1
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Rabe H, Lönnermark E, Johansson E, Gilljam M, Jönsson B. In vitro stimulation with nontuberculous mycobacteria induced a stronger cytokine response in leukocytes isolated from individuals with latent tuberculosis compared to those isolated from active tuberculosis or cystic fibrosis patients. Tuberculosis (Edinb) 2024; 147:102504. [PMID: 38522174 DOI: 10.1016/j.tube.2024.102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024]
Abstract
Mycobacterium tuberculosis and opportunistic environmental non-tuberculous mycobacteria (NTM) can cause severe infection. Why latent tuberculosis infection advances to active disease, and why some individuals with cystic fibrosis (CF) develop pulmonary infections with NTM is still poorly understood. The aim of this study was to investigate the effector function of peripheral blood mononuclear cells (PBMC) from individuals with active or latent tuberculosis, individuals with CF with or without pulmonary NTM-infection and healthy controls, by measuring cytokine response to in vitro stimulation with different species of NTMs. The cytokine concentrations of IL-17A, IL-22, IL-23, IL-10, IL12p70 and IFN-γ were measured in PBMC-culture supernatants after stimulation with NTMs. PBMCs from individuals with latent tuberculosis infection showed strong IL-17A, IL-22, and IFN-γ responses compared to individuals with active tuberculosis or CF. IL-10 production was low in both tuberculosis groups compared to the CF groups and controls. This study suggests that IL-17A and IL-22 might be important to keep tuberculosis in a latent phase and that individuals with CF with an ongoing NTM infection seem to have a low cytokine response.
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Affiliation(s)
- Hardis Rabe
- Unit of Biological Function, Research Institutes of Sweden (RISE AB), Gothenburg, Sweden; Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Elisabeth Lönnermark
- Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden.
| | - Ewa Johansson
- Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden.
| | - Marita Gilljam
- Region Västra Götaland, Sahlgrenska University Hospital, Respiratory Medicine, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg CF Centre, Adult Clinic, Gothenburg, Sweden.
| | - Bodil Jönsson
- Institute of Biomedicine, Department of infectious diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Microbiology, Gothenburg, Sweden.
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2
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Hedin W, Fröberg G, Fredman K, Chryssanthou E, Selmeryd I, Gillman A, Orsini L, Runold M, Jönsson B, Schön T, Davies Forsman L. A rough colony morphology of Mycobacterium abscessus is associated with cavitary pulmonary disease and poor clinical outcome. J Infect Dis 2023; 227:820-827. [PMID: 36637124 PMCID: PMC10043986 DOI: 10.1093/infdis/jiad007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The Mycobacterium abscessus complex (MABC) is a difficult to treat mycobacteria with two distinct morphologies: smooth and rough. As the clinical implications are unclear, we explored the morphology of MABC in relation to disease and outcome. METHODS We performed a retrospective multi-center cohort study including patients with confirmed MABC in Sweden between 2009-2020, with treatment outcome as the primary outcome. MABC colony morphology was determined by light microscopy on Middlebrook 7H10 agar plates. RESULTS Out of the 71 MABC isolates, a defined morphology could be determined for 63 isolates, of which 40 were smooth (56%) and 23 were rough (32%). Immunosuppression, pulmonary disease and cavitary lesion on chest x-ray were significantly associated with a rough isolate morphology. Participants with smooth isolates had more favorable treatment outcomes (12/14, 86%) compared to those with rough isolates (3/10, 30%). In an age-adjusted logistic regression, rough morphology of MABC was associated to lower odds of clinical cure compared to smooth morphology (aOR 0.12 p=0.049). CONCLUSION Study participants with rough MABC colony morphology of isolates had a worse clinical outcome compared to those with smooth isolates. The biological mechanisms should be further characterized and colony morphology of MABC taken into account during clinical management.
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Affiliation(s)
- Wilhelm Hedin
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gabrielle Fröberg
- Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Solna, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Kalle Fredman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Erja Chryssanthou
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Selmeryd
- Department of Infectious Diseases, Västmanland Hospital, Västerås, Sweden
| | - Anna Gillman
- Department of Medical Sciences, Section for Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Letizia Orsini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - Michael Runold
- Department of Medicine, Division of Respiratory Medicine and Allergology, Karolinska Institutet Solna, Sweden
| | - Bodil Jönsson
- Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Schön
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Infectious Diseases, Region Östergötland and Kalmar County Hospital, Sweden
| | - Lina Davies Forsman
- Department of Infectious Diseases, Karolinska University Hospital, Sweden.,Department of Medicine, Division of Infectious Diseases, Karolinska Institutet, Solna, Sweden
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3
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Fritzell P, Hägg O, Bergström T, Jönsson B, Andersson SGE, Skorpil M, Udby PM, Andersen M, Andersen M. Antibiotics should not be used for back/leg pain. Acta Orthop 2021; 92:244-246. [PMID: 33461391 PMCID: PMC8162125 DOI: 10.1080/17453674.2020.1871190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
| | - Olle Hägg
- Spine Center Göteborg, Västra Frölunda, Sweden; ,
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden;
| | | | - Siv G E Andersson
- Department of Cell and Molecular Biology, Biomedical, Center, Uppsala University, Sweden;
| | - Mikael Skorpil
- Department of Neuroradiology, Karolinska University, Hospital, Stockholm, Sweden;
| | - Peter Muhareb Udby
- Spine Unit, Ortopaedkirurgisk Afdeling, Sjaellands, Universitetshospital, Køge, Denmark;
| | - Mikkel Andersen
- Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
| | - Mikkel Andersen
- Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
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Affiliation(s)
- Peter Fritzell
- RKC Centre for Spine Surgery in Stockholm, Sweden/Futurum, Academy for Health and Care, Region Jönköping County, Sweden; ,Correspondence:
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Sweden;
| | | | - Siv G E Andersson
- Department of Cell and Molecular Biology, Biomedical Center, Uppsala University, Sweden;
| | | | - Peter Muhareb Udby
- Spine Unit, Ortopaedkirurgisk Afdeling, Sjaellands Universitetshospital, Køge, Denmark;
| | - Mikkel Andersen
- Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark;
| | - Olle Hägg
- Spine Center Göteborg, Västra Frölunda, Sweden
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5
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Lyngh D, de la Cour N, Åström L, Koning J, Jönsson B, Ghatnekar Nilsson S, Hall C, Beßler Y, Heldmann P, Lozza C, Schweiger H. Engineering and prototyping of ESS neutron beam extraction system. JNR 2020. [DOI: 10.3233/jnr-200155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the development of the European Spallation Source, the engineering phase of the Neutron Beam Extraction System is approaching its end. Currently, prototyping is ongoing to verify and increase the understanding of the manufacturing limitations in relation to the engineering aspects and beam extraction requirements from the instruments. After that the manufacturing of the suite of 16 neutron beam port inserts (NBPI) and light shutter systems (LSS) are phased into final detail design and manufacturing. The NBPIs have been developed as a close collaboration between ESS’ instruments design coordinators and intricately integrate a set of copper optics within a controlled atmosphere within the target monolith pressure vessel. The NBPIs therefore includes not only a processed atmosphere but also enables fine alignment of the optics assemblies within it, but also includes a system for inserting it into a very precisely aligned and measured position. Outside the NBPIs, along the neutron beam paths, sits the Neutron Beam Windows and sequentially, the LSS which incorporates an optical bridge beam guide before the beam enters the bunker area and the individual instrument beam transports. ESS have chosen the concept of LSS, which generates demanding requirements for alignment of moving shutter parts. These system parts are placed in the bunker area and bunker basement, areas that are partly accessible during maintenance periods.
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Affiliation(s)
- D. Lyngh
- European Spallation Source ERIC, P.O. BOX 176, 221 00 Lund, Sweden. E-mails: , , , , , ,
| | - N. de la Cour
- European Spallation Source ERIC, P.O. BOX 176, 221 00 Lund, Sweden. E-mails: , , , , , ,
| | - L. Åström
- European Spallation Source ERIC, P.O. BOX 176, 221 00 Lund, Sweden. E-mails: , , , , , ,
| | - J. Koning
- European Spallation Source ERIC, P.O. BOX 176, 221 00 Lund, Sweden. E-mails: , , , , , ,
- Heemskerk Innovative Technology BV, Mijnbouwstraat 120, 2628RX Delft, The Netherlands
| | - B. Jönsson
- European Spallation Source ERIC, P.O. BOX 176, 221 00 Lund, Sweden. E-mails: , , , , , ,
| | - S. Ghatnekar Nilsson
- European Spallation Source ERIC, P.O. BOX 176, 221 00 Lund, Sweden. E-mails: , , , , , ,
| | - C. Hall
- Central Institute of Engineering, Electronics and Analytics – Engineering and Technology (ZEA-1) Forschungszentrum Jülich GmbH, Germany. E-mails: , ,
| | - Y. Beßler
- Central Institute of Engineering, Electronics and Analytics – Engineering and Technology (ZEA-1) Forschungszentrum Jülich GmbH, Germany. E-mails: , ,
| | - P. Heldmann
- Central Institute of Engineering, Electronics and Analytics – Engineering and Technology (ZEA-1) Forschungszentrum Jülich GmbH, Germany. E-mails: , ,
| | - C. Lozza
- Swissneutronics AG, Bruehlstrasse 28, CH-5313 Klingau, Switzerland. E-mail:
| | - H. Schweiger
- European Spallation Source ERIC, P.O. BOX 176, 221 00 Lund, Sweden. E-mails: , , , , , ,
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Udby PM, Fritzell P, Bergström T, Jönsson B, Skorpil M, Hägg O, Andersen MØ. [Antibiotics should not be used for treating back pain due to Modic changes]. Ugeskr Laeger 2020; 182:V06200476. [PMID: 33046199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Infection has been proposed as a cause of back pain in individuals with Modic changes. This review summarises the knowledge on this topic in Scandinavia. A Norwegian randomized controlled trial could not replicate results in favor of antibiotic treatment for such patients. A Danish study demonstrated that patients with low back pain and Modic changes had similar physical disability-scores and less sick leave due to back pain than individuals without Modic changes at long-term follow-up (>10 years). A Swedish study displayed equal bacterial presence in discs of patients operated for lumbar disc herniation and in control patients, indicating that the presence of bacteria is caused by contamination during the surgical procedure and is not related to back pain.
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Oshalim M, Johansson E, Rabe H, Gilljam M, Lindblad A, Jönsson B. Th17 associated cytokines in sputum samples from patients with cystic fibrosis. Pathog Dis 2020; 78:ftaa050. [PMID: 32876666 DOI: 10.1093/femspd/ftaa050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/29/2020] [Indexed: 11/13/2022] Open
Abstract
Cystic fibrosis (CF) is a genetic disease leading to chronic bacterial airway infection and inflammation. T helper 17 (Th17) cells are identified by their production of interleukin (IL)-17A, which recruit neutrophils to the site of airway infection. IL-23 is an important inducer of IL-17 and IL-22 production. The aim of this study was to study the role of Th17 cells in CF airway infection by measuring the levels of Th17 associated cytokines in sputum from CF patients with or without airway infection and by comparison with non-CF-controls. In a cross-sectional screening study, cytokine levels were measured with a Th17 multiplex cytokine ELISA. Significantly lower levels of IL-17A and IL-23 were found in sputa from infected CF patients. The lowest levels of IL-17A were found in patients chronically infected with P. aeruginosa, which also had the lowest IL-17/IL-22 ratio, while children had a higher ratio. Children also had higher IL-23 levels than adults. IL-1ß and IL-10 were significantly lower in CF sputum compared to controls. Thus, in our study CF patients with chronic infections had a lower production of Th17 associated cytokines in sputum compared with non-infected CF patients and infected patient without CF.
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Affiliation(s)
- Merna Oshalim
- Department of infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Johansson
- Department of infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hardis Rabe
- Department of infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marita Gilljam
- Department of Internal medicine and Clinical Nutrition, Respiratory medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg
- Gothenburg CF Centre, Region Västra Götaland, Gothenburg, Sweden
| | - Anders Lindblad
- Department of Paediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Gothenburg CF Centre, Region Västra Götaland, Gothenburg, Sweden
| | - Bodil Jönsson
- Department of infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden and Department of Clinical Microbiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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8
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Fritzell P, Bergström T, Jönsson B, Andersson S, Skorpil M, Muhareb Udby P, Andersen M, Hägg O. [Antibiotics should not be used to treat patients with back/leg pain]. Lakartidningen 2020; 117:20067. [PMID: 32969480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This report is based on results from three research groups in Sweden (Fritzell et al), Denmark (Udby et al), and Norway (Bråten et al). The groups have conducted studies published in international journals in 2019 [8-10]. The results complement each other and strongly suggest that antibiotics, in the absence of clear signs of a clinically relevant infection (discitis/spondylitis), should not be used for back pain with or without leg pain. The Swedish study showed that bacteria found in the disc/vertebra during surgery are very likely due to contamination [8], the Danish study showed that patients with Modic Changes (MC) on MR in the long term were not associated with more back pain or functional impairment than in patients without MC [9], and the Norwegian study showed that antibiotics for residual back pain after previous disc herniation had no better clinical effect than placebo [10]. Antibiotic resistance is one of the biggest threats to public health today and in the future.
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Affiliation(s)
| | - Tomas Bergström
- professor, överläkare, Klinisk mikrobiologi, Göteborgs universitet
| | | | | | | | - Peter Muhareb Udby
- PhD, läkare, kiropraktor, Spine Unit, Ortopædkirurgisk Afdeling, Sjællands Universitetshospital, Køge
| | - Mikkel Andersen
- docent, överläkare, Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart
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9
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Hampe CS, Radtke JR, Wester A, Carlsson A, Cedervall E, Jönsson B, Ivarsson SA, Elding Larsson H, Larsson K, Lindberg B, Neiderud J, Rolandsson O, Lernmark Å. Reduced display of conformational epitopes in the N-terminal truncated GAD65 isoform: relevance for people with stiff person syndrome or DQ8/8-positive Type 1 diabetes mellitus. Diabet Med 2019; 36:1375-1383. [PMID: 30264481 PMCID: PMC6437014 DOI: 10.1111/dme.13827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 12/26/2022]
Abstract
AIMS To investigate whether the N-terminal truncated glutamic acid decarboxylase 65 (GAD65) isoform is as well recognized by people with stiff person syndrome as it is by people with Type 1 diabetes, and whether conformational GAD65 antibody epitopes are displayed properly by the isoform. METHODS GAD65 antibody-positive healthy individuals (n=13), people with stiff-person syndrome (n=15) and children with new-onset Type 1 diabetes (n=654) were analysed to determine binding to full-length GAD65 and the N-terminal truncated GAD65 isoform in each of these settings. GAD65 autoantibody epitope specificity was correlated with binding ratios of full-length GAD65/N-terminal truncated GAD65. RESULTS The N-terminal truncated GAD65 isoform was significantly less recognized in GAD65Ab-positive people with stiff-person syndrome (P=0.002) and in healthy individuals (P=0.0001) than in people with Type 1 diabetes. Moreover, at least two specific conformational GAD65Ab epitopes were not, or were only partially, presented by the N-terminal truncated GAD65 isoform compared to full-length GAD65. Finally, an N-terminal conformational GAD65Ab epitope was significantly less recognized in DQ8/8 positive individuals with Type 1 diabetes (P=0.02). CONCLUSIONS In people with stiff person syndrome preferred binding to the full-length GAD65 isoform over the N-terminal truncated molecule was observed. This binding characteristic is probably attributable to reduced presentation of two conformational epitopes by the N-terminal truncated molecule. These findings support the notion of disease-specific GAD65Ab epitope specificities and emphasize the need to evaluate the applicability of novel assays for different medical conditions.
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Affiliation(s)
- C S Hampe
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - J R Radtke
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - A Wester
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - A Carlsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - E Cedervall
- Department of Paediatrics, Ängelholm Hospital, Ängelholm, Malmo, Sweden
| | - B Jönsson
- Department of Paediatrics, Ystad Hospital, Ystad, Sweden
| | - S A Ivarsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - H Elding Larsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - K Larsson
- Department of Paediatrics, Kristianstad Hospital, Kristianstad, Sweden
| | - B Lindberg
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
| | - J Neiderud
- Department of Paediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - O Rolandsson
- Department of Public Health and Clinical Medicine, Section of Family Medicine, Umeå University, Umeå, Sweden
| | - Å Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmo, Sweden
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10
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Fritzell P, Welinder-Olsson C, Jönsson B, Melhus Å, Andersson SGE, Bergström T, Tropp H, Gerdhem P, Hägg O, Laestander H, Knutsson B, Lundin A, Ekman P, Rydman E, Skorpil M. Correction to: Bacteria: back pain, leg pain and Modic sign-a surgical multicenter comparative study. Eur Spine J 2019; 29:196-197. [PMID: 31664566 DOI: 10.1007/s00586-019-06199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Unfortunately, the 5th author name was incorrectly published in the original paper. The complete correct name is given below.
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Affiliation(s)
- Peter Fritzell
- Futurum Academy, Länssjukhuset Ryhov, 55185, Jönköping, Sweden.
| | | | - Bodil Jönsson
- Sahlgrenska University Hospital, 41346, Göteborg, Sweden
| | - Åsa Melhus
- Uppsala University Hospital, 75185, Uppsala, Sweden
| | - Siv G E Andersson
- Department of Cell and Molecular Biology, Biomedical Center, Uppsala University, 75123, Uppsala, Sweden
| | - Tomas Bergström
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, 41346, Göteborg, Sweden
| | - Hans Tropp
- Linköping University, 58183, Linköping, Sweden
| | - Paul Gerdhem
- Karolinska University Hospital, 14186, Stockholm, Sweden
| | - Olle Hägg
- Spine Center Göteborg, 42130, Västra Frölunda, Sweden
| | | | | | | | - Per Ekman
- Södersjukhuset, 11883, Stockholm, Sweden
| | | | - Mikael Skorpil
- Karolinska University Hospital, 17164, Stockholm, Sweden
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11
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Althin R, Färe R, Grosskopf S, Jönsson B, Wilking N. Measuring the efficiency of cancer care in Europe. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy268.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mortazavi N, Geers C, Esmaily M, Babic V, Sattari M, Lindgren K, Malmberg P, Jönsson B, Halvarsson M, Svensson JE, Panas I, Johansson LG. Interplay of water and reactive elements in oxidation of alumina-forming alloys. Nat Mater 2018; 17:610-617. [PMID: 29891892 DOI: 10.1038/s41563-018-0105-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
High-temperature alloys are crucial to many important technologies that underpin our civilization. All these materials rely on forming an external oxide layer (scale) for corrosion protection. Despite decades of research on oxide scale growth, many open questions remain, including the crucial role of the so-called reactive elements and water. Here, we reveal the hitherto unknown interplay between reactive elements and water during alumina scale growth, causing a metastable 'messy' nano-structured alumina layer to form. We propose that reactive-element-decorated, hydroxylated interfaces between alumina nanograins enable water to access an inner cathode in the bottom of the scale, at odds with the established scale growth scenario. As evidence, hydride-nanodomains and reactive element/hydrogen (deuterium) co-variation are observed in the alumina scale. The defect-rich alumina subsequently recrystallizes to form a protective scale. First-principles modelling is also performed to validate the RE effect. Our findings open up promising avenues in oxidation research and suggest ways to improve alloy properties.
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Affiliation(s)
- N Mortazavi
- Department of Physics, Chalmers University of Technology, Gothenburg, Sweden.
| | - C Geers
- Department of Chemistry and Chemical Engineering, Division of Energy and Materials, Chalmers University of Technology, Gothenburg, Sweden
| | - M Esmaily
- Department of Chemistry and Chemical Engineering, Division of Energy and Materials, Chalmers University of Technology, Gothenburg, Sweden
| | - V Babic
- Department of Chemistry and Chemical Engineering, Division of Energy and Materials, Chalmers University of Technology, Gothenburg, Sweden
| | - M Sattari
- Department of Physics, Chalmers University of Technology, Gothenburg, Sweden
| | - K Lindgren
- Department of Physics, Chalmers University of Technology, Gothenburg, Sweden
| | - P Malmberg
- Department of Chemistry and Chemical Engineering, Division of Chemistry and Biochemistry, Chalmers University of Technology, Gothenburg, Sweden
| | - B Jönsson
- Sandvik Heating Technology AB, Hallstahammar, Sweden
| | - M Halvarsson
- Department of Physics, Chalmers University of Technology, Gothenburg, Sweden
| | - J E Svensson
- Department of Chemistry and Chemical Engineering, Division of Energy and Materials, Chalmers University of Technology, Gothenburg, Sweden
| | - I Panas
- Department of Chemistry and Chemical Engineering, Division of Energy and Materials, Chalmers University of Technology, Gothenburg, Sweden
| | - L G Johansson
- The High Temperature Corrosion Centre (HTC), Chalmers University of Technology, Gothenburg, Sweden.
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Bengtsson D, Westerberg M, Nielsen S, Ridell M, Jönsson B. Mycobacterium chimaera in heater-cooler units used during cardiac surgery - growth and decontamination. Infect Dis (Lond) 2018; 50:736-742. [PMID: 29688098 DOI: 10.1080/23744235.2018.1464204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Previous studies have identified patients infected with Mycobacterium chimaera (M. chimaera) subsequent to cardiac surgery. Water tanks in heater-cooler units (HCUs) used cardiac heart surgery was traced as source. The aim was to investigate occurrence of M. chimaera and other microorganisms in HCUs and evaluate the silver-ion cleaning routine. METHOD Five HCUs were disinfected with silver-ions and examined for mycobacteria directly (15 min) after the disinfection procedures and later on three occasions (3, 6, 10 weeks). One HCU was selected for additional investigation of the presence of other microorganisms. In addition, tap water from five sinks in the surgical department was examined for the presence of mycobacteria and other microorganisms. RESULTS M. chimaera grew in all the HCU water tanks and in 35 of the 40 HCU samples. Three of the samples also contained Mycobacterium gordonae. When the selected HCU tanks were analysed directly after the disinfection procedure bacteria and fungi were found but no non-fermenting Gram-negative rods. These HCU samples contained a doubled to 3 fold amount of bacteria compared to initial tap water samples. No mycobacteria were found in any sample from the five water taps. CONCLUSION The silver-ion cleaning routine was insufficient and M. chimaera was found in all HCUs. However, no mycobacteria were found in any sample from the five water taps suggesting another source of colonization. It is probable that residual water and biofilm are of importance. Our results emphasize the need for improved disinfection procedures and improved construction of the HCUs.
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Affiliation(s)
- Daniel Bengtsson
- a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Göteborg , Sweden
| | - Martin Westerberg
- a Department of Cardiothoracic Surgery , Sahlgrenska University Hospital , Göteborg , Sweden
| | - Susanne Nielsen
- b Department of Molecular and Clinical Medicine , Sahlgrenska Academy, Göteborg University , Göteborg , Sweden
| | - Malin Ridell
- c Department of Microbiology and Immunology , Institute of Biomedicine, University of Gothenburg , Göteborg , Sweden
| | - Bodil Jönsson
- d Department of Infectious Medicine , Institute of Biomedicine, University of Gothenburg , Göteborg , Sweden.,e Clinical Microbiology Laboratories , Sahlgrenska University Hospital , Gothenburg , Sweden
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14
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Svedbom A, Borgstöm F, Hernlund E, Ström O, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jürisson M, Kallikorm R, Lember M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Solodovnikov A, Tamulaitiene M, Thomas T, Toroptsova N, Uusküla A, Tosteson ANA, Jönsson B, Kanis JA. Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporos Int 2018; 29:557-566. [PMID: 29230511 DOI: 10.1007/s00198-017-4317-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study used data from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) to estimate the quality of life (QoL) impact of fracture. Hip, vertebral, and distal forearm fractures incur substantial QoL losses. Hip and vertebral fracture results in markedly impaired QoL for at least 18 months. INTRODUCTION The International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) is a multinational observational study that aims to describe costs and quality of life (QoL) consequences of osteoporotic fractures. To date, 11 countries have participated in the study: Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, the UK, and the USA. The objective of this paper is to describe the QoL impact of hip, vertebral, and distal forearm fracture. METHODS Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall) and at 4, 12, and 18 months after fracture. Quality of life was measured as health state utility values (HSUVs) derived from the EQ-5D-3L. Complete case analysis was conducted as the base case with available case and multiple imputation performed as sensitivity analyses. Multivariate analysis was performed to explore predictors of QoL impact of fracture. RESULTS Among 5456 patients enrolled using convenience sampling, 3021 patients were eligible for the base case analysis (1415 hip, 1047 distal forearm, and 559 vertebral fractures). The mean (SD) difference between HSUV before and after fracture for hip, vertebral, and distal forearm fracture was estimated at 0.89 (0.40), 0.67 (0.45), and 0.48 (0.34), respectively (p < 0.001 for all fracture types). Eighteen months after fracture, mean HSUVs were lower than before the fracture in patients with hip fracture (0.66 vs. 0.77 p < 0.001) and vertebral fracture (0.70 vs. 0.83 p < 0.001). Hospitalization and higher recalled pre-fracture QoL were associated with increased QoL impact for all fracture types. CONCLUSIONS Hip, vertebral, and distal forearm fractures incur substantial loss in QoL and for patients with hip or vertebral fracture, QoL is markedly impaired for at least 18 months.
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Affiliation(s)
| | - F Borgstöm
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | | | - O Ström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden
| | - V Alekna
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - M L Bianchi
- Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - P Clark
- Clinical Epidemiology Unit, Hospital Infantil Federico Gómez and Faculty of Medicine UNAM, Mexico City, Mexico
| | - M D Curiel
- Servicio de Medicina Interna/Enfermedades Metabolicas Oseas, Fundacion Jimenez Diaz, Madrid, Spain
- Catedra de Enfermedades Metabolicas Óseas, Universidad Autonoma, Madrid, Spain
| | - H P Dimai
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - M Jürisson
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - R Kallikorm
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - M Lember
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - O Lesnyak
- Ural State Medical University, Yekaterinburg, Russia
- North West Mechnikov State Medical University, St. Petersburg, Russia
| | - E McCloskey
- Academic Unit of Bone Metabolism, Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - K M Sanders
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - M Tamulaitiene
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - T Thomas
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Service de Rhumatologie, CHU de Saint-Etienne, Université de Lyon, Saint-Etienne, France
| | - N Toroptsova
- FSBSI "Scientific Research Institute of Rheumatology named after V.A.Nasonova, Moscow, Russia
| | - A Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - A N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, PA, USA
| | - B Jönsson
- Stockholm School of Economics, Stockholm, Sweden
| | - J A Kanis
- Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
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15
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Jönsson B, Lönnermark E, Ridell M. [Not Available]. Lakartidningen 2018; 115:EWHD. [PMID: 29319836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
TB can be detected with PCR - but only in smear-positive respiratory samples Unnecessary and inappropriate clinical requests represent a great waste of time and money and may also result in false diagnoses. PCR-techniques, such as Cobas TaqMan MTB, are used for rapid detection of tuberculosis (TB). These assays are only validated for respiratory specimens, but they are commonly requested also for non-respiratory specimens. These assays perform well in smear-positive respiratory samples, while the sensitivities are quite unsatisfactory for both respiratory and non-respiratory smear-negatives samples. The specificity is high and it is possible to rapidly distinguish between TB and infections caused by environmental mycobacteria. The analyses demonstrate, furthermore, that PCR assays cannot be used to evaluate treatment, detect relapses or exclude TB. Nor can these assays be used to evaluate contagiousness or to screen for TB.
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Affiliation(s)
- Bodil Jönsson
- Goteborgs Universitet Institutionen for biomedicin - Infektionssjukdomar Göteborg, Sweden Sahlgrenska universitetssjukhuset Klinisk mikrobiologi bakteriologi - Goteborg, Sweden
| | - Elisabet Lönnermark
- Goteborgs Universitet Institutionen for biomedicin - Infektionssjukdomar Goteborg, Sweden Goteborgs Universitet Institutionen for biomedicin - Infektionssjukdomar Goteborg, Sweden
| | - Malin Ridell
- Goteborgs Universitet Institutionen for biomedicin - Mikrobiologi och immunologi Göteborg, Sweden Goteborgs Universitet Institutionen for biomedicin - Mikrobiologi och immunologi Göteborg, Sweden
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16
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Bryant JM, Grogono DM, Rodriguez-Rincon D, Everall I, Brown KP, Moreno P, Verma D, Hill E, Drijkoningen J, Gilligan P, Esther CR, Noone PG, Giddings O, Bell SC, Thomson R, Wainwright CE, Coulter C, Pandey S, Wood ME, Stockwell RE, Ramsay KA, Sherrard LJ, Kidd TJ, Jabbour N, Johnson GR, Knibbs LD, Morawska L, Sly PD, Jones A, Bilton D, Laurenson I, Ruddy M, Bourke S, Bowler IC, Chapman SJ, Clayton A, Cullen M, Daniels T, Dempsey O, Denton M, Desai M, Drew RJ, Edenborough F, Evans J, Folb J, Humphrey H, Isalska B, Jensen-Fangel S, Jönsson B, Jones AM, Katzenstein TL, Lillebaek T, MacGregor G, Mayell S, Millar M, Modha D, Nash EF, O'Brien C, O'Brien D, Ohri C, Pao CS, Peckham D, Perrin F, Perry A, Pressler T, Prtak L, Qvist T, Robb A, Rodgers H, Schaffer K, Shafi N, van Ingen J, Walshaw M, Watson D, West N, Whitehouse J, Haworth CS, Harris SR, Ordway D, Parkhill J, Floto RA. Emergence and spread of a human-transmissible multidrug-resistant nontuberculous mycobacterium. Science 2017; 354:751-757. [PMID: 27846606 DOI: 10.1126/science.aaf8156] [Citation(s) in RCA: 355] [Impact Index Per Article: 50.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/23/2016] [Indexed: 12/20/2022]
Abstract
Lung infections with Mycobacterium abscessus, a species of multidrug-resistant nontuberculous mycobacteria, are emerging as an important global threat to individuals with cystic fibrosis (CF), in whom M. abscessus accelerates inflammatory lung damage, leading to increased morbidity and mortality. Previously, M. abscessus was thought to be independently acquired by susceptible individuals from the environment. However, using whole-genome analysis of a global collection of clinical isolates, we show that the majority of M. abscessus infections are acquired through transmission, potentially via fomites and aerosols, of recently emerged dominant circulating clones that have spread globally. We demonstrate that these clones are associated with worse clinical outcomes, show increased virulence in cell-based and mouse infection models, and thus represent an urgent international infection challenge.
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Affiliation(s)
- Josephine M Bryant
- Wellcome Trust Sanger Institute, Hinxton, UK.,University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK
| | - Dorothy M Grogono
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK.,Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | - Daniela Rodriguez-Rincon
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK
| | | | - Karen P Brown
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK.,Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | - Pablo Moreno
- EMBL European Bioinformatics Institute, Hinxton, UK
| | - Deepshikha Verma
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins CO, USA
| | - Emily Hill
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins CO, USA
| | - Judith Drijkoningen
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK
| | - Peter Gilligan
- University of North Carolina School of Medicine, NC, USA
| | | | - Peadar G Noone
- University of North Carolina School of Medicine, NC, USA
| | | | - Scott C Bell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia.,The Prince Charles Hospital, Brisbane, Australia
| | - Rachel Thomson
- Gallipoli Medical Research Centre, University of Queensland, Brisbane, Australia
| | - Claire E Wainwright
- School of Medicine, The University of Queensland, Australia.,Lady Cilento Children's Hospital, Brisbane
| | - Chris Coulter
- Queensland Mycobacterial Reference Laboratory, Brisbane, Australia
| | - Sushil Pandey
- Queensland Mycobacterial Reference Laboratory, Brisbane, Australia
| | - Michelle E Wood
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia.,The Prince Charles Hospital, Brisbane, Australia
| | - Rebecca E Stockwell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia
| | - Kay A Ramsay
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, The University of Queensland, Australia
| | | | - Timothy J Kidd
- Centre for Experimental Medicine, Queen's University Belfast, UK.,School of Chemistry and Biomolecular sciences, The University of Queensland, Australia
| | - Nassib Jabbour
- Queensland University of Technology, Brisbane, Australia.,International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Andrew Jones
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Diana Bilton
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | | | | | - Stephen Bourke
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | | | | | | | - Mairi Cullen
- University Hospital of South Manchester NHS Foundation Trust, UK
| | - Thomas Daniels
- University Hospital of South Manchester NHS Foundation Trust, UK
| | - Owen Dempsey
- Aberdeen Royal Infirmary, NHS Grampian, Scotland, UK
| | | | - Maya Desai
- Birmingham Children's Hospital NHS Foundation Trust, UK
| | | | | | | | - Jonathan Folb
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Helen Humphrey
- University Hospital Southampton NHS Foundation Trust, UK
| | - Barbara Isalska
- University Hospital of South Manchester NHS Foundation Trust, UK
| | | | - Bodil Jönsson
- Department of Infectious Medicine, Institute of Biomedicine, University of Gothenburg, Sweden
| | - Andrew M Jones
- University Hospital of South Manchester NHS Foundation Trust, UK
| | - Terese L Katzenstein
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Troels Lillebaek
- International reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Gordon MacGregor
- Gartnavel Hospital, Glasgow, NHS Greater Glasgow and Clyde, Scotland, UK
| | | | | | | | - Edward F Nash
- Heart of England NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | | | - Audrey Perry
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Tania Pressler
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Laura Prtak
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK
| | - Tavs Qvist
- Copenhagen Cystic Fibrosis Center, Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Ali Robb
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | | | | | - Nadia Shafi
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martin Walshaw
- Liverpool Heart and Chest Hospital NHS Foundation Trust, UK
| | | | - Noreen West
- Sheffield Children's NHS Foundation Trust, UK
| | | | - Charles S Haworth
- Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
| | | | - Diane Ordway
- Mycobacteria Research Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins CO, USA
| | | | - R Andres Floto
- University of Cambridge Department of Medicine, MRC-Laboratory of Molecular Biology, Cambridge, UK.,Cambridge Centre for Lung Infection, Papworth Hospital, Cambridge, UK
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17
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Helås T, Sagafos D, Kleggetveit I, Quiding H, Jönsson B, Segerdahl M, Zhang Z, Salter H, Schmelz M, Jørum E. Pain thresholds,supra-threshold pain and lidocaine sensitivity in patients with erythromelalgia, including the I848Tmutation in NaV1.7. Eur J Pain 2017; 21:1316-1325. [DOI: 10.1002/ejp.1030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/09/2022]
Affiliation(s)
- T. Helås
- Section of Clinical Neurophysiology, Department of Neurology; Oslo University Hospital - Rikshospitalet; Norway
| | - D. Sagafos
- Section of Clinical Neurophysiology, Department of Neurology; Oslo University Hospital - Rikshospitalet; Norway
| | - I.P. Kleggetveit
- Section of Clinical Neurophysiology, Department of Neurology; Oslo University Hospital - Rikshospitalet; Norway
| | | | | | | | - Z. Zhang
- Astra-Zeneca R&D; Södertälje Sweden
| | - H. Salter
- Astra-Zeneca R&D; Södertälje Sweden
- Department of Clinical Neuroscience; Karolinska Institutet; Solna Sweden
| | - M. Schmelz
- Department of Anesthesiology Mannheim; Heidelberg University; Germany
| | - E. Jørum
- Section of Clinical Neurophysiology, Department of Neurology; Oslo University Hospital - Rikshospitalet; Norway
- Faculty of Medicine, Institute of Clinical Medicine; University of Oslo; Norway
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18
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Wilking N, Lindgren P, Wilking U, Jönsson B. Access to cancer drugs in Europe years 2005-2014. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw387.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Abstract
Seventeen patients with sciatica and isthmic lumbar spondylolisthesis were studied with magnetic resonance (MR) imaging. In 13, myelography was also performed: 5 had dural sac deformation and root sleeve shortening, 2 had deformation with unilateral root sleeve shortening, one had bilateral root sleeve shortening only, and one had sac deformation only. In 4, myelography was normal. On sagittal MR examinations the neural foramen had an altered shape bilaterally with the long axis horizontal in all cases. In addition to altered shape the following was found in the 33 foramina evaluated. I: normal nerve (n = 8); II: compressed nerve (n = 16); III: disappearance of fat, nerve not possible to identify (n = 9). In patients with unilateral sciatica, the degree of foraminal stenosis correlated well with the side of symptoms. Coronal views showed the course of the nerve and pedicular kinking. Eight patients underwent decompressive surgery which revealed nerve compression by hypertrophic fibrous tissue and pedicular kinking, which correlated well with the findings on MR. Since the site of nerve compression often was peripheral to the root sleeves, myelography did not give complete information.
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20
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Blomgren L, Zethraeus N, Johansson G, Jönsson B, Bergqvist D. Cost consequences of preoperative duplex examination before varicose vein surgery: a randomized clinical trial. Phlebology 2016. [DOI: 10.1258/026835506777304728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: To investigate the cost consequences of the addition of a duplex scan to the routine clinical examination prior to surgery for varicose veins (VV). Methods: Cost data are based on a prospective study, which randomized 293 VV patients for surgery either with or without a preoperative duplex scan. Costs are collected during a two-year follow-up time and include direct costs for primary surgery and reoperation. Results: The mean cost for the primary operation was SEK 12,827 (€1410) in the duplex group and SEK 9856 (€1083) in the control group ( P<0.001). A significant part of this increase was due to more extensive primary surgery. Costs for redo surgery decreased by SEK 1131 (€124) ( P = 0.011). The mean net cost increase because of duplex is estimated to be SEK 1840 (€202) ( P<0.003). Conclusion: The savings in costs for redo surgery did not offset the costs for preoperative duplex examination before VV surgery during a two-year follow-up period.
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Affiliation(s)
- L Blomgren
- Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
| | - N Zethraeus
- Stockholm School of Economics, Centre for Health Economics, Stockholm, Sweden
| | - G Johansson
- Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
| | - B Jönsson
- Stockholm School of Economics, Centre for Health Economics, Stockholm, Sweden
| | - D Bergqvist
- Department of Surgery, University Hospital, Uppsala, Sweden
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21
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Abstract
During the last two decades the treatment of varicose veins has undergone radical changes including shorter hospitalization, and the introduction of ambulatory (out-patient) surgery and modern compression sclerotherapy (CST). This article attempts to describe the changing pattern of care and its socio-economic consequences. It concludes that given optimal conditions possibly 60% of all patients suffering from varicose veins can have out-patient surgery performed, 20% need admission for surgery and the remaining 20% benefit from CST rather than surgery. Applied generally this policy would result in 30% lower costs when compared with in-patient surgery alone. The socio-economic gain is probably doubtful since productivity usually increases whereas the total health care cost does not decrease. However, in general the introduction of less costly medical methods of treatment might make it possible to use available resources in new medical fields within a given economic frame-work, preserving the same level of service.
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Affiliation(s)
- P. Neglén
- Departments of Surgery and Economics, University of Lund, Sweden and Kuwait University, Kuwait
| | - B. Jönsson
- Departments of Surgery and Economics, University of Lund, Sweden and Kuwait University, Kuwait
| | - E. Einarsson
- Departments of Surgery and Economics, University of Lund, Sweden and Kuwait University, Kuwait
| | - B. Eklöf
- Departments of Surgery and Economics, University of Lund, Sweden and Kuwait University, Kuwait
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22
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Kanatsuna N, Delli A, Andersson C, Nilsson AL, Vaziri-Sani F, Larsson K, Carlsson A, Cedervall E, Jönsson B, Neiderud J, Elding Larsson H, Ivarsson SA, Törn C, Fex M, Lernmark Å. Doubly Reactive INS-IGF2 Autoantibodies in Children with Newly Diagnosed Autoimmune (type 1) Diabetes. Scand J Immunol 2015; 82:361-9. [PMID: 26073034 DOI: 10.1111/sji.12325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/28/2015] [Indexed: 01/30/2023]
Abstract
The splice variant INS-IGF2 entails the preproinsulin signal peptide, the insulin B-chain, eight amino acids of the C-peptide and 138 unique amino acids from an ORF in the IGF2 gene. The aim of this study was to determine whether levels of specific INS-IGF2 autoantibodies (INS-IGF2A) were related to age at diagnosis, islet autoantibodies, HLA-DQ or both, in patients and controls with newly diagnosed type 1 diabetes. Patients (n = 676), 0-18 years of age, diagnosed with type 1 diabetes in 1996-2005 and controls (n = 363) were analysed for specific INS-IGF2A after displacement with both cold insulin and INS-IGF2 to correct for non-specific binding and identify double reactive sera. GADA, IA-2A, IAA, ICA, ZnT8RA, ZnT8WA, ZnT8QA and HLA-DQ genotypes were also determined. The median level of specific INS-IGF2A was higher in patients than in controls (P < 0.001). Irrespective of age at diagnosis, 19% (126/676) of the patients had INS-IGF2A when the cut-off was the 95th percentile of the controls (P < 0.001). The risk of INS-IGF2A was increased among HLA-DQ2/8 (OR = 1.509; 95th CI 1.011, 2.252; P = 0.045) but not in 2/2, 2/X, 8/8, 8/X or X/X (X is neither 2 nor 8) patients. The association with HLA-DQ2/8 suggests that this autoantigen may be presented on HLA-DQ trans-heterodimers, rather than cis-heterodimers. Autoantibodies reactive with both insulin and INS-IGF2A at diagnosis support the notion that INS-IGF2 autoimmunity contributes to type 1 diabetes.
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Affiliation(s)
- N Kanatsuna
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - A Delli
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - C Andersson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - A-L Nilsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden.,Department of Pediatrics, Östersund Hospital, Östersund, Sweden
| | - F Vaziri-Sani
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - K Larsson
- Department of Pediatrics, Kristianstad Hospital, Kristianstad, Sweden
| | - A Carlsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - E Cedervall
- Department of Pediatrics, Ängelholm Hospital, Ängelholm, Sweden
| | - B Jönsson
- Department of Pediatrics, Ystad Hospital, Ystad, Sweden
| | - J Neiderud
- Department of Pediatrics, Helsingborg Hospital, Helsingborg, Sweden
| | - H Elding Larsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - S-A Ivarsson
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - C Törn
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - M Fex
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
| | - Å Lernmark
- Department of Clinical Sciences, Lund University/CRC, Skåne University Hospital SUS, Malmö, Sweden
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23
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Abstract
Lumbar disc herniation (LDH) is uncommon in youth and few cases are treated surgically. Very few outcome studies exist for LDH surgery in this age group. Our aim was to explore differences in gender in pre-operative level of disability and outcome of surgery for LDH in patients aged ≤ 20 years using prospectively collected data. From the national Swedish SweSpine register we identified 180 patients with one-year and 108 with two-year follow-up data ≤ 20 years of age, who between the years 2000 and 2010 had a primary operation for LDH. Both male and female patients reported pronounced impairment before the operation in all patient reported outcome measures, with female patients experiencing significantly greater back pain, having greater analgesic requirements and reporting significantly inferior scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects of Short Form-36 and Oswestry Disabilities Index, when compared with male patients. Surgery conferred a statistically significant improvement in all registered parameters, with few gender discrepancies. Quality of life at one year following surgery normalised in both males and females and only eight patients (4.5%) were dissatisfied with the outcome. Virtually all parameters were stable between the one- and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in both male and female patients aged 20 years or younger, who failed to recover after non-operative management.
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Affiliation(s)
| | | | - B Jönsson
- Skåne University Hospital, Malmö, Sweden
| | - P Gerdhem
- Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Affiliation(s)
- A-M Lundgren
- Public Dental Health Service; Uppsala County Council; Uppsala Sweden
| | - K Öhrn
- School of Education, Health and Social Studies; Dalarna University; Falun Sweden
| | - B Jönsson
- School of Education, Health and Social Studies; Dalarna University; Falun Sweden
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN); Tromsø Norway
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Qvist T, Gilljam M, Jönsson B, Taylor-Robinson D, Jensen-Fangel S, Wang M, Svahn A, Kötz K, Hansson L, Hollsing A, Hansen CR, Finstad PL, Pressler T, Høiby N, Katzenstein TL. Epidemiology of nontuberculous mycobacteria among patients with cystic fibrosis in Scandinavia. J Cyst Fibros 2014; 14:46-52. [PMID: 25178871 PMCID: PMC4298356 DOI: 10.1016/j.jcf.2014.08.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/08/2014] [Accepted: 08/08/2014] [Indexed: 11/28/2022]
Abstract
Background Nontuberculous mycobacteria (NTM) are an emerging threat to cystic fibrosis (CF) patients but their epidemiology is not well described. Methods In this retrospective observational study we identified all Scandinavian CF patients with a positive NTM culture from airway secretions from 2000 to the end of 2012 and used national CF databases to describe microbiological and clinical characteristics. Results During the 13-year period 157 (11%) CF patients were culture positive for NTM at least once. Mycobacterium abscessus complex (MABSC) (45%) and Mycobacterium avium complex (MAC) (32%) were the predominant species with geographical differences in distribution. Younger patients were more prone to MABSC (p < 0.01). Despite treatment, less than one-third of MABSC patients with repeated positive cultures cleared their infection and a quarter had a lung transplant or died. Conclusion NTM are significant CF pathogens and are becoming more prevalent in Scandinavia. MABSC and MAC appear to target distinct patient groups. Having multiple positive cultures despite treatment conveys a poor outcome.
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Affiliation(s)
- Tavs Qvist
- Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark.
| | - Marita Gilljam
- Gothenburg CF Center, Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bodil Jönsson
- Clinical Microbiology Laboratories, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Mikala Wang
- Department of Clinical Microbiology, Aarhus University Hospital, Denmark
| | - Anita Svahn
- Department of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden
| | - Karsten Kötz
- Gothenburg CF Center, Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lennart Hansson
- Lund CF Center, Department of Respiratory Medicine and Allergology, Skane University Hospital, Sweden
| | | | - Christine R Hansen
- Department of Pediatrics, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Pål L Finstad
- Norwegian Resource Centre for Cystic Fibrosis, Oslo University Hospital, Oslo, Norway
| | - Tania Pressler
- Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Terese L Katzenstein
- Copenhagen CF Center, Department of Infectious Diseases, University Hospital Rigshospitalet, Denmark
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Hoffner S, Angeby K, Sturegård E, Jönsson B, Johansson A, Sellin M, Werngren J. Proficiency of drug susceptibility testing of Mycobacterium tuberculosis against pyrazinamide: the Swedish experience. Int J Tuberc Lung Dis 2014; 17:1486-90. [PMID: 24125455 DOI: 10.5588/ijtld.13.0195] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pyrazinamide (PZA) is a key drug in the treatment of tuberculosis (TB), including multidrug-resistant TB. Drug susceptibility testing (DST) of Mycobacterium tuberculosis against PZA is not included in the World Health Organization's yearly proficiency testing. There is an increasing need to establish quality control of PZA DST. OBJECTIVE To evaluate the performance of PZA DST and to introduce a quality assurance system for the test in Sweden. METHOD Panels with PZA-susceptible and -resistant isolates were used in three rounds of proficiency testing in all five Swedish clinical TB laboratories and our reference laboratory. All laboratories used the MGIT 960 system. Minimum inhibitory concentrations (MICs) were determined and the pncA gene was sequenced to further characterise the 52 panel strains. RESULTS Good agreement was seen between the phenotypic PZA DST and pncA sequence data, and MIC determination confirmed high levels of resistance. However, in contrast to other drugs, for which correct proficiency test results were observed, specificity problems occurred for PZA DST in some laboratories. CONCLUSIONS In Sweden, using panel testing, differences were seen in the proficiency of TB laboratories in correctly identifying PZA susceptibility. Improved results were noted in the third round; PZA has therefore been included in yearly proficiency testing.
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Affiliation(s)
- S Hoffner
- Department of Preparedness, Swedish Institute for Communicable Disease Control, Solna, Sweden
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28
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Blomström P, Ekman M, Lundqvist CB, Calvert M, Freemantle N, Lönnerholm S, Wikström G, Jönsson B. Cost effectiveness of cardiac resynchronization therapy in the Nordic region: An analysis based on the CARE-HF trial. Eur J Heart Fail 2014; 10:869-77. [DOI: 10.1016/j.ejheart.2008.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 05/28/2008] [Accepted: 06/30/2008] [Indexed: 11/16/2022] Open
Affiliation(s)
- P. Blomström
- Department of Cardiology; University Hospital in Uppsala; Stockholm Sweden
| | - M. Ekman
- European Health Economics; Stockholm Sweden
| | | | - M.J. Calvert
- Department of Primary Care and General Practice; University of Birmingham; Edgbaston Birmingham UK
| | - N. Freemantle
- Department of Primary Care and General Practice; University of Birmingham; Edgbaston Birmingham UK
| | - S. Lönnerholm
- Department of Cardiology; University Hospital in Uppsala; Stockholm Sweden
| | - G. Wikström
- Department of Cardiology; University Hospital in Uppsala; Stockholm Sweden
| | - B Jönsson
- Stockholm School of Economics; Stockholm Sweden
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Ström O, Jönsson B, Kanis JA. Intervention thresholds for denosumab in the UK using a FRAX®-based cost-effectiveness analysis. Osteoporos Int 2013; 24:1491-502. [PMID: 23224141 DOI: 10.1007/s00198-012-2115-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 06/12/2012] [Indexed: 01/29/2023]
Abstract
UNLABELLED The objective was to undertake a health economic analysis of denosumab for the treatment of osteoporosis in women from the UK, using the FRAX® tool. Denosumab was cost-effective in women with a risk of major osteoporotic fracture meeting or exceeding approximately 20% who are unable to take, comply with or tolerate generic alendronate. INTRODUCTION Denosumab is a novel biologic agent developed for the treatment of osteoporosis, which has been shown to reduce the risk of fractures in a phase-III trial. The objective of the present study was to undertake a health economic analysis of denosumab in women from the UK. Ten-year probabilities of a major osteoporotic fracture at which denosumab is a cost-effective alternative to no treatment, generic alendronate, risedronate and strontium ranelate were estimated. METHODS A previously published Markov model was adapted to incorporate fracture and mortality risk assessments based on absolute fracture probability, as estimated by FRAX®. The model included treatment persistence and residual effect after discontinuation. RESULTS At a willingness-to-pay (WTP) of £30,000 per quality-adjusted life year and a 10-year fracture probability equivalent to a woman with a prior fragility fracture, denosumab was cost-effective compared to no treatment from the age of 70 years. At the same WTP, denosumab was-irrespective of age-cost-effective compared to no treatment at a major osteoporotic fracture probability of approximately 20%. Denosumab was estimated to cost-effectively replace strontium, risedronate and generic alendronate at 10-year probabilities exceeding 11, 19 and 32%, respectively. CONCLUSION FRAX® facilitates the estimation of cost-effectiveness-based intervention thresholds applicable to patients with different combinations of clinical risk factors, which more closely matches the situation in clinical practice. Denosumab is cost-effective in patients with major osteoporotic fracture probabilities meeting or exceeding approximately 20% who are unable to take, comply with or tolerate generic alendronate.
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Affiliation(s)
- O Ström
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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Borgström F, Lekander I, Ivergård M, Ström O, Svedbom A, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jürisson M, Kallikorm R, Lesnyak O, McCloskey E, Nassonov E, Sanders KM, Silverman S, Tamulaitiene M, Thomas T, Tosteson ANA, Jönsson B, Kanis JA. The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)--quality of life during the first 4 months after fracture. Osteoporos Int 2013; 24:811-23. [PMID: 23306819 DOI: 10.1007/s00198-012-2240-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED The quality of life during the first 4 months after fracture was estimated in 2,808 fractured patients from 11 countries. Analysis showed that there were significant differences in the quality of life (QoL) loss between countries. Other factors such as QoL prior fracture and hospitalisation also had a significant impact on the QoL loss. INTRODUCTION The International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS) was initiated in 2007 with the objective of estimating costs and quality of life related to fractures in several countries worldwide. The ICUROS is ongoing and enrols patients in 11 countries (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, UK and the USA). The objective of this paper is to outline the study design of ICUROS and present results regarding the QoL (measured using the EQ-5D) during the first 4 months after fracture based on the patients that have been thus far enrolled ICUROS. METHODS ICUROS uses a prospective study design where data (costs and quality of life) are collected in four phases over 18 months after fracture. All countries use the same core case report forms. Quality of life was collected using the EQ-5D instrument and a time trade-off questionnaire. RESULTS The total sample for the analysis was 2,808 patients (1,273 hip, 987 distal forearm and 548 vertebral fracture). For all fracture types and countries, the QoL was reduced significantly after fracture compared to pre-fracture QoL. A regression analysis showed that there were significant differences in the QoL loss between countries. Also, a higher level of QoL prior to the fracture significantly increased the QoL loss and patients who were hospitalised for their fracture also had a significantly higher loss compared to those who were not. CONCLUSIONS The findings in this study indicate that there appear to be important variations in the QoL decrements related to fracture between countries.
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Affiliation(s)
- F Borgström
- LIME/MMC, Karolinska Institutet, Stockholm, Sweden.
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Trollfors B, Stangebye-Nielsen R, Karlsson E, Jönsson B, Dotevall L. Spread of tuberculosis in a high school. Acta Paediatr 2013; 102:e140-1. [PMID: 23216353 DOI: 10.1111/apa.12121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 12/04/2012] [Indexed: 12/20/2022]
Affiliation(s)
- Birger Trollfors
- Department of Paediatrics; Sahlgrenska University Hospital; Gothenburg; Sweden
| | | | - Elisabeth Karlsson
- Department of Paediatrics; Sahlgrenska University Hospital; Gothenburg; Sweden
| | - Bodil Jönsson
- Department of Clinical Microbiology; Sahlgrenska University Hospital; Gothenburg; Sweden
| | - Leif Dotevall
- Department of Communicable Disease Control; Västra Götaland Region; Gothenburg; Sweden
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Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 2013; 8:137. [PMID: 24113838 PMCID: PMC3880492 DOI: 10.1007/s11657-013-0137-0] [Citation(s) in RCA: 450] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/15/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED This report describes epidemiology, burden, and treatment of osteoporosis in each of the 27 countries of the European Union (EU27). INTRODUCTION In 2010, 22 million women and 5.5 million men were estimated to have osteoporosis in the EU; and 3.5 million new fragility fractures were sustained, comprising 620,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures. The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. The aim of this report was to characterize the burden of osteoporosis in each of the EU27 countries in 2010 and beyond. METHODS The data on fracture incidence and costs of fractures in the EU27 were taken from a concurrent publication in this journal (Osteoporosis in the European Union: Medical Management, Epidemiology and Economic Burden) and country specific information extracted. RESULTS The clinical and economic burden of osteoporotic fractures in 2010 is given for each of the 27 countries of the EU. The costs are expected to increase on average by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. CONCLUSIONS In spite of the high cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by aging populations, the use of pharmacological prevention of osteoporosis has decreased in recent years, suggesting that a change in healthcare policy concerning the disease is warranted.
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Affiliation(s)
| | | | | | - J. Compston
- Department of Medicine, Addenbrooke’s Hospital, Cambridge University, Cambridge, UK
| | - C. Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK ,NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Stenmark
- International Osteoporosis Foundation, Nyon, Switzerland
| | - E. V. McCloskey
- Academic Unit of Bone Metabolism, Northern General Hospital, Sheffield, UK ,WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - B. Jönsson
- Stockholm School of Economics, Stockholm, Sweden
| | - J. A. Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK ,WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX UK
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Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8:136. [PMID: 24113837 PMCID: PMC3880487 DOI: 10.1007/s11657-013-0136-1] [Citation(s) in RCA: 1630] [Impact Index Per Article: 148.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/11/2013] [Indexed: 02/03/2023]
Abstract
UNLABELLED This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27). INTRODUCTION Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for affected patients and substantial costs to society. The aim of this report was to characterize the burden of osteoporosis in the EU27 in 2010 and beyond. METHODS The literature on fracture incidence and costs of fractures in the EU27 was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010. RESULTS Twenty-two million women and 5.5 million men were estimated to have osteoporosis; and 3.5 million new fragility fractures were sustained, comprising 610,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and prior fragility fractures was estimated at <euro> 37 billion. Incident fractures represented 66 % of this cost, long-term fracture care 29 % and pharmacological prevention 5 %. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. CONCLUSIONS In spite of the high social and economic cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by the aging populations, the use of pharmacological interventions to prevent fractures has decreased in recent years, suggesting that a change in healthcare policy is warranted.
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Affiliation(s)
| | | | | | - J. Compston
- Department of Medicine, Addenbrooke’s Hospital, Cambridge University, Cambridge, UK
| | - C. Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK ,NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Stenmark
- International Osteoporosis Foundation, Nyon, Switzerland
| | - E. V. McCloskey
- Academic Unit of Bone Metabolism, Northern General Hospital, University of Sheffield, Sheffield, UK ,WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - B. Jönsson
- Stockholm School of Economics, Stockholm, Sweden
| | - J. A. Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK ,WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX UK
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Jönsson B, Ridell M, Wold AE. Non-tuberculous mycobacteria and their surface lipids efficiently induced IL-17 production in human T cells. Microbes Infect 2012; 14:1186-95. [DOI: 10.1016/j.micinf.2012.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/25/2012] [Accepted: 07/26/2012] [Indexed: 01/09/2023]
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Jönsson B, Ridell M, Wold AE. Phagocytosis and cytokine response to rough and smooth colony variants of Mycobacterium abscessus by human peripheral blood mononuclear cells. APMIS 2012; 121:45-55. [PMID: 23030647 DOI: 10.1111/j.1600-0463.2012.02932.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/11/2012] [Indexed: 01/19/2023]
Abstract
Mycobacterium abscessus is a non-tuberculous mycobacteria able to cause opportunistic infections in selected patient groups. During the last decades it has emerged as a cause of chronic pulmonary infection in patients with cystic fibrosis (CF). M. abscessus strains exhibit either smooth or rough colony morphology. Strains exhibiting the rough phenotype more often cause pulmonary infections in CF patients than did the smooth ones. Here, we examined phagocytosis and production of cytokines by human peripheral blood mononuclear cells, in response to M. abscessus strains with smooth and rough colony phenotype. The rough isolates all formed multicellular cords, similar to what is observed in Mycobacterium tuberculosis. Monocytes were generally unable to internalize these rough cord isolates, in contrast with the smooth ones. Furthermore, the rough M. abscessus strains induced a distinct cytokine profile differing from that induced by the smooth ones. Rough isolates induced significantly less IL-10 and tumour necrosis factor compared to smooth strains, but more IL-1β. Both varieties induced equal amounts of IFN-γ, IL-17, IL-23, IL-6, IL-8 and equally little IL-12. The ability to withstand phagocytosis might be a virulence factor contributing to the capacity of rough M. abscessus strains to give persistent pulmonary infections.
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Affiliation(s)
- Bodil Jönsson
- Clinical Bacteriology Section, Department of Infectious Medicine, Institute of Biomedicine, University of Gothenburg, Göteborg, Sweden.
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Jönsson B, Ström O, Eisman JA, Papaioannou A, Siris ES, Tosteson A, Kanis JA. Comment on: Cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 2012; 23:2063-5. [PMID: 22086308 PMCID: PMC5096933 DOI: 10.1007/s00198-011-1830-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 08/22/2011] [Indexed: 11/30/2022]
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Thegerström J, Jönsson B, Brudin L, Olsen B, Wold AE, Ernerudh J, Friman V. Mycobacterium avium subsp. avium and subsp. hominissuis give different cytokine responses after in vitro stimulation of human blood mononuclear cells. PLoS One 2012; 7:e34391. [PMID: 22506018 PMCID: PMC3323604 DOI: 10.1371/journal.pone.0034391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 03/02/2012] [Indexed: 12/11/2022] Open
Abstract
Background Mycobacterium avium is the principal etiologic agent of non-tuberculous lymphadenitis in children. It is also a known pathogen for birds and other animals. Genetic typing of M. avium isolates has led to a proposal to expand the set of subspecies to include M. avium subsp. hominissuis. Isolates associated with disease in humans belong to this subspecies. Methodology/Principal Findings Peripheral blood mononuclear cells from six healthy blood donors were stimulated in vitro with ten isolates of M. avium avium and 11 isolates of M. avium hominissuis followed by multiplex bead array quantification of cytokines in supernatants. M. avium hominissuis isolates induced significantly more IL-10 and significantly less IL-12p70, TNF, IFN-γ and IL-17 when compared to M. avium avium isolates. All strains induced high levels of IL-17, but had very low levels of IL-12p70. Conclusion/Significance The strong association between M. avium subsp. hominissuis and disease in humans and the clear differences in the human immune response to M. avium subsp. hominissuis compared to M. avium subsp. avium isolates, as demonstrated in this study, suggest that genetic differences between M. avium isolates play an important role in the pathogenicity in humans.
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Affiliation(s)
- Johanna Thegerström
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Abstract
BACKGROUND AND PURPOSE In 2005, we presented for the first time overall estimates of annual costs for brain disorders (mental and neurologic disorders) in Europe. This new report presents updated, more accurate, and comprehensive 2010 estimates for 30 European countries. METHODS One-year prevalence and annual cost per person of 19 major groups of disorders are based on 'best estimates' derived from systematic literature reviews by panels of experts in epidemiology and health economics. Our cost estimation model was populated with national statistics from Eurostat to adjust to 2010 values, converting all local currencies to Euros (€), imputing cost for countries where no data were available, and aggregating country estimates to purchasing power parity-adjusted estimates of the total cost of brain disorders in Europe in 2010. RESULTS Total European 2010 cost of brain disorders was €798 billion, of which direct health care cost 37%, direct non-medical cost 23%, and indirect cost 40%. Average cost per inhabitant was €5.550. The European average cost per person with a disorder of the brain ranged between €285 for headache and €30 000 for neuromuscular disorders. Total annual cost per disorder (in billion € 2010) was as follows: addiction 65.7; anxiety disorders 74.4; brain tumor 5.2; child/adolescent disorders 21.3; dementia 105.2; eating disorders 0.8; epilepsy 13.8; headache 43.5; mental retardation 43.3; mood disorders 113.4; multiple sclerosis 14.6; neuromuscular disorders 7.7; Parkinson's disease 13.9; personality disorders 27.3; psychotic disorders 93.9; sleep disorders 35.4; somatoform disorder 21.2; stroke 64.1; and traumatic brain injury 33.0. CONCLUSION Our cost model revealed that brain disorders overall are much more costly than previously estimated constituting a major health economic challenge for Europe. Our estimate should be regarded as conservative because many disorders or cost items could not be included because of lack of data.
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Affiliation(s)
- J Olesen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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Justo N, Wilking NE, Jönsson B. Breast cancer (BC) care and outcomes in Latin America and the Caribbean (LAC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
202 Background: The global BC Care and Outcomes Report revealed ample differences in BC care and outcomes exist across continents, exposing the need for regionally focused studies. Aim: Provide an overview of the burden of BC and of BC care and outcomes in LAC and identify the major challenges Methods: Review of literature (PubMed, LILACS, SCIELO), public databases (Globocan 2002 and 2008, CEPALSTAT, DIRAC, PAHO, WHOSYS, etc) and conference presentations (ASCO, ISPOR). Local experts and patient organizations were surveyed. Current BC epidemiology in LAC, countries’ risk profiles and future trends, disease burden and available resources, patterns of care and treatment access (case studies), and outcomes (such as mortality-to-incidence ratios - MIRs) were analyzed and compared (Sweden as benchmark). Results: BC exhibits the highest annual incidence (114,900 cases) and mortality (37,000 deaths) of all cancers in LAC and is expected to double by 2030. Age is the main risk factor. Heavy burden is due to younger age at diagnosis. Poor outcomes are partly due to late diagnosis. Availability of specialized surgeons, waiting times, node clearance policy and access to breast reconstruction vary widely across countries and between public and private settings. Radiotherapy equipment is insufficient, except in Uruguay, Chile, and Venezuela. All modern systemic therapies are available, but some not widely diffused due to their costs. Palliative care is developing but, despite great efforts, problems persist. BC MIRs have improved, albeit unevenly, over time. Conclusions: Inequalities in access to diagnosis and treatment, fragmented organization and management of BC care and poor uptake of evidence-based best practices result in high morbidity and associated societal costs. [Table: see text]
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Affiliation(s)
- N. Justo
- Optum Insight, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; Stockholm School of Economics, Stockholm, Sweden
| | - N. E. Wilking
- Optum Insight, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; Stockholm School of Economics, Stockholm, Sweden
| | - B. Jönsson
- Optum Insight, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden; Stockholm School of Economics, Stockholm, Sweden
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Jönsson B. 45 INVITED Performance-Based Agreement – Theory to Practice- the Current Use in Oncology and Future Trend. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wittchen HU, Jacobi F, Rehm J, Gustavsson A, Svensson M, Jönsson B, Olesen J, Allgulander C, Alonso J, Faravelli C, Fratiglioni L, Jennum P, Lieb R, Maercker A, van Os J, Preisig M, Salvador-Carulla L, Simon R, Steinhausen HC. The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21:655-79. [PMID: 21896369 DOI: 10.1016/j.euroneuro.2011.07.018] [Citation(s) in RCA: 2201] [Impact Index Per Article: 169.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU. METHOD Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY). RESULTS Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke. CONCLUSION In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.
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Affiliation(s)
- H U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Center of Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany.
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Wilkinq N, Jönsson B. 43 INVITED Cancer Drug Costs – Forecast for Europe – Will the Cost Explode? Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70258-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wilking NE, Högberg D, Jönsson B, Koinuma N. Use of oncology drugs in Japan compared to France, Germany, Italy, Spain, Sweden, the United Kingdom, and the United States: A comparison based on data from 1999 to 2009. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e16585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ohrn K, Jönsson B. A comparison of two questionnaires measuring oral health-related quality of life before and after dental hygiene treatment in patients with periodontal disease. Int J Dent Hyg 2011; 10:9-14. [PMID: 21564538 DOI: 10.1111/j.1601-5037.2011.00511.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to compare the usefulness of two different questionnaires assessing oral health-related quality of life (OHRQoL) at the basic examination and after initial dental hygiene treatment (DHtx). METHODS A total of 42 patients referred for periodontal treatment completed the Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI) at the basic periodontal examination. They underwent DHtx and completed the questionnaires once again after the treatment. RESULTS No statistically significant differences could be found between the two assessments, neither for the total scores nor for any of the separate items of the OHIP-14 or the GOHAI. However, the GOHAI questionnaire seems to result in a greater variety in the responses indicating that the floor effect is not as pronounced as for the OHIP-14. Those who had rated their oral health as good reported significantly better OHRQoL on both questionnaires. The same pattern was found for patients who reported that they were satisfied with their teeth. After DHtx and necessary extractions, there was a statistically significant correlation between the number of teeth and the total scores on both questionnaires. No other statistically significant correlations with periodontal variables could be found. CONCLUSION No statistically significant difference could be found after DHtx compared to before in regard to OHRQoL assessed with OHIP-14 and GOHAI. However, there was a greater variety in the responses with the GOHAI questionnaire; it may hereby be more useful for patients with periodontal disease.
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Affiliation(s)
- K Ohrn
- Dalarna University, School of Health and Social Sciences, Falun, Sweden.
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Jönsson B, Ström O, Eisman JA, Papaioannou A, Siris ES, Tosteson A, Kanis JA. Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis. Osteoporos Int 2011; 22:967-82. [PMID: 20936401 PMCID: PMC5104532 DOI: 10.1007/s00198-010-1424-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 09/13/2010] [Indexed: 01/22/2023]
Abstract
UNLABELLED Denosumab is an injectable drug that reduces the risk of fractures. The objective was to estimate the cost-effectiveness of denosumab in a Swedish setting, also accounting for poor adherence to treatment. Denosumab is cost-effective, particularly for patients at high risk of fracture and low adherence to oral treatments. INTRODUCTION Denosumab is a novel biologic agent developed for the treatment of osteoporosis and osteoporotic fractures that has been shown to reduce the risk of fractures in a phase III trial. The objective of this study was to estimate the cost-effectiveness of denosumab from a societal perspective compared with generic alendronate, branded risedronate, strontium ranelate, and no treatment in a Swedish setting. METHODS A Markov cohort model was used to estimate the cost-effectiveness of denosumab given for up to 5 years to a typical Swedish patient population (women aged 71 years, T-score ≤ -2.5 SD and a prevalence of morphometric vertebral fractures of 34%). The model included treatment persistence and residual effect after discontinuation assumed to be equal to the time on treatment. Persistence with the comparator treatments and with denosumab was derived from prescription data and a persistence study, respectively. RESULTS The base-case incremental cost-effectiveness ratios were estimated at €27,000, €12,000, €5,000, and €14,000, for denosumab compared with generic alendronate, risedronate, strontium ranelate, and no treatment, respectively. Sub-optimal persistence had the greatest impact in the comparison with generic alendronate, where the difference in drug cost was large. CONCLUSION Improving persistence with osteoporosis treatment impacts positively on cost-effectiveness with a larger number of fractures avoided in the population targeted for treatment. Denosumab is a cost-effective alternative to oral osteoporosis treatments, particularly for patients at high risk of fracture and low expected adherence to oral treatments.
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Affiliation(s)
- B Jönsson
- Stockholm School of Economics, Box 6501, SE 11383 Stockholm, Sweden.
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Andersson C, Larsson K, Vaziri-Sani F, Lynch K, Carlsson A, Cedervall E, Jönsson B, Neiderud J, Månsson M, Nilsson A, Lernmark A, Elding Larsson H, Ivarsson SA. The three ZNT8 autoantibody variants together improve the diagnostic sensitivity of childhood and adolescent type 1 diabetes. Autoimmunity 2011; 44:394-405. [PMID: 21244337 DOI: 10.3109/08916934.2010.540604] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS We tested whether autoantibodies to all three ZnT8RWQ variants, GAD65, insulinoma-associated protein 2 (IA-2), insulin and autoantibodies to islet cell cytoplasm (ICA) in combination with human leukocyte antigen (HLA) would improve the diagnostic sensitivity of childhood type 1 diabetes by detecting the children who otherwise would have been autoantibody-negative. METHODS A total of 686 patients diagnosed in 1996-2005 in Skåne were analyzed for all the seven autoantibodies [arginin 325 zinc transporter 8 autoantibody (ZnT8RA), tryptophan 325 zinc transporter 8 autoantibody (ZnT8WA), glutamine 325 Zinc transporter 8 autoantibody (ZnT8QA), autoantibodies to glutamic acid decarboxylase (GADA), Autoantibodies to islet-antigen-2 (IA-2A), insulin autoantibodies (IAA) and ICA] in addition to HLA-DQ genotypes. RESULTS Zinc transporter 8 autoantibody to either one or all three amino acid variants at position 325 (ZnT8RWQA) was found in 65% (449/686) of the patients. The frequency was independent of age at diagnosis. The ZnT8RWQA reduced the frequency of autoantibody-negative patients from 7.5 to 5.4%-a reduction by 28%. Only 2 of 108 (2%) patients who are below 5 years of age had no autoantibody at diagnosis. Diagnosis without any islet autoantibody increased with increasing age at onset. DQA1-B1(*)X-0604 was associated with both ZnT8RA (p = 0.002) and ZnT8WA (p = 0.01) but not with ZnT8QA (p = 0.07). Kappa agreement analysis showed moderate (>0.40) to fair (>0.20) agreement between pairs of autoantibodies for all combinations of GADA, IA-2A, ZnT8RWQA and ICA but only slight ( < 0.19) agreement for any combination with IAA. CONCLUSIONS This study revealed that (1) the ZnT8RWQA was common, independent of age; (2) multiple autoantibodies were common among the young; (3) DQA1-B1(*)X-0604 increased the risk for ZnT8RA and ZnT8WA; (4) agreement between autoantibody pairs was common for all combinations except IAA. These results suggest that ZnT8RWQA is a necessary complement to the classification and prediction of childhood type 1 diabetes as well as to randomize the subjects in the prevention and intervention of clinical trials.
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Affiliation(s)
- C Andersson
- Department of Clinical Sciences, Skåne University Hospital SUS, Lund University, CRC , Malmö , Sweden
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Lindgren P, Eriksson J, Buxton M, Kahan T, Poulter NR, Dahlöf B, Sever PS, Wedel H, Jönsson B. The economic consequences of non-adherence to lipid-lowering therapy: results from the Anglo-Scandinavian-Cardiac Outcomes Trial. Int J Clin Pract 2010; 64:1228-34. [PMID: 20500533 DOI: 10.1111/j.1742-1241.2010.02445.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Adherence to lipid-lowering therapy in clinical practice is less than ideal. Analysis of registry data has indicated that this is associated with poor outcomes. The objective of the present analysis was to assess the impact of high adherence to drug (defined as > 80% of days covered), compared with low adherence to drug (< 50% of days covered) in terms of risk of events and long-term economic consequences. DESIGN Open-label follow up of a randomised placebo-controlled trial in hypertensive patients. METHODS Cox proportional hazards and Poisson regression models were used to assess the hazard ratio of patients with high adherence compared with low adherence while controlling for cardiovascular risk. A Markov model was used to predict the long-term costs and health outcomes associated with poor adherence during the follow-up period. RESULTS Both statistical models indicated that high adherence is associated with improved prognosis [Cox model: 0.75; 95% confidence interval (CI): 0.56-0.98, Poisson model hazard ratio: 0.73; 95% CI: 0.58-0.98]. Discounted at 3.5% per year, the Markov model predicts that as a consequence of higher adherence during the follow-up period, costs would be higher (1689 pounds per patient compared with 1323 pounds per patient) because of higher drug costs, but the projected survival and quality-adjusted survival (QALY) would also be longer (10.83 compared with 10.81 life years and 8.13 compared with 8.11 QALYs). CONCLUSION Given the higher risk of cardiovascular events associated with low adherence shown here, measures to improve adherence are an important part of the prevention of cardiovascular disease.
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Gilljam M, Scherstén H, Silverborn M, Jönsson B, Ericsson Hollsing A. Lung transplantation in patients with cystic fibrosis and Mycobacterium abscessus infection. J Cyst Fibros 2010; 9:272-6. [DOI: 10.1016/j.jcf.2010.03.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 03/14/2010] [Accepted: 03/15/2010] [Indexed: 10/19/2022]
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Wilking NE, Bergh J, Jönsson B, Kasteng F. Breast cancer patients access to screening, radiotherapy, and cancer drugs in 18 European, Asian, and Latin American countries. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kasteng F, Bergh J, Jönsson B, Kössler I, Martin M, Reed L, Widdershoven G, Wilking N. 508 Breast cancer care and outcomes in 18 countries in Europe, Asia, and Latin America. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70529-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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