40 results on '"Lindblom, S."'
Search Results
2. Lectin binding profile of the small intestine of five-week-old pigs in response to the use of chlortetracycline as a growth promotant and under gnotobiotic conditions
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George, S., Oh, Y., Lindblom, S., Vilain, S., Rosa, A.J.M., Francis, D.H., Brozel, V.S., and Kaushik, R.S.
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Chlortetracycline -- Usage ,Swine -- Food and nutrition ,Intestine, Small -- Physiological aspects ,Lectins -- Analysis ,Zoology and wildlife conservation - Abstract
Antibiotics have traditionally been used for growth promotion in the pork industry; however, their use in animal feed has recently been limited because of human health concerns. The intestinal microbiota plays an important role in mediating many physiological functions such as digestion and animal growth. It was hypothesized that use of antibiotics as growth promotants and subsequent variations in intestinal microbiota induce significant changes in the intestinal glycoconjugate composition, which ultimately affects animal growth and disease susceptibility. The aim of this study was to characterize the lectin binding profiles of the ileum of weanling pigs in response to the absence of intestinal microbiota and to the use of the antibiotic chlortetracycline as growth promotant. Eighteen half-sib piglets obtained by cesarean section were divided into 3 treatment groups (n = 6) and maintained as control, antibiotic-fed, and gnotobiotic piglets until 5 wk of age. The glycoconjugate composition of the ileal tissues was examined by lectin histochemistry. Lycopersicon esculentum lectin, Jacalin, Pisum sativum agglutinin, Lens culinaris agglutinin (LCA), and Sambucus nigra lectin showed significant differences (P < 0.05) in binding intensities on the dome and villous epithelium between the treatment groups. Griffonia simplicifolia lectin I, Glycine maxi agglutinin, and Arachis bypogea agglutinin exhibited differences (P < 0.05) between treatment groups in lectin binding on goblet cells. Triticum vulgaris agglutinin, Pisum sativum agglutinin, and LCA showed significant differences (P < 0.05) in binding intensities on dome, corona, and follicular regions of the ileum among treatment groups of animals. Overall, ileal tissues from gnotobiotic piglets expressed significantly weaker (P < 0.05) lectin binding for many lectins compared with control and antibiotic groups. This suggests that the intestinal microbiota plays an important role in the expression of sugar moieties in the intestine. Lectins LCA, Phaseolus vulgaris Leucoagglutinin, and Maackia amurensis lectin II showed significant differences (P < 0.05) in lectin bindings between control and antibiotic-fed piglets. This indicates that chlortetracycline as a growth promotant induces biologically relevant changes in the lectin binding profile of the ileum. These findings will help in further understanding the role of the gut microbiota and the mechanisms of action of antibiotics as growth promotants in pigs. Key words: chlortetracycline, gnotobiotic, growth promotant, intestinal microbiota, lectin, pig
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- 2007
3. Magmatic-hydrothermal fluids in the Pahtohavare Cu-Au deposit in greenstone at Kiruna, Sweden
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Lindblom, S., Broman, C., and Martinsson, O.
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- 1996
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4. Additive hypothermic effects of the 5-HT1A receptor agonist 8-OH-DPAT and the dopamine D2/3 receptor agonist 7-OH-DPAT in the rat
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Eltayb, A., Lindblom, S., Oerther, S., and Ahlenius, S.
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- 2001
5. Oil source and peroxidation status interactively affect growth performance and oxidative status in broilers from 4 to 25 d of age.
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Lindblom, S C, Gabler, N K, Bobeck, E A, and Kerr, B J
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PEROXIDATION , *BROILER chickens , *OXIDATIVE stress , *PALM oil , *SOY oil - Abstract
The objectives of this experiment were to evaluate the effect of oil source and peroxidation status on broiler performance and oxidative stress. Broilers (initial BW 85.1 ± 7.8 g) were allotted to 40 cages with 5 birds per cage in a completely randomized design. The 4 × 2 factorial arrangement of treatments consisted of oil source (palm oil, soybean oil, flaxseed oil, and fish oil) and peroxidation status (fresh or peroxidized). Broilers were fed experimental diets for 20 d to measure growth performance; on day 21 of the experiment, plasma and liver samples were harvested for analysis of oxidative stress including thiobarbituric acid reactive substances (TBARS), protein carbonyls (PC), 8-hydroxy-2'-deoxyguanosine (8- OH-2dG), glutathione peroxidase activity (GPx) and superoxide dismutase and catalase (CAT). An interaction occurred between oil source and peroxidation status where broilers fed peroxidized oils had reduced ADFI, ADG, G:F, and plasma GPx in all oil sources except for fish oil (P ≤ 0.04). Plasma 8-OH-2dG was increased by feeding peroxidized oils (P = 0.01). An interaction occurred in liver TBARS where broilers fed peroxidized palm oil had greater liver TBARS compared to fresh palm oil (P = 0.09). An interaction was noted for liver PC where broilers fed palm, flaxseed, and fish oil had similar liver PC regardless of peroxidation status, while broilers fed peroxidized soybean oil had increased liver PC compared to the fresh soybean oil diet (P = 0.04). Oil source affected plasma TBARS and 8-OH-2dG (P = 0.01), plasma PC (P = 0.09), liver 8-OH-2dG (P = 0.08), and liver CAT (P = 0.02). Correlations between oil composition with growth performance and oxidative stress markers imply that oil UFA:SFA, p-anisidine value, DDE, total polar compounds, and polymerized triglycerides should be measured as an indicator of oil quality, with growth performance being correlated to plasma TBARS, PC, and GPx. In conclusion, the degree of unsaturation and peroxidation status of dietary oils affected growth performance and markers of oxidative stress in poultry. [ABSTRACT FROM AUTHOR]
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- 2019
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6. Influence of feeding thermally peroxidized soybean oil on oxidative status in growing pigs.
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Lindblom, S C, Gabler, N K, Dilger, R N, Olson, Z F, Loving, C L, and Kerr, B J
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FATTY acids , *OXIDATIVE stress , *ANTIOXIDANTS , *MALONDIALDEHYDE , *METABOLITES - Abstract
The objectives of this study were to determine whether feeding thermally processed peroxidized soybean oil (SO) induces markers of oxidative stress and alters antioxidant status in pig tissue, blood, and urine. Fifty-six barrows (25.3 ± 3.3 kg initial BW) were randomly assigned to dietary treatments containing 10% fresh SO (22.5 °C) or thermally processed SO (45 °C for 288 h, 90 °C for 72 h, or 180 °C for 6 h), each with constant air infusion rate of 15 liters/minute. Multiple indices of lipid peroxidation were measured in the SO including peroxide value (2.0, 96, 145, and 4.0 mEq/kg for 22.5, 45, 90, and 180 °C processed SO, respectively) and p-anisidine value (1.2, 8.4, 261, and 174 for 22.5, 45, 90, and 180 °C processed SO, respectively); along with a multitude of aldehydes. Pigs were individually housed and fed ad libitum for 49 d which included a 5 d period in metabolism crates for the collection of urine and serum for measures of oxidative stress. On day 49, pigs were euthanized to determine liver weight and analyze liver-based oxidative stress markers. Oxidative stress markers included serum, urinary, and liver thiobarbituric acid reactive substances (TBARS), and urinary F2-isoprostanes (ISP) as markers of lipid damage; serum and liver protein carbonyls (PC) as a marker of protein damage; and urinary and liver 8-hydroxy-2'-deoxyguanosine (8-OH-2dG) as a marker of DNA damage. Superoxide dismutase (SOD), and catalase activity (CAT) were measured in liver, glutathione peroxidase activity (GPx) was measured in serum and liver, and ferric reducing antioxidant power (FRAP) was measured in serum and urine as determinants of antioxidant status. Pigs fed 90 °C SO had greater urinary ISP (P = 0.02), while pigs fed the 45 °C SO had elevated urinary TBARS (P = 0.02) in comparison to other treatment groups. Pigs fed 45 °C and 90 °C SO had increased serum PC concentrations (P = 0.01) and pigs fed 90 °C SO had greater (P = 0.01) liver concentration of 8-OH-2dG compared to pigs fed the other SO treatments. Furthermore, pigs fed 90 °C SO had reduced serum GPx activity in comparison to pigs fed fresh SO (P = 0.01). In addition, pigs fed 180 °C SO had increased liver CAT activity (P = 0.01). Liver GPx and SOD or serum and urinary FRAP were not affected by dietary treatment. These results indicate that dietary peroxidized soybean oil induced oxidative stress by increasing serum PC while diminishing serum GPx, increasing urinary ISP and TBARS, and increasing 8-OH-2dG and CAT in liver. [ABSTRACT FROM AUTHOR]
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- 2018
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7. Digestibility of energy and lipids and oxidative stress in nursery pigs fed commercially available lipids.
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Lindblom, S. C., Dozier III, W. A., Shurson, G. C., and Kerr, B. J.
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LIPIDS , *OXIDATIVE stress , *SOY oil , *PALM oil , *LACTULOSE , *MANNITOL - Abstract
An experiment was conducted to evaluate the impact of lipid source on GE and ether extract (EE) digestibility, oxidative stress, and gut integrity in nursery pigs fed diets containing 10% soybean oil (SO), choice white grease (CWG), palm oil (PO), distillers' corn oil with approximately 5% FFA (DCO-1), or distillers' corn oil with approximately 10% FFA (DCO-2). Fifty-four barrows weaned at 28 d of age were fed a common starter diet for 7 d, group fed their respective experimental diets for an additional 7 d, and then moved to metabolism crates and individually fed their respective diets for another 10 d. Following this period, a 4-d total fecal and urine collection period was used to determine apparent total tract digestibility (ATTD) of GE and EE and to determine the DE and ME content of each lipid source (11.03 ± 0.51 kg final BW). Following the last day of fecal and urine collection, pigs were given an oral dose of lactulose and mannitol and fed their respective experimental diets with urine collected for the following 12 h. A subsequent urine collection occurred for 5 h to determine thiobarbituric acid reactive substances (TBARS) and isoprostane (IsoP) concentrations. Following this urine collection, serum was obtained and analyzed for TBARS and endotoxin concentrations. Soybean oil had the greatest (P < 0.05) DE (9,388 kcal/kg) content compared with DCO-1, DCO-2, CWG, and PO (8,001, 8,052, 8,531, and 8,293 kcal/kg lipid, respectively). Energy digestibility was greatest for SO compared with the other lipid sources (P < 0.05). The ATTD of EE averaged 85.0% and varied slightly (84.4 to 85.6%) among treatments. Differences in ME content among lipids were similar to those reported for DE, with ME values for DCO- 1, DCO-2, CWG, PO, and SO being 7,921, 7,955, 8,535, 8,350, and 9,408 kcal/kg lipid, respectively. Metabolizable energy as a percentage of DE did not differ among lipid sources. Pigs fed lipid diets had greater (P < 0.05) serum TBARS compared with pigs fed the control diet, but no differences were observed in urinary TBARS excretion among the lipid treatments. Urinary IsoP excretion differed among treatments (P < 0.01) but was highly variable (34.0 to 104.6 pg). However, no differences were observed among treatments for the urinary lactulose:mannitol ratio and serum endotoxin. These results indicate that DE and ME content of SO are greater than that of other lipid sources evaluated, but feeding these lipids has no effect on gut integrity while producing variable effects on oxidative stress. [ABSTRACT FROM AUTHOR]
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- 2017
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8. Fossilized microorganisms associated with zeolite–carbonate interfaces in sub-seafloor hydrothermal environments.
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Ivarsson, M., Lindblom, S., Broman, C., and Holm, N. G.
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ZEOLITES , *DRILLING platforms , *CARBONATES , *BIOFILMS , *VOLCANIC ash, tuff, etc. , *CALCIUM - Abstract
In this paper we describe carbon-rich filamentous structures observed in association with the zeolite mineral phillipsite from sub-seafloor samples drilled and collected during the Ocean Drilling Program (ODP) Leg 197 at the Emperor Seamounts. The filamentous structures are ~5 µm thick and ~100–200 µm in length. They are found attached to phillipsite surfaces in veins and entombed in vein-filling carbonates. The carbon content of the filaments ranges between ~10 wt% C and 55 wt% C. They further bind to propidium iodide (PI), which is a dye that binds to damaged cell membranes and remnants of DNA. Carbon-rich globular microstructures, 1–2 µm in diameter, are also found associated with the phillipsite surfaces as well as within wedge-shaped cavities in phillipsite assemblages. The globules have a carbon content that range between ~5 wt% C and 55 wt% C and they bind to PI. Ordinary globular iron oxides found throughout the samples differ in that they contain no carbon and do not bind to the dye PI. The carbon-rich globules are mostly concentrated to a film-like structure that is attached to the phillipsite surfaces. This film has a carbon content that ranges between ~25 wt% C and 75 wt% C and partially binds to PI. EDS analyses show that the carbon in all structures described are not associated with calcium and therefore not bound in carbonates. The carbon content and the binding to PI may indicate that the filamentous structures could represent fossilized filamentous microorganisms, the globules could represent fossilized microbial cells and the film-like structures could represent a microbially produced biofilm. Our results extend the knowledge of possible habitable niches for a deep biosphere in sub-seafloor environments and suggests, as phillipsite is one of the most common zeolite mineral in volcanic rocks of the oceanic crust, that it could be a common feature in the oceanic crust elsewhere. [ABSTRACT FROM AUTHOR]
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- 2008
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9. Additive hypothermic effects of the 5-HT1A receptor agonist 8-OH-DPAT and the dopamine D2/3 receptor agonist 7-OH-DPAT in the rat.
- Author
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Eltayb, A., Lindblom, S., Oerther, S., and Ahlenius, S.
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SEROTONIN , *DOPAMINE receptors , *NEUROTRANSMITTER receptors - Abstract
The objective of this study was to examine possible interactions between serotonergic and dopaminergic agents lowering core temperature via stimulation of 5-HT1A and dopamine (DA) D2 receptors, respectively. The effects of the 5-HT1A receptor agonist (±)-8-hydroxy-2-(di-n-propylamino)tetralin HBr (8-OH-DPAT) and the DA D2/3 receptor agonist 7-OH-DPAT on core temperature was monitored in adult male Wistar rats, approximately 300 g body weight. The temperature probe was connected to a PC-assisted temperature instrument, and an automated printer device was activated when the temperature reading had stabilized (±0.1 °C) for 10 s. As expected, 7-OH-DPAT [0.5 and 2.0 μmol kg–1 subcutaneous (s.c.)] as well as 8-OH-DPAT (0.15–2.4 μmol kg–1 s.c.), produced a dose-dependent hypothermia. When combined, there were additive effects of the two compounds, although the effects of 7-OH-DPAT were attenuated by 8-OH-DPAT at the higher doses (0.6–2.4 μmol kg–1), in all probability because of emerging DA D2 receptor blocking properties of the latter compound. [ABSTRACT FROM AUTHOR]
- Published
- 2001
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10. 268 General Concepts and Measures of Oxidative Stress, Implication on Oxidative Balance, an Update on Recent Research in Swine, and Thoughts on Future Research.
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Kerr, B J, Lindblom, S C, Overholt, M F, and Curry, S M
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OXIDATIVE stress , *DIGESTION , *SWINE nutrition , *METABOLISM , *SWINE - Abstract
Optimal nutrient utilization by farm animals is essential for supporting growth and development and is vital in maintaining economical animal production. While profiles, digestibilities, and balances of energy and nutrients of feedstuffs are critical in the nutrient utilization matrix, so is the ability of the animal to balance mechanisms generating oxidative stress with antioxidant defenses within the body. Pro-oxidants can be of environmental, dietary, or metabolic origin, where oxidative stress occurs when free radical production overwhelms the antioxidant defense system. While it is well known that free radicals can bind to or damage proteins, lipids, and DNA, most research to date involving oxidative stress in farm animals has focused on relatively few measures of oxidative stress (e.g., thiobarbituric acid reactive substances) or antioxidant status (e.g., Vitamin E or glutathione peroxidase); often only in one select tissue. Furthermore, traditional metabolite analysis in nutrition studies are hypothesis-driven and are generally designed to study a specific measure for a specific target, which may be limiting our ability to identify potentially novel and unexpected metabolic activities, especially in complex metabolic events and pathways associated with metabolism. It is hypothesized, therefore, that in order to accurately determine oxidative balance of the whole animal, multiple measures of lipid, protein, or DNA damage should be measured in combination with multiple measures of antioxidant capacity. In addition, a more comprehensive and non-targeted approach in experimental design and data analysis is likewise suggested in order to obtain a broader view of metabolic events (e.g., metabolomics, neuro networks, or multivariate analysis) in response to environmental, dietary, or metabolic stressors. While a proportion of this presentation will discuss recent research using peroxidized lipids as an inducer of oxidative stress and key measures of oxidative stress measured in multiple tissues, additional information will be provided on other models to generate oxidative stress (e.g., heat stress, disease, chemical injections, mycotoxins) in an effort to delineate if different stressors cause differential oxidative stress responses requiring stress- or tissue-specific measures, or can whole animal oxidative stress be measured using the same oxidative balance measures. [ABSTRACT FROM AUTHOR]
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- 2018
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11. Digestibility of energy and lipids, and metabolic oxidation status in nursery pigs fed various lipids.
- Author
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Lindblom, S. C., Shurson, G. C., Dozier, W. A., and Kerr, B. J.
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LIPIDS , *CHEMICAL reactions , *ANIMAL nutrition , *ANIMAL feeds , *LABORATORY swine - Abstract
An experiment was conducted to evaluate the impact of lipid source on energy and lipid digestibility, and on metabolic oxidation status of nursery pigs fed diets containing 10% of soybean oil (SO), choice white grease (CWG), palm oil (PO), or 1 of 2 different sources of distillers corn oil (DCOl and DCO2). Fifty-four barrows weaned at 28-d of age were fed a common starter diet from d 1 to 7, followed by group feeding their respective experimental diets (either 100% basal or 90% basal + 10% test lipid) from d 8 to 14 to adapt the pigs to their dietary treatments and to optimize subsequent feed intake. For the next 10 d (d 15 to 24), pigs were moved to metabolism crates for continued diet adaptation and to become accustomed to the twice daily feeding regimen in the metabolism crates. Following this period, a 4-d total fecal and urine collection occurred (d 25 to 29, final BW 11.03 ± 0.51 kg) to determine apparent total tract digestibility (ATTD) of energy and lipids, and to determine the DE and ME content of each lipid source. After an overnight fast of 12 h, urine was collected for 5 h, quantified, and subsequently analyzed for thiobarbituric acid reactive substances (TBARS) and isoprostane (IsoP) concentration. Following this collection, serum was obtained and analyzed for TBARS. Soybean oil had greatest (P < 0.05) DE (9388 kcal/kg) content compared with DCOl, DCO2, CWG, PO, and SO containing 8001, 8052, 8531, 8293, and 9388 kcal/kg lipid, respectively. Digestible energy as a percentage of GE was greatest (P < 0.05) for SO when compared to the other lipid sources (P < 0.05). The ATTD of EE averaged 85.0% and varied slightly (84.4% to 85.6%) among treatments. Differences in ME among lipids were similar to that for DE, with ME values for DCOl, DCO2, CWG, PO, and SO containing 7921, 7955, 8535, 8350, and 9408 kcal/kg lipid, respectively. Metabolizable energy as a percentage of DE did not differ between lipid sources. Pigs fed the diets containing lipids had higher (P < 0.05) plasma TBARS compared to pigs fed the control diet, but no differences were noted in urinary TBARS excretion among treatments. Urinary IsoP excretion differed among treatments (P < 0.01), but was highly variable (34.0 to 104.6 pg/ml). These results indicate that DE and ME values vary among lipid sources and appear to have variable effects on metabolic oxidation measures. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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12. Anaphylaxis from rifampin.
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Harland, R W, Lindblom, S S, and Munnell, M O
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- 1992
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13. Effect of Synovex-S and ractopamine on serum concentration of IGF-I, performance and carcass characteristics of finishing steers.
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Rosa, A. J. M., Clapper, J. L, Sanborn, A. M., Lindblom, S. L., Smith, C., Wulf, D. M., Wright, C. L., and Clapper, J. A.
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FACTORIAL experiment designs ,BEEF cattle ,SERUM ,GENE expression ,BLOOD sampling - Abstract
Twenty-nine Angus yearling steers (BW=417.3 ±31.3 kg) were used in a 2X2 factorial experiment conducted over 105 d feeding period to determine the effects of Synovex-S and ractopamine on serum concentration of IGF-I, performance and carcass characteristics. Traits analyzed were ADG from 0 d to 105 d after implant (ADG1) and ADG from 70 d to 105 d (ADG2), after starting ractopamine administration, HCW, LM area (LMA), back fat thickness (BF), marbling score (MARB), KPH and Yield Grade (YG), IGF-I and estradiol-17β (E2) concentrations. Treatments included: 1) control (C), 2) ractopamine (R), 3) Synovex-S implant (I) and 4) ractopamine and implant (RI). Weights were collected monthly, while blood samples were drawn on 0, 7, 35, 79 and 105 d. No interactions were found for any trait analyzed. ADG1 were 1.42, 1.55, 1.70 and 1.72 kg/d while ADG2 were 1.43, 1.73, 1.67 and 1.81 kg/d for C, R, I and RI respectively. Synovex-S affected ADG1 (P=0.02) but did not affect ADG2 (P=0.17). Ractopamine tended to increase ADG2 (P=0.06). No significant differences were found for HCW, LMA, BF, MARB, KPH or YG. Average carcass traits were HCW=357.8kg, LMA=83.1cm2, BF=1.12cm, MARB=415 (SM15), KPH=1.93% and YG=2.87. Synovex-S increased mean serum concentrations of E2 by 44% at 7 d (P=0.0003), by 42% at 35 d (P=0.0001), by 46% at 79 d (P=0.0001) and 13% at 105 d (P=0.012). Synovex-S increased mean serum concentrations of IGF-I by 43% at 7 d (P=0.036), by 51% at 5 d (P=0.007), by 60% at 79 d (P=0.011) and 25% at 105 d (P=0.063). Ractopamine did not alter serum concentration of E2 or IGF-I. Results indicate an effect of Synovex-S on IGF-I concentrations as well as on ADG1. Reduced increase on E2 and IGF-I might explain the lack of significance on ADG2 from the implant. Gene expression analysis using microarray will be performed on mRNA extracted from muscle biopsies (79 d) to identify changes in response to ractopamine and Synovex-S. [ABSTRACT FROM AUTHOR]
- Published
- 2006
14. I. VEGETATIVE OR VISCERAL NEUROLOGY..
- Author
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Lindblom, S.
- Published
- 1922
15. Chlamydia and HLA-DR genotypes in coronary atherosclerosis
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Saldeen, T.G.R., Ericson, K., Lindquist, O., Pahlson, C., Lindblom, S., and Liu, A.J.
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- 1998
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16. Experiences and preferences of people with stroke and caregivers, around supports provided at the transition from hospital to home: a qualitative descriptive study.
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O'Callaghan G, Fahy M, O'Meara S, Lindblom S, von Koch L, Langhorne P, Galvin R, and Horgan F
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- Humans, Female, Male, Middle Aged, Aged, Adult, Patient Discharge, Patient Preference psychology, Aged, 80 and over, Social Support, Stroke Rehabilitation methods, Stroke Rehabilitation psychology, Home Care Services, Caregivers psychology, Qualitative Research, Stroke psychology, Stroke therapy
- Abstract
Background: Transitioning home from the structured hospital setting poses challenges for people with stroke (PWS) and their caregivers (CGs), as they navigate through complex uncertainties. There are gaps in our understanding of appropriate support interventions for managing the transition home. In this qualitative study, we explored the perspectives of PWS and their CGs regarding their support experiences and preferences during this period., Methods: Between November 2022 and March 2023, and within six months of hospital discharge, audio-recorded, semi-structured interviews were conducted with PWS and CGs. All interviews were transcribed, imported into NVivo software, and analysed using reflexive thematic analysis., Results: Sixteen interviews were conducted, nine with PWS and seven with CGs. Four themes relevant to their collective experiences and preferences were identified: (i) Need for tailored information-sharing, at the right time, and in the right setting; (ii) The importance of emotional support; (iii) Left in limbo, (iv) Inequity of access. Experiences depict issues such as insufficient information-sharing, communication gaps, and fragmented and inequitable care; while a multi-faceted approach is desired to ease anxiety and uncertainty, minimise delays, and optimise recovery and participation during transition., Conclusions: Our findings highlight that regardless of the discharge route, and even with formal support systems in place, PWS and families encounter challenges during the transition period. The experiences of support at this transition and the preferences of PWS and CGs during this important period highlights the need for better care co-ordination, early and ongoing emotional support, and equitable access to tailored services and support. Experiences are likely to be improved by implementing a partnership approach with improved collaboration, including joint goal-setting, between PWS, CGs, healthcare professionals and support organisations., (© 2024. The Author(s).)
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- 2024
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17. Lifestyle counseling in patients with hypertension in primary health care and its association with antihypertensive pharmacotherapy.
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Lindblom S, Ivarsson C, Wändell P, Bergqvist M, Norrman A, Eriksson J, Lund L, Hagströmer M, Hasselström J, Sandlund C, and Carlsson AC
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- Humans, Female, Male, Middle Aged, Aged, Counseling methods, Sweden epidemiology, Adult, Hypertension drug therapy, Hypertension epidemiology, Primary Health Care statistics & numerical data, Antihypertensive Agents therapeutic use, Life Style
- Abstract
The study aimed to investigate differences in hypertensive- and cardio-preventive pharmacotherapy depending on if patients with hypertension received lifestyle counseling or not, including the difference between men and women. Data from the Region Stockholm VAL database was used to identify all patients with a hypertension diagnosis and had visited a primary health care center within the past five years. Data included registered diagnoses, pharmacotherapy, and codes for lifestyle counseling. Logistic regression adjusted for age and comorbidity (diabetes, stroke, coronary heart disease, atrial fibrillation, gout, obesity, heart failure) was used, presenting results as odds ratios (OR) with 99% confidence interval (CI). The study included 130,030 patients with hypertension; 63,402 men and 66,628 women. Patients receiving recommended lifestyle counseling were more frequently treated with three or more hypertensive drugs: women OR 1.38 (1.31, 1.45) and men = 1.36 (1.30, 1.43); certain drug classes: calcium antagonists: women 1.09 (1.04, 1.14) and men 1.11 (1.06, 1.16); thiazide diuretics: women 1.26 (1.20, 1.34) and men 1.25 (1.19, 1.32); and aldosterone antagonists: women 1.25 (1.12, 1.41) and men 1.49 (1.34, 1.65). Patients receiving recommended level of lifestyle counseling with concomitant coronary heart disease, atrial fibrillation, diabetes, or stroke were more frequently treated with statins than those who did not. Further, recommended lifestyle counseling was significantly associated with anticoagulant treatment in patients with atrial fibrillation. Lifestyle counseling according to recommendations in national guidelines was significantly associated with a more thorough pharmacological treatment of hypertension, statins, and antithrombotic drugs as well as anticoagulants, in both men and women., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)
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- 2024
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18. Predicting new cases of hypertension in Swedish primary care with a machine learning tool.
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Norrman A, Hasselström J, Ljunggren G, Wachtler C, Eriksson J, Kahan T, Wändell P, Gudjonsdottir H, Lindblom S, Ruge T, Rosenblad A, Brynedal B, and Carlsson AC
- Abstract
Background: Many individuals with hypertension remain undiagnosed. We aimed to develop a predictive model for hypertension using diagnostic codes from prevailing electronic medical records in Swedish primary care., Methods: This sex- and age-matched case-control (1:5) study included patients aged 30-65 years living in the Stockholm Region, Sweden, with a newly recorded diagnosis of hypertension during 2010-19 (cases) and individuals without a recorded hypertension diagnosis during 2010-19 (controls), in total 507,618 individuals. Patients with diagnoses of cardiovascular diseases or diabetes were excluded. A stochastic gradient boosting machine learning model was constructed using the 1,309 most registered ICD-10 codes from primary care for three years prior the hypertension diagnosis., Results: The model showed an area under the curve (95 % confidence interval) of 0.748 (0.742-0.753) for females and 0.745 (0.740-0.751) for males for predicting diagnosis of hypertension within three years. The sensitivity was 63 % and 68 %, and the specificity 76 % and 73 %, for females and males, respectively. The 25 diagnoses that contributed the most to the model for females and males all exhibited a normalized relative influence >1 %. The codes contributing most to the model, all with an odds ratio of marginal effects >1 for both sexes, were dyslipidaemia, obesity, and encountering health services in other circumstances., Conclusions: This machine learning model, using prevailing recorded diagnoses within primary health care, may contribute to the identification of patients at risk of unrecognized hypertension. The added value of this predictive model beyond information of blood pressure warrants further study., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)
- Published
- 2024
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19. Exploring home rehabilitation therapists' experiences of supporting older persons to physical exercise after acute hospitalization: a qualitative interview study.
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Sandlund C, Sandberg L, Lindblom S, Frisendahl N, Boström AM, and Welmer AK
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- Humans, Male, Female, Aged, Sweden, Physical Therapists, Exercise, Middle Aged, Interviews as Topic, Attitude of Health Personnel, Adult, Qualitative Research, Hospitalization, Home Care Services, Exercise Therapy
- Abstract
Purpose: After hospitalization, older persons may face a decline in physical function and daily independence. In-hospital exercise interventions can mitigate this decline, and continued support from primary healthcare post-discharge may enhance sustainability. This study aimed to explore home rehabilitation therapists' experiences of supporting physical exercise after acute hospitalization, including exercise programs initiated during hospital stay., Methods: This qualitative study was conducted alongside a randomized-controlled trial to investigate prerequisites for a transitional care intervention. Twelve interviews were conducted with physiotherapists, occupational therapists, and managers across seven rehabilitation therapy services in Stockholm, Sweden. Data were analyzed using reflexive thematic analysis., Results: The analysis generated the theme Striving for individualized support for physical exercise, although limited resources and a fragmented home care risk to direct support away from those who need it the most. It was based on four subthemes: The starting point is always the patient's current needs, goals, and prerequisites, Continuing the exercise initiated during hospitalization by adapting it to the patient's situation at home, Work premises not tailored to patients with complex care needs, and A home care organization that lacks coordination and unified purpose., Conclusions: Interventions supporting older persons to physical exercise after acute hospitalization need to be tailored to the individual, support motivation, and be adapted to the patient's home situation. Challenges may arise when care recourses lack alignment with the patients' needs, and when the collaboration among care providers is limited. The findings contribute valuable insights for future studies incorporating transitional care interventions in similar context., (© 2024. The Author(s).)
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- 2024
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20. In vitro activity of omadacycline against clinical isolates of Nocardia .
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Pham J, Benefield RJ, Baker N, Lindblom S, Canfield N, Gomez CA, and Fisher M
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- Humans, Nocardia drug effects, Microbial Sensitivity Tests, Tetracyclines pharmacology, Anti-Bacterial Agents pharmacology, Nocardia Infections microbiology, Nocardia Infections drug therapy
- Abstract
Nocardiosis typically requires a prolonged treatment duration of ≥6 months and initial combination therapy with 2-3 antibiotics. First-line regimens for nocardiosis are associated with considerable toxicity; therefore, alternative therapies are needed. Omadacycline is an aminomethylcycline with broad antimicrobial activity whose in vitro activity against Nocardia species has not been formally assessed. The in vitro potency of omadacycline was evaluated against 300 Nocardia clinical isolates by broth microdilution. The most common Nocardia species tested were N. cyriacigeorgica (21%), N. nova (20%), and N. farcinica (12%). The most common specimens were respiratory (178 isolates, 59%) and wound (57 isolates, 19%). Omadacycline minimum inhibitory concentrations (MICs) across all Nocardia species ranged from 0.06 µg/mL to 8 µg/mL, with an MIC
50 of 2 µg/mL and MIC90 of 4 µg/mL. The lowest MICs were found among N. paucivorans (MIC50 = 0.25 µg/mL, MIC90 = 0.25 µg/mL), N. asiatica (MIC50 = 0.25 µg/mL, MIC90 = 1 µg/mL), N. abscessus complex (MIC50 = 0.5 µg/mL, MIC90 = 1 µg/mL), N. beijingensis (MIC50 = 0.5 µg/mL, MIC90 = 2 µg/mL), and N. otitidiscaviarum (MIC50 = 1 µg/mL, MIC90 = 2 µg/mL). The highest MICs were found among N. farcinica (MIC50 = 4 µg/mL, MIC90 = 8 µg/mL). In vitro potency differed by species among Nocardia clinical isolates. Further studies are warranted to evaluate the potential clinical utility of omadacycline for nocardiosis., Competing Interests: R.J.B. reports receiving prior research support from Rempex Pharmaceuticals. The other authors have no relevant conflicts of interest to disclose.- Published
- 2024
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21. Association between general self-efficacy and health literacy among stroke survivors 1-year post-discharge: a cross-sectional study.
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Hess Engström A, Flink M, Lindblom S, von Koch L, and Ytterberg C
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- Humans, Self Efficacy, Activities of Daily Living psychology, Cross-Sectional Studies, Patient Discharge, Aftercare, Survivors psychology, Stroke Rehabilitation, Health Literacy, Stroke complications
- Abstract
Stroke may affect physical functioning, cognition, and mental and social aspects of one's life. Health literacy and self-efficacy are associated with positive health outcomes and are important factors for managing the diverse consequences of a stroke. However, there is very little literature on the association between health literacy and self-efficacy. This study aimed to investigate the association between health literacy and self-efficacy among stroke survivors 1 year after discharge from hospital. Participants in this cross-sectional study were patients diagnosed with a stroke, mainly a mild stroke, who were referred to rehabilitation in primary care after discharge from hospital in Sweden. Data was collected using questionnaires, performance-based tests, and medical records. Ordinal logistic regression was used to analyze the association between general self-efficacy and health literacy in adjusted models. The analysis revealed that higher levels of general self-efficacy and higher levels of performing activities of daily living were associated with higher levels of health literacy. Stroke survivors with higher general self-efficacy also report higher health literacy 1-year post-discharge from hospital. Future studies should focus on the pathways by which health literacy and general self-efficacy work among stroke survivors and in populations with low health literacy, severe stroke or significant cognitive impairments., (© 2024. The Author(s).)
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- 2024
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22. A person-centred care transition support for people with stroke/TIA: A study protocol for effect and process evaluation using a non-randomised controlled design.
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Lindblom S, Flink M, von Koch L, Tistad M, Stenberg U, Elf M, Carlsson AC, Laska AC, and Ytterberg C
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- Humans, Patient Discharge, Patient-Centered Care, Quality of Life, Controlled Clinical Trials as Topic, Ischemic Attack, Transient, Stroke therapy
- Abstract
Introduction: Care transitions following a stroke call for integrated care approaches to reduce death and disability. The proposed research described in this study protocol aims to evaluate the effectiveness of a person-centred multicomponent care transition support and the process in terms of contextual moderators, implementation aspects and mechanisms of impact., Methods: A non-randomized controlled trial design will be used. The intervention includes person-centred dialogue intended to permeate all patient-provider communication, various pedagogical modes of information, a person-centred care and rehabilitation plan, and a bridging e-meeting to prepare patients for homecoming. Patients with stroke or TIA who are to be discharged from the participating hospitals to home and referred to a neurorehabilitation team for continued rehabilitation will be included. Follow-ups will be conducted at one week, 3 months and 12 months. Data will be collected on the primary outcome of perceived quality of the care transition, and on the secondary outcomes of health literacy, medication adherence, and perceived person-centeredness. Data for process evaluation will be collected through semi-structured interviews, focus groups, participatory observations, and the Normalisation Measure Development Questionnaire., Discussion: The study will provide insights on implementation, mechanisms of impact, contextual moderators, and effectiveness of a care transition support, targeting a poorly functioning part of the care trajectory for people with stroke and TIA., Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT05646589., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lindblom et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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23. Health literacy is associated with less depression symptoms, higher perceived recovery, higher perceived participation, and walking ability one year after stroke - a cross-sectional study.
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Flink M, Lindblom S, von Koch L, Carlsson AC, and Ytterberg C
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- Male, Humans, Aged, Female, Cross-Sectional Studies, Depression etiology, Aftercare, Patient Discharge, Walking, Stroke diagnosis, Health Literacy, Stroke Rehabilitation
- Abstract
Introduction: Life after stroke may entail several lifestyle changes and new routines. Hence, it is imperative for people with stroke to understand and make use of health information, i.e. to have sufficient health literacy. This study aimed to explore health literacy and its associations with outcomes at 12-months post-discharge regarding depression symptoms, walking ability, perceived stroke recovery, and perceived participation in people with stroke., Methods: This was a cross-sectional study of a Swedish cohort. Data were collected at 12 months post-discharge using European Health Literacy Survey Questionnaire, the Hospital Anxiety and Depression Scale, the 10-m walk test, and the Stroke Impact Scale 3.0. Each outcome was then dichotomized into favorable versus unfavorable outcome. Logistic regression was performed to assess the association between health literacy and favorable outcomes., Results: The participants, n = 108, were on average 72 years old, 60% had mild disability, 48% had a university/college degree, and 64% were men. At 12 months post-discharge, 9% of the participants had inadequate health literacy, 29% problematic health literacy, and 62% sufficient health literacy. Higher levels of health literacy were significantly associated with favorable outcomes relating to depression symptoms, walking ability, perceived stroke recovery, and perceived participation in models adjusted for age, sex, and education level., Conclusion: The association between health literacy and mental, physical, and social functioning 12-months post-discharge suggests that health literacy is an important factor to consider in post-stroke rehabilitation. Longitudinal studies of health literacy in people with stroke are warranted to explore the underlying reasons for these associations.
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- 2023
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24. The Use of Teach Back at Hospital Discharge to Support Self-Management of Prescribed Medication for Secondary Prevention after Stroke-Findings from A Feasibility Study.
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Lindblom S, Ytterberg C, Flink M, Carlsson AC, Stenberg U, Tistad M, von Koch L, and Laska AC
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The study aimed to investigate whether a structured discharge letter and the use of the person-centred communication method Teach Back for sharing information at hospital discharge could support perceived understanding and knowledge of and adherence to prescribed medication for secondary prevention after stroke. Data from a feasibility study of a codesigned care transition support for people with stroke was used. Patients who at discharge received both a structured discharge letter and participated in the person-centred communication method Teach Back ( n = 17) were compared with patients receiving standard discharge procedures ( n = 21). Questionnaires were used to compare the groups regarding perceived understanding of information about medical treatment, knowledge of information about medical treatment and medication adherence at 1 week and 3 months. There was a statistically significant difference in perceived understanding of information about medical treatment ( p > 0.01) between the groups in favour of those who participated in Teach Back at the discharge encounter. No differences between groups were found regarding understanding health information about medical treatment and medication adherence. The results indicate that the use of Teach Back at the discharge encounter positively impacts perceived understanding of information about medical treatment in people with stroke. However, considering the nonrandomised study design and the small sample size, a large-scale trial is needed.
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- 2023
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25. Referral-based transition to subsequent rehabilitation at home after stroke: one-year outcomes and use of healthcare services.
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Lindblom S, Tistad M, Flink M, Laska AC, von Koch L, and Ytterberg C
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- Aged, Ambulatory Care, Delivery of Health Care, Female, Humans, Male, Referral and Consultation, Stroke therapy, Stroke Rehabilitation
- Abstract
Background: There is a lack of knowledge about patients' journeys across the stroke care continuum, especially regarding the transition from inpatient to outpatient care and rehabilitation. Therefore, the aim of the present study was to explore and describe patterns of healthcare use over a one-year period, health outcomes at 3 and 12 months for patients following a referral-based transition to subsequent rehabilitation in the home, and the caregiver burden on their significant others. A further aim was to explore factors associated with the use of rehabilitation and healthcare after the referral-based transition to continued rehabilitation in the home for people recovering from a stroke., Methods: Data regarding healthcare use during the first 12 months post-stroke was collected from the Region Stockholm computerized register. Data on patient characteristics, disease-related data, and functioning were retrieved drawn from medical records and questionnaires. Descriptive statistics were used to present healthcare use, participants' characteristics, disease-related data, and patient functioning. Multivariable regression models were created to explore associations between the total number of outpatient contacts, total visits with the neurorehabilitation team, and the independent variables., Results: The mean age for the 190 participants was 73 years for men and 78 years for women. Twenty-one participants (11%) had an acute rehospitalization within 30 days after discharge, and 41 participants (21%) were re-hospitalized within 90 days. Twenty-two (12%) of the participants had no visits with the neurorehabilitation team, 73 (39%) participants had 1-3 visits, 57 (30%) had 4-16 visits, and 38 (20%) had ≥17 visits. Female sex and length of hospital stay were associated with a higher number of visits with the neurorehabilitation team. Living alone, higher self-rated recovery, and being able to walk independently were associated with a lower number of visits with the neurorehabilitation team. Female sex, having home help services before the stroke, longer length of hospital stay, and more comorbidities were associated with a higher number of outpatient contacts., Conclusions: The findings indicate that there is no generic pattern of healthcare use during the first-year post-stroke in patients receiving referral-based transition to continued rehabilitation in the home. The different patterns of healthcare use seemed to mirror the participants' level of functioning. However, there is a need to further investigate how follow-up and rehabilitation correspond to the needs of patients and their significant others in the short- and long-term perspective., Trial Registration: ClinicalTrials.gov , registration number: NCT02925871 . Date of registration: October 6, 2016., (© 2022. The Author(s).)
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- 2022
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26. Person-centred care transitions for people with stroke: study protocol for a feasibility evaluation of codesigned care transition support.
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Flink M, Lindblom S, Tistad M, Laska AC, Bertilsson BC, Wärlinge C, Hasselström J, Elf M, von Koch L, and Ytterberg C
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- Aged, Feasibility Studies, Humans, Patient Transfer, Patient-Centered Care, Quality of Life, Stroke therapy, Stroke Rehabilitation
- Abstract
Background: Care transitions following stroke should be bridged with collaboration between hospital staff and home rehabilitation teams since well-coordinated transitions can reduce death and disability following a stroke. However, health services are delivered within organisational structures, rather than being based on patients' needs. The aim of this study protocol is to assess the feasibility, operationalised here as fidelity and acceptability, of a codesigned care transition support for people with stroke., Methods: This study protocol describes the evaluation of a feasibility study using a non-randomised controlled design. The codesigned care transition support includes patient information using videos, leaflets and teach back; what-matters-to me dialogue; a coordinated rehabilitation plan; bridged e-meeting; and a message system for cross-organisational collaboration. Patients with stroke, first time or recurrent, who are to be discharged home from hospital and referred to a rehabilitation team in primary healthcare for continued rehabilitation in the home will be included. One week after stroke, data will be collected on the primary outcome, namely satisfaction with the care transition support, and on the secondary outcome, namely health literacy and medication adherence. Data on use of healthcare will be obtained from a register of healthcare contacts. The outcomes of patients and significant others will be compared with matched controls from other geriatric stroke and acute stroke units, and with matched historic controls from a previous dataset at the intervention and control units. Data on acceptability and fidelity will be assessed through interviews and observations at the intervention units., Ethics and Dissemination: Ethical approvals have been obtained from the Swedish Ethical Review Authority. The results will be published open-access in peer-reviewed journals. Dissemination also includes presentation at national and international conferences., Discussion: The care transition support addresses a poorly functioning part of care trajectories in current healthcare. The development of this codesigned care transition support has involved people with stroke, significant other, and healthcare professionals. Such involvement has the potential to better identify and reconceptualise problems, and incorporate user experiences., Trial Registration Number: http://www.clinicaltrials.gov id: NCT02925871. Date of registration 6 October 2016., Protocol Version: 1., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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27. Supersaturated formulations of poorly soluble weak acid drugs evaluated in rodents; a case study.
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Sigfridsson K, Andreasson T, Fihn BM, Kearns M, and Lindblom S
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- Administration, Oral, Animals, Drug Compounding, Rodentia, Solubility, Pharmaceutical Preparations
- Abstract
In the present study we describe a way of working to overcome oral administration challenges in an early preclinical project. As candidate drugs were obtained, the preclinical delivery route was replaced by the intended route of the product and resources were allocated to optimize the oral absorption. Two main approaches were followed in order to formulate a selected weak acid, AZ'403, for oral administration in large scale toxicological studies and the early clinical phases. Both approaches relies on the suppression of precipitation from obtained supersaturated solutions achieved either by amorphous solid dispersions (using hydroxypropyl methylcellulose acetate succinate, HPMC-AS) or crystalline salts (sodium and potassium salts). In vivo studies in rodents were performed to evaluate oral AZ'403 absorption from amorphous and crystalline formulations, using nano- and micro crystalline particles of the neutral form, as references. The oral absorption of AZ'403 formulated using both approaches was significantly higher compared with the references. The improvements in overall exposures were 7-100 times during the investigated conditions. The pharmacokinetic profiles implied that both solid dispersions and crystalline salts of AZ'403 generated supersaturation in the small intestine in rodents and indicated that both approaches may be ways forward for subsequent late stage product development., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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28. The manifestation of participation within a co-design process involving patients, significant others and health-care professionals.
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Lindblom S, Flink M, Elf M, Laska AC, von Koch L, and Ytterberg C
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- Humans, Qualitative Research, Health Personnel, Hospitals
- Abstract
Background: Despite intentions to increase user participation in the development of health services, the concept of participation and how it unfolds within studies with a participatory design has rarely been addressed., Objective: The aim of this study was to describe how user participation manifests itself within a co-design process involving patients, significant others and health-care professionals, including potential enablers or barriers., Methods: This study was conducted in the context of a co-design process of a new person-centred transition from a hospital to continued rehabilitation in the home involving three patients with stroke, one significant other and 11 professionals. Data were collected by observations during the workshops, semi-structured interviews and questionnaires., Results: Four categories: 'Composition of individuals for an adaptive climate'; 'The balancing of roles and power'; 'Different perspectives as common ground for a shared understanding'; and 'Facilitating an unpredictable and ever-adaptive process', with all together nine subcategories, resulted from the analysis. Participation varied between individuals, groups and steps within the process, and on the topic of discussions and the motivation to contribute., Discussion/conclusion: Participation is not something that is realized by only applying participatory design methodology. Participation manifests itself through the interaction of the participants and their skills to handle different perspectives, roles and assignments. Participation is enabled by individual, group and facilitating aspects. Co-design processes should allow for varying levels of participation among the participants and throughout the process., Patient or Public Contribution: Patients, significant others and health-care professionals participated as co-designers of a care transition model between hospital and home., (© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.)
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- 2021
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29. Telecritical Care Clinical and Operational Strategies in Response to COVID-19.
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Singh J, Green MB, Lindblom S, Reif MS, Thakkar NP, and Papali A
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- Critical Care, Humans, Intensive Care Units, Pandemics, Surge Capacity, COVID-19, Delivery of Health Care organization & administration, Telemedicine economics, Telemedicine instrumentation
- Abstract
Background: The cororavirus disease 19 (COVID-19) pandemic has strained intensive care unit (ICU) material and human resources to global crisis levels. The risks of staffing challenges and clinician exposure are of significant concern. One resource, telecritical care (TCC), has the potential to optimize efficiency, maximize safety, and improve quality of care provided amid large-scale disruptions, but its role in pandemic situations is only loosely defined. Planning and Preparation Phase: We propose strategic initiatives by which TCC may act as a force multiplier for pandemic preparedness in response to COVID-19, utilizing a tiered approach for increasing surge capacity needs. The goals involved usage of TCC to augment ICU capacity, optimize safety, minimize personal protective equipment (PPE) use, improve efficiencies, and enhance knowledge of managing pandemic response. Implementation Phase: A phased approach utilizing TCC would involve implementing remote capabilities across the enterprise to accomplish the goals outlined. The hardware and software needed for initial expansion to cover 275 beds included $956,670 for mobile carts and $173,106 for home workstations. Team role deployment and bedside clinical care centering around TCC as critical care capacity expand beyond 275 beds. Surge capacity was not reached during early phases of the pandemic in the region, allowing refinement of TCC during subsequent pandemic phases. Conclusions: Leveraging TCC facilitated pandemic surge planning but required redefinition of typical ICU staffing models. The design was meant to workforce efficiencies, reduce PPE use, and minimize health care worker exposure risk, all while maintaining quality care standards through an intensivist-led model. As health care operations resumed and states reopened, TCC is being used to support shifts in volume and critical care personnel during the pandemic evolution. The lessons applied may help health care systems through variable phases of the pandemic.
- Published
- 2021
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30. Perceived Quality of Care Transitions between Hospital and the Home in People with Stroke.
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Lindblom S, Flink M, Sjöstrand C, Laska AC, von Koch L, and Ytterberg C
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- Aftercare, Aged, Hospitals, Humans, Patient Discharge, Patient Transfer, Stroke therapy, Stroke Rehabilitation
- Abstract
Objectives: To explore the perceived quality of care transitions from hospital to the home with referral to subsequent rehabilitation in the home, and factors associated with low perceived quality, in people with stroke., Design: Observational study., Setting and Participants: Eligible were patients with a suspected acute stroke admitted to 1 of 4 inpatient hospital units in the Stockholm region and discharged home with referral to a neurorehabilitation team in primary care., Methods: Data on perceived quality of care transition was collected with the Care Transition Measure (CTM-15) 1 week after discharge. Additional data were mainly retrieved from medical records. To analyze difference in mean total score of the CTM-15 between participants' characteristics, length of hospital stay, disease-related data, and functioning, the Mann-Whitney U test and independent sample t test were used for dichotomized variables and 1-way analysis of variance and the Tukey post hoc test for variables with more than 2 groups. To analyze differences between participants with low and high perceived quality per item, univariable regression analyses were performed. Thereafter, multivariable regression models were created to explore associations between low perceived quality and the independent variables., Results: Mean age of the 189 participants was 75 years and 91% had a mild or very mild stroke. The majority perceived most areas of the care transition to be of high quality. Nevertheless, several areas for improvement were identified. People with a more severe stroke perceived the quality of the care transition to be lower in comparison with those with a mild stroke. The association was weak between patient or clinical characteristics and the perceived quality., Conclusion and Implications: Our findings suggest that preparation for discharge and information and support for self-management postdischarge should be enhanced in the referral-based care transition after stroke. Special attention should be given to people with severe stroke., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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31. Defining the characteristics of intermediate care models including transitional care: an international Delphi study.
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Sezgin D, O'Caoimh R, O'Donovan MR, Salem MA, Kennelly S, Samaniego LL, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Holditch C, Bettger JP, Vernon M, Carroll Á, Gradinger F, Perman G, Wilson M, Vella A, Cherubini A, Tucker H, Fantini MP, Onder G, Roller-Wirnsberger R, Gutiérrez-Robledo LM, Cesari M, Bertoluci P, Kieliszek M, van der Vlegel-Brouwer W, Nelson M, Mañas LR, Antoniadou E, Barriere F, Lindblom S, Park G, Pérez I, Alguacil D, Lowdon D, Alkiza ME, Bouzon CA, Young J, Carriazo A, Liew A, and Hendry A
- Subjects
- Aged, Communication, Consensus, Delphi Technique, Humans, Surveys and Questionnaires, Transitional Care
- Abstract
Background: Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions., Aim: To identify and define the characteristics of intermediate care models., Methods: A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted., Results: Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models., Discussion: There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination., Conclusions: This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.
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- 2020
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32. Perceptive Dialogue for Linking Stakeholders and Units During Care Transitions - A Qualitative Study of People with Stroke, Significant Others and Healthcare Professionals in Sweden.
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Lindblom S, Ytterberg C, Elf M, and Flink M
- Abstract
Introduction: Care transitions are a complex set of actions that risk poor quality outcomes for patients and their significant others. This study explored the transition process between hospital and continued rehabilitation in the home. The process is explored from the perspectives of people with stroke, significant others and healthcare professionals in Stockholm, Sweden., Method: Focus group interviews (n = 10), semi-structured individual interviews (n = 23) and interviews in dyad (n = 4) were conducted with healthcare professionals, people with stroke and significant others, altogether 71 participants. Data was collected and analyzed using Grounded Theory., Results: One core category "Perceptive dialogue for a coordinated transition", and two categories "Synthesis of parallel processes for common understanding" and "The forced transformation from passive attendant to uninformed agent" emerged from the analysis. The transition consisted of several parallel processes which made it difficult for the stakeholders to get a common understanding of the transition as a whole. Enabling a perceptive dialogue was as a prerequisite for the creation of a common understanding of the care transition., Conclusion: This study elucidates that a perceptive dialogue with patients/significant others as well as within and across organizations is part of a coordinated and person-centred transition. There is an extensive need for increased involvement of patients and significant others regarding dialogue about health conditions, procedures at the hospital and preparation for self-management after discharge., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)
- Published
- 2020
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33. Southwest Greenland shelf glaciation during MIS 4 more extensive than during the Last Glacial Maximum.
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Seidenkrantz MS, Kuijpers A, Olsen J, Pearce C, Lindblom S, Ploug J, Przybyło P, and Snowball I
- Abstract
Although geological and modelling evidence indicate that the last glacial inception in North America was in NE Canada, little is known about the glacial response of the nearby western Greenland Ice Sheet (GIS) during the glacial advance of marine oxygen isotope stage 4 (MIS4). Our multi-proxy study of a marine sediment core collected about 60 km southwest of the Outer Hellefisk Moraines demonstrates that in the southern Davis Strait region the most extreme Greenland shelf glaciation of the last glacial cycle occurred during MIS 4, with another prominent glacial advance at 37-33 kyr BP. During those periods the GIS likely reached the Outer Hellefisk Moraines in this area. Except for these two periods, our data suggest significant advection of relatively warm Irminger Sea Water by the West Greenland Current since MIS 4. This advection likely limited the extent of the MIS2 glaciation on the SW Greenland shelf. Decreased precipitation over southwestern Greenland predicted by atmospheric models as a downstream effect of a much larger MIS2 Laurentide Ice Sheet may have played an additional role.
- Published
- 2019
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34. Characterization of Innate Immunity in an Extended Whole Blood Model of Human Islet Allotransplantation.
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Hårdstedt M, Lindblom S, Karlsson-Parra A, Nilsson B, and Korsgren O
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- Antithrombin III immunology, Blood Coagulation, CD40 Antigens blood, CD40 Antigens immunology, Cells, Cultured, Chemokines blood, Chemokines immunology, Complement Activation, Humans, Immunity, Cellular, Inflammation immunology, Interleukins blood, Interleukins immunology, Peptide Hydrolases blood, Peptide Hydrolases immunology, Platelet Activation, Transplantation, Homologous, Immunity, Innate, Inflammation blood, Islets of Langerhans Transplantation immunology
- Abstract
The instant blood-mediated inflammatory reaction (IBMIR) has been studied in whole blood models of human allo-islet transplantation for short periods (<6 h). Beyond this time frame the innate response to intraportally transplanted islets is less well described. A novel whole blood model was applied to study blood-islet-graft interactions up to 48 h. Heparinized polyvinyl chloride tubing was sealed into small bags containing venous blood together with allogeneic human islets and exocrine tissue, respectively. The bags were attached to a rotating wheel (37°C). Concentrated glucose and sodium hydrogen carbonate were added every 12 h to maintain physiological limits for sustained immune cell functions. Plasma was collected at repeated time points for analyses of coagulation/complement activation and chemokine/cytokine production. Immune cell infiltration was analyzed using immunohistochemistry. Coagulation and platelet activation markers, thrombin-antithrombin complex (TAT) and soluble CD40 ligand (sCD40L) showed early high concentrations (at 6-12 h). sC5b-9 steadily increased over 48 h. At 6 h neutrophils and monocytes surrounded the clotted cellular grafts with a following massive infiltration of neutrophils. High and increasing concentrations of CXCR1/2 ligands [IL-8 and growth-regulated oncogene α/β/γ (Gro-α/β/γ)] and IL-6 were produced in response to human islets and exocrine tissue. The CCR2 ligand monocyte chemoattractant protein 1 (MCP-1) exhibited increasing concentrations in response to exocrine tissue. The CXCR3 ligand interferon-inducible T cell α chemoattractant (I-TAC) was produced in response to both human islets and exocrine tissue from 6 h. Monokine induced by γ interferon (Mig) and interferon γ-induced protein 10 (IP-10) showed a later response, preferentially to exocrine tissue and with larger variations among preparations. An extended blood model of clinical islet transplantation allowed characterization of early immune activation in response to human islets and exocrine tissue. Increased production of chemokines targeting CXCR1/2, CCR2, and CXCR3 was observed, accompanied by massive intraislet neutrophil infiltration over 48 h. The model proved to be useful in exploring early blood-mediated reactions to cellular transplants and has relevance for evaluation of pharmacological interventions to prevent graft loss.
- Published
- 2016
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35. A novel model for studies of blood-mediated long-term responses to cellular transplants.
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Hårdstedt M, Lindblom S, Hong J, Nilsson B, Korsgren O, and Ronquist G
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- Animals, Antithrombin III chemistry, Blood Gas Analysis, Blood Glucose metabolism, Carbon Dioxide chemistry, Cations, Cell Survival, Chlorides chemistry, Collagen chemistry, Complement Activation, Glucose chemistry, Hemolysis, Humans, Hydrogen-Ion Concentration, Ions, Islets of Langerhans cytology, Islets of Langerhans Transplantation methods, Leukocytes cytology, Osmolar Concentration, Oxygen chemistry, Pancreas metabolism, Peptide Hydrolases chemistry, Rabbits, Thromboplastin chemistry, Time Factors, Cell Transplantation methods
- Abstract
Aims: Interaction between blood and bio-surfaces is important in many medical fields. With the aim of studying blood-mediated reactions to cellular transplants, we developed a whole-blood model for incubation of small volumes for up to 48 h., Methods: Heparinized polyvinyl chloride tubing was cut in suitable lengths and sealed to create small bags. Multiple bags, with fresh venous blood, were incubated attached to a rotating wheel at 37°C. Physiological variables in blood were monitored: glucose, blood gases, mono- and divalent cations and chloride ions, osmolality, coagulation (platelet consumption, thrombin-antithrombin complexes (TAT)), and complement activation (C3a and SC5b-9), haemolysis, and leukocyte viability., Results: Basic glucose consumption was high. Glucose depletion resulted in successive elevation of extracellular potassium, while sodium and calcium ions decreased due to inhibition of energy-requiring ion pumps. Addition of glucose improved ion balance but led to metabolic acidosis. To maintain a balanced physiological environment beyond 6 h, glucose and sodium hydrogen carbonate were added regularly based on analyses of glucose, pH, ions, and osmotic pressure. With these additives haemolysis was prevented for up to 72 h and leukocyte viability better preserved. Despite using non-heparinized blood, coagulation and complement activation were lower during long-term incubations compared with addition of thromboplastin and collagen., Conclusion: A novel whole-blood model for studies of blood-mediated responses to a cellular transplant is presented allowing extended observations for up to 48 h and highlights the importance of stringent evaluations and adjustment of physiological conditions.
- Published
- 2015
- Full Text
- View/download PDF
36. Putative fossilized fungi from the lithified volcaniclastic apron of Gran Canaria, Spain.
- Author
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Ivarsson M, Broman C, Holmström SJ, Ahlbom M, Lindblom S, and Holm NG
- Subjects
- Carbonates chemistry, Ecosystem, Ferric Compounds chemistry, Hyphae, Minerals chemistry, Paleontology, Spain, Volcanic Eruptions analysis, Fossils, Fungi isolation & purification, Geologic Sediments chemistry, Geologic Sediments microbiology
- Abstract
We report the discovery of fossilized filamentous structures in samples of the lithified, volcaniclastic apron of Gran Canaria, which were obtained during Leg 157 of the Ocean Drilling Program (ODP). These filamentous structures are 2-15 μm in diameter and several hundred micrometers in length and are composed of Si, Al, Fe, Ca, Mg, Na, Ti, and C. Chitin was detected in the filamentous structures by staining with wheat germ agglutinin dye conjugated with fluorescein isothiocyanate (WGA-FITC), which suggests that they are fossilized fungal hyphae. The further elucidation of typical filamentous fungal morphological features, such as septa, hyphal bridges, and anastomosis and their respective sizes, support this interpretation. Characteristic structures that we interpreted as fossilized spores were also observed in association with the putative hyphae. The fungal hyphae were found in pyroxene phenocrysts and in siderite pseudomorphs of a basalt breccia. The fungal colonization of the basalt clasts occurred after the brecciation but prior to the final emplacement and lithification of the sediment at ∼16-14 Ma. The siderite appears to have been partially dissolved by the presence of fungal hyphae, and the fungi preferentially colonized Fe-rich carbonates over Fe-poor carbonates (aragonite). Our findings indicate that fungi may be an important geobiological agent in subseafloor environments and an important component of the deep subseafloor biosphere, and that hydrothermal environments associated with volcanism can support a diverse ecosystem, including eukaryotes.
- Published
- 2011
- Full Text
- View/download PDF
37. Alteration of the ileal microbiota of weanling piglets by the growth-promoting antibiotic chlortetracycline.
- Author
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Rettedal E, Vilain S, Lindblom S, Lehnert K, Scofield C, George S, Clay S, Kaushik RS, Rosa AJ, Francis D, and Brözel VS
- Subjects
- Animals, Anti-Bacterial Agents administration & dosage, Chlortetracycline administration & dosage, Cluster Analysis, DNA, Bacterial chemistry, DNA, Bacterial genetics, DNA, Ribosomal chemistry, DNA, Ribosomal genetics, Intercellular Signaling Peptides and Proteins administration & dosage, Intestinal Mucosa microbiology, Molecular Sequence Data, Phylogeny, RNA, Ribosomal, 16S genetics, Sequence Analysis, DNA, Swine, Anti-Bacterial Agents pharmacology, Bacteria drug effects, Biodiversity, Chlortetracycline pharmacology, Ileum microbiology, Intercellular Signaling Peptides and Proteins pharmacology
- Abstract
Antibiotics such as chlortetracycline (CTC) have been used to promote growth of pigs for decades, but concerns over increased antibiotic-resistant infections in humans have prompted the development of alternative strategies. Developing alternatives to antibiotic growth promoters (AGPs) could be informed by information on the mechanisms of growth promotion, notably, how AGPs affect the microbial populations of the gastrointestinal tract. Pigs from three sows were aseptically delivered by cesarean section. Six piglets were distributed to each of two foster mothers until weaning, when piglets were fed a diet with or without 50 mg/kg CTC for 2 weeks. The ileal bacterial microbiota was characterized by using a cultivation-independent approach based on DNA extraction, PCR amplification, cloning, and sequencing of the 16S rRNA gene pool. The ileal and mucosal communities of these growing pigs were dominated by Lactobacillus bacteria, various members of the family Clostridiaceae, and members of the poorly known genus Turicibacter. Overall, CTC treatment resulted in three shifts: a decrease in Lactobacillus johnsonii, an increase in L. amylovorus, and a decrease in Turicibacter phylotypes. The composition of the microbiota varied considerably between individual pigs, as revealed by shared operational taxonomic units (OTUs) and similarity (SONS) analysis (theta(YC) values). While the observed variation between untreated pigs obscured the possible effect of CTC, integral-LIBSHUFF and SONS analyses of pooled libraries indicated a significant shift due to CTC in both the lumen and the mucosa, with some OTUs unique to either treated or control ileum. DOTUR analysis revealed little overlap between control and treated communities at the 3% difference level, indicating unique ileal communities in the presence of CTC.
- Published
- 2009
- Full Text
- View/download PDF
38. Fossilized microorganisms from the Emperor Seamounts: implications for the search for a subsurface fossil record on Earth and Mars.
- Author
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Ivarsson M, Lausmaa J, Lindblom S, Broman C, and Holm NG
- Subjects
- Biomarkers, Calcium Carbonate chemistry, Calcium Sulfate chemistry, Geography, Glass chemistry, Mass Spectrometry, Minerals chemistry, Pacific Ocean, Spectrum Analysis, Raman, Volcanic Eruptions, X-Ray Diffraction, Zeolites chemistry, Bacteria isolation & purification, Earth, Planet, Extraterrestrial Environment, Fossils, Mars, Space Flight
- Abstract
We have observed filamentous carbon-rich structures in samples drilled at 3 different seamounts that belong to the Emperor Seamounts in the Pacific Ocean: Detroit (81 Ma), Nintoku (56 Ma), and Koko Seamounts (48 Ma). The samples consist of low-temperature altered basalts recovered from all 3 seamounts. The maximum depth from which the samples were retrieved was 954 meters below seafloor (mbsf). The filamentous structures occur in veins and fractures in the basalts, where they are attached to the vein walls and embedded in vein-filling minerals like calcite, aragonite, and gypsum. The filaments were studied with a combination of optical microscopy, environmental scanning electron microscopy (ESEM), Raman spectroscopy, and time-of-flight secondary ion mass spectrometry (ToF-SIMS). Minerals were identified by a combination of optical microscopy, X-ray diffraction, Raman spectrometry, and energy dispersive spectrometry on an environmental scanning electron microscope. Carbon content of the filaments ranges between approximately 10 wt % and approximately 50 wt % and is not associated with carbonates. These results indicate an organic origin of the carbon. The presence of C(2)H(4), phosphate, and lipid-like molecules in the filaments further supports a biogenic origin. We also found microchannels in volcanic glass enriched in carbon (approximately 10-40 wt %) compatible with putative microbial activity. Our findings suggest new niches for life in subseafloor environments and have implications for further exploration of the subseafloor biosphere on Earth and beyond.
- Published
- 2008
- Full Text
- View/download PDF
39. Adults who snore.
- Author
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Lindblom SS
- Subjects
- Adult, Combined Modality Therapy, Humans, Medical History Taking, Physical Examination, Polysomnography, Positive-Pressure Respiration, Sleep Apnea Syndromes diagnosis, Sleep Apnea Syndromes therapy, Snoring therapy, Snoring diagnosis
- Abstract
Snoring is a common finding in adults and may signal sleep-disordered breathing. Careful history taking and physical examination may identify patients who require polysomnography. Any snoring that is disruptive to a patient's life or accompanied by symptoms suggesting obstructive sleep apnea requires further evaluation. Ambulatory polysomnography may be adequate in asymptomatic snorers (i.e., those without witnessed apneic episodes, daytime sleepiness, or significant associated disease processes) who seek treatment for social reasons. Split-night testing is a promising diagnostic protocol for symptomatic snorers. All snorers benefit from instruction on behavior modification. The best treatment option (fitting of an oral appliance, surgical intervention, CPAP) depends on whether apneic episodes accompany snoring and on patient preference. More studies are needed to determine the most reliable and cost-effective approach to symptomatic snoring.
- Published
- 1997
- Full Text
- View/download PDF
40. Phosphorylation of sucrose synthase from maize seedlings.
- Author
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Lindblom S, Ek P, Muszyńska G, Ek B, Szczegielniak J, and Engström L
- Subjects
- Amino Acid Sequence, Animals, Binding Sites, Gene Expression Regulation, Plant, Genes, Plant, Glucosyltransferases chemistry, Glucosyltransferases genetics, Isoenzymes chemistry, Isoenzymes genetics, Isoenzymes metabolism, Mammals, Phosphorylation, Protein Kinases metabolism, Serine chemistry, Substrate Specificity, Zea mays genetics, Zea mays growth & development, Glucosyltransferases metabolism, Zea mays enzymology
- Abstract
Two isoforms of sucrose synthase (SS1 and SS2) from maize (Zea mays, var. Mona) seedlings co-purified with a calcium and phospholipid dependent protein kinase. The enzymatic preparation obtained gave a positive reaction with the antibody against mammalian protein kinase C. Maize sucrose synthase was phosphorylated by the endogenous protein kinase. Also, mammalian protein kinases (protein kinase C and protein kinase A) were able to phosphorylate the 86 kDa subunit of sucrose synthase. When excised seedlings were fed [32P]orthophosphate, sucrose synthase was also phosphorylated. Microsequencing of in vivo labelled enzyme has shown phosphorylation of Ser-15 in SS2. The present work provides evidence that maize sucrose synthase is the physiological substrate of the endogenous calcium and phospholipid dependent protein kinase(s).
- Published
- 1997
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