S.
    Cleveland Clin, Blood & Marrow Transplant Program, Taussig Canc Inst, Cleveland, OH 44106 USA..
    Battiwallas, Minoo
    NHLBI, Hematol Branch, NIH, Bethesda, MD 20892 USA..
    Flowers, Mary E. D.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA..
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA..
    Akpek, Goerguen
    Banner MD Anderson Canc Ctr, Gilbert, AZ USA..
    Aljurf, Mahmoud D.
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia..
    Bajwa, Rajinder
    Nationwide Childrens, Bone Marrow Transplantat, Columbus, OH USA..
    Baker, K. Scott
    Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA..
    Beitinjaneh, Amer
    Univ Virginia, Sch Med, Hematol Oncol, Charlottesville, VA 22908 USA..
    Bitan, Menachem
    Tel Aviv Sourasky Med Ctr, Pediat Hematol Oncol & BMT, Tel Aviv, Israel..
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA..
    Dandoy, Christopher E.
    Cincinnati Childrens Hosp Med Ctr, Bone Marrow Transplantat & Immune Deficiency, Cincinnati, OH 45229 USA..
    Gale, Robert Peter
    Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Hayashi, Robert J.
    Washington Univ, Sch Med, Dept Pediat, Div Pediat Hematol Oncol, St Louis, MO 63110 USA..
    Hematti, Peiman
    Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA..
    Kamble, Rammurti T.
    Baylor Coll Med, Div Hematol & Oncol, Ctr Cell & Gene Therapy, Houston, TX 77030 USA..
    Kasow, Kimberly A.
    Univ N Carolina, Div Hematol Oncol, Dept Pediat, Chapel Hill, NC USA..
    Kletzel, Morris
    Northwestern Univ, Ann & Robert H Lurie Childrens Hosp Chicago, Feinberg Sch Med, Div Hematol Oncol & Stem Cell Transplantat, Chicago, IL 60611 USA..
    Lazarus, Hillard M.
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Adult Hematol Malignancies & Stem Cell Transplant, Cleveland, OH USA..
    Malone, Adriana K.
    Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA..
    O'Brien, Tracey
    Sydney Childrens Hosp, Kids Canc Ctr, Blood & Marrow Transplant Program, Sydney, NSW, Australia..
    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, Div Therapeut Immunol, Stockholm, Sweden..
    Reddy, Vijay
    Univ Cent Florida, Dept Internal Med, Gainesville, FL USA..
    Willert, Jennifer Reikes
    Univ Calif San Diego, Rady Childrens Hosp, Pediat Hematol Oncol BMT, San Diego, CA USA..
    Ringden, Olle
    Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Allogene Stem Cell Transplantat, Stockholm, Sweden..
    Schears, Raquel M.
    Mayo Clin, Rochester, MN USA..
    Seo, Sachiko
    Fred Hutchinson Canc Res Ctr, 1124 Columbia St, Seattle, WA 98104 USA..
    Steinberg, Amir
    Mt Sinai Hosp, Dept Hematol Oncol, New York, NY 10029 USA..
    Yu, Lolie C.
    Louisiana State Univ, Med Ctr, Childrens Hosp, Div Hematol Oncol, New Orleans, LA USA.;Louisiana State Univ, Med Ctr, Childrens Hosp, Ctr Canc & Blood Disorders,HSCT, New Orleans, LA USA..
    Shaw, Bronwen E.
    CIBMTR, Dept Med, Milwaukee, WI USA.;Med Coll Wisconsin, Milwaukee, WI 53226 USA..
    Duncan, Christine
    Boston Childrens Hosp, Dept Pediat Oncol, Boston, MA USA.;Dana Farber Canc Inst, Boston, MA 02115 USA..
    Survival and Late Effects of Children Undergoing Myeloablative Allogeneic HCT at Less Than Three Years of Age: A Report from the Center for International Blood and Marrow Transplant Research2016In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 22, no 3, p. S28-S29Article in journal (Other academic)
  • 392.
    Wackernagel, Dirk
    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 Pediatrics, Mälarsjukhuset Hospital, 63349 Eskilstuna, Sweden;Karolinska Institutet and University Hospital, Huddinge, 14186 Stockholm, Sweden.
    Brückner, Albrecht
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Department of Pediatrics, Mälarsjukhuset Hospital, 63349 Eskilstuna, Sweden;Department of Pediatrics, Marien-Hospital, 58452 Witten, Germany.
    Ahlsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Computer-aided nutrition - Effects on nutrition and growth in preterm infants < 32 weeks gestation2015In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 10, no 6, p. e234-e241Article in journal (Refereed)
    Abstract [en]

    Background & aims

    Preterm infants are often discharged from the NICU with suboptimal growth. The aim of our intervention study was to determine if a computer-aided nutrition calculation program could help to optimise the nutrition and secondary improve the growth of preterm infants.

    Methods

    Intake of macro- and micronutrients and anthropometric data was collected in 78 preterm infants with GA ≤32+0 from birth to postnatal week 7. The nutrition of 43 preterm infants was ordinated with help of the program Nutrium™​ (IG). Before the introduction of the program 35 consecutive preterm infants served as control group (CG). Their data were collected in retrospect.

    Results

    Amino acid, carbohydrate, fluid intake and total energy intake were statistically different at all time points. Fatty acid intake was statistically different expect for week 2 and 4. Similar differences were found for magnesium, calcium and phosphorus, zinc, copper and selenium. In contrast vitamin intake was higher in the control group.

    At birth there were no differences between the groups with respect to anthropometric data. Weight, length and head circumference (HC) SDS decreased in both groups from birth to day 28 of life (CG −1.2 SDS; −1.2 SDS; −0.8 SDS vs IG −0.9 SDS; −0.8 SDS; −0.4 SDS). The infants in the CG showed until discharge a partial catch-up but remained below birth SDS for weight and length (−0.5 SDS; −0.9 SDS). In the IG, infants reached birth values for weight and length (−0.1 SDS; 0 SDS). For HC both groups showed similar values at the time point for birth and discharge (CG +0.3 SDS vs IG +0.5 SDS).

    Conclusion

    By using a computer-aided nutrition calculation program better postnatal growth was achieved. Nutritional intake was increased in respect to nearly all micro- and macronutrients. There were no adverse effects. In contrast there was a tendency of decreased incidence of BPD, infection rate and PDA.

  • 393.
    Wackernagel, Dirk
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Institutet and University Hospital Huddinge, Stockholm, Sweden.
    Dube, Martina
    Malarsjukhuset Hosp, Dept Paediat, Eskilstuna, Sweden.
    Blennow, Mats
    Karolinska Inst, Stockholm, Sweden; Huddinge Univ Hosp, Stockholm, Sweden.
    Tindberg, Ylva
    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, Pediatrics.
    Continuous subcutaneous glucose monitoring is accurate in term and near-term infants at risk of hypoglycaemia2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 8, p. 917-923Article in journal (Refereed)
    Abstract [en]

    AIM: Postnatal hypoglycaemia increases the risk of adverse neurological outcomes in newborn infants, and adequate glucose control requires repetitive and painful blood sampling. This study evaluated a continuous glucose monitoring system (CGMS) that aims to improve glucose control and decrease the frequency of blood samples taken from neonates.

    METHODS: CGMS sensors, which measure glucose values every five minutes and require calibration twice a day, were placed on 20 infants at risk of hypoglycaemia. The infants also underwent blood glucose sampling, and the blood glucose values were compared with CGMS values six times during the first 30 minutes after sampling.

    RESULTS: We used 97/264 (37%) of the blood glucose values taken for the CGMS calibration. The highest accuracy, a mean of 0.22 (95% confidence interval 0.13-0.30 mmol/L), was found 15-19 minutes after sampling, due to the calibration process. No significant subcutaneous glucose time lag was detectable.

    CONCLUSION: The CGMS system was an accurate and feasible method for glucose control, provided earlier detection of hypoglycaemia in newborn infants and reduced their exposure to procedural pain. The delay in calibration in infants was a new finding and needs to be taken into account when comparing CGMS readings to blood glucose values.

  • 394.
    Wang, Eugen Y-H
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Eriksson, Hans G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Quality of life and functional outcomes 10 years after laparoscopic radical prostatectomy2014In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, no 1, p. 32-37Article in journal (Refereed)
    Abstract [en]

    Background.

    Minimally invasive laparoscopic radical prostatectomy (LRP) has proven equally effective as open surgery in terms of cancer control and peroperative complication rate with less bleeding and postoperative pain. However, long-term follow-up data after LRP are scarce, especially as related to quality of life (QoL).

    Aim.

    To compare QoL and functional outcomes at least 10 years after LRP with a population-based control group matched for age and region.

    Methods.

    Follow-up data were obtained by mailed questionnaires from patients who responded anonymously to five international questionnaires (EQ-5D, QLQ-C30, QLQ-PR25, IPSS, and IIEF). We collected self-reported outcome data directly from 49 patients who underwent LRP more than 10 years ago in our centre. The results of the patients' overall QoL and urinary continence rates were compared with 918 controls matched for region and age.

    Results.

    Forty-two patients (86%) and 808 (88%) controls reported having no urinary leakage. Only 11 patients (24%) still had sexual activities 10 years after LRP, and three were without erectile dysfunction. There was no difference in four of five statements of the self-assessed QoL questionnaires between the LRP and control group. Anxiety level was higher in the LRP group (44%) than in the control group (23%).

    Conclusion.

    Patients reported high self-assessed QoL, although they also reported low sexual activity 10 years after LRP. Prevalence of urinary leakage was similar in both groups. However, anxiety was more common in LRP patients.

  • 395.
    Wickman, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.
    Lupinek, Christian
    Med Univ Vienna, Ctr Pathophysiol Infectiol & Immunol, Dept Pathophysiol & Allergy Res, Div Immunopathol, Vienna, Austria.
    Andersson, Niklas
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.
    Belgrave, Danielle
    Imperial Coll, Dept Paediat, London, England.
    Asarnoj, Anna
    Karolinska Inst, Dept Med, Immunol & Allergy Unit, Stockholm, Sweden; Karolinska Univ Hosp, Stockholm, Sweden; Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Stockholm, Sweden; Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Benet, Marta
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.
    Pinart, Mariona
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.
    Wieser, Sandra
    Med Univ Vienna, Ctr Pathophysiol Infectiol & Immunol, Dept Pathophysiol & Allergy Res, Div Immunopathol, Vienna, Austria.
    Garcia-Aymerich, Judith
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain.
    Baar, Alexandra
    Med Univ Vienna, Ctr Pathophysiol Infectiol & Immunol, Dept Pathophysiol & Allergy Res, Div Immunopathol, Vienna, Austria.
    Pershagen, Göran
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.
    Simpson, Angela
    Univ Manchester, Div Infect Immun & Resp Med, Fac Biol Med & Hlth, Manchester, Lancs, England.
    Kull, Inger
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden; Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden.
    Bergström, Anna
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden.
    Melén, Erik
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden; Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden; Sachs Children & Youth Hosp, Dept Paediat, Stockholm, Sweden.
    Hamsten, Carl
    Karolinska Inst, Dept Med, Immunol & Allergy Unit, Stockholm, Sweden; Karolinska Univ Hosp, Stockholm, Sweden.
    Antó, Josep M.
    Ctr Res Environm Epidemiol CREAL, ISGlobal, Barcelona, Spain; UPF, Hosp del Mar, Med Res Inst, IMIM, Barcelona, Spain; CIBERESP, Barcelona, Spain; UPF, Barcelona, Spain.
    Bousquet, Jean
    Univ Hosp, Montpellier, France; INSERM, VIMA Ageing & Chron Dis, Paris, France; U1168, Epidemiol & Publ Hlth Approaches, Paris, France; Univ Versailles St Quentin En Yvelines, UVSQ, Versailles, France.
    Custovic, Adnan
    Imperial Coll, Dept Paediat, London, England.
    Valenta, Rudolf
    Med Univ Vienna, Ctr Pathophysiol Infectiol & Immunol, Dept Pathophysiol & Allergy Res, Div Immunopathol, Vienna, Austria.
    van Hage, Marianne
    Karolinska Inst, Dept Med, Immunol & Allergy Unit, Stockholm, Sweden; Karolinska Univ Hosp, Stockholm, Sweden.
    Detection of IgE Reactivity to a Handful of Allergen Molecules in Early Childhood Predicts Respiratory Allergy in Adolescence2017In: EBioMedicine, ISSN 0360-0637, E-ISSN 2352-3964, Vol. 26, p. 91-99Article in journal (Refereed)
    Abstract [en]

    Background: Sensitization in early childhood may precede respiratory allergy in adolescence.

    Methods: IgE reactivity against 132 allergen molecules was evaluated using the MeDALL microarray in sera obtained from a random sample of 786 children at the age of 4, 8 and 16 years in a population based birth cohort (BAMSE). Symptoms were analyzed by questionnaire at ages 4, 8 and 16 years. Clinically and independent relevant allergen molecules accounting for ≥ 90% of IgE reactivities in sensitized individuals and at all time-points were identified as risk molecules and used to predict respiratory allergy. The data was replicated in the Manchester Asthma and Allergy Study (MAAS) birth cohort by studying IgE reactivity with the use of a commercial IgE microarray. Sera were obtained from children at the ages of 3, 5, 8 and 11 years (N = 248) and the outcome was studied at 11 years.

    Findings: In the BAMSE cohort 4 risk molecules could be identified, i.e.: Ara h 1 (peanut), Bet v 1 (birch), Fel d 1 (cat), Phl p 1 (grass). For MAAS the corresponding number of molecules was 5: Der p 1 (dust mite), Der f 2 (dust mite), Phl p 1 (grass), Phl p 5 (grass), Fel d 1 (cat). In BAMSE, early IgE reactivity to ≥ 3 of 4 allergen molecules at four years predicted incident and persistent asthma and/or rhinitis at 16 years (87% and 95%, respectively). The corresponding proportions in the MAAS cohort at 16 years were 100% and 100%, respectively, for IgE reactivity to ≥ 3 of 5 risk molecules.

    Interpretations: IgE reactivity to a few allergen molecules early in life identifies children with a high risk of asthma and/or rhinitis at 16 years. These findings will be of importance for developing preventive strategies for asthma and rhinitis in children.

  • 396.
    Wilkinson, Tom
    et al.
    Southampton Univ, Fac Med, Southampton, Hants, England.
    Schembri, Stuart
    Univ Dundee, Scottish Ctr Resp Res, Dundee, Scotland.
    Brightling, Christopher
    Univ Leicester, Inst Lung Hlth, Leicester, Leics, England.
    Bakerly, Nawar Diar
    Salford Royal NHS Fdn Trust, Salford, Lancs, England.
    Macnee, William
    Univ Edinburgh, Edinburgh, Midlothian, Scotland.
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Hedner, Jan
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Allen, Martin
    Univ Hosp North Midlands NHS Trust, Stoke On Trent, Staffs, England.
    Walker, Paul
    Aintree Univ Hosp NHS Fdn Trust, Liverpool, Merseyside, England.
    De Ryck, Iris
    GSK, Siena, Italy.
    Tasciotti, Annaelisa
    GSK, Siena, Italy.
    Casula, Daniela
    GSK, Siena, Italy.
    Testa, Marco
    GSK, Siena, Italy.
    Arora, Ashwani Kumar
    GSK, Siena, Italy.
    Late Breaking Abstract - Safety and immunogenicity of non-typeable H. influenzae (NTHi) adjuvanted vaccine in older adults with chronic obstructive pulmonary disease (COPD)2018In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 52Article in journal (Other academic)
  • 397.
    Wood, William A.
    et al.
    Univ N Carolina, Div Hematol Oncol, Dept Med, Chapel Hill, NC 27515 USA.
    Brazauskas, Ruta
    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.
    Abdel-Azim, Hisham
    Univ Southern Calif, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Keck Sch Med, Los Angeles, CA USA.
    Ahmed, Ibrahim A.
    Childrens Mercy Hosp & Clin, Dept Hematol Oncol & Bone Marrow Transplantat, Kansas City, MO USA.
    Aljurf, Mahmoud
    King Faisal Specialist Hosp & Res Ctr, Dept Oncol, Riyadh, Saudi Arabia.
    Badawy, Sherif
    Ann & Robert H Lurie Childrens Hosp Chicago, Div Hematol Oncol & Stem Cell Transplantat, Chicago, IL 60611 USA.
    Beitinjaneh, Amer
    Univ Miami, Dept Hematol Oncol, Miami, FL USA.
    George, Biju
    Christian Med Coll & Hosp, Vellore, Tamil Nadu, India.
    Buchbinder, David
    Childrens Hosp Orange Cty, Div Pediat Hematol, Orange, CA 92668 USA.
    Cerny, Jan
    UMass Mem Med Ctr, Div Hematol Oncol, Worcester, MA USA.
    Dedeken, Laurence
    Hop Univ Enfants Reine Fabiola, Dept Hematol Oncol, Brussels, Belgium.
    Angel Diaz, Miguel
    Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain.
    Freytes, Cesar O.
    Texas Transplant Inst, San Antonio, TX USA.
    Ganguly, Siddhartha
    Univ Kansas, Med Ctr, Blood & Marrow Transplantat, Div Hematol & Oncol, Kansas City, KS 66103 USA.
    Gergis, Usama
    Presbyterian Hosp, Hematolg Malignancies & Bone Marrow Transplant, Dept Med Oncol, Weill Cornell Med Ctr, New York, NY USA.
    Gomez Almaguer, David
    Hosp Univ Autonoma Nuevo Leon, Monterrey, Mexico.
    Gupta, Ashish
    Univ Hosp Cleveland, Seidman Canc Ctr, Med Ctr, Cleveland, OH 44106 USA.
    Hale, Gregory
    Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL USA.
    Hashmi, Shahrukh K.
    Mayo Clin, Dept Internal Med, Rochester, MN USA;King Faisal Specialist Hosp & Res Ctr, Oncol Ctr, Riyadh, Saudi Arabia.
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan.
    Kamble, Rammurti T.
    Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA.
    Adekola, Kehinde
    Northwestern Univ, Div Hematol Oncol, Dept Med, Chicago, IL 60611 USA;Northwestern Univ, Robert H Lurie Comprehens Canc Ctr, Feinberg Sch Med, Chicago, IL 60611 USA.
    Kindwall-Keller, Tamila
    Univ Virginia Hlth Syst, Div Hematol Oncol, Charlottesville, VA USA.
    Knight, Jennifer
    Med Coll Wisconsin, Dept Psychol, Milwaukee, WI 53226 USA.
    Kumar, Lalit
    All India Inst Med Sci, Inst Rotary Canc Hosp, Dept Med Oncol, New Delhi, India.
    Kuwatsuka, Yachiyo
    Nagoya Univ, Ctr Adv Med & Clin Res, Grad Sch Med, Nagoya, Aichi, Japan.
    Law, Jason
    Floating Hosp Children, Tufts Med Ctr, Dept Pediat, Boston, MA USA.
    Lazarus, Hillard M.
    Univ Hosp Cleveland, Seidman Canc Ctr, Med Ctr, Cleveland, OH 44106 USA.
    LeMaistre, Charles
    Sarah Cannon, Hematol & Bone Marrow Transplant, Nashville, TN 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, Div Therapeut Immunol, Stockholm, Sweden.
    Pulsipher, Michael A.
    Univ Southern Calif, Childrens Hosp Los Angeles, Div Hematol & Blood & Marrow Transplantat, Keck Sch Med, Los Angeles, CA USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
    Schultz, Kirk R.
    Univ British Columbia, British Columbias Childrens Hosp, Dept Pediat Hematol Oncol & Bone Marrow Transplan, Vancouver, BC, Canada.
    Saad, Ayman A.
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA.
    Seftel, Matthew
    CancerCare Manitoba, Dept Med Oncol & Hematol, Winnipeg, MB, Canada.
    Seo, Sachiko
    Natl Canc Res Ctr East, Dept Hematol & Oncol, Chiba, Japan.
    Shea, Thomas C.
    Univ N Carolina, Div Hematol Oncol, Dept Med, Chapel Hill, NC 27515 USA.
    Steinberg, Amir
    Mt Sinai Hosp, Dept Hematol Oncol, New York, NY 10029 USA.
    Sullivan, Keith
    Duke Univ, Med Ctr, Durham, NC USA.
    Szwajcer, David
    CancerCare Manitoba, Dept Med Oncol & Hematol, Winnipeg, MB, Canada.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Yared, Jean
    Univ Maryland, Dept Med, Greenebaum Canc Ctr, Blood & Marrow Transplantat Program,Div Hematol O, Baltimore, MD 21201 USA.
    Yong, Agnes
    Univ Adelaide, Royal Adelaide Hosp, SA Pathol, Adelaide, SA, Australia;Univ Adelaide, Sch Med, Adelaide, SA, Australia.
    Dalal, Jignesh
    Univ Hosp Cleveland, Seidman Canc Ctr, Med Ctr, Cleveland, OH 44106 USA.
    Hahn, Theresa
    Roswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA.
    Khera, Nandita
    Mayo Clin, Dept Hematol Oncol, Phoenix, AZ USA.
    Bonfim, Carmem
    Hosp Clin Fed Univ Parana, Curitiba, Parana, Brazil.
    Atsuta, Yoshiko
    Nagoya Univ, Ctr Adv Med & Clin Res, Grad Sch Med, Nagoya, Aichi, Japan.
    Saber, Wael
    Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA.
    Country-Level Macroeconomic Indicators Predict Early Post-Allogeneic Hematopoietic Cell Transplantation Survival in Acute Lymphoblastic Leukemia: A CIBMTR Analysis2018In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 24, no 9, p. 1928-1935Article in journal (Refereed)
    Abstract [en]

    For patients with acute lymphoblastic leukemia (ALL), allogeneic hematopoietic cell transplantation (alloHCT) offers a potential cure. Life-threatening complications can arise from alloHCT that require the application of sophisticated health care delivery. The impact of country-level economic conditions on post-transplantation outcomes is not known. Our objective was to assess whether these variables were associated with outcomes for patients transplanted for ALL. Using data from the Center for Blood and Marrow Transplant Research, we included 11,261 patients who received a first alloHCT for ALL from 303 centers across 38 countries between the years of 2005 and 2013. Cox regression models were constructed using the following macroeconomic indicators as main effects: Gross national income per capita, health expenditure per capita, and Human Development Index (HDI). The outcome was overall survival at 100 days following transplantation. In each model, transplants performed within lower resourced environments were associated with inferior overall survival. In the model with the HDI as the main effect, transplants performed in the lowest HDI quartile (n = 697) were associated with increased hazard for mortality (hazard ratio, 2.42; 95% confidence interval, 1.64 to 3.57; P < .001) in comparison with transplants performed in the countries with the highest HDI quartile. This translated into an 11% survival difference at 100 days (77% for lowest HDI quartile versus 88% for all other quartiles). Country-level macroeconomic indices were associated with lower survival at 100 days after alloHCT for ALL. The reasons for this disparity require further investigation.

  • 398. Xu, Weiping
    et al.
    Morris, Ulrika
    Aydin-Schmidt, Berit
    Msellem, Mwinyi I.
    Shakely, Deler
    Petzold, Max
    Bjorkman, Anders
    Mårtensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    SYBR Green Real-Time PCR-RFLP Assay Targeting the Plasmodium Cytochrome B Gene - A Highly Sensitive Molecular Tool for Malaria Parasite Detection and Species Determination2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0120210Article in journal (Refereed)
    Abstract [en]

    A prerequisite for reliable detection of low-density Plasmodium infections in malaria pre-elimination settings is the availability of ultra-sensitive and high-throughput molecular tools. We developed a SYBR Green real-time PCR restriction fragment length polymorphism assay (cytb-qPCR) targeting the cytochrome b gene of the four major human Plasmodium species (P. falciparum, P. vivax, P. malariae, and P. ovale) for parasite detection and species determination with DNA extracted from dried blood spots collected on filter paper. The performance of cytb-qPCR was first compared against four reference PCR methods using serially diluted Plasmodium samples. The detection limit of the cytb-qPCR was 1 parasite/mu l (p/mu l) for P. falciparum and P. ovale, and 2 p/mu l for P. vivax and P. malariae, while the reference PCRs had detection limits of 0.5-10 p/mu l. The ability of the PCR methods to detect low-density Plasmodium infections was then assessed using 2977 filter paper samples collected during a cross-sectional survey in Zanzibar, a malaria pre-elimination setting in sub-Saharan Africa. Field samples were defined as 'final positive' if positive in at least two of the five PCR methods. Cytb-qPCR preformed equal to or better than the reference PCRs with a sensitivity of 100% (65/65; 95% CI 94.5-100%) and a specificity of 99.9%(2910/2912; 95% CI 99.7-100%) when compared against 'final positive' samples. The results indicate that the cytb-qPCR may represent an opportunity for improved molecular surveillance of low-density Plasmodium infections in malaria pre-elimination settings.

  • 399.
    Zander, Viktoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Univ Hosp Solna, Dept Womens & Childrens Hlth, Karolinska Inst, S-17176 Stockholm, Sweden..
    Eriksson, Henrik
    Swedish Red Cross Univ Coll, Dept Nursing & Care, S-11428 Stockholm, Sweden..
    Christensson, Kyllike
    Karolinska Univ Hosp Solna, Dept Womens & Childrens Hlth, Karolinska Inst, S-17176 Stockholm, Sweden..
    Mullersdorf, Maria
    Malardalen Univ, Sch Hlth Care & Social Welf, S-63105 Eskilstuna, Sweden..
    Development of an Interview Guide Identifying the Rehabilitation Needs of Women from the Middle East Living with Chronic Pain2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 10, p. 12043-12056Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.

  • 400.
    Zander, Viktoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.
    Eriksson, Henrik
    Swedish Red Cross Univ Coll, Dept Nursing & Care, Stockholm, Sweden.
    Christensson, Kyllike
    Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.
    Müllersdorf, Maria
    Sch Hlth Care & Social Welf, Eskilstuna, Vasteras, Sweden.
    Rehabilitation of Women From the Middle East Living With Chronic Pain-Perceptions From Health Care Professionals.2014In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 11, p. 1194-1207Article in journal (Refereed)
    Abstract [en]

    Meeting patients from other countries constitutes a challenge for health care. The purpose of this study was to increase knowledge about tacit understandings of treatment in practice by determining the perceptions of chronic pain and rehabilitation directed to resettled women from the Middle East, from a variety of health care professionals within primary care. Based on the results, we find a need to support and increase knowledge among health care professionals to involve the patient and consider her beliefs, expectations, background, current life situation, and spirituality, and to involve family in rehabilitation.

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