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  • 351.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Umeå universitet.
    Sara, Lundell
    Wiklund, Maria
    Nyberg, André
    Holmner, Åsa
    Wadell, Karin
    Co-creating an eHealth tool to support self-management in COPD:perspectives on usefulness and relevance2018Ingår i: JMIR Human Factors, E-ISSN 2292-9495, Vol. 5, nr 4, artikel-id e10801Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives.

    Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers.

    Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis.

    Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge.

    Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases.

  • 352.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Tham, Kerstin
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle.
    von Koch, Lena
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle.
    Ytterberg, Charlotte
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle.
    Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke: an explorative observational study2012Ingår i: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 12, artikel-id 40Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: People who have suffered a stroke commonly report unfulfilled need for rehabilitation. Using a model of patient satisfaction, we examined characteristics in individuals that at 3 months after stroke predicted, or at 12 months were associated with unmet need for rehabilitation or dissatisfaction with health care services at 12 months after stroke.

    METHODS: The participants (n = 175) received care at the stroke units at the Karolinska University Hospital, Sweden. The dependent variables "unfulfilled needs for rehabilitation" and "dissatisfaction with care" were collected using a questionnaire. Stroke severity, domains of the Stroke Impact Scale (SIS), the Sense of Coherence scale (SOC) and socio demographic factors were used as independent variables in four logistic regression analyses.

    RESULTS: Unfulfilled needs for rehabilitation at 12 months were predicted by strength (SIS) (odds ratio (OR) 7.05) at three months, and associated with hand function (SIS) (OR 4.38) and poor self-rated recovery (SIS) (OR 2.46) at 12 months. Dissatisfaction with care was predicted by SOC (OR 4.18) and participation (SIS) (OR 3.78), and associated with SOC (OR 3.63) and strength (SIS) (OR 3.08).

    CONCLUSIONS: Thirty-three percent of the participants reported unmet needs for rehabilitation and fourteen percent were dissatisfied with the care received. In order to attend to rehabilitation needs when they arise, rehabilitation services may need to be more flexible in terms of when rehabilitation is provided. Long term services with scheduled re-assessments and with more emphasis on understanding the experiences of both the patients and their social networks might better be able to provide services that attend to patients' needs and aid peoples' reorientation; this would apply particularly to those with poor coping capacity.

  • 353.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    von Koch, Lena
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle, Neurologkliniken Karolinska Universitetssjukhuset.
    Early supported discharge service after stroke - How is the service implemented in clinical practice?2014Konferensbidrag (Refereegranskat)
  • 354.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    von Koch, Lena
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle, Neurologkliniken Karolinska Universitetssjukhuset.
    Early supported discharge service after stroke in its natural habitat – adherence to guidelines, outcome, resource use and costs2014Konferensbidrag (Refereegranskat)
  • 355.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    von Koch, Lena
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle, Neurologkliniken Karolinska Universitetssjukhuset.
    Early supported discharge service in its natural habitat - how is the service implemented in clinical practice?2013Konferensbidrag (Övrigt vetenskapligt)
  • 356.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    von Koch, Lena
    Karolinska institutet.
    Usual clinical practice for early supported discharge after stroke with continued rehabilitation at home: an observational comparative study2015Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 7, artikel-id e0133536Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Based on randomised controlled trials, evidence exists that early supported discharge (ESD) from the hospital with continued rehabilitation at home has beneficial effects after stroke; however, the effects of ESD service in regular clinical practice have not been investigated. The purpose of the current study was to compare ESD service with conventional rehabilitation in terms of patient outcomes, caregiver burden at 3 and 12 months and the use and costs of healthcare during the first year after stroke.

    Material and methods: This study was a subgroup analysis of a longitudinal observational study of patients who received care in the stroke unit at Karolinska University Hospital in Sweden. Patients who met the inclusion criteria for ESD in previous experimental studies were included. The patients were referred to available rehabilitation services at discharge, and comparisons between those who received ESD service (the ESD group, n = 40) and those who received conventional rehabilitation (the NoESD group, n = 110) were performed with regard to independence in activities of daily living (ADL), the frequency of social activities, life satisfaction, and caregiver burden and the use and costs of healthcare during the first year after stroke.

    Results: At 3 and 12 months, no differences were observed with regard to patient outcomes; however, ESD was associated with a lower caregiver burden (p = 0.01) at 12 months. The initial length of stay (LOS) at the hospital was 8 days for the ESD group and 15 days for the NoESD group (p = 0.02). The median number of outpatient rehabilitation contacts was 20.5 for the ESD group (81% constituting ESD service) and 3 for the NoESD group (p<0.001). There was no difference between the groups with regard to overall healthcare costs.

    Conclusions: ESD service in usual clinical practice renders similar health benefits as conventional rehabilitation but a different pattern of resource use and with released capacity in acute stroke care.

  • 357.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    von Koch, Lena
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle, Neurologkliniken Karolinska Universitetssjukhuset.
    Sjöstrand, Christina
    Institutionen för klinisk neurovetenskap, Karolinska Institutet, Neurologkliniken Karolinska Universitetssjukhuset.
    Tham, Kerstin
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle.
    Ytterberg, Charlotte
    Karolinska Institutet, Institutionen för Neurobiologi, vårdvetenskap och samhälle.
    What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke - amount, place, operator or timing?2013Ingår i: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 16, nr 3, s. e24-35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: To a large extent, people who have suffered a stroke report unmet needs for rehabilitation. The purpose of this study was to explore aspects of rehabilitation provision that potentially contribute to self-reported met needs for rehabilitation 12 months after stroke with consideration also to severity of stroke.

    METHODS: The participants (n = 173) received care at the stroke units at the Karolinska University Hospital, Sweden. Using a questionnaire, the dependent variable, self-reported met needs for rehabilitation, was collected at 12 months after stroke. The independent variables were four aspects of rehabilitation provision based on data retrieved from registers and structured according to four aspects: amount of rehabilitation, service level (day care rehabilitation, primary care rehabilitation and home-based rehabilitation), operator level (physiotherapist, occupational therapist, speech therapist) and time after stroke onset. Multivariate logistic regression analyses regarding the aspects of rehabilitation were performed for the participants who were divided into three groups based on stroke severity at onset.

    RESULTS: Participants with moderate/severe stroke who had seen a physiotherapist at least once during each of the 1st, 2nd and 3rd-4th quarters of the first year (OR 8.36, CI 1.40-49.88 P = 0.020) were more likely to report met rehabilitation needs.

    CONCLUSION: For people with moderate/severe stroke, continuity in rehabilitation (preferably physiotherapy) during the first year after stroke seems to be associated with self-reported met needs for rehabilitation.

  • 358.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ytterberg, Charlotte
    Sjotrand, Christina
    Holmqvist, Lotta Widen
    von Koch, Lena
    Shorter length of stay in the stroke unit: comparison between the 1990s and 2000s2012Ingår i: Topics in Stroke Rehabilitation, ISSN 1074-9357, E-ISSN 1945-5119, Vol. 19, nr 2, s. 172-181Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The process ruling length of stay (LOS) in hospitals is complex, and changes over time in LOS have not been explored. The purpose of the study was to examine differences in LOS, use of and satisfaction with health-related services, and capacity in activities of daily living (ADLs) during the first year post stroke in 2 groups of patients with mild to moderate stroke who received care in the same stroke unit.

    Method: The patients (1993/96, n=40; 2006/07, n=43) in this study received care in the stroke unit at Karolinska University Hospital, Huddinge, Sweden. Data on LOS and on the use of health-related services were collected from the Stockholm County Council computerized registers. Satisfaction with health-related services was assessed using a questionnaire covering different dimensions of care, while ADLs were assessed using Katz Extended Index of ADL.

    Results: The LOS in the stroke unit was shorter in the 2006-2007 group (median 8 days) compared to the 1993-1996 group (13 days) (P < .001). Both groups were equally satisfied with health-related services received. A larger proportion of patients were independent in ADLs 3 months post stroke in the 2006-2007 group, but no difference was seen at 6 or 12 months post stroke.

    Conclusion: It seems possible to reduce the number of days spent in the stroke unit after mild to moderate stroke and instead spend days in a rehabilitation unit, and yet achieve similar patient satisfaction and faster recovery in ADL.

  • 359.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ytterberg, Charlotte
    Tham, Kerstin
    von Koch, Lena
    Different perspectives on disability three months after stroke: a mixed methods approach2011Ingår i: 16th Nordic Congress on Cerebrovascular Diseases, Tallinn, Estland, 2011Konferensbidrag (Refereegranskat)
    Abstract [en]

    Abstract Background A substantial number of people who have suffered a stroke perceive unmet needs for rehabilitation and other health care services. Disability is one of the phenomena underlying people’s need for health care services and disability/problems can be viewed both from the perspective of people with stroke (felt problems), and from the perspective of health professionals (assessed problems). Objective The aim was to describe the felt problems three months after stroke and to explore the concurrence between the felt problems and the assessed problems. Method The patients (n=203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, collected by posing an open question, were categorized. Results from three established assessment tools: Katz Extended Index of ADL (KE); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons between the felt problems and the assessed problems performed. Result Fatigue was the category with the largest number of felt problems (n=58, 28%). Fourteen out of the 28 categories of felt problems, had corresponding items/domains in the KE/ BI and the SIS. The KE/BI failed to identify 16-57% of the felt problems whereas the SIS failed to identify 0-33%. Conclusion There was a substantial lack of concurrence between felt and assessed problems. The results indicate that the use of standardized instruments has to be complemented by open questions and dialogue if the health care services are to be based on the problems experienced by the patients.

  • 360.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ytterberg, Charlotte
    Tham, Kerstin
    von Koch, Lena
    Different perspectives on disability three months after stroke: a mixed methods approach2011Ingår i: 20th European Stroke Conference, Hamburg, Tyskland, 2011Konferensbidrag (Refereegranskat)
    Abstract [en]

    Abstract Background People who have suffered a stroke perceive to a large extent unmet needs of rehabilitation. Needs of health care services can be viewed from the perspective of the phenomena underlying the need i.e. the disability/problems and also from the perspective of the people with stroke as well as the health professionals. The aim was to describe disability/problems from the perspective of the people with stroke, represented by felt problems, reported by patients three months after stroke and to examine if there were differences between men and women. A further aim was to explore the concurrence between the perspective of the people with stroke (felt problems) and the perspective of the health professionals (assessed problems). Methods The patients (n=203) received care at the stroke units at Karolinska University Hospital, Sweden. Felt problems, collected using an open question, were categorized. Results from three established assessment tools: Katz Extended Index of ADL (KE); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories with felt problems were identified and comparisons performed. Results Fatigue was the category in which the largest number of patients reported felt problems (n=58, 28%). More women than men had felt problems in the category Acquisition, meals and housework (p=0.01) whereas more men had felt problems in the categories Employment (p=0.02) and Driving (p=0.009). Fourteen out of the 28 categories of felt problems had corresponding items/domains in the KE/ BI and the SIS. The KE/BI failed to capture 16-57 % of the felt problems whereas the SIS failed to capture 0-33 %. Conclusion There was a substantial lack of concurrence between felt and assessed problems indicating that the use of assessment tools has to be complemented with open questions if health services are to address the problems experienced by the patients.

  • 361.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ytterberg, Charlotte
    Tham, Kerstin
    von Koch, Lena
    Poor concurrence between disability as described by patients and established assessments tools three months after stroke2011Ingår i: Conference on Advances in Health Care Science Research, Stockholm, 2011Konferensbidrag (Refereegranskat)
    Abstract [en]

    A substantial number of people who have suffered a stroke perceive unmet needs for rehabilitation and other health care services. Disability is one of the phenomena underlying people’s need for health care services and disability/problems can be viewed both from the perspective of people with stroke (felt problems), and from the perspective of health professionals (assessed problems). The aims were to describe the felt problems three months after stroke and to explore the concurrence between the felt problems and the assessed problems. The patients (n=203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, collected by posing an open question, were categorized. Results from three established assessment tools: Katz Extended Index of ADL (KE); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons the felt problems and the assessed problems performed. Fatigue was the category with the largest number of felt problems (n=58, 28%). Fourteen out of the 28 categories of felt problems, had corresponding items/domains in the KE/ BI and the SIS. The KE/BI failed to identify 16-57% of the felt problems whereas the SIS failed to identify 0-33%. There was a substantial lack of concurrence between felt and assessed problems. The results indicate that the use of standardized instruments has to be complemented by open questions and dialogue if the health care services are to be based on the problems experienced by the patients.

  • 362.
    Tistad, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Ytterberg, Charlotte
    Tham, Kerstin
    von Koch, Lena
    Poor concurrence between disability as described by patients and established assessments tools three months after stroke: a mixed methods approach2012Ingår i: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 313, nr 1-2, s. 160-166Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Disability/problems, one phenomenon underlying people's need for health care services, can be viewed both from the perspectives of people with stroke (felt problems), and the health professionals (assessed problems). Objective The aim was to describe felt problems three months after stroke and to explore the concurrence between felt problems and assessed problems.

    Method. The patients (n = 203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, drawn from an open question, were categorized. Results from established assessment tools: Katz Extended Index of ADL (KI); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons performed.

    Result. The category Fatigue had the largest number of felt problems (n = 58, 28%). Fourteen out of the 24 categories of felt problems had corresponding items/domains in the assessment tools. KE/BI failed to identify 16–57% and SIS 0–33% of the felt problems.

    Conclusion. There was a substantial lack of concurrence between felt and assessed problems. The results indicate that the use of standardized instruments should be complemented by a dialog if health services are to be based on problems experienced by the patients.

  • 363. Tonkonogi, Aleksandra
    et al.
    Carlsson, Axel C
    Helmersson-Karlqvist, Johanna
    Larsson, Anders
    Ärnlöv, Johan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap. Uppsala universitet.
    Associations between urinary kidney injury biomarkers and cardiovascular mortality risk in elderly men with diabetes2016Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, nr 3, s. 174-178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Three urinary biomarkers, kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and cystatin C, have been suggested as clinically relevant highly specific biomarkers of acute kidney tubular damage. Yet, the utility of these biomarkers in the prognostication of diabetic nephropathy has been less studied. Therefore, we aimed to investigate the longitudinal association between these urinary biomarkers and cardiovascular mortality in patients with diabetes.

    METHODS: The study sample consisted of participants with diabetes in the community-based Uppsala Longitudinal Study of Adult Men (n = 91; mean age 77.8 years). During follow-up (median 8.3 years, interval 0.7-13.4 years), 33 participants died of cardiovascular causes.

    RESULTS: In a multivariable Cox regression model adjusting for age, glomerular filtration rate, and urinary albumin/creatinine ratio, higher urinary KIM-1/creatinine was associated with an increased risk for cardiovascular mortality (HR per SD increase 1.51, 95% confidence intervals 1.03-2.24, P = 0.03). Neither urinary NGAL/creatinine nor urinary cystatin C/creatinine were independently associated with an increased cardiovascular mortality risk.

    CONCLUSION: In elderly men with diabetes, higher urinary KIM-1/creatinine was associated with an increased long-term risk of cardiovascular mortality independently of established markers of diabetic nephropathy. Our data provide support for kidney tubular damage as an important aspect of diabetic nephropathy that merits further investigation.

  • 364.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Alla äldre behöver denna träning2017Ingår i: Här&Nu, ISSN 1653-2287, nr 4, s. 13-13Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 365.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Antioxidanter och träning: sanningar och myter2013Ingår i: Bågskytten, ISSN 0345-1216, Vol. 66, nr 6, s. 23-25Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 366.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Bästa träningen är den som blir av2017Ingår i: Här&Nu, ISSN 1653-2287, nr 5, s. 17-17Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 367.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Bågskytte - en precisionsidrott med höga krav på specifik styrka2014Ingår i: Bågskytten, ISSN 0345-1216, Vol. 67, nr 4, s. 13-15Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 368.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    För att få resultat måste man äta rätt2018Ingår i: Här&Nu, ISSN 1653-2287, nr 1, s. 15-15Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 369.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Idrottsmedicinen sviker barnen2012Ingår i: Svenska Dagbladet, ISSN 1101-2412, nr 25 nov, s. 5-5Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 370.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Inget ont som inte medför något gott2018Ingår i: här&nu, ISSN 1653-2287, nr 5, s. 9-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 371.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Inverkan av akut arbete, träning och oxidativ stress på mitokondriell funktion och termogenes i human skelettmuskulatur.1999Ingår i: Svensk Idrottsmedicin, ISSN 1103-7652, nr 2, s. 5-10Artikel i tidskrift (Övrigt vetenskapligt)
  • 372.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Jag vill leva jag vill dö i Norden...2016Ingår i: här&nu, ISSN 1653-2287, nr 6, s. 15-15Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 373.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Klassa efter syreupptagning bättre sätt att stoppa doping2018Ingår i: Dagens Nyheter, ISSN 1101-2447, nr 2018-02-10, s. 5-5Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 374.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Mitochondrial function in human skeletal muscle: with special reference to exercise and training.2000Doktorsavhandling, monografi (Övrigt vetenskapligt)
    Abstract [en]

    The overall objective of this thesis was to study the adaptation of oxidative function in human skeletal muscle to acute exercise of different modes, intensities and durations, and to endurance training. The effects of endurance training on mitochondrial function were evaluated in cross-sectional and longitudinal studies by measurements of mitochondrial oxygen consumption in isolated mitochondria and permeabilised muscle fibres and measurements of mitochondrial ATP production rate in isolated mitochondria. A positive correlation was observed between maximal mitochondrial oxidative power measured in isolated mitochondria and permeabilised muscle fibres and other parameters related to local and whole body aerobic training status such as pulmonary maximal oxygen uptake, lactate threshold, and muscle activity of citrate synthase (CS). Previous studies have demonstrated that ADP and creatine are important regulators of oxidative phosphorylation. We found that the sensitivity of oxidative phosphorylation to ADP at the level of individual mitochondrion exhibits negative correlation with training status, whereas the creatine control of mitochondrial respiration is more pronounced in aerobically well-trained individuals. It is suggested that these adaptations may improve the potential for regulation of oxidative metabolism in trained muscle. The sensitivity of proton leakdependent oxygen consumption in isolated mitochondria to free fatty acids was up-regulated by a short-term endurance-training program. This may contribute to a higher basal metabolic rate in endurance-trained individuals. It is also suggested that this adaptation may prevent excessive free radical generation and enhance the potential for regulation of aerobic energy production in trained muscle. Exposure of isolated mitochondria to reactive oxygen species (ROS) reduced maximal ADP-stimulated respiration and P/O ratio and increased noncoupled respiration rate. The sensitivity of non-coupled respiration in isolated mitochondria to ROS was increased by 6 wk of endurance training, whereas the sensitivity of maximal ADP-stimulated respiration and P/O ratio to ROS was unaffected. These results indicate that inner mitochondrial membrane becomes more sensitive to oxidative stress after short-term endurance training. Activities of muscle antioxidative enzymes (SOD, GPX) and glutathione status were unaffected by training. This will result in a lowered antioxidative protection per mitochondrion, which may increase the susceptibility of inner membrane to oxidative stress. Maximal mitochondrial oxidative power in human vastus lateralis muscle was found to be intact or improved after high-intensity intermittent and moderate-intensity prolonged concentric cycling exercise as well as after eccentric cycling. Prolonged exercise increased the non-coupled mitochondrial respiration rate, which may contribute to the excess post-exercise oxygen consumption. After prolonged exercise an acute increase in muscle CS activity was observed. High-intensity intermittent exercise affected the ADP control of oxidative phosphorylation, as evidenced by transient decrease in ADP sensitivity of mitochondrial respiration in permeabilised muscle fibres. ADP sensitivity was unchanged after prolonged concentric and high-intensity eccentric exercise. Taken together these results indicate that mitochondrial function in human muscle is affected differently by exercise of different types. The effect of lactic acidosis on oxidative phosphorylation was evaluated in isolated mitochondria from rat skeletal muscle. It was demonstrated that acidosis induced on non-phosphorylating mitochondria reduces rate of subsequent maximal ADP-stimulated respiration. In contrast, when actively phosphorylating mitochondria were exposed to acidosis maximal ADP-stimulated respiration remained unchanged. On the basis of these results we suggested that the influence of lactic acidosis on muscle aerobic energy production may depend on the physiological conditions at the onset of acidity. Overall, the present investigations indicate that mitochondrial oxidative function is highly responsive to exercise. Endurance training induces adaptation of both quantitative and qualitative aspects of mitochondrial function, which improves the potential for metabolic control. The results suggest that acute physical exercise in humans is, in contrast to previous animal studies, well tolerated by skeletal muscle mitochondria.

  • 375.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Mitokondrier – muskelcellernas kraftverk: anpassnings- och överlevnadskonstnärer som är avgörande för prestation och hälsa.2001Ingår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, nr 1, s. 44-47Artikel i tidskrift (Övrigt vetenskapligt)
  • 376.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Musiken kan ge oss bättre resultat2017Ingår i: Här&Nu, ISSN 1653-2287, nr 6, s. 17-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 377.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Muskulaturens förmåga att utnyttja syre är avgörande för prestation och hälsa1998Ingår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, nr 3, s. 34-37Artikel i tidskrift (Övrigt vetenskapligt)
  • 378.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Rörelse bästa bot vid artros2017Ingår i: här&nu, ISSN 1653-2287, nr 3, s. 11-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 379.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Små förändringar ger stor effekt2018Ingår i: här&nu, ISSN 1653-2287, nr 4, s. 13-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 380.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Styrketräna för hjärtat2017Ingår i: här&nu, ISSN 1653-2287, nr 2, s. 23-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 381.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Styrketräning bra för balansen2016Ingår i: här&nu, ISSN 1653-2287, nr 5, s. 11-11Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 382.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Styrketräning för barn - bu eller bä?2007Ingår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, nr 1, s. 38-43Artikel i tidskrift (Övrigt vetenskapligt)
  • 383.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Styrketräning för barn: Sverige i det internationella perspektivet2013Ingår i: Vaskulär Medicin, ISSN 2000-3188, Vol. 29, nr 1, s. 15-18Artikel i tidskrift (Övrigt vetenskapligt)
  • 384.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Styrketräning för bågskyttar2013Ingår i: Bågskytten, ISSN 0345-1216, Vol. 66, nr 1-2, s. 12-15Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 385.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Styrketräning för friska och sjuka barn: Det internationella perspektivet2013Ingår i: Barnbladet, ISSN 0349-1994, Vol. XXXVIII, nr 4, s. 14-16Artikel i tidskrift (Övrigt vetenskapligt)
  • 386.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Styrketräning för unga bågskyttar2016Ingår i: Bågskytten, ISSN 0345-1216, Vol. 69, nr 7, s. 12-15Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 387.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Träna bort depressioner2017Ingår i: här&nu, ISSN 1653-2287, nr 1, s. 11-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 388.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Träning bra för nära relationer2016Ingår i: här&nu, ISSN 1653-2287, nr 4, s. 13-13Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 389.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Träning för hälsa och relationer2017Ingår i: Äldreomsorg, ISSN 1403-7025, nr 3, s. 33-34Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 390.
    Tonkonogi, Michail
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Träningslärans grunder - fysiska grundegenskaper och träningsprinciper2018Ingår i: Idrottens träning, Stockholm: SISU Idrottsböcker , 2018, s. 22-57Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 391.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Bellardini, Helena
    Högskolan Dalarna, Akademin Hälsa och samhälle, Idrotts- och hälsovetenskap.
    Fysisk trening for barn och ungdom: for helse, allsidig utvikling og prestasjon2013 (uppl. 1)Bok (Övrig (populärvetenskap, debatt, mm))
  • 392.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Bellardini, Helena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Idrotts- och hälsovetenskap.
    Träna bort den stressrelaterade ohälsan2016 (uppl. 1)Bok (Övrigt vetenskapligt)
  • 393.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Bellardini, Helena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Idrotts- och hälsovetenskap.
    Tunga vikter för en lättare ålderdom2013Ingår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 22, nr 3, s. 8-12Artikel i tidskrift (Övrigt vetenskapligt)
  • 394.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Fernström, Maria
    Walsh, Brandon
    Ji, Li Li
    Rooyackers, Olav
    Hammaqvist, Folke
    Wernerman, Jan
    Sahlin, Kent
    Reduced oxidative power but unchanged antioxidative capacity in skeletal muscle from aged humans.2003Ingår i: Pflügers Archiv: European Journal of Physiology, ISSN 0031-6768, E-ISSN 1432-2013, Vol. 446, nr 2, s. 261-269Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The hypothesis that the aging process is associated with mitochondrial dysfunction and oxidative stress has been investigated in human skeletal muscle. Muscle biopsy samples were taken from seven old male subjects [OS; 75 (range 61-86) years] and eight young male subjects [YS; 25 (22-31) years]. Oxidative function was measured both in permeabilised muscle fibres and isolated mitochondria. Despite matching the degree of physical activity, OS had a lower training status than YS as judged from pulmonary maximal O2 consumption (V£O2max, m36%) and handgrip strength (m20%). Both maximal respiration and creatine-stimulated respiration were reduced in muscle fibres from OS (m32 and m34%, respectively). In contrast, respiration in isolated mitochondria was similar in OS and YS. The discrepancy might be explained by a biased harvest of "healthy" mitochondria and/or disruption of structural components during the process of isolation. Cytochrome C oxidase was reduced (m40%, P<0.01), whereas UCP3 protein tended to be elevated in OS (P=0.09). Generation of reactive oxygen species by isolated mitochondria and measures of antioxidative defence (muscle content of glutathione, glutathione redox status, antioxidative enzymes activity) were not significantly different between OS and YS. It is concluded that aging is associated with mitochondrial dysfunction, which appears to be unrelated to reduced physical activity. The hypothesis of increased oxidative stress in aged muscle could not be confirmed in this study.

  • 395.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Harris, Bearn
    Sahlin, Kent
    Increased activity of citrate synthase in human skeletal muscle after a single bout of prolonged exercise.1997Ingår i: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 161, s. 435-436Artikel i tidskrift (Refereegranskat)
  • 396.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Harris, Bearn
    Sahlin, Kent
    Mitochondrial oxidative function in human saponin-skinned muscle fibres: effects of prolonged exercise.1998Ingår i: Journal of Physiology, ISSN 0022-3751, E-ISSN 1469-7793, Vol. 510, s. 279-286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    1. The influence of prolonged exhaustive exercise on mitochondrial oxidative function was investigated in ten men. 2. Muscle biopsies were taken before and after exercise and mitochondrial respiration investigated in fibre bundles made permeable by pretreatment with saponin. 3. After exercise, respiration in the absence of ADP increased by 18 % (P< 0.01), but respiration at suboptimal ADP concentration (0.1 mM) and maximal ADP-stimulated respiration (1 mM ADP) remained unchanged. 4. In the presence of creatine (20 mM), mitochondrial affinity for ADP increased markedly and respiration at suboptimal ADP concentration (0.1 mM) was similar (pre-exercise) or higher (post-exercise; P< 0.05) than with 1 mM ADP alone. The increase in respiratory rate with creatine was correlated to the relative type I fibre area (r = 0.84). Creatine-stimulated respiration increased after prolonged exercise (P< 0.01). 5. The respiratory control index (6.8 ± 0.4, mean ± s.e.m.) and the ratio between respiration at 0.1 and 1 mM ADP (ADP sensitivity index, 0.63 ± 0.03) were not changed after exercise. The sensitivity index was negatively correlated to the relative type I fibre area (r = -0.86). 6. The influence of exercise on muscle oxidative function has for the first time been investigated with the skinned-fibre technique. It is concluded that maximal mitochondrial oxidative power is intact or improved after prolonged exercise, while uncoupled respiration is increased. The latter finding may contribute to the elevated post-exercise oxygen consumption. The finding that the sensitivity of mitochondrial respiration for ADP and creatine are related to fibre-type composition indicates intrinsic differences in the control of mitochondrial respiration between fibres.

  • 397.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Medicinsk vetenskap.
    Hawke, Emma
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Idrotts- och hälsovetenskap.
    The way that physical education aims to provide the recommended dose of physical activity in school children is multifaceted2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 1, s. 12-13Artikel i tidskrift (Övrigt vetenskapligt)
  • 398.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Henriksson, Jan
    Cotgreave, Ian
    Human skeletal muscle interstitial glutathione levels are elevated in comparison to adipose tissue and blood plasma.2003Ingår i: Archives of Biochemistry and Biophysics, ISSN 0003-9861, E-ISSN 1096-0384, Vol. 413, nr 1, s. 147-149Artikel i tidskrift (Refereegranskat)
  • 399.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Krook, Anna
    Walsh, Brandon
    Sahlin, Kent
    Endurance training increases stimulation of uncoupling of skeletal muscle mitochondria in humans by non-esterified fatty acids: an uncoupling-protein-mediated effect?2000Ingår i: Biochemical Journal, ISSN 0264-6021, E-ISSN 1470-8728, Vol. 351, nr 3, s. 805-810Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Uncoupled respiration (UCR) is an essential property of muscle mitochondria and has several functions in the cell. We hypothesized that endurance training may alter the magnitude and properties of UCR in human muscle. Isolated mitochondria from muscle biopsies taken before and after 6 weeks of endurance exercise training (n = 8) were analysed for UCR. To investigate the role of uncoupling protein 2 (UCP2) and UCP3 in UCR, the sensitivity of UCR to UCP-regulating ligands (non-esterified fatty acids and purine nucleotides) and UCP2 and UCP3 mRNA expression in muscle were examined. Oleate increased the mitochondrial oxygen consumption rate, an effect that was not attenuated by GDP and/or cyclosporin A. The effect of oleate was significantly greater after compared with before training. Training had no effect on UCP2 or UCP3 mRNA levels, but after training the relative increase in respiration rate induced by oleate was positively correlated with the UCP2 mRNA level. In conclusion, we show that the sensitivity of UCR to non-esterified fatty acids is up-regulated by endurance training. This suggests that endurance training causes intrinsic changes in mitochondrial function, which may enhance the potential for regulation of aerobic energy production, prevent excess free radical generation and contribute to a higher basal metabolic rate.

  • 400.
    Tonkonogi, Michail
    et al.
    Högskolan Dalarna, Akademin Hälsa och samhälle, Medicinsk vetenskap.
    Sahlin, Kent
    Actively phosphorylating mitochondria are more resistant to lactic acidosis than inactive mitochondria.1999Ingår i: American Journal of Physiology. Cell Physiology, ISSN  0363-6143, Vol. 277, nr 2, s. C288-C293Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Oxidative phosphorylation of isolated rat skeletal muscle mitochondria after exposure to lactic acidosis in either phosphorylating or nonphosphorylating states has been evaluated. Mitochondrial respiration and transmembrane potential (Delta Psi m) were measured with pyruvate and malate as the substrates. The addition of lactic acid decreased the pH of the reaction medium from 7.5 to 6.4. When lactic acid was added to nonphosphorylating mitochondria, the subsequent maximal ADP-stimulated respiration decreased by 27% compared with that under control conditions (P < 0.05), and the apparent Michaelis-Menten constant (Km) for ADP decreased to 10 µM vs. 20 µM (P < 0.05) in controls. In contrast, maximal respiration and ADP sensitivity were not affected when mitochondria were exposed to acidosis during active phosphorylation in state 3. Acidosis significantly increased mitochondrial oxygen consumption in state 4 (post-state 3), irrespective of when acidosis was induced. This effect of acidosis was attenuated in the presence of oligomycin. The addition of lactic acid during state 4 respiration decreased Delta Psi m by 19%. The ratio between added ADP and consumed oxygen (P/O) was close to the theoretical value of 3 in all conditions. The addition of potassium lactate during state 3 (i.e., medium pH unchanged) had no effect on the parameters measured. It is concluded that lactic acidosis has different effects when induced on nonphosphorylating vs. actively phosphorylating mitochondria. On the basis of these results, we suggest that the influence of lactic acidosis on muscle aerobic energy production depends on the physiological conditions at the onset of acidity.

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