Search

Ellen Landgren,1– 3 Ann Bremander,1,3– 5 Elisabet Lindqvist,1,2 Maria Nylander,3,6 Kristien Van der Elst,7 Ingrid Larsson1,3,8 1Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden; 2Department of Rheumatology, Skåne University Hospital, Lund, Sweden; 3Spenshult Research and Development Centre, Halmstad, Sweden; 4Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 5Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark; 6Swedish Rheumatism Association, Stockholm, Sweden; 7Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; 8School of Health and Welfare, Halmstad University, Halmstad, SwedenCorrespondence: Ingrid LarssonSchool of Health and Welfare, Halmstad University, PO Box 823, Halmstad S-30118, SwedenTel +46 35 167965Email ingrid.larsson@hh.sePurpose: To explore patients’ preferred treatment outcomes during their first two years with rheumatoid arthritis (RA).Patients and Methods: A qualitative, longitudinal, multicenter study with interviews at two time points was performed in Sweden. Individual interviews were conducted at time point 1 with 31 patients with RA, defined as disease duration of ≤ 1 year and treatment for 3– 7 months. Seven focus group interviews and five individual interviews were conducted at time point 2 with 22 patients 12– 20 months after treatment initiation. The interviews were analyzed using the Qualitative Analysis Guide of Leuven. A core category with four related concepts emerged.Results: The core finding of patient-preferred treatment outcomes was “mastering a new life situation”. Patients preferred to experience control of the disease by controlling the symptoms and by experiencing absence of disease. To experience autonomy by regaining former activity level, experiencing independence, and being empowered was another preferred outcome. Patients preferred to regain identity through being able to participate, experience well-being, and regain former self-image. To experience joy in everyday life through vitality and believing in the future was another preferred outcome. Patients’ preferences developed over time from the acute phase of controlling the symptoms and wanting to return to the life they lived prior to diagnosis, to a more preventive way of self-management and empowerment to master the new life situation.Conclusion: The patients’ preferred treatment outcomes during the first two years with RA were to master their new life situation and changed from a preference to return to a life lived prior disease onset, to a preference of living with quality of life, despite RA. This study increases the understanding of patients’ preferred treatment outcomes in the early disease course and can be a foundation for tailoring interventions to be more person-centered and to improve long-term treatment outcomes.Keywords: focus groups, interviews, multicenter, patient perspective, rheumatic diseases

Ingrid Larsson1,2 1School of Health and Welfare, Halmstad University, 2Spenshult Research and Development Center, Halmstad, Sweden Background: Biological therapies are common in the treatment of patients with chronic inflammatory arthritis (CIA). However, despite the fact that many patients respond well to their biological therapies, there are still a number of nonresponders. In order to design the best care for patients, it is important to understand how they conceive their own role in their treatment response. Objective: To explore how patients with CIA conceive their own influence on a good treatment response to biological therapy. Methods: This study had an exploratory and descriptive design with a phenomenographic approach. Interviews were conducted with 25 patients (11 women and 14 men) aged 17–79 years, with CIA who were undergoing biological therapy and who had low disease activity or were in remission. Results: Patients with CIA undergoing biological therapy conceived their own influence on good treatment response in terms of adherence, physical activity, mental attitude, social support, and self-awareness. Adherence was described as the foundation for the patients’ own influence on good treatment response. Physical activity, mental attitude, and social support reflected three essential ways of understanding patients’ influence on good treatment response where the patients spoke about physical strength, mental strength, and social strength. Self-awareness reflected a comprehensive way of influencing good treatment response in which patients balanced their physical, mental, and social resources in partnership with health care professionals. Conclusion: Patients conceived that they had a responsibility for adhering to the treatment as well as achieving balance in life in order to ensure good treatment response. Self-awareness was essential for maintaining a good treatment response, and this reflected the patients’ awareness of the complexity of living their lives with a chronic illness. Keywords: biological therapy, chronic inflammatory arthritis, conceptions, good treatment response, phenomenography

Abstract For the extrapolation of data obtained from experimental animals to the human situation, it is important to know the similarities and differences between human and animal species. Some important characteristics of nitric oxide synthase (NOS) in myometrium and vagina from human and rat were compared. NOS-activity was measured by the formation of 14C-citrulline from 14C-arginine and the expression of NOS isoforms was examined by Western blotting. NOS activity in human uterus and vagina was significantly lower than in the tissues from rat. In contrast to the rat where NOS activity was predominantly found in the cytosolic fractions, NOS activity in particulate and cytosolic fractions from both human myometrium and vagina was similar. Data from Western blots confirmed that eNOS and nNOS isoforms were concentrated in the particulate and cytosolic fractions, respectively. Estrogen treatment of rats resulted in a down regulation of uterine cytosolic NOS activity. A down regulation of NOS in the cytosolic fraction was also seen in the human pregnant myometrium as compared with the nonpregnant myometrium. The vaginal NOS activity was considerably higher than the uterus in both species. In spite of some clear-cut qualitative and other differences between human and rat tissues, there are some interesting similarities. Downregulation in pregnancy of human uterine NOS is probably due to, at least in part, the influence of estrogen and progesterone.

Iron ore pellet production processes produce large amounts of CO2 emissions when burning fossil fuels. One example is the grate-kiln process, where normally a coal flame is used to indurate pellets. To mitigate the emissions, coal used in rotary kilns can be replaced with for example hydrogen. However, the fuel is mixed with secondary process air, and replacing a solid fuel with a gaseous one changes the mixing characteristics. This demands different means of injecting the fuel. A coaxial jet can be used to control the mixing of fuel and secondary air, as well as the flow field. The aim is to control the mixing of hydrogen and secondary air to achieve a hydrogen flame that is similar to the reference coal flame. This study numerically investigates different coaxial jet configurations. Steady-state simulations of a simplified model of the real kiln are performed using a Reynolds Stress turbulence model. Results show that decreasing the momentum flow ratio between the outer and inner jet, Mjet, to a certain value delays the spread of the hydrogen jet and thus gives a longer jet. Further decreasing this ratio gives an even longer jet, but has the side effect of producing recirculation of hydrogen. [ABSTRACT FROM AUTHOR]

Purpose To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors. Methods Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay [greater than or equal to] 12 h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3 months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score [greater than or equal to] 11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score > 45. Results A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65 years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81). Conclusions We developed an instrument to predict individual patients' risk for psychological problems 3 months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up. Trial registration The study was registered at clinicaltrials.gov, NCT02679157., Author(s): A. Milton [sup.1] [sup.2], A. Schandl [sup.3], I. W. Soliman [sup.4], K. Meijers [sup.5], M. van den Boogaard [sup.6], I. M. Larsson [sup.7], C. Brorsson [sup.8], U. Östberg [sup.9], [...]

BACKGROUND/OBJECTIVES: The prevalence of obesity, defined as body mass index (BMI) [greater than or equal to] 30 kg/[m.sup.2], differs between populations; however, there is a need for data on description on body composition in reference populations of different ages and from different countries. The objective of this study was to pool dual-energy X-ray absorptiometry (DXA) body composition reference data from population-based Swedish cohorts. SUBJECTS/METHODS: Four population-based cross-sectional cohort studies including 1424 adult Swedes were divided into five age groups (20-29, 30-39, 40-49, 50-61 and 75 years of age); BMI 24.6 [+ or -] 3.9 kg/[m.sup.2] were pooled. Body composition was measured with DXA. RESULTS: The difference in BMI from the youngest to the oldest age group was 3.2 and 4.3 kg/[m.sup.2] in men and women, respectively (P < 0.001, both sexes), and fat mass (FM) was 9.9 and 9.1% higher in the oldest compared with the youngest men and women (P < 0.001, both sexes). Fat-free mass (FFM) remained stable up to 60 years of age in men (P = 0.83) and was lower at 75 years of age compared with the younger ages. In women, FFM was lower from age 60. From youngest to oldest age groups, height- adjusted FM differed from 4.6 to 7.8 kg/[m.sup.2] in men and from 6.8 to 10.8 kg/[m.sup.2] in women (P < 0.001, both sexes). CONCLUSIONS: Our results provide reference data on body composition in Swedish populations. BMI and FM were higher among older age groups compared with the younger ones. FFM remained stable up to 60 years of age and was lower first among the 75 years of age. European Journal of Clinical Nutrition (2015) 69, 837-842; doi: 10.1038/ejcn.2014.268; published online 17 December 2014, INTRODUCTION The prevalence of overweight and obesity has increased differently between countries. (1) These differences depend on factors such as the composition of gender, age, ethnicity groups and several environmental [...]

Flow field measurements around cross-country (XC) skiers are lacking in the literature to date. The aim was therefore to investigate the possibility of using particle tracking velocimetry for visualization and measurement of the flow field around XC skiers roller skiing on a treadmill in a wind tunnel. The airflow was seeded with neutrally buoyant helium-filled soap bubbles as tracer particles, following the flow without affecting it. As illumination, two different approaches were tested: first, a laser in the cameras' line of sight (sagittal plane), then a LED unit directed vertically in a narrow slice, clearly limiting the depth of the measurement volume in the cameras' line of sight. The flow field was studied at various speeds (3-7 m/s) around a single skier as well as around two skiers in line with the streaming airflow. It was found that the experimental approach has the potential to provide detailed insights, both qualitatively and quantitatively, into the flow field dynamics. The main challenges regarding setup, illumination, seeding, and cameras were identified, and possible improvements to streamline the experimental methodology were discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES: The main objective was to test the hypothesis that dietary energy density (DED) decreases after Roux-en-Y gastric bypass (gastric bypass). SUBJECTS/METHODS: A total of 43 patients (31 women and 12 men) aged 43 (s.d. 10) years, with body mass index (BMI) 44.3 kg/ [m.sup.2] (4.9), were assessed preoperatively at 6 weeks and 1 and 2 years after gastric bypass. Self-reported energy intake (EI), food weight (FW) and food choice were assessed using a dietary questionnaire. DED was calculated by dividing EI by FW (kcal/g). Number of dropouts was 4 of 203 visits. RESULTS: Percent weight loss (%WL) was 13.5% at 6 weeks, 30.7% at 1 year and 31.8% at 2 years post surgery (Po0.001 for all). EI decreased from 2990 to 1774, 2131 and 2425 kcal after 6 weeks and 1 and 2 years postoperatively, respectively (Po0.001 at all time points). FW changed from 2844 to 1870g/day at 6 weeks (Po0.001) and 2416g/day after 1 year (Po0.05), but was not significantly different from baseline 2 years postoperatively (2602g/day, P - 0.105). DED decreased from 1.07 to 0.78 kcal/g at 6 weeks (Po0.001) and 0.90kcal/g (Po0.001) and 0.96kcal/g (P - 0.001) after 1 and 2 years, respectively. All statistical comparisons were made from baseline. There was no correlation between changes in DED and %WL, neither after 1 year (r 0.215;P - 0.183) nor after 2 years (r = -0.046;P - 0.775) post surgery. CONCLUSIONS: Besides substantial reduction in EI and large variation in FW, patients reported decreased DED over 2 years following gastric bypass. Despite lack of association between the reduction in DED and percentage weight loss, changes in food choice were overall nutritionally beneficial. doi: 10.1038/ejcn.2012.208; published online 9 January 2013 Keywords: dietary energy density; energy intake; food weight; food choice; Roux-en-Y gastric bypass, INTRODUCTION Dietary energy density (DED) is the amount of energy in a particular weight of foods, generally presented as kilocalories per gram of food (kcal/g). (1) Because of its high-energy [...]