49 results on '"Sjöberg D"'
Search Results
2. Herglotz functions and applications in electromagnetics
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Nedic, M., Ehrenborg, C., Ivanenko, Y., Ludvig-Osipov, A., Nordebo, S., Luger, A., Jonsson, B. Lars G., Sjöberg, D., Gustafsson, M., Nedic, M., Ehrenborg, C., Ivanenko, Y., Ludvig-Osipov, A., Nordebo, S., Luger, A., Jonsson, B. Lars G., Sjöberg, D., and Gustafsson, M.
- Abstract
Herglotz functions inevitably appear in pure mathematics, mathematical physics, and engineering with a wide range of applications. In particular, they are the pertinent functions to model passive systems, and thus appear in modeling of electromagnetic phenomena in circuits, antennas, materials, and scattering. In this chapter, we review the basic theory of Herglotz functions and its applications to determine sum rules and physical bounds for passive systems., Part of book: ISBN 978-1-78561-384-5QC 20220817
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- 2021
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3. P566 The cost for IBD care during the first 5 years after diagnosis
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Sjöberg, D, primary, Karlbom, U, additional, Thörn, M, additional, Fawunmi, D, additional, and Rönnblom, A, additional
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- 2019
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4. Nurse-led clinic for liver cirrhotic patients: Effects on health-related quality of life
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Hjorth, M., primary, Sjöberg, D., additional, Kaminsky, E., additional, Svanberg, A., additional, Langenskiöld, S., additional, and Rorsman, F., additional
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- 2018
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5. A combined electromagnetic and acoustic analysis of a triaxial carbon fiber weave for reflector antenna applications
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Ericsson, A., Rumpler, Romain, Sjöberg, D., Göransson, Peter, Wellander, N., Johansson, J., Ericsson, A., Rumpler, Romain, Sjöberg, D., Göransson, Peter, Wellander, N., and Johansson, J.
- Abstract
Fiber composites are widely used for space applications such as antennas, solar panels and spacecraft support structures. This paper presents a combined electromagnetic and acoustic analysis of a triaxial carbon fiber weave structure, designed for ultra lightweight reflector antennas in satellite communication systems. The electromagnetic and acoustic performance of the structure are analyzed over a wide range of parametric studies, both at a microscopic and mesoscopic length scale. The electromagnetic study indicates that the main parameter governing the electromagnetic reflection performance of the weave is the electric conductivity of the carbon fibers, given that the weave structure is significantly smaller than the wavelength of the incident signals. The acoustic study identifies a critical threshold in the mesoscale geometry in order to avoid a critically high resistive behavior of the weave structure, driven by viscous effects. Design guidelines are drawn from these analyses in order to achieve a trade-off between the electromagnetic reflection properties and the resistance to acoustic loading of such composite materials. These combined analyses allow to deepen the understanding from both an electromagnetic and acoustic perspective in order to open for some new design possibilities., QC 20161117
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- 2016
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6. Study of phased array in UE for 5G mm wave communication system with consideration of user body effect
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Ying, Z., Zhao, Kun, Bolin, T., Helander, J., Sjöberg, D., He, Sailing, Scannavini, A., Foged, L. J., Nicolas, G., Ying, Z., Zhao, Kun, Bolin, T., Helander, J., Sjöberg, D., He, Sailing, Scannavini, A., Foged, L. J., and Nicolas, G.
- Abstract
The latest study of the millimeter wave (mmWave) phased array in user device (UE) for 5G communication is presented in this paper. Particularly, the body effect on the phased array in a UE/mobile terminal at 15 GHz is investigated with the 3D measured data. Its impact on the recently introduced parameter for phased array in mobile terminal, the total scanning pattern, body loss and the coverage efficiency, is analyzed., QC 20161101
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- 2016
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7. FRI-009 - Nurse-led clinic for liver cirrhotic patients: Effects on health-related quality of life
- Author
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Hjorth, M., Sjöberg, D., Kaminsky, E., Svanberg, A., Langenskiöld, S., and Rorsman, F.
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- 2018
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8. Energy Efficient Transformers and Reactors : Some incentive models and case studies to show the long term profitability of such designs
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Fogelberg, T., Sjöberg, D., Swiatkowski, M., Mortensen, E., Pradhan, M. K., Pettersson, L. A. A., Dahlgren, M., Rehme, Jakob, Nordigården, Daniel, Fogelberg, T., Sjöberg, D., Swiatkowski, M., Mortensen, E., Pradhan, M. K., Pettersson, L. A. A., Dahlgren, M., Rehme, Jakob, and Nordigården, Daniel
- Abstract
During the coming decades energy efficiency will be a critical factor in reducing carbon emissions and fighting global warming. The power generation industry and transmission and distribution industries (T&D) contribute to a large part of energy losses in the society. The losses in T&D systems alone are total 10 % of a global average of the T&D energy transferred. One-third of these T&D losses have their origin in transformers and shunt reactors.This report emphasizes the need to bring in appropriate financial incentives and directives to utilities, in order to encourage investment in energy efficient electrical power systems. A critical financial parameter is the internal interest rate. In some countries there are directives from the authorities that internalinterest rates shall be 5 %. If this is to be applied together with the current prevailing electricityprices in Europe, capitalized cost of total transformer losses should increase by 2-3times of the average value used in the European market today. It isshown that the capitalized cost of losses may vary from 8,000 to 17,000 €/kW today or even higherin the future.This paper highlights cases where low and high capitalized costs of losses are used and the implications for cost related factors of transformer and shunt reactor are analyzed. It isshown that the transformer losses and total ownership cost (TOC) can be substantially reduced with an increase in price(first cost) of the transformers or shunt reactors. With increased value of losses, accuracy of loss measurement will play a much more important business role and require action to improve International Standards. New energy efficientsolutions to combat network losses will require further research and development. Different focus and strategies regarding interest rates and electricityprices in transmission companies lead to very different investment decisions. Without clear regulations promoting reductions in power loss, there might notbe eno
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- 2012
9. Physical bounds on the partial realized gain
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Gustafsson, M., Kristensson, G., Bernland, A., Sjöberg, D., Jonsson, B. Lars G., Gustafsson, M., Kristensson, G., Bernland, A., Sjöberg, D., and Jonsson, B. Lars G.
- Abstract
An antenna identity, derived from the forward scattering sum rule, shows that the partial realized gain of an antenna is related to the polarizability of the antenna structure. The partial realized gain contains the mismatch, directivity, efficiency, and polarization properties of the antenna. The antenna identity expresses how the performance depends on the electrical size and shape of the antenna structure. It is also the starting point for several antenna bounds. In this paper, the identity, its associated physical bounds, and computational aspects of the polarizability dyadics are discussed., QC 20120423
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- 2010
10. P555 Conservative approach results in lower colectomy rates in patients with severe ulcerative colitis – data from 70 patients with S3 in the ICURE study
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Sjöberg, D., primary, Larsson, M., additional, Nielsen, A.-l., additional, Holmqvist, L., additional, and Rönnblom, A., additional
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- 2013
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11. On the feasibility of using ferromagnetic materials for thin em absorbers
- Author
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Ramprecht, Jörgen, Sjöberg, D., Ramprecht, Jörgen, and Sjöberg, D.
- Abstract
In this paper the magnetization of a ferro- or ferri-magnetic material has been modeled with the Landau-Lifshitz-Gilbert (LLG) equation. We show that with the aid of a static magnetic bias field the material can be switched between a Lorentz-like material with a resonance frequency and a material exhibiting a magnetic conductivity. The reflection from a magnetic material backed by a perfect electrical conductor (PEC) is then analyzed. It is found that one can achieve low reflection (around -20 dB) for a quite large bandwidth (more than two decades)., QC 20141107
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- 2007
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12. P414 Anemia in a population based IBD cohort still high prevalence after one year
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Sjöberg, D., primary, Nielsen, A.-l., additional, Larsson, M., additional, Holmström, T., additional, and Rönnblom, A., additional
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- 2012
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13. P405 Microscopic colitis a population-based study from Uppsala health region in Sweden
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Thörn, M., primary, Sjöberg, D., additional, Ekbom, A., additional, Holmström, T., additional, Larsson, M., additional, Nielsen, A., additional, Holmquist, B., additional, and Rönnblom, A., additional
- Published
- 2012
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14. Opportunities and challenges in the characterization of composite materials in waveguides
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Sjöberg, D., primary and Larsson, C., additional
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- 2011
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15. Physical bounds on the all-spectrum transmission through periodic arrays: Oblique incidence
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Sjöberg, D., primary, Gustafsson, M., additional, and Larsson, C., additional
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- 2010
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16. On the dispersion equation for a homogeneous, bi‐isotropic waveguide of arbitrary cross‐section
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Ioannidis, A. D., primary, Kristensson, G., additional, and Sjöberg, D., additional
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- 2009
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17. Physical bounds on the all-spectrum transmission through periodic arrays
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Gustafsson, M., primary, Sohl, C., additional, Larsson, C., additional, and Sjöberg, D., additional
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- 2009
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18. Magnetic losses in composite materials
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Ramprecht, J, primary and Sjöberg, D, additional
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- 2008
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19. On Two Numerical Methods for Homogenization of Maxwell's Equations
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Engström, C., primary and Sjöberg, D., additional
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- 2007
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20. LOW-FREQUENCY SCATTERING ANALYSIS AND HOMOGENISATION OF SPLIT-RING ELEMENTS.
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Sten, J. C.-E. and Sjöberg, D.
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METAMATERIALS ,RESONATORS ,DIPOLE moments ,MAGNETOSPHERIC radio wave propagation ,POLARIZABILITY (Electricity) - Abstract
A key structure in so-called metamaterial mediums is the elementary split-ring resonator. We consider in this paper the low-frequency electromagnetic scattering by a split-ring particle modelled as a perfectly conducting wire ring, furnished with a narrow gap, and derive analytical solutions for the electric and magnetic dipole moments for different kinds of incidence and polarisation in the quasi-static approximation. Through a vectorial homogenisation process, the expressions discovered for the dipole moments and the related polarisability dyadics are linked with the macroscopic constitutive equations for the medium. We further show that the condition for resonance of a medium consisting of simple split-rings cannot be achieved by means of the given quasi-static terms without violating the underlying assumptions of homogenisation. Nevertheless, the results are applicable for sparse medium of rings, and we derive numerical guidelines for the applicability with some examples of the effect of the considered split-ring medium on electromagnetic wave propagation. [ABSTRACT FROM AUTHOR]
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- 2011
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21. REALIZATION OF A MATCHING REGION BETWEEN A RADOME AND A GROUND PLANE.
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Sjöberg, D. and Gustafsson, M.
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- 2010
22. THE PROPAGATION PROBLEM IN A BI-ISOTROPIC WAVEGUIDE.
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Ioannidis, A. D., Kristensson, G., and Sjöberg, D.
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- 2010
23. DETERMINATION OF PROPAGATION CONSTANTS AND MATERIAL DATA FROM WAVEGUIDE MEASUREMENTS.
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Sjöberg, D.
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- 2009
24. SCATTERING FROM A THIN MAGNETIC LAYER WITH A PERIODIC LATERAL MAGNETIZATION: APPLICATION TO ELECTROMAGNETIC ABSORBERS.
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Ramprecht, J., Norgren, M., and Sjöberg, D.
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- 2008
25. BIASED MAGNETIC MATERIALS IN RAM APPLICATIONS.
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Ramprecht, J. and Sjöberg, D.
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- 2007
26. FREQUENCY SELECTIVE STRUCTURES WITH STOCHASTIC DEVIATIONS.
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Karlsson, A., Sjöberg, D., and Widenberg, B.
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- 2007
27. ON UNIQUENESS AND CONTINUITY FOR THE QUASI-LINEAR, BIANISOTROPIC MAXWELL EQUATIONS, USING AN ENTROPY CONDITION.
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Sjöberg, D.
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- 2007
28. Exact and Asymptotic Dispersion Relations for Homogenization of Stratified Media with Two Phases.
- Author
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Sjöberg, D.
- Subjects
- *
DISPERSION (Chemistry) , *OPTICS , *ELECTROMAGNETIC waves , *WAVELENGTHS , *ELECTROMAGNETIC theory - Abstract
Using exact dispersion relations for electromagnetic wave propagation in layered, periodic media, consisting of two phases, we derive explicit asymptotic solutions for small wavenumbers. These solutions are compared to the numerical solutions of the exact dispersion relations, and applications to homogenization problems are discussed. The results can be used as test cases for homogenization techniques intended for finite scale homogenization, that is, where the wavelength is not assumed infinitely large compared to the microscale. [ABSTRACT FROM AUTHOR]
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- 2006
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29. Safety rounds in public environments: Experience of a new tool for prevention of accidental injuries
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Bjärås, G., primary, Danielsson, K., additional, Schelp, L., additional, Sjöberg, D., additional, and Skjönberg, G., additional
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- 1990
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30. COHERENT EFFECTS IN SINGLE SCATTERING AND RANDOM ERRORS IN ANTENNA TECHNOLOGY.
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Sjöberg, D.
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- 2005
31. «LUOGO PRESO IN PAROLA». Sul paesaggio lirico di ANDREA ZANZOTTO
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carbognin francesco, J. Nimis, S. Dal Bianco, L. Cecchinel, A. Russo Previtali, N. Gardini, F. Carbognin, S. Bassi, D. Favaretto, L. Toppan, L. Manigrasso, G. Bongiorno, M. Kangro, M. Donat, G. Sjöberg, D. Capaldi, J. P. Welle, J. Demarcq, M. Rueff, G. Bongiorno, L. Toppan, and carbognin francesco
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Zanzotto, paesaggio, poesia, fenomenologia, mappa, geocritica, filologia - Abstract
Per la prima volta nell'ambito degli studi zanzottiani, nel saggio si costruisce una mappatura completa del paesaggio Alto Trevigiano descritto da Andrea Zanzotto nelle poesie e nelle prose, opportunamente diviso per aree (montagna, colline, pianura, laghi e fiumi, altopiano del Montello). Tutti i toponimi presenti nell'opera di Zanzotto vengono elencati e rapportati al valore metaforico conferitovi dal poeta di Pieve di Soligo. Completa il saggio un'appendice fotografica e una mappa geografica del paesaggio lirico zanzottiano.
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- 2018
32. Anti-modified protein antibodies can be detected in saliva, but not in intestinal secretions of seropositive rheumatoid arthritis patients - evidence of site-specific mucosal autoantibody secretion in RA.
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Derksen VFAM, Martinsson K, van Mourik AG, Wagenaar CA, Toes REM, Walrabenstein W, Sjöberg D, van Schaardenburg D, Huizinga TWJ, Kastbom A, Svärd A, and van der Woude D
- Abstract
Objective: Anti-citrullinated protein antibodies (ACPA) have been detected in sputum and saliva, indicating that anti-modified protein antibodies (AMPA) can be produced at mucosal sites in rheumatoid arthritis (RA) patients. However, the body's largest mucosal compartment, the gut, has not yet been examined. We therefore investigated the presence of several AMPA (antibodies against citrullinated (ACPA), carbamylated (anti-CarP) and acetylated (AAPA) proteins) at different mucosal sites, including the intestinal tract., Methods: Paired fecal/ileal wash, saliva and serum samples of RA patients and healthy volunteers were collected in two independent cohorts. Data involving feces was replicated in a third cohort. In these secretions AMPA were analyzed using in-house ELISA with unmodified peptides as control. In fecal samples total IgA and anti-E. coli IgA were measured., Results: ACPA, anti-CarP and AAPA IgA were measurable in saliva of seropositive RA patients (prevalence 9-40%). No AMPA could be detected in feces. IgA was present since total IgA and anti-E. coli IgA was detectable in feces of ACPA-positive RA patients and healthy donors. Results were confirmed in another cohort using colonoscopically collected ileal wash samples., Conclusion: Our study shows the presence of ACPA, anti-CarP and AAPA IgA in saliva of ACPA-seropositive RA patients. However, no AMPA could be detected in feces/ileal wash samples of these patients, although our assays were able to measure other antigen-specific antibodies. These data suggest that mucosal autoantibody secretion may occur in the oral mucosa of RA patients, while no evidence could be found for this process in the lower gastro-intestinal tract., (This article is protected by copyright. All rights reserved.)
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- 2024
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33. Exploring medical first responders' perceptions of mass casualty incident scenario training: a qualitative study on learning conditions and recommendations for improvement.
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Schulz F, Nguyen Q, Baetzner A, Sjöberg D, and Gyllencreutz L
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- Humans, Male, Female, Adult, Disaster Planning, Interviews as Topic, Middle Aged, Emergency Medical Services, Attitude of Health Personnel, Mass Casualty Incidents, Emergency Responders education, Qualitative Research
- Abstract
Objective: Despite participating in scenario training, many medical first responders (MFRs) perceive themselves as inadequately prepared to respond to mass casualty incidents (MCIs). The objective of this study was to conduct a comprehensive examination of traditional MCI scenario training methods, focusing on their inherent strengths and limitations. An investigation into the perceptions of MFRs who had participated in MCI scenario training was carried out to identify potential areas for improvement and provide recommendations for refining MCI training protocols., Design: Qualitative inductive approach using semistructured interviews that took place between October 2021 and February 2022. Data were analysed with qualitative content analysis., Setting: MCI scenario training involving four organisations (three emergency medical services and one search-and-rescue organisation) tasked with responding to MCIs, collectively representing four European Union countries., Participants: 27 MFRs (17 emergency medical services personnel and 10 search-and-rescue volunteers) were recruited to participate in the study., Results: Two categories and seven associated subcategories (shown in parentheses) were identified as influencing the learning outcomes for MFRs: Training in a context mirroring real-world incidents (conducting incident scene risk assessment, realistic representation in casualties, incorporating scenario variety into the curriculum, interagency collaboration, role alignment when training incident site management) and use of a pedagogical framework (allowing for mistakes, the importance of post-training evaluation)., Conclusions: This study reaffirms the value of traditional MCI scenario training and identifies areas for enhancement, advocating for realistic scenarios, interagency collaboration, improved incident site management skills and thorough post-training evaluation. It suggests a shift in MCI training conceptualisation and delivery. The potential of virtual reality technologies as a valuable addition to training methods is explored, with a note on the need for further research to ascertain the long-term effectiveness of these technologies. However, the selection of a training method should consider programme goals, target population and resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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34. Accuracy of a faecal immunochemical test in patients under colonoscopy surveillance of colorectal adenoma and cancer.
- Author
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Olsson L and Sjöberg D
- Subjects
- Humans, Sensitivity and Specificity, Colonoscopy, Predictive Value of Tests, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology, Adenoma diagnosis, Adenoma epidemiology, Adenoma pathology
- Abstract
Background: Surveillance of colorectal neoplasia place great strain on colonoscopy resources, and faecal immunochemical tests (FIT) are under-investigated for this purpose. The aim of this study was to report the outcome of FIT among patients scheduled for post-polypectomy and post-resection colorectal cancer (CRC) surveillance., Methods: Patients scheduled for colonoscopy surveillance at five endoscopy units in mid-Sweden in 2016-2020 were eligible. They provided a faecal sample from 2 separate days, which were analysed by iFOBT QuikRead go® (Aidian Oy). Both the colonoscopies, and the FIT analyses were conducted by staff blinded to the other., Results: Out of 216 included patients, 157 (73%) underwent both a complete colonoscopy and had at least one FIT analysed prior to the examination. The indication for surveillance was previous adenoma in 69 (44%) and post-resection CRC in 88 (56%) patients. Two (1%) in the CRC surveillance group were diagnosed with a metachronous CRC, whereas 49 (56%) patients in the CRC surveillance, and 17 (25%) in the adenoma group had no pathology identified at colonscopy ( P < 0.001). The proportion of patients diagnosed with adenomas requiring surveillance according to European Society of Gastrointestinal Society (ESGE) guidelines 2020 was 6 (7%) in the post-CRC resection versus 7 (10%) in the adenoma surveillance group ( P = 0.4). Based on one FIT and at cut-off 10 µg Hb/g, sensitivity for CRC was 100%, specificity 83% (95% confidence interval [CI]: 77-89), Positive Predictive Value (PPV) 7% (-2 to 16) and Negative Predictive Value (NPV) 100%. All patients with an adenoma requiring surveillance had a FIT below this cut-off. Adding a second FIT decreased the specificity., Conclusion: Larger studies to evaluate the accuracy and consequences of using FIT for surveillance of colorectal neoplasia are needed. FIT may be more interesting for post-resection CRC surveillance than follow-up of adenoma., Competing Interests: Aidian Oy provided a QuikRead go® instrument for analysis. The authors declare no conflict of interest., (© 2023 The Author(s). Published by Upsala Medical Society.)
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- 2023
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35. Feeling safe or falling through the cracks-Patients' experiences of healthcare in cirrhosis illness: A qualitative study.
- Author
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Hjorth M, Svanberg A, Sjöberg D, Rorsman F, and Kaminsky E
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- Humans, Qualitative Research, Patients, Health Facilities, Delivery of Health Care, Health Personnel
- Abstract
Introduction: Patients with cirrhosis have a long-lasting relationship with medical personnel. Hierarchy in the healthcare contacts and feeling stigmatised may affect the patient's interactions with these care providers. Despite healthcare professionals' awareness of patients' increased self-care needs, patients report getting insufficient information and support. The patients' expectations and experiences of interacting with healthcare professionals in cirrhosis care is hence a research area that needs further investigation., Purpose: To capture patients' descriptions of healthcare experiences in relation to cirrhosis illness., Material and Methods: Data comprise semi-structured interviews (N = 18) and open-ended questionnaire responses (N = 86) of patients with cirrhosis. Braun and Clarke's thematic analysis process was used, including both semantic and inductive elements. The study is reported following the COREQ guidelines., Findings: The analysis resulted in two themes: 1) Struggle to be in a dialogue and 2) Being helped or harmed. Six sub-themes were identified concerning aspects of experiences within each theme during the analysis. These sub-themes included: 'getting information', 'being involved', 'being perceived as a person', 'enduring care', 'feeling lost in the healthcare organisation', and 'not being taken care of'., Conclusions: Patients with cirrhosis express concerns regarding where to turn in the continuum of cirrhosis care. They emphasise the importance of being involved in the dialogue with the healthcare professional, to be perceived as a person with a unique need to be informed. The healthcare organisation and continuity of care are either viewed as confusing or as helping to shape a safe and trustful contact, which was an important difference in feeling helped or harmed. Hence, patients wished for improved collaboration with healthcare professionals and to receive increased information about their disease. Person-centred communication in nurse-led clinics may increase patient satisfaction and prevent patients from falling through the cracks., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Hjorth 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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- 2023
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36. [Updated Swedish guidelines for endoscopic surveillance after colorectal polypectomy].
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Thorlacius H, Sjöberg D, Backman AS, Palmqvist R, and Toth E
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- Humans, Sweden, Colonoscopy, Colonic Polyps diagnosis, Colonic Polyps surgery, Colorectal Neoplasms diagnosis, Colorectal Neoplasms surgery, Colorectal Neoplasms epidemiology, Adenoma diagnosis, Adenoma surgery
- Abstract
These new guidelines are based on the recommendations published by European Society of Gastrointestinal Endoscopy (ESGE) in 2020. Low risk patients, i.e. after removal of 1-4 <10 mm adenomas with low grade dysplasia (irrespective of villous components), or any serrated lesion (hyperplastic polyp, sessile serrated lesion, or traditional serrated adenoma) <10 mm without dysplasia, are not recommended a surveillance colonoscopy. High-risk patients, i.e. after removal of at least one adenoma ≥10 mm or with high grade dysplasia or any serrated lesion ≥10 mm or with dysplasia, should undergo a surveillance colonoscopy after 3 years. If high-risk lesions are detected at surveillance colonoscopy, a 3-year repetition of the next endoscopic examination is recommended. If a high-risk patient has no high-risk lesions at surveillance colonoscopy, a 5-year period is recommended until the next surveillance colonoscopy. In general, follow-up should be terminated at 80 years of age.
- Published
- 2022
37. Liver cirrhosis turns life into an unpredictable roller coaster: A qualitative interview study.
- Author
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Hjorth M, Svanberg A, Sjöberg D, Rorsman F, and Kaminsky E
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Qualitative Research, Sweden, Adaptation, Psychological, Liver Cirrhosis psychology, Quality of Life
- Abstract
Aim: To explore how persons living with liver cirrhosis experience day-to-day life., Background: Liver cirrhosis is the sixth most common cause of death among adults in Western countries. Persons with advanced liver cirrhosis report poor quality of life, in comparison with other chronic diseases. However, knowledge regarding day-to-day life during earlier stages of the disease is lacking. In other chronic diseases, the suffering process is well explored, while in liver cirrhosis, suffering is insufficiently investigated., Design: An exploratory study, with a qualitative inductive interview approach., Methods: A purposive maximum variation sample of 20 informants with liver cirrhosis aged 25-71, from two gastroenterology outpatient clinics in mid-Sweden, were interviewed from September 2016 to October 2017. Interview data were analysed inductively with qualitative content analysis. Reporting followed the COREQ guidelines., Results: The experiences of day-to-day life living with liver cirrhosis comprised four sub-themes. Living with liver cirrhosis implied varying levels of deterioration, the most apparent being exhaustion or tiredness. The informants had to find ways of adapting to a new life situation. The insecurity of future health evoked existential reflections such as feeling emotionally and existentially distressed. Shame and guilt were reasons for feeling stigmatised. These sub-themes emerged into one overarching theme of meaning: life turns into an unpredictable roller coaster. This is based on experiences of liver cirrhosis as an unpredictable disease with fluctuating symptoms, worries and disease progression., Conclusion: Living with cirrhosis implies an unpredictable condition with a progressive, stigmatising disease. The fluctuating symptoms and deep concerns about future life pose an increased personal suffering., Relevance to Clinical Practice: Within health care, knowledge of the person's experience is vital to enable and fulfil the person's healthcare needs. Clinical registered nurses need a person-centred approach to strengthen their patients to cope with their new life situation., (© 2020 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)
- Published
- 2020
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38. Collagenous colitis without diarrhoea at diagnosis - a follow up study.
- Author
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Thörn M, Sjöberg D, Holmström T, and Rönnblom A
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- Adult, Aged, Aged, 80 and over, Colitis, Collagenous pathology, Colonoscopy, Diarrhea, Female, Follow-Up Studies, Humans, Male, Middle Aged, Colitis, Collagenous diagnosis
- Abstract
Objective: Chronic watery diarrhoea is a classical symptom of collagenous colitis (CC). However, in some cases, the typical histologic findings of CC can be found in patients without this symptom. In this study we have performed a follow up on patients with a confirmed histological diagnosis of CC without the typical symptom watery diarrhoea., Patients and Methods: A structured medical record follow-up was performed on the subgroup of patients without watery diarrhoea but diagnosed with the typical CC histologic appearance in a previous study of microscopic colitis., Results: At follow up after a median time of 8 years (range: 0.33-12 years), five of these fifteen patients developed bowel symptoms but only two developed characteristic CC symptoms with watery diarrhoea., Conclusion: The majority of patients without chronic watery diarrhoea at diagnosis remained free from this symptom during follow up and only in a few cases symptoms attributed to CC developed.
- Published
- 2019
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39. Nurse-led clinic for patients with liver cirrhosis-effects on health-related quality of life: study protocol of a pragmatic multicentre randomised controlled trial.
- Author
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Hjorth M, Sjöberg D, Svanberg A, Kaminsky E, Langenskiöld S, and Rorsman F
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- Adolescent, Adult, Aged, Aged, 80 and over, Clinical Protocols, Humans, Liver Cirrhosis therapy, Middle Aged, Secondary Prevention methods, Surveys and Questionnaires, Young Adult, Liver Cirrhosis nursing, Quality of Life
- Abstract
Introduction: Liver cirrhosis affects health-related quality of life (HRQoL) even in its early stages. Morbidity is especially high when the disease decompensates and self-care actions become essential. Nurse involvement in secondary prevention in other chronic diseases has contributed to better symptom control, less need of inpatient care and improved HRQoL. In order to evaluate the impact of nurse involvement in the follow-up of patients with liver cirrhosis, we decided to compare structured nurse-led clinics, inspired by Dorothea Orem's nursing theory and motivational strategies, with a group of patients receiving standard care. The primary outcome is HRQoL and the secondary outcomes are quality of care, visits to outpatient clinics or hospitals, disease progress and health literacy., Methods and Analysis: This is a pragmatic, multicentre randomised controlled study conducted at six Swedish hepatology departments. Eligible patients are adults with diagnosed cirrhosis of the liver (n=500). Participants are randomised into either an intervention with nurse-led follow-up group or into a standard of care group. Recruitment started in November 2016 and is expected to proceed until 2020. Primary outcomes are physical and mental HRQoL measured by RAND-36 at enrolment, after 1 and 2 years., Ethics and Dissemination: The study is ethically approved by the Regional Ethical Review Board in Uppsala. The results shall be disseminated in international conferences and peer-reviewed articles., Trial Registration Number: NCT02957253; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2018
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40. Long-term effectiveness of vedolizumab in inflammatory bowel disease: a national study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG).
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Eriksson C, Marsal J, Bergemalm D, Vigren L, Björk J, Eberhardson M, Karling P, Söderman C, Myrelid P, Cao Y, Sjöberg D, Thörn M, Karlén P, Hertervig E, Strid H, Ludvigsson JF, Almer S, and Halfvarson J
- Subjects
- Adult, Cohort Studies, Feces chemistry, Female, Humans, Kaplan-Meier Estimate, Leukocyte L1 Antigen Complex analysis, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Registries, Sweden, Treatment Outcome, Antibodies, Monoclonal, Humanized therapeutic use, Colitis, Ulcerative drug therapy, Crohn Disease drug therapy, Tumor Necrosis Factor-alpha antagonists & inhibitors
- Abstract
Objectives: Clinical trials have demonstrated the efficacy of vedolizumab in inflammatory bowel disease (IBD). However, these findings may not reflect the clinical practice. Therefore, we aimed to describe a vedolizumab-treated patient population and assess long-term effectiveness., Materials and Methods: Patients initiating vedolizumab between 1 June 2014 and 30 May 2015 were identified through the Swedish National Quality Registry for IBD. Prospectively collected data on treatment and disease activity were extracted. Clinical remission was defined as Patient Harvey Bradshaw index <5 in Crohn's disease (CD) and Patient Simple Clinical Colitis Activity index <3 in ulcerative colitis (UC)., Results: Two-hundred forty-six patients (147 CD, 92 UC and 7 IBD-Unclassified) were included. On study entry, 86% had failed TNF-antagonist and 48% of the CD patients had undergone ≥1 surgical resection. After a median follow-up of 17 (IQR: 14-20) months, 142 (58%) patients remained on vedolizumab. In total, 54% of the CD- and 64% of the UC patients were in clinical remission at the end of follow-up, with the clinical activity decreasing (p < .0001 in both groups). Faecal-calprotectin decreased in CD (p < .0001) and in UC (p = .001), whereas CRP decreased in CD (p = .002) but not in UC (p = .11). Previous anti-TNF exposure (adjusted HR: 4.03; 95% CI: 0.96-16.75) and elevated CRP at baseline (adjusted HR: 2.22; 95% CI: 1.10-4.35) seemed to be associated with discontinuation because of lack of response. Female sex was associated with termination because of intolerance (adjusted HR: 2.75; 95% CI: 1.16-6.48)., Conclusion: Vedolizumab-treated patients represent a treatment-refractory group. A long-term effect can be achieved, even beyond 1 year of treatment.
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- 2017
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41. Predicting the Individual Risk of Acute Severe Colitis at Diagnosis.
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Cesarini M, Collins GS, Rönnblom A, Santos A, Wang LM, Sjöberg D, Parkes M, Keshav S, and Travis SP
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- Acute Disease, Adult, Age Factors, C-Reactive Protein metabolism, Colitis, Ulcerative blood, Colonoscopy, Disease Progression, Female, Hemoglobins metabolism, Humans, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Severity of Illness Index, Sex Factors, Colitis, Ulcerative diagnosis, Colitis, Ulcerative pathology, Hospitalization statistics & numerical data, Nomograms
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Background and Aims: Acute severe colitis [ASC] is associated with major morbidity. We aimed to develop and externally validate an index that predicted ASC within 3 years of diagnosis., Methods: The development cohort included patients aged 16-89 years, diagnosed with ulcerative colitis [UC] in Oxford and followed for 3 years. Primary outcome was hospitalization for ASC, excluding patients admitted within 1 month of diagnosis. Multivariable logistic regression examined the adjusted association of seven risk factors with ASC. Backwards elimination produced a parsimonious model that was simplified to create an easy-to-use index. External validation occurred in separate cohorts from Cambridge, UK, and Uppsala, Sweden., Results: The development cohort [Oxford] included 34/111 patients who developed ASC within a median 14 months [range 1-29]. The final model applied the sum of 1 point each for extensive disease, C-reactive protein [CRP] > 10mg/l, or haemoglobin < 12g/dl F or < 14g/dl M at diagnosis, to give a score from 0/3 to 3/3. This predicted a 70% risk of developing ASC within 3 years [score 3/3]. Validation cohorts included different proportions with ASC [Cambridge = 25/96; Uppsala = 18/298]. Of those scoring 3/3 at diagnosis, 18/18 [Cambridge] and 12/13 [Uppsala] subsequently developed ASC. Discriminant ability [c-index, where 1.0 = perfect discrimination] was 0.81 [Oxford], 0.95 [Cambridge], 0.97 [Uppsala]. Internal validation using bootstrapping showed good calibration, with similar predicted risk across all cohorts. A nomogram predicted individual risk., Conclusions: An index applied at diagnosis reliably predicts the risk of ASC within 3 years in different populations. Patients with a score 3/3 at diagnosis may merit early immunomodulator therapy., (Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com)
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- 2017
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42. Clinical course of Crohn's disease during the first 5 years. Results from a population-based cohort in Sweden (ICURE) diagnosed 2005-2009 .
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Rönnblom A, Holmström T, Karlbom U, Tanghöj H, Thörn M, and Sjöberg D
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- Adolescent, Adult, Aged, Aged, 80 and over, Antimetabolites therapeutic use, Child, Colonoscopy, Female, Humans, Male, Mesalamine therapeutic use, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Prospective Studies, Risk Factors, Steroids therapeutic use, Sweden epidemiology, Time Factors, Tumor Necrosis Factor-alpha antagonists & inhibitors, Tumor Necrosis Factor-alpha therapeutic use, Young Adult, Crohn Disease mortality, Crohn Disease therapy, Disease Progression
- Abstract
Objective: The aim of the study was to describe the medical treatment, change in phenotype, need for surgery and IBD-associated mortality during the first 5 years after diagnosis., Material and Methods: Patients diagnosed with Crohn's disease including all age groups in the Uppsala healthcare region in the middle of Sweden 2005-2009 were included in the study. Medical notes were scrutinised and patients contacted. Out of 269 patients, 260 (96.3%) could be followed for 5 full years or until death., Results: The following drugs were used: 5-ASA 66.7%, systemic steroids 76.4%, antimetabolites 56.7% and anti-TNF 20.3%. Described with the Montreal classification, the proportion with inflammatory behaviour decreased from 78.1% to 74.0% from diagnosis to end of the observation, patients with stricturing behaviour increased from 13.0% to 15.4% and patients with penetrating behaviour increased from 8.9% to 10.6%. After the first year, 12.4% had been treated with intestinal resection or colectomy, a figure that increased to 14.8 after 5 years. Two patients suffered an IBD-related death., Conclusions: Compared to similar patient cohorts, the present study demonstrates that although the course of Crohn's disease seems difficult to change during the first year after diagnosis, the following years up to 5 years shows a more benign course than has usually been described earlier.
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- 2017
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43. Low colectomy rate five years after diagnosis of ulcerative colitis. Results from a prospective population-based cohort in Sweden (ICURE) diagnosed during 2005-2009.
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Rönnblom A, Holmström T, Tanghöj H, Karlbom U, Thörn M, and Sjöberg D
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- Adult, Aged, Aged, 80 and over, Colitis, Ulcerative mortality, Disease Progression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Prognosis, Proportional Hazards Models, Prospective Studies, Recurrence, Risk Factors, Severity of Illness Index, Sweden, Young Adult, Colectomy statistics & numerical data, Colitis, Ulcerative therapy, Immunologic Factors therapeutic use, Mesalamine therapeutic use, Steroids therapeutic use
- Abstract
Objective: The medical treatment of ulcerative colitis (UC) has seen a change towards a more active attitude during recent years, including both the use of more traditional drugs as well as new biological substances. In this epidemiological study we have evaluated the results of modern treatment of UC in a population-based cohort of patients including all age groups, with regard to relapse rate, colectomy and IBD-associated mortality., Material and Methods: Patients diagnosed with UC in the Uppsala health care region in the middle of Sweden during 2005-2009 were included in the study. Out of 524 patients, 491 (93%) could be followed for five full years or until death., Results: Nineteen patients (3.9%) had died and two of these deaths could be attributed to UC (one postoperative death and one colonic carcinoma). The following drugs were used by the patients during the study period: 5-ASA (91%), systemic steroids (66%), immunomodulators (IMM), mainly thiopurines (26%) and anti-TNF (11%). During the observation period, 74% experienced at least one relapse and 5.3% were subjected to colectomy. Among patients <17 years at diagnosis, colectomy was performed in two (4.8%)., Conclusions: Five years after diagnosis of ulcerative colitis, 5.3% had been subjected to colectomy and two patients (0.38%) had died because of the disease.
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- 2016
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44. Appearance of hepatobiliary diseases in a population-based cohort with inflammatory bowel diseases (Inflammatory Bowel Disease Cohort of the Uppsala Region).
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Rönnblom A, Holmström T, Tanghöj H, Rorsman F, and Sjöberg D
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- Adolescent, Adult, Age Factors, Aged, Alkaline Phosphatase blood, Biomarkers blood, Child, Cholangitis, Sclerosing diagnosis, Cholangitis, Sclerosing mortality, Cholangitis, Sclerosing surgery, Cohort Studies, Comorbidity, Female, Hepatitis, Autoimmune diagnosis, Hepatitis, Autoimmune epidemiology, Humans, Liver Function Tests, Liver Transplantation mortality, Male, Middle Aged, Prevalence, Prospective Studies, Survival Rate, Sweden epidemiology, Young Adult, Cholangitis, Sclerosing epidemiology, Colitis, Ulcerative epidemiology, Crohn Disease epidemiology
- Abstract
Background and Aim: To prospectively follow the evolution of hepatobiliary diseases in a population-based cohort of patients with inflammatory bowel diseases., Methods: Between 2005 and 2009, 790 incident cases of ulcerative colitis and Crohn's disease were registered in the Uppsala Health Region, corresponding to an average incidence of 20.0 and 9.9 new cases/100 000 inhabitants/year, respectively. Liver function tests were analyzed in 97.1% and the results of ensuing investigations were summarized., Results: Seventeen patients with primary sclerosing cholangitis were diagnosed corresponding to an overall prevalence of 2.2% (ulcerative colitis 1.7% and Crohn's disease 3.0%, respectively). The median age at diagnosis was 25 years (interquartile range: 17.0-34.0). Among the 92 patients below 17 years of age, three had autoimmune hepatitis and three primary sclerosing cholangitis, summing up to a prevalence of 6.5% immune-mediated hepatobiliary diseases among the pediatric patients. Three patients have undergone liver transplantation and one died of colonic carcinoma. Ten patients have demonstrated persistent elevation of alkaline phosphatases but had a normal magnetic resonance cholangiopancreatography (two patients) or refused further investigation (one patient)., Conclusion: In this first large prospective population-based cohort of 526 patients with ulcerative colitis (UC) and 264 with Crohn's disease, 17 cases of primary sclerosing cholangitis were found, among whom three (17%) so far have been liver transplanted and one has died of colon carcinoma. The average age of those affected by primary sclerosing cholangitis is considerably lower than usually reported. Ten patients had or have had elevated alkaline phosphatase without confirmed liver or biliary disease., (© 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.)
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- 2015
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45. Celiac disease, collagenous sprue and microscopic colitis in IBD. Observations from a population-based cohort of IBD (ICURE).
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Rönnblom A, Holmström T, Tanghöj H, Wanders A, and Sjöberg D
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- Adolescent, Adult, Age Distribution, Celiac Disease diagnosis, Cohort Studies, Colitis, Microscopic diagnosis, Collagenous Sprue diagnosis, Comorbidity, Female, Humans, Incidence, Inflammatory Bowel Diseases diagnosis, Male, Middle Aged, Prevalence, Prognosis, Prospective Studies, Risk Assessment, Severity of Illness Index, Sex Distribution, Statistics, Nonparametric, Sweden, Young Adult, Celiac Disease epidemiology, Colitis, Microscopic epidemiology, Collagenous Sprue epidemiology, Inflammatory Bowel Diseases epidemiology
- Abstract
Objective: Inflammatory bowel disease (IBD), microscopic colitis and celiac disease are all diseases with worldwide distribution and increased incidence has been reported from many areas. There is a shortage of studies investigating the occurrence of these diseases in the same individual and whether those affected demonstrate any particular phenotype. The aim of the study was to describe the concomitant incidence of microscopic colitis and celiac disease in a population-based IBD cohort., Methods: All 790 individuals in a prospective population-based cohort included 2005-09 from Uppsala region, Sweden, were reviewed regarding the appearance of microscopic or celiac disease before or after IBD diagnosis., Results: Fifty percent (396/790) of the patients had been examined for the possibility of celiac disease. Seventeen patients with celiac disease were found, representing 2.2% of the cohort. Patients with celiac disease were younger compared to the non-celiac patients and those with colitis had more often an extensive inflammation of the colon. Seventy-one percent (12/17) were women. The majority of the patients were diagnosed with celiac disease before IBD. Five patients with IBD had an earlier diagnosis of microscopic colitis or developed it after the IBD diagnosis. One teenager developed collagenous sprue, misinterpreted as a severe relapse of ulcerative colitis (UC) resulting in colectomy., Conclusions: The risk for celiac disease seems not to be increased in IBD, but those affected by both diseases seem to be predominantly women with extensive UC. There is a potential association between microscopic colitis and IBD.
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- 2015
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46. Anemia in a population-based IBD cohort (ICURE): still high prevalence after 1 year, especially among pediatric patients.
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Sjöberg D, Holmström T, Larsson M, Nielsen AL, Holmquist L, and Rönnblom A
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- Adolescent, Adult, Anemia etiology, Child, Child, Preschool, Colitis, Ulcerative diagnosis, Colitis, Ulcerative epidemiology, Crohn Disease diagnosis, Crohn Disease epidemiology, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prevalence, Prognosis, Prospective Studies, Risk Factors, Sweden epidemiology, Young Adult, Anemia epidemiology, Colitis, Ulcerative complications, Crohn Disease complications
- Abstract
Background: Prevalence of anemia in patients with inflammatory bowel disease (IBD) is uncertain because of scarcity of population-based studies. The aim of this study was to evaluate prevalence of anemia in a population-based cohort of newly diagnosed patients with IBD to identify risk factors for anemia and to describe contemporary anemia-specific treatment during the first year., Methods: All patients with ulcerative colitis or Crohn's disease in the IBD Cohort of Uppsala Region cohort (n = 790) and hemoglobin levels at the time of diagnosis were eligible for inclusion. The WHO definition of anemia was used., Results: Seven hundred forty-nine (95%) of the patients with IBD were included. Five hundred eighty of 749 (77%) patients had measured hemoglobin levels at 12-month follow-up. The prevalence of anemia at the time of diagnosis was 227/749 (30%). After 1 year, it was 102/580 (18%). Anemia was more common among newly diagnosed patients with Crohn's disease compared with ulcerative colitis (42% versus 24%, P < 0.0001), but after 1 year, there was no difference (18% versus 18%, P = NS). Children had more often anemia compared with adults, both at diagnosis and after 1 year (diagnosis: 55% versus 27%, P < 0.0001; follow-up: 28% versus 16%, P < 0.05). Anemia was associated with colonic engagement in Crohn's disease and the extent of inflammation in ulcerative colitis. Only 46% of patients with anemia were treated with iron supplementation or blood transfusion., Conclusions: The overall prevalence of anemia in patients with IBD at the time of diagnosis was high. A large proportion was still anemic after 1 year. Children were more at risk compared with adults. More efforts are needed to treat patients with anemia.
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- 2014
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47. Incidence and clinical course of Crohn's disease during the first year - results from the IBD Cohort of the Uppsala Region (ICURE) of Sweden 2005-2009.
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Sjöberg D, Holmström T, Larsson M, Nielsen AL, Holmquist L, Ekbom A, and Rönnblom A
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Colitis pathology, Colitis surgery, Constriction, Pathologic etiology, Constriction, Pathologic surgery, Crohn Disease pathology, Crohn Disease therapy, Female, Humans, Ileitis pathology, Ileitis surgery, Incidence, Male, Middle Aged, Phenotype, Risk Factors, Sweden epidemiology, Young Adult, Colitis epidemiology, Crohn Disease epidemiology, Ileitis epidemiology
- Abstract
Background and Aims: As a part of the Swedish ICURE study where the epidemiological results of ulcerative colitis and microscopic colitis recently have been published, we hereby present the corresponding figures for Crohn's disease., Methods: All patients diagnosed with Crohn's disease in Uppsala County (305,381 inhabitants) were prospectively registered during 2005-2006 and the same for all new patients with Crohn's disease in Uppsala Region (642,117 inhabitants) during 2007-2009., Results: 264 patients with Crohn's disease were included. The mean annual incidence was 9.9/100,000/year (95% CI: 7.1-12.6). Incidence among children <17 years was 10.0/100,000/year (95% CI: 3.8-16.3). 51% of the patients had ileal involvement (L1: n=73, 28%. L2: n=129, 49%. L3: n=62, 23%, L4: n=47, 18%) and 23% had a stricturing or penetrating disease (B1: n=204, 77%. B2: n=34, 13%. B3: n=26, 10%. p: n=27, 10%). Intestinal resection rate during the first year was 12.5%. Patients with complicated disease had longer symptom duration before diagnosis compared to patients with non-complicated disease (median months 12.0, IQR: 3.0-24.0 vs 4.0, IQR: 2.0-12.0, p=0.0032). Patients 40 years or older had an increased risk for surgery (HR: 2.03, 95% CI: 1.01-4.08, p=0.0457)., Conclusions: The incidence of Crohn's disease in a region of Sweden is one of the highest reported in Europe. Long symptom duration precedes stricturing or penetrating behaviour. Old age is an independent risk factor for surgery., (© 2013.)
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- 2014
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48. Incidence and natural history of ulcerative colitis in the Uppsala Region of Sweden 2005-2009 - results from the IBD cohort of the Uppsala Region (ICURE).
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Sjöberg D, Holmström T, Larsson M, Nielsen AL, Holmquist L, Ekbom A, and Rönnblom A
- Subjects
- Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal therapeutic use, Child, Child, Preschool, Colectomy statistics & numerical data, Colitis, Ulcerative drug therapy, Colitis, Ulcerative surgery, Female, Humans, Immunosuppressive Agents therapeutic use, Incidence, Male, Middle Aged, Recurrence, Sex Factors, Smoking epidemiology, Steroids therapeutic use, Sweden epidemiology, Tumor Necrosis Factor-alpha antagonists & inhibitors, Young Adult, Age of Onset, Colitis, Ulcerative epidemiology, Severity of Illness Index
- Abstract
Background and Aims: The incidence of ulcerative colitis (UC) increased during the 20th century in Western Europe and the North America, but there are conflicting reports whether the incidence has declined, stabilized or continued to increase. The aim of this study was to evaluate the incidence of UC in the Uppsala Region, Sweden., Methods: All new UC patients in Uppsala County (305,381 inhabitants) were prospectively registered during 2005-2006 and the same for all new UC patients in the Uppsala Region (642,117 inhabitants) during 2007-2009. The extent and severity of disease according to the Montreal classification, relapse rates and surgery were assessed., Results: 526 UC patients were included. The mean overall incidence for the time period was 20.0 (95% CI: 16.1-23.9) cases per 100,000 inhabitants. The incidence among children <17 years of age was 8.9 per 100,000. The extent at diagnosis was evenly distributed (E1: n=167, 32%, E2: n=161, 31%, E3: n=163, 31%). Half of the cases had moderate to severe symptoms (S1: n=269, 51%, S2: n=209, 40%, S3: n=45, 8.6%). 228 (43%) relapsed and 13 (2.5%) required colectomy during the first year. Children had a higher proportion of extensive disease vs adults (27/42 vs 136/484), but no increased risk for severe symptoms or colectomy., Conclusion: In this prospective population-based study we found one of the highest incidences of UC in the world. The proportion of severe cases is comparable with historical data. The conclusion is that the nature of UC has not changed, only the incidence., (Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.)
- Published
- 2013
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49. Microscopic colitis in Uppsala health region, a population-based prospective study 2005-2009.
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Thörn M, Sjöberg D, Ekbom A, Holmström T, Larsson M, Nielsen AL, Holmquist L, Thelander U, Wanders A, and Rönnblom A
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Anti-Inflammatory Agents therapeutic use, Celiac Disease complications, Celiac Disease epidemiology, Colitis, Microscopic complications, Colitis, Microscopic diagnosis, Colitis, Microscopic drug therapy, Diarrhea epidemiology, Diarrhea etiology, Female, Humans, Incidence, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases diagnosis, Inflammatory Bowel Diseases drug therapy, Male, Middle Aged, Prospective Studies, Registries, Sweden epidemiology, Young Adult, Colitis, Microscopic epidemiology, Inflammatory Bowel Diseases epidemiology
- Abstract
Objective: The aim of this study is to report on the incidence of microscopic colitis (MC), any possible relation with inflammatory bowel disease (IBD), concomitant drug consumption, related diseases and the clinical course of the diseases., Methods: Both new cases of IBD and MC were registered at the same time in the same geographical area. The study started in the county of Uppsala 2005-2006, and other parts of the surrounding health region were included 2007-2009. Established morphological criteria were used, i.e. a layer of subepithelial collagen band ≥ 10 μm in collagenous colitis (CC) with concomitant inflammation and at least 20 lymphocytes per 100 epithelial cells in lymphocytic colitis (LC)., Results: The authors found 272 new cases of MC, 154 with CC and 118 with LC. The mean age-adjusted incidence was 7.0/1,000,000 for CC and 4.8/100,000 for LC. The clinical course was dominated by single episodes with diarrhea or intermittent symptoms, but 14% suffered from chronic diarrhea. In 10% of the cases, diagnosis was made in individuals without chronic watery diarrhea. Although not systematically tested, concomitant celiac disease was found in approximately 5% of the patients., Conclusions: The incidence of MC in Uppsala health region is similar to other studied areas. The majority of patients had a self-limiting or easily treated condition, but 14% need a more or less continuous medication. Ten percent of the patients demonstrate other symptoms than chronic watery diarrhea. The possibility of concomitant celiac disease should be considered in new cases of MC.
- Published
- 2013
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