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  • 1.
    Alnadhari, Ibrahim
    et al.
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Sampige, Venkata Ramana Pai
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Abdeljaleel, Osama
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Ali, Omar
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Salah, Morshed
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Shamsodini, Ahmad
    Department of Urology, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar.
    Presentation, diagnosis, management, and outcomes of prostatic abscess: comparison of three treatment modalities2020In: Therapeutic advances in urology, ISSN 1756-2872, Vol. 12, p. 1-8, article id 1756287220930627Article in journal (Refereed)
    Abstract [en]

    Purpose:

    The lack of available guidelines for the management of prostatic abscess (PA) results in inconsistencies in its management. The most commonly used management modalities were conservative treatment with parenteral antibiotics alone, transrectal ultrasound-guided (TRUS) needle aspiration, or transurethral deroofing (TUD).

    The current study is a retrospective study and examines prostatic abscess cases treated by either one or more of the different modalities. We assess and compare presentation, diagnosis, management, and outcomes of prostatic abscess and we compare the outcomes of the three management modalities.

    Methods:

    We retrieved the records of all patients (n = 23) admitted to the Urology department at Al Wakra hospital with the computed tomography (CT) diagnosis of prostatic abscess from January 2013 to March 2018. Data collected included demographic, clinical, laboratory, and imaging findings, as well as management modality, duration of hospital stay, duration of follow up, outcome, and recurrence.

    Results:

    A total of nine (39.1%) patients had conservative treatment only; eight (34.8%) had TUD, and six (26.1%) had TRUS needle aspiration. The mean age was 52.7 years. Lower urinary tract symptoms and fever were the most common presentations (95.7% and 82.6%, respectively). CT scan of the abdomen and pelvis with contrast was undertaken for all patients and it showed that multiple abscesses were observed in 14 (60.9%) cases.

    The overall mean hospital stay was 8.45 days (range 2–21 days). We observed no recurrences for patients treated conservatively or those who undertook TUD, but three patient (50%) recurrences were noted in TRUS aspiration patients. There was no mortality across the sample.

    Conclusion:

    Early diagnosis of prostatic abscess and prompt management may have decreased the morbidity and mortality. Conservative management can succeed in subcentimeter abscesses but TUD is the definite therapy for large and multiloculated abscess. TRUS aspiration does have a role in treatment, but it has higher recurrence and longer hospital stay.

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  • 2.
    Ayukekbong, James A.
    et al.
    Department of Infectious Diseases/Section of Clinical Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
    Andersson, M. E.
    Department of Infectious Diseases/Section of Clinical Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
    Vansarla, Goutham
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Tah, F.
    Camyaids Institute of Laboratory Diagnosis and Clinical Research, Douala, Cameroon.
    Nkuo-Akenji, T.
    Faculty of Science Diagnostic Laboratory, University of Buea, Buea, Cameroon.
    Lindh, M.
    Department of Infectious Diseases/Section of Clinical Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
    Bergström, T.
    Department of Infectious Diseases/Section of Clinical Virology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
    Monitoring of seasonality of norovirus and other enteric viruses in Cameroon by real-time PCR: an exploratory study2014In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, no 7, p. 1393-1402Article in journal (Refereed)
    Abstract [en]

    We studied the seasonal fluctuation of norovirus and other enteric viruses in Cameroon. Two hundred participants aged between 1 and 69 years were prospectively followed up. Each participant provided monthly faecal samples over a 12-month period. A total of 2484 samples were tested using multiplex real-time PCR assay for the detection of norovirus, rotavirus and enterovirus. The effect of weather variables and risk factors were analysed by Pearson correlation and bivariate analysis. Overall, enterovirus was the most commonly detected virus (216% of specimens), followed by norovirus (39%) and rotavirus (04%). Norovirus and enterovirus were detected throughout the year with a peak of norovirus detection at the beginning of the rainy season and a significant alternation of circulation of norovirus genogroups from one month to the next. Age <5 years and consumption of tap water were risk factors for norovirus infection. Better understanding of factors influencing transmission and seasonality may provide insights into the relationship between physical environment and risk of infection for these viruses.

  • 3.
    Bengnér, Johannes
    et al.
    Paediatric Clinic, Ryhov County Hospital, Region Jönköping County, Sweden.
    Quttineh, Maysae
    Department of Laboratory Medicine, Region Jönköping County, Sweden.
    Gäddlin, Per-Olof
    Paediatric Clinic, Ryhov County Hospital, Region Jönköping County, Sweden.
    Salomonsson, Kent
    University of Skövde, School of Engineering Science. University of Skövde, Virtual Engineering Research Environment.
    Faresjö, Maria
    Biomedical Platform, Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Sweden ; Department of Biology and Biological Engineering, Chalmers University of Technology, Göteborg, Sweden.
    Serum amyloid A – A prime candidate for identification of neonatal sepsis2021In: Clinical Immunology, ISSN 1521-6616, E-ISSN 1521-7035, Vol. 229, no 108787Article in journal (Refereed)
    Abstract [en]

    Neonatal sepsis is common, lethal, and hard to diagnose. In combination with clinical findings and blood culture, biomarkers are crucial to make the correct diagnose. A Swedish national inquiry indicated that neonatologists were not quite satisfied with the available biomarkers. We assessed the kinetics of 15 biomarkers simultaneously: ferritin, fibrinogen, granulocyte colony-stimulating factor (G-CSF), interferon (IFN)-γ, interleukin (IL)-1β, −6, −8, −10, macrophage inflammatory protein (MIP)-1β, procalcitonin, resistin, serum amyloid A (SAA), tumor necrosis factor (TNF)-α, tissue plasminogen activator-3 and visfatin. The goal was to observe how quickly they rise in response to infection, and for how long they remain elevated. From a neonatal intensive care unit, newborns ≥28 weeks gestational age were recruited. Sixty-eight newborns were recruited to the study group (SG), and fifty-one to the control group (CG). The study group subjects were divided into three subgroups depending on clinical findings: confirmed sepsis (CSG), suspected sepsis (SSG) and no sepsis. CSG and SSG were also merged into an entire sepsis group (ESG) for sub-analysis. Blood samples were collected at three time-points; 0 h, 12–24 h and 48–72 h, in order to mimic a “clinical setting”. At 0 h, visfatin was elevated in SSG compared to CG; G-CSF, IFN-γ, IL-1β, −8 and − 10 were elevated in SSG and ESG compared to CG, whereas IL-6 and SAA were elevated in all groups compared to CG. At 12–24 h, IL-8 was elevated in ESG compared to CG, visfatin was elevated in ESG and SSG compared to CG, and SAA was elevated in all three groups compared to CG. At 48–72 h, fibrinogen was elevated in ESG compared to CG, IFN-γ and IL-1β were elevated in SSG and ESG compared to CG, whereas IL-8 and SAA were elevated in all three groups compared to CG. A function of time-formula is introduced as a tool for theoretical prediction of biomarker levels at any time-point. We conclude that SAA has the most favorable kinetics regarding diagnosing neonatal sepsis, of the biomarkers studied. It is also readily available methodologically, making it a prime candidate for clinical use. 

  • 4.
    Browall, Sarah
    et al.
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Backhaus, Erik
    Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden.
    Naucler, Pontus
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden / Department of Infectious Diseases, Karolinska University Hospital, Solna, Sweden.
    Galanis, Ilias
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Sjöström, Karin
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, Diana
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Berg, Stefan
    Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Luthander, Joachim
    Department of Paediatrics, Karolinska University Hospital, Solna, Sweden.
    Eriksson, Margareta
    Department of Paediatrics, Karolinska University Hospital, Solna, Sweden.
    Spindler, Carl
    Department of Infectious Diseases, Karolinska University Hospital, Solna, Sweden.
    Ejdebäck, Mikael
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Trollfors, Birger
    Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Darenberg, Jessica
    Public Health Agency of Sweden, Solna, Sweden.
    Kalin, Mats
    Department of Infectious Diseases, Karolinska University Hospital, Solna, Sweden.
    Örtqvist, Åke
    Department of Communicable Diseases Control and Prevention, Stockholm County Council, Stockholm, Sweden / Department of Medicine, Unit of Infectious Diseases, Karolinska Institutet, Solna, Sweden.
    Andersson, Rune
    Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
    Henriques-Normark, Birgitta
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden Dept of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types2014In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 44, no 6, p. 1646-1657Article in journal (Refereed)
  • 5.
    Carré, H.
    et al.
    Univ Hosp, Dept Publ Hlth, SE-90185 Umeå, Sweden / Univ Hosp, Dept Clin Med, SE-90185 Umeå, Sweden / Univ Hosp, Dept Dermatol & Venerol, SE-90185 Umeå, Sweden.
    Boman, J.
    Univ Hosp, Dept Clin Microbiol & Virol, Umeå, Sweden.
    Österlund, A.
    Sunderby Hosp, Luleå, Sweden.
    Gärden, Bodil
    University of Skövde, School of Life Sciences.
    Nylander, E.
    Univ Hosp, Dept Publ Hlth, SE-90185 Umeå, Sweden / Univ Hosp, Dept Clin Med, SE-90185 Umeå, Sweden / Univ Hosp, Dept Dermatol & Venerol, SE-90185 Umeå, Sweden.
    Improved contact tracing for Chlamydia trachomatis with experienced tracers, tracing for one year back in time and interviewing by phone in remote areas2008In: Sexually Transmitted Infections, ISSN 1368-4973, E-ISSN 1472-3263, Vol. 84, no 3, p. 239-242Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the Swedish model for contact tracing and especiallythe "Västerbotten model" with centralised, extended contactinterview periods, sometimes by telephone.

    Methods: Using questionnaires, the contact tracing and interview procedurewas evaluated during 2002, followed by an evaluation of contactinterviewing by phone in 2005–6.

    Results: Patients with diagnosed Chlamydia trachomatis infection reportedon average 2.5 sexual contacts, 3.0 contacts when contact interviewingwas performed at the clinic, and 2.3 contacts when performedby phone. 65% of the sexual contacts with a known test resultwere infected.

    Conclusion: Centralised contact tracing, exploring the sexual history forat least 12 months back in time, shows good results. Combinedwith screening of certain risk groups it is probably one effectiveway of preventing C trachomatis infections. Preventing C trachomatisby primary prevention such as information and counselling is,however, still of great importance.

  • 6.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar / College of Medicine, Qatar University, Doha 2713, Qatar .
    El-Menyar, Ayman
    Department of Surgery, Trauma and Vascular Surgery, Clinical Research, Hamad General Hospital, Doha 3050, Qatar / Clinical Medicine, Weill Cornell Medical School, Doha 24144, Qatar.
    Is routine preoperative esophagogastroduodenscopy prior to bariatric surgery mandatory?: Protocol for a systematic review and meta-analysis2020In: International Journal of Surgery Protocols, ISSN 2468-3574, Vol. 22, p. 1-5Article in journal (Refereed)
    Abstract [en]

    Introduction: Routine preoperative esophagogastroduodenscopy (p-EGD) prior to bariatric surgery (BS) is currently widely undertaken, and hence an important issue with many clinical and financial repercussions. Yet, the true extent of why p-EGD is routinely undertaken for all bariatric patients remains not well understood. Methods and analysis: To address this, we will undertake a systematic review and meta-analysis of routine p-EGD prior to BS from around the world. This protocol describes the methodological approach to be adopted and outlines the search strategies and eligibility criteria that will be employed to identify and select studies, and the way 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 2000 to 30 April 2019 for original studies written in English that provided prevalence estimates of the outcomes of routine p-EGD prior to BS. STROBE criteria will assess the methodological quality of the selected studies. The use of fixed or random effects model will depend on the results of statistical tests for heterogeneity. Publication bias will be visually estimated by assessing funnel plots. Pooled estimates will be calculated. This protocol conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and has been submitted for registration at the PROSPERO International Prospective Register of systematic reviews. No ethical clearance is required for this study. This review will be published in a peer- reviewed journal and will be presented at various national and international conferences. © 2020 The Author(s)

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  • 7.
    Elovainio, Marko
    et al.
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, Helsinki, Finland.
    Komulainen, Kaisla
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, Helsinki, Finland.
    Sipilä, Pyry N.
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Pulkki-Råback, Laura
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
    Cachón Alonso, Laura
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
    Pentti, Jaana
    Clinicum, Faculty of Medicine, University of Helsinki, Finland.
    Nyberg, Solja T.
    Clinicum, Faculty of Medicine, University of Helsinki, 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 ; Centre of Population Health Research, Turku University Hospital, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Finland ; Centre of Population Health Research, Turku University Hospital, Finland.
    Lipsanen, Jari
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
    Batty, G. David
    Department of Epidemiology and Public Health, University College London, United Kingdom.
    Hakulinen, Christian
    Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, Helsinki, Finland.
    Kivimäki, Mika
    Clinicum, Faculty of Medicine, University of Helsinki, Finland ; Department of Mental Health of Older People, Faculty of Brain Sciences, University College London, United Kingdom.
    Association of social isolation and loneliness with risk of incident hospital-treated infections: an analysis of data from the UK Biobank and Finnish Health and Social Support studies2023In: The Lancet Public Health, ISSN 2468-2667, Vol. 8, no 2, p. e109-e118Article in journal (Refereed)
    Abstract [en]

    Background: Although loneliness and social isolation have been linked to an increased risk of non-communicable diseases such as cardiovascular disease and dementia, their association with the risk of severe infection is uncertain. We aimed to examine the associations between loneliness and social isolation and the risk of hospital-treated infections using data from two independent cohort studies. Methods: We assessed the association between loneliness and social isolation and incident hospital-treated infections using data for participants from the UK Biobank study aged 38–73 years at baseline and participants from the nationwide population-based Finnish Health and Social Support (HeSSup) study aged 20–54 years at baseline. For inclusion in the study, participants had to be linked to national health registries, have no history of hospital-treated infections at or before baseline, and have complete data on loneliness or social isolation. Participants with missing data on hospital-treated infections, loneliness, and social isolation were excluded from both cohorts. The outcome was defined as a hospital admission with a primary diagnosis of infection, ascertained via linkage to electronic health records. Findings: After exclusion of 8·6 million participants for not responding or not providing appropriate consent, the UK Biobank cohort consisted of 456 905 participants (249 586 women and 207 319 men). 26 860 (6·2%) of 436 001 participants with available data were reported as being lonely and 40 428 (9·0%) of 448 114 participants with available data were socially isolated. During a median 8·9 years (IQR 8·0–9·6) of follow-up, 51 361 participants were admitted to hospital due to an infectious disease. After adjustment for age, sex, demographic and lifestyle factors, and morbidities, loneliness was associated with an increased risk of a hospital-treated infection (hazard ratio [HR] 1·12 [95% CI 1·07–1·16]), whereas social isolation was not (HR 1·01 [95% CI 0·97–1·04]). Of 64 797 individuals in the HeSSup cohort, 18 468 (11 367 women and 7101 men) were eligible for inclusion. 4466 (24·4%) of 18 296 were lonely and 1776 (9·7%) of 18 376 socially isolated. During a median follow-up of 10·0 years (IQR 10·0–10·1), 814 (4·4%) participants were admitted to hospital for an infectious disease. The HRs for the HeSSup study replicated those in the UK Biobank (multivariable-adjusted HR for loneliness 1·32 [95% CI 1·06–1·64]; 1·08 [0·87–1·35] for social isolation). Interpretation: Loneliness might increase susceptibility to severe infections, although the magnitude of this effect appears modest and residual confounding cannot be excluded. Interventional studies are required before policy recommendations can advance. Funding: Academy of Finland, the UK Medical Research Council, and Wellcome Trust UK.

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  • 8.
    Enroth, Helena
    et al.
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre. Department of Clinical Microbiology, Unilabs AB, Skövde, Sweden.
    Retz, Karolina
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre. Department of Clinical Microbiology, Unilabs AB, Skövde, Sweden.
    Andersson, Sofie
    Department of Clinical Microbiology, Unilabs AB, Skövde, Sweden.
    Andersson, Carl
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre. Department of Clinical Microbiology, Unilabs AB, Skövde, Sweden.
    Svensson, Kristina
    Department of Clinical Microbiology, Unilabs AB, Skövde, Sweden.
    Ljungström, Lars
    Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden.
    Tilevik, Diana
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Evaluation of QuickFISH and maldi Sepsityper for identification of bacteria in bloodstream infection2019In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 51, no 4, p. 249-258Article in journal (Refereed)
    Abstract [en]

    Background: Early detection of bacteria and their antibiotic susceptibility patterns are critical to guide therapeutic decision-making for optimal care of septic patients. The current gold standard, blood culturing followed by subculture on agar plates for subsequent identification, is too slow leading to excessive use of broad-spectrum antibiotic with harmful consequences for the patient and, in the long run, the public health. The aim of the present study was to assess the performance of two commercial assays, QuickFISH® (OpGen) and Maldi Sepsityper™ (Bruker Daltonics) for early and accurate identification of microorganisms directly from positive blood cultures.

    Materials and methods: During two substudies of positive blood cultures, the two commercial assays were assessed against the routine method used at the clinical microbiology laboratory, Unilabs AB, at Skaraborg Hospital, Sweden.

    Results: The Maldi Sepsityper™ assay enabled earlier microorganism identification. Using the cut-off for definite species identification according to the reference method (>2.0), sufficiently accurate species identification was achieved, but only among Gram-negative bacteria. The QuickFISH®assay was time-saving and showed high concordance with the reference method, 94.8% (95% CI 88.4–98.3), when the causative agent was covered by the QuickFISH® assay.

    Conclusions: The use of the commercial assays may shorten the time to identification of causative agents in bloodstream infections and can be a good complement to the current clinical routine diagnostics. Nevertheless, the performance of the commercial assays is considerably affected by the characteristics of the causative agents.

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  • 9.
    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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  • 10.
    Gärden, Bodil
    et al.
    University of Skövde, School of Life Sciences.
    Samarina, Arina
    Karolinska University Hospital, Sweden.
    Stavchanskaya, Irina
    Tuberculosis Dispensary Nr 8, St. Petersburg, Russia.
    Alsterlund, Rolf
    Central Hospital, Kristianstad, Sweden.
    Övregaard, Amanda
    Uddevalla Hospital, Sweden.
    Taganova, Olga
    Tuberculosis Dispensary Nr 8, St. Petersburg, Russia.
    Shpakovskaya, Ludmilla
    City Tuberculosis Dispensary, St. Petersburg, Russia.
    Zjemkov, Vladimir
    City Tuberculosis Dispensary, St. Petersburg, Russia.
    Ridell, Malin
    The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Larsson, Lars-Olof
    Karolinska University Hospital, Sweden.
    Food incentives improve adherence to tuberculosis drug treatment among homeless patients in Russia2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 1, p. 117-122Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to evaluate the impact of food incentives on adherence to tuberculosis (TB) drug treatment among homeless patients with TB. Food packages were thus given as a part of directly observed therapy to 142 homeless patients with TB at a dispensary in Saint Petersburg, Russian Federation. In addition, a social worker provided the patients with information and legal assistance, for example help with internal passports. Among the 142 patients, 66 were included in the study at the dispensary during their entire treatment period, while 76 patients were included in the study during shorter periods mainly because of transfer to inpatient care. In the first group, 59% of the patients continued the TB drug treatment without interruption in contrast to 31% in a control group. In the second group, that is those studied during shorter periods, 95% continued the TB drug treatment without interruption while attached to the dispensary. Food was introduced in the TB programme of the City of St. Petersburg as a consequence of this study. In conclusion, it can be stated that the food incentive had a strong positive impact on the adherence to TB drug treatment among these socially marginalized patients. The social support contributed in all probability also to the positive results.

  • 11.
    Irani Shemirani, Mahnaz
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Göteborg Universitet.
    Tilevik, Andreas
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Tilevik, Diana
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Enroth, Helena
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Department of Clinical Microbiology, Unilabs AB, Skövde.
    Comparison of Whole Genome Sequencing Pipelines for Analysis of Staphylococcus aureus Isolates from Sepsis Patients2019Conference paper (Refereed)
  • 12.
    Kokkonen, Alexander
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Unilabs AB.
    Tilevik, Diana
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Tilevik, Andreas
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Fagerlind, Magnus
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Enroth, Helena
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Department of Clinical Microbiology, Unilabs AB, Skövde.
    Clinical use of 16SrRNA Ion TorrentNext-generation sequencing and bioinformatics pipeline2019Conference paper (Other academic)
  • 13.
    Ljungström, Lars
    et al.
    Department of Infectious Diseases, Skaraborg Hospital.
    Jacobsson, Gunnar
    Department of Infectious Diseases, Skaraborg Hospital / The swedish strategic program against antibiotic resistance.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Tilevik, Diana
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    The diagnostic value of PCT as biomarker in patients suspected with community-onset bacterial sepsis2017Conference paper (Refereed)
  • 14.
    Ljungström, Lars
    et al.
    Skaraborg Hospital Skövde, Sweden.
    Karlsson, Diana
    Skaraborg Hospital Skövde, Sweden.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Andersson, R.
    Institute of Biosciences, Sahlgrenska Academy at the University of Gothenburg, Sweden.
    Jacobsson, Gunnar
    Skaraborg Hospital Skövde, Sweden.
    Neutrophil to lymphocyte count ratio performs better than procalcitonin as a biomarker for bacteremia and severe sepsis in the emergency department2015In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 19, no Suppl 1, article id P66Article in journal (Refereed)
  • 15.
    Ljungström, Lars R.
    et al.
    Department of Infectious Diseases, Skaraborg Hospital / CARe (Center for Antibiotic Resistance Research), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg.
    Jacobsson, Gunnar
    Department of Infectious Diseases, Skaraborg Hospital, Skövde / CARe (Center for Antibiotic Resistance Research), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg.
    Claesson, Berndt E. B.
    Department of Clinical Microbiology, Unilabs, Skaraborg Hospital, Skövde.
    Andersson, Rune
    CARe (Center for Antibiotic Resistance Research), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Enroth, Helena
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre. Department of Clinical Molecular Microbiology, Unilabs, Skaraborg Hospital, Skövde.
    Respiratory viral infections are underdiagnosed in patients with suspected sepsis2017In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 36, no 10, p. 1767-1776Article in journal (Refereed)
    Abstract [en]

    The study aim was to investigate the prevalence and clinical relevance of viral findings by multiplex PCR from the nasopharynx of clinically septic patients during a winter season. During 11 weeks of the influenza epidemic period in January-March 2012, consecutive adult patients suspected to be septic (n = 432) were analyzed with cultures from blood and nasopharynx plus multiplex PCR for respiratory viruses on the nasopharyngeal specimen. The results were compared with those from microbiology analyses ordered as part of standard care. During the winter season, viral respiratory pathogens, mainly influenza A virus, human metapneumovirus, coronavirus, and respiratory syncytial virus were clinically underdiagnosed in 70% of patients positive by the multiplex PCR assay. During the first four weeks of the influenza epidemic, few tests for influenza were ordered by clinicians, indicating low awareness that the epidemic had started. Nasopharyngeal findings of Streptococcus pneumoniae and Haemophilus influenzae by culture correlated to pneumonia diagnosis, and in those patients laboratory signs of viral co-infections were common but rarely suspected by clinicians. The role of respiratory viral infections in patients presenting with a clinical picture of sepsis is underestimated. Specific antiviral treatment might be beneficial in some cases and may reduce spread in a hospital setting. Diagnosing viral infections may promote reduction of unnecessary antibiotic use. It can also be a tool for decisions concerning patient logistics, in order to minimize exposure of susceptible patients and personnel.

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  • 16.
    Nematollahi Mahani, Seyed Alireza
    University of Skövde, School of Health and Education.
    Human placental trophoblast infection with rift valley fever virus and the cell cytokine response to infection2017Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Rift Valley Fever Virus (RVFV) is a Mosquito borne virus (Bunyaviridae family) associated withhemorrhagic fever and abortion in ruminants and humans. Geographic distribution of the virus has expanded to most countries in African continent and in 2001 to Arabian Peninsula resulting in repeated epidemic and epizootic events. With abortion being the hallmark of RVFV infection,Understanding RVFV infection in human placental tissue can provide better insight into disease pathobiology.

    In this study, three human trophoblast cell lines (A3, Jar & BeWo) were evaluated for permissiveness to RVFV infection. Furthermore, the viral capacity to spread by producing progeny viruses in trophoblasts was evaluated. The trophoblast response to infection was additionally assessed by measuring expression levels of important inflammatory cytokines in the cells (IL-1 β, IL-6, IL-8, IL-10, IL15, CSF-2, IFN-g, Fas-L). Finaly, two viral entrance mechanisms suggested for this virus were investigated in these cell models.

    Results suggested high permissiveness of studied trophoblasts cell lines to RVFV, leading to severe cytokine response (IL-8 and IL-1β in Jar and increase in CSF-2, IL-1β, IL-6 and IL-8 in A3 cell line). Since these cytokines are vital in embryonic regulation and development, the severe effect of infection could potentially be part of pathogenesis of virus-induced abortion. When viral entry routes were investigated, heparan sulfate proved to be the main cell entry membrane protein used by RVFV. However removal of all galactosylamintransferases resulted in higher infection rate suggesting presence of other entry mechanisms in absence of galactosylamin transferase. Considering these results and the nature of primary trophoblasts in resisting infection, it is important to evaluate if the primary trophoblasts show the same or similar pattern of sensitivity to RVFV infection with both wild type and mutated viral strains.These findings merit further investigations regarding pregnancy response to infection, vaccination and treatment.

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  • 17.
    Owemyr, Ida
    et al.
    University of Skövde, The Systems Biology Research Centre. University of Skövde, School of Life Sciences.
    Enroth, Helena
    Unilabs AB, Skövde, Sweden.
    Ljungström, Lars
    Skaraborg Hospital, Skövde, Sweden.
    Jacobsson, Gunnar
    Skaraborgs Sjukhus, Skövde, Sweden.
    Pernestig, Anna-Karin
    University of Skövde, The Systems Biology Research Centre. University of Skövde, School of Life Sciences.
    Karlsson, Diana
    University of Skövde, The Systems Biology Research Centre. University of Skövde, School of Life Sciences.
    Evaluation of microarray-based assay for identification of bloodstream bacteria in patients with suspected sepsis2013Conference paper (Refereed)
  • 18.
    Pendharkar, Sonal
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Brandsborg, Erik
    Bifodan AS, Hundested, Denmark.
    Hammarström, Lennart
    Karolinska Institutet, Stockholm, Sweden.
    Marcotte, Harold
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Per-Göran
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre. Department of Obstetrics and Gynaecology Kärnsjukhuset, Skaraborg hospital, Skövde, Sweden.
    Vaginal colonisation by probiotic lactobacilli and clinical outcome in women conventionally treated for bacterial vaginosis and yeast infection2015In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 15, p. 1-12, article id 255Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the colonisation by lactobacilli and clinical outcome in women with bacterial vaginosis (BV) and recurrent vulvovaginal candidiasis (R-VVC) receiving antibiotic or anti-fungal treatment in combination with the probiotic EcoVag(R) capsules. Methods: A total of 40 Scandinavian women diagnosed with BV or VVC on the basis of Amsel's criteria or clinical symptoms were consecutively recruited in two pilot open label clinical trials. In trial I, women with BV were treated with clindamycin and metronidazole followed by vaginal EcoVag(R) capsules, containing Lactobacillus rhamnosus DSM 14870 and Lactobacillus gasseri DSM 14869, for 5 consecutive days after each antibiotic treatment. In trial II, women were recruited in three groups as follows: women with BV receiving clindamycin and metronidazole treatment together with a prolonged administration of EcoVag(R) (10 consecutive days after each antibiotic treatment followed by weekly administration of capsules for next four months), women with R-VVC receiving extended fluconazole and EcoVag(R) treatment, and women receiving extended fluconazole treatments only. The difference in frequency of isolation of EcoVag(R) strains or other lactobacilli between groups was compared by Fisher's exact test. Results: The 6-month cure rate for BV was 50 % in trial I while both the 6- and 12-month cure rates were 67 % in trial II. The 6- and 12-month cure rates for VVC were 100 % and 89 % in women receiving fluconazole and EcoVag(R), and 100 % and 70 % in women receiving fluconazole only. The frequency of isolation of any Lactobacillus species during the course of the study was associated with cure of BV in trial I and II, whereas the frequency of isolation of EcoVag(R) strains was significantly associated with the cure of BV in trial II only. As previously observed, a change in sexual partner was associated with relapse of BV with an Odds ratio of 77 (95 % CI: 2.665 to 2225). Conclusions: The study suggests that the treatment with antibiotics or anti-fungal medication in combination with EcoVag(R) capsules provide long-term cure against BV and R-VVC as compared to previous reports.

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  • 19.
    Shebehe, Jacques
    et al.
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden.
    Ottertun, Emma
    University of Skövde, School of Health Sciences.
    Carlén, Kristina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Gustafson, Deborah R.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, United States.
    Knowledge about infections is associated with antibiotic use: cross-sectional evidence from the health survey Northern Ireland2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1041Article in journal (Refereed)
    Abstract [en]

    Background: Antibiotic overuse is the main modifiable driver of antibiotic resistance. Factors associated with overuse have been inconsistently reported and vary across populations. Given the burgeoning occurrence of infectious diseases around the world, there remains a great need to identify barriers and solutions to the control of infections. We examined whether knowledge about infections and antibiotic resistance is associated with antibiotic use in a northern European population sample. Methods: The Health Survey Northern Ireland 2014/15 was completed by a cross-sectional sample of 4135 participants aged > 16 years. Participants were asked whether they had taken an antibiotic in the past 12 months; and six questions were asked concerning knowledge about infections and antibiotic resistance. Correct answers to the six knowledge questions defined a knowledge score (score range 0–6 correct answers). We used multivariable logistic regression to estimate odds of self-reported antibiotic use during the last 12 months in association with knowledge score (lowest score, 0/6, as referent), and response to each knowledge question. Covariates included sex, age group, smoking, alcohol drinking, deprivation index, self-rated health, and satisfaction with life. Results were outputted as Odds Ratios (OR) and 95% Confidence Intervals (CI). Results: Antibiotic use in the past 12 months was reported by 39.0% (1614/4135); and 84.2% (3482/4135) scored < 6/6 correct on knowledge statements. Compared to the lowest knowledge score (0/6 correct), the highest knowledge score (6/6 correct) was associated with higher odds of antibiotic use (adjusted OR 2.03, 95% CI [1.46, 2.81], p < 0.001), with a P-value < 0.001 for trend with increasing knowledge score. Female sex, age, high deprivation, and poor general health, were independently associated with higher odds of antibiotic use. Stratified analyses showed sex and age group differences. Conclusion: Knowledge, and other modifiable and non-modifiable risk factors, were positively associated with antibiotic use in the past 12 months. While the causal direction of these associations could not be determined, given the high prevalence of lesser knowledge, as well as independent contributions of other factors including socioeconomic characteristics, health literacy campaigns to raise awareness of antibiotic resistance should take a multi-pronged approach. © 2021, The Author(s).

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  • 20.
    Shemirani, Mahnaz Irani
    et al.
    Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Tilevik, Diana
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Tilevik, Andreas
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Jurcevic, Sanja
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Arnellos, Dimitrios
    1928 Diagnostics, Gothenburg, Sweden.
    Enroth, Helena
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Molecular Microbiology, Laboratory Medicine, Unilabs AB, Skövde, Sweden.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Benchmarking of two bioinformatic workflows for the analysis of whole-genome sequenced Staphylococcus aureus collected from patients with suspected sepsis2023In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 23, no 1, p. 39-, article id 39Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The rapidly growing area of sequencing technologies, and more specifically bacterial whole-genome sequencing, could offer applications in clinical microbiology, including species identification of bacteria, prediction of genetic antibiotic susceptibility and virulence genes simultaneously. To accomplish the aforementioned points, the commercial cloud-based platform, 1928 platform (1928 Diagnostics, Gothenburg, Sweden) was benchmarked against an in-house developed bioinformatic pipeline as well as to reference methods in the clinical laboratory.

    METHODS: Whole-genome sequencing data retrieved from 264 Staphylococcus aureus isolates using the Illumina HiSeq X next-generation sequencing technology was used. The S. aureus isolates were collected during a prospective observational study of community-onset severe sepsis and septic shock in adults at Skaraborg Hospital, in the western region of Sweden. The collected isolates were characterized according to accredited laboratory methods i.e., species identification by MALDI-TOF MS analysis and phenotypic antibiotic susceptibility testing (AST) by following the EUCAST guidelines. Concordance between laboratory methods and bioinformatic tools, as well as concordance between the bioinformatic tools was assessed by calculating the percent of agreement.

    RESULTS: There was an overall high agreement between predicted genotypic AST and phenotypic AST results, 98.0% (989/1006, 95% CI 97.3-99.0). Nevertheless, the 1928 platform delivered predicted genotypic AST results with lower very major error rates but somewhat higher major error rates compared to the in-house pipeline. There were differences in processing times i.e., minutes versus hours, where the 1928 platform delivered the results faster. Furthermore, the bioinformatic workflows showed overall 99.4% (1267/1275, 95% CI 98.7-99.7) agreement in genetic prediction of the virulence gene characteristics and overall 97.9% (231/236, 95% CI 95.0-99.2%) agreement in predicting the sequence types (ST) of the S. aureus isolates.

    CONCLUSIONS: Altogether, the benchmarking disclosed that both bioinformatic workflows are able to deliver results with high accuracy aiding diagnostics of severe infections caused by S. aureus. It also illustrates the need of international agreement on quality control and metrics to facilitate standardization of analytical approaches for whole-genome sequencing based predictions.

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  • 21.
    Sipilä, Pyry N.
    et al.
    Clinicum, Department of Public Health, University of Helsinki, Finland ; Helsinki Institute of Life Science, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Heikkilä, Nelli
    Medicum, Department of Bacteriology and Immunology, University of Helsinki, Finland ; Translational Immunology Research Program, University of Helsinki, Finland.
    Lindbohm, Joni V.
    Clinicum, Department of Public Health, University of Helsinki, Finland ; Department of Epidemiology and Public Health, University College London, UK.
    Hakulinen, Christian
    Department of Psychology and Logopedics, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, 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.
    Elovainio, Marko
    Research Programs Unit, University of Helsinki, Finland ; Finnish Institute for Health and Welfare, Helsinki, 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 ; Research Services, 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.
    Clinicum, Department of Public Health, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland.
    Pentti, Jaana
    Clinicum, Department of Public Health, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland ; Department of Public Health, University of Turku, Finland.
    Strandberg, Timo E.
    Department of Medicine, Helsinki University Hospital, Finland ; Center for Life Course Health Research, University of Oulu, Finland.
    Kivimäki, Mika
    Clinicum, Department of Public Health, University of Helsinki, Finland ; Finnish Institute of Occupational Health, Helsinki, Finland ; Department of Epidemiology and Public Health, University College London, UK.
    Hospital-treated infectious diseases and the risk of dementia: a large, multicohort, observational study with a replication cohort2021In: The Lancet - Infectious diseases, ISSN 1473-3099, E-ISSN 1474-4457, Vol. 21, no 11, p. 1557-1567, article id S1473-3099(21)00144-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Infections have been hypothesised to increase the risk of dementia. Existing studies have included a narrow range of infectious diseases, relied on short follow-up periods, and provided little evidence for whether the increased risk is limited to specific dementia subtypes or attributable to specific microbes rather than infection burden. We aimed to compare the risk of Alzheimer's disease and other dementias across a wide range of hospital-treated bacterial and viral infections in two large cohorts with long follow-up periods.

    METHODS: In this large, multicohort, observational study, the analysis was based on a primary cohort consisting of pooled individual-level data from three prospective cohort studies in Finland (the Finnish Public Sector study, the Health and Social Support study, and the Still Working study) and an independent replication cohort from the UK Biobank. Community-dwelling adults (≥18 years) with no dementia at study entry were included. Follow-up was until Dec 31, 2012, in the Health and Social Support study, Dec 31, 2016, in the public sector study and the Still Working study, and Feb 7, 2018, in the replication cohort. Through record linkage to national hospital inpatient registers, we ascertained exposure to 925 infectious diseases (using the International Classification of Diseases 10th Revision codes) before dementia onset, and identified incident dementia from hospital records, medication reimbursement entitlements, and death certificates. Hazard ratios (HRs) for the associations of each infectious disease or disease group (index infection) with incident dementia were assessed by use of Cox proportional hazards models. We then repeated the analysis after excluding incident dementia cases that occurred during the first 10 years after initial hospitalisation due to the index infection.

    FINDINGS: From March 1, 1986, to Jan 1, 2005, 260 490 people were included in the primary cohort, and from Dec 19, 2006, to Oct 1, 2010, 485 708 people were included in the replication cohort. In the primary cohort analysis based on 3 947 046 person-years at risk (median follow-up 15·4 years [IQR 9·8-21·0]), 77 108 participants had at least one hospital-treated infection before dementia onset and 2768 developed dementia. Hospitalisation for any infectious disease was associated with increased dementia risk in the primary cohort (adjusted HR [aHR] 1·48 [95% CI 1·37-1·60]) and replication cohort (2·60 [2·38-2·83]). The association remained when analyses were restricted to new dementia cases that occurred more than 10 years after infection (aHR 1·22 [95% CI 1·09-1·36] in the primary cohort, the replication cohort had insufficient follow-up data for this analysis), and when comorbidities and other dementia risk factors were considered. There was evidence of a dose-response association between the number of episodes of hospital-treated infections and dementia risk in both cohorts (ptrend=0·0007). Although the greatest dementia risk was seen for central nervous system (CNS) infections versus no infection (aHR 3·01 [95% CI 2·07-4·37]), excess risk was also evident for extra-CNS infections (1·47 [1·36-1·59]). Although we found little difference in the infection-dementia association by type of infection, associations were stronger for vascular dementia than for Alzheimer's disease (aHR 2·09 [95% CI 1·59-2·75] versus aHR 1·20 [1·08-1·33] in the primary cohort and aHR 3·28 [2·65-4·04] versus aHR 1·80 [1·53-2·13] in the replication cohort).

    INTERPRETATION: Severe infections requiring hospital treatment are associated with long-term increased risk of dementia, including vascular dementia and Alzheimer's disease. This association is not limited to CNS infections, suggesting that systemic effects are sufficient to affect the brain. The absence of infection specificity combined with evidence of dose-response relationships between infectious disease burden and dementia risk support the hypothesis that increased dementia risk is driven by general inflammation rather than specific microbes.

    FUNDING: UK Medical Research Council, US National Institute on Aging, Wellcome Trust, NordForsk, Academy of Finland, and Helsinki Institute of Life Science.

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  • 22.
    Spears, Janine L.
    et al.
    Monte Ahuja College of Business, Cleveland State University, OH, USA.
    Padyab, Ali
    University of Skövde, School of Informatics. University of Skövde, Informatics Research Environment.
    Privacy risk in contact tracing systems2023In: Behavior and Information Technology, ISSN 0144-929X, E-ISSN 1362-3001, Vol. 42, no 2, p. 174-195Article in journal (Refereed)
    Abstract [en]

    For over a century, contact tracing has been an integral public health strategy for infectious disease control when there is no pharmaceutical treatment. Contact tracing for the coronavirus disease COVID-19 introduced a variety of automated methods deployed across several countries. The present paper examines privacy risk to infected persons and their physical contacts in contact tracing systems. Automated contact tracing systems implemented during the early months of COVID-19 are compared to conventional manual methods. Solove's taxonomy of privacy is applied to examine privacy risks in both conventional and automated contact tracing systems. As a method of epidemiological surveillance, all contact tracing systems inherently incur privacy risk. However, compared to conventional methods, automated contact tracing systems amplify privacy risk with pre-emptive data collection on all app users, regardless of exposure to an infectious disease; continuous, granular data collection on all users' location and proximity contacts; insecurities in proximity app technologies and interconnectivity; and in many cases, the use of centralised systems. Reducing these risk factors can reduce privacy harms, such as identification, distortion, secondary use, stigma, and social control.

  • 23.
    Tilevik, Diana
    University of Skövde, School of Bioscience. University of Skövde, The Systems Biology Research Centre.
    Long-term effects of penicillin resistance and fitness cost on pneumococcal transmission dynamics in a developed setting2016In: Infection Ecology & Epidemiology, ISSN 2000-8686, E-ISSN 2000-8686, Vol. 6, article id 31234Article in journal (Refereed)
    Abstract [en]

    Background: The increasing prevalence of penicillin non-susceptible pneumococci (PNSP) throughout the world threatens successful treatment of infections caused by this important bacterial pathogen. The rate at which PNSP clones spread in the community is thought to mainly be determined by two key determinants; the volume of penicillin use and the magnitude of the fitness cost in the absence of treatment. The aim of the study was to determine the impacts of penicillin consumption and fitness cost on pneumococcal transmission dynamics in a developed country setting.

    Methods: An individual-based network model based on real-life demographic data was constructed and applied in a developed country setting (Sweden). A population structure with transmission of carriage taking place within relevant mixing groups, i.e. families, day care groups, school classes, and other close contacts, was considered to properly assess the transmission dynamics for susceptible and PNSP clones. Several scenarios were simulated and model outcomes were statistically analysed.

    Results: Model simulations predicted that with an outpatient penicillin use corresponding to the sales in Sweden 2010 (118 recipes per 1,000 inhabitants per year), the magnitude of a fitness cost for resistance must be at least 5% to offset the advantage of penicillin resistance. Moreover, even if there is a fitness cost associated with penicillin resistance, a considerable reduction of penicillin usage appears to be required to significantly decrease the incidence of PNSP in a community.

    Conclusion: The frequency of PNSP clones is hard to reverse by simply reducing the penicillin consumption even if there is a biological cost associated with resistance. However, because penicillin usage does promote further spread of PNSP clones, it is important to keep down penicillin consumption considering future resistance problems.

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  • 24.
    Tilevik, Diana
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Fagerlind, Magnus
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Tilevik, Andreas
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Ljungström, Lars
    Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden.
    Johansson, Markus
    1928 Diagnostics, Arvid Hedvalls backe, Gothenburg, Sweden.
    Enroth, Helena
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment. Molecular Microbiology, Laboratory Medicine, Unilabs AB, Skaraborg Hospital, Skövde.
    Sequence-based genotyping of extra-intestinal pathogenic Escherichia coli isolates from patients with suspected community-onset sepsis, Sweden2022In: Microbial Pathogenesis, ISSN 0882-4010, E-ISSN 1096-1208, Vol. 173, no Part A, article id 105836Article in journal (Refereed)
    Abstract [en]

    Extra-intestinal pathogenic Escherichia coli (ExPEC) strains are responsible for a large number of human infections globally. The management of infections caused by ExPEC has been complicated by the emergence of antimicrobial resistance, most importantly the increasing recognition of isolates producing extended-spectrum β-lactamases (ESBL). Herein, we used whole-genome sequencing (WGS) on ExPEC isolates for a comprehensive genotypic characterization. Twenty-one ExPEC isolates, nine with and 12 without ESBL-production, from 16 patients with suspected sepsis were sequenced on an Illumina MiSeq platform. Analysis of WGS data was performed with widely used bioinformatics software and tools for genotypic characterization of the isolates. A higher number of plasmids, virulence and resistance genes were observed in the ESBL-producing isolates than the non-ESBL-producing, although not statistically significant due to the low sample size. All nine ESBL-producing ExPEC isolates presented with at least one bla gene, as did three of the 12 without ESBL-production. Multi-locus sequence typing analysis revealed a diversity of sequence types whereas phylogroup A prevailed among isolates both with and without ESBL-production. In conclusion, this limited study shows that analysis of WGS data can be used for genotypic characterization of ExPEC isolates to obtain in-depth information of clinical relevance.

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  • 25.
    Tilevik, Diana
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Ljungström, Lars
    Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden.
    Clinical routine biomarkers in combination for early identification of patients with bacterial sepsis2019Conference paper (Refereed)
  • 26.
    Tilevik, Diana
    et al.
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Saxenborn, Patricia
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Tilevik, Andreas
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Fagerlind, Magnus
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Lubovac-Pilav, Zelmina
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Pernestig, Anna-Karin
    University of Skövde, School of Bioscience. University of Skövde, Systems Biology Research Environment.
    Enroth, Helena
    Department of Clinical Microbiology, Unilabs AB, Skövde, Sweden.
    Using next-generation sequencing to study biodiversity in Klebsiella spp. isolated from patients with suspected sepsis2019Conference paper (Refereed)
  • 27.
    Toffaha, Ali
    et al.
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    El Ansari, Walid
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar.
    Ramzee, Ahmed Faidh
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Afana, Mohammad
    Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
    Aljohary, Hesham
    Department of General Surgery, Hamad Medical Corporation, Doha, Qatar.
    Rare presentation of primary varicella zoster as fatal fulminant hepatitis in adult on low-dose, short-term steroid: Case report2019In: Annals of Medicine and Surgery, E-ISSN 2049-0801, Vol. 48, p. 115-117Article in journal (Refereed)
    Abstract [en]

    Background: Varicella zoster virus presents clinically as primary (chickenpox) or secondary (herpes zoster) infection. Cutaneous and extracutaneous dissemination may occur, usually in immunocompromised patients. VZV hepatitis that progresses to fulminant hepatic failure is very rare and fatal. To the best of our knowledge, 9 cases have been reported to date, of which 7 were in immunocompromised adults, and only one patient was on short duration steroid therapy. Presentation of case: We present a 26-year old man who was admitted initially with acute abdomen as query persistent biliary colic. Later, he showed clinical and laboratory findings of VZV hepatitis that progressed rapidly despite maximal medical ICU support and he expired on day 3 of admission. Conclusions: Acute VZV infection may present as fulminant hepatitis. The presentation may initially be challenging for the diagnosis and should be considered if the patient has been in contact with a sick case. Low dose corticosteroid could carry a risk for fatal VZV fulminant hepatitis and should be used very cautiously especially with VZV patients’ contacts. Further causative relationships remain to be established. 

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