Lisa Wernroth - Academia.edu (original) (raw)
Papers by Lisa Wernroth
The Journal of Rheumatology
Variables for assessment of disease activity of juvenile idiopathic arthritis (JIA) were studied,... more Variables for assessment of disease activity of juvenile idiopathic arthritis (JIA) were studied, in order to develop a disease activity score for children with JIA. One randomly chosen hospital visit was studied for each of 312 patients with JIA, with regard to disease activity variables. The physician global assessment score visual analog scale (physician GA) was used as a dependent variable in comparisons between potential disease activity variables. Previous studies have shown this variable to be the most sensitive to changes in JIA disease activity and to be comparable between patients. Based on Spearman's rank order correlation the number of active joints had a strong association with the physician GA. The median physician GA score rose markedly for each active large joint, but less for small joints, although small joints were also statistically important in assessing disease activity. Among the laboratory data, the erythrocyte sedimentation rate, C-reactive protein level,...
Open heart, 2014
Despite increased awareness of the importance of early treatment in acute myocardial infarction (... more Despite increased awareness of the importance of early treatment in acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival is still too long and rehospitalisations are frequent. Little is known about how health-related quality of life (HRQL) affects delay time and the frequency of readmissions. We used quality registers to investigate whether patients' HRQL has any impact on delay time with a new AMI, and on the rate of readmissions during the first year. Patients with AMI <75 years, with HRQL assessed with EQ-5D at 1-year follow-up, and who thereafter had a new AMI registered, were evaluated for the correlation between HRQL and delay time (n=454). The association between HRQL and readmissions was evaluated among those who had an additional AMI and a new 1-year follow-up registration (n=216). Patients who reported poor total health status (EQ-VAS ≤50), compared to those who reported EQ-VAS 81-100, had tripled risk to delay ≥2 h from symptom onset ...
Läkartidningen, Jan 27, 1999
Science of The Total Environment, 2000
Results from the Swedish control programme regarding organochlorines in food were used to determi... more Results from the Swedish control programme regarding organochlorines in food were used to determine time trends of organochlorine concentrations in adipose tissues from swine (4-8 months old) and bovines (non-dairy, 12-36 months) slaughtered between 1991 and 1997. Moreover, possible regional differences in concentrations were studied, as well as differences in concentrations depending on sex and age of the slaughtered animals. Multiple linear regression indicated that the concentrations of PCB, p,p'-DDE, HCB and alpha-HCH decreased by 4-17% per year, suggesting that the decline in organochlorine concentrations in the Swedish environment and biota reported during the 1970s-1990s also has occurred in meat-producing animals during the 1990s. The concentrations of PCB, DDE and HCB in bovines and PCB and DDE in swine were 1.4-3.8-fold higher in the southern parts of Sweden than in the northern parts of the country, indicating a regional difference in exposure of the animals. The organochlorine concentrations were higher in bovines than in swine, and declined faster in swine than in bovines. Moreover, the concentrations of CB 153 and p,p'-DDE were similar in bovines, but in swine the average concentrations of the two compounds differed two-fold. Apart from possible species differences in metabolism of organochlorines, this may be due to differences in the age at slaughter between swine and bovines, and differences in husbandry of the animals. In the latter case, swine are generally kept inside during their whole life span, whereas bovines are kept outside grazing during the summer period. Finally, a sex-dependent difference in concentrations was indicated in swine, but not in bovines. Our study shows that a lot of information can be 'extracted' from control program results.
Scandinavian Journal of Primary Health Care, 1999
The aim of this study was to investigate the use of clinical laboratory tests in primary care and... more The aim of this study was to investigate the use of clinical laboratory tests in primary care and to evaluate if it is possible to improve the cost-effectiveness of laboratory testing by a short-term education programme. Our main goal has been to lower the total costs of care. An education programme that was monitored by laboratory test ratios. Primary health care. 63 primary care doctors at 19 primary care centres in the county of Uppsala, Sweden. The effects of the education programme were monitored by laboratory test ratios (e.g. ASAT/ALAT) of individual doctors before and after the education programme. The education programme resulted in significant changes for the majority of the ratios studied. The savings on direct laboratory costs were approximately SEK 400,000 for assays that were recommended to decrease. The increased cost for assays that were recommended to increase was approximately SEK 140,000 but was considered cost-effective. It is possible to achieve significant changes in clinical chemistry test ordering habits of primary care doctors with a 2 day education programme. It resulted in cost savings and a better use of clinical chemistry tests in primary care. The effects were sustained for at least 6 months.
Scandinavian Journal of Clinical & Laboratory Investigation, 2010
Objective. Laboratory tests are used increasingly in primary health care and they are thus associ... more Objective. Laboratory tests are used increasingly in primary health care and they are thus associated with rapidly growing costs. Variations in clinical practice, an important determinant of expenditure for laboratory tests, could further increase the fi nancial burden. The study's threefold objective was to determine the presence and extent of regional variations in test ordering between eight counties in Sweden, to investigate the infl uence on these variations by factors earlier described in the literature as explanatory, and to calculate the achievable savings that could be realized through optimized test ordering. Design. A retrospective study using test request data. Setting. A total of 223 primary health care centers in eight counties in Sweden. Main outcome measures. Thirteen ratios of commonly used laboratory tests, demographic data and the number of ordered tests per 1000 inhabitants served as the basis of comparison. The total savings per 100,000 inhabitants that could be achieved through optimized test ordering was estimated. Results. Large variations were found between all studied counties for all investigated ratios. However, none of the demographic variables investigated seemed to be able to explain the full extent of the variations. The range of achievable yearly savings per 100,000 inhabitants was €14,000-€185,000. Conclusion. The inter-county variations in Sweden are large and the savings associated with optimized test utilization are substantial. The investigated factors previously described as explaining the variations in test ordering only seem to explain a small part of the variation, and the variations are likely infl uenced by regional habits and traditions. Correspondence: Mirja Mindemark, Akademiska sjukhuset, entrance 61, 3rd fl oor, SE-751 85 Uppsala, Sweden. Tel: ϩ 46 18 611 42 04. Fax: ϩ 46 18 611 37 03. Scand J Clin Lab Invest Downloaded from informahealthcare.com by Uppsala Universitetsbibliotek on 01/04/15 For personal use only.
Oncology Reports, 2010
The value of early tumour marker changes during palliative chemotherapy in patients with upper ga... more The value of early tumour marker changes during palliative chemotherapy in patients with upper gastrointestinal adenocarcinoma (UGIA) is unclear. Seventy-three patients with advanced UGIA were randomised to receive 45 mg/m2 docetaxel or 180 mg/m2 irinotecan with 5-FU/leucovorin. After every 2nd course the patients were crossed over to the other regimen. Serum was sampled before start of chemotherapy and every 2nd week during 8 weeks for CEA, TPA, TPS, CA72-4, CA19-9 and CA242 measurements. Eighteen patients (25%) had partial response (PR) and 21 patients had stable disease for at least 4 months (SD4). All baseline marker levels, except CA72-4, correlated with time to progression and survival. Patients with normal levels, except CA72-4, also had more clinical responses (PR+SD4) than patients with elevated values. Tumour marker changes early during treatment provided modest predictive information for tumour response and survival. A model combining baseline level, the change and the interaction between them gave the best prediction of outcome, however, insignificantly better than baseline level for all markers except CA242. Baseline tumour marker levels provide prognostic information for patients with UGIA on palliative chemotherapy. Early changes generally failed to provide accurate information for tumour response and survival.
Free Radical Research, 2009
This study investigates oxidative stress and antioxidants in normal human pregnancy and post-part... more This study investigates oxidative stress and antioxidants in normal human pregnancy and post-partum period. Thirty-seven healthy women with normal pregnancies were included. Both urinary and serum samples were collected throughout the pregnancy and post-partum period. Oxidative stress was estimated by measuring the reliable in vivo marker, namely 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha,) an F(2)-isoprostane) and antioxidant status was evaluated by measuring alpha- and gamma-tocopherol in serum samples. Pregnancy was associated with successively increased levels of 8-iso-PGF(2alpha) with advancing gestational age. The median post-partum value corresponded to the values observed in early gestation and a significant decrease was observed from late pregnancy to the post-partum period. Lipid-adjusted alpha- and gamma-tocopherol levels decreased with advancing gestational age. This longitudinal study suggests that mild oxidative stress is involved in normal human pregnancy.
European Journal of Clinical Investigation, 2001
Previous studies indicate that the enteral bacterial urease is inhibited in victims of sudden inf... more Previous studies indicate that the enteral bacterial urease is inhibited in victims of sudden infant death syndrome (SIDS). One possible inhibitor of this bacterial activity is nitrate. If ambient pollution by nitrate is involved in the etiology of SIDS only a fraction of the nitrate concentration not infrequently found in drinking water would be enough for this inhibition. Occurrence of SIDS (n = 636) in Sweden during the period 1990 through 1996 were analysed regarding geographical and seasonal distribution in relation to the nitrate concentration in drinking water and changes in the groundwater level. Both the birth rate and the incidence of SIDS decreased during the study period. One quarter of the municipalities constituting 11% of the population had no cases, the maximum incidence being 6.5 per 1000 live births. Seasonality: The northernmost parts of the country had its highest incidence when the rest of the country had its lowest incidence, and the occurrence of individual deaths was associated with the recharge of groundwater which increases its nitrate content. The local incidence of SIDS was correlated (rs = 0.34-0.87) to maximally recorded concentrations of nitrate in drinking water. The seasonal distribution of SIDS was widely different from the south to the north of the country and seems to be associated with differences in the groundwater level changes subsequent to precipitation, frost penetration, and melting of snow. Use of drinking water with high peak concentrations or great variations in nitrate concentration was correlated to the incidence of SIDS.
Acta Oncologica, 2012
Background. To evaluate the predictive and prognostic value of serum and plasma tumor markers, in... more Background. To evaluate the predictive and prognostic value of serum and plasma tumor markers, in comparison with clinical and biomedical parameters for response rate (RR), progression-free survival (PFS) and overall survival (OS) among patients with metastatic colorectal cancer (mCRC) treated with combination chemotherapy. Material and methods. One-hundred and six patients with mCRC from three centers, part of a multicenter study, received irinotecan with the Nordic bolus 5-fl uorouracil (5-FU) and folinic acid schedule (FLIRI) or the de Gramont schedule (Lv5FU2-IRI). Blood samples for CEA, CA19-9, TPA, TIMP-1, SAA, transthyretin and CRP were taken at baseline and after two, four and eight weeks of treatment. Tumor marker levels at baseline and longitudinally were compared with responses evaluated (CT/MRI) after two and four months of treatment. The correlations to RR, PFS and OS were evaluated with regression analyses. Results. A signifi cant correlation to OS was seen for baseline levels of all markers. In multivariate analyses with clinical parameters, TPA, CRP, SAA and TIMP-1 provided independent information. The baseline values of CEA, TPA and TIMP-1 were also signifi cantly correlated to PFS and TPA to RR. Changes during treatment, i.e. the slope gave with the exception of CA19-9 for OS less information about outcomes. The best correlation to response was seen for CEA, CA19-9 and TPA with AUC values of 0.78, 0.83 and 0.79, respectively, using a combined model based upon an interaction between the slope and the baseline value. Conclusions. Baseline tumor markers together with clinical parameters provide prognostic information about survival in patients with mCRC. The ability of the individual tumor markers to predict treatment response and PFS is limited. Changes in marker levels during the fi rst two months of treatment are less informative of outcome.
Acta Obstetricia et Gynecologica Scandinavica, 2013
To study the role of inflammation throughout normal pregnancy and postpartum, 37 women with norma... more To study the role of inflammation throughout normal pregnancy and postpartum, 37 women with normal pregnancies, including normal neonatal outcome, participated. Blood and urine samples were collected from each woman at least six times during pregnancy and postpartum. Plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) and urinary levels of a prostaglandin-F 2a (PGF 2a ) metabolite were measured. Median, 25th to 75th centile and average change per gestational week of IL-6, TNF-a and the PGF 2a metabolite were measured. Levels of IL-6 increased significantly throughout pregnancy and remained high postpartum. No change in TNF-a could be seen. The PGF 2a metabolite levels increased significantly throughout pregnancy and decreased postpartum. These results suggest that mild but significant inflammatory activity is involved in the development of normal pregnancy, which might have important physiological roles.
Acta Obstetricia et Gynecologica Scandinavica, 2011
Objective. To describe plasma levels of angiogenic (PlGF, VEGF-A) and antiangiogenic (sFlt1) fact... more Objective. To describe plasma levels of angiogenic (PlGF, VEGF-A) and antiangiogenic (sFlt1) factors as well as the sFlt1:PlGF ratio throughout normal pregnancy and postpartum. Design. Longitudinal prospective study. Setting. One outpatient antenatal clinic in Uppsala, Sweden. Population. Thirty-seven healthy women with normal pregnancies and normal neonatal outcome were included. Methods. Blood samples were collected from each woman at least six times. Plasma levels of sFlt1, PlGF and VEGF-A were measured using commercially available ELISA kits. Main outcome measures. Median plasma levels, the 25th to the 75th percentile and the average change per gestational week of sFlt1, PlGF and the sFlt1:PlGF ratio. Results. sFlt1 levels were relatively constant until weeks 29-30, when they increased, reaching a peak at week 40. An increase of 643pg/ml per week was observed from weeks 30 to 40. Postpartum levels were low. PlGF increased by 16pg/ml per week from early pregnancy until weeks 29-30 and thereafter decreased by 14pg/ml per week until week 40. The sFlt1:PlGF ratio decreased from weeks 9-12, was constantly low from weeks 19-20 to 37-38 and then increased to weeks 39-40. VEGF-A was detectable in only 8% of the samples during pregnancy and in 64% postpartum. Conclusion. This longitudinal study demonstrates how sFlt1, PlGF and the sFlt1:PlGF ratio fluctuate throughout normal pregnancy and postpartum and may serve as a reference against which these factors can be studied in complicated pregnancies. VEGF-A levels were more often detectable postpartum.
International Journal of Cardiology, 2011
Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before ... more Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before seeking medical care. To investigate and compare patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and relatives&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge of AMI, attitudes toward seeking medical care, and intended behaviour if AMI-symptoms occur. The present study was a descriptive, multicentre study. Participants were AMI-patients ≤ 75 years (n = 364) and relatives to AMI-patients (n = 319). Questionnaires were used to explore the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge of AMI and attitudes toward seeking medical care. Both patients and relatives appeared to act more appropriate to someone else&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s chest pain than to their own. Patients did not have better knowledge of AMI-symptoms than relatives. Women would more often contact someone else before seeking medical care. A greater percentage of elderly (65-75 years), compared to younger individuals, reported that they would call for an ambulance if chest pain occurred. There were only minor differences between patients and relatives, regarding both knowledge and attitudes. It seems easier to act correctly as a bystander than as a patient. Therefore, in order to decrease patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; delay time it is important to educate relatives as well as patients on how to respond to symptoms of an AMI.
The Journal of Rheumatology
Variables for assessment of disease activity of juvenile idiopathic arthritis (JIA) were studied,... more Variables for assessment of disease activity of juvenile idiopathic arthritis (JIA) were studied, in order to develop a disease activity score for children with JIA. One randomly chosen hospital visit was studied for each of 312 patients with JIA, with regard to disease activity variables. The physician global assessment score visual analog scale (physician GA) was used as a dependent variable in comparisons between potential disease activity variables. Previous studies have shown this variable to be the most sensitive to changes in JIA disease activity and to be comparable between patients. Based on Spearman's rank order correlation the number of active joints had a strong association with the physician GA. The median physician GA score rose markedly for each active large joint, but less for small joints, although small joints were also statistically important in assessing disease activity. Among the laboratory data, the erythrocyte sedimentation rate, C-reactive protein level,...
Open heart, 2014
Despite increased awareness of the importance of early treatment in acute myocardial infarction (... more Despite increased awareness of the importance of early treatment in acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival is still too long and rehospitalisations are frequent. Little is known about how health-related quality of life (HRQL) affects delay time and the frequency of readmissions. We used quality registers to investigate whether patients' HRQL has any impact on delay time with a new AMI, and on the rate of readmissions during the first year. Patients with AMI <75 years, with HRQL assessed with EQ-5D at 1-year follow-up, and who thereafter had a new AMI registered, were evaluated for the correlation between HRQL and delay time (n=454). The association between HRQL and readmissions was evaluated among those who had an additional AMI and a new 1-year follow-up registration (n=216). Patients who reported poor total health status (EQ-VAS ≤50), compared to those who reported EQ-VAS 81-100, had tripled risk to delay ≥2 h from symptom onset ...
Läkartidningen, Jan 27, 1999
Science of The Total Environment, 2000
Results from the Swedish control programme regarding organochlorines in food were used to determi... more Results from the Swedish control programme regarding organochlorines in food were used to determine time trends of organochlorine concentrations in adipose tissues from swine (4-8 months old) and bovines (non-dairy, 12-36 months) slaughtered between 1991 and 1997. Moreover, possible regional differences in concentrations were studied, as well as differences in concentrations depending on sex and age of the slaughtered animals. Multiple linear regression indicated that the concentrations of PCB, p,p'-DDE, HCB and alpha-HCH decreased by 4-17% per year, suggesting that the decline in organochlorine concentrations in the Swedish environment and biota reported during the 1970s-1990s also has occurred in meat-producing animals during the 1990s. The concentrations of PCB, DDE and HCB in bovines and PCB and DDE in swine were 1.4-3.8-fold higher in the southern parts of Sweden than in the northern parts of the country, indicating a regional difference in exposure of the animals. The organochlorine concentrations were higher in bovines than in swine, and declined faster in swine than in bovines. Moreover, the concentrations of CB 153 and p,p'-DDE were similar in bovines, but in swine the average concentrations of the two compounds differed two-fold. Apart from possible species differences in metabolism of organochlorines, this may be due to differences in the age at slaughter between swine and bovines, and differences in husbandry of the animals. In the latter case, swine are generally kept inside during their whole life span, whereas bovines are kept outside grazing during the summer period. Finally, a sex-dependent difference in concentrations was indicated in swine, but not in bovines. Our study shows that a lot of information can be 'extracted' from control program results.
Scandinavian Journal of Primary Health Care, 1999
The aim of this study was to investigate the use of clinical laboratory tests in primary care and... more The aim of this study was to investigate the use of clinical laboratory tests in primary care and to evaluate if it is possible to improve the cost-effectiveness of laboratory testing by a short-term education programme. Our main goal has been to lower the total costs of care. An education programme that was monitored by laboratory test ratios. Primary health care. 63 primary care doctors at 19 primary care centres in the county of Uppsala, Sweden. The effects of the education programme were monitored by laboratory test ratios (e.g. ASAT/ALAT) of individual doctors before and after the education programme. The education programme resulted in significant changes for the majority of the ratios studied. The savings on direct laboratory costs were approximately SEK 400,000 for assays that were recommended to decrease. The increased cost for assays that were recommended to increase was approximately SEK 140,000 but was considered cost-effective. It is possible to achieve significant changes in clinical chemistry test ordering habits of primary care doctors with a 2 day education programme. It resulted in cost savings and a better use of clinical chemistry tests in primary care. The effects were sustained for at least 6 months.
Scandinavian Journal of Clinical & Laboratory Investigation, 2010
Objective. Laboratory tests are used increasingly in primary health care and they are thus associ... more Objective. Laboratory tests are used increasingly in primary health care and they are thus associated with rapidly growing costs. Variations in clinical practice, an important determinant of expenditure for laboratory tests, could further increase the fi nancial burden. The study's threefold objective was to determine the presence and extent of regional variations in test ordering between eight counties in Sweden, to investigate the infl uence on these variations by factors earlier described in the literature as explanatory, and to calculate the achievable savings that could be realized through optimized test ordering. Design. A retrospective study using test request data. Setting. A total of 223 primary health care centers in eight counties in Sweden. Main outcome measures. Thirteen ratios of commonly used laboratory tests, demographic data and the number of ordered tests per 1000 inhabitants served as the basis of comparison. The total savings per 100,000 inhabitants that could be achieved through optimized test ordering was estimated. Results. Large variations were found between all studied counties for all investigated ratios. However, none of the demographic variables investigated seemed to be able to explain the full extent of the variations. The range of achievable yearly savings per 100,000 inhabitants was €14,000-€185,000. Conclusion. The inter-county variations in Sweden are large and the savings associated with optimized test utilization are substantial. The investigated factors previously described as explaining the variations in test ordering only seem to explain a small part of the variation, and the variations are likely infl uenced by regional habits and traditions. Correspondence: Mirja Mindemark, Akademiska sjukhuset, entrance 61, 3rd fl oor, SE-751 85 Uppsala, Sweden. Tel: ϩ 46 18 611 42 04. Fax: ϩ 46 18 611 37 03. Scand J Clin Lab Invest Downloaded from informahealthcare.com by Uppsala Universitetsbibliotek on 01/04/15 For personal use only.
Oncology Reports, 2010
The value of early tumour marker changes during palliative chemotherapy in patients with upper ga... more The value of early tumour marker changes during palliative chemotherapy in patients with upper gastrointestinal adenocarcinoma (UGIA) is unclear. Seventy-three patients with advanced UGIA were randomised to receive 45 mg/m2 docetaxel or 180 mg/m2 irinotecan with 5-FU/leucovorin. After every 2nd course the patients were crossed over to the other regimen. Serum was sampled before start of chemotherapy and every 2nd week during 8 weeks for CEA, TPA, TPS, CA72-4, CA19-9 and CA242 measurements. Eighteen patients (25%) had partial response (PR) and 21 patients had stable disease for at least 4 months (SD4). All baseline marker levels, except CA72-4, correlated with time to progression and survival. Patients with normal levels, except CA72-4, also had more clinical responses (PR+SD4) than patients with elevated values. Tumour marker changes early during treatment provided modest predictive information for tumour response and survival. A model combining baseline level, the change and the interaction between them gave the best prediction of outcome, however, insignificantly better than baseline level for all markers except CA242. Baseline tumour marker levels provide prognostic information for patients with UGIA on palliative chemotherapy. Early changes generally failed to provide accurate information for tumour response and survival.
Free Radical Research, 2009
This study investigates oxidative stress and antioxidants in normal human pregnancy and post-part... more This study investigates oxidative stress and antioxidants in normal human pregnancy and post-partum period. Thirty-seven healthy women with normal pregnancies were included. Both urinary and serum samples were collected throughout the pregnancy and post-partum period. Oxidative stress was estimated by measuring the reliable in vivo marker, namely 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha,) an F(2)-isoprostane) and antioxidant status was evaluated by measuring alpha- and gamma-tocopherol in serum samples. Pregnancy was associated with successively increased levels of 8-iso-PGF(2alpha) with advancing gestational age. The median post-partum value corresponded to the values observed in early gestation and a significant decrease was observed from late pregnancy to the post-partum period. Lipid-adjusted alpha- and gamma-tocopherol levels decreased with advancing gestational age. This longitudinal study suggests that mild oxidative stress is involved in normal human pregnancy.
European Journal of Clinical Investigation, 2001
Previous studies indicate that the enteral bacterial urease is inhibited in victims of sudden inf... more Previous studies indicate that the enteral bacterial urease is inhibited in victims of sudden infant death syndrome (SIDS). One possible inhibitor of this bacterial activity is nitrate. If ambient pollution by nitrate is involved in the etiology of SIDS only a fraction of the nitrate concentration not infrequently found in drinking water would be enough for this inhibition. Occurrence of SIDS (n = 636) in Sweden during the period 1990 through 1996 were analysed regarding geographical and seasonal distribution in relation to the nitrate concentration in drinking water and changes in the groundwater level. Both the birth rate and the incidence of SIDS decreased during the study period. One quarter of the municipalities constituting 11% of the population had no cases, the maximum incidence being 6.5 per 1000 live births. Seasonality: The northernmost parts of the country had its highest incidence when the rest of the country had its lowest incidence, and the occurrence of individual deaths was associated with the recharge of groundwater which increases its nitrate content. The local incidence of SIDS was correlated (rs = 0.34-0.87) to maximally recorded concentrations of nitrate in drinking water. The seasonal distribution of SIDS was widely different from the south to the north of the country and seems to be associated with differences in the groundwater level changes subsequent to precipitation, frost penetration, and melting of snow. Use of drinking water with high peak concentrations or great variations in nitrate concentration was correlated to the incidence of SIDS.
Acta Oncologica, 2012
Background. To evaluate the predictive and prognostic value of serum and plasma tumor markers, in... more Background. To evaluate the predictive and prognostic value of serum and plasma tumor markers, in comparison with clinical and biomedical parameters for response rate (RR), progression-free survival (PFS) and overall survival (OS) among patients with metastatic colorectal cancer (mCRC) treated with combination chemotherapy. Material and methods. One-hundred and six patients with mCRC from three centers, part of a multicenter study, received irinotecan with the Nordic bolus 5-fl uorouracil (5-FU) and folinic acid schedule (FLIRI) or the de Gramont schedule (Lv5FU2-IRI). Blood samples for CEA, CA19-9, TPA, TIMP-1, SAA, transthyretin and CRP were taken at baseline and after two, four and eight weeks of treatment. Tumor marker levels at baseline and longitudinally were compared with responses evaluated (CT/MRI) after two and four months of treatment. The correlations to RR, PFS and OS were evaluated with regression analyses. Results. A signifi cant correlation to OS was seen for baseline levels of all markers. In multivariate analyses with clinical parameters, TPA, CRP, SAA and TIMP-1 provided independent information. The baseline values of CEA, TPA and TIMP-1 were also signifi cantly correlated to PFS and TPA to RR. Changes during treatment, i.e. the slope gave with the exception of CA19-9 for OS less information about outcomes. The best correlation to response was seen for CEA, CA19-9 and TPA with AUC values of 0.78, 0.83 and 0.79, respectively, using a combined model based upon an interaction between the slope and the baseline value. Conclusions. Baseline tumor markers together with clinical parameters provide prognostic information about survival in patients with mCRC. The ability of the individual tumor markers to predict treatment response and PFS is limited. Changes in marker levels during the fi rst two months of treatment are less informative of outcome.
Acta Obstetricia et Gynecologica Scandinavica, 2013
To study the role of inflammation throughout normal pregnancy and postpartum, 37 women with norma... more To study the role of inflammation throughout normal pregnancy and postpartum, 37 women with normal pregnancies, including normal neonatal outcome, participated. Blood and urine samples were collected from each woman at least six times during pregnancy and postpartum. Plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a) and urinary levels of a prostaglandin-F 2a (PGF 2a ) metabolite were measured. Median, 25th to 75th centile and average change per gestational week of IL-6, TNF-a and the PGF 2a metabolite were measured. Levels of IL-6 increased significantly throughout pregnancy and remained high postpartum. No change in TNF-a could be seen. The PGF 2a metabolite levels increased significantly throughout pregnancy and decreased postpartum. These results suggest that mild but significant inflammatory activity is involved in the development of normal pregnancy, which might have important physiological roles.
Acta Obstetricia et Gynecologica Scandinavica, 2011
Objective. To describe plasma levels of angiogenic (PlGF, VEGF-A) and antiangiogenic (sFlt1) fact... more Objective. To describe plasma levels of angiogenic (PlGF, VEGF-A) and antiangiogenic (sFlt1) factors as well as the sFlt1:PlGF ratio throughout normal pregnancy and postpartum. Design. Longitudinal prospective study. Setting. One outpatient antenatal clinic in Uppsala, Sweden. Population. Thirty-seven healthy women with normal pregnancies and normal neonatal outcome were included. Methods. Blood samples were collected from each woman at least six times. Plasma levels of sFlt1, PlGF and VEGF-A were measured using commercially available ELISA kits. Main outcome measures. Median plasma levels, the 25th to the 75th percentile and the average change per gestational week of sFlt1, PlGF and the sFlt1:PlGF ratio. Results. sFlt1 levels were relatively constant until weeks 29-30, when they increased, reaching a peak at week 40. An increase of 643pg/ml per week was observed from weeks 30 to 40. Postpartum levels were low. PlGF increased by 16pg/ml per week from early pregnancy until weeks 29-30 and thereafter decreased by 14pg/ml per week until week 40. The sFlt1:PlGF ratio decreased from weeks 9-12, was constantly low from weeks 19-20 to 37-38 and then increased to weeks 39-40. VEGF-A was detectable in only 8% of the samples during pregnancy and in 64% postpartum. Conclusion. This longitudinal study demonstrates how sFlt1, PlGF and the sFlt1:PlGF ratio fluctuate throughout normal pregnancy and postpartum and may serve as a reference against which these factors can be studied in complicated pregnancies. VEGF-A levels were more often detectable postpartum.
International Journal of Cardiology, 2011
Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before ... more Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before seeking medical care. To investigate and compare patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and relatives&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge of AMI, attitudes toward seeking medical care, and intended behaviour if AMI-symptoms occur. The present study was a descriptive, multicentre study. Participants were AMI-patients ≤ 75 years (n = 364) and relatives to AMI-patients (n = 319). Questionnaires were used to explore the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; knowledge of AMI and attitudes toward seeking medical care. Both patients and relatives appeared to act more appropriate to someone else&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s chest pain than to their own. Patients did not have better knowledge of AMI-symptoms than relatives. Women would more often contact someone else before seeking medical care. A greater percentage of elderly (65-75 years), compared to younger individuals, reported that they would call for an ambulance if chest pain occurred. There were only minor differences between patients and relatives, regarding both knowledge and attitudes. It seems easier to act correctly as a bystander than as a patient. Therefore, in order to decrease patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; delay time it is important to educate relatives as well as patients on how to respond to symptoms of an AMI.