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Collaboration with Region Västra Götaland provides new knowledge about major widespread diseases

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Nine researchers at the Institute of Medicine receive ALF positions in this year’s allocation. ALF (Avtal om Läkarutbildning och Forskning) is a collaboration agreement between the University of Gothenburg and Region Västra Götaland to promote the development of healthcare and medical services. Among other things, the positions will provide new knowledge about the risk of depression after coronary artery bypass surgery, how the AIRE gene affects the development of rheumatoid arthritis and how the lead we are exposed to primarily through food and drinking water can lead to cardiovascular disease.

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Susanne Nielsen is a researcher and surgical nurse at Sahlgrenska University Hospital.
Susanne Nielsen is a researcher and surgical nurse at Sahlgrenska University Hospital.
Photo: Laila Östlund

Many factors affect how patients fare after heart surgery. Socio-economic status, such as low income and low education, can affect the outcome as well as the incidence of depression.

“Many patients who undergo heart surgery are older and often have other diseases that make them especially vulnerable. To provide them with personal attention and the best care possible, we need to determine which risk factors affect surgical interventions in the heart,” says Susanne Nielsen.

Can lead to better results after heart surgery

She is a surgical nurse at Sahlgrenska University Hospital and an adjunct senior lecturer at the Department of Molecular and Clinical Medicine. The ALF position means a lot for her research.

“It gives me the opportunity to find answers to questions that are important for our patients. We hope the research will enable us to refine and personalise care so that our patients can live good and longer lives.”

Nielsen and her colleagues will conduct three studies. In the first study, they will investigate the risk of depression after coronary artery bypass surgery. Depression not only causes personal suffering but can also have negative effects after an operation. For example, the patient may fail to take the prescribed medication. In the second study, they will investigate how patients with lower socio-economic status fare after cardiac valve surgery.

“In previous studies, we have shown that coronary artery disease patients with lower socio-economic status use fewer secondary preventive medications that help reduce risk factors such as high blood pressure. They also have a higher mortality rate after surgery. But we do not know if social factors affect the survival of patients with valve diseases.”

Measuring frailty before surgery

The third study will investigate how frailty, such as old age and reduced mobility, affect how patients fare after heart valve surgery. Frailty needs to be assessed on a special scale before patients undergo a valve operation at Sahlgrenska University Hospital. The researchers then investigate how the result can be linked to complications, morbidity and survival.

The first two studies use national quality registries and databases to study large patient groups and follow them for a long period.

“This enables us to identify patterns and find unknown risk factors. If it turns out that a relatively simple instrument can show whether the degree of frailty is important for outcome after surgery, then this would be an important discovery with direct applications clinically.”

May provide more effective medications for RA

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Beatrice Bergström is a doctoral student and resident physician at Sahlgrenska University Hospital.
Beatrice Bergström is a doctoral student and resident physician at Sahlgrenska University Hospital.
Photo: Privat

Beatrice Bergström is a resident physician at Sahlgrenska University Hospital and a doctoral student at the Department of Rheumatology and Inflammation Research. She has received an ALF position to investigate how the AIRE gene affects the development of rheumatoid arthritis (RA).

The disease activates aggressive connective tissue cells in the synovial membrane, which contributes to chronic inflammation and destruction of the surrounding tissue.

“Our research has previously shown that AIRE is expressed in these cells and seems to amplify inflammatory signals. Using experimental methods and clinical data, such as joint samples, we will further investigate the role of AIRE in the disease processes in rheumatoid arthritis.”

The goal is greater knowledge about the molecular mechanisms behind the disease that will eventually contribute to the development of new treatments. Treatments with medications currently often focus on inhibiting the immune system, which increases the risk of infections.

“Many RA patients also have insufficient results from treatment. We still lack medications that specifically target activated connective tissue cells but have the potential to create treatments that are both more effective and safer.”

Lead causes half a million deaths

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Florencia Harari is a researcher and resident physician at Sahlgrenska University Hospital.
Florencia Harari is a researcher and resident physician at Sahlgrenska University Hospital.
Photo: Göteborgs universitet

Environmental pollutants have a major impact on our health. Globally, lead is estimated to cause half a million deaths from cardiovascular disease each year, primarily as a result of heart attacks and strokes. We know there is a connection between lead exposure and cardiovascular disease, but the nature of that connection and how lead affects the cardiovascular system is unclear.

Florencia Harari, a resident physician in Occupational and Environmental Medicine at Sahlgrenska University Hospital and a researcher at the Department of Public Health and Community Medicine, has received an ALF position to investigate these issues.

“People mainly ingest lead through food and drinking water. Despite that we are exposed to much lower levels of lead today than 20 or 30 years ago, more and more research shows that negative health effects occur at even lower levels.”

Florencia Harari and her colleagues will use databases from three large Swedish population-based studies: SCAPIS, MKC and VIPVIZA. More specifically, they will investigate whether there is any connection between lead exposure and arteriosclerosis in the coronary arteries of the heart and the vessels that supply the brain and the influence of certain proteins important for the cardiovascular system.

“I hope that our results will increase knowledge about how lead affects the cardiovascular system that can be used in future risk assessments. Ultimately, I hope the results can lead to lower public exposure to lead levels so that we can reduce the proportion of heart attacks and strokes due to lead.”

A total of 36 researchers granted positions

ALF is an abbreviation for Avtal om Läkarutbildning och Forskning (Agreement for Cooperation on Medical Education and Research). This agreement between the University of Gothenburg and Region Västra Götaland promotes the development of healthcare and medical services through enhanced and expanded collaboration in research, education and development.

A total of 36 researchers at Sahlgrenska Academy received ALF positions in the most recent application round. The positions are divided among physicians and other healthcare professionals. They continue for three years and take effect on 1 January 2022. 

Additional information about ALF

TEXT: KARIN ALLANDER
PHOTO: LAILA ÖSTLUND, PRIVATE PHOTOS

All researchers at the Institute of Medicine who received ALF positions

Beatrice Bergström 

Department of Rheumatology and Inflammation Research
Doctoral student, resident physician, Clinical Immunology and Transfusion Medicine, Sahlgrenska University Hospital
Title: Studies on the role of the autoimmune regulator, AIRE, in the joint in rheumatoid arthritis

Arndís Finna Ólafsdóttir

Department of Molecular and Clinical Medicine
Nurse, Medicine, Sahlgrenska University Hospital
Title: Treatment with Continuous and Flash Glucose Monitoring and the Excess Risk of Amputations in Persons with Type 1 Diabetes

Katarina Glise Sandblad

Department of Molecular and Clinical Medicine
Doctoral student, specialist physician, Medicine/Geriatrics, Sahlgrenska University Hospital
Title: Venös tromboembolism – riskfaktorer, trender och demografi (Venous thromboembolism – risk factors, trends and demographics)

Sara Hallström

Department of Molecular and Clinical Medicine
Doctoral student, specialist physician, Medicine/Geriatrics, Sahlgrenska University Hospital
Title: Insulindosering och riskfaktorer för diabeteskomplikationer vid typ 1 diabetes (Insulin dosage and risk factors for diabetic complications in type 1 diabetes)

Florencia Harari Thuresson

Department of Public Health and Community Medicine
Resident physician, Specialist Medicine, Sahlgrenska University Hospital
Title: Lead exposure and cardiovascular disease – disentangling underlying mechanisms

Charlotta Ljungman 

Department of Molecular and Clinical Medicine
Specialist physician, Cardiology, Sahlgrenska University Hospital
Title: Understanding metabolic pathways in heart failure

Susanne Nielsen

Department of Molecular and Clinical Medicine
Surgical nurse, Thorax, Sahlgrenska University Hospital
Title: Depression, socioekonomi och skörhet - faktorer av betydelse för resultaten efter öppna och kateterburna hjärtinterventioner?
(Depression, socio-economics and frailty – factors of importance for outcomes after open and catheterised cardiac interventions?)

Josefina Robertson

Department of Public Health and Community Medicine
Resident physician, Infection, Sahlgrenska University Hospital
Title: Övervikt och kardiovaskulära sjukdomars betydelse för risken att insjukna i svår covid-19 (Obesity and the significance of cardiovascular disease for the risk of developing severe COVID-19)

Anke Samulowitz

Department of Public Health and Community Medicine
Doctoral student, social medicine psychologist, Department of Healthcare and Medical Services

Title: The role of the patient-provider encounter in the complex interplay between pain, gendered norms, and health care