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  • 1.
    Ahlander, Britt-Marie
    et al.
    Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Maret, Eva
    Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
    Starck, Sven-Åke
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Department of Oncology, Hospital Physics, Ryhov County Hospital, Jönköping, Sweden.
    Engvall, Jan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion2017In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 1, p. 52-61Article in journal (Refereed)
    Abstract [en]

    Background: To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo–echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference.

    Methods: Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study.

    Results: Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI).

    Conclusion: GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.

  • 2.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Factors affecting in-hospital sleep-wake pattern in octogenarians during the early postoperative phase after transcutaneous aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S53-S53Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarian patients are an increasing group admitted for advanced cardiac treatment. Little is known about factors disturbing their sleep-wake pattern in the early postoperative phase after transcutaneous aortic valve replacement (TAVI), as current knowledge is based upon studies on younger age groups treated for surgical aortic valve replacement.

    Aim: To determine factors affecting the in-hospital sleep wake pattern in octogenarian patients after TAVI.

    Methods: This is a prospective cohort study in a tertiary university hospital. Inclusion criteria were age > 80 years with severe aortic stenosis accepted for TAVI. Actigraphy was used to identify sleep-wake pattern (sleep time night and sleep time day), and the Minimal Insomnia Symptom Scale (MISS) to measure self-reported insomnia daily during the first five postoperative days. Charlson`s comorbidity index was used as a measure of comorbidities and the Visual Analog Scale (VAS) to rate pain severity. Information regarding duration of anesthesia, blood transfusion and parenteral administration of morphine equivalents were derived from the patients’ medical journals. Multiple regression analysis was used to test associations between variables.

    Results: In all, 65 patients (41 women) were included. Mean age was 85 years (SD 2.8). No significant associations were found between age, comorbidities, blood transfusion and morphine equivalents and sleep. Gender was significantly associated with sleep time night and sleep efficiency as men had shortest duration of sleep from the third to the fifth postoperative night (p < .001, and adjusted R2=.230 to .283). Duration of anesthesia had a significant association with sleep time night and sleep efficiency from the third to the fifth postoperative night (p=.013 to p < .001, and adjusted R2=.230 to .283), where longer duration gave less total sleep and lower sleep efficiency. VAS score correlated with wake time night the third night, where a higher VAS score gave more wake time (p=.006 and adjusted R2 .236).

    Conclusion: Male gender, longer duration of perioperative anesthesia and postoperative pain were associated with disturbances in the postoperative sleep-wake pattern in octogenarian patients in the early postoperative phase after TAVI. This knowledge is important and relevant and should have implications in improving patient care.

  • 3.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Faculty of Health and Social Science, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway .
    Factors associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after surgical aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S63-S64Article in journal (Refereed)
    Abstract [en]

    Background: Disturbances of the sleep-wake pattern are known phenomenon in the postoperative phase after aortic valve replacement (SAVR) that have negative impact on the morbidity, quality of life and mortality. Octogenarian patients are an increasing group admitted for cardiac surgery, however knowledge is based on younger patients.

    Aims: To determine factors associated with disturbances in postoperative sleep-wake pattern in octogenarian patients after SAVR.

    Methods: A prospective cohort study of octogenarian patients in a single center university hospital. Inclusion criteria were age > 80 years, severe aortic stenosis, accepted for SAVR. Actigraphy was used to identify the sleep-wake pattern (sleep-time, sleep efficiency and wake time night and sleep- and wake-time day) for the five first postoperative days, and the sleep questionnaires Minimal Insomnia Symptom scale (MISS) to measure the selfreported insomnia at baseline and daily for the five first postoperative days. 

    Charlsons comorbidity index was used to score comorbidities and the Visual Analog Scale (VAS), was used to rate pain severity. The patients’ medical journals were used to record duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusions and parenteral administration of morphine equivalents. Multiple regression analysis was used to test associations between variables.

    Results: In all, 78 patients were included (40 women). Mean age was 82 years (SD 2.0). For the sleep-wake pattern first to fifth postoperative night, mean sleep-time night was 330-370 minutes (SD 32-124). Mean sleep efficiency was 68-77% (SD 21-26). Mean sleep-time day was 545-712 minutes (SD 146-169). Mean insomnia score was 1,8-5,3 (SD 2,6-3,8). On the first postoperative night the pain VAS score correlated with wake time night, where a higher VAS indicated more wake time (p=.014, adjusted R2=.213). No other variable; age, gender, duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusion or morphine equivalents showed significant association with the sleep-wake pattern or insomnia.

    Conclusion: Postoperative pain was associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after SAVR. This indicates that pain management may be inadequate for patients after SAVR. More research on this issue is needed to establish data needed to improve treatment and care.

  • 4.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, R.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Instenes, I.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Kuiper, K. K. J.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Ranhoff, A. H.
    University of Bergen, Department of clinical science, faculty of medicine, Bergen, Norway.
    Schjott, J. D.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Norekval, T. M.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Octogenarian patients experiences with hypnotics in relation to sleep disturbances and delirium after aortic valve therapy2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 104-105Article in journal (Refereed)
    Abstract [en]

    Background: Sleep disturbance and delirium are complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve replacement (TAVI), especially in octogenarian patients. Sedatives and z-hypnotics are medications distributed to promote sleep. However, a knowledge-gap exists on patient experiences with these medications, and sleep and delirium after the cardiac treatment.

    Aim: To explore and describe how octogenarians suffering from delirium after SAVR/TAVI experience their sleep situation related to sedatives and z-hypnotics, in a long-term perspective.

    Methods An explorative and descriptive design with a longitudinal qualitative approach was applied. Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium. Information about administration of sedatives and z-hypnotics was collected from the patients journals. The Confusion Assessment Method (CAM) was used to assess delirium, the Sleep Sufficient Index (SSI) and Minimal Insomnia Symptom Scale (MISS) were used to document self-reported sleep and insomnia. All measures were performed at baseline and daily the five first postoperative days. Ten patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were re-interviewed four years later, focusing on their sleep situation.

    Findings: For the initial interview, five men and five woman, four after TAVI and six after SAVR, mean age 83 were included. One overarching theme revealed; hours in bed represented an emotional chaos. Three sub-themes described the patients experiences with sleep and delirium, a cascade of distressful experiences, the struggle between sleep and activity and elements influencing sleep. In the category physical sleep distractions, sleep medications emerged as a sleep disturbing element but also to evoke delirium. Patients described to be offered sedatives and z-hypnotics in hospital. However, they did not have a positive experience with this as the medication did not make them sleep better. Moreover, they associated the nightmares by the sedatives Four years after the cardiac treatment, the octogenarian patients described that medication did not have a sleep promoting effect, and they did not want it.

    Conclusion: Octogenarian patients are vulnerable to complications like sleep disturbances and delirium. In preventing and treating these conditions, health-care professionals should be aware of the effect and side-effect of sedatives and z-hypnotics in the octogenarian patients. Our findings show that medications should be cautiously used within this group of patients.

  • 5.
    Amofah, Hege A.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Bjorvatn, Bjørn
    Norwegian Competence Centre for Sleep Disorders, Bergen, Norway.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 168-177Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.

    Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.

    Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.

    Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).

    Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

  • 6.
    Arenhall, Eva
    et al.
    Örebro Universitet, Department of Cardiology, Örebro, Sweden.
    Eriksson, Mats
    Uddevalla Hospital, Department of Pediatrics, Uddevalla, Sweden.
    Nilsson, Ulrica
    Örebro Universitet, School of Health Sciences, Örebro, Sweden.
    Steinke, Elaine E.
    Wichita State University, School of Nursing, Wichita, United States.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Decreased sexual function in partners after patients’ first-time myocardial infarction2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 521-526Article in journal (Refereed)
    Abstract [en]

    Background: A myocardial infarction event affects not only patients but also partners, although how it affects the partners’ sexual function is not studied.

    Aim: The purpose of this study was to describe and compare how partners experienced their sexual function one year before with one year after first-time myocardial infarction of their partner.

    Methods: A longitudinal and comparative design was used. Self-reported data on Watts Sexual Function Questionnaire was collected retrospectively at two occasions from 123 partners (87 women and 36 men), measuring the year prior to the first-time myocardial infarction and the year after. Data were analysed using descriptive and inferential statistics.

    Results: The total score for Watts Sexual Function Questionnaire showed a significant decrease over time. In all four subscales a decrease was found, which were statistically significant in three out of the four subscales (sexual desire, 19.39 vs 18.61; p<0.001, orgasm, 14.11 vs 13.64; p=0.027 and satisfaction, 12.61 vs 12.31; p=0.042). Twenty-six partners reported that their intercourse frequencies decreased over time, while six partners reported an increased intercourse frequency.

    Conclusions: Partners’ sexual function decreased after patients’ first-time myocardial infarction. It is important for health personnel to offer information and discussion about sexual function and concerns with both patients and partners after a first-time myocardial infarction. 

  • 7.
    Barmano, Neshro
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Walfridsson, Ulla
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Walfridsson, Håkan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Jan-Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Structured care of patients with atrial fibrillation improves guideline adherence2016In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 9, no 4Article in journal (Refereed)
    Abstract [en]

    There are many reports of lack of guideline adherence in the treatment of patients with atrial fibrillation (AF), and AF affects health-related quality of life (HRQo L) negatively. The aim of this study was to investigate whether structured care compared to standard care of a general AF population could improve guideline adherence and HRQo L, and reduce symptoms, anxiety and depression. In total, 176 patients were recruited to the intervention and 146 patients to the control group. The intervention consisted of a structured follow-up program, while patients serving as controls received standard care. The primary outcome was guideline adherence evaluated through: appropriate use of oral anticoagulants (OAC) and antiarrhythmics, whether echocardiogram and thyroid lab tests were performed, and patient-reported outcome measures (PROMs), assessed with the questionnaires SF-36, EQ-5D, HADS and ASTA at baseline and after one year Guideline adherence was significantly better in the intervention group, 91% vs. 63% (p < 0.01), mainly due to appropriate OAC treatment 94% vs. 74% (p < 0.01). Symptoms assessed with ASTA were less frequent and the negative impact of AF was reduced in the intervention group after one year/at follow-up. Five scales in SF-36, and the visual analogue scale for current health status in EQ-5D (EQ-VAS), improved significantly in both groups. Structured care of patients with AF significantly improved guideline adherence and patients reported fewer symptoms and a reduced negative impact on disease-specific HRQo L compared to standard care at one year follow-up.

  • 8.
    Björck, Hanna M.
    et al.
    Linköping University.
    Eriksson, Per
    Karolinska Institutet.
    Alehagen, Urban
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Ljungberg, Liza U.
    Linköping University.
    Persson, Karin
    Linköping University.
    Dahlstrom, Ulf
    Linköping University.
    Länne, Toste
    Linköping University.
    Gender-Specific Association of the Plasminogen Activator Inhibitor-1 4G/5G Polymorphism With Central Arterial Blood Pressure2011In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 24, no 7, p. 802-808Article in journal (Refereed)
    Abstract [en]

    BACKGROUND The functional plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism has previously been associated with hypertension. In recent years, central blood pressure, rather than brachial has been argued a better measure of cardiovascular damage and clinical outcome. The aim of this study was to investigate the possible influence of the 4G/5G polymorphism on central arterial blood pressure in a cohort of elderly individuals.

    METHODS We studied 410 individuals, 216 men and 194 women, aged 70-88. Central pressures and pulse waveforms were calculated from the radial artery pressure waveform by the use of the SphygmoCor system and a generalized transfer function. Brachial pressure was recorded using oscillometric technique (Dinamap, Critikon, Tampa, FL). PAI-1 antigen was determined in plasma.

    RESULTS The results showed that central pressures were higher in women carrying the PAI-1 4G/4G genotype compared to female carriers of the 5G/5G genotype, (P = 0.025, P = 0.002, and P = 0.002 for central systolic-, diastolic-, and mean arterial pressure, respectively). The association remained after adjustment for potentially confounding factors related to hypertension. No association of the PAI-1 genotype with blood pressure was found in men. Multiple regression analysis revealed an association between PAI-1 genotype and plasma PAI-1 levels (P = 0.048).

    CONCLUSIONS Our findings show a gender-specific association of the PAI-1 4G/5G polymorphism with central arterial blood pressure. The genotype effect was independent of other risk factors related to hypertension, suggesting that impaired fibrinolytic potential may play an important role in the development of central hypertension in women.

  • 9.
    Blomstrand, Peter
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. City Hospital Ryhov, Jönköping, Sweden.
    Engvall, Martin
    Linköping University.
    Festin, Karin
    Linköping University.
    Lindstrom, Torbjorn
    Linköping University.
    Länne, Toste
    Linköping University.
    Maret, Eva
    Karolinska University Hospital, Stockholm.
    Nyström, Fredrik H.
    Linköping University.
    Maret-Ouda, John
    Karolinska University Hospital, Stockholm.
    Östgren, Carl Johan
    Linköping University.
    Engvall, Jan
    Linköping University.
    Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes2015In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 16, no 9, p. 1000-1007Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the study was to determine whether left ventricular systolic function, in terms of global left ventricular longitudinal strain (GLS), and diastolic function, expressed as the ratio between early diastolic transmitral flow and mitral annular motion velocities (E/e'), can predict cardiovascular events in patients with diabetes mellitus type 2.

    Methods and results: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, pulse pressure (pp), and glycosylated haemoglobin (HbA1c) were analysed. Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 +/- 17 months. Univariate Cox regression analysis showed that E/e' was a strong predictor of cardiovascular events (hazards ratio 1.12; 95% confidence interval 1.06-1.18, P < 0.001). E/e' was prospectively associated with cardiovascular events independent of age, sex, GLS, left ventricular ejection fraction (LVEF), pp, and HbA1c in multivariate analysis. Receiver operating characteristic curves showed that E/e' and HbA1c were the strongest predictors for cardiovascular events, both having an area under the curve (AUC) of 0.71 followed by LVEF with an AUC of 0.65 and GLS of 0.61. In a Kaplan-Meyer analysis, the cumulative probability of an event during the follow-up period was 8.6% for patients with an E/e' ratio >15 compared with 2.6% for patients with E/e' <= 15, P = 0.011.

    Conclusion: In middle-aged patients with type 2 diabetes, E/e' is a strong predictor of myocardial infarction and stroke, comparable with HbA1c and superior to GLS and LVEF.

  • 10.
    Blomstrand, Peter
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. County Hospital Ryhov, Department of Clinical Physiology, Jönköping, Sweden.
    Sjöblom, Peter
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Nilsson, Mats
    Futurum, Academy for Health and Care, Jönköping, Sweden.
    Wijkman, Magnus
    Linköping University, Department of Internal Medicine and Department of Medical and Health Sciences, Norrköping, Sweden.
    Engvall, Martin
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain2018In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 17, no 1, article id 113Article in journal (Refereed)
    Abstract [en]

    Aims

    Obesity is associated with type 2 diabetes mellitus, left ventricular diastolic dysfunction and heart failure but it is unclear to which extent it is related to left ventricular systolic dysfunction. The aim of the study was to explore the effects of overweight and obesity on left ventricular systolic function in patients with type 2 diabetes mellitus and a control group of non-diabetic persons.

    Methods

    We prospectively investigated 384 patients with type 2 diabetes mellitus, and 184 controls who participated in the CARDIPP and CAREFUL studies. The participants were grouped according to body mass index (normal weight < 25 kg/m2, overweight 25–29 kg/m2, and obesity ≥ 30 kg/m2). Echocardiography was performed at the beginning of the study and after 4-years in the patient group.

    Results

    Univariable and multivariable regression analysis revealed that variations in left ventricular ejection fraction, global longitudinal strain, left ventricular mass and diastolic function expressed as E/é (the ratio between early diastolic mitral flow and annular motion velocities) all are related to body mass index. The mean and standard deviation of left ventricular ejection fraction and global longitudinal strain values were 57% (8%) vs. − 18.6% (2.3%) for normal weight patients, 53% (8%) vs. − 17.5% (2.3%) for overweight, and 49% (9%) vs. − 16.2% (3.0%) for obese (p < 0.05 vs. p < 0.05). Corresponding results in the control group were 58% (6%) vs. − 22.3% (3.0%), 55% (7%) vs. − 20.8% (3.1%) and 54% (8%) − 19.6% (4.0%) (p < 0.05 vs. p < 0.05). Patients who gained weight from baseline to follow-up changed left ventricular ejection fraction (median and interquartile range) by − 1.0 (9.0) % (n = 187) and patients who lost weight changed left ventricular ejection fraction by 1.0 (10.0) % (n = 179) (p < 0.05).

    Conclusion

    Overweight and obesity impair left ventricular ejection fraction and global longitudinal strain in both patients with type 2 diabetes mellitus and non-diabetic persons.

  • 11.
    Dahl, Julia
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Olander, Lisa
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Bestämning av ejektionsfraktion i vila med ekokardiografi och myokardscintigrafi: En metodjämförelse2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 12.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Benzein, Eva
    School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Sandgren, Anna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Managing uncertainty in couples living with atrial fibrillation2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 3, p. E1-E10Article in journal (Refereed)
    Abstract [en]

    Background: Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease.

    Objective: The aim of this study was to explore couples’ main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship.

    Methods: Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately.

    Results: Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples’ shifting between implicit and explicit sharing.

    Conclusions: Atrial fibrillation affects the partner relationship by bringing uncertainty into couples’ daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.

  • 13.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Sandgren, Anna
    Linnaeus University, The Center for Collaborative Palliative Care, Vaxjo, Sweden.
    Benzein, Eva
    Linnaeus University, The Center for Collaborative Palliative Care, Vaxjo, Sweden.
    The heart is a representation of life: an exploration of illness beliefs in couples living with atrial fibrillation2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S41-S41, article id 116Article in journal (Refereed)
    Abstract [en]

    Background: Beliefs are the lenses through which we view the world, guiding our behaviour and constructing our lives. Couples evolve an ecology of beliefs from their interaction whereby their actions and choices arise from their beliefs. Atrial fibrillation is a common cardiac arrhythmia that has implications for both patients and partners. A couple’s illness beliefs play an important role in convalescence and illness management, and no previous studies have examined illness beliefs in couples living with AF.

    Purpose: To explore illness beliefs in couples where one spouse has atrial fibrillation.

    Methods: Data collection constituted in-depth interviews with nine couples (patient and partner together). Hermeneutic philosophy as described by Gadamer was used to interpret and to understand illness beliefs in couples living with AF.

    Results: The findings revealed both core illness beliefs and secondary illness beliefs. From the core illness belief “Theheart is a representation of life,” two secondary illness beliefs were derived: atrial fibrillation is a threat to life and atrial fibrillation can and must be explained. From the core illness belief “Change is an integral part of life,” two secondary illness beliefs were derived: atrial fibrillation is a disruption in our lives and atrial fibrillation will not interfere with our lives. Finally, from the core illness belief “Adaptation is fundamental in life,” two secondary illness beliefs were derived: atrial fibrillation entails adjustment in daily life and atrial fibrillation entails confidence in and adherence to professional care.

    Conclusion: Couples’ interaction has developed mutual illness beliefs regarding atrial fibrillation that guide them in their daily lives and influence their decisions. The adoption of a family-centred perspective in cardiovascular care settings is warranted.

  • 14.
    De Basso, Rachel
    et al.
    Jönköping Hospital.
    Åstrand, Håkan
    Jönköping Hospital.
    Ahlgren, Åsa Rydén
    Lund University.
    Sandgren, Thomas
    Capio Lundby Hospital, Gothenburg, Sweden.
    Länne, Toste
    Linköping University.
    Low wall stress in the popliteal artery: Other mechanisms responsible for the predilection of aneurysmal dilatation?2014In: Vascular Medicine, ISSN 1358-863X, E-ISSN 1477-0377, Vol. 19, no 2, p. 131-136Article in journal (Refereed)
    Abstract [en]

    The popliteal artery (PA) is, after aorta, the most common site for aneurysm formation. Why the PA is more susceptible than other peripheral muscular arteries is unknown. We hypothesized that the wall composition, which in turn affects wall properties, as well as the circumferential wall stress (WS) imposed on the arterial wall, might differ compared to other muscular arteries. The aim was to study the WS of the PA in healthy subjects with the adjacent, muscular, common femoral artery (CFA) as a comparison. Ninety-four healthy subjects were included in this study (45 males, aged 10-78 years and 49 females, aged 10-83 years). The diameter and intima-media thickness (IMT) in the PA and CFA were investigated with ultrasound. Together with blood pressure the WS was defined according to the law of Laplace adjusted for IMT. The diameter increased with age in both PA and CFA (p<0.001), with males having a larger diameter than females (p<0.001). IMT increased with age in both PA and CFA (p<0.001), with higher IMT values in males only in PA (p<0.001). The calculated WS was unchanged with age in both arteries, but lower in PA than in CFA in both sexes (p<0.001). In conclusion, this study shows that the PA and CFA WS is maintained during aging, probably due to a compensatory remodelling response with an increase in arterial wall thickness. However, the stress imposed on the PA wall is quite low, indicating that mechanisms other than WS contribute to the process of pathological arterial dilatation in the PA.

  • 15.
    Debasso, Rachel
    et al.
    Department of Medicine and Care, University of Linköping, Sweden; Department of Clinical Physiology, Jönköping Hospital, Länssjukhuset Ryhov, Jönköping, Sweden.
    Åstrand, H.
    Department of Medicine and Care, University of Linköping, Sweden.
    Bjarnegård, N.
    Department of Medicine and Care, University of Linköping, Sweden.
    Ahlgren, Å. R.
    Department of Clinical Physiology, Malmö University Hospital, Sweden.
    Sandgren, T.
    Department of Surgery, Helsingborg Hospital, Sweden.
    Länne, T.
    Department of Medicine and Care, University of Linköping, Sweden.
    The popliteal artery, an unusual muscular artery with wall properties similar to the aorta: Implications for susceptibility to aneurysm formation?2004In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 39, no 4, p. 836-842Article in journal (Refereed)
    Abstract [en]

    Objective: The popliteal artery is, after the aorta, the most common site for aneurysm formation. Why the popliteal artery is more susceptible than other peripheral muscular arteries is unknown. An important factor may be differences in arterial wall composition as compared with other peripheral muscular arteries, which in turn affect wall properties. These are however unknown. We studied the mechanical wall properties of the popliteal artery in healthy subjects.

    Material and Methods: An ultrasound echo-tracking system was used to measure pulsatile changes in popliteal diameter in 108 healthy subjects (56 female, 52 male; age range, 9-82 years). In combination with blood pressure, stiffness (0), strain, cross-sectional artery wall compliance coefficient (CC), and distensibility coefficient (DC) were calculated. Intima-media thickness (IMT) was registered with a Philips P700 ultrasound scanner.

    Results: The popliteal diameter increased with age, and was larger in male subjects than in female subjects (P < .001). Fractional diameter change (strain) decreased with age (P < .001), and strain values were lower in male subjects than in female subjects (P < .01). Accordingly, stiffness increased with age (P < .001), with higher stiffness values in male subjects (P < .01). DC decreased with age (P < .001), with lower DC values in male subjects (P < .01). CC decreased with age, with no difference between genders (P < .001). IMT increased with age (P < .001), with higher IMT values in male subjects (P < .001). The increase in IMT did not affect distensibility.

    Conclusion: The wall properties of the popliteal artery are affected by age and gender, not only with an increase in diameter, but also with an age-related decrease in distensibility, with male subjects having lower distensibility than in female subjects. This seems not to be the behavior of a true muscular artery, but of a central elastic artery, such as the aorta, and might have implications for susceptibility to arterial dilatation, as well as the association of aneurysm formation between the aorta and the popliteal artery.

    Clinical Relevance: The popliteal artery is, after the abdominal aorta, the most common location for aneurysm formation in the arterial system. Why it is more susceptible than other arteries is unknown. This study shows that the wall function of the popliteal artery differs from other peripheral arteries, and instead show striking similarities to the abdominal aorta, indicating that the functional arrangement of arterial wall components are similar in the two arteries. This may have implications for the susceptibility to aneurysm formation, as well as the association of dilating disease between the popliteal artery and the abdominal aorta.

  • 16.
    Eide, L. S. P.
    et al.
    Bergen University College, Faculty of Health and Social Sciences, Bergen, Norway.
    Ranhoff, A. H.
    Haraldsplass Diakonale Hospital, Kavli Research Center for Geriatrics and Dementia, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Haaverstad, R.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Hufthammer, K. O.
    Haukeland University Hospital, Centre for Clinical Research, Bergen, Norway.
    Lauck, S.
    St Paul’s Hospital, Centre for Heart Valve Innovation, Vancouver, Canada.
    Norekval, T. M.
    Bergen University College, Faculty of Health and Social Sciences, Bergen, Norway.
    Urinary catheter use and delirium after aortic valve therapy2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S3-S4Article in journal (Refereed)
    Abstract [en]

    Background: Indwelling urinary catheters (IUC) are valuable devices that help to control and monitor urine output under and after invasive procedures. However, adverse outcomes might arise following use of IUC, and several studies show that IUC can be a risk factor for postoperative delirium. Delirium is an acute and fluctuating change in attention and cognition that might lead to extended hospital stay, and more morbidity and mortality. The association between delirium and the duration of IUC use in octogenarians after Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Implantation (TAVI) remains to be established.

    Purpose: To determine if the duration of IUC use after SAVR or TAVI predicts the development of delirium in older people.

    Methods: This is a prospective cohort study of octogenarian patients (N=136) in a tertiary university hospital. Inclusion criteria: ⩾80 years, severe aortic stenosis, and elective TAVI or SAVR. Exclusion criteria: Inability to speak Norwegian or declined consent to participate in the study. The Mini-Mental State examination was used to evaluate global cognitive function at baseline. The Confusion Assessment Method allowed the identification of delirium during five postoperative days. The duration of IUC use was collected from patients’ medical records. The predictive effect of IUC in the development of delirium was examined using multiple regression.

    Results: The majority (57%) of patients was female, and 46% received TAVI. Patients in the TAVI group were older (85 vs. 82 years-old, P<0.001), had more comorbidities (2.5 vs.1.8, P=0.001) and higher logistic EuroSCORE (19.6 vs. 9.4,P<0.001). Delirium was present in 66% of patients treated with SAVR vs. 44% of those receiving TAVI. The average duration of IUC use in SAVR patients with delirium was 66 hours (SD=29) compared to 59 hours (SD=27) in those without delirium (P=0.307), and in TAVI patients with delirium was 58 hours (SD=38) compared to 32 hours (SD=15) for those without delirium (P=0.001). Multivariate regression analysis shows that lower cognitive function (P=0.040), type of aortic valve treatment (P=0.043) and longer of IUC use (P=0.002) predicted the development of delirium.

    Conclusion: In octogenarian patients undergoing aortic valve treatment, the duration of IUC use can predict delirium. Further research is needed to mitigate the risks of delirium in patients undergoing aortic valve treatment.

  • 17.
    Eide, Leslie S. P.
    et al.
    Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Nordrehaug, Jan Erik
    Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
    Norekval, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway .
    Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: A prospective cohort study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 10, article id e012683Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission.

    Design: Prospective cohort study of patients undergoing elective SAVR or TAVI.

    Setting: Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway.

    Participants: Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. Primary and secondary outcome measures: The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries.

    Results: Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (nondelirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. Conclusions: Delirium in octogenarians after aortic valve therapy might be a serious risk factor for postoperative morbidity and mortality. Cardiovascular disorders and injuries were associated with first-time readmissions in these patients.

  • 18.
    Frantzen, A.
    et al.
    Haukeland Hospital, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eide, L. S. P.
    University of Bergen, Norway.
    Haaverstad, R.
    Haukeland Hospital, Bergen, Norway.
    Hufthammer, K. O.
    Haukeland Hospital, Bergen, Norway.
    Kuiper, K. K. J.
    Haukeland Hospital, Bergen, Norway.
    Ranhoff, A.
    University of Bergen, Norway.
    Norekval, T. M.
    Haukeland Hospital, Bergen, Norway.
    Change in frailty status in octogenarians with severe symptomatic aortic stenosis after aortic valve replacement2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, p. 788-789Article in journal (Other academic)
  • 19.
    Fålun, Nina
    et al.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Heart Disease, Haukeland University Hospital, Norway.
    Schaufel, Margrethe A.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Schei, Edvin
    Department of Global Public Health and Primary Care, University of Bergen, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Patients’ goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, p. 495-503Article in journal (Refereed)
    Abstract [en]

    Background: Myocardial infarction (MI) patients may find it challenging to adhere to lifestyle advice and medications. Understanding motivational factors and barriers to change is crucial. However, empirical evidence on patients’ ability to effect lifestyle changes at the time of discharge is limited.

    Aim: The aim of this study was to identify at the time of hospital discharge the goals, resources, and barriers to future change in MI patients.

    Methods: We conducted a qualitative interview study with a purposive sample of 20 MI patients (eight women) in a cardiac department at a university hospital in Norway. All interviews were conducted before hospital discharge, transcribed verbatim, and analysed using qualitative content analysis.

    Findings: Three themes suggested that, at the time of discharge, patients’ views of their MI were complex and diverse. Patients were motivated to change their lifestyle and contemplated taking their life in new directions, adopting a change of life perspective. Frequently, patients struggled to understand the context of living with an MI, manage symptoms, and understand the precipitating causes of MI. There were also patients who wanted to maintain their present lifestyle and live as normal as possible. They just wanted to keep going.

    Conclusions and implications: There is a need for a different approach to communicating with MI patients at the time of discharge. Person-centred care that allows personal narratives to emerge may enable health-care professionals to offer more individualised guidance to MI patients that will help them cope with the everyday challenges they experience after discharge.

  • 20.
    Gabrielson, Marike
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Vorkapic, Emina
    Department of Medical and Health Sciences, Linköping University.
    Folkesson, Maggie
    Department of Medical and Health Sciences, Linköping University.
    Welander, Martin
    Department of Medical and Health Sciences, Linköping University.
    Matussek, Andreas
    Department of Laboratory Services, County Hospital Ryhov.
    Dimberg, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Länne, Toste
    Department of Medical and Health Sciences, Linköping University.
    Skogberg, Josefin
    Division of Vascular Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm.
    Wågsäter, Dick
    Department of Medical and Health Sciences, Linköping University.
    Altered PPARγ coactivator-1 alpha expression in abdominal aortic aneurysm: Possible effects on mitochondrial biogenesis2016In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 53, no 1-2, p. 17-26Article in journal (Refereed)
    Abstract [en]

    Introduction: Abdominal aortic aneurysm (AAA) is a complex and deadly vascular disorder. The pathogenesis of AAA includes destruction and phenotypic alterations of the vascular smooth muscle cells (VSMCs) and aortic tissues. PPARγ coactivator-1 alpha (PGC1α) regulates VSMC migration and matrix formation and is a major inducer of mitochondrial biogenesis and function, including oxidative metabolism. Methods: Protein and gene expression of PGC1α and markers for mitochondria biogenesis and cell type-specificity were analysed in AAA aortas from humans and mice and compared against control aortas. Results: Gene expression of PPARGC1A was decreased in human AAA and angiotensin (Ang) II-induced AAA in mice when compared to control vessels. However, high expression of PGC1α was detected in regions of neovascularisation in the adventitia layer. In contrast, the intima/media layer of AAA vessel exhibited defective mitochondrial biogenesis as indicated by low expression of PPARGC1A, VDAC, ATP synthase and citrate synthase. Conclusion: Our results suggest that mitochondrial biogenesis is impaired in AAA in synthetic SMCs in the media, with the exception of newly formed supporting vessels in the adventitia where the mitochondrial markers seem to be intact. To our knowledge, this is the first study investigating PGC1α and mitochondria biogenesis in AAA.

  • 21.
    Gullvag, M.
    et al.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Gjeilo, K. H.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Falun, N.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Norekval, T. M.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Mo, R.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sleepless nights and sleepy days - a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep disordered breathing2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S57-S58Article in journal (Refereed)
    Abstract [en]

    Background: Sleep disordered breathing (SDB) is a pathologic, nocturnal breathing pattern present in at least 50% of patients with chronic heart failure (CHF). SDB is categorized as central or obstructive, and both are associated with worsened prognosis, affects physical and mental capacity and influences quality of life. Knowledge of how SDB is experienced by patients with CHF is limited, and has not previously been addressed in qualitative studies.

    Purpose: The aim of this study was to explore the experiences of patients with CHF and newly verified and untreated SDB.

    Methods: The study used an inductive descriptive design, collecting data through semi-structured interviews analysed with qualitative content analysis. Twelve participants (9 men and 3 women, mean age 62 (range 41-80)) diagnosed with CHF and a newly objectively verified (i.e., by polygraphy) SDB (6 obstructive, 5 central and 1 mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals.

    Results: The participants’ descriptions fell into five categories: Sleep disruption causing troublesome nights: Disruptive nights with sleep onset latency, frequent arousals and early morning awakenings caused frustration and a longing for a night of uninterrupted sleep. Daily life challenges due to daytime sleepiness: Excessive tiredness led to a need for sleep during the day, overactivity to avoid tiredness, extra care when operating a vehicle, and a feeling that concentration and memory were impaired. Involvement of a partner: The partners were described as being more affected by the sleep apnea than the participants, and it was apparent that the apneas caused fear and worry for the partners. Self-care strategies: Use of a dark, quiet and well-ventilated bedroom and avoidance of actions that could impair sleep; i.e. daytime naps, coffee, or heavy meals before bedtime were described. Some participants discussed their  sleep problems with their GP, but experienced that the problems were not examined in detail and sleep medication was a common, however unwanted, solution. Awareness of SDB: Some participants were relieved as the finding of the SDB finally gave an explanation to their problems, while others were surprised by the result.

    Conclusion: Patients with CHF and SDB experienced that sleep disturbances influenced their daily life. Raised awareness on sleep is needed for these patients. Possible underlying causes for disruptive sleep, such as SDB, should be identified in order to establish proper treatment strategies and follow-up care for the individual. Future studies on both medical and nursing strategies to improve sleep for patients with CHF and SDB are needed, and intervention studies should be prioritized.

  • 22.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Karlsson, J. E. K.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Arestedt, K. A.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Factors associated with involvement in risk communication and confidence in shared decision making among patients with atrial fibrillation.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S74-S75Article in journal (Refereed)
    Abstract [en]

    Background: Atrial fibrillation (AF) is a highly prevalent arrhythmia. Effective communication of risks (e.g., risk for stroke) and benefits to patients (e.g., treatment with oral anticoagulants) is crucial for shared decision making. Knowledge about how patients experience confidence and satisfaction in communication in relation to their health status is limited.

    Aim: The aim was to explore factors associated with involvement in risk communication and confidence in shared decision making among patients with AF.

    Method: A cross-sectional design was used and 322 patients (39 % women), mean age 67 years (SD 10.3 years) with AF were included at four hospitals in Sweden. Clinical examinations and self-rating scales for risk communication (COMRADE), uncertainty in illness (MUIS-C), depressive symptoms (HADS), mastery of daily life (MDL), as well as physical and mental health (SF-36) were used to collect data after a follow-up visit at the outpatient clinic 3 months post an AF episode.

    Results: Paroxysmal, persistent and permanent AF occurred among 32%, 34% and 7% of the patients, respectively. Patients whom had undergone DC-conversion (53%) and had anticoagulants (37%). Seven percent had been treated by a percutan ablation. Heart failure (15%) and ischemic heart disease (12%) were the most common co-morbidities. CHA2DS2-VASc >2 were seen among 62% of the patients. Overall, multiple regression analyses showed that uncertainty in illness and mastery of daily life were significantly associated with confidence in decisions and uncertainty in illness and hypertension were significantly associated with satisfaction in communication. Higher uncertainty in illness and poorer mastery of daily life were associated with poor confidence in decisions. Higher uncertainty in illness and occurrence of hypertension were associated with poor satisfaction in communication. Clinical AF variables (i.e.,symptom or treatment related) or depressive symptoms were not significantly associated with satisfaction in communication or confidence in decisions in the multiple regression analysis. The final models explained 29% and 30% of the variance in confidence in decision making and satisfaction in communication.

    Conclusion: In this cross-sectional study, including patients with AF, confidence in decision making and satisfaction in communication are associated with uncertainty in illness, mastery of daily life and hypertension.

  • 23.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköpings län.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Ryhov County Hospital, Region Jönköpings län Jönköping, Sweden.
    Karlsson, Jan-Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Sweden.
    Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 5, p. 446-455Article in journal (Refereed)
    Abstract [en]

    Background:

    Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

    Aim:

    The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

    Methods:

    A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

    Results:

    Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

    Conclusion:

    Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

  • 24.
    Hjelmfors, A-L
    et al.
    Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden.
    Sandgren, A. S.
    Linnaeus University, Department of Healthc and Caring Sciences, Kalmar, Sweden.
    Stromberg, A. S.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Jaarsma, T. J.
    Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden.
    Friedrichsen, M. F.
    Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden.
    Patient perspectives of prognosis communication2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S65-S66Article in journal (Refereed)
    Abstract [en]

    Background: Several studies describe that patients with heart failure (HF) find it important to discuss prognosis and that they want to be informed about the expectations about the illness progression. However, little is known about their actual preferences for professional communication about prognosis.

    Purpose: to explore patient’s perspectives regarding communication with health care professionals about the HF prognosis.

    Methods: 15 patients participated in focus group interviews and a further 9 patients completed individual semi-structured interviews. The patients (75% men, 52-87 years of age) were in NYHA I-III, and were not diagnosed with any other major life threatening disease. Data was analysed using thematic analysis to identify and interpret patterns in the data.

    Results: One overarching theme was identified: “The tension between hoping for the best and preparing for the worst” with three sub-themes. Ignorance is bliss. Describes how patients preferred to avoid thinking about the HF prognosis because they did not want to lose hope for the future. They lived one day at the time, focusing on here and now, wanting to forget about the illness altogether. Patients also preferred to decide themselves whether they wanted to talk about the prognosis with professionals or not. Nothing but the truth. Describes how patients wanted to know the objective and absolute truth about their illness and its’ prognosis and were afraid to live under false expectations. The truth about their prognosis was that they might die because of their illness. Even though the truth may hurt, they believed that knowing the truth was necessary to live as good as possible. Good news only. Patients described that they knew that HF was a chronic illness but they were ambivalent in their approach towards discussing prognosis. They wanted to know the truth about their prognosis, but at the same time they did not want to know anything since they fear they might hear something they do not want to, as this may hurt. They only wanted to receive “good” and positive information from the professionals, since they perceived such information to be something that they can benefit from.

    Conclusions: This study shows that patients have different preferences for communication about prognosis and uses different approaches in order to cope living with a serious condition such as heart failure. Professionals need to respect the strategies a patient uses, and be ready to support the patient according to their needs, preferences and life situation.

  • 25.
    Hjelmfors, Anna-Lisa
    et al.
    Linköping University.
    Van der Wal, M. H. L.
    Linköping University.
    Strömberg, A.
    Linköping University.
    Friedrichsen, M.
    Linköping University.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, Tiny
    Linköping University.
    Challenges in discussing prognosis and end-of-life care with heart failure patients2015In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, p. 351-351Article in journal (Other academic)
  • 26.
    Hjelmfors, Lisa
    et al.
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friedrichsen, Maria
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, no 1, article id 85Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this paper was to describe the development of an intervention that is developed to improve communication about the heart failure (HF) trajectory and end-of-life care. We also present data that provides a first insight in specific areas of feasibility of the intervention.

    Methods: Co-design was used and patients, family members and health care professionals were constructive participants in the design process of the intervention. Feasibility of the intervention was tested in two areas; acceptability and limited efficacy.

    Results: Two communication tools were designed and evaluated; 1) a Question Prompt List (QPL) for patients and family members and 2) a communication course for professionals which was web -based with one face-to-face training day with simulation. Data on feasibility was collected with questionnaires that were developed for this study, from the 13 participants who completed the course (all nurses). They reported improved knowledge, confidence and skills to discuss the HF trajectory and end-of-life care. The QPL was evaluated to be a useful tool in communication with patients and family members.

    Conclusions: In a co-design process, future users identified the need for a QPL and a communication course. These communication tools can be used as a dual intervention to improve communication about the HF trajectory and end-of-life care. The QPL can help patients and families to ask questions about the HF trajectory and end-of-life care. The communication course can prepare the professionals to be knowledgeable, confident and skilled to discuss the questions in the QPL. Before the tools are ready for implementation in clinical practice, further studies testing the feasibility of the intervention are needed, including also patients and their families. 

  • 27.
    Hjelmfors, Lisa
    et al.
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friedrichsen, Maria
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 23-23Article in journal (Other academic)
  • 28.
    Johansson, Peter
    et al.
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Svensson, Erland
    Swedish Defence Research Agency, 58111, Linköping, Sweden.
    Alehagen, Urban
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Dahlström, Ulf
    Department of Cardiology, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden .
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, County Council of Östergötland, 58185, Linköping, Sweden .
    Sleep disordered breathing, hypoxia and inflammation: associations with sickness behaviour in community dwelling elderly with and without cardiovascular disease2015In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 19, no 1, p. 263-271Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Inflammation can induce a cluster of symptoms, referred to as sickness behaviour (e.g., depressive symptoms, sleep disturbances, pain and fatigue). Cardiovascular disease (CVD) and sleep disordered breathing (SDB) are common in older adults. CVD is associated with an increased inflammatory activity and in SDB, hypoxia can also increase inflammation. The purpose of this study is to explore if SDB-related hypoxia is associated differently with inflammation and the presence of sickness behaviour in older adults with and without CVD.

    METHODS:

    Three hundred and thirty-one older adults, whose mean age is 78 years, underwent one-night polygraphic recording to measure SDB and hypoxia. CVD was established by a clinical investigation. Questionnaires were used to measure sickness behaviour and depressive symptoms. High sensitivity C-reactive protein was used as a marker of inflammation.

    RESULTS:

    Structural Equation Modelling showed that SDB-related hypoxia was associated with inflammation (β > 0.40) which mediated indirect associations with sickness behaviour (β = 0.19) and depressive symptoms (β = 0.11), but only in those with CVD (n = 119). In this model, inflammation had a direct effect on sickness behaviour (β = 0.43) and an indirect effect on depressive symptoms (β = 0.24). Hypoxia had the strongest effect (i.e., β = 0.41; significant) on inflammation, whereas the AHI or ODI had weak and non-significant effects (β = 0.03 and β = 0.15).

    CONCLUSIONS:

    Older adults with CVD and SDB are at a particular risk of developing sickness behaviour and depressive symptoms. The effect of SDB was mainly caused by hypoxia, suggesting that hypoxia is an important marker of SDB severity in older adults with CVD.

  • 29.
    Johansson, Peter
    et al.
    Department of Medicine and Health Sciences, Linköping University, Sweden.
    Svensson, Erland
    Swedish Defence Research Agency, Sweden.
    Alehagen, Urban
    Department of Medicine and Health Sciences, Linköping University, Sweden; Department of Cardiology, Linkoping University, Sweden .
    Jaarsma, Tiny
    Department of Cardiology, Linköping University, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    The contribution of hypoxia to the association between sleep apnoea, insomnia, and cardiovascular mortality in community-dwelling elderly with and without cardiovascular disease2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 3, p. 222-231Article in journal (Refereed)
    Abstract [en]

    Aims: This study explores if nightly hypoxia (i.e. percentage of sleep time with oxygen saturation lower than 90% (SaO2<90%)) contributed to the association between sleep-disordered breathing (SDB) and insomnia in community-dwelling elderly with and without cardiovascular disease (CVD). A second aim was to explore a potential cut-off score for hypoxia to predict insomnia and the association of the cut-off with clinical characteristics and cardiovascular mortality. Method: A total of 331 community-dwelling elderly aged 71-87 years underwent one-night polygraphic recordings. The presence of insomnia was recorded by a self-report questionnaire. The presence of CVD was objectively established and mortality data were collected after three and six years. Results: In both patients with CVD (n=119) or without CVD (n=212) SDB was associated with hypoxia (p<0.005). Only in the patients with CVD was hypoxia associated with insomnia (p<0.001) which mediated an indirect effect (p<0.05) between SDB and insomnia. Hypoxia of more than 1.5% of sleep time with SaO2<90% was found to be a critical level for causing insomnia. According to this criterion 32% (n=39) and 26% (n=55) of those with and without CVD had hypoxia, respectively. These groups did not differ with respect to age, gender, body mass index, diabetes, hypertension, respiratory disease or levels of SDB. However, in the CVD group, hypoxia was associated with cardiovascular mortality at the three-year follow-up (p=0.008) and higher levels of insomnia (p=0.002). Conclusion: In the elderly with CVD, SDB mediated by hypoxia can be associated with more insomnia and a worse prognosis.

  • 30.
    Johnsen, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Alfredsson, Lars
    Karolinska Institutet and Center for Occupational and Environmental Medicine, Stockholm County Council.
    Knutsson, Anders
    Mid Sweden University.
    Westerholm, Peter JM
    Uppsala University.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Weak associations between occupational physical activity and myocardial infarction2016In: Occupational and Environmental Medicine, BMJ Publishing Group Ltd, 2016, Vol. 73, p. A198-Conference paper (Refereed)
    Abstract [en]

    IntroductionRecommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results of research on occupational physical activity and the association to myocardial infarction are inconsistent. The aim of this study was to investigate if occupational physical activity affects the risk of myocardial infarction.

    Method In this prospective cohort study, data from the WOLF study are analysed. In total, 9,961 employees having no history of myocardial infarction were followed from inclusion to their first incidence of myocardial infarction. Hazard ratios (HR) were estimated using Cox proportional hazard regression, for different levels of occupational physical activity in relation to the risk of myocardial infarction.

    Results A follow-up with a mean of 13.1 years found 249 cases of myocardial infarction. In analyses adjusted for age, sex and socio-economic status, participants standing and walking more than 50% of their working day had HR of 1.13 (95% CI: 0.83– 1.54), compared to participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI: 0.59–1.24). Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI: 0.17–0.84), compared with younger persons who sat most of their working day.

    ConclusionOnly weak associations between occupational physical activity and the risk of myocardial infarction were observed in this study. A significant reduced risk were seen for young participants with work including lifting and carrying, but this result must be interpreted with caution due to few participants in the stratified analyses. Based on the results from this study, occupational physical activity does not seem to be enough for reducing the risk of myocardial infarction, which is an important message to people with high levels of occupational physical activity.

  • 31.
    Johnsen, Anna M.
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Knutsson, Anders
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Westerholm, Peter J. M.
    Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Association between occupational physical activity and myocardial infarction: a prospective cohort study2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 10, article id e012692Article in journal (Refereed)
    Abstract [en]

    Objective Recommendations regarding physical activity typically include both leisure time and occupational physical activity. However, the results from previous studies on occupational physical activity and the association with myocardial infarction have been inconsistent. The aim of this study was to investigate if occupational physical activity is associated with the risk of myocardial infarction.

    Design Prospective cohort study.

    Participants Data from the Swedish Work, Lipids and Fibrinogen (WOLF) study was used, comprising 9961 employees (6849 men, 3112 women, mean age 42.7 years) having no history of myocardial infarction. The participants were categorised into 3 groups according to their level of occupational physical activity.

    Outcome Data regarding incident myocardial infarction were obtained from the Swedish National Patient Register and the Cause of Death Register. Cox proportional hazard regression was used for estimation of HRs for different levels of occupational physical activity in relation to the risk of myocardial infarction.

    Results During a mean follow-up of 13.1 years, 249 cases of incident myocardial infarction were identified. In analyses adjusted for age, sex and socioeconomic status, participants standing and walking more than 50% of their working day had an HR of 1.13 (95% CI 0.83 to 1.54), compared with participants seated more than 50% of their working day. The corresponding HR for participants whose work included lifting or carrying was 0.86 (95% CI 0.59 to 1.24). Further adjustment did not alter the results. Stratified analyses resulted in a significantly decreased risk for young people whose work included lifting or carrying, HR 0.37 (95% CI 0.17 to 0.84), compared with younger persons who sat most of their working day.

    Conclusions No significant association between occupational physical activity and the risk of myocardial infarction was observed in the total group of employees in this study. Based on the results from this study, occupational physical activity in general does not seem to be enough for reducing the risk of myocardial infarction.

  • 32.
    Jonkman, Nini H.
    et al.
    Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.
    Westland, Heleen
    Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.
    Groenwold, Rolf H. H.
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
    Ågren, Susanna
    Department of Medical and Health Sciences and Department of Cardiothoracic Surgery, Linköping University, Linköping, Sweden.
    Anguita, Manuel
    Department of Cardiology, Hospital Reina Sofia, Cordoba, Spain .
    Blue, Lynda
    British Heart Foundation, Glasgow, United Kingdom.
    Bruggink-André de la Porte, Pieta W. F.
    Department of Cardiology, Deventer Hospital, Deventer, Netherlands.
    DeWalt, Darren A.
    Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States.
    Hebert, Paul L.
    Department of Health Services, University of Washington, Seattle, Washington, United States.
    Heisler, Michele
    Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States.
    Jaarsma, Tiny
    Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
    Kempen, Gertrudis I. J. M.
    Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
    Leventhal, Marcia E.
    Institute of Nursing Science, University of Basel, Basel, Switzerland.
    Lok, Dirk J. A.
    Department of Cardiology, Deventer Hospital, Deventer, Netherlands.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Muñiz, Javier
    Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña and INIBIC, A Coruña, Spain .
    Otsu, Haruka
    Graduate School of Health Sciences, Hirosaki University, Aomori, Japan.
    Peters-Klimm, Frank
    Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany .
    Rich, Michael W.
    Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, United States.
    Riegel, Barbara
    School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, United States.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden .
    Tsuyuki, Ross T.
    Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada .
    Trappenburg, Jaap C. A.
    Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.
    Schuurmans, Marieke J.
    Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands.
    Hoes, Arno W.
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
    What Are Effective Program Characteristics of Self-Management Interventions in Patients With Heart Failure?: An Individual Patient Data Meta-analysis2016In: Journal of Cardiac Failure, ISSN 1071-9164, E-ISSN 1532-8414, Vol. 22, no 11, p. 861-871Article in journal (Refereed)
    Abstract [en]

    Background

    To identify those characteristics of self-management interventions in patients with heart failure (HF) that are effective in influencing health-related quality of life, mortality, and hospitalizations.

    Methods and Results

    Randomized trials on self-management interventions conducted between January 1985 and June 2013 were identified and individual patient data were requested for meta-analysis. Generalized mixed effects models and Cox proportional hazard models including frailty terms were used to assess the relation between characteristics of interventions and health-related outcomes. Twenty randomized trials (5624 patients) were included. Longer intervention duration reduced mortality risk (hazard ratio 0.99, 95% confidence interval [CI] 0.97–0.999 per month increase in duration), risk of HF-related hospitalization (hazard ratio 0.98, 95% CI 0.96–0.99), and HF-related hospitalization at 6 months (risk ratio 0.96, 95% CI 0.92–0.995). Although results were not consistent across outcomes, interventions comprising standardized training of interventionists, peer contact, log keeping, or goal-setting skills appeared less effective than interventions without these characteristics.

    Conclusion

    No specific program characteristics were consistently associated with better effects of self-management interventions, but longer duration seemed to improve the effect of self-management interventions on several outcomes. Future research using factorial trial designs and process evaluations is needed to understand the working mechanism of specific program characteristics of self-management interventions in HF patients.

  • 33.
    Karlsson, Ida K.
    et al.
    Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Haegg, Sara
    Karolinska Institutet, Stockholm, Sweden.
    Ploner, Alexander
    Karolinska Institutet, Stockholm, Sweden.
    Song, Ci
    Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    University of Southern California, Los Angeles, CA, USA.
    Pedersen, Nancy L.
    Karolinska Institutet, Stockholm, Sweden.
    Genetic susceptibility to cardiovascular disease and risk of dementia2015In: Behavior Genetics, ISSN 0001-8244, E-ISSN 1573-3297, Vol. 45, no 6, p. 664-664Article in journal (Refereed)
  • 34.
    Karlsson, Ida K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ploner, A.
    Song, C.
    Gatz, M.
    Pedersen, Nancy L.
    Hägg, S.
    Genetic susceptibility to cardiovascular disease and risk of dementia2017In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 7, no 5Article in journal (Refereed)
    Abstract [en]

    Several studies have shown cardiovascular disease (CVD) to be associated with dementia, but it is not clear whether CVD per se increases the risk of dementia or whether the association is due to shared risk factors. We tested how a genetic risk score (GRS) for coronary artery disease (CAD) affects dementia risk after CVD in 13 231 Swedish twins. We also utilized summarized genome-wide association data to study genetic overlap between CAD and Alzheimer´s disease (AD), and additionally between shared risk factors and each disease. There was no direct effect of a CAD GRS on dementia (hazard ratio 0.99, 95% confidence interval (CI): 0.98-1.01). However, the GRS for CAD modified the association between CVD and dementia within 3 years of CVD diagnosis, ranging from a hazard ratio of 1.59 (95% CI: 1.05-2.41) in the first GRS quartile to 1.91 (95% CI: 1.28-2.86) in the fourth GRS quartile. Using summary statistics, we found no genetic overlap between CAD and AD. We did, however, find that both AD and CAD share a significant genetic overlap with lipids, but that the overlap arose from clearly distinct gene clusters. In conclusion, genetic susceptibility to CAD was found to modify the association between CVD and dementia, most likely through associations with shared risk factors.

  • 35.
    Karlsson, Kåre J.
    et al.
    Jönköping University, School of Health and Welfare, HHJ. ADULT. Ambulance Service, Skaraborg Hospital, Skövde, Sweden.
    Niemelä, Patrik H.
    Ambulance Service, Skaraborg Hospital, Skövde, Sweden.
    Jonsson, Anders R.
    School of Health Sciences, Borås University, Borås, Sweden.
    Törnhage, Carl-Johan A.
    Department of Paediatrics, Skaraborg Hospital, Skövde, Sweden.
    Using shoulder straps decreases heart rate variability and salivary cortisol concentration in Swedish ambulance personnel2016In: SH@W Safety and Health at Work, ISSN 2093-7911, E-ISSN 2093-7997, Vol. 7, no 1, p. 32-37Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has shown that paramedics are exposed to risks in the form of injuries to the musculoskeletal system. In addition, there are studies showing that they are also at increased risk of cardiovascular disease, cancer, and psychiatric diseases, which can partly be explained by their constant exposure to stress. The aim of this study is to evaluate whether the use of shoulder straps decreases physical effort in the form of decreased heart rate and cortisol concentration.

    Methods: A stretcher with a dummy was carried by 20 participants for 400 m on two occasions, one with and one without the shoulder straps. Heart rate was monitored continuously and cortisol samples were taken at intervals of 0 minutes, 15 minutes, 30 minutes, 45 minutes, and 60 minutes. Each participant was her or his own control.

    Results: A significant decrease in heart rate and cortisol concentration was seen when shoulder straps were used. The median values for men (with shoulder straps) at 0 minutes was 78 bpm/21.1 nmol/L (heart rate/cortisol concentration), at 15 minutes was 85 bpm/16.9 nmol/L, and at 60 minutes was 76 bpm/15.7 nmol/L; for men without shoulder straps, these values were 78 bpm/21.9 nmol/L, 93 bpm/21.9 nmol/L, and 73 bpm/20.5 nmol/L. For women, the values were 85 bpm/23.3 nmol/L, 92 bpm/20.8 nmol/L, and 70 bpm/18.4 nmol/L and 84 bpm/32.4 nmol/L, 100 bpm/32.5 nmol/L, and 75 bpm/25.2 nmol/L, respectively.

    Conclusion: The use of shoulder straps decreases measurable physical stress and should therefore be implemented when heavy equipment or a stretcher needs to be carried. An easy way to ensure that staff use these or similar lifting AIDS is to provide them with personalized, well-adapted shoulder straps. Another better option would be to routinely sewn these straps into the staff's personal alarm jackets so they are always in place and ready to be used.

  • 36.
    Karlsson, Kåre
    et al.
    Borås University, School of Health Sciences, Knowledge Centre for Prehospital Care, Borås, Sweden .
    Niemelä, Patrik
    Borås University, School of Health Sciences, Knowledge Centre for Prehospital Care, Borås, Sweden.
    Jonsson, Anders
    Swedish Armed Forces, Centre for Defence Medicine, Västra Frölunda, Sweden.
    Heart rate as a marker of stress in ambulance personnel: A pilot study of the body's response to the ambulance alarm2011In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 26, no 1, p. 21-26Article in journal (Refereed)
    Abstract [en]

    Introduction: Studies have demonstrated the presence of stress and post-traumatic stress among ambulance personnel, but no previous research has focused on the body's reaction in the form of the change in heart rate of ambulance staff in association with specific occupational stress.

    Hypothesis: The purpose of this study is to investigate whether work as an ambulance professional generates prolonged physiological arousal that can be measured by heart rate in different situations.

    Methods: Twenty participants carried a pulse-meter in the form of a wristwatch, which continuously measured and stored their heart rate 24 hours per day for a period of seven days. All ambulance alarms that occurred during the test period were recorded in journals, and the participants completed diaries and a questionnaire describing their experiences. The alarms were divided into different phases. Correlations between heart rate in the different phases were computed.

    Results: Analysis of study data indicated a significant rise of heart rate unrelated to physical effort during an emergency alarm and response. This increased heart rate was noticed throughout the mission and it was not related to the length of experience the staff had in the ambulance profession. In addition, a non-significant trend suggested that alarms involving acutely ill children lead to an even higher increase in heart rate. In addition, this research showed that constant tension existed during sleep, while available for an emergency, indicated by a noticeable increase in heart rate during sleep at work compared to sleeping at home.

    Conclusions: A rise in heart rate was experienced during all acute emergency missions, regardless of a subject's experience, education, and gender. Missions by themselves generated a rate increase that did not seem to correlate with physical effort required during an emergency response. This study shows that working on an ambulance that responds to medical emergencies is associated with a prolonged physiological arousal.

  • 37. Kivimäki, Mika
    et al.
    Nyberg, Solja
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Heikkilä, Katriina
    Alfredsson, Lars
    Casini, Annalisa
    Clays, Els
    DeBacquer, Dirk
    Dragano, Nico
    Ferrie, Jane
    Goldberg, Marcel
    Hamer, Mark
    Jokela, Markus
    Karasek, Robert
    Kittel, France
    Knutsson, Anders
    Koskenvuo, Markku
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Salo, Paula
    Siegrist, Johannes
    Suominen, Sakari
    Theorell, Töres
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Steptoe, Andrew
    Singh-Manoux, Archana
    Batty, David
    Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data2013In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel: ECMAJ. ISSN 1488-2329, ISSN 0820-3946, E-ISSN 1488-2329, Vol. 185, no 9, p. 763-769Article in journal (Refereed)
    Abstract [en]

    Background: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease.

    Methods: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985–2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2–4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death).

    Results: There were 1086 incident events in 743 948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18–2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06–1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000).

    Interpretation: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy lifestyle may substantially reduce disease risk among people with job strain.

  • 38.
    Klompstra, L.
    et al.
    Linköping University, Linköping, Sweden.
    Sedlar, N.
    National Institute of Public Health, Ljubljana, Slovenia.
    Strömberg, A.
    Linköping University, Linköping, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Lainscak, M.
    Gen Hosp Murska Sobota, Dept Cardiol, Murska Sobota, Slovenia.
    Farkas, J.
    Gen Hosp Murska Sobota, Dept Cardiol, Murska Sobota, Slovenia..
    Jaarsma, T.
    Linköping University, Linköping, Sweden.
    Effective interventions to improve self-care in patients with heart failure2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 308-308Article in journal (Refereed)
  • 39.
    Lainscak, M.
    et al.
    General Hospital Celje, Department of Cardiology, Celje, Slovenia.
    Sedlar, N.
    National Institute of Public Health, Ljubljana, Slovenia.
    Socan, G.
    University of Ljubljana, Department of psychology, Faculty of Arts, Ljubljana, Slovenia.
    Farkas, J.
    National Institute of Public Health, Ljubljana, Slovenia.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Stromberg, A.
    Linkoping University, Department of Medical and Health Sciences, Division of Nursing Science, Linkoping, Sweden.
    Jaarsma, T.
    Linkoping University, Department of Social and Welfare Studies, Faculty of Health Science, Linkoping, Sweden.
    Psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS)2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S74-S74Article in journal (Refereed)
    Abstract [en]

    Background: The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours that heart failure patients perform to maintain daily life activities, healthy functioning, and wellbeing. Psychometrics validation of several language versions has been published.

    Purpose: The aim of this study was to review the psychometric properties of the scale.

    Methods: Following PRISMA guidelines, PubMed, Scopus and ScienceDirect were searched in November 2015. Papers examining the psychometric properties of the EHFScBS-12 and/or the EHFScBS-9 were included to analyse validity and reliability.

    Results: From total of 1357 potentially eligible abstracts screened 74 full-text papers were retrieved and reviewed and 13 studies were eventually included in the review. Nine of the included studies investigated the psychometric properties of the EHFScBS-12 and five of the EHFScBS-9.The results demonstrated satisfactory content, discriminantand convergent validity of the translated versions of both scales across the samples. Discriminant validity of the scale was confirmed through its low associations with measures of the quality of life, while its convergent validity was supported through its small/moderate associations with measures of adherence. Regarding the construct validity, the factorial structure of the scales was inconsistent, but the consulting behaviour factor was recognized in all of the studies. Most commonly used reliability estimates (e.g.Cronbach’s alpha) for the total scale were satisfactory.

    Conclusion(s): Published data demonstrate satisfactory psychometric properties of the EHFScBS, indicating that the scale is a reliable and valid tool for clinical practice. 

  • 40.
    Larsson, Malin K.
    et al.
    KTH, Medicinsk teknik.
    Da Silva, Cristina
    Gunyeli, Elif
    Bin Ilami, Ali Akebat
    Szummer, Karolina
    Winter, Reidar
    KTH, Medicinsk teknik.
    Bjällmark, Anna
    KTH, Medicinsk teknik.
    The potential clinical value of contrast-enhanced echocardiography beyond current recommendations2016In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 14, article id 2Article in journal (Refereed)
    Abstract [en]

    Background: Contrast agents are used in resting echocardiography to opacify the left ventricular (LV) cavity and to improve LV endocardial border delineation in patients with suboptimal image quality. If a wider use of contrast-enhanced echocardiography would be adopted instead of the current selective approach, diagnoses such as myocardial ischemia and LV structural abnormalities could potentially be detected earlier. The aim was therefore to retrospectively investigate if contrast- enhanced echocardiography beyond the current recommendations for contrast agent usage affects assessment of wall motion abnormalities, ejection fraction (EF) and detection of LV structural abnormalities. A secondary aim was to evaluate the user dependency during image analysis. Methods: Experienced readers (n = 4) evaluated wall motion score index (WMSI) and measured EF on greyscale and contrast-enhanced images from 192 patients without indications for contrast-enhanced echocardiography. Additionally, screening for LV structural abnormalities was performed. Repeated measurements were performed in 20 patients by the experienced as well as by inexperienced (n = 2) readers. Results: Contrast analysis resulted in significantly higher WMSI compared to greyscale analysis (p < 0.003). Of the 83 patients, classified as healthy by greyscale analysis, 55 % were re-classified with motion abnormalities by contrast analysis. No significant difference in EF classification (>= 55 %, 45-54 %, 30-44 %, < 30 %) was observed. LV structural abnormalities, such as increased trabeculation (n = 21), apical aneurysm (n = 4), hypertrophy (n = 1) and thrombus (n = 1) were detected during contrast analysis. Intra- and interobserver variability for experienced readers as well as the variability between inexperienced and experienced readers decreased for WMSI and EF after contrast analysis. Conclusions: Contrast-enhanced echocardiography beyond current recommendations for contrast agent usage increased the number of detected wall motion and LV structural abnormalities. Moreover, contrast- enhanced echocardiography increased reproducibility for assessment of WMSI and EF.

  • 41.
    Larsson, Malin K.
    et al.
    KTH, Medicinsk bildteknik.
    Larsson, Matilda
    KTH, Medicinsk bildteknik.
    Nowak, Greg
    Paradossi, Gaio
    Brodin, Lars-Åke
    KTH, Medicinsk bildteknik.
    Janerot Sjöberg, Birgitta
    KTH, Medicinsk teknik.
    Caidahl, Kenneth
    Bjällmark, Anna
    KTH, Medicinsk bildteknik.
    Endocardial border delineation capability of a novel multimodal polymer-shelled contrast agent2014In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 12, p. 24-Article in journal (Refereed)
    Abstract [en]

    Background: A novel polymer-shelled contrast agent (CA) with multimodal and target-specific potential was developed recently. To determine its ultrasonic diagnostic features, we evaluated the endocardial border delineation as visualized in a porcine model and the concomitant effect on physiological variables. Methods: Three doses of the novel polymer-shelled CA (1.5 ml, 3 ml, and 5 ml [5 x 10(8) microbubbles (MBs)/ml]) and the commercially available CA SonoVue (1.5 ml [2-5 x 10(8) MBs/ml]) were used. Visual evaluations of ultrasound images of the left ventricle were independently performed by three observers who graded each segment in a 6-segment model as either 0 = not visible, 1 = weakly visible, or 2 = visible. Moreover, the duration of clinically useful contrast enhancement and the left ventricular opacification were determined. During anesthesia, oxygen saturation, heart rate, and arterial pressure were sampled every minute and the effect of injection of CA on these physiological variables was evaluated. Results: The highest dose of the polymer-shelled CA gave results comparable to SonoVue. Thus, no significant difference in the overall segment score distribution (2-47-95 vs. 1-39-104), time for clinically sufficient contrast enhancement (20-40 s for both) and left ventricular overall opacification was found. In contrast, when comparing the endocardial border delineation capacity for different regions SonoVue showed significantly higher segment scores for base and mid, except for the mid region when injecting 1.5 ml of the polymer-shelled CA. Neither high nor low doses of the polymer-shelled CA significantly affected the investigated physiological variables. Conclusions: This study demonstrated that the novel polymer-shelled CA can be used in contrast-enhanced diagnostic imaging without influence on major physiological variables.

  • 42.
    Larsson, Malin
    et al.
    KTH, Medicinsk teknik.
    Larsson, Matilda
    KTH, Medicinsk teknik.
    Oddo, Letizia
    Margheritelli, Silvia
    Paradossi, Gaio
    Nowak, Jacek
    Brodin, Lars-Åke
    KTH, Medicinsk teknik.
    Caidahl, Kenneth
    Bjällmark, Anna
    KTH, Medicinsk teknik.
    Visualization of multimodal polymer-shelled contrast agents using ultrasound contrast sequences: An experimental study in a tissue mimicking flow phantom2013In: Cardiovascular Ultrasound, ISSN 1476-7120, E-ISSN 1476-7120, Vol. 11, p. 33-Article in journal (Refereed)
    Abstract [en]

    Background: A multimodal polymer-shelled contrast agent (CA) with target specific potential was recently developed and tested for its acoustic properties in a single element transducer setup. Since the developed polymeric CA has different chemical composition than the commercially available CAs, there is an interest to study its acoustic response when using clinical ultrasound systems. The aim of this study was therefore to investigate the acoustic response by studying the visualization capability and shadowing effect of three polymer-shelled CAs when using optimized sequences for contrast imaging. Methods: The acoustic response of three types of the multimodal CA was evaluated in a tissue mimicking flow phantom setup by measuring contrast to tissue ratio (CTR) and acoustic shadowing using five image sequences optimized for contrast imaging. The measurements were performed over a mechanical index (MI) range of 0.2-1.2 at three CA concentrations (10(6), 10(5), 10(4) microbubbles/ml). Results: The CTR-values were found to vary with the applied contrast sequence, MI and CA. The highest CTR-values were obtained when a contrast sequence optimized for higher MI imaging was used. At a CA concentration of 106 microbubbles/ml, acoustic shadowing was observed for all contrast sequences and CAs. Conclusions: The CAs showed the potential to enhance ultrasound images generated by available contrast sequences. A CA concentration of 106 MBs/ml implies a non-linear relation between MB concentration and image intensity.

  • 43.
    Lin, Chung-Ying
    et al.
    Faculty of Health and Social Sciences, Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Blvd, Qazvin, Iran.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Jaarsma, Tiny
    Mary MacKillop Institute of Health Research, ACU, Melbourne, Australia.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients.2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 3, p. 281-288Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF).

    OBJECTIVE: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran.

    METHODS: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA).

    RESULTS: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFScB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legs/feet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47).

    CONCLUSIONS: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

    The full text will be freely available from 2019-04-25 00:00
  • 44. Lindfors, M.
    et al.
    Frenckner, B.
    Sartipy, U.
    Bjällmark, Anna
    KTH, Medicinsk bildteknik.
    Broomé, Michael
    KTH, Medicinsk teknik.
    Venous Cannula Positioning in Arterial Deoxygenation During Veno-Arterial Extracorporeal Membrane Oxygenation-A Simulation Study and Case Report2017In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 41, no 1, p. 75-81Article in journal (Refereed)
    Abstract [en]

    Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is indicated in reversible life-threatening circulatory failure with or without respiratory failure. Arterial desaturation in the upper body is frequently seen in patients with peripheral arterial cannulation and severe respiratory failure. The importance of venous cannula positioning was explored in a computer simulation model and a clinical case was described. A closed-loop real-time simulation model has been developed including vascular segments, the heart with valves and pericardium. ECMO was simulated with a fixed flow pump and a selection of clinically relevant venous cannulation sites. A clinical case with no tidal volumes due to pneumonia and an arterial saturation of below 60% in the right hand despite VA-ECMO flow of 4 L/min was described. The case was compared with simulation data. Changing the venous cannulation site from the inferior to the superior caval vein increased arterial saturation in the right arm from below 60% to above 80% in the patient and from 64 to 81% in the simulation model without changing ECMO flow. The patient survived, was extubated and showed no signs of hypoxic damage. We conclude that venous drainage from the superior caval vein improves upper body arterial saturation during veno-arterial ECMO as compared with drainage solely from the inferior caval vein in patients with respiratory failure. The results from the simulation model are in agreement with the clinical scenario.

  • 45.
    Ljungberg, L. U.
    et al.
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Alehagen, U.
    Linköping University.
    Björck, H. M.
    Linköping University.
    Persson, K.
    Linköping University.
    Dahlström, U.
    Linköping University.
    Länne, T.
    Linköping University.
    Impaired Abdominal aortic wall Integrity in Elderly Men Carrying the Angiotensin-converting Enzyme D Allele2011In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 42, no 3, p. 309-316Article in journal (Refereed)
    Abstract [en]

    Objective: A polymorphism in the angiotensin-converting-enzyme gene (ACE I/D) has been associated with abdominal aortic aneurysm and a link between aortic aneurysm and aortic stiffness has been suggested. This study aimed to explore the links between ACE I/D polymorphism, circulating ACE and abdominal aortic wall integrity as reflected by abdominal aortic wall stiffness.

    Material: A total of 212 men and 194 women, aged 70-88 years, were studied. Methods: Mechanical properties of the abdominal aorta were determined using the Wall Track System, ACE genotype using the polymerase chain reaction (PCR) and circulating ACE level by enzyme-linked immunosorbent assay (ELISA).

    Results: In men, pulsatile diameter change differed between genotypes (II 0.70, ID 0.55 and DD 0.60 mm, P = 0.048), whereas a tendency was seen for distensibility coefficient (DC) (II 10.38, ID 7.68 and ID 8.79, P = 0.058). Using a dominant model (II vs. ID/DD), men carrying the ACE D allele had lower pulsatile diameter change (P = 0.014) and DC (P = 0.017) than II carriers. Multiple regression analyses showed additional associations between the D allele and increased stiffness beta, and reduced compliance coefficient.

    Conclusion: Men carrying the ACE D allele have stiffer abdominal aortas compared with II carriers. Deranged abdominal aortic stiffness indicates impaired vessel wall integrity, which, along with other local predisposing factors, may be important in aneurysmal disease. (C) 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  • 46.
    Ljungberg, Liza
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    Länne, Toste
    Linköping University.
    Björck, Hanna
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Persson, Karin
    Linköping University.
    The association between circulating angiotensin-converting enzyme and cardiovascular risk in the elderly: a cross-sectional study2011In: jraas. Journal of the renin-angiotensin-aldosterone system, ISSN 1470-3203, E-ISSN 1752-8976, Vol. 12, no 3, p. 281-289Article in journal (Refereed)
    Abstract [en]

    Introduction: A polymorphism in the angiotensin-converting enzyme gene (ACE I/D polymorphism) has been associated with increased risk for cardiovascular disease (CVD). This polymorphism affects the level of circulating ACE, but there is great individual variation, even between those with the same genotype. Few previous studies have investigated the link between circulating ACE and cardiovascular risk. The aim of this study was to investigate this association, and to examine the relationship between ACE level, ACE genotype and CVD.

    Materials and methods: The study population consisted of 322 men and 350 women aged 69-87. Plasma ACE level was determined using enzyme-linked immunosorbent assay (ELISA), and ACE genotype was analysed using PCR followed by gel electrophoresis.

    Results: In men, ACE levels increased with increasing number of cardiovascular risk factors (p = 0.003). There was a significant association in men between increased ACE level and both diabetes (p = 0.007) and smoking (p = 0.037).

    Conclusions: This study shows that cardiovascular risk factors (such as smoking and diabetes) are associated with higher levels of circulating ACE in men. High ACE levels may represent one of the cellular mechanisms involved in producing the vascular damage associated with cardiovascular risk factors.

  • 47.
    Ljungberg, Liza U.
    et al.
    Linköping University.
    Alehagen, Urban
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Persson, Karin
    Linköping University.
    Dahlström, Ulf
    Linköping University.
    Länne, Toste
    Linköping University.
    Circulating angiotensin-converting enzyme is associated with left ventricular dysfunction, but not with central aortic hemodynamics2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 166, no 2, p. 540-541Article in journal (Other academic)
  • 48.
    Luttik, M.L.A.
    et al.
    Hanze University of Applied Sciences, Research Group Nursing Diagnostics, Groningen, Netherlands.
    Goossens, E.
    KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Ågren, S.
    Linköping University, Department of Medicine and Health Sciences, Department of Cardiothoracic Surgery, Linköping, Sweden.
    Jaarsma, T.
    Linköping University, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Thompson, D. R.
    Australian Catholic University, Centre for the Heart and Mind, Melbourne, Australia.
    Moons, P.
    KU Leuven, University of Leuven, Department of Public Health and Primary Care, Leuven, Belgium.
    Strömberg, A.
    Linköping University, Division of Nursing Science, Department of Medicine and Health Sciences, Linköping, Sweden.
    Attitudes of nurses towards family involvement in the care for patients with cardiovascular diseases2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 299-308Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: There is increasing evidence supporting the relationship between family support and patient outcomes. Therefore, involving families in the care of cardiovascular patients is expected to be beneficial for patients. The quality of the encounter with families highly depends on the attitudes of nurses towards the importance of families in patient care.

    AIM: The aim of this study was to describe the attitudes of nurses towards family involvement in patient care and to investigate the individual contributions of demographic, professional and regional background characteristics.

    METHOD: A survey was distributed among cardiovascular nurses attending an international conference in Norway and a national conference in Belgium. Nurses were asked to complete a questionnaire, including the Families' Importance in Nursing Care - Nurses' Attitudes scale. The study population consisted of respondents from Belgium (n = 348) and from Scandinavian countries (Norway, Sweden and Denmark; n = 77).

    RESULTS: In general, nurses viewed the family as important in care. However, attitudes towards actively inviting families to take part in patient care were less positive. Higher educational level and a main practice role in research, education or management were significantly associated with more positive attitudes. Furthermore, the attitudes of respondents living in Scandinavia were more positive as compared to the attitudes of respondents living in Belgium.

    CONCLUSION: Education on the importance of families and active family involvement in patient care seems to be necessary in basic, undergraduate education, but also in clinical practice. More research is necessary in order to explore the cultural and regional differences in the attitudes of nurses towards the involvement of families in patient care.

  • 49.
    Länne, T.
    et al.
    Division of Clinical Physiology, Department of Medicine and Care, University Hospital, Linköping, Sweden.
    De Basso, Rachel
    Division of Clinical Physiology, Department of Medicine and Care, University Hospital, Linköping, Sweden.
    Powell, J. T.
    University Hospitals of Coventry and Warwickshire, Walsgrave, Coventry, United Kingdom.
    Influence of fibrillin-1 genotype on aortic stiffness in men: a note of caution - Reply2006In: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 100, no 4, p. 1431-1432Article in journal (Other academic)
  • 50.
    Malm, Dan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Pakpour, Amir H.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Ekblad, Helena
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Impact of a cognitive behavioral intervention on quality of life and psychological distress in patients with atrial fibrillation: the importance of relatives2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S49-S50Article in journal (Refereed)
    Abstract [en]

    Background: Although there is an evidence to support the efficacy of cognitive behavioral therapy (CBT) in improving quality of life and decreasing psychological distress in patients with cardiovascular diseases but involving patient’s and relatives in the CBT and its effect on patient’s general health, has not been evaluated.

    Aim: The aim was to determine whether involving the relatives in CBT for patients with Atrial Fibrillation (AF) enhances treatment outcomes relative to treatment as usual group (TAU).

    Method: In a randomized controlled trial, 78 patients diagnosed with AF were randomly assigned to experimental (EXP) or TAU groups. In the EXP group, patients and relative participated in a 6-week program while the patient in the TAU group received standard care. Short Form 36(SF-36), Hospital Anxiety and Depression Scale (HADS),Euro-QoL 5-Dimension Self-Report Questionnaire (EQ-5D) and Sense of Coherence (SOC-13) were completed at  baseline and at 12-month follow-up. 

    Results: In all 78 patients completed the assessment at 12 months. The two groups were similar for sociodemographic and clinical variables at baseline. The EXP group reported significantly higher scores in EQ-5D (F= 6.18, p = 0.01) and SOC (F= 4.15, p = 0.04) than TAU group. Compared with TAU group, patients in EXP group reported significantly lower depression (F= 4.58, p = 0.04). Thirteen percent of Indirect effect of the intervention on improving patient’s quality of life in the EXP group was related to the SOC improvement (z = 11.83, p < .01).

    Conclusions: This study provides evidence that patients and their relatives’ involvement is more effective in improving quality of life and decreasing psychological distress than those who receiving standard care. Our results also indicate that interventions should initially focus on increasing patient’s sense of coherence.

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