Publications by authors named "Petra Nilsson"

19 Publications

  • Page 1 of 1

Structural Changes on MRI Demonstrate Specific Cerebellar Involvement in SLE Patients-A VBM Study.

Brain Sci 2021 Apr 16;11(4). Epub 2021 Apr 16.

Department of Clinical Sciences Lund, Diagnostic Radiology, Faculty of Medicine, Lund University, 221 00 Lund, Sweden.

The purpose of this study is to investigate possible differences in brain structure, as measured by T1-weighted MRI, between patients with systemic lupus erythematosus (SLE) and healthy controls (HC), and whether any observed differences were in turn more severe in SLE patients with neuropsychiatric manifestations (NPSLE) than those without (non-NPSLE). Structural T1-weighted MRI was performed on 69 female SLE patients (mean age = 35.8 years, range = 18-51 years) and 24 age-matched female HC (mean age = 36.8 years, range = 23-52 years) in conjunction with neuropsychological assessment using the CNS Vital Signs test battery. T1-weighted images were preprocessed and analyzed by FSL-VBM. The results show that SLE patients had lower grey matter probability values than the control group in the VIIIa of the cerebellum bilaterally, a region that has previously been implied in sensorimotor processing in human and non-human primates. No structural differences for this region were found between NPSLE and non-NPSLE patients. VBM values from the VIIIa region showed a weak positive correlation with the psychomotor speed domain from CNS Vital Signs ( = 0.05, = 0.21), which is in line with its presumed role as a sensorimotor processing area.
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http://dx.doi.org/10.3390/brainsci11040510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072619PMC
April 2021

Dental care of patients exposed to sexual abuse: Need for alliance between staff and patients.

Eur J Oral Sci 2021 06 24;129(3):e12782. Epub 2021 Mar 24.

Department of Psychology, Lund University, Lund, Sweden.

The aim was to explore the experiences of sexually abused individuals as dental patients. Purposively selected were 13 informants (11 women) aged 19-56. All had experienced sexual abuse as children or adults and memories of this abuse had been triggered and expressed during a dental appointment. They were encouraged to relate in their own words their experiences of the dental appointment. The interviews were recorded digitally, transcribed verbatim, and analysed according to Qualitative Content Analysis. The overall theme illustrating the latent content was The dental appointment - a volatile base requiring predictability and a secure working alliance. The first category covering the manifest content was The dental care provider "assumes responsibility," with two subcategories: (i) contradictory disclosure, and (ii) alliance formation - a levelling of power. The second category was The patient is "in focus," with two subcategories: (i) alertness to signs of discomfort, and (ii) attention to obvious but subtle expressions of needs. On an understanding that the patient has been sexually abused, an individually tailored, patient-centered approach to treatment is suggested. Dental care providers may also need to be aware of and reflect on their position of power, in relation to the patient and its possible chairside implications.
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http://dx.doi.org/10.1111/eos.12782DOI Listing
June 2021

Limbic encephalitis in a neuroscientist: CASPR 2 antibody-associated disease after antigen exposure.

J Neuroimmunol 2020 06 1;343:577231. Epub 2020 Apr 1.

Division of Neurology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, SE-221 85 Lund, Sweden.

Autoimmune limbic encephalitis is part of CASPR 2 antibody-associated disease. A man with this rare disorder and a very high antibody titre had a unique history of laboratory exposure to the antigen. Together with earlier observations this case calls for caution in laboratory handling of nerve tissue.
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http://dx.doi.org/10.1016/j.jneuroim.2020.577231DOI Listing
June 2020

Cancer Risk for Fingolimod, Natalizumab, and Rituximab in Multiple Sclerosis Patients.

Ann Neurol 2020 05 9;87(5):688-699. Epub 2020 Mar 9.

Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.

Objective: Novel, highly effective disease-modifying therapies have revolutionized multiple sclerosis (MS) care. However, evidence from large comparative studies on important safety outcomes, such as cancer, is still lacking.

Methods: In this nationwide register-based cohort study, we linked data from the Swedish MS register to the Swedish Cancer Register and other national health care and census registers. We included 4,187 first-ever initiations of rituximab, 1,620 of fingolimod, and 1,670 of natalizumab in 6,136 MS patients matched for age, sex, and location to 37,801 non-MS general population subjects. Primary outcome was time to first invasive cancer.

Results: We identified 78 invasive cancers among treated patients: rituximab 33 (incidence rate [IR] per 10,000 person-years = 34.4, 95% confidence interval [CI] = 23.7-48.3), fingolimod 28 (IR = 44.0, 95% CI = 29.2-63.5), and natalizumab 17 (IR = 26.0, 95% CI = 15.1-41.6). The general population IR was 31.0 (95% CI = 27.8-34.4). Adjusting for baseline characteristics, we found no difference in risk of invasive cancer between rituximab, natalizumab, and the general population but a possibly higher risk with fingolimod compared to the general population (hazard ratio [HR] = 1.53, 95% CI = 0.98-2.38) and rituximab (HR = 1.68, 95% CI = 1.00-2.84).

Interpretation: In this first large comparative study of 3 highly effective MS disease-modifying therapies, no increased risk of invasive cancer was seen with rituximab and natalizumab, compared to the general population. However, there was a borderline-significant increased risk with fingolimod, compared to both the general population and rituximab. It was not possible to attribute this increased risk to any specific type of cancer, and further studies are warranted to validate these findings. ANN NEUROL 2020;87:688-699.
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http://dx.doi.org/10.1002/ana.25701DOI Listing
May 2020

Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies.

JAMA Neurol 2020 02;77(2):184-191

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

Importance: Although highly effective disease-modifying therapies for multiple sclerosis (MS) have been associated with an increased risk of infections vs injectable therapies interferon beta and glatiramer acetate (GA), the magnitude of potential risk increase is not well established in real-world populations. Even less is known about infection risk associated with rituximab, which is extensively used off-label to treat MS in Sweden.

Objective: To examine the risk of serious infections associated with disease-modifying treatments for MS.

Design, Setting, And Participants: This nationwide register-based cohort study was conducted in Sweden from January 1, 2011, to December 31, 2017. National registers with prospective data collection from the public health care system were used. All Swedish patients with relapsing-remitting MS whose data were recorded in the Swedish MS register as initiating treatment with rituximab, natalizumab, fingolimod, or interferon beta and GA and an age-matched and sex-matched general population comparator cohort were included.

Exposures: Treatment with rituximab, natalizumab, fingolimod, and interferon beta and GA.

Main Outcomes And Measures: Serious infections were defined as all infections resulting in hospitalization. Additional outcomes included outpatient treatment with antibiotic or herpes antiviral medications. Adjusted hazard ratios (HRs) were estimated in Cox regressions.

Results: A total of 6421 patients (3260 taking rituximab, 1588 taking natalizumab, 1535 taking fingolimod, and 2217 taking interferon beta/GA) were included, plus a comparator cohort of 42 645 individuals. Among 6421 patients with 8600 treatment episodes, the mean (SD) age at treatment start ranged from 35.0 (10.1) years to 40.4 (10.6) years; 6186 patients were female. The crude rate of infections was higher in patients with MS taking interferon beta and GA than the general population (incidence rate, 8.9 [95% CI, 6.4-12.1] vs 5.2 [95% CI, 4.8-5.5] per 1000 person-years), and higher still in patients taking fingolimod (incidence rate, 14.3 [95% CI, 10.8-18.5] per 1000 person-years), natalizumab (incidence rate, 11.4 [95% CI, 8.3-15.3] per 1000 person-years), and rituximab (incidence rate, 19.7 [95% CI, 16.4-23.5] per 1000 person-years). After confounder adjustment, the rate remained significantly higher for rituximab (HR, 1.70 [95% CI, 1.11-2.61]) but not fingolimod (HR, 1.30 [95% CI, 0.84-2.03]) or natalizumab (HR, 1.12 [95% CI, 0.71-1.77]) compared with interferon beta and GA. In contrast, use of herpes antiviral drugs during rituximab treatment was similar to that of interferon beta and GA and lower than that of natalizumab (HR, 1.82 [1.34-2.46]) and fingolimod (HR, 1.71 [95% CI, 1.27-2.32]).

Conclusions And Relevance: Patients with MS are at a generally increased risk of infections, and this differs by treatment. The rate of infections was lowest with interferon beta and GA; among newer treatments, off-label use of rituximab was associated with the highest rate of serious infections. The different risk profiles should inform the risk-benefit assessments of these treatments.
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http://dx.doi.org/10.1001/jamaneurol.2019.3365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784753PMC
February 2020

Comparative effectiveness of dimethyl fumarate as the initial and secondary treatment for MS.

Mult Scler 2020 10 8;26(12):1532-1539. Epub 2019 Aug 8.

Department of Clinical Neuroscience, Center for Molecular Medicine (CMM), Karolinska Institutet, Stockholm, Sweden.

Background: Population-based real-world evidence studies of the effectiveness and tolerability of dimethyl fumarate in relation to common treatment alternatives are still limited.

Objective: To evaluate the clinical effectiveness and tolerability of dimethyl fumarate (DMF) as the initial and secondary treatment for relapsing-remitting multiple sclerosis (RRMS) patients compared with common treatment alternatives in Sweden.

Methods: We conducted a nationwide retrospective observational cohort study of all RRMS patients identified through the Swedish MS registry initiating DMF ( = 641) or interferons/glatiramer acetate (IFN/GA;  = 555) as the initial therapy, or DMF ( = 703) or fingolimod (FGL;  = 194) after switch from IFN/GA between 1 January 2014 and 31 December 2016.

Results: The discontinuation rate was lower with DMF as the initial treatment than IFN/GA (adjusted hazard rate (HR): 0.46, 95% confidence interval (CI): 0.37-0.58,  < 0.001), but higher than FGL as the secondary treatment (HR: 1.51, CI: 1.08-2.09,  < 0.05). Annualized relapse rate (ARR) was lower with DMF compared to IFN/GA (0.04, CI: 0.03-0.06 vs 0.10, CI: 0.07-0.13;  < 0.05), but not FGL (0.03, CI: 0.02-0.05 vs 0.02, CI: 0.01-0.04;  = 0.41). Finally, time to first relapse (TTFR) was longer with DMF as the initial, but not secondary, therapy ( < 0.05 and  = 0.20, respectively).

Conclusion: Our findings indicate that DMF performs better than IFN/GA as the initial treatment for RRMS. Compared to FGL, DMF displayed a lower tolerability, but largely similar effectiveness outcomes.
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http://dx.doi.org/10.1177/1352458519866600DOI Listing
October 2020

Functional connectivity changes in core resting state networks are associated with cognitive performance in systemic lupus erythematosus.

J Comp Neurol 2019 08 19;527(11):1837-1856. Epub 2019 Feb 19.

Division of Clinical Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden.

To investigate core resting state networks in SLE patients with and without neuropsychiatric symptoms by examining functional connectivity changes correlating with results of cognitive testing. Structural MRI and resting state-fMRI (rs-fMRI) were performed in 61 female SLE patients (mean age: 36.8 years, range 18.2-52.0 years) and 20 healthy controls (HC) (mean age 36.2 years, range 23.3-52.2 years) in conjunction with clinical examination and cognitive testing. Alterations in core resting state networks, not found in our healthy controls sample, correlated with cognitive performance gauged by neuropsychological tests in non-neuropsychiatric SLE (nNP) as well as in neuropsychiatric SLE patients (NP). The observed pattern of increased functional connectivity in core resting state networks correlated with reduced cognitive performance on all cognitive domains tested and with a heavy focus on DM, CE, and DM-CE in the NP subgroup. Furthermore, we found that the observed alterations in memory and psychomotor speed correlated with disease duration. In SLE patients both with and without clinically overt neuropsychiatric manifestations, we found changes in the functional connectivity of core resting state networks essential to cognitive functions. These findings may represent a rewiring of functional architecture in response to neuronal damage and could indicate suboptimal compensatory mechanisms at play.
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http://dx.doi.org/10.1002/cne.24656DOI Listing
August 2019

Functional Connectivity Changes in Systemic Lupus Erythematosus: A Resting-State Study.

Brain Connect 2018 05 5;8(4):220-234. Epub 2018 Apr 5.

7 Department of Clinical Sciences , Lund/Memory Research Unit, Lund University, Lund, Sweden .

To investigate resting-state functional connectivity of lupus patients and associated subgroups according to the ACR NPSLE case definitions (ACR ad hoc). In addition, we investigated whether or not the observed alterations correlated with disease duration, the systemic lupus erythematosus (SLE)-Disease Activity Index-2000 (SLEDAI-2k), and Systemic Lupus International Collaborating Clinical/ACR organ damage index (SDI)-scores. Anatomical 3T magnetic resonance imaging (MRI) and resting-state functional MRI were performed in 61 female lupus patients (mean age = 37.0 years, range = 18.2-52.0 years) and 20 gender- and age-matched controls (mean age = 36.2 years, range = 23.3-52.2 years) in conjunction with clinical examination and laboratory testing. Whole-brain voxelwise functional connectivity analysis with permutation testing was performed to extract network components that differed in lupus patients relative to healthy controls (HCs). Lupus patients exhibited both inter- and intranetwork hypo- and hyperconnectivity involving several crucial networks. We found reduced connectivity within the default mode network (DMN), the central executive network (CEN), and in-between the DMN and CEN in lupus patients. Increased connectivity was primarily observed within and between the sensory motor network in lupus patients when compared to HCs. Comparing lupus patients with and without neuropsychiatric symptoms, hypoconnectivity was more pronounced in the group with neuropsychiatric complaints. The functional connectivity of SLE patients was both positively and negatively correlated to duration of disease. We conclude that SLE patients in general and neuropsychiatric SLE patients in particular experience altered brain connectivity. These patterns may be due both to direct neuronal damage and compensatory mechanisms through neuronal rewiring and recruitment and may partly explain neuropsychiatric symptoms in SLE patients.
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http://dx.doi.org/10.1089/brain.2017.0557DOI Listing
May 2018

Altered white matter microstructure in lupus patients: a diffusion tensor imaging study.

Arthritis Res Ther 2018 02 7;20(1):21. Epub 2018 Feb 7.

Department of Clinical Sciences Lund/Diagnostic Radiology, Lund University, Lund, Sweden.

Background: The purpose of this study was to investigate whether white matter microstructure is altered in patients suffering from systemic lupus erythematosus (SLE), and if so, whether such alterations differed between patients with and without neuropsychiatric symptoms.

Methods: Structural MRI and diffusion tensor imaging (DTI) were performed in 64 female SLE patients (mean age 36.9 years, range 18.2-52.2 years) and 21 healthy controls (mean age 36.7 years, range 23.3-51.2 years) in conjunction with clinical examination, laboratory tests, cognitive evaluation, and self-assessment questionnaires. The patients were subgrouped according to the American College of Rheumatology Neuropsychiatric Systemic Lupus Erythematosus case definitions into non-neuropsychiatric SLE (nonNPSLE) and neuropsychiatric SLE (NPSLE).

Results: Comparisons between the SLE group and healthy controls showed that the mean fractional anisotropy (FA) was significantly reduced in the right rostral cingulum (p = 0.038), the mid-sagittal corpus callosum (CC) (p = 0.050), and the forceps minor of the CC (p = 0.015). The mean diffusivity (MD) was significantly increased in the left hippocampal cingulum (p = 0.017). No significant differences in MD or FA values were identified between NPSLE and nonNPSLE patients. Disease duration among all SLE patients correlated significantly with reduced FA in the CC (p < 0.05). No correlations were found between DTI parameters and white matter hyperintensities, SLE Disease Activity Index-2000, Systemic Lupus International Collaborating Clinical/ACR Organ Damage Index, or Montgomery Asberg Depression Rate Score Self-report.

Conclusions: We found alterations of white matter microstructure in SLE patients that were related to disease duration and fatigue. Our results indicate that cerebral involvement in SLE is not isolated to the NPSLE subgroup.
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http://dx.doi.org/10.1186/s13075-018-1516-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5803933PMC
February 2018

Survey process quality: a question of healthcare manager approach.

Int J Health Care Qual Assur 2017 Aug;30(7):591-602

School of Health and Society, Kristianstad University , Kristianstad, Sweden.

Purpose The purpose of this paper is to explore how healthcare first-line managers think about and act regarding workplace survey processes. Design/methodology/approach This interview study was performed at a hospital in south Sweden. First-line healthcare managers ( n=24) volunteered. The analysis was inspired by phenomenography, which aims to describe the ways in which different people experience a phenomenon. The phenomenon was a workplace health promotion (WHP) survey processes. Findings Four main WHP survey process approaches were identified among the managers: as a possibility, as a competition, as a work task among others and as an imposition. For each, three common subcategories emerged; how managers: stated challenges and support from hospital management; described their own work group and collaboration with other managers; and expressed themselves and their situation in their roles as first-line managers. Practical implications Insights into how hospital management can understand their first-line managers' motivation for survey processes and practical suggestions and how managers can work proactively at organizational, group and individual level are presented. Originality/value Usually these studies focus on those who should respond to a survey; not those who should run the survey process. Focusing on managers and not co-workers can lead to more committed and empowered managers and thereby success in survey processes.
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http://dx.doi.org/10.1108/IJHCQA-05-2016-0077DOI Listing
August 2017

Autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: the Swedish experience.

J Neurol Neurosurg Psychiatry 2014 Oct 19;85(10):1116-21. Epub 2014 Feb 19.

Department of Neuroscience, Uppsala University, Uppsala, Sweden Department of Neurology, Uppsala University Hospital, Uppsala, Sweden.

Background: Autologous haematopoietic stem cell transplantation (HSCT) is a viable option for treatment of aggressive multiple sclerosis (MS). No randomised controlled trial has been performed, and thus, experiences from systematic and sustained follow-up of treated patients constitute important information about safety and efficacy. In this observational study, we describe the characteristics and outcome of the Swedish patients treated with HSCT for MS.

Methods: Neurologists from the major hospitals in Sweden filled out a follow-up form with prospectively collected data. Fifty-two patients were identified in total; 48 were included in the study and evaluated for safety and side effects; 41 patients had at least 1 year of follow-up and were further analysed for clinical and radiological outcome. In this cohort, 34 patients (83%) had relapsing-remitting MS, and mean follow-up time was 47 months.

Results: At 5 years, relapse-free survival was 87%; MRI event-free survival 85%; expanded disability status scale (EDSS) score progression-free survival 77%; and disease-free survival (no relapses, no new MRI lesions and no EDSS progression) 68%. Presence of gadolinium-enhancing lesions prior to HSCT was associated with a favourable outcome (disease-free survival 79% vs 46%, p=0.028). There was no mortality. The most common long-term side effects were herpes zoster reactivation (15%) and thyroid disease (8.4%).

Conclusions: HSCT is a very effective treatment of inflammatory active MS and can be performed with a high degree of safety at experienced centres.
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http://dx.doi.org/10.1136/jnnp-2013-307207DOI Listing
October 2014

Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis.

Nat Genet 2013 Nov 29;45(11):1353-60. Epub 2013 Sep 29.

1] John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA. [2].

Using the ImmunoChip custom genotyping array, we analyzed 14,498 subjects with multiple sclerosis and 24,091 healthy controls for 161,311 autosomal variants and identified 135 potentially associated regions (P < 1.0 × 10(-4)). In a replication phase, we combined these data with previous genome-wide association study (GWAS) data from an independent 14,802 subjects with multiple sclerosis and 26,703 healthy controls. In these 80,094 individuals of European ancestry, we identified 48 new susceptibility variants (P < 5.0 × 10(-8)), 3 of which we found after conditioning on previously identified variants. Thus, there are now 110 established multiple sclerosis risk variants at 103 discrete loci outside of the major histocompatibility complex. With high-resolution Bayesian fine mapping, we identified five regions where one variant accounted for more than 50% of the posterior probability of association. This study enhances the catalog of multiple sclerosis risk variants and illustrates the value of fine mapping in the resolution of GWAS signals.
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http://dx.doi.org/10.1038/ng.2770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832895PMC
November 2013

The Work Experience Measurement Scale (WEMS): a useful tool in workplace health promotion.

Work 2013 ;45(3):379-87

Centre of Public Health, School of Health and Society, Kristianstad University, Kristianstad, Sweden Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Lund, Sweden.

Objective: To present validity data for the Work Experience Measurement Scale (WEMS), an instrument measuring multifaceted work experience from a salutogenic health resource perspective as a contrast to the more common pathogenic risk perspective, by exploring WEMS relationship to established measurements that are positively related to health and work. A salutogenic perspective focuses on finding conditions and resources in life, for example at work, that can enhance the individual's health and strength, instead of those causing illness and weakness.

Method: This study was carried out in 2009 at a Swedish hospital with a web-based survey (WEMS) to 770 employees. Different occupational groups at the hospital participated. Additional questionnaires used at the same time were the Utrecht Work Engagement Scale (UWES-9), the Salutogenic Health Indicator Scale (SHIS), the General Self-Efficacy scale (GSE), and three questions about self-rated health, general well-being, and quality of life.

Results: Cronbach's Alpha of WEMS sub-indices were in the interval of 0.85-0.96. Convergent validity and discriminant validity of WEMS and its sub-indices were shown to be satisfying by correlations. In addition, WEMS demonstrated the ability to discriminate between groups. WEMS sub-indices discriminated even better between groups than the total index.

Conclusion: The WEMS proved to be a workplace health promotion questionnaire that was able to measure experiences of work from a salutogenic perspective. The WEMS has a potential of being a useful tool in workplace health promotion to enhance positive human capabilities and resources to improve work performance.
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http://dx.doi.org/10.3233/WOR-121541DOI Listing
May 2014

How to make a workplace health promotion questionnaire process applicable, meaningful and sustainable.

J Nurs Manag 2011 Oct 29;19(7):906-14. Epub 2011 Sep 29.

Department of Clinical Sciences, Lund University, Malmö, Sweden.

Background: In workplace health promotion, a questionnaire could be of great use. Unfortunately, fatigue regarding answering questionnaires has recently become greater than before. An action research approach could be a possible way of increasing employee participation.

Aim: This study reports an attempt to explore key aspects for participation in, and commitment to, a workplace health promotion questionnaire process.

Method: The study was conducted at two wards in a Swedish hospital. Data was collected during an action research process. Data were analysed with regard to a framework of questions.

Findings: The three key aspects for participation in, and commitment to, a workplace health promotion questionnaire process were: an applicable questionnaire, a meaningful questionnaire process and a continuous and sustainable questionnaire process. A structure is presented as practical advice to managers, describing how such a process could be established to be applicable, meaningful and sustainable.

Conclusion: This study has identified key aspects and prerequisites for questionnaire processes. The prerequisites - share decision-making, involve a core group and follow a structure - are discussed and proposed for managers and workgroups to consider in further workplace health promotion questionnaire processes.

Implications For Nursing Management: The key aspects and prerequisites presented could provide a stimulating standpoint or advice, useful for planning and accomplishing workplace questionnaire processes.
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http://dx.doi.org/10.1111/j.1365-2834.2011.01257.xDOI Listing
October 2011

A Swedish national post-marketing surveillance study of natalizumab treatment in multiple sclerosis.

Mult Scler 2011 Jun 12;17(6):708-19. Epub 2011 Jan 12.

Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.

Background: A post marketing surveillance study was conducted to evaluate safety and efficacy of natalizumab in Swedish multiple sclerosis (MS) patients since its introduction in August 2006 until March 2010.

Methods: Patients were registered in the web-based Swedish MS-registry at 40 locations and evaluated every 6 months. Adverse events and clinical outcomes were recorded.

Results: One thousand one hundred and fifty-two patients were included (71.4% female) and 149 patients stopped treatment; the main reason was planned pregnancy. Anti-natalizumab antibodies were found in 4.5% (52 patients) of which 1.6% displayed persistent antibodies. Serious adverse events were rare, but included three cases with progressive multifocal leukoencephalopathy (PML). There were seven fatal cases, probably unrelated to the natalizumab treatment. For relapsing-remitting MS patients (n=901), mean Expanded Disability Status Scale (EDSS, -10.7%), Multiple Sclerosis Severity Scale (MSSS, -20.4%), Multiple Sclerosis Impact Scale (MSIS-29, physical -9.9%, psychological -13.3%) and Symbol Digit Modalities Test (SDMT, +10.7%) all showed significant improvements during 24 months of treatment with natalizumab. The Swedish web-based MS quality registry proved to function as a platform for post-marketing MS drug surveillance, providing long-term data regarding drug effects and adverse events beyond clinical trials.

Conclusions: Our results indicate that natalizumab is generally well tolerated and has sustained efficacy for patients with active MS, though the risk of PML is still an important concern.
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http://dx.doi.org/10.1177/1352458510394701DOI Listing
June 2011

Development and quality analysis of the Work Experience Measurement Scale (WEMS).

Work 2010 ;35(2):153-61

Centre of Public Health, School of Health and Society, Kristianstad University College, Kristianstad, Sweden.

Instruments related to work are commonly illuminated from an ill-health perspective. The need for a concise and useable instrument in workplace health promotion governed the aim of this paper which is to present the development process and quality assessment of the Work Experience Measurement Scale (WEMS). A survey, using a questionnaire based on established theories regarding work and health, and a focus group study were performed in hospital settings in 2005 and 2006 respectively. A Principal Component Analysis (PCA) was used to statistically develop a model, and focus group interviews were made to compare quantitative and qualitative results for convergence and corroboration. The PCA resulted in a six factor model of dimensions containing items regarding management, reorganization, internal work experience, pressure of time, autonomy and supportive working conditions. In the analysis of the focus group study three themes appeared and their underlying content was compared to, and matched, with the dimensions of the PCA. The reliability, shown by weighted kappa values, ranged from 0.36 to 0.71, and adequate Cronbach's Alpha values of the dimensions were all above 0.7. The study validity, indicated by discriminant validity, with correlation values that ranged from 0.10 to 0.39, in relation to the content validity appeared to be good when the theoretical content of the WEMS was compared to the content of similar instruments. The WEMS presents a multidimensional picture of work experience. Its theoretical base and the psychometric properties give support for applicability and offer a possibility to measure trends in the work experience over time in health care settings. One intention of the WEMS is to stimulate the ability of organizations and the employees themselves to take action on improving their work experience. The conciseness of the instrument is intended to increase its usability.
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http://dx.doi.org/10.3233/WOR-2010-0967DOI Listing
May 2010

[Transient global amnesia--a benign condition which can also occur in young people].

Lakartidningen 2005 Jun 13-26;102(24-25):1905-7

Avdelningen för neurologi, institutionen för klinisk neurovetenskap, Universitetssjukhuset i Lund.

Transient global amnesia (TGA) occurs mostly in middle-aged and elderly individuals, and is generally believed to be very rare in individuals less than 40 years of age. We present three cases of TGA in young persons (16-22 years). They all had a medical history and presented symptoms fulfilling the criteria for TGA. Physical examinations and investigations were all normal. All three presented their symptoms while playing football. Reviewing the literature the suggested causes are partly different for TGA in old and young people, respectively. The present report confirms that TGA may also occur in younger individuals. We propose that single TGA is a benign condition also in younger persons and that the investigation should be similar to that of TGA in older age groups.
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July 2005

[New investigations in suspected Creutzfeldt-Jakob disease. Analysis of 14-3-3 protein and T-tau in cerebrospinal fluid for safer diagnosis].

Lakartidningen 2005 Mar 21-Apr 3;102(12-13):956-8, 960-1

Institutionen för klinisk neurovetenskap, Göteborgs universitet, Sweden.

Creutzfeldt-Jakob disease (CJD) is a prion disease characterized by rapid neurodegeneration that leads to the death of the patient within months to a few years. Since the disease is transmissible, there is an obligation in Sweden to report possible CJD cases to the Swedish Institute for Infectious Disease Control. To make a diagnosis of CJD is difficult, especially early in the course of the disease when the clinical features may be very vague and heterogeneous. Hence, accurate biological markers both for confirming and excluding CJD would be of great value. The currently recommended investigation of a patient with possible CJD comprises clinical evaluation. electroencephalography, computed tomography or magnetic resonance imaging of the brain and test for 14-3-3 protein in the cerebrospinal fluid (CSF). Recent studies suggest that analysis of total tau (T-tau) and phospho-tau (P-tau) in CSF is a valuable complement to this set of investigations. Here, we review how CSF T-tau and P-tau may aid in the diagnosis of CJD and illustrate this by presenting cases from routine clinical practice.
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May 2005

Predicting the outcome of optic neuritis: evaluation of risk factors after 30 years of follow-up.

J Neurol 2005 Apr 22;252(4):396-402. Epub 2005 Mar 22.

Department of Neurology, University Hospital, 22185 Lund, Sweden.

Background: Multiple sclerosis (MS) is a common disease with considerable risk for disability. Optic neuritis (ON) is a common first symptom of MS but it can also remain an isolated episode. Therefore, predicting the outcome of ON has gained in importance, particularly in light of current discussions of early disease modifying treatments in individuals at risk of developing MS. We reported previously on our cohort of 86 patients with acute monosymptomatic unilateral ON of whom 33 had progressed to MS after up to 18 years. Three patients had died. The present study extends the observation period to 31 years.

Methods: Patients were followed for up to 31 years or until a diagnosis of MS was made. Cerebrospinal fluid (CSF) was examined at onset. HLA class I and II antigens were determined. Magnetic Resonance Imaging (MRI) was performed during follow up.

Findings: Only one of 50 patients at risk developed clinical manifestations of MS during the extended follow up period. The estimated 15-year-risk of MS was 40 % (confidence interval [CI] 31%-52%). Most cases, 20 of 34 or 60%, occurred within three years. Among factors present at onset, CSF with mononuclear pleocytosis and/or oligoclonal Ig increased the risk for subsequent MS significantly, 49% (CI 38%-65%) compared with 23 % (CI 12%-44%) for those with normal CSF, p=0.02. Younger patients and those with winter onset also had greater risk. Recurrence of ON similarly elevated the risk significantly, p<0.001. After 19-31 years MRI lesions suggestive of demyelinating disease were detected in 20 of 30 individuals although no clinical manifestations of MS had occurred.

Conclusion: The risk of MS in this large population-based prospective ON patient series was 40% and significantly higher in those with inflammatory CSF abnormalities at onset. Clinically silent MRI lesions suggestive of MS were detected in a majority of those with "ON-only". This finding should be taken into account when discussing prognosis and early intervention in patients with clinically isolated ON.
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http://dx.doi.org/10.1007/s00415-005-0655-9DOI Listing
April 2005
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