Asthmatics Exhibit Altered Oxylipin Profiles Compared to Healthy Individuals after Subway Air Exposure

Asthma is a chronic inflammatory lung disease that causes significant morbidity and mortality worldwide. Air pollutants such as particulate matter (PM) and oxidants are important factors in causing exacerbations in asthmatics, and the source and composition of pollutants greatly affects pathological implications.This randomized crossover study investigated responses of the respiratory system to Stockholm subway air in asthmatics and healthy individuals. Eicosanoids and other oxylipins were quantified in the distal lung to provide a measure of shifts in lipid mediators in association with exposure to subway air relative to ambient air.Sixty-four oxylipins representing the cyclooxygenase (COX), lipoxygenase (LOX) and cytochrome P450 (CYP) metabolic pathways were screened using liquid chromatography-tandem mass spectrometry (LC-MS/MS) of bronchoalveolar lavage (BAL)-fluid. Validations through immunocytochemistry staining of BAL-cells were performed for 15-LOX-1, COX-1, COX-2 and peroxisome proliferator-activated receptor gamma (PPARγ). Multivariate statistics were employed to interrogate acquired oxylipin and immunocytochemistry data in combination with patient clinical information.Asthmatics and healthy individuals exhibited divergent oxylipin profiles following exposure to ambient and subway air. Significant changes were observed in 8 metabolites of linoleic- and α-linolenic acid synthesized via the 15-LOX pathway, and of the COX product prostaglandin E(2) (PGE(2)). Oxylipin levels were increased in healthy individuals following exposure to subway air, whereas asthmatics evidenced decreases or no change.Several of the altered oxylipins have known or suspected bronchoprotective or anti-inflammatory effects, suggesting a possible reduced anti-inflammatory response in asthmatics following exposure to subway air. These observations may have ramifications for sensitive subpopulations in urban areas

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Upplevelsen av att inte kunna sluta röka vid kronisk obstruktiv lungsjukdom

COPD (Chronic Obstructive Pulmonary Disease) is one of the most widespread lung diseases today and is a growing cause for suffering and mortality worldwide. It is considered to be the third leading cause of death in the near future. Smoking is the most important risk factor for this disease and about 50% of smokers develop COPD. The purpose of this study was to mediate the experience of not being able to stop smoking described by persons diagnosed with mild or moderate COPD. The study involved five women and five men. Data was collected by semi-structured interviews and analyzed using qualitative latent content analysis. The analysis resulted in two themes: Life is governed by a long smoking history that is difficult to break and To be aware of and enlightened, but lacking ability to make a decision, and in five categories: That it is the wrong time in life to stop; To break a lifelong pattern is almost impossible; That plans to stop does not lead to results; Being aware of the consequences of continued smoking and to have received help and support but not liking to be patronized. Participants' lives were governed by a lifelong smoking habit which was difficult to break, although they had knowledge about the harmful effects of smoking. Individuals life situation is very important if the cessation of smoking can be successfully implemented and with lasting results. To have plans to stop smoking is not enough it is also necessary to get motivation and support from the environment and at the right time. Participants that where reluctant to smoking cessation where also critical to the information and support that was given to them. This indicates that health professionals should be more sensitive and provide an individually tailored support when an individual decides to stop smoking.Validerat; 20110102 (ysko

Upplevelsen av att inte kunna sluta röka vid kronisk obstruktiv lungsjukdom

COPD (Chronic Obstructive Pulmonary Disease) is one of the most widespread lung diseases today and is a growing cause for suffering and mortality worldwide. It is considered to be the third leading cause of death in the near future. Smoking is the most important risk factor for this disease and about 50% of smokers develop COPD. The purpose of this study was to mediate the experience of not being able to stop smoking described by persons diagnosed with mild or moderate COPD. The study involved five women and five men. Data was collected by semi-structured interviews and analyzed using qualitative latent content analysis. The analysis resulted in two themes: Life is governed by a long smoking history that is difficult to break and To be aware of and enlightened, but lacking ability to make a decision, and in five categories: That it is the wrong time in life to stop; To break a lifelong pattern is almost impossible; That plans to stop does not lead to results; Being aware of the consequences of continued smoking and to have received help and support but not liking to be patronized. Participants' lives were governed by a lifelong smoking habit which was difficult to break, although they had knowledge about the harmful effects of smoking. Individuals life situation is very important if the cessation of smoking can be successfully implemented and with lasting results. To have plans to stop smoking is not enough it is also necessary to get motivation and support from the environment and at the right time. Participants that where reluctant to smoking cessation where also critical to the information and support that was given to them. This indicates that health professionals should be more sensitive and provide an individually tailored support when an individual decides to stop smoking.Validerat; 20110102 (ysko

Sjuksköterskors erfarenheter av att arbeta med evidensbaserad omvårdnad : en litteraturstudie

Validerat; 20101217 (root

Introduction of a Multimodal Pain Rehabilitation Intervention in Primary Care: A Pilot Study

Objective: To evaluate patient-reported outcome measures in patients with chronic musculoskeletal pain 1 year after participation in a case manager-led multimodal rehabilitation intervention in a Finnish primary care centre. Changes in healthcare utilization (HCU) were also explored. Methods: A prospective pilot study with 36 participants. The intervention consisted of screening, multidisciplinary team assessment, a rehabilitation plan and case manager follow-up. Data were collected through questionnaires filled in after the team assessment and 1 year later. HCU data 1 year before and 1 year after team assessment were compared. Results: At follow-up, satisfaction with vocational situation, self-reported work ability and health-related quality of life (HRQoL) had improved and pain intensity had diminished significantly for all participants. The participants who reduced their HCU improved their activity level and HRQoL. Early intervention by a psychologist and mental health nurse was distinctive for the participants who reduced HCU at follow-up. Conclusion: The findings demonstrate the importance of early biopsychosocial management of patients with chronic pain in primary care. Identification of psychological risk factors at an early stage may lead to better psychosocial wellbeing, improve coping strategy and reduce HCU. A case manager may free up other resources and thereby contribute to cost savings. LAY ABSTRACT The majority of patients with chronic pain seek and receive care in primary care, yet their identification and management are often fragmented and inadequate. Many patients end up in a vicious circle of healthcare utilization (HCU), undergoing unnecessary diagnostic and medical procedures. Identifying those at risk of developing chronic pain and avoiding exclusion from work, family and social life may generate cost savings and reduce individual suffering. Multimodal rehabilitation (MMR) is an evidence-based treatment for patients with chronic pain, recurrently provided in specialized care but underutilized in primary care. This pilot study evaluated a case manager-led MMR intervention for patients with musculoskeletal chronic pain in a Finnish primary care centre. HCU was also studied. The results showed that addressing physiological, psychological and social factors in the patient’s life simultaneously and at an early stage may lead to reduced pain perception, increased psychosocial wellbeing and cost savings for society

Why do smokers diagnosed with COPD not quit smoking? - a qualitative study

Background Chronic Obstructive Pulmonary Disease (COPD) is currently one of the most widespread chronic lung diseases and a growing cause of suffering and mortality worldwide. It is predicted to become the third leading cause of death in the near future. Smoking is the most important risk factor, and about 50% of smokers develop COPD. Smoking cessation is the most important way to improve prognosis. The aim of the study was to describe difficulties of smoking cessation experienced by individuals with COPD who are unable to stop smoking. Methods Ten smokers (five women) with COPD, GOLD stage II, participated in semi-structured interviews in 2010. The data were analyzed using qualitative content analysis. The participants were recruited from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Results The participants lives were governed by a lifelong smoking habit that was difficult to break although they had knowledge about the harmful effects and the consequences of COPD. The participants described incidents in their lives as reasons for never finding the time to quit smoking. Demands to quit smoking from other people could lead to continued smoking or get them started again after cessation as they did not want to be patronized. They wanted to receive support from relatives and care providers but they wanted to make the decision to quit on their own. Conclusions For successful smoking cessation, it is important to understand the difficulties smokers are experiencing that influence their efforts to quit smoking. To achieve a successful lasting smoking cessation it might be more effective to first ensure that the smoker has the right internal motivation to make the decision to quit, then assist with smoking cessation

Poor school bonding and delinquency over time : bidirectional effects and sex differences

The association between poor school bonding and delinquency has only been partly addressed in earlier research. Using a longitudinal design, the objective of our study was to investigate possible bidirectional effects and sex differences between adolescents’ experienced school bonding and self-rated delinquency over time. A total of 788 adolescents (353 boys and 435 girls) were investigated by questionnaire at age 14 and 16. Poor school attachment and commitment as well as poor teacher attachment were found to be stronger determinants of delinquency for males than for females. Delinquency predicted poor school commitment for both boys and girls, and poor school attachment for girls, thus indicating bidirectional effects over time and sex differences in some of the bidirectional effects. The study concludes that the delinquency propensity of adolescent boys may be affected by all school bonding dimensions, whereas for girls it is their relationship with their teachers that is of significance

Quality of Life in Different Male Offender Groups : Possible Underlying Effects of Intelligence and Psychopathic Tendencies

The role of psychopathic tendencies and intelligence on Quality of life (QoL) ratings in different male offender groups was explored. Participants were 199 Swedish males with a history of criminality at age 11-14 and matched controls from the longitudinal project Young Lawbreakers as Adults. Based on registered crimes prior to 15 years and up to 34 years of age, four criminal groups were yielded: non-criminals (NC); adolescence-limited (AL); persistent (P); and adult-onset (AO). The QoL construct consists of the following dimensions: Self-perception, Psychological health, Family, Children, Education, Work, and Finances, all self-rated at age 38-41 when also psychopathic tendencies were clinically assessed using the Psychopathy Check List (PCL). The P group reported lower QoL in all dimensions compared to the NC and AL groups and lower QoL regarding Family and Education than the AO group. When controlling for psychopathic tendencies, the group differences in QoL regarding Self-perception and Children was no longer significant. Generally, individuals with higher IQ scores rated higher QoL than individuals with lower IQ scores. IQ however did not explain the divergence in QoL between offender groups. Psychopathic tendencies are suggested to overtake the importance of group belonging regarding the QoL dimensions of Self-perception and Children