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Dimenäs SL, Jönsson B, Lundin M, Lundgren J, Abrahamsson KH. Changing from disease-centred to person-centred - Swedish dental hygienists' views on a theory-based behavioural intervention for improved oral hygiene among adolescents. Int J Dent Hyg 2024. [PMID: 38659277 DOI: 10.1111/idh.12811] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/22/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To explore dental hygienists' (DHs') views on (i) a person-centred, theory-based, behavioural intervention for improving oral hygiene among adolescents and (ii) professional and organizational factors to consider in the implementation of such an intervention in daily dental practice. METHODS Semi-structured interviews were conducted with 13 DHs who had applied the person-centred, theory-based, behavioural intervention directed at adolescents with poor oral hygiene in a field study within the Public Dental Service, Region Västra Götaland, Sweden. The interviews were audio-taped, transcribed verbatim and analysed using qualitative content analysis. RESULTS The main theme 'From individual experts to partners - DHs changing direction from a disease-centred towards a person-centred approach' illustrated a changed professional approach among DHs, from exerting their roles as experts to encouraging partnership in treatment by supporting the adolescents in taking health behavioural decisions and responsibility for their oral health. The DHs considered the changed approach as challenging, but also more enjoyable, compared to conventional information/instruction. Adequate knowledge and skills, personal interest and willingness for a change as well as support from colleagues and clinic management were identified as prerequisites for implementing the person-centred, theory-based, behavioural intervention in daily practice, while the expenditure of time needed in relation to economic demands in care were seen as barriers. CONCLUSIONS The findings elucidate that DHs considered the application of a person-centred, theory-based, behavioural intervention to be challenging but also enjoyable. For such an intervention to be implemented in daily practice, prerequisites and barriers need to be considered on both personal/professional and organizational levels.
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Affiliation(s)
- Sandra L Dimenäs
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - Birgitta Jönsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
| | - Mona Lundin
- Department of Education, Communication and Learning, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Lundgren
- Department of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kajsa H Abrahamsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
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Dimenäs SL, Andersson JS, Jönsson B, Lundgren J, Petzold M, Östberg AL, Abrahamsson KH. Adolescents' self-reported experiences following a person-centred, theory-based educational intervention versus conventional education for improved oral hygiene: Analysis of secondary outcomes of a randomized field study. J Clin Periodontol 2024; 51:63-73. [PMID: 37822115 DOI: 10.1111/jcpe.13883] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/11/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023]
Abstract
AIM To analyse adolescents' self-reported experiences and behavioural outcomes of a person-centred, theory-based intervention in comparison with conventional information/instruction for improved oral hygiene. MATERIALS AND METHODS Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Västra Götaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person-centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three-hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed. RESULTS The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p < .01). CONCLUSIONS The person-centred, theory-based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self-reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction.
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Affiliation(s)
- Sandra L Dimenäs
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - Jessica S Andersson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
| | - Birgitta Jönsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
| | - Jesper Lundgren
- Department of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Lena Östberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kajsa H Abrahamsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Periodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
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Eriksson MCM, Lindblad U, Daka B, Lundgren J. Validation of a single question to measure internal health locus of control in Swedish primary care. Scand J Psychol 2023; 64:674-678. [PMID: 37102405 DOI: 10.1111/sjop.12923] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/22/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Behavioral risk factors are highlighted in the prevention of diabetes and cardiovascular disease. Screening for health locus of control could be a feasible way to better identify individuals who could benefit from preventive behavioral change interventions. The aim of the study was to investigate the correlation between a single question measuring internal health locus of control (IHLC) and the Multidimensional Health Locus of Control Scale (MHLC) and to assess how IHLC relates to the General Self-Efficacy scale (GSE) in a primary care setting. METHODS Primary care patients, aged 18 and older, attending three primary care centers in southwest Sweden were consecutively asked to anonymously participate in the study. The patients were given a questionnaire and instructed to return the questionnaire in a sealed box in the waiting room. RESULTS In all, 519 patients were included. The correlation between MHLC Internality and IHLC was weak (r = 0.21, p < 0.001). An increase of one point on the internality scale of the MHLC gave an odds ratio of 1.19 (95% CI 1.11-1.28) for reporting high IHLC, and thus a five-point increase gave a doubled likelihood, OR = 2.40, CI 1.67-3.46. The results for the other scales of the MHLC and GSE were similar. CONCLUSION In this study, we found weak but statistically significant support for the single-question IHLC as a measure of internal health locus of control. Given that the correlation was weak, we recommend using the MHLC when possible.
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Affiliation(s)
- Maria C M Eriksson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Ulf Lindblad
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Bledar Daka
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Jesper Lundgren
- Department of Psychology, Gothenburg University, Gothenburg, Sweden
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Eék N, Sundström C, Kraepelien M, Lundgren J, Kaldo V, Berman AH. High- versus low-intensity internet interventions for alcohol use disorders (AUD): A two-year follow-up of a single-blind randomized controlled trial. Internet Interv 2023; 33:100630. [PMID: 37293578 PMCID: PMC10244691 DOI: 10.1016/j.invent.2023.100630] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Alcohol Use Disorders (AUD) are widespread and have serious consequences, but are among the most undertreated mental disorders. Internet interventions have been found effective in treating AUD, but we know little about long-term outcomes, two years or more after treatment. This study explored 12- and 24-month outcomes in alcohol consumption following initial 6-month improvements after a therapist-guided high-intensity internet intervention and an unguided low-intensity internet intervention among individuals with alcohol use disorder. Between-group comparisons were analyzed, as well as within-group comparisons with (1) pre-treatment measurements (2) post-treatment measurements. Participants consisted of a general population sample of internet help-seekers in Sweden. A total of 143 adults (47% men) with a score of 14 (women)/16 (men) or more on the Alcohol Use Disorders Identification Test, alcohol consumption of 11 (women)/14 (men) or more standard drinks the preceding week and ≥ 2 DSM-5 alcohol use disorder (AUD) criteria based on a diagnostic interview were included. The high- and low-intensity internet interventions (n = 72 and n = 71 respectively) consisted of modules based on relapse prevention and cognitive-behavioral therapy. The primary outcome was self-reported alcohol consumption in the preceding week measured as (1) number of standard drinks and (2) number of heavy drinking days. Attrition from self-reported questionnaires was 36% at the 12-month follow-up and 53% at the 24-month follow-up. No significant between-group differences occurred in outcomes at either long-term follow-up. Regarding within-group differences, compared to pre-treatment, alcohol consumption was lower in both high- and low-intensity interventions at both long-term follow-ups [within-group standard drinks effect sizes varied between g = 0.38-1.04 and heavy drinking days effect sizes varied between g = 0.65-0.94]. Compared to post-treatment, within-group alcohol consumption in the high intensity intervention increased at both follow-ups; for the low-intensity intervention, within-group consumption decreased at 12-month follow-up, but did not differ compared to post-treatment at 24 months. Both high- and low-intensity internet interventions for AUD were thus associated with overall reductions in alcohol consumption at long term follow-ups, with no significant differences between the two. However, conclusions are hampered by differential and non-differential attrition.
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Affiliation(s)
- Niels Eék
- University of Gothenburg, Department of Psychology, Sweden
| | - Christopher Sundström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
| | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | | | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
- Linnaeus University Faculty of Health and Life Sciences, Sweden
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Terrones-Campos C, Ledergerber B, Forbes N, Smith AG, Petersen J, Helleberg M, Lundgren J, Specht L, Vogelius IR. Prediction of Radiation-induced Lymphopenia following Exposure of the Thoracic Region and Associated Risk of Infections and Mortality. Clin Oncol (R Coll Radiol) 2023; 35:e434-e444. [PMID: 37149425 DOI: 10.1016/j.clon.2023.04.003] [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] [Received: 10/13/2022] [Revised: 02/08/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
AIMS Large blood volumes are irradiated when the heart is exposed to radiation. The mean heart dose (MHD) may be a good surrogate for circulating lymphocytes exposure. We investigated the association between MHD and radiation-induced lymphopenia and explored the impact of the end-of-radiation-therapy (EoRT) lymphocyte count on clinical outcomes. MATERIALS AND METHODS In total, 915 patients were analysed: 303 patients with breast cancer and 612 with intrathoracic tumours: oesophageal cancer (291), non-small cell lung cancer (265) and small cell lung cancer (56). Heart contours were generated using an interactive deep learning delineation process and an individual dose volume histogram for each heart was obtained. A dose volume histogram for the body was extracted from the clinical systems. We compared different models analysing the effect of heart dosimetry on the EoRT lymphocyte count using multivariable linear regression and assessed goodness of fit. We published interactive nomograms for the best models. The association of the degree of EoRT lymphopenia with clinical outcomes (overall survival, cancer treatment failure and infection) was investigated. RESULTS An increasing low dose bath to the body and MHD were associated with a low EoRT lymphocyte count. The best models for intrathoracic tumours included dosimetric parameters, age, gender, number of fractions, concomitant chemotherapy and pre-treatment lymphocyte count. Models for patients with breast cancer showed no improvement when adding dosimetric variables to the clinical predictors. EoRT lymphopenia grade ≥3 was associated with decreased survival and increased risk of infections among patients with intrathoracic tumours. CONCLUSION Among patients with intrathoracic tumours, radiation exposure to the heart contributes to lymphopenia and low levels of peripheral lymphocytes after radiotherapy are associated with worse clinical outcomes.
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Affiliation(s)
- C Terrones-Campos
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - B Ledergerber
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N Forbes
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A G Smith
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - J Petersen
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - M Helleberg
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Lundgren
- Centre of Excellence for Health, Immunity and Infections (CHIP), Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - I R Vogelius
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Eriksson MCM, Lundgren J, Hellgren M, Li Y, Björkelund C, Lindblad U, Daka B. Association between low internal health locus of control, psychological distress and insulin resistance. An exploratory study. PLoS One 2023; 18:e0285974. [PMID: 37216359 DOI: 10.1371/journal.pone.0285974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
AIM To assess the hypothesis that low internal health locus of control (IHLC) and psychological distress (PD) are associated with insulin resistance. MATERIALS AND METHODS In 2002-2005, a random population sample of 2,816 men and women aged 30-74 years participated (76%) in two municipalities in southwestern Sweden. This study included 2,439 participants without previously known diabetes or cardiovascular disease. IHLC was measured by a global scale and PD was measured by the 12-item General Health Questionnaire. Insulin resistance was estimated using HOMA-ir. General linear models were used to estimate differences in HOMA-ir between groups with low IHLC, PD, and both low IHLC and PD, respectively. RESULTS Five per cent (n = 138) had both PD and low IHLC, 62 per cent of participants (n = 1509) had neither low IHLC nor PD, 18 per cent (n = 432) had PD, and 15 per cent (n = 360) low IHLC. Participants with both low IHLC and PD had significantly higher HOMA-ir than participants with neither low IHLC nor PD (Δ = 24.8%, 95%CI: 12.0-38.9), also in the fully adjusted model (Δ = 11.8%, 95%CI: 1.5-23.0). Participants with PD had significantly higher HOMA-ir (Δ = 12%, 95%CI: 5.7-18.7), but the significance was lost when BMI was included in the model (Δ = 5.3%, 95%CI:0.0-10.8). Similarly, participants with low IHLC had significantly higher HOMA-ir (Δ = 10.1%, 95%CI: 3.5-17.0) but the significance was lost in the fully adjusted model (Δ = 3.5%, 95%CI: -1.9-9.3). CONCLUSIONS Internal health locus of control (IHLC) and psychological distress (PD) were associated with insulin resistance. Especially individuals with both PD and low IHLC may need special attention.
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Affiliation(s)
- Maria C M Eriksson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Hellgren
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- The Skaraborg Institute, Skövde, Sweden
| | - Ying Li
- Biostatistics, School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Lindblad
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bledar Daka
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Dimenäs SL, Östberg A, Lundin M, Lundgren J, Abrahamsson KH. Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study. Int J Dent Hyg 2022; 20:609-619. [PMID: 35925040 PMCID: PMC9804348 DOI: 10.1111/idh.12606] [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: 10/12/2021] [Revised: 02/16/2022] [Accepted: 07/31/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Adequate oral hygiene, that is self-performed infection control, is crucial to prevent periodontal disease. Epidemiological studies reveal poor oral hygiene conditions among Swedish adolescents and indicate a need for more effective prevention programs. The aim of the current study was to analyse adolescents' experiences of a person-centred, theory-based, oral health education program for improved oral hygiene. METHODS Data were obtained by interviewing 19 adolescents treated by dental hygienists in accord with the person-centred education program in a preceding clinical field study (ClinicalTrials.gov NCT02906098). Study participants were selected to reflect a variation of male and female adolescents, treated at clinics in areas with various socio-demographic profiles within Region Västra Götaland, Sweden. Interviews were audio-taped, transcribed verbatim and analysed with qualitative content analysis. RESULTS A main theme was identified: 'Adolescents on a guided and challenging journey towards beneficial oral hygiene behavior'. The results elucidate the importance of a person-centred approach in therapy. The adolescents described insight on a personal level about the importance of improved oral hygiene as fundamental for behavioural change. Planning and monitoring of the behaviour, with guidance and support by the dental hygienist, was considered to facilitate change and encouraged further behavioural efforts. However, the adolescents expressed a need of reminders and support to keep up oral hygiene routines over time. CONCLUSIONS The study brings knowledge on factors of importance in educational interventions to increase beneficial health behaviours among adolescents and emphasize areas for further improvements of such interventions.
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Affiliation(s)
- Sandra L. Dimenäs
- Department of Periodontology, Institute of Odontology, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
| | - Anna‐Lena Östberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Mona Lundin
- Department of Education, Communication and Learning, Faculty of EducationUniversity of GothenburgGothenburgSweden
| | - Jesper Lundgren
- Department of Psychology, Faculty of Social SciencesUniversity of GothenburgGothenburgSweden
| | - Kajsa H. Abrahamsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Clinic of Periodontics, Public Dental ServiceRegion Västra GötalandGothenburgSweden
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Mourad G, Lundgren J, Andersson G, Husberg M, Johansson P. Cost-effectiveness of Internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.106] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): The Swedish Research Council and the Medical Research of Southeast Sweden
Introduction
Cost-effectiveness evaluations of psychological interventions, such as Internet-delivered cognitive behavioural therapy (iCBT) programs, in patients with cardiovascular disease (CVD) are rare. In a recent study we reported that a 9-week iCBT program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients.
Purpose
To evaluate the cost-effectiveness of this intervention.
Methods
Cost-effectiveness analysis of a RCT, using an incremental cost-effectiveness ratio (ICER). The costs and effects included in the ICER are from baseline to one year post intervention, but also costs for guidance and support to patients in iCBT and ODF groups. Data on healthcare costs were retrieved from healthcare registries, and the EQ-5D-3L was used to calculate the quality-adjusted life years (QALYs). The ICER can be seen as the additional costs needed to gain an additional QALY by the iCBT compared to ODF.
Results
At 12-month follow-up, the QALY was significantly higher in iCBT compared to the ODF group (0.713 vs.0.598, p=.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of one year. The ICER for iCBT versus ODF was €18,865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared to ODF.
Conclusions
The ICER of €18,865 was lower than the cost-effectiveness threshold range of €23,400-€35,100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective.
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Affiliation(s)
- G Mourad
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
| | - J Lundgren
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
| | - G Andersson
- Linköping University, Department of Behavioural Sciences and Learning and Department of Biomedical and Clinical Sciences , Linköping , Sweden
| | - M Husberg
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
| | - P Johansson
- Linköping University, Department of Health, Medicine and Caring Sciences and Department of internal medicine , Linköping , Sweden
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Westas M, Mourad G, Andersson G, Lundgren J, Johansson P. Effects of internet-delivered cognitive behavioral therapy for patients with cardiovascular disease and depression on quality of life. A sub-analysis of a randomized controlled trial. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.099] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Research Council (2015-02600), ALF grants Region Östergötland (LIO-600321 and LIO-687531)
Background
In patients with cardiovascular disease (CVD), depression can cause poorer Health-Related Quality of Life (HRQoL). However, less is known about whether changes in depression over time are associated with changes in HRQoL. We have recently shown that a 9-week internet-based cognitive behavioral therapy (iCBT) program had a significant positive treatment effect on depression in CVD patients and that this effect was maintained at 12-month follow-up. If long-term improvements in depression corresponded to improvements in HRQoL was however not investigated.
Purpose
To explore if changes in depression after 9 weeks of iCBT are associated with changes in HRQoL at 12 months follow-up.
Methods
This study is a sub-analysis of a randomized controlled trial evaluating the effects of a nine-week iCBT program for depression in CVD patients. Data from patients who had performed iCBT were analyzed (n=72). Patient Health Questionnaire-9 (PHQ-9) was used to measure depression. The 12-Item Short Form Health Survey (SF12) including the Mental Component Score (MCS) and the Physical Component Score (PCS), and the EQ Visual Analogue Scale (EQ-VAS) were used to measure HRQoL. Data was collected at baseline, 9 weeks, 6 months, and 12 months. Linear mixed model was used to explore long-term treatment effects on HRQoL. Pearson correlation was used to explore the association between changes in depression and HRQoL at 12-month follow-up.
Results
There was a significant improved treatment effect of iCBT on HRQoL after 12-months (MCS p<.001, PCS p<.032, and EQ-VAS p<.001). Decreased depression was correlated with improved HRQoL after 12-months. The correlation scores between changes in depression and HRQoL were: MCS p<.001, r=-0.62; PCS p<.001, r=-.34; and EQ-VAS r=-.57, p<.001respectively.
Conclusion
Long term improvement in depression was associated with improvement in HRQoL (Figure 1). Interventions that improve depression in CVD patients are also likely to have sustained positive effect on HRQoL.
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Affiliation(s)
- M Westas
- Department of Health, Medicine and Caring Sciences (HMV) , Norrkoping , Sweden
| | - G Mourad
- Department of Health, Medicine and Caring Sciences (HMV) , Norrkoping , Sweden
| | - G Andersson
- Department of Behavioural Sciences and Learning (IBL), Division of Psychology (PSY) , Linköping , Sweden
| | - J Lundgren
- Department of Health, Medicine and Caring Sciences (HMV) , Norrkoping , Sweden
| | - P Johansson
- Department of Health, Medicine and Caring Sciences (HMV) , Norrkoping , Sweden
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Eriksson-Liebon M, Lundgren J, Rytterstrom P, Johansson P, Mourad G. The experience of internet-delivered cognitive behavioural therapy among patients with non-cardiac chest pain. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.118] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Kamprad Family Foundation
Region Östergötland
Background
Non-cardiac chest pain (NCCP) is a common health problem at emergency departments. Many patients are discharged with no further explanation regarding the cause of their chest pain. Recurring chest pain, functional limitations and cardiac anxiety affect lives of patients with NCCP and lead to increased healthcare use. Hence, we developed and tested a five-week, nurse-led iCBT program adapted to patients with NCCP in order to improve psychological distress and other patient-reported outcomes. This study was aimed to explore the experiences of patients with NCCP and cardiac anxiety regarding their participation in the iCBT program.
Methods
A qualitative interview study using content analysis to explore the experiences of patients participating in the iCBT program. The data was collected by individual face-to-face interviews with 16 patients after their participation in the iCBT using a semi-structured interview guide.
Results
The study resulted in three categories and eight subcategories, presented in Table 1. "Driving factors for participation in the iCBT program" was the first category and described the impact of pain on patients´ lives and their struggle before participating in the program. The second, "The program facilitates change", described how the program helped them make changes regarding pain, fear and anxiety. The last category, "Learning to live with chest pain", described the program as a tool for gaining the strength and skills to live a normal life despite chest pain.
Conclusions
The life impacted by recurrent chest pain, anxiety and feeling of being disregarded by healthcare was commonly experienced by participants. The invitation to the program was perceived as an opportunity to return to a normal life, without fear or chest pain. By being trustworthy, supportive and encouraging, the program helped participants to challenge their fear, and gain the strength and new insights they needed to live a normal life.
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Affiliation(s)
- M Eriksson-Liebon
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
| | - J Lundgren
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
| | - P Rytterstrom
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
| | - P Johansson
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
| | - G Mourad
- Linköping University, Department of Health, Medicine and Caring Sciences , Linköping , Sweden
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11
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Dimenäs SL, Jönsson B, Andersson JS, Lundgren J, Petzold M, Abrahamsson I, Abrahamsson KH. A person-centred, theory-based, behavioural intervention programme for improved oral hygiene in adolescents: A randomized clinical field study. J Clin Periodontol 2022; 49:378-387. [PMID: 35132653 PMCID: PMC9306963 DOI: 10.1111/jcpe.13601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/25/2021] [Revised: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
Aim To test the effectiveness of a person‐centred and theory‐based educational intervention to increase adolescents′ adherence to adequate oral hygiene behaviour, that is, self‐performed periodontal infection control. Materials and Methods Data were derived from a prospective, multi‐centred, two‐arm, quasi‐randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. Results Three‐hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6‐month follow‐up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. Conclusion A person‐centred and theory‐based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. ClinicalTrials.gov (NCT02906098).
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Affiliation(s)
- Sandra L Dimenäs
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinic of Periodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Birgitta Jönsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,The Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway
| | - Jessica S Andersson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinic of Periodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Jesper Lundgren
- Department of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ingemar Abrahamsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinic of Periodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
| | - Kajsa H Abrahamsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinic of Periodontics, Gothenburg, Public Dental Service, Region Västra Götaland, Sweden
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12
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Helleberg M, Niemann CU, Moestrup KS, Kirk O, Lebech AM, Lundgren J. Response to Aviv et al. J Infect Dis 2021; 224:559-561. [PMID: 33964164 PMCID: PMC8136013 DOI: 10.1093/infdis/jiab249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
- CHIP, Rigshospitalet, Copenhagen University Hospital, Denmark
- Corresponding author: Marie Helleberg, Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ö, Denmark, Phone: +45 35458555 Fax: +45 35455758, E-mail:
| | - C U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - K S Moestrup
- CHIP, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - O Kirk
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - A M Lebech
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - J Lundgren
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Denmark
- CHIP, Rigshospitalet, Copenhagen University Hospital, Denmark
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13
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Baxter JD, Dunn D, Tostevin A, Marvig RL, Bennedbaek M, Cozzi-Lepri A, Sharma S, Kozal MJ, Gompels M, Pinto AN, Lundgren J. Transmitted HIV-1 drug resistance in a large international cohort using next-generation sequencing: results from the Strategic Timing of Antiretroviral Treatment (START) study. HIV Med 2021; 22:360-371. [PMID: 33369017 PMCID: PMC8049964 DOI: 10.1111/hiv.13038] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/11/2020] [Accepted: 11/10/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The aim of this analysis was to characterize transmitted drug resistance (TDR) in Strategic Timing of Antiretroviral Treatment (START) study participants by next-generation sequencing (NGS), a sensitive assay capable of detecting low-frequency variants. METHODS Stored plasma from participants with entry HIV RNA > 1000 copies/mL were analysed by NGS (Illumina MiSeq). TDR was based on the WHO 2009 surveillance definition with the addition of reverse transcriptase (RT) mutations T215N and E138K, and integrase strand transfer inhibitor (INSTI) surveillance mutations (Stanford HIVdb). Drug resistance mutations (DRMs) detected at three thresholds are reported: > 2%, 5% and 20% of the viral population. RESULTS Between 2009 and 2013, START enrolled 4684 antiretroviral therapy (ART)-naïve individuals in 35 countries. Baseline NGS data at study entry were available for 2902 participants. Overall prevalence rates of TDR using a detection threshold of 2%/5%/20% were 9.2%/5.6%/3.2% for nucleoside reverse transcriptase inhibitors (NRTIs), 9.2%/6.6%/4.9% for non-NRTIs, 11.4%/5.5%/2.4% for protease inhibitors (PIs) and 3.5%/1.6%/0.1% for INSTI DRMs and varied by geographic region. Using the 2% detection threshold, individual DRMs with the highest prevalence were: PI M46IL (5.5%), RT K103NS (3.5%), RT G190ASE (3.1%), T215ISCDVEN (2.5%), RT M41L (2.2%), RT K219QENR (1.7%) and PI D30N (1.6%). INSTI DRMs were detected almost exclusively below the 20% detection threshold, most commonly Y143H (0.4%), Q148R (0.4%) and T66I (0.4%). CONCLUSIONS Use of NGS in this study population resulted in the detection of a large proportion of low-level variants which would not have been detected by traditional Sanger sequencing. Global surveillance studies utilizing NGS should provide a more comprehensive assessment of TDR prevalence in different regions of the world.
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Affiliation(s)
- J D Baxter
- Cooper University Hospital/Cooper Medical School of Rowan University, Camden, NJ, USA
| | - D Dunn
- Institute for Global Health, UCL, London, UK
| | - A Tostevin
- Institute for Global Health, UCL, London, UK
| | - R L Marvig
- Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - M Bennedbaek
- Copenhagen HIV Programme, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - S Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - M J Kozal
- Yale University School of Medicine, New Haven, CT, USA
| | - M Gompels
- North Bristol NHS Trust, Westbury on Trym, UK
| | - A N Pinto
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - J Lundgren
- Copenhagen HIV Programme, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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14
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Terrones Campos C, Ledergerber B, Vogelius I, Helleberg M, Specht L, Lundgren J. PO-1817: Kinetics and dose-volume effect of radiotherapy on leucocyte and platelet blood cell components. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Mortensen SB, Hansen AE, Lundgren J, Barfod TS, Ambye L, Dunø M, Schade Larsen C, Andersen DC, Jakobsen MA, Johansen IS. Characteristics of patients with familial Mediterranean fever in Denmark: a retrospective nationwide register-based cohort study. Scand J Rheumatol 2020; 49:489-497. [PMID: 32608308 DOI: 10.1080/03009742.2020.1756400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To investigate epidemiology, demography, and genetic and clinical characteristics of patients with familial Mediterranean fever (FMF) in Denmark. Method: In this population-based, cross-sectional cohort study, we identified FMF patients from discharge diagnoses using ICD-10 codes in the Danish National Patient Register, and linked data from the Danish Civil Registration System and laboratory databases for results of MEFV gene variant screening. Results: We identified 495 FMF patients (prevalence 1:11 680) with a median age of 29 years and a female ratio of 51%. The median age at diagnosis of FMF was 13 (IQR 7-22) years, with an estimated median diagnostic delay of 3 (IQR 0.7-6.9) years. The predominant ethnicities were Turkish (41.8%), Lebanese (15.8%), Syrian (6.5%), South-West Asian (7.9%), and South-East Asian (3.0%). The MEFV genotype distribution was 18.7% homozygous, 21.2% compound heterozygous, 32.0% heterozygous, 11.0% with complex alleles or unresolved zygosity, and 17.1% with no detected variants. M694V was the most prevalent variant in the overall cohort (32.5%). Homozygous or compound heterozygous MEFV exon 10 variants were associated with younger age at diagnosis (p < 0.001) and reduced number of hospital contacts before diagnosis (p = 0.008). The Charlson Comorbidity Index was ≥ 2 in 8.1% of patients. The prevalence of amyloidosis was 1.0%. Conclusions: FMF in Denmark is rare and patients are mainly of Eastern Mediterranean ethnicity. Diagnostic delay was long but patients with exon 10 MEFV variants were diagnosed at a younger age. Prolonged diagnostic delay is probably caused by lack of FMF awareness in the Danish healthcare system.
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Affiliation(s)
- S B Mortensen
- Department of Infectious Diseases, Odense University Hospital , Odense, Denmark.,Department of Clinical Immunology, Odense University Hospital , Odense, Denmark.,Odense Patient Exploratory Network (OPEN), Odense University Hospital , Odense, Denmark.,Department of Clinical Research, University of Southern Denmark , Odense, Denmark
| | - A E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital , Hvidovre, Denmark
| | - J Lundgren
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet , Copenhagen, Denmark
| | - T S Barfod
- Department of Medicine, Division of Infectious Diseases, Zealand University Hospital , Roskilde, Denmark
| | - L Ambye
- Department of Clinical Biochemistry, Copenhagen University Hospital , Hvidovre, Denmark
| | - M Dunø
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet , Copenhagen, Denmark
| | - C Schade Larsen
- Department of Infectious Diseases, Aarhus University Hospital , Aarhus, Denmark
| | - D C Andersen
- Department of Clinical Research, University of Southern Denmark , Odense, Denmark.,Laboratory of Molecular and Cellular Cardiology, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital , Odense, Denmark
| | - M A Jakobsen
- Department of Clinical Immunology, Odense University Hospital , Odense, Denmark.,Department of Clinical Research, University of Southern Denmark , Odense, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital , Odense, Denmark.,Department of Clinical Research, University of Southern Denmark , Odense, Denmark
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16
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Fägerstad A, Lundgren J, Arnrup K, Carlson E. Barriers and facilitators for adolescent girls to take on adult responsibility for dental care - a qualitative study. Int J Qual Stud Health Well-being 2019; 14:1678971. [PMID: 31608818 PMCID: PMC6807868 DOI: 10.1080/17482631.2019.1678971] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2019] [Indexed: 11/03/2022] Open
Abstract
Purpose: This study aims to explore and describe experiences of the dental care system among adolescent dental patients with a recent history of missed dental appointments at public dental clinics (PDCs) in a Swedish county. Methods: Twelve adolescent girls participated in the study. Data were collected by individual, semi-structured, open-ended interviews and analysed with qualitative content analysis. Results: The study findings could be summed into the theme "Triggers for adolescent girls to take on or not take on adult responsibility for dental care". The experience of free dental care could be summarized in five main categories: Pain and discomfort; Attractive and healthy teeth; Feeling safe and secure; Taking on the responsibility; and Free of charge. These five categories consisted of 15 subcategories. Conclusions: The results of this study should increase the knowledge on how to meet and treat adolescent girls in dental care. Knowing what will happen during the dental visit was highlighted by the participants as decisive to whether or not they would attend their dental appointments. Therefore, we should as far as possible ensure that our patients feel safe at their dental visits and by trying to avoid painful treatments.
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Affiliation(s)
- Anida Fägerstad
- Public Dental Service, Region Örebro County, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Kristina Arnrup
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Eva Carlson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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17
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Hasse B, Hannan MM, Keller PM, Maurer FP, Sommerstein R, Mertz D, Wagner D, Fernández-Hidalgo N, Nomura J, Manfrin V, Bettex D, Hernandez Conte A, Durante-Mangoni E, Tang THC, Stuart RL, Lundgren J, Gordon S, Jarashow MC, Schreiber PW, Niemann S, Kohl TA, Daley CL, Stewardson AJ, Whitener CJ, Perkins K, Plachouras D, Lamagni T, Chand M, Freiberger T, Zweifel S, Sander P, Schulthess B, Scriven JE, Sax H, van Ingen J, Mestres CA, Diekema D, Brown-Elliott BA, Wallace RJ, Baddour LM, Miro JM, Hoen B, Athan E, Bayer A, Barsic B, Corey GR, Chu VH, Durack DT, Fortes CQ, Fowler V, Hoen B, Krachmer AW, Durante-Magnoni E, Miro JM, Wilson WR. International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass. J Hosp Infect 2019; 104:214-235. [PMID: 31715282 DOI: 10.1016/j.jhin.2019.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 09/20/2019] [Accepted: 10/08/2019] [Indexed: 02/09/2023]
Abstract
Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.
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Affiliation(s)
- B Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland.
| | - M M Hannan
- Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P M Keller
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - F P Maurer
- Diagnostic Mycobacteriology Group, National and WHO Supranational Reference Center for Mycobacteria, Research Center, Borstel, Germany
| | - R Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mertz
- Departments of Medicine, Health Research Methods, Evidence and Impact, and Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - D Wagner
- Department of Internal Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg i.Br, Germany
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Nomura
- Kaiser Permanente Infectious Diseases, Los Angeles Medical Center, CA, USA
| | - V Manfrin
- Infectious and Tropical Diseases Department, San Bortolo Hospital, Vincenca, Italy
| | - D Bettex
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - A Hernandez Conte
- Department of Anaesthesiology, Kaiser Permanente, Los Angeles Medical Center, CA, USA
| | - E Durante-Mangoni
- Infectious and Transplant Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - T H-C Tang
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - R L Stuart
- Monash Infectious Diseases, Monash Health, Australia
| | - J Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - S Gordon
- Department of Infectious Diseases, Cleveland Clinic, OH, USA
| | - M C Jarashow
- Acute Communicable Disease Control, Los Angeles Department of Public Health, LA, USA
| | - P W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - S Niemann
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - T A Kohl
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - C L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - C J Whitener
- Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - K Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | - D Plachouras
- Healthcare-associated Infections, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - M Chand
- National Infection Service, Public Health England, London, UK; Guy's and St Thomas' NHS Foundation Trust, Imperial College London, UK
| | - T Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - S Zweifel
- Ophthalmology Unit, University of Zurich, Switzerland
| | - P Sander
- National Center for Mycobacteria, Zurich, Switzerland, Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - B Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - J E Scriven
- Department of Infection and Tropical Medicine, University Hospitals Birmingham, Birmingham, UK
| | - H Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - J van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A Mestres
- Clinic for Cardiovascular Surgery, University Hospital and University of Zurich, Switzerland
| | - D Diekema
- Division of Infectious Diseases, University of Iowa, Carver College of Medicine, IA, USA
| | - B A Brown-Elliott
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - R J Wallace
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - L M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Diseases, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
| | - J M Miro
- Infectious Diseases Service at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France.
| | | | | | - E Athan
- Infectious Diseases Department at Barwon Health, University of Melbourne and Deakin University, Australia
| | - A Bayer
- Geffen School of Medicine at UCLA Senior Investigator - LA Biomedical Research Institute at Harbor-UCLA, USA
| | - B Barsic
- Department for Infectious Diseases, School of Medicine, University of Zagreb, Croatia
| | - G R Corey
- Duke University Medical Center, Hubert-Yeargan Center for Global Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - V H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - D T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - C Q Fortes
- Division of Infectious Diseases, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - V Fowler
- Departments of Medicine and Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France
| | - A W Krachmer
- Harvard Medical School, Division of Infectious Diseases at the Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Durante-Magnoni
- Infectious and Transplant Medicine of the 'V. Monaldi' Teaching Hospital in Naples, University of Campania 'L. Vanvitelli', Italy
| | - J M Miro
- Infectious Diseases at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
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18
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Petersen N, Knudsen AD, Mocroft A, Kirkegaard-Klitbo D, Arici E, Lundgren J, Benfield T, Oturai P, Nordestgaard BG, Feldt-Rasmussen B, Nielsen SD, Ryom L. Prevalence of impaired renal function in virologically suppressed people living with HIV compared with controls: the Copenhagen Comorbidity in HIV Infection (COCOMO) study. HIV Med 2019; 20:639-647. [PMID: 31359592 DOI: 10.1111/hiv.12778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES While renal impairment is reported more frequently in people living with HIV (PLWH) than in the general population, the PLWH samples in previous studies have generally been dominated by those at high renal risk. METHODS Caucasian PLWH who were virologically suppressed on antiretroviral treatment and did not have injecting drug use or hepatitis C were recruited from the Copenhagen Comorbidity in HIV Infection (COCOMO) study. Sex- and age-matched controls were recruited 1:4 from the Copenhagen General Population Study up to November 2016. We defined renal impairment as one measurement of estimated glomerular filtration rate ≤ 60 mL/min/1.73 m2 , and assessed associated factors using adjusted logistic regression models. The impact of HIV-related factors was explored in a subanalysis. RESULTS Among 598 PLWH and 2598 controls, the prevalence of renal impairment was 3.7% [95% confidence interval (CI) 2.3-5.5%] and 1.7% (95% CI 1.2-2.2%; P = 0.0014), respectively. After adjustment, HIV status was independently associated with renal impairment [odds ratio (OR) 3.4; 95% CI 1.8-6.3]. In addition, older age [OR 5.4 (95% CI 3.9-7.5) per 10 years], female sex [OR 5.0 (95% CI 2.6-9.8)] and diabetes [OR 2.9 (95% CI 1.3-6.7)] were strongly associated with renal impairment. The association between HIV status and renal impairment became stronger with older age (P = 0.02 for interaction). Current and nadir CD4 counts, duration of HIV infection and previous AIDS-defining diagnosis were not associated with renal impairment among virologically suppressed PLWH. CONCLUSIONS The prevalence of renal impairment is low among low-risk virologically suppressed Caucasian PLWH, but remains significantly higher than in controls. Renal impairment therefore remains a concern in all PLWH and requires ongoing attention.
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Affiliation(s)
- N Petersen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - A D Knudsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - A Mocroft
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, UCL, London, UK
| | | | - E Arici
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - J Lundgren
- Department of Infectious Diseases, CHIP, Center of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - T Benfield
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - B G Nordestgaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Copenhagen General Population Study and Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - B Feldt-Rasmussen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S D Nielsen
- Department of Infectious Diseases, Viro-immunology Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - L Ryom
- Department of Infectious Diseases, CHIP, Center of Excellence for Health, Immunity and Infections, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Campos CT, Ledergerber B, Vogelius I, Helleberg M, Specht L, Lundgren J. OC-0278 Radiation-induced lymphopenia: Fractionation effect and association with infections and mortality. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30698-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Abstract
OBJECTIVE This study is a part of a project with the aim to construct and evaluate a structured treatment model (the Jönköping Dental Fear Coping Model, DFCM) for the treatment of dental patients. The aim of the present study was to evaluate the DFCM from a patient perspective. MATERIAL AND METHODS The study was performed at four Public Dental Clinics, with the same 13 dentists and 14 dental hygienists participating in two treatment periods. In Period I, 1351 patients were included and in Period II, 1417. Standard care was used in Period I, and in Period II the professionals had been trained in and worked according to the DFCM. In the evaluation, the outcome measures were self-rated discomfort, pain and tension, and satisfaction with the professionals. RESULTS In comparison with standard care, less tension was reported among patients treated according to the DFCM, (p = .041), which was also found among female patients in a subgroup analysis (p = .028). Additional subgroup analyses revealed that patients expecting dental treatment (as opposed to examination only) reported less discomfort (p = .033), pain (p = .016) and tension (p = .012) in Period II than in Period I. Patients with low to moderate dental fear reported less pain in Period II than in Period I (p = .014). CONCLUSIONS The DFCM has several positive effects on adult patients in routine dental care. In a Swedish context, the differences between standard care and treatment according to the model were small but, in part, statistically significant. However, it is important to evaluate the model in further studies to allow generalization to other settings.
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Affiliation(s)
- Carl-Otto Brahm
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oral and Maxillofacial Surgery, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Sven G. Carlsson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Peter Nilsson
- Department of Oral and Maxillofacial Surgery, Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Catharina Hägglin
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Special Care Dentistry and Oral Medicine, Public Dental Service, Gothenburg, Sweden
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21
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Kemani MK, Grimby-Ekman A, Lundgren J, Sullivan M, Lundberg M. Factor structure and internal consistency of a Swedish version of the Pain Catastrophizing Scale. Acta Anaesthesiol Scand 2019; 63:259-266. [PMID: 30132784 DOI: 10.1111/aas.13246] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/28/2018] [Accepted: 07/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain catastrophizing is highly relevant to assess in the context of long-standing pain. The Pain Catastrophizing Scale (PCS) is a well-established questionnaire used to measure catastrophizing in individuals with long-standing pain. So far, no Swedish translation has been evaluated in regard to validity and reliability. The aims of this study were to translate the PCS questionnaire from English to Swedish, and to investigate its construct validity (face, content, and structural validity) and reliability (internal consistency). METHODS We translated the original English version of the PCS to Swedish and collected item responses from 194 persons suffering from primarily long-standing musculoskeletal pain. We used confirmatory factor analysis to evaluate structural validity, and tested the model fit of a one-factor model, an oblique two-factor model, and an oblique three-factor model. We evaluated the measure's reliability in regard to internal consistency calculated with Cronbach's alpha. RESULTS A three-factor model comprising a four-item rumination factor, a three-item magnification factor, and a six-item helplessness factor provided the best fit to the data. Internal consistency was adequate and Cronbach's α was 0.92 for the entire scale, 0.84 for the rumination subscale; 0.69 for the magnification subscale, and 0.89 for the helplessness subscale. CONCLUSIONS The results indicated adequacy of a three-factor solution and the questionnaire's internal consistency, and provide initial support for the structural validity and internal consistency of a Swedish version of the PCS. Future studies should replicate the study in larger samples and extend the current evaluation in regard to validity and reliability.
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Affiliation(s)
- Mike K. Kemani
- Division of Psychology; Department of Clinical Neuroscience (CNS); Karolinska Institutet; Stockholm Sweden
- Functional Area Medical Psychology; Functional Unit Behavior Medicine; Karolinska University Hospital; Stockholm Sweden
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
| | - Anna Grimby-Ekman
- Health Metrics; Department of Medicine; Sahlgrenska Academy; Gothenburg University; Gothenburg Sweden
| | - Jesper Lundgren
- Department of Psychology; Gothenburg University; Gothenburg Sweden
| | - Michael Sullivan
- Department of Psychology; McGill University; Montréal Québec Canada
| | - Mari Lundberg
- Division of Physiotherapy; Department of Neurobiology, Care Sciences and Society (NVS); Karolinska Institutet; Stockholm Sweden
- Department of Orthopaedics; Sahlgrenska University Hospital; Gothenburg Sweden
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22
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Fägerstad A, Lundgren J, Windahl J, Arnrup K. Dental avoidance among adolescents - a retrospective case -control study based on dental records in the public dental service in a Swedish county. Acta Odontol Scand 2019; 77:1-8. [PMID: 30022701 DOI: 10.1080/00016357.2018.1489978] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: This study aimed to investigate the occurrence of missed dental appointments among 16-19-year-old adolescents in a Swedish county. A second aim was to explore associations between background and concomitant factors and missed appointments and to investigate if these associations differed between areas with different sociodemographic profiles.Materials and methods: A list of booked, and missed, appointments for 10,158 individuals during 2012 was used for assessments. Based on the total sample, 522 cases with, and 522 matched controls without, dental avoidance behavior in 2012 were identified. Data on previous missed and cancelled appointments, oral health status, dental treatment, fear or behavior problems, and medical, and, where available, psychosocial or lifestyle factors were extracted from the dental records using a preset protocol covering the period 2009-2012.Results: In 2012, 13.1% of 23,522 booked appointments were missed, with a higher proportion of missed appointments among boys than girls. Cases with avoidance behavior more often had a record of sociodemographic load and dental fear or behavior management problems. They also had more oral health problems, more invasive dental treatments, and, in the past, more missed and canceled appointments.Conclusion: To enable good oral health and continued regular dental care, we need to pay more attention to adolescents' individual situation and be observant of early signs of avoidance.
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Affiliation(s)
- Anida Fägerstad
- Public Dental Service, Dental research Department, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Jenny Windahl
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Kristina Arnrup
- Public Dental Service, Dental research Department, Örebro, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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23
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Thudium RF, Lundgren J, Benfield T, Nordestgaard BG, Borges ÁH, Gerstoft J, Nielsen SD, Ronit A. HIV infection is independently associated with a higher concentration of alpha-1 antitrypsin. HIV Med 2018; 19:745-750. [PMID: 30160349 DOI: 10.1111/hiv.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Alpha-1 antitrypsin (AAT) deficiency is associated with an increased risk of chronic obstructive pulmonary disease and has been related to CD4 T-cell count decline in people living with HIV (PLWH). We determined whether HIV status is associated with AAT concentrations and assessed associations between AAT concentration, pulmonary function and immunological status. METHODS Alpha-1 antitrypsin was measured and spirometry performed in 1011 PLWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) study and in 11 962 age- and sex-matched uninfected controls. We studied associations between AAT concentration, HIV status, pulmonary function, and current and nadir CD4 T-cell counts using multivariate linear regression analyses. RESULTS The mean age of PLWH was 50.7 [standard deviation (SD) 11.3] years and 98.6% were receiving combination antiretroviral therapy (cART). The mean current CD4 T-cell count was 718 (SD 284) cells/μL. PLWH had a higher median AAT concentration than uninfected controls [1.4 (interquartile range (IQR) 1.3-1.6) versus 1.3 (IQR 1.2-1.4) g/L; P < 0.0001] and HIV infection was independently associated with higher AAT concentration [adjusted β = 0.10 g/L; 95% confidence interval (CI) 0.08; 0.11 g/L; P < 0.001]. Low AAT concentration (< 1.0 g/L) was not more common in PLWH with airflow limitation (defined as forced expiratory volume in 1 second/forced vital capacity (FEV1 /FVC) < 0.7 with FEV1 -predicted < 80%) compared with uninfected controls with airflow limitation, and the effect of AAT on FEV1 %-predicted was comparable to that in uninfected controls (P-interaction = 0.66). AAT concentration was not associated with current or nadir CD4 T-cell count. CONCLUSIONS HIV infection was independently associated with a higher concentration of AAT through unknown mechanisms. However, AAT does not seem to contribute to lower pulmonary function or to low CD4 T-cell counts in PLWH.
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Affiliation(s)
- R F Thudium
- Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Lundgren
- Centre for Health and Infectious Diseases (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - T Benfield
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - B G Nordestgaard
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Á H Borges
- Centre for Health and Infectious Diseases (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Gerstoft
- Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S D Nielsen
- Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Ronit
- Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Brahm CO, Lundgren J, Carlsson SG, Nilsson P, Hägglin C. Development and evaluation of the Jönköping Dental Fear Coping Model: a health professional perspective. Acta Odontol Scand 2018; 76:320-330. [PMID: 29560758 DOI: 10.1080/00016357.2018.1453082] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to design a structured treatment model focusing on all levels of adult's dental fear, the Jönköping Dental Fear Coping Model (DFCM). The aim was to study the DFCM from a dental health professional perspective. MATERIAL AND METHODS The DFCM was studied by means of quantitative and qualitative analyses. Nine dental clinics participated in Period I (pre-intervention/standard care), and 133 dental health professionals (dentists, dental hygienists, dental assistants) and 3088 patients were included. After completion of Period I, four of the clinics were randomized to Period II (intervention), beginning with the professionals undergoing DFCM training. Following that, 51 dental health professionals treated 1417 patients according to the DFCM. The other five clinics served as controls. RESULTS Half or more of the dental health professionals assessed the model as better than standard care, regarding anamnesis and diagnostics, communication and contact, and understanding of patients and dental fear. The dental health professionals reported higher tension in their fearful patients in Period II compared with Period I, possibly due to their increased awareness of dental fear. CONCLUSIONS The qualitative data suggest that dental health professionals find the DFCM beneficial in routine dental care. The model promotes a holistic approach to the treatment of adult patients. However, stress among the professionals was not reduced when measured, neither quantitatively nor qualitatively. It is important to evaluate the model in further studies to make it possible to draw generalizable conclusions.
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Affiliation(s)
- Carl-Otto Brahm
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oral and Maxillofacial Surgery, Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Sven G. Carlsson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Peter Nilsson
- Department of Oral and Maxillofacial Surgery, Institute for Postgraduate Dental Education, Region Jönköping County, Jönköping, Sweden
| | - Catharina Hägglin
- Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Clinic of Special Care Dentistry and Oral Medicine, Public Dental Service, Region Västra Götaland, Gothenburg, Sweden
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Engelbrechtsen L, Lundgren J, Wewer Albrechtsen NJ, Mahendran Y, Iepsen EW, Finocchietto P, Jonsson AE, Madsbad S, Holst JJ, Vestergaard H, Hansen T, Torekov SS. Treatment with liraglutide may improve markers of CVD reflected by reduced levels of apoB. Obes Sci Pract 2017; 3:425-433. [PMID: 29259801 PMCID: PMC5729494 DOI: 10.1002/osp4.133] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 05/15/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 01/14/2023] Open
Abstract
Background Dislipidaemia and increased levels of apolipoprotein B (apoB) in individuals with obesity are risk factors for development of cardiovascular disease (CVD). The aim of this study was to investigate the effect of weight loss and weight maintenance with and without liraglutide treatment on plasma lipid profiles and apoB. Methods Fifty‐eight individuals with obesity (body mass index 34.5 ± 3.0 kg/m2 [mean ± SD]) were included in this study. After 8 weeks on a very low‐calorie diet (800 kcal/day), participants were randomized to weight maintenance with meal replacements with or without liraglutide (1.2 mg daily) for 1 year. Plasma samples from before and after weight loss and after 1 year of weight maintenance were subjected to nuclear magnetic resonance‐based lipidomics analysis. Results After an 8‐week low‐calorie diet, study participants lost 12.0 ± 2.9 kg (mean ± SD) of their body weight, which was reflected in their lipid profiles (80 out of 124 lipids changed significantly), including reduced levels of apoB, total cholesterol, free cholesterol, remnant cholesterol, triglycerides, low‐density lipoprotein and very low‐density lipoprotein subclasses. After 1 year of maintained weight loss, the majority of the lipids had returned to pre‐weight loss levels even though weight loss was successfully maintained in both groups. Interestingly, apoB levels remained low in the liraglutide treated group (apoB change: 0.03 ± 0.02 mmol/L, p = 0.4) in contrast to an increase in the control group (apoB change: 0.06 ± 0.07 mmol/L, p = 0.02). Conclusion An 8‐week low‐calorie diet, in individuals with obesity, reduced plasma levels of lipids and the atherogenic marker apoB. After 1 year of weight maintenance, only study participants treated with liraglutide maintained reduced levels of apoB, despite similar body weight maintenance. Treatment with liraglutide may therefore reduce apoB levels and thus reflect lower CVD risk. Including apoB measurements in clinical practice when monitoring patients with dislipidemia or CVD might prove to be useful.
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Affiliation(s)
- L Engelbrechtsen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,The Danish Diabetes Academy Odense Denmark
| | - J Lundgren
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - N J Wewer Albrechtsen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Y Mahendran
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,The Danish Diabetes Academy Odense Denmark
| | - E W Iepsen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,The Danish Diabetes Academy Odense Denmark
| | - P Finocchietto
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - A E Jonsson
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - S Madsbad
- Department of Endocrinology, Hvidovre Hospital University of Copenhagen Hvidovre Denmark
| | - J J Holst
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - H Vestergaard
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - T Hansen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - S S Torekov
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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26
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Peterson L, Lundgren J, Carlsson SG. A multi-facet pain survey of psychosocial complaints among patients with long-standing non-malignant pain. Scand J Pain 2017; 17:68-76. [DOI: 10.1016/j.sjpain.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 06/28/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
Abstract
Background and aims
Psychometric inventories and scales intended to measure cognitive, emotional and behavioural concomitants of pain are typically constructed by deducting items from theoretically derived concepts related to pain states, e.g. social support, perceived control, depressiveness, and catas- trophizing. The aim of this study was to design a clinically useful, generic pain distress inventory - The Multi-Facet Pain Survey (MFPS) - inductively derived from psychological and social complaints reported by a study group of individuals with severe chronic nonmalignant pain.
Methods
Extensive clinical interviews with hospitalized chronic pain patients were made by clinical psychologists. The purpose was to highlight the patients’ pain histories and their beliefs and feelings about the pain, and to determine factors possibly influencing their rehabilitation potential. The types of distress reported were sorted into categories with a procedure similar to content analysis. Distress reports were converted to statements, forming items in a questionnaire, the Multi-Facet Pain Survey.
Results
Our analyses supported a distress structure including 15 categories, or “facets”, comprising in all 190 types of psychosocial distress. Ten of the facets denote beliefs about the present condition and aspects of distress experienced in daily life (e.g. cognitive problems); three facets reflect the illness history, and two the patient’s views on future prospects. To improve the clinical utility, we shortened the scale into a 53 items inventory. A factor analysis of these 53 items revealed four clinically meaningful factors: (1) stress-related exhaustion; (2) impact of pain on daily life; (3) self-inefficacy in regard to future prospects; and (4) negative experiences of health care. While the second factor represents distress directly related to the pain, the first factor reflects long-term exhaustion effects of the pain condition similar to those seen in individuals exposed to long periods of stress. Items loading in the third factor reflect a pessimistic outlook on the future. The content validity of the scale was explored by predicting and testing correlations between the 15 MFPS facets, and the Symptom Checklist (SCL-90) and the West Haven Yale Multidimensional Pain Inventory (MPI). Some of the MFPS facets showed little or no agreement with any of the subscales of the comparison measures. The homogeneity was satisfactory both for facets and factors.
Conclusions
The Multi-Facet Pain Survey (MFPS) facets cover a broad array of experienced psychosocial distress in patients with severe, longstanding pain. Some facets of psychosocial impact of longstanding pain states shown in the qualitatively derived distress facets, or by the latent factors found in the factor analysis, may complement our understanding of the long-term impact of pain. Consequently, MFPS may improve the assessment of psychological and social complaints and complications in patients with chronic pain.
Implications
The MFPS will hopefully be an assessment tool supporting the psychological contribu-tion to a biopsychosocial evaluation of patients with severe, longstanding pain. By exposing a broadrange of suffering, MFPS may contribute to alternative treatment options and a better prognosis of future rehabilitation.
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Affiliation(s)
- Leif Peterson
- Department of Psychology , University of Gothenburg , Gothenburg , Sweden
| | - Jesper Lundgren
- Department of Psychology , University of Gothenburg , Gothenburg , Sweden
| | - Sven G. Carlsson
- Department of Psychology , University of Gothenburg , Gothenburg , Sweden
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27
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Oras J, Lundgren J, Redfors B, Brandin D, Omerovic E, Seeman-Lodding H, Ricksten SE. Takotsubo syndrome in hemodynamically unstable patients admitted to the intensive care unit - a retrospective study. Acta Anaesthesiol Scand 2017; 61:914-924. [PMID: 28718877 DOI: 10.1111/aas.12940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/02/2017] [Accepted: 06/21/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Takotsubo syndrome (TS) is an acute cardiac condition that is often triggered by critical illness but that has rarely been studied in the intensive care unit (ICU) setting. The aim of this study was to (i) estimate the incidence of TS in a hemodynamically unstable ICU-population; (ii) identify predictors of TS in this population; (iii) study the impact of TS on prognosis and course of hospitalization. METHODS Medical records from all patients admitted to our general ICU from 2012 to 2015 were analyzed. TS was defined as having transient regional wall motion abnormalities (RWMA) with a typical pattern not attributable to a history of coronary artery disease or acute coronary syndromes. RESULTS Out of 6470 patients admitted to the ICU, echocardiography due to hemodynamic instability was performed in 1051 patients; 467 had LV dysfunction and 59 fulfilled TS criteria. Patients with TS had higher SAPS 3 scores on admission than patients with normal LV function. Septic shock, cardiac arrest, cerebral mass lesion, female sex and low pH were independently associated with TS on admission. Patients with TS needed more ICU resources measured by higher NEMS scores and longer ICU-stay. Crude mortality was higher in TS patients (32%) vs the ICU-population (20%, P = 0.020), but there were no differences in a SAPS 3 adjusted analysis. CONCLUSION TS was not an uncommon cause of LV dysfunction in hemodynamically unstable ICU-patients. Furthermore, TS was associated with a more complex disease. TS is a complication to take in consideration in the critically ill.
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Affiliation(s)
- J. Oras
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - J. Lundgren
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - B. Redfors
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - D. Brandin
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Omerovic
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - H. Seeman-Lodding
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S.-E. Ricksten
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Shepherd L, Borges ÁH, Harvey R, Bower M, Grulich A, Silverberg M, Weber J, Ristola M, Viard JP, Bogner JR, Gargalianos-Kakolyris P, Mussini C, Mansinho K, Yust I, Paduta D, Jilich D, Smiatacz T, Radoi R, Tomazic J, Plomgaard P, Frikke-Schmidt R, Lundgren J, Mocroft A. The extent of B-cell activation and dysfunction preceding lymphoma development in HIV-positive people. HIV Med 2017; 19:90-101. [PMID: 28857427 DOI: 10.1111/hiv.12546] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Accepted: 07/05/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES B-cell dysfunction and activation are thought to contribute to lymphoma development in HIV-positive people; however, the mechanisms are not well understood. We investigated levels of several markers of B-cell dysfunction [free light chain (FLC)-κ, FLC-λ, immunoglobulin G (IgG), IgA, IgM and IgD] prior to lymphoma diagnosis in HIV-positive people. METHODS A nested matched case-control study was carried out within the EuroSIDA cohort, including 73 HIV-positive people with lymphoma and 143 HIV-positive lymphoma-free controls. Markers of B-cell dysfunction were measured in prospectively stored serial plasma samples collected before the diagnosis of lymphoma (or selection date in controls). Marker levels ≤ 2 and > 2 years prior to diagnosis were investigated. RESULTS Two-fold higher levels of FLC-κ [odds ratio (OR) 1.84; 95% confidence interval (CI) 1.19, 2.84], FLC-λ (OR 2.15; 95% CI 1.34, 3.46), IgG (OR 3.05; 95% CI 1.41, 6.59) and IgM (OR 1.46; 95% CI 1.01, 2.11) were associated with increased risk of lymphoma > 2 years prior to diagnosis, but not ≤ 2 years prior. Despite significant associations > 2 years prior to diagnosis, the predictive accuracy of each marker was poor, with FLC-λ emerging as the strongest candidate with a c-statistic of 0.67 (95% CI 0.58, 0.76). CONCLUSIONS FLC-κ, FLC-λ and IgG levels were higher > 2 years before lymphoma diagnosis, suggesting that B-cell dysfunction occurs many years prior to lymphoma development. However, the predictive value of each marker was low and they are unlikely candidates for risk assessment for targeted intervention.
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Affiliation(s)
- L Shepherd
- Research Department of Infection and Population Health, University College London, London, UK
| | - Á H Borges
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - R Harvey
- Charing Cross Oncology Laboratory and Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College Healthcare National Health Service Trust, London, UK
| | - M Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Grulich
- Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - M Silverberg
- Kaiser Permanente Northern California, Oakland, CA, USA
| | - J Weber
- Imperial College London, London, UK
| | - M Ristola
- Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J-P Viard
- AP-HP, Diagnostic & Therapeutic Center, Hotel Dieu Hospital, Paris, France
| | - J R Bogner
- Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - P Gargalianos-Kakolyris
- First Department of Internal Medicine and Infectious Diseases Unit, General Hospital of Athens "G. Gennimatas", Athens, Greece
| | - C Mussini
- Clinic of Infectious and Tropical Diseases, University of Modena and Reggio Emilia, Azienda Policlinico, Modena, Italy
| | - K Mansinho
- Department of Infectious Diseases, Hospital Egas Moniz-CHLO, E.P.E., Lisboa, Portugal
| | - I Yust
- Ichilov Hospital, Tel Aviv, Israel
| | - D Paduta
- Gomel Regional Centre for Hygiene, Gomel, Belarus
| | - D Jilich
- Department of Infectious and Tropical Diseases, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - T Smiatacz
- Infectious Diseases Department, Medical University of Gdańsk, Gdańsk, Poland
| | - R Radoi
- Clinical Hospital of Infectious and Tropical Diseases 'Dr. Victor Babeş', Bucharest, Romania
| | - J Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - P Plomgaard
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - R Frikke-Schmidt
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - J Lundgren
- Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Research Department of Infection and Population Health, University College London, London, UK
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Lundgren J, Nielsen S, Scheele C, Rådegran G. Alterations in Vascular Endothelial Growth Factors After Heart Transplantation. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1128] [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: 11/25/2022] Open
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Oras J, Redfors B, Ali A, Lundgren J, Sihlbom C, Thorsell A, Seeman-Lodding H, Omerovic E, Ricksten SE. Anaesthetic-induced cardioprotection in an experimental model of the Takotsubo syndrome - isoflurane vs. propofol. Acta Anaesthesiol Scand 2017; 61:309-321. [PMID: 28111740 DOI: 10.1111/aas.12857] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Takotsubo syndrome (TS) is an acute cardiac condition with a substantial mortality for which no specific treatment is available. We have previously shown that isoflurane attenuates the development of left ventricular (LV) dysfunction in an experimental TS-model. We compared the effects of equi-anaesthetic doses of isoflurane, propofol and ketamine+midazolam on haemodynamics, global and regional LV systolic function and the activation of intracellular metabolic pathways in experimental TS. We hypothesized that cardioprotection in experimental TS is specific for isoflurane. METHODS Forty-five rats were randomized to isoflurane (0.6 MAC, n = 15), propofol (bolus 200 mg/kg+360 mg/kg/h, n = 15) or ketamine (100 mg/kg)+midazolam (10 mg/kg, n = 15) anaesthesia. Arterial pressure, heart rate and body temperature were continuously measured and arterial blood gas analysis was performed intermittently. TS was induced by intraperitoneal injection of isoprenaline, 50 mg/kg. LV echocardiography was performed 90 min after isoprenaline injection. Apical cardiac tissue was analysed by global discovery proteomics and pathway analysis. RESULTS Isoprenaline-induced changes in arterial blood pressure, heart rate or body temperature did not differ between groups. LV ejection fraction was higher and extent of LV akinesia was lower with isoflurane, when compared with the propofol and the ketamine+midazolam groups. In this TS-model, the proteomic analysis revealed an up-regulation of pathways involved in inflammation, coagulation, endocytosis and lipid metabolism. This up-regulation was clearly attenuated with isoflurane compared to propofol. CONCLUSION In an experimental model of TS, isoflurane, but not propofol, exerts a cardioprotective effect. The proteomic analysis suggests that inflammation might be involved in pathogenesis of TS.
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Affiliation(s)
- J. Oras
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - B. Redfors
- Department of Molecular and Clinical Medicine; Wallenberg Laboratory; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - A. Ali
- Department of Molecular and Clinical Medicine; Wallenberg Laboratory; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - J. Lundgren
- Department of Molecular and Clinical Medicine; Wallenberg Laboratory; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - C. Sihlbom
- Proteomics Core Facility; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - A. Thorsell
- Proteomics Core Facility; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - H. Seeman-Lodding
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - E. Omerovic
- Department of Molecular and Clinical Medicine; Wallenberg Laboratory; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Cardiology; Institute of Medicine; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - S.-E. Ricksten
- The Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Nguy L, Shubbar E, Jernås M, Nookaew I, Lundgren J, Olsson B, Nilsson H, Guron G. Adenine-induced chronic renal failure in rats decreases aortic relaxation rate and alters expression of proteins involved in vascular smooth muscle calcium handling. Acta Physiol (Oxf) 2016; 218:250-264. [PMID: 27239807 DOI: 10.1111/apha.12724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/08/2015] [Revised: 11/24/2015] [Accepted: 05/27/2016] [Indexed: 12/23/2022]
Abstract
AIM Rats with adenine-induced chronic renal failure (A-CRF) develop a reduced rate of relaxation of the thoracic aorta. The aim of this study was to elucidate the mechanisms underlying this abnormality. METHODS Male Sprague Dawley rats received either chow containing adenine or were pair-fed with normal chow (controls). After 8-14 weeks, arterial function was analysed ex vivo using wire myography and the expression of proteins involved in vascular smooth muscle excitation-contraction coupling in the thoracic aorta was analysed. RESULTS The rate of relaxation following washout of KCl was reduced in A-CRF rats vs. controls in the thoracic aorta (P < 0.01), abdominal aorta (P < 0.05), and common carotid artery (P < 0.05), but not in the common femoral artery. Relaxation rates of thoracic aortas increased (P < 0.01), but were not normalized, in response to washout of KCl with Ca2+ -free buffer. Microarray and qRT-PCR analyses of genes involved in excitation-contraction coupling identified 10 genes, which showed significantly altered expression in A-CRF thoracic aortas. At the protein level, the α2 subunit of the Na,K-ATPase (P < 0.001) and SERCA2 (P < 0.05) was significantly downregulated, whereas stromal interaction molecule 1 and calsequestrin-1 and calsequestrin-2 were significantly upregulated (P < 0.05). CONCLUSIONS Rats with A-CRF show a marked alteration in relaxation of larger conduit arteries localized proximal to the common femoral artery. This abnormality may be caused by reduced cytosolic Ca2+ clearance in vascular smooth muscle cells secondary to dysregulation of proteins crucially involved in this process.
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Affiliation(s)
- L. Nguy
- Department of Molecular and Clinical Medicine/Nephrology; Institute of Medicine; Gothenburg Sweden
- Department of Physiology; Institute of Neuroscience and Physiology; Gothenburg Sweden
| | - E. Shubbar
- Department of Molecular and Clinical Medicine/Nephrology; Institute of Medicine; Gothenburg Sweden
| | - M. Jernås
- Department of Internal Medicine; Institute of Medicine; Gothenburg Sweden
| | - I. Nookaew
- Department of Chemical and Biological Engineering; Chalmers University of Technology; Gothenburg Sweden
- Comparative Genomics Group; Biosciences Division; Oak Ridge National Laboratory; Oak Ridge TN USA
| | - J. Lundgren
- Department of Molecular and Clinical Medicine/Nephrology; Institute of Medicine; Gothenburg Sweden
| | - B. Olsson
- Department of Psychiatry and Neurochemistry; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - H. Nilsson
- Department of Physiology; Institute of Neuroscience and Physiology; Gothenburg Sweden
| | - G. Guron
- Department of Molecular and Clinical Medicine/Nephrology; Institute of Medicine; Gothenburg Sweden
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Lord E, Stockdale AJ, Malek R, Rae C, Sperle I, Raben D, Freedman A, Churchill D, Lundgren J, Sullivan AK. Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions. HIV Med 2016; 18:300-304. [PMID: 27535357 PMCID: PMC5347885 DOI: 10.1111/hiv.12430] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Accepted: 06/02/2016] [Indexed: 01/19/2023]
Abstract
Objectives European guidelines recommend HIV testing for individuals presenting with indicator conditions (ICs) including AIDS‐defining conditions (ADCs). The extent to which non‐HIV specialty guidelines recommend HIV testing in ICs and ADCs is unknown. Our aim was to pilot a methodology in the UK to review specialty guidelines and ascertain if HIV was discussed and testing recommended. Methods UK and European HIV testing guidelines were reviewed to produce a list of 25 ADCs and 49 ICs. UK guidelines for these conditions were identified from searches of the websites of specialist societies, the National Institute of Clinical Excellence (NICE) website, the NICE Clinical Knowledge Summaries (CKS) website, the Scottish Intercollegiate Guidance Network (SIGN) website and the British Medical Journal Best Practice database and from Google searches. Results We identified guidelines for 12 of 25 ADCs (48%) and 36 of 49 (73%) ICs. In total, 78 guidelines were reviewed (range 0–13 per condition). HIV testing was recommended in six of 17 ADC guidelines (35%) and 24 of 61 IC guidelines (39%). At least one guideline recommended HIV testing for six of 25 ADCs (24%) and 16 of 49 ICs (33%). There was no association between recommendation to test and publication year (P = 0.62). Conclusions The majority of guidelines for ICs do not recommend testing. Clinicians managing ICs may be unaware of recommendations produced by HIV societies or the prevalence of undiagnosed HIV infection among these patients. We are piloting methods to engage with guideline development groups to ensure that patients diagnosed with ICs/ADCs are tested for HIV. We then plan to apply our methodology in other European settings as part of the Optimising Testing and Linkage to Care for HIV across Europe (OptTEST) project.
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Affiliation(s)
- E Lord
- Department of Sexual Health, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A J Stockdale
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - R Malek
- Imperial College London NHS Healthcare, St Mary's Hospital, London, UK
| | - C Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - I Sperle
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - D Raben
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Freedman
- Cardiff University School of Medicine, Cardiff, UK
| | - D Churchill
- Royal Sussex County Hospital, Brighton and Hove, UK
| | - J Lundgren
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Shepherd L, Borges Á, Ledergerber B, Domingo P, Castagna A, Rockstroh J, Knysz B, Tomazic J, Karpov I, Kirk O, Lundgren J, Mocroft A. Infection-related and -unrelated malignancies, HIV and the aging population. HIV Med 2016; 17:590-600. [PMID: 26890156 DOI: 10.1111/hiv.12359] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES HIV-positive people have increased risk of infection-related malignancies (IRMs) and infection-unrelated malignancies (IURMs). The aim of the study was to determine the impact of aging on future IRM and IURM incidence. METHODS People enrolled in EuroSIDA and followed from the latest of the first visit or 1 January 2001 until the last visit or death were included in the study. Poisson regression was used to investigate the impact of aging on the incidence of IRMs and IURMs, adjusting for demographic, clinical and laboratory confounders. Linear exponential smoothing models forecasted future incidence. RESULTS A total of 15 648 people contributed 95 033 person-years of follow-up, of whom 610 developed 643 malignancies [IRMs: 388 (60%); IURMs: 255 (40%)]. After adjustment, a higher IRM incidence was associated with a lower CD4 count [adjusted incidence rate ratio (aIRR) CD4 count < 200 cells/μL: 3.77; 95% confidence interval (CI) 2.59, 5.51; compared with ≥ 500 cells/μL], independent of age, while a CD4 count < 200 cells/μL was associated with IURMs in people aged < 50 years only (aIRR: 2.51; 95% CI 1.40-4.54). Smoking was associated with IURMs (aIRR: 1.75; 95% CI 1.23, 2.49) compared with never smokers in people aged ≥ 50 years only, and not with IRMs. The incidences of both IURMs and IRMs increased with older age. It was projected that the incidence of IRMs would decrease by 29% over a 5-year period from 3.1 (95% CI 1.5-5.9) per 1000 person-years in 2011, whereas the IURM incidence would increase by 44% from 4.1 (95% CI 2.2-7.2) per 1000 person-years over the same period. CONCLUSIONS Demographic and HIV-related risk factors for IURMs (aging and smoking) and IRMs (immunodeficiency and ongoing viral replication) differ markedly and the contribution from IURMs relative to IRMs will continue to increase as a result of aging of the HIV-infected population, high smoking and lung cancer prevalence and a low prevalence of untreated HIV infection. These findings suggest the need for targeted preventive measures and evaluation of the cost-benefit of screening for IURMs in HIV-infected populations.
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Affiliation(s)
- L Shepherd
- Department of Infection and Population Health, University College London Medical School, London, UK
| | - Áh Borges
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
| | | | - A Castagna
- San Raffaele Scientific Institute, Milan, Italy
| | - J Rockstroh
- Department of Medicine I, University Hospital Bonn, Bonn, Germany
| | - B Knysz
- Department of Infectious Diseases, Wroclaw University, Wroclaw, Poland
| | - J Tomazic
- Department of Infectious Diseases, University Clinical Centre Ljubljana, Ljubljana, Slovenia
| | - I Karpov
- Belarus State Medical University, Minsk, Belarus
| | - O Kirk
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Lundgren
- Centre for Health and Infectious Diseases Research (CHIP), Department of Infectious Diseases and Rheumatology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Mocroft
- Department of Infection and Population Health, University College London Medical School, London, UK
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Oldin A, Lundgren J, Norén JG, Robertson A. Individual risk factors associated with general unintentional injuries and the relationship to traumatic dental injuries among children aged 0-15 years in the Swedish BITA study. Dent Traumatol 2016; 32:296-305. [PMID: 26799248 DOI: 10.1111/edt.12258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/29/2022]
Abstract
AIM To investigate general unintentional injuries (GUI) and traumatic dental injuries (TDI) in relation to behavioral and psychosocial strengths and difficulties among Swedish children aged 0-17 years, and to investigate general unintentional injuries in relation to temperament and socioeconomic status among the same children. SUBJECTS AND METHODS The study included 2363 children in four different age cohorts aged 3, 7, 11, and 15 years at the study start. Twelve Public Dental Service clinics in Sweden participated, representing different types of demographic areas, both rural and urban. Data were collected from parents and children through an interview, questionnaires, and dental records. RESULTS Twenty-four percentage (24%) of the children had experienced a serious general unintentional injury (GUI) at some point during their lifetime up until 3 months prior to the study start. Children who were regarded by their parents as being injured more often than other children also had occasions with general unintentional injuries to a greater extent. Most general unintentional injuries occurred at home. Children with incidents of general unintentional injuries had occasions with TDI to a greater extent than children without general unintentional injury. Children, whose mothers had 11 years of school/education or less, were involved in more general unintentional injuries during the 3-month period prior to the study start, compared to children of mothers with higher education level. CONCLUSIONS Children with general unintentional injuries had more traumatic dental injuries. Children who were assessed by their parents as being injured more often than other children also had occasions with general unintentional injuries to a greater extent. Temperament, behavioral and psychosocial strengths and difficulties had different impacts at different ages for experiencing a general unintentional injury.
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Affiliation(s)
- Anna Oldin
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Jörgen G Norén
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Robertson
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Moestedt J, Nordell E, Shakeri Yekta S, Lundgren J, Martí M, Sundberg C, Ejlertsson J, Svensson BH, Björn A. Effects of trace element addition on process stability during anaerobic co-digestion of OFMSW and slaughterhouse waste. Waste Manag 2016; 47:11-20. [PMID: 25827257 DOI: 10.1016/j.wasman.2015.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/24/2015] [Accepted: 03/02/2015] [Indexed: 06/04/2023]
Abstract
This study used semi-continuous laboratory scale biogas reactors to simulate the effects of trace-element addition in different combinations, while degrading the organic fraction of municipal solid waste and slaughterhouse waste. The results show that the combined addition of Fe, Co and Ni was superior to the addition of only Fe, Fe and Co or Fe and Ni. However, the addition of only Fe resulted in a more stable process than the combined addition of Fe and Co, perhaps indicating a too efficient acidogenesis and/or homoacetogenesis in relation to a Ni-deprived methanogenic population. The results were observed in terms of higher biogas production (+9%), biogas production rates (+35%) and reduced VFA concentration for combined addition compared to only Fe and Ni. The higher stability was supported by observations of differences in viscosity, intraday VFA- and biogas kinetics as well as by the 16S rRNA gene and 16S rRNA of the methanogens.
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Affiliation(s)
- J Moestedt
- Department of R&D Biogas, Tekniska verken i Linköping AB, SE-581 15 Linköping, Sweden; Department of Microbiology, BioCenter, Swedish University of Agricultural Sciences, SE-750 07 Uppsala, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden.
| | - E Nordell
- Department of R&D Biogas, Tekniska verken i Linköping AB, SE-581 15 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden
| | - S Shakeri Yekta
- Department of Thematic Studies, Water and Environmental Studies, Linköping University, SE-581 83 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden
| | - J Lundgren
- Department of R&D Biogas, Tekniska verken i Linköping AB, SE-581 15 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden
| | - M Martí
- Department of Thematic Studies, Water and Environmental Studies, Linköping University, SE-581 83 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden
| | - C Sundberg
- Department of Thematic Studies, Water and Environmental Studies, Linköping University, SE-581 83 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden
| | - J Ejlertsson
- Department of Thematic Studies, Water and Environmental Studies, Linköping University, SE-581 83 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden; Scandinavian Biogas Fuels AB, SE-111 60 Stockholm, Sweden
| | - B H Svensson
- Department of Thematic Studies, Water and Environmental Studies, Linköping University, SE-581 83 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden
| | - A Björn
- Department of Thematic Studies, Water and Environmental Studies, Linköping University, SE-581 83 Linköping, Sweden; Biogas Research Center, Linköping University, SE-581 83 Linköping, Sweden
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Baxter JD, Dunn D, White E, Sharma S, Geretti AM, Kozal MJ, Johnson MA, Jacoby S, Llibre JM, Lundgren J. Global HIV-1 transmitted drug resistance in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial. HIV Med 2015; 16 Suppl 1:77-87. [PMID: 25711326 DOI: 10.1111/hiv.12236] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES HIV-1 transmitted drug resistance (TDR) in treatment-naïve individuals is a well-described phenomenon. Baseline genotypic resistance testing is considered standard of care in most developed areas of the world. The aim of this analysis was to characterize HIV-1 TDR and the use of resistance testing in START trial participants. METHODS In the Strategic Timing of AntiRetroviral Treatment (START) trial, baseline genotypic resistance testing results were collected at study entry and analysed centrally to determine the prevalence of TDR in the study population. Resistance was based on a modified 2009 World Health Organization definition to reflect newer resistance mutations. RESULTS Baseline resistance testing was available in 1946 study participants. Higher rates of testing occurred in Europe (86.7%), the USA (81.3%) and Australia (89.9%) as compared with Asia (22.2%), South America (1.8%) and Africa (0.1%). The overall prevalence of TDR was 10.1%, more commonly to nonnucleoside reverse transcriptase inhibitors (4.5%) and nucleoside reverse transcriptase inhibitors (4%) compared with protease inhibitors (2.8%). The most frequent TDR mutations observed were M41L, D67N/G/E, T215F/Y/I/S/C/D/E/V/N, 219Q/E/N/R, K103N/S, and G190A/S/E in reverse transcriptase, and M46I/L and L90M in protease. By country, the prevalence of TDR was highest in Australia (17.5%), France (16.7%), the USA (12.6%) and Spain (12.6%). No participant characteristics were identified as predictors of the presence of TDR. CONCLUSIONS START participants enrolled in resource-rich areas of the world were more likely to have baseline resistance testing. In Europe, the USA and Australia, TDR prevalence rates varied by country.
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Affiliation(s)
- J D Baxter
- Cooper University Hospital/Cooper Medical School of Rowan University, Camden, NJ, USA
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Wide Boman U, Armfield JM, Carlsson SG, Lundgren J. Translation and psychometric properties of the Swedish version of the Index of Dental Anxiety and Fear (IDAF-4C+). Eur J Oral Sci 2015; 123:453-9. [DOI: 10.1111/eos.12229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ulla Wide Boman
- Department of Behavioral and Community Dentistry; Institute of Odontology; The Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - Jason M. Armfield
- Australian Research Centre for Population Oral Health; School of Dentistry; University of Adelaide; Adelaide SA Australia
| | - Sven G. Carlsson
- Department of Psychology; University of Gothenburg; Göteborg Sweden
| | - Jesper Lundgren
- Department of Psychology; University of Gothenburg; Göteborg Sweden
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Oldin A, Lundgren J, Norén JG, Robertson A. Reply from the Authors. Dent Traumatol 2015; 31:419. [PMID: 26358628 DOI: 10.1111/edt.12212] [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: 12/01/2022]
Affiliation(s)
- Anna Oldin
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Jörgen G Norén
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Robertson
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Achhra AC, Mocroft A, Reiss P, Sabin C, Ryom L, de Wit S, Smith CJ, d'Arminio Monforte A, Phillips A, Weber R, Lundgren J, Law MG. Short-term weight gain after antiretroviral therapy initiation and subsequent risk of cardiovascular disease and diabetes: the D:A:D study. HIV Med 2015. [PMID: 26216031 DOI: 10.1111/hiv.12294] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [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: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to assess the impact of the gain in body mass index (BMI) observed immediately after antiretroviral therapy (ART) initiation on the subsequent risk of cardiovascular disease (CVD) and diabetes. METHODS We analysed data from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) cohort study. Outcomes were development of (i) CVD (composite of myocardial infarction/stroke/coronary procedure) and (ii) diabetes. The main exposure variable was change in BMI from ART initiation (pre-ART) to 1 year after initiation (continuous variable) in treatment-naïve individuals initiating ART with no history of CVD or diabetes (for respective outcomes). BMI [weight (kg)/(height (m))(2)] was categorized as underweight (< 18.5), normal (18.5-25), overweight (25-30) and obese (> 30). Poisson regression models were fitted stratified for each pre-ART BMI category to allow for category-specific estimates of incidence rate ratio (IRR). Models were adjusted for pre-ART BMI and CD4 count, key known risk factors (time-updated where possible) and calendar year. RESULTS A total of 97 CVD events occurred in 43,982 person-years (n = 9321) and 125 diabetes events in 43,278 person-years (n = 9193). In fully adjusted analyses for CVD, the IRR/unit gain in BMI (95% confidence interval) in the first year of ART, by pre-ART BMI category, was: underweight, 0.90 (0.60-1.37); normal, 1.18 (1.05-1.33); overweight, 0.87 (0.70-1.10), and obese, 0.95 (0.71-1.28) (P for interaction = 0.04). For diabetes, the IRR/unit gain in BMI was 1.11 (95% confidence interval 1.03 to 1.21), regardless of pre-ART BMI (P for interaction > 0.05). CONCLUSIONS Short-term gain in BMI following ART initiation appeared to increase the longer term risk of CVD, but only in those with pre-ART BMI in the normal range. It was also associated with increased risk of diabetes regardless of pre-ART BMI.
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Affiliation(s)
- A C Achhra
- Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - A Mocroft
- Research Department of Infection & Population Health, University College London, London, UK
| | - P Reiss
- Division of Infectious Diseases and Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - C Sabin
- Research Department of Infection & Population Health, University College London, London, UK
| | - L Ryom
- University of Copenhagen, Copenhagen, Denmark
| | - S de Wit
- Infectious Diseases Department, Saint-Pierre University Hospital, Brussels, Belgium
| | - C J Smith
- Research Department of Infection & Population Health, University College London, London, UK
| | | | - A Phillips
- Research Department of Infection & Population Health, University College London, London, UK
| | - R Weber
- University Hospital in Zurich, Zurich, Switzerland
| | - J Lundgren
- Rigshospitalet & University of Copenhagen, Copenhagen, Denmark
| | - M G Law
- Kirby Institute, UNSW Australia, Sydney, NSW, Australia
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Oldin A, Lundgren J, Norén JG, Robertson A. Temperamental and socioeconomic factors associated with traumatic dental injuries among children aged 0-17 years in the Swedish BITA study. Dent Traumatol 2015; 31:361-7. [PMID: 25962323 DOI: 10.1111/edt.12180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 11/27/2022]
Abstract
AIM The aim of the study was to identify individual risk factors for traumatic dental injuries (TDI) among Swedish children aged 0-17 years. The studied risk factors were temperamental reactivity of the child, family structure, parent's country of birth, and the socioeconomic status of the family represented by parental education and occupation. SUBJECTS AND METHODS The study included 2363 children in four different age cohorts at 12 public dental service clinics in Sweden, representing different types of demographic areas, both rural and urban. Data were collected from parents and children through an interview and questionnaires. RESULTS The more social and active children in the two older age cohorts showed less occasions of TDI. Having one parent/guardian protected the child from dental injury just as well as two parents/guardians. Parents born outside of the Nordic countries showed children with less TDI. Low parental education was related to more occasions of TDI among the children. CONCLUSIONS This study has increased the knowledge on certain individual risk factors for TDI. To prevent dental injuries, information could be given to families and children at risk.
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Affiliation(s)
- Anna Oldin
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesper Lundgren
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Jörgen G Norén
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Robertson
- Department of Pediatric Dentistry, Institute of Odontology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Abstract
Molar incisor hypomineralization (MIH) is a developmental disturbance of the enamel. This study presents analyses of hypomineralized and normal enamel in first molar teeth diagnosed with MIH, utilizing time-of-flight secondary ion mass spectrometry area analyses and X-ray microanalysis of area and spot profiles in uncoated samples between gold lines which provide electrical conductivity. Statistical analysis of mean values allows discrimination of normal from MIH enamel, which has higher Mg and lower Na and P. Inductive analysis using complete data sets for profiles from the enamel surface to the enamel-dentin junction found that Mg, Cl and position in the profile provide useful discrimination criteria. Element profiles provide a visual complement to the inductive analysis and several elements also provide insight into the development of both normal and MIH enamel. The higher Mg content and different Cl profiles of hypomineralized enamel compared with normal enamel are probably related to a relatively short period during the development of ameloblasts between birth and the 1st year of life.
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Affiliation(s)
- Lisa Melin
- 1Department of Pediatric Dentistry,Institute of Odontology at the Sahlgrenska Academy,University of Gothenburg,P.O. Box 450,SE 405 30 Gothenburg,Sweden
| | - Jesper Lundgren
- 2Department of Psychology,University of Gothenburg,P.O. Box 500,SE 405 30 Gothenburg,Sweden
| | - Per Malmberg
- 3Department of Chemical and Biological Engineering,Chalmers University of Technology,Kemivägen 10,412 96 Gothenburg,Sweden
| | - Jörgen G Norén
- 1Department of Pediatric Dentistry,Institute of Odontology at the Sahlgrenska Academy,University of Gothenburg,P.O. Box 450,SE 405 30 Gothenburg,Sweden
| | - Fabian Taube
- 4Department of Occupational and Environmental Medicine,Sahlgrenska University Hospital,P.O. Box 414,SE 405 30 Gothenburg,Sweden
| | - David H Cornell
- 5Department of Earth Sciences,University of Gothenburg,P.O. Box 460,SE 405 30 Gothenburg,Sweden
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Vingerhoets J, Calvez V, Flandre P, Marcelin AG, Ceccherini-Silberstein F, Perno CF, Mercedes Santoro M, Bateson R, Nelson M, Cozzi-Lepri A, Grarup J, Lundgren J, Incardona F, Kaiser R, Sonnerborg A, Clotet B, Paredes R, Günthard HF, Ledergerber B, Hoogstoel A, Nijs S, Tambuyzer L, Lavreys L, Opsomer M. Efficacy of etravirine combined with darunavir or other ritonavir-boosted protease inhibitors in HIV-1-infected patients: an observational study using pooled European cohort data. HIV Med 2015; 16:297-306. [PMID: 25585664 DOI: 10.1111/hiv.12218] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This observational study in antiretroviral treatment-experienced, HIV-1-infected adults explored the efficacy of etravirine plus darunavir/ritonavir (DRV group; n = 999) vs. etravirine plus an alternative boosted protease inhibitor (other PI group; n = 116) using pooled European cohort data. METHODS Two international (EuroSIDA; EUResist Network) and five national (France, Italy, Spain, Switzerland and UK) cohorts provided data (collected in 2007-2012). Stratum-adjusted (for confounding factors) Mantel-Haenszel differences in virological responses (viral load < 50 HIV-1 RNA copies/mL) and odds ratios (ORs) with 95% confidence intervals (CIs) were derived. RESULTS Baseline characteristics were balanced between groups except for previous use of antiretrovirals (≥ 10: 63% in the DRV group vs. 49% in the other PI group), including previous use of at least three PIs (64% vs. 53%, respectively) and mean number of PI resistance mutations (2.3 vs. 1.9, respectively). Week 24 responses were 73% vs. 75% (observed) and 49% vs. 43% (missing = failure), respectively. Week 48 responses were 75% vs. 73% and 32% vs. 30%, respectively. All 95% CIs around unadjusted and adjusted differences encompassed 0 (difference in responses) or 1 (ORs). While ORs by cohort indicated heterogeneity in response, for pooled data the difference between unadjusted and adjusted for cohort ORs was small. CONCLUSIONS These data do not indicate a difference in response between the DRV and other PI groups, although caution should be applied given the small size of the other PI group and the lack of randomization. This suggests that the efficacy and virology results from DUET can be extrapolated to a regimen of etravirine with a boosted PI other than darunavir/ritonavir.
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Fägerstad A, Lundgren J, Arnrup K. Dental fear among children and adolescents in a multicultural population--a cross-sectional study. Swed Dent J 2015; 39:109-120. [PMID: 26529836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study was to explore dental fear in a multicultural population of child and adolescent dental patients, with background, gender, age, and socioeconomic status taken into account. A specific aim was to investigate whether the level of DF differed between patients with a non- Swedish background and patients with a Swedish background. In conjunction with a routine visit to the dental clinic, 301 patients (8-19 years old) assessed their dental fear on the Children's Fear Survey Schedule - Dental Subscale, using self-ratings. Following an interview protocol, patients' and their parents' country of birth, and parents' education and occupation/employment were registered. An interpreter was present when needed. Self-rated dental fear was almost equal among patients coming from a non-Swedish background and patients with a Swedish background. Girls scored higher than boys and younger children scored slightly higher compared to older children, but the pattern of dental fear variation was inconsistent. Socioeconomic status differed between the groups with a non-Swedish vs. a Swedish background, but no impact on dental fear was revealed. When children and adolescents with a non-Swedish vs. a Swedish background were modelled separately, female gender and younger age had an impact on dental fear only in the group with a Swedish background. No differences in dental fear were found between children and adolescents from non-Swedish vs. Swedish backgrounds. Dental fear variations according to gender and age were more pronounced in the group with a Swedish background compared to the group with a non-Swedish background. No impact of socioeconomic status could be revealed.
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Affiliation(s)
- V Delpech
- Public Health England, London, United Kingdom
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Oldin A, Lundgren J, Nilsson M, Norén JG, Robertson A. Traumatic dental injuries among children aged 0-17 years in the BITA study - A longitudinal Swedish multicenter study. Dent Traumatol 2014; 31:9-17. [DOI: 10.1111/edt.12125] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Anna Oldin
- Department of Pediatric Dentistry; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Jesper Lundgren
- Department of Psychology; University of Gothenburg; Gothenburg Sweden
| | - Marita Nilsson
- Region Västra Götaland; Public Dental Service; Gothenburg Sweden
| | - Jörgen G. Norén
- Department of Pediatric Dentistry; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Agneta Robertson
- Department of Pediatric Dentistry; Institute of Odontology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Kapetanakis M, Liuba P, Odermarsky M, Lundgren J, Hallböök T. Effects of ketogenic diet on vascular function. Eur J Paediatr Neurol 2014; 18:489-94. [PMID: 24703903 DOI: 10.1016/j.ejpn.2014.03.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 10/04/2013] [Revised: 03/09/2014] [Accepted: 03/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ketogenic diet is a well-established treatment in children with difficult to treat epilepsy. Very little is known about the long-term effects on vascular atherogenic and biochemical processes of this high-fat and low carbohydrate and protein diet. METHODS We evaluated 26 children after one year and 13 children after two years of ketogenic diet. High resolution ultrasound-based assessment was used for carotid artery intima-media thickness (cIMT), carotid artery distensibility and carotid artery compliance. Blood lipids including high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, (LDL-C), total cholesterol (TC), apolipoprotein A (apoA), apolipoprotein B (apoB) and high-sensitivity C-reactive protein (hsCRP) were analysed. RESULTS A gradual decrease in carotid distensibility and an increase in LDL-C, apoB and the TC:LDL-C and LDL-C:HDL-C ratios were seen at three and 12 months of KD-treatment. These differences were not significant at 24 months. cIMT, BMI and hsCRP did not show any significant changes. CONCLUSIONS The initial alterations in lipids, apoB and arterial function observed within the first year of KD-treatment appear to be reversible and not significant after 24 months of treatment.
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Affiliation(s)
- M Kapetanakis
- Department of Paediatric Neurology, Pediatric Child Neurology, Skåne University Hospital, 22185 Lund, Sweden.
| | - P Liuba
- Department of Paediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, 22185 Lund, Sweden.
| | - M Odermarsky
- Department of Paediatric Cardiology, Pediatric Heart Center, Skåne University Hospital, 22185 Lund, Sweden.
| | - J Lundgren
- Department of Paediatric Neurology, Pediatric Child Neurology, Skåne University Hospital, 22185 Lund, Sweden.
| | - T Hallböök
- Department of Paediatric Neurology, Pediatric Child Neurology, Skåne University Hospital, 22185 Lund, Sweden.
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Boman KK, Hornquist L, Rickardsson J, Lannering B, Gustafsson G, Pitchford N, Davis E, Walker D, Hoang DH, Pagnier A, Cousin E, Guichardet K, Schiff I, Dubois-Teklali F, Krainik A, Lazar MB, Resnik K, Olsson IT, Perrin S, Burtscher IB, Lundgren J, Kahn A, Johanson A, Korzeniewska J, Dembowska-Baginska B, Perek-Polnik M, Walsh K, Gioia A, Wells E, Packer R, de Speville ED, Dufour C, Bolle S, Giraudat K, Longaud A, Kieffer V, Grill J, Puget S, Valteau-Couanet D, Hetz-Pannier L, Noulhiane M, Chieffo D, Tamburrini G, Caldarelli M, Di Rocco C, Margelisch K, Studer M, Steinlin M, Leibundgut K, Heinks T, Longaud-Vales A, Chevignard M, Dufour C, Grill J, Pujet S, Sainte-Rose C, Valteau-Couanet D, Dellatolas G, Kahalley L, Grosshans D, Paulino A, Ris MD, Chintagumpala M, Okcu F, Moore B, Stancel H, Minard C, Guffey D, Mahajan A, Herrington B, Raiker J, Manning E, Criddle J, Karlson C, Guerry W, Finlay J, Sands S, Dockstader C, Skocic J, Bouffet E, Laughlin S, Tabori U, Mabbott D, Moxon-Emre I, Scantlebury N, Taylor MD, Bouffet E, Malkin D, Laughlin S, Law N, Kumabe T, Leonard J, Rubin J, Jung S, Kim SK, Gupta N, Weiss W, Faria C, Vibhakar R, Spiegler B, Janzen L, Liu F, Decker L, Mabbott D, Lemiere J, Vercruysse T, Haers M, Vandenabeele K, Geuens S, Jacobs S, Van Gool S, Riggs L, Piscione J, Bouffet E, Timmons B, Laughlin S, Cunningham T, Bartels U, Skocic J, Liu F, Mabbott D, Riggs L, Bouffet E, Chakravarty M, Laughlin S, Laperriere N, Liu F, Skocic J, Pipitone J, Strother D, Hukin J, Fryer C, McConnell D, Mabbott D, Secco DE, Cappelletti S, Gentile S, Chieffo D, Cacchione A, Del Bufalo F, Staccioli S, Spagnoli A, Messina R, Carai A, Marras CE, Mastronuzzi A, Brinkman T, Armstrong G, Kimberg C, Gajjar A, Srivastava DK, Robison L, Hudson M, Krull K, Hardy K, Hostetter S, Hwang E, Walsh K, Leiss U, Bemmer A, Pletschko T, Grafeneder J, Schwarzinger A, Deimann P, Slavc I, Batchelder P, Wilkening G, Hankinson T, Foreman N, Handler M. NEUROPSYCHOLOGY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lundgren J, Rådegran G. Pathophysiology and potential treatments of pulmonary hypertension due to systolic left heart failure. Acta Physiol (Oxf) 2014; 211:314-33. [PMID: 24703457 DOI: 10.1111/apha.12295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/03/2014] [Accepted: 03/28/2014] [Indexed: 12/19/2022]
Abstract
Pulmonary hypertension (PH) due to left heart failure is becoming increasingly prevalent and is associated with poor outcome. The precise pathophysiological mechanisms behind PH due to left heart failure are, however, still unclear. In its early course, PH is caused by increased left ventricular filling pressures, without pulmonary vessel abnormalities. Conventional treatment for heart failure may partly reverse such passive PH by optimizing left ventricular function. However, if increased pulmonary pressures persist, endothelial damage, excessive vasoconstriction and structural changes in the pulmonary vasculature may occur. There is, at present, no recommended medical treatment for this active component of PH due to left heart failure. However, as the vascular changes in PH due to left heart failure may be similar to those in pulmonary arterial hypertension (PAH), a selected group of these patients may benefit from PAH treatment targeting the endothelin, nitric oxide or prostacyclin pathways. Such potent pulmonary vasodilators could, however, be detrimental in patients with left heart failure without pulmonary vascular pathology, as selective pulmonary vasodilatation may lead to further congestion in the pulmonary circuit, resulting in pulmonary oedema. The use of PAH therapies is therefore currently not recommended and would require the selection of suitable patients based on the underlying causes of the disease and careful monitoring of their progress. The present review focuses on the following: (i) the pathophysiology behind PH resulting from systolic left heart failure, and (ii) the current evidence for medical treatment of this condition, especially the role of PAH-targeted therapies in systolic left heart failure.
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Affiliation(s)
- J. Lundgren
- The Haemodynamic Laboratory; The Clinic for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
- Department of Cardiology, Clinical Sciences; Lund University; Lund Sweden
| | - G. Rådegran
- The Haemodynamic Laboratory; The Clinic for Heart Failure and Valvular Disease; Skåne University Hospital; Lund Sweden
- Department of Cardiology, Clinical Sciences; Lund University; Lund Sweden
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Hallböök T, Tideman P, Rosén I, Lundgren J, Tideman E. Epilepsy surgery in children with drug-resistant epilepsy, a long-term follow-up. Acta Neurol Scand 2013; 128:414-21. [PMID: 23742270 DOI: 10.1111/ane.12154] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this follow-up study, we wanted to present the long-term outcome (5-21 years) in terms of seizure freedom, seizure reduction, and the cognitive development in the first 47 children who underwent epilepsy surgery at the University Hospital in Lund from 1991 to 2007. MATERIALS AND METHODS All children who underwent epilepsy surgery in the southern region of Sweden were assessed for cognitive function before surgery and at follow-up. A review of medical documents for demographic data and seizure-related characteristics was made by retrospectively examining the clinical records. RESULTS Forty-seven children with a median age at surgery of 8 years (range 0.5-18.7 years) were included. Twenty-three children achieved seizure freedom, six demonstrated >75% improvement in seizure frequency, and none of the children experienced an increase in seizure frequency. Twenty-one children required a reoperation to achieve satisfactory seizure outcomes. Cognitive functional level was preserved, and the majority of patients, 34 (76%), followed their expected cognitive trajectory. The patients who became seizure free significantly improved their cognitive processing speed, even after long-term follow-up. CONCLUSIONS Epilepsy surgery in children offers suitable candidates a good chance of significantly improved outcome and low rates of complications. Several children, however, required a reoperation to achieve satisfactory seizure outcomes. Cognitive level was preserved, and the majority of patients followed their expected cognitive trajectory. Cognitive improvements in processing speed appear to occur in parallel with seizure control and were even more pronounced in subjects with no anti-epilepsy drugs. These improvements persisted even after long-term follow-up.
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Affiliation(s)
- T. Hallböök
- Department of Pediatrics; Sahlgrenska Academy; Institution of Clinical Sciences; University of Gothenburg; Gothenburg Sweden
| | - P. Tideman
- Department of Psychology; Lund University; Lund Sweden
| | - I. Rosén
- Department of Clinical Neurophysiology; Skane University Hospital; Lund Sweden
| | - J. Lundgren
- Department of Pediatrics; Skane University Hospital; Lund Sweden
| | - E. Tideman
- Department of Psychology; Lund University; Lund Sweden
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Abstract
OBJECTIVE The Functional Outcomes of Sleep Questionnaire, FOSQ, is a self-administered 30 item questionnaire, designed to assess the impact of disorders of excessive sleepiness on activities of daily living. The aim was to evaluate the psychometric properties of a Swedish translation of the English original. MATERIALS AND METHODS A Swedish version of the FOSQ was answered by 75 consecutive patients, diagnosed with obstructive sleep apnea syndrome and in need of treatment. The Short Form Health Survey (SF-36) and Epworth Sleepiness Scale (ESS) were also answered at the same time to evaluate validity. The first 25 patients answered the FOSQ a second time, 3 weeks later, to assess reliability. RESULTS The test-re-test reliability and intra-class correlation of the different sub-scales in the FOSQ varied between 0.71-0.92 and was 0.92 for the total scale, all statistically significant. Cronbach's alpha, calculated as a measure of internal consistency, varied between 0.84-0.92 for FOSQ sub-scales and was 0.96 for the total score. Statistically significant correlations between FOSQ sub-scales and the eight sub-scales in the SF-36 supported the validity. Discriminant validity, calculated by splitting responders with high and low ESS scores, revealed that FOSQs scores differed significantly between the groups. CONCLUSIONS The results suggest that the Swedish version of the FOSQ has psychometric qualities in line with the original. It might, therefore, be a potentially useful, reliable and valid instrument for clinicians and researchers when measuring variables related to quality-of-life in sleep disorders in this language area.
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Affiliation(s)
- Lena Korpe
- Department of Orofacial Pain, Public Dental Service, Sahlgrenska University Hospital/Mölndal, Sweden
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