Publikationer från Linköpings universitet
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The PainSMART project: Protocol for a research program on effectiveness, mechanisms of effect and patient-practitioner experiences of the PainSMART-strategy as an adjunct to usual primary care physiotherapy management for musculoskeletal pain
No full textBackground Musculoskeletal pain (MSKP) disorders entail a significant burden for individuals and healthcare systems. The PainSMART-strategy has been developed aiming to reduce divergences between patients and healthcare practitioners in their understanding of MSKP by providing a shared basis for communication and to facilitate patients' self-management of MSKP. The objective of the PainSMART-project is to evaluate the effects of the PainSMART-strategy as an adjunct to usual physiotherapy management compared to usual physiotherapy management alone.Methods The PainSMART-project is a research program with a collective suite of studies utilising mixed methods, centred around a randomised controlled trial (ClinicalTrials.gov NCT06187428). Subjects: Adults (18 years or older) seeking primary care for MSKP who are triaged and booked for an initial physiotherapy consultation at five primary care physiotherapy departments within the Swedish public healthcare regions of & Ouml;sterg & ouml;tland and J & ouml;nk & ouml;ping. A total of 490 subjects will be randomised to receive one of two possible interventions.Interventions Both groups will receive usual physiotherapy management for benign MSKP. The intervention group will also receive the PainSMART-strategy consisting of an educational film, reflection and reinforcement of the film's key messages prior to the initial physiotherapy consultation and a patient-practitioner discussion based on the film.Outcome The primary outcome is 1) between group mean change over time from baseline to 24 hours post initial physiotherapy consultation and baseline to 3 months regarding self-reported average pain intensity and pain self-efficacy. Secondary outcomes include similar measurements for MSKP illness perception, reassurance of benign nature, pain coping, physical activity, analgesic medication use, sick leave, healthcare use and direct healthcare costs. Physiotherapist and patient reported experience measures and qualitative evaluation of the effects of the PainSMART-strategy on communication at the initial physiotherapy consultation will also be explored.Discussion This study will investigate potential added effects of PainSMART-strategy upon usual primary care physiotherapy for MSKP.Funding Agencies|Medical Research Council of Southeast Sweden [FORSS-963776, 981776, 995094]; Region Ostergotland [RO-990984, 987927]</p
Plasma proteomic and metabolomic profiling of coronary and carotid atherosclerosis in the SCAPIS study-differences and similarities
No full textFunding Agencies|European Research Council [ERC-STG-2018-801965]; Swedish Research Council [VR 2019-01471, 2019-01236]; Swedish Heart-Lung Foundation [Hjart-Lungfonden] [20190505, 20200173]; Swedish Government [ALFGBG-991828]; Swedish county councils, the ALF-agreement [ALFGBG-991828]</p
Exogamy, Proximity to Parents, and the Residential Choices of 1.5‐ and Second‐Generation Immigrants in Sweden
No full text Living near kin facilitates intergenerational support, which may be especially important for immigrant families. For 1.5- and second-generation immigrants, this creates a tension between residential integration and family obligations. This tension can grow when forming a union, particularly with a nonimmigrant. Yet little is known about how residential moves for partnered immigrants shape and are shaped by proximity to parents. Using Swedish register data from 1990 to 2017, we examine the settlement patterns and residential choices of (1) endogamous immigrant couples where partners have the same national background, (2) exogamous couples featuring one immigrant and one nonimmigrant partner, and (3) endogamous unions with two nonimmigrant Swedish partners. Descriptive statistics show that endogamous immigrants are most likely to be living near their parents, followed by exogamous immigrants, and then endogamous and exogamous Swedes. However, discrete choice models of residential mobility behaviors, which account for the spatial distribution of housing, reveal that all groups are more likely to locate nearer to parents, with only modest differences between them. Across model specifications, the effect of distance to parents for immigrants in exogamous unions is slightly, but consistently, weaker than for their partners or counterparts in other kinds of unions. These findings suggest weaker attachments between exogamous immigrants and their parents, while also underscoring how group differences in proximity to family reflect the uneven geographic distributions of housing and immigrant families in Sweden.Funding Agencies|Formas (2021-00534, 2018-00269), Vetenskapsrdet (2023-00933, 2022-05205, 2022-05251, 2016-01987), National Institutes on Aging (NIA) (R15AG074050) and Eunice Kennedy Shriver National Institute of Child Health and Human Development (P2CHD050959).</p
Probabilistisk modell för kapacitetsanalys av driftplatser
No full text Denna forskningsrapport redovisar en metod för kapacitetsanalys och dimensionering av trafikflöden över en järnvägsstation under olika driftsförhållanden. En optimeringsmodell har utvecklats, vilken maximerar mängden tåg som körs över en uppsättning med trafikrelationer, var och en med olika ruttningsalternativ. Modellen hanterar begränsad spårkapacitet på anslutande spår, plattformar och eventuella uppställningsspår, samt använder en probabilistisk kapacitetsmodell för växlingsområden. Den senare hanterar samtidiga tågrörelser över de olika växlingsområdena på en driftplats, där beräkningsformlerna generaliserats från existerande forskningslitteratur. Tågvägarna kan ha olika beläggningstid, baserat på tågens körtider inklusive tider för tågvägsläggning och frisläppning i signalsystemet. Dessutom hanteras stopp- och uppställningstider vid plattformar och bangårdsspår. Framför allt beräknas alla tågvägar och deras inbördes konflikter automatiskt från driftplatsens spårlayout. Beräkningsmodellen har implementerats och testats på olika testinstanser och i en fallstudie för Gävle driftplatsområde. Resultaten visar att modellen kan användas för realistiska problem och för att snabbt skapa kapacitetsanpassade trafiklösningar under olika avstängningsalternativ. En stor fördel är att en generaliserad trafikbeskrivning används, samt att tågvägarna beräknas automatiskt. Detta gör modellen lättare att använda och att den också passar för strategiska analyser av olika driftplatsutformningar. Den föreslagna modellen skulle kunna bli ett viktigt verktyg för kapacitetsanalyser, dimensionering av tågtrafik, och utformning av såväl arbetsområden på existerande driftplatser, som framtida spårlayouter eller ombyggnader. Därmed skulle ett viktigt analysbehov för långsiktig kapacitetsplanering på större driftsplatser kunna erbjudas och på sikt ge ett sammanhållet stöd för kapacitetskoordinering av hela järnvägsnätet och dess trafikering. Arbetet har utförts i forskningsprojektet ProPå (Probabilistisk metod för trafioch kapacitetspåverkan på driftplatser), finansierat av Trafikverket (FoI-portfölj Vidmakthålla, ärende-ID 8139, diarienummer TRV2024/111657) via branschprogrammet KAJT, Kapacitet i järnvägstrafiken (www.kajt.org). Rapporten har kontrollerats av Trafikverkets arbetsgrupp och är oberoende forskningsgranskad av Emma Solinen, Tekn. Dr., TrafikverketFUD-ärende 8139LiU projektnummer 312689LiU diarienummer ITN-2024-00370</p
Epigenetic changes in lung immune cells and buccal mucosa during tuberculosis infection and treatment
No full textTuberculosis (TB) is the leading infectious disease in terms of global mortality and remains a major contributor to poor health worldwide. Infection with Mycobacterium tuberculosis, the causative agent of TB, can result in a wide range of clinical outcomes – from early clearance by the innate immune system to TB infection, subclinical disease and active TB. This variability highlights TB as a disease with a broad clinical spectrum. Although TB is curable with antibiotics, some patients still experience poor outcomes due to relapse or treatment failure. Drug resistance further complicates care, highlighting the need for better tools to monitor treatment and predict outcomes. Epigenetic mechanisms like DNA methylation have shown promise in disease diagnostics and monitoring. Notably, DNA methylation changes can be detected in buccal cells collected via non-invasive mouth swabs, offering a practical approach for clinical sampling. To address the need for improved TB monitoring tools, this thesis investigates whether DNA methylation can serve as a biomarker for TB diagnosis, treatment response and prognosis. The research is driven by the hypothesis that exposure to M. tuberculosis induces epigenetic changes in host immune cells, potentially reflecting disease status and progression. Paper I and II investigate the DNA methylation landscape of host immune cells in the lung compartment and buccal mucosa in healthy controls, individuals exposed to TB and in patients with active TB at the onset of treatment. Notably, TB exposure, TB infection (as indicated by a positive interferongamma release assay) and active TB were associated with distinct DNA methylation signatures in lung and buccal mucosa, reflecting the clinical spectrum of TB. In Paper II, we developed and validated a DNA methylation-based classifier for active TB, comprising seven CpG sites selected for their ability to distinguish TB patients from TB-exposed individuals and healthy controls. Furthermore, the longitudinal study presented in Paper III followed TB patients from the start of treatment through six months of therapy. During treatment, the DNA methylation signature derived from buccal swab samples showed dynamic changes, indicating treatment-associated epigenetic alterations. Using a machine learning approach, we developed a regression model based on nine CpG sites to predict TB symptom severity across multiple populations. Collectively, these findings support the potential of DNA methylation-based biomarkers to aid in TB diagnosis and prognosis. While the hypothesis was partially confirmed (DNA methylation changes were observed in TB exposure and infection) the specificity to M. tuberculosis remains to be fully established. Further longitudinal studies and mechanistic investigations are needed to validate these epigenetic signatures and their clinical utility.Funding agencies: "Forskarlinjen"; "Student till docent", Region Östergötland; the Swedish Heart-Lung Foundation’s travel grant; travel support from the World Infection Fund2025-11-13: The thesis was first published online. The online published version reflects the printed version. 2025-12-15: The thesis was updated with an errata list which is also downloadable from the DOI landing page. Before this date the PDF has been downloaded 36 times.</p
Thoughts and Experiences on Self Management in people with COPD after Participating in a COPD School : A Qualitative Interview Study
No full textBakgrund: Kroniskt obstruktiv lungsjukdom (KOL) påverkar lungkapacitet och leder till andningsbesvär och nedsatt fysisk ork. Egenvård är centralt för att kunna hantera symtom, bibehålla eller öka lungkapacitet och även förbättra livskvaliteten. KOL-skola syftar till att ge personer med KOL kunskap och verktyg för att stärka sin egenvård. Syfte: Syftet med studien var att beskriva tankar om och erfarenheter av egenvård hos personer med KOL, 12 månader efter att de har deltagit i KOL-skola. Metod: En kvalitativ studie med semistrukturerade intervjuer. Åtta informanter intervjuades. Intervjumaterialet analyserades med induktiv kvalitativ innehållsanalys. Resultat: Det identifierades fyra huvudkategorier: “Att leva med KOL”, ” Inhämtning av kunskap om KOL”, “Egenvårdsstrategier vid KOL” och “Hindrande faktorer till egenvård. Konklusion: Personer som deltagit i KOL-skola har varierande kunskap och strategier för egenvård, och fysisk aktivitet är den största utmaningen att upprätthålla över tid på grund av bland annat låg motivation och samsjuklighet. Studien betonar behovet av fortsatt stöd och uppföljning för att stärka långsiktigt engagemang i fysisk aktivitet.
Sustainable datacentres and eco-modernist frictions in Sweden
No full textThis article discusses frictions related to a datacentre enterprise in amunicipality in northern Sweden. These frictions were related to theeco-modernist underpinnings of the enterprise and at the sametime contributed to shaping eco-modernism as a concept. Thearticle builds on critical datacentre studies, critiques of ecomodernismand the twin transition, and the concept of friction.The empirical context is ongoing plans for a ‘green’ industrialdatacentre enterprise in Östersund, a municipality in northernSweden, planned to host servers for AI. Two major frictions werefound: one concerning the datacentre company and how itnegotiated its sustainability profile knowing that its business stillrequired considerable material resources, and the otherconcerning the resistance that the initiative met from actors inÖstersund. I argue that even though the enterprise was framed ineco-modernist terms, the frictions contributed to shaping theuniversal of eco-modernism in a way that shifted focus fromecological to social sustainability and to discursive legitimisationof sustainability efforts. However, this did not make the businessany less resource intensive
Risk Factors for Autism Spectrum Disorder in Individuals Born Preterm: A Systematic Review and Meta-Analysis of Population-Based Studies
No full textBACKGROUND: Preterm children are at an increased risk of autism spectrum disorder (ASD), although the determinants of ASD among them remain unclear. In this systematic review and meta-analysis, we summarize the population-based literature on ASD risk factors in preterm-born individuals. METHODS: We searched Ovid MEDLINE, Embase, and Web of Science through September 2023 for population based studies on ASD risk factors in preterm cohorts (&lt;37 weeks' gestation). From 3921 articles, 19 met inclusion criteria. Registered in PROSPERO and following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, data were extracted and analyzed using fixed and random effects meta-analysis models. Primary outcomes included ASD risk factors, pooled when consistently examined in at least 2 studies. RESULTS: The qualitative synthesis included 16 cohort studies, 2 case-control studies, and 1 cross-sectional study, while 3 cohort studies were included in the meta-analysis. Sample sizes ranged from 410 to 515,789. Male sex was the only risk factor eligible for meta-analysis and was associated with increased risk of ASD (relative risk 3.04; 95% CI, 2.02-4.57). Low birth weight suggested a potential positive association with ASD, while neonatal jaundice showed no clear link. Pooled estimates were unavailable for these exposures due to heterogeneity in exposure definitions and effect measures. All other risk factors were examined in two or fewer studies. CONCLUSIONS: Significant knowledge gaps remain regarding the risk of ASD in individuals born preterm. The only consistent risk factor identified is male sex, with potential links to low birth weight. To better understand the differences in ASD etiology between preterm and term-born individuals, further research is crucial.Funding Agencies|Swedish Research Council [Dnr 2021-0214]; Simons Foundation [7340697]; National Institutes of Health [R01HD113669]; Karolinska Institutet's Research Foundation [Dnr 2018-01499, 2020-02156, 2022-02021]; Horizon 2020 award [733280 RECAP]; Formas [2022-02021] Funding Source: Formas</p
Effects of Vestibular Rehabilitation on Dizziness in Patients with Multiple Sclerosis : A systematical critical literature overview
No full textBakgrund: Hos personer med multipel skleros (PmMS) är yrsel ett vanligt förekommande symtom, där cirka 75% rapporterar någon form av yrselproblematik. Vestibulär rehabilitering (VR) har visat sig ha god effekt vid andra sjukdomar med vestibulär dysfunktion, men evidensläget för VR vid yrsel relaterad till multipel skleros är osäkert. Enligt författarnas vetskap saknas systematiska litteraturöversikter som granskar effekten av VR på yrsel hos PmMS. Syfte: Att sammanställa evidens och bedöma evidensstyrkan för effekten av vestibulär rehabilitering på yrsel, hos personer med multipel skleros. Metod: Systematisk sökning av artiklar i PubMed och CINAHL. Urval enligt PICO-modellen. Granskning av metodologisk kvalitet med Fowkes & Fultons granskningsmall och graderings av evidens enligt GRADE. Resultat: Åtta studier inkluderades med totalt 367 deltagare. Interventionerna varierade i upplägg, frekvens och duration (6-16 veckor). Fem studier rapporterade signifikanta förbättringar i Dizziness Handicap Inventory (DHI) efter VR, varav fyra av dessa också uppnådde minsta kliniskt viktiga förändring. Tre studier rapporterade förbättringar, dock var dessa inte signifikanta. Metodologiska begränsningar förekom bland studierna. Konklusion: Översikten tyder på att VR kan minska självupplevda yrselbesvär hos PmMS. Evidensstyrkan bedöms som måttlig, variation i träningsupplägg och begränsning av generaliserbarhet försvårar slutsatser. Fler välstrukturerade studier med större populationer och standardiserade protokoll behövs för att stärka evidensläget.
Treatment Satisfaction and Well-Being With CGM in People With T1D: An Analysis Based on the GOLD Randomized Trial
No full textBackground: The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. Methods: The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R-2-decomposition was used to understand which variables contributed most to treatment satisfaction. Results: A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. Conclusions: While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation