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  • 1.
    Adawi, Rahim
    University of Skövde, School of Engineering Science.
    Preventing fatal effects of overworking: Product design solution2018Independent thesis Basic level (university diploma), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    “Overworking to death” is a phenomenon that has been noticeable in developing countries. The cause of death is mainly through ischemic strokes. While the victims’ occupations differed, they all shared a common characteristic, being positioned in a sedentary work, ranging from IT workers to doctors. This project’s aim was to develop a product that prevented or decreased the strokes that derived from sedentary overwork. This was mainly tackled by preventing one of the three causes of developing blood props, slowed blood flow. In order to gather rich data of the phenomenon, a qualitative study was conducted in China, during two months. By doing an extensive structured sampling, information rich data could be gathered during a short period of time. Data were derived from observations, questionnaires and an interview, which then was interpreted to customer needs and the final product specification. The final product became a trouser with an in built dynamic compression mechanic, that can compress the veins mostly during sitting activities, in order to prevent blood stasis. The compression mechanic works like the Chinese finger trap; compressing the calves while sitting and stretching the legs forward. It is made only out of polysaccharides fibres; cotton and corn.

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    PREVENTING FATAL EFFECTS OF OVERWORKING – PRODUCT DESIGN SOLUTION / Rahim_Adawi
  • 2.
    Asp, Julia
    et al.
    Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden.
    Synnergren, Jane
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Jonsson, Marianne
    Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden.
    Dellgren, Goran
    Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, the Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Comparison of human cardiac gene expression profiles in paired samples of right atrium and left ventricle collected in vivo2012In: Physiological Genomics, ISSN 1094-8341, E-ISSN 1531-2267, Vol. 44, no 1, p. 89-98Article in journal (Refereed)
    Abstract [en]

    Studies of expressed genes in human heart provide insight into both physiological and pathophysiological mechanisms. This is of importance for extended understanding of cardiac function as well as development of new therapeutic drugs. Heart tissue for gene expression studies is generally hard to obtain, particularly from the ventricles. Since different parts of the heart have different functions, expression profiles should likely differ between these parts. The aim of the study was therefore to compare the global gene expression in cardiac tissue from the more accessible auricula of the right atrium to expression in tissue from the left ventricle. Tissue samples were collected from five men undergoing aortic valve replacement or coronary artery bypass grafting. Global gene expression analysis identified 542 genes as differentially expressed between the samples extracted from these two locations, corresponding to similar to 2% of the genes covered by the microarray; 416 genes were identified as abundantly expressed in right atrium, and 126 genes were abundantly expressed in left ventricle. Further analysis of the differentially expressed genes according to available annotations, information from curated pathways and known protein interactions, showed that genes with higher expression in the ventricle were mainly associated with contractile work of the heart. Transcription in biopsies from the auricula of the right atrium on the other hand indicated a wider area of functions, including immunity and defense. In conclusion, our results suggest that biopsies from the auricula of the right atrium may be suitable for various genetic studies, but not studies directly related to muscle work.

  • 3.
    Behboudi, Afrouz
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Thelander, Tilia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Yazici, Duygu
    Koc University Research Center for Translational Medicine (KUTTAM), Koc University Hospital, Istanbul, Turkey.
    Celik, Yeliz
    Koc University Research Center for Translational Medicine (KUTTAM), Koc University Hospital, Istanbul, Turkey.
    Yucel-Lindberg, Tülay
    Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
    Thunström, Erik
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Peker, Yüksel
    Koc University Research Center for Translational Medicine (KUTTAM), Koc University Hospital, Istanbul, Turkey ; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden ; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, PA, USA.
    Association of TNF-alpha (-308G/A) Gene Polymorphism with Circulating TNF-alpha Levels and Excessive Daytime Sleepiness in Adults with Coronary Artery Disease and Concomitant Obstructive Sleep Apnea2021In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 10, no 15, article id 3413Article in journal (Refereed)
    Abstract [en]

    Obstructive sleep apnea (OSA) is common in patients with coronary artery disease (CAD), in which inflammatory activity has a crucial role. The manifestation of OSA varies significantly between individuals in clinical cohorts; not all adults with OSA demonstrate the same set of symptoms; i.e., excessive daytime sleepiness (EDS) and/or increased levels of inflammatory biomarkers. The further exploration of the molecular basis of these differences is therefore essential for a better understanding of the OSA phenotypes in cardiac patients. In this current secondary analysis of the Randomized Intervention with Continuous Positive Airway Pressure in CAD and OSA (RICCADSA) trial (Trial Registry: ClinicalTrials.gov; No: NCT 00519597), we aimed to address the association of tumor necrosis factor alpha (TNF-α)-308G/A gene polymorphism with circulating TNF-α levels and EDS among 326 participants. CAD patients with OSA (apnea–hypopnea-index (AHI) ≥ 15 events/h; n = 256) were categorized as having EDS (n = 100) or no-EDS (n = 156) based on the Epworth Sleepiness Scale score with a cut-off of 10. CAD patients with no-OSA (AHI < 5 events/h; n = 70) were included as a control group. The results demonstrated no significant differences regarding the distribution of the TNF-α alleles and genotypes between CAD patients with vs. without OSA. In a multivariate analysis, the oxygen desaturation index and TNF-α genotypes from GG to GA and GA to AA as well as the TNF-α-308A allele carriage were significantly associated with the circulating TNF-α levels. Moreover, the TNF-α-308A allele was associated with a decreased risk for EDS (odds ratio 0.64, 95% confidence interval 0.41–0.99; p = 0.043) independent of age, sex, obesity, OSA severity and the circulating TNF-α levels. We conclude that the TNF-α-308A allele appears to modulate circulatory TNF-α levels and mitigate EDS in adults with CAD and concomitant OSA.

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  • 4.
    Celik, Yeliz
    et al.
    Department of Pulmonary Medicine, Koc University School of Medicine, Koc University Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul, Turkey.
    Peker, Yüksel
    Department of Pulmonary Medicine, Koc University School of Medicine, Koc University Research Center for Translational Medicine (KUTTAM), Koc University, Istanbul, Turkey ; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden ; Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Sweden ; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States ; Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States.
    Yucel-Lindberg, Tülay
    Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
    Thelander, Tilia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Behboudi, Afrouz
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Association of TNF-α (-308G/A) Gene Polymorphism with Changes in Circulating TNF-α Levels in Response to CPAP Treatment in Adults with Coronary Artery Disease and Obstructive Sleep Apnea2023In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 12, no 16, article id 5325Article in journal (Refereed)
    Abstract [en]

    Rationale: We recently demonstrated that patients with coronary artery disease (CAD) and obstructive sleep apnea (OSA) carrying the tumor necrosis factor-alpha (TNF-α) A allele had increased circulating TNF-α levels compared with the ones carrying the TNF-α G allele. In the current study, we addressed the effect of TNF-α (-308G/A) gene polymorphism on circulating TNF-α levels following continuous positive airway pressure (CPAP) therapy. Methods: This study was a secondary analysis of the RICCADSA trial (NCT00519597) conducted in Sweden. CAD patients with OSA (apnea–hypopnea index) of ≥15 events/h and an Epworth Sleepiness Scale (ESS) score of <10 were randomized to CPAP or no-CPAP groups, and OSA patients with an ESS score of ≥10 were offered CPAP treatment. Blood samples were obtained at baseline and 12-month follow-up visits. TNF-α was measured by immunoassay (Luminex, R&D Systems). Genotyping of TNF-α-308G/A (single nucleotide polymorphism Rs1800629) was performed by polymerase chain reaction–restriction fragment length polymorphism. Results: In all, 239 participants (206 men and 33 women; mean age 64.9 (SD 7.7) years) with polymorphism data and circulating levels of TNF-α at baseline and 1-year follow-up visits were included. The median circulating TNF-α values fell in both groups between baseline and 12 months with no significant within- or between-group differences. In a multivariate linear regression model, a significant change in circulating TNF-α levels from baseline across the genotypes from GA to GA and GA to AA (standardized β-coefficient −0.129, 95% confidence interval (CI) −1.82; −0.12; p = 0.025) was observed in the entire cohort. The association was more pronounced among the individuals who were using the device for at least 4 h/night (n = 86; standardized β-coefficient −2.979 (95% CI −6.11; −1.21); p = 0.004)), whereas no significant association was found among the patients who were non-adherent or randomized to no-CPAP. The participants carrying the TNF-α A allele were less responsive to CPAP treatment regarding the decline in circulating TNF-α despite CPAP adherence (standardized β-coefficient −0.212, (95% CI −5.66; −1.01); p = 0.005). Conclusions: Our results suggest that TNF-α (-308G/A) gene polymorphism is associated with changes in circulating TNF-α levels in response to CPAP treatment in adults with CAD and OSA. 

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  • 5.
    Correia, Cláudia
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Wang, Qing-Dong
    Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Linhardt, Gunilla
    Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Carlsson, Leif G.
    Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Ulfenborg, Benjamin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Walentinsson, Anna
    Translational Science & Experimental Medicine, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Rydén-Markinhutha, Katarina
    Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Behrendt, Margareta
    Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Wikström, Johannes
    Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Sartipy, Peter
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Late-Stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Jennbacken, Karin
    Bioscience Cardiovascular, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Synnergren, Jane
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Unraveling the Metabolic Derangements Occurring in Non-infarcted Areas of Pig Hearts With Chronic Heart Failure2021In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 8, article id 753470Article in journal (Refereed)
    Abstract [en]

    Objective: After myocardial infarction (MI), the non-infarcted left ventricle (LV) ensures appropriate contractile function of the heart. Metabolic disturbance in this region greatly exacerbates post-MI heart failure (HF) pathology. This study aimed to provide a comprehensive understanding of the metabolic derangements occurring in the non-infarcted LV that could trigger cardiovascular deterioration. Methods and Results: We used a pig model that progressed into chronic HF over 3 months following MI induction. Integrated gene and metabolite signatures revealed region-specific perturbations in amino acid- and lipid metabolism, insulin signaling and, oxidative stress response. Remote LV, in particular, showed impaired glutamine and arginine metabolism, altered synthesis of lipids, glucose metabolism disorder, and increased insulin resistance. LPIN1, PPP1R3C, PTPN1, CREM, and NR0B2 were identified as the main effectors in metabolism dysregulation in the remote zone and were found differentially expressed also in the myocardium of patients with ischemic and/or dilated cardiomyopathy. In addition, a simultaneous significant decrease in arginine levels and altered PRCP, PTPN1, and ARF6 expression suggest alterations in vascular function in remote area. Conclusions: This study unravels an array of dysregulated genes and metabolites putatively involved in maladaptive metabolic and vascular remodeling in the non-infarcted myocardium and may contribute to the development of more precise therapies to mitigate progression of chronic HF post-MI.

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  • 6.
    Dybjer, Elin
    et al.
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Nilsson, Erik D.
    Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Nägga, Katarina
    Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden ; Department of Acute Internal Medicine and Geriatrics, Linköping University, Sweden.
    Nilsson, Peter M.
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Hassing, Linda B.
    Department of Psychology, University of Gothenburg, Sweden ; Centre for Ageing and Health, University of Gothenburg, Sweden.
    Type 1 diabetes, cognitive ability and incidence of cardiovascular disease and death over 60 years of follow-up time in men2022In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 39, no 8, article id e14806Article in journal (Refereed)
    Abstract [en]

    Aims: There are few cohorts of type 1 diabetes that follow individuals over more than half a century in terms of health outcomes. The aim of this study was to examine associations between type 1 diabetes, diagnosed before age 18, and long-term morbidity and mortality, and to investigate whether cognitive ability plays a role in long-term morbidity and mortality risk. Methods: In a Swedish cohort, 120 men with type 1 diabetes and 469 without type 1 diabetes were followed between 18 and 77 years of age as regards morbidity and mortality outcomes, and impact of cognitive ability at military conscription for the outcomes. In Cox regression analyses and Kaplan-Meier analyses with log-rank tests, associations between diabetes and cognitive ability respectively, and outcomes (mortality, cardiovascular morbidity and diabetes complications) were investigated. Results: Men with type 1 diabetes suffered from dramatically higher mortality (HR 4.62, 95% CI: 3.56–5.60), cardiovascular mortality (HR 5.60, 95% CI: 3.27–9.57), and cardiovascular events (HR 3.97, 95% CI: 2.79–5.64) compared to men without diabetes. Higher cognitive ability at military conscription was associated with lower mortality in men without diabetes, but was not associated with any outcome in men with diabetes. Conclusions: In this historical cohort study with 60 years of follow-up time and a less effective treatment of diabetes than today, mortality rates and cardiovascular outcomes were high for men with type 1 diabetes. Morbidity or mortality did not differ between those that had low to normal or high cognitive ability among men with type 1 diabetes.

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  • 7.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Sathian, Brijesh
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
    El-Menyar, Ayman
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar / Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
    Venous thromboembolic events after bariatric surgery: Protocol for a systematic review and meta-analysis2020In: International Journal of Surgery Protocols, ISSN 2468-3574, Vol. 22, p. 10-14Article in journal (Refereed)
    Abstract [en]

    Introduction: Considerably large numbers of bariatric surgery (BS) procedures are undertaken globally, and are projected to increase with the obesity epidemic. Venous thromboembolic events (VTE) comprise an important cause of postoperative morbidity and mortality after BS and an important issue with wide clinical and financial repercussions. Yet, a precise extent of the prevalence of VTE after BS for obesity and its mortality remains uncertain. Methods and analysis: In order to respond to this knowledge gap, we will conduct a systematic review and meta-analysis of the prevalence of and mortality associated with VTE after BS. This protocol outlines the methodology that will be used and the search strategies and eligibility criteria that will be utilized to identify and select studies, as well as the method by which data from the selected studies will be extracted for analysis. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry Platform, Cochrane Library, MEDLINE, Scopus, clinicaltrials.gov and Google scholar will be searched from 01 January 1990 through 10th April 2020, for original studies written in English that provided prevalence estimates of VTE after BS. Articles will also be searched for mortality estimates of VTE after BS. STROCSS (Strengthening the Reporting of Cohort Studies in Surgery) criteria will evaluate the methodological quality of the selected studies. The use of fixed effect or random effects model will be subject to the findings of the statistical tests for heterogeneity. Publication bias will be visually estimated by inspecting the funnel plots. Pooled estimates will be computed. Th current protocol conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and has been submitted to the PROSPERO International Prospective Register of systematic reviews. No ethical clearance is required for this study. This systematic review and meta-analysis will be published in a peer-reviewed journal and presented at national and international conferences. © 2020 The Author(s)

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  • 8.
    Entonen, Anitta H.
    et al.
    Department of Public Health, Faculty of Medicine, University of Turku, Finland.
    Suominen, Sakari B.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Research Services, Turku University Hospital, Finland.
    Sillanmäki, Lauri H.
    Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Turku University Hospital, Finland ; Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Rautava, Päivi T.
    Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Research Services, Turku University Hospital, Finland.
    Kauniskangas, Katariina
    Department of Public Health, Faculty of Medicine, University of Turku, Finland ; Healthcare Services, City of Turku, Section of Welfare, Turku, Finland.
    Mäntyselkä, Pekka T.
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland and Primary Health Care Unit, Kuopio University Hospital, Finland.
    Sumanen, Markku
    Faculty of Medicine and Health Technology, University of Tampere, Finland.
    Koskenvuo, Markku J.
    Department of Public Health, Faculty of Medicine, University of Helsinki, Finland.
    Prevalent migraine as a predictor of incident hypertension2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 2, p. 297-301Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Migraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013. METHODS: The present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets. RESULTS: A significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20-1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables. CONCLUSION: Extra attention should be paid to prevention and control of hypertension in working-age migraine patients. 

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  • 9.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Pentti, Jaana
    Finnish Institute of Occupational Health, Helsinki, Finland ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Finland.
    Nyberg, Solja T.
    Finnish Institute of Occupational Health, Helsinki, Finland ; Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Shipley, Martin J.
    Department of Epidemiology and Public Health, University College London, UK.
    Leineweber, Constanze
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Sørensen, Jeppe K.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Centre for Occupational and Environmental Medicine, Region Stockholm, Sweden.
    Bjorner, Jakob B.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Borritz, Marianne
    Bispebjerg University Hospital, Copenhagen, Denmark.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health, Berlin, Germany.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment, Copenhagen, Denmark.
    Magnusson Hanson, Linda L.
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Oksanen, Tuula
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
    Pejtersen, Jan H.
    VIVE–The Danish Center for Social Science Research, Copenhagen, Denmark.
    Rugulies, Reiner
    National Research Centre for the Working Environment, Copenhagen, Denmark ; Department of Public Health, University of Copenhagen, Denmark ; Department of Psychology, University of Copenhagen, Denmark.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Finland.
    Theorell, Töres
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Westerlund, Hugo
    Stress Research Institute at the Department of Psychology, Stockholm University, Sweden.
    Vahtera, Jussi
    Department of Public Health, University of Turku, and Population Research Centre, University of Turku and Turku University Hospital, Finland.
    Virtanen, Marianna
    School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland ; Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, UK.
    Kivimäki, Mika
    Finnish Institute of Occupational Health, Helsinki, Finland ; Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Department of Epidemiology and Public Health, University College London, UK.
    Long working hours and risk of 50 health conditions and mortality outcomes: a multicohort study in four European countries2021In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 11, article id 100212Article in journal (Refereed)
    Abstract [en]

    Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints. Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers. Findings: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality. Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality. Funding: NordForsk, the Medical Research Council, the National Institute on Aging, the Wellcome Trust, Academy of Finland, and Finnish Work Environment Fund. 

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  • 10.
    Gellerstedt, Martin
    et al.
    University of Trollhättan/Uddevalla, Uddevalla, Sweden.
    Bång, Angela
    Prehospital Research Centre of Western Sweden, University College of Borås, Borås, Sweden.
    Andréasson, Emma
    University of Trollhättan/Uddevalla, Uddevalla, Sweden.
    Johansson, Anna
    University of Trollhättan/Uddevalla, Uddevalla, Sweden.
    Herlitz, Johan
    Prehospital Research Centre of Western Sweden, University College of Borås, Borås, Sweden ; The Prehospital Research Centre of Western Sweden, Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
    Does sex influence the allocation of life support level by dispatchers in acute chest pain?2010In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, no 8, p. 922-927Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL. PATIENTS: All patients in Göteborg, Sweden, who called the dispatch center because of chest pain during 3 months (n = 503) were included in this study. METHODS: Age, sex, and symptom profile were background variables. Based on these, we studied allocation of LSL by the dispatchers and its relationship to AMI, LTC, and death. All evaluations were made from a sex perspective. Finally, we studied the potential benefit of using a statistical model for allocating LSL. RESULTS: The advanced life support level (ALSL) was used equally frequently for men and women. There was no difference in age or symptom profile between men and women in relation to allocation. However, the allocation of ALSL was predictive of AMI and LTC only in men. The sensitivity was far lower for women than for men. When a statistical model was used for allocation, the ALSL was predictive for both men and women. Using a separate model for men and women respectively, sensitivity increased, especially for women, and specificity was kept at the same level. CONCLUSION: This exploratory study indicates that women would benefit most from the allocation of LSL using a statistical model and computer-based decision support among patients who call for an ambulance because of acute chest pain. This needs further evaluation.

  • 11.
    Gellerstedt, Martin
    et al.
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Bång, Angela
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Herlitz, Johan
    Sahlgrenska University Hospital, Göteborg, Sweden.
    Could a Computer Based System for Evaluating Patients with Suspected Myocardial Infarction Improve Ambulance Allocation?2004In: Biological and Medical Data Analysis: 5th International Symposium, ISBMDA 2004, Barcelona, Spain, November 18-19, 2004, Proceedings / [ed] José María Barreiro, Fernando Martín-Sánchez, Víctor Maojo, Ferran Sanz, Springer Berlin/Heidelberg, 2004, p. 141-147Conference paper (Refereed)
    Abstract [en]

    The very early handling of patients with suspected acute myocardial infarction (AMI) is crucial for the outcome. In Gothenburg approximately two-third of all patients with AMI dial the emergency number for ambulance transport (reference).

  • 12.
    Gellerstedt, Martin
    et al.
    University West, School of Business, Economics and IT, Trollhättan, Sweden.
    Rawshani, Nina
    Department of Emergency Medicine, University of Gothenburg, Göteborg, Sweden.
    Herlitz, Johan
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden ; Department of Medicine, University of Gothenburg, Göteborg, Sweden.
    Bång, Angela
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Gelang, Carita
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden ; Department of Ambulance and Prehospital Emergency Care, University of Gothenburg, Göteborg, Sweden.
    Andersson, Jan-Otto
    Department of Ambulance and Prehospital Emergency Care, Skaraborg, Sweden.
    Larsson, Anna
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Rawshani, Araz
    Department of Medicine, University of Gothenburg, Göteborg, Sweden.
    Could prioritisation by emergency medicine dispatchers be improved by using computer-based decision support?: A cohort of patients with chest pain2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, p. 734-738Article in journal (Refereed)
    Abstract [en]

    Background: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity. Methods: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model. Results: A total of 2048 patients answered all 10 questions. Among the 235 patients with ACS, 194 were allocated the highest prioritisation by dispatchers (sensitivity 82.6%) and 41 patients were given a lower prioritisation (17.4% false negatives). The allocation suggested by the model used the highest prioritisation in 212 of the patients with ACS (sensitivity of 90.2%), while 23 patients were underprioritised (9.8% false negatives). The results were similar when the two systems were compared with regard to LTC and 30-day mortality. This indicates that computer-based decision support could be used either for increasing sensitivity or for saving resources. Three questions proved to be most important in terms of predicting ACS/LTC, [1] the intensity of pain, [2] the localisation of pain and [3] a history of ACS. Conclusion: Among patients with acute chest pain, computer-based decision support with a model based on a few fundamental questions could improve sensitivity and reduce the number of cases with the highest prioritisation without endangering the patients.

  • 13.
    Gerafi, Joel
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Faculty of Social Sciences, Department of Psychology, University of Gothenburg, Sweden / Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden / The Skaraborg Institute for Research and Development, Skövde, Sweden.
    Samuelsson, Hans
    Faculty of Social Sciences, Department of Psychology, University of Gothenburg, Sweden / Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden.
    Viken, Jo I.
    Faculty of Social Sciences, Department of Psychology, University of Gothenburg, Sweden / Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden.
    Jern, Christina
    Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Sweden.
    Blomstrand, Christian
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden.
    Jood, Katarina
    Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Neurology, The Sahlgrenska University Hospital, Gothenburg, Sweden.
    The presence and prediction of lateralized inattention 7 years post-stroke2020In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 141, no 5, p. 423-430Article in journal (Refereed)
    Abstract [en]

    Objective: Lateralized inattention is a typical sign of neglect and related to poor functional outcome. Knowledge of the long-term course of this phenomenon is limited. The purpose of this study was to investigate presence and predictors for signs of lateralized inattention 7 years after stroke. Methods: From a cohort of acute ischemic stroke patients, aged 18-69 years (n = 297), a consecutive series of 188 survivors without recurrent stroke at follow-up 7 years later were included. Within the first week after stroke onset, stroke severity was assessed according to the Scandinavian Stroke Scale. Target omissions, asymmetry of omissions, and perceptual speed according to Star- and Letter Cancellation Tests were also assessed. Presence of lateralized inattention at the 7-year follow-up was investigated with the Star- and Letter Cancellation Tests and with the neglect item in the National Institutes of Health Stroke Scale. Results: At the follow-up, 22 (11.7%) participants had lateralized inattention and the multivariable regression showed that independent significant baseline predictors were total omissions in target cancellations (P <.001) and inferior baseline performance on visual processing speed (P =.008). Conclusion: About one of ten individuals exhibited signs of lateralized inattention 7 years after stroke. Baseline performance in perceptual processing speed and target omissions independently predicted presence of late signs of lateralized inattention. This is the first time processing speed is recognized as a significant predictor of lateralized inattention several years after the stroke incidence, indicating that the longitudinal course of processing speed following stroke is a critical subject for future research. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 14.
    González-Gil, Esther M.
    et al.
    Department of Biochemistry and Molecular Biology II, Instituto de Nutrición y Tecnología de los Alimentos, Center of Biomedical Research (CIBM), Universidad de Granada, Spain ; GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Spain ; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain.
    Santaliestra-Pasías, Alba M.
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain ; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain ; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain ; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
    Buck, Christoph
    Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany.
    Gracia-Marco, Luis
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain ; PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Spain.
    Lauria, Fabio
    Institute of Food Sciences, National Research Council, Avellino, Italy.
    Pala, Valeria
    Epidemiology and Prevention Unit, Fondazione IRCCS—Istituto Nazionale dei Tumori, Milan, Italy.
    Molnar, Denes
    Department of Pediatrics, Medical School, University of Pécs, Hungary.
    Veidebaum, Toomas
    National Institute for Health Development, Center of Health and Behavioral Science, Tallinn, Estonia.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy ; Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy.
    Tornaritis, Michael
    Research and Education Institute of Child Health, Strovolos, Cyprus.
    Eiben, Gabriele
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Lissner, Lauren
    Department of Public Health and Community Medicine, University of Gothenburg, Sweden.
    Schwarz, Heike
    Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany.
    Ahrens, Wolfgang
    Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany ; Institute of Statistics, Bremen University, Germany.
    De Henauw, Stefaan
    Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
    Fraterman, Arno
    Laboratoriumsmedizin Dortmund, Eberhard & Partner, Dortmund, Germany.
    Moreno, Luis A.
    GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain ; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain ; Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain ; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
    Improving cardiorespiratory fitness protects against inflammation in children: the IDEFICS study2022In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 91, no 3, p. 681-689Article in journal (Refereed)
    Abstract [en]

    Background: Muscular and cardiorespiratory fitness (MF and CRF) have been related to inflammation. Thus, the aim of this study was to assess the relationship between fitness and high-sensitivity C-reactive protein (hs-CRP) in European children both in the cross-sectional and longitudinal analysis. Methods: Three hundred and fifty-seven children (46.2% males) aged 2–9 years with hs-CRP measured, data from MF and CRF, diet quality, objectively measured physical activity (PA) and screen time at baseline and follow-up after 2 years were included. Body mass index z-score (zBMI), waist circumference (WC) and fat mass index (FMI) were assessed. MF and CRF were also dichotomized as follows: low-medium quartiles (Q1–Q3) and highest quartile (Q4). Results: At follow-up, children with the highest CRF (Q4) showed a lower probability of having high hs-CRP. In the longitudinal analysis, children who improved their CRF over time showed a significantly lower probability (p < 0.05) of being in the highest hs-CRP category at follow-up, independently of the body composition index considered: odds ratio (OR) = 0.22 for zBMI, OR = 0.17 for WC, and OR = 0.21 for FMI. Conclusions: Improving CRF during childhood reduces the odds of an inflammatory profile, independently of body composition and lifestyle behaviours. These highlight the importance of enhancing fitness, especially CRF, to avoid an inflammatory state in children. Impact: Improvements in the cardiorespiratory profile during childhood could reverse an unfavourable inflammatory status.There is a longitudinal and inverse association between CRF and inflammation in children.This is the first longitudinal study assessing the relationship between fitness and inflammation during childhood that takes also into account the lifestyle behaviours.Results from the present study suggest a protective role of fitness already in childhood.Efforts to improve fitness in children should be aimed at as inflammation could trigger future cardiovascular disease. 

  • 15.
    Granath, Carl
    et al.
    Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Noren, Hunter
    Cell Therapy Institute, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA.
    Björck, Hanna
    Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Simon, Nancy
    Cardiovascular Medicine Unit, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Olesen, Kim
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden / Department of Chemistry, Ångström Laboratory, Uppsala University, Sweden.
    Rodin, Sergey
    Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden / Division of Cardiothoracic Surgery and Anesthesiology, Department of Surgical Sciences, Uppsala University, Akademiska University Hospital, Uppsala, Sweden.
    Grinnemo, Karl-Henrik
    Division of Cardiothoracic Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden / Division of Cardiothoracic Surgery and Anesthesiology, Department of Surgical Sciences, Uppsala University, Akademiska University Hospital, Uppsala, Sweden.
    Österholm, Cecilia
    Division of Clinical Genetics, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Characterization of Laminins in Healthy Human Aortic Valves and a Modified Decellularized Rat Scaffold2020In: BioResearch Open Access, ISSN 2164-7844, E-ISSN 2164-7860, Vol. 9, no 1, p. 269-278Article in journal (Refereed)
    Abstract [en]

    Aortic valve stenosis is one of the most common cardiovascular diseases in western countries and can only be treated by replacement with a prosthetic valve. Tissue engineering is an emerging and promising treatment option, but in-depth knowledge about the microstructure of native heart valves is lacking, making the development of tissue-engineered heart valves challenging. Specifically, the basement membrane (BM) of heart valves remains incompletely characterized, and decellularization protocols that preserve BM components are necessary to advance the field. This study aims to characterize laminin isoforms expressed in healthy human aortic valves and establish a small animal decellularized aortic valve scaffold for future studies of the BM in tissue engineering. Laminin isoforms were assessed by immunohistochemistry with antibodies specific for individual alpha, beta, and gamma chains. The results indicated that LN-411, LN-421, LN-511, and LN-521 are expressed in human aortic valves (n = 3), forming a continuous monolayer in the endothelial BM, whereas sparsely found in the interstitium. Similar results were seen in rat aortic valves (n = 3). Retention of laminin and other BM components, concomitantly with effective removal of cells and residual DNA, was achieved through 3 h exposure to 1% sodium dodecyl sulfate and 30 min exposure to 1% Triton X-100, followed by nuclease processing in rat aortic valves (n = 3). Our results provide crucial data on the microenvironment of valvular cells relevant for research in both tissue engineering and heart valve biology. We also describe a decellularized rat aortic valve scaffold useful for mechanistic studies on the role of the BM in heart valve regeneration.

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  • 16.
    Gustafson, Deborah R.
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Section for NeuroEpidemiology, Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, NY, USA.
    McFarlane, Samy I.
    Division of Endocrinology, Department of Medicine, College of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, NY, USA.
    Obesity, vascular disease and frailty in aging women with HIV2021In: Advances in Geriatric Medicine and Research, E-ISSN 2632-9921, Vol. 3, no 3, article id e210014Article, review/survey (Refereed)
    Abstract [en]

    Women with chronic HIV infection (WWH) living in the United States, experience a disproportionately high rate of obesity compared to uninfected populations. Both overweight and obesity, particularly central obesity, are major contributors to insulin resistance, hypertension, and dyslipidemia—the major components of metabolic syndromes, including type 2 diabetes, and leading to increased cardiovascular risk, including coronary heart disease, and cerebrovascular diseases. Notably, declining physical performance and frailty co-occur with vascular morbidities as well as changes in bone. These factors tend to exacerbate each other and accelerate the aging trajectory, leading to poorer quality of life, cognitive impairments, dementia, and eventually, death. In WWH, persistent HIV infection, sustained treatment for HIV infection, and concomitant obesity, may accelerate aging-related morbidities and poorer aging outcomes. Furthermore, health disparities factors common among some WWH, are independently associated with obesity and higher vascular risk. The purpose of this review is to describe the constellation of obesity, cardio- and cerebrovascular diseases, bone health and frailty among aging WWH, a 21st century emergence.

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  • 17.
    Hammad, Yasser
    et al.
    Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Box 3050, Doha, Qatar / Department Clinical Anesthesiology, Weill Cornell Medicine, Doha, Qatar.
    Elmoghazy, Walid
    Department of Transplant Surgery, Hamad General Hospital, Doha, Qatar / Department of Surgery, Sohag University, Egypt.
    El Ansari, Walid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Surgery, Hamad General Hospital, Doha, Qatar / Department of Medical Education, College of Medicine, Qatar University, Doha, Qatar.
    Lance, Marcus
    Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Doha, Qatar / Department Clinical Anesthesiology, Weill Cornell Medicine, Doha, Qatar.
    Zaghw, Ahmed
    Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Doha, Qatar.
    Shallik, Nabil
    Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Doha, Qatar / Department Clinical Anesthesiology, Weill Cornell Medicine, Doha, Qatar / Department of Anesthesia, SICU, Tanta University, Egypt.
    Experimental effect of different dilutions of blood with human plasma protein fraction and large dose factor one on blood coagulation and chemistry in vitro2019In: Indian Journal of Anaesthesia, ISSN 0019-5049, Vol. 63, no 12, p. 1015-1021Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Human plasma protein fraction 5% (PPF5%) is an albumin-based colloid used to expand the plasma volume during volume deficiency. The current basic medical experimental study assessed in vitro coagulation of PPF5% solution and its effects on blood coagulation and chemistry. Methods: The study involved 20 volunteers, and each volunteer donated 20-50 ml of fresh blood. Three dilutions of blood with PPF5% dilutions were prepared (30, 50, and 70%). The fibrinogen dose required to correct coagulation in the 50% diluted samples was assessed (two doses used). The thromboelastogram (TEG) measured the haemostatic parameters (fibrinogen level, initiation of coagulation [R time], kinetics [K], acceleration of coagulation [α angle], maximum amplitude [MA] and coagulation index [CI]), and the ABL gas analyser measured the blood chemistry changes. Results: All dilutions showed significant TEG and blood chemistry changes when compared to controls. The two doses of fibrinogen corrected the clot formation speed with no significant difference in speed between the two doses. Acidosis measured by the strong ion gap (SID) and pH were significant for all dilutions when compared with the baseline. The 30% dilution remained within the lower normal acceptable value while 50% dilution was beyond the critical normal values. Conclusion: In vitro PPF5% to replace blood loss up to 50% dilution did not have significant coagulation and blood chemistry effects while coagulopathy should be expected in extreme dilutions (70%). Fibrinogen in a dose equivalent to 4 gm/70 kg adult improved clot strength at 50% dilution. 

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  • 18.
    Handlin, Linda
    et al.
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre. Department of Animal Environment and Health, Swedish University of Agriculture, Skara, Sweden.
    Jonas, Wibke
    Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
    Ransjö-Arvidson, Anna-Berit
    Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
    Petersson, Maria
    Department of Molecular Medicine, Endocrine and Diabetes Unit, Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden.
    Uvnäs-Moberg, Kerstin
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre. Department of Animal Environment and Health, Swedish University of Agriculture, Skara, Sweden.
    Nissen, Eva
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre. Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden.
    Influence of Common Birth Interventions on Maternal Blood Pressure Patterns During Breastfeeding 2 Days After Birth2012In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 7, no 2, p. 93-99Article in journal (Refereed)
    Abstract [en]

    Objective: This study investigated possible influences of medical interventions during labor on maternal blood pressure during a breastfeed 2 days postpartum.

    Subjects and Methods: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at –5, 10, 30, and 60 minutes during a morning breastfeed 2 days postpartum. Five treatment groups were formed based on the medical interventions received during labor: Non-medicated mothers (Control group, n=21); mothers receiving epidural analgesia (EDA) with oxytocin (OT) stimulation (EDAOT group, n=14); mothers receiving EDA without OT stimulation (EDAnon-OT group, n=7); mothers receiving OT stimulation only (OT intravenously [iv] group, n=9); and mothers receiving 10 IU of OT intramuscularly (im) only (OT im group, n=15).

    Results: Baseline diastolic, but not systolic, blood pressure differed between the groups as displayed by significantly lower diastolic blood pressure in the EDAnon-OT group compared with the Control group, the OT iv group, and the EDAOT group (p=0.045, p=0.041, and p=0.024, respectively). Both systolic and diastolic blood pressure fell significantly during the breastfeeding session in the Control group (p=0.001 and p=0.004, respectively), the OT im group (p=0.006 and p=0.001, respectively), and the EDAOT group (p=0.028 and p=0.002, respectively), and the fall in diastolic blood pressure tended to be significant in the OT iv group (p=0.050). The duration of skin-to-skin contact before breastfeeding correlated positively with the decrease in systolic blood pressure in the OT im group (Rs=0.540, p=0.046).

    Conclusion: Administration of EDA during labor lowers baseline diastolic blood pressure and abolishes the fall in blood pressure in response to a breastfeed 2 days after birth.

  • 19.
    Heikkilä, Katriina
    et al.
    Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine London United Kingdom / Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Pentti, Jaana
    Department of Public Health University of Turku and Turku University Hospital Turku Finland / Department of Public Health University of Helsinki Finland.
    Madsen, Ida E. H.
    National Research Centre for the Working Environment Copenhagen Denmark.
    Lallukka, Tea
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland / Department of Public Health University of Helsinki Finland.
    Virtanen, Marianna
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland / Department of Public Health and Caring Sciences University of Uppsala Sweden / Stress Research Institute University of Stockholm Sweden.
    Alfredsson, Lars
    Centre for Occupational and Environmental Medicine Stockholm County Council Stockholm Sweden / Institute of Environmental Medicine Karolinska Institute Stockholm Sweden.
    Bjorner, Jakob
    National Research Centre for the Working Environment Copenhagen Denmark.
    Borritz, Marianne
    Department of Occupational and Environmental Medicine Bispebjerg Hospital Copenhagen University Copenhagen Denmark.
    Brunner, Eric
    Department of Epidemiology and Public Health University College London London United Kingdom.
    Burr, Hermann
    Federal Institute for Occupational Safety and Health Berlin Germany.
    Ferrie, Jane E.
    Department of Epidemiology and Public Health University College London London United Kingdom / Bristol Medical School: Population Health Sciences University of Bristol United Kingdom.
    Knutsson, Anders
    Department of Health Sciences Mid Sweden University Sundsvall Sweden.
    Koskinen, Aki
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Leineweber, Constanze
    Stress Research Institute University of Stockholm Sweden.
    Magnusson Hanson, Linda L.
    Stress Research Institute University of Stockholm Sweden.
    Nielsen, Martin L.
    Lægekonsulenten AS3 Companies Århus Denmark.
    Nyberg, Solja T.
    Department of Public Health University of Helsinki Finland.
    Oksanen, Tuula
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Pejtersen, Jan H.
    VIVE The Danish Center for Social Science Research Copenhagen Denmark.
    Pietiläinen, Olli
    Department of Public Health University of Helsinki Finland.
    Rahkonen, Ossi
    Department of Public Health University of Helsinki Finland.
    Rugulies, Reiner
    National Research Centre for the Working Environment Copenhagen Denmark / Department of Public Health and Department of Psychology University of Copenhagen Denmark.
    Singh-Manoux, Archana
    Department of Epidemiology and Public Health University College London London United Kingdom.
    Steptoe, Andrew
    Department of Epidemiology and Public Health University College London London United Kingdom.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health University of Turku and Turku University Hospital Turku Finland.
    Theorell, Töres
    Stress Research Institute University of Stockholm Sweden.
    Vahtera, Jussi
    Department of Public Health University of Turku and Turku University Hospital Turku Finland.
    Väänänen, Ari
    Finnish Institute of Occupational Health Tampere, Helsinki and Turku Finland.
    Westerlund, Hugo
    Stress Research Institute University of Stockholm Sweden.
    Kivimäki, Mika
    Department of Public Health University of Helsinki Finland / Department of Epidemiology and Public Health University College London London United Kingdom.
    Job Strain as a Risk Factor for Peripheral Artery Disease: A Multi-Cohort Study2020In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 9, no 9, article id e013538Article in journal (Refereed)
    Abstract [en]

    Background Job strain is implicated in many atherosclerotic diseases, but its role in peripheral artery disease (PAD) is unclear. We investigated the association of job strain with hospital records of PAD, using individual-level data from 11 prospective cohort studies from Finland, Sweden, Denmark, and the United Kingdom. Methods and Results Job strain (high demands and low control at work) was self-reported at baseline (1985-2008). PAD records were ascertained from national hospitalization data. We used Cox regression to examine the associations of job strain with PAD in each study, and combined the study-specific estimates in random effects meta-analyses. We used τ2, I2, and subgroup analyses to examine heterogeneity. Of the 139 132 participants with no previous hospitalization with PAD, 32 489 (23.4%) reported job strain at baseline. During 1 718 132 person-years at risk (mean follow-up 12.8 years), 667 individuals had a hospital record of PAD (3.88 per 10 000 person-years). Job strain was associated with a 1.41-fold (95% CI, 1.11-1.80) increased average risk of hospitalization with PAD. The study-specific estimates were moderately heterogeneous (τ2=0.0427, I2: 26.9%). Despite variation in their magnitude, the estimates were consistent in both sexes, across the socioeconomic hierarchy and by baseline smoking status. Additional adjustment for baseline diabetes mellitus did not change the direction or magnitude of the observed associations. Conclusions Job strain was associated with small but consistent increase in the risk of hospitalization with PAD, with the relative risks on par with those for coronary heart disease and ischemic stroke.

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  • 20.
    Javeed, Ashir
    et al.
    Aging Research Center, Karolinska Institutet, Stockholm, Sweden ; Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Dallora, Ana Luiza
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Blekinge Institute of Technology, Department of Health, Sweden.
    An Intelligent Learning System for Unbiased Prediction of Dementia Based on Autoencoder and Adaboost Ensemble Learning2022In: Life, E-ISSN 2075-1729, Vol. 12, no 7, p. 1-18, article id 1097Article in journal (Refereed)
    Abstract [en]

    Dementia is a neurological condition that primarily affects older adults and there is stillno cure or therapy available to cure it. The symptoms of dementia can appear as early as 10 yearsbefore the beginning of actual diagnosed dementia. Hence, machine learning (ML) researchershave presented several methods for early detection of dementia based on symptoms. However,these techniques suffer from two major flaws. The first issue is the bias of ML models caused byimbalanced classes in the dataset. Past research did not address this issue well and did not takepreventative precautions. Different ML models were developed to illustrate this bias. To alleviate theproblem of bias, we deployed a synthetic minority oversampling technique (SMOTE) to balance thetraining process of the proposed ML model. The second issue is the poor classification accuracy ofML models, which leads to a limited clinical significance. To improve dementia prediction accuracy,we proposed an intelligent learning system that is a hybrid of an autoencoder and adaptive boostmodel. The autoencoder is used to extract relevant features from the feature space and the Adaboostmodel is deployed for the classification of dementia by using an extracted subset of features. Thehyperparameters of the Adaboost model are fine-tuned using a grid search algorithm. Experimentalfindings reveal that the suggested learning system outperforms eleven similar systems which wereproposed in the literature. Furthermore, it was also observed that the proposed learning systemimproves the strength of the conventional Adaboost model by 9.8% and reduces its time complexity.Lastly, the proposed learning system achieved classification accuracy of 90.23%, sensitivity of 98.00%and specificity of 96.65%.

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  • 21.
    Javeed, Ashir
    et al.
    Aging Research Center, Karolinska Institutet, Stockholm, Sweden ; Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Saleem, Muhammad Asim
    Center of Excellence in Artificial Intelligence, Machine Learning and Smart Grid Technology, Department of Electrical Engineering, Chulalongkorn University, Bangkok, Thailand.
    Dallora, Ana Luiza
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Ali, Liaqat
    Department of Electrical Engineering, University of Science and Technology Bannu, Pakistan.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Decision Support System for Predicting Mortality in Cardiac Patients Based on Machine Learning2023In: Applied Sciences, E-ISSN 2076-3417, Vol. 13, no 8, article id 5188Article in journal (Refereed)
    Abstract [en]

    Researchers have proposed several automated diagnostic systems based on machine learning and data mining techniques to predict heart failure. However, researchers have not paid close attention to predicting cardiac patient mortality. We developed a clinical decision support system for predicting mortality in cardiac patients to address this problem. The dataset collected for the experimental purposes of the proposed model consisted of 55 features with a total of 368 samples. We found that the classes in the dataset were highly imbalanced. To avoid the problem of bias in the machine learning model, we used the synthetic minority oversampling technique (SMOTE). After balancing the classes in the dataset, the newly proposed system employed a (Formula presented.) statistical model to rank the features from the dataset. The highest-ranked features were fed into an optimized random forest (RF) model for classification. The hyperparameters of the RF classifier were optimized using a grid search algorithm. The performance of the newly proposed model ((Formula presented.) _RF) was validated using several evaluation measures, including accuracy, sensitivity, specificity, F1 score, and a receiver operating characteristic (ROC) curve. With only 10 features from the dataset, the proposed model (Formula presented.) _RF achieved the highest accuracy of 94.59%. The proposed model (Formula presented.) _RF improved the performance of the standard RF model by 5.5%. Moreover, the proposed model (Formula presented.) _RF was compared with other state-of-the-art machine learning models. The experimental results show that the newly proposed decision support system outperforms the other machine learning systems using the same feature selection module ((Formula presented.)). 

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  • 22.
    Javeed, Ashir
    et al.
    Aging Research Center, Karolinska Institutet, Solna, Stockholm, Sweden ; Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Sanmartin Berglund, Johan
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Dallora, Ana Luiza
    Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Saleem, Muhammad Asim
    Center of Excellence in Artificial Intelligence, Machine Learning and Smart Grid Technology, Chulalongkorn University, Bangkok, Thailand.
    Anderberg, Peter
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden.
    Predictive Power of XGBoost_BiLSTM Model: A Machine-Learning Approach for Accurate Sleep Apnea Detection Using Electronic Health Data2023In: International Journal of Computational Intelligence Systems, ISSN 1875-6891, E-ISSN 1875-6883, Vol. 16, no 1, article id 188Article in journal (Refereed)
    Abstract [en]

    Sleep apnea is a common disorder that can cause pauses in breathing and can last from a few seconds to several minutes, as well as shallow breathing or complete cessation of breathing. Obstructive sleep apnea is strongly associated with the risk of developing several heart diseases, including coronary heart disease, heart attack, heart failure, and stroke. In addition, obstructive sleep apnea increases the risk of developing irregular heartbeats (arrhythmias), which can lead to low blood pressure. To prevent these conditions, this study presents a novel machine-learning (ML) model for predicting sleep apnea based on electronic health data that provides accurate predictions and helps in identifying the risk factors that contribute to the development of sleep apnea. The dataset used in the study includes 75 features and 10,765 samples from the Swedish National Study on Aging and Care (SNAC). The proposed model is based on two modules: the XGBoost module assesses the most important features from feature space, while the Bidirectional Long Short-Term Memory Networks (BiLSTM) module classifies the probability of sleep apnea. Using a cross-validation scheme, the proposed XGBoost_BiLSTM algorithm achieves an accuracy of 97% while using only the six most significant features from the dataset. The model’s performance is also compared with conventional long-short-term memory networks (LSTM) and other state-of-the-art ML models. The results of the study suggest that the proposed model improved the diagnosis and treatment of sleep apnea by identifying the risk factors. 

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  • 23.
    Johansson, Anna
    et al.
    University of Skövde, School of Life Sciences. Department of Cardiology, Skaraborgs Hospital, Skövde, Sweden, Department of Medical and Health Sciences, University of Linköping, Sweden.
    Svanborg, Eva
    Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine Linköping University Hospital, Faculty of Health Sciences, University of Linköping, Sweden.
    Edéll-Gustafsson, Ulla
    Department of Medical and Health Sciences, University of Linköping, Sweden.
    Sleep-wake activity rhythm and health-related quality of life among patients with coronary artery disease and in a population-based sample: An actigraphy and questionnaire study2013In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 19, no 4, p. 390-401Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore whether there are gender differences in sleep and health-related quality of life in patients with coronary artery disease (CAD) and a matched population-based sample and to see how subjectively rated sleep is associated with actigraphy. Secondly, to explore whether factors that predict patients' sleep quality could be identified. Fifty-seven patients with stable CAD and 47 participants from a population-based sample were included. All participants completed the Uppsala Sleep Inventory (USI), the Epworth Sleepiness Scale and the SF-36. Actigraphy recordings and a sleep diary were performed for seven 24-h periods. Multiple stepwise regression analysis showed that sleep duration, sleep onset latency, nocturnal awakenings, vitality (SF-36) and body mass index explained 60% of the sleep quality outcome (USI). Sleep duration, sleep efficiency and fragmentation index assessed with actigraphy and sleep diary accounted for 36% of the sleep quality outcome (diary). The result can form the basis for a non-pharmacological, self-care programme supported and led by nurses. © 2013 Wiley Publishing Asia Pty Ltd.

  • 24.
    Johansson, Linda
    et al.
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Finkel, Deborah
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden / Department of Psychology, Indiana University Southeast, New Albany, IN, United States.
    Lannering, Christina
    Region Jönköping County, Futurum, Ryhov, Jönköping, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden / Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Andersson-Gäre, Boel
    Region Jönköping County, Futurum, Ryhov, Jönköping, Sweden / Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Lindmark, Ulrika
    Department of Natural Science and Biomedicine, School of Health and Welfare, Centre for Oral Health and Aging Research Network – Jönköping (ARN-J), Jönköping University, Sweden.
    Bravell, Marie E.
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Using aggregated data from Swedish national quality registries as tools to describe health conditions of older adults with complex needs2021In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 33, no 5, p. 1297-1306Article in journal (Refereed)
    Abstract [en]

    Background: Combining National Quality Registries (NQRs) with existing National Health Registries (NHRs) might make it possible to get a wider picture of older adults health situation. The aim was to examine the feasibility of aggregating data across different NQRs and existing NHRs to explore the possibility to investigate trajectories and patterns of disease and care, specifically for the most ill older adults. Method: A Swedish twin population (N = 44,816) was linked to nine NQRs and four NHRs. A descriptive mixed-method study was performed. A manifest content analysis identified which health parameters were collected from each NQR. Factor analysis identified patterns in representation across NQRs. Two case studies illustrated individual trajectories of care by using NQRs and NHRs. Results: About 36% of the population was registered in one or more NQRs. NQRs included 1849 variables that were sorted into 13 categories with extensive overlap across the NQRs. Health and function variables were identified, but few social or cognitive variables. Even though most individuals demonstrated unique patterns of multi-morbidities, factor analysis identified three clusters of representation in the NQRs with sufficient sample sizes for future investigations. The two cases illustrated the possibility of following patterns of disease and trajectories of care. Conclusions: NQRs seem to be a significant source for collecting data about a population that may be underrepresented in most research on aging because of their age and poor health. However, NQRs are primarily disease related, and further development of the registries to maximize coverage and utility is needed. 

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  • 25.
    Johansson, Markus
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden.
    Ulfenborg, Benjamin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Andersson, Christian X.
    Takara Bio Europe AB, Gothenburg, Sweden.
    Heydarkhan-Hagvall, Sepideh
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Bioscience, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals, R&D AstraZeneca, Gothenburg, Sweden.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Sweden / Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sartipy, Peter
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.
    Synnergren, Jane
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Cardiac hypertrophy in a dish: a human stem cell based model2020In: Biology open, ISSN 2046-6390, Vol. 9, no 9, article id bio052381Article in journal (Refereed)
    Abstract [en]

    Cardiac hypertrophy is an important and independent risk factor for the development of heart failure. To better understand the mechanisms and regulatory pathways involved in cardiac hypertrophy, there is a need for improved in vitro models. In this study, we investigated how hypertrophic stimulation affected human induced pluripotent stem cell (iPSC)-derived cardiomyocytes (CMs). The cells were stimulated with endothelin-1 (ET-1) for 8, 24, 48, 72, or 96 h. Parameters including cell size, ANP-, proBNP-, and lactate concentration were analyzed. Moreover, transcriptional profiling using RNA-sequencing was performed to identify differentially expressed genes following ET-1 stimulation. The results show that the CMs increase in size by approximately 13% when exposed to ET-1 in parallel to increases in ANP and proBNP protein and mRNA levels. Furthermore, the lactate concentration in the media was increased indicating that the CMs consume more glucose, a hallmark of cardiac hypertrophy. Using RNA-seq, a hypertrophic gene expression pattern was also observed in the stimulated CMs. Taken together, these results show that hiPSC-derived CMs stimulated with ET-1 display a hypertrophic response. The results from this study also provide new molecular insights about the underlying mechanisms of cardiac hypertrophy and may help accelerate the development of new drugs against this condition.

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  • 26.
    Karim, Md Rezaul
    et al.
    Rajshahi University, Bangladesh ; Islamic University, Bangladesh.
    Rahman, Mashiur
    Rajshahi University, Bangladesh.
    Islam, Khairul
    Rajshahi University, Bangladesh.
    Al Mamun, Abdullah
    Rajshahi University, Bangladesh.
    Hossain, Shakhawoat
    Rajshahi University, Bangladesh.
    Hossain, Ekhtear
    Rajshahi University, Bangladesh.
    Aziz, Abdul
    Rajshahi University, Bangladesh.
    Yeasmin, Fouzia
    Rajshahi University, Bangladesh.
    Agarwal, Smita
    Rajshahi University, Bangladesh.
    Hossain, Md Imam
    Rajshahi University, Bangladesh.
    Saud, Zahangir Alam
    Rajshahi University, Bangladesh.
    Nikkon, Farjana
    Rajshahi University, Bangladesh.
    Hossain, Mostaque
    Rajshahi University, Bangladesh.
    Mandal, Abul
    University of Skövde, School of Life Sciences. University of Skövde, The Systems Biology Research Centre.
    Jenkins, Richard O.
    De Montfort University, United Kingdom .
    Haris, Parvez I.
    De Montfort University, United Kingdom .
    Miyataka, Hideki
    Tokushima Bunri University, Japan.
    Himeno, Seiichiro
    Tokushima Bunri University, Japan.
    Hossain, Khaled
    Rajshahi University, Bangladesh.
    Increases in Oxidized Low-Density Lipoprotein and Other Inflammatory and Adhesion Molecules With a Concomitant Decrease in High-Density Lipoprotein in the Individuals Exposed to Arsenic in Bangladesh2013In: Toxicological Sciences, ISSN 1096-6080, E-ISSN 1096-0929, Vol. 135, no 1, p. 17-25Article in journal (Refereed)
    Abstract [en]

    Elevated exposure to arsenic has been suggested to be associated with atherosclerosis leading to cardiovascular disease (CVD). However, biochemical events underlying the arsenic-induced atherosclerosis have not yet been fully documented. The aim of this study was to investigate the associations of circulating molecules involved in atherosclerosis with arsenic exposure in the individuals exposed to arsenic in Bangladesh. A total of 324 study subjects, 218 from arsenic-endemic areas and 106 from nonendemic areas in Bangladesh, were recruited. Drinking water, hair, nail, and blood samples were collected from the study subjects for analysis. Total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels were lower in arsenic-endemic subjects than those of nonendemic subjects. Oxidized LDL (Ox-LDL), C-reactive protein (CRP), intercellular adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule-1 (VCAM-1) levels were significantly higher in arsenic-endemic subjects than those in nonendemic subjects. All these circulating molecules showed significant correlations with arsenic exposure (water, hair, and nail arsenic concentrations), and all these relations were significant before and after adjusting for relevant covariates. Among the circulating molecules tested in this study, HDL, Ox-LDL, and CRP showed dose-response relationships with arsenic exposure. Ox-LDL/ HDL ratios were increased with the increasing concentrations of arsenic in the water, hair, and nails. Furthermore, non-HDL cholesterol and TC/ HDL ratios were significantly correlated with arsenic exposure before and after adjusting for relevant covariates. Thus, all the observed associations may be the major features of arsenic exposure-related atherosclerosis leading to CVD.

  • 27.
    Kjellsdotter, Anna
    et al.
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Edéll-Gustafsson, Ulla
    Department of Medical and Health Sciences, Division of Nursing Sciences, Faculty of Health Sciences, Linköping University, Sweden.
    Yngman-Uhlin, Pia
    Research & Development Unit, and Department of Medicine and Health Sciences, Linköping University, Sweden.
    Associations Between Sleep and Personality Factors Among Patients Living With Coronary Artery Disease2020In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 35, no 6, p. 568-575Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insomnia symptoms have become increasingly common in patients with coronary artery disease (CAD). Increasing evidence suggests comorbidity between personality traits and health status. Considering personality traits may act as a predisposition for future illness; this state may influence sleep quality and it appears to precipitate cardiac events in high-risk patients.

    OBJECTIVE: The aim of this study was to investigate self-reported sleep deficiency in relation to vicious cycle of sleeplessness (VCS) behavior, hyperarousal behavioral trait (H-personality), and type D personality traits in patients with CAD and in a population-based group. Furthermore, our aim was to explore the association of VCS behavior with H-personality trait and type D personality. Finally, we investigated to what extent type D personality can explain self-reported too little sleep in patients with CAD.

    METHODS: An observational case-control design was applied comprising 859 patients in cardiac outpatient care and 859 participants from a population-based group. Questionnaires assessing VCS behavior, H-personality, type D personality, and perceptions of too little sleep were used.

    RESULTS: Statistically significant higher scores of a hyperarousal and sleeplessness behavior were revealed for those with too little sleep compared with those with sufficient sleep in both the patient and the population-based group. Age, female gender, or sleeplessness behavior significantly predicted too little sleep (P < .001).

    CONCLUSIONS: The current study highlights the advantage of studying heterogeneity in patients with CAD from a person-centered perspective with focus to identify distressed individuals in order to prevent or treat sleep deficiency. A cluster of factors may be a more accurate predictor of patient-reported outcomes than a single psychosocial factor.

  • 28.
    Knez, Rajna
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Gillberg Neuropsychiatry Centre, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden ; Research and Development, Department of Women’s and Child Health, Skaraborg Hospital, Skövde, Sweden.
    Niksic, Milan
    Department of Cardiology, Skaraborg Hospital, Skövde, Sweden.
    Omerovic, Elmir
    Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Orexin/hypocretin system dysfunction in patients with Takotsubo syndrome: A novel pathophysiological explanation2022In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 9, article id 1016369Article in journal (Refereed)
    Abstract [en]

    Takotsubo syndrome (TTS) is an acute heart failure syndrome. Emotional or physical stressors are believed to precipitate TTS, while the pathophysiological mechanism is not yet completely understood. During the coronavirus disease (COVID-19) pandemic, an increased incidence of TTS has been reported in some countries; however, the precise pathophysiological mechanism for developing TTS with acute COVID-19 infection is unknown. Nevertheless, observing the symptoms of COVID-19 might lead to new perspectives in understanding TTS pathophysiology, as some of the symptoms of the COVID-19 infection could be assessed in the context of an orexin/hypocretin-system dysfunction. Orexin/hypocretin is a cardiorespiratory neuromodulator that acts on two orexin receptors widely distributed in the brain and peripheral tissues. In COVID-19 patients, autoantibodies against one of these orexin receptors have been reported. Orexin-system dysfunction affects a variety of systems in an organism. Here, we review the influence of orexin-system dysfunction on the cardiovascular system to propose its connection with TTS. We propose that orexin-system dysfunction is a potential novel explanation for the pathophysiology of TTS due to direct or indirect dynamics of orexin signaling, which could influence cardiac contractility. This is in line with the conceptualization of TTS as a cardiovascular syndrome rather than merely a cardiac abnormality or cardiomyopathy. To the best of our knowledge, this is the first publication to present a plausible connection between TTS and orexin-system dysfunction. We hope that this novel hypothesis will inspire comprehensive studies regarding orexin's role in TTS pathophysiology. Furthermore, confirmation of this plausible pathophysiological mechanism could contribute to the development of orexin-based therapeutics in the treatment and prevention of TTS. Copyright 

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  • 29.
    Malmrot, Gustav
    et al.
    University of Skövde, School of Life Sciences.
    Ulver, Erika
    University of Skövde, School of Life Sciences.
    Ett sviktande hjärta: patientupplevelser av att leva med en kronisk hjärtsvikt2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    As the occurrence of obesity increases amongst young people, so increases the risk of more people suffering from heart failure as early as during middle age. The aim is to describe the life experiences of middle aged persons living with chronic heart failure. The literature study is based on twelve published, qualitative, and scientifically proved articles derived from MedLine and Cinahl using queries representing the subject, as well as from manual searching in ScienceDirect and LIBRIS. These articles have been analyzed from a life world perspective. Four main themes and four sub themes were identified from the articles' results. The main themes are "The social life", "Quality of life", "Body failing", and "the Economical impact of chronic heart failure". These represent the main areas where the patients feel the greatest loss due to their condition. The discussion reveals the importance of informing the patients of the common prevalence of the feelings described in this study. Also, the nurse should function as a coach for self-care with continuous follow-ups. The result of this study will hopefully increase the understanding of the heart diseased patients' life situations.

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  • 30.
    Monneret, Denis
    et al.
    Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Paris, France.
    Gellerstedt, Martin
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SSORG-Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden ; School of Business, Economics and IT, University West, Göteborg, Sweden.
    Bonnefont-Rousselot, Dominique
    Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Paris, France ; Faculty of Pharmacy, Department of Biochemistry, Paris Descartes University, Paris, France ; Faculty of Pharmacy, Paris Descartes University, Paris, France.
    Determination of age- and sex-specific 99th percentiles for high-sensitive troponin T from patients: An analytical imprecision- and partitioning-based approach2018In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 56, no 5, p. 818-829Article in journal (Refereed)
    Abstract [en]

    Detection of acute myocardial infarction (AMI) is mainly based on a rise of cardiac troponin with at least one value above the 99th percentile upper reference limit (99th URL). However, circulating high-sensitive cardiac troponin T (hs-cTnT) concentrations depend on age, sex and renal function. Using an analytical imprecision-based approach, we aimed to determine age- A nd sex-specific hs-cTnT 99th URLs for patients without chronic kidney disease (CKD). A 3.8-year retrospective analysis of a hospital laboratory database allowed the selection of adult patients with concomitant plasma hs-cTnT (<300 ng/L) and creatinine concentrations, both assayed twice within 72 h with at least 3 h between measurements. Absence of AMI was assumed when the variation between serial hs-cTnT values was below the adjusted-analytical change limit calculated according to the inverse polynomial regression of analytical imprecision. Specific URLs were determined using Clinical and Laboratory Standards Institute (CLSI) methods, and partitioning was tested using the proportion method, after adjustment for unequal prevalences. After outlier removal (men: 8.7%; women: 6.6%), 1414 men and 1082 women with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 were assumed as non-AMI. Partitioning into age groups of 18-50, 51-70 and 71-98 years, the hs-cTnT 99th URLs adjusted on French prevalence were 18, 33, 66 and 16, 30, 84 ng/L for men and women, respectively. Age-partitioning was clearly required. However, sex-partitioning was not justified for subjects aged 18-50 and 51-70 years for whom a common hs-cTnT 99th URLs of about 17 and 31 ng/L could be used. Based on a laboratory approach, this study supports the need for age-specific hs-cTnT 99th URLs.

  • 31.
    Nordblom, Ann-Katrin
    et al.
    Department of Cardiology, Skaraborg Hospital Skövde, Sweden ; Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Sweden.
    Norberg Boysen, Gabriella
    Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Sweden ; PreHospen - Centre for Prehospital Research, University of Borås, Sweden.
    Berglund, Mia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Kjellsdotter, Anna
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Research and Development Centre, Skaraborg Hospital Skövde, Sweden.
    Health care centre and emergency department utilization by patients with episodes of tachycardia2022In: BMC Cardiovascular Disorders, E-ISSN 1471-2261, Vol. 22, no 1, article id 124Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Outpatients seek to visit health care facilities for episodes of tachycardia-related signs and symptoms. The challenge for physicians is to balance a proper initial assessment and avoid overlooking a possible arrhythmia. This common clinical situation affects individuals and health care utilization, and effective management may substantially affect health care resources. This study aimed to explore health care utilization for outpatients with episodes of tachycardia visiting health care centres (HCCs) and/or emergency departments (EDs). METHOD: This retrospective study used data of adult outpatients (≥ 18 years) who were assessed by a physician as having a specific or nonspecific diagnosis of arrhythmia between 2017 and 2018, and data were retrieved from medical records and a regional registry database. Data was analysed with appropriate statistical analyses to identify disparities between sex, age and terms of search pattern for each health care facility. Analysis of variance was used to test disparities between the sexes, and one-factor ANOVA was used for the incidence of missed arrhythmias. RESULTS: A total of 2719 visits with 2373 outpatients were included in the study. The result showed a significant difference in the total number of visits (n = 2719) between female and male patients (68% vs. 32%, p < .001). In the 60-69- and 70-79-year age groups, females had significantly higher frequencies of visits than males (p = .018). A significant difference was also observed between sexes in terms of which health care facility they tended to visit (p < .001). Ninety-five percent of the outpatients visiting EDs were hospitalized. When estimating the incidence of missed arrhythmias (diagnoses) in relation to assessments, the results showed a 5% missed diagnosis involving potential atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia. Moreover, the referral rate was low, especially from HCCs to cardiologists. CONCLUSIONS: This study shows a significant difference in total visits in HCCs and/or EDs by patients of different sexes and indicates the need for improved care for outpatients with episodes of tachycardia. Sex- and age-related differences must be addressed with an aim of providing equal care. Finally, the low rate of referral from HCCs to cardiologists compared to the high proportion of hospitalizations from EDs, deserves further investigation. 

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  • 32.
    Olofsson, Peder S.
    et al.
    Center for Bioelectronic Medicine, Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden / Laboratory of Biomedical Science, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Steinberg, Benjamin E.
    Laboratory of Biomedical Science, The Feinstein Institute for Medical Research, Manhasset, New York, USA / The Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ontario, Canada.
    Sobbi, Roozbeh
    Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
    Cox, Maureen A.
    The Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ontario, Canada.
    Ahmed, Mohamed N.
    Center for Heart and Lung Research, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Oswald, Michaela
    Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Szekeres, Ferenc
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Hanes, William M.
    Laboratory of Biomedical Science, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Introini, Andrea
    Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Liu, Shu Fang
    Center for Heart and Lung Research, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Holodick, Nichol E.
    Center for Oncology and Cell Biology, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Rothstein, Thomas L.
    Center for Oncology and Cell Biology, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Lövdahl, Cecilia
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Chavan, Sangeeta S.
    Laboratory of Biomedical Science, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Yang, Huan
    Laboratory of Biomedical Science, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Pavlov, Valentin A.
    Laboratory of Biomedical Science, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Broliden, Kristina
    Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Andersson, Ulf
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Diamond, Betty
    The Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Miller, Edmund J.
    Center for Heart and Lung Research, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Arner, Anders
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Gregersen, Peter K.
    Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Backx, Peter H.
    Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada / Department of Biology, York University, Toronto, Ontario, Canada.
    Mak, Tak W.
    The Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ontario, Canada.
    Tracey, Kevin J.
    Laboratory of Biomedical Science, The Feinstein Institute for Medical Research, Manhasset, New York, USA.
    Blood pressure regulation by CD4lymphocytes expressing choline acetyltransferase2016In: Nature Biotechnology, ISSN 1087-0156, E-ISSN 1546-1696, Vol. 34, no 10, p. 1066-1071Article in journal (Refereed)
    Abstract [en]

    Blood pressure regulation is known to be maintained by a neuro-endocrine circuit, but whether immune cells contribute to blood pressure homeostasis has not been determined. We previously showed that CD4(+) T lymphocytes that express choline acetyltransferase (ChAT), which catalyzes the synthesis of the vasorelaxant acetylcholine, relay neural signals(1). Here we show that these CD4(+)CD44(hi)CD62L(Io) T helper cells by gene expression are a distinct T-cell population defined by ChAT (CD4 T-ChAT). Mice lacking ChAT expression in CD4(+) cells have elevated arterial blood pressure, compared to littermate controls. Jurkat T cells overexpressing ChAT (JT(ChAT)) decreased blood pressure when infused into mice. Co-incubation of JT(ChAT) and endothelial cells increased endothelial cell levels of phosphorylated endothelial nitric oxide synthase, and of nitrates and nitrites in conditioned media, indicating increased release of the potent vasorelaxant nitric oxide. The isolation and characterization of CD4 T-ChAT cells will enable analysis of the role of these cells in hypotension and hypertension, and may suggest novel therapeutic strategies by targeting cell-mediated vasorelaxation.

  • 33.
    Osborn, Daniel Peter Sayer
    et al.
    Genetics Research Centre, Molecular and Clinical Sciences Institute, St George’s University of London, United Kingdom.
    Emrahi, Leila
    Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University Tehran, Iran.
    Clayton, Joshua
    Centre for Medical Research, The University of Western Australia and the Harry Perkins Institute of Medical Research, Nedlands, WA, Australia.
    Tabrizi, Mehrnoush Toufan
    Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
    Wan, Alex Yui Bong
    Genetics Research Centre, Molecular and Clinical Sciences Institute, St George’s University of London, United Kingdom.
    Maroofian, Reza
    Genetics Research Centre, Molecular and Clinical Sciences Institute, St George’s University of London, United Kingdom.
    Yazdchi, Mohammad
    Centre for Neuroscience Research center, Tabriz University of medical science, Tabriz, Iran.
    Garcia, Michael Leon Enrique
    Genetics Research Centre, Molecular and Clinical Sciences Institute, St George’s University of London, United Kingdom.
    Galehdari, Hamid
    Department of Genetics, Faculty of Science, Shahid Chamran University of Ahvaz, Iran.
    Hesse, Camila
    Institute of Biomedicine, Sahlgrenska academy, University of Gothenburg, Sweden.
    Shariati, Gholamreza
    Department of Medical Genetics, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
    Mazaheri, Neda
    Department of Genetics, Faculty of Science, Shahid Chamran University of Ahvaz, Iran.
    Sedaghat, Alireza
    Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of medical Sciences, Ahvaz, Iran.
    Goullée, Hayley
    Centre for Medical Research, The University of Western Australia and the Harry Perkins Institute of Medical Research, Nedlands, WA, Australia.
    Laing, Nigel
    Centre for Medical Research, The University of Western Australia and the Harry Perkins Institute of Medical Research, Nedlands, WA, Australia.
    Jamshidi, Yalda
    Genetics Research Centre, Molecular and Clinical Sciences Institute, St George’s University of London, United Kingdom.
    Tajsharghi, Homa
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Centre for Medical Research, The University of Western Australia and the Harry Perkins Institute of Medical Research, Nedlands, WA, Australia.
    Autosomal recessive cardiomyopathy and sudden cardiac death associated with variants in MYL32021In: Genetics in Medicine, ISSN 1098-3600, E-ISSN 1530-0366, Vol. 23, no 4, p. 787-792Article in journal (Refereed)
    Abstract [en]

    Purpose: Variants in genes encoding sarcomeric proteins are the most common cause of inherited cardiomyopathies. However, the underlying genetic cause remains unknown in many cases. We used exome sequencing to reveal the genetic etiology in patients with recessive familial cardiomyopathy. Methods: Exome sequencing was carried out in three consanguineous families. Functional assessment of the variants was performed. Results: Affected individuals presented with hypertrophic or dilated cardiomyopathy of variable severity from infantile- to early adulthood–onset and sudden cardiac death. We identified a homozygous missense substitution (c.170C&gt;A, p.[Ala57Asp]), a homozygous translation stop codon variant (c.106G&gt;T, p.[Glu36Ter]), and a presumable homozygous essential splice acceptor variant (c.482-1G&gt;A, predicted to result in skipping of exon 5). Morpholino knockdown of the MYL3 orthologue in zebrafish, cmlc1, resulted in compromised cardiac function, which could not be rescued by reintroduction of MYL3 carrying either the nonsense c.106G&gt;T or the missense c.170C&gt;A variants. Minigene assay of the c.482-1G&gt;A variant indicated a splicing defect likely resulting in disruption of the EF-hand Ca2+ binding domains. Conclusions: Our data demonstrate that homozygous MYL3 loss-of-function variants can cause of recessive cardiomyopathy and occurrence of sudden cardiac death, most likely due to impaired or loss of myosin essential light chain function. 

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  • 34.
    Peker, Yüksel
    et al.
    Pulmonary Medicine, Koç University School of Medicine, Istanbul, Turkey.
    Thelander, Tilia
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Yazici, D.
    Pulmonary Medicine, Koç University School of Medicine, Istanbul, Turkey.
    Celik, Y.
    Pulmonary Medicine, Koç University School of Medicine, Istanbul, Turkey.
    Yucel-Lindberg, T.
    Odontology, Karolinska Institute, Stockholm, Sweden.
    Thunström, E.
    Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Behboudi, Afrouz
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Association of TNF-α (-308G/A) Gene Polymorphism with Circulating TNF-α Levels and Excessive Daytime Sleepiness in Adults with Coronary Artery Disease and Concomitant Obstructive Sleep Apnea2021In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 203, no 9 suppl S, article id A4713Article in journal (Other academic)
  • 35.
    Rawshani, Araz
    et al.
    Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Larsson, Anna
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Gelang, Carita
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Lindqvist, Jonny
    Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Gellerstedt, Martin
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden ; University West, School of Business, Economics and IT, Trollhättan, Sweden.
    Bång, Angela
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Herlitz, Johan
    Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden ; University West, School of Business, Economics and IT, Trollhättan, Sweden.
    Characteristics and outcome among patients who dial for the EMS due to chest pain2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, no 3, p. 859-865Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aims to describe patients who called for the emergency medical service (EMS) due to chest discomfort, in relation to gender and age. Methods: All patients who called the emergency dispatch centre of western Sweden due to chest discomfort, between May 2009 and February 2010, were included. Initial evaluation, aetiology and outcome are described as recorded in the databases at the dispatch centre, the EMS systems and hospitals. Patients were divided into the following age groups: ≀ 50, 51-64 and ≥ 65 years. Results: In all, 14,454 cases were enrolled. Equal proportions of men (64%) and women (63%) were given dispatch priority 1. The EMS clinicians gave priority 1 more frequently to men (16% versus 12%) and older individuals (10%, 15% and 14%, respective of age group). Men had a significantly higher frequency of central chest pain (83% versus 81%); circulatory compromise (34% versus 31%); ECG signs of ischaemia (17% versus 11%); a preliminary diagnosis of acute coronary syndrome (40% versus 34%); a final diagnosis of acute myocardial infarction (14% versus 9%) and any potentially life-threatening condition (18% versus 12%). Individuals aged ≥ 65 years were given a lower priority than individuals aged 51-64 years, despite poorer characteristics and outcome. In all, 78% of cases with a potentially life-threatening condition and 67% of cases that died within 30 days of enrolment received dispatch priority 1. Mortality at one year was 1%, 4% and 18% in each individual age group. Conclusion: Men and the elderly were given a disproportionately low priority by the EMS. 

  • 36.
    Rawshani, Araz
    et al.
    Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Rawshani, Nina
    Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Gelang, Carita
    The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson, Jan-Otto
    The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Larsson, Anna
    Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
    Bång, Angela
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Sweden.
    Herlitz, Johan
    Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden ; The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Trollhättan, Sweden.
    Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, no I June, p. 43-48Article in journal (Refereed)
    Abstract [en]

    Background and aims: We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30 days. Methods: Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC.Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest). Results: Among patients who died, a 7-fold increase in odds of missing to give priority 1 was noted at 1.00 pm, as compared with midnight. Compared with assistant nurses, odds ratio for dispatchers with no (medical) training was 0.34 (95% CI 0.14 to 0.77). Among patients with an ACS, odds ratio for calls arriving before lunch was 2.02 (95% CI 1.22 to 3.43), compared with midnight. Compared with assistant nurses, odds ratio for operators with no training was 0.23 (95% CI 0.13 to 0.40). Similar associations were noted for those with any LTC. Dispatcher's education was not associated with the patient's survival. Conclusions: In this group of patients, which experience substantial mortality and morbidity, the risk of not obtaining highest dispatch priority was increased up to 7-fold during lunchtime. Dispatch operators without medical education had the lowest risk, compared with nurses and assistant nurses, of missing to give priority 1, at the expense of lower positive predictive value. Key messages: What is already known about this subject? Use of the emergency medical service (EMS) increases survival among patients with acute coronary syndromes. It is unknown whether the efficiency – as judged by the ability to identify life-threatening cases among patients with chest pain – varies according to the dispatcher's educational level and the time of day.What does this study add? We provide evidence that the dispatcher's education does not influence survival among patients calling the EMS due to chest discomfort. However, medically educated dispatchers are at greatest risk of missing to identify life threatening cases, which is explained by more parsimonious use of the highest dispatch priority. We also show that the risk of missing life-threatening cases is at highest around lunch time.How might this impact on clinical practice? Dispatch centers are operated differently all over the world and chest discomfort is one of the most frequent symptoms encountered; we provide evidence that it is safe to operate a dispatch center without medically trained personnel, who actually miss fewer cases of acute coronary syndromes. However, non-medically trained dispatchers consume more pre-hospital resources.

  • 37.
    Rawshani, Nina
    et al.
    Sahlgrenska University Hospital, Östra Sjukhuset, Department of Emergency Medicine, Göteborg, Sweden.
    Rawshani, Araz
    Department of Medicine, University of Gothenburg, Göteborg, Sweden.
    Gelang, Carita
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University of Borås, Borås, Sweden.
    Herlitz, Johan
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University of Borås, Borås, Sweden.
    Bång, Angela
    University of Borås, School of Health Science, Borås, Sweden.
    Andersson, Jan-Otto
    Department of Ambulance and Prehospital Emergency Care, Skaraborg, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Trollhättan, Sweden.
    Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 248, no 1 December, p. 77-81Article in journal (Refereed)
    Abstract [en]

    Background

    In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality).

    Methods

    The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n = 13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG.

    Results

    In the overall cohort, 21% (n = 2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n = 1159) did not undergo a pre-hospital ECG while 32% (n = 1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p &lt; 0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p &lt; 0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74).

    Conclusion

    Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality.

  • 38.
    Scholtes, Rosalie A.
    et al.
    Diabetes Centre, Department of Internal Medicine, Amsterdam University Medical Centres, location VUmc, Amsterdam, The Netherlands.
    van Raalte, Daniël H.
    Diabetes Centre, Department of Internal Medicine, Amsterdam University Medical Centres, location VUmc, Amsterdam, The Netherlands.
    Correa-Rotter, Ricardo
    Nephrology and Mineral Metabolism, National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico.
    Toto, Robert D.
    University of Texas Southwestern Medical Center, Dallas, TX, United States.
    Heerspink, Hiddo J. L.
    Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands.
    Cain, Valerie
    Bogier Clinical and IT Solutions Inc., Raleigh, NC, United States.
    Sjöström, C. David
    AstraZeneca, Gothenburg, Sweden.
    Sartipy, Peter
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre. AstraZeneca, Gothenburg, Sweden.
    Stefánsson, Bergur V.
    AstraZeneca, Gothenburg, Sweden.
    The effects of dapagliflozin on cardio-renal risk factors in patients with type 2 diabetes with or without renin-angiotensin system inhibitor treatment: a post hoc analysis2020In: Diabetes, obesity and metabolism, ISSN 1462-8902, E-ISSN 1463-1326, Vol. 22, no 4, p. 549-556Article in journal (Refereed)
    Abstract [en]

    Aims: Renin-angiotensin system inhibitors (RASi) are the most effective treatments for diabetic kidney disease but significant residual renal risk remains, possibly because of other mechanisms of kidney disease progression unrelated to RAS that may be present. Sodium-glucose co-transporter-2 inhibitors reduce albuminuria and may complement RASi by offering additional renal protection. This post hoc analysis investigated the effects of dapagliflozin on cardio-renal risk factors in patients with type 2 diabetes (T2D) with increased albuminuria treated with or without RASi at baseline. Materials and methods: We evaluated the effects of dapagliflozin 10 mg/day over 12–24 weeks across 13 placebo-controlled studies in patients with T2D with a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g at baseline. Patients were divided into two subgroups based on treatment with or without RASi at baseline. Results: Compared with patients with RASi at baseline (n = 957), patients without RASi (n = 302) were younger, had a shorter duration of diabetes (7 vs. 12 years), higher estimated glomerular filtration rate (eGFR) and lower UACR, serum uric acid (sUA), body weight and systolic blood pressure. Placebo-adjusted treatment effects of dapagliflozin on UACR, eGFR, glycated haemoglobin and haematocrit over 24 weeks were similar across groups. Mean reductions in body weight and sUA were more distinct in patients without RASi treatment at baseline. Conclusions: Treatment with dapagliflozin over 24 weeks provides similar clinically relevant improvements in metabolic and haemodynamic parameters, and similar reductions in UACR, in patients with T2D with elevated albuminuria treated with or without RASi at baseline. © 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

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  • 39.
    Sipilä, Pyry N.
    et al.
    Department of Public Health, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Lindbohm, Joni V.
    Department of Public Health, University of Helsinki, Finland ; UCL Brain Sciences, University College London, United Kingdom.
    Batty, G. David
    UCL Brain Sciences, University College London, United Kingdom.
    Heikkilä, Nelli
    Department of Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland ; Centre for Population Health Research, University of Turku and Turku University Hospital, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; Turku University Hospital, Finland.
    Väänänen, Ari
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Koskinen, Aki
    Finnish Institute of Occupational Health, Helsinki, Finland.
    Nyberg, Solja T.
    Department of Public Health, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Meri, Seppo
    Department of Bacteriology and Immunology and Translational Immunology Research Program, University of Helsinki, Finland ; HUSLAB, Helsinki University Hospital, Finland.
    Pentti, Jaana
    Department of Public Health, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland ; Department of Public Health, University of Turku, Finland.
    Warren-Gash, Charlotte
    Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
    Hayward, Andrew C.
    Institute of Epidemiology and Health Care, University College London, United Kingdom.
    Kivimäki, Mika
    Department of Public Health, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland ; UCL Brain Sciences, University College London, United Kingdom.
    Severe Infection and Risk of Cardiovascular Disease: A Multicohort Study2023In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 147, no 21, p. 1582-1593Article in journal (Refereed)
    Abstract [en]

    Background: The excess risk of cardiovascular disease associated with a wide array of infectious diseases is unknown. We quantified the short- and long-term risk of major cardiovascular events in people with severe infection and estimated the population-attributable fraction. Methods: We analyzed data from 331 683 UK Biobank participants without cardiovascular disease at baseline (2006-2010) and replicated our main findings in an independent population from 3 prospective cohort studies comprising 271 329 community-dwelling participants from Finland (baseline 1986-2005). Cardiovascular risk factors were measured at baseline. We diagnosed infectious diseases (the exposure) and incident major cardiovascular events after infections, defined as myocardial infarction, cardiac death, or fatal or nonfatal stroke (the outcome) from linkage of participants to hospital and death registers. We computed adjusted hazard ratios (HRs) and 95% CIs for infectious diseases as short- and long-term risk factors for incident major cardiovascular events. We also calculated population-attributable fractions for long-term risk. Results: In the UK Biobank (mean follow-up, 11.6 years), 54 434 participants were hospitalized for an infection, and 11 649 had an incident major cardiovascular event at follow-up. Relative to participants with no record of infectious disease, those who were hospitalized experienced increased risk of major cardiovascular events, largely irrespective of the type of infection. This association was strongest during the first month after infection (HR, 7.87 [95% CI, 6.36-9.73]), but remained elevated during the entire follow-up (HR, 1.47 [95% CI, 1.40-1.54]). The findings were similar in the replication cohort (HR, 7.64 [95% CI, 5.82-10.03] during the first month; HR, 1.41 [95% CI, 1.34-1.48] during mean follow-up of 19.2 years). After controlling for traditional cardiovascular risk factors, the population-attributable fraction for severe infections and major cardiovascular events was 4.4% in the UK Biobank and 6.1% in the replication cohort. Conclusions: Infections severe enough to require hospital treatment were associated with increased risks for major cardiovascular disease events immediately after hospitalization. A small excess risk was also observed in the long-term, but residual confounding cannot be excluded.

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  • 40.
    Szekeres, Ferenc L. M.
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Division of Genetic Physiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Walum, Erik
    Glucox Biotech AB, Färentuna, Sweden.
    Wikström, Per
    Glucox Biotech AB, Färentuna, Sweden.
    Arner, Anders
    Division of Genetic Physiology, Department of Physiology and Pharmacology, Karolinska Institutet, Stockhom, Sweden ; Department of Clinical Sciences Lund, Thoracic Surgery, Lund University, c/o Igelösa Life Science AB, Lund, Sweden.
    A small molecule inhibitor of Nox2 and Nox4 improves contractile function after ischemia–reperfusion in the mouse heart2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 11970Article in journal (Refereed)
    Abstract [en]

    The NADPH oxidase enzymes Nox2 and 4, are important generators of Reactive oxygen species (ROS). These enzymes are abundantly expressed in cardiomyocytes and have been implicated in ischemia–reperfusion injury. Previous attempts with full inhibition of their activity using genetically modified animals have shown variable results, suggesting that a selective and graded inhibition could be a more relevant approach. We have, using chemical library screening, identified a new compound (GLX481304) which inhibits Nox 2 and 4 (with IC50 values of 1.25 µM) without general antioxidant effects or inhibitory effects on Nox 1. The compound inhibits ROS production in isolated mouse cardiomyocytes and improves cardiomyocyte contractility and contraction of whole retrogradely (Langendorff) perfused hearts after a global ischemia period. We conclude that a pharmacological and partial inhibition of ROS production by inhibition of Nox 2 and 4 is beneficial for recovery after ischemia reperfusion and might be a promising venue for treatment of ischemic injury to the heart. 

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  • 41.
    Trindade, Fábio
    et al.
    Department of Medical Sciences, iBiMED-Institute of Biomedicine, University of Aveiro, Portugal / Department of Surgery and Physiology, UnIC-Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Portugal.
    Saraiva, Francisca
    Department of Surgery and Physiology, UnIC-Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Portugal.
    Keane, Simon
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Leite-Moreira, Adelino
    Department of Surgery and Physiology, UnIC-Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Portugal.
    Vitorino, Rui
    Department of Medical Sciences, iBiMED-Institute of Biomedicine, University of Aveiro, Portugal / Department of Surgery and Physiology, UnIC-Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Portugal.
    Tajsharghi, Homa
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Falcão-Pires, Inês
    Department of Surgery and Physiology, UnIC-Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Portugal.
    Preoperative myocardial expression of E3 ubiquitin ligases in aortic stenosis patients undergoing valve replacement and their association to postoperative hypertrophy2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 9, article id e0237000Article in journal (Refereed)
    Abstract [en]

    Currently, aortic valve replacement is the only treatment capable of relieving left ventricle pressure overload in patients with severe aortic stenosis. It aims to improve cardiac function and revert hypertrophy, by triggering myocardial reverse remodeling. Despite immediately relieving afterload, reverse remodeling turns out to be extremely variable. Among other factors, the extent of reverse remodeling may depend on how well ubiquitin-proteasome system tackle hypertrophy. Therefore, we assessed tagged ubiquitin and ubiquitin ligases in the left ventricle collected from patients undergoing valve replacement and tested their association to the degree of reverse remodeling. Patients were classified according to the regression of left ventricle mass (ΔLVM) and assigned to complete (ΔLVM≥15%) or incomplete (ΔLVM≤5%) reverse remodeling groups. No direct inter-group differences were observed. Nevertheless, correlation analysis supports a fundamental role of the ubiquitin-proteasome system during reverse remodeling. Indeed, total protein ubiquitination was associated to hypertrophic indexes such as interventricular septal thickness (r = 0.55, p = 0.03) and posterior wall thickness (r = 0.65, p = 0.009). No significant correlations were observed for Muscle Ring Finger 3. Surprisingly, though, higher levels of atrogin-1 were associated to postoperative interventricular septal thickness (r = 0.71, p = 0.005). In turn, Muscle Ring Finger 1 correlated negatively with this postoperative hypertrophy marker (r = -0.68, p = 0.005), suggesting a cardioprotective role during reverse remodeling. No significant correlations were found with left ventricle mass regression, although a trend for a negative association between the ligase Murine Double Minute 2 and mass regression (r = -0.44, p = 0.10) was found. Animal studies will be necessary to understand whether this ligase is protective or detrimental. Herein, we show, for the first time, an association between the preoperative myocardial levels of ubiquitin ligases and postoperative hypertrophy, highlighting the therapeutic potential of targeting ubiquitin ligases in incomplete reverse remodeling.

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  • 42.
    Van Dijk, Willeke
    et al.
    Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Netherlands.
    Huizink, Anja C.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
    Muller, Jasmin
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Uvnäs-Moberg, Kerstin
    Section of Anthrozoology and Applied Ethology, Swedish University of Agricultural Sciences, Uppsala, Sweden.
    Ekström-Bergström, Anette
    Department of Health Sciences, University West, Trollhättan, Sweden.
    Handlin, Linda
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    The Effect of Mechanical Massage and Mental Training on Heart Rate Variability and Cortisol in Swedish Employees: A Randomized Explorative Pilot Study2020In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 82Article in journal (Refereed)
    Abstract [en]

    Work-related stress is relatively common in modern society and is a major cause of sick-leave. Thus, effective stress reducing interventions are needed. This study examined the effects of mental training and mechanical massage, on employee's heart rate variability (HRV) and plasma cortisol at their workplaces. Moreover, it was investigated whether baseline systolic blood pressure (SBP) can explain differences in effectiveness of the intervention. Ninety-three participants from four workplaces were randomly assigned to one of the five programs: (I) Mechanical massage and mental training combined, II) Mechanical massage, III) Mental training, IV) Pause, or V) Control. HRV and plasma cortisol were measured at baseline and after 4 and 8 weeks. SBP was measured at baseline. On the reduction of cortisol levels, a small effect of the mechanical massage program was found, whereas no effect was found for the other programs. None of the programs showed any effect on HRV. Nonetheless, when the level of systolic blood pressure was taken into account, some small beneficial effects on HRV and cortisol of mental training and the mechanical massage were found. This exploratory pilot-study provides useful information for future studies that aim to reduce stress among employees. 

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