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  • 401.
    Carlgren, Ingrid
    et al.
    Stockholms universitet.
    Nyberg, Gunn
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Från ord till rörelser och dans: en analys av rörelsekunnandet i en dansuppgift2015In: Forskning om undervisning och lärande, ISSN 2000-9674, E-ISSN 2001-6131, no 14, p. 24-40Article in journal (Refereed)
    Abstract [sv]

    I artikeln redovisar vi ett exempel på hur kunnande, som kommer till uttryck då elever redovisar en dansuppgift, kan analyseras och bidra till vår förståelse av detta kunnande såväl som till ett artikulerat språk att använda vid utvecklingen av undervisningen. En utgångspunkt är att kunskaper om kunnande är en nödvändig grund för att förbättra undervisningen. En annan utgångspunkt är att det råder brist på sådan kunskap. Eleverna (ca 12 år gamla) var indelade i tre grupper som fick en uppgift där de med utgångspunkt i två meningar skulle skapa en dans genom att översätta varje ord till en rörelse och därefter sammanfoga ord-rörelserna. Vi presenterar resultaten av en fenomenografisk analys som grundar sig på en videoinspelning av dessa redovisningar.

  • 402.
    Carlson, Åsa
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Söderström, Monica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Vuxna personers upplevelser av att leva med diabetes typ 2: En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Diabetes mellitus will be the seventh leading cause of death in 2030 and 422 million adults in the world are currently living with diabetes. Type 2 diabetes account for the vast majority of people affected with the disease. Diabetes can result in a variety of serious complications. Making lifestyle changes is a central part of the treatment and the patient’s ability to self-manage the disease is therefore emphasised. Nurses are responsible for providing high quality nursing care, and this includes collecting information about the patient and strengthening the patient’s ability for self-care.

    Aim:

    To describe adult persons’ experiences of living with diabetes type 2.

    Method:

    A literature review of 16 qualitative articles, which were critically reviewed, analyzed and compiled.

    Result:

    The persons’ experiences are presented in three main categories with associated subcategories. The emotional aspects of living with diabetes were prominent and many had difficulties adapting to a new lifestyle. Relationships were affected and social support was seen as important.

    Conclusion:

    Living with diabetes can cause emotional reactions and making lifestyle changes is a struggle for many. The social support from family and friends is important and receiving feedback, information and support from doctors and nurses regarding self-care is also of great importance.

  • 403. Carlsson, A. C.
    et al.
    Riserus, U.
    Engstrom, G.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Melander, O.
    Leander, K.
    Gigante, B.
    Hellenius, M-L
    de Faire, U.
    Novel and established anthropometric measures and the prediction of incident cardiovascular disease: a cohort study2013In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 37, no 12, p. 1579-1585Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to compare novel and established anthropometrical measures in their ability to predict cardiovascular disease (CVD), and to determine whether they improve risk prediction beyond classical risk factors in a cohort study of 60-year-old men and women. We also stratified the results according to gender to identify possible differences between men and women. Furthermore, we aimed to replicate our findings in a large independent cohort (The Malmo Diet and Cancer study-cardiovascular cohort).

    METHODS: This was a population-based study of 1751 men and 1990 women, aged 60 years and without CVD at baseline, with 375 incident cases of CVD during 11 years of follow-up. Weight, height, waist circumference (WC), hip circumference and sagittal abdominal diameter (SAD) were measured at baseline. Body mass index (BMI), waist-hip ratio (WHR), waist-hip-height ratio (WHHR), WC-to-height ratio (WCHR) and SAD-to-height ratio (SADHR) were calculated.

    RESULTS: All anthropometric measures predicted CVD in unadjusted Cox regression models per s.d. increment (hazard ratios, 95% confidence interval), while significant associations after adjustments for established risk CVD factors were noted for WHHR 1.20 (1.08-1.33), WHR 1.14 (1.02-1.28), SAD 1.13 (1.02-1.25) and SADHR 1.17 (1.06-1.28). WHHR had higher increases in C-statistics, and model improvements (likelihood ratio tests (P<0.001)). In the replication study (MDC-CC, n = 5180), WHHR was the only measure that improved Cox regression models in men (P = 0.01).

    CONCLUSION: WHHR, a new measure reflecting body fat distribution, showed the highest risk estimates after adjustments for established CVD risk factors. These findings were verified in men but not women in an independent cohort.

  • 404.
    Carlsson, A C
    et al.
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Riserus, Ulf
    Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Public Health and Caring Sciences/Section of Geriatrics Uppsala University, Uppsala, Sweden.
    Borné, Y
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Leander, K
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Gigante, B
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Hellénius, M-L
    Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bottai, M
    Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Sweden.
    de Faire, U
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Prediction of cardiovascular disease by abdominal obesity measures is dependent on body weight and sex: results from two community based cohort studies2014In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 24, no 8, p. 891-899Article in journal (Refereed)
    Abstract [en]

    AIM: To study waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), and waist-hip-height ratio (WHHR) as predictors of CVD, in men and women stratified by BMI (cut-off ≥25).

    METHODS AND RESULTS: A cohort of n = 3741 (53% women) 60-year old individuals without CVD was followed for 11-years (375 CVD cases). To replicate the results, we also assessed another large independent cohort; The Malmö Diet and Cancer study - cardiovascular cohort (MDCC, (n = 5180, 60% women, 602 CVD cases during 16-years). After adjustment for established risk factors in normal-weight women, the hazard ratio (HR) per one standard deviation (SD) were; WHR; 1.91 (95% confidence interval (CI) 1.35-2.70), WC; 1.81 (95% CI 1.02-3.20), SAD; 1.25 (95% CI 0.74-2.11), and WHHR; 1.97 (95% CI 1.40-2.78). In men the association with WHR, WHHR and WC were not significant, whereas SAD was the only measure that significantly predicted CVD in men (HR 1.19 (95% CI 1.04-1.35). After adjustments for established risk factors in overweight/obese women, none of the measures were significantly associated with CVD risk. In men, however, all measures were significant predictors; WHR; 1.24 (955 CI 1.04-1.47), WC 1.19 (95% CI 1.00-1.42), SAD 1.21 (95% CI 1.00-1.46), and WHHR; 1.23 (95% CI 1.05-1.44). Only the findings in men with BMI ≥ 25 were verified in MDCC.

    CONCLUSION: In normal weight individuals, WHHR and WHR were the best predictors in women, whereas SAD was the only independent predictor in men. Among overweight/obese individuals all measures failed to predict CVD in women, whereas WHHR was the strongest predictor after adjustments for CVD risk factors in men.

  • 405. Carlsson, A. C.
    et al.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Sundström, J.
    Michaëlsson, K.
    Byberg, L.
    Lind, L.
    Physical activity, obesity and risk of cardiovascular disease in middle-aged men during a median of 30 years of follow-up2016In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 4, p. 359-365Article in journal (Refereed)
    Abstract [en]

    Background: We aimed to investigate associations between combinations of body mass index (BMI)-categories, levels of physical activity and long-term risk of cardiovascular disease.

    Method and results: At age 50 years, cardiovascular risk factors were assessed in 2196 participating men of the ULSAM-study. This investigation was repeated at age 60, 70, 77 and 82 years. Being physically active (PA) was defined as three hours of recreational or hard physical training per week. The men were categorized according to BMI/PA-status, as PA/normal weight (n = 593 at baseline), non-PA/normal weight (BMI &lt; 25 kg/m2, n = 580), PA/overweight (n = 418), non-PA/overweight (BMI 25-30 kg/m2, n = 462), PA/obese (n = 62), non-PA/obese (BMI &gt;30 kg/m2, n = 81). We used updated data on BMI and physical activity obtained at all examinations. During follow-up (median 30 years) 850 individuals suffered a cardiovascular disease (myocardial infarction, stroke or heart failure). Using updated data on BMI/PA categories, an increased risk for cardiovascular disease was seen with increasing BMI, but a high physical activity was associated with a lower risk of cardiovascular disease within each BMI category: non-PA/normal weight (hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.04-1.66), PA/overweight (HR 1.52, 95% CI 1.20-1.94), non-PA/overweight (HR 1.65, 95% CI 1.31-2.07) PA/obese (HR 2.05, 95% CI 1.44-2.92) and non-PA/obese (HR 2.39, 95% CI 1.74-3.29), using PA/normal weight men as referent.

    Conclusions: Although physical activity was beneficial at all levels of BMI regarding the risk of future cardiovascular disease, there was still a substantial increased risk associated with being overweight or obese during 30 years of follow-up. 

  • 406. Carlsson, A C
    et al.
    Östgren, C J
    Länne, T
    Larsson, A
    Nystrom, F H
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    The association between endostatin and kidney disease and mortality in patients with type 2 diabetes2016In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 42, no 5, p. 351-357Article in journal (Refereed)
    Abstract [en]

    AIM: Circulating endostatin, a biologically active derivate of collagen XVIII, is considered to be a marker of kidney disease and a risk factor for its related mortality. However, less is known of the role of endostatin in diabetes and the development of diabetic nephropathy. For this reason, our study investigated the associations between circulating endostatin and the prevalence and progression of kidney disease, and its mortality risk in patients with type 2 diabetes (T2D).

    METHODS: This was a cohort study of 607 patients with T2D (mean age: 61 years, 44% women). Estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, was used to assess the patients' kidney function decline and mortality.

    RESULTS: Of the total study cohort, 20 patients declined by ≥20% in eGFR over 4 years, and 44 died during the follow-up (mean duration: 6.7 years). At baseline, participants with diabetic nephropathy (defined as eGFR<60mL/min/1.73m(2)) and/or microalbuminuria [defined as a urinary albumin-to-creatinine ratio (ACR)>3g/mol] had higher median levels of endostatin than those without nephropathy (62.7μg/L vs 57.4μg/L, respectively; P=0.031). In longitudinal analyses adjusted for age, gender, baseline eGFR and ACR, higher endostatin levels were associated with a higher risk of decline (≥20% in eGFR, OR per 1 SD increase: 1.73, 95% CI: 1.13-2.65) and a higher risk of mortality (HR per 1 SD increase: 1.57, 95% CI: 1.19-2.07).

    CONCLUSION: In patients with T2D, circulating endostatin levels can predict the progression of kidney disease and mortality independently of established kidney disease markers. The clinical usefulness of endostatin as a risk marker in such patients merits further studies.

  • 407.
    Carlsson, Amanda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Lindström, Camilla
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Skador inom svensk judo: Skadade strukturer, skadefrekvens, köns- och åldersskillnader.2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Judo is a complex sport that places great demands on the judoka, which means there is a risk for injuries in judo.

    The aim of this study is to analyze how male and female judokas experience injuries and mechanisms where injuries appear in Swedish judo. This was done by publishing a survey on a judo group on Facebook.com. Previously collected data and data from Provins Insurance AB was used.

    Most injuries happened during exercise and usually under tachi waza and mainly tachi waza randori. Achi waza was the mechanism that caused the most injuries to women and for men it was achi waza and te waza.

    The technics that caused the most injuries were O soto gari, which caused ligament damage in the knee, and Seoi Nage caused various types of injuries.

    On competition the most common mechanism for injuries for both men and women was te waza. The technics were Seoi nage and Tai Otoshi.

    With this study results, previous data and statistics from Provins Insurance AB in combination with previous studies, some conclusions can be reached on the most frequent injuries and how they occur. It is also possible to draw conclusions about how participants were affected in their daily life after the injury.

    This can provide an insight as to what injuries the sports movement should focus on trying to counteract.

  • 408.
    Carlsson, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Andersson, Linda
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer som bidrar till ett stabilare mående hos patienter med emotionellt instabil personlighetsstörning i heldygnsvård: en kvalitativ intervjustudie ur ett patientperspektiv2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Patients with emotional unstable personality disorder is experienced as a

    difficult to treat patient population in inpatient care. Nursing staff knowledge surrounding the

    introduction and the treatment of this patient population is diverse, which means that the care

    is different. This can result in increased suffering of the patient and frustration in the staff

    group.

    Aim: The aim of the study was to describe factors that contribute to a more stable mood in

    patients with emotionally unstable personality disorder.

    Method: The method that has been used is a qualitative design with inductive approach. The

    study was based on six interviews with informants that who were patients diagnosed with

    emotionally unstable personality disorder. The interviews were analyzed using content

    analysis.

    Result: The results showed that the hospitality and commitment of the staff was of great

    importance. Structure and participation were other important factors for achieving a stable

    mood. It was revealed that inpatient care could contribute to an interruption of everyday life

    and meaningful activities were another important factor that emerged.

    Conclusion: Patients experienced to be treated as an individual by committed staff and to be

    involved in their care was part of the process towards a stable mood. Inpatient care structure

    and change of environment support for recovery and an opportunity to regain routines. There

    was a desire for more meaningful activities such as physical activity and psycho education to

    best take advantage of the period of care

  • 409.
    Carlsson, Axel C
    et al.
    Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden ; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Calamia, Michael
    Landstinget Dalarna, Falun, Sweden.
    Risérus, Ulf
    Department of Public Health and Caring Sciences/Section of Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Helmersson-Karlqvist, Johanna
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Kidney injury molecule (KIM)-1 is associated with insulin resistance: results from two community-based studies of elderly individuals2014In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 103, no 3, p. 516-21Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Insulin resistance has been shown to be closely associated with glomerular filtration rate and urinary albumin/creatinine ratio, even prior to the development of diabetes. Urinary kidney injury molecule 1 (KIM-1) is a novel, highly specific marker of kidney tubular damage. The role of insulin resistance in the development of kidney tubular damage is not previously reported. Thus, we aimed to investigate the associations between insulin sensitivity (assessed by HOMA) and urinary KIM-1.

    DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Two community-based cohorts of elderly individuals were investigated: Prospective Investigation of the vasculature in Uppsala seniors (PIVUS, n=701; mean age 75 years, 52% women); and Uppsala Longitudinal Study of adult men (ULSAM, n=533; mean age 78 years).

    RESULTS: Lower insulin sensitivity was associated with higher urinary KIM-1 in both cohorts after adjustments for age, BMI, blood pressure, antihypertensive treatment, glomerular filtration rate, and urinary albumin-creatinine ratio (PIVUS: regression coefficient for 1-SD higher HOMA-IR 0.11, 95% CI 0.03-0.20, p=0.009, and ULSAM: 0.13, 95% CI 0.04-0.22, p=0.007). Results were similar in individuals without diabetes, with normal kidney function and normo-albuminuria.

    CONCLUSIONS: Our findings in elderly individuals support the notion that the interplay between an impaired glucose metabolism and renal tubular damage is evident even prior to the development of diabetes and overt kidney disease.

  • 410. Carlsson, Axel C.
    et al.
    Carrero, Juan-Jesus
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Endostatin, cathepsin S, and cathepsin L, and their association with inflammatory markers and mortality in patients undergoing hemodialysis2015In: Blood Purification, ISSN 0253-5068, E-ISSN 1421-9735, Vol. 39, no 4, p. 259-265Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Although both endostatin and cathepsins S have been associated with higher mortality, data in patients with end-stage renal disease (ESRD) are scarce.

    Methods: A longitudinal cohort study of 207 prevalent patients undergoing hemodialysis.

    Results: Cathepsins S and L were associated with soluble receptors for tumor necrosis factor (sTNFR1 and sTNFR2, rho between 0.28 and 0.43, p < 0.001 for all). Weaker or absent associations between endostatin, cathepsins S and L were seen with other inflammatory biomarkers, that is, CRP, interleukin 6, pentraxin 3, and TNF. In Cox and Laplace regression models adjusted for age, sex, dialysis vintage, and diabetes: standard deviation increments of endostatin was associated with a lower mortality (hazard ratio 0.75, 95% confidence interval (CI) 0.57-0.98), and with 6.8 months longer median survival.

    Conclusions: The high levels of endostatin, cathepsins S and L, and their associations with sTNFR1 and sTNFR2 warrant further studies exploring mortality, and the angiogenic and inflammatory pathways in ESRD. (C) 2015 S. Karger AG, Basel

  • 411. Carlsson, Axel C.
    et al.
    Carrero, Juan-Jesus
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    High levels of soluble tumor necrosis factor receptors 1 and 2 and their association with mortality in patients undergoing hemodialysis2015In: CardioRenal Medicine, ISSN 1664-3828, Vol. 5, no 2, p. 89-95Article in journal (Refereed)
    Abstract [en]

    Objective: Circulating soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and 5TNFR2) are associated with chronic kidney disease (CKD) progression in patients with CKD or diabetes, and with higher mortality. However, data in patients with end-stage renal disease are scarce. Therefore, we analyzed serum levels of sTNFR1 and sTNFR2 and investigated their association with inflammatory markers and mortality in dialysis patients. Research Design and Methods: This was a longitudinal cohort study of 207 prevalent patients (median age 66 years, 56% men) undergoing hemodialysis in Stockholm, Sweden. Demographics, clinical characteristics, including comorbidities and laboratory data, were obtained at baseline, together with prospective follow-up for mortality.

    Results: The median sTNFR1 and sTNFR2 levels were 17,680 ng/l [95% confidence interval (CI) 17,023-18,337] and 24,450 ng/l (95% CI 23,721-25,179), respectively. During a follow-up of 31 months (interquartile range, 21-38), 77 patients died. There was no association between the levels of sTNFRs and mortality in Cox regression models, and no consistent trend towards higher or lower mortality was seen in Laplace regression models. sTNFR1 and sTNFR2 levels were highly associated with other inflammatory markers including interleukin-6, pentraxin 3 and TNF-alpha. Conclusions:Prevalent hemodialysis patients have several-fold higher levels of sTNFRs compared to previous studies in CKD stage 4 patients. As no consistent association between TNFR and mortality was observed, clinical implications of measuring these receptors to predict outcome end-stage renal disease patients provide limited results.

  • 412. Carlsson, Axel C
    et al.
    Ingelsson, Erik
    Sundström, Johan
    Carrero, Juan Jesus
    Gustafsson, Stefan
    Feldreich, Tobias
    Stenemo, Markus
    Larsson, Anders
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Use of proteomics to investigate kidney function decline over 5 years2017In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 12, no 8, p. 1226-1235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Using a discovery/replication approach, we investigated associations between a multiplex panel of 80 circulating proteins associated with cardiovascular pathology or inflammation, and eGFR decline per year and CKD incidence.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used two cohorts, the Prospective Investigation of the Vasculature in Uppsala Seniors Study (PIVUS; n=687, mean age of 70 years, 51% women) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n=360 men, mean age of 78 years), with 5-year follow-up data on eGFR. There were 231 and 206 incident cases of CKD during follow-up in the PIVUS and ULSAM studies, respectively. Proteomic profiling of 80 proteins was assessed by a multiplex assay (proximity extension assay). The assay uses two antibodies for each protein and a PCR step to achieve a high-specific binding and the possibility to measure multiple proteins in parallel, but gives no absolute concentrations.

    RESULTS: In the discovery cohort from the PIVUS Study, 28 plasma proteins were significantly associated with eGFR decline per year, taking into account the multiple testing. Twenty of these proteins were significantly associated with eGFR decline per year in the replication cohort from the ULSAM Study after adjustment for age, sex, cardiovascular risk factors, medications, and urinary albumin-to-creatinine ratio (in order of significance: TNF-related apoptosis-inducing ligand receptor 2*, CD40L receptor, TNF receptor 1*, placenta growth factor*, thrombomodulin*, urokinase plasminogen activator surface receptor*, growth/differentiation factor 15*, macrophage colony-stimulating factor 1, fatty acid-binding protein*, cathepsin D, resistin, kallikrein 11*, C-C motif chemokine 3, proteinase-activated receptor 1*, cathepsin L, chitinase 3-like protein 1, TNF receptor 2*, fibroblast growth factor 23*, monocyte chemotactic protein 1, and kallikrein 6). Moreover, 11 of the proteins predicted CKD incidence (marked with * above). No protein consistently predicted eGFR decline per year independently of baseline eGFR in both cohorts.

    CONCLUSIONS: Several circulating proteins involved in phosphate homeostasis, inflammation, apoptosis, extracellular matrix remodeling, angiogenesis, and endothelial dysfunction were associated with worsening kidney function. Multiplex proteomics appears to be a promising way of discovering novel aspects of kidney disease pathology.

  • 413. Carlsson, Axel C
    et al.
    Jansson, Jan-Håkan
    Söderberg, Stefan
    Ruge, Toralph
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Levels of soluble tumor necrosis factor receptor 1 and 2, gender, and risk of myocardial infarction in Northern Sweden2018In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 272, p. 41-46Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Soluble receptors for tumor necrosis factor alpha (sTNFR1 and sTNFR2) have been associated with cardiovascular diseases, and some evidence points towards a difference in associated risk between men and women. We aimed to study the association between sTNFR1 and sTNFR2 and incident myocardial infarctions (MI) and to explore the influence of established cardiovascular risk factors in men and women.

    METHODS: We conducted a nested case control study in three large Swedish cohorts, including 533 myocardial infarction cases, and 1003 age-, sex- and cohort-matched controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

    RESULTS: An association between circulating sTNFR1 and sTNFR2 and an increased risk for MI was found when comparing cases and controls. The odds ratios were significant after adjustment for established cardiovascular risk factors and C-reactive protein in women (OR 1.44, 95% CI 1.08-1.93 for TNFR1, and 1.61, 95% CI 1.11-2.34 for TNFR2), but was abolished in men. Women with a combination of elevated CRP and values in the upper quartile of TNFR1 or TNFR2 had a 5-fold higher risk of myocardial infarction versus those with normal CRP and values in the lower three quartiles of TNFR1 or TNFR2.

    CONCLUSIONS: As the risk estimates for TNFR1 and TNFR2 were higher and remained significant after adjustments for established cardiovascular risk factors in women but not in men, a potential role for TNFR1 and TNFR2 in identifying women with a higher MI risk is possible. The future clinical role of TNFR1 and TNFR2 in combination with CRP to identify high risk patients for coronary heart disease has yet to be determined.

  • 414. Carlsson, Axel C
    et al.
    Juhlin, C Christofer
    Larsson, Tobias E
    Larsson, Anders
    Ingelsson, Erik
    Sundström, Johan
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Soluble tumor necrosis factor receptor 1 (sTNFR1) is associated with increased total mortality due to cancer and cardiovascular causes: findings from two community based cohorts of elderly2014In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 237, no 1, p. 236-242Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experimental evidence support soluble receptors for tumor necrosis factor alpha as important mediators of the underlying pathology leading to cardiovascular disease and cancer. However, prospective data concerning the relation between circulating soluble tumor necrosis factor receptor-1 (sTNFR1) and mortality in humans are lacking. We aimed to explore and validate the association between sTNFR1 and mortality, and to explore the influence of other established risk factors for mortality, including other inflammatory markers.

    METHODS: The association between serum sTNFR1and the risk for mortality was investigated in two community-based cohorts of elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 50%, n = 1005, mean age 70 years, median follow-up 7.9 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 775, mean age 77 years, median follow-up 8.1 years).

    RESULTS: In total, 101 participants in PIVUS and 274 in ULSAM died during follow-up. In multivariable Cox regression models adjusted for inflammation, lifestyle and established cardiovascular risk factors, one standard deviation (SD) higher sTNFR1 was associated with a hazard ratio (HR) for mortality of 1.37, 95% confidence interval (CI) 1.17-1.60, in PIVUS and HR 1.22, 95% CI 1.10-1.37 in ULSAM. Moreover, circulatingsTNFR1 was associated with cardiovascular mortality (HR per SD of sTNFR1, 1.24, 95% CI 1.07-1.44) and cancer mortality (HR per SD of sTNFR1, 1.32, 95% CI 1.11-1.57) in the ULSAM cohort. High levels of sTNFR1 identified individuals with increased risk of mortality among those with high as well as low levels of systemic inflammation.

    CONCLUSIONS: An association between circulating sTNFR1 and an increased risk for mortality was found and validated in two independent community-based cohorts. The future clinical role of sTNFR1 to identify high risk patients for adverse outcomes and mortality has yet to be determined.

  • 415.
    Carlsson, Axel C
    et al.
    Centre for Family Medicine, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Huddinge, Sweden; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Helmersson-Karlqvist, Johanna
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Ingelsson, Erik
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Larsson, Tobias E
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Bottai, Matteo
    Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Sundström, Johan
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Urinary kidney injury molecule-1 and the risk of cardiovascular mortality in elderly men2014In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 9, no 8, p. 1393-1401Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Kidney injury molecule-1 (KIM-1) has been suggested as a clinically relevant highly specific biomarker of acute kidney tubular damage. However, community-based data on the association between urinary levels of KIM-1 and the risk for cardiovascular mortality are lacking. This study aimed to investigate the association between urinary KIM-1 and cardiovascular mortality.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a prospective study, using the community-based Uppsala Longitudinal Study of Adult Men (N=590; mean age 77 years; baseline period, 1997-2001; median follow-up 8.1 years; end of follow-up, 2008).RESULTS: During follow-up, 89 participants died of cardiovascular causes (incidence rate, 2.07 per 100 person-years at risk). Models were adjusted for cardiovascular risk factors (age, systolic BP, diabetes, smoking, body mass index, total cholesterol, HDL cholesterol, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, and history of cardiovascular disease) and for markers of kidney dysfunction and damage (cystatin C-based eGFR and urinary albumin/creatinine ratio). Higher urinary KIM-1/creatinine (from 24-hour urine collections) was associated with a higher risk for cardiovascular mortality (hazard ratio per SD increase, 1.27; 95% confidence interval [95% CI], 1.05 to 1.54; P=0.01). Participants with a combination of high KIM-1/creatinine (upper quintile, ≥175 ng/mmol), low eGFR (≤60 ml/min per 1.73 m(2)), and microalbuminuria/macroalbuminuria (albumin/creatinine ratio≥3 g/mol) had a >8-fold increased risk compared with participants with low KIM-1/creatinine (<175 ng/mmol), normal eGFR (>60 ml/min per 1.73 m(2)), and normoalbuminuria (albumin/creatinine ratio<3 g/mol) (hazard ratio, 8.56; 95% CI, 4.17 to 17.56; P<0.001).CONCLUSIONS: These findings suggest that higher urinary KIM-1 may predispose to a higher risk of cardiovascular mortality independently of established cardiovascular risk factors, eGFR, and albuminuria. Additional studies are needed to further assess the utility of measuring KIM-1 in the clinical setting.

  • 416. Carlsson, Axel C
    et al.
    Larsson, Anders
    Helmersson-Karlqvist, Johanna
    Lind, Lars
    Ingelsson, Erik
    Larsson, Tobias E
    Sundström, Johan
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Urinary kidney injury molecule 1 and incidence of heart failure in elderly men2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 4, p. 447-446Article in journal (Refereed)
    Abstract [en]

    AIMS: There is growing recognition of the clinical importance of cardiorenal syndrome-the bidirectional interplay between kidney and cardiac dysfunction. Yet, the role of kidney tubular damage in the development of heart failure is less studied. The objective of this study was to investigate whether urinary kidney injury molecule (KIM)-1, a specific marker of tubular damage, predisposes to an increased heart failure risk.

    METHODS AND RESULTS: This was a community-based cohort study [Uppsala Longitudinal study of Adult Men (ULSAM)] of 565, 77-year-old men free from heart failure at baseline. Heart failure hospitalizations were used as outcome. During follow-up (median 8.0 years), 73 participants were hospitalized for heart failure. In models adjusted for cardiovascular risk factors (age, systolic blood pressure, diabetes, smoking, body mass index, LDL/HDL ratio, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, LV hypertrophy, and prevalent cardiovascular disease) and markers of kidney dysfunction and damage [cystatin C-based glomerular filtration rate (GFR) and urinary albumin/creatinine ratio], a higher urinary KIM-1/creatinine ratio was associated with higher risk for heart failure (hazard ratio upper vs. lower tertile, 1.81; 95% confidence interval 1.01-3.29; P < 0.05). Participants with a combination of low GFR (<60 mL/min/1.72 m(2)) and high KIM-1/creatinine (>128 ng/mmol) had a 3-fold increase in heart failure risk compared with participants with normal GFR and KIM-1 (P < 0.001).

    CONCLUSION: Our findings suggest that kidney tubular damage predisposes to an increased risk for heart failure in the community. Further studies are needed to clarify the causal role of KIM-1 in the development of heart failure, and to evaluate the clinical utility of urinary KIM-1 measurements.

  • 417.
    Carlsson, Axel C
    et al.
    Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden ; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Larsson, Tobias E
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Helmersson-Karlqvist, Johanna
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Soluble TNF receptors and kidney dysfunction in the elderly2014In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 25, no 6, p. 1313-1320Article in journal (Refereed)
    Abstract [en]

    The importance of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in the development of kidney disease is being unraveled. Yet, community-based data regarding the role of sTNFRs are lacking. We assessed serum sTNFRs and aspects of kidney damage cross-sectionally in two independent community-based cohorts of elderly participants: Prospective Investigation of the Vasculature in Uppsala Seniors (n=815; mean age, 75 years; 51% women) and Uppsala Longitudinal Study of Adult Men (n=778; mean age, 78 years). Serum sTNFR1 correlated substantially with different aspects of kidney pathology in the Uppsala Longitudinal Study of Adult Men cohort (R=-0.52 for estimated GFR, R=0.22 for urinary albumin-to-creatinine ratio, and R=0.17 for urinary kidney injury molecule-1; P<0.001 for all), with similar correlations in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort. These associations remained significant after adjustment for age, sex, inflammatory markers, and cardiovascular risk factors and were also evident in participants without diabetes. Serum sTNFR2 was associated with all three markers in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort (P<0.001 for all). Our findings from two independent community-based cohorts confirm and extend results of previous studies supporting circulating sTNFRs as relevant biomarkers for kidney damage and dysfunction in elderly individuals, even in the absence of diabetes.

  • 418. Carlsson, Axel C
    et al.
    Li, Xinjun
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institute.
    Wändell, Per
    Gasevic, Danijela
    Sundquist, Jan
    Sundquist, Kristina
    Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years: A nationwide cohort study from Sweden.2017In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 12, no 8, p. 815-826Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years.

    Methods: All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated.

    Results: A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78-0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06-1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02-1.23).

    Conclusions: In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.

  • 419.
    Carlsson, Axel C.
    et al.
    Karolinska Institutet.
    Nordquist, Lina
    Uppsala Universitet.
    Larsson, Tobias E.
    Karolinska Institutet.
    Carrero, Juan-Jesus
    Karolinska Institutet.
    Larsson, Anders
    Uppsala Universitet.
    Lind, Lars
    Uppsala university hospital.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Soluble tumor necrosis factor receptor 1 is associated with glomerular filtration rate progression and incidence of chronic kidney disease in two community-based cohorts of elderly individuals2015In: CardioRenal Medicine, ISSN 1664-3828, Vol. 5, no 4, p. 278-288Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to explore and validate the longitudinal associations between soluble tumor necrosis factor receptor 1 (sTNFR1), glomerular filtration rate (GFR) progression, and chronic kidney disease (CKD) incidence in two independent community-based cohorts of elderly individuals with prespecified subgroup analyses in individuals without prevalent diabetes.

    Research design and methods: Two community-based cohorts of elderly individuals were used with 5-year follow-up data on estimated GFR: the Uppsala Longitudinal Study of Adult Men (ULSAM; n = 437 men; mean age: 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 703; mean age: 70 years; 51% women). GFR categories were defined as >= 60, 30-60, and <30 ml/min/1.73 m(2).

    Results: In longitudinal multivariable logistic regression models adjusted for inflammatory markers and established cardiovascular risk factors, higher serum sTNFR1 was significantly associated with an increased risk to progress to a lower GFR category in both ULSAM and PIVUS [odds ratio (OR) per standard deviation (SD) increase 1.28 (95% CI 1.03-1.60) and OR 1.56 (95% CI 1.30-1.87), respectively]. Also, in subgroup analyses in individuals with a GFR >= 60 ml/min/1.73 m(2) at baseline, higher sTNFRs were associated with incident CKD after 5 years in both cohorts [ULSAM: OR per SD increase 1.49 (95% CI 1.16-1.9) and PIVUS: OR 1.84 (95% CI 1.50-2.26)]. Associations were similar in individuals without diabetes.

    Conclusions: Higher circulating sTNFR1 independently predicts the progression to a worse GFR category and CKD incidence in elderly individuals even in the absence of diabetes. Further studies are warranted to investigate the underlying mechanisms, and to evaluate the clinical relevance of our findings. 

  • 420. Carlsson, Axel C
    et al.
    Nowak, Christoph
    Lind, Lars
    Östgren, Carl Johan
    Nyström, Fredrik H
    Sundström, Johan
    Carrero, Juan Jesus
    Riserus, Ulf
    Ingelsson, Erik
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    Growth differentiation factor 15 (GDF-15) is a potential biomarker of both diabetic kidney disease and future cardiovascular events in cohorts of individuals with type 2 diabetes: a proteomics approach2019In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Diabetic kidney disease (DKD) is a leading risk factor for end-stage renal disease and is one of the most important risk factors for cardiovascular disease in patients with diabetes. It is possible that novel markers portraying the pathophysiological underpinning processes may be useful.Aim: To investigate the associations between 80 circulating proteins, measured by a proximity extension assay, and prevalent DKD and major adverse cardiovascular events (MACE) in type 2 diabetes.Methods: We randomly divided individuals with type 2 diabetes from three cohorts into a two-thirds discovery and one-third replication set (total n = 813, of whom 231 had DKD defined by estimated glomerular filtration rate <60 mg/mL/1.73 m2 and/or urinary albumin-creatinine ratio ≥3 g/mol). Proteins associated with DKD were also assessed as predictors for incident major adverse cardiovascular events (MACE) in persons with DKD at baseline.Results: Four proteins were positively associated with DKD in models adjusted for age, sex, cardiovascular risk factors, glucose control, and diabetes medication: kidney injury molecule-1 (KIM-1, odds ratio [OR] per standard deviation increment, 1.65, 95% confidence interval [CI] 1.27-2.14); growth differentiation factor 15 (GDF-15, OR 1.40, 95% CI 1.16-1.69); myoglobin (OR 1.57, 95% CI 1.30-1.91), and matrix metalloproteinase 10 (MMP-10, OR 1.43, 95% CI 1.17-1.74). In patients with DKD, GDF-15 was significantly associated with increased risk of MACE after adjustments for baseline age, sex, microalbuminuria, and kidney function and (59 MACE events during 7 years follow-up, hazard ratio per standard deviation increase 1.43 [95% CI 1.03-1.98]) but not after further adjustments for cardiovascular risk factors.Conclusion: Our proteomics approach confirms and extends previous associations of higher circulating levels of GDF-15 with both micro- and macrovascular disease in patients with type 2 diabetes. Our data encourage additional studies evaluating the clinical utility of our findings.

  • 421. Carlsson, Axel C.
    et al.
    Riserus, Ulf
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Hypertriglyceridemic waist phenotype is associated with decreased insulin sensitivity and incident diabetes in elderly men2014In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 22, no 2, p. 526-529Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between hypertriglyceridemic waist (HTGW) and insulin sensitivity (assessed by euglycemic clamp method), and the development of diabetes in a longitudinal community-based cohort of elderly men without diabetes at baseline.

    Design and Methods: The present cross-sectional study comprised 1,026, 70-year-old men without diabetes. The gold standard euglycaemic-hyperinsulinaemic clamp technique was used. Six-year follow-up on diabetes status were available in n = 667. The HTGW phenotype was defined as having waist circumference >= 90 cm, and triglycerides >= 2 mmol L-1. The men were stratified into those having normal WC and TG (n = 299), one HTGW component (n = 606), and HTGW (n = 121).

    Results: The association between insulin sensitivity and one HTGW component as well as HTGW was highly significant (P < 0.001) in the whole sample, as well as in individuals with high/low BMI (stratified at >= 25). In longitudinal analyses, participants with HTGW was associated with a more than fourfold increased risk for diabetes (Odds ratio 4.64, 95% CI 1.61-13.4, P = 0.004) compared to those with normal WC and TG.

    Conclusion: The present study both confirm and extend previous research suggesting that the HTGW-phenotype portrays an increased glucometabolic risk, also in lean individuals.

  • 422. Carlsson, Axel C
    et al.
    Ruge, Toralph
    Kjøller, Erik
    Hilden, Jørgen
    Kolmos, Hans Jørn
    Sajadieh, Ahmad
    Kastrup, Jens
    Jensen, Gorm Boje
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    10-year associations between tumor necrosis factor receptors 1 and 2 and cardiovascular events in patients with stable coronary heart disease: a CLARICOR (effect of clarithromycin on mortality and morbidity in patients with ischemic heart disease) trial substudy2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 9, article id e008299Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We aimed to assess the associations and predictive powers between the soluble receptors for tumor necrosis factor (TNF)-α (TNFR1 and TNFR2) and cardiovascular outcomes in patients with stable coronary heart disease.

    METHODS AND RESULTS: <0.001 for TNFR2). The associations were similar in the replication sample. The associations with the composite outcome were mainly driven by acute myocardial infarction, cardiovascular mortality, and noncardiovascular mortality. The addition of TNFR1 and TNFR2 to established cardiovascular risk factors improved prediction only modestly (<1%).

    CONCLUSIONS: Increased concentrations of circulating TNFR1 and TNFR2 were associated with increased risks of cardiovascular events and mortality in patients with stable coronary heart disease. Yet, the utility of measuring TNFR1 and TNFR2 to improve risk prediction in these patients appears limited.

    CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00121550.

  • 423. Carlsson, Axel C
    et al.
    Ruge, Toralph
    Sundström, Johan
    Ingelsson, Erik
    Larsson, Anders
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Association between circulating endostatin, hypertension duration, and hypertensive target-organ damage2013In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 62, no 6, p. 1146-1151Article in journal (Refereed)
    Abstract [en]

    Our aim is to study associations between circulating endostatin, hypertension duration, and hypertensive target-organ damage. Long-term hypertension induces cardiovascular and renal remodeling. Circulating endostatin, a biologically active derivate of collagen XVIII, has been suggested to be a relevant marker for extracellular matrix turnover and remodeling in various diseases. However, the role of endostatin in hypertension and hypertensive target-organ damage is unclear. Serum endostatin was measured in 2 independent community-based cohorts: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 51%; n=812; mean age, 75 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n=785; mean age, 77.6 years). Retrospective data on blood pressure measurements and antihypertensive medication (PIVUS >5 years, ULSAM >27 years), and cross-sectional data on echocardiographic left ventricular mass, endothelial function (endothelium-dependent vasodilation assessed by the invasive forearm model), and urinary albumin/creatinine ratio were available. In PIVUS, participants with ≥5 years of history of hypertension portrayed 0.42 SD (95% confidence interval, 0.23-0.61; P<0.001) higher serum endostatin, compared with that of normotensives. This association was replicated in ULSAM, in which participants with 27 years hypertension duration had the highest endostatin (0.57 SD higher; 95% confidence interval, 0.35-0.80; P<0.001). In addition, higher endostatin was associated with higher left ventricular mass, worsened endothelial function, and higher urinary albumin/creatinine ratio (P<0.03 for all) in participants with prevalent hypertension. Circulating endostatin is associated with the duration of hypertension, and vascular, myocardial, and renal indices of hypertensive target-organ damage. Further studies are warranted to assess the prognostic role of endostatin in individuals with hypertension.

  • 424. Carlsson, Axel C
    et al.
    Sundström, Johan
    Carrero, Juan Jesus
    Gustafsson, Stefan
    Stenemo, Markus
    Larsson, Anders
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala University.
    Use of a proximity extension assay proteomics chip to discover new biomarkers associated with albuminuria.2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 4, p. 340-348Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The underlying mechanisms for the development of albuminuria and the increased cardiovascular risk in patients with elevated albuminuria levels are incompletely understood. We therefore investigated the associations between 80 cardiovascular proteins and the urinary albumin to creatinine ratio (ACR).

    METHODS: We used a discovery/replication approach in two independent community-based cohorts of elderly patients: the Uppsala Longitudinal Study of Adult Men (n = 662; mean age 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors (n = 757; mean age 75 years; 51% women). A proteomic chip with a panel of 80 plasma proteins associated with different aspects of cardiovascular disease was analysed. In the discovery cohort, we used a false discovery rate of 5% to take into account the multiple statistical testing. Nominal p values were used in the replication.

    RESULTS: Higher levels of T-cell immunoglobulin mucin-1, placenta growth factor, growth/differentiation factor-15, urokinase plasminogen activator surface receptor and kallikrein-11 were robustly associated with a higher ACR in both cohorts in multivariable linear regression models adjusted for sex, established cardiovascular risk factors, antihypertensive treatment, prevalent cardiovascular disease and glomerular filtration rate (p < 0.02 for all). All associations were also significant in separate analyses of patients without diabetes.

    CONCLUSIONS: We discovered and replicated associations between ACR and five cardiovascular proteins involved in tubular injury, atherosclerosis, endothelial function, heart failure, inflammation, glomerulosclerosis and podocyte injury. Our findings put forward multiplex proteomics as a promising approach to explore novel aspects of the complex detrimental interplay between kidney function and the cardiovascular system.

  • 425. Carlsson, Axel C
    et al.
    Wessman, T
    Larsson, A
    Leijonberg, G
    Tofik, R
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    Melander, O
    Ruge, T
    Endostatin predicts mortality in patients with acute dyspnea - a cohort study of patients seeking care in emergency departments.2019In: Clinical Biochemistry, ISSN 0009-9120, E-ISSN 1873-2933, article id S0009-9120(19)30514-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Increased levels of circulating endostatin predicts cardiovascular morbidity and impaired kidney function in the general population. The utility of endostatin as a risk marker for mortality in the emergency department (ED) has not been reported.

    AIM: Our main aim was to study the association between plasma endostatin and 90-day mortality in an unselected cohort of patients admitted to the ED for acute dyspnea. Design Circulating endostatin was analyzed in plasma from 1710 adults and related to 90-day mortality in Cox proportional hazard models adjusted for age, sex, body mass index, oxygen saturation, respiratory rate, body temperature, C-reactive protein, lactate, creatinine and medical priority according to the Medical Emergency Triage and Treatment System-Adult score (METTS-A). The predictive value of endostatin for mortality was evaluated with receiver operating characteristic (ROC) analysis and compared with the clinical triage scoring system and age.

    RESULTS: Each one standard deviation increment of endostatin was associated with a HR of 2.12 (95 % CI 1.31-3.44 p< 0.01) for 90-day mortality after full adjustment. Levels of endostatin were significantly increased in the group of patients with highest METTS-A (p<0.001). When tested for the outcome 90-day mortality, the area under the ROC curve (AUC) was 0.616 for METTS-A, 0.701 for endostatin, 0.708 for METTS -A and age and 0.738 for METTS-A, age and levels of endostatin.

    CONCLUSIONS: In an unselected cohort of patients admitted to the ED with acute dyspnea, endostatin had a string association to 90-day mortality and improved prediction of 90-day mortality in the ED beyond the clinical triage scoring system and age with 3 %.

  • 426. Carlsson, Axel C
    et al.
    Wändell, Per
    Riserus, Ulf
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Borné, Yan
    Engström, Gunnar
    Leander, Karin
    Gigante, Bruna
    Hellénius, Mai-Lis
    de Faire, Ulf
    Differences in anthropometric measures in immigrants and Swedish-born individuals: results from two community-based cohort studies2014In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 69, p. 151-156Article in journal (Refereed)
    Abstract [en]

    AIM: To study differences in body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), waist-hip-height ratio (WHHR) and percent body fat in immigrants and Swedish-born men and women in two large population-based samples.

    METHODS: A cross-sectional analysis of 60-year-old individuals, n=4 232. To replicate the results, we also assessed another large independent cohort cross-sectionally, the Malmö Diet and Cancer Study (MDC, n=26 777). The data from both cohorts were collected in the 1990s in Sweden.

    RESULTS: Significant differences between Finnish-born, Middle Eastern and women from the rest of the world were seen for all anthropometric measures, using Swedish-born women as referent. However, WHHR was the only anthropometric measure that identified all these three groups of immigrant women as different from Swedish-born women with high statistical certainty (p<0.001). Apart from WHHR that identified differences in anthropometry in all immigrant groups of men using Swedish-born men as referent, few significant differences were seen in anthropometry among groups of immigrant men. These finding were observed in both cohorts, and remained after adjustments for smoking, physical activity and educational level.

    CONCLUSION: The present study confirms previous findings of more obesity among immigrants and is the first to report that WHHR measurements may detect anthropometric differences between different ethnic groups better than other anthropometrical measures.

  • 427. Carlsson, Axel C
    et al.
    Östgren, Carl Johan
    Nystrom, Fredrik H
    Länne, Toste
    Jennersjö, Pär
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes2016In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 15, article id 40Article in journal (Refereed)
    Abstract [en]

    AIMS/HYPOTHESIS: Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) contribute to experimental diabetic kidney disease, a condition with substantially increased cardiovascular risk when present in patients. Therefore, we aimed to explore the levels of sTNFRs, and their association with prevalent kidney disease, incident cardiovascular disease, and risk of mortality independently of baseline kidney function and microalbuminuria in a cohort of patients with type 2 diabetes. In pre-defined secondary analyses we also investigated whether the sTNFRs predict adverse outcome in the absence of diabetic kidney disease.

    METHODS: The CARDIPP study, a cohort study of 607 diabetes patients [mean age 61 years, 44 % women, 45 cardiovascular events (fatal/non-fatal myocardial infarction or stroke) and 44 deaths during follow-up (mean 7.6 years)] was used.

    RESULTS: Higher sTNFR1 and sTNFR2 were associated with higher odds of prevalent kidney disease [odd ratio (OR) per standard deviation (SD) increase 1.60, 95 % confidence interval (CI) 1.32-1.93, p < 0.001 and OR 1.54, 95 % CI 1.21-1.97, p = 0.001, respectively]. In Cox regression models adjusting for age, sex, glomerular filtration rate and urinary albumin/creatinine ratio, higher sTNFR1 and sTNFR2 predicted incident cardiovascular events [hazard ratio (HR) per SD increase, 1.66, 95 % CI 1.29-2.174, p < 0.001 and HR 1.47, 95 % CI 1.13-1.91, p = 0.004, respectively]. Results were similar in separate models with adjustments for inflammatory markers, HbA1c, or established cardiovascular risk factors, or when participants with diabetic kidney disease at baseline were excluded (p < 0.01 for all). Both sTNFRs were associated with mortality.

    CONCLUSIONS/INTERPRETATIONS: Higher circulating sTNFR1 and sTNFR2 are associated with diabetic kidney disease, and predicts incident cardiovascular disease and mortality independently of microalbuminuria and kidney function, even in those without kidney disease. Our findings support the clinical utility of sTNFRs as prognostic markers in type 2 diabetes.

  • 428.
    Carlsson, Daniel
    Dalarna University, School of Education, Health and Social Studies.
    Uppmärksamhetsfokus. En studie som undersöker om fotbollstränare i Dalarna ger verbal feedback som är riktad mot antingen internt eller externt uppmärksamhetsfokus2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 429. Carlsson, Eva
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Multidisciplinary recording and continuity of care for stroke patients with eating difficulties2010In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, no 3, p. 298-310Article in journal (Refereed)
    Abstract [en]

    Eating difficulties after stroke are common and can, in addition to being a risk for serious medical complications, impair functional capability, social life and self-image. Stroke unit care entails systematic multidisciplinary teamwork and continuity of care. The purpose of this study was to describe (i) multidisciplinary stroke care as represented in patient records for patients with eating difficulties, and (ii) the written information that was transferred from hospital to elderly care. Data from 59 patient records were analysed with descriptive statistics and by categorization of phrases. Signs of multidisciplinary collaboration to manage eating problems were scarce in the records. While two notes from physiotherapists were found, nurses contributed with 78% of all notes (n=358). Screening of swallowing and body weight was documented for most patients, whereas data on nutritional status and eating were largely lacking. The majority of notes represented patients' handling of food in the mouth, swallowing and lack of energy. Care plans were unstructured and few contained steps for managing eating. Discharge summaries held poor information on care related to eating difficulties. The language of all professionals was mostly unspecific. However, notes from speech-language therapists were comprehensive and entailed information on follow-up and patient participation.

  • 430. Carlsson, Eva
    et al.
    Ehnfors, Margareta
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet, Örebro university.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Accuracy and continuity in discharge information for patients wtih eating difficulties after stroke2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 2, p. 21-31Article in journal (Refereed)
    Abstract [en]

    Aims. To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke. Design. Prospective, descriptive. 

    Methods. The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics. 

    Results. Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities. 

    Conclusions. Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking. Relevance to clinical practice. Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

  • 431. Carlsson, Eva
    et al.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Information transfer and continuity of care for stroke patients with eating difficulties from the perspective of nursing staff in Swedish elderly care2012In: AMIA proceedings, Montreal, Kanada, 2012Conference paper (Refereed)
  • 432. Carlsson, Eva
    et al.
    Stålnacke, Katri
    Persenius, Mona
    Olai, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hägg, Mary
    Aspects of eating and quality of care among elderly in short-term accommodations - before and after an intervention.2014Conference paper (Other academic)
  • 433.
    Carlsson, Ida
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Harnisch, Madelene
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Fallförebyggande teamarbete för den äldre personen inom kommunal vård: En kvalitativ intervjustudie2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Older people over the age of 65 are over-represented in fall accidents in Sweden. As a nurse in municipal care, great demands are placed on a functioning fall prevention teamwork, in order to reduce suffering for the patient and for the costs of the health and medical care.  Aim: The aim of this study was to describe how nurses experiences the fall prevention teamwork for the older person in ordinary living in municipal care. Method: Empirical qualitative study with inductive approach. Focus group interviews with nine nurses who worked with the care of the elderly in municipal care in a municipality in central Sweden. Data was analyzed with qualitative content analysis.  Results: A fall prevention teamwork requires leadership with clear roles.  The organization and lack of clear leadership, communication and working under two different laws, SOL and HSL turned out to be an obstacle to fall prevention teamwork. Decisions on working methods, a project for this and someone who would lead this project were needed. Improvements in the structure experienced nurse were needed. Patient's self-determination and autonomy is an obstacle in case-prevention teamwork.  Conclusion: The organization needs to give the nurses the opportunity to develop teamwork with clear roles in fall prevention teamwork. Improved communication and information transfer is needed. Overview of how basic staff and nurses plan their working hours is needed.

  • 434.
    Carlsson, Magnus
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Elitlängdskidåkningens fysiologiska krav2016In: Svensk idrottsmedicin, ISSN 1103-7652, Vol. 35, no 1, p. 22-24Article in journal (Other academic)
  • 435.
    Carlsson, Magnus
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Umeå universitet, Idrottsmedicin.
    Physiological demands of competitive elite cross-country skiing2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction Researchers have, for decades, contributed to an increased collective understanding of the physiological demands in cross-country skiing; however, almost all of these studies have used either non-elite subjects and/or performances that emulate cross-country skiing. To establish the physiological demands of cross-country skiing, it is important to relate the investigated physiological variables to the competitive performance of elite skiers. The overall aim of this doctoral thesis was, therefore, to investigate the external validity of physiological test variables to determine the physiological demands in competitive elite cross-country skiing.

    Methods The subjects in Study I – IV were elite male (I – III) and female (III – IV) cross-country skiers. In all studies, the relationship between test variables (general and ski-specific) and competitive performances (i.e. the results from competitions or the overall ski-ranking points of the International Ski Federation (FIS) for sprint (FISsprint) and distance (FISdist) races) were analysed. Test variables reflecting the subject’s general strength, upper-body and whole-body oxygen uptake, oxygen uptake and work intensity at the lactate threshold, mean upper-body power, lean mass, and maximal double-poling speed were investigated.

    Results The ability to maintain a high work rate without accumulating lactate is an indicator of distance performance, independent of sex (I, IV). Independent of sex, high oxygen uptake in whole-body and upper-body exercise was important for both sprint (II, IV) and distance (I, IV) performance. The maximal double-poling speed and 60-s double-poling mean power output were indicators of sprint (IV) and distance performance (I), respectively. Lean mass was correlated with distance performance for women (III), whereas correlations were found between lean mass and sprint performance among both male and female skiers (III). Moreover, no correlations between distance performance and test variables were derived from tests of knee-extension peak torque, vertical jumps, or double poling on a ski-ergometer with 20-s and 360-s durations (I), whereas gross efficiency while treadmill roller skiing showed no correlation with either distance or sprint performance in cross-country skiing (IV).

    Conclusion The results in this thesis show that, depending on discipline and sex, maximal and peak oxygen uptake, work intensity at the lactate threshold, lean mass, double-poling mean power output, and double-poling maximal speed are all externally valid physiological test variables for evaluation of performance capability among elite cross-country skiers; however, to optimally indicate performance capability different test-variable expressions should be used; in general, the absolute expression appears to be a better indicator of competitive sprint performance whereas the influence of body mass should be considered when evaluating competitive distance performance capability of elite cross-country skiers.

  • 436.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Assarsson, Hannes
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    The influence of sex, age, and race experience on pacing profiles during the 90 km Vasaloppet ski race2016In: Open Access Journal of Sports Medicine, ISSN 1179-1543, E-ISSN 1179-1543, Vol. 7, p. 11-19Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate pacing-profile differences during the 90 km Vasaloppet ski race related to the categories of sex, age, and race experience. Skiing times from eight sections (S1 to S8) were analyzed. For each of the three categories, 400 pairs of skiers were matched to have a finish time within 60 seconds, the same start group, and an assignment to the same group for the other two categories. Paired-samples Student’s t-tests were used to investigate sectional pacing-profile differences between the subgroups. Results showed that males skied faster in S2 (P=0.0042), S3 (P=0.0049), S4 (P=0.010), and S1–S4 (P<0.001), whereas females skied faster in S6 (P<0.001), S7 (P<0.001), S8 (P=0.0088), and S5–S8 (P<0.001). For the age category, old subjects (40 to 59 years) skied faster than young subjects (19 to 39 years) in S3 (P=0.0029), and for the other sections, there were no differences. Experienced subjects (≥4 Vasaloppet ski race completions) skied faster in S1 (P<0.001) and S1–S4 (P=0.0054); inexperienced skiers (<4 Vasaloppet ski race completions) had a shorter mean skiing time in S5–S8 (P=0.0063). In conclusion, females had a more even pacing profile than that of males with the same finish time, start group, age, and race experience. No clear age-related pacing-profile difference was identified for the matched subgroups. Moreover, experienced skiers skied faster in the first half whereas inexperienced skiers had higher skiing speeds during the second half of the race.

  • 437.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Health and Social Studies, Sport and Health Science.
    Carlsson, Tomas
    Dalarna University, School of Health and Social Studies, Sport and Health Science.
    Styrketräning för äldre: mirakelkur för individen, familjen och samhället?2008In: Svensk idrottsmedicin, ISSN 1103-7652, Vol. 27, no 1, p. 14-19Article in journal (Other academic)
  • 438.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Hammarström, Daniel
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Granath, Johan
    Regional Sports Federation of Dalarna.
    Westergren, Jens
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Malm, Christer
    Idrottsmedicin, Umeå Universitet.
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Validation of off-season physiological tests with ski ranking in elite male junior cross-country skiing2012In: Book of Abstract: Supplement to Medicine and Science in Sports and Exercise, Volume 44, Number 5, May 2012, 2012, p. 353-353Conference paper (Refereed)
  • 439.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Hammarström, Daniel
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Granath, Johan
    Westergren, Jens
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Malm, Christer
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Validation of off-season physiological tests with ski ranking in elite male junior cross-country skiing2012In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 44, no s2, p. 516-516Article in journal (Other academic)
  • 440.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Sports Medicine Unit, Umeå University, Umeå, Sweden, Dala Sports Academy, Falun, Sweden.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Sports Medicine Unit, Umeå University, Umeå, Sweden, Dala Sports Academy, Falun, Sweden.
    Hammarström, Daniel
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Lillehammer University College, Lillehammer, Norway.
    Malm, Christer
    Sports Medicine Unit, Umeå University, Umeå, Sweden.
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Prediction of race performance of elite cross-country skiers by lean mass2014In: International Journal of Sports Physiology and Performance, ISSN 1555-0265, E-ISSN 1555-0273, Vol. 9, no 6, p. 1040-1045Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the relationship between race performance and lean mass (LM) variables, as well as to examine sex differences in body composition in elite-standard cross-country skiers. 

    Methods: Thirty-four elite cross-country skiers (18 men and 16 women) underwent a dual-emission x-ray absorptiometry body composition test to determine LM, fat mass, and bone mineral content. For both sexes, performance data were collected from a sprint prologue and a distance race. 

    Results: The absolute expression of LM variables [whole body (LMWB), upper body (LMUB), and lower body (LMLB)] was significantly correlated with finishing time in the sprint prologue independent of sex. Distance-race performance was significantly related to LMWB, LMUB, and LMLB in women; however, no correlation was found in men. Men had a significantly higher LM and lower fat mass, independent of expression (absolute or relative), for the whole body, arms, trunk, and legs, except for the absolute fat mass in the trunk. 

    Conclusions: The absolute expressions of LMWB, LMUB, and LMLB were significant predictors of sprint-prologue performance in both sexes, as well as of distance-race performance in women only. Compared with women, male skiers have a higher LM in the body segments that are major contributors to propelling forces. These results suggest that muscle mass in the lower and upper body is equally important for race performance; thus, more focus of elite skiers’ training should be directed to increasing whole-body muscle mass to improve their competitive performance capability.

  • 441.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Hammarström, Daniel
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Malm, Christer
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Time trials predict the competitive performance capacity of junior cross-country skiers2014In: International Journal of Sports Physiology and Performance, ISSN 1555-0265, E-ISSN 1555-0273, Vol. 9, no 1, p. 12-18Article in journal (Refereed)
    Abstract [en]

    Purpose: This study investigated whether there is a correlation between time-trial performance and competitive performance capacity of male and female junior cross-country skiers and sought to explain sex-specific competitive performance capacity through multiple-regression modeling.

    Methods: The International Ski Federation's (FIS) junior ranking points for distance (FISdist) and sprint (FISsprint) competitions were used as performance parameters. A total of 38 elite junior (age 18.5 +/- 1.0 y) cross-country skiers (24 men and 14 women) completed 3 time-trial tests: a 3-km level-running time trial (TTRun), a 2-km moderate uphill (1.2 slope) roller-skiing time trial using the double-poling technique (TTDP), and a 2-km uphill (2.8 slope) roller-skiing time trial using the diagonal-stride technique (TTDiag). The correlations were investigated using Pearson correlation analysis, and regression models were created using multiple-linear-regression analysis. Results: For men, FISsprint and FISdist were correlated with the times for TTRun, TTDP, and TTDiag (all P < .001). For women, FISsprint was correlated with the times for TTRun (P < .05), TTDP (P < .01), and TTDiag (P < .01), whereas FISdist was correlated only with the times for TTDP (P < .01) and TTDiag (P < .05). The models developed for FISdist and FISsprint explained 73.9-82.3% of the variance in the performance capacity of male junior cross-country skiers. No statistically valid regression model was found for the women.

    Conclusions: Running and roller-skiing time trials are useful tests for accurately predicting the performance capacity of junior cross-country skiers.

  • 442.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Hammarström, Daniel
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Tiivel, Toomas
    Malm, Christer
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Validation of physiological tests in relation to competitive performances in elite male distance cross-country skiing2012In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 26, no 6, p. 1496-1504Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to establish which physiological test parameters reflects the distance performances in the Swedish National Championships in cross-country skiing (SNC) and the International Ski Federation's ranking points for distance performances (FISdist). The present study also aimed to create multiple regression models to describe skiing performance for the SNC distance races and International Ski Federation's (FIS) ranking. Twelve male, Swedish, national elite, cross-country skiers (maximal oxygen consumption [(V) over dotO(2)max] = 5.34 +/- 0.34 L.min(-1)) volunteered to participate in the study. Their results in the 2008 SNC (15 km race [SNC15] and 30 km race [SNC30]) and FISdist points were used as performance data. On the week preceding the Championship, subjects completed a test battery consisting of 7 physiological tests: isokinetic knee extension peak torque (PT), vertical jumps (VJ), lactate threshold (LT), (V) over dotO(2)max, and 3 double poling tests of different durations (DP20, DP60, and DP360). Correlations were established using Pearson's correlation analysis, and models to describe skiing performance were created using standard multiple linear regression analysis. Significant correlations were found between the performance parameters and test parameters derived from LT, (V) over dotO(2)max, and DP60 tests. No correlations with any performance parameter were found for PT, VJ, DP20, and DP360 tests. For FISdist and SNC15, the models explain 81% and 78% of the variance in performance, respectively. No statistically valid regression model was found for SNC30. The results of this study imply that the physiological demands in male elite distance cross-country skiing performances are different in different events. To adequately evaluate a skier's performance ability in distance cross-country skiing, it is necessary to use test parameters and regression models that reflect the specific performance.

  • 443.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Sports Medicine Unit, Umeå University, Umeå, Sweden; Dala Sports Academy, Falun, Sweden.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Sports Medicine Unit, Umeå University, Umeå, Sweden; Dala Sports Academy, Falun, Sweden.
    Knutsson, Magnus
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Dala Sports Academy, Falun, Sweden.
    Malm, Christer
    Sports Medicine Unit, Umeå University, Umeå, Sweden; Winternet, Boden, Sweden .
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Oxygen uptake at different intensities and sub‑techniques predicts sprint performance in elite male cross‑country skiers2014In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 114, no 12, p. 2587-2595Article in journal (Refereed)
    Abstract [en]

    Purpose. To investigate the relationship between sprint-prologue performance (using the classical technique) and the oxygen uptake at the lactate threshold ( V˙O2obla), maximal oxygen uptake ( V˙O 2max), and mean oxygen uptake during double poling ( V˙O 2dp).

    Methods. Eight elite male cross-country skiers [age 24.8 ± 4.8 years, (mean ± SD)] completed two treadmill roller-skiing tests using the diagonal-stride technique and a 60 s double-poling test on a ski-ergometer to determine their V˙O2obla, V˙O 2max, and V˙O 2dp. Performance data were generated from a 1.25 km sprint prologue. Power-function modelling was used to predict the skiers’ race speeds based on the oxygen-uptake variables and body mass.

    Results. There were correlations between the race speed and the absolute expression of the V˙O2obla (r = 0.79, P = 0.021), V˙O 2max (r = 0.86, P = 0.0069), and V˙O 2dp (r = 0.94, P = 0.00062). The following power-function models were established for race-speed prediction: 1.09 · V˙O 2obla0.21, 1.05 · V˙O 2max0.21, and 1.19 · V˙O 2dp0.20; these models explained 60 % (P = 0.024), 73 % (P = 0.0073), and 87 % (P = 0.00073), respectively, of the variance in the race speed. However, body mass did not contribute to any of the models (P = 0.97, 0.88, and 0.21, respectively).

    Conclusions. Oxygen uptake at different intensities and sub-techniques is an indicator of elite male sprint-prologue performance. The absolute expression of the investigated oxygen-uptake variables should be used when evaluating elite male sprint-prologue performances; if skiers oxygen uptake differs by 1 %, their performances will likely differ by 0.2 % in favour of the skier with higher oxygen uptake.

  • 444.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Olsson, Mats
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Brorsson, Sofia
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Malm, Christer
    Idrottsmedicin, Umeå Universitet.
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Peak hand-grip force predicts competitive performance in elite female cross-country skiers2014Conference paper (Refereed)
  • 445.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Umeå universitet; Dala Sports Academy.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Umeå universitet; Dala Sports Academy.
    Wedholm, Lars
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science. Dala Sports Academy.
    Nilsson, Mattias
    Regional Sports Federation of Dalarna.
    Malm, Christer
    Idrottsmedicin, Umeå Universitet.
    Tonkonogi, Michail
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Physiological demands of competitive sprint and distance performance in elite female cross-country skiing2016In: Journal of Strength and Conditioning Research, ISSN 1064-8011, E-ISSN 1533-4287, Vol. 30, no 8, p. 2138-2144Article in journal (Refereed)
    Abstract [en]

    The purpose was to investigate the relationship between elite females' competitive performance capability in sprint and distance cross-country skiing and the variables of gross efficiency (GE), work rate at the onset of blood-lactate accumulation (OBLA4mmol), maximal oxygen uptake (VO2max), maximal speed (Vmax), and peak upper-body oxygen uptake (VO2peak). Ten elite female cross-country skiers (age 24.5 ± 2.8 years) completed treadmill roller-skiing tests to determine GE, OBLA4mmol, and VO2max using the diagonal-stride technique as well as Vmax and VO2peak using the double-poling technique. International Ski Federations ranking points for sprint (FISsprint) and distance (FISdist) races were used as competitive performance data. There were correlations between the FISsprint and the VO2max expressed absolutely (P = 0.0040), Vmax (P = 0.012), and VO2peak expressed absolutely (P < 0.001) and as a simple ratio-standard (P = 0.049). The FISdist were correlated with OBLA4mmol (P = 0.048), VO2max expressed absolutely (L·min) (P = 0.015) and as a simple ratio-standard (P = 0.046), and VO2peak expressed absolutely (P = 0.036) and as a simple ratio-standard (mL·min·kg) (P = 0.040). The results demonstrate that the physiological abilities reflected by VO2max and VO2peak are indicators of competitive sprint and distance performance in elite female cross-country skiing. In addition, the ability to generate a high Vmax indicates the performance in sprint races whereas the skier's OBLA4mmol reflects the performance capability in distance races. Based on the results, when evaluating the performance capacity of elite female cross-country skiers, it is recommended to use physiological variables that reflect competitive performance.

  • 446.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Isberg, Jenny
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Nilsson, Johnny
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    The acute effects of a short technique-intense training period on side-foot kick performance among elite female soccer players2019In: Journal of Sports Medicine and Physical Fitness, ISSN 0022-4707, E-ISSN 1827-1928, Vol. 59, no 9, p. 1442-1449Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previously, it was shown that elite soccer teams were 24% more likely to win matches if their passing effectiveness were increased by 1%. However, research interventions aiming to improve passing performance are scarce. The current study aimed to investigate the effect of a short technique-intense training period on side-foot kick performance among elite female soccer players.

    METHODS: Four side-foot kick tests were completed before and after a training period: kicking a stationary ball using match-relevant (SBRS) and maximal ball speed (SBMS), passing the ball on the move using match-relevant ball speed (RBRS), and repeated side-foot kicks onto a rebound-box with continuously increasing passing distance (RRB). The players were assigned to either the intervention group or the control group. The training intervention consisted of six 55-min training sessions with five side-foot kick exercises. Within-group and between-group differences were investigated using paired-samples t-test and Mann-Whitney U test, respectively.

    RESULTS: The intervention group improved the performance in the RBRS and RRB tests (both P < 0.05), but no differences were found for the SBRS and SBMS tests (both P > 0.05). No improvements were found for the control group independent of test condition (all P > 0.05). Significant between-group differences were found for the RBRS and RRB tests (both P < 0.05), whereas no differences were found for the SBRS and SBMS tests (both P > 0.05).

    CONCLUSIONS: The fundamental soccer skill of passing a moving ball was improved in elite female soccer players by a short technique-intense training period.

  • 447.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Isberg, Jenny
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Nilsson, Johnny
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    The effect of training on side foot-kick performance among swedish first league women´s soccer players2018Conference paper (Refereed)
    Abstract [en]

    THE EFFECT OF TRAINING ON SIDE FOOT-KICK PERFORMANCE AMONG SWEDISH FIRST LEAGUE WOMEN’S SOCCER PLAYERS

    Carlsson, M.1, Isberg, J.1, Nilsson, J.1, Carlsson, T.1 1: Dalarna University (Falun, Sweden)

    Introduction

    A high completion rate for passes is important for success in soccer, because longer passing sequences are related to more scored goals (Hughes & Franks, 2005). In a recent study, it was found that female players had a lower pass-completion rate than male players at the highest competitive standard of European soccer, which suggests that elite female players in general do not have the same technical characteristics as elite male players (Paul S. Bradley et al., 2014). The purpose of the study was investigate the effect of a 2-week training intervention on side foot-kick performance among Swedish first league women’s soccer players.

     Methods

    To investigate the effect of training on side foot-kick performance, a pre-post-intervention study was implemented where four side foot-kick tests were performed before and after a 2-week training period. The side foot-kick accuracy were investigated when kicking a stationary ball using match-relevant ball speed (SBRS) and maximal ball speed (SBMS) as well as subsequent to a 5-m run with the ball from different approach angles (0°, 30°, and 60°) to a predetermined position, where passing of the ball on the move was executed using match-relevant ball speed (RBRS). The fourth test comprised repeated side-foot kicks onto a rebound-box with continuously increasing passing distance (RRB).

    Based on the results from the pre-tests, the players were assigned to either the intervention group (INT) or the control group (CON). The training intervention consisted of six 55-min training sessions. In each session, two rounds of five exercises focusing on improvement of side foot-kick accuracy were executed. Within-group and between-group differences were investigated using paired samples Student’s t-tests and Mann-Whitney U tests, respectively.

    Results

    Prior to the training intervention, there were no significant differences between the groups for any of the investigated test variables. The INT group improved RBRS (P = 0.036) and RRB (P = 0.010) during the training intervention, whereas no significant within-group changes were found for either SBRS or SBMS (both P > 0.05). No within-group differences were found for any of the test variables in the CON group (all P > 0.05). Significant between-group differences were found for RBRS (P = 0.040) and RRB (P = 0.005), whereas no differences were found for either SBRS or SBMS (both P > 0.05).

    Conclusion

    The fundamental soccer skill of passing a moving ball could be improved in elite women players by a 2-week training period focusing on improving   side foot-kick performance.

    References

    Bradley PS, Carling C, Diaz AG, Hood P, Barnes C, Ade J, Boddy M, Krustrup P, Mohr M (2013) Hum Mov Sci, 32, 808-821.

    Hughes M, Franks I (2005) J Sports Sci, 23, 509-514.

  • 448.
    Carlsson, Magnus
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Nilsson, Johnny
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Hellström, John
    Svenska Golfförbundet.
    Tinmark, Fredrik
    Gymnastik och idrottshögskolan.
    Carlsson, Tomas
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    The effect of ball temperature on ball speed and carry distance in golf drives2019In: Proceedings of the Institution of Mechanical Engineers, Part P: Journal of Sports Engineering and Technology, ISSN 1754-3371, Vol. 233, no 2, p. 186-192Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate the effect of ball temperature on impact ball speed and carry distance during golf drives in a blind randomized test design. The balls were exposed to a temperature-controlled environment (4 °C, 18 °C, 32 °C, and 46 °C) for 24 h prior to the test and each temperature group consisted of 30 balls. The 120 drives were performed by an elite male golfer (handicap: 0.0) in an indoor driving range. All drives were measured by a Doppler-radar system to determine the club-head speed, launch angle, spin rate, ball speed, and carry distance. Differences between the groups were investigated using a one-way analysis of variance. The results indicated that ball-speed and carry-distance differences occurred within the four groups (p < 0.001 and p < 0.01, respectively). The post hoc analyses showed that the ball temperatures of 18 °C and 32 °C had greater ball speeds and carry distances than balls at 4 °C and 46 °C (all p < 0.05). The intervals for the between-group differences were 0.6–0.7 m s−1 and 2.9–3.9 m for ball speed and carry distance, respectively. Hence, the results showed that ball temperature influences both the ball speed and the carry distance. Based on the findings in this study, standardization of ball temperature should be factored into governing body regulation tests for golf equipment.

  • 449.
    Carlsson, Maria
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science.
    Sofri, Fatima
    Dalarna University, School of Health and Social Studies, Caring Science.
    Behandlingsmetoder och amningsförekomst vid bröstböld2013Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Amningens fördelar för mor, barn och samhälle är välkända. En komplikation vid amning är bröstböld. Medvetenhet om fördelar och nackdelar med olika behandlingsmetoder vid bröstböld och deras inverkan på fortsatt amning är viktig.

    Syftet: Att studera behandlingsmetoder och amningsförekomst vid bröstböld.

    Metod: Retrospektiv design från en journalgranskning genomförd på Södersjukhuset mellan januari 2006 och september 2008. Statistiska analyser genomfördes med Chi-två test, Independent samples T-test samt Fishers exakta test.

    Resultat: Totalt 139 kvinnor med bröstböld behandlades med nålpunktions-, pigtail- eller dränagebehandling, eller en kombination av dessa. Sextiotre procent pigtailbehandlades enbart och dessa behövde i mindre omfattning sjukhusinläggning jämfört med ej enbart pigtailbehandlade, samt resulterade i större andel av ett till tre sjukhusbesök. Enbart dränagebehandling och flera metoder resulterade i större andel sjukhusinläggningar än ej enbart dränagebehandling och en metod. Amningsförekomsten sjönk från 96 procent före behandling till 69 procent en månad efteråt.

    Konklusion: Enbart pigtailbehandling var den vanligaste metoden och resulterade i färre sjukhusinläggningar och sjukhusbesök. Förekomsten av amning hade sjunkit efter behandling av bröstböld

  • 450.
    Carlsson, Pamela
    et al.
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Spante, Marianne
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    PRIM-VIPS i omvårdnadsjournalen: Antal använda sökord före och efter dokumentationscirkel2005Independent thesis Basic level (degree of Bachelor), 10 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie; en en-grupps före- och eftertest, var att beskriva förekomstfrekvens av alla PRIM-VIPS sökord i omvårdnadsjournalen på en vårdcentral före och efter en studiecirkel där distriktssköterskor (n = 19) och undersköterskor (n = 7) deltog. Två tidsperioder om vardera tre veckor valdes, en före studiecirkelns start och den andra när studiecirkeln var avslutad. Tidsperioderna var representativa ur både patient- och personalhänseende. Det totala antalet patientkontakter i respektive period bedömdes vara jämförbara. Samtliga distriktssköterskor och undersköterskor inbjöds till studiecirkeln, inbjudan sändes också till vårdcentralsledningen för kännedom. Studiecirkeln innefattade fyra träffar om två timmar vardera då alla sökord gicks igenom och diskuterades. Vid varje cirkelträff gavs hemuppgift som gicks igenom vid kommande studietillfälle. Dokumentationsmallar för de vanligaste typerna av kontakter gicks igenom, diskuterades och reviderades. Statistik från respektive period togs fram av en systemadministratör. Denna statistik har analyserats. Resultatet visade en ökning med 32% av förekomsten av sökord från period ett till period två. Man ser inte bara en ökning av förekomst av sökord utan man ser också vilka vårdfunktioner som är mest frekventa. Resultatet visar även en kraftig ökning när det gäller förekomstfrekvensen av sökordet medverkan, som bland annat beskriver patientens delaktighet i vården.

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