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Henriksson P. Infertility treatment and cardiovascular disease: What do we know? J Intern Med 2024; 295:580-582. [PMID: 38500244 DOI: 10.1111/joim.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Peter Henriksson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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2
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Dyar A, Henriksson P, Stenfors T, Lachmann H, Kiessling A. Differences in Supervision on Peer Learning Wards: A Pilot Survey of the Supervisor's Perspective. Adv Med Educ Pract 2024; 15:85-96. [PMID: 38327849 PMCID: PMC10849097 DOI: 10.2147/amep.s439968] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024]
Abstract
Introduction Multiple students are placed on clinical wards simultaneously due to increasing student numbers. This has the potential to create stress for the supervisor and reduce quality of student learning. Peer learning as a pedagogical framework to supervise multiple students has been widely shown to have advantages for the students by developing teaching skills, team collaboration, and independence. However, whether peer learning impacts the characteristics of supervision and the experience of the supervisor is less understood. It is unknown whether wards that use peer learning as a pedagogical framework (peer learning wards) are any different compared to wards that do not (non-peer learning wards), from the supervisor's perspective. Methods We aimed to develop and pilot test a questionnaire to compare peer-learning wards and non-peer learning wards from the supervisor's perspective. We used the AMEE 7-step guide to develop questions investigating supervision, the learning environment and satisfaction. We piloted the questionnaire with 46 nurse supervisors working on inpatient hospital wards in Stockholm, Sweden. We compared answers from peer learning with non-peer learning wards. We used Orthogonal Projections to Latent Structures (OPLS) discriminant analysis to show what differed between the wards. Results Peer learning wards compared to non-peer learning wards had more student-centred activities, the physical space had more adaptations for students, more support available to the supervisor, and supervisors perceived greater overall satisfaction with the quality of education and with the ward as a whole. The variables that had most influence on the discrimination between the two ward types related to peer learning activities and perceptions (p=0.0034). Conclusion This pilot study shows that peer learning wards differ compared to non-peer learning wards regarding peer learning activities and perceptions among supervisors. Our questionnaire needs to be distributed on a larger scale to validate our findings and explore further the way in which the pedagogical framework and peer learning can affect supervision and satisfaction.
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Affiliation(s)
- Anna Dyar
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Lachmann
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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3
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Brodin N, Conradsson DM, Swinnen TW, Esbensen BA, Kennedy N, Hammer NM, McKenna S, Henriksson P, Nordgren B. Self-report and device-based physical activity measures and adherence to physical activity recommendations: a cross-sectional survey among people with inflammatory joint disease in four European countries. BMJ Open 2023; 13:e064278. [PMID: 36746546 PMCID: PMC9906173 DOI: 10.1136/bmjopen-2022-064278] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Self-monitoring of physical activity (PA) has the potential to contribute to successful behaviour change in PA interventions in different populations, including people with inflammatory joint diseases (IJDs). The objectives of this study were to describe the use and knowledge of self-report-based and device-based PA measures in people with IJDs in four European countries, and to explore if the use of such devices, sociodemographic or disease-related variables were associated with adherence to the recommendations of at least 150 min of moderate to vigorous PA per week. SETTING Cross-sectional survey, performed in 2015-2016. PARTICIPANTS People with IJDs in Belgium, Denmark, Ireland and Sweden. PRIMARY AND SECONDARY OUTCOME MEASURES Use of self-report and device-based PA measures, receipt of instructions how to use PA measures, confidence in using them, adherence to PA recommendations and associated factors for adherence to PA recommendations. RESULTS Of the 1305 respondents answering questions on PA measures, 600 (46%) reported use of any kind of self-report or device-based measures to self-monitor PA. Between country differences of 34%-58% was observed. Six per cent and four per cent received instructions from health professionals on how to use simple and complex devices, respectively. Independent associated factors of fulfilment of recommendations of PA were living in Ireland (OR=84.89, p<0.001) and Sweden (OR=1.68, p=0.017) compared with living in Denmark, not perceiving activity limitations in moderate activities (OR=1.92, p<0.001) and using a device to measure PA (OR=1.56, p<0.001). Those living in Belgium (OR=0.21, p<0.001) were less likely to fulfil recommendations of PA. CONCLUSIONS Almost half of the participants with IJDs used self-report-based or deviced-based PA measures, although few used wearable devices regularly. The results indicate that participants meeting public PA health guidelines were engaged in self-monitoring of PA.
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Affiliation(s)
- N Brodin
- Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Division of Physiotherapy, Orthopaedic Clinic, Danderyds Sjukhus AB, Stockholm, Sweden
| | - David Moulaee Conradsson
- Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
| | - Thijs Willem Swinnen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Division of Rheumatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (Copecare), Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Norelee Kennedy
- Discipline of Physiotherapy, School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Nanna Maria Hammer
- Copenhagen Center for Arthritis Research (Copecare), Copenhagen University Hospital - Rigshospitalet, Glostrup, Denmark
| | - Sean McKenna
- Health Service Executive, Department of Physiotherapy, University of Limerick Hospitals Group, Dooradoyle, Ireland
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Birgitta Nordgren
- Department of Neurobiology Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
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4
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Michelsen HÖ, Henriksson P, Wallert J, Bäck M, Sjölin I, Schlyter M, Hagström E, Kiessling A, Held C, Hag E, Nilsson L, Schiopu A, Zaman MJ, Leosdottir M. Organizational and patient-level predictors for attaining key risk factor targets in cardiac rehabilitation after myocardial infarction: The Perfect-CR study. Int J Cardiol 2023; 371:40-48. [PMID: 36089158 DOI: 10.1016/j.ijcard.2022.09.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Benefits of cardiac rehabilitation (CR) programme components on attaining risk factor targets post-myocardial infarction (MI) and their predictive strength relative to patient characteristics remain unclear. We aimed to identify organizational and patient-level predictors of risk factor target attainment at one-year post-MI. METHODS In this observational study data on CR organization at 78 Swedish CR centres was collected and merged with patient-level registry data (n = 7549). Orthogonal partial least squares discriminant analysis identified predictors (Variables of Importance for the Projection (VIP) values >0.8) of attaining low-density lipoprotein-cholesterol (LDL-C) <1.8 mmol/L, blood pressure (BP) <140/90 mmHg and smoking abstinence. RESULTS The strongest predictors (VIP [95% CI]) for attaining LDL-C and BP targets were offering psychosocial management (2.14 [1.78-2.50]; 2.45 [1.91-2.99]), having a psychologist in the CR team (1.62 [1.36-1.87]; 2.05 [1.67-2.44]), extended opening hours (2.13 [2.00-2.27]; 1.50 [0.91-2.10]), adequate facilities (1.54 [0.91-2.18]; 1.89 [1.38-2.40]), and having a medical director (1.70 [0.91-2.48]; 1.46 [1.04-1.88]). The strongest patient-level predictors of attaining LDL-C and/or BP targets were low baseline LDL-C (3.95 [3.39-4.51]) and having no history of hypertension (2.93 [2.60-3.26]), respectively, followed by exercise-based CR participation (1.38 [0.66-2.10]; 1.46 [1.14-1.78]). For smoking abstinence, the strongest organizational predictor was varenicline being prescribed by CR physicians (1.88 [0.95-2.80]) and patient-level predictors were participation in exercise-based CR (2.47 [2.07-2.88]) and group education (1.92 [1.43-2-42]), and no cardiovascular disease history (2.13 [1.78-2.48]). CONCLUSIONS We identified multiple CR organizational and patient-level predictors of attaining risk factor targets post-MI. These results may influence the future design of comprehensive CR programmes.
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Affiliation(s)
- Halldora Ögmundsdottir Michelsen
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - John Wallert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Maria Bäck
- Department of Occupational therapy and Physiotherapy, Sahlgrenska University Hospital Gothenburg, Sweden; Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingela Sjölin
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Mona Schlyter
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Uppsala, Sweden
| | - Emma Hag
- Department of Internal Medicine, County hospital Ryhov, Jönköping, Sweden
| | - Lennart Nilsson
- Department of Health Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Alexandru Schiopu
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Internal Medicine, Skåne University Hospital, Lund, Sweden; Department of Pathology, University of Medicine Pharmacy Sciences and Technology of Targu-Mures, Targu-Mures, Romania
| | - M Justin Zaman
- Cardiac Centre, West Suffolk Hospital, Bury St Edmunds, UK
| | - Margret Leosdottir
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden.
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5
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Chen C, Ahlqvist VH, Henriksson P, Migueles JH, Christiansen F, Galanti MR, Berglind D. Increasing Children's physical Activity by Policy (CAP) in preschools within the Stockholm region: study protocol for a pragmatic cluster-randomized controlled trial. Trials 2022; 23:577. [PMID: 35854370 PMCID: PMC9295109 DOI: 10.1186/s13063-022-06513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Background Systematic reviews suggest that preschool environmental/organizational changes may be effective in increasing physical activity (PA) levels of preschool children, but evidence is scarce regarding feasible, effective, and equitable interventions that can be scaled up. Specifically, it is essential to understand whether introducing a multicomponent organizational change in terms of policy in the preschool context may be beneficial for children’s PA levels and concomitant health outcomes. To bridge this knowledge gap, our main aim is to examine the feasibility and effectiveness of a policy package in increasing PA levels in preschool children, using a large-scale pragmatic cluster-randomized controlled trial. Methods This proposed study is a pragmatic cluster-randomized controlled trial with two conditions (intervention and control with a 1:1 ratio) with preschools as clusters and the unit of randomization. We aim to recruit approximately 4000 3–5-year-old children from 90 preschools and retain more than 2800 children from 85 preschools to provide adequate statistical power for the analyses. The intervention to implement is a co-created, multicomponent policy package running for 6 months in preschools randomized to intervention. Change in accelerometer measured PA levels in children between intervention and control from pre- and post-intervention will be the primary outcome of the study, while secondary outcomes include health outcomes such as musculoskeletal fitness, psychosocial functioning, and absence due to illness in children among others. Implementation will be studied carefully using both quantitative (dose, fidelity) and qualitative (interview) methodologies. The change in primary and secondary outcomes, from pre- to post-intervention, will be analyzed with linear mixed-effect models (to allow both fixed and random effects) nested on a preschool level. Discussion This is a large-scale co-creation project involving the City of Stockholm, childcare stakeholders, preschool staff, and the research group with the potential to influence more than 30,000 preschool children within the Stockholm area. The study will add reliable evidence for the implementation of PA policies at the organizational level of preschools and clarify its potential effect on objectively measured PA and health markers in children. Trial registration ClinicalTrials.govNCT04569578. Prospectively registered on September 20, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06513-4.
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Affiliation(s)
- C Chen
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden. .,Centre for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden.
| | - V H Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - P Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - J H Migueles
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,PROFITH "PROmoting FITness and Health through physical activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - F Christiansen
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - M R Galanti
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.,Centre for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
| | - D Berglind
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.,Centre for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
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Kiessling A, Amiri C, Arhammar J, Lundbäck M, Wallingstam C, Wikner J, Svensson R, Henriksson P, Kuhl J. Interprofessional simulation-based team-training and self-efficacy in emergency medicine situations. J Interprof Care 2022; 36:873-881. [PMID: 35341425 DOI: 10.1080/13561820.2022.2038103] [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] [Indexed: 10/18/2022]
Abstract
Teamwork quality has been shown to influence patient safety, and simulation-based team-training (SBTT) is an effective means to increase this quality. However, long-term effects are rarely studied. This study aims to investigate the long-term effects of interprofessional SBTT in emergency medicine in terms of global confidence, self-efficacy in interprofessional communication and in emergency medicine situations. Newly graduated doctors, nurses, auxiliary nurses, and medical and nursing students participated. Four emergency medicine scenarios focused on teamwork according to the A-B-C-D-E-strategy. All participants increased their global confidence from 5.3 (CI 4.9-5.8) before to 6.8 (CI 6.4-7.2; p < .0001) after SBTT. Confidence in interprofessional communication increased from 5.3 (CI 4.9-5.8) to 7.0 (CI 6.6-7.4; p < .0001). Students had the greatest gain. The self-efficacy following the A-B-C-D-E strategy increased from 4.9 (CI 4.4-5.3) to 6.6 (CI 6.2-7.0). Again, students had the steepest increase. Newly graduated doctors achieved a superior increase in global confidence as compared to nurses and auxiliary nurses (p < .0001). Their propensity to recommend SBTT to colleagues was 9.9 (CI 9.8-10.0). The positive effects were sustained over a six-month period, indicating that interprofessional SBTT had a positive impact on competence development, and a potential to contribute to increased team quality in emergency medicine care.
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Affiliation(s)
- A Kiessling
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - C Amiri
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Arhammar
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Lundbäck
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - C Wallingstam
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Wikner
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Rm Svensson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - P Henriksson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - J Kuhl
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Specialised Medical Care, Danderyd Hospital, Stockholm, Sweden
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Lambraki I, Chadag M, Cousins M, Graells T, Léger A, Henriksson P, Troell M, Harbarth S, Wernli D, Jørgensen PS, Carson C, Parmley J, Majowicz S. Antimicrobial Resistance in South East Asia: A Participatory Systems Modelling Approach. Int J Infect Dis 2022. [DOI: 10.1016/j.ijid.2021.12.033] [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: 11/30/2022] Open
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8
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De-la-O A, Jurado-Fasoli L, Gracia-Marco L, Henriksson P, Castillo MJ, Amaro-Gahete FJ. Association of Energy and Macronutrients Intake with S-Klotho Plasma Levels in Middle-Aged Sedentary Adults: A Cross-Sectional Study. J Nutr Health Aging 2022; 26:360-366. [PMID: 35450992 DOI: 10.1007/s12603-022-1763-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The ageing process can be influenced by energy intake and different macronutrients within the diet. The soluble form of the α-Klotho gene (called S-Klotho) is widely considered as a powerful anti-ageing biomarker. OBJECTIVE To analyze the association of energy, dietary energy density and macronutrient intake with S-Klotho plasma levels in middle-aged sedentary adults. METHODS A total of 72 (52.8% women) middle-aged sedentary adults (53.7 ± 5.2 years old) participated in the study. Energy and macronutrients intake (i.e. fat, carbohydrate and protein) were assessed using three non-consecutive 24-h recalls. S-Klotho plasma levels were measured in the Ethylenediaminetetraacetic acid (EDTA) plasma using a solid-phase sandwich enzyme-linked immunosorbent assay. RESULTS No association was observed between energy, dietary energy density or macronutrient intake and S-Klotho plasma levels in men (all P≥ 0.1). We found an inverse association between energy, protein and carbohydrate intake with S-Klotho plasma levels in women (all P≤0.043), which disappeared after controlling for age, lean mass index and sedentary time. An inverse association was observed between dietary energy density and S-Klotho plasma levels in women after controlling for covariates (all P≤0.05). CONCLUSION In summary, the present study showed an inverse association of dietary energy density with S-Klotho plasma levels in middle-aged women. In addition, our data suggest that the associations between energy and macronutrient intake could be highly dependent on lean mass and sedentary time.
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Affiliation(s)
- A De-la-O
- Lucas Jurado-Fasoli, EFFECTS 262 Research Group, Department of Medical Physiology, School of Medicine. University of Granada; 18071 Granada, Spain; E.mail: ; ORCID: 0000-0002-5254-1816
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9
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Ogmundsdottir Michelsen H, Henriksson P, Wallert J, Back M, Sjolin I, Schlyter M, Hagstrom E, Kiessling A, Held C, Hag E, Nilsson L, Schiopu A, Zaman MJ, Leosdottir M. Organizational and patient-level predictors for reaching key risk factor targets in cardiac rehabilitation after myocardial infarction – the perfect-CR study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2538] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The benefits of specific cardiac rehabilitation (CR) programme components on patient outcomes after myocardial infarction (MI) remain unclear, as does their relative predictive strength compared to patient-level predictors.
Purpose
To identify CR organizational and patient-level predictors for reaching risk factor targets at one-year post-MI.
Methods
This was an observational survey- and registry-based study. Data on CR organization at all 78 CR centres in Sweden was collected in 2016 and merged with individual patient data from nationwide registries (n=7549, median age 64 years, 24% females). Cross-validation resampled orthogonal partial least squares discriminant analysis identified predictors for reaching treatment targets for low-density lipoprotein-cholesterol (LDL-C<1.8 mmol/L), blood pressure (BP<140/90 mmHg) and smoking abstinence (yes/no). Predictors with Variables of Importance for the Projection (VIP) value >0.8 and 95% confidence intervals (CI) excluding zero, were considered meaningful.
Results
Of the 71 analysed organizational variables, 36 were identified as meaningful predictors for reaching LDL-C and 35 for BP targets (Figure 1). The strongest predictors (VIP [95% CI]) for LDL-C and BP were: offering psychosocial management at initial CR assessment 2.09 [1.70–2.49]; 2.34 [1.90–2.78], having a CR team psychologist 1.59 [1.28–1.91]; 2.00 [1.46–2.55], having extended CR centre opening hours 2.17 [1.95–2.40]; 1.51 [1.03–2.00], staff reporting satisfaction with CR centre facilities 1.55 [1.07–2.04]; 1.96 [1.64–2.28], having a medical director 1.71 [1.45–1.97]; 1.47 [1.07–1.87], nurses using protocols for antihypertensive and/or lipid lowering medication adjustment 1.58 [1.35–1.81]; 1.56 [1.03–2.08], having operational team meetings 1.36 [1.08–1.64]; 1.34 [0.99–1.70], and using audit data for quality improvement 1.00 [0.79–1.20]; 1.27 [0.99–1.56]. Offering pre-exercise-based CR (exCR) assessment and different modes of exCR were predictors for reaching both targets. The strongest patient-level predictor of reaching LDL-C target was low baseline LDL-C 3.90 [3.25–4.56], and for BP it was having no history of hypertension 2.93 [2.74–3.12]. Second, participation in exCR was the strongest predictor for both outcomes 1.60 [0.83–2.37]; 1.50 [1.15–1.86]. For smoking abstinence, 5 organizational variables were identified as meaningful predictors, the strongest being prescription of varenicline by the centre physicians 1.98 [0.13–3.84] (Figure 2). The strongest patient-level predictors were exCR participation 2.51 [2.24–2.79] and socioeconomic status variables e.g., income 1.67 [1.28–2.06], living with partner 1.47 [0.84–2.09] and education 0.80 [0.48–1.12].
Conclusion
The study identified multiple CR organizational and patient-level predictors for reaching key risk factor targets one-year post-MI. The results might contribute to defining the optimal composition of comprehensive CR programmes.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1) The Swedish Research Council for Health, Working Life and Welfare (FORTE)2) The Swedish Heart and Lung Foundation (Hjärt Lung Fonden)
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Affiliation(s)
| | - P Henriksson
- Karolinska Institute, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - J Wallert
- Karolinska Institute, Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden
| | - M Back
- Sahlgrenska University Hospital, Department of Occupational therapy and Physiotherapy, Gothenburg, Sweden
| | - I Sjolin
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
| | - M Schlyter
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - A Kiessling
- Karolinska Institute, Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - E Hag
- Ryhov County Hospital, Department of Internal Medicine, Jonkoping, Sweden
| | - L Nilsson
- Linkoping University, Department of Health Medicine and Caring Sciences, Linkoping, Sweden
| | - A Schiopu
- Lund University, Department of Clinical Sciences, Malmo, Sweden
| | - M J Zaman
- James Paget Hospitals, Department of Cardiology, Norfolk, United Kingdom
| | - M Leosdottir
- Skane University Hospital, Department of Cardiology, Malmo, Sweden
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Abstract
We are now in the beginning of the fifth decade of in vitro fertilization (IVF) with more than ten million children born and an annual growth rate of half a million. It was recently found that there is a sevenfold increase in the incidence of pulmonary embolism (PE) during the first trimester of an IVF pregnancy as compared to spontaneous pregnancy. PE is a major cause of maternal mortality, and it is thus of outmost importance to understand the pathophysiological mechanism. The oestrogen surge during the ovarian stimulation has been hypothesized to be the initiating pathophysiological event. A support of this is a current report showing that embryo transfer performed directly after ovarian stimulation increased the risk of PE more than eightfold, whereas no such increase was noted after delayed embryo transfer. This increased risk coincides with a persisting increased oestrogen level. Further reported cardiovascular problems are arterial thromboses, pre-eclampsia and gestational hypertension. Global haemostasis tests change in the direction of increased coagulability, but mostly within normal limits. Cell-bound haemostasis and in particular platelet activation are less studied. However, a major increase in the number of microvesicles (MVs) and markers indicating platelet activation was reported during ovarian stimulation. We now need longitudinal data concerning haemostatic variables that extends into the first trimester. A major research focus should be to identify biomarkers that could be used already before instigation of IVF. Another way to avoid risk could be to delay embryo transfer by adapting a freeze-all strategy.
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Affiliation(s)
- P Henriksson
- From the, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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Olausson N, Mobarrez F, Zubarev R, Chernobrovkin A, Rutishauser D, Bremme K, Westerlund E, Hovatta O, Wallén H, Henriksson P. Changes in the plasma microvesicle proteome during the ovarian hyperstimulation phase of assisted reproductive technology. Sci Rep 2020; 10:13645. [PMID: 32788624 PMCID: PMC7423945 DOI: 10.1038/s41598-020-70541-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 07/22/2020] [Indexed: 11/26/2022] Open
Abstract
The incidence of pulmonary and venous thromboembolism is increased during the first trimester of pregnancies after assisted reproductive technology (ART) compared to spontaneous conception. We previously found that haemostatic plasma variables changed but within normal limits during controlled ovarian hyperstimulation (COH) concomitant with a major increase in plasma microvesicles (MVs) and markers indicating cell activation. We now explored the proteome of these MVs. Thirty-one women undergoing ART were blood sampled at down-regulation (DR) of oestrogen and at high level stimulation (HLS) with its 10–100-fold increased oestrogen level. Samples were analysed by liquid chromatography and tandem mass spectrometry to identify and quantify the proteome. We identified 306 proteins in the MVs and 72 had changed significantly at HLS compared to DR and more than 20% of them were associated with haemostasis. Thus, proteins related to both haemostasis and complement activation altered in plasma MVs in parallel with MV activation during COH. This needs to be further explored in the clinical context.
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Affiliation(s)
- Nina Olausson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 18288, Stockholm, Sweden.
| | - Fariborz Mobarrez
- Department of Medical Sciences, Uppsala University, 75185, Uppsala, Sweden
| | - Roman Zubarev
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Alexey Chernobrovkin
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Dorothea Rutishauser
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Katarina Bremme
- Department of Women's and Children's Health, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Eli Westerlund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 18288, Stockholm, Sweden
| | - Outi Hovatta
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 18288, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 18288, Stockholm, Sweden
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12
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Olausson N, Discacciati A, Nyman AI, Lundberg F, Hovatta O, Westerlund E, Wallén HN, Mobarrez F, Bottai M, Ekbom A, Henriksson P. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilization with fresh respectively frozen-thawed embryo transfer: Nationwide cohort study. J Thromb Haemost 2020; 18:1965-1973. [PMID: 32289205 DOI: 10.1111/jth.14840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 09/18/2019] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The assisted reproductive technique in vitro fertilization (IVF) is associated with an increased risk of venous thromboembolism (VTE) and pulmonary embolism (PE) during the first trimester. OBJECTIVES To compare the incidence of VTE and PE during the first trimester of IVF pregnancies using fresh or frozen-thawed embryo transfer to that during natural pregnancies. PATIENT/METHODS Nationwide Swedish registry-based cohort study of women who gave birth (n = 902 891) at the age of 15-50 years to their first child from the 1st of January 1992 until the 31st of December 2012. Exposure groups were IVF with fresh respectively frozen-thawed embryo transfer. Incidences of VTE and PE were calculated, and time-varying hazard ratios estimated for all trimesters after fresh respectively frozen-thawed embryo transfer IVF and compared to natural conception. RESULTS AND CONCLUSION Women giving birth after fresh embryo transfer IVF had a more than eightfold increased incidence of venous thromboembolism (hazard ratio [HR] 8.96, 95% CI 6.33 to 12.67) and pulmonary embolism during the first trimester, (HR 8.69, 95% CI 3.83 to 19.71) compared to women giving birth after natural conception. The incidence of VTE in women giving birth after frozen-thawed embryo transfer was not increased during the first trimester. To conclude, fresh embryo transfer IVF was associated with a significantly increased incidence of VTE and PE during the first trimester. These results suggest that frozen-thawed embryo transfer could be a preferred method of IVF with a minimised maternal risk.
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Affiliation(s)
- Nina Olausson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Discacciati
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anastasia I Nyman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Frida Lundberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Outi Hovatta
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Eli Westerlund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Håkan N Wallén
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fariborz Mobarrez
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Matteo Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ekbom
- Department of Medicine Solna, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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13
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Lundström A, Mobarrez F, Rooth E, Thålin C, von Arbin M, Henriksson P, Gigante B, Laska AC, Wallén H. Prognostic Value of Circulating Microvesicle Subpopulations in Ischemic Stroke and TIA. Transl Stroke Res 2020; 11:708-719. [PMID: 31983048 PMCID: PMC7340656 DOI: 10.1007/s12975-019-00777-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/03/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Platelet microvesicles (PMV) have previously been found elevated in acute ischemic stroke (IS) and could be biomarkers for risk of recurrence. PMV surface antigens such as P-selectin and phosphatidylserine (PS) reflect platelet activation and procoagulance. Tissue factor-positive microvesicles (TF+MV) are considered procoagulant, in particular if co-expressing PS. We enumerated MV subpopulations with these surface antigens in a cohort of 211 patients with primarily non-cardioembolic IS or transient ischemic attack (TIA) and investigated their association with long-term outcome. MV concentrations were determined by flow cytometry in the acute and convalescent phase. Primary outcome was a composite of fatal and non-fatal recurrent IS or myocardial infarction. Secondary outcomes were recurrent IS and all-cause mortality. Outcome events were obtained from Swedish registers during a follow-up of 1100 patient years. Concentrations of PS-positive and PS-negative MV populations were elevated in patients compared with healthy controls in both the acute and convalescent phase. PS+TF+PMV displayed pronounced elevations, median fold change 77 in the acute phase (p < 0.0001) but were not associated with outcome, neither were PS+P-selectin+PMV. The only subpopulation positively associated with primary outcome was PS-TF+PMV, with adjusted hazard ratio of 1.86 (1.04-3.31, p = 0.036) by Cox regression. Unexpectedly, several MV subpopulations tended to be associated with reduced risk of poor long-term outcome. Our results suggest that PS+TF+PMV may be a promising marker for cerebral ischemia, and that the in vivo generation of PS-MV after IS/TIA warrants further study. Future MV studies should ideally enumerate PS+ and PS-MV subpopulations separately.
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Affiliation(s)
- Annika Lundström
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, SE-182 88, Stockholm, Sweden.
| | - Fariborz Mobarrez
- Department of Medical Sciences, Division of Cancer Pharmacology and Computational Medicine, Uppsala University, Uppsala, Sweden
| | - Elisabeth Rooth
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, SE-182 88, Stockholm, Sweden
| | - Charlotte Thålin
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, SE-182 88, Stockholm, Sweden
| | - Magnus von Arbin
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, SE-182 88, Stockholm, Sweden
| | - Peter Henriksson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.,Division of Cardiovascular Medicine, Department Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Charlotte Laska
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, SE-182 88, Stockholm, Sweden
| | - Håkan Wallén
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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Hägg-Martinell A, Hult H, Henriksson P, Kiessling A. Nursing Students Learn to Handle Stress and to Prioritize in a Complex Context During Workplace Learning in Acute Internal Medicine Care - An Ethnographic Study. Adv Med Educ Pract 2020; 11:21-30. [PMID: 32021539 PMCID: PMC6971285 DOI: 10.2147/amep.s230476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION A common focus in many studies, in the short-term perspective, is to evaluate students' workplace learning and its outcome. However, the outcome can be perceived differently depending on when it was evaluated. The aim of this study was to explore student nurses' learning activities in an acute internal medicine unit and the nurses perceived learning outcome in a long-term perspective. MATERIAL AND METHODS Repetitive ethnographic observations were performed in an internal medicine care unit at a teaching hospital in Sweden between 2011 and 2013. Four student nurses and supervisors were repetitively observed. Two years later retrospective interviews were performed with four nurses who had performed workplace learning, as students, in this unit during the observation period. An inductive comparative analysis involving all interviews and observational data was applied. RESULTS Three themes were identified: To handle shifting situations - illustrating how student nurses learnt to adapt to shifting situations, to manage stress, to create structure and space for learning and to deal with hierarchies; To build relationships - illustrating how student nurses learnt to collaborate and to interact with patients; To act independently - illustrating how student nurses trained to act independently in the unit, took responsibility, and prioritized in this complex context. CONCLUSION Learning activities in a complex acute medical unit setting were characterized by a high workload and frequent stressful situations, and a demand on students to interact, to take responsibility, and to prioritize. To learn in such a stressful context, have in a long-term perspective, a potential to develop students' embodied understanding of and in practice, making them more prepared to work and independently apply their nursing expertise in similar contexts as graduated nurses.
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Affiliation(s)
- Ann Hägg-Martinell
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm
| | - Håkan Hult
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm
| | - Anna Kiessling
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm
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15
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Forsum E, Eriksson B, Flinke E, Henriksson H, Henriksson P, Löf M. Fat and fat-free mass of healthy Swedish children show tracking during early life, but there are differences. Acta Paediatr 2019; 108:1704-1708. [PMID: 30830968 DOI: 10.1111/apa.14771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Received: 12/16/2018] [Revised: 02/08/2019] [Accepted: 03/01/2019] [Indexed: 01/11/2023]
Abstract
AIM Obesity may start early in life. We investigated relationships between size and body composition variables in infancy and at 4 years of age using valid estimates of body composition. The results were compared to those obtained when body mass index (BMI) was used to estimate body fatness at 4 years. METHODS Using air displacement plethysmography, size, fat mass and fat-free mass were studied, between 2007 and 2015, in 253 full-term healthy Swedish children at 1 week, 12 weeks and 4 years of age. RESULTS Positive associations between variables in infancy and at 4 years were found at 1 and 12 weeks for weight, height, BMI, fat-free mass and fat-free mass index (p ≤ 0.002) and for fat mass, per cent body fat and fat mass index (p ≤ 0.04) at 12 weeks. Fat mass gained during infancy correlated positively (p ≤ 0.031) with per cent fat mass, fat mass index and BMI, all at 4 years. In girls, gains in fat-free mass during infancy correlated with BMI (p = 0.0005) at 4 years. CONCLUSION The results provide information regarding body composition trajectories during early life and demonstrate limitations of BMI as a proxy for body fatness when relating early weight gain to variables, relevant for later obesity risk.
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Affiliation(s)
- E Forsum
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - B Eriksson
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - E Flinke
- Department of Clinical and Experimental Medicine Linköping University Linköping Sweden
| | - H Henriksson
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - P Henriksson
- Department of Medical and Health Sciences Linköping University Linköping Sweden
- Department of Biosciences and Nutrition Karolinska Institute Stockholm Sweden
| | - M Löf
- Department of Medical and Health Sciences Linköping University Linköping Sweden
- Department of Biosciences and Nutrition Karolinska Institute Stockholm Sweden
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16
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Hägg-Martinell A, Hult H, Henriksson P, Kiessling A. Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study. BMJ Open 2019; 9:e027590. [PMID: 31362963 PMCID: PMC6677984 DOI: 10.1136/bmjopen-2018-027590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Almost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE. DESIGN AND SETTING Between 2011 and 2013 ethnographic observations were performed of medical and nursing students' interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE: learning with, from and about. PARTICIPANTS 21 medical, 4 nursing students and 30 supervisors participated. RESULTS Learning with-there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions. Learning from-interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills. Learning about-students were observed to actively observe interactions between staff and learnt how staff conducted different tasks. CONCLUSION This study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.
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Affiliation(s)
| | - Håkan Hult
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
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17
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Ögmundsdottir Michelsen H, Sjölin I, Schlyter M, Hagström E, Kiessling A, Henriksson P, Held C, Hag E, Nilsson L, Bäck M, Schiopu A, Zaman MJ, Leosdottir M. Cardiac rehabilitation after acute myocardial infarction in Sweden – evaluation of programme characteristics and adherence to European guidelines: The Perfect Cardiac Rehabilitation (Perfect-CR) study. Eur J Prev Cardiol 2019; 27:18-27. [DOI: 10.1177/2047487319865729] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 12/24/2022]
Abstract
Background While patient performance after participating in cardiac rehabilitation programmes after acute myocardial infarction is regularly reported through registry and survey data, information on cardiac rehabilitation programme characteristics is less well described. Aim The aim of this study was to evaluate Swedish cardiac rehabilitation programme characteristics and adherence to European Guidelines on Cardiovascular Disease Prevention. Method Cardiac rehabilitation programme characteristics at all 78 cardiac rehabilitation centres in Sweden in 2016 were surveyed using a web-based questionnaire (100% response rate). The questions were based on core components of cardiac rehabilitation as recommended by European Guidelines. Results There was a wide variation in programme duration (2–14 months). All programmes reported offering an individual post-discharge visit with a nurse, and 90% ( n = 70) did so within three weeks from discharge. Most programmes offered centre-based exercise training ( n = 76, 97%) and group educational sessions ( n = 61, 78%). All programmes reported to the national audit, SWEDEHEART, and 60% ( n = 47) reported that performance was regularly assessed using audit data, to improve quality of care. Ninety-six per cent ( n = 75) had a core team consisting of a cardiologist, a physiotherapist and a nurse and 76% ( n = 59) reported having a medical director. Having other allied healthcare professionals included in the cardiac rehabilitation team varied. Forty per cent ( n = 31) reported having regular team meetings where nurses, physiotherapists and cardiologist could discuss patient cases. Conclusion The overall quality of cardiac rehabilitation programmes provided in Sweden is high. Still, there are several areas of potential improvement. Monitoring programme characteristics as well as patient outcomes might improve programme quality and patient outcomes both at a local and a national level.
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Affiliation(s)
| | - Ingela Sjölin
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Mona Schlyter
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Centre, Uppsala University, Sweden
| | - Emma Hag
- Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Lennart Nilsson
- Department of Medical and Health Sciences, Linköping University, Sweden
| | - Maria Bäck
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Sweden
| | - Alexandru Schiopu
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - M Justin Zaman
- Department of Cardiology, James Paget University Hospital, Gorleston-on-Sea, Great Yarmouth, Norfolk, UK
| | - Margret Leosdottir
- Department of Cardiology, Skane University Hospital and Department of Clinical Sciences, Lund University, Malmö, Sweden
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18
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Ingemansson M, Jonsson M, Henriksson P, Hedlin G, Kull I, Wikström Jonsson E, Krakau I, Kiessling A. Influence of contextual factors on quality of primary care in children with asthma. J Eval Clin Pract 2019; 25:521-530. [PMID: 30461139 DOI: 10.1111/jep.13078] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Asthma is a common chronic disease among children, quality assurance is thus important. Adherence to pre-specified quality indicators of practice guidelines could be used to assess the quality of asthma care. The aim was to estimate which contextual factors that had an influence on the primary health care centres (PHCs) adherence to the quality indicators as stated in the practice guidelines. METHOD A pragmatic cross-sectional study was performed comprising 14 PHCs in Sweden. Included contextual factors were socio-demographic characteristics, organizational characteristics, and indicators regarding engagement in asthma care. Documentation on adherence to the quality indicators was retrieved from the medical health care records. Quality indicators included documentation of history of allergy and risk factors, diagnostics and patient support performed, and pharmacological treatment. To score adherence, a composite quality indicator (CQI) was computed for each PHC. A multivariable regression analysis was performed by orthogonal projection to latent structures (OPLS). By this analysis, the relationship between the result variable (CQI) and 26 pre-specified contextual factors was assessed. RESULTS There was a wide variation of CQI between the PHCs. The OPLS analysis identified that 10 of the contextual factors influenced CQI. The most pronounced influences were found in more time scheduled for asthma care, a lower age-limit for performing spirometry, a lower duty-grade for general practitioners, and a higher activity at asthma educational seminars. We found no influence of socio-demographic contextual factors. CONCLUSION We found that some of the contextual factors at the PHCs influenced the quality of performed care. Evidence-based care in paediatric asthma may thus be presumed to be facilitated by allocating time, by improving interprofessional collaboration, and by creating structures and opportunities for commitment to asthma care.
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Affiliation(s)
- Maria Ingemansson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marina Jonsson
- Centre of Occupational and Environmental Medicine, Stockholm County Council, Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Hedlin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Sachs Children and Youth Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Eva Wikström Jonsson
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden.,Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingvar Krakau
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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19
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Nymark C, Henriksson P, Mattiasson AC, Saboonchi F, Kiessling A. Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction. Eur J Cardiovasc Nurs 2019; 18:512-520. [PMID: 31132880 DOI: 10.1177/1474515119844654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/31/2022]
Abstract
BACKGROUND The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking. AIM To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay. METHODS A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis. RESULTS The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay (P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour. CONCLUSION Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.
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Affiliation(s)
- Carolin Nymark
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
| | - Peter Henriksson
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
| | | | - Fredrik Saboonchi
- 3 Karolinska Institutet, Department of Clinical Neuroscience, Sweden.,4 The Red Cross University College, Stockholm, Sweden
| | - Anna Kiessling
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
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20
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Henriksson P, Lind L, Qing L, Freyschuss A. Microvascular capillary assessment in relation to forearm blood flow. Clin Physiol Funct Imaging 2019; 39:322-326. [PMID: 31074581 DOI: 10.1111/cpf.12575] [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: 11/05/2018] [Accepted: 04/25/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study whether vascular reactivity as assessed by the methods forearm blood flow (FBF) and postocclusive reactive hyperaemia (PRH) in the nail fold was related as a measure of endothelium-dependent vasodilation in the microcirculation. METHODS Microvascular reactivity was assessed in forearm blood flow and in the nail fold by vital capillaroscopy of individual microvessels as postocclusive reactive hyperaemia. Vascular reactivity was assessed at baseline (n = 25) as well as after infusion of acetylcholine and of sodium nitroprusside (n = 13). We also performed a multivariate regression analysis to assess whether forearm blood flow or flow-mediated dilatation related to postocclusive reactive hyperaemia. RESULTS This study showed a distinct microvascular response to both acetylcholine (endothelium-dependent vasodilation) and sodium nitroprusside (endothelium-independent vasodilation) during forearm blood flow assessment and postocclusive reactive hyperaemia assessment in the nail fold (n = 13). These changes were inversely related (r- = -0·57; P<0·05). CONCLUSIONS Forearm blood flow was inversely correlated to postocclusive reactive hyperaemia. Postocclusive reactive hyperaemia was shortened after infusion with both acetylcholine and sodium nitroprusside. This occurred in parallel with the expected increase in forearm blood flow, conceivably reflecting that both methods can be used to assess endothelium-dependent vasodilation in the microcirculation.
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Affiliation(s)
- Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Stockholm, Sweden
| | - Lu Qing
- Division of Clinical Chemistry, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Freyschuss
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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Hallin K, Gordon M, Sköldenberg O, Henriksson P, Kiessling A. Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study. BMJ Open 2018; 8:e022251. [PMID: 30341125 PMCID: PMC6196845 DOI: 10.1136/bmjopen-2018-022251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study aimed to compare the rate of patient readmissions and mortality between care provided at an orthopaedic interprofessional training ward (IPTW) and usual care. DESIGN Retrospective cohort study. SETTING Orthopaedic wards at a level II trauma centre at a Swedish university teaching hospital between 2006 and 2011. PARTICIPANTS Two cohorts were identified: (1) a control cohort that had not received care at the IPTW, and (2) patients who had been treated for at least 1 day at the IPTW. MAIN OUTCOME MEASURES Readmission at 90 days and 1-year mortality. RESULTS We included 4652 controls and 1109 in the IPTW group. The mean age was 63 years, and 58% were women. The groups did not differ in any of the outcomes: the readmission rate in the control and IPTW groups was 13.5% and 14.0%, respectively, while mortality was 5.2% and 5.3%, respectively. This lack of difference remained after adjusting for confounders. CONCLUSION Interprofessional undergraduate training in patient-based settings can be performed in a level II trauma hospital with satisfactory patient safety.
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Affiliation(s)
- Karin Hallin
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Max Gordon
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Division of Orthopaedics, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Peter Henriksson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anna Kiessling
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Schlyter M, Ogmundsdottir Michelsen H, Sjolin I, Hag E, Hagstrom E, Nilsson L, Kiessling A, Henriksson P, Held C, Schiopu A, Zaman MJ, Leosdottir M. 410Treatment targets for systolic blood pressure are more often reached at cardiac rehabilitation centres where nurses adjust blood pressure medication doses - the Perfect-CR study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.410] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Schlyter
- Malmo University, Department of Clinical Sciences and Department of Cardiology, Lund University and Skane University H, Malmo, Sweden
| | - H Ogmundsdottir Michelsen
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
| | - I Sjolin
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
| | - E Hag
- Department of Internal Medicine, County hospital Ryhov, Jönköping, Sweden, Jönköping, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - L Nilsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, Linköping, Sweden
| | - A Kiessling
- Department of Clinical Sciences Danderyd Hospital and the Karolinska Institute, Stockholm, Sweden, Stockholm, Sweden
| | - P Henriksson
- Department of Clinical Sciences Danderyd Hospital and the Karolinska Institute, Stockholm, Sweden, Stockholm, Sweden
| | - C Held
- Uppsala University, Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Centre, Uppsala, Sweden
| | - A Schiopu
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
| | - M J Zaman
- James Paget University Hospital, Department of Cardiology, Norfolk, United Kingdom
| | - M Leosdottir
- Lund University and Skane University Hospital, Department of Clinical Sciences Malmo and Department of Cardiology, Malmo, Sweden
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Lindholm D, James S, Andersson J, Braun OÖ, Heller S, Henriksson P, Lauermann J, Öhagen P, Varenhorst C. Caffeine and incidence of dyspnea in patients treated with ticagrelor. Am Heart J 2018; 200:141-143. [PMID: 29898843 DOI: 10.1016/j.ahj.2018.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/14/2018] [Indexed: 01/08/2023]
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Henriksson P, Henriksson H, Labayen I, Huybrechts I, Gracia-Marco L, Ortega FB, España-Romero V, Manios Y, González-Gross M, Marcos A, Moreno LA, Gutiérrez Á, Ruiz JR. Correlates of ideal cardiovascular health in European adolescents: The HELENA study. Nutr Metab Cardiovasc Dis 2018; 28:187-194. [PMID: 29241667 DOI: 10.1016/j.numecd.2017.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 05/10/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The ideal cardiovascular health (iCVH) construct consists of 4 health behaviors (smoking status, body mass index, physical activity and diet) and 3 health factors (total cholesterol, blood pressure and fasting glucose). A greater number of iCVH components in adolescence are related to better cardiovascular health, but little is known about the correlates of iCVH in adolescents. Thus, the aim of the study was to examine correlates of iCVH in European adolescents. METHODS AND RESULTS The study comprised 637 European adolescents with complete iCVH data. Participants were part of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional, multicenter study conducted in 9 different European countries. Correlates investigated were sex and age, family affluence scale, maternal education, geographic location, sleep time, television viewing, duration of pregnancy, birth weight and breastfeeding. Younger adolescents, those whose mothers had medium/high education or those who watched television less than 2 h per day had a greater number of iCVH components compared to those who were older, had a mother with low education or watched television 2 h or more daily (P ≤ 0.01). CONCLUSION Since in our study older adolescents had worse iCVH than younger adolescents, early promotion of cardiovascular health may be important. Future studies may also investigate the usefulness of limiting television viewing to promote iCVH. Finally, since adolescents of mothers with low education had poorer iCVH, it may be of special interest to tailor public health promotion to adolescents from families with low socioeconomic status.
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Affiliation(s)
- P Henriksson
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
| | - H Henriksson
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - I Labayen
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Spain
| | - I Huybrechts
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - L Gracia-Marco
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Children's Health and Exercise Research Centre (CHERC), Sport and Health Sciences, University of Exeter, Exeter, UK
| | - F B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - V España-Romero
- Department of Physical Education, School of Education, University of Cádiz, Spain
| | - Y Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - M González-Gross
- ImFine Research Group, Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain; CIBER: CB12/03/30038 Fisiopatología de la Obesidad y la Nutrición, CIBERobn, Instituto de Salud Carlos III (ISCIII), Spain
| | - A Marcos
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Instituto del Frio, Institute of Food Science, Technology and Nutrition, Spanish National Research Council, Madrid, Spain
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Facultad de Ciencias de la Salud, Instituto Agroalimentario de Aragón (IA2), Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Spain
| | - Á Gutiérrez
- Department of Medical Physiology, School of Medicine, University of Granada, Spain
| | - J R Ruiz
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
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Mobarrez F, Wallen H, Westerlund E, Hovatta O, Henriksson P, Olausson N. Microparticles reveal cell activation during IVF – a possible early marker of a prothrombotic state during the first trimester. Thromb Haemost 2017; 116:517-23. [DOI: 10.1160/th15-12-0970] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 05/10/2016] [Indexed: 01/07/2023]
Abstract
SummaryCell-derived microparticles (MPs) are known to be elevated in a number of diseases related to arterial and venous thromboembolism (VTE), such as acute myocardial infarction, VTE (deep-vein thrombosis and pulmonary embolism) and peripheral arterial disease. IVF-associated pregnancies have previously been shown to be associated with an increased incidence of VTE, mechanisms behind being unknown and sparsely studied. Our objective was to assess cell activation during IVF through analysis of MP levels and phenotype following ovarian stimulation. Thirty-one women undergoing IVF were included and blood samples were collected at down regulation of oestrogen and at high level stimulation with 10- to 100-fold increased endogenous oestrogen levels. MPs were analysed by flow cytometry and phenotyped according to size and protein expression. We found that overall phosphatidylserine positive platelet-, endothelial- and monocyte-derived MPs significantly increased following ovarian stimulation with increased levels of platelet activation markers CD40 ligand and P-selectin. Furthermore, there was an increase in endothelial-derived MPs exposing activation marker E-selectin and monocyte-derived MPs, while neutrophil-derived MPs decreased slightly. In conclusion we found a major increase in MPs and markers indicating cell activation in parallel with the profound oestrogen boost during IVF. To assess whether these changes in MPs are associated with thromboembolic events requires extended longitudinal studies.
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Fresk M, Backlund L, Arrelöv B, Skånér Y, Henriksson P, Kiessling A. Factors influencing the quality of sickness certificates in primary care in Sweden. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.343] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Fresk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - L Backlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - B Arrelöv
- Stockholm County Council, Stockholm, Sweden
| | - Y Skånér
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - P Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Danderyd, Sweden
| | - A Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Danderyd, Sweden
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Nyström CD, Sandin S, Henriksson P, Henriksson H, Trolle-Lagerros Y, Maddison R, Ortega F, Pomeroy J, Ruiz J, Timpka T, Löf M. Mobile-based intervention intended to stop obesity in pre-school children: The MINISTOP RCT. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.193] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - S Sandin
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - P Henriksson
- Department of Biosciences and Nutrition, Karolinska Institute, Granada, Spain
| | - H Henriksson
- PROFITH “PROmoting FITness and Health through physical activity” research group, Department of Physi, Granada, Spain
| | - Y Trolle-Lagerros
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - R Maddison
- .Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin Uni, Victoria, Australia
| | - F Ortega
- PROFITH “PROmoting FITness and Health through physical activity” research group, Department of Physi, Granada, Spain
| | - J Pomeroy
- Marshfield Clinic Research Foundation, Marshfield, United States
| | - J Ruiz
- PROFITH “PROmoting FITness and Health through physical activity” research group, Department of Physi, Granada, Spain
| | - T Timpka
- Department of Medical and Health Sciences, Faculty of the Health Sciences, Linköping University, Linköping, Sweden
| | - M Löf
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
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Kiessling A, Roll M, Henriksson P. Enhanced hospital-based learning at a medical school through application of management principles - a case study. BMC Med Educ 2017; 17:185. [PMID: 29017549 PMCID: PMC5635566 DOI: 10.1186/s12909-017-1024-y] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/05/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND A hospital with all its brimming activity constitutes a unique learning environment for medical students. However, to organise high-quality education within this context is a task of great complexity. This paper describes a teaching hospital case, where management principles were applied to enhance the learning quality of medical education. METHODS Traditional attempts from the faculty had been unsuccessful in improving learning among medical students at a teaching hospital. We therefore applied management principles to be able to improve the learning quality. An evaluation was performed from the perspectives of management (course directors/ heads of health care departments), medical students, and physician supervisors. Presages were defined, including educational resources and management; processes were adjusted, including learning activities and staff schedules; and products were assessed. RESULTS Charting and benchmarking the use of local educational resources identified unused funding. Structured recurrent collaboration within resource utilization was established between course directors and heads of all concerned health care departments. By formulating a joint agreement, the identified assets were used to reorganise the course, to create constructive alignment, and to increase assigned supervisor time. This resulted in a sustainable improvement of learning quality and culture. CONCLUSION By using management principles in combination with a scholarship of teaching and learning, it was possible to locate and redistribute educational resources in an effective way. This improved student learning and the learning culture of the health care departments. We propose that such an initiative could also be transferable to other contexts. Faculty leaders facing similar problems should consider the advantages of a structured collaboration with health care department heads.
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Affiliation(s)
- Anna Kiessling
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
| | - Martin Roll
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
| | - Peter Henriksson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Danderyd University Hospital, SE-182 88 Stockholm, Sweden
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Rodriguez-Ayllon M, Cadenas-Sanchez C, Esteban-Cornejo I, Migueles JH, Mora-Gonzalez J, Henriksson P, Martín-Matillas M, Mena-Molina A, Molina-García P, Estévez-López F, Enriquez GM, Perales JC, Ruiz JR, Catena A, Ortega FB. Physical fitness and psychological health in overweight/obese children: A cross-sectional study from the ActiveBrains project. J Sci Med Sport 2017; 21:179-184. [PMID: 29031643 DOI: 10.1016/j.jsams.2017.09.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 12/10/2016] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine the associations of physical fitness (i.e. cardiorespiratory fitness, muscular strength, and speed/agility) with psychological distress and psychological well-being in overweight/obese pre-adolescent children. DESIGN 110 overweight/obese children (10.0±1.1years old, 61 boys) from the ActiveBrains project (http://profith.ugr.es/activebrains) participated in this cross-sectional study. METHODS Physical fitness was evaluated by the ALPHA battery test. Cardiorespiratory fitness was additionally evaluated by a maximal incremental treadmill. Stress was assessed by the Children's Daily Stress Inventory, anxiety by the State-Trait Anxiety Inventory, depression by the Children Depression Inventory, positive affect and negative affect by the Positive and Negative Affect Scale for Children, happiness by the Subjective Happiness Scale, optimism by the Life Orientation Test, and self-esteem by the Rosenberg Self-Esteem questionnaire. Linear regression adjusted for sex and peak height velocity was used to examine associations. RESULTS Absolute upper-body muscular strength was negatively associated with stress and negative affect (β=-0.246, p=0.047; β=-0.329, p=0.010, respectively). Furthermore, absolute lower-body muscular strength was negatively associated with negative affect (β=-0.301, p=0.029). Cardiorespiratory fitness, expressed by the last completed lap, and relative upper-body muscular strength were positively associated with optimism (β=0.220, p=0.042; β=0.240, p=0.017, respectively). Finally, absolute upper-body muscular strength was positively associated with self-esteem (β=0.362, p=0.003) independently of sex and weight status (p for interactions >0.3), and absolute lower-body muscular strength was also positively associated with self-esteem (β=0.352, p=0.008). CONCLUSIONS Muscular strength was associated with psychological distress (i.e. stress and negative affect) and psychological well-being (i.e. optimism and self-esteem) as well as cardiorespiratory fitness was associated with optimism. Therefore, increased levels of physical fitness, specifically muscular strength, could have significant benefits for overweight/obese children psychological health.
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Affiliation(s)
- M Rodriguez-Ayllon
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain.
| | - C Cadenas-Sanchez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - I Esteban-Cornejo
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - J H Migueles
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - J Mora-Gonzalez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - P Henriksson
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - M Martín-Matillas
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - A Mena-Molina
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - P Molina-García
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - F Estévez-López
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Spain; Department of Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands
| | - G M Enriquez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain
| | - J C Perales
- Mind, Brain, and Behaviour Research Centre-CIMCYC, University of Granada, Spain; Department of Experimental Psychology, University of Granada, Spain
| | - J R Ruiz
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition, Karolinska Institutet, Sweden
| | - A Catena
- Mind, Brain, and Behaviour Research Centre-CIMCYC, University of Granada, Spain; Department of Experimental Psychology, University of Granada, Spain
| | - F B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition, Karolinska Institutet, Sweden
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Henriksson H, Eriksson B, Forsum E, Flinke E, Henriksson P, Löf M. Longitudinal assessment of body composition in healthy Swedish children from 1 week until 4 years of age. Eur J Clin Nutr 2017; 71:ejcn2017125. [PMID: 28832576 DOI: 10.1038/ejcn.2017.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/21/2017] [Accepted: 07/17/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Knowledge of longitudinal body composition development is required to identify the mechanisms behind childhood overweight and obesity and to prevent these conditions. However, accurate data on this development in early childhood are lacking. Our aim was to describe the longitudinal body composition development in healthy young Swedish children. SUBJECTS/METHODS Body size and composition were assessed in 26 children using air-displacement plethysmography (1 and 12 weeks and 4.4 years of age) and isotope dilution (1.5 and 3 years of age) and compared with available reference data. RESULTS Body fat (%) for boys (n=16) was 12.8±3.9 (1 week), 25.6±4.8 (12 weeks), 28.2±3.8 (1.5 years), 27.3±5.1 (3 years) and 26.1±3.5 (4.4 years). For girls (n=10) these values were 15.3±2.9, 25.7±3.9, 27.9±3.3, 26.3±7.2 and 26.0±5.3, respectively. These values were above the Fomon reference values at 1.5 years of age and later and higher than the Butte reference (P<0.05) for boys at 1.5 years of age. At all ages the coefficients of variation were higher for body fat (%) (12-30%) than for BMI (4-11%). CONCLUSIONS At 4 years of age our children had more body fat than indicated by reference data. This high level may have already been established at 1.5 years of age but our small sample and the lack of appropriate reference data limit the possibility of drawing firm conclusions. Our results demonstrate the limitations of BMI when investigating overweight and obesity in early life and highlight the need for appropriate reference body composition data in infants and young children.European Journal of Clinical Nutrition advance online publication, 23 August 2017; doi:10.1038/ejcn.2017.125.
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Affiliation(s)
- H Henriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - B Eriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - E Forsum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - E Flinke
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - P Henriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - M Löf
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
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Olausson N, Discacciati A, Nyman A, Hovatta O, Westerlund E, Wallen H, Bottai M, Ekbom A, Henriksson P. P1610Ovarian stimulation explains the increased incidence of pulmonary embolism and venous thromboembolism in IVF. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1610] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nymark C, Henriksson P, Mattiasson AC, Saboonchi F, Kiessling A. P2486Influence of symptom appraisal and ability to act on patient delay when afflicted by an acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2486] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Delisle Nyström C, Pomeroy J, Henriksson P, Forsum E, Ortega FB, Maddison R, Migueles JH, Löf M. Evaluation of the wrist-worn ActiGraph wGT3x-BT for estimating activity energy expenditure in preschool children. Eur J Clin Nutr 2017; 71:1212-1217. [PMID: 28745334 DOI: 10.1038/ejcn.2017.114] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 05/09/2017] [Accepted: 06/12/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Easy-to-use and accurate methods to assess free-living activity energy expenditure (AEE) in preschool children are required. The aims of this study in healthy preschool children were to (a) evaluate the ability of the wrist-worn ActiGraph wGT3x-BT to predict free-living AEE and (b) assess wear compliance using a 7-day, 24-h protocol. SUBJECTS/METHODS Participants were 40 Swedish children (5.5±0.2 years) in the Mobile-based intervention intended to stop obesity in preschoolers (MINISTOP) obesity prevention trial. Total energy expenditure (TEE) was assessed using the doubly labeled water method during 14 days. AEE was calculated as (TEEx0.9) minus predicted basal metabolic rate. The ActiGraph accelerometer was worn on the wrist for 7 days and outputs used were mean of the daily and awake filtered vector magnitude (mean VM total and mean VM waking). RESULTS The ActiGraph was worn for 7 (n=34, 85%), 6 (n=4, 10%), 5 (n=1, 2.5%) and 4 (n=1, 2.5%) days (a valid day was ⩾600 awake minutes). Alone, mean VM total and mean VM waking were able to explain 14% (P=0.009) and 24% (P=0.001) of the variation in AEE, respectively. By incorporating fat and fat-free mass in the models 58% (mean VM total) and 62% (mean VM waking) in the variation of AEE was explained (P<0.001). CONCLUSIONS The wrist-worn ActiGraph wGT3x-BT in combination with body composition variables explained up to the 62% of the variation in AEE. Given the high wear compliance, the wrist-worn ActiGraph has the potential to provide useful information in studies where physical activity in preschool children is measured.
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Affiliation(s)
- C Delisle Nyström
- Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, Huddinge, Sweden
| | - J Pomeroy
- Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - P Henriksson
- Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, Huddinge, Sweden.,PROFITH PROmoting FITness and Health through physical activity Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - E Forsum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - F B Ortega
- Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, Huddinge, Sweden.,PROFITH PROmoting FITness and Health through physical activity Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - R Maddison
- School of Exercise and Nutrition Sciences, Deakin University
| | - J H Migueles
- PROFITH PROmoting FITness and Health through physical activity Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - M Löf
- Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, Huddinge, Sweden
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Svennberg E, Henriksson P, Engdahl J, Hijazi Z, Al-Khalili F, Friberg L, Frykman V. N-terminal pro B-type natriuretic peptide in systematic screening for atrial fibrillation. Heart 2017; 103:1271-1277. [PMID: 28255099 DOI: 10.1136/heartjnl-2016-310236] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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] [Received: 06/28/2016] [Revised: 12/29/2016] [Accepted: 01/29/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Screening for atrial fibrillation (AF) in individuals aged 65 and above is recommended by the European Society of Cardiology. Increased levels of the biomarker N-terminal pro B-type natriuretic peptide (NT-proBNP) has in cohort studies been associated with incident AF.The aim of this study was to assess whether NT-proBNP could be useful for AF detection in systematic screening. METHODS The Strokestop study entailed 7173 Swedish residents aged 75/76 that were screened for AF using twice daily intermittent ECG recordings during 2 weeks. In a substudy of 886 participants, the last 815 consecutive participants and 71 individuals with newly detected AF, levels of NT-proBNP were determined. RESULTS Participants with newly detected AF (n=96) had a median NT-proBNP of 330 ng/L (IQR 121;634). In individuals without AF (n=742), median NT-proBNP was 171 ng/L (IQR 95;283), p<0.001. The CHA2DS2-VASc parameters did not differ significantly between individuals with newly detected AF and without AF nor between newly detected AF in the NT-proBNP cohort compared with the cohort where NT-proBNP was not assessed. Using an NT-proBNP cut-off of ≥125 ng/L in a non-acute setting yielded a negative predictive value of 92%, meaning that 35% fewer participants would need to be screened when applied to systematic AF screening. Adding weight to NT-proBNP further reduced participants needed to be screened with a preserved sensitivity. CONCLUSIONS NT-proBNP was increased in individuals with newly detected AF. Prospective studies could clarify if NT-proBNP can be used to correctly select individuals that benefit most from AF screening. CLINICAL TRIALS ClinicalTrials.gov. Identifier: NCT01593553.
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Affiliation(s)
- Emma Svennberg
- Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden
| | - Peter Henriksson
- Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden
| | - Johan Engdahl
- Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden
| | - Ziad Hijazi
- Department of Medical Sciences and Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Faris Al-Khalili
- Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden
| | - Leif Friberg
- Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden
| | - Viveka Frykman
- Department of Clinical Sciences, Cardiology Unit, Karolinska Institutet, Danderyd's University Hospital, Stockholm, Sweden
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Olausson N, Henriksson P, Zubarev R, Hovatta O, Westerlund E, Wallen H, Mobarrez F. P-070: The microparticle proteome in IVF – changes during the oestrogen surge of controlled ovarian hyperstimulation. Thromb Res 2017. [DOI: 10.1016/s0049-3848(17)30168-8] [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: 11/28/2022]
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Abstract
OBJECTIVES To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture. DESIGN AND SETTING Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice. PARTICIPANTS 21 medical students and 30 supervisors participated. RESULTS Two themes were identified: Nervousness and curiosity-students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved-students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives. CONCLUSIONS This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.
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Affiliation(s)
- A Hägg-Martinell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - H Hult
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - P Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Hägg-Martinell A, Hult H, Henriksson P, Kiessling A. Community of practice and student interaction at an acute medical ward: An ethnographic study. Med Teach 2016; 38:793-800. [PMID: 26573137 DOI: 10.3109/0142159x.2015.1104411] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND A deeper understanding is needed of the acute medical care setting as a learning environment for students. AIM To explore workplace culture of an acute medical ward and students' interactions within this community. METHOD An ethnographic design was applied. Medical and nurse students' interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers' "Community of practice" theory. RESULTS We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups. CONCLUSION The culture shaped a pattern for, and created prerequisites that challenged students' adaptation and created a space for learning. Students' task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.
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Affiliation(s)
| | - H Hult
- a Karolinska Institutet , Sweden
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Nymark C, Saboonchi F, Mattiasson AC, Henriksson P, Kiessling A. Development and validation of an instrument to assess patients’ appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction: The PA-AMI questionnaire. Eur J Cardiovasc Nurs 2016; 16:240-248. [DOI: 10.1177/1474515116652758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C Nymark
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - F Saboonchi
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance medicine, Sweden
- The Swedish Red Cross University College, Sweden
| | - A-C Mattiasson
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Sweden
| | - P Henriksson
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - A Kiessling
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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Henriksson P, Eriksson B, Forsum E, Löf M. Gestational weight gain according to Institute of Medicine recommendations in relation to infant size and body composition. Pediatr Obes 2015; 10:388-94. [PMID: 25521831 DOI: 10.1111/ijpo.276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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] [Received: 06/10/2014] [Revised: 09/17/2014] [Accepted: 10/28/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intrauterine life may be a critical period for programming childhood obesity; however, there is insufficient knowledge concerning how gestational weight gain (GWG) affects infant fat mass (FM) and fat-free mass (FFM). OBJECTIVES The aim of this study was to investigate relationships between GWG according to Institute of Medicine (IOM) recommendations and infant size, FM and FFM. We also investigated if the associations were different for normal-weight and overweight/obese women. METHODS This study included 312 healthy Swedish mother-infant pairs. Infant body composition at 1 week of age was assessed using air-displacement plethysmography. Maternal GWG was defined as below, within or above the 2009 IOM recommendations. Multiple regression analyses were used. RESULTS Compared with women whose weight gain was within IOM recommendations, women with weight gain below the recommendations had infants that were shorter (-0.7 cm, P = 0.008) when adjusting for confounders. Normal-weight women exceeding IOM recommendations had infants with higher FM (+58 g, P = 0.008) compared with normal-weight women who gained within the recommendations. No corresponding association was observed for overweight/obese women. CONCLUSIONS Inadequate GWG was associated with shorter infants, while excessive GWG was associated with greater infant FM for women who were of normal weight before pregnancy.
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Affiliation(s)
- P Henriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Eriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - E Forsum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - M Löf
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institute, Huddinge, Sweden
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Petrillo M, Angers-Loustau A, Henriksson P, Bonfini L, Patak A, Kreysa J. JRC GMO-Amplicons: a collection of nucleic acid sequences related to genetically modified organisms. Database (Oxford) 2015; 2015:bav101. [PMID: 26424080 PMCID: PMC4589694 DOI: 10.1093/database/bav101] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/10/2015] [Indexed: 01/08/2023]
Abstract
The DNA target sequence is the key element in designing detection methods for genetically modified organisms (GMOs). Unfortunately this information is frequently lacking, especially for unauthorized GMOs. In addition, patent sequences are generally poorly annotated, buried in complex and extensive documentation and hard to link to the corresponding GM event. Here, we present the JRC GMO-Amplicons, a database of amplicons collected by screening public nucleotide sequence databanks by in silico determination of PCR amplification with reference methods for GMO analysis. The European Union Reference Laboratory for Genetically Modified Food and Feed (EU-RL GMFF) provides these methods in the GMOMETHODS database to support enforcement of EU legislation and GM food/feed control. The JRC GMO-Amplicons database is composed of more than 240 000 amplicons, which can be easily accessed and screened through a web interface. To our knowledge, this is the first attempt at pooling and collecting publicly available sequences related to GMOs in food and feed. The JRC GMO-Amplicons supports control laboratories in the design and assessment of GMO methods, providing inter-alia in silico prediction of primers specificity and GM targets coverage. The new tool can assist the laboratories in the analysis of complex issues, such as the detection and identification of unauthorized GMOs. Notably, the JRC GMO-Amplicons database allows the retrieval and characterization of GMO-related sequences included in patents documentation. Finally, it can help annotating poorly described GM sequences and identifying new relevant GMO-related sequences in public databases. The JRC GMO-Amplicons is freely accessible through a web-based portal that is hosted on the EU-RL GMFF website. Database URL: http://gmo-crl.jrc.ec.europa.eu/jrcgmoamplicons/
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Affiliation(s)
- Mauro Petrillo
- Molecular Biology and Genomics Unit, Joint Research Centre, European Commission, Ispra, Italy
| | | | - Peter Henriksson
- Molecular Biology and Genomics Unit, Joint Research Centre, European Commission, Ispra, Italy
| | - Laura Bonfini
- Molecular Biology and Genomics Unit, Joint Research Centre, European Commission, Ispra, Italy
| | - Alex Patak
- Molecular Biology and Genomics Unit, Joint Research Centre, European Commission, Ispra, Italy
| | - Joachim Kreysa
- Molecular Biology and Genomics Unit, Joint Research Centre, European Commission, Ispra, Italy
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Henriksson P, Lu Q, Diczfalusy U, Freyschuss A. Immediate effect of passive smoking on microcirculatory flow. Microcirculation 2015; 21:587-92. [PMID: 24698527 DOI: 10.1111/micc.12137] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 03/31/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Exposure to SHS, as by passive smoking, seems to increase the incidence of cardiovascular events. It has been shown that active smoking of a single cigarette causes an immediate and significant decrease in microcirculatory blood flow velocity, whereas the acute effects of exposure to SHS on microcirculatory flow have as yet not been demonstrated. METHODS Healthy nonsmoking volunteers of both genders were studied during acute exposure to SHS of two cigarettes burning up to 10 minutes. Microvessels were examined by in vivo vital capillaroscopy (Capiflow(®)), allowing continuous assessment of CBV. RESULTS CBV decreased from 514 mm/sec (CI 383-646) at baseline to 306 mm/sec (CI 191-420) at end of SHS exposure with a further decrease to a nadir of 240 mm/sec (CI 155-325) four minutes after the end of this exposure (p < 0.0001; ANOVA). CONCLUSIONS The result of this study shows that passive inhalation of secondhand cigarette smoke induces an immediate and prolonged marked reduction in CBV in nonsmoking healthy volunteers.
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Affiliation(s)
- Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Groot-Jensen S, Kiessling A, Zethraeus N, Björnstedt-Bennermo M, Henriksson P. Cost-effectiveness of case-based training for primary care physicians in evidence-based medicine of patients with coronary heart disease. Eur J Prev Cardiol 2015; 23:420-7. [DOI: 10.1177/2047487315583798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/19/2015] [Accepted: 04/02/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Susanne Groot-Jensen
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
| | - Anna Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
| | | | - Peter Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden
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Löfsjögård J, Kahan T, Díez J, López B, González A, Edner M, Henriksson P, Mejhert M, Persson H. Biomarkers of collagen type I metabolism are related to B-type natriuretic peptide, left ventricular size, and diastolic function in heart failure. J Cardiovasc Med (Hagerstown) 2015; 15:463-9. [PMID: 24983265 DOI: 10.2459/01.jcm.0000435617.86180.0b] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Myocardial collagen metabolism can be assessed indirectly by circulating biomarkers. We aimed to examine associations between myocardial collagen type I synthesis and degradation, and echocardiographic, clinical, and B-type natriuretic peptide (BNP) findings in heart failure. METHODS We studied 57 women and 75 men 60 years or older with systolic heart failure (New York Heart Association II-IV and an ejection fraction ≤ 45%). Mean age was 75 years, blood pressure 134/80 mmHg, ejection fraction 34%, and median BNP 210 ng/l. Analyses of the carboxy-terminal propeptide of procollagen type I (PICP, biomarker of collagen type I synthesis) and the serum carboxy-terminal telopeptide of collagen type I (CITP, biomarker of collagen type I degradation) were measured. Extensive echocardiographic examinations were performed, including variables of dyssynchrony. RESULTS Increased collagen synthesis (PICP) was independently related to increased BNP levels (r = 0.24, P = 0.018). Furthermore, independent associations were found between PICP and left ventricular size, isovolumic relaxation time, and relative wall thickness. Increased collagen degradation (CITP) was independently related to increased BNP levels (r = 0.35, P < 0.001). Also, univariable, but not multivariable, associations were found between CITP and E/E' septal and QRS duration. CONCLUSION Biomarkers of collagen type I synthesis and degradation are independently related to BNP and to indices of left ventricular size and diastolic function in systolic heart failure. It is proposed that BNP may contribute to alterations in collagen type I metabolism in systolic heart failure.
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Affiliation(s)
- Johan Löfsjögård
- aDivision of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet bDepartment of Cardiology, Danderyd University Hospital, Stockholm, Sweden cDivision of Cardiovascular Sciences, Centre of Applied Medical Research dDepartment of Cardiology and Cardiac Surgery, School of Medicine, University of Navarra, Pamplona, Spain eErsta Hospital, Stockholm, Sweden
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Agren A, Jörneskog G, Elgue G, Henriksson P, Wallen H, Wiman B. Response to comment on Ågren et al. Increased incorporation of antiplasmin into the fibrin network in patients with type 1 diabetes. Diabetes care 2014;37:2007-2014. Diabetes Care 2014; 37:e244. [PMID: 25342841 DOI: 10.2337/dc14-1644] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Anna Agren
- Coagulation Unit, Division of Haematology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gun Jörneskog
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Graciela Elgue
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Peter Henriksson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Håkan Wallen
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Björn Wiman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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Henriksson P, Löf M, Söderkvist P, Forsum E. Variation in the fat mass and obesity-related (FTO) genotype is not associated with body fatness in infants, but possibly with their length. Pediatr Obes 2014; 9:e112-5. [PMID: 24846219 DOI: 10.1111/ijpo.231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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] [Received: 08/15/2013] [Revised: 12/13/2013] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Data relating variation at the fat mass and obesity-related (FTO) locus (rs9939609) to fat mass in infancy are inconclusive. OBJECTIVE To study relationships between FTO genotype and infant size (at 1 and 12 weeks and at 1 year of age) and body composition (at 1 and 12 weeks). METHODS Body composition was assessed using air displacement plethysmography in 207 infants. FTO was genotyped using the TaqMan assay. RESULTS The number of risk alleles was related to length at 1 and 12 weeks (P = 0.007-0.033) but not to fat mass. The relationship to length was stronger in boys than in girls. CONCLUSIONS Our results suggest that the FTO genotype is not related during infancy to fat mass but is related to length in boys but not in girls.
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Affiliation(s)
- P Henriksson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Agren A, Jörneskog G, Elgue G, Henriksson P, Wallen H, Wiman B. Increased incorporation of antiplasmin into the fibrin network in patients with type 1 diabetes. Diabetes Care 2014; 37:2007-14. [PMID: 24760258 DOI: 10.2337/dc13-1776] [Citation(s) in RCA: 22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is associated with various vascular complications and is suggested to induce a prothrombotic state. In the current study, we characterized antiplasmin incorporation into fibrin in relation to other fibrinolytic compounds in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 236 patients with type 1 diabetes and 78 control subjects were investigated. The incorporation of antiplasmin into the fibrin network and the plasma levels of plasminogen activator inhibitor type 1 (PAI-1) activity, tissue plasminogen activator (tPA) activity, tPA/PAI-1 complex, plasmin-antiplasmin complex, antiplasmin, factor XIII, and d-dimer were measured. In addition, we used global assays to study fibrinolysis. RESULTS The incorporation of antiplasmin into the fibrin network was significantly higher in patients with type 1 diabetes than in control subjects without diabetes (1.65 ± 0.25 vs. 1.35 ± 0.18 mg/L, respectively; P < 0.0001). The patients also had lower PAI-1 activity (2.19 units/mL [interquartile range 0.96-5.42] vs. 4.25 units/mL [1.95-9.0]; P = 0.0012) and antiplasmin level in plasma (78.5 ± 13.3 vs. 83.2 ± 15.4 mg/L; P < 0.05), resulting in a higher fibrinolytic capacity (shorter clot lysis time; P = 0.0090). We did not find any important sex differences regarding fibrinolysis in the patients or in the control subjects. CONCLUSIONS Patients with type 1 diabetes incorporate more antiplasmin into the fibrin network than control subjects without diabetes do and have a reduced PAI-1 activity and a shorter clot lysis time. These results suggest that patients with type 1 diabetes produce a fibrin clot that is more resistant to fibrinolysis, which, however, may be counteracted by an increased fibrinolytic potential in plasma.
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Affiliation(s)
- Anna Agren
- Coagulation Unit, Division of Haematology, Department of Medicine, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Gun Jörneskog
- Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Graciela Elgue
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Peter Henriksson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Håkan Wallen
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - Björn Wiman
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
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A. Gedefaw D, Ma Z, Henriksson P, Zhang F, R. Andersson M, Mammo W. Random polyfluorene co-polymers designed for a better optical absorption coverage of the visible region of the electromagnetic spectrum. B CHEM SOC ETHIOPIA 2014. [DOI: 10.4314/bcse.v28i1.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hägg-Martinell A, Hult H, Henriksson P, Kiessling A. Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community. Educ Health (Abingdon) 2014; 27:15-23. [PMID: 24934938 DOI: 10.4103/1357-6283.134296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The healthcare system is complex and the education of medical and nursing students is not always a priority within it. However, education offered at the point of care provides students with opportunities to apply knowledge, and to develop the necessary skills and attitudes needed to practice their future profession. The major objective of this study was to identify students' views of generic aspects of the healthcare environment that influences their progress towards professional competence. METHODS We collected free text answers of 75 medical students and 23 nursing students who had completed an extensive questionnaire concerning their learning in clinical wards. In order to obtain richer data and a deeper understanding, we also interviewed a purposive sample of students. Qualitative content analysis was conducted. RESULTS We identified three themes: (1) How management, planning and organising for learning enabled content and learning activities to relate to the syllabus and workplace, and how this management influenced space and resources for supervision and learning; (2) Workplace culture elucidated how hierarchies and communication affected student learning and influenced their professional development and (3) Learning a profession illustrated the importance of supervisors' approaches to students, their enthusiasm and ability to build relationships, and their feedback to students on performance. DISCUSSION From a student perspective, a valuable learning environment is characterised as one where management, planning and organising are aligned and support learning. Students experience a professional growth when the community of practice accepts them, and competent and enthusiastic supervisors give them opportunities to interact with patients and to develop their own responsibilities.
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Affiliation(s)
| | | | | | - Anna Kiessling
- Department of Clinical Science, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
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Groot-Jensen S, Kiessling A, Zethraeus N, Bjoernstedt-Bennermo M, Henriksson P. Long-term cost effectiveness of case-based training of evidence-based clinical practice in primary care patients with coronary heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3345] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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