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Yerramalla, M. S., Darin-Mattsson, A., Udeh-Momoh, C. T., Holleman, J., Kåreholt, I., Aspö, M., . . . Sindi, S. (2024). Cognitive reserve, cortisol, and Alzheimer's disease biomarkers: A memory clinic study. Alzheimer's & Dementia: Journal of the Alzheimer's Association, 20(7), 4486-4498
Open this publication in new window or tab >>Cognitive reserve, cortisol, and Alzheimer's disease biomarkers: A memory clinic study
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2024 (English)In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 20, no 7, p. 4486-4498Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Cognitive reserve might mitigate the risk of Alzheimer's dementia among memory clinic patients. No study has examined the potential modifying role of stress on this relation.

METHODS: We examined cross-sectional associations of the cognitive reserve index (CRI; education, occupational complexity, physical and leisure activities, and social health) with cognitive performance and AD-related biomarkers among 113 memory clinic patients. The longitudinal association between CRI and cognition over a 3-year follow-up was assessed. We examined whether associations were influenced by perceived stress and five measures of diurnal salivary cortisol.

RESULTS: Higher CRI scores were associated with better cognition. Adjusting for cortisol measures reduced the beneficial association of CRI on cognition. A higher CRI score was associated with better working memory in individuals with higher (favorable) cortisol AM/PM ratio, but not among individuals with low cortisol AM/PM ratio. No association was found between CRI and AD-related biomarkers.

DISCUSSION: Physiological stress reduces the neurocognitive benefits of cognitive reserve among memory clinic patients. Highlights: Physiological stress may reduce the neurocognitive benefits accrued from cognitively stimulating and enriching life experiences (cognitive reserve [CR]) in memory clinic patients. Cortisol awakening response modified the relation between CR and P-tau181, a marker of Alzheimer's disease (AD). Effective stress management techniques for AD and related dementia prevention are warranted.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
amyloid beta, cerebrospinal fluid biomarkers, cognitive performance, cognitive reserve, memory clinic, perceived stress, phosphorylated tau, salivary cortisol, total tau
National Category
Geriatrics
Identifiers
urn:nbn:se:hj:diva-64784 (URN)10.1002/alz.13866 (DOI)001239197700001 ()38837661 (PubMedID)2-s2.0-85195143468 (Scopus ID)HOA;intsam;955357 (Local ID)HOA;intsam;955357 (Archive number)HOA;intsam;955357 (OAI)
Funder
Swedish Research CouncilAlzheimerfondenThe Swedish Brain FoundationKnut and Alice Wallenberg FoundationForte, Swedish Research Council for Health, Working Life and WelfareKonung Gustaf V:s och Drottning Victorias FrimurarestiftelseRiksbankens JubileumsfondNordForskEU, European Research Council
Available from: 2024-06-10 Created: 2024-06-10 Last updated: 2024-07-19Bibliographically approved
Sørensen, C., Kåreholt, I., Kalpouzos, G., Udeh-Momoh, C. T., Holleman, J., Aspo, M., . . . Sindi, S. (2024). Daytime Sleepiness, Apnea, Neuroimaging Correlates and Cortisol Dysregulation in a Memory Clinic Cohort. The Journal of Prevention of Alzheimer's Disease, 11(6), 1798-1808
Open this publication in new window or tab >>Daytime Sleepiness, Apnea, Neuroimaging Correlates and Cortisol Dysregulation in a Memory Clinic Cohort
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2024 (English)In: The Journal of Prevention of Alzheimer's Disease, ISSN 2274-5807, E-ISSN 2426-0266, Vol. 11, no 6, p. 1798-1808Article in journal (Refereed) Published
Abstract [en]

Background

Sleep disturbances as well as cortisol hypersecretion are increasingly acknowledged as risk factors for Alzheimer's disease (AD). However, the mechanisms underlying the association, and the interplay with cortisol abnormalities, remain unclear.

Objectives

This study aims to identify how self-reported sleep disturbances are associated with structural brain measures and diurnal cortisol dysregulation among memory clinic patients.

Design

A cross-sectional study performed at Karolinska University Hospital Memory Clinic, Sweden.

Participants

The study was based on 146 memory clinic patients diagnosed with either subjective cognitive impairment or mild cognitive impairment.

Measurements

Self-reported sleep was measured using the Karolinska Sleep Questionnaire. MRI or CT was used to quantify structural brain measures using four visual rating scales (Scheltens, Pasquier, Koedam, and Fazekas scales), and salivary cortisol was sampled to measure diurnal cortisol patterns through measures of cortisol immediately after awakening, cortisol awakening response, bedtime cortisol, total cortisol from awakening to bedtime, and the AM/PM cortisol ratio.

Results

Increased sleep apnea index (OR=1.20, 95% CI=1.04:1.39, p=0.015) was associated with greater odds of posterior brain atrophy, measured by the Koedam visual rating scale, and reduced awakening Cortisol (beta=-0.03, 95% CI=- 0.07:0.00, p=0.045). Increased daytime sleepiness was associated with both reduced awakening cortisol (beta=-0.03, 95% CI=-0.06:0.00, p=0.025) and a reduced AM/PM cortisol ratio (beta=-0.04, CI=-0.08:-0.01, p= 0.021).

Conclusion

In a memory clinic cohort self-reported sleep disturbances are associated with both worse structural brain tissue integrity and altered diurnal cortisol profiles. These findings may add insights into possible mechanisms behind sleep disturbances in aging with subjective and cognitive impairment.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Self-reported sleep, neuroimaging, Cortisol, cognitive impairment
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-65967 (URN)10.14283/jpad.2024.145 (DOI)001271496000001 ()2-s2.0-85198968712 (Scopus ID)HOA;;966121 (Local ID)HOA;;966121 (Archive number)HOA;;966121 (OAI)
Funder
AlzheimerfondenThe Swedish Brain FoundationForte, Swedish Research Council for Health, Working Life and WelfareKnut and Alice Wallenberg FoundationKonung Gustaf V:s och Drottning Victorias FrimurarestiftelseRiksbankens JubileumsfondNordForskEU, European Research CouncilSwedish Research Council
Available from: 2024-08-16 Created: 2024-08-16 Last updated: 2025-01-12Bibliographically approved
Sorensen, C., Kåreholt, I., Kalpouzos, G., Momoh, C. U. & Sindi, S. (2024). Daytime sleepiness, apnea, neuroimaging correlates and cortisol dysregulation in a memory clinic cohort. Journal of Sleep Research, 33(Supplement 1), 310-311
Open this publication in new window or tab >>Daytime sleepiness, apnea, neuroimaging correlates and cortisol dysregulation in a memory clinic cohort
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2024 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 33, no Supplement 1, p. 310-311Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Several sleep disturbance parameters as well asabnormal cortisol secretion levels are increasingly acknowledged as risk factors for Alzheimer's disease (AD). Currently, the mechanisms between sleep disturbances and AD, and the interplay with abnormal cortisol levels, are still not understood. This study examines how self-reported sleep disturbances are associated with structural brain mea-sures and diurnal cortisol dysregulation in a cohort of memory clinic patients.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
National Category
Neurology
Identifiers
urn:nbn:se:hj:diva-67271 (URN)001319389402005 ()
Funder
Swedish Research CouncilAlzheimerfonden
Available from: 2025-02-10 Created: 2025-02-10 Last updated: 2025-02-10Bibliographically approved
Holleman, J., Daniilidou, M., Kåreholt, I., Aspö, M., Hagman, G., Udeh-Momoh, C. T., . . . Sindi, S. (2024). Diurnal cortisol, neuroinflammation, and neuroimaging visual rating scales in memory clinic patients. Brain, behavior, and immunity, 118, 499-509
Open this publication in new window or tab >>Diurnal cortisol, neuroinflammation, and neuroimaging visual rating scales in memory clinic patients
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2024 (English)In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 118, p. 499-509Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Neuroinflammation is a hallmark of the Alzheimer's disease (AD) pathogenic process. Cortisol dysregulation may increase AD risk and is related to brain atrophy. This cross-sectional study aims to examine interactions of cortisol patterns and neuroinflammation markers in their association with neuroimaging correlates.

METHOD: 134 participants were recruited from the Karolinska University Hospital memory clinic (Stockholm, Sweden). Four visual rating scales were applied to magnetic resonance imaging or computed tomography scans: medial temporal lobe atrophy (MTA), global cortical atrophy (GCA), white matter lesions (WML), and posterior atrophy. Participants provided saliva samples for assessment of diurnal cortisol patterns, and underwent lumbar punctures for cerebrospinal fluid (CSF) sampling. Three cortisol measures were used: the cortisol awakening response, total daily output, and the ratio of awakening to bedtime levels. Nineteen CSF neuroinflammation markers were categorized into five composite scores: proinflammatory cytokines, other cytokines, angiogenesis markers, vascular injury markers, and glial activation markers. Ordinal logistic regressions were conducted to assess associations between cortisol patterns, neuroinflammation scores, and visual rating scales, and interactions between cortisol patterns and neuroinflammation scores in relation to visual rating scales.

RESULT: Higher levels of angiogenesis markers were associated with more severe WML. Some evidence was found for interactions between dysregulated diurnal cortisol patterns and greater neuroinflammation-related biomarkers in relation to more severe GCA and WML. No associations were found between cortisol patterns and visual rating scales.

CONCLUSION: This study suggests an interplay between diurnal cortisol patterns and neuroinflammation in relation to brain structure. While this cross-sectional study does not provide information on causality or temporality, these findings suggest that neuroinflammation may be involved in the relationship between HPA-axis functioning and AD.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Alzheimer’s Disease, Cortical Atrophy, Cortisol, Cytokines, Hypothalamic-Pituitary-Adrenal Axis, Neuroimaging, Neuroinflammation, Visual Rating Scales, White Matter Lesions
National Category
Neurosciences
Identifiers
urn:nbn:se:hj:diva-63933 (URN)10.1016/j.bbi.2024.03.024 (DOI)001216219600001 ()38503394 (PubMedID)2-s2.0-85188779839 (Scopus ID)
Available from: 2024-04-03 Created: 2024-04-03 Last updated: 2024-05-21Bibliographically approved
Bazzi, M., Afram, S. S., Ndipen, I. M., Kåreholt, I. & Bjällmark, A. (2024). Factors affecting radiographers' use of dose-reduction measures. Journal of Radiological Protection, 44(1), Article ID 011506.
Open this publication in new window or tab >>Factors affecting radiographers' use of dose-reduction measures
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2024 (English)In: Journal of Radiological Protection, ISSN 0952-4746, E-ISSN 1361-6498, Vol. 44, no 1, article id 011506Article in journal (Refereed) Published
Abstract [en]

This study investigates radiographers' views on implementing dose-reduction measures, with a focus on verifying patient identity and pregnancy status, practising gonad shielding in men and using compression. An electronic questionnaire was distributed to radiographers working in general radiography and/or computed tomography. The questionnaire was based on factors from a framework for analysing risk and safety in clinical medicine. Ordered logistic regressions were used to analyse associations among factors and use of dose-reduction measures. In total, 466 questionnaires were distributed and 170 radiographers (36%) completed them. Clear instructions and routines, support from colleagues, knowledge and experience, a strong safety culture, managerial support and access to proper equipment influence the likelihood of using dose-reduction measures. The strongest associations were found between support from colleagues and verifying pregnancy status (OR = 5.65, P = 0.026), safety culture and use of gonad shielding (OR = 2.36, P = 0.042), and having enough time and use of compression (OR = 2.11, P = 0.003). A strong safety culture and a supportive work environment appears to be essential for the use of dose-reduction measures, and education, training and stress management can improve utilisation of dose-reduction measures.

Place, publisher, year, edition, pages
Institute of Physics (IOP), 2024
Keywords
gonad shield, compression, radiation protection, ALARA, shielding, patient safety
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:hj:diva-63533 (URN)10.1088/1361-6498/ad1fde (DOI)001152115800001 ()38232402 (PubMedID)2-s2.0-85183955573 (Scopus ID)
Available from: 2024-02-12 Created: 2024-02-12 Last updated: 2024-02-14Bibliographically approved
Nilsen, C., Agerholm, J., Kelfve, S., Wastesson, J. W., Kåreholt, I., Nabe-Nielsen, K. & Meinow, B. (2024). History of working conditions and the risk of old-age dependency: a nationwide Swedish register-based study. Scandinavian Journal of Public Health, 52(6), 726-732
Open this publication in new window or tab >>History of working conditions and the risk of old-age dependency: a nationwide Swedish register-based study
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2024 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 52, no 6, p. 726-732Article in journal (Refereed) Published
Abstract [en]

Aims: There is substantial evidence that previous working conditions influence post-retirement health, yet little is known about previous working conditions' association with old-age dependency. We examined job strain, hazardous and physical demands across working life, in relation to the risk of entering old-age dependency of care.

Methods: Individually linked nationwide Swedish registers were used to identify people aged 70+ who were not receiving long-term care (residential care or homecare) at baseline (January 2014). Register information on job titles between the years 1970 and 2010 was linked with a job exposure matrix of working conditions. Random effects growth curve models were used to calculate intra-individual trajectories of working conditions. Cox regression models with age as the timescale (adjusted for living situation, educational attainment, country of birth, and sex) were conducted to estimate hazard ratios for entering old-age dependency during the 24 months of follow-up (n = 931,819).

Results: Having initial adverse working conditions followed by an accumulation throughout working life encompassed the highest risk of entering old-age dependency across the categories (job strain: HR 1.23, 95% CI 1.19-1.27; physical demands: HR 1.36, 95% CI 1.31-1.40, and hazardous work: HR 1.35, 95% CI 1.30-1.40). Initially high physical demands or hazardous work followed by a stable trajectory, or initially low-level physical demand or hazardous work followed by an accumulation throughout working life also encompassed a higher risk of dependency.

Conclusions: A history of adverse working conditions increased the risk of old-age dependency. Reducing the accumulation of adverse working conditions across the working life may contribute to postponing old-age dependency.

Place, publisher, year, edition, pages
Sage Publications, 2024
Keywords
Older age, later life, dependency, long-term care, physical working conditions, psychosocial working conditions, work-related stress, longitudinal, Sweden
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-62244 (URN)10.1177/14034948231188999 (DOI)001042373400001 ()37537973 (PubMedID)2-s2.0-85166902323 (Scopus ID)HOA;intsam;898013 (Local ID)HOA;intsam;898013 (Archive number)HOA;intsam;898013 (OAI)
Funder
Swedish Research Council, 2016-00197Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01141, 2016-01072Riksbankens Jubileumsfond, P21-0173
Available from: 2023-08-22 Created: 2023-08-22 Last updated: 2024-10-21Bibliographically approved
Norrgard, A., Tham, P., Strömberg, A. & Kåreholt, I. (2024). How Do Child Welfare Social Workers Assess the Leadership of Their First-line Managers? A 15-Year Perspective. British Journal of Social Work, 54(4), 1737-1752
Open this publication in new window or tab >>How Do Child Welfare Social Workers Assess the Leadership of Their First-line Managers? A 15-Year Perspective
2024 (English)In: British Journal of Social Work, ISSN 0045-3102, E-ISSN 1468-263X, Vol. 54, no 4, p. 1737-1752Article in journal (Refereed) Published
Abstract [en]

The study aimed to investigate how child welfare social workers assessed the leadership of their first-line managers over a period of fifteen years and to examine whether the assessments have changed over time. More specifically, the analysis focused on the extent to which social workers perceive the leadership of their first-line managers to be empowering, supportive and fair. Data were collected in the years 2003 (n = 293), 2014 (n = 300) and 2018 (n = 309) using the same questionnaire, mainly based on QPS Nordic, which was distributed to social workers working with investigations of children and youth. The results show that the social workers assessed all measured aspects of their first-line managers' leadership as better in 2014 compared to 2003 and significantly better in 2018 compared to 2003. In light of previous studies showing that child welfare managers experience less optimal conditions for their leadership, the results are surprising. How is it possible that the first-line managers, despite their own descriptions of a more difficult leadership situation, are seen as more supportive, empowering and fair in their leadership from the social workers' perspective? Possible explanations for the social workers' better assessments over the years, such as specialisation, are discussed. This article investigates how child welfare social workers have assessed the leadership of their first-line managers over a period of fifteen years. Questionnaires were collected in the same geographical areas in 2003, 2014 and 2018. The results show that child welfare social workers assessed the leadership of their first-line managers as increasingly empowering, supportive and fair over the years. In light of previous studies showing that child welfare managers experience less optimal conditions for their leadership, the results are surprising. How is it possible that the first-line managers, despite their own descriptions of a more difficult leadership situation, are seen as more supportive, empowering and fair in their leadership from the social workers' perspective? Potential explanations as to why assessments have improved are discussed.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
child welfare, first-line manager, follow-up study, leadership, questionnaire, social worker
National Category
Social Work
Identifiers
urn:nbn:se:hj:diva-63220 (URN)10.1093/bjsw/bcad255 (DOI)001124880400001 ()2-s2.0-85197584380 (Scopus ID)HOA;;924948 (Local ID)HOA;;924948 (Archive number)HOA;;924948 (OAI)
Funder
AFA Insurance, 170025
Available from: 2024-01-08 Created: 2024-01-08 Last updated: 2024-07-15Bibliographically approved
Hoang, M. T., Kåreholt, I., Lindgren, E., von Koch, L., Xu, H., Tan, E. C., . . . Garcia-Ptacek, S. (2024). Immigration and access to dementia diagnostics and treatment: A nationwide study in Sweden. SSM - Population Health, 25, Article ID 101573.
Open this publication in new window or tab >>Immigration and access to dementia diagnostics and treatment: A nationwide study in Sweden
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2024 (English)In: SSM - Population Health, ISSN 2352-8273, Vol. 25, article id 101573Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Dementia, Diagnosis, Difference, Drug, Ethnic, Inequality, Treatment, angiotensin receptor antagonist, antidepressant agent, anxiolytic agent, beta adrenergic receptor blocking agent, calcium channel blocking agent, cholinesterase inhibitor, dipeptidyl carboxypeptidase inhibitor, diuretic agent, hydroxymethylglutaryl coenzyme A reductase inhibitor, hypnotic agent, memantine, neuroleptic agent, adult, aged, Article, clinical feature, cohort analysis, comparative study, controlled study, ethnicity, female, health care access, health disparity, human, immigration, major clinical study, male, middle aged, observational study, prescription, sensitivity analysis, Sweden, very elderly
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-63226 (URN)10.1016/j.ssmph.2023.101573 (DOI)001142416200001 ()38162224 (PubMedID)2-s2.0-85179469304 (Scopus ID)HOA;;925172 (Local ID)HOA;;925172 (Archive number)HOA;;925172 (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017–01646Stiftelsen Sigurd och Elsa Goljes minneSwedish Society for Medical Research (SSMF)
Available from: 2024-01-09 Created: 2024-01-09 Last updated: 2024-02-07Bibliographically approved
Finkel, D., Nilsen, C., Sindi, S. & Kåreholt, I. (2024). Impact of childhood and adult socioeconomic position on change in functional aging. Health Psychology, 43(5), 388-395
Open this publication in new window or tab >>Impact of childhood and adult socioeconomic position on change in functional aging
2024 (English)In: Health Psychology, ISSN 0278-6133, E-ISSN 1930-7810, Vol. 43, no 5, p. 388-395Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To examine life-course models by investigating the roles of childhood and adult socioeconomic position (SEP) in longitudinal changes in a functional aging index.

METHOD: Up to eight waves of testing, covering 25 years, were available from the Swedish Adoption/Twin Study of Aging: N = 654, intake age = 50-82. A two-slope latent growth curve model was applied to the data, and the impact of including childhood and adult SEP as covariates of the intercept (at age 70) and slopes (before and after age 70) was tested.

RESULTS: Both childhood and adult SEP contributed to the best-fitting model. Childhood SEP was significantly associated with intercept and Slope 1 (before age 70) of the latent growth curve model (p < .05). Association of adult SEP with Slope 2 (after age 70) trended toward significance (p < .10). There was a significant interaction effect of childhood and adult SEP on the intercept (p < .05). As a result, intercept at age 70 was highest and change after age 70 was fastest for those whose SEP decreased from childhood to adulthood.

CONCLUSIONS: Both childhood and adult SEP impact change in functional abilities with age, supporting both critical period and social mobility models. The social environment is modifiable by policies at local, national, and international levels, and these policies need to recognize that early social disadvantage can have long-lasting health impacts.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-63386 (URN)10.1037/hea0001356 (DOI)001137077200001 ()38190203 (PubMedID)2-s2.0-85190902745 (Scopus ID);intsam;928824 (Local ID);intsam;928824 (Archive number);intsam;928824 (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 97:0147:1B, 2009-0795Swedish Research Council, 825-2007-7460, 825-2009-6141Axel and Margaret Ax:son Johnson FoundationVårdal FoundationRiksbankens Jubileumsfond
Available from: 2024-01-17 Created: 2024-01-17 Last updated: 2024-05-03Bibliographically approved
Norgren, J., Kåreholt, I. & Sindi, S. (2024). Is there evidence of a ketogenic effect of coconut oil? Commentary: Effect of the Mediterranean diet supplemented with nicotinamide riboside and pterostilbene and/or coconut oil on anthropometric variables in amyotrophic lateral sclerosis. A pilot study [Letter to the editor]. Frontiers in Nutrition, 10, Article ID 1333933.
Open this publication in new window or tab >>Is there evidence of a ketogenic effect of coconut oil? Commentary: Effect of the Mediterranean diet supplemented with nicotinamide riboside and pterostilbene and/or coconut oil on anthropometric variables in amyotrophic lateral sclerosis. A pilot study
2024 (English)In: Frontiers in Nutrition, E-ISSN 2296-861X, Vol. 10, article id 1333933Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
caprylic acid, coconut oil, diet terminology, ketogenic diet, ketosis, lauric acid, medium-chain triglycerides, non-ketogenic
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:hj:diva-63447 (URN)10.3389/fnut.2023.1333933 (DOI)001171386200001 ()38260082 (PubMedID)2-s2.0-85182809057 (Scopus ID)GOA;;933708 (Local ID)GOA;;933708 (Archive number)GOA;;933708 (OAI)
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-05-02Bibliographically approved
Projects
Swedish research collaboration on digital care [2024-02152_Forte]; Uppsala University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8617-0355

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