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  • 1.
    Ademovski, S. Erovic
    et al.
    Kristianstad Univ, Sect Hlth & Soc, S-29188 Kristianstad, Sweden..
    Lingstrom, P.
    Univ Gothenburg, Sahlgrenska Acad, Inst Odontol, Dept Cariol, Gothenburg, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The effect of different mouth rinse products on intra-oral halitosis2016In: International Journal of Dental Hygiene, ISSN 1601-5029, E-ISSN 1601-5037, Vol. 14, no 2, p. 117-123Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the effect of different mouth rinses 12 h after rinsing on genuine intra-oral halitosis. Materials and Methods: Twenty-four adults with halitosis were included in a double-blind, crossover, randomized clinical trial. Halitosis was evaluated 12 h after rinsing with placebo and five mouth rinse products containing zinc acetate and chlorhexidine diacetate; zinc lactate, chlorhexidine and cetylpyridinium chloride; zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol; zinc chloride and essential oil; and chlorine dioxide using the organoleptic method and a gas chromatograph. Test periods were separated by 1 week. Results: Hydrogen sulphide (H2S), methyl mercaptan (MM) and the organoleptic scores (OLS) were significantly reduced 12 h following rinsing with all substances compared to placebo (P < 0.05). H2S was more effectively reduced after rinsing with zinc acetate and chlorhexidine diacetate and zinc acetate and chlorhexidine diacetate with reduced amounts of mint and menthol compared to rinsing with zinc chloride and essential oil (P < 0.05), and significantly lower values of MM were obtained after rinsing with zinc acetate and chlorhexidine diacetate compared to zinc lactate, chlorhexidine and cetylpyridinium chloride (P < 0.05). The percentage effectively treated individuals (H2S (<112 ppb), MM (<26 ppb) and OLS score <2) varied from 58% percentage (zinc acetate and chlorhexidine diacetate) to 26% (zinc chloride and essential oil). Conclusion: All treatments resulted in reduction in halitosis 12 h after rinsing compared to placebo. H2S and MM were most effectively reduced by zinc acetate and chlorhexidine diacetate.

  • 2. Ademovski, Seida Erovic
    et al.
    Lingström, Peter
    Winkel, Edwin
    Tangerman, Albert
    Persson, Rutger
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    Comparison of different treatment modalities for oral halitosis2012In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 70, no 3, p. 224-233Article in journal (Refereed)
    Abstract [en]

    Objectives. To assess the effects on intra-oral halitosis by a mouth rinse containing zinc acetate (0.3%) and chlorhexidine diacetate (0.025%) with and without adjunct tongue scraping. Materials and methods. Twenty-one subjects without a diagnosis of periodontitis were randomized in a cross-over clinical trial. Organoleptic scores (OLS) were assessed to define intra-oral halitosis by total volatile sulfur compound (T-VSC) measurements and by gas chromatography. Results. Twenty-one subjects with a mean age of 45.7 years (SD: +/- 13.3, range: 21-66). The OLS were significantly lower following active rinse combined with tongue scraping (p < 0.001) at all time points. Immediately after, at 30 min, and at day 14, the T-VSC values were lower in the active rinse sequence than in the negative rinse sequence (p < 0.001, p < 0.001 and p < 0.05, respectively). At 30 min and at day 14, the hydrogen sulfide (H2S) and methyl mercaptan (MM) values were lower in the active rinse sequence compared to the inactive rinse sequence (p < 0.001). The inactive rinse sequence with tongue scraping reduced T-VSC at 30 min (p < 0.001) but not at 14 days. Similar reductions in T-VSC, H2S and MM were found in the active rinse sequence with or without tongue scraping. Conclusion. The use of a tongue scraper did not provide additional benefits to the active mouth rinse, but reduced OLS and tongue coating index.

  • 3.
    Ademovski, Seida Erovic
    et al.
    Kristianstad Univ, Sch Hlth & Soc, S-29188 Kristianstad, Sweden..
    Martensson, Carina
    Kristianstad Univ, Sch Hlth & Soc, S-29188 Kristianstad, Sweden..
    Persson, G. Rutger
    Kristianstad Univ, Sch Hlth & Soc, S-29188 Kristianstad, Sweden.;Univ Washington, Sch Dent, Dept Periodont, Seattle, WA 98195 USA..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The effect of periodontal therapy on intra-oral halitosis: a case series2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 5, p. 445-452Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to evaluate the effects of non-surgical periodontal therapy on intra-oral halitosis 3months after therapy. Material and methods: Sixty-eight adults with intra-oral halitosis were included in a case series. Intra-oral halitosis was evaluated at baseline, and at 3months after treatment using the organoleptic scores (OLS), Halimeter (R), and a gas chromatograph. Results: Significant reductions for OLS (p<0.01), total sum of volatile sulphur compounds (T-VSC) (p<0.01) and methyl mercaptan (MM) (p<0.05) values were found after treatment. Hydrogen sulphide (H2S) levels were not significantly reduced. The numbers of probing pockets 4mm, 5mm and 6mm were significantly reduced as a result of therapy (p<0.001). Bleeding on probing (BOP) and plaque indices were also significantly reduced (p<0.001). For the 34 individuals with successful periodontal treatment (BOP<20% and a 50% reduction of total pocket depth) reductions in OLS (p<0.01) and T-VSC scores (p<0.01) were found. Eleven individuals were considered effectively treated for intra-oral halitosis presenting with a T-VSC value <160ppb, a H2S value <112ppb and a MM value <26ppb. Conclusion: Non-surgical periodontal therapy resulted in reduction of OLS, MM and T-VSC values 3months after therapy. Few individuals were considered as effectively treated for intra-oral halitosis.

  • 4. Ademovski, Seida
    et al.
    Persson, Gösta Rutger
    Winkel, Edwin
    Tangerman, Albert
    Lingström, Peter
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    The short-term treatment effects on the microbiota at the dorsum of the tongue in intra-oral halitosis patients-a randomized clinical trial2013In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 17, no 2, p. 463-473Article in journal (Refereed)
    Abstract [en]

    This study aims to assess the effects of rinsing with zinc- and chlorhexidine-containing mouth rinse with or without adjunct tongue scraping on volatile sulfur compounds (VSCs) in breath air, and the microbiota at the dorsum of the tongue. Material and methods: A randomized single-masked controlled clinical trial with a cross-over study design over 14 days including 21 subjects was performed. Bacterial samples from the dorsum of the tongue were assayed by checkerboard DNA-DNA hybridization. Results: No halitosis (identified by VSC assessments) at day 14 was identified in 12/21 subjects with active rinse alone, in 10/21with adjunct use of tongue scraper, in 1/21 for negative control rinse alone, and in 3/21 in the control and tongue scraping sequence. At day 14, significantly lower counts were identified only in the active rinse sequence (p < 0.001) for 15/78 species including, Fusobacterium sp., Porphyromonas gingivalis, Pseudomonas aeruginosa, Staphylococcus aureus, and Tannerella forsythia. A decrease in bacteria from baseline to day 14 was found in successfully treated subjects for 9/74 species including: P. gingivalis, Prevotella melaninogenica, S. aureus, and Treponema denticola. Baseline VSC scores were correlated with several bacterial species. The use of a tongue scraper combined with active rinse did not change the levels of VSC compared to rinsing alone. Conclusions: VSC scores were not associated with bacterial counts in samples taken from the dorsum of the tongue. The active rinse alone containing zinc and chlorhexidine had effects on intra-oral halitosis and reduced bacterial counts of species associated with malodor. Tongue scraping provided no beneficial effects on the microbiota studied. Clinical relevance: Periodontally healthy subjects with intra-oral halitosis benefit from daily rinsing with zinc- and chlorhexidine-containing mouth rinse.

  • 5. Aghazadeh, Ahmad
    et al.
    Persson, G. Rutger
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    A single-centre randomized controlled clinical trial on the adjunct treatment of intra-bony defects with autogenous bone or a xenograft: results after 12 months2012In: Journal of Clinical Periodontology, ISSN 0303-6979, Vol. 39, no 7, p. 666-673Article in journal (Refereed)
    Abstract [en]

    Background Limited evidence exists on the efficacy of regenerative treatment of peri-implantitis. Material and Methods Subjects receiving antibiotics and surgical debridement were randomly assigned to placement of autogenous bone (AB) or bovine-derived xenograft (BDX) and with placement of a collagen membrane. The primary outcome was evidence of radiographic bone fill and the secondary outcomes included reductions of probing depth (PD) bleeding on probing (BOP) and suppuration. Results Twenty-two subjects were included in the AB and 23 subjects in the BDX group. Statistical analysis failed to demonstrate differences for 38/39 variables assessed at baseline. At 12 months, significant better results were obtained in the BDX group for bone levels (p < 0.001), BOP (p = 0.004), PI (p = 0.003) and suppuration (p < 0.01). When adjusting for number of implants treated per subject, a successful treatment outcome PD = 5.0 mm, no pus, no bone loss and BOP at 1/4 or less sites the likelihood of defect fill was higher in the BDX group (LR: 3.2, 95% CI: 1.010.6, p < 0.05). Conclusions Bovine xenograft provided more radiographic bone fill than AB. The success for both surgical regenerative procedures was limited. Decreases in PD, BOP, and suppuration were observed.

  • 6.
    Alotaibi, Mohammad
    et al.
    Trinity College Dublin, IRE.
    Moran, Gary
    Dublin Dental University Hospital, IRE.
    Grufferty, Brendan
    Trinity College Dublin, IRE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Polyzois, Ioannis
    Trinity College Dublin, IRE.
    The effect of a decontamination protocol on contaminated titanium dental implant surfaces with different surface topography in edentulous patients2018In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate if it is possible to achieve complete decontamination of dental implant surfaces with different surface characteristics. Materials and methods: Twelve implant pieces with an Osseotite® surface and 12 implant pieces with a Ti-Unite® surface were attached on to the complete lower dentures of six patients and were allowed to accumulate plaque for 30 days. When retrieved, the implant decontamination protocol used, involved both mechanical (PeriBrush™) and chemical (3% H2O2) decontamination. The number of colony forming units per millilitre was determined and the dominant micro-organisms in selected samples was identified by 16s rRNA gene amplicon sequencing. The effect of the titanium brush on the implant surface was examined by SEM. Results: Complete decontamination was achieved in five out of 24 implants (four Osseotite® and one Ti-Unite®). The mean CFU/ml detected after decontamination were 464.48 for Osseotite® and 729.09 for Ti-Unite® implants. On the surface of the implants in which complete decontamination was not achieved, all of the predominant bacteria identified were streptococci except for one which was identified as micrococcus. SEM images revealed that the surface features of the decontaminated implants were not significantly altered. Conclusions: Mechanical decontamination using a titanium brush supplemented with chemical treatment for one minute (3% H2O2) can achieve complete decontamination of implant surfaces in edentulous patients. © 2018, © 2018 Acta Odontologica Scandinavica Society.

  • 7.
    Andersson, P.
    et al.
    Kristianstad Univ, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sjogren, P.
    Oral Care AB, SWE.
    Zimmerman, M.
    Oral Care AB, SWE.
    Dental status in nursing home residents with domiciliary dental care in Sweden2017In: Community Dental Health, ISSN 0265-539X, Vol. 34, no 4, p. 203-207Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the dental health status of elderly people in nursing homes receiving domiciliary dental care. Design: Case note review. Clinical setting: Nursing homes in 8 Swedish counties. Participants: Care dependent elderly people (>= 65 years). Methods: Clinical data, including the number of remaining natural teeth, missing and decayed teeth (manifest dental caries) and root remnants, recorded by dentists according to standard practices. Medical and dental risk assessments were performed. Results: Data were available for 20,664 patients. Most were women (69.1%), with a mean age of 87.1 years (SD 7.42, range 65-109). The mean age for men was 83.5 years (SD 8.12, range 65-105). Two or more medical conditions were present in most of the population. A total of 16,210 individuals had existing teeth of whom 10,974 (67.7%) had manifest caries. The mean number of teeth with caries was 5.0 (SD 5.93) corresponding to 22.8% of existing teeth. One in four individuals were considered to have a very high risk in at least one professional dental risk assessment category. Conclusions: Care dependent elderly in nursing homes have very poor oral health. There is a need to focus on the oral health-related quality of life for this group of frail elderly during their final period of life.

  • 8.
    Axmon, Anna
    et al.
    Lunds Universitet, SWE.
    Kristensson, Jimmie
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Ahlström, Gerd
    Lunds Universitet, SWE.
    Midlöv, Patrik
    Lunds Universitet, SWE.
    Use of antipsychotics, benzodiazepine derivatives, and dementia medication among older people with intellectual disability and/or autism spectrum disorder and dementia2017In: Research in Developmental Disabilities, ISSN 0891-4222, Vol. 62, p. 50-57Article in journal (Refereed)
    Abstract [en]

    Background Although people with intellectual disability (ID) and people with dementia have high drug prescription rates, there is a lack of studies investigating drug use among those with concurrent diagnoses of ID and dementia. Aim To investigate the use of antipsychotics, benzodiazepine derivatives, and drugs recommended for dementia treatment (anticholinesterases [AChEIs] and memantine) among people with ID and dementia. Methods and procedures Having received support available for people with ID and/or autism spectrum disorder (ASD) was used as a proxy for ID. The ID cohort consisted of 7936 individuals, aged at least 55 years in 2012, and the referent cohort of age- and sex-matched people from the general population (gPop). People with a specialists’ diagnosis of dementia during 2002–2012 were identified (ID, n = 180; gPop, n = 67), and data on prescription of the investigated drugs during the period 2006–2012 were collected. Outcome and results People with ID/ASD and dementia were more likely than people with ID/ASD but without dementia to be prescribed antipsychotics (50% vs 39% over the study period; odds ratio (OR) 1.85, 95% confidence interval 1.13–30.3) and benzodiazepine derivatives (55% vs 36%; OR 2.42, 1.48–3.98). They were also more likely than people with dementia from the general population to be prescribed antipsychotics (50% vs 25%; OR 3.18, 1.59–6.34), but less likely to be prescribed AChEIs (28% vs 45%; OR 0.32, 0.16–0.64).

  • 9.
    Beiranvand, Samira
    et al.
    Ahvaz Jundishapur Univ Med Sci, IRN.
    Zarea, Kourosh
    Ahvaz Jundishapur Univ Med Sci, IRN.
    Ghanbari, Saeed
    Shiraz Univ Med Sci, IRN.
    Tuvesson, Hanna
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Keikhaei, Bijan
    Ahvaz Jundishapur Univ Med Sci, IRN.
    Ten years incidence of cancer in Iran: a systematic review and meta-analysis2018In: CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH, ISSN 2452-0918, Vol. 6, no 2, p. 94-102Article, review/survey (Refereed)
    Abstract [en]

    Background: Designing and implementation of screening programs depend on greatly epidemiologic basic data in every country. Also Variation in the incidence of various cancers in our country has been a favorite topic. Objectives: This systematic review was conducted to provide an overall perspective about incidence, geographical and age distribution of cancers in Iran. Methods: A comprehensive search were done according to MOOSE guideline criteria in national and international databases for selecting eligible articles from 2005 to 2015. After screening titles and abstracts, duplicated and irrelevant studies were excluded. Selected papers are written in Persian or English. The standard error of the cancer incidence was calculated based on the binomial distribution. Because of the significant heterogeneity observed among the results, we used a random-effects model combine the results of the primary studies. Moreover, a sensitivity analysis was undertaken to explore the effects of the risk of bias and other sources of heterogeneity. Results: Overall 16 articles met eligibility criteria for inclusion. The total incidence of cancer was 19.4 and 17.2 per hundred thousand of people in males and females respectively. The five most common cancers in male were: Lymphoma, leukemia, esophagus, stomach, colorectal and in the female are: breast, colorectal, stomach, thyroid and esophagus. The highest incidence rate was seen in Golestan Province and in the age group over 65 years. Conclusion: According to increasing incidence rate of cancers in Iran, Development, holding and accomplish of universal public cancer control program should be the first precedence for health policy. (c) 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of INDIACLEN.

  • 10.
    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.

  • 11. Bengtsson, VW
    et al.
    Persson, Rutger
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review2014In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 72, no 6, p. 401-412Article, review/survey (Refereed)
    Abstract [en]

    Objectives. To assess the literature on carotid calcifications defined from panoramic radiographs (PMX) and concurrent diagnosis of stroke and periodontitis. Materials and methods. A literature search screening for publications using search terms such as PMX and carotid calcification, stroke and periodontitis was performed in November 2012. Results. A total of 189 articles were retrieved, among which 30 were included in the review. The sensitivity for PMX findings of carotid calcifications (CC) compared to a diagnosis by Doppler sonography varied between 31.1-100%. The specificity for PMX findings of carotid calcifications compared to a diagnosis by Doppler sonography varied between 21.4-87.5%. Individuals with CC findings from PMX have more periodontitis and risk for stroke. Conclusions. There is a shortage of well-designed studies in older dentate individuals assessing the associations between periodontitis and radiographic evidence of CC and in relation to stroke or other cardiovascular diseases.

  • 12. Capozza, Korey
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Black, Jeff
    Bello, Nelly
    Lence, Clare
    Oostema, Steve
    North, Christie
    Going Mobile With Diabetes Support: A Randomized Study of a Text Message–Based Personalized Behavioral Intervention for Type 2 Diabetes Self-Care2015In: Diabetes Spectrum, ISSN 1040-9165, E-ISSN 1944-7353, Vol. 28, no 2, p. 83-91Article in journal (Refereed)
    Abstract [en]

    Objective. Patients with type 2 diabetes often fail to achieve self-management goals. This study tested the impact on glycemic control of a two-way text messaging program that provided behavioral coaching, education, and testing reminders to enrolled individuals with type 2 diabetes in the context of a clinic-based quality improvement initiative. The secondary aim examined patient interaction and satisfaction with the program.

    Methods. Ninety-three adult patients with poorly controlled type 2 diabetes (A1C >8%) were recruited from 18 primary care clinics in three counties for a 6-month study. Patients were randomized by a computer to one of two arms. Patients in both groups continued with their usual care; patients assigned to the intervention arm also received from one to seven diabetes-related text messages per day depending on the choices they made at enrollment. At 90 and 180 days, A1C data were obtained from the electronic health record and analyzed to determine changes from baseline for both groups. An exit survey was used to assess satisfaction. Enrollment behavior and interaction data were pulled from a Web-based administrative portal maintained by the technology vendor.

    Results. Patients used the program in a variety of ways. Twenty-nine percent of program users demonstrated frequent engagement (texting responses at least three times per week) for a period of ≥90 days. Survey results indicate very high satisfaction with the program. Both groups’ average A1C decreased from baseline, possibly reflecting a broader quality improvement effort underway in participating clinics. At 90 and 180 days, there was no statistically significant difference between the intervention and control groups in terms of change in A1C (P >0.05).

    Conclusions. This study demonstrated a practical approach to implementing and monitoring a mobile health intervention for self-management support across a wide range of independent clinic practices.

  • 13.
    Dalago, Haline Renata
    et al.
    Fed Univ Santa Catarina UFSC, BRA.
    Schuldt Filho, Guenther
    Fed Univ Santa Catarina UFSC, BRA.
    Rodrigues, Monica Abreu
    Paulista Univ UNIP, BRA.
    Renvert, Sterfan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Bianchini, Marco Aurelio
    Fed Univ Santa Catarina UFSC, BRA.
    Risk indicators for Peri-implantitis: A cross-sectional study with 916 implants2016In: Clinical Oral Implants Research, ISSN 0905-7161, E-ISSN 1600-0501, Vol. 28, no 2, p. 144-150Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to identify systemic and local risk indicators associated with peri-implantitis. Material and methods: One hundred eighty-three patients treated with 916 osseointegrated titanium implants, in function for at least 1 year, were included in the present study. The implants were installed at the Foundation for Scientific and Technological Development of Dentistry (FUNDECTO) - University of Sao Paulo (USP) - from 1998 to 2012. Factors related to patient’s systemic conditions (heart disorders, hypertension, smoking habits, alcoholism, liver disorders, hepatitis, gastrointestinal disease, diabetes mellitus I and II, hyperthyroidism or hypothyroidism, radiation therapy, chemotherapy, menopause, osteoporosis, active periodontal disease, history of periodontal disease and bruxism), implant’s characteristics (location, diameter, length, connection, shape, and antagonist), and clinical parameters (wear facets, periodontal status on the adjacent tooth, plaque accumulation on the adjacent tooth, modified plaque index, sulcus bleeding index, probing depth, bleeding on probing, width of keratinized tissue and marginal recession). Results: An increased risk of 2.2 times for history of periodontal disease (PD), 3.6 times for cemented restorations compared to screw-retained prostheses, 2.4 times when wear facets were displayed on the prosthetic crown and 16.1 times for total rehabilitations when compared to single rehabilitations were found. Logistic regression analysis did not show any association between the implant’s characteristics and peri-implantitis. Conclusions: A history of periodontal disease, cemented prostheses, presences of wear facets on the prosthetic crown and full mouth rehabilitations were identified as risk indicators for peri-implantitis. Implants’ characteristics were not related to the presence of peri-implantitis. © 2016 John Wiley & Sons A/S.

  • 14.
    Ekerot, Amanda
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Gemfeldt, Lisa
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Diabetes typ 2 och följsamheten till fysisk aktivitet: En litteraturstudie2018Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Diabetes typ 2 är en kronisk sjukdom som obehandlad eller dåligt skött, kan leda till svåra komplikationer. Emellertid är det en av få sjukdomar som till viss mån, går att kontrollera och styra med livsstilsförändringar, däribland fysisk aktivitet. Sjuksköterskans roll är att stötta, informera och ge individen råd, dock ligger mycket på personens egna vilja, drivkraft och motivation till att genomföra en förändring till ökad motion.

    Syfte: Syftet var att belysa följsamheten till fysisk aktivitet hos personer med diabetes typ 2.

    Metod: En kvalitativ litteraturstudie baserad på 15 vetenskapliga artiklar med kvalitativ ansats. Artiklarna analyserades med Graneheim och Lundmans tolkning av en kvalitativ innehållsanalys.

    Resultat: I resultatet framkom huvudkategorierna brist på motivation och egen drivkraft som motivation med tillhörande underkategorier hotande egenvårdskapacitet, avsaknad av socialt stöd, upplevelsen av att vara begränsad och miljöns betydelse respektive att förstå sin sjukdom, att leva med en rädsla för komplikationer, behov av stöd samt behov av kunskap.

    Slutsats: Det huvudsakliga fyndet som framkom i litteraturstudien berörde motivationens betydelse för följsamheten till fysisk aktivitet, hos personer med diabetes typ 2.

     

  • 15. Ekström, Magnus
    et al.
    Jogreus, Claes
    Blekinge Institute of Technology, School of Engineering, Department of Mathematics and Natural Sciences.
    Ström, Kerstin
    Comorbidity and Sex-Related Differences in Mortality in Oxygen-Dependent Chronic Obstructive Pulmonary Disease2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 4Article in journal (Refereed)
    Abstract [en]

    Background: It is not known why survival differs between men and women in oxygen-dependent chronic obstructive pulmonary disease (COPD). The present study evaluates differences in comorbidity between men and women, and tests the hypothesis that comorbidity contributes to sex-related differences in mortality in oxygen-dependent COPD. Methods: National prospective study of patients aged 50 years or older, starting long-term oxygen therapy (LTOT) for COPD in Sweden between 1992 and 2008. Comorbidities were obtained from the Swedish Hospital Discharge Register. Sex-related differences in comorbidity were estimated using logistic regression, adjusting for age, smoking status and year of inclusion. The effect of comorbidity on overall mortality and the interaction between comorbidity and sex were evaluated using Cox regression, adjusting for age, sex, Pa-O2 breathing air, FEV1, smoking history and year of inclusion. Results: In total, 8,712 patients (55% women) were included and 6,729 patients died during the study period. No patient was lost to follow-up. Compared with women, men had significantly more arrhythmia, cancer, ischemic heart disease and renal failure, and less hypertension, mental disorders, osteoporosis and rheumatoid arthritis (P<0.05 for all odds ratios). Comorbidity was an independent predictor of mortality, and the effect was similar for the sexes. Women had lower mortality, which remained unchanged even after adjusting for comorbidity; hazard ratio 0.73 (95% confidence interval, 0.68-0.77; P<0.001). Conclusions: Comorbidity is different in men and women, but does not explain the sex-related difference in mortality in oxygen-dependent COPD.

  • 16.
    Erovic Ademovski, Seida
    et al.
    Högskolan Kristianstad, SWE.
    Mårtensson, Carina
    Högskolan Kristianstad, SWE.
    Persson, Gösta Rutger
    Högskolan Kristianstad, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    The long-term effect of a zinc acetate and chlorhexidine diacetate containing mouth rinse on intra-oral halitosis: A randomized clinical trial2017In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 44, no 10, p. 1010-1019Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the long-term effects of a zinc acetate and chlorhexidine diacetate mouth rinse (Zn/CHX) on intra-oral halitosis. Materials and methods: Forty-six adults with intra-oral halitosis were randomized into a 6-month, double-blind, placebo-controlled clinical study. The presence of intra-oral halitosis was evaluated at baseline, 3 and 6 months after treatment by assessment of organoleptic score (OLS) and by total volatile sulphur compounds (T-VSC), hydrogen sulphide (H2S) and methyl mercaptan (MM) concentrations in exhaled air. Results: A Zn/CHX mouth rinse provided significantly better control of intra-oral halitosis than a placebo mouth rinse. At 3 and 6 months, individuals rinsing with the Zn/CHX rinse presented with reductions of the OLS, T-VSC (p &lt;.01, respectively), H2S (p &lt;.001), and MM (p &lt;.01) in subjects’ exhaled air. At 6 months, 68.2% of individuals using the Zn/CHX rinse experienced a 1 or 2 category improvement in OLS compared with 19.1% of placebo-treated subjects. 91% of subjects in the Zn/CHX group were categorized as being effectively treated for intra-oral halitosis (i.e. H2S &lt; 112 ppb), compared to 43% in the placebo group. Conclusion: Zn/CHX mouth rinse provides effective long-term efficacy against intra-oral halitosis, assessed both objectively and subjectively. With regular rinsing, the effect was sustained for 6 months. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 17. Figuero, Elena
    et al.
    Lindahl, Christel
    Marin, MJ
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Herrera, David
    Ohlsson, Ola
    Wetterling, Thomas
    Sanz, Mariano
    Quantification of Periodontal Pathogens in Vascular, Blood, and Subgingival Samples From Patients With Peripheral Arterial Disease or Abdominal Aortic Aneurysms2014In: Journal of Periodontology, ISSN 0022-3492, E-ISSN 1943-3670, Vol. 85, no 9, p. 1182-1193Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this investigation is to quantify periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Campylobacter rectus, and Tannerella forsythia) in vascular, blood, and subgingival samples. As a secondary objective, two molecular bacterial identification methods (nested polymerase chain reaction [PCR] and quantitative PCR [qPCR]) are compared. Methods: Seventy consecutive patients provided a vascular lesion, a blood sample, and 36 subgingival samples. Bacterial DNA was extracted, and qPCR was used to determine the prevalence and amounts of the target pathogens in each sample. Nested PCR was performed only in the samples from vascular lesions. Periodontal examination was performed in 42 patients. Mann-Whitney U or x(2) tests were used to compare microbiologic results according to periodontal diagnosis. Results: All targeted periodontal pathogens (A. actinomycetemcomitans, P. gingivalis, T. forsythia, or C. rectus) were detected in subgingival samples, with a prevalence rate of 72.2%, 47.2%, 74.3%, and 82.9%, respectively. In 7.1% and 11.4% of vascular and blood samples, bacterial DNA was detected. One patient was positive for A. actinomycetemcomitans in the three types of samples. No differences were found in the levels of targeted bacteria when comparing patients with and without periodontitis. Prevalence rates obtained with nested PCR were significantly higher than those obtained with qPCR. Conclusions: The presence of A. actinomycetemcomitans was demonstrated in vascular, blood, and subgingival samples in one of 36 patients. These results, although with a very low frequency, may support the hypothesis of a translocation of periodontal pathogens from subgingival microbiota to the bloodstream and then to atheromatous plaques in carotid or other peripheral arteries. Nested PCR is not an adequate method for identifying DNA of periodontal pathogens in low quantities because of the high number of false-negative results.

  • 18. Forssell, Henrik
    et al.
    Wester, Michael
    Åkesson, Katrin
    Johansson, Sigrid
    Blekinge Institute of Technology, School of Health Science.
    A proposed model for prediction of survival based on a follow-up study in unresectable pancreatic cancer2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, no 12, p. 1-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To define an easy-to-use model for prediction of survival time in patients with unresectable pancreatic cancer in order to optimise patient' care. DESIGN: An observational retrospective study on patients with unresectable pancreatic cancer. The initial radiographs at presentation of symptoms were reviewed and the maximum diameter of the primary tumour was determined. The occurrence of liver metastases and performance status that determines initiation of chemotherapy was also used in the regression analysis to identify prognostic subgroups. SETTING: County hospital in south-east of Sweden. POPULATION: Consecutive patients with unresectable pancreatic cancer who were diagnosed between January 2003 and May 2010 (n=132). MAIN OUTCOME MEASURES: Statistical analyses were performed using Stata V.13. Survival time was assessed with Kaplan-Meier analysis, log-rank test for equality of survivor functions and Cox regression for calculation of individual hazard based on tumour diameter, presence of liver metastases and initiation of chemotherapy treatment according to patient performance status. RESULTS: The individual hazard was log h=0.357 tumour size+1.181 liver metastases-0.989 performance status/chemotherapy. Three prognostic groups could be defined: a low-risk group with a median survival time of 6.7 (IQR 9.7) months, a medium-risk group with a median survival time of 4.5 (IQR 4.5) months and a high-risk group with a median survival time of 1.2 (IQR 1.7) months. CONCLUSIONS: The maximum diameter of the primary tumour and the presence of liver metastases found at the X-ray examination of patients with pancreatic cancer, in conjunction with whether or not chemotherapy is initiated according to performance status, predict the survival time for patients who do not undergo surgical resection. The findings result in an easy-to-use model for predicting the survival time.

  • 19.
    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.

  • 20.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Weir, Charlene
    A Modified User-Oriented Heuristic Evaluation of a Mobile Health System for Diabetes Self-management Support2016In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 34, no 2, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Mobile health platforms offer significant opportunities for improving diabetic self-care, but only if adequate usability exists. Expert evaluations such as heuristic evaluation can provide distinct usability information about systems. The purpose of this study was to complete a usability evaluation of a mobile health system for diabetes patients using a modified heuristic evaluation technique of (1) dual-domain experts (healthcare professionals, usability experts), (2) validated scenarios and user tasks related to patients' self-care, and (3) in-depth severity factor ratings. Experts identified 129 usability problems with 274 heuristic violations for the system. The categories Consistency and Standards dominated at 24.1% (n = 66), followed by Match Between System and Real World at 22.3% (n = 61). Average severity ratings across system views were 2.8 (of 4), with 9.3% (n = 12) rated as catastrophic and 53.5% (n = 69) as major. The large volume of violations with severe ratings indicated clear priorities for redesign. The modified heuristic approach allowed evaluators to identify unique and important issues, including ones related to self-management and patient safety. This article provides a template for one type of expert evaluation adding to the informaticists' toolbox when needing to conduct a fast, resource-efficient and user-oriented heuristic evaluation. 

  • 21.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics2016In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 23, no 1, p. 5-11Article in journal (Refereed)
    Abstract [en]

    Objective Mobile health (mHealth) systems are becoming more common for chronic disease management, but usability studies are still needed on patients' perspectives and mHealth interaction performance. This deficiency is addressed by our quantitative usability study of a mHealth diabetes system evaluating patients' task performance, satisfaction, and the relationship of these measures to user characteristics. Materials and Methods We used metrics in the International Organization for Standardization (ISO) 9241-11 standard. After standardized training, 10 patients performed representative tasks and were assessed on individual task success, errors, efficiency (time on task), satisfaction (System Usability Scale [SUS]) and user characteristics. Results Tasks of exporting and correcting values proved the most difficult, had the most errors, the lowest task success rates, and consumed the longest times on task. The average SUS satisfaction score was 80.5, indicating good but not excellent system usability. Data trends showed males were more successful in task completion, and younger participants had higher performance scores. Educational level did not influence performance, but a more recent diabetes diagnosis did. Patients with more experience in information technology (IT) also had higher performance rates. Discussion Difficult task performance indicated areas for redesign. Our methods can assist others in identifying areas in need of improvement. Data about user background and IT skills also showed how user characteristics influence performance and can provide future considerations for targeted mHealth designs. Conclusion Using the ISO 9241-11 usability standard, the SUS instrument for satisfaction and measuring user characteristics provided objective measures of patients' experienced usability. These could serve as an exemplar for standardized, quantitative methods for usability studies on mHealth systems.

  • 22.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Using activity theory as a framework for the usability evaluation process and task determination in mhealth self-management systems for diabetes2018In: Studies in Health Technology and Informatics, IOS Press , 2018, Vol. 249, p. 158-163Conference paper (Refereed)
    Abstract [en]

    mHealth systems can be used for patients in their diabetes selfmanagement, but usability evaluations are often needed to determine how to make them more useful for the diabetes patient user in the monitoring and managing of their disease. Activity Theory (AT) was developed within Russian psychology to define the work and activity process in an activity system. AT was here considered to also be a particularly suitable framework for inspiration in usability evaluation both for the whole evaluation process and also for the usability task determination in this process for diabetes patient users. In the following paper, examples are provided from four usability studies using both user-based and expert usability methods in evaluation showing how AT was applied to guide the thoughts in evaluating the usability of two mHealth self-management systems for diabetes. Experiences and insights are provided from this process. © 2018 The authors and IOS Press. All rights reserved.

  • 23.
    Georgsson, Mattias
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Nancy, Staggers
    An evaluation of patients' experienced usability of a diabetes mHealth system using a multi-method approach2016In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 59, p. 115-129Article in journal (Refereed)
  • 24.
    Georgsson, Mattias
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Staggers, Nancy
    Summit Health Informatics, USA.
    Årsand, Eirik
    University Hospital of North Norway, NOR.
    Kushniruk, André
    University of Victoria, CAN.
    Employing a user-centered cognitive walkthrough to evaluate a mHealth diabetes self-management application: A case study and beginning method validation2019In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 91, article id 103110Article in journal (Refereed)
    Abstract [en]

    Introduction: Self-management of chronic diseases using mobile health (mHealth) systems and applications is becoming common. Current evaluation methods such as formal usability testing can be very costly and time-consuming; others may be more efficient but lack a user focus. We propose an enhanced cognitive walkthrough (CW) method, the user-centered CW (UC-CW), to address identified deficiencies in the original technique and perform a beginning validation with think aloud protocol (TA) to assess its effectiveness, efficiency and user acceptance in a case study with diabetes patient users on a mHealth self-management application. Materials and methods: A total of 12 diabetes patients at University of Utah Health, USA, were divided into UC-CW and think aloud (TA) groups. The UC-CW method included: making the user the main evaluator for detecting usability problems, having a dual domain facilitator, and using three other improved processes: validated task development, higher level tasks and a streamlined evaluation process. Users interacted with the same mHealth application for both methods. Post-evaluation assessments included the NASA RTLX instrument and a set of brief interview questions. Results: Participants had similar demographic characteristics. A total of 26 usability problems were identified with the UC-CW and 20 with TA. Both methods produced similar ratings: severity across all views (UC-CW = 2.7 and TA = 2.6), numbers of problems in the same views (Main View [UC-CW = 11, TA = 10], Carbohydrate Entry View [UC-CW = 4, TA = 3] and List View [UC-CW = 3, TA = 3]) with similar heuristic violations (Match Between the System and Real World [UC-CW = 19, TA = 16], Consistency and Standards [UC-CW = 17, TA = 15], and Recognition Rather than Recall [UC-CW = 13, TA = 10]). Both methods converged on eight usability problems, but the UC-CW group detected five critical issues while the TA group identified two. The UC-CW group identified needed personalized features for patients’ disease needs not identified with TA. UC-CW was more efficient on average time per identified usability problem and on the total evaluation process with patients. NASA RTLX scores indicated that participants experienced the UC-CW half as cognitively demanding. Common themes from interviews indicated the UC-CW as enjoyable and easy to perform while TA was considered somewhat awkward and more cognitively challenging. Conclusions: UC-CW was effective for finding severe, recurring usability problems and it highlighted the need for personalized user features. The method was also efficient and had high user acceptance. These results indicate UC-CW's utility and user acceptance in evaluating a mHealth self-management application. It provides an additional usability evaluation technique for researchers. © 2019

  • 25. Hallström, H.
    et al.
    Lindgren, S.
    Widén, C.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Twetman, S.
    Probiotic supplements and debridement of peri-implant mucositis: A randomized controlled trial2016In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 74, no 1, p. 60-66Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this double-blind randomized placebo-controlled trial was to evaluate the effects of probiotic supplements in adjunct to conventional management of peri-implant mucositis. Materials and methods. Forty-nine adult patients with peri-implant mucositis were consecutively recruited after informed consent. After initial mechanical debridement and oral hygiene instructions, the patients received a topical oil application (active or placebo) followed by twice-daily intake of lozenges (active or placebo) for 3 months. The active products contained a mix of two strains of Lactobacillus reuteri. Patients were clinically monitored and sampled at baseline and after 1, 2, 4, 12 and 26 weeks. The clinical end-points were pocket-probing depth (PPD), plaque index (PI) and bleeding on probing (BOP). In addition, the subgingival microbiota was processed with checkerboard DNA-DNA hybridization and samples of gingival crevicular fluid (GCF) were analyzed for selected cytokines with the aid of multiplex immunoassays. Results. After 4 and 12 weeks, all clinical parameters were improved in both the test and the placebo group. PPD and BOP were significantly reduced compared with baseline (p < 0.05), but no significant differences were displayed between the groups. The clinical improvements persisted 3 months after the intervention. No major alterations of the subgingival microflora were disclosed and the levels of inflammatory mediators in GCF did not differ between the groups. Conclusions. Mechanical debridement and oral hygiene reinforcement resulted in clinical improvement of peri-implant mucositis and a reduction in cytokine levels. Probiotic supplements did not provide added benefit to placebo. © 2015 Informa Healthcare.

  • 26. Hallström, Hadar
    et al.
    Persson, G. Rutger
    Stromberg, Ulf
    Twetman, Svante
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Reproducibility of subgingival bacterial samples from patients with peri-implant mucositis2015In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 19, no 5, p. 1063-1068Article in journal (Refereed)
    Abstract [en]

    Objective The aim of the present study was to investigate the reproducibility of bacterial enumeration from subsequent subgingival samples collected from patients with peri-implant mucositis. Material and methods Duplicate microbial samples from 222 unique implant sites in 45 adult subjects were collected with paper points and analyzed using the checkerboard DNA-DNA hybridization technique. Whole genomic probes of 74 preselected bacterial species were used. Based on the bacterial scores, Cohen's kappa coefficient was used to calculate the inter-annotator agreement for categorical data. The percentage agreement was considered as "good" when the two samples showed the same score or differed by 1 to the power of 10. Results Moderate to fair kappa values were displayed for all bacterial species in the test panel (range 0.21-0.58). There were no significant differences between Gram-positive and Gram-negative species. The percentage of good agreement between the first and second samples averaged 74.7 % (n=74; range 56-83 %), while the proportion of poor agreement ranged from 1 to 19 % for the various strains. Conclusion While an acceptable clinical agreement was obtained in most cases, diverging bacterial scores may appear in subgingival samples collected at the same time point from patients with peri-implant mucositis. Clinical relevance The broad bulky base of implant crowns may present an obstacle for the collection of reproducible subgingival samples with paper points.

  • 27.
    Hallström, Hadar
    et al.
    Centre for Oral Health Sciences Malmö, SWE.
    Persson, Gösta Rutger
    Högskolan Kristianstad, SWE.
    Lindgren, Susanne
    Halland Hospital, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Open flap debridement of peri-implantitis with or without adjunctive systemic antibiotics: A randomized clinical trial2017In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 44, no 12, p. 1285-1293Article in journal (Refereed)
    Abstract [en]

    Aims: To investigate clinical, radiographic and microbiological outcome over 12 months following open flap debridement of peri-implantitis with or without antibiotics. Materials and methods: Peri-implantitis was surgically treated with or without Zithromax® in 19 control and 20 test individuals. Probing pocket depth (PPD), gingival inflammation (BOP), intra-oral radiographs and microbial samples were studied. Per protocol and intent-to-treat analyses were performed. Results: The mean difference (reduction) in PPD values between baseline and month 12 in the test and control groups was 1.7 mm (SD ± 1.1, 95% CI: 1.1, 2.3, p &lt;.001) and 1.6 mm (SD ± 1.5, 95% CI: 0.8, 2,4, p &lt;.001), respectively. Data analysis failed to show study group differences for BOP, PPD, radiographic bone level and microbial load. Successful treatment (per protocol: PPD ≤ 5 mm, no BOP, no suppuration and no bone loss ≥0.5 mm) at 12 months in test and control groups was 7/15 (46.7%) and 4/16 (25.0%). Bacterial load reduction was similar in study groups with a temporary reduction following treatment. Conclusions: Surgical treatment of peri-implantitis with adjunctive systemic azithromycin did not provide 1-year clinical benefits in comparison with those only receiving open flap debridement. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

  • 28. Hallström, Hadar
    et al.
    Persson, Rutger
    Lindgren, Susann
    Olofsson, Maria
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    Systemic antibiotics and debridement of peri-implant mucositis. A randomized clinical trial2012In: Journal of Clinical Periodontology, ISSN 0303-6979, Vol. 39, no 6, p. 574-581Article in journal (Refereed)
    Abstract [en]

    Background This RCT compared non-surgical treatment of peri-implant mucositis with or without systemic antibiotics. Materials and Methods Forty-eight subjects received non-surgical debridement with or without systemic Azithromax (R) (4 similar to days), and were followed during 6 similar to months. The checkerboard DNA-DNA hybridization method was used to analyse the microbiological material. Results Five subjects were excluded due to antibiotic medication during follow-up. At baseline,1 and 3 similar to months no group differences were found. Statistical analysis failed to demonstrate differences in probing pocket depths (PPD) values at 6 similar to months (Mean diff PPD: 0.5 similar to mm, SE: +/- 0.4 similar to mm, 95% CI: -0.2, 1.3, p similar to 0.16). Mean% implant bleeding decreased between baseline and month 6 from 82.6% to 27.3% in the test, and from 80.0% to 47.5% in the control group (p similar to 0.02). Throughout the study, no study group differences in bacterial counts were found. Conclusion No short-term differences were found between study groups. The clinical improvements observed at 6 similar to months may be attributed to improvements in oral hygiene. The present study does not provide evidence for the use of systemic antibiotics in treatment of peri-implant mucositis.

  • 29. Hellström, A.
    et al.
    Nilsson, C.
    Nilsson, A.
    Fagerström, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Leg ulcers in older people: A national study addressing variation in diagnosis, pain and sleep disturbance2016In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 25Article in journal (Refereed)
    Abstract [en]

    Background: Leg ulcers commonly emerge as a symptom of other comorbidities, often in older people. As a consequence of the ulcer, pain and sleep disturbances might occur. Due to the complex illness, the responsibility of treatment is unclear between health caregivers. The interaction between ulcer type, sleep and pain has not previously been investigated. This study aimed to explore pain in older men and women (65 years and older) with different diagnoses of leg ulcers and to investigate the associations of sleep disturbances and pain in people with leg ulcer diagnosis. Methods: The study used a cross-sectional design and data from the Swedish Registry of Ulcer Treatment, collected between May 2009 and December 2013. One thousand and eight hundred and twenty four people were included, and 62.9 % were women. The mean age was 83.4 years (SD 8.8). For the analyses, the chi-square test, Mann-Whitney U-test, t-test, one-way ANOVA and logistic regression was performed. Pain was measured by the Numeric Rating Scale (NRS), and sleep disturbances was assessed dichotomously. Results: We found the prevalence of pain intensity ≥ 5 on the NRS to be 34.8 % in those reporting pain. Additionally, the pain intensity was associated with the number of ulcers (p = 0.003). Sleep disturbances were associated with pain (p < 0.001) and were found in 34.8 % of the total sample. Although more women than men reported pain and scored higher on the NRS, no significant gender difference in sleep disturbances was found (p = 0.606). The mean NRS scores did not differ significantly between the ulcer types; however, arterial and venous-arterial ulcers increased the risk of sleep disturbances, as did higher pain scores. Conclusions: The majority of the participants were of advanced age (>80 years) and frequently suffered from pain and sleep disturbances. Further research is needed regarding pain, sleep and wound healing in the oldest old with leg ulcers. Ulcer pain sometimes appears to receive less attention in ulcer management, as do sleep disturbances, implying that individual needs might not be satisfactorily met. National guidelines in managing leg ulcers, which also consider consequences such as sleep disturbances, pain and discomfort, are needed. © 2016 Hellström et al.

  • 30.
    Holst, Adelheid
    et al.
    Faculty of Professional Studies Nord University Bodø, NOR.
    Skär, Lisa
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Formal caregivers' experiences of aggressive behaviour in older people living with dementia in nursing homes: A systematic review2017In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 12, no 4, article id e12158Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of this study was to investigate formal caregivers' experiences of aggressive behaviour in older people living with dementia in nursing homes. Background: Aggressive behaviour symptoms among older people living with dementia are reported to be prevalent. As aggressive behaviour includes both verbal and physical behaviours, such as kicking, hitting and screaming, it causes an increased burden on formal caregivers. Professionals experiencing this aggression perceived it as challenging, causing physical and psychological damage, leading to anger, stress and depression. Methods: A systematic review was conducted. A search of published research studies between 2000 and 2015 was conducted using appropriate search terms. Eleven studies were identified and included in this review. Results: The analysis resulted in four categories: formal caregivers' views on triggers of aggression, expressions of aggression, the effect of aggressive behaviours on formal caregivers and formal caregivers' strategies to address aggression. The results show that aggressive behaviour may lead to negative feelings in formal caregivers and nursing home residents. Conclusion: The results of this study suggest that having the ability to identify triggers possibly assists caregivers with addressing aggressive behaviour. Aggressive behaviour might also affect quality of care. Implications for practice: Results from this systematic review indicate that caregivers prefer person-centred strategies to handle aggressive behaviour among older people, while the use of pharmaceuticals and coercion strategies is a last resort. © 2017 John Wiley & Sons Ltd.

  • 31.
    Isehed, Catrine
    et al.
    Umeå universitet, SWE.
    Holmlund, Anders
    Uppsala Universitet, SWE.
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Svenson, Björn
    Postgraduate Dental Education Center Örebro, SWE.
    Johansson, Ingegerd
    Umeå universitet, SWE.
    Lundberg, Pernilla
    Umeå universitet, SWE.
    Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri-implantitis: A randomized controlled trial2016In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 43, no 10, p. 863-873Article in journal (Refereed)
    Abstract [en]

    Objective: This randomized clinical trial aimed at comparing radiological, clinical and microbial effects of surgical treatment of peri-implantitis alone or in combination with enamel matrix derivative (EMD). Methods: Twenty-six subjects were treated with open flap debridement and decontamination of the implant surfaces with gauze and saline preceding adjunctive EMD or no EMD. Bone level (BL) change was primary outcome and secondary outcomes were changes in pocket depth (PD), plaque, pus, bleeding and the microbiota of the peri-implant biofilm analyzed by the Human Oral Microbe Identification Microarray over a time period of 12 months. Results: In multivariate modelling, increased marginal BL at implant site was significantly associated with EMD, the number of osseous walls in the peri-implant bone defect and a Gram+/aerobic microbial flora, whereas reduced BL was associated with a Gram−/anaerobic microbial flora and presence of bleeding and pus, with a cross-validated predictive capacity (Q2) of 36.4%. Similar, but statistically non-significant, trends were seen for BL, PD, plaque, pus and bleeding in univariate analysis. Conclusion: Adjunctive EMD to surgical treatment of peri-implantitis was associated with prevalence of Gram+/aerobic bacteria during the follow-up period and increased marginal BL 12 months after treatment.

  • 32.
    Jaworski, Jacek
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Applied Signal Processing.
    Bates, Jason
    University of Vermont, USA.
    Sources of breathing pattern variability in the respiratory feedback control loop2019In: Journal of Theoretical Biology, ISSN 0022-5193, E-ISSN 1095-8541, Vol. 469, p. 148-162Article in journal (Refereed)
    Abstract [en]

    The variability of the breath-to-breath breathing pattern, and its alterations in disease, may hold information of physiologic and/or diagnostic value. We hypothesized that this variability arises from the way that noise is processed within the respiratory feedback control loop, and that pathologic alterations to specific components within the system give rise to characteristic alterations in breathing pattern variability. We explored this hypothesis using a computational model of the respiratory control system that integrates mechanical factors, gas exchange processes, and chemoreceptor signals to simulate breathing patterns subject to the influences of random variability in each of the system components. We found that the greatest changes in the coefficient of variation (CV) of both breathing amplitude and timing were caused by increases in lung resistance and impairments in gas exchange, both common features of pulmonary disease. This suggests that breathing pattern variability may reflect discernible deterministic processes involved in the control of breathing. © 2019 Elsevier Ltd

  • 33.
    Jepsen, K.
    et al.
    Univ Bonn, Dept Periodontol Operat & Prevent Dent, D-53111 Bonn, Germany..
    Jepsen, S.
    Univ Bonn, Dept Periodontol Operat & Prevent Dent, D-53111 Bonn, Germany..
    Laine, M. L.
    Univ Amsterdam, Dept Periodontol, Acad Ctr Dent Amsterdam, Amsterdam, Netherlands.;Vrije Univ Amsterdam, Amsterdam, Netherlands..
    Moin, D. Anssari
    Univ Amsterdam, Dept Periodontol, Acad Ctr Dent Amsterdam, Amsterdam, Netherlands.;Vrije Univ Amsterdam, Amsterdam, Netherlands..
    Pilloni, A.
    Univ Roma La Sapienza, Sect Periodont, Rome, Italy..
    Zeza, B.
    Univ Roma La Sapienza, Sect Periodont, Rome, Italy..
    Sanz, M.
    Univ Complutense Madrid, ETEP Etiol & Therapy Periodontal Dis Res Grp, Madrid, Spain..
    Ortiz-Vigon, A.
    Univ Complutense Madrid, ETEP Etiol & Therapy Periodontal Dis Res Grp, Madrid, Spain..
    Roos-Jansaker, A. M.
    Publ Dent Hlth Serv, Dept Periodontol, Kristianstad, Sweden.;Kristianstad Univ, Dept Oral Sci, Kristianstad, Sweden..
    Renvert, Stefan
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health. Publ Dent Hlth Serv, Dept Periodontol, Kristianstad, Sweden.;Kristianstad Univ, Dept Oral Sci, Kristianstad, Sweden.;Blekinge Inst Technol, Karlskrona, Sweden.;Univ Dublin Trinity Coll, Sch Dent Sci, Dublin 2, Ireland..
    Reconstruction of Peri-implant Osseous Defects: A Multicenter Randomized Trial2016In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 95, no 1, p. 58-66Article in journal (Refereed)
    Abstract [en]

    There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD <= 4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

  • 34. Juuso, Päivi
    et al.
    Skär, Lisa
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sundin, Karin
    Söderberg, Siv
    The Workplace Experiences of Women with Fibromyalgia2016In: Musculoskeletal Care, ISSN 1478-2189, E-ISSN 1557-0681, Vol. 14, no 2, p. 69-76Article in journal (Refereed)
    Abstract [en]

    Purpose: Fibromyalgia (FM) is a common pain syndrome that mostly affects women. Chronic pain and other symptoms often chalenge work for women with FM. This study aimed to explore how women with FM experience their work situations. Method: A purposive sample of 15 women with FM was interviewed with in-depth qualitative interviews. Data were analysed using a hermeneutic approach. Results: The results revealed that women with FM experienced incapacity to work as they had previously and eventually accepted that their work life had changed or reached its end. Since their work had great significance in their lives, feelings of loss and sorrow were common. Women who were working, unemployed, or on sick leave described feelings of fear for their future work situations. Conclusions: Women with FM greatly value their work. Their wish to perform work as before is however, not consistent with their abilities. As such, women with FM need support in continuing to work for as long as possible, after which they need support in finding new values in life. © 2016 John Wiley & Sons, Ltd.

  • 35.
    Karlsson, Staffan
    et al.
    Lund Univ, SWE.
    Rahm Hallberg, Ingalill
    Lund Univ, SWE.
    Midlöv, Patrik
    Lund Univ, SWE.
    Fagerstrom, Cecilia
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Trends in treatment with antipsychotic medication in relation to national directives, in people with dementia: a review of the Swedish context2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 251Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore trends in treatment with antipsychotic medication in Swedish dementia care in nursing homes as reported in the most recent empirical studies on the topic, and to relate these trends to directives from the national authorities. Methods: The study included two scoping review studies based on searches of electronic databases as well as the Swedish directives in the field. Results: During the past decade, directives have been developed for antipsychotic medication in Sweden. These directives were generic at first, but have become increasingly specific and restrictive with time. The scoping review showed that treatment with antipsychotic drugs varied between 6% and 38%, and was higher in younger older persons and in those with moderate cognitive impairment and living in nursing homes for people with dementia. A decreasing trend in antipsychotic use has been seen over the last 15 years. Conclusions: Directives from the authorities in Sweden may have had an impact on treatment with antipsychotic medication for people with dementia. Treatment with antipsychotic medication has decreased, while treatment with combinations of psychotropic medications is common. National directives may possibly be even more effective, if applied in combination with systematic follow-ups.

  • 36.
    Leigod, Linnéa
    et al.
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Fransson, Maja
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Sjuksköterskors erfarenheter av att stödja barn till egenvård vid diabetes typ-1: En kvalitativ empirisk studie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Barn kan sakna förståelse för hur diabetes typ-1 påverkar deras kroppar och de kan uppleva sin kropp som främmande. Personer som lever med diabetes bör ta ett stort ansvar över sin egenvård, men även hälso- och sjukvården har ett ansvar att ge personerna de rätta verktygen som de behöver. Sjuksköterskans roll är att ge stöd till patienter och undervisa dem med syftet att främja hälsa. Egenvård är en stor utmaning för barnen på grund av smärta och rädsla och barnen behöver därför stöd från vårdpersonalen när det gäller att lära sig att utföra egenvård. 

    Syfte: Syftet med studien var att beskriva sjuksköterskors erfarenheter av att stödja barn till egenvård vid diabetes typ-1.

    Metod: Studien genomfördes som en empirisk intervjustudie i kvalitativt syfte med Graneheim och Lundmans beskrivning av en kvalitativ innehållsanalys. 

    Resultat: Resultatet av sjuksköterskornas erfarenheter av att stödja barn till egenvård mynnade ut i fyra kategorier: att anpassa undervisningen, att främja delaktighet, att underlätta till självständighet och att uppmuntra barnen. Resultatet visade att sjuksköterskorna skulle anpassa undervisningen utefter barnets ålder, mognadsgrad och utveckling. Sjuksköterskorna skulle främja delaktigheten genom att rikta sig till barnen och underlätta självständigheten genom att barnen själva fick göra de moment som sjukdomen kräver. Resultatet visade även att sjuksköterskorna skulle uppmuntra barnen när de hade klarat av ett moment och ge dem belöningar i form av presenter.

    Slutsats: För att stödja barn med diabetes typ-1 till egenvård bör sjuksköterskorna besitta olika förmågor, som att kunna anpassa undervisningen, var pedagogisk och uppmuntra barnen i olika situationer. Studiens resultat kan öka kunskapen om sjuksköterskors erfarenheter av att stödja barn till egenvård vid diabetes typ-1. Resultatet kan även öka medvetenheten och utgöra en grund för sjuksköterskors sätt att stödja barn till egenvård.

     

     

    Nyckelord: Barn, diabetes typ-1, egenvård, sjuksköterska, stöd.

  • 37.
    Levi, Gabriella
    et al.
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Jonason, Minna
    Blekinge Institute of Technology, Faculty of Health Sciences, Department of Health.
    Fångad i en dröm: att vara i ett psykotiskt tillstånd: - en narrativ analys av patografier2019Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Psykisk problematik i form av psykoser kan drabba alla människor när som helst under livets gång. Unga som gamla drabbas av psykoser i olika sammanhang. Symtom som vanföreställningar, hallucinationer och magiskt tänkande kan göra det svårt för vårdpersonal att behandla och vårda personen.En balans mellan att vara öppen och intresserad till att vara beslutsam och förstående kan vara en utmaning i omvårdnadssammanhang. Genom att fördjupa sig i upplevelser av psykoser kan vårdpersonal anpassa vården utifrån en personcentrerad vård och vårda personen utifrån bästa möjliga förutsättningar. Personer med psykossjukdomar drabbas oftare än andra av de vanligaste somatiska sjukdomarna som hjärt- och kärlsjukdomar, lungsjukdomar och diabetes och är därför vanligt förekommande patienter vid den typen av vårdenheter. Många sjuksköterskor upplever patientgruppen som svår att bemöta och skapa relation till på grund av patientens symtom. Bättre kunskap hos sjuksköterskor om vad patienten kan uppleva i sitt psykotiska tillstånd kan minska osäkerheten och skapa bättre förutsättningar för en allians och en personcentrerad vård. 

    Syfte: Syftet med studien var att belysa personers upplevelser av att vara i ett psykotiskt tillstånd

    Metod: En litteraturstudie med kvalitativ ansats baserad på tre patografier som sökts via en sökning på Libris. Data har analyserats med en kvalitativ innehållsanalys med en latent ansats utifrån Graneheim, Lindgren och Lundmans beskrivning.

    Resultat: I studien framkom tre kategorier som alla kunde sammanföras under det övergripande temat Fångad i en dröm. I kategorin Vara mellan verklighet och psykotisk världbeskriver personerna med det psykotiska tillståndet hur de upplever att vara i olika verkligheter samtidigt. Under kategorin Att förlora kontrollen beskriver personerna känslorna av att vara uppslukad och styrd av psykosen, att vara missförstådd och paranoid samt att uppleva ensamhet och isolering. Den sista kategorin Drömlikt tillstånd beskriver personernas upplevelser av att vara unika och utvalda samt hur saker och ting ändrar form och karaktär. 

    Slutsats: Studiens resultat visar att personer i det psykotiska tillståndet upplever verkligheten på ett högst individuellt sätt som kan liknas vid att vara fångad i en dröm som personen inte kan vakna ur. Med kunskap om hur det kan vara att vara psykotisk och förståelse för personens ofta skrämmande upplevelser, kan en mer personcentrerad vård utformas vilket skapar bättre förutsättningar för en bra vårdrelation och ett gott vårdande. 

  • 38.
    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.

  • 39.
    Lundberg, Jenny
    et al.
    Linnaeus Univ, SWE..
    Claesson, Lena
    Blekinge Institute of Technology, Faculty of Engineering, Department of Applied Signal Processing.
    Early Signs of Diabetes Explored from an Engineering Perspective2019In: SMART INDUSTRY & SMART EDUCATION / [ed] Auer, ME Langmann, R, SPRINGER INTERNATIONAL PUBLISHING AG , 2019, p. 22-31Conference paper (Refereed)
    Abstract [en]

    Undetected diabetes is a global issue, estimated to over 200 million persons affected. Engineering opportunities in capturing early signs of diabetes has a potential due to the complexity to interpret early signs and link it to diabetes. Persons with untreated diabetes are doubled in risk of getting cardiovascular diseases and may also suffer other consequent diseases. In Sweden, approximately 450 thousand have diabetes where 80-90% are of type 2 with 1/4 unaware of it, i.e. approx. 100 thousand. Screening approaches, searching specifically for diabetes in persons not showing symptoms has been initiated with positive results. However, some general drawbacks of screening such as false sense of security are an issue. In this publication, we focus upon in home measurements and empowering of the individual in identifying early signs of diabetes. The methods in this publication are to gather data, evaluate and give suggestion if clinical test to confirm or reject diabetes. In home measurements, education process with companies for innovation possibilities.

  • 40.
    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.

  • 41.
    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.

  • 42.
    Ndziba, Chantal
    et al.
    Blekinge Institute of Technology.
    Johansson, Felix
    Patienters upplevelser av dagkirurgisk vård: En litteraturstudie2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 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.
    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

  • 44.
    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

  • 45.
    Ola, Spjuth
    et al.
    Karolinska Institutet, SWE.
    Andreas, Karlsson
    Karolinska Institutet, SWE.
    Mark, Clements
    Karolinska Institutet, SWE.
    Keith, Humphreys
    Karolinska Institutet, SWE.
    Emma, Ivansson
    Karolinska Institutet, SWE.
    Jim, Dowling
    Royal Institute of Technology, SWE.
    Martin, Eklund
    Karolinska Institutet, SWE.
    Alexandra, Jauhiainen
    AstraZeneca AB R&D, SWE.
    Kamila, Czene
    Karolinska Institutet, SWE.
    Henrik, Grönberg
    Karolinska Institutet, SWE.
    Pär, Sparén
    Karolinska Institutet, SWE.
    Fredrik, Wiklund
    Karolinska Institutet, SWE.
    Abbas, Cheddad
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    þorgerður, Pálsdóttir
    Nordic Information for Action e-Science Center, SWE.
    Mattias, Rantalainen
    Karolinska Institutet, SWE.
    Linda, Abrahamsson
    Karolinska Institutet, SWE.
    Erwin, Laure
    Royal Institute of Technology, SWE.
    Jan-Eric, Litton
    European Research Infrastructure Consortium, AUT.
    Juni, Palmgren
    Helsinki University, FIN.
    E-Science technologies in a workflow for personalized medicine using cancer screening as a case study2017In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 24, no 5, p. 950-957Article in journal (Refereed)
    Abstract [en]

    Objective: We provide an e-Science perspective on the workflow from risk factor discovery and classification of disease to evaluation of personalized intervention programs. As case studies, we use personalized prostate and breast cancer screenings.

    Materials and Methods: We describe an e-Science initiative in Sweden, e-Science for Cancer Prevention and Control (eCPC), which supports biomarker discovery and offers decision support for personalized intervention strategies. The generic eCPC contribution is a workflow with 4 nodes applied iteratively, and the concept of e-Science signifies systematic use of tools from the mathematical, statistical, data, and computer sciences.

    Results: The eCPC workflow is illustrated through 2 case studies. For prostate cancer, an in-house personalized screening tool, the Stockholm-3 model (S3M), is presented as an alternative to prostate-specific antigen testing alone. S3M is evaluated in a trial setting and plans for rollout in the population are discussed. For breast cancer, new biomarkers based on breast density and molecular profiles are developed and the US multicenter Women Informed to Screen Depending on Measures (WISDOM) trial is referred to for evaluation. While current eCPC data management uses a traditional data warehouse model, we discuss eCPC-developed features of a coherent data integration platform.

    Discussion and Conclusion: E-Science tools are a key part of an evidence-based process for personalized medicine. This paper provides a structured workflow from data and models to evaluation of new personalized intervention strategies. The importance of multidisciplinary collaboration is emphasized. Importantly, the generic concepts of the suggested eCPC workflow are transferrable to other disease domains, although each disease will require tailored solutions.

  • 46.
    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

  • 47.
    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.

  • 48. Persson, Gösta Rutger
    et al.
    Renvert, Stefan
    Blekinge Institute of Technology, School of Health Science.
    Cluster of Bacteria Associated with Peri-Implantitis2014In: Clinical Implant Dentistry and Related Research, ISSN 1523-0899, E-ISSN 1708-8208, Vol. 16, no 6, p. 783-893Article in journal (Refereed)
    Abstract [en]

    Information on the microbiota in peri-implantitis is limited. We hypothesized that neither gender nor a history of periodontitis/smoking or the microbiota at implants differ by implant status. Materials and Methods: Baseline microbiological samples collected at one implant in each of 166 participants with peri-implantitis and from 47 individuals with a healthy implant were collected and analyzed by DNA-DNA checkerboard hybridization (78 species). Clinical and radiographic data defined implant status. Results: Nineteen bacterial species were found at higher counts from implants with peri-implantitis including Aggregatibacter actinomycetemcomitans, Campylobacter gracilis, Campylobacter rectus, Campylobacter showae, Helicobacter pylori, Haemophilus influenzae, Porphyromonas gingivalis, Staphylococcus aureus, Staphylococcus anaerobius, Streptococcus intermedius, Streptococcus mitis, Tannerella forsythia, Treponema denticola, and Treponema socranskii (p<.001). Receiver operating characteristic curve analysis identified T. forsythia, P. gingivalis, T. socranskii, Staph. aureus, Staph. anaerobius, Strep. intermedius, and Strep. mitis in peri-implantitis comprising 30% of the total microbiota. When adjusted for gender (not significant [NS]), smoking status (NS), older age (p=.003), periodontitis history (p<.01), and T. forsythia (likelihood ratio 3.6, 95% confidence interval 1.4, 9.1, p=.007) were associated with peri-implantitis. Conclusion: A cluster of bacteria including T. forsythia and Staph. aureus are associated with peri-implantitis.

  • 49. Persson, Marie
    Operational strategies to manage non-elective orthopaedic surgical flows: a simulation modelling study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 4Article in journal (Refereed)
    Abstract [en]

    Objectives To explore the value of simulation modelling in evaluating the effects of strategies to plan and schedule operating room (OR) resources aimed at reducing time to surgery for non-elective orthopaedic inpatients at a Swedish hospital.

    Methods We applied discrete-event simulation modelling. The model was populated with real world data from a university hospital with a strong focus on reducing waiting time to surgery for patients with hip fracture. The system modelled concerned two patient groups that share the same OR resources: hip-fracture and other non-elective orthopaedic patients in need of surgical treatment. We simulated three scenarios based on the literature and interaction with staff and managers: (1) baseline; (2) reduced turnover time between surgeries by 20 min and (3) one extra OR during the day, Monday to Friday. The outcome variables were waiting time to surgery and the percentage of patients who waited longer than 24 hours for surgery.

    Results The mean waiting time in hours was significantly reduced from 16.2 hours in scenario 1 (baseline) to 13.3 hours in scenario 2 and 13.6 hours in scenario 3 for hip-fracture surgery and from 26.0 hours in baseline to 18.9 hours in scenario 2 and 18.5 hours in scenario 3 for other non-elective patients. The percentage of patients who were treated within 24 hours significantly increased from 86.4% (baseline) to 96.1% (scenario 2) and 95.1% (scenario 3) for hip-fracture patients and from 60.2% (baseline) to 79.8% (scenario 2) and 79.8% (scenario 3) for patients with other non-elective patients.

    Conclusions Healthcare managers who strive to improve the timelines of non-elective orthopaedic surgeries may benefit from using simulation modelling to analyse different strategies to support their decisions. In this specific case, the simulation results showed that the reduction of surgery turnover times could yield the same results as an extra OR.

  • 50.
    Persson, Marie
    et al.
    Blekinge Institute of Technology, Faculty of Computing, Department of Computer Science and Engineering.
    Hvitfeldt-Forsberg, Helena
    Medical Management Centre (MMC), SWE.
    Unbeck, Maria
    Danderyds sjukhus, SWE.
    Sköldenberg, Olof Gustaf
    Danderyds sjukhus, SWE.
    Stark, Andreas
    Danderyds sjukhus, SWE.
    Kelly-Pettersson, Paula
    Danderyds sjukhus, SWE.
    Mazzocato, Pamela
    Medical Management Centre (MMC), SWE.
    Operational strategies to manage non-elective orthopaedic surgical flows: A simulation modelling study2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 4, article id e013303Article in journal (Refereed)
    Abstract [en]

    Objectives To explore the value of simulation modelling in evaluating the effects of strategies to plan and schedule operating room (OR) resources aimed at reducing time to surgery for non-elective orthopaedic inpatients at a Swedish hospital. Methods We applied discrete-event simulation modelling. The model was populated with real world data from a university hospital with a strong focus on reducing waiting time to surgery for patients with hip fracture. The system modelled concerned two patient groups that share the same OR resources: hip-fracture and other non-elective orthopaedic patients in need of surgical treatment. We simulated three scenarios based on the literature and interaction with staff and managers: (1) baseline; (2) reduced turnover time between surgeries by 20â €..min and (3) one extra OR during the day, Monday to Friday. The outcome variables were waiting time to surgery and the percentage of patients who waited longer than 24â €..hours for surgery. Results The mean waiting time in hours was significantly reduced from 16.2â €..hours in scenario 1 (baseline) to 13.3â €..hours in scenario 2 and 13.6â €..hours in scenario 3 for hip-fracture surgery and from 26.0â €..hours in baseline to 18.9â €..hours in scenario 2 and 18.5â €..hours in scenario 3 for other non-elective patients. The percentage of patients who were treated within 24â €..hours significantly increased from 86.4% (baseline) to 96.1% (scenario 2) and 95.1% (scenario 3) for hip-fracture patients and from 60.2% (baseline) to 79.8% (scenario 2) and 79.8% (scenario 3) for patients with other non-elective patients. Conclusions Healthcare managers who strive to improve the timelines of non-elective orthopaedic surgeries may benefit from using simulation modelling to analyse different strategies to support their decisions. In this specific case, the simulation results showed that the reduction of surgery turnover times could yield the same results as an extra OR. © 2017 Published by the BMJ Publishing Group Limited.

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