Search

To estimate the intake of some mycotoxins from food in Sweden, approximately 600 samples were collected and analysed for aflatoxins, ochratoxin A, patulin and trichothecenes. Intakes were calculated for average and high consumers among adults and children and compared with the tolerable daily intake (TDI) of the respective toxin. Mycotoxin levels in the food samples were generally below the European/national maximum limits. However, high levels of aflatoxins were found in some samples of Brazil nuts and pistachios. The intake of ochratoxin A, patulin and trichothecenes was found to be below the temporary TDI values (tTDI) proposed for these toxins by international expert groups, although the intake of trichothecenes (expressed as T-2 toxin equivalents) in children with a high consumption of cereals was close to the tTDI for T-2 toxin. Since there is to date no established numerical tTDI for aflatoxins, such a value was estimated for use within the project. The calculated intake of aflatoxins in high consumers exceeded this 'tTDI' by a factor of two. In conclusion, the exposure to mycotoxins in Sweden did not generally give rise to any major health concerns in the present study. However, the high levels of aflatoxins in certain commodities emphasize the need for preventive measures and improved control of toxin levels in these food items. Furthermore, the need for regulatory levels for trichothecenes in cereal products should be evaluated. [ABSTRACT FROM AUTHOR]

Mycotoxin producing moulds may contaminate numerous agricultural commodities either before harvest or during storage. A varied diet consisting of different foods may therefore be contaminated with a range of mycotoxins. The aim of the present study was to study concurrent exposure to mycotoxins through urinary multi-biomarker analysis, as well as its possible associations with the diet. Urinary samples from 252 adults, participating in the Swedish national dietary survey Riksmaten 2010–11, were collected together with a 4-day diet record. Concurrent mycotoxin exposure was studied using a multi-biomarker LC-MS/MS method. The results revealed that exposure to mycotoxins is common and concurrent exposure to more than one toxin was found in 69% of the study population. However, when comparing the number of toxins detected with the reported consumption data it was difficult to distinguish food patterns which would indicate an increased risk of exposure to many mycotoxins simultaneously. This is the first study to investigate concurrent mycotoxin exposure and urinary levels of fumonisin B 1 (FB 1 ), fumonisin B 2 (FB 2 ), nivalenol (NIV), ochratoxin A (OTA), zearalenone (ZEA), α-zearalenol (α-ZOL), β-zearalenol (β-ZOL) and de-epoxydeoxynivalenol (DOM-1) among adults in Sweden. [ABSTRACT FROM AUTHOR]

Background/purpose: Non-resuscitation fluids constitute the majority of fluid administered for septic shock patients in the intensive care unit (ICU). This multicentre, randomized, feasibility trial was conducted to test the hypothesis that a restrictive protocol targeting non-resuscitation fluids reduces the overall volume administered compared with usual care., Methods: Adults with septic shock in six Swedish ICUs were randomized within 12 h of ICU admission to receive either protocolized reduction of non-resuscitation fluids or usual care. The primary outcome was the total volume of fluid administered within three days of inclusion., Results: Median (IQR) total volume of fluid in the first three days, was 6008 ml (interquartile range [IQR] 3960-8123) in the restrictive fluid group (n = 44), and 9765 ml (IQR 6804-12,401) in the control group (n = 48); corresponding to a Hodges-Lehmann median difference of 3560 ml [95% confidence interval 1614-5302]; p < 0.001). Outcome data on all-cause mortality, days alive and free of mechanical ventilation and acute kidney injury or ischemic events in the ICU within 90 days of inclusion were recorded in 98/98 (100%), 95/98 (98%) and 95/98 (98%) of participants respectively. Cognition and health-related quality of life at six months were recorded in 39/52 (75%) and 41/52 (79%) of surviving participants, respectively. Ninety out of 134 patients (67%) of eligible patients were randomized, and 15/98 (15%) of the participants experienced at least one protocol violation., Conclusion: Protocolized reduction of non-resuscitation fluids in patients with septic shock resulted in a large decrease in fluid administration compared with usual care. A trial using this design to test if reducing non-resuscitation fluids improves outcomes is feasible., Trial Registration: Clinicaltrials.gov, NCT05249088, 18 February 2022. https://clinicaltrials.gov/ct2/show/NCT05249088., (© 2024. The Author(s).)

Objective: Studies on the quality of home care services (HCS) offered to persons with dementia (PwDs) reveal the prevalence of unmet needs and dissatisfaction related to encounters and a lack of relationships with staff. The objective of this study was to enhance knowledge of the perceptions of PwDs regarding their treatment with dignity and respect in HCS over time., Design: A mixed longitudinal cohort study was designed to study trends in the period between 2016 and 2018 and compare the results between PwDs (cases) and persons without dementia (controls) living at home with HCS., Setting and Participants: Persons aged 65 years and older with HCS in Sweden., Methods: Data from an existing yearly HCS survey by the Swedish National Board of Health and Welfare (NBHW) was used. The focus was on questions concerning dignity and respect. NBHW data sets on diagnoses, medications, HCS hours, and demographic information were also used. We applied GEE logistic and cumulative logit regression models to estimate effects and trends of interest after controlling for the effects of age, gender, self-rated health, and number of HCS hours., Results: Over the study period, 271,915 (PwDs = 8.1%) respondents completed the survey. The results showed that PwDs were significantly less likely (3%-10% lower odds and cumulative odds) than controls to indicate that they were satisfied in response to questions related to dignity and respect. Both groups experienced a decrease in satisfaction from 2016 to 2018. Females, individuals with poor self-rated health, and individuals granted more HCS hours were found to be more dissatisfied., Conclusions and Implications: The HCS organization needs to shift from a task-oriented system to a person-centered approach, where dignity and respect are of the utmost importance. The HCS organizations need to be developed to focus on competence in person-centered care, and leadership to support staff., (Copyright © 2020 AMDA — The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

The exposure to mycotoxins of Swedish adolescents is currently unknown. The aim of the present study was to investigate the exposure to mycotoxins and their association with food intake, and background characteristics in adolescents of a national dietary survey. About 3000 school students (1000 from the 5th, 8th and 11th school years) were recruited for the survey. The participants completed Web-based questionnaires on food propensity, sociodemography and health, and a Web-based dietary recall. Spot urine and blood samples were collected from 1105 of the participants for mycotoxin biomarker analysis. Mycotoxins were analysed with multibiomarker methods in urine (HPLC-MS/MS) and serum (HPLC-MS/MS). Of the 35 different analytes in urine, the frequency of positive samples were the following: deoxynivalenol (DON, 4.8%), DON-15-β-D-O-glucuronide (DON-15GlcA, 9.1%), dihydro-citrinone (DH-CIT, 0.5%), HT-2-glucuronide (HT-2-3-GlcA, 0.1%) and ochratoxin A (OTA, 0.1%). Of the 27 different analytes in serum, OTA was detected in all samples, while 2'R-ochratoxin A (2'R-OTA) was found in 8.3% and enniatin B (EnB) in 99.2% of the samples. Exposure assessment calculations were performed on OTA from the serum concentration and on DON equivalents (DON eqv) from the urine concentration. All probable daily intake (PDI) estimates were below tolerable daily intakes, except for 1.6% of the participants for DON. The maximum PDI was 4.3 μg DON eqv/kg body weight and day. Consumption of cereal grain commodities was associated with levels of DON, EnB or OTA in biofluids. Serum OTA was also associated with intakes of raisins and coffee. Furthermore, coffee consumption correlated well with 2'R-OTA concentration in serum. In conclusion, exposure to mycotoxins in Swedish adolescents is common, but fortunately, high exposure was rare.

Objective: Atrial fibrillation (AF) is the most common arrhythmia and associated with increased morbidity and mortality. Its increasing prevalence calls for novel biomarkers to identify underlying pathophysiological mechanisms as well as patients at risk., Methods: Plasma samples from 1694 individuals from the Swedish population-based Malmö Preventive Project (mean age 69.5 years; 29.3% female; mean follow-up time 9.7±3.1 years) were analysed with the Olink proximity extension assay CVD III panel consisting of 92 proteins to identify proteins associated with incident AF or atrial flutter, referred to as incident AF. Incident cases of AF (n=278) were retrieved by linkage to the registers. Participants were followed until the first episode of AF or until censoring by death or emigration. Bonferroni-corrected multivariable Cox regression models adjusted for known risk factors were used to explore possible associations of the 92 proteins and incidence of AF., Results: Multivariable Cox regression analyses of 11 proteins associated with incident AF (mean follow-up time 9.7±3.1 years) after Bonferroni correction confirmed N-terminal pro-B-type natriuretic peptide (HR per 1 SD increment (95% CI) 1.80 (1.58 to 2.04); p=1.2×10 -19 ) as risk marker of incident AF. Further, matrix metalloproteinase-2 (1.22 (1.07 to 1.39); p=0.002) and osteopontin (1.27 (1.12 to 1.44); p=2.7×10 -4 ) were associated with incident AF at follow-up independently of traditional risk markers and NT-proBNP., Conclusion: In a general Swedish population, we confirmed the well-known association of NT-proBNP with incident AF and also identified matrix metalloproteinase-2 and osteopontin as novel risk markers for incident AF, independently of traditional risk factors and NT-proBNP., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The determination of mycotoxin and metabolite concentrations in human and animal urine is currently used for risk assessment and mycotoxin intake measurement. In this study, pig urine ( n = 195) was collected at slaughterhouses in 2012 by the Swedish National Food Agency in three counties representing East, South and West regions of Sweden. Urinary concentrations of four mycotoxins, (deoxynivalenol (DON), zearalenone (ZEA), fumonisin B 1 (FB 1 ), and ochratoxin A (OTA)), and four key metabolites, (deepoxy-deoxynivalenol (DOM-1), aflatoxin M 1 (AFM 1 , biomarker of AFB 1 ), α-zearalenol (α-ZOL), and β-zearalenol (β-ZOL)) were identified and measured by UPLC-MS/MS. Statistically significant regional differences were detected for both total DON (DON + DOM-1) and total ZEA (ZEA + α-ZOL + β-ZOL) concentrations in pig urine from the three regions. These regional differences were in good agreement with the occurrence of Fusarium graminearum mycotoxins (DON + ZEA) in cereal grains harvested in 2011 in Sweden. There were no statistically significant differences in FB 1 , AFM 1 and OTA urinary concentrations in pigs from the three regions. The overall incidence of positive samples was high for total ZEA (99-100%), total DON (96-100%) and OTA (85-95%), medium for FB 1 (30-61%) and low for AFM 1 (0-13%) in the three regions. Urinary mycotoxin biomarker concentrations were used to estimate mycotoxin intake and the level of mycotoxins in feeds consumed by the monitored pigs. The back-calculated levels of mycotoxins in feeds were low with the exception of seven samples that were higher the European limits.

Objectives: To assess the effect and safety of moderate-to-vigorous resistance exercise during pregnancy., Design: Randomized controlled study., Setting: Two antenatal clinics in Gothenburg, Sweden., Population: Ninety-two healthy pregnant women., Methods: The intervention was administered during gestational weeks 14-25. The intervention group received supervised resistance exercise twice a week, performed at an activity level equivalent to within moderate-to-vigorous (n = 51). The control group received generalized exercise recommendation, a home-based training program and a telephone follow up (n = 41)., Main Outcome Measures: Health-related quality of life, physical strength, pain, weight, blood pressure, functional status, activity level, and perinatal data., Results: Functional status deteriorated during the intervention in both groups and pain increased. Significant differences between the groups were obtained only for birthweight. Newborns delivered by women who underwent resistance exercise during pregnancy were significantly heavier than those born to control women; 3561 (±452) g vs. 3251 (±437) g (p = 0.02), a difference that disappeared when adjustment was made for gestational age (p = 0.059). Both groups showed normal health-related quality of life, blood pressure, and perinatal data., Conclusions: These findings indicate that supervised, moderate-to-vigorous resistance exercise does not jeopardize the health status of healthy pregnant women or the fetus during pregnancy, but instead appears to be an appropriate form of exercise in healthy pregnancy., (© 2014 Nordic Federation of Societies of Obstetrics and Gynecology.)

A survey of moulds and mycotoxins was performed on 99 rice samples taken from the Swedish retail market. The main objective was to study the mould and mycotoxin content in basmati rice and rice with a high content of fibre. Samples of jasmine rice as well as long-grain rice were also included. The samples were analysed for their content of ochratoxin A (high-performance liquid chromatography (HPLC)), aflatoxin B(1), B(2), G(1), and G(2) (HPLC, RIDA(R)QUICK), and mould (traditional cultivation methods in combination with morphological analysis). The majority of samples were sampled according to European Commission Regulation 401/2006. Subsamples were pooled and mixed before milling and both mould and mycotoxin analyses were performed on milled rice. The results showed that the majority of basmati rice (71%) and many jasmine rice samples (20%) contained detectable levels of aflatoxin B(1) (level of quantification = 0.1 microg aflatoxin kg(-1) rice). Two samples of jasmine rice and ten basmati rice samples contained levels over the regulated European maximum limits of 2 microg kg(-1) for aflatoxin B(1) or 4 microg kg(-1) for total aflatoxins. Aspergillus was the most common mould genus isolated, but also Penicillium, Eurotium, Wallemia, Cladosporium, Epicoccum, Alternaria, and Trichotecium were found. The presence of Aspergillus flavus in 21% of the samples indicates that incorrect management of rice during production and storage implies a risk of mould growth and subsequent production of aflatoxin. Rough estimates showed that high rice consumers may have an intake of 2-3 ng aflatoxin kg(-1) bodyweight and day(-1) from rice alone. This survey shows that aflatoxin is a common contaminant in rice imported to Europe.

Blood levels of ochratoxin A were determined in 406 Scandinavian blood donors (206 from Oslo, Norway, and 200 from Visby on the island of Gotland, Sweden), using an HPLC method. In connection with the blood collection, the subjects were asked to fill in a food questionnaire to obtain individual dietary information relevant to ochratoxin A exposure. The mean plasma level of ochratoxin A was 0.18 ng/ml in Oslo and slightly higher, 0.21 ng/ml (P=0.046) in Visby. There was no correlation between plasma levels of ochratoxin A and the estimated total dietary intake of ochratoxin A based on consumption data and levels in food (retrieved from the literature), neither was the plasma level of ochratoxin A correlated with the total amount of food consumed. However, consumption of several foods, including cereal products, wine, beer and pork, were to some minor degree related to high plasma levels of ochratoxin A. The strongest correlations (correlation coefficient r>0.4; P<0.001) were observed for women in relation to the consumption of beer or medium brown bread. Correlation analysis of combinations of two or more food categories did not result in any statistically significant correlation.

The effect of storage on the performance of four mycological media, DG18, DRBC and two Rose Bengal agars, one from Difco, the other recommended by the Swedish Standard Institution, was investigated. The autoclaved media were stored (+4 degrees C) in the dark for up to 26 weeks. Following each storage period, the media were remelted and poured and the plates stored (+4 degrees C) in the dark for a maximum of 8 weeks before inoculation with test microorganisms. All media contained antibiotics. Both rapidly and slowly growing moulds, and also yeasts and bacteria were used as test microorganisms. No distinct effect of storage time on colony appearance could be shown for any of the four media. If the loss of restricted growth of Rhizopus stolonifer is used as a measure of the performance of the media, DRBC plates should not be stored for longer than 2 weeks after being poured from fresh medium. Storage of DRBC in flasks should not exceed 4 weeks and plates prepared from this medium should not be kept for more than 1 week. DG18 plates should only be poured from fresh medium and kept for a maximum of 1 week. The inhibitory effect of the antibiotic supplement on bacteria lasted for at least 4 weeks in DG18 and the two rose bengal media.

A method for determining ochratoxin A in milk has been elaborated in which the sample was subjected to a liquid-liquid extraction step and then purified on a silica gel column packed in a Pasteur pipet. The purified samples were analyzed by ion-pair liquid chromatography with fluorescence detection. The detection and quantitation limits for determination of ochratoxin A in cow's milk were 10 and 40 ng ochratoxin A/L milk, respectively. The same limits were valid for the analysis of human milk. A total of 36 cow's milk and 40 human milk samples were analyzed. All samples were collected in Sweden. Ochratoxin A was found in 5 (14%) of the cow's milk samples (range 10-40 ng/mL) and in 23 (58%) of the human milk samples (range 10-40 ng/L). Blood samples were collected from the mothers who gave milk samples. A total of 39 samples were analyzed. All blood samples contained ochratoxin A in concentrations exceeding the quantitation limit (60 ng/L blood). The mean concentration of ochratoxin A in the samples was 167 ng/L blood (range 90-940 ng/L). The concentration of ochratoxin A in human milk was < or = 0.1 of that in the human blood.

A new HPLC method for the analysis of ochratoxin A in plasma samples is described. The analysis is performed at an alkaline pH using an ion-pair technique, fluorescence detection at an excitation wavelength 380 nm, and an emission wavelength 420 nm. The detection and quantification limits are 0.02 ng and 0.05 ng ochratoxin A/ml plasma, respectively. The method was used to determine the ochratoxin A content of human plasma samples, collected in three districts of Sweden. The Visby district had a significantly higher proportion of ochratoxin A positive samples and higher levels than the other two districts--Uppsala and Ostersund. The calculated daily intake of ochratoxin A in the Visby district (0.35 ng/kg body weight), exceeds the lower tolerable daily intake (TDI) value suggested by Kuiper-Goodman and Scott (1989). The calculated daily intake by the population on the mainland of Sweden (0.04 ng/kg body weight) is below the proposed TDIs.