Publications by authors named "Therese Karlsson"

48 Publications

Assessment of Dietary Choline Intake, Contributing Food Items and Associations with One-carbon and Lipid Metabolites in Middle-aged and Elderly Adults: The Hordaland Health Study.

J Nutr 2021 Oct 13. Epub 2021 Oct 13.

Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.

Background: Choline is an essential nutrient for humans and is involved in various physiological functions. Through its metabolite betaine, it is closely connected to the one-carbon metabolism and the fat-soluble choline form phosphatidylcholine is essential for very-low-density-lipoprotein synthesis and secretion in the liver connecting choline to the lipid metabolism. Dietary recommendations for choline are not available in the Nordic countries primarily due to data scarcity.

Objective: The aim of this study was to investigate the dietary intake of total choline and individual choline forms, dietary sources, and the association of total choline intake with circulating one-carbon metabolites and lipids.

Methods: We included 5746 participants in the Hordaland Health Study (HUSK), a survey including community-dwelling adults born in 1925-1927 (mean age 72 years, 55% women) and 1950-1951 (mean age 48 years, 57% women). Dietary data was obtained using a 169-item food frequency questionnaire and choline content was calculated using the USDA Database for Choline Content of Common Foods, release 2. Metabolites of the one-carbon and lipid metabolism were measured in a non-fasting blood sample obtained at baseline and association with total choline intake were assessed using polynomial splines.

Results: The geometric mean (95% prediction interval) energy-adjusted total choline intake was 260 (170, 389) mg/d with phosphatidylcholine being the main form (44%). The major food items providing dietary choline were eggs, low-fat milk, potatoes, and leafy vegetables. Dietary total choline was inversely associated with circulating concentrations of total homocysteine, glycine and serine and positively associated with choline, methionine, cystathionine, cysteine, trimethyllysine, trimethylamine-N-oxide and dimethylglycine. A weak association was observed between choline intake and serum lipids.

Conclusion: Phosphatidylcholine was the most consumed choline form in community-dwelling adults in Norway. Our findings suggest that choline intake is associated with the concentration of most metabolites involved in the one-carbon and lipid metabolism.
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http://dx.doi.org/10.1093/jn/nxab367DOI Listing
October 2021

Dizziness and health-related quality of life among older adults in an urban population: a cross-sectional study.

Health Qual Life Outcomes 2021 Oct 2;19(1):231. Epub 2021 Oct 2.

Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska Universitetssjukhuset, Gothenburg University, Gröna Stråket 5, 413 45, Gothenburg, Sweden.

Background: Dizziness is a common complaint among older adults and may affect quality of life in a negative way. The aim of this study was to assess health-related quality of life (HRQL), sense of coherence (SOC), self-rated health (SRH) and comorbidity in relation to dizziness, among older persons from an urban population.

Methods: The study is part of the Gothenburg H70 Birth Cohort Studies (H70). A cross-sectional population-based sample including 662 79-years-olds (404 women, 258 men, 62% response rate) were surveyed with questions regarding dizziness, imbalance, comorbidities and general health. HRQL was assessed using the 36-item Short Form-36 Health Survey (SF-36) and SOC with the 13-items questionnaire Sense of Coherence (SOC-13).

Results: Half of the participants reported problems with dizziness (54%). Dizziness was negatively associated with HRQL, including after adjusting for comorbidities, especially in the physical domains of SF-36. Having dizziness was also associated with poorer SRH, tiredness and comorbidity among both men and women. SOC (mean total score), however, did not differ between dizzy and non-dizzy participants.

Conclusions: Dizziness was negatively associated with HRQL, also after adjusting for comorbidities. Identification and treatment of dizziness, when possible, are important because reduction of dizziness symptoms may potentially help to enhance overall well-being in this age group.
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http://dx.doi.org/10.1186/s12955-021-01864-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487566PMC
October 2021

Benign paroxysmal positional vertigo and vestibular impairment among older adults with dizziness.

Laryngoscope Investig Otolaryngol 2021 Jun 6;6(3):488-495. Epub 2021 May 6.

Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden.

Objective: This article aimed to investigate older adults visiting a geriatric institution for a bone density measurement who reported dizziness on a daily or weekly basis (but who are not seeking care for dizziness), according to BPPV, vestibular function, walking abilities, and frequency of falls.

Methods: Patients coming for a bone density measurement answered questions regarding occurrence of dizziness. Patients having dizziness on a daily or weekly basis were considered eligible for the study and invited for investigation at the Ear, Nose, and Throat clinic at Södra Älvsborg Hospital, Sweden. The patients answered questions about history of dizziness, medications, and comorbidities. They were also investigated for BPPV, vestibular deficits using the video head impulse test (vHIT), walking speed, Timed Up and Go test (TUG), and for perception of verticality and horizontality and Romberg test.

Results: A total of 55 patients with dizziness were included. Fifteen (27%) were diagnosed with BPPV. Forty (73%) patients reported falling during the previous year, including 11 with BPPV. Dizziness when turning in bed was more common among patients with BPPV and increased the risk of BPPV 8-fold.

Conclusion: BPPV is common among older adults with dizziness, including among those not seeking medical care. It is important to identify older adults with BPPV and treat the condition since BPPV may contribute to falls. Asking about dizziness when turning in bed can help to distinguish patients with increased risk for BPPV and older adults with dizziness should be investigated for BPPV even when typical history is lacking. : 4.
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http://dx.doi.org/10.1002/lio2.566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223472PMC
June 2021

Dietary Methyl-Group Donor Intake and Breast Cancer Risk in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Nutrients 2021 May 28;13(6). Epub 2021 May 28.

Office of the Director, International Agency for Research on Cancer, CEDEX 08, 69372 Lyon, France.

(1) Background: Methyl-group donors (MGDs), including folate, choline, betaine, and methionine, may influence breast cancer (BC) risk through their role in one-carbon metabolism; (2) Methods: We studied the relationship between dietary intakes of MGDs and BC risk, adopting data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort; (3) Results: 318,686 pre- and postmenopausal women were followed between enrolment in 1992-2000 and December 2013-December 2015. Dietary MGD intakes were estimated at baseline through food-frequency questionnaires. Multivariable Cox proportional hazards regression models were used to quantify the association between dietary intake of MGDs, measured both as a calculated score based on their sum and individually, and BC risk. Subgroup analyses were performed by hormone receptor status, menopausal status, and level of alcohol intake. During a mean follow-up time of 14.1 years, 13,320 women with malignant BC were identified. No associations were found between dietary intakes of the MGD score or individual MGDs and BC risk. However, a potential U-shaped relationship was observed between dietary folate intake and overall BC risk, suggesting an inverse association for intakes up to 350 µg/day compared to a reference intake of 205 µg/day. No statistically significant differences in the associations were observed by hormone receptor status, menopausal status, or level of alcohol intake; (4) Conclusions: There was no strong evidence for an association between MGDs involved in one-carbon metabolism and BC risk. However, a potential U-shaped trend was suggested for dietary folate intake and BC risk. Further research is needed to clarify this association.
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http://dx.doi.org/10.3390/nu13061843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228096PMC
May 2021

Food Sources Contributing to Intake of Choline and Individual Choline Forms in a Norwegian Cohort of Patients With Stable Angina Pectoris.

Front Nutr 2021 14;8:676026. Epub 2021 May 14.

Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.

Choline is an essential nutrient involved in a wide range of physiological functions. It occurs in water- and lipid-soluble forms in the body and diet. Foods with a known high choline content are eggs, beef, chicken, milk, fish, and selected plant foods. An adequate intake has been set in the US and Europe, however, not yet in the Nordic countries. A higher intake of lipid-soluble choline forms has been associated with increased risk of acute myocardial infarction, highlighting the need for knowledge about food sources of the individual choline forms. In general, little is known about the habitual intake and food sources of choline, and individual choline forms. Investigate foods contributing to the intake of total choline and individual choline forms. The study population consisted of 1,929 patients with stable angina pectoris from the Western Norway B Vitamin Intervention Trial. Dietary intake data was obtained through a 169-item food frequency questionnaire. Intake of total choline and individual choline forms was quantified using the USDA database, release 2. The geometric mean (95% prediction interval) total choline intake was 287 (182, 437) mg/d. Phosphatidylcholine accounted for 42.5% of total choline intake, followed by free choline (25.8%) and glycerophosphocholine (21.2%). Phosphocholine and sphingomyelin contributed 4.2 and 4.5%, respectively. The main dietary choline sources were eggs, milk, fresh vegetables, lean fish, and bread. In general, animal food sources were the most important contributors to choline intake. This study is, to the best of our knowledge, the first to assess the intake of all choline forms and their dietary sources in a European population. Most choline was consumed in the form of phosphatidylcholine and animal food sources contributed most to choline intake. There is a need for accurate estimates of the dietary intake of this essential nutrient to issue appropriate dietary recommendations.
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http://dx.doi.org/10.3389/fnut.2021.676026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160433PMC
May 2021

Further validation of the Gothenburg Trismus Questionnaire (GTQ).

PLoS One 2020 17;15(12):e0243805. Epub 2020 Dec 17.

Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.

This study aimed to update and, if necessary, revise the Gothenburg Trismus Questionnaire (GTQ), the only existing trismus-specific questionnaire, and retest its psychometric properties. Semi-structured interviews were performed with 10 trismus patients of which 5 had head and neck cancer (HNC) and 5 suffered from benign temporomandibular disorders. Trismus was defined as a maximal incisal opening of ≤ 35mm. An expert panel discussed and revised the GTQ based on interview information, expertise knowledge and the original questionnaire. The revised questionnaire was then tested in a study sample consisting of benign jaw-related conditions (n = 26), patients treated for HNC (n = 90) and an age- and gender-matched control group with no trismus (n = 116). The revised version of the GTQ (GTQ 2) was well accepted by patients. The original three domains continued to show high internal consistency (Cronbach's alpha 0.74-0.94) and construct validity. Two dually posed single items were split into four questions and the wording was altered in another three items. Moreover, a new domain (Facial pain) was identified, which had excellent internal consistency (α = 0.96) and good construct validity. The revision of the original Gothenburg Trismus Questionnaire (GTQ 1) with inclusion of patient-input, resulted in splitting of ambiguous items, identifying a fourth domain named Facial pain and the recall time shortened for some items. Additionally, the remaining domains and items were re-confirmed as strong in the psychometric analysis. Henceforth, the new version, GTQ 2 should be used.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243805PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746186PMC
January 2021

Benign paroxysmal positional vertigo, dizziness, and health-related quality of life among older adults in a population-based setting.

Eur Arch Otorhinolaryngol 2021 May 19;278(5):1637-1644. Epub 2020 Sep 19.

Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg University, 413 45, Göteborg, Sweden.

Purpose: Dizziness may affect quality of life in a negative way and contribute to falls. The aim of this study was to investigate and compare 75 years old with dizziness caused by benign paroxysmal positional vertigo (BPPV) to those with general dizziness/impaired balance (non-BPPV related) and to those reporting no dizziness, regarding health-related quality of life (HRQL), falls, tiredness, and walking speed in a population-based setting.

Method: A cross-sectional population-based sample, including 671 75 years old (398 women, 273 men), was investigated for BPPV, dizziness symptoms, falls, and walking speed. HRQL was assessed using the 36-item Short Form-36 Health Survey (SF-36).

Result: A total of 67 persons (10%) had symptoms of BPPV with 11 (1.6%) having nystagmus when tested for BPPV. Having BPPV as well as general dizziness/impaired balance was associated with reduced HRQL, more tiredness, enhanced number of falls, and lower walking speed. Furthermore, the risk of having BPPV increased fourfold if symptoms of dizziness when turning in bed was reported.

Conclusion: Having problems with dizziness is common among senior citizens where BPPV can be an unrecognized cause of dizziness that may impact HRQL and overall well-being. As BPPV is common among older adults, and is potentially curable through reposition maneuvers, it is important to liberally test for, and treat the condition. Information about dizziness when turning in bed can help to pinpoint persons with enhanced risk for BPPV also on a population-based level.
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http://dx.doi.org/10.1007/s00405-020-06357-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058011PMC
May 2021

Voice Quality, Function, and Quality of Life for Laryngeal Cancer: A Prospective Longitudinal Study Up to 24 Months Following Radiotherapy.

Ear Nose Throat J 2020 Jun 2:145561320929941. Epub 2020 Jun 2.

Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.

Objective: To study the potential changes of health-related quality of life (HRQL), voice quality, and communicative function up to 24 months following radiotherapy for patients with laryngeal cancer.

Methods: A total of 28 patients with laryngeal cancer, treated by curatively intended radiotherapy were included in this prospective longitudinal descriptive study. Patients were followed pre-radiotherapy, 12 months, and 24 months post-radiotherapy. At each time point, voice recordings and patient-reported outcome instruments (European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core30, Head and Neck35, Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer) were completed. Perceptual analysis using the Grade-Roughness-Breathiness-Asthenia-Strain was performed using the voice recordings.

Results: Voice quality remains inferior to the voices of healthy controls both before and up to 24 months post-radiotherapy, demonstrating no statistically significant changes during the study period. Self-perceived communicative function revealed a trend toward improvement. Health-related quality of life remains mostly at stable levels, however, with statistically significant deterioration regarding dry mouth and sticky saliva. Generally, patients reported inferior scores compared to a normal population.

Conclusion: This study demonstrated no statistically significant changes over time in HRQL and perceptual voice quality at pre-radiotherapy compared to 24 months post-radiotherapy. However, the values remain inferior to the voices of healthy controls or a normal population.
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http://dx.doi.org/10.1177/0145561320929941DOI Listing
June 2020

Jaw exercise therapy for the treatment of trismus in head and neck Cancer: a prospective three-year follow-up study.

Support Care Cancer 2021 Jul 24;29(7):3793-3800. Epub 2020 Nov 24.

Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.

Purpose: This study aims to examine effects of jaw exercise on trismus 3 years following completion of a post-radiotherapy jaw exercise intervention.

Methods: Prospective study including 50 patients with head-and-neck cancer receiving radiotherapy and/or chemotherapy, plus a matched control group. The intervention group underwent 10 weeks of jaw exercise training. Patients were followed pre-and postintervention and 3 years postintervention completion. Outcome measures were maximal interincisal opening (MIO), trismus-related symptoms, and health-related quality-of-life as measured by Gothenburg Trismus Questionnaire, EORTC QLQ-C30, and EORTC QLQ-H&N35.

Results: The intervention group had a statistically significantly higher mean MIO compared with the control group (40.1 mm and 33.9 mm, respectively, p < 0.001), reported less trismus-related problems and had an improved health-related quality-of-life when compared with the control group at the 3-year follow-up. These differences were all statistically significant.

Conclusion: Jaw exercise therapy resulted in increased MIO, less trismus-related symptoms, and improved health-related quality-of-life. Jaw exercise therapy should be initiated early, in a structured manner and continued long-term.
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http://dx.doi.org/10.1007/s00520-020-05517-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8163667PMC
July 2021

Microplastics in sea-surface waters surrounding Sweden sampled by manta trawl and in-situ pump.

Mar Pollut Bull 2020 Apr 29;153:111019. Epub 2020 Feb 29.

Örebro University, MTM Research Centre, Fakultetsgatan 1, 701 82 Örebro, Sweden. Electronic address:

Microplastics were sampled in open surface waters by using a manta trawl and an in-situ filtering pump. A total of 24 trawl samples and 11 pump samples were taken at 12 locations around Sweden. Overall, the concentration of microplastic particles was higher in pump samples compared to trawl samples. The median microplastic particle concentration was 0.04 particles per m for manta trawl samples and 0.10 particles per m in pump samples taken with a mesh size of 0.3 mm. The highest concentrations were recorded on the west coast of Sweden. Fibers were found in all samples and were also more frequent in the pump samples. Even higher concentrations of fibers and particles were found on the 0.05 mm pump filters. Using near-infrared hyperspectral imaging the majority of the particles were identified as polyethylene followed by polypropylene.
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http://dx.doi.org/10.1016/j.marpolbul.2020.111019DOI Listing
April 2020

Well-Being of Caregivers of Patients with Laryngeal Cancer Treated by Radiotherapy.

Int Arch Otorhinolaryngol 2020 Apr 28;24(2):e170-e174. Epub 2020 Jan 28.

Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.

 Laryngeal cancer is the second most common head and neck cancer, but no study to date reports exclusively on the well-being of the caregivers of patients with laryngeal cancer treated by radiotherapy.  The present prospective pilot study aims to describe the impact of the work on the well-being of the caregivers of patients with laryngeal cancer.  The caregivers of patients undergoing radiotherapy with curative intent for laryngeal cancer were included in the present study, and they were asked to fill out a specific questionnaire, while the patients filled out the Hospital Anxiety and Depression Scale (HADS) following diagnosis but prior to treatment.  A total of 50 caregivers were included, 20% of which were male, and 80%, female. In total, 62% (  = 31) of the caregivers were spouses, while the remaining were daughters/sons (  = 11; 22%), siblings (  = 6; 12%), or they were classified as "other" (  = 2; 4%). The female caregivers scored lower (worse) on the depression/worry domain, and this was statistically significant (  = 0.047); they also reported a statistically significant higher negative impact on employment (  = 0.011) compared with the male caregivers. In general, the caregivers of patients with late-stage tumors tended to report lower (worse) scores on all domains (except hospital contact) compared with the caregivers of patients with early-stage tumors. No other differences were observed regarding the patients' age, gender, tumor site or their HADS score.  The diagnosis and treatment of laryngeal cancer impacts the caregiver's psychological well-being, particularly that of female caregivers. This should be taken into consideration when the patients begin the hospital treatment pathway. However, larger studies are needed to target resources more appropriately.
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http://dx.doi.org/10.1055/s-0039-3399542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986947PMC
April 2020

Body Composition During Pregnancy: Longitudinal Changes and Method Comparisons.

Reprod Sci 2020 07 28;27(7):1477-1489. Epub 2020 Jan 28.

Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 432, SE-405 30, Gothenburg, Sweden.

The Pregnancy Obesity Nutrition and Child Health study is a longitudinal study of reproductive health. Here we analyzed body composition of normal-weight and obese Swedish women by three methods during each trimester of pregnancy. Cross-sectional and longitudinal fat mass estimates using quantitative magnetic resonance (QMR) and bioelectrical impedance analysis (BIA) (Tanita MC-180MA-III) were compared with fat mass determined by air displacement plethysmography (ADP) in pregnancy weeks 8-12, 24-26, and 35-37 in normal-weight women (n = 122, BMI = 22.1 ± 1.6 kg/m) and obese women (n = 29, BMI = 34.6 ± 3.6 kg/m). ADP results were calculated from pregnancy-adjusted fat-free mass densities. Mean fat mass by QMR and ADP were similar in obese women, although with wide limits of agreement. In normal-weight women, QMR overestimated mean fat mass in all trimesters, with systematic overestimation at low fat mass values in trimesters 1 and 3. In obese women, fat mass by BIA was grossly underestimated and imprecise in all trimesters, especially at higher values in trimester 2. In normal-weight women, fat mass by BIA was moderately lower than by ADP in trimester 1, similar in trimester 2, and moderately higher in trimester 3. QMR and ADP assessed fat mass changes similarly in obese women, whereas BIA overestimated fat mass changes in normal-weight women. Mean fat mass and fat mass changes by QMR and pregnancy-adjusted ADP were similar in pregnant obese women. Mean fat mass by QMR and fat mass changes by BIA were higher than corresponding values determined by pregnancy-adjusted ADP in normal-weight women.
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http://dx.doi.org/10.1007/s43032-020-00141-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272490PMC
July 2020

Comparison between manta trawl and in situ pump filtration methods, and guidance for visual identification of microplastics in surface waters.

Environ Sci Pollut Res Int 2020 Feb 18;27(5):5559-5571. Epub 2019 Dec 18.

Department of Marine Sciences, University of Gothenburg, Kristineberg 566, 45178, Fiskebäckskil, Sweden.

Owing to the development and adoption of a variety of methods for sampling and identifying microplastics, there is now data showing the presence of microplastics in surface waters from all over the world. The difference between the methods, however, hampers comparisons, and to date, most studies are qualitative rather than quantitative. In order to allow for a quantitative comparison of microplastics abundance, it is crucial to understand the differences between sampling methods. Therefore, a manta trawl and an in situ filtering pump were compared during realistic, but controlled, field tests. Identical microplastic analyses of all replicates allowed the differences between the methods with respect to (1) precision, (2) concentrations, and (3) composition to be assessed. The results show that the pump gave higher accuracy with respect to volume than the trawl. The trawl, however, sampled higher concentrations, which appeared to be due to a more efficient sampling of particles on the sea surface microlayer, such as expanded polystyrene and air-filled microspheres. The trawl also sampled a higher volume, which decreased statistical counting uncertainties. A key finding in this study was that, regardless of sampling method, it is critical that a sufficiently high volume is sampled to provide enough particles for statistical evaluation. Due to the patchiness of this type of contaminant, our data indicate that a minimum of 26 particles per sample should be recorded to allow for concentration comparisons and to avoid false null values. The necessary amount of replicates to detect temporal or spatial differences is also discussed. For compositional differences and size distributions, even higher particle counts would be necessary. Quantitative measurements and comparisons would also require an unbiased approach towards both visual and spectroscopic identification. To facilitate the development of such methods, a visual protocol that can be further developed to fit different needs is introduced and discussed. Some of the challenges encountered while using FTIR microspectroscopic particle identification are also critically discussed in relation to specific compositions found.
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http://dx.doi.org/10.1007/s11356-019-07274-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028838PMC
February 2020

The effect of jaw exercises on anxiety and depression in patients with head and neck cancer receiving radiotherapy: Prospective 2-year follow-up study.

Head Neck 2020 02 22;42(2):330-335. Epub 2019 Nov 22.

Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background: This nonrandomized matched study investigates jaw exercise effect on anxiety/depressive symptoms in head and neck cancer patients with trismus during 2 years postradiotherapy.

Methods: Fifty patients with trismus postradiotherapy were included in a 10-week jaw-training intervention. A matched control group was included (N = 50). Maximum interincisal opening (MIO) ≤ 35 mm was used as the trismus criterion. Patients were assessed using MIO and Hospital Anxiety Depression Scale preintervention, postintervention, and at 2-year follow-up.

Results: A significant difference was found in depressive symptoms between the intervention group and control group (4% vs 33%) at 2-year follow-up, with more control group patients reporting possible depression. In the intervention group, significantly fewer patients had possible/probable depressive symptoms at follow-up (4%) compared to preintervention (34%). No change was seen within the control group.

Conclusion: Structured jaw exercise in patients with postradiation trismus had positive effects on MIO and depressive symptoms but does not seem to have any significant effects on anxiety symptoms.
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http://dx.doi.org/10.1002/hed.26012DOI Listing
February 2020

Dizziness and its association with walking speed and falls efficacy among older men and women in an urban population.

Aging Clin Exp Res 2020 Jun 5;32(6):1049-1056. Epub 2019 Sep 5.

Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.

Background: Dizziness is common among older people and falling is a feared complication.

Aim: The purpose of this study was to investigate the presence of dizziness and its association with falls, walking speed and fear of falling, including sex differences, among 79-year-olds. Secondary purposes were to describe the relationship between dizziness and falls to number of medications and diseases.

Method: The study consisted of the fifth cohort of Gothenburg's H70 birth cohort studies. A sample of 662 79-year-olds (404 women, 258 men) were investigated with questions regarding dizziness, previous falls and falls efficacy [estimated according to the falls efficacy scale Swedish version (FES (S))]. Functional tests included self-selected and maximal walking speed over 20 m.

Results: Dizziness was reported among 51% of the women and by 58% of the men (p = 0.12). Approximately, 40% had fallen during the past 12 months (41% women, 38% of the men, p = 0.48). Dizziness was related to a higher risk of falls among women (OR 2.63 (95% CI 1.67-4.14, p < 0.0001), but not among men (OR 1.07, 95% CI 0.63-1.82, p = 0.8). Dizzy individuals had lower scores on FES (S) (p < 0.01), more medications (p < 0.001) and diseases (p < 0.001) than those without dizziness. Participants who reported dizziness walked 10% slower than participants without dizziness (p < 0.001).

Conclusion: Women with dizziness more often reported falls compared to women without dizziness-a trend that was not seen among men. Persons with dizziness walked slower. Many medications increased risk of falling; hence, number of medications alone might help pinpoint risk groups for falling.
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http://dx.doi.org/10.1007/s40520-019-01303-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260266PMC
June 2020

Letter to editor: Misleading conclusions in the recently published study by Taito et al. "Voice rehabilitation for laryngeal cancer after radiotherapy: a systematic review and meta-analysis".

Eur Arch Otorhinolaryngol 2019 11 24;276(11):3253-3254. Epub 2019 Aug 24.

Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.

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http://dx.doi.org/10.1007/s00405-019-05586-3DOI Listing
November 2019

Are We Speaking the Same Language? Recommendations for a Definition and Categorization Framework for Plastic Debris.

Environ Sci Technol 2019 02 17;53(3):1039-1047. Epub 2019 Jan 17.

Department of Biology , Norwegian University of Science and Technology (NTNU) , Trondheim 7491 , Norway.

The accumulation of plastic litter in natural environments is a global issue. Concerns over potential negative impacts on the economy, wildlife, and human health provide strong incentives for improving the sustainable use of plastics. Despite the many voices raised on the issue, we lack a consensus on how to define and categorize plastic debris. This is evident for microplastics, where inconsistent size classes are used and where the materials to be included are under debate. While this is inherent in an emerging research field, an ambiguous terminology results in confusion and miscommunication that may compromise progress in research and mitigation measures. Therefore, we need to be explicit on what exactly we consider plastic debris. Thus, we critically discuss the advantages and disadvantages of a unified terminology, propose a definition and categorization framework, and highlight areas of uncertainty. Going beyond size classes, our framework includes physicochemical properties (polymer composition, solid state, solubility) as defining criteria and size, shape, color, and origin as classifiers for categorization. Acknowledging the rapid evolution of our knowledge on plastic pollution, our framework will promote consensus building within the scientific and regulatory community based on a solid scientific foundation.
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http://dx.doi.org/10.1021/acs.est.8b05297DOI Listing
February 2019

Influence of thermooxidative degradation on the in situ fate of polyethylene in temperate coastal waters.

Mar Pollut Bull 2018 Oct 13;135:187-194. Epub 2018 Jul 13.

Rise Research Institutes of Sweden, Dept. of Energy and circular economy, Gibraltargatan 35, 412 79 Göteborg, Sweden.

Polyethylene is a commonly used polymer in plastic products and is often found as marine litter. Nevertheless there is limited knowledge about what happens to the material when it ends up in the sea. Polyethylene films were therefore thermally oxidised to four different levels of degradation. The films were then placed in stainless-steel cages in the sea off the Swedish west coast for 12 summer weeks. Subsamples were analysed with respect to biofouling, degradation and buoyancy. All levels showed a continued oxidation in the field. The pre-degraded films started fragmenting and the non-degraded films showed a decrease in tensile strain. All levels showed increased biofouling with higher presence of filamentous algae and bryozoans on pre-degraded materials. The density (kg·m) of the films was seen to increase slightly, and the apparent density for the pre-degraded films (density of the films with biofilm) showed a strong increase, which resulted in sinking.
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http://dx.doi.org/10.1016/j.marpolbul.2018.07.015DOI Listing
October 2018

Asking about dizziness when turning in bed predicts examination findings for benign paroxysmal positional vertigo.

J Vestib Res 2018 ;28(3-4):339-347

Department of Otorhinolaryngology Head and Neck Surgery, Clinical Sciences, Lund, Sweden.

Background: Benign paroxysmal positional vertigo (BPPV) is the single most common cause of vestibular vertigo and is characterised by short episodes of rotational vertigo precipitated by changes in head positions like lying down or turning in bed.

Objective: This study aims to assess useful questions when suspecting benign paroxysmal positional vertigo (BPPV) caused dizziness as well as identifying if a single question can be useful in identify or distinguish patients with BPPV from other dizziness aetiology.

Method: A total of 149 patients admitted due to dizziness were included. Patients answered a questionnaire and were investigated for BPPV with diagnostic manoeuvres.

Result: Two of the 15 questions were of diagnostic importance. Dizziness when laying down or turning in bed, increased likelihood of BPPV by an odds ratio (95% confidence interval) of 60 (7.47-481.70). Continuous dizziness duration as opposed to lasting seconds decreased likelihood of BPPV with an odds ratio of 0.06 (0.01-0.27).

Conclusion: Vertiginous attacks by turning or laying down in bed together with dizziness <1 minute, are important questions and strongly related to BPPV. Such questions are important when taking a medical history and may help to early identify BPPV, also for non-medical staff, as well as reduce the need of further investigations.
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http://dx.doi.org/10.3233/VES-180637DOI Listing
November 2019

The Limited Benefit of Fish Consumption on Risk of Hip Fracture among Men in the Community-Based Hordaland Health Study.

Nutrients 2018 Jul 6;10(7). Epub 2018 Jul 6.

Department of Global Public Health and Primary Care, University of Bergen, 5021 Bergen, Norway.

Hip fractures have a high prevalence worldwide. Few studies have investigated whether fish consumption is associated with risk of hip fractures. The objective of the present study was to investigate the effect of fish intake on the subsequent risk of a hip fracture because of the low number of studies on this topic. A community-based prospective cohort study of 2865 men and women from Hordaland county in Norway, born between 1925⁻1927 and enrolled in the study in 1997⁻1999. Information on hip fracture cases was extracted from hospital records until 31 December 2009. Baseline information on the intake of fish was obtained from a semi-quantitative food frequency questionnaire. Cox proportional hazard regression models with death as a competing risk were used to evaluate the association of fish intake with risk of hip fracture. During a mean (SD) follow-up time of 9.6 (2.7) years, 226 hip fractures (72 in men, 154 in women) were observed. The mean (SD) fish intake was 48 (25) g/1000 kcal. The association between fish intake and risk of hip fracture was not linear and displayed a threshold, with low intake of fish being associated with an increased risk of hip fracture in men (HR (Hazard Ratio) = 1.84, 95% CI 1.10, 3.08). In this community-based prospective study of men and women, a low intake of fish was associated with the risk of a hip fracture in men.
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http://dx.doi.org/10.3390/nu10070873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073237PMC
July 2018

Increased plasma trimethylamine-N-oxide is associated with incident atrial fibrillation.

Int J Cardiol 2018 Sep;267:100-106

Haukeland University Hospital, Dept of Heart Disease, Bergen, Norway; University of Bergen, Dept of Clinical Science, Bergen, Norway.

Background: Plasma trimethylamine-N-oxide (TMAO) is associated with cardiovascular disease; however specific relationships with cardiac arrhythmias are unknown. We evaluated the association between plasma TMAO and incident atrial fibrillation (AF).

Methods: Risk associations were explored among 3797 patients with suspected stable angina in the Western Norway Coronary Angiography Cohort (WECAC) and verified in 3143 elderly participants in the community-based Hordaland Health Study (HUSK). Information on endpoints was obtained from nationwide registries.

Results: Median follow-up was 7.3 and 10.8 years in the WECAC and HUSK cohorts, respectively, and 412 (10.9%) and 484 (15.4%) subjects were registered with incident AF. The age and gender adjusted HRs were 1.16, 95% CI 1.05-1.28 and 1.10, 95% CI 1.004-1.19 per 1 SD increase in log-transformed plasma TMAO. Adjusting for hypertension, BMI, smoking, diabetes, or intake of total choline, a TMAO precursor, did not materially influence the risk associations. Among patients in WECAC, further extensive adjustment for other AF risk factors yielded similar results. Adding TMAO to traditional AF risk factors (age, gender, hypertension, BMI, smoking and diabetes) yielded a continuous net reclassification improvement of 0.108, 95% CI 0.015-0.202 and 0.139, 95% CI 0.042-0.235.

Conclusions: Plasma TMAO was associated with and improved reclassification of incident AF in two independent Norwegian cohorts with long-term follow-up. The relationship was independent of traditional AF risk factors, as well as of dietary choline intake. Our findings motivate further studies to explore endogenous metabolic factors influencing the relationship between TMAO and cardiovascular disease.
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http://dx.doi.org/10.1016/j.ijcard.2018.04.128DOI Listing
September 2018

The unaccountability case of plastic pellet pollution.

Mar Pollut Bull 2018 Apr 10;129(1):52-60. Epub 2018 Feb 10.

University of Gothenburg, Department of Marine Sciences, Kristineberg Marine Research Station, 45178 Fiskebäckskil, Sweden. Electronic address:

Plastic preproduction pellets are found in environmental samples all over the world and their presence is often linked to spills during production and transportation. To better understand how these pellets end up in the environment we assessed the release of plastic pellets from a polyethylene production site in a case study area on the Swedish west coast. The case study encompasses; field measurements to evaluate the level of pollution and pathways, models and drifters to investigate the potential spread and a revision of the legal framework and the company permits. This case study show that millions of pellets are released from the production site annually but also that there are national and international legal frameworks that if implemented could help prevent these spills. Bearing in mind the negative effects observed by plastic pollution there is an urgent need to increase the responsibility and accountability of these spills.
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http://dx.doi.org/10.1016/j.marpolbul.2018.01.041DOI Listing
April 2018

Total and lean fish intake is positively associated with bone mineral density in older women in the community-based Hordaland Health Study.

Eur J Nutr 2019 Jun 15;58(4):1403-1413. Epub 2018 Mar 15.

Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.

Purpose: Fish is a source of various nutrients beneficial for bone health, but few studies have investigated the association between bone mineral density (BMD) and fish consumption. Thus, the aim was to investigate the relationship between total fish intake and BMD and between both lean and fatty fish intake and BMD.

Method: These cross-sectional analyses include 4656 participants in the Hordaland Health Study, a community-based study conducted in 1997-1999. The study includes two birth cohorts of men and women from Hordaland county (Norway) born in 1950-1951 and 1925-1927. BMD was measured by dual-energy X-ray absorptiometry and dietary intake was obtained from a semi-quantitative food-frequency questionnaire.

Results: The average total fish intake was 33 ± 18 g/1000 kcal and was primarily lean fish. Older women had significantly lower BMD than older men and middle-aged men and women. In older women, total and lean fish intake (50 g/1000 kcal) was significantly and positively associated with BMD also after multivariate adjustments (β-coefficient 0.018, p = 0.017 and 0.026, p = 0.021).

Conclusion: A high intake of fish, in particular lean fish, was positively associated with BMD in older women. No association between intake of fatty fish and BMD was found in either of the age and sex groups.
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http://dx.doi.org/10.1007/s00394-018-1665-6DOI Listing
June 2019

A critical perspective on early communications concerning human health aspects of microplastics.

Sci Total Environ 2018 Jun 19;626:720-726. Epub 2018 Feb 19.

University of Gothenburg, Department of Marine Sciences, Kristineberg Marine Research Station, 45178 Fiskebäckskil, Sweden. Electronic address:

Microplastic research in recent years has shown that small plastic particles are found almost everywhere we look. Besides aquatic and terrestrial environments, this also includes aquatic species intended for human consumption and several studies have reported their prevalence in other food products and beverages. The scientific as well as public debate has therefore increasingly focused on human health implications of microplastic exposure. However, there is a big discrepancy between the magnitude of this debate and actual scientific findings, which have merely shown the presence of microplastics in certain products. While plastics can undoubtedly be hazardous to human health due to toxicity of associated chemicals or as a consequence of particle toxicity, the extent to which microplastics in individual food products and beverages contribute to this is debatable. Considering the enormous use of plastic materials in our everyday lives, microplastics from food products and beverages likely only constitute a minor exposure pathway for plastic particles and associated chemicals to humans. But as this is rarely put into perspective, the recent debate has created a skewed picture of human plastic exposure. We risk pulling the focus away from the root of the problem: the way in which we consume, use and dispose of plastics leading to their widespread presence in our everyday life and in the environment. Therefore we urge for a more careful and balanced discussion which includes these aspects.
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http://dx.doi.org/10.1016/j.scitotenv.2018.01.092DOI Listing
June 2018

Quality of Life after Free Fibula Flap Reconstruction of Segmental Mandibular Defects.

J Reconstr Microsurg 2018 Feb 13;34(2):108-120. Epub 2017 Sep 13.

Department of Plastic Surgery, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.

Background:  Free fibula flap (FFF) is considered gold standard in the reconstruction of mandibular defects. Despite the frequent use, patients' quality of life (QoL) after reconstruction has been sparsely investigated. This study aims to evaluate QoL and outcomes in patients who have undergone FFF reconstruction of segmental mandibular defects.

Methods:  A retrospective cohort study of consecutive patients ( = 73) operated at a single center during the years 2000 to 2014 was performed. Charts were reviewed and all living patients ( = 41) were invited to fill out three quality of life questionnaires (QLQ): SF-36, EORTC QLQ-C30, and QLQ-H&N35. Factors associated with poor outcome were derived from regression models and the results of the QLQs were compared with Swedish reference populations. Subgroup analysis was performed for two groups depending on reconstructive indication: cancer and osteoradionecrosis (ORN).

Results:  The response rate of the QLQs was 93%. General QoL did not differ from reference populations, but the study group had significantly larger proportions of poor functioning patients in three domains in EORTC QLQ-C30: global health status, role functioning, and social functioning. Patients also reported a high incidence of poor functioning/high symptom burden in EORTC QLQ-H&N35, with a significantly higher frequency in the ORN group compared with the cancer group for the domains "swallowing" and "social eating." The overall flap success rate was 92% and complication rate was 48%. Previous surgery had a significant association with reoperation due to bleeding, and longer duration of surgery was significantly associated with local infection.

Conclusion:  When evaluated with validated QLQs, most patients experienced persistent functional loss in one or several domains, but still perceived a general QoL that is close to that of reference populations. Patients having ORN as the indication for surgery, as compared with cancer, reported a higher frequency of poor functioning patients in disease-specific QoL domains.
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http://dx.doi.org/10.1055/s-0037-1606537DOI Listing
February 2018

Associations between fish intake and the metabolic syndrome and its components among middle-aged men and women: the Hordaland Health Study.

Food Nutr Res 2017 13;61(1):1347479. Epub 2017 Jul 13.

Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.

In epidemiologic studies, the relationship between fish consumption and the metabolic syndrome (MetS) have been inconclusive and sex differences reported. The aim was to investigate associations between fish intake and the MetS in a cross-sectional study of men and women. Fish intake, waist circumference, triglycerides (TG), HDL-C, glucose and blood pressure were assessed among 2874 men and women (46-49 y) in the Hordaland Health Study (1997-1999). Fatty fish intake was inversely associated with TG in men only; mean difference in TG between highest and lowest quartile of fatty fish intake was -0.33 mmol/L (95% CI: -0.51, -0.15). Lean fish intake was inversely associated with TG in women only; mean difference in TG between highest and lowest quartile of lean fish intake was -0.23 mmol/L (95% CI: -0.34, -0.11). Fatty fish intake was positively associated with serum HDL-C in both men and women. Total fish intake was inversely associated with MetS; adjusted OR 0.75 (95% CI 0.57, 0.97). Higher fish intake was associated with lower odds of having MetS possibly driven by associations of higher fish intake with lower TG and higher HDL-C. The findings of differential associations by sex needs to be confirmed and possible biologic mechanisms explored.
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http://dx.doi.org/10.1080/16546628.2017.1347479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510233PMC
July 2017

Screening for microplastics in sediment, water, marine invertebrates and fish: Method development and microplastic accumulation.

Mar Pollut Bull 2017 Sep 6;122(1-2):403-408. Epub 2017 Jul 6.

Department of Environment and Health, Vrije Universiteit, De Boelelaan 1087, 1081 HV Amsterdam, The Netherlands.

Measurements of microplastics in biota and abiotic matrices are key elements of exposure and risk assessments for this emerging environmental pollutant. We investigated the abundance of microplastics in field-collected biota, sediment and water. An improved sediment extraction method, based on density separation was developed. For analysis of microplastics in biota we found that an adapted enzymatic digestion protocol using proteinase K performed best, with a 97% recovery of spiked plastic particles and no observed degradation effects on the plastics in subsequent Raman analysis. Field analysis revealed that 8 of 9 tested invertebrate species from the North Sea and 68% of analyzed individuals of brown trout (Salmo trutta) from the Swedish West Coast had microplastics in them. Based on the number of plastic particles per kg d.w. the microplastic concentrations found in mussels were approximately a thousand-fold higher compared to those in sediment and surface water samples from the same location.
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http://dx.doi.org/10.1016/j.marpolbul.2017.06.081DOI Listing
September 2017

Dietary Choline Intake Is Directly Associated with Bone Mineral Density in the Hordaland Health Study.

J Nutr 2017 04 8;147(4):572-578. Epub 2017 Mar 8.

Heart Disease and.

Choline is an important nutrient either obtained from a variety of foods or synthesized endogenously, and it is the precursor of betaine. We previously reported positive associations between plasma free choline and bone mineral density (BMD). Animal studies suggest an impact of dietary choline on bone metabolism, but the role of dietary intake of choline and betaine for human bone health is unknown. The main aims were to examine the associations of dietary choline, choline species, and betaine with BMD and to study the relations between dietary and plasma free choline and betaine. Study subjects were participants in the Hordaland Health Study, including 2649 women and 1983 men (aged 46-49 or 71-74 y). BMD was measured by dual-energy X-ray absorptiometry, and dietary intake was obtained by using a validated 169-item food-frequency questionnaire. Risk associations were assessed by logistic regression and correlations by ρ (Spearman's bivariate rank order correlation). Subjects in the lowest compared with the highest tertile of dietary total choline, free choline, glycerophosphocholine, phosphocholine, phosphatidylcholine, and sphingomyelin had a higher risk of low-femoral neck BMD, defined as the lowest BMD quintile. Particularly strong associations were found among middle-aged men for intake of free choline (OR: 1.83; 95% CI: 1.24, 2.69; = 0.002) and glycerophosphocholine (OR: 2.13; 95% CI: 1.43, 3.16; < 0.001) and among elderly women for total choline (OR: 1.96; 95% CI: 1.33, 2.88; = 0.001) and phosphatidylcholine (OR: 1.94; 95% CI: 1.33, 2.84: = 0.001) intake. No significant associations were observed between dietary betaine and BMD. Dietary total choline, free choline, glycerophosphocholine, phosphatidylcholine, and sphingomyelin correlated weakly with plasma free choline (ρ: 0.07, 0.05, 0.07, 0.07, and 0.05, respectively; < 0.01). Dietary betaine correlated with plasma betaine (ρ: 0.23; < 0.001). Dietary choline was positively associated with BMD in middle-aged and elderly participants.
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http://dx.doi.org/10.3945/jn.116.243006DOI Listing
April 2017
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