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  • 1.
    Bengtsson, Viveca Wallin
    et al.
    Univ Kristianstad, SE-29188 Kristianstad, Sweden..
    Persson, G. Rutger
    Univ Kristianstad, SE-29188 Kristianstad, Sweden.;Univ Washington, Dept Periodont, Seattle, WA 98195 USA.;Univ Washington, Dept Oral Med, Seattle, WA 98195 USA..
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health. Blekinge Inst Technol, Sch Hlth Sci, Karlskrona, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    A cross-sectional study of the associations between periodontitis and carotid arterial calcifications in an elderly population2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 2, p. 115-120Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate if the presence of periodontitis is associated with carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population. Materials and methods. Study individuals were randomly selected from the Swedish civil registration database representing the aging population (60-96 years) in Karlskrona, Sweden. Bleeding on probing (BOP) and the deepest probing measurement at each tooth were registered. The proportions of teeth with a probing depth 5 mm and the proportion of teeth with bleeding on probing were calculated. Analog panoramic radiographs were taken and the proportion of sites with a distance 5 mm between the alveolar bone level and the cement-enamel junction (CEJ) were assessed. A diagnosis of periodontitis was declared if a distance between the alveolar bone level and the CEJ 5 mm could be identified from the panoramic radiographs at >10% of sites, probing depth of 5 mm at one tooth or more and with BOP at >20% of teeth. Results. Readable radiographs were obtained from 499 individuals. Carotid calcification was identified in 39.1%. Individuals were diagnosed with periodontitis in 18.4%. Data analysis demonstrated that individuals with periodontitis had a higher prevalence of carotid calcifications (Pearson (2) = 4.05 p < 0.05) and with a likelihood of 1.5 (95% CI = 1.0, 2.3, p < 0.05). Conclusions. Data analysis demonstrated a significant association between periodontitis and carotid calcification.

  • 2. Bennet, Louise
    et al.
    Berglund, Johan
    Reinfection with Lyme borreliosis: A retrospective follow-up study in southern Sweden2002In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, p. 183-186Article in journal (Refereed)
    Abstract [en]

    In a 5-y retrospective follow-up study in southern Sweden that initially included > 1000 individuals with previously diagnosed erythema migrans, factors that influenced the risk of reinfection with Lyme borreliosis were elucidated. The total frequency of reinfection was 4% and the number of tick bites influenced the risk of reinfection: those bitten > 10 times during the observation period had a 4-8-fold increased risk compared with those bitten < 5 times. Women manifested to a greater extent than men although both genders were bitten equally by ticks, thus indicating that women may be more susceptible to reinfection. All reinfected women were > 44 y old. The county of Kalmar including Oland was found to be highly endemic for reinfection with Lyme borreliosis. Thus the number of tick bites, gender, age and study area influenced the risk of reinfection.

  • 3. Bennet, Louise
    et al.
    Danell, Sven
    Berglund, Johan
    Clinical Outcome of Erythema Migrans after Treatment with Phenoxymethyl Penicillin2003In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 35, no 2, p. 129-131Article in journal (Refereed)
    Abstract [en]

    In a 5 y retrospective follow-up study in southern Sweden of 708 adult individuals with erythema migrans as the single manifestation of Lyme borreliosis, the clinical outcome and the antibiotic treatment were studied. 80%, were treated with phenoxymethyl penicillin, 15% with doxycycline and 5% with other antibiotics. Phenoxymethyl penicillin and doxycycline were extremely effective: 98 and 94% of the individuals reported complete recovery without complications. Few individuals reported the development of new symptoms following treatment and none developed any late manifestation of Lyme borreliosis during the observation period. Thus, in the area studied the treatment of the early localized manifestation of Lyme borreliosis (erythema migrans) with antibiotics was extremely successful. The current Swedish recommendation to use phenoxymethyl penicillin, when no sign of disseminated infection or coinfection with other tick-borne pathogens is present, seems excellent.

  • 4. Bennet, Louise
    et al.
    Fraenkel, Carl-Johan
    Garpmo, Ulf
    Halling, Anders
    Ingman, Mikael
    Ornstein, Katharina
    Stjernberg, Louise
    Berglund, Johan
    Clinical appearance of erythema migrans caused by Borrelia afzelii and Borrelia garinii: effect of the patient´s sex2006In: Wiener Klinische Wochenschrift, ISSN 0043-5325, E-ISSN 1613-7671, Vol. 118, no 17-18, p. 531-537Article in journal (Refereed)
    Abstract [en]

    Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.

  • 5. Bennet, Louise
    et al.
    Fraenkel, Carl-Johan
    Stjernberg, Louise
    Garpmo, Ulf
    Ingman, Mikael
    Ornstein, Katharina
    Berglund, Johan
    Clinical Aspects of Erythema Migrans in Southern Sweden2005Conference paper (Refereed)
    Abstract [en]

    Background: The aim of this study was to describe and categorize the different predominant patterns of PCR confirmed erythema migrans (EM) and to study possible correlations according to the clinical pictures and Borrelia substrains. Methods: Patients over 18 years old, seeking care with tick exposure and an EM were consecutively included during a study period of three years. We evaluated clinical and laboratory findings with regard to Borrelia burgdorferi s.l. spirochetes detected with nested Osp A PCR in skin biopsy specimens. Laboratory and serology testing were done acute, after 6 weeks and after 6 months. The patients were clinically evaluated at the initial visit and repeatedly after 14 days unitl recovery. Results: 118 patients (women=54, men=64) with a positive B. Burgdorferi s.l. PCR analysis were included. In this area totally 73.7% of the EM were caused by B. afzelii and 26.3% by B. garinii (p=0.0001). Leisons caused by B. garinii had a shorter duration from tick bite to the initial visit (p= 0.001) but there were no differences between the sizes of the EM, indicating a faster development of lesions caused by B. garinii. Patients with lesions caused by B. garinii to a greater extent had presented with fever at the initial visit (p=0.02). Also patients with B. garinii lesions to a greater extent had elevated levels of CRP at the initial visit (p=0.006). 45% of the EM were categorized as “annular”, 27% as “homogeneous”, 19% as “central erythemas” and 9% as “atypical”. The lesions caused by B. afzelii were predominately “annular” and the lesions caused by B. gaarinii were predominately “homogeneous”. Conclusions: In this study most EM were caused by B. afzelii. Leisons caused by B. garinii developed faster and the patients to a greater extent presented with fever and elevated levels of CRP at the initial visit. Leisons caused by B. garinii were mostly homogenous and by B. afzelii were mostly annular.

  • 6. Bennet, Louise
    et al.
    Halling, Anders
    Berglund, Johan
    Increased incidence of Lyme borreliosis in southern Sweden following mild winters and during warm, humid summers.2006In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 25, no 7, p. 426-432Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to investigate the long-term incidence rate of Lyme borreliosis and, additionally, to determine whether a correlation exists between climatic factors and summer-season variations in the incidence of Lyme borreliosis. Climatic variability acts directly on tick population dynamics and indirectly on human exposure to Lyme borreliosis spirochetes. In this study, conducted in primary healthcare clinics in southeastern Sweden, electronic patient records from 1997-2003 were searched for those that fulfilled the criteria for erythema migrans. Using a multilevel Poisson regression model, the influence of various climatic factors on the summer-season variations in the incidence of erythema migrans were studied. The mean annual incidence rate was 464 cases of erythema migrans per 100,000 inhabitants. The incidence was significantly higher in women than in men, 505 and 423 cases per 100,000 inhabitants, respectively (p<0.001). The summer-season variations in the erythema migrans incidence rate correlated with the monthly mean summer temperatures (incidence rate ratio 1.12; p<0.001), the number of winter days with temperatures below 0 degrees C (incidence rate ratio 0.97; p<0.001), the monthly mean summer precipitation (incidence rate ratio 0.92; p<0.05), and the number of summer days with relative humidity above 86% (incidence rate ratio 1.04; p<0.05). In conclusion, Lyme borreliosis is highly endemic in southeastern Sweden. The climate in this area, which is favourable not only for human tick exposure but also for the abundance of host-seeking ticks, influences the summer-season variations in the incidence of Lyme borreliosis.

  • 7. Bennet, Louise
    et al.
    Stjernberg, Louise
    Berglund, Johan
    Effect of Gender on Clinical and Epidemiologic Features of Lyme Borreliosis2007In: Vector Borne and Zoonotic Diseases, ISSN 1530-3667, E-ISSN 1557-7759, Vol. 7, no 1, p. 34-41Article in journal (Refereed)
    Abstract [en]

    The aim is to highlight the influence of patients’ gender on Lyme borreliosis and especially erythema migrans (EM), focusing on exposure to tick bites, epidemiology, and the clinical picture. All studies were conducted in the county of Blekinge, located in southeastern Sweden. A prospective study was conducted in 235 individuals (women, n=110; men, n=125) engaged in recreational or occupational activities focusing on exposure to tick bites. A retrospective epidemiological study evaluating 123,495 electronic patients´ records (women, n=61,712; men, n=61,783) and a prospective clinical study including 118 patients (women, n=54; men, n=64) 18 years or older seeking care for EM > 5 cm in diameter with genospecies verified by polymerase chain reaction were conducted. Results: Women 40 years or older had a 48% higher risk than men 40 years or older and 42% higher risk than women younger than 40 years of attracting tick bites (0.0188 versus 0.0127 and 0.0188 versus 0.0132 tick bites respectively per hour). Additionally they had a 96% higher risk than men younger than 40 years of attracting tick bites (0.0188 versus 0.0096). The annual incidence rate of EM in women was 506 and in men 423 cases per 100,000 inhabitants (p<0.001). Significant differences in incidence rates occurred in those 40 years or older. Odds ratios for males infected with Borrelia afzelii developing nonannular EM were 0.09 (95% confidence interval [CI] 0.03 to 0.33) in comparison with females infected by Borrelia afzelii. Conclusions: Significant gender differences in the risk of contracting tick bites, incidence rates, and clinical picture of EM have been observed. Exposure to tick bites alone may not explain these observations and further studies need to be done to clarify the biologic, immunologic, and sociological mechanisms causing these differences.

  • 8. Berglund, Johan
    Association of diagnosis of ischaemic heart disease, diabetes mellitus and heart failure with cognitive function in the elderly population.2006In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 12, no 3, p. 114-119Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to describe the association between ischaemic heart disease (IHD), diabetes mellitus (DM) and heart failure (HF) and the prevalence of cognitive impairment. METHODS: In a cross-sectional, community-based study in Karlskrona, Sweden, 1402 participants of the Swedish National Study on Ageing and Care (60-96 y) underwent a medical examination and psychological testing including the Mini Mental State Examination (MMSE). Of these, 58% stated that they were treated for hypertension, IHD, DM or HF, or had ECG abnormalities (positive screen). RESULTS: The prevalence of cognitive impairment (MMSE score < 24) in patients treated for IHD, DM or HF was 28.5% compared to 16.1% in the population with a negative screen without cardiovascular disease or DM. After stratification by age, the difference was seen to be due to a higher prevalence of cognitive impairment in the age group 70-79 y, where 68.8% of the cognitively impaired came from the group treated for IHD, DM or HF. The odds ratio for cognitive impairment in this age group was 4.4 (95% CI 1.7-11.4), when compared to those with a negative screen as baseline. CONCLUSION: This study has shown that the patient group treated for IHD, DM or HF has a higher prevalence of cognitive impairment and a higher risk of developing early cognitive impairment between the ages of 70 and 79 y. Although this study has not provided conclusive evidence that cardiovascular disease and DM are associated with the early development of cognitive impairment, it provides incentive for further studies.

  • 9. Berglund, Johan
    et al.
    Persson, Rutger
    Renvert, Stefan
    Persson, Rigmor
    Osteoporosis and peridontitis in older subjects participating in the Swedish National Survey on Aging and Care (SNAC-Blekinge)2011In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 69, no 4, p. 201-207Article, review/survey (Refereed)
    Abstract [en]

    Abstract Objective. We assessed the relationships between (I) ultrasonography calcaneus T-scores (PIXI) and mandibular cortex characteristics on oral panoramic radiographs in older subjects; and (II) osteoporosis and periodontitis. Material and methods. We examined 778 subjects (53% women) aged 59-96 years. Periodontitis was defined by alveolar bone loss assessed from panoramic radiographs. Results. PIXI calcaneus T-values ≤-2.5 (osteoporosis) were found in 16.3% of women and in 8.1% of men. PIXI calcaneus T-values <-1.6 (osteoporosis, adjusted) were found in 34.2% of women and in 21.4% of men. The age of the subjects and PIXI T-values were significantly correlated in women (Pearson's r = 0.37, P < 0.001) and men (Pearson's r = 0.19, P < 0.001). Periodontitis was found in 18.7% of subjects defined by alveolar bone level ≥5 mm. Subjects with osteoporosis defined by adjusted PIXI T-values had fewer remaining teeth [mean difference 4.1, 95% confidence interval (CI) -1.1 to -6.5, P < 0.001]. The crude odds ratio (OR) of an association between the panoramic assessment of mandibular cortex erosions as a sign of osteoporosis and the adjusted T-value (T-value cut-off <-1.6) was 4.8 (95% CI 3.1-7.2, P < 0.001; Pearson χ(2) = 60.1, P < 0.001). A significant OR between osteoporosis and periodontitis was only found in women for the T-value cut-off ≤-2.5 (crude OR 1.8, 95% CI 1.1-3.3, P < 0.03). Conclusions. An association between osteoporosis and periodontitis was only confirmed in women. The likelihood that the mandibular cortex index agrees with adjusted PIXI T-values is significant.

  • 10. Berglund, Johan
    et al.
    Stjernberg, Louise
    Ornstein, Katharina
    Tykesson/Joelsson, Katarina
    Walter, Hallstein
    5-y follow-up study of patients with neuroborreliosis2002In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 34, no 6, p. 421-425Article in journal (Refereed)
    Abstract [en]

    The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, between 1992 and 1993. A total of 349 identified cases with suspected neuroborreliosis were followed up 5 years later. Medical records were reviewed and all participants filled in a questionnaire. Of those classified with definite neuroborreliosis 114/130 completed the follow-up, of whom 111 had completed the initial antibiotic treatment. Of the 114 patients followed up, 86 (75%) had recovered completely and 70 (61%) had recovered within 6 months. Residual neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy were reported by 28/114. No significant differences between different antibiotic treatments were observed in terms of occurrence of sequelae. To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 years post-treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post-treatment. Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae.

  • 11. Berglund, Johan
    et al.
    Stjernberg, Louise
    Ornstein, Katharina
    Tykesson/Joelsson, Katarina
    Walter, Hallstein
    A 5-years follow-up of patients with neuroborreliosis.2002Conference paper (Refereed)
    Abstract [en]

    The objective of this follow-up study was to determine the long-term outcome in patients treated with antibiotics for strictly classified cases of neuroborreliosis. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, 1992-1993. Totally 349 identified cases with suspected neuroborreliosis were registered. Of those, 130 were classified as definitively neuroborreliosis and followed up five years later. Medical records were reviewed and all participants filled in a questionnaire. Totally, 114/130 (88%) completed the follow-up of whom 111/114 (97%) had fulfilled the initial antibiotic treatment. Of these, 86/114 (75%) had recovered completely and 70 (61%) recovered within six months. However 28/114 (25%) suffered from remaining neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy. The longer the duration from the neurological symptoms onset to antibiotic treatment the higher was the rate of sequelae. Of those who were treated within 30 days 5/32 (16%) and of those who were treated after 30 days 16/41 (39%) respectively, reported sequelae. Women suffered significantly more from sequelae compared to men, this difference was not seen among the children. No significant differences between the different antibiotic treatments given and experience of sequelae were seen. To conclude, we found that 25% (95% CI 17% to 33%) of the patients suffered from remaining neurological symptoms five years post treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post treatment and early diagnosis and treatment seems to be of great importance to possibly avoid also these cases.

  • 12.
    Berglund, Johan
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Vink, Peter
    Tavares Da Silva, Fernanda
    Lestrate, Pascal
    Boutriau, Dominique
    Safety, immunogenicity and antibody persistence following an investigational Streptococcus pneumoniae and Haemophilus influenzae tri-protein vaccine: a phase 1 randomized controlled study in healthy adults.2014In: Clinical and Vaccine Immunology, ISSN 1556-6811, E-ISSN 1556-679X, Vol. 21, no 1, p. 56-65Article in journal (Refereed)
    Abstract [en]

    We investigated a protein-based nontypeable Haemophilus influenzae (NTHi) and pneumococcal (HiP) vaccine containing pneumococcal histidine triad D (PhtD), detoxified pneumolysin (dPly), and NTHi protein D (PD) in adults. In a phase I study, 40 healthy 18- to 40-year-old subjects were randomized (2:2:1) to receive two HiP doses administered 60 days apart, with or without AS03 adjuvant (HiP-AS and HiP groups, respectively), or Engerix B (GlaxoSmithKline, Belgium) as a control. Safety, antibodies, and antigen-specific CD4+ T-cell immune responses were assessed before and until 480 days after vaccination. No serious adverse events were reported, and no subject withdrew due to an adverse event. Local and systemic symptoms were reported more frequently in the HiP-AS group than in the other two groups. The frequency and intensity of local and systemic symptoms appeared to increase after the second dose of HiP-AS or HiP but not Engerix B. Antibody geometric mean concentrations (GMCs) for PhtD, dPly, and PD increased after each dose of HiP-AS or HiP, with higher GMCs being observed in the HiP-AS group (statistically significant for anti-PD after dose 1 and anti-Ply after dose 2). GMCs remained higher at day 420 than prior to vaccination in both the HiP-AS and HiP groups. Antigen-specific CD4+ T cells increased after each dose but were unmeasurable by day 480. Two doses of an investigational PhtD-dPly-PD protein vaccine induced humoral immunity and antigen-specific CD4+ T-cell responses after each dose, with generally higher responses when the vaccine was administered with AS03. HiP combined with AS03 appeared to be more reactogenic than the antigens alone. (This study has been registered at ClinicalTrials.gov under registration no. NCT00814489.)

  • 13.
    Berner, Jesica
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Rennemark, Mikael
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Case Management for Frail Older Adults Through Tablet Computers and Skype2016In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 41, no 4, p. 405-416Article in journal (Refereed)
    Abstract [en]

    Background: Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication. Objective: This paper examines frail older adults’ use of tablet computers and Skype, with their case managers.Method: Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data. Results: The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use. Conclusion: Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further. © 2015 Taylor & Francis

  • 14.
    Berner, Jessica
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Rennemark, Mikael
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Jogreus, Claes
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Sköldunger, Anders
    Wahlberg, Maria
    Elmståhl, Sölve
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Factors influencing Internet usage in older adults (65 years and above) living in rural and urban Sweden2015In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 21, no 3, p. 237-249Article in journal (Refereed)
    Abstract [en]

    Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

  • 15.
    Berner, Jessica
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Rennemark, Mikael
    Blekinge Institute of Technology, School of Health Science.
    Jogréus, Claes
    Blekinge Institute of Technology, School of Engineering, Department of Mathematics and Natural Sciences.
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Distribution of personality, individual characteristics and internet usage in Swedish older adults2012In: Aging and Mental Health, ISSN 1360-7863 , Vol. 16, no 1, p. 119-126Article in journal (Refereed)
    Abstract [en]

    Objectives: This paper investigated factors associated with internet usage in the Swedish older adults ranging in age from 60 to 96. Personality traits and individual characteristics have been previously noted to influence internet usage, where older adults have not been the focus population. In this study the relationships between personality, individual characteristics and internet usage were investigated. Methods: A descriptive analysis of the personality tests of a total of 1402 subjects included in the Swedish National Study on Aging and Care (SNAC) was conducted. Three variables were controlled for: sex, age and education. Descriptive statistics, Mann-Whitney and Kruskal-Wallis tests, chi square tests and a logistic regression were used in order to detect the relationships with internet usage. Results: Men differ significantly from women in the personality traits analysis. Those with higher education were more open and neuroticism was lower in the oldest older adults. Internet usage declined significantly with age and those with middle to higher education were using the internet the most. No other associations with internet use were found Conclusion: Personality traits and individual characteristics do not seem to influence the Swedish older adult and their internet usage. What one needs to account for is the age and education of the person. The more educated and the youngest cohorts were using the internet more frequently.

  • 16.
    Berner, Jessica
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Rennemark, Mikael
    Blekinge Institute of Technology, School of Health Science.
    Jogréus, Claes
    Blekinge Institute of Technology, School of Engineering, Department of Mathematics and Natural Sciences.
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Factors associated with change in Internet usage of Swedish older adults (2004-2010)2013In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 19, no 2, p. 152-162Article in journal (Refereed)
    Abstract [en]

    The increased reliance on Internet use in social functions has presumably left out a part of the population: the oldest-older adults. These are people who have not kept themselves up to date with the technological developments for various reasons. There are, however, exceptions from whom we have something to learn. This study investigates the older people in Sweden who started to use the Internet over a period of 6 years. Cognition, extraversion, openness, functional disability, household economy, sex, age and education were investigated in relation to starting to use the Internet. A chi-square test, Spearman correlation and a logistic regression analysis were conducted. It was found that higher cognition, being male and being between the ages of 60 and 80 years were determining factors in starting to use the Internet for the Swedish older adult. Our results indicate that the oldest-older adults are slow to adapt to using the Internet and more attention should be paid on how to support this group.

  • 17. Bunikis, Jonas
    et al.
    Garpmo, Ulf
    Tsao, J.
    Berglund, Johan
    Fish, Durland
    Barbour, AG
    Sequence typing reveals extensive strain diversity of the Lyme borreliosis agents Borrelia burgdorferi in North America and Borrelia afzelii in Europe.2004In: Microbiology, ISSN 1350-0872, E-ISSN 1465-2080, Vol. 150, no 6, p. 1741-1755Article in journal (Refereed)
    Abstract [en]

    The genetic polymorphism of Borrelia burgdorferi and Borrelia afzelii, two species that cause Lyme borreliosis, was estimated by sequence typing of four loci: the rrs-rrlA intergenic spacer (IGS) and the outer-membrane-protein gene p66 on the chromosome, and the outer-membrane-protein genes ospA and ospC on plasmids. The major sources of DNA for PCR amplification and sequencing were samples of the B. burgdorferi tick vector Ixodes scapularis, collected at a field site in an endemic region of the north-eastern United States, and the B. afzelii vector Ixodes ricinus, collected at a similar site in southern Sweden. The sequences were compared with those of reference strains and skin biopsy isolates, as well as database sequences. For B. burgdorferi, 10-13 alleles for each of the 4 loci, and a total of 9 distinct clonal lineages with linkage of all 4 loci, were found. For B. afzelii, 2 loci, ospC and IGS, were examined, and 11 IGS genotypes, 12 ospC alleles, and a total of 9 linkage groups were identified. The genetic variants of B. burgdorferi and B. afzelii among samples from the field sites accounted for the greater part of the genetic diversity previously reported from larger areas of the north-eastern United States and central and northern Europe. Although ospC alleles of both species had higher nucleotide diversity than other loci, the ospC locus showed evidence of intragenic recombination and was unsuitable for phylogenetic inference. In contrast, there was no detectable recombination at the IGS locus of B. burgdorferi. Moreover, beyond the signature nucleotides that specified 10 IGS genotypes, there were additional nucleotide polymorphisms that defined a total of 24 subtypes. Maximum-likelihood and parsimony cladograms of B. burgdorferi aligned IGS sequences revealed the subtype sequences to be terminal branches of clades, and the existence of at least three monophyletic lineages within B. burgdorferi. It is concluded that B. burgdorferi and B. afzelii have greater genetic diversity than had previously been estimated, and that the IGS locus alone is sufficient for strain typing and phylogenetic studies.

  • 18. Bunikis, Jonas
    et al.
    Tsao, J.
    Garpmo, Ulf
    Berglund, Johan
    Fish, Durland
    Barbour, AG
    Typing of Borrelia relapsing fever group strains.2004In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 10, no 9, p. 1661-1664Article in journal (Refereed)
    Abstract [en]

    Partial sequencing of the 16S-23S rDNA intergenic spacer showed two to four genotypes each for Borrelia hermsii and B. turicatae, both relapsing fever agents transmitted by argasid ticks, and for B. miyamotoi and B. lonestari, transmitted by ixodid ticks. Field surveys of Ixodes ticks in Connecticut and Sweden showed limited local diversity for B. miyamotoi.

  • 19.
    Eivazzadeh, Shahryar
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Johan, Berglund
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Tobias, Larsson
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Designing with Priorities and Thresholds for Health Care Heterogeneity: The Approach of Constructing Parametric Ontology2015Conference paper (Refereed)
    Abstract [en]

    Designing systems working in health care needs complying with the heterogeneous, overlapping, non-overlapping, competing, or even contradicting requirements expressed by the various actors of the health care complex environment, including regulatory bodies. The unification method introduced in this paper, utilized ontological struc- tures to unify heterogeneous requirements in different levels of ab- straction. Also the weighting and threshold algorithms defined upon the ontology structure allows to both prioritize the requirements and align design resources upon that priority, at the same time to enforce regulatory requirements in an easy, clear and integrated way and reject designs which cannot comply with them. Application of the method introduced in this paper is not limited to health care, but it might be applied in design for any heterogeneous environment.

  • 20.
    Eivazzadeh, Shahryar
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Larsson, Tobias
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Fricker, Samuel
    Blekinge Institute of Technology, Faculty of Computing, Department of Software Engineering. University of Applied Sciences and Arts Northwestern Switzerland.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Evaluating Health Information Systems Using Ontologies2016In: JMIR Medical Informatics, ISSN 2291-9694, Vol. 4, no 2, article id e20Article in journal (Refereed)
    Abstract [en]

    Background: There are several frameworks that attempt to address the challenges of evaluation of health information systems by offering models, methods, and guidelines about what to evaluate, how to evaluate, and how to report the evaluation results. Model-based evaluation frameworks usually suggest universally applicable evaluation aspects but do not consider case-specific aspects. On the other hand, evaluation frameworks that are case specific, by eliciting user requirements, limit their output to the evaluation aspects suggested by the users in the early phases of system development. In addition, these case-specific approaches extract different sets of evaluation aspects from each case, making it challenging to collectively compare, unify, or aggregate the evaluation of a set of heterogeneous health information systems.

    Objectives: The aim of this paper is to find a method capable of suggesting evaluation aspects for a set of one or more health information systems—whether similar or heterogeneous—by organizing, unifying, and aggregating the quality attributes extracted from those systems and from an external evaluation framework.

    Methods: On the basis of the available literature in semantic networks and ontologies, a method (called Unified eValuation using Ontology; UVON) was developed that can organize, unify, and aggregate the quality attributes of several health information systems into a tree-style ontology structure. The method was extended to integrate its generated ontology with the evaluation aspects suggested by model-based evaluation frameworks. An approach was developed to extract evaluation aspects from the ontology that also considers evaluation case practicalities such as the maximum number of evaluation aspects to be measured or their required degree of specificity. The method was applied and tested in Future Internet Social and Technological Alignment Research (FI-STAR), a project of 7 cloud-based eHealth applications that were developed and deployed across European Union countries.

    Results: The relevance of the evaluation aspects created by the UVON method for the FI-STAR project was validated by the corresponding stakeholders of each case. These evaluation aspects were extracted from a UVON-generated ontology structure that reflects both the internally declared required quality attributes in the 7 eHealth applications of the FI-STAR project and the evaluation aspects recommended by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. The extracted evaluation aspects were used to create questionnaires (for the corresponding patients and health professionals) to evaluate each individual case and the whole of the FI-STAR project.

    Conclusions: The UVON method can provide a relevant set of evaluation aspects for a heterogeneous set of health information systems by organizing, unifying, and aggregating the quality attributes through ontological structures. Those quality attributes can be either suggested by evaluation models or elicited from the stakeholders of those systems in the form of system requirements. The method continues to be systematic, context sensitive, and relevant across a heterogeneous set of health information systems.

  • 21.
    Eivazzadeh, Shahryar
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Larsson, Tobias
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mechanical Engineering.
    Fiedler, Markus
    Blekinge Institute of Technology, Faculty of Computing, Department of Technology and Aesthetics.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Most Influential Qualities in Creating Satisfaction Among the Users of Health Information Systems: A Study in Seven EU Countries2018In: JMIR Medical Informatics, Vol. 6, no 4, p. 3-21Article in journal (Refereed)
    Abstract [en]

    Background:

    Several models suggest how the qualities of a product or service influence user satisfaction. Models, such as the Customer Satisfaction Index (CSI), Technology Acceptance Model (TAM), and Delone and McLean Information Systems Success (D&M IS), demonstrate those relations and have been used in the context of health information systems.

    Objective:

    We want to investigate which qualities foster greater satisfaction among patient and professional users. In addition, we are interested in knowing to what extent improvement in those qualities can explain user satisfaction and if this makes user satisfaction a proxy indicator of those qualities.

    Methods:

    The Unified eValuation using ONtology (UVON) method was utilised to construct an ontology of the required qualities for seven e-health applications being developed in the FI-STAR project, a European Union (EU) project in e-health. The e-health applications were deployed across seven EU countries. The ontology included and unified the required qualities of those systems together with the aspects suggested by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. Two similar questionnaires, for 87 patient users and 31 health professional users, were elicited from the ontology. In the questionnaires, user was asked if the system has improved the specified qualities and if the user was satisfied with the system. The results were analysed using Kendall correlation coefficients matrices, incorporating the quality and satisfaction aspects. For the next step, two Partial Least Squares Structural Equation Modelling (PLS-SEM) path models were developed using the quality and satisfaction measure variables and the latent construct variables that were suggested by the UVON method.

    Results:

    Most of the quality aspects grouped by the UVON method are highly correlated. Strong correlations in each group suggest that the grouped qualities can be measures which reflect a latent quality construct. The PLS-SEM path analysis for the patients reveals that the effectiveness, safety, and efficiency of treatment provided by the system are the most influential qualities in achieving and predicting user satisfaction. For the professional users, effectiveness and affordability are the most influential. The parameters of the PLS-SEM that are calculated allow for the measurement of a user satisfaction index similar to CSI for similar health information systems.

    Conclusions:

    For both patients and professionals, the effectiveness of systems highly contributes to their satisfaction. Patients care about improvements in safety and efficiency, while professionals care about improvements in the affordability of treatments with health information systems. User satisfaction is reflected more in the users' evaluation of system output and fulfilment of expectations, but slightly less in how far the system is from ideal. Investigating satisfaction scores can be a simple, fast way to infer if the system has improved the abovementioned qualities in treatment and care.

  • 22.
    Frögren, Joakim
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Quitana, M.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Designing a model app for older persons with cognitive impairment: insights from a usability perspective2018In: Gerontechnology, ISSN 1569-1101, E-ISSN 1569-111X, Vol. 17, p. 80-Article in journal (Refereed)
    Abstract [en]

    Purpose Research indicates that health-oriented applications on mobile units such as smartphones and PDAs, so called mHealth applications, can be useful to support older persons with cognitive impairment and their informal caregivers1. However, several studies suggest that a prerequisite for older persons to start using computer-based technology is that it offers individual customization according to personal preference 2,3,4. In the ongoing Horizon 2020 project SMART4MD (Support, Monitoring And Reminder Technology for older persons with Mild Dementia), an health-oriented model app has been developed through a user-centered process involving stakeholders in six European countries and with an emphasis on customization to allow for the various needs of older persons with cognitive impairment and their informal caregivers. The aim of this study is to gain insights about the specific needs of the target group and success factors related to the user-centered design process. Method Within the frames of the SMART4MD project, an initial Feasibility study was conducted in two countries (Spain and Sweden) simultaneously, in which in total nineteen persons with cognitive impairment aged 66-93, and their respective informal caregivers, performed a taskbased usability test of the SMART4MD model app individually in a clinical setting, followed by a four-week testing of the app in their home environment. Finally, a usability evaluation was done through individual structured interviews. Results & Discussion The result indicates that less exposure to similar technology affects both ability and self-esteem when confronted with the model app, and that evaluating usability with the target group using standard forms within usability testing requires pre-cautions. © 2018 International Society for Gerontechnology.

  • 23.
    Ghani, Zartashia
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Jarl, Johan
    Lunds universitet, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Andersson, Martin
    Blekinge Institute of Technology, Faculty of Engineering, Department of Industrial Economics.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The Cost Effectiveness of M-health Interventions for Older Adults: Protocol for a Systematic Review2018Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Many studies reported effectiveness of mhealth interventions targeting middle aged and older adults to improve healthcare delivery process, efficacy and management of chronic diseases. However, the knowledge about their cost-effectiveness is important to implement mhealth interventions at large scale for proper allocation of scarce resources. This systematic review will summarize the results from identified studies for the cost effectiveness of mhealth interventions aimed for middle aged and older adults.

    Method: mhealth interventions aimed to improve healthcare delivery process, efficacy and delivering training will be included in this systematic review. A comprehensive electronic search strategy will be used to identify health economic evaluations, published since 2007, and indexed in Pubmed, Scopus and CINAHL. The search strategy will include terms (and synonyms) for the following mhealth devices: mobile phone, smartphone, mhealth. Middle aged and older adults will be used to identify all mhealth interventions introduced to middle aged and older adults. Terms such as economic evaluation, cost effectiveness, cost utility etc will be used to identify economic evaluations of all mhealth interventions.

    Discussion: This systematic review will report evidence on cost effectiveness of mhealth interventions targeting middle aged and older adults.

  • 24. Halling, Anders
    et al.
    Berglund, Johan
    Concordance between elderly patients' understanding of and their primary healthcare physician's diagnosis of heart failure.2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 2, p. 110-104Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective was to study primary healthcare patients' understanding of their diagnosis of heart failure (HF), using patients treated for diabetes mellitus (DM) as a comparative group. DESIGN: A cross-sectional community based study. SETTING: Karlskrona community situated on the Swedish south-east coast with 60,600 inhabitants. SUBJECTS: A total of 1402 subjects, aged 60-96 years in 10 age cohorts, selected randomly from the national population registry participating in the Swedish National study on Ageing and Care - Blekinge. MAIN OUTCOME MEASURES: Understanding of diagnosis of HF or DM in primary healthcare. Prevalence of cognitive impairment. RESULTS: In all, 39.8% of patients with a diagnosis of HF treated in primary healthcare and 97.1% of patients with DM had an understanding of their respective diagnosis. Cognitive impairment was significantly more prevalent in the groups of patients treated for HF (OR 1.9, 95% CI 1.2 to 3.0) and DM (OR 1.8, 95% CI 1.1 to 3.1), when compared with those not treated for either HF or DM. The odds ratio for understanding of diagnosis was 0.013 (95% CI 0.003 to 0.052, p < 0.001) in patients treated for HF, compared with patients treated for DM, when adjusted for the subject's age, sex, and cognitive function. CONCLUSION: In this study it was shown that patients' understanding of their diagnosis was highly dependent on diagnosis, independently of age, sex, or cognitive function. The results suggest that there is room for improvement of care in primary healthcare, to increase HF patients' understanding of their diagnosis.

  • 25. Halling, Anders
    et al.
    Berglund, Johan
    Diagnosis and treatment of heart failure in primary health care among elderly patients with non-insulin-dependent diabetes mellitus, with special reference to use of echocardiography2003In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 2, p. 96-98Article in journal (Refereed)
    Abstract [en]

    Objective-The aim of the present study was to describe how the diagnosis of heart failure (HF) was assessed, aetiology and management in elderly patients with non-insulin-dependent diabetes mellitus (NIDDM) in primary health care, with special reference to use of echocardiography. Design-Descriptive retrospective investigation. Setting-Ronneby and Karlskrona communities, both situated on the Swedish south-east coast, 28,600 and 60,600 inhabitants, respectively. Patients-279 patients with NIDDM, mean age 77 years (range 70-85). Main outcome measures-Prevalence, aetiology, diagnostic procedures and management of HF. Results-The majority of patients were given the diagnosis of HF mainly as a result of clinical examination, ECG and chest X-ray, or of hospitalisation for HF. The diagnosis of HF by the primary care physicians was based on an objective evaluation of cardiac function in 8% of the patients. Hypertension was the predominant associated disease, followed by ischaemic heart disease (IHD). Therapy included diuretics (91%), angiotensin-converting enzyme (ACE) inhibitors (43%) and digoxin (53%). Conclusion-There is still a gap between current management of HF in primary care and guidelines, particularly in the case of diagnosis that is not generally based on an objective evaluation of cardiac function.

  • 26. Halling, Anders
    et al.
    Persson, Gösta Rutger
    Berglund, Johan
    Johansson, Owe
    Renvert, Stefan
    Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly.2005In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 16, no 8, p. 999-1003Article in journal (Refereed)
    Abstract [en]

    Osteopenia/osteoporosis affect many elderly people and might not be detected until symptoms of fractures occur. Early detection of osteopenia/osteoporosis is important and would allow preventive measures and treatment. Access to screening for osteopenia/osteoporosis is often limited, whereas panoramic radiography is commonly used in dentistry. The aim of this study was to determine the validity of the Klemetti index (KI), measured on panoramic radiographs, in the diagnosis of osteopenia/osteoporosis as defined by a bone mineral density (BMD) measurement below -1.5 standard deviations (SDs) of a community based sample. In total, 211 consecutive participants (102 men and 109 women) 60-96 years in the SNAC-Blekinge study (Swedish National Study on Ageing and Care) underwent bone densitometry [by dual-energy X-ray absorptiometry (DXA)] of both heels. A panoramic radiograph was taken of each participant, and mandibular cortex on a panoramic radiograph was classified as '0' or normal (even and sharp endosteal margin), '1', moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or '2', severely eroded (unequivocal porosity). From logistic regression, the odds ratio of having a BMD measurement below -1.5 SD was 8.04 (95% CI 2.39 to 27.12, P<0.001) in the 'osteopenic' (KI category 2), compared with the 'normal' group (KI categories 0 and 1). Receiver operating characteristic (ROC) curve analysis was used to measure the validity of the KI indicating osteopenia (KI category 2) in predicting reduced BMD. This point provided a sensitivity of 50% and a specificity of 89%. Positive and negative predictive values were 21% and 97%, respectively. There were 87% correctly classified subjects. The area under the ROC curve was 0.64. The present study demonstrated that a negative finding (KI category <2) is highly predictive of the absence of osteopenia/osteoporosis as defined by the DXA measurements.

  • 27. Hamnerius, N.
    et al.
    Berglund, Johan
    Faergemann, J.
    Pedal dermatophyte infection in psoriasis.2004In: British Journal of Dermatology, ISSN 0007-0963, Vol. 50(6), p. 1125-1118Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dermatophyte infections have been considered rare in psoriasis. However, there are data indicating that tinea unguium is as common or even more common in psoriasis compared with healthy controls. Tinea unguium is generally a secondary event to tinea pedis infection. OBJECTIVES: To study the prevalence of tinea pedis and tinea unguium in psoriasis compared with a control group. METHODS: Consecutive psoriasis outpatients aged 18-64 years attending a department of dermatology were examined. Samples for direct microscopy and culture were taken from the interdigital spaces, soles and toenails. Consecutive patients without signs of psoriasis or atopic dermatitis seeking examination of moles constituted the control group. RESULTS: In total, 239 patients with psoriasis and 245 control patients were studied. The prevalence of tinea pedis was 8.8%[95% confidence interval (CI) +/- 3.6%] in the psoriasis group and 7.8% (95% CI +/- 3.4%) in the control group. The corresponding figures for prevalence of tinea unguium were 4.6% (95% CI +/- 2.7%) and 2.4% (95% CI +/- 1.9%), respectively. The differences found in the psoriasis vs. the control groups were not statistically significant. CONCLUSIONS: This study does not support the hypothesis that the prevalence of tinea pedis and tinea unguium in patients with psoriasis differs from that in a normal population.

  • 28. Holst, Göran
    et al.
    Rennemark, Mikael
    Berglund, Johan
    Vård och omsorg i Karlskrona, personer 65 år och däröver, våren 20022002Report (Other academic)
  • 29. Jarefors, Sara
    et al.
    Bennet, Louise
    You, Elin
    Forsberg, Pia
    Ekerfelt, Christina
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Ernerudh, Jan
    Lyme borreliosis reinfection: might it be explained by a gender difference in immune response?2006In: Immunology, ISSN 0019-2805, E-ISSN 1365-2567, Vol. 118, no 2, p. 224-232Article in journal (Refereed)
    Abstract [en]

    Lyme borreliosis is a tick-borne disease often manifesting as a circular skin lesion. This cutaneous form of the disease is known as erythema migrans. In a 5-year follow-up study in southern Sweden, 31 of 708 individuals initially diagnosed with erythema migrans and treated with antibiotics were found to be reinfected with Borrelia burgdorferi. Although men and women were tick-bitten to the same extent, 27 of the 31 reinfected individuals were women, all of whom were over 44 years of age. The aim of this study was to determine whether this discrepancy in gender distribution could be a result of differences in immunological response. Twenty single-infected and 21 reinfected women and 18 single-infected and three reinfected men were included in the study. None of the participants showed any sign of an ongoing B. burgdorferi infection, and thus the habitual response was captured. Lymphocytes were separated from blood and stimulated with antigens. The secretion of interleukin (IL)-4, IL-6, IL-10, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha was measured by enzyme-linked immunosorbent assay (ELISA), enzyme-linked immunosorbent spot-forming cell assay (ELISPOT) or Immulite. No difference was detected in cytokine secretion between single-infected and reinfected individuals. We also compared the immunological response in men and women, regardless of the number of B. burgdorferi infections. Women displayed a significantly higher spontaneous secretion of all cytokines measured. The ratios of IL-4:IFN-gamma and IL-10:TNF-alpha were significantly higher in women. Gender differences in immune reactivity might in part explain the higher incidence of reinfection in women. The higher IL-4:IFN-gamma and IL-10:TNF-alpha ratios seen in women indicate that postmenopausal women have T helper type 2 (Th2)-directed reactivity with impaired inflammatory responses which might inhibit the elimination of spirochetes.

  • 30.
    Lagergren, Marten
    et al.
    Stockholm Gerontol Res Ctr, Stockholm, Sweden..
    Fagerstrom, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sjolund, Britt-Marie
    Karolinska Inst, Dept Neurobiol, Aging Res Ctr, Care Sci & Soc, Solna, Sweden.;Stockholm Univ, Solna, Sweden..
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Fratiglioni, Laura
    Stockholm Gerontol Res Ctr, Stockholm, Sweden.;Karolinska Inst, Dept Neurobiol, Aging Res Ctr, Care Sci & Soc, Solna, Sweden.;Stockholm Univ, Solna, Sweden..
    Nordell, Eva
    Lund Univ, Dept Hlth Sci, Div Geriatr Med, Malmo, Sweden.;Skane Univ Hosp, Malmo, Sweden..
    von Strauss, Eva
    Karolinska Inst, Dept Neurobiol, Aging Res Ctr, Care Sci & Soc, Solna, Sweden.;Stockholm Univ, Solna, Sweden.;Red Cross Hosp, Nonprofit Org, Stockholm, Sweden.;Red Cross Univ Coll, Stockholm, Sweden..
    Wimo, Anders
    Karolinska Inst, Dept Neurobiol, Alzheimers Dis Res Ctr, Care Sci & Soc, Solna, Sweden..
    Elmstahl, Solve
    Lund Univ, Dept Hlth Sci, Div Geriatr Med, Malmo, Sweden.;Skane Univ Hosp, Malmo, Sweden..
    Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden2016In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 28, no 1, p. 147-158Article in journal (Refereed)
    Abstract [en]

    The concepts of target efficiency can be used to assess the extent to which service provision is in line with the needs of the population. Horizontal target efficiency denotes the extent to which those deemed to need a service receive it and vertical target efficiency is the corresponding extent to which those who receive services actually need them. The aim of this study was to assess the target efficiency of the Swedish eldercare system and to establish whether target efficiencies differ in different geographical areas such as large urban, midsize urban and rural areas. Vertical efficiency was measured by studying those people who received eldercare services and was expressed as a percentage of those who received services who were functionally dependent. To measure horizontal target efficiency, data collected at baseline in the longitudinal population study SNAC (Swedish National study on Aging and Care) during the years 2001-2004 were used. The horizontal efficiency was calculated as the percentage of functionally dependent persons who received services. Functional dependency was measured as having difficulty with instrumental activities of daily living (IADL) and/or personal activities of daily living (PADL). Services included long-term municipal eldercare services (LTC). Horizontal target efficiency for the public LTC system was reasonably high in all three geographical areas, when using dependency in PADL as the measure of need (70-90 %), but efficiency was lower when the less restrictive measure of IADL dependency was used (40-50 %). In both cases, the target efficiency was markedly higher in the large urban and the rural areas than in the midsize urban areas. Vertical target efficiency showed the same pattern-it was almost 100 % in all areas for IADL dependency, but only 50-60 % for PADL dependency. Household composition differed in the areas studied as did the way public long-term care was provided to people living alone as compared to those co-habiting.

  • 31. Lagergren, Mårten
    et al.
    Fratiglioni, Laura
    Hallberg, Ingalill R
    Berglund, Johan
    Elmståhl, Sölve
    Hagberg, Bo
    Holst, Göran
    Rennemark, Mikael
    Sjölund, Britt-Marie
    Thorslund, Mats
    A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC).2004In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 16, no 2, p. 158-168Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: A large, national, long-term, longitudinal, multi-purpose study has been launched in Sweden--the Swedish National study on Aging and Care (SNAC). The study involves four research centers collecting data in four different areas of Sweden. METHODS: The study consists of two parts: the population part and the care and services part. In the population part, a large, representative panel of elders in different age cohorts is followed over time to record and describe the aging process from different aspects. In the care and services part, a systematic, longitudinal, individually-based collection of data is performed concerning provision of care and services together with functional ability, specific health care problems, and living conditions of the recipients living in the area. RESULTS: The data collection in the population part of the SNAC is not yet completed. In the present article, some preliminary results are reported from the care and services part. These pertain to comparisons between the participating areas with respect to the prevalence of disability among those receiving care and social services in their ordinary homes and those receiving care in special accommodation. A comparison is also presented with regard to the amount of home help provided to subjects with a given disability. CONCLUSIONS: This project has several advantages. It is expected to generate a rich data base relevant for future research on aging and care and to have a direct impact on the future Swedish system of care and services for the elderly.

  • 32. Lagergren, Mårten
    et al.
    Sjölund, Britt-Marie
    Fagerström, Cecilia
    Blekinge Institute of Technology, School of Health Science.
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Fratiglioni, Laura
    Nordell, Eva
    Wimo, Anders
    Elmståhl, Sölve
    Horizontal and vertical target efficiency – a comparison between users and non-users of public long-term care in Sweden2014In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 34, no 4, p. 700-719Article in journal (Refereed)
    Abstract [en]

    The extent to which a system of services is in tune with the needs of the population can be expressed in terms of target efficiency, which includes horizontal target efficiency – the extent to which those deemed to need a service receive it – and vertical target efficiency – the corresponding extent to which those who receive a service actually need it. Vertical efficiency can be measured by looking only at those receiving services. To measure horizontal target efficiency in a population, one must have access to population surveys. Data were taken from the baseline survey of the Swedish National Study on Ageing and Care (SNAC study). The results show that more than 80 per cent of those dependent in personal activities of daily living in the studied geographic areas were users of public long-term care (LTC). Dependency in instrumental activities of daily living was identified as the most important predictor of using LTC. Vertical target efficiency was 83–95 per cent depending on age, gender and type of household, if need was defined as dependency in instrumental activities of daily living. It was considerably lower, 35–61 per cent when defined as dependency in personal daily activities. Overall, long-term target efficiency in Sweden must be regarded as high. Few persons who need public LTC services fail to receive them.

  • 33.
    Lilje, Stina C.
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Skillgate, Eva
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Negative psychosocial and heavy physical workloads associated with musculoskeletal pain interfering with normal life in older adults: Cross-sectional analysis2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 5, p. 453-459Article in journal (Refereed)
    Abstract [en]

    Aims: Pain is one of the most frequent reasons for seeking health care, and is thus a public health problem. Although there is a progressive increase in pain and impaired physical function with age, few studies are performed on older adults. The aim of this study was to investigate if there are associations between musculoskeletal pain interfering with normal life in older adults and physical and psychosocial workloads through life. Methods: The association of heavy physical workload and negative psychosocial workload and musculoskeletal pain interfering with normal life (SF 12) was analyzed by multiple logistic regression. The model was adjusted for eight background covariates: age, gender, growing-up environment, educational level, if living alone or not, obesity, smoking, and leisure physical activity. Results: Negative psychosocial and heavy physical workloads were independently associated with musculoskeletal pain interfering with normal life (adjusted OR: 4.44, 95% CI: 2.84-6.92), and (adjusted OR: 1.88, 95% CI: 1.20-2.93), respectively. The background covariates female gender and higher education were also associated with musculoskeletal pain interfering with normal life, and physical leisure activity was inversely associated. Conclusions: The findings suggest that negative psychosocial and heavy physical workloads are strongly associated with musculoskeletal pain interfering with normal life in older adults.

  • 34.
    Lindberg, Terese
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Bohman, Doris M.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Elmstahl, Solve
    Lund Univ, Dept Hlth Sci, Lund, Sweden..
    Jogreus, Claes
    Blekinge Institute of Technology, Faculty of Engineering, Department of Mathematics and Natural Sciences.
    Berglund, Johan Sanmartin
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Prevalence of unknown and untreated arrhythmias in an older outpatient population screened by wireless long-term recording ECG2016In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 11, p. 1083-1090Article in journal (Refereed)
    Abstract [en]

    Purpose: With longer life expectancies, the prevalence of arrhythmias is increasing; thus, there is a need for new methods to screen the older outpatient population. This population-based study describes the prevalence of arrhythmias in 200 outpatients aged. 66 years. We also investigated the feasibility of wireless long-term recording (LTR) using the ECG-BodyKom (R). Methods: Two hundred elderly persons aged 66-93 years were recruited from the Swedish National Study on Aging and Care in 2010-2013, and data were collected via wireless LTR ECG-BodyKom. Results: Screening with the LTR ECG revealed that persistent atrial fibrillation (AF) occurred in 10% of the outpatient population aged. 66 years. Paroxysmal AF occurred in 5.5% of the population, with no difference between younger (60-80 years) and older (>80 years) elderly participants. Furthermore, all patients with paroxysmal AF had a CHA(2)DS(2)VASc score of >= 2 and were therefore potential candidates for follow-up and medical examination. LTR ECG-BodyKom can be considered a feasible method to screen for arrhythmias in older outpatient populations. This simple method requires little of the user, and there was high satisfaction with the equipment and a good overall experience wearing it. Conclusion: The increasing occurrence of arrhythmias in the older population, as well as the high number of untreated cases of arrhythmias such as persistent AF and paroxysmal AF, poses a challenge for health care. Therefore, it is essential to develop effective strategies for their prevention and treatment.

  • 35.
    Lindberg, Terese
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Elmståhl, Sölve
    Lunds Universitet, SWE.
    Bohman, Doris
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Older individuals’ need for knowledge and follow-up about their chronic atrial fibrillation, lifelong medical treatment and medical controls2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 4, p. 1022-1030Article in journal (Refereed)
    Abstract [en]

    Older individuals with chronic atrial fibrillation (AF) often experience physical symptoms and feel psychologically unwell. In addition, these persons are prescribed lifelong medical treatment that requires regular monitoring. Through 11 individual interviews, this interpretive description study aimed to explore and describe lifelong medical treatment and the need for medical controls as experienced from the perspective of older individuals living with chronic AF. The interviews were performed during 2014–2015; furthermore, they were recorded, transcribed verbatim and analysed for thematic patterns using thematic analysis inspired by Braun and Clarke. Ethical standards were followed throughout the study. The findings revealed one main theme: ‘ambivalence in the need of knowledge’ showing that lifelong medical treatment and the need for medical controls, in general, meant experiencing feelings of ‘it doesn't matter, but it does matter’ and ‘being in the hands of the healthcare system’. The older persons lacked knowledge about their condition, which generated poor insight into their medical treatment and this in turn affected their daily life. They had thoughts and questions about their medication, but did not have an opportunity to ask the questions because of lack of follow-up from the healthcare system. The findings underscore the negative impact chronic AF has on older people's life and emphasises the need for follow-up and providing information from health care to these individuals. © 2017 Nordic College of Caring Science

  • 36. Lindström, V.
    et al.
    Andersson, K.
    Lintrup, Mats
    Blekinge Institute of Technology, School of Health Science.
    Holst, Göran
    Blekinge Institute of Technology, School of Health Science.
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Prevalence of sleep problems and pain among the elderly in Sweden2012In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 16, no 2, p. 180-83Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: Sleep problems and pain are common among the elderly and have been shown to affect quality of life. The objectives were to determine the prevalence of sleep problems and pain among the elderly and to compare the two factors in relation to age and gender. Design: A cross-sectional study based on baseline material collected by the Swedish National Study on Aging and Care in Blekinge (SNACBlekinge). Setting: The data were gathered from questionnaires distributed between the years 2001 and 2003 in the municipality of Karlskrona, Sweden. Participants: The participants comprised 1402 Swedish men and women aged 60-96. Results: Of all the participants 70 percent met the criteria for sleep problems and 62 percent indicated some experience of pain during the preceding 4 weeks. Both sleep problems and pain were more frequent among women than men and sleep problems tended to be more common with increasing age. Among the participants who experienced pain during the preciding 4 weeks 77 percent suffered from sleep problems. Conclusions: Sleep problems and pain are common among older people. Furthermore it is common to suffer from sleep problems when pain has been experienced during the preciding 4 weeks.

  • 37. Lindwall, Magnus
    et al.
    Rennemark, Mikael
    Halling, Anders
    Berglund, Johan
    Hassmén, P
    Depression and exercise in elderly men and women: findings from the Swedish national study on aging and care.2007In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 15, no 1, p. 41-55Article in journal (Refereed)
    Abstract [en]

    This study investigated the relationship between light and strenuous exercise and depression, as well as gender differences in this relationship, in a representative sample of 860 elderly Swedish suburb-dwelling men and women in age cohorts from 60 to 96 years, drawn from among participants in the Swedish National Aging and Care study. The relationship between depression and self-reported changes in exercise status over time was also examined. Exercise activities were measured with four survey questions, and depression, with the Montgomery Asberg Depression Rating Scale. The inactive elderly had higher depression scores than more active individuals, both in terms of light and strenuous exercise. The continuously active group had lower depression scores than both continuously inactive individuals and individuals reporting a shift from activity to inactivity during the preceding year. Light exercise had a somewhat stronger effect on depression for women.

  • 38.
    McElhaney, Janet
    et al.
    Hlth Sci North Res Inst, CAN.
    Lal, Himal
    GlaxoSmithKline, King Of Prussia, PA USA..
    Cunningham, Anthony
    Westmead & Univ Sydney, AUS.
    Levin, Myron
    Univ Colorado Anschutz Med Campus, USA.
    Chlibek, Roman
    Univ Def, Hradec Kralove, CZE.
    Diez-Domingo, Javier
    Fdn Fomentode Invest Sanitaria & Biomed FISABIO, ESP.
    Athan, Eugene
    Deakin Univ, AUS.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health. Blekinge Inst Technol, Karlskrona, Sweden..
    Downey, Jackson
    Jacksonville Ctr Clin Res, USA.
    Ghesquiere, Wayne
    Univ British Columbia, CAN.
    Godeaux, Olivier
    GlaxoSmithKline, King Of Prussia, PA USA..
    Gorfinkel, Iris
    Prime Hlth Clin Res, CAN.
    Hwang, Shinn-Jang
    Taipei Vet Gen Hosp, TWN.
    Korhonen, Tiina
    Univ Tampere, FIN.
    McNeil, Shelly
    IWK Hlth Ctr, Halifax, CAN.
    Pauksens, Karlis
    Uppsala Univ Hosp, SWE.
    Puig-Barbera, Joan
    Fdn Fomentode Invest Sanitaria & Biomed FISABIO, ESP.
    Avelino-Silva, Thiago
    Univ Sao Paulo, BRA.
    Vesikari, Timo
    Univ Tampere, FIN.
    Volpi, Antonio
    Univ Roma Tor Vergata, ITA.
    Watanabe, Daisuke
    Aichi Med Univ, JPN.
    Yeo, Wilfried
    Univ Wollongong, AUS.
    Campora, Laura
    GlaxoSmithKline, King Of Prussia, PA USA..
    Vanden Abeele, Carline
    GlaxoSmithKline, King Of Prussia, PA USA..
    Oostvogels, Lidia
    GlaxoSmithKline, King Of Prussia, PA USA..
    Heinemann, Thomas
    GlaxoSmithKline, King Of Prussia, PA USA..
    Hain, Johannes
    GlaxoSmithKline GmbH & Co KG, DEU.
    Efficacy, Immunogenicity and Safety of adjuvanted Herpes Zoster-Virus Subunit Vaccine Candidates in Adults from 60 Years and older: Results from the Efficacy Studies ZOE-50 and ZOE-702018In: Der Internist, ISSN 0020-9554, E-ISSN 1432-1289, Vol. 59, p. S64-S65Article in journal (Other academic)
  • 39.
    Moraes, Ana Louiza Dallora
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    Eivazzadeh, Shahryar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Mendes, Emilia
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Prognosis of Dementia Employing Machine Learning and Microsimulation Techniques: A Systematic Literature Review2016In: Procedia Computer Science / [ed] Martinho R.,Rijo R.,Cruz-Cunha M.M.,Bjorn-Andersen N.,Quintela Varajao J.E., Elsevier, 2016, Vol. 100, p. 480-488Conference paper (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this paper is to investigate the goals and variables employed in the machine learning and microsimulation studies for the prognosis of dementia. METHOD: According to preset protocols, the Pubmed, Socups and Web of Science databases were searched to find studies that matched the defined inclusion/exclusion criteria, and then its references were checked for new studies. A quality checklist assessed the selected studies, and removed the low quality ones. The remaining ones (included set) had their data extracted and summarized. RESULTS: The summary of the data of the 37 included studies showed that the most common goal of the selected studies was the prediction of the conversion from mild cognitive impairment to Alzheimer's Disease, for studies that used machine learning, and cost estimation for the microsimulation ones. About the variables, neuroimaging was the most frequent used. CONCLUSIONS: The systematic literature review showed clear trends in prognosis of dementia research in what concerns machine learning techniques and microsimulation.

  • 40.
    Moraes, Ana Luiza Dallora
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    Eivazzadeh, Shahryar
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Mendes, Emilia
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering. Blekinge Institute of Technology, Faculty of Computing, Department of Software Engineering.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Anderberg, Peter
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Machine learning and microsimulation techniques on the prognosis of dementia: A systematic literature review2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 6, article id e0179804Article in journal (Refereed)
    Abstract [en]

    Background Dementia is a complex disorder characterized by poor outcomes for the patients and high costs of care. After decades of research little is known about its mechanisms. Having prognostic estimates about dementia can help researchers, patients and public entities in dealing with this disorder. Thus, health data, machine learning and microsimulation techniques could be employed in developing prognostic estimates for dementia. Objective The goal of this paper is to present evidence on the state of the art of studies investigating and the prognosis of dementia using machine learning and microsimulation techniques. Method To achieve our goal we carried out a systematic literature review, in which three large databases -Pubmed, Socups and Web of Science were searched to select studies that employed machine learning or microsimulation techniques for the prognosis of dementia. A single backward snowballing was done to identify further studies. A quality checklist was also employed to assess the quality of the evidence presented by the selected studies, and low quality studies were removed. Finally, data from the final set of studies were extracted in summary tables. Results In total 37 papers were included. The data summary results showed that the current research is focused on the investigation of the patients with mild cognitive impairment that will evolve to Alzheimer's disease, using machine learning techniques. Microsimulation studies were concerned with cost estimation and had a populational focus. Neuroimaging was the most commonly used variable. Conclusions Prediction of conversion from MCI to AD is the dominant theme in the selected studies. Most studies used ML techniques on Neuroimaging data. Only a few data sources have been recruited by most studies and the ADNI database is the one most commonly used. Only two studies have investigated the prediction of epidemiological aspects of Dementia using either ML or MS techniques. Finally, care should be taken when interpreting the reported accuracy of ML techniques, given studies' different contexts. © 2017 Dallora et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • 41. Nilsson, Helena
    et al.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Tooth loss and cognitive functions among older adults2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 8, p. 639-644Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the association between the number of teeth and cognitive functions adjusted for age and education level in a cohort of older adults living in Sweden. Materials and methods. The study employed a cross-sectional design in which 1147 individuals between 60-96 years underwent a clinical oral examination. The cognitive functions were assessed using Mini-Mental State Examination (MMSE) and Clock-test. The level of education was obtained from a questionnaire. Data were subjected to Chi-square tests and multivariate logistic regression analyses were employed, grouping the different variables into pre-determined categories. Results. The co-variables age and education were significantly associated with the number of teeth (p < 0.05). The multivariate logistic regression analysis revealed that the association between the number of teeth and the cognitive functions persisted even after adjusting for age and level of education. Conclusions. The findings suggest that the presence of teeth may be of importance for cognitive abilities in older adults.

  • 42.
    Nilsson, Helena
    et al.
    Halland Hospital, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Longitudinal evaluation of periodontitis and development of cognitive decline among older adults2018In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 45, no 10, p. 1142-1149Article in journal (Refereed)
    Abstract [en]

    Aim: To determine whether having periodontitis is associated with cognitive decline among older adults. Material and Methods: A prospective population study of older adults, Swedish National Study on Ageing and Care, (SNAC) provided repeated registrations of cognitive functions. Cognitive decline was defined as ≥3-points deterioration from a predetermined level at baseline, using the Mini-Mental State Examination (MMSE). Between 2001 and 2003, 715 individuals had a medical as well as a clinical and radiographic dental examination. The individuals were re-examined after 6 years. Periodontitis was defined as ≥4 mm bone loss at ≥30% of tooth sites. Social variables were captured from questionnaires. Results: The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of periodontitis and cognitive decline after adjustments of confounding factors of importance. Conclusions: A history of periodontitis may be of importance for cognitive functions among older adults. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 43.
    Nilsson, Helena
    et al.
    Halland Hospital, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Periodontitis, tooth loss and cognitive functions among older adults2018In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 22, no 5, p. 2103-2109Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to evaluate the potential association between periodontitis, the number of teeth and cognitive functions in a cohort of older adults in Sweden. Material and methods: In total, 775 individuals from 60 to 99 years of age were selected for the study. A clinical and radiographic examination was performed. The number of teeth and prevalence of periodontal pockets and bone loss was calculated and categorised. Cognitive functions were assessed using the Mini-Mental State Examination (MMSE) and clock test. The education level was obtained from a questionnaire. Data were analysed using chi-square tests and multivariate logistic regression. Results: Age and gender were associated with the prevalence of bone loss. Age and education were associated with lower number of teeth. Gender was also associated with the presence of pockets. The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of bone loss, the number of teeth and the outcome on MMSE test. This association remained even after adjustment for age, education and gender. Tooth loss was also associated with lower outcome on clock test. Presence of periodontal pockets ≥ 5 mm was not associated with cognitive test outcome. Conclusions: A history of periodontitis and tooth loss may be of importance for cognitive functions among older adults. Clinical relevance: Diseases with and inflammatory profile may have an impact on cognitive decline. © 2017 Springer-Verlag GmbH Germany, part of Springer Nature

  • 44. Nordberg, Marika
    et al.
    Forsberg, Pia
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Bjöersdorff, Anneli
    Ernerudh, Jan
    Garpmo, Ulf
    Haglund, Mats
    Nilsson, Kenneth
    Eliasson, Ingvar
    Aetiology of Tick-Borne Infections in an Adult Swedish Population: Are Co-Infections with Multiple Agents Common?2014In: Open Journal of Clinical Diagnostics, ISSN 2162-5816 , Vol. 4, no 1, p. 31-40Article in journal (Refereed)
    Abstract [en]

    In Scandinavia, tick-borne infections affecting humans include Lyme borreliosis (LB), tick-borne encephalitis (TBE) and human granulocytic anaplasmosis (HGA). Each of these infections can present with unspecific symptoms. In this prospective clinical study, we recruited patients based on two independent inclusion criteria; 1) patients with unspecific symptoms, i.e. fever (≥38.0˚C) or a history of feverishness and/or any combination of headache, myalgia or arthralgia and 2) patients with erythema migrans (EM), following an observed tick bite or tick exposure within one month prior to onset of symptoms. A total of 206 patients fulfilled the study. Among these, we could identify 186 cases of LB (174 with EM), 18 confirmed and two probable cases of HGA and two cases of TBE. Thirteen of the HGA cases presented without fever. Furthermore, 22 of the EM patients had a sub-clinical co-infection with Anaplasma phagocytophilum, based on serology. Both TBE cases had co-infections, one with Borrelia burgdorferi and one with Anaplasma phagocytophilum. We conclude that it is important to consider several causative agents and possible co-infections in the clinical management of infectious diseases where ticks may be suspected as vectors.

  • 45.
    Olsson, Anki
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Alfredsson, Joakim
    Håkansson, Erik
    Svedjeholm, R.
    Berglund, Johan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Berg, Sören
    Protamine reduces whole blood platelet aggregation after cardiopulmonary bypass2015In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, p. 58-63Article in journal (Refereed)
    Abstract [en]

    Objectives: Platelet dysfunction is an important cause of postoperative bleeding after cardiac surgery. Protamine is routinely used for reversal of heparin after cardiopulmonary bypass (CBP), but may affect platelet aggregation. We assessed changes in platelet function in relation to protamine administration. Design: Platelet aggregation was analyzed by impedance aggregometry before and after protamine administration in 25 adult cardiac surgery patients. Aggregation was also studied after in vitro addition of heparin and protamine. The activators adenosine diphosphate (ADP), thrombin receptor activating peptide-6 (TRAP), arachidonic acid (AA) and collagen (COL) were used. Results: Platelet aggregation was reduced by approximately 50% after in vivo protamine administration; ADP 640 ± 230 (AU*min, mean ± SD) to 250 ± 160, TRAP 939 ± 293 to 472 ± 260, AA 307 ± 238 to 159 ± 143 and COL 1022 ± 350 to 506 ± 238 (all p < 0.001). Aggregation was also reduced after in vitro addition of protamine alone with activators ADP from 518 ± 173 to 384 ± 157 AU*min p < 0.001, and AA 449 ± 311 to 340 ± 285 (p < 0.01) and protamine combined with heparin (1:1 ratio) with activators ADP to 349 ± 160 and AA to 308 ± 260 (both p < 0.001); and COL from 586 ± 180 to 455 ± 172 (p < 0.05). Conclusions: Protamine given after CPB markedly reduces platelet aggregation. Protamine added in vitro also reduces platelet aggregation, by itself or in combination with heparin. © 2015 Taylor & Francis

  • 46.
    Olsson, Anki
    et al.
    Blekinge Inst Technol, Dept Hlth Sci, Vallhallavagen 1, S-37179 Karlskrona, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.;Blekinge Hosp, Dept Cardiothorac Surg, Karlskrona, Sweden..
    Alfredsson, Joakim
    Linkoping Univ, SWE.
    Ramstrom, Sofia
    Linkoping Univ, SWE.
    Svedjeholm, Rolf
    Linkoping Univ, SWE.
    Kenny, Dermot
    Royal Coll Surgeons Ireland, IRE.
    Hakansson, Eric
    Linkoping Univ, SWE.
    Sanmartin Berglund, Johan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Berg, Soren
    Linkoping Univ, SWE.
    Better platelet function, less fibrinolysis and less hemolysis in re-transfused residual pump blood with the Ringer's chase technique: a randomized pilot study2018In: Perfusion, ISSN 0267-6591, E-ISSN 1477-111X, Vol. 33, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    Introduction: Residual pump blood from the cardiopulmonary bypass (CPB) circuit is often collected into an infusion bag (IB) and re-transfused. An alternative is to chase the residual blood into the circulation through the arterial cannula with Ringer's acetate. Our aim was to assess possible differences in hemostatic blood quality between these two techniques. Methods: Forty adult patients undergoing elective coronary artery bypass graft surgery with CPB were randomized to receive the residual pump blood by either an IB or through the Ringer's chase (RC) technique. Platelet activation and function (impedance aggregometry), coagulation and hemolysis variables were assessed in the re-transfused blood and in the patients before, during and after surgery. Results are presented as median (25-75 quartiles). Results: Total hemoglobin and platelet levels in the re-transfused blood were comparable with the two methods, as were soluble platelet activation markers P-selectin and soluble glycoprotein VI (GPVI). Platelet aggregation (U) in the IB blood was significantly lower compared to the RC blood, with the agonists adenosine diphosphate (ADP) 24 (10-32) vs 46 (33-65), p<0.01, thrombin receptor activating peptide (TRAP) 50 (29-73) vs 69 (51-92), p=0.04 and collagen 24 (17-28) vs 34 (26-59), p<0.01. The IB blood had higher amounts of free hemoglobin (mg/L) (1086 (891-1717) vs 591(517-646), p<0.01) and D-dimer 0.60 (0.33-0.98) vs 0.3 (0.3-0.48), p<0.01. Other coagulation variables showed no difference between the groups. Conclusions: The handling of blood after CPB increases hemolysis, impairs platelet function and activates coagulation and fibrinolysis. The RC technique preserved the blood better than the commonly used IB technique.

  • 47. Olsson Möller, Ulrika
    et al.
    Midlöv, Patrik
    Kristensson, Jimmie
    Ekdahl, Charlotte
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Jakobsson, Ulf
    Prevalence and predictors of falls and dizziness in people younger and older than 80 years of age-A longitudinal cohort study2013In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 56, no 1, p. 160-168Article in journal (Refereed)
    Abstract [en]

    The objectives were to investigate the prevalence and predictors for falls and dizziness among people younger and older than 80 years of age. The sample was drawn from the Swedish National study on Aging and Care (SNAC) and comprised 973 and 1273 subjects with data on the occurrence of falls and dizziness respectively at baseline. Follow-ups were made after 3- and 6-years. Data included socio-demographics, physical function, health complaints, cognition, quality of life and medications. The prevalence of falls was 16.5% in those under aged 80 and 31.7% in those 80+ years while dizziness was reported by 17.8% and 31.0% respectively. Predictors for falls in those under aged 80 were neuroleptics, dependency in personal activities of daily living (PADL), a history of falling, vision impairment and higher age, and in those 80+ years a history of falling, dependency in instrumental activities of daily living (IADL), fatigue and higher age. Factors predicting dizziness in those under aged 80 were a history of dizziness, feeling nervous and reduced grip strength and in those 80+ years a history of dizziness and of falling. Predictors for falls and dizziness differed according to age. Specific factors were identified in those under aged 80. In those 80+ years more general factors were identified implying the need for a comprehensive investigation to prevent falls. This longitudinal study also showed that falling and dizziness in many older people are persistent and therefore should be treated as chronic conditions. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

  • 48. Ostergaard, Lars
    et al.
    Silfverdal, Sven-Arne
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Flodmark, Carl-Erik
    West, Christina
    Bianco, Veronique
    Baine, Yaela
    Miller, Jacqueline M.
    A tetravalent meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine is immunogenic and well-tolerated when co-administered with Twinrix2012In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 30, no 4, p. 774-783Article in journal (Refereed)
    Abstract [en]

    The co-administration of the tetravalent meningococcal conjugate vaccine, MenACWY-TT, with a licensed hepatitis A and B vaccine, HepA/B (Twinrix (R)), was compared to their separate administration in this open, randomised, controlled study. Healthy subjects 11-17 years of age (n = 611) were randomised (3:1:1) to receive both vaccines, MenACWY-TT alone or HepA/B alone. The co-administration of both vaccines was shown to be non-inferior to their individual administration. At seven months after the first vaccination, 99.4-100% of the subjects who received both vaccines co-administered showed seroprotection against all meningococcal serogroups and at least 99.1% of them were seropositive for hepatitis A and seroprotected against hepatitis B. This study suggests that MenACWY-TT vaccine could be co-administered with HepA/B without adversely impacting the immunogenicity, safety and reactogenicity of either of the vaccines.

  • 49. Pedersen, Court
    et al.
    Breindahl, Morten
    Aggarwal, Naresh
    Berglund, Johan
    Blekinge Institute of Technology, School of Health Science.
    Oroszlan, Gyoergy
    Silfverdal, Sven Arne
    Szuts, Peter
    O'Mahony, Michael
    David, Marie-Pierre
    Dobbelaere, Kurt
    Randomized Trial: Immunogenicity and Safety of Coadministered Human Papillomavirus-16/18 AS04-Adjuvanted Vaccine and Combined Hepatitis A and B Vaccine in Girls2012In: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972, Vol. 50, no 1, p. 38-46Article in journal (Refereed)
    Abstract [en]

    Purpose: This randomized, open, controlled, multicenter study (110886/NCT00578227) evaluated human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (HPV-16/18 vaccine) coadministered with inactivated hepatitis A and B (HAB) vaccine. Coprimary objectives were to demonstrate noninferiority of hepatitis A, hepatitis B, and HPV-16/18 immune responses at month 7 when vaccines were coadministered, compared with the same vaccines administered alone. Methods: Healthy girls (9-15 years) were age-stratified (9, 10-12, and 13-15 years) and randomized to receive HPV (n = 270), HAB (n = 271), or HPV + HAB (n = 272). Vaccines were administered at months 0, 1, and 6. Immunogenicity was evaluated at months 0 and 7. Results: The hepatitis A immune response was noninferior for HPV + HAB, versus HAB, for seroconversion rates (100% in each group) and geometric mean antibody titers (GMTs) (95% CI) (4,504.2 [3,993.0-5,080.8] and 5,288.4 [4,713.3-5,933.7] mIU/mL, respectively). The hepatitis B immune response was noninferior for HPV + HAB, versus HAB, for anti-HBs seroprotection rates (98.3% and 100%); GMTs were 3,136.5 [2,436.0-4,038.4] and 5,646.5 [4,481.3-7,114.6] mIU/mL, respectively. The HPV-16/18 immune response was noninferior for HPV + HAB, versus HPV, for seroconversion rates (99.6% and 100% for both antigens) and GMTs (22,993.5 [20,093.4-26,312.0] and 26,981.9 [23,909.5-30,449.1] EL.U/mL for HPV-16; 8,671.2 [7,651.7-9,826.6] and 11,182.7 [9,924.8-12,600.1] EL.U/mL for HPV-18, respectively). No subject withdrew because of adverse events. No vaccine-related serious adverse events were reported. Immune responses and reactogenicity were similar in girls aged 9 years compared with the entire study population. Conclusions: Results support coadministration of HPV-16/18 vaccine with HAB vaccine in girls aged 9-15 years. The HPV-16/18 vaccine was immunogenic and generally well tolerated in 9-year-old girls.

  • 50. Persson, Rutger
    et al.
    Berglund, Johan
    Persson, Ringmor
    Renvert, Stefan
    Prediction of hip and hand fractures in older persons with or without a diagnosis of periodontitis2011In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 48, no 3, p. 552-556Article in journal (Refereed)
    Abstract [en]

    PURPOSE: In a prospective study, we assessed if a diagnosis of osteoporosis and periodontitis could predict hip and hand fractures in older persons. MATERIALS AND METHODS: Bone density was assessed by a Densitometer. Periodontitis was defined by evidence of alveolar bone loss. RESULTS: 788 Caucasians (52.4% women, overall mean age: 76years, S.D.±9.0, range: 62 to 96) were enrolled and 7.4% had a hip/hand fracture in 3years. Calcaneus PIXI T-values<-1.6 identified osteoporosis in 28.2% of the older persons predicting a hip/hand fracture with an odds ratio of 3.3:1 (95% CI: 1.9, 5.7, p<0.001). Older persons with osteoporosis had more severe periodontitis (p<0.01). Periodontitis defined by ≥30% of sites with ≥5mm distance between the cemento-enamel junction (CEJ) and bone level (ABL) was found in 18.7% of the older persons predicting a hip/hand fracture with an odds ratio of 1.8:1 (95% CI: 1.0, 3.3, p<0.05). Adjusted for age, the odds ratio of a hip/hand fracture in older persons with osteoporosis (PIXI T-value<-2.5) and periodontitis was 12.2:1 (95% CI: 3.5, 42.3, p<0.001). CONCLUSIONS: Older persons with osteoporosis and periodontitis have an increased risk for hip/hand fractures.

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