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Ekstrand J, Takamiya A, Nordenskjold A, Kirov G, Sienaert P, Kellner CH, Movahed Rad P. Ketamine or ECT? What Have We Learned From the KetECT and ELEKT-D Trials? Int J Neuropsychopharmacol 2024; 27:pyad065. [PMID: 38114073 PMCID: PMC10829070 DOI: 10.1093/ijnp/pyad065] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/18/2023] [Indexed: 12/21/2023] Open
Abstract
1. Two recent clinical trials, KetECT and ELEKT-D, compared the effectiveness of ketamine and electroconvulsive therapy (ECT) for major depressive disorder. Notably, these trials reported marked differences in ECT's clinical outcomes of, with remission rates of 63% for KetECT and a strikingly lower rate of 22% for ELEKT-D, while the remission rates for ketamine were 46% and 38%, respectively. Considering that the primary objective of both trials was to compare the standard treatment (ECT) with an experimental intervention (ketamine), it is crucial to highlight the pronounced disparities in ECT's clinical outcomes. This article offers a comprehensive comparison of these trials while also exploring how patient characteristics, treatment protocols, and study designs may contribute to such pronounced outcome discrepancies. These differences highlight the heterogeneous nature of depression and underscore the need for personalized treatments. These studies also provide valuable insights into identifying the most suitable candidates for ketamine and ECT.
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Affiliation(s)
- Joakim Ekstrand
- Department of Clinical Sciences, Division of Adult Psychiatry Faculty of Medicine, Lund University, Lund, Sweden
| | - Akihiro Takamiya
- KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan. Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
| | - Axel Nordenskjold
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - George Kirov
- Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Division of Psychological Medicine and Clinical Neuroscience, Cardiff, UK
| | - Pascal Sienaert
- Department of Neurosciences, University Psychiatric Center KU Leuven, Research Group Psychiatry, Academic Center for ECT and Neuromodulation (AcCENT), KU Leuven, Leuven, Belgium
| | - Charles H Kellner
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Pouya Movahed Rad
- Department of Clinical Sciences, Division of Adult Psychiatry Faculty of Medicine, Lund University, Lund, Sweden
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Olsson Möller U, Zingmark M, Ekstrand J, Haak M. The Content of Physiotherapy and Factors Impacting on Reablement - A National Study. J Multidiscip Healthc 2023; 16:3075-3088. [PMID: 37881528 PMCID: PMC10596052 DOI: 10.2147/jmdh.s415112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose Reablement is a multidisciplinary intervention aimed at promoting function and independence for people with functional decline. Detailed descriptions of various professions' actions are needed for organization and evaluation of reablement services. This study describes physiotherapy practice in a reablement context in Swedish municipalities, focusing on the content and magnitude of interventions. Methods Physiotherapists (n=108) from 34 municipalities answered a web-based survey covering the target group, content and duration of their actions, and number of contacts initiated over a 3-week period. Data were analyzed with descriptive statistics and multiple logistic regression. Results Overall, 1005 cases were reported, with a mean age of 78.9 years (SD: 11.7); about 91% (n=912) were aged ≥65 and 61% (n=612) were women. About 70% were allocated to home care; 16% (n=160) of these had minor functional limitations (eg, needing safety alarms/help with domestic tasks), and 55% (n=550) had major functional limitations (eg, needing help with personal activities of daily living). The most reported actions were providing technical aids (60.8%, n=576), instructions/counseling (41.5%, n=393), walking/climbing stairs (27.6%, n=262), strength training (27.2%, n=258), and fall prevention (25.5%, n=242). Almost half of the cases included one action (n=494) and about 89% (n=890) targeted primary needs (body functions, walking indoors, self-care, or domestic life), mainly in clients with major functional limitations (odds ratio=2.96; 95% confidence interval: 1.95-4.49). About 50% (n=517) of the cases involved 1-2 contacts; about 55% (n=549) were completed within 3 weeks. Exercise was associated with ≥6 visits over ≥7 weeks. Supervision of home care staff was performed in 19.1% (n=181) of cases. Conclusion Reablement physiotherapy mostly comprises a few actions over a relatively short period. Whether this is a conscious strategy based on the purpose of home-based physiotherapy or clients' needs and wishes, or conversely an expression of limited resources, remains to be investigated.
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Affiliation(s)
- Ulrika Olsson Möller
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Zingmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
- Health and Social Care Administration, Municipality of Östersund, Östersund, Sweden
- Department of Community Medicine and Rehabilitation, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Joakim Ekstrand
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Maria Haak
- Department of Nursing and Health Sciences, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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Gasser F, Bala SV, Westergren A, Ekstrand J, Hagell P. Further development and evaluation of a questionnaire targeting person-centred outpatient care for persons with long-term conditions. J Patient Rep Outcomes 2023; 7:85. [PMID: 37610497 PMCID: PMC10447667 DOI: 10.1186/s41687-023-00623-6] [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: 03/13/2023] [Accepted: 07/28/2023] [Indexed: 08/24/2023] Open
Abstract
AIM To further develop the Person-Centred Care instrument for outpatient care (PCCoc), evaluate its user-friendliness and content validity, and to explore its basic psychometric properties in various outpatient settings for adults with long-term conditions. BACKGROUND Person-centred care (PCC) has been identified as a key factor to provide high-quality care. However, there is still a lack of instruments that are based on a clearly defined framework for PCC for persons with long-term conditions in an outpatient context. The PCCoc is a patient-reported experience measure under development aiming to fill this gap. METHODS First, the 35-item PCCoc was reviewed and further developed in collaboration with a user-council. Second, the revised 36-item PCCoc was tested among persons receiving outpatient care for various long-term conditions. A total of 179 persons with long-term conditions from four different specialties participated in the study. User-friendliness and content validity were assessed through structured interviews and relevance ratings of each item. Content validity index (CVI) for individual items (I-CVI) and for the overall scale (S-CVI) were calculated, and basic psychometric properties of the PCCoc using classical test theory were explored. RESULTS It took a median of 8 min for participants to complete the PCCoc. The majority found items easy to understand, response categories distinct and that no important areas were missing. Results from the CVI analyses suggested that participants found the content of the PCCoc relevant (I-CVI range 0.82-1, S-CVI = 0.95). All psychometric properties examined were satisfactory (e.g., item-total correlations, 0.45-0.75; Cronbach's alpha, 0.96; test-retest stability, 0.83). CONCLUSION The PCCoc was considered user-friendly and relevant by the intended users, and its psychometric properties were satisfactory. This implies that the PCCoc can be a valuable instrument for evaluating and developing PCC in outpatient care for persons with long-term conditions. However, further studies of the PCCoc are needed to establish its measurement properties in various outpatient settings.
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Affiliation(s)
- Fredrik Gasser
- The Pro-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
| | - Sidona-Valentina Bala
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Medicine, Section of Rheumatology, Helsingborg Central Hospital, Helsingborg, Sweden
| | - Albert Westergren
- The Pro-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- The Research Platform for Collaboration for Health, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Joakim Ekstrand
- The Pro-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Peter Hagell
- The Pro-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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Ekstrand J, Fattah C, Persson M, Cheng T, Nordanskog P, Åkeson J, Tingström A, Lindström MB, Nordenskjöld A, Movahed Rad P. Racemic Ketamine as an Alternative to Electroconvulsive Therapy for Unipolar Depression: A Randomized, Open-Label, Non-Inferiority Trial (KetECT). Int J Neuropsychopharmacol 2021; 25:339-349. [PMID: 35020871 PMCID: PMC9154276 DOI: 10.1093/ijnp/pyab088] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/19/2021] [Accepted: 12/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Ketamine has emerged as a fast-acting and powerful antidepressant, but no head to head trial has been performed, Here, ketamine is compared with electroconvulsive therapy (ECT), the most effective therapy for depression. METHODS Hospitalized patients with unipolar depression were randomized (1:1) to thrice-weekly racemic ketamine (0.5 mg/kg) infusions or ECT in a parallel, open-label, non-inferiority study. The primary outcome was remission (Montgomery Åsberg Depression Rating Scale score ≤10). Secondary outcomes included adverse events (AEs), time to remission, and relapse. Treatment sessions (maximum of 12) were administered until remission or maximal effect was achieved. Remitters were followed for 12 months after the final treatment session. RESULTS In total 186 inpatients were included and received treatment. Among patients receiving ECT, 63% remitted compared with 46% receiving ketamine infusions (P = .026; difference 95% CI 2%, 30%). Both ketamine and ECT required a median of 6 treatment sessions to induce remission. Distinct AEs were associated with each treatment. Serious and long-lasting AEs, including cases of persisting amnesia, were more common with ECT, while treatment-emergent AEs led to more dropouts in the ketamine group. Among remitters, 70% and 63%, with 57 and 61 median days in remission, relapsed within 12 months in the ketamine and ECT groups, respectively (P = .52). CONCLUSION Remission and cumulative symptom reduction following multiple racemic ketamine infusions in severely ill patients (age 18-85 years) in an authentic clinical setting suggest that ketamine, despite being inferior to ECT, can be a safe and valuable tool in treating unipolar depression.
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Affiliation(s)
- Joakim Ekstrand
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christian Fattah
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marcus Persson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Helsingborg, Sweden
| | - Tony Cheng
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Pia Nordanskog
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jonas Åkeson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Anders Tingström
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mats B Lindström
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | | | - Pouya Movahed Rad
- Correspondence: Pouya Movahed Rad, MD, PhD, Psychiatric Clinic in Lund, Baravägen 1, 221 85 Lund, Sweden ()
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Ekstrand J. Letter to the Editor: Comparative efficacy of racemic ketamine and esketamine for depression: A systematic review and meta-analysis. J Affect Disord 2021; 289:88-89. [PMID: 33957360 DOI: 10.1016/j.jad.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Joakim Ekstrand
- Department of Psychiatry, Faculty of Clinical Sciences, University of Lund, Sweden.
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Carli V, Hadlaczky G, Petros NG, Iosue M, Zeppegno P, Gramaglia C, Amore M, Baca-Garcia E, Batra A, Cosman D, Courtet P, Di Sciascio G, Ekstrand J, Galfalvy H, Gusmão R, Jesus C, Heitor MJ, Constante M, Rad PM, Saiz PA, Wojnar M, Sarchiapone M. A Naturalistic, European Multi-Center Clinical Study of Electrodermal Reactivity and Suicide Risk Among Patients With Depression. Front Psychiatry 2021; 12:765128. [PMID: 35069276 PMCID: PMC8766803 DOI: 10.3389/fpsyt.2021.765128] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Electrodermal hyporeactivity has been proposed as a marker of suicidal risk. The EUDOR-A study investigated the prevalence of electrodermal hyporeactivity among patients with depression and its association with attempted and completed suicide. Methods: Between August 2014 and March 2016, 1,573 in- and outpatients with a primary diagnosis of depression (active or remission phase) were recruited at 15 European psychiatric centers. Each patient was followed-up for 1 year. Electrodermal activity was assessed at baseline with the ElectroDermal Orienting Reactivity Test. Data on the sociodemographic characteristics, clinical diagnoses, and treatment of the subjects were also collected. The severity of the depressive symptoms was assessed through the Montgomery-Asberg Depression Rating Scale. Information regarding number, time, and method of suicide attempts was gathered at baseline and at the end of the 1-year follow-up. The same data were collected in case of completed suicide. Results: Hyporeactive patients were shown to be significantly more at risk of suicide attempt compared to reactive patients, both at baseline and follow-up. A sensitivity of 29.86% and a positive predictive value (PPV) of 46.77% were found for attempted suicide at baseline, while a sensitivity of 35.36% and a PPV of 8.92% were found for attempted suicide at follow-up. The sensitivity and PPV for completed suicide were 25.00 and 0.61%, respectively. However, when controlled for suicide attempt at baseline, the association between hyporeactivity and follow-up suicide attempt was no longer significant. The low number of completed suicides did not allow any analysis.
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Affiliation(s)
- Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Gergo Hadlaczky
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Nuhamin Gebrewold Petros
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Miriam Iosue
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Patrizia Zeppegno
- Department of Translational Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità, University of Piemonte Orientale, Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Azienda Ospedaliero Universitaria Maggiore della Carità, University of Piemonte Orientale, Novara, Italy
| | - Mario Amore
- Clinica Psichiatrica, DINOGMI, University of Genoa, Genoa, Italy
| | - Enrique Baca-Garcia
- Department of Psychiatry, Fundacion Jimenez Diaz University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - Anil Batra
- Department of Psychiatry and Psychotherapy, University Hospital of Tuebingen, Tuebingen, Germany
| | - Doina Cosman
- Clinical Psychology and Mental Health Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Philippe Courtet
- Department of Emergency Psychiatry and Acute Care, University Hospital of Montpellier, Montpellier, France
| | | | - Joakim Ekstrand
- Department of Psychiatry, Institute of Clinical Sciences, Lund University, Lund, Sweden
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Ricardo Gusmão
- Department of Psychiatry, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, Portugal.,Instituto de Saúde Pública, Universidade Do Porto (ISPUP), Porto, Portugal
| | - Catarina Jesus
- Department of Psychiatry, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental (CHLO), Lisbon, Portugal
| | | | - Miguel Constante
- Psychiatry Service, Hospital Beatriz Ângelo (HBA), Loures, Portugal
| | - Pouya Movahed Rad
- Department of Psychiatry, Institute of Clinical Sciences, Lund University, Lund, Sweden
| | - Pilar A Saiz
- Department of Psychiatry, Biomedical Research Networking Centre in Mental Health (CIBERSAM), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Mental Health Services of Principado de Asturias (SESPA), University of Oviedo, Oviedo, Spain
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Marco Sarchiapone
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Schmidt M, Ekstrand J, Tops AB. Self-Reported Needs for Care, Support and Treatment of Persons Who Frequently Visit Psychiatric Emergency Rooms in Sweden. Issues Ment Health Nurs 2018; 39:738-745. [PMID: 30111203 DOI: 10.1080/01612840.2018.1481471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM To investigate self-reported needs for care, support and treatment among persons who frequently visit psychiatric emergency rooms (PERs). DESIGN A cross-sectional design. Qualitative and quantitative data were collected using an interview-based manual. Qualitative data were analysed using content analysis, whereas quantitative data were analysed using descriptive, non-parametric statistical tests. RESULTS Persons who frequently visit PERs self-reported unmet needs for care, support and treatment in life domains such as health, socialisation, daytime activities, and emotional and financial security. CONCLUSION To meet the needs of persons who frequently visit PERs, close cooperation between concerned welfare actors should be implemented.
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Affiliation(s)
- Manuela Schmidt
- a Faculty of Health Science , Kristianstad University , Kristianstad , Sweden.,b Department of Health Sciences , Lund University , Lund , Sweden
| | - Joakim Ekstrand
- c Faculty of Business , Kristianstad University , Kristianstad , Sweden
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Bjarnegård N, Länne T, Cinthio M, Ekstrand J, Hedman K, Nylander E, Henriksson J. Vascular characteristics in young women-Effect of extensive endurance training or a sedentary lifestyle. Acta Physiol (Oxf) 2018; 223:e13041. [PMID: 29359513 DOI: 10.1111/apha.13041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/13/2022]
Abstract
AIM To explore whether high-level endurance training in early age has an influence on the arterial wall properties in young women. METHODS Forty-seven athletes (ATH) and 52 controls (CTR), all 17-25 years of age, were further divided into runners (RUN), whole-body endurance athletes (WBA), sedentary controls (SC) and normally active controls (AC). Two-dimensional ultrasound scanning of the carotid arteries was conducted to determine local common carotid artery (CCA) geometry and wall distensibility. Pulse waves were recorded with a tonometer to determine regional pulse wave velocity (PWV) and pulse pressure waveform. RESULTS Carotid-radial PWV was lower in WBA than in RUN (P < .05), indicating higher arterial distensibility along the arm. Mean arterial pressure was lower in ATH than in CTR and in RUN than in WBA (P < .05). Synthesized aortic augmentation index (AI@75) was lower among ATH than among CTR (-12.8 ± 1.6 vs -2.6 ± 1.2%, P < .001) and in WBA than in RUN (-16.4 ± 2.5 vs -10.7 ± 2.0%, P < .05), suggesting a diminished return of reflection waves to the aorta during systole. Carotid-femoral PWV and intima-media thickness (IMT), lumen diameter and radial distensibility of the CCA were similar in ATH and CTR. CONCLUSION Elastic artery distensibility and carotid artery IMT are not different in young women with extensive endurance training over several years and in those with sedentary lifestyle. On the other hand, our data suggest that long-term endurance training is associated with potentially favourable peripheral artery adaptation, especially in sports where upper body work is added. This adaptation, if persisting later in life, could contribute to lower cardiovascular risk.
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Affiliation(s)
- N. Bjarnegård
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Department of Clinical Physiology; Region Jönköping County; Jönköping Sweden
| | - T. Länne
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Department of Thoracic and Vascular Surgery; Region Östergötland; Linköping Sweden
| | - M. Cinthio
- Department of Biomedical Engineering; Faculty of Engineering; Lund University; Lund Sweden
| | - J. Ekstrand
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - K. Hedman
- Department of Clinical Physiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - E. Nylander
- Department of Clinical Physiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - J. Henriksson
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
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Abstract
AIMS To describe persons visiting the psychiatric emergency room (PER) in Sweden and to compare persons who frequently (PFV) and infrequently (PIFV) visit PERs in terms of group size, age, gender, PER location inside versus outside the home municipality, diagnosis (ICD 10), temporal patterns of visits and hospital admissions. METHODS This register study included all visits to PERs in one Swedish county over 3 years, 2013-2015 (N = 67,031 visits). The study employed descriptive statistics as well as Chi-square tests combined with Bonferroni correction to compare PFV with PIFV. RESULTS Of the total of 27,282 visitors, 2201 (8.1%) were identified as PFV (five or more visits within 12 months) and they accounted for 38.1% of the total visits. The study found differences between PFV and PIFV in gender, diagnostic profile, hospital admissions and temporal patterns. Differences were also detected with regard to distance between PERs and home municipalities. However, no age-related differences were found between the two groups. CONCLUSIONS PFV and PIFV have different clinical profiles and temporal patterns. These results may be important when planning, developing and evaluating interventions targeting the needs of each group, which is in accordance with a person-centred approach. Such an approach might eventually result in fewer visits to PERs.
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Affiliation(s)
- Manuela Schmidt
- a Faculty of Health Science , Kristianstad University , Kristianstad , Sweden.,b Department of Health Sciences , Lund University , Lund , Sweden
| | - Joakim Ekstrand
- c Faculty of Business , Kristianstad University , Kristianstad , Sweden
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Ekstrand J, Movahed P. [Warning against over-interpretation of the Swedish Agency for Health Technology Assessment and Assessment of Social Services conclusions about ketamine]. Lakartidningen 2017; 114:EL44. [PMID: 28440852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Etemadi L, Mohammed M, Thorbergsson PT, Ekstrand J, Friberg A, Granmo M, Pettersson LME, Schouenborg J. Embedded Ultrathin Cluster Electrodes for Long-Term Recordings in Deep Brain Centers. PLoS One 2016; 11:e0155109. [PMID: 27159159 PMCID: PMC4861347 DOI: 10.1371/journal.pone.0155109] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/25/2016] [Indexed: 01/03/2023] Open
Abstract
Neural interfaces which allow long-term recordings in deep brain structures in awake freely moving animals have the potential of becoming highly valuable tools in neuroscience. However, the recording quality usually deteriorates over time, probably at least partly due to tissue reactions caused by injuries during implantation, and subsequently micro-forces due to a lack of mechanical compliance between the tissue and neural interface. To address this challenge, we developed a gelatin embedded neural interface comprising highly flexible electrodes and evaluated its long term recording properties. Bundles of ultrathin parylene C coated platinum electrodes (N = 29) were embedded in a hard gelatin based matrix shaped like a needle, and coated with Kollicoat™ to retard dissolution of gelatin during the implantation. The implantation parameters were established in an in vitro model of the brain (0.5% agarose). Following a craniotomy in the anesthetized rat, the gelatin embedded electrodes were stereotactically inserted to a pre-target position, and after gelatin dissolution the electrodes were further advanced and spread out in the area of the subthalamic nucleus (STN). The performance of the implanted electrodes was evaluated under anesthesia, during 8 weeks. Apart from an increase in the median-noise level during the first 4 weeks, the electrode impedance and signal-to-noise ratio of single-units remained stable throughout the experiment. Histological postmortem analysis confirmed implantation in the area of STN in most animals. In conclusion, by combining novel biocompatible implantation techniques and ultra-flexible electrodes, long-term neuronal recordings from deep brain structures with no significant deterioration of electrode function were achieved.
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Affiliation(s)
- Leila Etemadi
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Mohsin Mohammed
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
- * E-mail: (MM); (JS); (LP)
| | - Palmi Thor Thorbergsson
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Joakim Ekstrand
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Annika Friberg
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Marcus Granmo
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Lina M. E. Pettersson
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
- * E-mail: (MM); (JS); (LP)
| | - Jens Schouenborg
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden
- * E-mail: (MM); (JS); (LP)
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Svensson M, Grahm M, Ekstrand J, Höglund P, Johansson M, Tingström A. Effect of electroconvulsive seizures on cognitive flexibility. Hippocampus 2016; 26:899-910. [DOI: 10.1002/hipo.22573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Maria Svensson
- Department of Clinical Sciences Lund; Psychiatric Neuromodulation Unit, Lund University; Lund Sweden
| | - Matilda Grahm
- Department of Clinical Sciences Lund; Psychiatric Neuromodulation Unit, Lund University; Lund Sweden
| | - Joakim Ekstrand
- Department of Clinical Sciences Lund; Psychiatric Neuromodulation Unit, Lund University; Lund Sweden
| | - Peter Höglund
- Department of Laboratory Medicine; Division of Clinical Chemistry and Pharmacology, Lund University; Lund Sweden
| | - Mikael Johansson
- Department of Clinical Sciences Lund; Psychiatric Neuromodulation Unit, Lund University; Lund Sweden
- Department of Psychology; Neuropsychology, Lund University; Lund Sweden
| | - Anders Tingström
- Department of Clinical Sciences Lund; Psychiatric Neuromodulation Unit, Lund University; Lund Sweden
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Kristenson K, Bjørneboe J, Waldén M, Andersen TE, Ekstrand J, Hägglund M. Injuries in male professional football: A prospective comparison between individual and team-based exposure registration. Scand J Med Sci Sports 2015; 26:1225-32. [DOI: 10.1111/sms.12551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K. Kristenson
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Football Research Group; Linköping Sweden
| | - J. Bjørneboe
- Department of Sports Medicine; Oslo Sports Trauma Research Center; Norwegian School of Sport Sciences; Oslo Norway
| | - M. Waldén
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Football Research Group; Linköping Sweden
| | - T. E. Andersen
- Department of Sports Medicine; Oslo Sports Trauma Research Center; Norwegian School of Sport Sciences; Oslo Norway
| | - J. Ekstrand
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Football Research Group; Linköping Sweden
| | - M. Hägglund
- Football Research Group; Linköping Sweden
- Division of Physiotherapy; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Svensson M, Grahm M, Ekstrand J, Movahed-Rad P, Johansson M, Tingström A. Effect of electroconvulsive seizures on pattern separation. Hippocampus 2015; 25:1351-60. [PMID: 25850383 DOI: 10.1002/hipo.22441] [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: 03/10/2015] [Indexed: 12/21/2022]
Abstract
Strategies employing different techniques to inhibit or stimulate neurogenesis have implicated a role for adult-born neurons in the therapeutic effect of antidepressant drugs, as well as a role in memory formation. Electroconvulsive seizures (ECS), an animal model of electroconvulsive therapy, robustly stimulate hippocampal neurogenesis, but it is not known how this relates to either therapeutic efficacy or unwanted cognitive side effects. We hypothesized that the ECS-derived increase in adult-born neurons would manifest in improved pattern separation ability, a memory function that is believed to be both hippocampus-dependent and coupled to neurogenesis. To test this hypothesis, we stimulated neurogenesis in adult rats by treating them with a series of ECS and compared their performances in a trial-unique delayed nonmatching-to-location task (TUNL) to a control group. TUNL performance was analyzed over a 12-week period, during which newly formed neurons differentiate and become functionally integrated in the hippocampal neurocircuitry. Task difficulty was manipulated by modifying the delay between sample and choice, and by varying the spatial similarity between target and distracter location. Although animals learned the task and improved the number of correct responses over time, ECS did not influence spatial pattern separation ability.
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Affiliation(s)
- Maria Svensson
- Psychiatric Neuromodulation Unit, Clinical Sciences, Lund University, Sweden
| | - Matilda Grahm
- Psychiatric Neuromodulation Unit, Clinical Sciences, Lund University, Sweden
| | - Joakim Ekstrand
- Psychiatric Neuromodulation Unit, Clinical Sciences, Lund University, Sweden
| | - Pouya Movahed-Rad
- Psychiatric Neuromodulation Unit, Clinical Sciences, Lund University, Sweden
| | - Mikael Johansson
- Psychiatric Neuromodulation Unit, Clinical Sciences, Lund University, Sweden.,Neuropsychology, Department of Psychology, Lund University, Sweden
| | - Anders Tingström
- Psychiatric Neuromodulation Unit, Clinical Sciences, Lund University, Sweden
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Kristenson K, Bjørneboe J, Waldén M, Andersen TE, Ekstrand J, Hägglund M. THE NORDIC FOOTBALL INJURY AUDIT: HIGHER INJURY RATES FOR PROFESSIONAL FOOTBALL CLUBS WITH THIRD-GENERATION ARTIFICIAL TURF AT THEIR HOME VENUE. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.166] [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: 11/03/2022]
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Bengtsson H, Ekstrand J, Waldén M, Hägglund M. MUSCLE INJURY RATES IN PROFESSIONAL FOOTBALL INCREASE WITH FIXTURE CONGESTION: AN 11-YEAR FOLLOW-UP OF THE UEFA CHAMPIONS LEAGUE INJURY STUDY. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
The cariostatic benefit from water fluoridation is indisputable, but the knowledge of possible adverse effects on bone and fracture risk due to fluoride exposure is ambiguous. The association between long-term (chronic) drinking water fluoride exposure and hip fracture (ICD-7-9: '820' and ICD-10: 'S72.0-S72.2') was assessed in Sweden using nationwide registers. All individuals born in Sweden between January 1, 1900 and December 31, 1919, alive and living in their municipality of birth at the time of start of follow-up, were eligible for this study. Information on the study population (n = 473,277) was linked among the Swedish National In-Patient Register (IPR), the Swedish Cause of Death Register, and the Register of Population and Population Changes. Estimated individual drinking water fluoride exposure was stratified into 4 categories: very low, < 0.3 mg/L; low, 0.3 to 0.69 mg/L; medium, 0.7 to 1.49 mg/L; and high, ≥ 1.5 mg/L. Overall, we found no association between chronic fluoride exposure and the occurrence of hip fracture. The risk estimates did not change in analyses restricted to only low-trauma osteoporotic hip fractures. Chronic fluoride exposure from drinking water does not seem to have any important effects on the risk of hip fracture, in the investigated exposure range.
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Affiliation(s)
- P Näsman
- Clinical Epidemiology Unit, Karolinska Institutet and Karolinska University Hospital, Solna, Sweden
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Ekstrand J. Playing too Many Matches is Negative for both Performance and Player Availability – Results from the On-Going UEFA Injury Study. Dtsch Z Sportmed 2013. [DOI: 10.5960/dzsm.2012.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Razuvaev A, Ekstrand J, Folkersen L, Agardh H, Markus D, Swedenborg J, Hansson G, Gabrielsen A, Paulsson-Berne G, Roy J, Hedin U. Correlations Between Clinical Variables and Gene-expression Profiles in Carotid Plaque Instability. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.10.014] [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: 10/14/2022]
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Waldén M, Hägglund M, Orchard J, Kristenson K, Ekstrand J. Regional differences in injury incidence in European professional football. Scand J Med Sci Sports 2011; 23:424-30. [PMID: 22092416 DOI: 10.1111/j.1600-0838.2011.01409.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [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: 09/08/2011] [Indexed: 01/15/2023]
Abstract
The objective of this study was to investigate regional differences in injury incidence in men's professional football in Europe. A nine-season prospective cohort study was carried out between 2001-2002 and 2009-2010 involving 1357 players in 25 teams from nine countries. Teams were categorized into different regions according to the Köppen-Geiger climate classification system. Teams from the northern parts of Europe (n = 20) had higher incidences of injury overall [rate ratio 1.12, 95% confidence interval (CI) 1.06 to 1.20], training injury (rate ratio 1.16, 95% CI 1.05 to 1.27), and severe injury (rate ratio 1.29, 95% CI 1.10 to 1.52), all statistically significant, compared to teams from more southern parts (n = 5). In contrast, the anterior cruciate ligament injury incidence was lower in the northern European teams with a statistically significant difference (rate ratio 0.43, 95% CI 0.25 to 0.77), especially for noncontact anterior cruciate ligament injury (rate ratio 0.19, 95% CI 0.09 to 0.39). In conclusion, this study suggests that there are regional differences in injury incidence of European professional football. However, further studies are needed to identify the underlying causes.
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Affiliation(s)
- M Waldén
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Razuvaev A, Ekstrand J, Folkersen L, Agardh H, Markus D, Swedenborg J, Hansson GK, Gabrielsen A, Paulsson-Berne G, Roy J, Hedin U. Correlations between clinical variables and gene-expression profiles in carotid plaque instability. Eur J Vasc Endovasc Surg 2011; 42:722-30. [PMID: 21741279 DOI: 10.1016/j.ejvs.2011.05.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/30/2011] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Strokes, a major cause of disability, are often caused by embolism from unstable carotid plaques. The aim of this study was to validate a biobank of human carotid endarterectomies as a platform for further exploration of pathways for plaque instability. For this purpose, we investigated the relationship between clinical parameters of plaque instability and expression of genes previously shown to be associated with either plaque instability or healing processes in the vessel wall. METHODS A database of clinical information and gene-expression microarray data from 106 carotid endarterectomies were used. RESULTS Expression of matrix metalloproteinase (MMP)-9 and MMP-7 was 100-fold higher in plaques than in normal artery. In general, genes associated with inflammation (such as RANKL and CD68) were overexpressed in symptomatic compared with asymptomatic plaques. Plaques obtained from patients undergoing surgery within 2 weeks after an embolic event showed up-regulation of genes involved in healing reactions in the vessel wall (including elastin and collagen). Statin treatment, as well as echodense lesions, were associated with a more stable phenotype. CONCLUSION Here, we demonstrate that gene-expression profiles reflect clinical parameters. Our results suggest that microarray technology and clinical variables can be used for the future identification of central molecular pathways in plaque instability.
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Affiliation(s)
- A Razuvaev
- Center for Molecular Medicine and Division of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden.
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Gertow K, Nobili E, Folkersen L, Newman J, Pedersen T, Ekstrand J, Swedenborg J, Kühn H, Wheelock C, Hansson G, Hedin U, Haeggström J, Gabrielsen A. 754 12- AND 15-LIPOXYGENASES IN HUMAN CAROTID ATHEROSCLEROTIC LESIONS: ASSOCIATIONS WITH CEREBROVASCULAR SYMPTOMS. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70755-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Walden M, Hagglund M, Kristenson K, Ekstrand J. The influence of climate type on injury epidemiology in european professional football. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2011.084038.58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Werner J, Hägglund M, Waldén M, Ekstrand J. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 2011; 43:1036-40. [PMID: 19945984 DOI: 10.1136/bjsm.2009.066944] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Groin injury is a common injury in football and a complicated area when it comes to diagnosis and therapy. There is a lack of comprehensive epidemiological data on groin injuries in professional football. OBJECTIVE To investigate the incidence, pattern and severity of hip and groin injuries in professional footballers over seven consecutive seasons. STUDY DESIGN Prospective cohort study. SETTING European professional football. METHODS During the 2001/2 to 2007/8 seasons, between nine and 17 clubs per season (23 clubs in total) were investigated, accounting for 88 club seasons in total. Time loss injuries and individual exposure during club and national team training sessions and matches were recorded. MAIN OUTCOME MEASURE Injury incidence. RESULTS A total of 628 hip/groin injuries were recorded, accounting for 12-16% of all injuries per season. The total injury incidence was 1.1/1000 h (3.5/1000 match hours vs 0.6/1000 training hours, p<0.001) and was consistent over the seasons studied. Eighteen different diagnostic entities were registered, adductor (n = 399) and iliopsoas (n = 52) related injuries being the most common. More than half of the injuries (53%) were classified as moderate or severe (absence of more than a week), the mean absence per injury being 15 days. Reinjuries accounted for 15% of all registered injuries. In the 2005/6 to 2007/8 seasons, 41% of all diagnoses relied solely on clinical examination. CONCLUSIONS Hip/groin injuries are common in professional football, and the incidence over consecutive seasons is consistent. Hip/groin injuries are associated with long absences. Many hip/groin diagnoses are based only on clinical examination.
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Affiliation(s)
- J Werner
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
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Agardh HE, Folkersen L, Ekstrand J, Marcus D, Swedenborg J, Hedin U, Gabrielsen A, Paulsson-Berne G. Expression of fatty acid-binding protein 4/aP2 is correlated with plaque instability in carotid atherosclerosis. J Intern Med 2011; 269:200-10. [PMID: 21073559 DOI: 10.1111/j.1365-2796.2010.02304.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [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: 11/30/2022]
Abstract
OBJECTIVE the molecular basis for atherosclerotic plaque vulnerability with high risk of plaque rupture and thromboembolism is complex. We investigated whether clinical estimates of plaque stability correlate with differentially expressed mRNA transcripts within the lesion. METHODS AND RESULTS endarterectomy samples from patients undergoing surgery for symptomatic and asymptomatic carotid stenosis were prospectively collected and clinical parameters recorded in the Biobank of Karolinska Carotid Endarterectomies. mRNA expression profiling (n = 40) and quantitative RT-PCR (n = 105) revealed increased levels of fatty acid-binding protein 4 (FABP4/aP2) in lesions from patients with recent symptoms of plaque instability compared to asymptomatic patients (array: FC = 2, P < 0.05; RT-PCR: P < 0.05). At the mRNA level, FABP4/aP2 correlated with the cell markers CD36, CD68 and CD163 of monocyte/macrophage lineage as well as with CD4-positive T cells. FABP4/aP2 mRNA expression was also correlated with enzymes of the leukotriene pathway, 5-lipoxygenase and leukotriene A4 hydrolase. In addition, analysis of transcript profiles identified CD52 and adipophilin as the mRNAs with the highest correlation with FABP4/aP2. Expression of FABP4/aP2 by macrophages and CD52 by T cells in the lesion was confirmed by immunohistochemistry. CONCLUSIONS expression of FABP4/aP2 is increased at the mRNA level in unstable carotid plaques. Immunohistochemical analyses showed localization of FABP4/aP2 to macrophage populations. These FABP4/aP2-positive macrophages constitute an important and prevalent phenotype and could provide a new link between scavenging-mediated lipid uptake and cellular metabolic stress in plaque. In addition FABP4/aP2 correlates with other important signs of inflammation and plaque instability, such as T cells and leukotriene enzymes. Taken together, these results indicate that FABP4/aP2 is a key factor connecting vascular and cellular lipid accumulation to inflammation.
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Affiliation(s)
- H E Agardh
- Department of Medicine, Experimental Cardiovascular Research, Karolinska Institutet Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Abstract
The objective was to investigate the incidence, type and distribution of stress fractures in professional male football players. Fifty-four football teams, comprising 2379 players, were followed prospectively for 189 team seasons during the years 2001-2009. Team medical staff recorded individual player exposure and time-loss injuries. The first team squads of 24 clubs selected by UEFA as belonging to the 50 best European teams, 15 teams of the Swedish Super League and 15 teams playing their home matches on artificial turf pitches were included. In total, 51 stress fractures occurred during 1,180,000 h of exposure, giving an injury incidence of 0.04 injuries/1000 h. A team of 25 players can therefore expect one stress fracture every third season. All fractures affected the lower extremities and 78% the fifth metatarsal bone. Stress fractures to the fifth metatarsal bone, tibia or pelvis caused absences of 3-5 months. Twenty-nine percent of the stress fractures were re-injuries. Players that sustained stress fractures were significantly younger than those that did not. Stress fractures are rare in men's professional football but cause long absences. Younger age and intensive pre-season training appear to be risk factors.
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Affiliation(s)
- J Ekstrand
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Ekstrand J, Hägglund M, Fuller CW. Comparison of injuries sustained on artificial turf and grass by male and female elite football players. Scand J Med Sci Sports 2010; 21:824-32. [PMID: 20456680 DOI: 10.1111/j.1600-0838.2010.01118.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The objective of this study was to compare incidences and patterns of injury for female and male elite teams when playing football on artificial turf and grass. Twenty teams (15 male, 5 female) playing home matches on third-generation artificial turf were followed prospectively; their injury risk when playing on artificial turf pitches was compared with the risk when playing on grass. Individual exposure, injuries (time loss) and injury severity were recorded by the team medical staff. In total, 2105 injuries were recorded during 246,000 h of exposure to football. Seventy-one percent of the injuries were traumatic and 29% overuse injuries. There were no significant differences in the nature of overuse injuries recorded on artificial turf and grass for either men or women. The incidence (injuries/1000 player-hours) of acute (traumatic) injuries did not differ significantly between artificial turf and grass, for men (match 22.4 v 21.7; RR 1.0 (95% CI 0.9-1.2); training 3.5 v 3.5; RR 1.0 (0.8-1.2)) or women [match 14.9 v 12.5; RR 1.2 (0.8-1.8); training 2.9 v 2.8; RR 1.0 (0.6-1.7)]. During matches, men were less likely to sustain a quadriceps strain (P=0.031) and more likely to sustain an ankle sprain (P=0.040) on artificial turf.
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Affiliation(s)
- J Ekstrand
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Abstract
All 12 female football clubs (228 players) and 11 of 14 male clubs (239 players) in the Swedish premier league were followed prospectively during the 2005 season. Individual exposure (playing time), injuries (time loss), and injury severity (days lost due to injury) were recorded by the team medical staffs. Injury incidence was higher for male players during both training (4.7 vs 3.8 injuries/1000 h, P=0.018) and match play (28.1 vs 16.1, P<0.001). However, no difference was found in the incidence of severe injury (absence >4 weeks) (0.7/1000 h in both groups). The thigh, especially the hamstrings, was the overall most commonly injured region in both sexes, while the hip/groin was more commonly injured in male players and the knee in female players. Knee ligament injuries accounted for 31% and 37% of the total time lost from football for male and female players, respectively. In conclusion, male elite players had a higher injury incidence than their female counterparts although no difference was observed in the incidence of moderate to severe injury. We recommend that preventive measures should be focused on hamstring and knee ligament injury in order to reduce the overall injury burden.
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Affiliation(s)
- M Hägglund
- Department of Medical and Health Sciences, Linköping University, Sweden.
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Abstract
OBJECTIVE To study the injury characteristics in professional football and to follow the variation of injury incidence during a match, during a season and over consecutive seasons. DESIGN Prospective cohort study where teams were followed for seven consecutive seasons. Team medical staff recorded individual player exposure and time-loss injuries from 2001 to 2008. SETTING European professional men's football. PARTICIPANTS The first team squads of 23 teams selected by the Union of European Football Associations as belonging to the 50 best European teams. MAIN OUTCOME MEASUREMENT Injury incidence. RESULTS 4483 injuries occurred during 566 000 h of exposure, giving an injury incidence of 8.0 injuries/1000 h. The injury incidence during matches was higher than in training (27.5 vs 4.1, p<0.0001). A player sustained on average 2.0 injuries per season, and a team with typically 25 players can thus expect about 50 injuries each season. The single most common injury subtype was thigh strain, representing 17% of all injuries. Re-injuries constituted 12% of all injuries, and they caused longer absences than non re-injuries (24 vs 18 days, p<0.0001). The incidence of match injuries showed an increasing injury tendency over time in both the first and second halves (p<0.0001). Traumatic injuries and hamstring strains were more frequent during the competitive season, while overuse injuries were common during the preseason. Training and match injury incidences were stable over the period with no significant differences between seasons. CONCLUSIONS The training and match injury incidences were stable over seven seasons. The risk of injury increased with time in each half of matches.
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Affiliation(s)
- J Ekstrand
- Department of Medical and Health Sciences, Linköping University, Solstigen 3, S-589 43 Linköping, Sweden.
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Razuvaev A, Ekstrand J, Karlöf E, Lund K, Caidahl K, Hedin U, Roy J. Abstract: P629 NON-INVASIVE REAL-TIME IMAGING OF INTIMA THICKNESS, VESSEL DIAMETER AND BLOOD FLOW ASSESSMENT AFTER ARTERIO-VENOUS FISTULA CREATION ON AN INJURED RAT CAROTID ARTERY USING ULTRASOUND BIOMICROSCOPY. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70797-4] [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: 11/26/2022]
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Abstract
OBJECTIVE To study the incidence and nature of injuries at European Championships, to compare training and match injury characteristics and to study differences in injury incidence between tournaments. DESIGN Team physicians prospectively recorded individual player exposure and time loss injuries during 12 European Championships (men's EURO n = 1, men's Under-21 n = 2, men's Under-19 n = 3, men's Under-17 n = 3, women's Under-19 n = 3) from 2006 to 2008. SETTING International football tournaments. PARTICIPANTS 1594 men and 433 women. MAIN OUTCOME MEASUREMENT Injury incidence. RESULTS 224 injuries (45 training, 179 match play) were registered among 208 (10%) players. No differences in training injury incidence were seen between tournaments (range 1.3-3.9 injuries/1000 hours). The men's EURO had the highest match injury incidence (41.6 injuries/1000 hours) followed by the men's Under-21 tournaments (33.9). The lowest match injury incidence was seen in the women's Under-19 tournaments (20.5). Training injuries constituted 20% of all injuries and caused 26% of all match unavailability. A greater proportion of match injuries were due to trauma (83 vs 47%, p<0.001) and occurred from player contact (75 vs 48%, p = 0.018) compared to training injuries. A higher frequency of re-injury was found among training injuries than match injuries (20 vs 6%, p = 0.009). CONCLUSIONS Match injury incidence increased with age, indicating greater risk with higher intensity of play. Training injury incidence was relatively low, but training injuries were responsible for a quarter of all match unavailability and may thus have a profound impact on team performance and should be the object of preventive measures.
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Affiliation(s)
- M Hägglund
- Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden.
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Ekstrand J, Hellsten J, Tingström A. Environmental enrichment, exercise and corticosterone affect endothelial cell proliferation in adult rat hippocampus and prefrontal cortex. Neurosci Lett 2008; 442:203-7. [DOI: 10.1016/j.neulet.2008.06.085] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2008] [Revised: 06/11/2008] [Accepted: 06/26/2008] [Indexed: 01/29/2023]
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Ekstrand J, Hellsten J, Wennström M, Tingström A. Differential inhibition of neurogenesis and angiogenesis by corticosterone in rats stimulated with electroconvulsive seizures. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1466-72. [PMID: 18583010 DOI: 10.1016/j.pnpbp.2008.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [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] [Received: 03/15/2008] [Revised: 05/05/2008] [Accepted: 05/06/2008] [Indexed: 01/19/2023]
Abstract
Antidepressant drugs and electroconvulsive seizure (ECS)-treatment, an animal model of electroconvulsive therapy, induce neurogenesis in adult rats. Stress and high levels of corticosterone (CORT) on the contrary inhibit neurogenesis. Hippocampal neurogenesis has been described to occur in an angiogenic niche where proliferation of neural progenitors takes place in an environment with active vascular growth. Here we investigate the effect of ECS-treatment on the proliferation of endothelial cells and neuronal precursors in hippocampus of CORT-treated rats. Bromodeoxyuridine (BrdU) was used to identify dividing cells. The number of newborn neuronal precursors and endothelial cells was quantified in the subgranular zone (SGZ) and the molecular layer (ML) of the dentate gyrus. The increase in neuronal precursor proliferation in the SGZ following ECS-treatment was not inhibited by elevated levels of CORT despite CORT strongly inhibiting ECS-induced endothelial cell proliferation. Also in the ML CORT-treatment inhibited the ECS-induced angiogenic response. We conclude that despite common factors regulating neurogenesis and angiogenesis, ECS-induced proliferation of neuronal precursors can take place even if the angiogenic response is blunted. Whether inhibition of angiogenesis affects other steps in the chain of events leading to the formation of fully integrated granule neurons remains to be elucidated.
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Affiliation(s)
- Joakim Ekstrand
- Molecular Psychiatry Unit, Wallenberg Neuroscience Center BMC B12, S-22184 Lund, Sweden
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Liu WS, Yasue H, Eyer K, Hiraiwa H, Shimogiri T, Roelofs B, Landrito E, Ekstrand J, Treat M, Paes N, Lemos M, Griffith AC, Davis ML, Meyers SN, Yerle M, Milan D, Beever JE, Schook LB, Beattie CW. High-resolution comprehensive radiation hybrid maps of the porcine chromosomes 2p and 9p compared with the human chromosome 11. Cytogenet Genome Res 2008; 120:157-63. [PMID: 18467842 DOI: 10.1159/000118757] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2007] [Indexed: 11/19/2022] Open
Abstract
We are constructing high-resolution, chromosomal 'test' maps for the entire pig genome using a 12,000-rad WG-RH panel (IMNpRH2(12,000-rad))to provide a scaffold for the rapid assembly of the porcine genome sequence. Here we present an initial, comparative map of human chromosome (HSA) 11 with pig chromosomes (SSC) 2p and 9p. Two sets of RH mapping vectors were used to construct the RH framework (FW) maps for SSC2p and SSC9p. One set of 590 markers, including 131 microsatellites (MSs), 364 genes/ESTs, and 95 BAC end sequences (BESs) was typed on the IMNpRH2(12,000-rad) panel. A second set of 271 markers (28 MSs, 138 genes/ESTs, and 105 BESs) was typed on the IMpRH(7,000-rad) panel. The two data sets were merged into a single data-set of 655 markers of which 206 markers were typed on both panels. Two large linkage groups of 72 and 194 markers were assigned to SSC2p, and two linkage groups of 84 and 168 markers to SSC9p at a two-point LOD score of 10. A total of 126 and 114 FW markers were ordered with a likelihood ratio of 1000:1 to the SSC2p and SSC9p RH(12,000-rad) FW maps, respectively, with an accumulated map distance of 4046.5 cR(12,000 )and 1355.2 cR(7,000 )for SSC2p, and 4244.1 cR(12,000) and 1802.5 cR(7,000) for SSC9p. The kb/cR ratio in the IMNpRH2(12,000-rad) FW maps was 15.8 for SSC2p, and 15.4 for SSC9p, while the ratio in the IMpRH(7,000-rad) FW maps was 47.1 and 36.3, respectively, or an approximately 3.0-fold increase in map resolution in the IMNpRH(12,000-rad) panel over the IMpRH(7,000-rad) panel. The integrated IMNpRH(12,000-rad) andIMpRH(7,000-rad) maps as well as the genetic and BAC FPC maps provide an inclusive comparative map between SSC2p, SSC9p and HSA11 to close potential gaps between contigs prior to sequencing, and to identify regions where potential problems may arise in sequence assembly.
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Affiliation(s)
- W-S Liu
- Department of Dairy and Animal Science, College of Agricultural Sciences, Pennsylvania State University, University Park, PA, USA
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Abstract
OBJECTIVE To compare injury risk in elite football played on artificial turf compared with natural grass. DESIGN Prospective two-cohort study. SETTING Male European elite football leagues. PARTICIPANTS 290 players from 10 elite European clubs that had installed third-generation artificial turf surfaces in 2003-4, and 202 players from the Swedish Premier League acting as a control group. MAIN OUTCOME MEASURE Injury incidence. RESULTS The incidence of injury during training and match play did not differ between surfaces for the teams in the artificial turf cohort: 2.42 v 2.94 injuries/1000 training hours and 19.60 v 21.48 injuries/1000 match hours for artificial turf and grass respectively. The risk of ankle sprain was increased in matches on artificial turf compared with grass (4.83 v 2.66 injuries/1000 match hours; rate ratio 1.81, 95% confidence interval 1.00 to 3.28). No difference in injury severity was seen between surfaces. Compared with the control cohort who played home games on natural grass, teams in the artificial turf cohort had a lower injury incidence during match play (15.26 v 23.08 injuries/1000 match hours; rate ratio 0.66, 95% confidence interval 0.48 to 0.91). CONCLUSIONS No evidence of a greater risk of injury was found when football was played on artificial turf compared with natural grass. The higher incidence of ankle sprain on artificial turf warrants further attention, although this result should be interpreted with caution as the number of ankle sprains was low.
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Affiliation(s)
- J Ekstrand
- Department of Social Medicine and Public Health Science, Linköping University, and the Sports Clinic, Linköping, Sweden.
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Abstract
BACKGROUND Previous injury is often proposed to be a risk factor for football injury, but most studies rely on players reporting their own medical history and are thus potentially subject to recall bias. Little is known about the natural variation in injury pattern between seasons. OBJECTIVES To study whether prospectively recorded injuries during one season are associated with injuries sustained during the following season, and to compare injury risk and injury pattern between consecutive seasons. METHODS The medical staffs of 12 elite Swedish male football teams prospectively recorded individual exposure and time loss injuries over two full consecutive seasons (2001 and 2002). A multivariate model was used to determine the relation between previous injury, anthropometric data, and the risk of injury. RESULTS The training and match injury incidences were similar between seasons (5.1 v 5.3 injuries/1000 training hours and 25.9 v 22.7/1000 match hours), but analysis of injury severity and injury patterns showed variations between seasons. Players who were injured in the 2001 season were at greater risk of any injury in the following season compared with non-injured players (hazard ratio 2.7; 95% confidence interval 1.7 to 4.3, p<0.0001). Players with a previous hamstring injury, groin injury, and knee joint trauma were two to three times more likely to suffer an identical injury in the following season, whereas no such relation was found for ankle sprain. Age was not associated with an increased injury risk. CONCLUSIONS This study confirmed previous results showing that previous injury is an important risk factor for football injury. Overall injury incidences were similar between consecutive seasons, indicating that an injury surveillance study covering one full season can provide a reasonable overview of the injury problem among elite football players in a specific environment. However, a prolonged study period is recommended for analyses of specific injury patterns.
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Affiliation(s)
- M Hägglund
- Department of Health and Society, Linköping University, S-58183 Linköping, Sweden.
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Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40:193-201. [PMID: 16505073 PMCID: PMC2491990 DOI: 10.1136/bjsm.2005.025270] [Citation(s) in RCA: 681] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.
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Affiliation(s)
- C W Fuller
- Centre for Sports Medicine, University of Nottingham, Nottingham, UK.
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Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Scand J Med Sci Sports 2006; 16:83-92. [PMID: 16533346 DOI: 10.1111/j.1600-0838.2006.00528.x] [Citation(s) in RCA: 309] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football injuries; this has made inter-study comparisons difficult. An Injury Consensus Group was established under the auspices of FIFA Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology and implementation was discussed by members of the group during a 2-day meeting. Following this meeting, iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis and causation are proposed. Proforma for recording players' baseline information, injuries and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.
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Affiliation(s)
- C W Fuller
- Centre for Sports Medicine, University of Nottingham, Nottingham, UK.
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Waldén M, Hägglund M, Ekstrand J. High risk of new knee injury in elite footballers with previous anterior cruciate ligament injury. Br J Sports Med 2006; 40:158-62; discussion 158-62. [PMID: 16432004 PMCID: PMC2492018 DOI: 10.1136/bjsm.2005.021055] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2005] [Indexed: 01/15/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a severe event for a footballer, but it is unclear if the knee injury rate is higher on returning to football after ACL injury. OBJECTIVE To study the risk of knee injury in elite footballers with a history of ACL injury compared with those without. METHOD The Swedish male professional league (310 players) was studied during 2001. Players with a history of ACL injury at the study start were identified. Exposure to football and all time loss injuries during the season were recorded prospectively. RESULTS Twenty four players (8%) had a history of 28 ACL injuries in 27 knees (one rerupture). These players had a higher incidence of new knee injury of any type than the players without ACL injury (mean (SD) 4.2 (3.7) v 1.0 (0.7) injuries per 1000 hours, p = 0.02). The risk of suffering a knee overuse injury was significantly higher regardless of whether the player (relative risk 4.8, 95% confidence interval 2.0 to 11.2) or the knee (relative risk 7.9, 95% confidence interval 3.4 to 18.5) was used as the unit of analysis. No interactive effects of age or any other anthropometric data were seen. CONCLUSION The risk of new knee injury, especially overuse injury, was significantly increased on return to elite football after ACL injury regardless of whether the player or the knee was used as the unit of analysis.
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Affiliation(s)
- M Waldén
- Department of Health and Society, Linköping University, S-581 83 Linköping, Sweden.
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Wennström M, Hellsten J, Ekstrand J, Lindgren H, Tingström A. Corticosterone-induced inhibition of gliogenesis in rat hippocampus is counteracted by electroconvulsive seizures. Biol Psychiatry 2006; 59:178-86. [PMID: 16431219 DOI: 10.1016/j.biopsych.2005.08.032] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 07/08/2005] [Accepted: 08/16/2005] [Indexed: 01/05/2023]
Abstract
BACKGROUND Volumetric changes and glial pathology have been reported in the central nervous system (CNS) of patients with depressive disorder, an illness often associated with elevated glucocorticoid levels. Glucocorticoids reduce gliogenesis in the adult rat CNS. Electroconvulsive seizure (ECS)-treatment, an animal model for the antidepressant treatment electroconvulsive therapy, can enhance proliferation of glial cells. This study examined glial cell proliferation in response to ECS in rats whose glucocorticoid levels were elevated to mimic the conditions seen in depression. METHODS Rats were injected daily for seven days with either corticosterone or vehicle. ECS- or sham- treatment was given once daily during the first five days. Proliferating cells in the hippocampus were labeled with bromodeoxyuridine and analyzed for co-labeling with the glial cell markers NG2, Ox42, S-100beta and Rip. RESULTS ECS counteracted the glucocorticoid-induced inhibition of NG2+, Ox42+ and Rip+ cell proliferation, and the gliogenesis rate was restored to baseline levels. Volumetric changes in rats treated with ECS were detected. CONCLUSIONS Our results show that ECS-treatment affects the proliferation of glial cells even in the presence of elevated levels of glucocorticoids. This result adds to an increasing number of studies suggesting that antidepressant treatment can counteract degenerative processes associated with major depression.
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Affiliation(s)
- Malin Wennström
- Molecular Psychiatry Unit, Wallenberg Neuroscience Center, S-22184, Lund, Sweden
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44
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Paulsson-Berne G, Gabrielsen A, Agardh H, Ekstrand J, Marcus D, Bodin I, Swedenborg J, Hansson G, Hedin U. Tu-P7:289 Inflammatory response in human atherosclerosis:Bike — biobank of Karolinska endartherectomy. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80992-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: 11/15/2022]
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Hellsten J, West MJ, Arvidsson A, Ekstrand J, Jansson L, Wennström M, Tingström A. Electroconvulsive seizures induce angiogenesis in adult rat hippocampus. Biol Psychiatry 2005; 58:871-8. [PMID: 16043138 DOI: 10.1016/j.biopsych.2005.05.023] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 04/06/2005] [Accepted: 05/11/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Electroconvulsive seizure (ECS)-treatment, a model for electroconvulsive therapy (ECT) has been shown to induce proliferation of endothelial cells in the dentate gyrus (DG) of adult rats. Here we quantified the net angiogenic response after chronic ECS-treatment in the molecular layer (ML) of the dentate gyrus. Patients undergoing ECT are routinely oxygenated to prevent hypoxia, a known inducer of angiogenesis. Therefore we also examined the effect of oxygenation on ECS-induced proliferation of endothelial cells. METHODS Total endothelial cell numbers and vessel length were estimated utilizing design based stereological analysis methods. Endothelial cell proliferation in the DG after ECS with or without oxygenation was assessed using bromodeoxyuridine. RESULTS The total number of endothelial cells and total vessel length was increased. Oxygenation did not abolish the ECS-induced proliferation of endothelial cells in the DG. CONCLUSIONS ECS-treatment induces a dramatic increase in endothelial cell proliferation leading to a 30% increase in the total number of endothelial cells. The increase in cell number resulted in a 16% increase in vessel length. These findings raise the possibility that similar vascular growth is induced by clinically administered ECT.
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Affiliation(s)
- Johan Hellsten
- Molecular Psychiatry Unit, Wallenberg Neuroscience Center, Lund, Sweden
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Abstract
BACKGROUND No previous study on adult football involving several different countries has investigated the incidence and pattern of injuries at the highest club competitive level. OBJECTIVE To investigate the risk exposure, risk of injury, and injury pattern of footballers involved in UEFA Champions League and international matches during a full football season. METHOD Eleven top clubs (266 players) in five European countries were followed prospectively throughout the season of 2001-2002. Time-lost injuries and individual exposure times were recorded during all club and national team training sessions and matches. RESULTS A total of 658 injuries were recorded. The mean (SD) injury incidence was 9.4 (3.2) injuries per 1000 hours (30.5 (11.0) injuries per 1000 match hours and 5.8 (2.1) injuries per 1000 training hours). The risk of match injury was significantly higher in the English and Dutch teams than in the teams from France, Italy, and Spain (41.8 (3.3) v 24.0 (7.9) injuries per 1000 hours; p = 0.008). Major injuries (absence > 4 weeks) constituted 15% of all injuries, and the risk of major injury was also significantly higher among the English and Dutch teams (p = 0.04). National team players had a higher match exposure, with a tendency towards a lower training injury incidence than the rest of the players (p = 0.051). Thigh strain was the most common injury (16%), with posterior strains being significantly more common than anterior ones (67 v 36; p < 0.0001). CONCLUSIONS The risk of injury in European professional football is high. The most common injury is the thigh strain typically involving the hamstrings. The results suggest that regional differences may influence injury epidemiology and traumatology, but the factors involved are unclear. National team players have a higher match exposure, but no higher risk of injury than other top level players.
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Affiliation(s)
- M Waldén
- Department of Health and Society, Linköping University, S-581 83 Linköping, Sweden.
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Timpka T, Lindqvist K, Ekstrand J, Karlsson N. Impact of social standing on sports injury prevention in a WHO safe community: intervention outcome by household employment contract and type of sport. Br J Sports Med 2005; 39:453-7. [PMID: 15976170 PMCID: PMC1725261 DOI: 10.1136/bjsm.2004.014472] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES As physical activity is promoted as part of a healthy lifestyle, sports injuries are becoming an important public health concern in many countries. The objective of this study is to investigate rates of sports injuries before and after implementation of a WHO Safe Community program. METHODS Sports injury data were collected pre- and post-implementation from all individuals below 65 years of age during 1 year in the targeted municipality (population 41,000) and in a control municipality (population 26,000). A quasi-experimental design was used and individuals were divided into three categories based on household relationship to the labour market. RESULTS There were no differences between socio-economic categories regarding pre-intervention injury rates. No statistically significant post-intervention changes in injury rate were observed in the control area or among any females in either area. In the intervention area, a statistically significant (p = 0.011) decrease in injury rate was observed among male members of households in which the vocationally important member was employed. A statistically significant decrease was observed in injuries sustained in team sports among male members of households in which the vocationally important member was employed (p = 0.001) and among members of households in which the vocationally important member was self employed (p<0.05). CONCLUSIONS The study indicates areas for improvement in the civic network based WHO Safe Community model. The results show that females, participants in individual sports, and members of non-vocationally active households were less affected by the interventions. These facts have to be addressed in planning future community based sports injury prevention programmes and their evaluations.
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Affiliation(s)
- T Timpka
- Linköping University, Department of Health and Society, Linköping SE 58185, Sweden.
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48
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Abstract
A problem with epidemiological studies of football injuries is the inconsistent manner in which injury is defined and data are collected. Projects have been initiated to study the incidence and causes of injury in football, but there is no uniformly accepted reporting system. In this report, some common pitfalls encountered in the recording of injury are addressed, and practical guidelines for epidemiological studies are provided. An injury reporting system developed for the UEFA Football Safety Project for studies on professional footballers is used as a starting point for a general discussion on injury registration and compared with other existing reporting systems. The recording definition of injury may vary between studies depending on its purpose. A time loss injury definition is practical for all playing levels, and, as a minimum, results on time loss injuries should therefore always be reported separately to allow direct comparisons between studies. There is a need to agree on a uniform sports injury classification system with corresponding diagnostic criteria, as well as standardised return to play criteria after injury.
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Affiliation(s)
- M Hägglund
- Department of Social Medicine and Public Health Science, Linköping University, Linköping, Sweden
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Ekstrand J, Waldén M, Hägglund M. A congested football calendar and the wellbeing of players: correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performances during that World Cup. Br J Sports Med 2005; 38:493-7. [PMID: 15273193 PMCID: PMC1724854 DOI: 10.1136/bjsm.2003.009134] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To investigate the correlation between exposure of footballers in European clubs to match play in the months before the World Cup 2002 and their injuries and performances during that World Cup. METHODS The team doctors at 11 of the best football clubs in Europe prospectively recorded players' exposure and injuries during the 2001-2002 season (July 2001-May 2002). Sixty five players participated in the World Cup in Korea/Japan (June 2002). During the World Cup, the clubs reported injuries sustained by these players, and their performance was evaluated by three international experts. RESULTS The number of team matches during the season varied between 40 and 76 for the different countries involved. The individual player had a mean of 36 matches during the season. Top players played more matches, especially during the final period of the season. Players who participated in the World Cup played more matches during the season than those who did not (46 v 33 matches). World Cup players did not show any increased risk of injury during the season. About 29% incurred injuries during the World Cup, and 32% performed below their normal standard. The players who underperformed had played more matches during the 10 weeks before the World Cup than those who performed better than expected (12.5 v 9, p<0.05). Twenty three (60%) of the 38 players who had played more than one match a week before the World Cup incurred injuries or underperformed during the World Cup. CONCLUSIONS There is considerable variation in the number of matches played per season in European professional football leagues. Top level players are obliged to play many matches especially during the final period of the season.
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Affiliation(s)
- J Ekstrand
- Department of Social Medicine and Public Health Science, Linköping University, Linköping, Sweden.
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Abstract
The aim of the present study was to investigate the G-1 uptake of mercury (Hg) after intake of a single dose of amalgam-Hg, followed by pharmacokinetic analysis of the data. Eleven volunteers without amalgam fillings ingested 1.00 g amalgam powder. Hg in plasma vs. time was analyzed with a two-compartment model by means of mixed-effects modeling. A fraction of the absorption rate of Hg to the central compartment was inversely proportional to the plasma ferritin levels. The population mean half-life of the terminal phase of Hg in plasma was 37 days, with a considerable standard deviation in the population. The absorbed fraction of the administered dose was estimated to be about 0.04%. It is concluded that the G-1 uptake of Hg is of quantitative importance during dental treatment.
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Affiliation(s)
- E af Geijersstam
- Dept. of Basic Oral Sciences, School of Dentistry, Karolinska Institutet, Huddinge, Sweden
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