| 81. |
- Andersson, Inger S
(författare)
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Utveckling av metoder för mätning av vårdkvalitet : Med inriktning mot omvårdnad
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present thesis has its roots in the need to measure and evaluate quality of care, especially in times when resources allocated to health- and medical care are being limited. This is of concern for many groups in society, but perhaps mOst of all for patients, hospital staff and politicians.The main purpose of the thesis was to develop methods for measuring quality of care within nursing.The thesis has been organised in three main parts, the first of which deals with the principal concepts in this research,in addition to research and develop- ment in existing instruments for measuring quality of care. The second part contains the empirical study and its results. Finally, the third part deals with the development of variables for methods of measurement based on the empirical study: it also looks ahead, at visions and viewpoints governing future research and development work.Data collection was carried out by means of a thematic interview, and by measuring attitudes to quality of care on a modified attitude scale based on Osgood's semantic differential. The interview group comprised 128 people; 25 patients and 25 staff members at a local hospital, 25 patients and 27 staff members at a health centre, and 26 county council politicians. The interview material was analysed inductively using qualitative and quantitative content analysis. On analysing the three themes which dealt with the interviewees' perception of health, quality of life as a result of care received, the quality of selfcare as well as care goals, literature studies were added which dealt with the above-mentioned phenomena.The result of the interview study, and the literature studies included in the analysis phase, can be stated in brief, that the main focus in the perception of quality of care held by the patients, the staff and the politicians was on 1) the quality of the staff, with an emphasis on the characteristics and skills of the staff, 2) quality in implementing care, involving care measures of an affective nature and the quality of the patient- staff relationship, and 3) the patient-related quality of results, consisting of such changes in the patient's health status as a cure or a change in health; cognitively oriented results like better knowledge about one's condition; wellbeing as a result of care; satisfaction with the care and treatment provided, and with the staff.The result of the attitudes survey was that politicians were the most positive towards the quality of the care provided, while the personal at the health centre were the least positive. Of the various professional categories interviewed, physicians were the most positive. Other staff comprising paramedical groups were the least positive.Further groups of variables have been generated from the data collected and from the literature studies in order to extend the evaluation of the quality of nursing care. All of the variable groups developed in the present thesis have been named and grouped together in a system called the KISAAL system, after the initials of the author. The different groups of variables can be related to each other to facilitate a total assessment of the quality of nursing care, and its management.
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| 82. |
- Andersson, Kerstin
(författare)
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Inhibition of phagocyte signaling by the Yersinia virulence protein YopH
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Yersinia pseudotuberculosis evades the immediate immune defense of a host organism by inhibiting bactericidal functions of phagocytes, including phagocytosis, cytokine release, and the oxidative burst. Consequently, this pathogen can survive and multiply in lymphatic tissues. An ensemble of proteins called Yops are involved in the virulence of Y. pseudotuberculosis. Through a polarized mechanism, certain Yops are translocated directly into the host cell, where they are assumed to exert their effects. The present studies were performed to gain further knowledge about the role of the tyrosine phosphatase YopH in Yersinia virulence, especially in regard to effects on the immediate functions and signals of phagocytes.Y. pseudotuberculosis was found to resist phagocytic uptake by a mechanism involving translocation of bacterially synthesized YopH into the target cell. The antiphagocytic mechanism had an impact on ingestion of both non-opsonized and IgO-opsonized bacteria. Phagocytosis of a YopH-negative strain was accompanied by induction of tyrosinephosphorylated cellular proteins (among them paxillin), and this involved binding of the bacterial surface protein invasin to ß1 integrins of the eukaryotic cell, which also initiated an immediate Ca2+ signal in the target cell. The phosphotyrosine proteins Cas and FYB were recruited to the focal complex area during phagocytosis of the YopH-negative strain. Furthermore, we found that a phosphatase-inactive YopH eo-localized with focal adhesion to the periphery of a host cell. In phagocytes infected with wild-type bacteria, phosphatase-active YopH dephosphorylated Cas and FYB, which caused disruption of focal complex structures, and inhibition of the Ca2+ signal. The phosphorylation events as well as the Ca2+ signal were rapid responses to bacterial attachment, suggesting that the action of YopH is instantaneous.Genetic studies revealed that the YopH protein contain an inherent sequence important for anchoring at focal complex structures. Specifically, deletion of the amino acids 223-226 disabled YopH to localize to the focal complexes and to inhibit phagocytosis and Ca2+-signaling. This indicates that Y opH must bind to a specific site in focal complexes to focus its activity on the appropriate substrates (i.e. Cas and FYB). Our results show that targeting such complexes is important for Y. pseudotuberculosis, not only as a means of avoiding ingestion by phagocytes, but also for its virulence in mice.
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| 83. |
- Andersson, Patiyan, 1978-
(författare)
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Molecular Genetic Studies on Prostate and Penile Cancer
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is comprised of two parts. In the first part we study the influence of four frequently disputed genes on the susceptibility for developing prostate cancer, and in the second part we attempt to establish a basic understanding of the molecular genetic events in penile cancer.In a prostate cancer cohort we have investigated the relation of prostate cancer risk and single nucleotide polymorphisms (SNPs) in four different genes coding for the androgen receptor (AR), the vitamin D receptor (VDR), insulin (INS) and insulin receptor substrate 1 (IRS1). Despite strong biological indications of an involvement of these genes in prostate carcinogenesis, the results from different studies are contradictory and inconclusive.The action of the AR varies between individuals in part owing to a repetitive CAG sequence (polyglutamine) in the first exon of the AR gene. The results presented in this thesis show that in our cohort of prostate cancer patients the average number of repeats is 20.1, which is significantly (p<0.001) fewer repeats compared to healthy control individuals, where the average is 22.5 repeats. We find a 4.94 fold (p=0.00003) increased risk of developing prostate cancer associated with having short repeat lengths (≤19 repeats), compared with long repeats (≥23 repeats). In paper I we also study the TaqI polymorphism in the VDR gene, and find that it does not modify the risk of prostate cancer.In the INS gene we study the +1127 PstI polymorphism and find no overall effect on the risk of prostate cancer. However, we do find that the CC genotype is associated with low grade disease defined as having a Gleason score ≤6 (OR=1.46; p=0.018). In the IRS1 gene we study the G972R polymorphism and observe that the R allele is significantly associated with a 2.44 fold increased prostate cancer risk (p=0.010).The knowledge of molecular genetic events in penile cancer is very scarce and to date very few genes have been identified to be involved in penile carcinogenesis. We chose therefore to analyse the penile cancer samples using genome-wide high-density SNP arrays. We find major regions of frequent copy number gain in chromosome arms 3q, 5p and 8q, and slightly less frequent in 1p, 16q and 20q. The chromosomal regions of most frequent copy number losses are 3p, 4q, 11p and 13q. We suggest four candidate genes residing in these areas, the PIK3CA gene (3q26.32), the hTERT gene (5p15.33), the MYC gene (8q24.21) and the FHIT gene (3p14.2).The mutational status of the PIK3CA and PTEN genes in the PI3K/AKT pathway and the HRAS, KRAS, NRAS and BRAF genes in the RAS/MAPK pathway was assessed in the penile cancer samples. We find the PIK3CA, HRAS and KRAS genes to be mutated in 29%, 7% and 3% of the cases, respectively. All mutations are mutually exclusive. In total the PI3K/AKT and RAS/MAPK pathways were found to be activated through mutation or amplification in 64% of the cases, indicating the significance of these pathways in the aetiology of penile cancer.
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| 84. |
- Andersson, Peter, 1957-
(författare)
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Surgery and anorectal function in Crohn's colitis
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The study concerns surgery in Crohn's disease, particularly Crohn's colitis, its relation to medical treatment, symptomatic load, perceived health, quality of life, outcome on anorectal function and also anorectal physiologic conditions.Four hundred and thirty-two patients treated at the University Hospital, Linköping from 1970 to 1997 were included in the study. Operations and medical treatment were retrospectively reviewed, whereas symptomatic load, perceived health, quality of life, function outcome and anorectal physiology were prospectively evaluated.In a cross-sectional analysis of all patients surveilled 1995 the annual incidence of surgery was 5.7% in a population-based cohort and 10.3% in referred patients. Medical maintenance treatment was used in 61 and 55% respectively. This led to 89% of the patients being in clinical remission or having only mild symptoms and to a large proportion with a perception of good health. The treatment was paralleled by a low rate of septic and surgical complications.Surgical treatment of Crohn's colitis prior to 1990 mainly implied colectomy or proctocolectomy and thereafter almost exclusively segmental resection. The creation of a permanent stoma decreased and was rarely needed at the end of the study period when the annual risk was 0.23%. This development was basically due to a deliberate change in surgical attitude aiming at introducing similar treatment principles as for small bowel Crohn's disease With limited resections and preservation of transanal defecation. The reduced colectomy rate may have been facilitated by the introduction of immunosuppressive medical treatment as a reduction of colectomies tended to be associated with medical maintenance treatment during the later part of the study. Time from diagnosis to surgery was prolonged and stricture replaced active disease as the major indication for surgery. Symptomatic load and anorectal function outcome were better after segmental resection without the expense of an increased reresection rate. Seventy percent of patients with Crohn's colitis were in clinical remission and these patients scored quality of life similar to the general population but patients with active disease scored worse in all indexed aspects. The need of immunosuppression or previous surgery was not related to quality of life except when operated with a permanent stoma which negatively influenced psychological well being.Anorectal physiology in Crohn's disease differed from controls with increased anal resting pressures and increased rectal sensitivity. This provides possible prerequisites for later development of anal pathology such as fissures and fistulas.The study indicates that the concept oflimited surgery is applicable also in Crohn's colitis with obvious benefits for the patients. A treatment concept including medical maintenance treatment and limited resections implies that the vast majority of patients with Crohn's disease may live with only minor symptoms and minimal risk of having a permanent stoma, factors associated with a quality of life similar to that of the general population.
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| 85. |
- Andersson, Roland, 1950-
(författare)
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Appendicitis : Epidemiology and diagnosis
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The study concerns appendicitis, its epidemiology and diagnosis, and the outcome of appendectomy. A population based cohort of 9,274 patients undergoing appendectomy in 1969 to 1990 in Jönköping County was retrospectively studied, and 502 patients admitted for suspected appendicitis to the hospitals in Jönköping and Eksjö between October 1992 and December 1993 were prospectively studied.Appendicitis was found to occur in outbreaks and space-time clusters, indicating an infectious etiology. The incidence of non-perforating appendicitis was strongly age-dependent, with a peak in adolescence, whereas the incidence of perforating appendicitis was stable at all ages. This suggests that perforating and non-perforating appendicitis are separate entities.There was a high rate of negative appendectomies, but during the study period an increasing diagnostic accuracy and decreasing incidence of negative appendectomies was observed, indicating a trend towards a more restrictive attitude to exploration in patients with suspected appendicitis. This was accompanied by a decreasing incidence of non-perforating appendicitis, whereas the incidence of perforating appendicitis was stable. An analysis of population based studies showed a strong relation between surgeons' attitude to exploration and the incidence of non-perforating ap9endicitis, whereas the incidence of perforating appendicitis was unrelated. This is consistent with a high proportion of potentially resolving appendicitis.A conservative management decreases the munber of negative explorations and saves a number of patients with resolving appendicitis from an unnecessary operation. This leads to a high proportion of perforations among the operated patients but the number of perforations is not increased. The perforation rate, therefore, should not be used as a quality measure of the management of patients with suspected appendicitis.The rate of negative explorations is higher in women. This gender difference is found at all ages and is not due to gynecological diseases alone. The explanation is the larger number of women attending for nonsurgical abdominal pain, whereas the rate of diagnostic errors among these patients is similar in men and women.Patients with a negative appendectomy are characterized by high intensity of pain and tenderness without signs of a systemic inflammatory response. Surgeons pay too much attention to pain and tenderness in their decision to operate, and underestimate the importance of temperature, laboratory variables and duration of symptoms.No single clinical or laboratory variable has sufficiently high discriminating power to be used as a true diagnostic test. The inflammatory variables are as important predictors as the clinical findings, and they are especially important in advanced appendicitis. Their diagnostic value is higher at a repeat examination after a few hours of observation.The study show for a need of an improved management of patients with suspected appendicitis, and the potential for improved clinical diagnosis. Inflammatory variables should be given more attention, and pain and tenderness should be interpreted more cautiously. An expectant management, with repeated clinical and laboratory examinations, is advisable once advanced appendicitis has been ruled out.
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| 86. |
- Andersson, Sten-Ove, 1953-
(författare)
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Militär akutsjukvård i fält : när den övade verkligheten blir verklig
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: Governing for the Armed Forces health care is respect for human dignity and the view of each individual as irreplaceable. The quality of the military care will be at a level equivalent to that of today's civil peace healthcare, which requires that the training is of high quality. Casualty care in the military environment is a complex, challenging and dangerous task. Today there is a lack of knowledge about how to learn these skills. The purpose of the research was to identify the knowledge area pre-hospital care in the military environment by examining what doctors, nurses, paramedics and officers learn about military health care during preparation and exercise.Method: A phenomenographic approach was used in all sub-studies, and empirical data were collected by means of semi-structured interviews. Study I‐III are cross-sectional studies and study IV is a longitudinal study. Twelve registered nurses who had served in Bosnia were interviewed for study I, and 24 conscript paramedics were interviewed for study II. Study III included 20 officers in their pre-deployment training for service in Afghanistan and Liberia, and Study IV included 7 doctors and twenty nurses who previously had served in Afghanistan, Bosnia, Kosovo and Liberia.Results: Learning military health care by training and gaining experience can be seen as different abilities; interaction, action and reflection. In-depth analysis at a meta--‐level revealed that the integration between the military and military medical fields of knowledge was missing. The results indicate that participants' understanding of their respective fields of knowledge is inadequate and needs to be integrated in education in a clearer way.Implications: To create opportunities for better education and integration in these fields of knowledge are proposed (1) that the findings of the thesis could be utilised to develop the design of the curriculum (2) the inter-professional learning is introduced as a part of creating a safer and more effective pre-hospital care, (3) the clinical competence becomes part of the development of pre-hospital emergency care in the field, and (4) that the training is built according to the principle of "train as you fight" with emphasis on the requirements in the combat zone.
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| 87. |
- Andersson, Thomas
(författare)
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Cutaneous microdialysis : a technique for human in vivo sampling
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Microdialysis enables in vivo sampling of endogenous and exogenous substances in the interstitial fluid. A probe equipped with a tubular semi-permeable dialysis membrane is inserted into the skin, and perfused with a physiological solution. Diffusion of molecules from the extracellular space to the perfusate takes place, and the perfusate is collected for analysis. In this thesis, experimental and clinical applications of human cutaneous microdialysis in the fields of skin inflammation and percutaneous absorption are presented.The in vivo absorption kinetics of the model solvents ethanol and isopropanol, applied in excess to the skin over the dialysis probe, could be demonstrated in all subjects. Ethanol levels increased in a linear fashion to reach a peak at about 100 min, then establishing a plateau level. Isopropanol absorption showed similar kinetics. The absolute levels detected were lower for isopropanol than for ethanol.Laser Doppler perfusion imaging visualized the skin circulatory response to the microdialysis probe insertion. An immediate increase in skin blood perfusion was observed. The response began to subside after 15 min and returned to near normal within 60 min after probe insertion.Histamine, a ubiquitous inflammatory mediator, was studied as a model. Following the skin trauma caused by probe insertion, peak histamine levels were observed in the first 10-min sample, then falling successively to reach baseline within 40-60 min. Multiple regression analysis did not reveal any correlation between probe depth, as measured by ultrasoundtechnique, and obtained histamine levels during the equilibration period following probe insertion. Provocation with compound 48/80 as a positive control for skin histamine release, resulted in increased histamine levels in the perfusate. Histamine release was followed in reactions provoked in the skin of patients with cold urticaria. An up to 80-fold increase of histamine levels was observed, with peak levels 20-30 min after start of ice provocation, returning to baseline within 50-60 min.Human, in vivo, cutaneous microdialysis has the potential to be an important sampling method in studies of skin inflammation and percutaneous absorption of noxious chemicals as well as in dennal and transdermal drug delivery studies.
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| 88. |
- Andersson, Tony P. M., 1973-
(författare)
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Melanophore signaling : regulation and application
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Melanophores are pigment-containing cells responsible for quick physiological color changes in lower vertebrates due to redistribution of melanosomes, pigment granules. We have studied melanophores from African clawed frog, Xenopus laevis. Classically, melanosomes can be stimulated to aggregate in the cell center by the hormone melatonin via a process involving activation of the inhibitory Gi/o protein and inhibition of adenylate cyclase/cAMP/protein kinase A pathway. In addition, tyrosine phosphorylations have been shown to be crucial for aggregation. In this thesis, we demonstrate that mitogen-activated protein kinase (MAPK) are activated and phosphoinositol 3-kinase (PI3-K) are involved in melatonininduced aggregation. Inhibition of MAPK kinase or PI3-K inhibits MAPK activation, tyrosine phosphorylation of a 280-kDa protein and aggregation. Further, PI3-K inhibition is less dramatic in fish Labrus melanophores. Together with findings that phosphodiesterase (PDE) 4 and/or PDE2 are involved in keeping the aggregated state in Xenopus, we suggest that active PI3-K via MAPK stimulates PDE, thus lowering cAMP. We also use latrunculin A to induce aggregation via disruption of actin filaments. Kinetic studies indicate that melatonin and latrunculin share final downstream target, possibly inactivate myosin-V leading to melanosome aggregation. As biosensor application, a new computer screen assisted technique suitable for bioassays is demonstrated using melanophores to monitor kinetic responses of melanosome movement and blood plasma sample detection of the asthma drug and ß2 adrenergic agonist formoterol. We also used melanophores to examine the efficacy of enantiomers of formoterol. We confirm that (R;R)-formoterol is more potent than (S;S)-formoterol, in guinea pig tracheal ring preparations, cultured melanophores, and radioligand binding on COS-7 cells, but demonstrate and calculate that (S;S)-formoterol has more efficacy than previously described. Characterization of melanophores are important for biosensor applications, i e to understand mechanisms of drugs, and will probably also increase the knowledge of cell signaling in other cell systems.
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| 89. |
- Andersson White, Pär, 1983-
(författare)
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Social Inequalities in Child Health : Type 1 Diabetes, Obesity, Cardiovascular Risk Factors and the Role of Self-control
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish Commission on Health Inequality defined health inequality as systematic differences in health between groups in society with different social positions. All avoidable socioeconomic health inequalities are unfair, and as stated by WHO's Commission on the Social Determinants of Health, we have a moral obligation to try to reduce them. "Putting these inequities right is a matter of social justice. Reducing health inequities is, for the Commission on Social Determinants of Health, an ethical imperative." This ethical imperative is especially apparent regarding the health of children and adolescents. Children’s right to the highest attainable standard of health is also enshrined in Article 24 of the Convention on the Rights of the Child. To reach the goal of a reduction of health inequalities, research is necessary to describe the social gradients of health. Research is also needed to better understand why these gradients occur. A better understanding and knowledge about health inequalities can lead to policies that reduce these inequalities and ensure children’s right to health.This thesis investigates social inequality in child health using data from a Swedish population-based prospective birth cohort, the All Babies in Southeast Sweden (ABIS) cohort. Social inequality in obesity in the ABIS cohort is also compared with other birth cohorts participating in the Elucidating Pathways to Child Health Inequality (EPOCH) collaboration which includes cohorts from six high-income countries; Sweden, the Netherlands, Canada (one national and one cohort from Quebec), UK, Australia, and USA.In Paper 1 we show that health inequalities in overweight and obesity are detectable already at two years of age and that these inequalities increase during childhood. In adolescents, low socioeconomic status increases the risk of becoming overweight and the risk of components of the metabolic syndrome, including high blood pressure and dyslipidemia (low high-density cholesterol).The level of inequality in obesity in the Swedish ABIS cohort was lower than in the other participating countries in the EPOCH collaboration (Paper 2). Inequality was lower in absolute and relative terms when SES was measured by household income. Inequality was also lower in absolute, but not relative, terms when SES was measured by maternal education. This finding indicates that some of the policies implemented in Sweden may attenuate social inequalities in obesity in children. Examples of such policies with evidence for reducing social inequality in obesity implemented in Sweden include universal preschools and free school meals.This thesis also investigates health inequalities in autoimmune disease (Paper 3). In this study, we found that low socioeconomic status increased the risk of Type 1 Diabetes but not the other autoimmune diseases investigated. Path analysis indicated that part of the increased risk in children with low SES of Type 1 Diabetes might be mediated by a higher body mass index and an elevated risk of serious life events.In the final paper, this thesis tests the hypothesis that differences in maternal and child self-control mediate social inequalities in obesity. Two measures of self-control were used; for mothers, the self-control variable was based on behaviors related to self-control (smoking during pregnancy, smoking during the child’s first year of life, breastfeeding duration, and participating in the ABIS study with biological samples). For the children, the self-control variable was based on questionnaire data on the impulsivity subscale of the Strengths and Difficulties Questionnaire (SDQ). The results showed that the two measures of self-control mediated 87.5 % of the increased risk of obesity at age 19 years in children with low maternal education and 93 % of the risk if maternal BMI was also included in the selfcontrol variable.In the discussion part of this thesis, the conclusions that can be deduced from understanding the mechanisms of social inequality in child health are discussed. A theory with a central role of self-control for health inequality predicts that social inequality will increase without interventions. In an environment with rising numbers of stimuli of the human reward system, stimuli that also have negative long-term consequences (socalled Limbic traps), child and adolescent health, in general, will decrease. Because of the mechanisms related to SES and self-control, children with low SES will be disproportionally affected. The result of this development will be increasing levels of social inequalities in child health.The discussion also includes implications for policies that may improve health and reduce inequalities. These policies should reduce the exposure of children and adolescents to harmful behaviors/limbic traps. Examples of policies that have this effect include universal preschools for all children, free healthy meals in preschools and schools, increased after-school activities for all children, and longer school days for adolescents with increased hours for physical activity, music, and art. Mobile phones and social media restrictions in schools and policies to reduce use at home should also be implemented. Finally, policies should be implemented to reduce residential and school segregation in the community.
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| 90. |
- Anderzén, Johan
(författare)
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Differences in glycemic control in type 1 diabetes children and adolescents : in a national and international perspective and the effect on microvascular complications in young adults
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on glycemic control measured as HbA1c in type 1 diabetes (T1D) patients during childhood and especially during adolescence, both in a Swedish and an international context, and relates the glycemic control to the risk of complications in young adults. In studies I and II, the Swedish Pediatric Diabetes Quality Register (SWEDIABKIDS) and the Swedish National Diabetes Register (NDR) were used. More than 4000 young adults with T1D and data on HbA1c in NDR both in 2011 and 2012 as well as data on HbA1c in SWEDIABKIDS were used. The T1D patients with poor glycemic control during their teenage period had a risk for retinopathy several times higher than those with good glycemic control. The risk for micro- and macroalbuminuria was also higher in those with poor glycemic control and was most pronounced in the T1D patients with high HbA1c in both registers. Females had worse glycemic control than males during the teenage period and an increased risk of retinopathy as young adults. In studies III and IV, pediatric diabetes quality register data from, respectively, eight and seven Western high-income countries were collected in the year 2013. Data on about 60 000 T1D patients were analyzed according to mean HbA1c levels in the countries and related to actual age and T1D duration to determine if there were differences in glycemic control between the countries. There were large differences in mean HbA1c between the countries, both when related to age and T1D duration. Despite the differences in mean HbA1c, the increase in mean HbA1c with increasing age and T1D duration was very similar in all countries. The overall picture of these studies is that good glycemic control is very important to avoid complications of T1D as young adults, and it seems particularly important to maintain a good glycemic control during adolescence. Furthermore large differences in glycemic control in T1D patients in Western high-income countries were found. Despite the differences in glycemic control, the pattern of rising HbA1c with increasing age and duration of T1D was very similar in all countries. Females have worse glycemic control than males during their teenage period, both in Sweden and internationally, and they also have more retinopathy as young adults. This thesis shows that it is of the utmost importance to treat T1D patients intensively directly after diagnosis, to treat the young T1D patients intensely and to reduce the rise in HbA1c with increasing age and duration of T1D in order to avoid complications early in life. Diabetes quality registers give the opportunity to compare results and share experiences, both within and between countries, so treatment of T1D can be designed in the best possible way and thereby minimize T1D complications.
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