Publications by authors named "Anna Forsberg"

111 Publications

Building a bridge between patients and transplant healthcare professionals - a descriptive study.

Transpl Int 2021 Sep 15. Epub 2021 Sep 15.

Donation and Transplant Coordination Unit, Associate Professor Surgical Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.

This article describes a pathway for collaboration between transplant healthcare professionals and organ recipients. Under the umbrella of the European Society for Organ Transplantation (ESOT) a joint initiative started from three Sections and Committees of ESOT: EDTCO (European Donation and Transplant Coordination Organisation), ETHAP (European Transplant Allied Healthcare Professionals) and ELPAT (Ethical, Legal and Psycho-social Aspects of Transplantation). The formal 'kick-off' of the Advisory Board Meeting of the European Transplant Patient Organisation (ETPO) was during the ESOT congress in 2019. The aim was to produce a series of statements to serve as a path to dialogue between patients and transplant professionals and to define the next steps towards giving a voice to the patient network. To include the patients' perspectives, two surveys have been performed. The results identified the unmet needs and lead to a proposal for future plans. Educational activities have since started leading to a patient learning workstream. All initiatives taken have one purpose: to include patients, give them a voice and build a foundation for collaboration between patients and transplant professionals. ESOT has created a platform for mutual understanding, learning and a collaborative partnership between ETPO and European donation and transplant professionals.
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http://dx.doi.org/10.1111/tri.14111DOI Listing
September 2021

Social Belonging as the Main Concern for Achieving Life Satisfaction When Adapting to Parkinson's Disease.

Int J Environ Res Public Health 2021 08 16;18(16). Epub 2021 Aug 16.

Department of Health Sciences, Lund University, S-221 00 Lund, Sweden.

Parkinson's disease (PD) is a complex, progressive neurological condition that impacts daily life and reduces life satisfaction (LS). To achieve and maintain high LS, persons with PD (PwPD) must go through a process of change to adapt to their new life situation. However, our knowledge about this process is very limited. The aim of this study was to investigate the process of change, and the main concern in this process, in PwPD. To study the transitional experience of PwPD, an inductive qualitative approach, using Grounded Theory (GT), was employed. Thirteen participants (9 women, 3 men and 1 non-binary), with a mean age of 54 years (range from 47-62 years), participated in in-depth interviews. Data showed that social belonging is the main concern in the process of change for PwPD. In this process of change, they use strategies to comprehend, accept, adapt, and balance in their strive for social belonging, which in turn can enhance LS. Health care professionals can use this model with an interdisciplinary approach to support PwPD through a successful process of change to achieve social belonging, and thereby achieving and maintaining LS.
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http://dx.doi.org/10.3390/ijerph18168653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391246PMC
August 2021

Inequalities and short-term outcome among patients assessed as non-urgent in a Swedish ambulance service setting.

Int Emerg Nurs 2021 07 17;57:101018. Epub 2021 Jun 17.

Department of Health Sciences, Lund University, Lund, Sweden; Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden. Electronic address:

Background: Within the ambulance service, assessment and referral of patients, especially those with non-urgent conditions, is a difficult and complicated task. Studies indicate that 12 to 20 percent of all patients are subjected to non-conveyance and discharged at the scene. There is lack of knowledge of what characterizes conveyed and non-conveyed patients. The aim of this study was to explore non-urgent patients who are conveyed or not conveyed to hospital and the short-term outcome of non-conveyance in a Swedish Ambulance Service setting.

Methods: This study has a descriptive, cross-sectional design. All patients who were prioritized as non-urgent were eligible for the study and 1,048 patients were followed-up in an administrative data system that stores information about the patients' trajectory in both primary and hospital care.

Results: More women than men were subjected to non-conveyance and most of the non-conveyed patients were left at home out-of-hours. 53% sought care again within 72 h. A large proportion of the non-conveyed patients were assessed as having unspecific symptoms.

Conclusions: There are prominent gender differences in the context of non-conveyance where unspecific symptoms seem to be the main reason for being left at home. As many of the non-conveyed patients who did not receive any advice about further investigation or intervention sought care again within 72 h, the assessments may be insufficient or inaccurate.
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http://dx.doi.org/10.1016/j.ienj.2021.101018DOI Listing
July 2021

Role of smoking in functional dyspepsia and irritable bowel syndrome: three random population-based studies.

Aliment Pharmacol Ther 2021 07 13;54(1):32-42. Epub 2021 May 13.

Department of Psychology, Macquarie University, North Ryde, NSW, Australia.

Background: It is uncertain if functional dyspepsia (FD) or irritable bowel syndrome (IBS) are linked to smoking, and smoking cessation is not part of the routine advice provided to these patients.

Aim: To assess if smoking is an independent risk factor for FD and IBS.

Methods: Three population-based endoscopy studies in Sweden with 2560 community individuals in total (mean age 51.5 years, 46% male). IBS (14.9%), FD (33.5%), and associated symptoms were assessed using the validated abdominal symptom questionnaire, and smoking (17.9%) was obtained from standardised questions during a clinic visit. The effect of smoking on symptom status was analysed in an individual person data meta-analysis using mixed effect logistic regression, adjusted for snuffing, age and sex.

Results: Individuals smoking cigarettes reported significantly higher odds of postprandial distress syndrome (FD-PDS) (OR 10-19 cig/day = 1.42, 95% CI 1.04-1.98 P = 0.027, OR ≥20 cig/day = 2.16, 95% CI 1.38-3.38, P = 0.001) but not epigastric pain. Individuals smoking 20 or more cigarettes per day reported significantly higher odds of IBS-diarrhoea (OR = 2.40, 95% CI 1.12-5.16, P = 0.025), diarrhoea (OR = 2.01, 95%CI 1.28-3.16, P = 0.003), urgency (OR = 2.21, 95%CI 1.41-3.47, P = 0.001) and flatus (OR = 1.77, 95%CI 1.14-2.76, P = 0.012) than non-smokers. Smoking was not associated with IBS-constipation or IBS-mixed.

Conclusion: Smoking is an important environmental risk factor for postprandial distress syndrome, the most common FD subgroup, with over a twofold increased odds of PDS in heavy smokers. The role of smoking in IBS-diarrhoea, but not constipation, is also likely important.
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http://dx.doi.org/10.1111/apt.16372DOI Listing
July 2021

Life Satisfaction and Adaptation in Persons with Parkinson's Disease-A Qualitative Study.

Int J Environ Res Public Health 2021 03 23;18(6). Epub 2021 Mar 23.

Department of Health Sciences, Lund University, S-221 00 Lund, Sweden.

Persons with Parkinson's disease (PD) need to adapt to their progressive disability to achieve and maintain a high degree of life satisfaction (LS), but little is known about the meaning of LS and adaptation. This study aimed to gain an in-depth understanding of the meaning of LS and adaptation in persons with PD. Open-ended in-depth interviews were performed with 13 persons diagnosed with PD, 9 women, 3 men, and one non-binary person (mean age 54 years, mean time since diagnosis 3.4 years). The interviews were analyzed using a phenomenological-hermeneutic approach. The participants were in the process of adapting to their new health situation. There were two quite distinct groups: one that adapted through acceptance and one that struggled to resist the disease and the profound impact it had on their lives. The thematic structural analysis covers eight themes illustrating the meaning of LS and adaptation, through either acceptance or resistance. Adaptation to PD involves a transitional process characterized by either acceptance or resistance, which influences a person's LS. Acceptance makes LS possible, whereas resistance constitutes a behavioral barrier to adaptation and LS. Rehabilitation professionals need to understand this individual process to be able to support a person with PD to reach and maintain a high level of LS. Understanding the link between LS and adaptation can support rehabilitation professionals to provide targeted interventions for people with PD.
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http://dx.doi.org/10.3390/ijerph18063308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004639PMC
March 2021

Fear of graft rejection after heart transplantation - a nationwide cross-sectional cohort study.

Eur J Cardiovasc Nurs 2021 01;20(1):71-79

The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background: Cellular rejection is most common 3-6 months after heart transplantation while chronic rejection, that is, cardiac allograft vasculopathy and malignancy are the most common causes of death in heart-transplant recipients beyond the third year after transplantation. However, the heart transplantation recipient's perceived threat of graft rejection has never been explored.

Aim: The aim was to explore perceived threat of the risk of graft rejection and its relationship to psychological wellbeing, fatigue, health literacy, adherence and self-efficacy 1-5 years after heart transplantation.

Methods: In a nationwide, cross-sectional study that constituted part of the Self-management after thoracic transplantation project, 79 heart recipients (68% men and 32% women with a mean age of 52.6 years) were investigated after one year (n=28), two years (n=17), three years (n=11), four years (n=17) and five years (n=6). The instruments used were: the Perceived Threat of the Risk of Graft Rejection, the Psychological General Well-being, Self-efficacy for Managing Chronic Disease, the Multidimensional Fatigue Inventory, the Newest Vital Sign and the Basel Assessment of Adherence to Immunosuppressive Medication Scale.

Results: Twenty-eight per cent of the heart transplantation recipients perceived graft rejection as a serious threat. Intrusive anxiety was low and 37% perceived the threat of the risk of graft rejection as being beyond their control. Heart transplant recipients with high level of fatigue and low psychological well-being reported stronger intrusive anxiety and less control.

Conclusion: A perceived threat of the risk of graft rejection is present in the everyday lives of heart transplantation recipients and is strongly related to overall psychological well-being.
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http://dx.doi.org/10.1177/1474515120937838DOI Listing
January 2021

Self-efficacy, recovery and psychological wellbeing one to five years after heart transplantation: a Swedish cross-sectional study.

Eur J Cardiovasc Nurs 2021 01;20(1):34-39

Institute of Health Sciences, Lund University, Sweden.

Background: Self-efficacy refers to a person´s confidence in carrying out treatment-related activities and constitutes the foundation of self-management as well as long-term follow-up after heart transplantation. Exploring the heart recipients´ experiences by means of self-report instruments provides healthcare professionals with valuable information on how to supply self-management support after heart transplantation.

Aims: The aim was to explore self-efficacy in relation to the self-reported level of recovery and psychological wellbeing, among adult heart recipients, one to 5 years after transplantation.

Methods: This cross-sectional study includes 79 heart recipients, due for follow-up one to 5 years after transplantation. Three different self-assessment instruments were employed: the self-efficacy for managing chronic disease 6-item scale; the postoperative recovery profile; and the psychological general wellbeing instrument.

Results: The reported level of self-efficacy was high (median 8.3, maximum score 10). Significantly higher self-efficacy was seen among those who had returned to work (P = 0.003) and those without pre-transplant mechanical circulatory support (P = 0.033). In total, 65.5% (n = 52) reported being reasonably recovered, while 18.8% (n = 12) were not recovered. The median total psychological general wellbeing score was 108 (P25 = 24, P75 = 117), suggesting overall good psychological wellbeing in the whole group of heart recipients.

Conclusion: The heart transplant recipients in our study had an overall high level of self-efficacy. Low self-efficacy was found among those with a low self-reported level of recovery, pre-transplant treatment with mechanical circulatory support or who had not returned to work. This is important information for transplant professionals when helping heart recipients to balance their expectations about recovery.
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http://dx.doi.org/10.1177/1474515120927121DOI Listing
January 2021

The Meaning of Boarding in a Swedish Accident & Emergency Department: A Qualitative Study on Patients' Experiences of Awaiting Admission.

Healthcare (Basel) 2021 Jan 12;9(1). Epub 2021 Jan 12.

Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden.

The number of in-hospital beds in Sweden has decreased during recent decades, resulting in the smallest number (2.2 available beds/1000 inhabitants) within the European Union. At the same time, the number of patients attending Accident and Emergency (A&E) departments has increased, resulting in overcrowding and boarding. The aim of this study was to explore the meaning of being subjected to boarding at an A&E department, as experienced by patients. A phenomenological-hermeneutic approach was chosen to interpret and understand the meaning of boarding at A&E. The study was carried out at a hospital in the south of Sweden. Seventeen participants with a mean age of 64 years (range: 35-86 years) were interviewed. The thematic structural analysis covers seven themes: Being in a state of uncertainty, Feeling abandoned, Fearing death, Enduring, Adjusting to the circumstances, Being a visitor in an unsafe place, and Acknowledging the staff, all illustrating that the participants were in a state of constant uncertainty and felt abandoned with no guidance or support from the clinicians. The conclusion is that the situation where patients are forced to wait in A&E, i.e., boarding, violates all conditions for professional ethics, presumably causing profound ethical stress in the healthcare professionals involved. Thus, boarding should be avoided.
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http://dx.doi.org/10.3390/healthcare9010066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828189PMC
January 2021

Fatigue after heart transplantation - a possible barrier to self-efficacy.

Scand J Caring Sci 2020 Dec 28. Epub 2020 Dec 28.

Department of Health Sciences at Lund University, Lund, Sweden.

Rationale: Recovery after heart transplantation is challenging and many heart recipients struggle with various transplant-related symptoms, side-effects of immunosuppressive medications and mental challenges. Fatigue has been reported to be one of the most common and distressing symptoms after heart transplantation and might therefore constitute a barrier to self-efficacy, which acts as a moderator of self-management.

Aim: To explore the prevalence of fatigue and its relationship to self-efficacy among heart recipients 1-5 years after transplantation.

Research Method: An explorative cross-sectional design, including 79 heart recipients due for follow-up 1-5 years after transplantation. Three different self-assessment instruments were employed; The Multidimensional Fatigue Inventory-19, Self-efficacy for managing chronic disease 6-Item Scale and The Postoperative Recovery Profile.

Ethical Approval: The study was approved by the Regional Ethics Board of Lund (Dnr. 2014/670-14/10) with supplementary approval from the Swedish Ethical Review Authority (Dnr. 2019-02769).

Results: The reported levels of fatigue for the whole group were moderate in all dimensions of the Multidimensional Fatigue Inventory-19, with highest ratings in the General Fatigue sub-scale. Those most fatigued were the groups younger than 50 years; pretransplant treatment with Mechanical Circulatory Support; not recovered or had not returned to work. Self-efficacy was associated with the sub-dimensions Mental Fatigue (ρ = -0·.649) and Reduced Motivation (ρ = -0·617), which explained 40·1% of the variance when controlled for age and gender.

Study Limitations: The small sample size constitutes a limitation.

Conclusions: The moderate levels of fatigue reported indicate that it is not a widespread problem. However, for those suffering from severe fatigue it is a troublesome symptom that affects the recovery process and their ability to return to work. Efforts should be made to identify those troubled by fatigue to enable sufficient self-management support.
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http://dx.doi.org/10.1111/scs.12951DOI Listing
December 2020

Recovery and Quality of Life After Trauma: A 6-Month Follow-Up Study.

J Trauma Nurs 2020 Nov/Dec;27(6):327-334

Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (Ms Nasirian and Dr Engström); Institute of Health and Care Sciences (Dr Engström) and Department of Institute of Neuroscience and Physiology (Dr Fagevik Olsén), Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; and Department of Health Sciences, Lund University, Lund, Sweden (Dr Forsberg).

Background: Injuries were the most common cause of hospitalization in Sweden in 2017. There is a lack of knowledge about trauma recovery and its relation to health-related quality of life (HRQoL) after hospitalization due to minor trauma. This study aimed to prospectively evaluate recovery and HRQoL at discharge from hospital and 3 and 6 months after the trauma.

Methods: This is a secondary analysis of data from a prospective follow-up study. Fifty-seven patients who sustained physical trauma were included. Recovery was measured with postoperative recovery profile and HRQoL 3 and 6 months after discharge. The association between the outcomes was analyzed, as well as the impact of gender, age, Injury Severity Score (ISS), and trauma mechanism using nonparametric statistics.

Results: There was a significant improvement in recovery and HRQoL between discharge and 3 months after the trauma (p < .001) as well as between 3 and 6 months after the trauma (p < .001) except for EQ-5D VAS scale (p = .222). However, only 14 (25%) patients viewed themselves as fully recovered 6 months after the incident. Correlation between recovery and HRQoL increased after discharge and was at its strongest 6 months after the trauma (rs > .071).

Conclusion: Trauma mechanism has an impact on recovery but not gender, age, or ISS score. Most patients did not consider themselves fully recovered even at 6 months postinjury, indicating that they require additional support to manage their recovery.
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http://dx.doi.org/10.1097/JTN.0000000000000539DOI Listing
September 2021

Symptom Occurrence and Distress after Heart Transplantation-A Nationwide Cross-Sectional Cohort Study.

Int J Environ Res Public Health 2020 11 1;17(21). Epub 2020 Nov 1.

Department of Cardiothoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden.

Experiencing symptoms after heart transplantation may hamper the heart recipient's self-management which can lead to negative effects. We know little about symptom occurrence and distress after heart transplantation, especially in relation to sociodemographic variables. The aim of the study was to explore self-reported symptom occurrence and distress after heart transplantation and their relationship with self-reported psychological well-being and sociodemographic factors. This multicenter, cross-sectional, cohort study is associated with the Swedish national Self-Management After Thoracic Transplantation study (SMATT). Two questionnaires were distributed at the heart recipients' yearly follow-up, one to five years post-transplant at three Swedish university hospitals from 2014-2017. In a total 79 heart recipients, 54 men and 25 women, with a mean age 53 years returned the questionnaires. Symptoms occurred differently depending on type and duration of follow-up. The most common symptoms, trembling hands, and decreased libido were also the most distressing. Heart recipients most burdened by symptoms were those younger than 50 years, not working, with poor psychological well-being or living alone. Fatigue explained more than 60% of the variation in transplant specific well-being. In conclusion this study points at the target groups within the heart transplant population that needs person centered symptom management support where the focus should be on side-effects of the medication i.e., trembling hands as well as the patients' sexual health.
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http://dx.doi.org/10.3390/ijerph17218052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663327PMC
November 2020

An Increasing Incidence of Upper Gastrointestinal Disorders Over 23 Years: A Prospective Population-Based Study in Sweden.

Am J Gastroenterol 2021 01;116(1):210-213

Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.

Introduction: We hypothesized that the prevalence of functional dyspepsia and gastroesophageal reflux disease in the community may be increasing.

Methods: Randomly selected adults were surveyed on 4 occasions: 1988 (n = 1,151, 21-79 years, response rate [rr] = 90%), 1989 (n = 1,097, 22-80 years, rr = 87%), 1995 (n = 1,139, 20-85 years, rr = 76%), and 2011 (n = 1,175, 20-93 years, rr = 63%).

Results: In functional dyspepsia, the odds of postprandial distress syndrome tripled over 23 years' follow-up (odds ratio [OR]: 3.55; 95% confidence interval [CI]: 2.60-4.84, mixed-effect regression analysis), whereas a small decrease in epigastric pain syndrome was observed (OR: 0.65, 95% CI: 0.42-1.00). The odds of reporting gastroesophageal reflux disease doubled (OR: 2.02; 95% CI: 1.50-2.73).

Discussion: The underlying mechanisms behind the increase in postprandial distress syndrome and gastroesophageal reflux disease remain to be determined.
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http://dx.doi.org/10.14309/ajg.0000000000000972DOI Listing
January 2021

Sociodemographic changes in the population frequency of colonoscopy following the implementation of organised bowel cancer screening: An analysis of data from Swedish registers, 2006-2015.

J Med Screen 2021 09 22;28(3):244-251. Epub 2020 Sep 22.

Department of Medicine, Karolinska Institutet, Solna, Sweden.

Objective: To assess sociodemographic changes in the population frequency of colonoscopy (PFC; number of colonoscopies per 1000 inhabitants per year) among people aged 50-74 in relation to the implementation of a regional colorectal cancer screening programme for people aged 60-69 in the Stockholm-Gotland region (RSG) in 2008.

Method: The PFC was estimated by year (2006-2015), pre- and post-implementation of colorectal cancer screening programme (2006-2007 vs. 2014-2015), age, sex, residential region, immigrant status and educational level. The data were obtained from Swedish patient and population registers.

Results: The PFC largely increased during 2006-2015 in all six Swedish regions. The estimated increase in the pre- vs. post period PFC (ΔPFC) within the RSG was (i) greater for men than for women (5.8 vs. 4.5) and (ii) smaller for people aged 70-74 than for those aged 60-69 (5.5 vs. 9.0), while the corresponding ΔPFCs within each of the other regions were (i) not greater, or even smaller, for men and (ii) not smaller, or even larger, for elderly people aged 70-74.

Conclusion: A regional implementation of an organised colorectal cancer screening programme did not lead to a higher PFC increase in the screening relevant age group 50-74 years. Nevertheless, changes in the PFC were more pronounced for men and less pronounced for people aged 70-74 than those invited to participate in the screening programme (60-69 years), as compared with the rest of Sweden (without organised colorectal cancer screening).
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http://dx.doi.org/10.1177/0969141320957708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8366167PMC
September 2021

Gender, having a positive FIT and type of hospital are important factors for colonoscopy experience in colorectal cancer screening - findings from the SCREESCO study.

Scand J Gastroenterol 2020 Nov 18;55(11):1354-1362. Epub 2020 Sep 18.

Department of Medicine Solna, Karolinska Institutet, Sweden.

Objectives: Assessing the experience of screening procedures is crucial for improving the quality and acceptance of colonoscopy in colorectal cancer screening. The aim of the study was to investigate the colonoscopy experience and associated factors among individuals who underwent a colonoscopy in the Screening of Swedish Colons (SCREESCO) study.

Methods: Participants in the Screening of Swedish Colons (SCREESCO;  = 7593) randomized clinical trial (colonoscopy vs. faecal immunochemical test (FIT)) were enrolled. The primary outcome was overall colonoscopy experience measured with a study-specific questionnaire. Secondary endpoints were measured using multiple regression analyses with factors that included sex, randomization group, geographical regions, university hospital, complications, sedation, clean bowel, time to cecum, and presence of polyps or cancer.

Results: A total of 6572 (87%) individuals responded to the questionnaire. The majority was satisfied with the information, care and treatment. Women reported more worry, discomfort and pain, but also better information, care and treatment compared with men. The FIT group was more worried and perceived more discomfort and pain than the colonoscopy group. Type of hospital (geographical region; university hospital vs. not university hospital) was also a significant predictor for the colonoscopy experience.

Conclusions: Although most participants were satisfied with the colonoscopy experience, the study has highlighted areas for improvement. Important factors for colonoscopy experience were gender, randomization group, and type of hospital and therefore crucial to bear in mind when designing screening programs.
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http://dx.doi.org/10.1080/00365521.2020.1820568DOI Listing
November 2020

Parents' Reported Experiences When Having a Child with Cataract-Important Aspects of Self-Management Obtained from the Paediatric Cataract Register (PECARE).

Int J Environ Res Public Health 2020 08 31;17(17). Epub 2020 Aug 31.

Research Group: Care in High Tech Environments, Institute of Health Sciences, Lund University, 22100 Lund, Sweden.

Parents are a crucial part in the care of children with pediatric cataract. The aim of this study was to explore and explain sense of coherence, family self-efficacy, perceived social support, fatigue and parent reported experiences (PREM), in order to improve clinical care. Questionnaires were sent to the parents of children registered in the Swedish national Paediatric Cataract Register, PECARE, from 2006-2019 ( = 506). The response rate was 46% ( = 231), 185 mothers and 44 fathers with a mean age of 40.39 years (SD ± 6.41 years). In total, 38% of the parents reported severe fatigue, and mothers were more burdened than fathers. Sense of coherence was strongly related to fatigue, especially among parents of children with bilateral cataract. Mental fatigue and reduced motivation explained 45% of the variation in sense of coherence. Being taken seriously by the ophthalmological clinic explained over 60% of the variation in satisfaction with care when controlled for parents' age and gender. In conclusion, fatigue is important to take in consideration when interacting with parents of children with cataract, especially those with bilateral cataract. Being taken seriously is the key marker of satisfaction with care and support from professionals. In addition to fatigue, the parents' age and life situation affect how they perceive their own, as well as the professionals' effort, and should be considered when tailoring family-centered care.
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http://dx.doi.org/10.3390/ijerph17176329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503903PMC
August 2020

The Career Core of Successful Scientific Leaders in Nursing - Their Motivators and Strategies.

J Healthc Leadersh 2020 6;12:49-57. Epub 2020 Jul 6.

Department of Health Sciences, Lund University, Lund 221 00, Sweden.

Background: No studies explore the career core of successful scientific leaders in nursing, a context where role models and career support would be desirable. To achieve a successful academic career, there is a need for an in-depth understanding of how successful scientific leaders in healthcare think in order to guide junior researchers through their early careers.

Aim: To explore the main concern of successful scientific leaders in nursing and their mind-set, motivators and strategies for dealing with it.

Methods: A strategic group of 24 scientific leaders in nursing (professors and associate professors) in the United States (US) (n=12) and Sweden (n=12) was interviewed. The transcribed text was analysed using grounded theory.

Results: The core category, fulfilment, summarizes a process where the generated grounded theory is presented through four main categories: create, struggle, interact and maintain, illustrating how the informants dealt with fulfilment, which was their main concern. The theoretical link between the strategies is professional dedication through reflection, characterized by a will to go beyond themselves to be clinically useful and implement their research.

Conclusion: Successful scientific leaders in nursing construct a foundation for professional fulfilment by doing good for patients and improving the healthcare system maintaining being creative and interacting with others, all of which involve a great deal of struggle.
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http://dx.doi.org/10.2147/JHL.S255093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7351630PMC
July 2020

The Meaning of Surviving Three Years after a Heart Transplant-A Transition from Uncertainty to Acceptance through Adaptation.

Int J Environ Res Public Health 2020 07 28;17(15). Epub 2020 Jul 28.

Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden.

The rationale was to longitudinally follow-up interviews performed with heart recipients at their one-year examination in order to deepen the understanding of the meaning of surviving a heart transplant. The aim was to explore the meaning of surviving three years after a heart transplant compared to one year and to identify what constitutes the change process. A phenomenological-hermeneutic method was used. This multicenter study was carried out at the two hospitals in Sweden where heart transplants are performed. A total of 13 heart recipients who survived three years after a heart transplant were invited to participate in this three-year follow-up study and 12 accepted, 3 women and 9 men, with a mean age of 51.25 years. The understanding revealed that the heart recipients strongly accepted their life situation and that time had enabled this acceptance of limitations through adaptation. The thematic structural analyses cover six themes illustrating the meaning of acceptance and adaptation, i.e., accepting life as it is, adapting to post-transplant limitations, adapting to a changed body, social adaptation, showing gratitude and trusting oneself and others. In conclusion, achieving acceptance and a solid sense of self-efficacy after heart transplantation is a time-consuming process that involves courage to face and accept the reality and adapt in every life dimension.
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http://dx.doi.org/10.3390/ijerph17155434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432631PMC
July 2020

Dealing with uncertainty after transplantation in times of COVID-19.

Transpl Int 2020 10 17;33(10):1337-1338. Epub 2020 Aug 17.

Institute of Health Sciences at Lund University, Lund, Sweden.

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http://dx.doi.org/10.1111/tri.13709DOI Listing
October 2020

Specialist Ambulance Nurses' Perceptions of Nursing: A Phenomenographic Study.

Int J Environ Res Public Health 2020 07 13;17(14). Epub 2020 Jul 13.

Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden.

Although nursing is the main area of interest in the curriculum of the specialist ambulance nursing program in the advanced level of education, there has been reported a lack of knowledge about nursing in within the ambulance service. The aim was to explore specialist ambulance nurses' perceptions of nursing, which were explored by employing a phenomenographic approach. The study comprises individual interviews with 19 strategically selected specialist ambulance nurses. The results showed seven descriptive categories emerged detailing the variations in how the specialist ambulance nurses perceive, understand, and conceptualize the phenomenon of nursing in the Swedish Ambulance Service. Four categories revealed the specialist ambulance nurses' qualitatively different perceptions of nursing, i.e., their role and responsibility, while three showed perceived barriers to assuming their role and responsibility, comprising culture and leadership, conditions, and framework. The seven categories are outlined in the outcome space. In conclusion, there is a very wide variety of perceptions of ambulance nursing within the Swedish Ambulance Service. There is a need for implement the nursing process both in the Specialist Nursing Pre-hospital Emergency Care education curriculum and within clinical practice. Further, there is a necessity to develop and implement nursing guidelines in the ambulance.
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http://dx.doi.org/10.3390/ijerph17145018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400022PMC
July 2020

Chronic pain 1-5 years after heart transplantation-A nationwide cross-sectional cohort study.

Nurs Open 2020 07 27;7(4):1146-1156. Epub 2020 Apr 27.

Institute of Health Sciences Lund University Lund Sweden.

Aim: To provide a multidimensional assessment of self-reported chronic pain 1-5 years after heart transplantation and its relationship with self-reported well-being, fatigue, recovery, self-efficacy and socio-economic factors and to explore differences between heart recipients and a cohort of lung recipients.

Design: This multicentre, cross-sectional, cohort study is a part of the Swedish national Self-management after thoracic transplantation study.

Methods: Six questionnaires were distributed at the heart recipients yearly follow-up (1-5 years) at three Swedish university hospitals 2014-2017.

Results: The study group comprised of 79 heart recipients, 25 women and 54 men with a mean age of 52.68 years. Chronic pain among heart recipients was common and those not in paid employment as well as those with low psychological well-being and high general fatigue reported significantly more pain. Female heart recipients were more affected by pain. General health and vitality, general fatigue, physical fatigue and reduced activity were related to the pain intensity score.

Relevance To Clinical Practice: As it is the duty of the healthcare system to provide adequate pain treatment, screening for pain should be a mandatory part of long-term follow-up.
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http://dx.doi.org/10.1002/nop2.489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308699PMC
July 2020

Implementing a Feasible Exercise Programme in an Allogeneic Haematopoietic Stem Cell Transplantation Setting-Impact on Physical Activity and Fatigue.

Int J Environ Res Public Health 2020 06 16;17(12). Epub 2020 Jun 16.

Institute of Health Sciences, Lund University, SE-221 00 Lund, Sweden.

Physical exercise for patients treated with allogeneic haematopoietic stem cell transplantation (allo-HSCT) has shown positive effects on the quality of life and fatigue in experimental trials. However, there is a need for longitudinal evaluation of exercise programmes implemented in a real-world clinical setting. The aim of this prospective study was to evaluate the impact of an exercise programme introduced before allo-HSCT on physical activity and fatigue before, during and after in-patient care. A structured exercise programme, including strength and endurance exercises, was implemented at a Swedish university hospital four weeks before transplantation, continuing during in-patient care and after discharge. Between March 2016 and May 2018, 67 adult patients, 33 women and 34 men with a mean age of 55.5 years participated. Fatigue was measured by the Multidimensional Fatigue Inventory at four time points. The patients documented their exercises on a checklist each week during the entire study period. The fatigue trajectory differed between various sub-groups, thus individualized supervision and support to maintain motivation is needed. In conclusion, a structured yet realistic exercise programme before admission is beneficial for allo-HSCT patients in order to reduce fatigue and prepare them for transplantation both physically and mentally.
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http://dx.doi.org/10.3390/ijerph17124302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345502PMC
June 2020

Postcolonoscopy Colorectal Cancer in Sweden From 2003 to 2012: Survival, Tumor Characteristics, and Risk Factors.

Clin Gastroenterol Hepatol 2020 11 15;18(12):2724-2733.e3. Epub 2020 Jun 15.

Department of Medicine, Karolinska Institutet, Solna (MedS), Stockholm, Sweden.

Background & Aims: The rate of postcolonoscopy colorectal cancer (PCCRC) is a measure of colonoscopy quality, but there are conflicting results from studies of survival times of patients with PCCRC. We assessed survival times of patients with PCCRC and characterized the microscopic and macroscopic features of postcolonoscopy colorectal tumors.

Methods: We performed a population-based cohort study using data from a database in Sweden, on 458,937 colonoscopies (54.0% women) performed from 2003 through 2012. Rates of colorectal cancer within 3 years of a colonoscopy were calculated based on the World Endoscopy Organization guidelines. Risk factors were evaluated using Poisson regression analysis. We used Cox regression models and Kaplan-Meier analyses, stratified by sex, to assess conditional survival. Logistic regression models were used to evaluate features of postcolonoscopy colorectal tumors, including stage location (right, left, or rectum) differentiation grade (high or low), synchronous tumors, perineural growth, resection margins, and mucinous and vessel characteristics.

Results: Within 36 months after a colonoscopy, there were 19,184 individuals who had received a diagnosis of CRC; 1384 of these were PCCRCs (7.2%). The proportion of individuals with PCCRC decreased from 9.4% in 2003 to 6.1% in 2012. The largest risk factors for PCCRC were a prior diagnosis of CRC (relative risk [RR], 3.31; 95% CI, 2.71-4.04), ulcerative colitis (RR, 5.44; 95% CI, 4.75-6.23), Crohn's disease (RR, 3.81; 95% CI, 2.98-4.87), and prior polypectomy (RR, 2.32; 95% CI, 1.97-2.72). Individuals with PCCRCs had shorter survival times than individuals with CRCs detected during the index colonoscopy. Multivariate hazard ratios for PCCRC were 2.75 for men (95% CI, 2.21-3.42) and 2.00 for women (95% CI, 1.59-2.52), respectively. Individuals with left-side PCCRC had shorter survival times than patients with CRC detected during the index colonoscopy. Postcolonoscopy colorectal tumors had increased odds of low differentiation grade (odds ratio, 1.27; 95% CI, 1.09-1.49) compared with colorectal tumors detected during the index colonoscopy.

Conclusions: In an analysis of colonoscopies in Sweden, the rate of PCCRCs decreased from 9.4% in 2003 to 6.1% in 2012. Diseases that require surveillance (such as prior colorectal neoplasms and inflammatory bowel diseases) are the largest risk factors for PCCRC. Patients with PCCRC have shorter survival times than patients with CRC detected during their initial colonoscopy-especially women and patients with left-side tumors.
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http://dx.doi.org/10.1016/j.cgh.2020.06.010DOI Listing
November 2020

Health Literacy among patients with end-stage kidney disease and kidney transplant recipients.

Scand J Caring Sci 2021 Jun 28;35(2):485-491. Epub 2020 Apr 28.

Institute of Health Sciences at Lund University, Lund, Sweden.

Main Problem: Self-management is essential for patients both before and after kidney transplantation and requires an adequate level of health literacy (HL), that is the ability to comprehend and process health information. Low HL is associated with poor clinical outcome and an increased risk of death. In Europe, HL has been scarcely studied. The aim of this study was to investigate the levels of HL in a Swedish cohort of kidney transplant (KTx) candidates and KTx recipients.

Methods: A single centre cross-sectional cohort study. Participants; n = 50 KTx candidates and n = 49 KTx recipients. HL was measured with the Newest Vital Sign instrument (NVS). Statistical analysis was made using the chi-square, Mann-Whitney U- or t-test.

Results: Study participants; n = 99, 61.6% male, mean age 52 years. Low or possible inadequate HL was seen in 20%. There was no statistical difference in the levels of HL related to sex, educational level, ability to work or between KTx candidates and KTx recipients.

Conclusions: In this cohort, one fifth had low or possible inadequate HL measured by the NVS. Screening is needed to identify persons with poor HL. These persons require tailored education and person-centred care to cope with self-management.
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http://dx.doi.org/10.1111/scs.12860DOI Listing
June 2021

The Being Taken Seriously Questionnaire-Development and Psychometric Evaluation of a PREM Measure for Person-Centeredness in a High-Tech Hospital Environment.

Int J Environ Res Public Health 2020 04 13;17(8). Epub 2020 Apr 13.

Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden.

There is a need for patient-reported experience measures (PREMs) in high-tech hospital environments based on the philosophy of person-centeredness. The aim of this study was to describe the development and initial psychometric evaluation of a measure of person-centeredness by means of being taking seriously. In this cross-sectional survey, the study sample (n = 79) completed two measures, the Being Taken Seriously Questionnaire-Patient version (BTSQ-P) which was the measure undergoing psychometric evaluation, and the Person-Centered Climate Questionnaire-Patient version (PCQ-P) that was used to evaluate the climate in which the intervention was occurring. The expected scale dimensionality was examined both by the confirmatory multi-trait analysis program and by explorative principal component analysis (with oblique, varimax rotation). Scale reliability was estimated using ordinal alpha and Cronbach's alpha. One solid factor was generated. This factor had good internal convergent validity and good item-scale reliability, covering 80.41% of the variance. The interitem correlation ranged from 0.759 to 0.908 and the alpha was 0.93 (ordinal alpha) and 0.87 (Cronbach's alpha) respectively. There was a strong relationship between BTSQ-P and the PCQ-P dimension safety climate. In conclusion, the internal consistency, reliability and concurrent validity of the BTSQ-P was satisfactory for use in a high-tech hospital environment.
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http://dx.doi.org/10.3390/ijerph17082660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7215555PMC
April 2020

Pre- and postnatal Lactobacillus reuteri treatment alters DNA methylation of infant T helper cells.

Pediatr Allergy Immunol 2020 07 3;31(5):544-553. Epub 2020 Apr 3.

Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.

Background: Perinatal childhood exposures, including probiotic supplementation, may affect epigenetic modifications and impact on immune maturation and allergy development. The aim of this study was to assess the effects of pre- and postnatal Lactobacillus reuteri supplementation on DNA methylation in relation to immune maturation and allergy development.

Methods: DNA methylation patterns were investigated for allergy-related T helper subsets using a locus-specific method and at a genome-wide scale using the Illumina 450K array. From a randomised, double-blind, placebo-controlled allergy prevention trial with pre- and postnatal probiotic supplementation, CD4+ T helper cells were obtained at birth (from cord blood), and 12 and 24 months of age (total (placebo/probiotics); locus-specific method: CB = 32 (17/15), 12 months = 24 (9/15), 24 months = 35 (15/20); Illumina: CB = 19 (10/9), 12 months = 10 (6/4), 24 months = 19(11/8)).

Results: Comparing probiotics to placebo, the greatest genome-wide differential DNA methylation was observed at birth, where the majority of sites were hypomethylated, indicating transcriptional accessibility in the probiotic group. Bioinformatic analyses, including network analyses, revealed a module containing 91 genes, enriched for immune-related pathways such as chemotaxis, PI3K-Akt, MAPK and TGF-β signalling. A majority of the module genes were associated with atopic manifestations (OR = 1.43, P = 2.4 × 10 ), and a classifier built on this model could predict allergy development (AUC = 0.78, P = 3.0 × 10 ). Pathways such as IFN-γ signalling and T-cell activation were more hypermethylated at birth compared with later in life in both intervention groups over time, in line with DNA methylation patterns in the IFNG locus obtained by the locus-specific methodology.

Conclusion: Maternal L. reuteri supplementation during pregnancy alters DNA methylation patterns in CD4+ T cells towards enhanced immune activation at birth, which may affect immune maturation and allergy development.
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http://dx.doi.org/10.1111/pai.13240DOI Listing
July 2020

Unique Case Report of a Meningeal Sarcoma Arising during Ongoing Treatment for Progressing Intraparenchymal Glioma.

Case Rep Oncol Med 2019 27;2019:7950782. Epub 2019 Nov 27.

HealthPartners Neuroscience Center, St Paul, MN, USA.

Radiation-induced sarcomas in the brain are extremely rare, usually occur with an average latency of 9 years, and are associated with poor outcomes. Latency periods shorter than 1 year may indicate a genetic predisposition such as Li-Fraumeni syndrome. A 34-year-old man underwent initial tumor resection and radiation therapy for a World Health Organization (WHO) Grade II Astrocytoma. Within 6 months, the tumor recurred as WHO Grade III and was treated with temozolomide and then bevacizumab. Despite the patient's apparent improving condition, MRI revealed new dural-based lesions 10 months after radiation therapy and identified as high-grade sarcoma. The patient resumed bevacizumab, began NovoTTF treatment for progressing glioma, and ifosfamide/doxorubicin for the sarcoma. Genetic testing revealed no pathogenic mutation in the TP53 gene. Ultimately, treatment was unsuccessful and the patient succumbed to glioma and sarcoma within 2 years of initial diagnosis. This case was unique due to the rapidly progressing glioma and sudden appearance of a high-grade sarcoma. It is unusual to have two separate intracranial primary cancers with each requiring a different chemotherapy regimen. We discuss the difficulty of simultaneously treating with separate chemotherapy regimens. It remains unclear whether the sarcoma was induced by the radiation treatment or a genetic predisposition.
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http://dx.doi.org/10.1155/2019/7950782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900946PMC
November 2019

Significant others' perceptions of being taken seriously by the Swedish Ambulance Service when the patient is assessed as nonurgent.

Scand J Caring Sci 2020 Dec 27;34(4):1028-1037. Epub 2019 Dec 27.

Department of Health Sciences at, Lund University, Lund, Sweden.

Background: At least 50% of all ambulance assignments are deemed nonurgent, while 47-96% are initiated by someone other than the patient. Previous research has highlighted the importance of being taken seriously. However, additional knowledge of how significant others experience the situation when a patient is assessed as nonurgent is needed.

Objective: The aim of this study was to explore the person-centred climate in the Ambulance Service from the perspective of significant others by means of the Person-centred Climate Questionnaire - Family version (PCQ-F), to psychometrically investigate the construct validity of additional items intended to measure perceptions of being taken seriously and to explore possible relationships between the person-centred climate and these additional items.

Methods: A retrospective, explorative, cross-sectional survey design was employed. In total, 241 questionnaires were distributed. Descriptive and comparative statistics and a factor analysis of eight items possibly constructing person-centredness are presented.

Results: The 100 respondents experienced the climate as very person-centred. Relationships were found between the items that might constitute person-centredness and the PCQ-F. The PCQ-F can explain perceived person-centredness through the additional items that may constitute person-centredness in the Ambulance Service context.

Conclusion: Significant others consider eight aspects of being taken seriously as the core of person-centredness in nonurgent Ambulance Service assignments. There is a relationship between the psychosocial climate and the additional items that might constitute person-centredness.
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http://dx.doi.org/10.1111/scs.12811DOI Listing
December 2020

Persons' Experiences of Suffering from Nephrotic Syndrome.

J Ren Care 2020 Mar 19;46(1):45-51. Epub 2019 Nov 19.

Department of Health Science, Faculty of Medicine, Lund University, Lund, Sweden.

Background: Little is known about health and wellbeing among patients with nephrotic syndrome (NS), despite it being a serious condition in patients with renal failure. In order to promote health, it is important that both healthcare professionals and patients are aware of the signs and symptoms of the disease.

Objectives: The aim was to explore patients' experience of suffering from nephrotic syndrome.

Design: An inductive, qualitative method.

Participants: Ten adult patients with either newly diagnosed or a relapse of NS treated in a University hospital, south of Sweden from February 2016 to February 2019.

Measurements: Data were collected using open-ended interviews and analysed by means of Lindseth and Norberg's phenomenological-hermeneutical method.

Results: Suffering from NS meant being a stranger in an unfamiliar world of symptoms, signs and medical treatment without professional guidance or piloting, illustrated by four themes: Feeling ill and well at the same time, Being passively adherent, Being in uncertainty, and Trying to comprehend and cope.

Implications For Practice: The result provides an in-depth understanding of the illness experience among patients with NS and constitutes a foundation for clinical guidelines on treatment, follow-up and health promotion.

Conclusion: Patients with NS end up in a state of ambiguity due to a profound knowledge deficit that causes uncertainty and a lack of self-management. The experienced lack of professional self-management support is partly compensated for by social support from relatives, enabling those with NS to manage everyday life in a reasonable way.
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http://dx.doi.org/10.1111/jorc.12307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328708PMC
March 2020

The prediction of colorectal cancer using anthropometric measures: A Swedish population-based cohort study with 22 years of follow-up.

United European Gastroenterol J 2019 11 24;7(9):1250-1260. Epub 2019 May 24.

Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Background: Obesity is a risk factor for colorectal cancer (CRC).

Objective: The objective of this article is to investigate whether anthropometric measures reflecting visceral obesity are better predictors of CRC than body mass index (BMI).

Methods: Data were analysed from the Malmö Diet and Cancer study in Sweden, comprising 16,669 women and 10,805 men (median age 56.6 and 59.1 years) followed for a median 21.5 years. Diagnoses of CRC were identified using Swedish national registers. Cox regression was used to test the associations of BMI, waist circumference (WC), waist-hip ratio, waist-to-height ratio, waist-to-hip-to-height ratio, A Body Shape Index (ABSI) and percentage body fat with the development of CRC adjusted for age, alcohol consumption, smoking, education and physical activity in men and women.

Results: None of the measures were significantly associated with an increased risk for CRC in women. WC was the strongest predictor of colon cancer (CC) in men and the only measure that was independent of BMI. ABSI was the only measure significantly associated with the risk of rectal cancer in men.

Conclusions: Visceral obesity, best expressed as WC, is a risk factor for CC in men but a poor predictive marker for CRC in women.
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http://dx.doi.org/10.1177/2050640619854278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826529PMC
November 2019

No distinct microbiome signature of irritable bowel syndrome found in a Swedish random population.

Gut 2020 06 10;69(6):1076-1084. Epub 2019 Oct 10.

Center for Translational Microbiome Research, CTMR, Department of Microbiology, Tumour and Cell Biology (MTC), Karolinska Institutet, Science for Life Laboratory, Solna, Sweden

Objective: The ethiopathogenesis of irritable bowel syndrome (IBS) is unknown. While a link to the gut microbiome is postulated, the heterogeneity of the healthy gut makes it difficult to draw definitive conclusions. We aimed to describe the faecal and mucosa-associated microbiome (MAM) and health correlates on a community cohort of healthy and IBS individuals with no colonoscopic findings.

Design: The PopCol study recruited a random sample of 3556 adults; 745 underwent colonoscopy. IBS was defined by Rome IV criteria and organic disease excluded. 16S rRNA gene sequencing was conducted on sigmoid biopsy samples from 376 representative individuals (63 IBS cases) and faecal samples from 185 individuals (32 IBS cases).

Results: While sigmoid MAM was dominated by Lachnospiraceae, faeces presented a higher relative abundance of Ruminococcaceae. Microbial richness in MAM was linearly correlated to that in faeces from the same individual (R²=0.255, p<3E-11) as was diversity (R²=0.06, p=0.0022). MAM diversity decreased with increasing body mass index (BMI; Pearson's r=-0.1, p=0.08) and poorer self-rated health (r=-0.15, p=0.007), but no other health correlates. Faecal microbiome diversity was correlated to stool consistency (r=-0.16, p=0.043). Several taxonomic groups were correlated to age, BMI, depression and self-reported health, including associated with lower levels of depression (r=-0.003, p=0.00017). The degree of heterogeneity observed between IBS patients is higher than that observed between healthy individuals.

Conclusions: No distinct microbial signature was observed in IBS. Individuals presenting with low self-rated health or high BMI have lower gut microbiome richness.
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http://dx.doi.org/10.1136/gutjnl-2019-318717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282555PMC
June 2020
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