What is known about the health and living conditions of the indigenous people of northern Scandinavia, the Sami?

The Sami are the indigenous ethnic population of northern Scandinavia. Their health condition is poorly known, although the knowledge has improved over the last decade.The aim was to review the current information on mortality, diseases, and risk factor exposure in the Swedish Sami population.Health-related research on Sami cohorts published in scientific journals and anthologies was used to compare the health condition among the Sami and the majority non-Sami population. When relevant, data from the Sami populations in Swedish were compared with corresponding data from Norwegian and Finnish Sami populations.Life expectancy and mortality patterns of the Sami are similar to those of the majority population. Small differences in incidences of cancer and cardiovascular diseases have been reported. The traditional Sami lifestyle seems to contain elements that reduce the risk to develop cancer and cardiovascular diseases, e.g. physical activity, diet rich in antioxidants and unsaturated fatty acids, and a strong cultural identity. Reindeer herding is an important cultural activity among the Sami and is associated with high risks for accidents. Pain in the lower back, neck, shoulders, elbows, and hands are frequent among both men and women in reindeer-herding families. For men, these symptoms are related to high exposure to terrain vehicles, particularly snowmobile, whereas for women psychosocial risk factors seem to more important, e.g. poor social support, high effort, low reward, and high economical responsibilities.Although the health condition of the Sami population appears to be rather similar to that of the general Swedish population, a number of specific health problems have been identified, especially among the reindeer-herding Sami. Most of these problems have their origin in marginalization and poor knowledge of the reindeer husbandry and the Sami culture in the majority population. It is suggested that the most sustainable measure to improve the health among the reindeer-herding Sami would be to improve the conditions of the reindeer husbandry and the Sami culture

Vitamin A-reglerad homeostas och regeneration av neuroner

The olfactory epithelium is a dynamic tissue maintained by continuous neurogenesis throughout life. Upon injury, neurons and other olfactory cell types are regenerated through proliferation of horizontal stem cells. Some genes that regulate vitamin A metabolism are spatially expressed in the olfactory epithelium. Retinoic acid is a vitamin A derivate, a key regulator of proliferation and stem cell activity. Retinoic acid is generated and inactivated by enzymes with opposing expression patterns which create local variations in retinoic acid levels in the olfactory epithelium. The overall aim of this thesis is to elucidate functional relationships between retinoic acid metabolism and the regulation of temporal and spatial features of normal tissue homeostasis and regeneration of neurons within the olfactory epithelium. I have studied the association between the activity-dependent retinoic acid inactivating enzyme CYP26B1 and neurogenesis.  During doubled stimulation by odorants and air flow the level of CYP26B1 was further induced in olfactory sensory neurons and proliferation of progenitor/stem cells was increased. In the absence of stimuli, CYP26B1 expression was reduced and proliferation decreased. Stimuli-independent transgenic over-expression of CYP26B1 resul-ted in increased proliferation, which was compared to acute intranasal admini-stration of retinoic acid that reduced the number of proliferating cells. The region of the olfactory epithelium with low CYP26B1 and high levels of retinoic acid synthesizing enzymes had the greatest level of proliferation and regenerated efficiently after chemical induced injury. Furthermore, neurons in this region differentiated surprisingly fast. In the region with high CYP26B1 and low levels of retinoic acid synthesizing enzymes the proliferation rate was low and the regeneration after injury was incomplete. Together these results indicate that retinoic acid within the olfactory epithelial stem cell niche regulates local differences in functional neuronal diversity, neurogenesis, and generative capacity of olfactory epithelial progenitor/stem cells. My research has revealed that ageing as well as constitutive transgenic over-expression of CYP26B1 activated dormant horizontal basal stem cells in the olfactory epithelium in an injury like manner. Continuous stem cell activation by constitutive CYP26B1 expression, repeated injuries or old age results in the appearance of epithelial patches devoid of normal olfactory epithelial cells, containing metaplastic respiratory cells. The respiratory patches either contained ciliated cells or a previously unidentified columnar secretory cell type.  Moreover, we investigated whether increased proliferation of stem cells affected their regenerative potential over time. Repeated injury-repair cycles maximized the number of stem cell division, which decreased their potential to regenerate olfactory epithelial cells. Together these results indicate a premature exhaustion of the stem cell niche upon reduced levels of retinoic acid, repeated injury induced regeneration, and ageing.I publikationen felaktigt ISSN: 0346-6612</p

Handgrip Strength and Anthropometry in Parkinson's Disease at Diagnosis

Objectives. To investigate how age, malnutrition, and the level of plasma cortisol and phosphate in patients with Parkinson's disease (PD) at time of diagnosis are associated with body composition and handgrip strength in males and females compared to controls. Materials &amp; Methods. This cross-sectional study includes baseline data from a cohort of newly diagnosed patients with Parkinson's disease (N = 75; M/F = 41/34) in the New Parkinsonism in Umeå study (NYPUM). Body Impedance (BIS), handgrip strength (HGS) assessments, and evaluation of risk for malnutrition (Mini Nutritional Assessment (MNA) score) and cognitive performance (Mini-Mental State Examination (MMSE)) were performed at time of PD diagnosis. Results. Low fat-free mass index (FFMI), MNA score, and a high Unified Parkinson's Disease Rating Scale (UPDRS-total and UPDRS-III) were associated with high daytime levels of P-cortisol in total PD population but not in controls. Partial correlations reveal that high fat mass percent (FM (%)) and low FFMI were associated with older age in males with PD but not females with PD. Risk of malnutrition was associated with P-cortisol in males but not in females with PD (r =-0.511, P=0.001, and n = 41 and r =-0.055, P=0.759, and n = 34, respectively). Multiple linear regressions show that an interaction between P-cortisol and P-phosphate, older age, and high UPDRS-III score were associated with HGS in total patient population and males but not females. Conclusions. Age-and disease-associated risk factors that decrease muscle mass and HGS and increase FM (%) in patients with PD differ between males and females by an association with levels of cortisol and phosphate

Palliative care of children : - Parents experience

Bakgrund: När barn får palliativ vård har föräldrarna en nyckelroll i omvårdnad och stöd för sitt barn. Detta gör att föräldrarna hamnar i en ansträngd situation vilket kan leda till en ökad stress och belastning för hela familjen. Syfte: Syftet var att undersöka utmaningar som föräldrar upplever när deras barn får palliativ vård. Metod: En kvalitativ litteraturstudie där nio vetenskapliga artiklar har granskats, bedömts samt analyserats utifrån Fribergs femstegsmodell. Databassökning skedde i Cinahl och Pubmed.  Resultat: Utmaningarna som föräldrar till barn som får palliativ vård ställs inför kunde delas upp i tre huvudkategorier och sex underkategorier. 1. Otillräckligt stöd; 1.1 Överväldigande ansvar, 1.2 Ekonomisk påfrestning. 2. Brist på betydelsefull information; 2.1 Undermålig kommunikation, 2.2 Avsaknad av hoppfullhet. 3. Bristfälligt familjestöd; 3.1 Avsaknad av samtalskontakt, 3.2 Svårigheter att upprätthålla vardagen.  Konklusion:  Vårdpersonal behöver öka sin medvetenhet om att föräldrar till barn som får palliativ vård har ett behov av ytterligare stöd i form av tillgänglig information, uppmärksamma ekonomiska utmaningar, samt se föräldrarnas individuella behov.

Obesity, smoking habits, and serum phosphate levels predicts mortality after life-style intervention

Background: Life-style interventions, including smoking cessation and weight control are of importance for managing future escalating prevalence of obesity. Smoking habits and obesity have jointly great impact on mortality, however mechanisms behind the effect and variables involved in the obesity paradox is still unknown. Objectives: This study examines risk factors for all-cause, cardiovascular, and cancer mortality in males and females with high cardiovascular risk, mediated by smoking habits, body mass index (BMI, kg/m2), and serum phosphate (S-P) levels. Methods: Patients were admitted to the Vindeln Patient Education Center in groups of 30 for a four-week residential comprehensive program (114 hours) focusing on smoking cessation, stress reduction, food preferences and selections, and physical exercise. The follow-up, in years from 1984 to 2014 corresponds to 30 years. This study included 2,504 patients (1,408 females and 1,096 males). Cox regression analysis was used to assess mortality risk associated with smoking habits, low and high BMI, and low and high S-P levels. Results: High BMI (&gt;34,2 kg/m2), current smoking, type 2 diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic blood pressure (SBP, mmHg) were associated with all-cause mortality irrespective of sex. Former and current smoking females had a high all-cause mortality (adjusted hazard ratio [HR] 1.581; 95% CI 1.108–2.256, adjusted hazard ratio [HR] 1.935; 95% CI 1.461–2.562, respectively) while current smoking and high BMI increased risk for cardiovascular mortality (adjusted hazard ratio [HR] 3.505; 95% CI 2.140–5.740 and [HR] 1.536; 95% CI 1.058–2.231, respectively). Neither low nor high levels of S-P predicted all-cause, cardiovascular disease (CVD) and cancer mortality in males or females while low levels of S-P predicted all-cause mortality in smokers (adjusted hazard ratio [HR] 1.713; 95% CI 1.211–2.424). In non-smokers, low BMI (&lt;27.6 kg/m2) was protecting and high BMI a risk for all-cause mortality. In males, ischemic heart disease (IHD), and low serum albumin (S-Alb) were associated with all-cause mortality. In females, an interaction between high BMI and smoking (HbmiSM) decreased the cardiovascular mortality (adjusted hazard ratio [HR] 0.410; 95% CI 0.179–0.937, respectively). Conclusions: High BMI and current smoking were associated with all-cause mortality in both males and females in the present high cardiovascular-risk cohort. In current smokers and non-smokers, T2DM and high S-Ca were associated with an increase in all-cause mortality, while low S-P was associated with all-cause mortality in smokers. Interaction between high BMI and smoking contribute to the obesity paradox by being protective for cardiovascular mortality in females

Validation of SenseWear Armband and ActiHeart monitors for assessments of daily energy expenditure in free-living women with chronic obstructive pulmonary disease

To provide individually adapted nutritional support to patients with chronic obstructive pulmonary disease (COPD), objective and reliable methods must be used to assess patient energy requirements. The aim of this study was to validate the use of SenseWear Armband (SWA) and ActiHeart (AH) monitors for assessing total daily energy expenditure (TEE) and activity energy expenditure (AEE) and compare these techniques with the doubly labeled water (DLW) method in free‐living women with COPD. TEE and AEE were measured in 19 women with COPD for 14 days using SWAs with software version 5.1 (TEESWA5, AEESWA5) or 6.1 (TEESWA6, AEESWA6) and AH monitors (TEEAH, AEEAH), using DLW (TEEDLW) as the criterion method. The three methods were compared using intraclass correlation coefficient (ICC) and Bland–Altman analyses. The mean TEE did not significantly differ between the DLW and SWA5.1 methods (−21 ± 726 kJ/day; P = 0.9), but it did significantly differ between the DLW and SWA6.1 (709 ± 667 kJ/day) (P &lt; 0.001) and the DLW and AH methods (709 ± 786 kJ/day) (P &lt; 0.001). Strong agreement was observed between the DLW and TEESWA5 methods (ICC = 0.76; 95% CI 0.47–0.90), with moderate agreements between the DLW and TEESWA6 (ICC = 0.66; 95% CI 0.02–0.88) and the DLW and TEEAH methods (ICC = 0.61; 95% CI 0.05–0.85). Compared with the DLW method, the SWA5.1 underestimated AEE by 12% (P = 0.03), whereas the SWA6.1 and AH monitors underestimated AEE by 35% (P &lt; 0.001). Bland–Altman plots revealed no systematic bias for TEE or AEE. The SWA5.1 can reliably assess TEE in women with COPD. However, the SWA6.1 and AH monitors underestimate TEE. The SWA and AH monitors underestimate AEE

High serum phosphate and triglyceride levels in smoking women and men with CVD risk and type 2 diabetes

This is the published version of a paper published in Diabetology and Metabolic Syndrome. Citation for the original published paper (version of record): Håglin, L., Törnkvist, B., Bäckman, L. Diabetology and Metabolic Abstract Background: Both low and high serum phosphate levels may be associated with morbidity and mortality from cardiovascular disease. As smoking increases risk for type 2 diabetes (as shown by dyslipidemia and hyperglycemia), we wanted to study whether smoking and type 2 diabetes were associated with serum phosphate and triglyceride levels independently from other CVD risk factors