90 results on '"E Nyström"'
Search Results
2. 234 LONG-TERM RESULTS OF APP-BASED SELF-MANAGEMENT OF URGENCY AND MIXED URINARY INCONTINENCE IN WOMEN
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T Wadensten, E Nyström, A Nord, A Lindam, M Sjöström, and E Samuelsson
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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3. The influence of organizational models on the implementation of internet-based cognitive behavior therapy in primary care: A mixed methods study using the RE-AIM framework
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Elisabet Gervind, Mathilda Ben Salem, Cecilia Svanborg, Monica E. Nyström, Josefine L. Lilja, Viktor Kaldo, and Sandra Weineland
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Internet-based cognitive behavior therapy ,iCBT ,Implementation science ,Complex intervention ,Primary care ,RE-AIM framework ,Information technology ,T58.5-58.64 ,Psychology ,BF1-990 - Abstract
Background: Internet-Based Cognitive Behavioral Therapy (iCBT) holds great potential in addressing mental health issues, yet its real-world implementation poses significant challenges. While prior research has predominantly focused on centralized care models, this study explores the implementation of iCBT in the context of decentralized organizational structures within the Swedish primary care setting, where all interventions traditionally are delivered at local Primary Care Centers (PCCs). Aim: This study aims to enhance our understanding of iCBT implementation in primary care and assess the impact of organizational models on the implementation's outcome using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Method: A mixed-methods research design was employed to identify the factors influencing iCBT implementation across different levels, involving patients, therapists and managers. Data spanning two years was collected and analyzed through thematic analysis and statistical tests. The study encompassed 104 primary care centers, with patient data (n = 1979) sourced from the Swedish National Quality Register for Internet-Based Psychological Treatment (SibeR). Additionally, 53 iCBT therapists and 50 PCC managers completed the Normalization Measure Development Questionnaire, and 15 leaders participated in interviews. Results: Our investigation identified two implementation approaches, one concentrated and one decentralized. Implementation effectiveness was evident through adherence rates suggesting that iCBT is a promising approach for treating mental ill-health in primary care, although challenges were observed concerning patient assessment and therapist drift towards unstructured treatment. Mandatory implementation, along with managerial and organizational support, positively impacted adoption. Results vary in terms of adherence to established protocols, with therapists working in concentrated model showing a significantly higher percentage of registration in the quality register SibeR (X2 (1, N = 2973) = 430.5774, p = 0.001). They also showed significantly higher means in cognitive participation (Z = −2.179, p = 0.029) and in reflective monitoring (Z = −2.548, p = 0.011). Discussion: Overall, the study results demonstrate that iCBT, as a complex and qualitatively different intervention from traditional psychological treatment, can be widely implemented in primary care settings. The study's key finding highlights the substantial advantages of the concentrated organizational model. This model has strengths in sustainability, encourages reflective monitoring among therapists, the use of quality registers, and enforces established protocols. Conclusion: In conclusion, this study significantly contributes to the understanding of the practical aspects associated with the implementation of complex internet interventions, particularly in the context of internet-based cognitive-behavioral therapy (iCBT). The study highlights that effective iCBT integration into primary care requires a multifaceted approach, taking into account organizational models, robust support structures, and a commitment to maintaining quality standards. By emphasizing these factors, our research aims to provide actionable insights that can enhance the practicability and real-world applicability of implementing iCBT in primary care settings.
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- 2024
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4. Systems thinking in practice when implementing a national policy program for the improvement of women's healthcare
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Monica E. Nyström, Sara Tolf, Vibeke Sparring, and Helena Strehlenert
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systems thinking ,healthcare improvement ,policy implementation ,public health ,healthcare services ,Public aspects of medicine ,RA1-1270 - Abstract
IntroductionInterest in applying systems thinking (ST) in public health and healthcare improvement has increased in the past decade, but its practical use is still unclear. ST has been found useful in addressing the complexity and dynamics of organizations and welfare systems during periods of change. Exploring how ST is used in practice in national policy programs addressing complex and ill-structured problems can increase the knowledge of the use and eventually the usefulness of ST during complex changes. In ST, a multi-level approach is suggested to coordinate interventions over individual, organizational, and community levels, but most attempts to operationalize ST focus on the individual level. This study aimed to investigate how ST is expressed in policy programs addressing wicked problems and describe the specific action strategies used in practice in a national program in Sweden, using a new conceptual framework comprising ST principles on the organizational level as an analytical tool. The program addresses several challenges and aims to achieve systems change within women's healthcare.MethodsThe case study used a rich set of qualitative, longitudinal data on individual, group, and organizational levels, collected during the implementation of the program. Deductive content analysis provided narrative descriptions of how the ST principles were expressed in actions, based on interviews, observations, and archival data.ResultsThe results showed that the program management team used various strategies and activities corresponding to organizational level ST. The team convened numerous types of actors and used collaborative approaches and many different information sources in striving to create a joint and holistic understanding of the program and its context. Visualization tools and adaptive approaches were used to support regional contact persons and staff in their development work. Efforts were made to identify high-leverage solutions to problems influencing the quality and coordination of care before, during, and after childbirth, solutions adaptable to regional conditions.Discussion/conclusionsThe organizational level ST framework was useful for identifying ST in practice in the policy program, but to increase further understanding of how ST is applied within policy programs, we suggest a multi-dimensional model to identify ST on several levels.
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- 2023
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5. Sense-Making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples From Sweden; Comment on 'What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health'
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Monica E. Nyström, Sara Tolf, and Helena Strehlenert
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systems thinking ,soft systems methodology ,healthcare development ,double-loop learning ,policy-makers ,sweden ,Public aspects of medicine ,RA1-1270 - Abstract
It is widely acknowledged that systems thinking (ST) should be implemented in the area of public health, but how this should be done is less clear. In this commentary we focus on sense-making and double-loop learning processes when using ST and soft systems methodology in research collaborations with policy-makers. In their study of policy-makers’ experiences of ST, Haynes et al emphasize the importance of knowledge processes and mutual learning between researchers and policy-makers, processes which can change how policy-makers think and thus have impact on real-world policy concerns. We provide some additional examples from Sweden on how ST has been applied to create learning and shared mental models among stakeholders and researchers in national and regional healthcare development initiatives. We conclude that investigating and describing such processes on micro-level can aid the knowledge on how to implement ST in public health.
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- 2021
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6. Advancing Health Services Collaborative and Partnership Research; Comment on 'Experience of Health Leadership in Partnering with University-Based Researchers in Canada – A Call to ‘Re-imagine’ Research'
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Monica E. Nyström and Helena Strehlenert
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research partnerships ,collaborative research ,integrated knowledge translation ,health services research ,sweden ,Public aspects of medicine ,RA1-1270 - Abstract
Bowen et al highlight the trend towards partnership research to address the complex challenges currently facing healthcare systems and organizations world-wide. They focus on important strategic actors in partner organizations and their experiences, views and advice for sustainable collaboration, within a Canadian context. The authors call for a multi-system change to provide better conditions for research partnerships. They highlight needs to re-imagine research, to move beyond an ‘acute care’ and clinical focus in research, to re-think research funding, and to improve the academic preparation for research partnerships. In this commentary we provide input to the discussion on practical guidance for those involved in research partnerships based on our partnership experiences from ten research projects conducted within the Swedish healthcare system since 2007. We also highlight areas that need attention in future research in order to learn from approaches used for collaborative and partnership research.
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- 2021
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7. Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses’ work situation
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Anna Westerlund, Vibeke Sparring, Henna Hasson, Lars Weinehall, and Monica E. Nyström
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care of older people ,national quality registries ,quality improvement ,team interaction ,work environment ,Nursing ,RT1-120 - Abstract
Abstract Aim The aim was to investigate assistant nurses’ perceptions of how working with national quality registries affected their work situation in care of older people. Design Qualitative interview study. Methods Sixteen semi‐structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied. Results The introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication. The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.
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- 2021
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8. Digital tools as promoters for person-centered care practices in chronic care? Healthcare professionals’ experiences from rheumatology care
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Emma Granström, Carolina Wannheden, Mats Brommels, Helena Hvitfeldt, and Monica E. Nyström
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Patient-centered care ,Person-centered care ,Digital tools ,Chronic care ,Improvement ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Person-centered care (PCC) emphasize the importance of supporting individuals’ involvement in care provided and self-care. PCC has become more important in chronic care as the number of people living with chronic conditions is increasing due to the demographic changes. Digital tools have potential to support interaction between patients and healthcare providers, but empirical examples of how to achieve PCC in chronic care and the role of digital tools in this process is limited. The aim of this study was to investigate strategies to achieve PCC used by the healthcare professionals at an outpatient Rheumatology clinic (RC), the strategies’ relation to digital tools, and the perceived impact of the strategies on healthcare professionals and patients. Methods A single case study design was used. The qualitative data consisted of 14 semi-structured interviews and staff meeting minutes, covering the time period 2017–2019. The data were analyzed using conventional content analysis, complemented with document analyses. Results Ten strategies on two levels to operationalize PCC, and three categories of perceived impact were identified. On the individual patient level strategies involved several digital tools focusing on flexible access to care, mutual information sharing and the distribution of initiatives, tasks, and responsibilities from provider to patients. On the unit level, strategies concerned involving patient representatives and individual patients in development of digital services and work practices. The roles of both professionals and patients were affected and the importance of behavioral and cultural change became clear. Conclusions By providing an empirical example from chronic care the study contributes to the knowledge on strategies for achieving PCC, how digital tools and work practices interact, and how they can affect healthcare staff, patients and the unit. A conclusion is that the use of the digital tools, spanning over different dimensions of engagement, facilitated the healthcare professionals’ interaction with patients and the patients’ involvement in their own care. Digital tools complemented, rather than replaced, care practices.
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- 2020
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9. One size fits none – a qualitative study investigating nine national quality registries’ conditions for use in quality improvement, research and interaction with patients
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Vibeke Sparring, Emma Granström, Magna Andreen Sachs, Mats Brommels, and Monica E. Nyström
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National quality registry ,Clinical registry ,Clinical database ,Quality improvement ,Registry-based research ,Patient-centred care ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Swedish National Quality Registries (NQRs) are observational clinical registries that have long been seen as an underused resource for research and quality improvement (QI) in health care. In recent years, NQRs have also been recognised as an area where patients can be involved, contributing with self-reported experiences and estimations of health effects. This study aimed to investigate what the registry management perceived as barriers and facilitators for the use of NQRs in QI, research, and interaction with patients, and main activities undertaken to enhance their use for these purposes. The aim was further to identify potential differences between various types of NQRs for their use in these areas. Methods In this multiple case study, nine NQRs were purposively selected. Interviews (n = 18) were conducted and analysed iteratively using conventional and directed content analysis. Results A recent national investment initiative enabled more intensive work with development areas previously identified by the NQR management teams. The recent focus on value-based health care and other contemporary national healthcare investments aiming at QI and public benchmarking were perceived as facilitating factors. Having to perform double registrations due to shortcomings in digital systems was perceived as a barrier, as was the lack of authority on behalf of the registry management to request participation in NQRs and QI activities based on registry outcomes. The registry management teams used three strategies to enhance the use of NQRs: ensuring registering of correct and complete data, ensuring updated and understandable information available for patients, clinicians, researchers and others stakeholders, and intensifying cooperation with them. Varied characteristics of the NQRs influenced their use, and the possibility to reach various end-users was connected to the focus area and context of the NQRs. Conclusions The recent national investment initiative contributed to already ongoing work to strengthen the use of NQRs. To further increase the use, the demands of stakeholders and end-users must be in focus, but also an understanding of the NQRs’ various characteristics and challenges. The end-users may have in common a need for training in the methodology of registry based research and benchmarking, and how to be more patient-centred.
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- 2018
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10. Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region
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M. E. Nyström, E. Höög, R. Garvare, M. Andersson Bäck, D. D. Terris, and J. Hansson
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Continuous quality improvement ,Organizational learning ,Change management ,Organizational development ,Health care ,Social services ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors’ approaches to COIL. The approach, named “Sustainable Improvement and Development through Strategic and Systematic Approaches” (SIDSSA), was applied through an action-research and action-learning intervention. Methods The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses. Results The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting. Conclusions An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.
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- 2018
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11. Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare – a two-year follow up
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Therese Kardakis, Lars Jerdén, Monica E. Nyström, Lars Weinehall, and Helene Johansson
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Implementation ,Lifestyle ,Clinical practice guidelines ,Primary health care ,Preventive health services ,Health promotion ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients’ unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice. Methods Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test. Results Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients’ tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills. Conclusions Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients’ lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses’ attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians’ uptake and use of the CPGs.
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- 2018
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12. Adequate iodine nutrition in Sweden: a cross-sectional national study of urinary iodine concentration in school-age children
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Maria Andersson, Lena Hulthén, Helena Filipsson, Malin Hansson, E Nyström, Mille Milakovic, Robert Eggertsen, Elisabeth Gramatkovski, and Gertrud Berg
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Male ,medicine.medical_specialty ,Goiter ,Cross-sectional study ,education ,Iodine nutrition ,Nutritional Status ,Medicine (miscellaneous) ,chemistry.chemical_element ,Urine ,Iodine ,Nutrition Policy ,Environmental health ,medicine ,Cluster Analysis ,Humans ,Child ,Sweden ,Nutrition and Dietetics ,business.industry ,medicine.disease ,Surgery ,Iodised salt ,Cross-Sectional Studies ,chemistry ,National study ,Female ,business ,Goiter, Endemic ,Body mass index - Abstract
Sweden has a long-standing salt iodization program; however, its effects on iodine intake have never been monitored on a national level. The objective of this study was to evaluate iodine nutrition in the Swedish population by measuring the urinary iodine concentration (UIC) in a national sample of Swedish school-age (6-12 years of age) children.A stratified probability proportionate to size cluster sampling method was used to obtain a representative national sample of school-age children from 30 clusters. Spot urine samples were collected for UIC analysis using a modified Sandell-Kolthoff method.The median UIC of the children (n=857) was 125 microg/l (range 11-757 microg/l). The proportion of children with a UIC100 microg/l was 30.0% and the proportion of children with a UIC50 and300 microg/l was 5.5 and 3.0%, respectively.The iodine nutritional status of the Swedish population is adequate. Iodized table salt remains the main dietary source of iodine in Swedish diet. Recommendations to reduce total salt intake in the population urge increased use of iodized salt in the production of processed foods. Pregnant and lactating women with high iodine requirements may still be at risk for low iodine intake. This study will serve as the basis for future monitoring of iodine nutritional status in Sweden.
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- 2008
13. Amiodarone inhibits thyroidal iodide transport in vitro by a cyclic adenosine 5'-monophosphate- and iodine-independent mechanism
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S. Tedelind, Fredrik Larsson, H C van Beeren, Mikael Nilsson, E. Nyström, W. M. Wiersinga, C. Johanson, Laboratory for Endocrinology, Amsterdam Gastroenterology Endocrinology Metabolism, and Endocrinology
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Adenosine monophosphate ,medicine.medical_specialty ,Swine ,Iodide ,Thyroid Gland ,Amiodarone ,Thyrotropin ,chemistry.chemical_element ,Iodine ,Electrolytes ,chemistry.chemical_compound ,Endocrinology ,Internal medicine ,Cyclic AMP ,medicine ,Animals ,RNA, Messenger ,Iodide transport ,Dronedarone ,Cells, Cultured ,chemistry.chemical_classification ,Symporters ,Chemistry ,Thyroid ,Biological Transport ,Iodides ,Adenosine ,Epithelium ,medicine.anatomical_structure ,Symporter ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Thyroid side effects are common in patients treated for cardiac arrhythmias with amiodarone (AM). A major disturbance is inhibited thyroidal radioiodine uptake in AM-induced thyrotoxicosis, which makes 131I therapy ineffective. On the other hand, failure to escape from the Wolff-Chaikoff effect by down-regulation of the sodium/iodide symporter (NIS) is proposed to explain AM-induced hypothyroidism. However, previously no experimental studies on the possible mechanisms have been conducted. We therefore investigated the early effects of AM on thyroidal iodide transport using bicameral chamber cultures of primary pig thyrocytes that reproduce the three tissue compartments (epithelium, lumen, and extrafollicular space) of the gland. AM dose-dependently (1-50 microm) inhibited the TSH-stimulated transepithelial (basal to apical) transport of 125I- by up to 90%. The inhibitory effect was noticed already after 8 h and was further pronounced after 1-4 d, depending on the AM concentration. The intracellularly accumulated 125I- was reduced by perchlorate but not AM, and quantitative real-time RT-PCR revealed no change in the NIS expression in AM-treated cells. Blocking of cAMP degradation with 3-isobutyl-1-methylxanthine or withdrawal of AM reversed AM-induced changes in electrolyte transport but were unable to recover the suppressed 125I- transport. The iodine-free AM analog dronedarone also inhibited 125I- transport to the same extent as AM. The findings indicate that AM blocks thyroidal iodide uptake by reducing the iodide permeability of the apical plasma membrane of the thyroid epithelial cells. The effect is iodine independent and long-lasting and does not involve impaired function of NIS or the TSH receptor/cAMP signaling pathway.
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- 2006
14. The liquorice effect on the RAAS differs between the genders
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Magnus Axelson, Helga Agusta Sigurjonsdottir, Karin Manhem, Gudmundur Johannsson, E Nyström, and Sven Wallerstedt
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Adult ,Male ,medicine.medical_specialty ,Blood Pressure ,Essential hypertension ,Pseudohyperaldosteronism ,Renin-Angiotensin System ,chemistry.chemical_compound ,Sex Factors ,Mineralocorticoid receptor ,Internal medicine ,Renin–angiotensin system ,Glycyrrhiza ,Internal Medicine ,medicine ,Humans ,Aldosterone ,Mineralocorticoid Receptor Antagonists ,biology ,business.industry ,Case-control study ,General Medicine ,medicine.disease ,biology.organism_classification ,Endocrinology ,Blood pressure ,chemistry ,Case-Control Studies ,Hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Liquorice-induced increase in blood pressure (BP) is more profound in subjects with essential hypertension (HT) than in healthy individuals. Liquorice induces pseudohyperaldosteronism by inhibiting the 11beta-hydroxysteroid dehydrogenase type 2 and is also known to inhibit the renin-angiotensin-aldosterone system (RAAS). We explored the difference in response in BP, considering the RAAS and the genders.Patients with HT (eight men and three women, mean age 40.7 years) and healthy controls (13 men and 12 women, mean age 31.2 years) consumed 100 g of liquorice (150 mg glycyrrhetinic acid) daily for 4 weeks.Blood, urine samples and BP were evaluated before and after 4 weeks of liquorice consumption and 4 weeks after cessation of liquorice consumption.The relative change in serum aldosterone levels differed between the genders (p0.02), men being more responsive than women, but not between patients with HT and healthy subjects.The liquorice-induced inhibition of aldosterone secretion differs between the genders and is not influenced by the BP levels. This difference between the genders has not been exposed before.
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- 2006
15. Liquid-gel chromatography on lipophilic-hydrophobic Sephadex derivatives
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J. Ellingboe, E. Nyström, and J. Sjövall
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alkyl ether ,column chromatography ,reversed- and straight-phase partition ,wax ,fatty acid ,glyceride ,Biochemistry ,QD415-436 - Abstract
Hydrophobic long-chain alkyl ethers of Sephadex have been synthesized and tested for use in liquid chromatography. With columns prepared in such polar solvents as methanol, reversed-phase systems are obtained where compounds separate in order of decreasing polarity. In such nonpolar solvents as heptane, straight-phase systems are formed, and separations occur in order of increasing polarity. The retention volume of a compound is determined mainly by its polarity, the type and degree of substitution of Sephadex, and the nature of the solvent system. Examples are given of straight- and reversed-phase separations of waxes, fatty acids, glycerides, glycerol ethers, sterols, bile acids, and hormonal steroids. The Sephadex derivatives are simple to make, the columns are easy to prepare, and they can be used over long periods of time. Liquid-gel chromatography on alkyl ethers of Sephadex is a mild separation technique and should be a useful complement to other chromatographic methods.
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- 1970
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16. Thyroid volume in Swedish school children: a national, stratified, population-based survey
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Gertrud Berg, Maria Andersson, Lena Hulthén, Robert Eggertsen, Mille Milakovic, E Gramatkowski, H Filipsson Nyström, Marie Hansson, E Nyström, and Sahlgrenska University Hospital [Gothenburg]
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Male ,medicine.medical_specialty ,Goiter ,Urban Population ,Thyroid Gland ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,children ,Reference Values ,Internal medicine ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Child ,Population based survey ,Iodine intake ,Ultrasonography ,2. Zero hunger ,Body surface area ,Sweden ,Nutrition and Dietetics ,business.industry ,Thyroid ,goitre ,national ,Age Factors ,thyroid volume ,Organ Size ,medicine.disease ,3. Good health ,Endocrinology ,medicine.anatomical_structure ,El Niño ,Population Surveillance ,Cluster sampling ,Female ,business ,Body mass index ,Demography ,Iodine - Abstract
International audience; Background/ Objectives: Sweden has had a salt iodination program since 1936. This first national surveillance study on iodine nutrition infers an adequate level of urinary iodine concentration (UIC 125 ug/L) and the aim is now to evaluate thyroid volume (Tvol) in the same national sample. Subjects/ Methods: A stratified probability proportionate to size cluster sampling was used to obtain a representative national sample of Swedish children aged 6-12 years. Median Tvol obtained ultrasonografically and the prevalence of enlarged thyroid glands were compared with an international reference standard. Regional differences were evaluated through comparisons of Tvol between coastal and inland areas, urban and rural regions, and former goitre and non-goitre regions. Results: Tvol correlated to age, body surface area (BSA), weight, height, and BMI for both sexes, (p
- Published
- 2010
17. Effect of lifelong iodine supplementation on thyroid 131-I uptake: a decrease in uptake in euthyroid but not hyperthyroid individuals compared to observations 50 years ago
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Robert Eggertsen, Mille Milakovic, E Nyström, and Gertrud Berg
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Male ,endocrine system ,medicine.medical_specialty ,Time Factors ,endocrine system diseases ,Population ,Thyroid Gland ,Medicine (miscellaneous) ,chemistry.chemical_element ,Scintigraphy ,Iodine ,Hyperthyroidism ,Iodine Radioisotopes ,Hypothyroidism ,Oral administration ,Internal medicine ,medicine ,Humans ,Euthyroid ,Sodium Chloride, Dietary ,education ,Radionuclide Imaging ,Aged ,Sweden ,education.field_of_study ,Nutrition and Dietetics ,medicine.diagnostic_test ,business.industry ,Thyroid ,Middle Aged ,Multinodular goitre ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Female ,business - Abstract
BACKGROUND: In Sweden, iodine has been added to table salt (10 mg/kg) since 1936; this amount was increased in 1966 to 50 mg/kg. OBJECTIVE: To investigate a euthyroid Swedish population (n = 44, 60-65 years) with its entire lifespan with iodine supplementation as for 24-h 131-I uptake (24 h IU) and thyroid nodularity (thyroid scintigraphy). To compare the euthyroid 24 h IU with uptake of thyrotoxic individuals, and with observations from 1955. METHODS: The 24 h IU was used in euthyroid individuals after oral administration of 0.1 MBq/2.7 microCi radioiodine and imaging of the thyroid gland was carried out using 99mTc-pertechnetate. RESULTS: In 1999-2000, the mean 24 h IU in the euthyroid individuals was 21% (range 11-33%) and the normal (central 95%) reference interval was 14-30%. Scintigraphy suggested multinodular goitre in three euthyroid individuals. In Graves' patients (n = 53, 50-65 years), the mean 24 h IU was 61% (range 29-89%). In 1955, the 24 h IU in euthyroid individuals was higher (38%, range 10-70%), while hyperthyroid patients had uptake values similar to those recorded in the present investigation (mean 62%, range 40-90%). CONCLUSIONS: The population sample studied had to be small for ethical reasons. We conclude that the reference interval for 24 h IU is 14-30% in this population that had spent its entire lifespan with iodine supplementation. This is lower than that recorded in a Swedish euthyroid population half a century ago having had low-grade table-salt iodine supplementation for 20 years. Values for hyperthyroid patients, however, do not appear to have been affected likewise.
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- 2005
18. Screening for thyroid disease of 15-17-year-old schoolchildren in an area with normal iodine intake
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Robert Eggertsen, Mille Milakovic, Göran Lindstedt, Gertrud Berg, and E Nyström
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Male ,endocrine system ,medicine.medical_specialty ,Pediatrics ,endocrine system diseases ,Adolescent ,medicine.medical_treatment ,Thyroid Function Tests ,Thyroid function tests ,Thyroiditis ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Mass Screening ,Euthyroid ,Mass screening ,Subclinical infection ,Aged ,Sweden ,medicine.diagnostic_test ,business.industry ,Antithyroid agent ,Thyroid disease ,Incidence ,Thyroid ,Thyroiditis, Autoimmune ,Middle Aged ,medicine.disease ,Thyroid Diseases ,medicine.anatomical_structure ,Endocrinology ,Cross-Sectional Studies ,Female ,business - Abstract
Milakovic M, Berg G, Eggersten R, Lindstedt G, Nystrom E (Sahlgrenska University Hospital, Goteborg, Sweden). Screening for thyroid disease of 15–17-year-old schoolchildren in an area with normal iodine intake. J Intern Med 2001; 250: 208–212. Objective. The prevalence of thyroid disease in Swedish schoolchildren is today insufficiently known. The aim of the study was therefore to determine the prevalence of abnormal thyroid function and thyroid autoimmunity in teen-age schoolchildren and to compare the findings with a healthy control group of 60–65-year-old inhabitants from the same community. Setting. A semirural community of approximately 15 000 inhabitants. Design. Cross-sectional study. Main outcome measures. Thyroid volume and serum concentrations of serum thyrotropin (TSH), total and free thyroxine (T4), total and free 3,5,3′-triiodothyronine (T3), and antithyroperoxidase antibodies (TPOAb). Results. Four schoolchildren (7%, 59 screened) had elevated TPOAb concentration, three of the subjects being girls (8%). One girl with a goitre was overtly hypothyroid and one girl showed borderline-high serum TSH concentration suggesting subclinical autoimmune thyroid disease. One euthyroid boy had a goitre and high concentration of TPOAb. The serum free T3 concentration was significantly higher in 15–17-year-old than 60–65-year-old (7.4 vs. 6.4 pmol L–1, P
- Published
- 2001
19. [Comment: cost-efficient investigation of chronic fatigue]
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G, Lindstedt, P A, Lundberg, G, Sundbeck, S, Edén, R, Eggertsen, and E, Nyström
- Subjects
Fatigue Syndrome, Chronic ,Cost-Benefit Analysis ,Thyroid Gland ,Thyroiditis, Autoimmune ,Humans ,Thyroid Function Tests ,Iodide Peroxidase ,Sensitivity and Specificity ,Autoantibodies - Published
- 2000
20. [TSH and TPOAb should be the first to analyze in suspected dysfunction of thyroid gland]
- Author
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G, Lindstedt, P A, Lundberg, G, Sundbeck, S, Edén, R, Eggertsen, and E, Nyström
- Subjects
Reference Values ,Practice Guidelines as Topic ,Thyroiditis, Autoimmune ,Humans ,Thyrotropin ,Thyroid Function Tests ,Iodide Peroxidase ,Thyroid Diseases ,Antibodies ,Aged - Published
- 2000
21. [How reliable is the laboratory? Increased needs of patient-related quality assurance]
- Author
-
G, Lindstedt, R, Ekman, P, Fernlund, R, Forberg, B, Lindblad, K, Hellsing, and E, Nyström
- Subjects
Male ,Thyroid Hormones ,Quality Assurance, Health Care ,Chemistry, Clinical ,Humans ,False Positive Reactions ,Female ,Thyroid Function Tests ,Laboratories, Hospital ,Thyroid Diseases ,Antibodies ,Biomarkers - Abstract
Recent developments in medical care and research involve the increased use of immunochemical assays for hormones, tumour markers, vitamins and drugs. External quality assurance programmes using pooled human sera usually fail to detect analytical interference due to substances (e.g. anti-immunoglobulin or anti-ligand antibodies) present in individual serum specimens. The article reports on experience gained during a three-year period when specimens from individual patients attending a thyroid unit were distributed to hospital laboratories in Sweden for analysis. Specimen selection criteria were based on contradictory findings at the initial clinical or laboratory evaluation. The programme has given rise to the formation of a network of the laboratories involved, under the co-ordination of EQUALIS (External quality assurance in laboratory medicine in Sweden).
- Published
- 1999
22. [Increased value of TSH should always be investigated. Risk of incorrect treatment when the diagnosis is wrong]
- Author
-
G, Lindstedt, G, Berg, and E, Nyström
- Subjects
Diagnosis, Differential ,Risk Factors ,Thyroiditis, Autoimmune ,Humans ,Thyrotropin ,False Positive Reactions ,Diagnostic Errors ,Thyroid Diseases ,Antibodies - Published
- 1999
23. Body weight and body composition changes after treatment of hyperthyroidism
- Author
-
L, Lönn, K, Stenlöf, M, Ottosson, A K, Lindroos, E, Nyström, and L, Sjöström
- Subjects
Adult ,Male ,Thyroid Hormones ,Absorptiometry, Photon ,Body Weight ,Body Composition ,Humans ,Female ,Middle Aged ,Energy Intake ,Energy Metabolism ,Tomography, X-Ray Computed ,Hyperthyroidism - Abstract
Body composition changes in nine adults with hyperthyroidism were determined with dual energy x-ray absorptiometry and computed tomography at diagnosis and after 3 and 12 months of euthyroidism achieved by surgery, antithyroid drugs, or treatment with radioiodine. Mean body weight was 67.6 kg at diagnosis and increased 2.7 kg (P=0.06) and 8.7 kg (P0.001) after 3 and 12 months of euthyroidism, respectively. Basal metabolic rate decreased from 2087 Cal/24 h at diagnosis to 1601 Cal/24 h at 12 months (P=0.001), whereas reported energy intake dropped from 3244 to 2436 Cal/24 h (P=0.01). According to dual energy x-ray absorptiometry, body fat was unchanged at 3 months, but increased by 5.3 kg (P0.0001) at 12 months. Fat-free mass increased 2.7 kg (P=0.003) at 3 months and 3.5 kg (P0.0001) at 12 months. Changes in bone mineral content and density did not reach significance. According to computed tomography, skeletal muscle plus skin areas increased by 11% (trunk) and 18% (thigh) at 3 months and by 17% (trunk) and 25% (thigh) at 12 months. There was no increase in sc adipose tissue (AT) at 3 months, but at 12 months this AT depot increased by 15% (thigh) and 33% (trunk). Intraperitoneal AT showed a borderline significant increase by 28% (P=0.08) at 3 months and by 40% (P=0.015) at 12 months. Areas of visceral organs and bone tissue of femur did not change significantly during the study. It is concluded that during early recovery from hyperthyroidism, priority is given to the replenishment of skeletal muscles and ip AT, whereas sc AT is increased at a later stage.
- Published
- 1998
24. [Hypothyroidism--a common disease with many faces. Thyroid function in women should be regularly examined]
- Author
-
G, Lindstedt and E, Nyström
- Subjects
Male ,Sweden ,Sex Factors ,Hypothyroidism ,Risk Factors ,Prevalence ,Humans ,Mass Screening ,Female ,Thyroid Function Tests - Published
- 1998
25. The relations of microalbuminuria to ambulatory blood pressure and myocardial wall thickness in a population
- Author
-
Göran Lindstedt, Leif Lapidus, A. Svensson, Robert Eggertsen, E Nyström, and T. Nilsson
- Subjects
Blood Glucose ,Male ,medicine.medical_specialty ,Ambulatory blood pressure ,Population ,Hemodynamics ,Blood Pressure ,Body Mass Index ,Risk Factors ,Diabetes mellitus ,Internal medicine ,medicine ,Internal Medicine ,Albuminuria ,Humans ,education ,Triglycerides ,Aged ,Sweden ,education.field_of_study ,business.industry ,Myocardium ,Middle Aged ,medicine.disease ,Heart septum ,Surgery ,Blood pressure ,Cardiovascular Diseases ,Echocardiography ,Creatinine ,Population Surveillance ,Ambulatory ,Cardiology ,Microalbuminuria ,Female ,business - Abstract
Nilsson T, Svensson A, Lapidus L, Lindstedt G, Nystrom E, Eggertsen R (Molnlycke Primary Health Care and Research Centre; Goteborg University, Goteborg, Sweden). The relations of microalbuminuria to ambulatory blood pressure and myocardial wall thickness in a population. J Intern Med 1998; 244: 55–9. Objectives To examine the relationship between microalbuminuria (20–200 μg min−1) and 24 h ambulatory blood pressure and heart wall thickness, in a representative population sample of men and women aged 56–65 years. Design Every second individual aged 56–65 years (n= 488) in the district, was invited for a health examination, which included determination of urinary albumin and creatinine (overnight sample). The highest and lowest decentile of urinary albumin/creatinine ratio were compared. Setting The district of the Primary Health Care and Research Centre of Molnlycke, Sweden. Subjects After excluding 2 individuals with a urinary albumin excretion exceeding 200 μg min−1, 26 subjects (group 1) could be compared with 27 subjects in the lowest decentile (group 2). Main outcome measures Comparison between the determinations of the ambulatory blood pressure and echocardiographic variables in the two groups. Results Group 1 had significantly higher 24 104 ambulatory blood pressure, and heart septum and posterior wall thickness as well as significantly higher fasting blood glucose and serum triglyceride concentrations. The differences in blood pressure (P < 0.05) but not heart wall thickness remained significant (P < 0.05) after excluding subjects with hypertension, angina pectoris, treated diabetes mellitus, and/or history of heart or cerebrovascular disease. When excluding individuals with both treated and untreated diabetes mellitus, fasting blood glucose concentration was higher in group 1. The waist-hip ratio, weight and body mass index did not differ between the groups. Conclusions The findings indicate that microalbuminuria is related to signs of cardiovascular and metabolic influence and therefore could be a valuable tool for grading the risk of later cardiovascular morbidity.
- Published
- 1998
26. Overweight--a common problem among women treated for hyperthyroidism
- Author
-
E. Nyström, G. Lindstedt, G. Berg, A. Michanek, and Svante Jansson
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Goiter ,Levothyroxine ,Overweight ,Weight Gain ,Body Mass Index ,Iodine Radioisotopes ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Obesity ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Endocrinology ,Population study ,Female ,medicine.symptom ,business ,Body mass index ,Weight gain ,Hormone ,medicine.drug ,Follow-Up Studies ,Research Article - Abstract
Summary We sent out a questionnaire to 112 women treated for diffuse toxic goitre 2-5 years earlier to evaluate the prevalence of problems with overweight after the disease. Of 87 responders, about 50% (irrespective of surgical or radioiodine treatment) reported weight problems, and we randomly selected 40 of these women (20 with and 20 without reported weight problems) for a clinical follow-up (32 appearing). At the follow-up examination (mean 4 years after treatment for hyperthyroidism), 27 women had a higher weight than their estimated premorbid weight. The weight gain correlated with the estimated premorbid body mass index (BMI; P < 0.005), indicating that excess weight gainers may have had a premorbid problem now exaggerated in the post-hyperthyroid period. However, many women with a BMI within the limits stated to be ideal (21-25 kg/m2) also showed dramatic increases in weight. In contrast, the average middle-aged woman in our region did not appear to have gained in weight during a corresponding time period as judged from a longitudinal population study. Women with reported weight problems (mean weight increase 15.6%, n = 16) did not differ from women without (mean weight increase 6.7%, n = 16) as regards pretreatment hormone levels, method of treatment, (change of) smoking habits or post-treatment levothyroxine administration, or in serum concentrations of thyroid hormones, thyrotrophin, cortisol, procollagen-III-peptide, cholesterol, HDL cholesterol or triglycerides. Women with hyperthyroidism should be informed about the risk of gaining weight after therapy and given early support as to dietary and lifestyle change.
- Published
- 1993
27. Screening for thyroid disease in women greater than or equal to 50 years of age seeking hospital care: influence of common nonthyroidal illness on serum free thyroxin as determined by analog radioimmunoassay
- Author
-
Göran Lindstedt, Per-Arne Lundberg, K. Petersen, and E Nyström
- Subjects
medicine.medical_specialty ,Pediatrics ,business.industry ,Thyroid disease ,Biochemistry (medical) ,Clinical Biochemistry ,Radioimmunoassay ,medicine.disease ,Hospital care ,Surgery ,Serum free ,Nonthyroidal illness ,medicine ,Outpatient clinic ,Clinical significance ,business ,hormones, hormone substitutes, and hormone antagonists ,Mass screening - Abstract
We determined free thyroxin (fT4; analog radioimmunoassay) and thyrotropin in serum of women greater than or equal to 50 years of age who were attending a medical casualty ward (n = 363) or a medical outpatient clinic (n = 496), in order to estimate the prevalence of low fT4 results associated with nonthyroidal illness and to screen for previously unknown thyroid disease. Individuals with results outside stated limits were followed up within two to four weeks. Only about 5% of the women seeking acute medical care showed a decrease in fT4 concentration in association with a normal thyrotropin concentration. As expected, this combination was even less common in outpatients. We found a prevalence of previously undiagnosed thyroid disease of clinical significance of 0.8% in medical acute-care cases, 1.8% in medical outpatients. For this clinical setting we regard the simple analog technique as acceptable in spite of the low values reported for some hospitalized patients with nonthyroidal illness.
- Published
- 1986
28. On the natural history of hypergastrinemia
- Author
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Calle Bengtsson, Leif Lapidus, Göran Lindstedt, Per-Arne Lundberg, Anders Kilander, D Runsteen, and E Nyström
- Subjects
medicine.medical_specialty ,biology ,Atrophic gastritis ,business.industry ,digestive, oral, and skin physiology ,Biochemistry (medical) ,Clinical Biochemistry ,Peptide hormone ,Serum samples ,medicine.disease ,digestive system ,Natural history ,Endocrinology ,Pepsin ,Internal medicine ,medicine ,biology.protein ,Population study ,Gastritis ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists ,Gastrin - Abstract
We determined total gastrin and pepsinogen I in frozen serum samples from 175 overnight-fasted women 54 years old, and from 81 overnight-fasted women 60 years old, who took part in a population study in 1968-69. We also assayed samples from some of these women, who participated in clinical follow-up studies in 1974-75 and 1980-81: all of the women in the initial group whose serum gastrin concentration exceeded the 85th centile value and, as a reference group, a randomized subsample of women whose initial serum gastrin concentration was less than the 80th centile. Samples with total gastrin concentration greater than 400 ng/L were also assayed for gastrin-17 and gastrin-34. We found that: a pronounced increase of serum gastrin persisted throughout the study period for most of these postmenopausal women, indicating that conversion of type A gastritis (antrum-sparing) to pan-gastritis is uncommon; unexplained high concentrations of pepsinogen I in relation to the reference interval for young and middle-aged adults, as well as in relation to serum gastrin, were common; and the gastrin-17/gastrin-34 ratio is not correlated with the outcome of pronounced hypergastrinemia.
- Published
- 1985
29. Hypergastrinemia--a risk factor for myocardial infarction?
- Author
-
E Nyström, Calle Bengtsson, Göran Lindstedt, and Leif Lapidus
- Subjects
Adult ,Risk ,medicine.medical_specialty ,Clinical Biochemistry ,Myocardial Infarction ,Angina ,Diabetes mellitus ,Internal medicine ,Gastrins ,medicine ,Humans ,Longitudinal Studies ,Myocardial infarction ,Risk factor ,Stroke ,Sweden ,Pepsinogens ,business.industry ,Incidence (epidemiology) ,Smoking ,Biochemistry (medical) ,Middle Aged ,medicine.disease ,Blood pressure ,Cardiovascular Diseases ,Cardiology ,Female ,business ,Body mass index - Abstract
We determined gastrin and pepsinogen I in serum samples obtained in 1968-69 from 256 women (175 women 54 years old and 81 women 60 years old when sampled). The concentration of gastrin in serum was significantly (p less than 0.01) and positively correlated with the incidence of myocardial infarction during a 12-year follow-up, with age taken into account as a background variable in multivariate analysis. It was not correlated with overall mortality or with the 12-year incidences of angina pectoris, electrocardiographic changes indicating ischemic heart disease, or stroke. The correlation with myocardial infarction was independent of smoking, systolic blood pressure, indices of obesity, concentrations of blood glucose during fasting and of serum triglycerides and cholesterol, and of the presence of diabetes mellitus at screening or during follow-up. Serum gastrin was significantly (p less than 0.05) related to body mass index (positive age-specific relation) and to smoking (negative age-specific relation). These findings may provide a new aspect to analysis of risk factors for myocardial infarction.
- Published
- 1985
30. The effect of proteolysis on the stability of the profilactin complex
- Author
-
B. Malm, L.-E. Nyström, and Uno Lindberg
- Subjects
medicine.diagnostic_test ,Chemistry ,Polymers ,Proteolysis ,Profilactin ,Biophysics ,Proteins ,Cell Biology ,Carboxypeptidases ,Biochemistry ,Actins ,Profilins ,Structural Biology ,Genetics ,medicine ,Animals ,Cattle ,Trypsin ,Molecular Biology - Full Text
- View/download PDF
31. Serum thyrotropin and more accurate diagnosis of 'thyroid hormone resistance'
- Author
-
Göran Lindstedt, Per-Arne Lundberg, L E Tisell, R Olegård, O Westphal, and E Nyström
- Subjects
Thyroid hormone resistance ,medicine.medical_specialty ,Endocrinology ,business.industry ,Internal medicine ,Biochemistry (medical) ,Clinical Biochemistry ,medicine ,medicine.disease ,business - Published
- 1983
32. Increase in serum ferritin concentration induced by fasting
- Author
-
E Nyström, G Lundquister, Göran Lindstedt, B Branegârd, Per-Arne Lundberg, and T Andersson
- Subjects
medicine.medical_specialty ,Endocrinology ,business.industry ,Reference values ,Internal medicine ,Biochemistry (medical) ,Clinical Biochemistry ,medicine ,business ,Serum ferritin - Published
- 1984
33. High prevalence of atrophic gastritis in the elderly: implications for health-associated reference limits for cobalamin in serum
- Author
-
P M Johansson, E Nyström, G Ellertz, Per-Arne Lundberg, Göran Lindstedt, and Robert Eggertsen
- Subjects
medicine.medical_specialty ,High prevalence ,business.industry ,Atrophic gastritis ,Biochemistry (medical) ,Clinical Biochemistry ,medicine.disease ,Gastroenterology ,Cobalamin ,chemistry.chemical_compound ,chemistry ,Internal medicine ,Medicine ,business - Published
- 1989
34. Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit
- Author
-
Robert Eggertsen, K. Petersen, Per-Arne Lundberg, E Nyström, and Göran Lindstedt
- Subjects
Male ,medicine.medical_specialty ,endocrine system ,endocrine system diseases ,Cross-sectional study ,Thyrotropin ,Physical examination ,Disease ,Immunoenzyme Techniques ,Thyroid-stimulating hormone ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Mass Screening ,Mass screening ,General Environmental Science ,Sweden ,medicine.diagnostic_test ,business.industry ,Thyroid disease ,General Engineering ,General Medicine ,Middle Aged ,medicine.disease ,Thyroid Diseases ,Endocrinology ,Cross-Sectional Studies ,Predictive value of tests ,General Earth and Planetary Sciences ,Female ,Thyroid function ,business ,Research Article - Abstract
In a study at a primary care centre in a predominantly rural area of Sweden the records of all patients with established thyroid disease were scrutinised and 2000 consecutive adult patients screened with an immunoenzymometric thyroid stimulating hormone assay. The aims of the study were fourfold: firstly, to assess the total burden of thyroid disease in primary care centres in Sweden; secondly, to assess the efficacy of clinical diagnosis of the disease in unselected populations of patients; thirdly, to assess the efficacy of clinical evaluation of treatment with thyroxine; and, lastly, to see whether a single analysis of the serum thyroid stimulating hormone concentration by recent methods would be enough to identify an abnormality of thyroid function. Of the roughly 17,400 adults in the study community, 111 women and 10 men were being treated for thyroid disease. Screening detected 68 patients (3.5%) not receiving thyroxine who had a serum thyroid stimulating hormone concentration of 0.20 mU/l or less, all of whom were followed up clinically. Fifty of these patients were also studied biochemically during follow up. Only nine of the 68 patients had thyroid disease (three with thyrotoxicosis requiring treatment), no evidence of the disease being found in the remainder. Sixteen patients had spontaneous hypothyroidism requiring treatment, and neither these nor three patients with thyrotoxicosis had been detected at the preceding clinical examination. Of 35 patients in whom thyroid disease was suspected clinically at screening, none had laboratory evidence of thyroid dysfunction. In this series 1.3% of all women in the study community (2.6% of all 50-59 year olds) and 0.1% of the men were being treated for thyroid disease at the primary care centre, roughly 1.0% of adults subjected to screening were found to have thyroid disease requiring treatment, and most patients with a thyroid stimulating hormone concentration of 0.20 mU/l or less did not have thyroid dysfunction. It is concluded that measuring the basal serum thyroid stimulating hormone concentration by present methods is insufficient for the biochemical assessment of thyroid dysfunction in unselected populations.
- Published
- 1988
35. Serum dopamine beta-hydroxylase: assay and enzyme properties
- Author
-
Irene E. Nyström and E. S. Markianos
- Subjects
Chromatography, Gas ,Clinical Biochemistry ,education ,Tyramine ,Dopamine beta-Hydroxylase ,Serum enzymes ,chemistry.chemical_compound ,Drug Stability ,Dopamine ,medicine ,Humans ,Octopamine ,Edetic Acid ,chemistry.chemical_classification ,Chromatography ,Biochemistry (medical) ,Temperature ,Substrate (chemistry) ,Dopamine beta-monooxygenase ,General Medicine ,Hydrogen-Ion Concentration ,Reaction product ,Enzyme ,chemistry ,Octopamine (neurotransmitter) ,Chromatography, Thin Layer ,Copper ,medicine.drug - Abstract
A method for the estimation of dopamine beta-hydroxylase activity in human serum is described, based on a thin layer chromatographic separation of the substrate ([14C]tyramine) from the reaction product ([14C]octopamine). The basic properties of the human serum enzyme, investigated by this method are described.
- Published
- 1975
36. The amino acid sequence of profilin from calf spleen
- Author
-
Uno Lindberg, Ross Jakes, L.-E. Nyström, and John Kendrick-Jones
- Subjects
Biophysics ,macromolecular substances ,Biochemistry ,Filamentous actin ,chemistry.chemical_compound ,Structural Biology ,Genetics ,medicine ,Animals ,Chymotrypsin ,Trypsin ,Amino Acid Sequence ,Cyanogen Bromide ,Molecular Biology ,Peptide sequence ,Actin ,biology ,Chemistry ,Skeletal muscle ,Proteins ,Cell Biology ,Peptide Fragments ,medicine.anatomical_structure ,Profilin ,biology.protein ,Cyanogen bromide ,Cattle ,Spleen ,medicine.drug - Abstract
Many kinds of cells contain a large pool of unpolymerised actin and there is evidence for conversion of unpolymerised to filamentous actin as a response to stimuli resulting in cell movements ([l-4], reviewed [5,6]). An unpolymerised form of actin has been purified from extracts of various kinds of cells as a 1: 1 complex with a protein called profilin, which prevents the polymerisation of the actin. Profilin, isolated from calf spleen, thymus and brain and from human platelets can combine with rabbit skeletal muscle actin and prevent its polyme~sation ([7,8], Blikstad, Sundquist and Eriksson, unpublished results). The profhn : actin complex (profilactin) from calf spleen has been crystallized [9] and crystals suitable for high resolution X-ray crystallography have been obtained. The amino acid sequence of actin and profilin will be useful in solving the crystal structure of profilactin and for the detailed characterisation of its biochemical properties. The amino acid sequence of actin from various sources has been reported [ 10,l l]. This paper describes the amino acid sequence of profilin from calf spleen.
- Published
- 1979
37. Do antihypertensive drugs precipitate diabetes?
- Author
-
Olof Lindquist, Johann A. Sigurdsson, K. Petersen, E Nyström, Göran Blohmé, Leif Lapidus, Calle Bengtsson, and H. Lundgren
- Subjects
Adult ,Blood Glucose ,Risk ,medicine.medical_specialty ,medicine.medical_treatment ,Adrenergic beta-Antagonists ,Pharmacology ,Body weight ,Internal medicine ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Humans ,Longitudinal Studies ,Diuretics ,Antihypertensive Agents ,General Environmental Science ,Sweden ,Chemotherapy ,business.industry ,Body Weight ,General Engineering ,General Medicine ,Middle Aged ,medicine.disease ,Increased risk ,Relative risk ,Hypertension ,General Earth and Planetary Sciences ,Population study ,Drug Therapy, Combination ,Female ,Diuretic ,business ,Research Article - Abstract
A longitudinal population study of 1462 women aged 38-60 was carried out from 1968-9 to 1980-1 in Gothenburg, Sweden. The initial and follow up examinations included questions concerning history of diabetes and antihypertensive treatment. A considerably increased risk of developing diabetes was observed for subjects with hypertension taking diuretics (895 patient years), subjects taking beta blockers (682 patient years), and subjects taking a combination of diuretics and beta blockers (281 patient years) compared with subjects not taking antihypertensive drugs (13 855 control years). When diuretics and beta blockers were compared no difference was found in relative risk. Despite this increased risk, and because little is known about the relation between other forms of antihypertensive treatment and diabetes, diuretics and beta blockers should remain the treatments of choice in arterial hypertension.
- Published
- 1984
38. Steroids in newborns and infants. Identification of 24,25-dihydro-delta-9(ll)-lanosterol and 4 alpha, 14 alpha-dimethyl substituted sterols among the esterified and free sterols in human meconium
- Author
-
P, Eneroth, J A, Gustafsson, and E, Nyström
- Subjects
Meconium ,Squalene ,Sterols ,Cholesterol ,Chromatography, Gas ,Cholestanes ,Spectrum Analysis ,Chromatography, Gel ,Infant, Newborn ,Humans ,Esters ,Chromatography, Thin Layer - Published
- 1969
39. Investigation of the peat bogs and peat industry of Canada, during the season 1908-9
- Author
-
E Nyström and S A Anrep
- Published
- 1909
40. 'Hyperprolactinemia' in healthy women
- Author
-
E Nyström, Göran Lindstedt, N Bjurstam, Calle Bengtsson, Jan Leman, Per-Arne Lundberg, and Göran Rybo
- Subjects
Gynecology ,medicine.medical_specialty ,Text mining ,business.industry ,Reference values ,Biochemistry (medical) ,Clinical Biochemistry ,medicine ,Physiology ,business ,Prolactin - Published
- 1984
41. Statistics, common sense, and serum free T4 in disease
- Author
-
Göran Lindstedt, E Nyström, and Per-Arne Lundberg
- Subjects
medicine.medical_specialty ,business.industry ,Serum free ,Internal medicine ,media_common.quotation_subject ,Biochemistry (medical) ,Clinical Biochemistry ,Medicine ,Common sense ,Disease ,business ,media_common - Published
- 1987
42. Improving care for immigrant women before, during, and after childbirth – what can we learn from regional interventions within a national program in Sweden?
- Author
-
M. E. Nyström, E. C. Larsson, K. Pukk Härenstam, and S. Tolf
- Subjects
Immigrant women ,Healthcare improvement ,Complex interventions ,Sexual and reproductive health ,Antenatal care ,Delivery care ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Migration has increased the number of immigrant women in western countries, which has led to a need to adapt sexual and reproductive health (SRH) care to a larger variety of experiences. Examples of problems are poor access/utilization of SRH services among migrants and a comparatively higher rate of mortality and morbidity in relation to pregnancy, especially among those from low- and middle-income settings. Attempts to improve SHR care must consider the complexity of both the problem and the system. A national program to improve women’s health in Sweden provided opportunities to study interventions aimed at immigrant women, using a complexity theory lens. The purpose was to explore the characteristics and complexity of regional interventions aiming to improve care and health of immigrant women before, during and after childbirth, and provide knowledge on how regional healthcare actors perceive and address problems in these areas. Methods This archival research study is based on qualitative data from detailed yearly reports of all regional program interventions (n = 21 regions) performed between January 2017 and January 2019. The archival data consists of the regional actors’ answers to an extensive questionnaire-like template, where the same questions were to be filled in for each reported intervention. Data analyses were performed in several steps, combining classic and directive content analysis. Results Six problem categories were addressed by 54 regional interventions, 26 directed at immigrant women and their families, 11 at healthcare staff, and 17 at the organizational system. The simple level interventions (n = 23) were more unilateral and contained information campaigns, information material and translation, education, mapping e.g., of genital mutilation, and providing staff and/or financial resources. The complicated interventions (n = 10) concerned increasing communication diversity e.g., by adding iPads and out-reach visits. The complex interventions (n = 21), e.g., health schools, integration of care, contained development, adaptions, and flexibility with regards to the immigrant women’s situation, and more interaction among a diversity of actors, also from the wider welfare system. Conclusions It is important that complex problems, such as ensuring equal care and health among a diverse population, are addressed with a mix of simple, complicated, and complex interventions. To enhance intended change, we suggest that pre-requisites e.g., communication channels and knowledge on behalf of immigrant women and staff, are ensured before the launch of complex interventions. Alternatively, that simple level interventions are embedded in complex interventions.
- Published
- 2022
- Full Text
- View/download PDF
43. Collaborative and partnership research for improvement of health and social services: researcher’s experiences from 20 projects
- Author
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M. E. Nyström, J. Karltun, C. Keller, and B. Andersson Gäre
- Subjects
Collaborative research ,co-production ,integrated knowledge translation ,partnership research ,quality improvement ,healthcare ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Getting research into policy and practice in healthcare is a recognised, world-wide concern. As an attempt to bridge the gap between research and practice, research funders are requesting more interdisciplinary and collaborative research, while actual experiences of such processes have been less studied. Accordingly, the purpose of this study was to gain more knowledge on the interdisciplinary, collaborative and partnership research process by investigating researchers’ experiences of and approaches to the process, based on their participation in an inventive national research programme. The programme aimed to boost collaborative and partnership research and build learning structures, while improving ways to lead, manage and develop practices in Swedish health and social services. Methods Interviews conducted with project leaders and/or lead researchers and documentation from 20 projects were analysed using directed and conventional content analysis. Results Collaborative approaches were achieved by design, e.g. action research, or by involving practitioners from several levels of the healthcare system in various parts of the research process. The use of dual roles as researcher/clinician or practitioner/PhD student or the use of education designed especially for practitioners or ‘student researchers’ were other approaches. The collaborative process constituted the area for the main lessons learned as well as the main problems. Difficulties concerned handling complexity and conflicts between different expectations and demands in the practitioner’s and researcher’s contexts, and dealing with human resource issues and group interactions when forming collaborative and interdisciplinary research teams. The handling of such challenges required time, resources, knowledge, interactive learning and skilled project management. Conclusions Collaborative approaches are important in the study of complex phenomena. Results from this study show that allocated time, arenas for interactions and skills in project management and communication are needed during research collaboration to ensure support and build trust and understanding with involved practitioners at several levels in the healthcare system. For researchers, dealing with this complexity takes time and energy from the scientific process. For practitioners, this puts demands on understanding a research process and how it fits with on-going organisational agendas and activities and allocating time. Some of the identified factors may be overlooked by funders and involved stakeholders when designing, performing and evaluating interdisciplinary, collaborative and partnership research.
- Published
- 2018
- Full Text
- View/download PDF
44. Neonatal microbiota colonization drives maturation of primary and secondary goblet cell mediated protection in the pre-weaning colon.
- Author
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Johansson Å, Subramani MV, Yilmaz B, Nyström E, Layunta E, Arike L, Sommer F, Rosenstiel P, Vereecke L, Holm LM, Wullaert A, Pelaseyed T, Johansson MEV, and Birchenough GMH
- Abstract
In the distal colon, mucus secreting goblet cells primarily confer protection from luminal microorganisms via generation of a sterile inner mucus layer barrier structure. Bacteria-sensing sentinel goblet cells provide a secondary defensive mechanism that orchestrates mucus secretion in response to microbes that breach the mucus barrier. Previous reports have identified mucus barrier deficiencies in adult germ-free mice, thus implicating a fundamental role for the microbiota in programming mucus barrier generation. In this study, we have investigated the natural neonatal development of the mucus barrier and sentinel goblet cell-dependent secretory responses upon postnatal colonization. Combined in vivo and ex vivo analyses of pre- and post-weaning colonic mucus barrier and sentinel goblet cell maturation demonstrated a sequential microbiota-dependent development of these primary and secondary goblet cell-intrinsic protective functions, with dynamic changes in mucus processing dependent on innate immune signalling via MyD88, and development of functional sentinel goblet cells dependent on the NADPH/Dual oxidase family member Duox2. Our findings therefore identify new mechanisms of microbiota-goblet cell regulatory interaction and highlight the critical importance of the pre-weaning period for the normal development of colonic barrier function.
- Published
- 2024
- Full Text
- View/download PDF
45. Minimum important difference of the ICIQ-UI SF score after self-management of urinary incontinence.
- Author
-
Nyström E, Asklund I, Lindam A, and Samuelsson E
- Subjects
- Humans, Female, Treatment Outcome, Prospective Studies, Exercise Therapy methods, Surveys and Questionnaires, Pelvic Floor, Quality of Life, Urinary Incontinence, Stress therapy, Self-Management, Urinary Incontinence therapy
- Abstract
Background: This study aimed to evaluate clinically relevant improvement after conservative self-management of urinary incontinence via a mobile app. It further aimed to establish Minimum Important Differences (MIDs) based on the severity and type of urinary incontinence., Methods: Data was collected in a prospective cohort study that evaluated the freely available app Tät®. The app provided pelvic floor muscle training (PFMT) and life-style advice. Non-pregnant, non-postpartum women (≥ 18 years) who downloaded the app to treat urinary incontinence were included, if they completed the Patient Global Impression of Improvement (PGI-I) question at the 3-month follow-up (n = 1,733). Participants answered the International Consultation on Incontinence Questionnaire (ICIQ-UI SF) at baseline and after 3 months. The score change was analysed for correlation (Spearman) with the PGI-I. We then analysed one-way ANOVAs to determine whether there were significant differences between the groups based on the answers to the PGI-I. The MID was set to the mean change of the group that selected the answer "a little better" to the PGI-I question., Results: The one-way ANOVA showed significant differences between PGI-I groups (p < 0.001). The MID for the general group was set to 1.46 (95% Confidence Interval [CI] 1.26-1.67). In the sub-group analyses, a MID for the group with slight incontinence could not be determined. For the group with moderate severity the MID was determined to be 1.33 (95% CI 1.10-1.57) and for the severe/very severe group it was 3.58 (95% CI 3.08-4.09). Analysis of different types of incontinence showed no difference in MIDs., Conclusions: The MID for self-management via a mobile app was lower than previously established MIDs, but differed depending on baseline severity. This study shows that MIDs need adjustment for baseline severity and treatment intensity when interpreting clinical trial results. If using MIDs as exact numbers, the study population and the treatment must be comparable., (© 2024. The Author(s).)
- Published
- 2024
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46. A Mobile App for Self-management of Urgency and Mixed Urinary Incontinence in Women: Randomized Controlled Trial.
- Author
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Wadensten T, Nyström E, Franzén K, Lindam A, Wasteson E, and Samuelsson E
- Subjects
- Adolescent, Exercise Therapy, Female, Humans, Middle Aged, Pelvic Floor, Quality of Life, Surveys and Questionnaires, Treatment Outcome, Mobile Applications, Self-Management, Urinary Incontinence therapy
- Abstract
Background: Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care. Treatment access and self-management for these conditions can be supported through eHealth approaches., Objective: This study aimed to investigate the efficacy of the mobile app Tät II for self-management of UUI and MUI in women., Methods: This randomized controlled trial included women ≥18 years old with UUI or MUI and ≥2 leakages per week. Those with red-flag symptoms were excluded. Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire. Data were collected using another questionnaire and a 2-day bladder diary. A telephone interview confirmed the symptom diagnosis. Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided. The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)-Urinary Incontinence Short Form (ICIQ-UI SF). Urgency symptoms were assessed using the ICIQ-Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ-Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol). Incontinence episode frequency (IEF) was calculated per bladder diary entries. Improvement was measured using the Patient's Global Impression of Improvement. All outcomes were self-reported. Cure was defined as no leakages per the bladder diary. Intention-to-treat analysis was performed., Results: Between April 2017 and March 2018, 123 women (mean age 58.3, SD 9.6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group. Of these, 35 (28%) women had UUI, and 88 (72%) had MUI. Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference -3.1, 95% CI -4.8 to -1.3). The estimated between-group difference was -1.8 (95% CI -2.8 to -0.99) for mean ICIQ-OAB score and -6.3 (95% CI -10.5 to -2.1) for the mean ICIQ-LUTSqol score at follow-up. IEF reduction from baseline to follow-up was greater in the treatment group (-10.5, IQR -17.5 to -3.5) than in the information group (P<.001). Improvement was reported by 87% (52/60) of treatment group participants and by 30% (19/63) of information group participants. The cure rate was 32% in the treatment group, and 6% in the information group (odds ratio 5.4, 95% CI 1.9-15.6; P=.002). About 67% (40/60) of the treatment group participants used the app more than thrice a week., Conclusions: The treatment app was effective for improving urgency and mixed incontinence in women. When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care., Trial Registration: ClinicalTrials.gov NCT03097549; https://clinicaltrials.gov/ct2/show/NCT03097549., (©Towe Wadensten, Emma Nyström, Karin Franzén, Anna Lindam, Elisabet Wasteson, Eva Samuelsson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.04.2021.)
- Published
- 2021
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47. Evaluation of guanfacine as a potential medication for alcohol use disorder in long-term drinking rats: behavioral and electrophysiological findings.
- Author
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Fredriksson I, Jayaram-Lindström N, Wirf M, Nylander E, Nyström E, Jardemark K, and Steensland P
- Subjects
- Alcohol Drinking drug therapy, Alcohol Drinking physiopathology, Animals, Central Nervous System Depressants administration & dosage, Choice Behavior drug effects, Choice Behavior physiology, Conditioning, Operant drug effects, Conditioning, Operant physiology, Disease Models, Animal, Drug Evaluation, Preclinical, Drug-Seeking Behavior drug effects, Drug-Seeking Behavior physiology, Ethanol administration & dosage, Glutamic Acid metabolism, Male, Naltrexone pharmacology, Prefrontal Cortex drug effects, Prefrontal Cortex physiopathology, Pyramidal Cells drug effects, Pyramidal Cells physiology, Rats, Wistar, Tissue Culture Techniques, Treatment Outcome, Alcohol Deterrents pharmacology, Alcohol-Related Disorders drug therapy, Alcohol-Related Disorders physiopathology, Guanfacine pharmacology
- Abstract
One of the main treatment challenges in alcohol use disorder (AUD) is the high rate of craving in combination with decreased cognitive functioning including impaired decision making and impulse control that often lead to relapse. Recent studies show that guanfacine, an α-2-adrenoceptor agonist and FDA-approved ADHD medication, attenuates stress-induced relapse of several drugs of abuse including alcohol. Here we evaluated guanfacine's effects on voluntary alcohol intake, the alcohol deprivation effect (ADE), alcohol seeking behavior, and cue/priming-induced reinstatement in Wistar rats that had voluntarily consumed alcohol for at least 2 months before treatment. In addition, guanfacine's ability to regulate glutamatergic neurotransmission was evaluated through electrophysiological recordings in medial prefrontal cortex (mPFC) slices prepared from long-term drinking rats (and alcohol-naive controls) that had received three daily guanfacine (0.6 mg/kg/day) or vehicle injections in vivo. Guanfacine decreased alcohol intake in high, but not low, alcohol-consuming rats and the effects were generally more long lasting than that of the AUD medication naltrexone. Repeated guanfacine treatment induced a long-lasting decrease in alcohol intake, persistent up to five drinking sessions after the last injection. In addition, guanfacine attenuated the ADE as well as alcohol seeking and cue/priming-induced reinstatement of alcohol seeking. Finally, subchronic guanfacine treatment normalized an alcohol-induced dysregulated glutamatergic neurotransmission in the mPFC. These results support previous studies showing that guanfacine has the ability to improve prefrontal connectivity through modulation of the glutamatergic system. Together with the fact that guanfacine appears to be clinically safe, these results merit evaluation of guanfacine's clinical efficacy in AUD individuals.
- Published
- 2015
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48. Intercellular variation in signaling through the TGF-β pathway and its relation to cell density and cell cycle phase.
- Author
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Zieba A, Pardali K, Söderberg O, Lindbom L, Nyström E, Moustakas A, Heldin CH, and Landegren U
- Subjects
- Animals, Cell Count, Cell Line, Fibroblasts cytology, Fibroblasts drug effects, Fibroblasts metabolism, Humans, Kinetics, Mice, Microscopy, Fluorescence, Multiprotein Complexes analysis, Organ Specificity, Proteasome Endopeptidase Complex, Protein Binding, Protein Isoforms analysis, Protein Isoforms metabolism, Proteolysis, Single-Cell Analysis methods, Smad Proteins analysis, Cell Cycle drug effects, Multiprotein Complexes metabolism, Signal Transduction drug effects, Smad Proteins metabolism, Transforming Growth Factor beta pharmacology
- Abstract
Fundamental open questions in signal transduction remain concerning the sequence and distribution of molecular signaling events among individual cells. In this work, we have characterized the intercellular variability of transforming growth factor β-induced Smad interactions, providing essential information about TGF-β signaling and its dependence on the density of cell populations and the cell cycle phase. By employing the recently developed in situ proximity ligation assay, we investigated the dynamics of interactions and modifications of Smad proteins and their partners under native and physiological conditions. We analyzed the kinetics of assembly of Smad complexes and the influence of cellular environment and relation to mitosis. We report rapid kinetics of formation of Smad complexes, including native Smad2-Smad3-Smad4 trimeric complexes, in a manner influenced by the rate of proteasomal degradation of these proteins, and we found a striking cell to cell variation of signaling complexes. The single-cell analysis of TGF-β signaling in genetically unmodified cells revealed previously unknown aspects of regulation of this pathway, and it provided a basis for analysis of these signaling events to diagnose pathological perturbations in patient samples and to evaluate their susceptibility to drug treatment.
- Published
- 2012
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49. [Quality shortages in the diagnostics of thyroid nodules. National guidelines should be introduced].
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Jansson S, Eggertsen R, Grunditz T, Mölne J, Nyström E, Reihnér E, Christensen LR, and Tennvall J
- Subjects
- Biopsy, Fine-Needle standards, Diagnosis, Differential, False Negative Reactions, Humans, Lymphatic Metastasis pathology, Practice Guidelines as Topic, Quality Assurance, Health Care, Radionuclide Imaging, Sweden, Thyroid Diseases pathology, Thyroid Gland diagnostic imaging, Thyroid Neoplasms pathology, Thyroid Nodule classification, Thyroid Nodule diagnostic imaging, Ultrasonography, Thyroid Gland pathology, Thyroid Nodule pathology
- Published
- 2011
50. Thyroid volume in Swedish school children: a national, stratified, population-based survey.
- Author
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Filipsson Nyström H, Andersson M, Berg G, Eggertsen R, Gramatkowski E, Hansson M, Hulthén L, Milakovic M, and Nyström E
- Subjects
- Age Factors, Child, Female, Goiter diagnostic imaging, Humans, Iodine administration & dosage, Male, Organ Size, Population Surveillance methods, Prevalence, Reference Values, Sex Factors, Sweden epidemiology, Thyroid Gland diagnostic imaging, Thyroid Gland pathology, Ultrasonography, Urban Population, Goiter epidemiology, Thyroid Gland anatomy & histology
- Abstract
Background/objectives: Sweden has had a salt iodination program since 1936. This first national surveillance study on iodine nutrition infers an adequate level of urinary iodine concentration (UIC 125 μg/l) and the aim is now to evaluate thyroid volume (Tvol) in the same national sample., Subjects/methods: A stratified probability proportionate to size cluster sampling was used to obtain a representative national sample of Swedish children aged 6-12 years. Median Tvol obtained ultrasonographically and the prevalence of enlarged thyroid glands were compared with an international reference standard. Regional differences were evaluated through comparisons of Tvol between coastal and inland areas, urban and rural regions, and former goitre and non-goitre regions., Results: Tvol was correlated with age, body surface area (BSA), weight, height and body mass index for both sexes (P<0.0001) but not with UIC. The most important predictors for Tvol were age (girls: P<0.0001, boys: P=0.001) and BSA (girls: P<0.0001, boys: P<0.01). Median Tvol was higher in Sweden than in the reference study (P<0.0001). The prevalence of goitre was higher in Sweden (correlated to age 22.3%, BSA 15.7%, weight 17.6%, height 12.9%) than in the international reference (correlated to age 2.5%, BSA 2.5%, weight 2.5%, height 2.5%) (P<0.0001). Thyroids were larger in boys from urban and former non-goitre areas., Conclusions: Tvols were higher in Swedish school children than in the international reference study although iodine intake is considered optimal in Sweden. These findings underline the importance of regular monitoring of iodine intake, especially with regard to the decreased intake of table salt that is likely to follow initiation of health campaigns.
- Published
- 2010
- Full Text
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