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  • 1.
    Carlsson, Martin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Hospital.
    Wanby, Pär
    Kalmar County Hospital.
    Brudin, Lars
    Linköping University;Kalmar County Hospital.
    Lexne, Erik
    Kalmar County Hospital.
    Mathold, Karin
    Kalmar County Hospital.
    Nobin, Rebecca
    Kalmar County Hospital.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nordqvist, Ola
    Kalmar County Council.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Older Swedish Adults with High Self-Perceived Health Show Optimal 25-Hydroxyvitamin D Levels Whereas Vitamin D Status Is Low in Patients with High Disease Burden2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 11, article id 717Article in journal (Refereed)
    Abstract [en]

    Controversy pervades the definition of adequate and optimal vitamin D status. The Institutes of Medicine have recommended serum 25(OH) D levels above 50 nmol/L based upon evidence related to bone health, but some experts, including the Endocrine Society and International Osteoporosis Foundation, suggest a minimum serum 25(OH) D level of 75 nmol/L to reduce the risk of falls and fractures in older adults. In a cross-sectional study, we compared vitamin D status in people >= 75 years selected from four groups with a frailty phenotype, combined with a control group free from serious illness, and who considered themselves completely healthy. Only 13% of the 169 controls were vitamin D deficient (S-25(OH) D) < 50 nmol/L), in contrast with 49% of orthopedic patients with hip fractures (n = 133), 31% of stroke patients (n = 122), 39% of patients visiting the hospital's emergency department >= 4 times a year (n = 81), and 75% of homebound adult residents in long-term care nursing homes (n = 51). The mean vitamin D concentration of the healthy control group (74 nmol/L) was similar to a suggested optimal level based on physiological data and mortality studies, and much higher than that of many officially recommended cut-off levels for vitamin D deficiency (< 50 nmol/L). The present study provides a basis for planning and implementing public guidelines for the screening of vitamin D deficiency and vitamin D treatment for frail elderly patients.

  • 2.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Sjukskrivningskoordinatorns roll: Patientens perspektiv2014Report (Other academic)
    Abstract [sv]

    Inom landstinget har funktionen sjukskrivningskoordinator införts med uppgift att bland annat samordna arbetet inom rehabiliteringsgarantin.

    I den här studien utvärderades funktionen sjukskrivningskoordinator inom primärvården i Landstinget i Kalmar län utifrån patientens perspektiv. Målet var att ta reda på patienters egen uppfattning om betydelsen av en sjukskrivningskoordinator inom deras sjukskrivningsprocess. Denna studie är en fortsättning av en tidigare studie kring effekterna av införandet av en sjukskrivningskoordinator inom Landstinget i Kalmar län då koordinatorsfunktionen utvärderades utifrån hälso- och sjukvårdspersonalens perspektiv.

    Samtliga patienter var positiva till att ha en koordinator involverad i sin sjukskrivningsprocess och de upplevde koordinatorsfunktionen som ett stöd. Koordinatorn sågs som ”spindeln i nätet” som samordnade kontakter både internt och externt. Patienterna upplevde att de hade fått ett bra bemötande och koordinatorns personlighet var en viktig faktor för hur väl de tyckte att funktionen fungerade.

    Sammanfattningsvis såg patienten koordinatorn som ett värdefullt stöd i sin sjukskrivningsprocess och för sitt välmående.

  • 3.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Utvärdering – Sjukskrivningskoordinators roll inom Landstinget i Kalmar län2013Report (Other academic)
    Abstract [sv]

    Rehabiliteringsgarantin syftar till att stärka den enskildes ställning i sjukskrivningsprocessen och säkerställa att patienten får tillgång till medicinsk behandling och rehabilitering i form av kognitiv beteendeterapi och multimodal rehabilitering. Sjukskrivningskoordinatorns huvuduppgifter är dels att samordna detta nya arbetssätt och dels att förebygga eller minska behovet av sjukskrivning. Därutöver ska koordinatorn fungera som kontaktperson med berörda interna och externa enheter i sjukskrivnings/rehabiliteringsprocessen.

    Målet med denna utvärdering var att ta reda på hur enheterna och de berörda yrkeskategorierna, indirekt patienterna, har påverkats av införandet av funktionen sjukskrivningskoordinator inom Landstinget i Kalmar län. Utvärderingen avses vara ett underlag för beslut om koordinatorns framtida roll i landstinget om statsbidraget upphör.

    Datainsamlingen skedde både kvalitativt och kvantitativt genom semistrukturerade djupintervjuer respektive webbenkät.

    Införandet av sjukskrivningskoordinator uppfattades som mestadels positivt bland tillfrågade koordinatorer, verksamhetschefer och läkare, det fanns dock genomgående en del som var mer negativa. De tre yrkeskategorierna har olika perspektiv vilket delvis återspeglades i svaren. Koordinatorerna själva var ofta lite mer positivt inställda, och läkarna hamnade delvis i ”två läger”. Rollen/funktionen som sjukskrivningskoordinator ansågs dock vara viktig för såväl verksamheten och sjukskrivningsprocessen, som för patienten och läkaren. Koordinatorn ansågs fungera som samordnande ”spindel i nätet” med kontakter både internt och externt, och uppfattades ha lett till en effektivare sjukskrivningsprocess. Detta skiljde sig dock utifrån olika enheters behov. Ur patientens perspektiv bedömde majoriteten av de tillfrågade att det inneburit ökad trygghet och säkerhet samt snabbare vårdkedja och färre sjukvårdskontakter.

    Sammanfattningsvis verkar rollen som sjukskrivningskoordinator i stort vara en uppskattad resurs av både verksamhetschefer och läkare samt av koordinatorerna själva. Det finns dock mer att önska kring dess utformning, och kanske att funktionen borde anpassas utifrån respektive enhets enskilda behov.

  • 4.
    Ericson, Lisa
    et al.
    Nordic Health Economics AB.
    Ambring, Anneli
    Björholt, Ingela
    Dahm, Peter
    Opioid rotation in patients initiated on oxycodone or morphine: a register study.2013In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 6, p. 379-86Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Strong opioids are recommended for the treatment of moderate to severe pain. However, some patients do not achieve a successful treatment outcome due to intolerable adverse events and/or inadequate analgesia, thus may benefit from switching to another opioid, a procedure known as "opioid rotation." The type of opioid at treatment initiation may influence the risk of opioid rotation and the objective of this study was to assess such rotation after treatment initiation with two alternative treatments, controlled-release (CR) oxycodone versus CR morphine in patients suffering from non-cancer pain.

    METHOD: The study reported here was a real-life study based on Swedish register data: the Prescribed Drug, National Patient, and Cause of Death registers. The captured data cover the entire Swedish population treated in specialist care. A statistical analysis plan was agreed and signed before data were accessed.

    RESULTS: Data from 50,223 cases were included in the analyses. The risk of rotation was 19% higher in patients initiating treatment with morphine compared with oxycodone (hazard ratio 1.19; 95% confidence interval 1.11-1.27; P < 0.001), after adjusting for such baseline variables that were both significantly correlated with the outcome variable (time to rotation) and significantly different between the groups; age at index date, osteoarthritis and number of pain-related drugs.

    CONCLUSION: Patients with non-cancer pain who initiated treatment with CR morphine had a higher risk of opioid rotation than patients initiated with CR oxycodone.

  • 5.
    Ericson, Lisa
    et al.
    Nordic Health Economic Research.
    Bergfeldt, Lennart
    University of Gothenburg.
    Björholt, Ingela
    Nordic Health Economic Research.
    Atrial fibrillation: the cost of illness in Sweden2011In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 12, no 5, p. 479-87Article in journal (Refereed)
    Abstract [en]

    AIM: To provide an estimate of the annual cost of atrial fibrillation (AF) in Sweden.

    METHODS: Prevalence-based cost analysis of AF in Sweden for 2007. Direct medical (hospitalizations, hospital outpatient care, primary health care, non-pharmacological interventions, pharmaceuticals, and anticoagulation monitoring) and non-medical (transportation associated with health care visits) costs of AF, direct costs of AF complications (stroke and heart failure), and indirect costs (production loss), were included. Data were based on Swedish registries, reports and databases, published literature, and an expert panel.

    RESULTS: There were 100,557 individuals with AF as primary or secondary diagnosis that were either hospitalized or treated in hospital outpatient care in 2007. The total cost of AF was estimated at <euro>708 million. The major cost driver was the direct cost of complications (54%), followed by hospitalization due to AF including AF as secondary diagnosis (18%), and production loss (12%).

    CONCLUSION: This is a comprehensive, nation-based cost analysis of AF where relevant data were derived from national registries covering the entire Swedish population. The results showed that the annual cost of AF was high in comparison with other diseases, but likely to be underestimated as a conservative approach was applied in the analysis.

  • 6.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hammar, Tora
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schönström, Nils
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Stakeholder consensus on the purpose of clinical evaluation of electronic health records is required2017In: Health Policy and Technology, ISSN 2211-8837, E-ISSN 2211-8845, Vol. 6, no 2, p. 152-160Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore the purpose and performance of clinical evaluation of electronic health records (EHRs) among stakeholders in order to identify any need for regulatory actions or guidelines.

    Methods

    This was a qualitative study of information collected in semi-structured interviews (n=28) of representatives of the five largest EHR vendors in Sweden, healthcare provider IT managers, users, and representatives of national authorities.

    Results

    We found a difference between the stated purpose of clinical evaluation of EHRs by the authorities and the perception of the purpose by the vendors, IT managers, and the users. The respondents gave divergent answers about the medical purpose of the application: e.g. availability of data, overview and documentation, patient safety, process efficiency, decision support, a working tool, and an aid to communication and follow-up. Several vendors found it difficult to put the term clinical evaluation in its specific context, instead referring to literature reviews, risk analyses, risk-management processes, acceptance tests, test facilities, pilot tests, and proven experience.

    Conclusions

    Stakeholders need to agree on a mutually acceptable, consistent method to guide regulatory decisions. The lack of consensus regarding the purpose and performance of clinical evaluation of EHRs could impact negatively on a safe and efficient documentation in healthcare. Thus, there is a need for more consistent use of terms and concepts in, and a more systematic approach to, clinical evaluation of EHRs. To ensure that the implementation of IT in healthcare meets expectations, delivers the desired outcome, and does not create new problems, it should be evaluated.

  • 7.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Carlsson, Martin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Hospital.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Wanby, Pär
    Kalmar County Hospital.
    A cost analysis of systematic vitamin D supplementation in the elderly versus supplementation based on assessed requirements2017In: Journal of Aging Research and Healthcare, ISSN 2474-7785, Vol. 2, no 2, p. 13-22Article in journal (Refereed)
    Abstract [en]

    Hypovitaminosis D is common among older people and treatment with vitamin D is associated with reduced risk of falls and fractures. This paper provides a cost analysis of assessing the vitamin D status of and providing the pharmaceuticals for elderly citizens in Kalmar County, Sweden (population approximately 230,000). Four hypothetical interventions were analyzed: (a) systematic vitamin D/calcium supplementation to all elderly (≥75 years), (b) assessment of vitamin D status in elderly and supplementation to those with insufficient levels, (c) systematic vitamin D/calcium supplementation to all nursing-home residents, and (d) assessment of vitamin D status in nursing-home residents and supplementation to those with insufficient levels. The calculations were based on an estimated reduction in overall costs due to the assessed number of hip fractures after vitamin D/calcium supplementation. The annual net economic benefit of vitamin D/calcium supplementation was estimated at (a) €304,000, (b) €860,000, (c) €755,000, and (d) €740,000. The provision of systematic vitamin D supplementation to nursing-home residents would provide a substantial net economic benefit to society and assessment of the vitamin D status before starting supplementation does not seem to be necessary. Although assessment of all elderly citizens would be more comprehensive, the true proportion with insufficient vitamin D levels in the general population is uncertain and to reaching consensus on the most advantageous daily vitamin D intake, vitamin D blood levels are necessary. Also, systematic supplementation to all elderly would result in other outcomes that could be worth the cost, but that remains to be evaluated.

  • 8.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Swedish Family Care Competence Centre (NKA).
    Hälsoekonomisk studie av barn och vuxna med fetalt alkoholsyndrom2015Report (Other academic)
    Abstract [sv]

    Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medför direkta och indirekta kostnader för samhället på kort och lång sikt. Denna hälsoekonomiska studie är en beräkning av samhällets årliga kostnad för den andel av befolkningen som vuxit upp som barn som anhörig till förälder med psykisk sjukdom eller missbruk av alkohol eller narkotika.

  • 9.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. The Swedish Family Care Competence Centre.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Societal costs of fetal alcohol syndrome in Sweden2017In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 18, no 5, p. 575-585Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the annual societal cost of fetal alcohol syndrome (FAS) in Sweden, focusing on the secondary disabilities thought feasible to limit via early interventions.

    METHODS: Prevalence-based cost-of-illness analysis of FAS in Sweden for 2014. Direct costs (societal support, special education, psychiatric disorders and alcohol/drug abuse) and indirect costs (reduced working capacity and informal caring), were included. The calculations were based on published Swedish studies, including a register-based follow-up study of adults with FAS, reports and databases, and experts.

    RESULTS: The annual total societal cost of FAS was estimated at €76,000 per child (0-17 years) and €110,000 per adult (18-74 years), corresponding to €1.6 billion per year in the Swedish population using a prevalence of FAS of 0.2 %. The annual additional cost of FAS (difference between the FAS group and a comparison group) was estimated at €1.4 billion using a prevalence of 0.2 %. The major cost driver was the cost of societal support.

    CONCLUSIONS: The cost burden of FAS on the society is extensive, but likely to be underestimated. A reduction in the societal costs of FAS, both preventive and targeted interventions to children with FAS, should be prioritized. That is, the cost of early interventions such as placement in family homes or other forms of housing, and special education, represent unavoidable costs. However, these types of interventions are highly relevant to improve the individual's quality of life and future prospects, and also, within a long-term perspective, to limit the societal costs and personal suffering.

  • 10.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Schönström, Nils
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Klinisk utvärdering av medicinska informationssystem: Fokus på elektroniska patientjournalsystem2014Report (Other academic)
    Abstract [sv]

    Vården blir allt mer beroende av effektiva och ändamålsenliga informationssystem. Många system har införts utan närmare prövning och kontroll av den kliniska nyttan till skillnad mot införande av nya läkemedel. Medicinska informationssystem är en medicinteknisk produkt och ska följa dess regelverk, till exempel ha en uttalad avsedd användning som inbegriper patientnyttan. Att regelverket för medicintekniska produkter även gäller för medicinska informationssystem har dock i vissa delar haft svårt att slå igenom hos tillverkarna som, bland annat, har skyldighet att genomföra kliniska utvärderingar. För att förbättra genomslagskraften av regelverket uppdrog Läkemedelsverket åt eHälsoinstitutet att kartlägga kunskapen om och följsamheten till regelverket avseende klinisk utvärdering.

    Syftet med föreliggande studie var primärt att ta fram ett beslutsunderlag för hur klinisk utvärdering av medicinska informationssystem bör gå till, med fokus på elektroniska patientjournalsystem, och sekundärt att konkretisera de krav som ska vara uppfyllda för systemen och att undersöka vilken information som är lämplig i en framtida vägledning. För att lösa detta preciserades flera målfrågeställningar vilka berörde vad klinisk utvärdering av patientjournalsystem innebär och syftar till, varför det är nödvändigt, hur de genomförs, om de överensstämmer med regelverket och hur de bör genomföras.

    Totalt 28 semistrukturerade intervjuer genomfördes med tillverkare, IT-förvaltare, användare och nationella företrädare, med kommentarer från en referensgrupp.

    Respondenterna var positiva till att diskutera klinisk utvärdering och till att frågan belystes, men tyckte att frågeställningarna var komplexa och svåra att besvara samt att termer och begrepp uppfattades svåra att förstå. Det kunde upplevas abstrakt och svårt att kliniskt utvärdera ett medicinskt informationssystem jämfört med mer hårdvarubaserad medicinteknisk apparatur.

    Det medicinska syftet och den avsedda användningen med journalsystemet ska definieras av tillverkaren, vilka också var tydliga med att beskriva detta, medan IT-förvaltarna och användarna inte visste vad tillverkarna angivit för medicinskt syfte. Trots att IT-förvaltarna och användarna var osäkra på tillverkarnas beskrivning av det medicinska syftet hade de ändå en ganska tydlig uppfattning om vad det medicinska syftet med systemen är eller kanske snararare vilket/vilka behov de borde uppfylla enligt användaren. Syfte och behov upplevdes gå i vartannat och beskrevs bland annat med orden tillgänglighet, överblick, dokumentation, patientsäkerhet, effektivitet, beslutsstöd, arbetsverktyg, kommunikation och uppföljning.

    Flera av tillverkarna hade svårt att koppla begreppet klinisk utvärdering till patientjournalsystem och hade svårt att sätta begreppet i ett sammanhang. Tillverkarna förknippade istället sina svar till vad man faktiskt använder sig av såsom litteraturstudier, riskanalys, riskhanteringsprocess, acceptanstest, testmiljö, pilottest och beprövad erfarenhet.

    Till skillnad från vad som gäller för läkemedel har införandet av medicinska informationssystem inga tydligt definierade faser. Ett sätt att förtydliga och förenkla klinisk utvärdering av medicinska informationssystem skulle vara att göra en tydlig fasindelning, som blir lätt att kontrollera. Utifrån våra intervjuer skulle faserna kunna innehålla följande steg:

    • Teoretisk del – litteraturstudier, intervjuform
    • Utvecklingsfasen – riskanalys, riskhanteringsprocess, acceptanstest
    • Testmiljö – standardiserade användningsfall/testfall
    • Pilottest – skarp miljö i liten skala under översikt
    • Breddinförande
    • Uppföljning
    • Beprövad erfarenhet

    Sammanfattningsvis har vi funnit stora variationer i tolkningen av klinisk utvärdering av medicinska informationssystem och ett stort behov av förslag till att stärka den kliniska utvärderingen. Våra rekommendationer i det framtida arbetet med klinisk utvärdering av medicinska informationssystem är att ta fram:

    • Enhetliga definitioner av termer och begrepp
    • Gemensamt regelverk med tydliga riktlinjer
    • Förenklad vägledning anpassad till svenska förhållanden
    • Specifik utbildning kring avsedd användning och regelverkens tillämpning
    • Branschöverenskommelser
    • Tydliga krav vid tillsyn

    Föreliggande rapport avser att bidra till att både förtydliga tolkningen av regelverket och underlätta följsamheten och förhoppningen är att rapporten ska kunna användas i en framtida vägledning avseende klinisk utvärdering av medicinska informationssystem.

  • 11.
    Gustafsson, Lisa
    et al.
    Uppsala universitet.
    Nylander, Ingrid
    Time-dependent alterations in ethanol intake in male wistar rats exposed to short and prolonged daily maternal separation in a 4-bottle free-choice paradigm.2006In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 30, no 12, p. 2008-16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous studies have shown that maternal separation can be used in animal studies of early environmental influence on adult ethanol intake. These studies have shown that short daily separations result in low ethanol intake, whereas prolonged separations relate to an enhanced risk for a high ethanol intake. The aim of the present study was to further examine the long-term effects of early-life events on ethanol intake.

    METHODS: Rat pups were exposed to 15 minutes (MS15) or 360 minutes (MS360) of daily maternal separation during postnatal days 1 to 21 or kept under normal animal facility rearing (AFR) conditions. In adulthood, male rats were given free access to 5, 10, and 20% ethanol, in addition to water, in a 4-bottle-choice paradigm.

    RESULTS: No differences in total ethanol intake or preference between the 3 experimental groups were found. The 54-day drinking period was divided into acquisition, stabilization, and maintenance phases for analysis of time and group differences. The MS15 rats increased ethanol intake over time; they mostly consumed 5% ethanol and had a low intake of 20% ethanol throughout the experiment. MS360 rats increased ethanol intake, changed preference from 5% to 20% ethanol, and had a higher increase in intake of 20% ethanol over time. The ethanol intake and preference in the AFR rats were more similar to that of the MS360 rats.

    CONCLUSIONS: Time-dependent changes were observed in the preferred choice of low versus high ethanol concentrations in MS15 and MS360 rats. The results support previous findings suggesting that MS15 can be used as a model for environmental protective factors and that MS360 represents a risk environment for acquisition of a high adult ethanol intake.

  • 12.
    Gustafsson, Lisa
    et al.
    Uppsala universitet.
    Oreland, Sadia
    Hoffmann, Pernilla
    Nylander, Ingrid
    The impact of postnatal environment on opioid peptides in young and adult male Wistar rats.2008In: Neuropeptides, ISSN 0143-4179, E-ISSN 1532-2785, Vol. 42, no 2, p. 177-91Article in journal (Refereed)
    Abstract [en]

    Early environmental influences can change the neuronal development and thereby affect behavior in adult life. The aim in the present study was to thoroughly examine the impact of early environmental factors on endogenous opioids by using a rodent maternal separation (MS) model. The endogenous opioid peptide system is not fully developed at birth, and short- and/or long-term alterations may occur in these neural networks in animals exposed to manipulation of the postnatal environment. Rat pups were subjected to one of five rearing conditions; 15 min (MS15) litter (l) or individual (i), 360 min (MS360) l or i daily MS, or housed under normal animal facility rearing (AFR) conditions during postnatal days 1-21. Measurements of immunoreactive (ir) Met-enkephalin-Arg6Phe7 (MEAP) and dynorphin B (DYNB) peptide levels in the pituitary gland and in a number of brain areas, were performed at three and 10 weeks of age, respectively. MS-induced changes were more pronounced in ir MEAP levels, especially in individually separated rats at three weeks of age and in litter-separated rats at 10 weeks of age. The enkephalin and dynorphin systems have different developmental patterns, dynorphin appearing earlier, which may point at a more sensitive enkephalin system during the early postnatal weeks. The results provide evidence that opioid peptides are sensitive for early environmental factors and show that the separation conditions are critical and also result in changes manifesting at different time points. MS-induced effects were observed in areas related to stress, drug reward and dependence mechanisms. By describing effects on opioid peptides, the study addresses the possible role of a deranged endogenous opioid system in the previously described behavioral consequences of MS.

  • 13.
    Gustafsson, Lisa
    et al.
    Uppsala universitet.
    Ploj, Karolina
    Nylander, Ingrid
    Effects of maternal separation on voluntary ethanol intake and brain peptide systems in female Wistar rats.2005In: Pharmacology, Biochemistry and Behavior, ISSN 0091-3057, E-ISSN 1873-5177, Vol. 81, no 3, p. 506-16Article in journal (Refereed)
    Abstract [en]

    In previous studies, changes in adult ethanol intake after early environmental experiences, such as short and prolonged maternal separation, have been described in male rats. The aim of this study was to further investigate long-term effects of maternal separation on voluntary ethanol intake as well as brain opioid and nociceptin/orphanin FQ (N/OFQ) peptides in female Wistar rats. During postnatal days (PNDs) 1-21, rat pups were subjected to 15 min (MS15) or 360 min (MS360) of daily maternal separation, or were kept under normal animal facility rearing (AFR) conditions. At 10 weeks of age, ethanol intake was measured using a two-bottle free choice paradigm and dynorphin B (DYNB), Met-enkephalin-Arg6-Phe7 (MEAP) and N/OFQ levels were analyzed. MS15 resulted in changes in hypothalamus (DYNB), medial prefrontal cortex and nucleus accumbens (MEAP), and amygdala (N/OFQ). MS360 induced alterations in medial prefrontal cortex (MEAP) and amygdala (N/OFQ). MS15 and MS360 had no effect on ethanol intake. However, 4 weeks of ethanol intake affected peptide levels differently in MS15, MS360 and AFR rats and resulted in attenuation of the separation-induced differences. These results show that even though maternal separation has no effect on voluntary ethanol intake in female rats, the ethanol-induced effects on peptide levels depend on the early environmental setting.

  • 14.
    Gustafsson, Lisa
    et al.
    Uppsala universitet.
    Zhou, Q
    Nylander, I
    Ethanol-induced effects on opioid peptides in adult male Wistar rats are dependent on early environmental factors.2007In: Neuroscience, ISSN 0306-4522, E-ISSN 1873-7544, Vol. 146, no 3, p. 1137-49Article in journal (Refereed)
    Abstract [en]

    The vulnerability to develop alcoholism is dependent on both genetic and environmental factors. The neurobiological mechanisms underlying these factors are not fully understood but individual divergence in the endogenous opioid peptide system may contribute. We have previously reported that early-life experiences can affect endogenous opioids and also adult voluntary ethanol intake. In the present study, this line of research was continued and the effects of long-term voluntary ethanol drinking on the opioid system are described in animals reared in different environmental settings. Rat pups were subjected to 15 min (MS15) or 360 min (MS360) of daily maternal separation during postnatal days 1-21. At 10 weeks of age, male rats were exposed to voluntary ethanol drinking in a four-bottle paradigm with 5%, 10% and 20% ethanol solution in addition to water for 2 months. Age-matched controls received water during the same period. Immunoreactive (ir) Met-enkephalin-Arg6Phe7 (MEAP) and dynorphin B (DYNB) peptide levels were thereafter measured in the pituitary gland and several brain areas. In water-drinking animals, lower ir MEAP levels were observed in the MS360 rats in the hypothalamus, medial prefrontal cortex, striatum and the periaqueductal gray, whereas no differences were seen in ir DYNB levels. Long-term ethanol drinking induced lower ir MEAP levels in MS15 rats in the medial prefrontal cortex and the periaqueductal gray, whereas higher levels were detected in MS360 rats in the hypothalamus, striatum and the substantia nigra. Chronic voluntary drinking affected ir DYNB levels in the pituitary gland, hypothalamus and the substantia nigra, with minor differences between MS15 and MS360. In conclusion, manipulation of the early environment caused changes in the opioid system and a subsequent altered response to ethanol. The altered sensitivity of the opioid peptides to ethanol may contribute to the previously reported differences in ethanol intake between MS15 and MS360 rats.

  • 15.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Swedish Family Care Competence Centre (NKA).
    Barn som anhöriga: ekonomisk studie av samhällets långsiktiga kostnader2015Report (Other academic)
    Abstract [sv]

    Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medför direkta och indirekta kostnader för samhället på kort och lång sikt. Denna hälsoekonomiska studie är en beräkning av samhällets årliga kostnad för den andel av befolkningen som vuxit upp som barn som anhörig till förälder med psykisk sjukdom eller missbruk av alkohol eller narkotika.

  • 16.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Trends in Inappropriate Drug Therapy Prescription in the Elderly in Sweden from 2006 to 2013: Assessment Using National Indicators2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 5, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document "Indicators of appropriate drug therapy in the elderly" as a guideline for improving prescribing for the elderly. Objective The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment. Methods Individual-based data on dispensed prescription drugs for the entire Swedish population aged >= 65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored. Results For the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65-74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged >= 75 years), all indicators except excessive polypharmacy showed improvement. Conclusion According to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.

  • 17. Lesén, Eva
    et al.
    Ericson, Lisa
    Nordic Health Economics AB.
    Simonsberg, Christian
    Varelius, Riitta
    Björholt, Ingela
    Söderpalm, Bo
    Dose patterns among patients using low-dose buprenorphine patches.2013In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 14, no 9, p. 1374-80Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of this study was to investigate the dose pattern of low-dose buprenorphine patches among patients in Swedish clinical practice. The clinical experts among the coauthors interpreted the results in relation to possible indications of development of tolerance and/or dependence/addiction.

    DESIGN AND SETTING: This was a nationwide, observational study using data from the Swedish Prescribed Drug Register.

    SUBJECTS: Individuals who were dispensed the low-dose buprenorphine patches continuously for more than 24 weeks during July 1, 2005 to February 28, 2011 were included.

    METHODS: The dose pattern was analyzed as the change in dose over time for each patient: 1) the dose at baseline compared with each of the following 8-week intervals, and 2) the dose at baseline compared with the dose during the patients' last treatment period.

    RESULTS: The majority of the patients were female (74%), and most were 75 years and older (69%). The median treatment duration was 260 days, and 4% and 1% of patients remained on continuous treatment for 2 and 3 years, respectively. The mean dose was 11 μg/h at baseline, and 15 μg/h during the patients' last treatment period. The average dose increased by 4 μg/h during the patients' entire treatment course.

    CONCLUSIONS: The average dose increased by 4 μg/h during the patients' treatment course, which lasted on an average of 260 days. From a clinical perspective, the dose increase of 4 μg/h is low and does not suggest dependence/addiction, as also supported by the low proportion of patients remaining on continuous treatment.

  • 18.
    Nilsson, Anna-Lena
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Broberg, Hanna
    Linnaeus University, Faculty of Technology, Department of Informatics.
    Användbarhet och ändamålsenlighet med Gemensam informationsstruktur2016Report (Other academic)
    Abstract [sv]

    eHälsoinstitutet vid Linnéuniversitetet i Kalmar har fått i uppdrag av Socialstyrelsen att stödja arbetet att kartlägga uppfattningen om ändamålsenlighet och användbarhet hos produkter och tjänster inom Gemensam informationsstruktur (GI). GI består av Nationell informationsstruktur (NI) och Nationellt fackspråk (NF) samt tjänster, verktyg, metoder och ändringshantering. NF består i sin tur av Snomed CT, Hälsorelaterade klassifikationer och Socialstyrelsens termbank. Detta uppdrag är en aktivitet inom Socialstyrelsens projekt "Långsiktig utveckling av GI". Uppdraget till eHälsoinstitutet sträckte sig från början av mars till slutet av april 2016, som en del av Socialstyrelsens eget arbete som ska pågå maj månad ut.

  • 19. Oreland, S
    et al.
    Daoura, L
    Gustafsson-Ericson, Lisa
    Uppsala universitet.
    Damberg, M
    Hyytiä, P
    Oreland, L
    Nylander, Ingrid
    Does the transcription factor AP-2beta have an impact on the genetic and early environmental influence on ethanol consumption?2010In: Journal of neural transmission, ISSN 0300-9564, E-ISSN 1435-1463, Vol. 117, no 9, p. 1077-81Article in journal (Refereed)
    Abstract [en]

    Genes involved in alcoholism have consensus sites for the transcription factor activator protein (TFAP) 2beta. In the present study, we investigated TFAP-2beta protein levels in the ethanol-preferring alko, alcohol (AA) and the ethanol-avoiding alko, non-alcohol (ANA) rat lines. Furthermore, basal and ethanol-induced TFAP-2beta levels were examined in Wistar rats exposed to different early postnatal environments that are known to affect later ethanol consumption. Taken together, we found differences in brainstem TFAP-2beta protein between the AA and ANA rats.

  • 20. Oreland, Sadia
    et al.
    Gustafsson-Ericson, Lisa
    Uppsala universitet.
    Nylander, Ingrid
    Short- and long-term consequences of different early environmental conditions on central immunoreactive oxytocin and arginine vasopressin levels in male rats.2010In: Neuropeptides, ISSN 0143-4179, E-ISSN 1532-2785, Vol. 44, no 5, p. 391-8Article in journal (Refereed)
    Abstract [en]

    Numerous studies have provided evidence for an important role for the neuropeptides oxytocin (OT) and arginine vasopressin (AVP) in establishment of social behaviour early in life, such as mother-pup interactions. However, there are few reports examining the consequences of early-life experiences on OT and AVP in male offspring. We have used the maternal separation (MS) model to study the effect of different early environmental conditions in rats. The purpose was to study OT and AVP in rats subjected to prolonged daily MS (360 min, MS360), short daily MS (15 min, MS15) and conventional animal facility rearing (AFR) during postnatal days 1-21. In addition, the influence of the presence or absence of littermates during MS, i.e. litter-wise (l) or individual (i) MS, was assessed. The immunoreactive (ir) peptide levels were measured in the hypothalamus, amygdala and pituitary gland of 3 and 10 weeks old male rats. Assessment in 3-week-old rats revealed that MS15 was associated with low ir OT levels in the hypothalamus and amygdala and high levels in the pituitary gland compared with the MS360 and AFR condition. In the amygdala, differences between groups were also detected in adulthood. MS studies commonly use either MS15 or AFR as a control for prolonged MS. The present results show differences in MS360 rats as compared to MS15 but not AFR rats. Consequently, comparisons between prolonged MS with either short periods of MS or AFR will generate divergent results, hence, making the outcome of MS difficult to compare between studies. Moreover, the different early environments had no effect on ir AVP levels. In conclusion, OT in the amygdala was most sensitive to MS. Besides both short- and long-term consequences, distinct effects were seen after litter and individual separation, respectively. We propose that environmentally induced alterations in OT transmission due to disrupted mother-pup interactions early in life may cause altered susceptibility to challenges later in life.

  • 21. Pickering, Chris
    et al.
    Gustafsson, Lisa
    Uppsala universitet.
    Cebere, Aleta
    Nylander, Ingrid
    Liljequist, Sture
    Repeated maternal separation of male Wistar rats alters glutamate receptor expression in the hippocampus but not the prefrontal cortex.2006In: Brain Research, ISSN 0006-8993, E-ISSN 1872-6240, Vol. 1099, no 1, p. 101-8Article in journal (Refereed)
    Abstract [en]

    Stress early in life puts the individual at a greater risk for developing mental disorders in adulthood. The animal model of maternal separation involves daily removal of pups from their mother over the early postnatal period and leads to several behavioral deficits in adults. Since this period corresponds to a time of extensive developmental changes in the glutamatergic system, glutamate receptor mRNA expression was studied in the hippocampus and prefrontal cortex. Male Wistar rats were either separated from their mother for 15 min (MS15 or 'handling') or 360 min (MS360) once a day from pnd 1-21 and glutamate receptor expression levels were measured at 25 weeks of age using real-time RT-PCR analysis. A third group of animal facility reared (AFR) rats was included as a control for the handling group. In the hippocampus, mRNA expression of NMDA NR2B and AMPA GluR1 and GluR2 receptors was significantly lower in MS360 rats relative to MS15. In addition, expression of the glutamate transporter GLAST was increased in MS360 relative to MS15. No differences were observed for AFR rats relative to MS15, which indicates that the hippocampal effects were not a result of handling or maternal care. For the prefrontal cortex, no difference in mRNA expression was observed for NMDA NR2A and NR2B or AMPA GluR1 and GluR2. These findings suggest that prolonged maternal separation produces neuroadaptive changes in the hippocampus that may, at least partially, account for the behavioral deficits previously observed in this animal model.

  • 22. Ploj, K
    et al.
    Roman, E
    Gustavsson, Lisa
    Uppsala universitet.
    Nylander, I
    Basal levels and alcohol-induced changes in nociceptin/orphanin FQ, dynorphin, and enkephalin levels in C57BL/6J mice.2000In: Brain Research Bulletin, ISSN 0361-9230, E-ISSN 1873-2747, Vol. 53, no 2, p. 219-26Article in journal (Refereed)
    Abstract [en]

    In order to investigate the involvement of the opioid and nociceptin/orphanin FQ (N/OFQ) system in alcohol drinking behaviour, N/OFQ and the opioid peptides dynorphin B (DYNB) and Met-enkephalin-Arg(6) Phe(7) (MEAP) were examined in the alcohol-preferring C57BL/6J mice. Basal peptide levels were compared in the brain and the pituitary gland with basal levels in the alcohol-avoiding DBA/2J mice. Furthermore, the effects of chronic alcohol self-administration on peptides were studied in the C57BL/6J mice. Compared to the DBA/2J mice, C57BL/6J mice had low immunoreactive (ir) levels of DYNB and MEAP in the nucleus accumbens, the hippocampus, and the substantia nigra, low ir-DYNB levels in the striatum and low ir-MEAP levels in the frontal cortex. Higher ir-DYNB levels in the pituitary gland and in the periaqueductal gray (PAG) and higher ir-N/OFQ levels in the frontal cortex and in the hippocampus were detected in C57BL/6J mice compared to the DBA/2J mice. After 4 weeks of voluntary alcohol consumption, only minor changes in steady-state peptide levels were identified. However, 5 days after the alcohol-drinking period, lower levels of all peptides were detected in the ventral tegmental area and ir-DYNB levels were also lower in the amygdala and in the substantia nigra. Twenty-one days after cessation of alcohol self-administration, the opioid peptides in alcohol-consuming C57BL/6J mice were lower in the PAG, the N/OFQ was lower in the frontal cortex and DYNB was higher in the amygdala and substantia nigra as compared to control C57BL/6J mice. This study demonstrates strain differences between C57BL/6J mice and DBA/2J mice that could contribute to divergent drug-taking behaviour, and it also demonstrates time- and structure-specific changes in neuropeptide levels after alcohol self-administration in the C57BL/6J mice.

  • 23. Roman, Erika
    et al.
    Gustafsson, Lisa
    Uppsala universitet.
    Berg, Marita
    Nylander, Ingrid
    Behavioral profiles and stress-induced corticosteroid secretion in male Wistar rats subjected to short and prolonged periods of maternal separation.2006In: Hormones and Behavior, ISSN 0018-506X, E-ISSN 1095-6867, Vol. 50, no 5, p. 736-47Article in journal (Refereed)
    Abstract [en]

    Early life experiences are important for the development of neurobiobehavioral mechanisms and subsequent establishment of mental functions. In experimental animals, early life experiences can be studied using the maternal separation model. Maternal separation has been described to induce neurobiological changes and thus affect brain function, mental state and behavior. We have established a protocol in order to study the effects of repeated short and prolonged periods of maternal separation during the postnatal period on adult neurochemistry, voluntary ethanol intake and behavior. In the present experiment, we focus on the long-term effects of maternal separation on exploration and risk assessment behavior as well corticosteroid secretion. Rat pups were assigned to 15 min (MS15) or 360 min (MS360) of daily maternal separation and normal animal facility rearing (AFR) during postnatal days 1-21. To establish the adult behavioral profile in male rats, three tests were used: the Concentric Square Field (CSF), the Open Field (OF) and the Elevated Plus-maze (EPM). No differences between the three experimental groups were found in the traditional OF and EPM tests. The CSF test indicated that the MS360 rats were more explorative and expressed an altered risk assessment and risk-taking profile. In response to a restraint stress, MS360 rats had a blunted corticosterone release in contrast to MS15 and AFR rats. In contrast to previous results, the outcome of the present investigation does not support the notion that a prolonged period of maternal separation results in an adult phenotype characterized by an increased emotional reactivity.

  • 24. Roman, Erika
    et al.
    Gustafsson, Lisa
    Uppsala universitet.
    Hyytiä, Petri
    Nylander, Ingrid
    Short and prolonged periods of maternal separation and voluntary ethanol intake in male and female ethanol-preferring AA and ethanol-avoiding ANA rats.2005In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 29, no 4, p. 591-601Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Genetic as well as environmental factors can affect the propensity for psychopathology and/or drug dependence. Maternal separation represents an animal experimental model that is useful in studies of effects of early life experiences. The authors have established a protocol for short and prolonged periods of maternal separation to study adult neurochemistry, behavior, and ethanol intake and have previously reported alterations in ethanol intake in Wistar rats and ethanol-preferring rats. The aim of the current study was to more thoroughly study how early life experiences affect an inherited propensity for high and low ethanol intake, respectively, in male and female ethanol-preferring AA (Alko alcohol) and ethanol-avoiding ANA (Alko, Non-Alcohol) rats.

    METHODS: AA and ANA pups were assigned to one of three different rearing conditions: 15 min (MS15) or 360 min (MS360) of daily maternal separation in litters or normal animal facility rearing (AFR) during postnatal days 1 to 21. In adulthood, voluntary ethanol intake was investigated using the two-bottle free choice paradigm.

    RESULTS: In male ethanol-preferring AA rats, MS15 resulted in a lower intake and fewer high-preferring animals at 8% and 10% ethanol compared with MS360 rats. The male MS360 rats had a higher ethanol intake at 8% and 10% ethanol in comparison with AFR rats. In contrast, the female AA MS15 and MS360 rats had a lower ethanol intake and a lower preference for the 10% ethanol solution compared with the female AA AFR rats. In male and female ANA rats, no major separation-induced effects were found.

    CONCLUSIONS: The current results show that genetic inheritance can be affected by environmental manipulations in AA rats with an inherent high ethanol intake. The findings in female ethanol-preferring AA rats give further evidence of a differential outcome of maternal separation in male and female rats, as previously shown.

  • 25. Roman, Erika
    et al.
    Ploj, Karolina
    Gustafsson, Lisa
    Uppsala universitet.
    Meyerson, Bengt J
    Nylander, Ingrid
    Variations in opioid peptide levels during the estrous cycle in Sprague-Dawley rats.2006In: Neuropeptides, ISSN 0143-4179, E-ISSN 1532-2785, Vol. 40, no 3, p. 195-206Article in journal (Refereed)
    Abstract [en]

    The estrous cycle, with its various hormonal conditions, may provide us with the means of understanding how endocrine states relate to opioid mechanisms. There has been increasing experimental support for interaction between sex steroids and opioid peptides in the central nervous system. Here, we describe fluctuations in endogenous brain immunoreactive (ir) peptide levels during various phases of the estrous cycle in the female Sprague-Dawley rat. Ir levels of dynorphin A, dynorphin B, Leu-enkephalin-Arg(6), Met-enkephalin-Arg(6)Phe(7) and nociceptin/orphanin FQ were measured in the pituitary gland and in 10 areas of the brain during the diestrus, proestrus and estrus phase. In several areas of the brain, basal levels of endogenous opioid peptides showed variation during the course of the estrous cycle. Significant differences were found between the diestrus state and the proestrus and/or estrus conditions, particularly in the nucleus accumbens, caudate putamen and the substantia nigra. The ir levels of the endogenous peptide nociceptin/orphanin FQ became altered in only one of the areas measured, indicating less variance during the estrous cycle. Correlation analyses revealed that significant associations between dynorphin A or dynorphin B and Leu-enkephalin-Arg(6) were found more often during estrus than during the diestrus and proestrus conditions. The ratio between the ir levels of Leu-enkephalin-Arg(6), a cleavage product of the enzymatic conversion of dynorphin peptides into shorter peptides in vivo, and dynorphin peptides was calculated. The significantly lower ratio between Leu-enkephalin-Arg(6) and dynorphin B in diestrus than in proestrus and estrus also indicates cyclic fluctuations in the enzymatic cleavage of dynorphin. These findings are discussed in relation to the possible role of interactions between sex steroids and opioid peptide mechanisms during the normal estrous cycle.

  • 26. Salomé, N
    et al.
    Hansson, C
    Taube, M
    Gustafsson-Ericson, Lisa
    Göteborgs universitet.
    Egecioglu, E
    Karlsson-Lindahl, L
    Fehrentz, J A
    Martinez, J
    Perrissoud, D
    Dickson, S L
    On the central mechanism underlying ghrelin's chronic pro-obesity effects in rats: new insights from studies exploiting a potent ghrelin receptor antagonist.2009In: Journal of neuroendocrinology (Print), ISSN 0953-8194, E-ISSN 1365-2826, Vol. 21, no 9, p. 777-85Article in journal (Refereed)
    Abstract [en]

    In the present study, we explore the central nervous system mechanism underlying the chronic central effects of ghrelin with respect to increasing body weight and body fat. Specifically, using a recently developed ghrelin receptor antagonist, GHS-R1A (JMV2959), we investigate the role of GHS-R1A in mediating the effects of ghrelin on energy balance and on hypothalamic gene expression. As expected, in adult male rats, chronic central treatment with ghrelin for 14 days, when compared to vehicle-treated control rats, resulted in an increased body weight, lean mass and fat mass (assessed by dual X-ray absorptiometry), dissected white fat pad weight, cumulative food intake, food efficiency, respiratory exchange ratio and a decrease of energy expenditure. Co-administration of the ghrelin receptor antagonist JMV2959 suppressed/blocked the majority of these effects, with the notable exception of ghrelin-induced food intake and food efficiency. The hypothesis emerging from these data, namely that GHS-R1A mediates the chronic effects of ghrelin on fat accumulation, at least partly independent of food intake, is discussed in light of the accompanying data regarding the hypothalamic genes coding for peptides and receptors involved in energy balance regulation, which were found to have altered expression in these studies.

  • 27.
    Throfast, Victoria
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    e-Learning for the elderly on drug utilization: a pilot study2019In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 25, no 2, p. 227-239Article in journal (Refereed)
    Abstract [en]

    This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.

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